Objective To investigate the clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer.Methods The retrospective cohort study was adopted.The clinical data of 210 patients with gastric cancer who underwent laparoscopy-assisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and December 2012 were collected.Fifty-two,43 and 115 patients were respectively detected in stage Ⅰ,Ⅱ and Ⅲ of postoperative pathological stage.Laparoscopy-assisted radical distal,proximal and total gastrectomies were selectively performed according to the location and extent of tumors.(1) Overall treatment indicators were observed,including surgical procedure,with or without conversion to open surgery,operation time,volumes of intraoperative blood loss and transfusion,number of lymph node dissected,time to anal exsufflation,duration of hospital stay,occurrence of complications,radical degree of tumors of pathological examination.(2) Other indicators were observed,including pathological features of patients in stage Ⅰ,Ⅱ and Ⅲ [gender,age,body mass index (BMI),scores of American Society of Anesthesiologists (ASA),medicinal complication,location of tumors,degree of tumor differentiation and with or without vascular tumor thrombi],intraoperative and postoperative situations (surgical procedure,conversion to open surgery,operation time,volumes of intraoperative blood loss and transfusion,number of lymph node dissected,time to anal exsufflation,duration of hospital stay and radical degree of tumors),postoperative complications,reoperation,death within postoperative day 30 and during follow-up,3-and 5-year survival rates.(3) Evaluation criteria:stages and classification of tumors were evaluated according to the tumor node metastasis (TNM) classification of malignant tumours (Seventh Edition) published by American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC).Severity of complications was evaluated according to Clavien-Dindo classification.Patients were followed up by outpatient examination,telephone interview and correspondence once every half a year up to December 31,2015,abdominal / pelvic CT,chest X-ray and blood test were performed once every half a year within 2 years and once every year within 2-5 years postoperatively,and gastroscopy was performed once every year.Overall survival time was counted from operation date to end of follow-up or time of death.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using the ANOVA.Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric test.Comparisons of count data were analyzed using the chisquare test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Logrank test.Results (1) Overall treatment:all the 210 patients underwent successful radical gastrectomy,including 100 undergoing distal gastrectomy,35 undergoing proximal gastrectomy and 75 undergoing total gastrectomy.There were 198 patients undergoing radical gastrectomy and 12 patients converted to open surgery.Operation time,volume of intraoperative blood loss,number of patients with blood transfusion and number of lymph node dissected were (258 ± 54) minutes,(103 ± 86) mL,19 and 29 ± 12,respectively.Postoperative recovery:time to anal exsufflation and duration of hospital stay were (3.8 ± 0.9) days and (17 ± 7) days.Fortyfive patients had postoperative complications and 2 were dead within 30 days postoperatively.R0 and R1 resections were respectively applied to 209 and 1 patients.(2) Comparisons among the patients with the different pathological stage:numbers of patients in stage Ⅰ,Ⅱ and Ⅲ were 9,17 and 36 with tumor located in the upper stomach,3,9 and 22 with tumor located in the middle stomach,40,16 and 47 with tumor located in the lower stomach,0,1 and 10 with tumor located in the cross-region stomach,30,23 and 23 in G1 and G2 of tumor differentiation,21,19 and 92 in G3 and G4 of tumor differentiation,7,13 and 69 with vascular tumor thrombi,respectively,with significant differences in above indicators among the patients in stage Ⅰ,Ⅱ and Ⅲ (x2 =25.990,32.928,35.027,P ＜ 0.05).(3) Intra-and post-operative comparisons among the patients with the different pathological stage:numbers of patients in stage Ⅰ,Ⅱ and Ⅲl were respectively 40,20 and 40 with distal gastrectomy,3,8 and 24 with proximal gastrectomy,9,15 and 51 with total gastrectomy,and number of lymph node dissected were 26 ± 9,29 ± 13 and 31 ± 12 in patients with stage Ⅰ,Ⅱ and Ⅲ,showing significant differences in above indicators among the patients in stage Ⅰ,Ⅱ and Ⅲ (x2 =25.730,F =4.336,P ＜ 0.05).(4) Numbers of patients with postoperative overall complications were 11,8 and 26 in stage Ⅰ,Ⅱ and Ⅲ,showing no significant difference (x2 =0.301,P ＞ 0.05).(5) Of 210 patients,203 were followed up for a median time of 43 months (range,1-80 months) with a follow-up rate of 96.67％ (203/210).Sixty-eight patients were dead till the end of follow-up,including 60 died of recurrence of tumor,2 died of surgical complications and 6 died of other causes.Postoperative 3-,5-year overall survival rates were 96.1％,87.8％,62.4％ and 92.9％,77.5％,52.7％ in patients with stage Ⅰ,Ⅱ and Ⅲ,respectively,with a significant difference (x2 =29.071,P ＜ 0.05).Conclusion Laparoscopy-assisted radical gastrectomy for advanced gastric cancer is at least equivalent to early gastric cancer in the safety,with the satisfactory long-term outcomes.

