ObjectiveTo evaluate the possible role of the expression of insulin-like growth factor-1 receptor (IGF-1R) in determining rectal cancer radiosensitivity. MethodsThe paired preradiation biopsy specimens and postoperative specimens were obtained from 87 patients with rectal cancer in the department of digestive tumor surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2009 to December 2010. The IGF-1R expression was examined by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR). The tumor radiosensitivity was defined according to Rectal Cancer Regression Grade, then the relation between the IGF-1R expression and tumor radiosensitivity was evaluated. ResultsCompared with the preradiation biopsy specimens, IGF-1R expression significantly increased in the paired postoperative specimens of the residual cancer cells (Plt;0.001). The IHC result demonstrated IGF-1R overexpression was significantly associated with a poor response to radiotherapy (rs=0.401, Plt;0.001); RT-PCR detection of IGF-1R expression on preradiation biopsy specimens also showed that IGF-1R mRNA negative patients had a higher radiation sensitivity (rs=0.497, Plt;0.001). ConclusionDetection of IGF-1R expression may predict radiosensitivity of preoperative irradiation for rectal cancer.
Objective To evaluate the accuracy of preoperative 64 multidetector spiral computed tomography (MDCT) in the diagnosis of stage Ⅳ gastric cancer. Methods The data of patients with stage Ⅳ gastric cancer between July 2007 and April 2008 were collected. Twenty-nine patients underwent preoperative 64 MDCT were retrospectively analyzed. All computed tomography scans were prospectly analyzed by 2 abdominal radiologists separately. Pathological tumor stage was based on TNM stage according to the revised Japanese Classification of Gastric Carcinoma from the Japanese Gastric Cancer Association. All CT results were compared with clinical, surgical and histopathologic results. Results The 65.2% (15/23), 47.8% (11/23) and 70.8% (17/24) of the stage Ⅳ patients were accurately predicted of T, N and M stage, respectively. Moreover, 58.6% (17/29) of the stage Ⅳ patients were accurately predicted of TNM stage. But 6/9 cases with peritoneal metastases were not detected by preoperative 64 MDCT. Conclusion The 64 MDCT is a promising technique for detection and preoperative staging of stage Ⅳ gastric cancer. It was difficult to detect peritoneal metastases, but it may not increase the rate of exploratory laparotomy.
Objective To evaluate whether to defer abdomen surgery in patients having poorly controlled or untreated hypertension before operation. MethodsThe perioperative clinical data of 531 patients with hypertension in our hospital from January 1997 to December 1998 was retrospectively analyzed. ResultsThe modility of perioperative hypertensive events was not significantly different, between controlled and uncontrolled patients with grade one and grade two（Pgt;0.05）. In grade three and systolic hypertension, certain complications in patients with poorly controlled hypertension were higher than in those with wellcontrolled hypertension（P＜0.05）. Conclusion The patients with grade one and grade two hypertension are not at increased operative risk. In patients with grade three and systolic hypertension, perioperative complications are increased and elective surgery should be postponed until their blood pressure is brought under 24/14.7 kPa （180/110 mm Hg） over 1 to 2 weeks.
ObjectiveTo systematically review the efficacy and safety of prophylactic use of intra-aortic balloon pump counterpulsation (IABP) before coronary artery bypass grafting (CABG) in high risk patients. MethodsDatabases including The Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to July 2014, to collect randomized controlled trials (RCTs) and cohort studies about prophylactic use of IABP before CABG in high risk patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 6 RCTs and 6 cohort studies involving 1 359 patients were included, of which 633 prophylactically used IABP before CABG (the IABP group) and 736 didn't prophylactically use IABP before CABG (the control group). The results of meta-analysis showed that: compared with the control group, prophylactic use of IABP could significantly reduce perioperative mortality (RCT: OR=0.15, 95%CI 0.06 to 0.38, P<0.000 1; cohort study: OR=0.36, 95%CI 0.19 to 0.67, P=0.001) and postoperative LCOS (RCT: OR=0.23, 95%CI 0.12 to 0.43, P<0.000 01; cohort study: OR=0.21, 95%CI 0.10 to 0.43, P<0.000 1); there was no significant difference between two groups in incidence rate of postoperative myocardial infarction (MI) (RCT: OR=0.34, 95%CI 0.10 to 1.11, P=0.07; cohort study: OR=0.56, 95%CI 0.26 to 1.24, P=0.15); the results of combined analyses of RCTs showed that, prophylactic use of IABP could significantly reduce postoperative ICU stay (MD=-42.94, 95%CI -56.11 to -29.76, P<0.000 01) and postoperative hospital stay (MD=-3.83, 95%CI-5.82 to -1.85, P=0.0002), but these differences were not found in the results of combined analyses of cohort studies (MD=-4.68, 95%CI 20.69 to 11.33, P=0.57; MD=-0.77, 95%CI -1.80 to 0.26, P=0.14). ConclusionProphylactic use of IABP before CABG in high risk patients can significantly reduce the perioperative mortality, postoperative LCOS and the length of ICU stay, however it cannot reduce postoperative MI. Due to the limited quantity and quality of included studies, the above conclusions still need to be verified by more high quality studies.
Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) with serum amyloid A protein (SAA) or fibrinogen (FIB) on the selection of operative procedures of rectal cancer under the multidisciplinary team. Methods Prospectively enrolled 240 patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to June 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+FIB group, both MSCT and FIB combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results According to the criteria, 234 patients were actually included into MSCT+SAA group (n=118) and MSCT+FIB group (n=116). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 72.9%, 83.1%, 100% and 80.1%, respectively. For MSCT+FIB group, the accuracies of preoperative staging T, N, M and TNM were 68.1%, 75.0%, 100% and 74.1%, respectively, and there was not a statistically significant difference (Pgt;0.05). There was also not a statistically significant difference of the accuracy of prediction to operative procedures in two groups (99.6% vs. 96.6%, Pgt;0.05). The preoperative T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), serum level of SAA (P＜0.001), serum level of FIB (Plt;0.001) and distance of tumor to the dentate line (P＜0.05) were associated to the operative procedures. Conclusions Combinative assessment of MSCT and FIB could improve the accuracy of preoperative staging and operative procedures prediction, however, it may be not superior to MSCT plus SAA.
ObjectiveTo assess the feasibility of 3D digital lung software used in preoperative planning of patients with multiple pulmonary nodules and poor pulmonary function. MethodsFive patients with multiple pulmonary nodules in the left lung, meanwhile with a history of single lung lobectomy in the right lung were included in our hospital between June and December 2015. There were 4 males and 1 female at an average age of 50.4±2.6 years. A 320-slice volumetric CT scanner was used to the CT angiography (CTA) of the pulmonary artery. The data of CT images were imported into the 3D digital lung software that was researched and developed by Xiamen QiangBen Science and Technology Company. The 3D reconstruction of digital virtual lung was completed by this software based on those data. At the same time the soft-ware completed the automatic segmentation of the lung based on the pulmonary artery system and the 3D reconstruction of the pulmonary nodules. The 3D digital lung software calculated the volume proportion of the intended removal (segm-ental lesions) to the whole lung, estimated the effect of surgery on forced expired volume in one second (FEV1), and the patient's tolerance ability to surgery. After the preoperative planning, the patients received multiple pulmonary segmental/subsegmental resection under the general anesthesia by video-assisted thoracoscopic surgery (VATS). ResultsThe 3d reconstruction of the pulmonary arteries reached 5 levels in 5 patients. And the software automatically identified out the lung segment/subsegment to show the lung nodules of lung segment/subsegment. The preselection lung volume of 5 patients accounted for 14.00%-27.00% of total lung volume. The software estimated FEV1 as 1.16-1.46 L which can tolerate the operation. The 5 patients were successfully performed surgery of multiple pulmonary segmental/subsegmental resection under the general anesthesia by VATS. The software located lung nodules from the resection of pulmonary segments during operation immediately. Then we sent them to the rapid pathological examination for diagnosis. After operation, the patients recovered well, and had no respiratory insufficiency. Hospitalization day was 4 days. ConclusionThe 3D digital pulmonary software can not only automatically identify the pulmonary segments, precisely position the pulmonary nodule, show the relationship among the target pulmonary segments artery, vein, bronchus and the surroun-ding artery, vein, and bronchus, but also calculate the volume of the pulmonary segments, estimate the impact of the pulmonary segmentectomy on the FEV1. It is useful for precise evaluation of the tolerant capacity of multiple pulmonary nodules in patients with unstaged multiple pulmonary segments.
ObjectiveTo summarize the prevention method for pancreatic fistula following pancreaticoduodenec-tomy. MethodLiteratures related to the prevention methods for postoperative pancreatic fistula at home and abroad in recent years were retrieved and summarized. ResultsThe pancreatic fistula was a common complication following pancreaticoduodenectomy. It was mainly caused by preoperative continuous high jaundice, selection of intraoperative anastomosis, and early postoperative pancreatic juice secretion. Trypsinogen was activated by alkaline intestinal juice and then the nearby tissue was digested. Pancreatic juice flowed into abdominal cavity to digest the tissue, then caused serious complications or even death. Through the prevention of drugs, preoperative biliary drainage and intraoperative anastomosis, etc., the incidence of postoperative pancreatic fistula was slightly decreased. ConclusionThe prevention for postoperative pancreatic fistula is an integrated process, and it needs to be ran through the whole perioperative period.
Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
Objective To research the relationship between decrease of serum surfactant protein D (SP-D) level reduced by pulmonary rehabilitation training and postoperative pulmonary complications (PPC). Methods From May 2015 through December 2015, 80 consecutive non-small cell lung cancer (NSCLC) patients with surgical treatment in West China Hospital, who were at least with a high risk factor, were randomly divided into two groups including a group R and a group C. There were 36 patients with 25 males and 11 females at age of 63.98±8.32 years in the group R and 44 patients with 32 males and 12 females at age of 64.58±6.71 years in the group C.The group R underwent an intensive preoperative pulmonary rehabilitation (PR) training for one week, and then with lobectomy. The group C underwent only lobectomy with conventional perioperative managements. Postoperative pulmonary complications, average days in hospital, other clinic data and the serum SP-D level in a series of time from the date of admission to discharge (5 time points) were analyzed. Results The incidence of PPC in the group R was 5.56%(2/36),which was lower than that in the group C (P=0.032). The descender of the serum SP-D level of the patients in the group R (30.75±5.57 ng/mlvs. 24.22±3.08 ng/ml) was more obvious than that in the group C (31.16±7.81 ng/mlvs. 30.29±5.80 ng/ml,P=0.012). The descender of the serum SP-D level of the patients with PPC was more obvious than that of patients without PPC (P=0.012). Conclusion The preoperative PR training could reduce the PPC of lung cancer surgery with high risk factors. The serum SP-D level could reflect the effect of preoperative pulmonary rehabilitation training.
Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. ResultsThe operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5±1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.