Surgery following neoadjuvant chemoradiotherapy(NCRT) is a common multidisciplinary treatment for resectable esophageal cancer(EC). After analyzing 12 randomized controlled trials(RCTs), we discuss the key issues of s...Surgery following neoadjuvant chemoradiotherapy(NCRT) is a common multidisciplinary treatment for resectable esophageal cancer(EC). After analyzing 12 randomized controlled trials(RCTs), we discuss the key issues of surgery in the management of resectable EC. Along with chemoradiotherapy, NCRT is recommended for patients with squamous cell carcinoma(SCC) and adenocarcinoma(AC), and most chemotherapy regimens are based on cisplatin, fluorouracil(FU), or both(CF). However, taxane-based schedules or additional studies, together with newer chemotherapies, are warranted. In nine clinical trials, post-operative complications were similar without significant differences between two treatment groups. In-hospital mortality was significantly different in only 1 out of 10 trials. Half of the randomized trials that compare NCRT with surgery in EC demonstrate an increase in overall survival or disease-free survival. NCRT offers a great opportunity for margin negative resection, decreased disease stage, and improved loco-regional control. However, NCRT does not affect the quality of life when combined with esophagectomy. Future trials should focus on the identification of optimum regimens and selection of patients who are most likely to benefit from specific treatment options.展开更多
AIM To evaluate the clinical and prognostic significance of preoperative and postoperative cytokeratin 19(CK19) and carcinoembryonic antigen(CEA) m RNA levels in peripheral blood of patients with gastric cardia cancer...AIM To evaluate the clinical and prognostic significance of preoperative and postoperative cytokeratin 19(CK19) and carcinoembryonic antigen(CEA) m RNA levels in peripheral blood of patients with gastric cardia cancer(GCC).METHODS We detected the preoperative and postoperative mR NA levels of CK19 and CEA in peripheral blood of 129 GCC patients by using reverse transcription-polymerase chain reaction and evaluated their clinical and prognostic significance by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard analysis. A new prognostic model which stratified patients into three different risk groups was established based on the independent prognostic factors.RESULTS Elevated preoperative and postoperative CK19 and CEA mR NA levels in peripheral blood of GCC patients were associated with lymph node metastasis. Univariate analysis showed that tumor size, histological grade, depth of tumor invasion, lymph node metastasis, preoperative CK19 m RNA, and preoperative and postoperative CEA m RNA levels were correlated with the prognosis of GCC patients. The multivariate analysis showed that lymph node status(P = 0.018), preoperative CK19(P = 0.035) and CEA(P = 0.011) m RNA levels were independent prognostic factors for overall survival(OS). The 5-year OS rates for the low-, intermediate-, and high-risk groups were 48.3%, 22.6%, and 4.6%, respectively(P < 0.001).CONCLUSION Elevated preoperative CK19 and CEA mR NA levels may be regarded as promising biomarkers for predicting lymph node metastasis and poor prognosis in patients with GCC. This new prognostic model may help us identify the subpopulations of GCC patients with the highest risk.展开更多
Esophageal cancer is the eighth most common malignant tumor and the sixth leading cause of cancer-related death worldwide.Esophageal squamous cell carcinoma(ESCC)is the main histological type of esophageal cancer,and ...Esophageal cancer is the eighth most common malignant tumor and the sixth leading cause of cancer-related death worldwide.Esophageal squamous cell carcinoma(ESCC)is the main histological type of esophageal cancer,and accounts for 90%of all cancer cases.Despite the progress made in surgery,chemotherapy,and radiotherapy,the mortality rate from esophageal cancer remains high,and the overall 5-year survival rate is less than 20%,even in developed countries.The C-X-C motif chemokine ligand 12(CXCL12)is a member of the CXC chemokine subgroup,which is widely expressed in a variety of tissues and cells.CXCL12 participates in the regulation of many physiological and pathological processes by binding to its specific receptor,C-X-C motif chemokine receptor type 4(CXCR4),where it causes embryonic development,immune response,and angiogenesis.In addition,increasing