Objective:To explore the clinicopathological factors in node-negative colon cancer patients with synchronous liver metasta-ses and to improve the efficiency of follow-up and rate of early diagnosis for high-risk patients. Methods:Clinical data of 140 colon cancer patients who underwent operation from January 2008 to December 2012 in Beijing Cancer Hospital were analyzed. The high-risk variables associated with synchronous liver metastases were subjected to univariate and multivariate analyses. Results:Synchro-nous liver metastases developed in 13 out of the 140 node-negative colon cancer patients. Eight out of those 13 patients (61.5%) ex-hibited complications with incomplete colon obstruction, and 6 cases underwent surgical treatment for both primary tumor and liver metastases. Both univariate and multivariate analyses revealed that preoperative abnormal serum carcinoembryonic antigen levels (≥5 ng/mL) and vascular invasion were significant independent risk factors for synchronous liver metastases. Conclusion:The risk of syn-chronous liver metastases for colon cancer patients with negative lymph node is slightly high. Vascular invasion and abnormal preoper-ative CEA levels are significant independent risk factors for synchronous liver metastases. Specific examination of livers is necessary for the special cohort at the time of diagnosis or after operation to avoid misdiagnosis.

Objective: This study aimed to compare the short- and long-term outcomes of laparoscopy-assisted radical gastrectomy between elderly and non-elderly patients with gastric cancer. Methods: A total of 219 patients who underwent laparoscopy-assisted radical gastrectomy in the Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute from April 2009 to October 2013 were included in this retrospective study. All patients were divided into elderly (≥65 years) and non- elderly (<65 years)groups. We compared these groups based on clinicopathological characteristics, postoperative morbidities, and survival. Results:Theelderly group showed higher ASA scores and higher number of preoperative comorbidities (P<0.05). The operative time, blood loss,and conversion rate did not differ significantly between the groups (all P>0.05). The mean time to first ambulation in elderly group was 2.2±2.3d while first ambulation time in the non-elderly group was 1.4±1.3d,which showed significant difference between the two groups (P<0.05). No significant differences were observed between groups in terms of postoperativemorbidities (34.8％ vs. 28.5％, P> 0.05) as well as 3-year disease-free survival and overall survival (P>0.05). However, the elderly patients withpostoperative morbidities experienced significantly poorer overall survival rate than non-elderly patients (44.5％ vs. 70.5％, P<0.05). Conclusion: Laparoscopy-assisted gastrectomy can be safely and successfully performed in an elderly population with acceptable short- and long-term outcomes.Enhanced perioperative treatment is necessary to improve postoperative outcomes.

Objective:To investigate whether increased levels of preoperative carcinoembryonic antigen (CEA) and CA199 were associated with the mortality of patients with advanced colorectal cancer and to determine whether CA199 can be used to discriminate patients with normal preoperative CEA level from good to poor prognosis. Methods:A total of 314 patients with advanced colorectal cancer cases who underwent primary tumor resection were collected from 2014 to 2016 at Peking University Cancer Hospital and Institute. Preoperative CEA and CA199 serum levels were examined using electrochemiluminescence immunoassay. The association of CEA and CA199 with clinicopathologic features and their possible prognostic values were analyzed. Results:In the tested patients, 5.4%of whom had increased CA199 level but not up-regulated CEA level, whereas 28.3%only had increased CEA level, and 21.3%had both CEA and CA199 levels increased. Kaplan-Meier survival curves indicated that patients with elevated preoperative CEA level had worse disease-free survival (DFS) and overall survival (OS) than those with normal CEA (P<0.001 and P<0.001, respectively). Meanwhile, patients with elevated CA199 level had worse DFS and OS than those with normal CA199 (P<0.001 and P<0.001, respectively). Preoperative CA199 level could be used in discriminating patients with normal CEA from good to poor prognosis (P=0.012). Multivariate analysis revealed that elevated CA199 level was an independent prognostic factor for OS in patients with advanced colorectal cancer (HR=2.025, 95%CI=1.331-3.082, P=0.001). Conclusion:Combined detection of preoperative CEA and CA199 can be used in evaluating the prognosis of patients with advanced colorectal cancer. Preoperative serum CA199 level can be used in evaluating the prognosis of patients with colorectal cancer without an increase in CEA level. Patients with increased CA199 level had worse 5-year survival than those with increased CEA level.

