OBJECTIVETo summarize the surgical treatment and clinical bio-characteristics of primary esophageal adenocarcinoma (PEAC).

METHODSClinical data of 43 cases with PEAC who had undergone operation from February 1980 to December 2000 in Linzhou City Esophageal Tumor Hospital were retrospectively analyzed.

RESULTSForty-three cases PEAC were reported in this study, which were 0.8% out of 5638 cases pathologically confirmed esophageal carcinoma treated during this period. Twelve cases (27.9%) were in the middle 1/3 of esophagus, thirty-one cases (72.1%) in the lower 1/3, which were significantly different from esophageal squamous cell carcinoma (ESCC). Fourteen cases were pure esophageal adenocarcinoma (32.6%), twenty-nine cases were adenosquamous cell carcinoma and adenoacanthoma cell carcinoma (67.4%). The ratio of lymph node metastasis of PEAC was higher than that of ESCC (65.1% vs. 31.6%, P < 0.001). The overall survival rates of 1, 3 and 5-year of PEAC were 81.4%, 46.5% and 28.2%, respectively, which were lower than those of ESCC (89.7%, 68.2% and 39.4%, respectively; chi 2 = 4.846, P = 0.028).

CONCLUSIONSCompared with ESCC, PEAC, mainly located in the inferior 1/3 of esophagus, is a malignant disease with higher frequency of lymph node metastasis and poor prognosis. Surgical resection should be the first choice of treatment. Early diagnosis and early treatment as well as curative operation could improve prognosis. The long-term survival may be increased by adjunct multi-modality treatment.

Adenocarcinoma ; pathology ; surgery ; Adult ; Aged ; Anastomosis, Surgical ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo review the experience of the surgical procedure in the treatment of postoperative severe cicatricial anastomotic stricture for esophageal cancer and cardiac cancer.

METHODSTwenty-four cases with severe anastomotic strictures and dysphagia after esophagectomy underwent second operation. The anastomosis was opened by two small transverse incisions about 1-2 mm above and below the anastomotic line. The esophageal and gastric walls were half opened. Then the circular cicatricial tissue was partially removed. The re-anastomosis was performed with a one layer, intermittent technique.

RESULTSThe second operations were successfully completed in 24 cases, cervical anastomotic leakage happened in 1 case and no operative mortality. All cases were followed up for 2-3 years. All patients can eat soft and common diet smoothly. No anastomotic strictures were found and the quality of life was significantly improved.

CONCLUSIONThe second surgery with partial removal of the narrow cicatricial ring and reanastomosis for postoperative severe anastomotic stricture after esophagectomy is feasible, and the result is satisfactory.

Adult ; Aged ; Anastomosis, Surgical ; Cardia ; surgery ; Esophageal Neoplasms ; surgery ; Esophageal Stenosis ; etiology ; surgery ; Esophagectomy ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; surgery ; Reoperation ; Retrospective Studies ; Stomach Neoplasms ; surgery

OBJECTIVETo elucidate the necessity of No.14v lymph node dissection in D2 lymphadenectomy for advanced gastric cancer.

METHODSClinicopathological data of 131 cases of advanced gastric cancer receiving D2 or D2+ plus No.14v lymph node dissection were reviewed retrospectively. Clinicopathological factors associated with No.14v lymph node metastasis were analyzed and prognostic value of No.14v lymph node metastasis was evaluated.

RESULTSOf the 131 patients, 24 (18.3%) had positive No.14v lymph node. The incidence of 14v metastasis was associated with tumor location, tumor size, depth of invasion, N staging, TNM staging, No.1, No.6, and No.8a lymph nodes metastasis. Tumor location and N staging were independent risk factors for No.14v metastasis (all P<0.05). The 5-year survival rate was 8.3% and 37.8% in patients with and without No.14v metastasis respectively. The difference was statistically significant (P<0.01). Multivariate analysis revealed that metastasis of No.14v was an independent prognostic factor for advanced gastric cancer after D2 lymphadenectomy (P=0.029, RR=1.807, 95%CI:1.064-3.070).

CONCLUSIONSFor advanced middle and lower gastric cancers, especially those with larger size, serosa invasion and possibility of No.6 lymph node metastasis, it is necessary and feasible to remove the No.14v lymph node.

Adult ; Aged ; Female ; Humans ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; surgery

OBJECTIVETo evaluate the clinicopathologic characteristics and prognosis of mixed histological type (MHT) gastric cancer.

METHODSClinical and follow-up data of 1108 gastric cancer patients undergoing radical operation in Tianjin Cancer Hospital between 2003 and 2006 were analyzed retrospectively. Clinicopathologic characteristics of MHT gastric cancer were summarized and the prognosis was analyzed by Kaplan-Meier analysis and COX regression.

