1.Effect of gastric signet ring cell cancer on T,N,M stages
Junxiu YU ; Facai WEI ; Yongling SUI ; Daogui YANG ; Feng SHAO
International Journal of Surgery 2009;36(3):160-163
Objective To evaluate the effect of the gastric signet ring cell cancer(SIG)on the T,N,M stages. Methods Three hundred and fifty-one patients undergoing D2 or greater gastrectomy for gastric cancer were ana lyzed retrospectively.The T,N,M stages of 59 patients with SIG and 161 patients with tubular adenocarcmonla (TUB)were compared using univariate and multivariate analysis.Results The chi-square test showed that there were not significant differences in T,N,M stages between TUB and SIG.Multivariate Logistic regression analysis indicated that SIG Was not a independent factor influencing the T,N.M stage.Conclusion Gastric cancer with SIG has not higher T,N,M stages than that with TUB.
2.Effects of the extent of regional lymph node dissection on the prognosis of patients with T4 gallbladder carcinoma: a multi-center retrospective analysis
Anqi DUAN ; Facai YANG ; Zhiyuan BO ; Ningjia SHEN ; Yuanjin LIU ; Zhimin GENG ; Zhaohui TANG ; Jingdong LI ; Yongjie ZHANG ; Yinghe QIU
Chinese Journal of Digestive Surgery 2019;18(2):135-139
Objective To investigate the effects of the extent of regional lymph node dissection on the prognosis of patients with T4 gallbladder carcinoma.Methods The retrospective cohort study was conducted.The clinicopathological data of 64 patients with T4 gallbladder carcinoma who underwent radical cholecystectomy in the 4 medical centers between January 2013 and December 2016 were collected,including 31 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,16 in the First Affiliated Hospital of Xi'an Jiaotong University,11 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 6 in the Affiliated Hospital of North Sichuan Medical College.There were 27 males and 37 females,aged from 35 to 77 years,with a median age of 59 years.Sixty-four patients underwent radical cholecystectomy and regional lymph node dissection.According to the extent of intraoperative lymph node dissection,25 patients (13 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,6 in the First Affiliated Hospital of Xi'an Jiaotong University,4 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 2 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct,hepatoduodenal ligament,back of head of pancreas,next to common hepatic artery and celiac trunk were allocated into the extended dissection group,39 patients (18 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,10 in the First Affiliated Hospital of Xi'an Jiaotong University,7 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 4 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct and hepatoduodenal ligament were allocated into the control group.Observation indicators:(1) postoperative complications;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival up to January 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was evaluated with the independentsample t test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test and Fisher exact probability.The survival curve was drawn using the KaplanMeier method,and the comparison of survival rates was done by the Log-rank test.Results (1) Postoperative complications:64 patients with T4 gallbladder carcinoma underwent successful radical cholecystectomy and regional lymph node dissection,without intraoperative death.Twelve patients had different degrees of postoperative complications.Four of 7 patients undergoing extended radical cholecystectomy had postoperative complications.Twenty-five patients in the extended dissection group were cured by conservative treatment,including 4 with intraperitoneal infection and 2 with pancreatic leakage,with a complication incidence of 24.0% (6/25).Thirtynine patients in the control group were cured by conservative treatment,including 5 with intraperitoneal infection and 1 with gastric retention,with a complication incidence of 15.4% (6/39).There was no statistically significant difference in the complication incidence between the two groups (x2=0.284,P>0.05).(2) Follow-up and survival situations:64 patients were followed up for 1-60 months.The postoperative overall median survival time was l l months.The postoperative median survival time,1-,3-and 5-year cumulative survival rates were respectively 18 months,80%,16%,9% in the extended dissection group and 8 months,21%,4%,0 in the control group,with a statistically significant difference in the prognosis between the two groups (x2=14.744,P< 0.05).Conclusions On the premise of practiced surgical skill,extended regional lymph node dissection cannot increase incidence of surgical complication in patients with T4 gallbladder carcinoma after radical resection.Actively extending lymph node dissection up to near common hepatic artery,peri-celiac trunk and back of head of pancreas can improve long-term survival and prognosis.
