The incidence of adenocarcinoma of esophagogastric junction is increasing worldwide during recent decades.The therapeutic strategies have been transformed from surgery alone to multimodal treatments involing also perioperative chemoradiotherapy.Although there are still many problems on preoperative staging,surgical approach,excisional extent and perioperative chemoradiotherapy regimen,multidisciplinary team collaboration can provide an optimal diagnosis and treatment to achieve the principles of standardization and individualization in malignant tumor,which will prolong the survival and improve the quality of life for every patient.

ObjectiveTo investigate rational surgical approaches for Siewert type Ⅰ adenocarcinoma of the esophagogastric junction (AEG),and analyze the prognostic factors.MethodsThe clinical data of 103 patients with Siewert type Ⅰ AEG who were admitted to the Renji Hospital from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into transthoracic approach group (61 patients) and thoracoabdominal approach group (42 patients).The incidences of numbers of lymph node dissected and postoperative complications of the 2 groups were compared using the chi-square test,Fisher exact probability or the t test.The survival curve was drawn by the Kaplan-Meier method and the survival was analyzed using the Log-rank test.Prognostic factors were analyzed using the one-way analysis of variance and Cox regression model.ResultsNo perioperative death was observed in the 2 groups.There were significant differences in the number of lymph node dissected and number of metastatic lymph node between the 2 groups (t =2.18,2.29,P ＜ 0.05 ).There was no significant difference in splenic injury between the 2 groups (P ＞ 0.05 ).There were no significant differences in postoperative bleeding,anastomotic fistula and stricture,esophagogastric reflux,pulmonary infection and esteomyelitis between the 2 groups (x2 =0.07,0.94,0.22,1.41,0.17,P＞0.05).Of the 103 patients,97(94.2％) were followed up.The mean postoperative survival time was 26 months.The median survival time was 26 months,and the 3-yearsurvival rate was 35.9％.The 3-year survival rates of transthoracic approach group and thoracoabdominal approach group were 32.8％ and 40.2％,with no significant difference between the 2 groups ( x2 =0.37,P ＞ 0.05).The results of univariate analysis showed that radical or palliative resection,TNM stage,lymph node metastasis stage,tumor diameter and metastasis rate,degree of radical resection were independent factors influencing the prognosis of patients with Siewert type Ⅰ AEG (x2 =21.07,26.04,22.42,6.26,32.20,20.80,P＜0.05).The results of multivariate analysis showed that degree of TNM stage,lymph node metastasis rate and radical resection were independent factors influencing the prognosis of patients ( Wald =12.01,8.75,10.03,P ＜ 0.05 ).Conclusions Thoracoabdominal approach is a reasonable selection for patients with Siewert type I AEG.Degree of TNM stage,lymph node metastasis rate and radical resection were independent risk factors influencing the prognosis of patients.

Objective To explore the diagnosis and re-operation of the recurrent retroperitoneal soft tissue sarcoma(RPS).Methods Clinical data of 25 patients with recurrent RPS were retrospectively analyzed.Results All of 25 cases of recurrent RPS were diagnosed by operation and postoperative pathologic examination.They underwent a total of 42 time operations,with mean time of re-operations was 1.68.Of the 42 time operations,26 time were complete resection,11 time partial resection and 5 time only biopsy.A total of 19 cases underwent removal of contiguous intra-abdominal organs and 5 underwent resection of major invaded blood vessel.The 1-,3-and 5-year survival rate of recurrent RPS was 52.0%,40.0% and 28.0% respectively.The rate of complete resection in recurrent RPS with major blood vessel invasion was 35.7%.In contrast,the complete resection rate in recurrent RPS without major blood vessel invasion was 75%(P=0.013).On the other hand,there was no significant difference in complete resection rate between the recurrent RPS with adjacent organs invasion and the recurrent RPS with no adjacent organs invasion(P=0.462).Conclusions Preoperative imaging results are crucial factor for assessment of operative resectability.Unless there are obvious comtraindications,recurrent RPS should undergo aggressive surgical excision.

Objective To investigate the preopera ti ve diagnosis and the surgical treatment of primary retroperitoneal tumor(PRT). Methods The clinical dat a of 71 patients with PRT were retrospectively analyzed including clinical manif estation, radiologic studies, pathologic examination and surgical procedures. Results There were 32 cases of benign tumor, 38 cases of malignant tumor and 1 case of borderline tumor. Of the 32 patients with benign tumor, 31 underwent complete surgical resection. Of the 38 patients with malignant tumor, 29 underwent complete resection. One patie nt with borderline tumor underwent total resection. The 5-year survival rate of benign PRT was 89.29%, the 5-year survival rate of malignant PRT was 20.80%. Four cases of recurrent benign PRT underwent complete resection. Ten cases of r ecurrent malignant PRT underwent complete resection and 3 underwent partial rese ction. ConclusionsRadiolog ical study is crucial for the diagnosis. Complete resection is the key for the t reatment of PRT.