RESULTSAmong the 1108 patients, 144 (13.0%) had mixed histology type of gastric cancer. Compared to the unitary histological type (UHT), MHT gastric cancer had bigger tumor size, higher proportion of T4 tumor, and was easier for lymph node and distant metastasis (all P<0.05). The 3- and 5-year survival rates of patients with MHT were 26.5% and 10.8% respectively, which were lower than those with UHT (58.8% and 35.0%, P<0.01). Univariate and multivariate analyses showed TNM classification was an independent prognostic factor (P<0.01).

CONCLUSIONSMHT gastric cancer shows worse prognosis than UHT gastric cancer. There is no difference in prognosis among various combination of MHT gastric cancer. TNM classification is an independent prognostic factor of MHT gastric cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms, Complex and Mixed ; diagnosis ; pathology ; surgery ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; surgery ; Young Adult

OBJECTIVETo evaluate the prognostic value of metastatic lymph node ratio (MLR) for gastric cancer patients with less than 15 lymph nodes dissected.

METHODSClinical data of 610 gastric cancer patients undergoing operation in Tianjin Cancer Hospictal from January 2003 to July 2007 were analyzed retrospectively. Patients were divided into two groups: <15 lymph nodes dissected group (n=320) and ≥ 15 lymph nodes dissected group (n=290). MLR was classified based on the following intervals: rN1 ≤ 10%, rN2 10%-30%, rN3 30%-60% and rN4 >60%. Survival was determined by Kaplan-Meier method and difference was assessed by Log-rank test. Multivariate analysis was performed using Cox proportional hazard regression model. Survival rates were compared between two groups in pN and rN stages respectively.

RESULTSIn <15 nodes group, all the survival differences among various rN stages were not significant (all P>0.05), while in same rN stage, all the survival differences among various pN stages were not significant (all P>0.05). Significant differences of 5-year cumulative survival rates were found between the two groups in pN2 and pN3a stage patients (both P<0.05) while no significant differences were found among different rN stages (all P>0.05). Multivariate analysis demonstrated rN stage was an independent prognostic factor for gastric cancer patients with <15 lymph nodes dissected (P=0.012, RR=1.617, 95%CI:1.111-2.354).

CONCLUSIONThe rN staging system based on MLR can predict the prognosis of gastric cancer patients with less than 15 lymph nodes dissected.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Young Adult

OBJECTIVETo evaluate the feasibility and necessity of No.13 lymph node dissection in D2 radical gastrectomy for lower-third advanced gastric cancer (AGC).

METHODSData of 379 cases who were diagnosed as TNM II-III stage AGC were collected from January 2001 to June 2007. One hundred cases who undergone No.13 lymph node dissection during D2 gastrectomy for lower-third AGC were selected as study group. Other 279 cases (control group) received only D2 gastrectomy. The differences in clinicopathologic and intraoperative and postoperative parameters and 5-years survival rate were compared using the SPSS 17.0 software.

RESULTSThere were no significant differences between the two groups in patients' gender, age, tumor size, histologic type, Borrmann type, duodenum invasion, tumor depth, lymph node metastasis, TNM classification, operative time, blood loss and the incidence of postoperative complications (P > 0.05). In the study group, there were 9 patients with positive No. 13 lymph node, and its 5-year survival rate (46.0%) was higher than the control group (36.5%, χ² = 4.452, P < 0.05). The Univariate analysis showed that age (χ² = 7.539), No.13 lymph node dissection (χ² = 4.452), tumor size (χ² = 7.100), duodenum invasion (χ² = 9.106), tumor depth (χ² = 7.428), lymph node metastasis (χ² = 45.046), TNM classification (χ² = 57.008) are associated with prognosis of lower-third AGC (P < 0.05). Multivariate analysis identified age (HR = 0.500, 95% CI: 0.343 - 0.730), tumor size (HR = 0.545, 95%CI: 0.339 - 0.876), duodenum invasion (HR = 5.821, 95%CI: 2.326 - 14.572), and tumor depth (T4: HR = 2.087, 95% CI: 1.283 - 3.394) as independent prognostic factors (P < 0.05).

CONCLUSIONNo. 13 lymph node dissection for TNM II-III stage lower-third advanced gastric cancer is feasible and necessary.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate ; Young Adult

OBJECTIVETo investigate the impact of tumor size in the prognosis of T4a stage gastric cancer.

METHODSThe best cut-off point depending on tumor size was selected by Kaplan-Meier. Compare cliniclópathological characteristics between small size gastric cancer (SSG) and large size gastric cancer (LSG). Univariate analysis was done by Log-rank test and multivariate analysis was performed using the Cox proportional hazard regression model. The independent prognostic factors of patients were performed subgroup analysis.

