With the increasing number of complex and difficult thyroid cancer patients, the traditional medical model is difficult to solve the problem of diagnosis and treatment of patients optimally. In recent years, multidisciplinary team (MDT) model is applied clinically. For complex and difficult thyroid cancer diseases, the model can play a multidisciplinary advantage and provide more personalized and accurate diagnosis and treatment scheme for patients. The diagnosis and treatment of complex and difficult thyroid cancer involve thyroid surgery, otolaryngology, thoracic surgery, anesthesiology, endocrinology, nuclear medicine, radiotherapy, oncology, ultrasound, imaging, pathology and other disciplines. Based on the important role of MDT in diagnosis, treatment, nursing, postoperative management and clinical research of thyroid cancer, as well as the challenges and difficulties faced in implementation of MDT, the status and progress of multi-disciplinary comprehensive diagnosis and treatment of thyroid cancer will be systematically elaborated in the paper.

Objective:To investigate the prognostic factors and pathological characteristics of mixed subtype thyroid cancer (MSTC) .Methods:Data of 41 cases of MSTC, which were confirmed by postoperative pathology, among from 24, 912 cases of thyroid cancer admitted in Mar. 2005 to Aug. 2020 in the First Medical Center of Chinese People’s Liberation Army General Hospital, were retrospectively analyzed. 37 cases underwent surgical treatment, while 4 cases only underwent puncture to confirm the pathology due to physical conditions, and no surgical treatment was performed. The tumor size, number of lesions, capsule invasion, AJCC 8th TNM staging, surgical methods, radiotherapy and chemotherapy were collected. The MSTC patients in the group were followed up to obtain the postoperative situation. SPSS 25.0 and R studio statistical software was used for data processing, and Cox single factor and multivariate regression were used to analyze independent risk factors.Results:In the 41 cases, there were 9 cases of papillary carcinoma (PTC) mixed with follicular carcinoma (FTC) , and 8 cases of mixed medullary and follicular carcinoma (MMFTC) . There were 15 cases of poorly differentiated thyroid cancer (PDTC) , 4 cases of squamous cell carcinoma of thyroid (SCCT) , and 5 cases of undifferentiated thyroid carcinoma (ATC) . The median follow-up time was 18 months, and 11 patients died during the follow-up, with a mortality rate of 26.8%. Average onset age was (51.41+15.69) years. 4 cases had postoperative recurrence during the follow-up, including 2 cases of local recurrence, and 2 cases of distant metastasis. Single factor results showed that age, degree of tumor differentiation, surgical method, radiotherapy and chemotherapy were the risk factors affecting the prognosis of patients with MSTC ( P<0.05) . Multivariate analysis showed that age at diagnosis ( P=0.007) and surgical procedure ( P=0.017) were independent risk factors for prognosis in patients with MSTC. Conclusion:Middle-aged and elderly women are at high risk for MSTC, and the degree of tumor differentiation is proportional to survival. Due to the multi-type and pleomorphic pathological findings, a reasonable treatment plan has good effects on prognosis of MSTC.

Objective To explore the application of team-based learning (TBL) and problem-based learning (PBL) method in clinical teaching of laparoscopic surgery in general surgery. Methods 48 students of surgery in our department were selected as the subjects to conduct the clinical teaching study. These students were divided randomly into two groups. The experimental group (24 students) adopted the method that combined TBL and PBL method, while the control group (24 students) adopted the traditional teaching method. We compared the efficacy of two groups in term of theoretical knowledge, surgical practice, com-prehensive surgical grade, and questionnaire survey. Results The score of theoretical knowledge and sur-gical practice on clipping soybean and making suturation and instrumental tie of two groups were obviously higher than that before teaching. After finishing teaching, the score of experimental group on theoretical knowledge, making suturation and instrumental tie and comprehensive surgical grade were higher than that of control group. The score of clipping soybean was similar between two groups. In addition, in term of questionnaire survey on the consciousness of independent study, the depth and width of study, and satisfac-tions to teaching, the TBL and PBL group had a better score than the control group. Conclusion The new teaching method which combines TBL with PBL enhances the teaching effect on theoretical knowledge and laparoscopic surgery practice. It is an effective method to train medical students.

The high postoperative recurrence rate of advanced-stage gastric cancer has been an unsolved problem for its treatment. Postoperative surveillance is an important step for the multiple disciplinary treatment. At present, most guidelines worldwide recommended standardization programs of follow-up after gastrectomy, based on different timing and items. Standard postoperative surveillance is critical for the building up of multiple disciplinary team. And to make sure the success of postoperative surveillance, we should specify the timing and items according to different recurrence risks by prediction model. In the end, improving the quality of postoperative surveillance is the key to benefit patients of gastric cancer.