evidence indicates that the CXCL12/CXCR4 axis plays an important role in the biological processes of tumor cells.Studies have shown that CXCL12 and its receptor,CXCR4,are highly expressed in ESCC.This abnormal expression contributes to tumor proliferation,lymph node and distant metastases,and worsening prognosis.At present,antagonists and imaging agents against CXCL12 or CXCR4 have been developed to interfere with the malignant process and monitor metastasis of tumors.This article summarizes the structure,function,and regulatory mechanism of CXCL12/CXCR4 and its role in the malignancy of ESCC.Current results from preclinical research targeting CXCL12/CXCR4 are also summarized to provide a reference for the clinical diagnosis and treatment of ESCC.展开更多
AIM: To assess the prognostic value of serum human relaxin 2 (H2 RLN) level in patients with esophageal squamous cell carcinoma (ESCC). METHODS: From October 1998 to September 2009, 146 patients with histopathological...AIM: To assess the prognostic value of serum human relaxin 2 (H2 RLN) level in patients with esophageal squamous cell carcinoma (ESCC). METHODS: From October 1998 to September 2009, 146 patients with histopathologically confirmed ESCC were enrolled in this study. One hundred patients underwent en bloc esophagectomy, and 46 patients with unresectable tumors underwent palliative surgery. Five of the 146 patients died of surgical complications. Serum levels of H2 RLN were measured by enzyme linked immunosorbent assay. The relationship between serum H2 RLN level and each of the clinicopathological parameters was analyzed using the χ2 test. Patients were classified into two groups according to their H2 RLN level (< 0.462 ng/mL vs ≥ 0.462 ng/mL). When any analysis cell had fewer than five cases, the Fisher's exact test was used. The statistical difference between groups A and B in each clinicopathological category was determined by the Student's t test (two-tailed) or analysis of variance. Survival curves were plotted using the Kaplan-Meier method. The statistical difference in survival between the different groups was compared using the log-rank test. Survival correlation with the prognostic factors was further investigated by multivariate analysis using the Cox proportional hazards model with backward stepwise likelihood ratio. RESULTS: ESCC patients tended to have significantly higher serum H2 RLN concentrations (0.48 ± 0.17 ng/ mL, n=141) compared with the healthy control group (0.342 ± 0.12 ng/mL, n=112). There was a significant difference between patients with lymph node involvement (0.74 ± 0.15 ng/mL, n=90), distant metastasis (0.90 ± 0.19 ng/mL, n=32) and those without lymph node involvement (0.45 ± 0.12 ng/mL, n=51), and distant metastasis (0.43 ± 0.14 ng/mL, n=109), respectively (P < 0.01). Patients with high H2 RLN levels (≥ 0.462 ng/mL) had a poorer prognosis than patients with low serum H2 RLN levels (< 0.462 ng/mL; P=0.0056). The H2 RLN level was also correlated with survival and tumor-node-metastasis staging, but not with age, tumor size, gender, lymphovascular invasion or the histological grade of tumors. Cox regression analysis showed that H2 RLN was an independent variable. CONCLUSION: Serum concentrations of H2 RLN are frequently elevated in ESCC patients and are correlated with disease metastasis and survival. Serum concentrations of H2 RLN may be an important prognostic marker in ESCC patients.展开更多
Objective： We studied the extent and value of the lymphadenectomy in surgical treatment of carcinoma of gastroesophageal junction （GEJ）. Methods： 217 patients with GEJ who underwent surgical resection were retrosp...Objective： We studied the extent and value of the lymphadenectomy in surgical treatment of carcinoma of gastroesophageal junction （GEJ）. Methods： 217 patients with GEJ who underwent surgical resection were retrospectively analyzed. The extent of lymphadenectomy was divided into 5 types （DO to D4） and the curability of operation was graded as A, B and C. Results： The patients had been treated as follows： 186 with proximal gastrectomy, 31 with total gastrectomy, 97 with a combined-visceral resection. The patients who underwent D1, D2 and D3 lymphadenectomy were respectively 158, 58 and 1. The patients who were performed with resection of grade A, B and C were 53, 107 and 57 respectively. All patients were performed with a lymphadenectomy and well registered. The lymph node metastasis occurred in 157 cases （72.4%）. The lymph node metastasis rate in the group 1, 2, 3, 4, 7, 9, 12 and 110 as well as in the pulmonary ligament group were higher than other groups. 