OBJECTIVETo review the experience in surgical treatment for tumors of trachea, carina and main bronchus.

METHODSFrom Jan. 1996 to Jun. 2004, 27 patients with tumor of trachea, carina or main bronchus underwent surgery including resection and reconstruction of trachea in 8, right/left pneumonectomy and carinal resection and reconstruction in 9 (6/3), right sleeve upper lobectomy and carnial resection with reconstruction of trachea and carina in 2, carina resection and reconstruction in 3, tumor removal through tracheal windows in 5. CPB (cardiopulmonary bypass) was used in 2 patients during surgery.

RESULTSThere were 3 peri-operative deaths caused by acute respiratory failure in 2 and severe postoperative bleeding in 1 case. After follow-up of more than 6 months, no death or post-operative complication occurred.

CONCLUSIONResection and reconstruction for patients with tumor of trachea, main bronchus or carina can be performed with excellent results using effective surgical and anaesthetic methods with or without CPB assistance.

Adenocarcinoma ; mortality ; surgery ; Adult ; Aged ; Bronchi ; pathology ; surgery ; Bronchial Neoplasms ; mortality ; surgery ; Carcinoma, Squamous Cell ; mortality ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pneumonectomy ; methods ; Survival Rate ; Trachea ; pathology ; surgery ; Tracheal Neoplasms ; mortality ; surgery

OBJECTIVETo investigate the feasibility and therapeutic results of multiple organ resection in patients with tumor of the body and tail of pancreas.

METHODSThe clinical and pathological data were analysed in 16 consecutive patients with neoplasm of the body and tail of pancreas from 1999 to 2004 retrospectively.

RESULTSMultiple organ resection was performed in 6 cases of primary pancreatic adenocarcinoma of the body and tail (3 cases of pancreatic cancer, 2 cases of malignant glucagonoma, and 1 case of well-differentiated pancreatic stromal sarcoma) and 10 cases of extrapancreatic malignancy (4 cases of gastric cancer, 2 cases of gastric leiomyosarcoma, 1 case of duodenal cancer, and 3 cases of colon cancer of hepatic flexure). Distal pancreatectomy with splenectomy was performed in all cases. In addition, 10 patients received splenic flexure colectomy, 6 patients received distal gastrectomy, 3 patients received left nephrectomy, left colectomy, total gastrectomy, liver lobe resection, left adrenalectomy, and local diaphragma resection, and 2 patients received transverse colectomy, subtotal colectomy, proximal proctectomy, proximal gastrectomy, and duodenectomy. No perioperative death and severe complications were observed. Patients with primary pancreatic cancer or pancreatic stromal sarcoma died within 1 year. Two patients with malignant glucagonoma died 51 and 39 months later. The 3-year survival rate was 70% in 10 patients with extrapancreatic malignancy, among which 2 patients with enteric cancer have survived 37 and 48 months.

CONCLUSIONRadical combined multiple organ resection may be performed actively in appropriately selected patients.

Adenocarcinoma ; mortality ; pathology ; surgery ; Adult ; Aged ; Colectomy ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; mortality ; pathology ; surgery ; Pancreaticoduodenectomy ; Retrospective Studies ; Splenectomy ; Survival Rate ; Treatment Outcome

OBJECTIVE: To determine the clinical application of the new classification of adenocarcinoma of esophagogastric junction (AEG). METHODS: The data of cancer of distal esophagus, cancer of cardia, and proximal gastric cancer were reviewed. Clinicopathologic characteristics, surgical modes and survival were analyzed according to Siewert's standards. RESULTS: Among the 203 patients that were up to the standard, 29 had adenocarcinoma of the distal esophagus (Type I), 80 had true carcinoma of cardia (Type II), and 94 had subcardial carcinoma (Type III). The 5-year survival rates of the 3 types of patients after the operation were 34% for Type I, 27.5% for Type II, and 24.5% for Type III (P<0.05). Further analysis of the patients with curative resection suggested there was no significant difference in the 5-year survival rates, with 37.5% for Type I, 34.5% for Type II, and 33.3% for Type III (P>0.05). CONCLUSION Difference has been found in the clinicopathologic characteristics of the 3 types of adenocarcinoma of the esophagogastric junction. The exact relation of the 3 types is still unknown. The TNM classification, complete tumor resection and the extent of lymph node metastasis are critical for the prognosis of the patients.
Adenocarcinoma ; classification ; mortality ; surgery ; China ; Esophageal Neoplasms ; classification ; mortality ; surgery ; Esophagectomy ; Esophagogastric Junction ; pathology ; surgery ; Female ; Humans ; Male ; Retrospective Studies ; Survival Analysis ; Survival Rate