The number of lymph node dissection and positive lymph nodes are the necessary guarantees for patients to achieve accurate staging after gastric cancer surgery. On the basis of the minimum number of lymph nodes dissection recommended by the NCCN guidelines, as many as possible lymph node yields will be most likely to benefit patients. Many factors can influence the number of lymph node yields including surgery, patient, tumor pathology and postoperative sorting factors. Compared with traditional manual nodal dissection method, fat-clearing technique and methylene blue staining method can improve the number of lymph nodes detection, while lymphatic tracers, such as carbon nanoparticles, are conducive to show lymphatic vessels, contributing to the dissection of small lymph nodes. The initial results from People′s Liberation Army General Hospital show that lymph node packet submission after isolation by surgeon yields more lymph nodes. For the establishment of standards, lymph node retrieval-related procedures need further in-depth exploration and investigation.

It has already been ten years since the concept of enhanced recovery after surgery (ERAS) was introduced in China. The ERAS protocol focuses on relieving surgical stress and accelerating physiological recovery. From our perspective, besides the post hospital stay, it would be better to evaluate patient′s recovery by different indicators. It is important to improve the compliance of ERAS protocol. The guideline-related factors, administration, medical staff and patients have impact on compliance. Integrating stakeholders, strengthening communication and cooperation among multidiscipline teams, combining theory with practice would facilitate use of ERAS protocol in clinical settings.

The continuous development and application of new technology in thyroid surgery has promoted the rapid improvement of thyroid surgery. New technology in the field of thyroid surgery has developed rapidly. The application of neural monitoring technology has enabled the thyroid surgery to enter an accurate era. Imtraoperative neuromonitoring and continuous intraoperative neuromonitoring have made the recurrent laryngeal nerve protection more secure. Nano-carbon parathyroid gland negative imaging technology could identify parathyroid gland more precise. However, when the nano-carbon was used, the injection time, position and dosage should be grasped so as to achieve the best effect of negative imaging. Endoscopic and robotic thyroid surgery could meet the demand of cosmetic. "Treatment first, beauty second" is still the principle to be strictly followed. Do not blindly expand indications and pursue endoscopic surgery. Energy surgical instruments′ update made the operation more efficient, while the instruments have some disadvantages. Thyroid surgeon must correctly understand the working principle of new energy devices and use them rationally. Through grasping the working principle and application skills of new technology in clinical work, definiting its advantages and disadvantages, adhereing to the "reasonable choice, standard application" principle, learning the pioneers′ experience, the application of new thyroid diagnosis and treatment technology could be more reasonable and safe.

Gastric cancer with liver metastasis (GCLM) is the leading cause of death in patients with advanced gastric cancer. Multiple metastasis was common in GCLM and usually complicated with lesions outside the liver, especially peritoneal metastasis. Most of liver metastasis lesions could not be resected radically. Currently, main treatments for GCLM included radical operation, palliative resection of gastric cancer, ablation of metastatic lesions, intervention and systemic chemotherapy. Based on the current progress in the treatment for GCLM and our clinical experience, the general status of patients, the type of gastric cancer and the degree of liver metastasis should be analyzed, and a cooperative multidisciplinary team (MDT) should be applied to conduct and to choose active and suitable comprehensive treatment for GCLM patients based on individualized therapy principle.
Humans ; Liver Neoplasms ; secondary ; therapy ; Stomach Neoplasms ; pathology ; therapy