2868 lymph nodes were removed, in which 655 （22.8%） demonstrated the existence of metastasis. The total lymph node metastatic degree in these groups was higher compared to the other groups. Conclusion： The survival rate in the D1 lymphadenectomy and D2 is similar for all patients, and there may be some differences in the 2nd and 3rd years for the DI lymphadenectomy and D2 in the stage-Ⅲb patients. The survival rate of D2 lymphadenectomy in stage Ⅲb is better than D1 and that of D2 lymphadenectomy is superior to D1 in stage-Ⅳ patients. The survival rate of grade A and B operation is much better than grade C, and the survival rate of grade A is also higher than B.展开更多
OBJECTIVE To explore the role （HIF-1α） in the proliferation and cells under hypoxic conditions. of hypoxic inducible factor-1α apoptosis of pancreatic cancer METHODS A cassette encoding small interference RNA （si...OBJECTIVE To explore the role （HIF-1α） in the proliferation and cells under hypoxic conditions. of hypoxic inducible factor-1α apoptosis of pancreatic cancer METHODS A cassette encoding small interference RNA （siRNA） targeting HIF-1α mediated by recombinant adeno-associated virus （rAAV） was constructed, giving rAAV-siHIE rAAV-siHIF or rAAV- hrGFP was transfected into exponentially growing MiaPaCa2 cells under hypoxic conditions. Then, the expression of HIF-1α mRNA and protein, the proliferation and apoptosis of MiaPaCa2 cells were examined, using real-time PCR, Western Blot, MTT and TUNEL, respectively. RESULTS Under hypoxic conditions, rAAV-siHIF inhibited the expression of HIF-1α mRNA and protein in MiaPaCa2 cells. At the same time, rAAV-siHIF decreased MiaPaCa2 cell proliferation and induced apoptosis. However, rAAV-hrGFP had no effect on the expression of HIF-1α as well as the proliferation and apoptosis of MiaPaCa2 cells under hypoxic conditions. CONCLUSION Under hypoxic conditions, HIF-1α plays a key role in the proliferation of MiaPaCa2 cells, and inhibition of HIF- 1α expression can lead to MiaPaCa2 cell apoptosis.展开更多
OBJECTIVE： To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS： We retrospectively analyzed 217 random patients with carcinoma of the gastric c...OBJECTIVE： To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS： We retrospectively analyzed 217 random patients with carcinoma of the gastric cardia who underwent a gastric cardiac resection. The patients had been treated as follows： 186 with partial gastrectomy, 31 with total gastrectomy, 97 with a combined-visceral resection, of which 82 underwent a splenectomy plus partial pancreatectomy, 10 with splenectomy alone and 5 with partial hepatectomy and diaphragmatectomy. RESULTS： The total patients were divided into 3 groups： 128 with a gastrectomy alone, 10 with gastrectomy and splenectomy, and 82 with gastrectomy and splenectomy plus pancreatectomy. The operating times for these 3 groups were respectively 3.0 h, 3.1 h and 3.8 h. The hospitalization times were respectively 23.8 d, 31.2 d and 25.9 d. No differences in post-operative complications were found between these 3 groups. There were 92 patients who underwent a gastrectomy combined with a splenectomy and （or） the pancreatectomy, in which 92 No.10 lymph nodes were eliminated, with an average of one in each patient. Among the 125 patients not receiving a splenectomy but with elimination of lymph nodes, 82 underwent a gastrectomy combined with partial pancreatectomy, of which 107 lymph nodes were eliminated for the No. 11 group, with an average of 1.3 in each patient. There was a statistically significant difference between the 2 groups. The overall survival rates were similar in the 3 groups showing no statistical differences, but was higher in the Stage Ⅲ patients with a combined resection of multi-organs. For patients in the Stage Ⅳ without resection of multi-organs, the survival rate was higher, but there was no significant difference between the 2 groups. CONCLUSION： It is difficult to determine precisely the involvement of para-tumorous organs with the eye during an operation. Combining a splenectomy with a pancreatectomy does not increase the post-operative complications following surgical treatment for carcinoma of the gastric cardia. The combination of a splenectomy and partial pancreatectomy results in a higher survival rate and has an important significance for eliminating the lymph nodes of group 10 and 11, especially for patients in Stage Ⅲ. In the application of a resection combining multi-organs, the doctor should make every effort to decrease the trauma and the complications based on the condition that the cancerous tissue is totally resected.展开更多