3.Safety and efficacy of laparoscopic hepatectomy for intrahepatic cholangiocarcinoma
Taian CHEN ; Facai YANG ; Meng LI ; Yi HE ; Li HE ; Jingdong LI
Chinese Journal of Hepatobiliary Surgery 2021;27(7):485-488
Objective:To study the safety and efficacy of laparoscopic liver resection in treatment of intrahepatic cholangiocarcinoma (ICC).Methods:A retrospective study was conducted on the clinicopathological data of 65 patients with ICC who underwent hepatectomy from January 2014 to May 2020 in the Affiliated Hospital of North Sichuan Medical College. There were 37 males and 28 female with an average age of 52 years old. There were 23 patients in the laparoscopy group and 42 patients in the open liver resection (laparotomy) group. The surgical data, complications, long-term recurrence and survival rates were compared between groups.Results:The blood transfusion rate in the laparoscopy group was 8.7% (2/23), which was significantly lower than that in the laparotomy group (16.7% or 7/42) ( P=0.028). The recovery time of gastrointestinal function in the laparoscopy group was (2.8±1.6) days, which was significantly shorter than that in the laparotomy group (4.3±1.1 days, P=0.006). The incidence of complications in the laparotomy group was 31.0% (13/42), which was significantly higher than that in the laparoscopy group (17.4% or 4/23) ( P=0.033). There were 11 patients (47.8%) in the laparoscopy group and 22 patients (52.4%) in the laparotomy group who developed tumor recurrence, with no significant difference in the recurrence rates between the two groups ( P=0.788). The 1, 3, and 5-year cumulative survival rates in the laparoscopy group were 82.6%, 47.8%, and 34.8%, and 83.3%, 42.9%, and 28.6% respectively in the laparotomy group. There were no significant differences in the cumulative survival rates between the two groups ( P=0.494). Conclusions:Laparoscopic radical resection of ICC was technically feasible, safe, and efficacious. Laparoscopic liver resection achieved better results in blood transfusion, gastrointestinal function recovery, and perioperative complications rates than laparotomy.
4.Hotspots and disputes concerning surgical management of gallbladder cancer
Facai YANG ; Zhimin GENG ; Jingdong LI ; Yinghe QIU
Journal of Xi'an Jiaotong University(Medical Sciences) 2021;42(1):30-35
Gallbladder cancer (GBC) is the most common malignant tumor of the biliary tract, with a high degree of malignancy and poor prognosis. R0 resection is the basic principle of surgical treatment of GBC. However, disputes still exist over the extent of liver resection, extrahepatic bile duct resection, range of lymphadenectomy, surgical treatment of GBC diagnosed during or after surgery, and the application of laparoscopy in GBC. This paper reviews the progress in surgical treatment of GBC and discusses the disputes over surgical treatment in order to provide reference for clinical research and treatment of GBC in clinical work.
5. Applicational value of modified pancreaticojejunostomy and risk factors of pancreatic fistula following pancreaticoduodenectomy
Zhiyuan BO ; Yinghe QIU ; Ningjia SHEN ; Facai YANG ; Anqi DUAN ; Bin ZHU ; Lianghe YU ; Yuanjin LIU ; Yongjie ZHANG
Chinese Journal of Surgery 2019;57(6):434-439
Objective:
To compare the efficacy of modified pancreaticojejunostomy with traditional pancreaticojejunostomy following pancreaticoduodenectomy, and to investigate the risk factors of postoperative pancreatic fistula.
Methods:
Clinical data of 68 patients who underwent pancreaticoduodenectomy between October 2017 and October 2018 at the Second Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital was retrospectively collected and analyzed.According to the method of pancreaticojejunostomy, the patients were divided into two groups: modified pancreaticojejunostomy group (34 patients) and traditional pancreaticojejunostomy group (34 patients). There were 18 males and 16 females, aged (60.4±9.6) years of modified pancreaticojejunostomy groups; there were 17 males and 18 females, aged (58.9±10.9) years of traditional pancreaticojejunostomy group. The major postoperative complications such as pancreatic fistula were compared between the two groups, and the risk factors of postoperative pancreatic fistula were analyzed by univariate and multivariate analyses.
Results:
All of the 68 operations were successfully completed. The overall incidence of postoperative complications was 51.5% (35/68). The incidence of postoperative pancreatic fistula was 13.2% (9/68), of which all were cases of grade B.There were 16 patients (23.5%) occurred with abdominal infection, and 11 patients (16.2%) occurred with delayed gastric emptying, including 1 case of grade A, 1 case of grade B and 9 cases of grade C.And 9 patients (13.2%) occurred with postoperative bleeding was, including 2 cases of mild bleeding, 5 cases of moderate bleeding, and 2 cases of severe bleeding.Biliary leakage occurred in one patient (1.5%) and chylous leakage occurred in two patients (2.9%). The modified pancreaticojejunostomy could significantly reduce the incidence of postoperative bleeding compared with control group (χ2=4.610,
6. Discussion on pT3 staging in TNM staging of AJCC 8th edition gallbladder carcinoma
Facai YANG ; Jingdong LI ; Anqi DUAN ; Zhiyuan BO ; Ningjia SHEN ; Bin ZHU ; Wenlong YU ; Longjiu CUI ; Xiang WANG ; Lianghe YU ; Lei YIN ; Xiaohui FU ; Yongjie ZHANG ; Yinghe QIU
Chinese Journal of Surgery 2019;57(11):834-839
Objective:
To discuss the rationality of stage pT3 in the AJCC 8th TNM criteria of gallbladder carcinoma.
Methods:
A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage: tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure; (2) pT3b stage: tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females, aged 36 to 80 years, with a median age of 59 years; 43 patients with pT3b, including 24 males and 19 females, aged 41 to 78 years old, median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample