The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors （GISTs） would produce better perioperative and similar oncologic outcomes compared with open...The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors （GISTs） would produce better perioperative and similar oncologic outcomes compared with open surgical resection in Chinese patients. Thirty-six gastric GISTs cases were divided into a minimally invasive laparoscopic group and open resection group, depending on the surgical approach that was used. The general preoperative information, operative time, incision length, intraoperative blood loss, postoperative time to first flatulence, postoperative complications, postoperative hospital stay, total hospitalization costs, and such follow-up data as recurrence, metastasis, and mortality rates were compared between two groups. Among the 36 gastric GISTs, 15 received laparoscopic surgical treatment （laparoscopy group, n=15）, and 21 received routine open resection treatment （open resection group, n=21）. The laparoscopy group and the open resection group showed statistically significant differences （P〈0.05） in incision length （7.8±2.3 vs. 16.9±3.8 cm）, postoperative time to first flatulence （3.8±1.3 vs. 5.1±2.1 d）, postoperative hospitalization time （7.6±2.5 vs. 11.3±3.7 d）, and total cost of hospitalization （RMB 28,239±5,521 vs. RMB 23,761±5,362）. There were no statistically significant differences （P〉0.05） between the laparoscopy group and the open resection group in operative time （147.8±59.3 vs. 139.2±62.1 min） and intraoperative blood loss （149.8±98.9 VS. 154.2±99.3 mL）. Both groups had no postoperative complications, no recurrence and metastasis, and no postoperative mortality. There were no statistically significant differences between the two groups in postoperative complications, postoperative recurrence and metastasis, and postoperative mortality. In conclusion, compared with open resection, the laparoscopic resection of gastric GISTs offers the advantages of less trauma, faster recovery, and shorter hospital stay.展开更多
Introduction: Laparoscopy-assisted gastrectomy (LAG) for early gastric cancer (EGC) was considered as a treatment with many advantages due to the application of laparoscopic equipment. The aim of this study was to com...Introduction: Laparoscopy-assisted gastrectomy (LAG) for early gastric cancer (EGC) was considered as a treatment with many advantages due to the application of laparoscopic equipment. The aim of this study was to compare the effect of use of laparoscopic equipment in blood loss, the number of harvested lymph nodes (HLNs), and complications between LAG and open gastrectomy (OG) for EGC. Methods: Patients received surgical treatment for early distal gastric cancer (EDGC) were retrospectively reviewed. Patients were classified into three groups by different operation methods: traditional open distal gastrectomy (ODG) group, laparoscopy-assisted distal gastrectomy (LADG) group, and open distal gastrectomy with assistance of laparoscopic equipment (ODGA) group. Results: Altogether 65 patients with EDGC received surgical treatment, including 20 cases of ODG, 22 of LADG, and 23 of ODGA. No lymph node metastasis was found in all patients. 25 (38.5%) postoperative confirmed T2 were misdiagnosed as T1 preoperatively. Compared with ODG group, the blood loss was significantly reduced in LADG and ODGA groups (106.4 ± 46.0;and 73.3 ± 35.7 ml vs. 250.5 ± 65.1 ml respectively;P 0.01), but the operation time was significantly longer in these groups (231.0 ± 34.5, and 222.5 ± 42.6 min vs. 128.5 ± 22.3 min respectively;P 0.01). No difference was found in the blood loss, operation time, the number of harvested lymph nodes and the types of gastrointestinal continuity reconstruction between LADG and ODGA groups. No difference was found in the postoperative complications among the three groups. Conclusions: Laparoscopic equipment might be the key factor in the reduction of blood loss and the delay of operation time for LADG. Application of laparoscopic equipment in open gastrectomy can be used as a training method to shorten learning curve for LAG beginners.展开更多
Mammalian target of rapamycin(m TOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant(LT) recipie...Mammalian target of rapamycin(m TOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant(LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival(RFS) in hepatocellular carcinoma(HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specifc for the frst 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefts for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data.展开更多