Esophageal carcinoma(EC)is a common malignant tumor of the upper digestive tract worldwide.An analysis of the latest data from cancer centers in China showed that the incidence of EC and the number of deaths due to EC...Esophageal carcinoma(EC)is a common malignant tumor of the upper digestive tract worldwide.An analysis of the latest data from cancer centers in China showed that the incidence of EC and the number of deaths due to EC in China in 2015 were 266,000 and 188,000,respectively,ranking sixth(6.3%)and fourth(8.0%)among all malignant tumors.The early diagnosis and treatment of EC and standardized diagnosis and treatment are important tasks for EC healthcare professionals in various centers across the country.At present,the 8th edition of the EC staging system jointly released by Union for International Cancer Control(UICC)and American Joint Committee on Cancer(AJCC)is the most recent,authoritative and widely used EC staging standard.The EC professional committee of the Chinese Anti-Cancer Association also organizes the"EC Standardization Campaign in China"every year to promote the development of EC diagnostic and treatment norms throughout the country.Since 2011,the EC Committee of the Chinese Anti-Cancer Association has published the Guidelines for Standardized Diagnosis and Treatment of EC.Considering the increasing number of EC clinical studies and the continuous progress in diagnostic and treatment technologies in recent years,the updated Guidelines will include the latest progress in the diagnosis and treatment of EC,with a goal of promoting the forward development of EC diagnosis and treatment in clinical practice.展开更多
Splenic metastasis is generally not a common clinical event. However, metastasis to the spleen from adrenal pheochromocytoma is extremely rare and has not been reported in literature. This report presents a case of a ...Splenic metastasis is generally not a common clinical event. However, metastasis to the spleen from adrenal pheochromocytoma is extremely rare and has not been reported in literature. This report presents a case of a 58 year-old male patient who developed spleen-only metastases in July 2007. The patient had a previous history of left epinephroectomy for adrenal pheochromocytoma in January 2003. Abdominal computed tomography demonstrated multiple enhancing lesions suggestive of metastases; thus splenectomy was performed. Pathological examinations confirmed the diagnosis of splenic metastases from pheochromocytoma. The patient was alive without recurrence 48 months after splenectomy. qttis study is the first report on splenic metastasis from previous adrenal pheochromocytoma, and long-term survival was achieved by splenectomy. A history of malignancy indicates a high index of suspicion for splenic metastasis, and long-term survival can be achieved by splenectomy for spleen-only metastasis.展开更多
文摘Surgery following neoadjuvant chemoradiotherapy(NCRT) is a common multidisciplinary treatment for resectable esophageal cancer(EC). After analyzing 12 randomized controlled trials(RCTs), we discuss the key issues of surgery in the management of resectable EC. Along with chemoradiotherapy, NCRT is recommended for patients with squamous cell carcinoma(SCC) and adenocarcinoma(AC), and most chemotherapy regimens are based on cisplatin, fluorouracil(FU), or both(CF). However, taxane-based schedules or additional studies, together with newer chemotherapies, are warranted. In nine clinical trials, post-operative complications were similar without significant differences between two treatment groups. In-hospital mortality was significantly different in only 1 out of 10 trials. Half of the randomized trials that compare NCRT with surgery in EC demonstrate an increase in overall survival or disease-free survival. NCRT offers a great opportunity for margin negative resection, decreased disease stage, and improved loco-regional control. However, NCRT does not affect the quality of life when combined with esophagectomy. Future trials should focus on the identification of optimum regimens and selection of patients who are most likely to benefit from specific treatment options.