OBJECTIVE: To compare the clinicopathological features and the prognosis between patients with adenocarcinoma of esophagogastric junction (AEG) and with adenocarcinoma of gastric antrum (AGA), and to investigate the prognostic factors of AEG and AGA. METHODS: A retrospective cohort study was performed on clinicopathological data of 239 AEG patients (AEG group) and 313 AGA patients selected simultaneously (AGA group) undergoing operation at Harbin Medical University Cancer Hospital from January 2001 to December 2012. INCLUSION CRITERIA: (1) receiving radical surgery (R0 resection); (2) AEG or AGA confirmed by pathological examination of postoperative tissue specimens; (3) without preoperative neoadjuvant radiotherapy or chemotherapy; (4) complete clinicopathological and follow-up data; (5) patients who died of non-tumor-related causes were excluded. Chi-square test and independent samples t-test were used to determine differences in clinicopathological factors between two groups. The overall survival (OS) of patients was compared by Kaplan-Meier method and Log-rank test. Multivariate prognosis analysis was performed using Cox proportional hazards regression model. RESULTS: As compared to AGA group, AEG group had higher proportion of male [82.0%(196/239) vs. 65.2%(204/313),χ²=19.243,P<0.001], older age [(60±10) years vs. (55±12) years, t=4.895, P<0.001], larger tumor diameter [(5.6±2.4) cm vs. (5.0±3.3) cm, t=2.480,P=0.013], more T4 stage[64.8%(155/239) vs. 55.6%(174/313),Z=-3.998, P<0.001], and more advanced tumor stage [stage III:60.7%(145/239) vs. 55.6%(174/313),Z=-2.564,P=0.010]. There were no statistically significant differences in serum albumin or hemoglobin between two groups (all P>0.05). The 5-year OS rate was 33.5% and 56.9% in AEG group and AGA group respectively and the median OS was 60.0(3.0-60.0) months and 33.6(3.0-60.0) months respectively; the difference was statistically significant (P<0.001). In AEG group, univariate analysis showed that differences of hemoglobin level (5-year OS rate: 24.0% for <130 g/L, 39.9% for ≥130 g/L, P=0.006), tumor diameter (5-year OS rate: 41.9% for <5 cm,28.8% for ≥5 cm, P=0.014), N stage (5-year OS rate: 42.2% for N0, 40.9% for N1, 31.7% for N2, 15.8% for N3a, 9.0% for N3b, P<0.001) and TNM stage (5-year OS rate: 56.2% for stage I, 38.5% for stage II, 28.3% for stage III,P=0.017) were statistically significant (all P<0.05); multivariate analysis revealed that the worse N stage was an independent risk factor of prognosis survival for AEG patients(HR=1.404,95%CI:1.164-1.693, P<0.001), and serum hemoglobin level ≥130 g/L was an independent protective factor of prognosis survival for AEG patients (HR=0.689,95%CI:0.501-0.946,P=0.021). In AGA group, univariate analysis showed that differences of serum albumin (5-year OS rate: 49.1% for <40 g/L, 61.1% for ≥ 40 g/L, P=0.021), tumor diameter (5-year OS rate: 74.2% for <5 cm, 39.9% for ≥ 5 cm, P<0.001), T stage (5-year OS rate: 98.3% for T1,83.3% for T2,50.0% for T3,36.8% for T4, P<0.001), N stage (5-year OS rate: 89.0% for N0, 62.3% for N1, 50.0% for N2, 33.9% for N3a, 10.3% for N3b, P<0.001) and TNM stage (5-year OS rate: 97.3% for stage I, 75.8% for stage II, 32.8% for stage III, P<0.001) were statistically significant (all P<0.05); multivariate analysis revealed that the worse T stage (HR=1.516,95%CI:1.060-2.167,P=0.023) and the worse N stage (HR=1.453,95%CI:1.209-1.747,P<0.001) were independent risk factors for prognosis of AGA patients. CONCLUSIONS As compared to AGA, AEG presents have poorer prognosis,and is easier to present with later pathological stage and larger tumor diameter. N stage and hemoglobin level are independent factors associated with the OS of AEG patients. T stage and N stage are independent factors associated with the OS of AGA patients.
Adenocarcinoma ; mortality ; pathology ; surgery ; Adult ; Aged ; Esophagogastric Junction ; pathology ; surgery ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Pyloric Antrum ; pathology ; surgery ; Retrospective Studies ; Stomach Neoplasms ; mortality ; pathology ; surgery