文摘The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors （GISTs） would produce better perioperative and similar oncologic outcomes compared with open surgical resection in Chinese patients. Thirty-six gastric GISTs cases were divided into a minimally invasive laparoscopic group and open resection group, depending on the surgical approach that was used. The general preoperative information, operative time, incision length, intraoperative blood loss, postoperative time to first flatulence, postoperative complications, postoperative hospital stay, total hospitalization costs, and such follow-up data as recurrence, metastasis, and mortality rates were compared between two groups. Among the 36 gastric GISTs, 15 received laparoscopic surgical treatment （laparoscopy group, n=15）, and 21 received routine open resection treatment （open resection group, n=21）. The laparoscopy group and the open resection group showed statistically significant differences （P〈0.05） in incision length （7.8±2.3 vs. 16.9±3.8 cm）, postoperative time to first flatulence （3.8±1.3 vs. 5.1±2.1 d）, postoperative hospitalization time （7.6±2.5 vs. 11.3±3.7 d）, and total cost of hospitalization （RMB 28,239±5,521 vs. RMB 23,761±5,362）. There were no statistically significant differences （P〉0.05） between the laparoscopy group and the open resection group in operative time （147.8±59.3 vs. 139.2±62.1 min） and intraoperative blood loss （149.8±98.9 VS. 154.2±99.3 mL）. Both groups had no postoperative complications, no recurrence and metastasis, and no postoperative mortality. There were no statistically significant differences between the two groups in postoperative complications, postoperative recurrence and metastasis, and postoperative mortality. In conclusion, compared with open resection, the laparoscopic resection of gastric GISTs offers the advantages of less trauma, faster recovery, and shorter hospital stay.
文摘Introduction: Laparoscopy-assisted gastrectomy (LAG) for early gastric cancer (EGC) was considered as a treatment with many advantages due to the application of laparoscopic equipment. The aim of this study was to compare the effect of use of laparoscopic equipment in blood loss, the number of harvested lymph nodes (HLNs), and complications between LAG and open gastrectomy (OG) for EGC. Methods: Patients received surgical treatment for early distal gastric cancer (EDGC) were retrospectively reviewed. Patients were classified into three groups by different operation methods: traditional open distal gastrectomy (ODG) group, laparoscopy-assisted distal gastrectomy (LADG) group, and open distal gastrectomy with assistance of laparoscopic equipment (ODGA) group. Results: Altogether 65 patients with EDGC received surgical treatment, including 20 cases of ODG, 22 of LADG, and 23 of ODGA. No lymph node metastasis was found in all patients. 25 (38.5%) postoperative confirmed T2 were misdiagnosed as T1 preoperatively. Compared with ODG group, the blood loss was significantly reduced in LADG and ODGA groups (106.4 ± 46.0;and 73.3 ± 35.7 ml vs. 250.5 ± 65.1 ml respectively;P 0.01), but the operation time was significantly longer in these groups (231.0 ± 34.5, and 222.5 ± 42.6 min vs. 128.5 ± 22.3 min respectively;P 0.01). No difference was found in the blood loss, operation time, the number of harvested lymph nodes and the types of gastrointestinal continuity reconstruction between LADG and ODGA groups. No difference was found in the postoperative complications among the three groups. Conclusions: Laparoscopic equipment might be the key factor in the reduction of blood loss and the delay of operation time for LADG. Application of laparoscopic equipment in open gastrectomy can be used as a training method to shorten learning curve for LAG beginners.
基金supported by grants from the National S&T Major Project (2017ZX10203205)Key Program,National Natural Science Foundation of China (81930016)Zhejiang Provincial Natural Science Foundation of China (LY21H160026)。
文摘Mammalian target of rapamycin(m TOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant(LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival(RFS) in hepatocellular carcinoma(HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specifc for the frst 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefts for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data.