基金Supported by the National Key Clinical Specialist Construction Programs of China,No.2013-544Science and Technology Development Fund of Tianjin Education Commission for Higher Education,No.20130121Science Foundation of Tianjin Medical University,No.2016KYZM03
文摘AIM To evaluate the clinical and prognostic significance of preoperative and postoperative cytokeratin 19(CK19) and carcinoembryonic antigen(CEA) m RNA levels in peripheral blood of patients with gastric cardia cancer(GCC).METHODS We detected the preoperative and postoperative mR NA levels of CK19 and CEA in peripheral blood of 129 GCC patients by using reverse transcription-polymerase chain reaction and evaluated their clinical and prognostic significance by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard analysis. A new prognostic model which stratified patients into three different risk groups was established based on the independent prognostic factors.RESULTS Elevated preoperative and postoperative CK19 and CEA mR NA levels in peripheral blood of GCC patients were associated with lymph node metastasis. Univariate analysis showed that tumor size, histological grade, depth of tumor invasion, lymph node metastasis, preoperative CK19 m RNA, and preoperative and postoperative CEA m RNA levels were correlated with the prognosis of GCC patients. The multivariate analysis showed that lymph node status(P = 0.018), preoperative CK19(P = 0.035) and CEA(P = 0.011) m RNA levels were independent prognostic factors for overall survival(OS). The 5-year OS rates for the low-, intermediate-, and high-risk groups were 48.3%, 22.6%, and 4.6%, respectively(P < 0.001).CONCLUSION Elevated preoperative CK19 and CEA mR NA levels may be regarded as promising biomarkers for predicting lymph node metastasis and poor prognosis in patients with GCC. This new prognostic model may help us identify the subpopulations of GCC patients with the highest risk.
基金supported by the National Natural Science Foundation of China(Grant Nos.81772619 and 81702405)Wu Jieping Medical Foundation(Grant No.320.6750.17519)+1 种基金Bethune Charitable Foundation(Grant No.HZB-20190528-18)Tianjin Natural Science Foundation for Youth(Grant No.19JCQNJC10800)。
文摘Esophageal cancer is the eighth most common malignant tumor and the sixth leading cause of cancer-related death worldwide.Esophageal squamous cell carcinoma(ESCC)is the main histological type of esophageal cancer,and accounts for 90%of all cancer cases.Despite the progress made in surgery,chemotherapy,and radiotherapy,the mortality rate from esophageal cancer remains high,and the overall 5-year survival rate is less than 20%,even in developed countries.The C-X-C motif chemokine ligand 12(CXCL12)is a member of the CXC chemokine subgroup,which is widely expressed in a variety of tissues and cells.CXCL12 participates in the regulation of many physiological and pathological processes by binding to its specific receptor,C-X-C motif chemokine receptor type 4(CXCR4),where it causes embryonic development,immune response,and angiogenesis.In addition,increasing evidence indicates that the CXCL12/CXCR4 axis plays an important role in the biological processes of tumor cells.Studies have shown that CXCL12 and its receptor,CXCR4,are highly expressed in ESCC.This abnormal expression contributes to tumor proliferation,lymph node and distant metastases,and worsening prognosis.At present,antagonists and imaging agents against CXCL12 or CXCR4 have been developed to interfere with the malignant process and monitor metastasis of tumors.This article summarizes the structure,function,and regulatory mechanism of CXCL12/CXCR4 and its role in the malignancy of ESCC.Current results from preclinical research targeting CXCL12/CXCR4 are also summarized to provide a reference for the clinical diagnosis and treatment of ESCC.