Objective With the development of laparoscopic surgery technique, the concept of minimally invasive surgery has gradually gained popularity. Laparoscopic minimally invasive technique applied in the treatment of gastric cancer has been recognized by surgeons. In recent years, the indocyanine green labeled near-infrared fluorescence laparoscopic technique has been gradually applied to the surgical treatment of gastric cancer. This technique overcomes the drawbacks of tactile lack of laparoscopic surgery and makes the laparoscopic surgery of gastric cancer more precise and minimally invasive. This article introduces the injection method of indocyanine green and discusses the application of fluorescent laparoscopy in gastric cancer surgery, including intraoperative tumor localization of early gastric cancer, sentinel lymph node biopsy, lymph node navigation of advanced gastric cancer, digestive tract reconstruction and gastrointestinal blood perfusion assessment during the procedure.

OBJECTIVETo investigate the application and short-term efficacy of laparoscopic complete mesocolic excision in right colectomy.

METHODSThe data of continuous 70 cases of ascending colon cancer enrolled in the Peking University Cancer Hospital and Institute between April, 2009 and November, 2011 were analyzed retrospectively.

RESULTSA total of 65 cases received laparoscopic CME procedure and were enrolled in the final analysis. The median number of lymph nodes retrieved was 24, the median operation time was 185 min, the median blood loss was 50 ml. The overall postoperative complication rate was 9.2%(6/65), and the median time of first flatus and post-operative hospital stay was 3 days and 7 days respectively. The median 30-day hospital readmission and postoperative death were not found. The 2-years overall survival rate and disease-free survival rate were 98.5% and 83.1% respectively.

CONCLUSIONSLaparoscopic complete mesocolic excision in right colectomy is feasible and do not give patients extra burden. The short-term follow up reveals good efficacy.

Colectomy ; Colon, Ascending ; surgery ; Colonic Neoplasms ; surgery ; Disease-Free Survival ; Humans ; Laparoscopy ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Survival Rate

OBJECTIVETo investigate the clinical and pathological features of patients with concurrent gastric adenocarcinoma and primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

METHODSA 77-year-old man referred to Beijing Cancer Hospital for the evaluation of two primary cancers of stomach revealed by gastroscope was reported. The English literature was retrieved and analyzed.

RESULTSTotal gastrectomy was performed. Histological examination confirmed that the gastric body lesion was consistent with advanced poorly differentiated adenocarcinoma, while the lesion at the fundus with low grade MALT lymphoma. A systematic review of literature in English was performed, and 40 similar patients from 12 studies were found. There were 25 males(61.0%). More patients with adenocarcinoma were at early stage (65.9%) and the majority of lymphoma was low grade (82.9%). Furthermore, most of the patients experienced Helicobacter pylori infection (72.5%). As for therapeutic strategy, most of the patients underwent subtotal or total gastrectomy.

CONCLUSIONSConcurrent gastric adenocarcinoma with MALT lymphoma is rare. The characteristics of these tumors are still unclear. The majority of gastric adenocarcinoma is at early stage, and most of the patients have Helicobacter pylori infection. The treatment is mainly based on gastric adenocarcinoma.

Adenocarcinoma ; surgery ; Aged ; Gastrectomy ; Humans ; Lymphoma, B-Cell, Marginal Zone ; pathology ; surgery ; Male ; Stomach Neoplasms ; pathology ; surgery

Purpose: Recently, totally laparoscopic gastrectomy has been gradually accepted by surgeons worldwide for gastric cancer treatment. Complete dissection of the lymph nodes and the establishment of the surgical margin are the most important considerations for curative gastric cancer surgery. Previous studies have demonstrated that indocyanine green (ICG)-traced laparoscopic gastrectomy significantly improves the completeness of lymph node dissection. However, it remains difficult to identify the tumor location intraoperatively for gastric cancers that are staged ≤T3. Here, we investigated the feasibility of ICG fluorescence for lymph node mapping and tumor localization during totally laparoscopic distal gastrectomy. Materials and Methods: Preoperative and perioperative data from consecutive patients with gastric cancer who underwent a totally laparoscopic distal gastrectomy were collected and analyzed. The patients were categorized into the ICG (n=61) or the non-ICG (n=75) group based on whether preoperative endoscopic mucosal ICG injection was performed. Results: The ICG group had a shorter operation time and less intraoperative blood loss.Moreover, significantly more lymph nodes were harvested in the ICG group than the non-ICG group. No pathologically positive margin was found and there was no significant difference in either the proximal or distal surgical margins between the 2 groups. Conclusions Near-infrared fluorescence imaging with ICG can be successfully used in totally laparoscopic distal gastrectomy, and it contributes to both the completeness of D2 lymph node dissection and confirmation of the gastric transection line. Well-designed prospective randomized studies are needed in the future to fully validate our findings.

OBJECTIVETo investigate the influence of obesity on short-term outcomes after laparoscopy-assisted radical gastrectomy.

METHODSClinical data of 214 patients with gastric cancer, who underwent laparoscopy-assisted radical gastrectomy between May 2009 and December 2012 were analyzed retrospectively. Patients were divided into two groups, consisting of obese and non-obese patients. In the obese group, the BMI was ≥ 25.0 kg/m² (n=66), and in the non-obese group was <25.0 kg/m² (n=148). Operative procedure and postoperative recovery were compared between the two groups.

RESULTSThe operative time was longer in obese group than that in non-obese group [(271.5 ± 51.2) min vs. (252.1 ± 53.6) min, P<0.05]. The number of retrieved lymph nodes in obese group was less than that in non-obese group (26.2 ± 10.3 vs. 30.3 ± 12.4, P<0.05). No significant differences were observed in terms of blood loss, blood transfusion rate, conversion to laparotomy and time to first flatus between these two groups (all P>0.05). There were no significant differences between the two groups with respect to postoperative complications rate (25.8% vs. 20.9%, P>0.05) and perioperative mortality (1.5% vs. 0.7%, P>0.05). However, minor surgery-related complication rate was higher in obese group(16.7% vs. 6.8%, P<0.05), mainly presented as delayed gastric emptying. There was no difference in perioperative mortality between the two groups (1.5% vs. 0.7%, P>0.05).

CONCLUSIONSAlthough obesity prolongs the duration of laparoscopy-assisted radical gastrectomy, and increases the risk of minor surgery-related complications, it has no influence on the surgical safety.

Aged ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity ; complications ; Retrospective Studies ; Stomach Neoplasms ; complications ; surgery

OBJECTIVETo assess the accuracy of POSSUM scoring system in predicting surgical risk in patients with gastric cancer, and provide a feasible reference to clinical decision.

METHODSClinical data of 310 patients suffered from gastric cancer were analyzed retrospectively, including 278 cases in laparoscopic group and 32 cases in open group, between April 2009 and April 2014 in the department of minimally invasive gastrointestinal surgery, Peking University Cancer Hospital. Preoperative physiology score(PS), operative score(OS) and predictive morbidity rate(R1) were calculated according to POSSUM scoring system, which were used to assess the accuracy of R1 in open group. Two different scoring systems (R1traditional and R1modified according to adjustment of operative excision area) were applied in the laparoscopic group, and were compared for predicting the accuracy of R1 in the laparoscopic group. Besides, postoperative morbidities were compared between the two groups of patients with different preoperative physiological status(low risk group: PS≤20, high risk group: PS≥21).

RESULTSThe predictive accuracy for open group patients were acceptable, and the ratio of expected and observed(E/O) was 1.2. In the laparoscopic group, the R1modified was 29.1%, and observed morbidity was 23.4% with an E/O of 1.2. The R1modified was more accurate than R1traditional(38.5%, E/O traditional was 1.6). Both modified and traditional POSSUM scoring system predicted well in low risk patients in the laparoscopic and open group, and E/O was 1.0. However, it overestimated morbidities in median and high risk patients for both laparoscopic and open group. E/O was 1.6, and 1.9 in laparoscopic group, as well as 1.2 and 1.3 in open group. For patients in poor preoperative physiological status(PS≥21), the morbidity in laparoscopic group was lower than that in open group(27.3% vs. 5/7, P=0.020).

CONCLUSIONSModified POSSUM scoring system predicted morbidity more accurately in the laparoscopic group than traditional system. As for patients in poor preoperative physiological status, laparoscopic assisted gastrectomy procedure might reduce postoperative morbidities.

Gastrectomy ; Humans ; Laparoscopy ; Morbidity ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms