Objective To explore the intraoperative process and determine that the stomach resection margin is accurate so as to ensure the quality of operation and improve the patients′survival rate .Method Nor-mally,tissue samples were continuously collected from two sides of visualized tumor edge as center .Specifically, the tissue samples were collected from upper side when tumor located at gastric antrum ,collected from lower side when tumor located at gastric cardia ,and collected from distant side when tumor located at gastric body .All sam-ples were processed with paraffin embedding ,staining,and were judged by the distance of tumor cell infiltration . Results The mucosa infiltration distance was more than 5 cm in 5 cases,more than 3 cm but less than 5 cm in 5 cases,and less than 3 cm in 118 cases.A total of 218 cases had less 0 cm mucosa infiltration distance ,which was visualized distance less than the microscopic .The serosa infiltration distance was more than 5 cm in 6cases,more than 3 cm but less than 5cm in 19 cases,and more or equal than 0 cm in 251 cases.A total of 95 cases had less 0 cm infiltration distance .The results of the single factor analysis showed that whether the general observed infil -tration distance of the mucosal membrane was greater than what observed under the microscope ,is associated with gender,age, maximum diameter,thickness of the tumor,external quality,and TNM stage.It significantly demon-strated the relationship of microscopic mucous membrane infiltration distance with sex , vertical diameter , thick-ness,stroma mass,and TNM stage.Stroma membrane infiltration distance significantly correlated with vertical di-ameter,the largest diameter,thickness,gross type,histological type,stroma mass,and TNM stage.Conclusion The infiltration of distance was less than 5 cm among ninety nine percent of patients with gastric cancer .There-fore,enlarged resection of 5 cm from visualized margin of tumor is necessary for operative treatment .There are as-sociations between tumor infiltration distance and vertical diameter ,thickness,stroma mass,manner of infiltration, and TNM stage .

The incidence of gastric cancer is in the fourth place of all cancers in worldwide ,and the fatal-ity rate is in the second place .Standard chemotherapy regimens play an important role in prolonging gastric cancer survival rate.However,most of gastric cancers are in advanced stage when diagnose is finally made .The current medical practice can only meet the limited treatment options .In the last several decades ,study of the molecular mechanisms of gastric cancer gets constant new progress .By inhibiting the human epidermal growth factor receptor 2(Her-2)for advanced gastric cancer,it provides a new treatment for patients.Trastuzumab is a kind of Her -2 monoclonal antibody .It is the first kind of targeted therapy drug for the treatment of metastatic gastric cancer .A combination of trastuzumab with cisplatin and 5-fluorouracil based chemotherapy benefits gastric cancer overall survival.Overexpression of Her -2 provides evidence for the targeted therapy .So we reviewed Her -2 excessive expression of gastric carcinoma in recent years and represented by bead sheet resistance to targeted therapy .In this paper ,research of overpression of Her -2 and targeted threrapy in gastric cancer are summarized .

Objective: To explore the effects of Layhey’s and Lawrence’s reconstruction procedures on nutritional status and digestive symptoms following total gastrectomy for gastric cancer.Methods: To analyze retrospectively 146 patients performed total gastrectomy for gastric cancer.Among them,83 cases were operated by Lahey’s reconstruction procedures and 63 cases by Lawrence’s.It was focused on the comparision of the body weight changing,nutritional status and digestive symptoms in 6 months after operation.Results: In 6 months after operation,the weight loss of Lawrence group was less than that of Lahey group significanly.For the level of total protein and albumin at that time,they increased in Lawrence group,but decreased in Lahey’ group,and the difference was significant.The changing tedency for hemoglobin level in Lawrence group was less than that of Lahey group,but there was no significant difference between them.For the quantity and frequency of food intake,there was no significnat difference between them.In Lawrence group,the number of patients with vomiting were less than that in Lahey’group significantly.Conclusion:The Lawrence reconstruction procedure is more reasonable following total gastrectomy for gastric cancer.

Objective To explore the relationship between peritoneal lavage cytology in gastric carcinoma and lymph node metastasis.Methods From June 2012 to May 2014,intraoperative peritoneal lavage for cancer cells was carried out in 226 gastric cancer patients undergoing gastrectomy.During the process 63 patients were irrigated with 500 ml of normal saline,while the others were using 1 000 ml.D2+ lymph nodes dissection was performed to evaluate the relationship between peritoneal lavage cytology in gastric carcinoma and lymph nodes metastasis.Results The positive rates of exfoliative carcinoma cells were 11.1％ in the 500 ml group and 9.2％ in the 1 000 ml group (x2 =0.188,P=0.695).In both groups,rate of exforliative cancer cells were positively related to lymph node metastasis,the numbers of positive lymph nodes,the station of lymph nodes metastasis,the rate of the lymph nodes metastasis and that of the second station (all P ＜ 0.05),but not to the numbers of the lymph node cleaned (P ＞ 0.05).Conclusions Lymph nodes metastasis was an important risk factor that contribute to exfoliated carcinoma cells in patients with gastric carcinoma,and especially in those with lymph nodes metastasis at the second station.

Objective The aims of this study were to investigate the prognostic value of CEA and CA19-9 expression in advanced gastric cancer and the prognostic factors of advanced gastric cancer.Methods A total of 255 patients with advanced gastric cancer who underwent radical R0 radical surgery were enrolled in the Department of Gastrointestinal Surgery,Harbin Medical University Cancer Hospital from January 2010 to December 2010,and were divided into group A(CEA<2.19ng/mL and CA19-9<10.78U/mL),group B(CEA≥2.19ng/mL or CA19-9≥10.78U/mL)and group C(CEA≥2.19ng/mL and CA19-9≥10.78U/mL).These groups were analyzed the differences in gastric cancer patients with clinical pathology and survival,and prognostic factors of patients with advanced gastric cancer factors.Results There were statistically significant differences in clinical N staging,clinical TNM staging and pathological TNM staging in three groups of patients with advanced gastric cancer(P<0.05).There was no significant difference in the median survival time in three groups of patients with advanced gastric cancer(P>0.05).The 1-year,3-year and 5-year survival rates of group A were higher than those of group B and group C(P>0.05).The factors affecting the prognosis of gastric cancer included the degree of tumor differentiation,pathological T staging,pathological TNM staging,the total number of lymph nodes,the number of positive lymph nodes and lymph node metastasis.Conclusion Combined detection of CEA and CA19-9 expression indicates a certain reference value for prognosis of gastric cancer.

Although chemotherapy is an effective way for advanced gastric cancer ,it does not significant-ly improve the prognosis of patients .Recently ,further researches on the mechanism of gastric cancer have led to the identification of ′driver gene′and the development of new agents that target these genes .By inhibiting the hu-man epidermal growth factor receptor 2(Her-2)for advanced gastric cancer ,it provides a new treatment for pa-tients.Trastuzumab is a kind of Her -2 monoclonal antibody ,it is the first kind of targeted therapy drug for the treatment of advanced and metastatic gastric cancer .A combination of trastuzumab with cisplatin and fluorouracil based chemotherapy can benefit patients overall survival .Therefore,in this paper,we make a review and summary of a set of recent studies related to the gastric targeted therapy .