文摘AIM: To assess the prognostic value of serum human relaxin 2 (H2 RLN) level in patients with esophageal squamous cell carcinoma (ESCC). METHODS: From October 1998 to September 2009, 146 patients with histopathologically confirmed ESCC were enrolled in this study. One hundred patients underwent en bloc esophagectomy, and 46 patients with unresectable tumors underwent palliative surgery. Five of the 146 patients died of surgical complications. Serum levels of H2 RLN were measured by enzyme linked immunosorbent assay. The relationship between serum H2 RLN level and each of the clinicopathological parameters was analyzed using the χ2 test. Patients were classified into two groups according to their H2 RLN level (< 0.462 ng/mL vs ≥ 0.462 ng/mL). When any analysis cell had fewer than five cases, the Fisher's exact test was used. The statistical difference between groups A and B in each clinicopathological category was determined by the Student's t test (two-tailed) or analysis of variance. Survival curves were plotted using the Kaplan-Meier method. The statistical difference in survival between the different groups was compared using the log-rank test. Survival correlation with the prognostic factors was further investigated by multivariate analysis using the Cox proportional hazards model with backward stepwise likelihood ratio. RESULTS: ESCC patients tended to have significantly higher serum H2 RLN concentrations (0.48 ± 0.17 ng/ mL, n=141) compared with the healthy control group (0.342 ± 0.12 ng/mL, n=112). There was a significant difference between patients with lymph node involvement (0.74 ± 0.15 ng/mL, n=90), distant metastasis (0.90 ± 0.19 ng/mL, n=32) and those without lymph node involvement (0.45 ± 0.12 ng/mL, n=51), and distant metastasis (0.43 ± 0.14 ng/mL, n=109), respectively (P < 0.01). Patients with high H2 RLN levels (≥ 0.462 ng/mL) had a poorer prognosis than patients with low serum H2 RLN levels (< 0.462 ng/mL; P=0.0056). The H2 RLN level was also correlated with survival and tumor-node-metastasis staging, but not with age, tumor size, gender, lymphovascular invasion or the histological grade of tumors. Cox regression analysis showed that H2 RLN was an independent variable. CONCLUSION: Serum concentrations of H2 RLN are frequently elevated in ESCC patients and are correlated with disease metastasis and survival. Serum concentrations of H2 RLN may be an important prognostic marker in ESCC patients.
文摘Objective： We studied the extent and value of the lymphadenectomy in surgical treatment of carcinoma of gastroesophageal junction （GEJ）. Methods： 217 patients with GEJ who underwent surgical resection were retrospectively analyzed. The extent of lymphadenectomy was divided into 5 types （DO to D4） and the curability of operation was graded as A, B and C. Results： The patients had been treated as follows： 186 with proximal gastrectomy, 31 with total gastrectomy, 97 with a combined-visceral resection. The patients who underwent D1, D2 and D3 lymphadenectomy were respectively 158, 58 and 1. The patients who were performed with resection of grade A, B and C were 53, 107 and 57 respectively. All patients were performed with a lymphadenectomy and well registered. The lymph node metastasis occurred in 157 cases （72.4%）. The lymph node metastasis rate in the group 1, 2, 3, 4, 7, 9, 12 and 110 as well as in the pulmonary ligament group were higher than other groups. 2868 lymph nodes were removed, in which 655 （22.8%） demonstrated the existence of metastasis. The total lymph node metastatic degree in these groups was higher compared to the other groups. Conclusion： The survival rate in the D1 lymphadenectomy and D2 is similar for all patients, and there may be some differences in the 2nd and 3rd years for the DI lymphadenectomy and D2 in the stage-Ⅲb patients. The survival rate of D2 lymphadenectomy in stage Ⅲb is better than D1 and that of D2 lymphadenectomy is superior to D1 in stage-Ⅳ patients. The survival rate of grade A and B operation is much better than grade C, and the survival rate of grade A is also higher than B.
基金supported by a grant from Nature Science Foundation of Tianjin,China(No.05YFSYSF01300).
文摘OBJECTIVE To explore the role （HIF-1α） in the proliferation and cells under hypoxic conditions. of hypoxic inducible factor-1α apoptosis of pancreatic cancer METHODS A cassette encoding small interference RNA （siRNA） targeting HIF-1α mediated by recombinant adeno-associated virus （rAAV） was constructed, giving rAAV-siHIE rAAV-siHIF or rAAV- hrGFP was transfected into exponentially growing MiaPaCa2 cells under hypoxic conditions. Then, the expression of HIF-1α mRNA and protein, the proliferation and apoptosis of MiaPaCa2 cells were examined, using real-time PCR, Western Blot, MTT and TUNEL, respectively. RESULTS Under hypoxic conditions, rAAV-siHIF inhibited the expression of HIF-1α mRNA and protein in MiaPaCa2 cells. At the same time, rAAV-siHIF decreased MiaPaCa2 cell proliferation and induced apoptosis. However, rAAV-hrGFP had no effect on the expression of HIF-1α as well as the proliferation and apoptosis of MiaPaCa2 cells under hypoxic conditions. CONCLUSION Under hypoxic conditions, HIF-1α plays a key role in the proliferation of MiaPaCa2 cells, and inhibition of HIF- 1α expression can lead to MiaPaCa2 cell apoptosis.
