Objective To investigate the clinical efficacy of the superior pancreatic region approach guided by pancreatic capsule in laparoscopic radical gastrectomy of 438 patients.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 438 patients who underwent laparoscopic radical gastrectomy of gastric cancer in the Second Hospital of Jilin University between April 2013 and April 2017were collected.Patients were confirmed with stage T2 and above by postoperative pathological examination and then underwent adjuvant chemotherapy of XELOX regimen.Observation indicators:(1) surgical situation;(2)postoperative recovery situation;(3) postoperative pathological examination;(4) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy,postoperative long-term complications and tumor metastasis or recurrence up to May 2017.Measurement data with normal distribution were represented as x±s.Results (1) Surgical situation:all the 438patients underwent laparoscopic radical gastrectomy of gastric cancer through the superior pancreatic region approach guided by pancreatic capsule,including 295 undergoing distal gastrectomy and 143 undergoing total gastrectomy.There were no conversion to open surgery.Operation time and volume of intraoperative blood loss were respectively (178 ±32) minutes and (39± 11)mL.There were no intraoperative complications and death in perioperative period.(2) Postoperative recovery situation:time to anal exsufflation,time for fluid diet intake and duration of hospital stay were (32±6) hours,(26±3) hours and (8.7±2.3) days,respectively.Volume of amylase drainage was (157±35) U/L at postoperative day 1,(68±25) U/L at postoperative day 2 and (43±17) U/L at postoperative day 3,respectively.No pancreatic fistula occurred postoperatively.(3) Postoperative pathological examination:results of postoperative pathological examination showed that 218,209 and 11 patients were detected in T2,T3 and T4a staging,respectively.Numbers of lymph node dissected and lymph node metastases were respectively 27.0± 6.0 and 4.2-± 2.9.Pathological typing:high-or moderate-differentiated adenocarcinoma,lowdifferentiated adenocarcinoma and undifferentiated carcinoma or signet-ring cell carcinoma were detected in 67,279 and 92 patients,respectively.(4) Follow-up situation:of 438 patients,415 were followed up for 1-48months,with a median time of 33 months of 438 patients,293 received postoperative adjuvant chemotherapy of XELOX regimen,122 received unknown adjuvant chemotherapy or refused chemotherapy.During the follow-up,there was no oecurrence of tumor-related complications,13 patients had tumor metastases or recurrence and 5patients died of tumor recurrence or metastases.Conclusion The superior pancreatic region approach guided by pancreatic capsule is safe and feasible in laparoscopic radical gastrectomy.

OBJECTIVETo investigate the clinical advantage of the application of modified Roux-en-Y reconstruction after totally laparoscopic total gastrectomy.

METHODSClinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group (CRY, 16 cases) and modified Roux-en-Y group (MRY, 20 cases) according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared.

RESULTSOperation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [(260.9 ± 21.2) min vs. (287.9 ± 19.0) min, P=0.000], shorter mean reconstruction duration [(32.4 ± 9.2] min vs. (45.4 ± 13.2) min, P=0.001] and less intraoperative bleeding [(50.9 ± 23.5) ml vs. (67.0 ± 20.5) ml, P=0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups.

CONCLUSIONSAs compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.

Anastomosis, Roux-en-Y ; Humans ; Laparoscopy ; Lymph Nodes ; Mesentery ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms

The RET(REarranged during transfection) gene as a novel has broken the therapeutic deadlock in the last two years, whith is attributed to the rapid approval of targeted therapies and inclusion in treatment guidelines, bringing more hope for the survival of patients with non-small cell lung cancer(NSCLC). Usually, the main activation of the RET proto-oncogene contributes to the development of lung cancer via somatic rearrangements. Thus, this study reviews the biological characteristics of RET gene, the classification of RET fusion in lung cancer and the detection of RET fusion. Meanwhile the pathological and clinical features, targeted therapies, drug resistance, prognosis of lung cancer patients with RET fusion were further discussed.