RESULTSEight centimetre was the optimal cut-off of tumor size for T4a stage gastric cancer. There were significantly differences between SSG and LSG in tumor location (χ² = 15.695), histological grade (χ² = 4.393), macroscopic type (χ² = 5.629) and early recurrence (χ² = 4.292). Univariate analysis showed age (χ² = 4.463), tumor size (χ² = 9.057), macroscopic type (χ² = 6.679), histological grade (χ² = 5.122), location of tumor (χ² = 8.707) and N stage (χ² = 132.954) are related to survival (P < 0.05). Among them, tumor size (HR = 1.339), histological grade (HR = 1.169) and N stage (HR = 1.876) were independent risk factor for survival (P = 0.05). For SSG, N stage (HR = 2.014) and histological grade (HR = 1.192) were independent risk factor for survival (P = 0.05), and for LSG, N stage (HR = 1.876) was independent risk factor for survival (P = 0.000). Further stratified analysis indicated that the 5-year survival rate of LSG is significantly lower than that of SSG in T4a stage patients of gastric cancer without lymph nodes metastasis or poorly differentiated (HR = 0.182 and 0.653, P < 0.01).

CONCLUSIONSTumor size is an independent prognostic factor in patients of T4a stage gastric cancer. Tumor size cut-off point of 8 cm can exert significant impact on the prognosis of T4a stage gastric cancer without lymph nodes metastasis or poorly differentiated.

Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Stomach ; pathology ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate

OBJECTIVETo evaluate the value of negative lymph node count (NLNC) in prediction of prognosis of advanced gastric cancer after radical resection.

METHODSThe 544 cases of radical gastrectomy patients with complete clinical and follow-up data between January 2011 and July 2007 were collected. Survival was determined by the Kaplan-Merier method and univariate analysis was done by Log-rank test, Multivariate analysis was performed using the Cox proportional hazard regression model.

RESULTSUnivariate analysis showed age (χ(2) = 4.449), T stage (χ(2) = 30.482), N stage (χ(2) = 205.452), location of tumor (χ(2) = 16.649), tumor size (χ(2) = 35.117), macroscopic type (χ(2) = 4.750), histological grade (χ(2) = 6.130), NLNC stage (χ(2) = 150.369) and type of gastrectomy (χ(2) = 25.605) were related to survival. Among them, T stage, N stage, tumor size and NLNC stage were independent risk factors for survival (P < 0.05). The prognostic factors of patients were performed subgroup analysis, NLNC > 15 group can prolong the survival than NLNC ≤ 15 group in the T2 stage (HR = 0.315), T4 stage (HR = 0.401), the same classification of location of tumor (HR = 0.286-0.493), tumor size (HR = 0.336, 0.465), macroscopic type (HR = 0.306, 0.418), histological grade (HR = 0.411, 0.365) and type of gastrectomy (HR = 0.444, 0.358 and 0.356, all P < 0.05). More NLNC can prolong Disease-Free Survival for patient of early recurrence (χ(2) = 8.648, P = 0.003).

CONCLUSIONSSufficient negative lymph node count can prolong the survival and decrease the risk of early recurrence.

Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; prevention & control ; Prognosis ; Proportional Hazards Models ; Stomach Neoplasms ; mortality ; pathology ; surgery

Animals ; Calcium ; metabolism ; Diaphragm ; physiology ; ultrastructure ; Male ; Muscle Contraction ; Rats ; Rats, Sprague-Dawley ; Respiration, Artificial ; Sarcoplasmic Reticulum ; metabolism

OBJECTIVETo summarize therapeutic experience and the long-term results of early cardiac adenocarcinoma with surgical resection.

METHODSNinety cases were diagnosed with early cardiac adenocarcinoma during endoscopic screening in high incidence rate area of esophageal cancer from 1972 to 1997. All of the patients accepted surgical treatment. Cardiectomy included partial stomach and esophagus was performed through left thoracotomy in all patients. Esophagogastrostomy was carried out in the infra-aortic region and thoracoabdominal lymphatic dissection was performed in all cases.

RESULTSThe resection rate was 100%. One patient died in one month after the operation. Postoperative complications occurred in 4 cases (4.4%). Pathological examination of cancer specimens showed that 46 cases (51.1%) were intramucosal carcinoma without lymphatic metastasis and 44 cases (48.9%) were submucous infiltrating carcinoma with lymphatic metastasis in 5 (11.4%). The patients were followed-up to 2002, and the overall 5, 10, 15, 20 and 25 year survival rates were 91.9%, 83.6%, 69.6%, 49.8% and 16.6%, respectively.

CONCLUSIONSEarly diagnosis and early treatment may be the best approach for promoting the survival of the cardiac cancer. Surgical resection of early cardiac carcinoma provides excellent long-term survival.

Adenocarcinoma ; diagnosis ; surgery ; Adult ; Aged ; Cardia ; Early Detection of Cancer ; Esophagectomy ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Mass Screening ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; surgery ; Survival Analysis ; Treatment Outcome