文摘OBJECTIVE： To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS： We retrospectively analyzed 217 random patients with carcinoma of the gastric cardia who underwent a gastric cardiac resection. The patients had been treated as follows： 186 with partial gastrectomy, 31 with total gastrectomy, 97 with a combined-visceral resection, of which 82 underwent a splenectomy plus partial pancreatectomy, 10 with splenectomy alone and 5 with partial hepatectomy and diaphragmatectomy. RESULTS： The total patients were divided into 3 groups： 128 with a gastrectomy alone, 10 with gastrectomy and splenectomy, and 82 with gastrectomy and splenectomy plus pancreatectomy. The operating times for these 3 groups were respectively 3.0 h, 3.1 h and 3.8 h. The hospitalization times were respectively 23.8 d, 31.2 d and 25.9 d. No differences in post-operative complications were found between these 3 groups. There were 92 patients who underwent a gastrectomy combined with a splenectomy and （or） the pancreatectomy, in which 92 No.10 lymph nodes were eliminated, with an average of one in each patient. Among the 125 patients not receiving a splenectomy but with elimination of lymph nodes, 82 underwent a gastrectomy combined with partial pancreatectomy, of which 107 lymph nodes were eliminated for the No. 11 group, with an average of 1.3 in each patient. There was a statistically significant difference between the 2 groups. The overall survival rates were similar in the 3 groups showing no statistical differences, but was higher in the Stage Ⅲ patients with a combined resection of multi-organs. For patients in the Stage Ⅳ without resection of multi-organs, the survival rate was higher, but there was no significant difference between the 2 groups. CONCLUSION： It is difficult to determine precisely the involvement of para-tumorous organs with the eye during an operation. Combining a splenectomy with a pancreatectomy does not increase the post-operative complications following surgical treatment for carcinoma of the gastric cardia. The combination of a splenectomy and partial pancreatectomy results in a higher survival rate and has an important significance for eliminating the lymph nodes of group 10 and 11, especially for patients in Stage Ⅲ. In the application of a resection combining multi-organs, the doctor should make every effort to decrease the trauma and the complications based on the condition that the cancerous tissue is totally resected.
基金supported by China Anti-Cancer Association(CACA).
文摘Esophageal carcinoma(EC)is a common malignant tumor of the upper digestive tract worldwide.An analysis of the latest data from cancer centers in China showed that the incidence of EC and the number of deaths due to EC in China in 2015 were 266,000 and 188,000,respectively,ranking sixth(6.3%)and fourth(8.0%)among all malignant tumors.The early diagnosis and treatment of EC and standardized diagnosis and treatment are important tasks for EC healthcare professionals in various centers across the country.At present,the 8th edition of the EC staging system jointly released by Union for International Cancer Control(UICC)and American Joint Committee on Cancer(AJCC)is the most recent,authoritative and widely used EC staging standard.The EC professional committee of the Chinese Anti-Cancer Association also organizes the"EC Standardization Campaign in China"every year to promote the development of EC diagnostic and treatment norms throughout the country.Since 2011,the EC Committee of the Chinese Anti-Cancer Association has published the Guidelines for Standardized Diagnosis and Treatment of EC.Considering the increasing number of EC clinical studies and the continuous progress in diagnostic and treatment technologies in recent years,the updated Guidelines will include the latest progress in the diagnosis and treatment of EC,with a goal of promoting the forward development of EC diagnosis and treatment in clinical practice.
文摘Splenic metastasis is generally not a common clinical event. However, metastasis to the spleen from adrenal pheochromocytoma is extremely rare and has not been reported in literature. This report presents a case of a 58 year-old male patient who developed spleen-only metastases in July 2007. The patient had a previous history of left epinephroectomy for adrenal pheochromocytoma in January 2003. Abdominal computed tomography demonstrated multiple enhancing lesions suggestive of metastases; thus splenectomy was performed. Pathological examinations confirmed the diagnosis of splenic metastases from pheochromocytoma. The patient was alive without recurrence 48 months after splenectomy. qttis study is the first report on splenic metastasis from previous adrenal pheochromocytoma, and long-term survival was achieved by splenectomy. A history of malignancy indicates a high index of suspicion for splenic metastasis, and long-term survival can be achieved by splenectomy for spleen-only metastasis.