Objective:To improve the understanding of acute pain after thoracoscopic surgery in patients with early-stage lung adenocarcinoma, to analyze and screen out the independent risk factors that may induce acute postoperative pain. The patients' surgery experience may get improved through the corresponding timely and effective interventions.Methods:We retrospectively reviewed the clinical data of 204 patients with early-stage lung adenocarcinoma who were treated by a single medical team of our center from May 2021 to October 2021, and analyzed the assessment results of acute postoperative pain. Patients were grouped according to the general condition, past medical history, social and spiritual attributes, lesion characteristics, surgical approaches and anesthetic methods. Comparison of proportions of acute postoperative pain between the groups were made, and independent risk factors were identified.Results:A total of 84 males and 120 females were enrolled, with a mean age of(57.9±11.5)years old and a median operation time of 120(110, 145) min. No serious complication or perioperative death occurred in the whole group. Postoperative pain control failed in 76 cases(37.3%), 24 cases(11.8%) suffered from severe postoperative pain, and 33 cases(16.2%) required additional intramuscular injection of strong analgesics after surgery. Those who were younger than 60 years old, with a university degree or above, received two-incision surgery, operated for more than 2 h, received general anesthesia only, or in a state of depression, had significantly higher rates of postoperative acute pain, compared with their respective control groups( P<0.05). The independent risk factors for acute pain after thoracoscopic surgery included age( P=0.002), history of alcoholism( P=0.014), number of incisions( P=0.016), operation time( P=0.010), depression status( P=0.037) and enhanced anesthetic method( P=0.012). Conclusion:A large amount of patients with early-stage lung cancer suffered from acute pain after thoracoscopic surgery, which seriously affected their treatment experience and even quality of life. Young patients with a history of alcoholism and depression status were high-risk groups for postoperative acute pain. Applying Uniportal video-assisted thoracoscopic surgery, reducing the operation time as much as possible, and choosing enhanced analgesic anesthesia represented by epidural block combined with general anesthesia might be effective ways to reduce the probability of acute postoperative pain.

Adenocarcinoma of esophagogastric junction (AEG) has attracted more attention in recent years. Surgical method of Siewert type Ⅱ AEG is especially controversial, mainly focusing on the scope of lymph node dissection, safety of surgical margin, and digestive tract reconstruction. The abdominal transhiatal approach and right thoracoabdominal Ivor-Lewis approach are the main surgical approaches of totally laparoscopic or thoracoscopic surgery for Siewert type Ⅱ AEG, which not only need close teamwork, but also require rich experience in laparoscopic surgery. The authors has started to choose these two totally minimally invasive surgical approaches, the feasibility and safety of which are proved. The key surgical details are presented in this article for reference.

Objective To explore the clinical efficacy of modified totally laparoscopic intra-gastric surgery for the treatment of submucosal tumors adjacent to the cardia or pylorus.Methods The retrospective crosssectional study was conducted.The clinicopathological data of 48 patients with gastric submucosal tumors adjacent to the cardia or pylorus between September 2014 and March 2018 were collected.There were 22 males and 26 females,aged from 38 to 78 years,with an average age of 58 years.Patients were performed multi-port or singleport modified laparoscopic intra-gastric surgery.Observation indicators:(1) surgical treatments;(2) postoperative recovery;(3) results of postoperative pathological examination;(4) follow-up.Patients were followed up by outpatient examination and telephone interview to detect the postoperative complications and tumor metastasis and recurrence up to June 2018.Measurement data with normal distribution were expressed as Mean±SD and measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage.Results (1) Surgical treatments:48 patients underwent modified totally laparoscopic intra-gastric surgery successfully,including one patient combined with proximal gastrectomy,without conversion to open surgery.Of the 48 patients,43 underwent multi-port modified laparoscopic intra-gastric surgery and 5 underwent single-port modified laparoscopic intra-gastric surgery.The operation time and volume of intraoperative blood loss were 68 minutes (range,45-110 minutes) and 20 mL (range,5-100 mL).The oncologic evaluation of 48 patients:48 patients had complete resection of tumors,without tumor rupture.The tumor diameter and distance from margin to tumor were 32 mm (range,20-40 mm) and 6 mm (range,5-10 mm).(2) Postoperative recovery:the time for initial oral intake and duration of postoperative stay were 2.8 days (rang,1.0-5.0 days) and 5.3 days(range,3.0-11.0 days).There were 4,3,1 and 1 patients complicated with surgical infection,delayed gastric emptying,sub-phrenic hydrops and digestive leakage respectively in the 48 patients.(3) Results of postoperative pathological examination:the distance from tumor margin to gastric cardia or pylorus,tumor diameter,circumferential resection margin were 15 mm (range,0-30 mm),24 mm (range,10-65 mm),6 mm (range,5-10 mm),respectively.Growth patterns of cancer in the 48 patents included 27 of intraluminal type,12 of intermural type,9 of mixed type.Pathological types of 48 patients:there were 26 patients with leiomyoma,9 with gastrointestinal stromal tumor,4 with other rare tumors,2 with carcinoid,2 with mucosa associated lymphoma,2 with inflammatory fibrous polyps,2 with gastritis cystica profunda,1 with ectopic pancreas.(4) Follow-up:41 of the 48 patients were followed up for 3-48 months,with a median follow-up time of 22 months.No tumor recurrence was detected in 37 of 41 patients by 3 times of gastroscopy and no stenosis or dysfunction of cardia or pylorus was detected in 39 patients by 2 times of upper gastrointestinal imaging (one patient undergoing two examinations).During the follow-up,there was no surgery-related complication or tumorspecific death.Conclusion Modified totally laparoscopic intra-gastric surgery is safe and feasible for the treatment of gastric submucosal tumors adjacent to the cardia or pylorus.

Intraoperative hemorrhage is the most common complication of laparoscopic radical gastrectomy,which is also the main cause of conversion to open surgery.With the popularization of laparoscopic surgery technology worldwide,how to complete high-quality surgery and effectively avoid intraoperative or postoperative complications is the goal pursued by all surgeons.Intraoperative hemorrhage in the laparoscopic radical gastrectomy is mainly divided into parenchymal hemorrhage,perigastric vascular injury-induced hemorrhage,lymph node hemorrhage and anastomotic bleeding.Compression,electrocoagulation,vascular clipping and vascular suture repair are the most common treatments for intraoperative hemorrhage.It is necessary to use above methods in clinical work.Proficiency in laparoscopic operation skills,familiarity with perigastric vascular anatomy and variation,and improved teamwork to reduce complications are the key to laparoscopic surgery for gastric cancer.Combined with literature reports,the authors summarize experience in laparoscopic surgery for gastric cancer,discuss the prevention and treatment of hemorrhagic complications during laparoscopic radical gastrectomy.

Objective:To investigate the application of low-dose chest CT(LDCT) in the screening of pulmonary subsolid nodules in population and the application value of artificial intelligence.Methods:People who received chest LDCT screening between January 2015 and December 2017 were included. A retrospective study was developed to analyze the enrolled population features , detection of pulmonary subsolid nodules and independent predictors of subsolid nodules , and to evaluate the accuracy of the artificial intelligence reading method.Results:Result of three cross-sectional studies reveals that the detection rates of pulmonary subsolid nodules were 0.42%, 0.69% and 0.92% in three rounds. 726 cases who completed the three rounds of screening were included in the cohort study. The cohort population was predominantly male(83.2%), with a median age of 43 years, and nearly half of the subjects(47.0%) had a history of smoking. GEE revealed that the patient's family history of lung cancer( OR=8.753, 95% CI: 1.877-40.816, P=0.006) was an independent predictor of the detection of subsolid nodules. In the 110 kVp tube voltage group, AUC of AI model was 0.740, and AUC of the manual reading method was 0.721, no significant differences were observed( P=0.502); when the preseted cutoff value of AI model was 0.75, the NRI was -0.15, indicating the accuracy of AI model was inferior to manual method( P=0.006). In the 130 kVp tube voltage group, AUC of the model was 0.888, and AUC of the manual reading method was 0.756, no significant differences were observed( P=0.128); and the NRI was 0.19, indicating the accuracy of AI model was not inferior to manual method( P=0.123). Conclusion:This population' s detection rates of pulmonary subsolid nodules were 0.42%-0.92%. Family history of lung cancer was an independent predictor of subsolid pulmonary nodules. The result of AI pulmonary nodule detection model could be a reference when the training set data parameters match the actual application parameters.

Objective:To investigate the application value of modified Overlap esophago-gastric tube (MO-EG) reconstruction in totally laparoscopic radical proximal gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 7 patients with upper gastric cancer or adenocarcinoma of esophagogastric junction (AEG) who underwent totally laparoscopic radical proximal gastrectomy with MO-EG reconstruction in the Second Hospital of Jilin University from January 2019 to December 2020 were collected. There were 4 males and 3 females, aged 62(range, 55-72)years. The body mass index of the 7 patients was 21.5(range, 18.5-26.0)kg/m 2. Of the 7 patients, 2 cases had early upper third gastric cancer and 5 cases had Siewert Ⅱ AEG. All patients underwent totally laparoscopic radical proximal gastrectomy with MO-EG recons-truction using barbed sutures. Observation indicators: (1) surgical situations; (2) postoperative recovery situations; (3) postoperative histopathological examinations; (4) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative esophageal reflux, endoscopic classification of esophageal reflux, anastomotic complications, tumor recurrence and metastasis and survival of patients up to December 2021. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 7 patients underwent totally laparoscopic radical proximal gastrectomy and D 1+ lymph node dissection with MO-EG reconstruction through abdominal transhiatal approach. None of the 7 patients underwent conversion to open surgery or additional thoracotomy. The operation time, time of digestive reconstruction, volume of intraoperative blood loss and length of esophagus dissected of 7 patients were (271±36)minutes, (44±10)minutes, (53±26)mL and (6.4±0.3)cm, respec-tively. (2) Postoperative recovery situations. The time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial liquid food intake and duration of hospital stay of 7 patients were (21±5)hours, (2.9±0.9)days, (5.0±0.7)days and (10.1±1.9)days, respectively. None of the 7 patients had postoperative severe complications such as bleeding, anasto-motic leakage or mortality. One patient had postoperative pulmonary infection and recovered after anti-infection treatment. Two patients had pleural effusion and were improved after conserva-tive treatment. (3) Postoperative histopathological examinations. The tumor diameter of 7 patients was (2.5±0.7)cm. Histopathological examination of upper margins of 7 patients was negative. The distance between the esophagus margin and the superior margin of the tumor of patients with AEG was (1.8±0.6)cm. The number of lymph node dissected and the number of inferior mediastinum lymph node dissected of 7 patients were 26.0±3.6 and 3.7±1.1, respectively. Pathological TNM stages of 7 patients were 2 cases of stage ⅠB, 4 cases of ⅡA, 1 case of ⅡB. (4) Follow-up. All the 7 patients were followed up for 18(range, 12?36)months. Of the 7 patients, 4 cases reported asymptomatic, 2 cases had symptoms of reflux and 1 case had chocked feeling after eating. All the 7 patients underwent barium meal examination of gastrointestinal tract without anastomotic dysfunction or anastomotic stenosis. Six of the 7 patients underwent gastroscopy at postoperative 1 year and only 1 of them reported grade B reflux esophagitis according to Los Angeles classification, while the rest of 5 patients had no evidence of obvious reflux. None of the 7 patients had postoperative gastric cancer tumor recurrence, metastasis or death. Conclusion:Application of MO-EG reconstruction in totally laparoscopic radical proximal gastrectomy is safe and feasible, with satisfactory short-term effects.