Objective To explore the risk factors of complications after laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer (GC).Methods The retrospective case-control study was conducted.The clinicopathological data of 488 GC patients who underwent LADG in the General Hospital of the Chinese People's Liberation Army between January 2010 and May 2016 were collected.Observation indicators:(1)surgical and postoperative situations;(2) risk factors analysis of postoperative complications;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the post-operative survival of patients up to October,2017.Measurement data with normal distribution were represented as (x)±s,and measurement data with skewed distribution were described as M (interquartile range).The univariate analysis was done using the chi-square test (count data),t test (measurement data with normal distrubution and homogeneity of variance) or t'test (measurement data with normal distribution and heterogeneity of variance) and nonparametric test (measurement data with skewed distrubution).The multivariate analysis was done using the Logistic regression model.Results (1) Surgical and postoperative situations:all the 488 patients underwent successful surgery,including 7 with conversion to open surgery due to intraoperative bleeding and difficult surgery and 481 with LADG.The operation time and volume of intraoperative blood loss of 488 patients were (233±71)minutes and 100 mL (100 mL).The postoperative complications occurred in 99 of 488 patients,some patients merged simultaneously multiple complications.The Clavien-Dindo Ⅰ,Ⅱ,Ⅲa,Ⅲb,Ⅳa,Ⅳb and Ⅴ complications were detected in 39,26,26,6,0,0 and 2 patients,respectively.The top 3 postoperative complications were delayed gastric emptying (18 patients),intestinal obstruction (14 patients) and anastomotic fistula (14 patients).Cases with delayed gastric emptying,intestinal obstruction and anastomotic fistula were respectively 12,12,6 with the Clavien-Dindo classification ＜ Ⅲ a and 6,2,8 with the Clavien-Dindo classification ≥ Ⅲ a.Of 99 patients with postoperative complications,97 were improved by symptomatic treatment and 2 died.Duration of postoperative hospital stay was (13± 12)days.(2) Risk factors analysis of postoperative complications:the results of univariate analysis showed that preoperative concomitant diseases and digestive tract reconstruction were the related factors affecting postoperative complications of patients undergoing LADG;(x2 =11.225,6.581,P＜0.05).The results of multivariate analysis showed that preoperative concomitant diseases and Billroth Ⅱ anastomosis were the independent risk factors affecting postoperative complications of patients undergoing LADG (Odds ratio=2.336,2.630,95％ confidence interval:1.475-3.687,1.369-5.053,P＜0.05).(3) Follow-up and survival situations:of 486 discharged patients,380 were followed up for 2-89 months,with a median time of 42 months.During the follow-up,289,35,48 and 8 patients had respectively tumor-free survival,tumor recurrence and/or metastasis,tumor-related death and non-tumor-related death.Conclusion The anastomotic fistula is one of the common and severe complications after LADG,and preoperative concomitant diseases and Billroth Ⅱ anastomosis are the independent risk factors affecting postoperative complications of patients undergoing LADG.

OBJECTIVETo analyze relationships between the tumor deposits (TD) and clinicopathologic features of gastric cancer and investigate the value of TD in staging and prognosis in gastric cancer patients.

METHODSRetrospective cohort study was conducted to evaluate the clinicopathologic data of 388 gastric cancer patients who underwent surgical procedures in Chinese PLA General Hospital between November 2011 and December 2012. Relationships between TD and clinicopathologic features were analyzed by χor Fisher exact tests. Survival curves were also generated by Kaplan-Meier method. The univariate and multivariate analysis were performed with Log-rank and COX proportional hazard model to examine the association between prognosis and TD.

RESULTSTD were observed in 67 (17.3%) of 388 gastric cancer patients, including 48 male patients (48/289, 16.6%) and 19 female patients (19/99, 19.2%). There were 40 patients (40/198, 20.2%) whose age was above 64 years old. TNM staging of positive TD patients was as follows: for pathology, there were 5 patients (5/64, 7.8%) in stage II(b, 6 patients (6/58, 10.3%) in stage III(a, 14 patients (14/75, 18.7%) in stage III(b, 30 patients (30/135, 22.2%) in stage III(c, 12 patients (12/39, 30.8%) in stage IIII( and no one in stage I(b or II(a; for T-staging, there were 2 patients (2/18, 11.1%) in stage T2, 2 patients (2/27, 7.4%) in stage T3, 36 patients (36/259, 13.9%) in stage T4a and 27 patients (27/84, 32.1%) in stage T4b; for N-stage, there were 5 patients (5/72, 6.9%) in stage N0, 6 patients (6/72, 8.3%) in stage N1, 19 patients (19/82, 23.2%) in stage N2, 27 patients (27/100, 27.0%) in stage N3a and 10 patients(10/62, 16.1%) in stage N3b; for M-stage, there were 12 patients (12/40, 30.0%) in distal metastases; for vascular invasion, there were 29 patients (29/129, 22.5%). Among positive TD patients, the number of TD >3 was found in 38 of 67 cases(56.7%). TD was associated with pTNM-stage (χ=16.898, P=0.010), T-stage (χ=17.382, P=0.001), N-stage (χ=18.080, P=0.001), M-stage (χ=5.060, P=0.036) and vascular invasion(χ=3.675, P=0.039). The median survival time of positive TD patients was significantly shorter as compared to negative TD patients (22 months vs. 32 months, χ=23.391, P=0.012). Among positive TD patients, the median survival time of patients with TD number >3 was significantly shorter as compared to those with TD number <3 (17 months vs. 25 months, χ=5.157, P=0.023). Multivariate survival analysis showed that TD number >3 was the independent risk factor of prognosis (RR=2.350, 95%CI:1.345 to 4.106, P=0.003).

CONCLUSIONSTD state is closely associated with the staging of gastric cancer and TD number >3 indicates a poor prognosis.

Aged ; China ; Cohort Studies ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; pathology ; Neoplasm Metastasis ; Neoplasm Staging ; methods ; statistics & numerical data ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; classification ; diagnosis ; mortality ; pathology ; Survival Rate