The incidence of gastric cancer in East Asia is highest in the world. Level of screening and inspection in high risk population, diagnosis and treatment in early stage, standardized surgery, minimally invasive techniques and clinical research always reach the international lead. In the past few years, the surgeons and researchers from China have already made considerable progress by learning the experience from Japan and Korea. The early detection of gastric cancer increases annually, the minimally invasive surgeries including endoscopic or laparoscopic operations are widely used, the standard surgical procedure and lymphadenectomy are popularized, meanwhile the clinical research for gastric cancer has also started. In the future, as long as following this way, we will definitely achieve better improvement in diagnosis and treatment of gastric cancer in China.

Gastric cancer is one of the malignant tumors with high morbidity and high mortality in China.Research has shown that viral infection is closely related to the occurrence of gastric cancer.EpsteinBarr virus-associated gastric cancer characterized by EB virus infection has been classified as a subtype of gastric cancer,whose epidemiology,pathogenesis,clinical and histopathologic features have been studied in detail.At the same time,oncolytic viruses reveal the inhibitory effect of the virus on tumors,and their ability to target and kill tumor cells is used in the treatment of some advanced cancers.This article will review the research advances about relevance to gastric cancer of several viruses that have been reported and the latest progress in anticancer mechanisms and combined therapies for oncolytic viruses.

As a new medical concept and medical model,precision medicine has been increasingly showing its benefits in the clinical diagnosis and treatment. With the development and progress of cancer genomics,imaging diagnosis and surgical techniques,the diagnosis and treatment of malignant tumors is gradually moving towards the era of precision medicine. The precision surgical treatment for gastric cancer is the use of modern molecular and imaging diagnostic technologies,on the basis of molecular classification and clinical staging,to develop accurate and individualized surgical plan with the concept of minimally invasive surgery and functional preservation. For the advanced gastric cancer, comprehensive treatments including chemoradiotherapy,molecular targeted therapy and immunotherapy are used to further improve the prognosis of patients.

China has the number of cases and deaths of gastric cancer ranking first in the world every year. Gastric cancer is a heterogeneous disease with significant individual differences and poor prognosis. In recent years, with the development of multi-omics technology, by analyzing different molecular subtypes and underlying mechanisms of gastric cancer, more and more targets and molecular features related to gastric cancer have been identified, targeted or immunotherapeu-tic drugs based on these molecular features have been partially applied in the clinical treatment of gastric cancer. In this article, the authors summarize the latest research progress based on the molecular characteristics of gastric cancer, elaborate on the current status and prospects of precise therapy strategies for gastric cancer, in order to provide new theoretical basis for improving the comprehensive treatment efficacy and prognosis of gastric cancer.

The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing worldwide annually. Surgical resection still plays the most important role in multi-modality therapy for AEG. However, due to the specialities of tumor location and biological features, general surgeons and thoracic surgeons do not reach an agreement on regional lymph-adenectomy, extents of resection, surgical approaches, etc. The development of minimally invasive surgery makes it possible to operate by laparoscopy and thoracoscopy. With the promotion of neoadjuvant therapy, a multidisciplinary team will be essential for optimal diagnosis and treatment in the near future. From the developmental perspective of a general surgeon, the authors summarize current status and controversies of the diagnosis and treatment of AEG, and inspect its research advances.

Due to the unique position and biological behaviors of adenocarcinoma of esophagogastric junction (AEG), the pattern of treatment has gradually changed from surgery alone leading by surgeons to comprehensive treatment by multidisciplinary teams including thoracic surgeons, oncologists, radiotherapy physicians, anesthetists and so on. The development of laparoscopic surgery makes the jointed operation possible by laparoscopy and thoracoscopy. The concept of enhanced recovery after surgery could further promote minimally invasive surgery in AEG. Meanwhile, with the continuous innovation of neoadjuvant chemotherapy, popularization of neoadjuvant radiotherapy and bold attempt of targeted therapy and immunotherapy, the resection rate, pathologic release rate and long-term survival of AEG have already achieved inspiring effects.