OBJECTIVE: The aim of this study was to estimate the survival impact of lymphadenectomy in patients diagnosed with uterine clear cell cancer (UCCC). METHODS: Patients with a diagnosis of UCCC were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t-test, Kaplan-Meier survival methods, and Cox proportional hazard regression were performed. RESULTS: One thousand three hundred eighty-five patients met the inclusion criteria; 955 patients (68.9%) underwent lymphadenectomy. Older patients (> or =65) were less likely to undergo lymphadenectomy compared with their younger cohorts (64.3% vs. 75.9%, p<0.001). The prevalence of nodal metastasis was 24.8%. Out of 724 women who had disease clinically confined to the uterus and underwent lymphadenectomy, 123 (17%) were found to have nodal metastasis. Lymphadenectomy was associated with improved survival. Patients who underwent lymphadenectomy were 39% (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.52 to 0.72; p<0.001) less likely to die than patient who did not have the procedure. Moreover, more extensive lymphadenectomy correlated positively with survival. Compared to patients with 0 nodes removed, patients with more extensive lymphadenectomy (1 to 10 and >10 nodes removed) were 32% (HR, 0.68; 95% CI, 0.56 to 0.83; p<0.001) and 47% (HR, 0.53; 95% CI, 0.43 to 0.65; p<0.001) less likely to die, respectively. CONCLUSION: The extent of lymphadenectomy is associated with an improved survival of patients diagnosed with UCCC.
Adenocarcinoma, Clear Cell/*diagnosis/mortality/pathology/*surgery ; Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/*diagnosis/mortality/pathology/*surgery ; Female ; Humans ; *Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Pelvis ; Prognosis ; Retrospective Studies ; Survival Rate ; Uterine Neoplasms/diagnosis/mortality/pathology/surgery

OBJECTIVETo investigate the factors that influence survival of the patients with differentiated thyroid carcinoma in young people and evaluate the efficiency of unilateral lobectomy plus isthmectomy with therapeutic cervical lymph node dissection and postoperative TSH (thyroid stimulating hormone) suppressive therapy.

METHODSOne hundred and thirty-one patients under 30 years old with differentiated thyroid carcinoma treated in this hospital (14 cases no more than and 117 cases more than 16 years) from Jan. 1st, 1985 to Dec. 31st, 1997 were retrospectively reviewed. One hundred and twenty-eight patients were received only surgery and TSH suppressive therapy, and 3 patients received chemotherapy or radiotherapy because of the progressive metastasis in necks or mediastina. A multivariate analysis was performed in these patients by the Cox proportional hazard model.

RESULTSThe mean follow-time (x +/- s) of all patients were (140.86 +/- 43.76) months, with range from 20 to 229 months; Ninety-eight patients followed more than 10 years. Ten patients died of thyroid cancer. The overall 10-year survival rate was 97.18%. The 10-year survival rate for patients < or = 16 years of age and > 16 years were 75.97% and 96.57% respectively (P = 0. 0006). The 10-year survival rate for women and men were 94.91% and 93.69% respectively (P = 0.5261). The 10-year survival rates of patients with papillary thyroid carcinoma and follicular thyroid carcinoma were 93.77% and 96. 55% respectively (P = 0.8137). For patients with tumor size of < or = 1 cm, 1-4 cm and >4 cm the survival rate was 100.0%, 96.40%, and 80.67% respectively (P = 0. 0589). The 10-year survival rates of patients with or without lymph node metastasis were 88.37% and 100. 0% respectively (P = 0.0313). For patients of with or without distant metastasis, The survival rate was 96.64% or 60.00% (P = 0.0000). The 10-year survival rates with or without recurrence were 86. 67% and 95.48% respectively (P = 0. 5681). Using multivariate analysis, risk factors that independently influence survival were distant metastasis, tumor size and age.

CONCLUSIONSThe distant metastasis, tumor size and age at diagnosis were the independent factors influencing survival significantly. The status of lymph node metastasis may have certain effect on the prognosis. Unilateral lobectomy plus isthmectomy with a therapeutic cervical lymph node dissection followed by postoperative TSH suppressive therapy is a favourable model to children and young adults with DTC without distant metastasis, but to the patients with distant metastasis, their prognosis of this therapy model is disappointing.

Adenocarcinoma, Follicular ; mortality ; pathology ; surgery ; Adolescent ; Adult ; Child ; Female ; Humans ; Lymphatic Metastasis ; Male ; Papilloma ; mortality ; pathology ; surgery ; Prognosis ; Retrospective Studies ; Survival Rate ; Thyroid Neoplasms ; mortality ; pathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVE: A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. METHODS: From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. RESULTS: There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. CONCLUSION: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.
Adenocarcinoma/mortality/pathology/surgery ; Adult ; Carcinoma, Adenosquamous/mortality/pathology/surgery ; Carcinoma, Squamous Cell/mortality/pathology/surgery ; Female ; Humans ; Hysterectomy/adverse effects/*methods ; Middle Aged ; *Organ Sparing Treatments/adverse effects/methods ; Pelvis/*innervation/surgery ; Recovery of Function ; Survival Analysis ; Treatment Outcome ; Urinary Bladder/*innervation/physiology/surgery ; Uterine Cervical Neoplasms/mortality/pathology/*surgery ; Uterus/*innervation/surgery

The most appropriate time to introduce androgen deprivation therapy for prostate cancer remains controversial. Our aim was to evaluate the effects of early versus delayed surgical castration on prostate cancer progression and survival in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. TRAMP mice were randomly divided into three groups: the early castration group (on which castration was performed at the age of 4 weeks), the delayed castration group (on which castration was performed when abdominal tumours could be palpated), and the sham-castrated group. Mice were monitored daily throughout their lives until cancer-related death or the development of an obviously moribund appearance, at which time the individual mouse was killed. Androgen receptor expression in prostate tumours was also evaluated. The results shows that the average lifespan in early castration, delayed castration and sham-castrated groups were 54.1 weeks, 59.9 weeks and 39.1 weeks, respectively. Both early castration and delayed castration conferred a statistically significant survival advantage when compared with the sham-castrated group (P<0.001). However, the difference in lifespan between the early castration group and the delayed castration group was not statistically significant (P=0.85). The increase in lifespan in the TRAMP mice that received either early or delayed castration correlated with lower G/B value (genitourinary tract weight/body weight) at death than the sham-castrated mice. In conclusion, early and delayed castrations in TRAMP mice prolonged survival to a similar extent. This finding may provide a guide for clinical practice in prostate cancer therapy.
Adenocarcinoma ; mortality ; pathology ; surgery ; Animals ; Body Weight ; Disease Models, Animal ; Kaplan-Meier Estimate ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Transgenic ; Orchiectomy ; Organ Size ; Prostate ; metabolism ; pathology ; surgery ; Prostatic Neoplasms ; mortality ; pathology ; surgery ; Receptors, Androgen ; metabolism ; Time Factors ; Transgenes ; genetics

BACKGROUND/AIMS: The aim of this study was to evaluate clinicopathologic differences between Type II and Type III groups that were classified by Siewert in cardia cancer. METHODS: A hundred forty-one patients who were diagnosed as gastric cardia cancer and underwent surgery between January 1990 and December 2006 by single surgeon at Department of Surgery, Yonsei University College of Medicine were included in this study. The Kaplan-Meier method and log rank test were used for survival analysis. RESULTS: Barrett's adenocarcinoma was recognized in two patients so called type I. There were significant differences between type II and III in aspect of depth of invasion, Lauren's classification, and the number of retrieved lymph nodes in which cancer infiltrated. In type III, prognostic factors affecting survival were depth of invasion and nodal status in contrast to the no demonstrable prognostic factors existing in type II. However, there were no differences in recurrence and survival between two groups. CONCULSIONS: Several clinicopathologic differences exist between type II and III cardia cancer. In the future, further evaluation is needed regarding the classification and entities of the cardia cancer.
Adenocarcinoma/classification/mortality/*pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Barrett Esophagus/pathology/surgery ; *Cardia ; Esophageal Neoplasms/classification/mortality/pathology ; Female ; Humans ; Kaplan-Meiers Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms/classification/mortality/*pathology ; Survival Analysis

We present a recurrence prediction model using multiple clinical parameters in patients surgically treated for non-small cell lung cancer. Among 1,578 lung cancer patients who underwent complete resection, we compared the early-recurrence group with the 3-yr non-recurrence group for evaluating those factors that influence early recurrence within one year after surgery. Adenocarcinoma and squamous cell carcinoma were analyzed independently. We used multiple logistic regression analysis to identify the independent clinical predictors of recurrence and Cox's proportional hazard regression method to develop a clinical prediction model. We randomly divided our patients into the training and test subsets. The pathologic stages, tumor cell type, differentiation of tumor, neoadjuvant therapy and age were significant factors on the multivariable analysis. We constructed the model for the training set with adenocarcinoma (n=236) and squamous cell carcinoma (n=305), and we applied it to the test set with adenocarcinoma (n=110) and squamous cell carcinoma (n=154). It was predictive for the in adenocarcinoma (P<0.001) and the squamous cell carcinoma (P=0.037), respectively. Our results showed that our recurrence prediction model based on the clinical parameters could significantly predict the individual patients who were at high risk or low risk for recurrence.
Adenocarcinoma/mortality/pathology/surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/mortality/pathology/*surgery ; Carcinoma, Squamous Cell/mortality/pathology/surgery ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms/mortality/pathology/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; Regression Analysis ; Risk Factors ; Survival Rate