Hepatectomy ; methods ; Humans ; Liver ; surgery

ObjectiveTo evaluate the technique and implications of No.12 lymph node dissection for advanced gastric cancer with D2 lymphadenectomy.MethodsIn this study 102 advanced gastric cancer patients undergoing D2 lymphadenectomy from January 2010 to January 2011were retrospectively analysed. ResultsThe average number of No.12 lymph node dissected was 4.3.The metastatic rate of No.12 lymph node was 21.6％.Postoperative pancreatic fistula developed in 4 cases,and lymphatic fistula in 6.There was no anastomotic leakage,lymphatic duct leakage,biliary leakage,post-operative jaundice and bleeding.ConclusionsNo.12 lymph node dissection for advanced gastric cancer is safe and necessary.

Pancreatic ductal adenocarcinoma is a highly aggressive disease with a grim prognosis. Surgical resection offers the best chance for long-term survival. Negative-margin resection still remains the goal, the influence of margin status on outcomes in pancreatic head carcinoma remains controversial, as conflicting data have been plagued by a lack of standardization in R0 resection and margin definitions, pathologic analysis, and reporting. In contrast to common belief, a high rate of R1 resections in pancreatic cancer is not a marker of low-quality surgery but rather of high-quality pathology. The international pathological consensus of pancreatic head carcinoma is still needed to fully understand the prognostic value of margin status in order to optimize treatment strategy for this disease.

Objective: To investigate the rationale for appropriate diagnostic methods and treatment protocols for unexpected gallbladder carcinoma(UGC). Methods: The clinical and pathological data of 45 patients with UGC admitted at Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine,from January 2008 to December 2017 were retrospectively collected and analyzed.There were 11 males(28.9%) and 34 females(71.1%),aged 68 years(range:27 to 68 years).And there were 20 cases who aged above 70 years. Twenty-four cases were diagnosed preoperatively as cholecystolithiasis plus chronic cholecystitis.Ten cases were diagnosed preoperatively as cholecystolithiasis plus actue cholecystitis.Six cases were diagnosed preoperatively as cholecystolithiasis plus choledocholith.Six cases were admitted because of gallbladder polyp and 1 case was admitted because of gallbladder adenomyomatosis. Results: Thirty-four patients with UGC received radical surgery.Among them,11 patients experienced postoperative complication and no posterative mortality occoured during hospital stay.Thirteen patients were diagnosed with T1b UGC, the harvested lymph node of Nx, N0, N1 and N2 was 2, 9, 1 and 1, respectively.In addition, 2 cases were identified to have local-regional tumor recurrence during our rescue radical surgery.The median overall survival time of the patients who did not receive radical surgery was 7 months(range:2-56 months).Nevertheless,the median overall survival time for patients diagnosed with T1, T2 and T3 tumors who received radical surgery, was 41 months(range: 19-82 months), 33.5 months(range: 31-36 months) and 17 months(range: 7-46 months), respectively. Conclusions For patients with UGC, rescue radical surgery can achieve a better survival time.Furhtermore, our experience proved that rescue radical surgery for UGC is safe and feasible.Therefore,rescue radical surgery should be performed in patients with diagnose with UGC especially those T1b patients.

Objective To observe the protective effect of Rhodiola rosea on vascular endothelium in rats with intermittent hypoxia (IH) and to explore its possible mechanism. Methods According to random number table method, 45 male Sprague-Dawley (SD) rats were divided into normal control group, IH group and Rhodiola rosea low, medium and high dose groups, with 9 rats in each group. The IH model was reproduced by putting the rats into IH model chamber, and then feeding them with nitrogen, oxygen and compressed air for 45 days. The feeding bin and feeding time of rats in the normal control group were consistent with those in other groups, and the oxygen concentration in the tank was maintained at 20%-21%. The rats in Rhodiola rosea high, medium and low dose groups were intraperitoneally injected with Rhodiola rosea (0.2, 0.1 and 0.05 mL/100 g), starting from the 15 th day in IH chamber, and the injection continued for 30 days. The levels of malondialdehyde (MDA), superoxide dismutase (SOD) and nitric oxide (NO) in the coronary arteries of rats in each group were detected by automatic biochemical analyzer. The contents of coronary hypoxia-inducible factor-1α(HIF-1α) and tumor necrosis factor-α(TNF-α) in rats were determined by enzyme linked immunosorbent assay (ELISA). The mRNA expression levels of endothelin-1 (ET-1) and vascular endothelial growth factor (VEGF) in coronary artery tissues of rats in each group were measured by reverse transcription-polymerase chain reaction (RT-PCR). The pathological changes of aorta in each group were observed under light microscope. Results Compared with the normal control group, SOD and NO in the IH group decreased [SOD (U/mg): 4.43±0.22 vs. 8.60±0.34, NO (μmol/g): 3.09±0.07 vs. 4.81±0.41, both P < 0.01], MDA, TNF-α, HIF-1α and mRNA expression of ET-1 and VEGF increased [MDA (nmol/mg): 0.78±0.03 vs. 0.50±0.03, TNF-α(pg/mg): 6.35±0.29 vs. 3.27±0.14, HIF-1α (ng/mg): 14.55±0.70 vs. 7.16±0.17, ET-1 mRNA (2-ΔΔCt): 1.75±0.03 vs. 1.10±0.07, VEGF mRNA (2-ΔΔCt):4.38±0.10 vs. 1.20±0.07, all P < 0.01]. Compared with the IH group, SOD and NO were increased in three Rhodiola rosea groups, MDA, TNF-α, HIF-1α and mRNA expression of ET-1 and VEGF were decreased in three Rhodiola rosea groups, and the changes in the Rhodiola rosea high dose group were more significant than those in the low and medium dose Rhodiola rosea groups [SOD(U/mg): 7.47±0.19 vs. 5.41±0.37, 6.71±0.28, MDA (nmol/mg): 0.57±0.20 vs. 0.74±0.04, 0.70±0.03, NO (μmol/g): 4.00±0.28 vs. 3.27±0.18, 3.47±0.28, TNF-α(pg/mg): 3.90±0.17 vs. 5.08±0.27, 4.39±0.26, HIF-1α(ng/mg): 8.40±0.23 vs. 11.07±0.41, 9.81±0.44, ET-1 mRNA (2-ΔΔCt): 1.12±0.04 vs. 1.71±0.03, 1.63±0.07, VEGF mRNA (2-ΔΔCt): 2.45±0.09 vs. 3.99±0.12, 3.27±0.08, all P < 0.05]. Under light microscope, the inner membrane of the normal control group was intact, and the endothelial cells were loose and slightly stained on the surface of the inner membrane; in the IH group, part of the arterial areas showed endointima edema or even abscission, and interstitial edema in the vascular wall. The pathological changes in three Rhodiola rosea groups were less than that in the IH group, and the changes of Rhodiola rosea high dose group were more significant. Conclusion Rhodiola rosea can protect the vascular endothelium caused by IH exposure through improving the level of anti-hypoxia in tissues and inhibiting oxidative stress and inflammatory response.

Gallbladder cancer (GBC) is one of common cancers of the biliary tract.Surgery is the only possible way to cure this malignancy because other adjuvant therapies work ineffectively on GBC.This paper was aimed to discuss the hotspots and dilemmas in the field of surgery on GBC,such as preoperative jaundice,the role of tumor location on surgery,lymph node dissection,liver excision,combined vessel resection,the role of laparoscopy on surgery,and will provide clinical evidences for surgical treatment of GBC.

OBJECTIVETo prepare cisPLLAtin-loaded polylactic acid/cnts, and to study the anti-tumor effect of 5-FU-PLLA-CNTs on human gastric carcinoma cell lines(MGC803 and MNK45).

METHODS5-FU-PLLA-CNTs were prepared with ultrasound emulsification. The morphology of 5-FU-PLLA-CNTs was determined by scanning electron microscope(SEM), and its drug loading and drug release curve in vitro were detected by UV-Vis-NIR spectrophotometer. Cells were divided into experiment, positive control and negative control groups. CCK8 method was used to test the cytotoxic effect of 5-FU-PLLA-CNTs in different concentrations on MGC803 and MNK45 cell proliferation. Flow cytometry was employed to measure the apoptotic rate of MGC803 and MNK45 cells before and after the intervention of 5-FU-PLLA-CNTs.

RESULTSDeep layer film of 5-FU-PLLA-CNTs was successfully established, whose drug-load rate was(4.54±0.43)%, entrapment rate was(21.56±2.36)%. In vitro release test showed release rate within 24 h of 5-FU-PLLA-CNTs was 23.9% in a as lowly increasing manner, and accumulating release rate was 85.3% at day 31. CCk8 experiment revealed, as compared to control group, 5-FU-PLLA-CNTs significantly inhibited the proliferation of two cell lines in dose-dependent and time-dependent manner. The best 5-FU-PLLA-CNTs concentration of inhibition for human gastric cancer cell lines was 1 mg/well. Flow cytometry indicated the apoptotic rate of MGC803 and MNK45 cells in experiment group treated by 1 mg/well 5-FU-PLLA-CNTs significantly increased as compared to negative control group (P<0.05), while the difference was not significant as compared to positive control group (P>0.05).

CONCLUSIONThe 5-FU-PLLA-CNTs has good drug sustained-release capacity, and can significantly kill and inhibit the proliferation of MGC803 and MNK45 cell lines.

Cell Line, Tumor ; Cell Proliferation ; drug effects ; Delayed-Action Preparations ; Fluorouracil ; pharmacology ; Humans ; Lactic Acid ; pharmacology ; Nanotubes, Carbon ; Polyesters ; Polymers ; pharmacology ; Stomach Neoplasms ; pathology

Objective: To evaluate the role of anatomical hepatectomy in the treatment of intrahepatic cholangiocarcinoma. Methods: The cases of intrahepatic cholangiocarcinoma who received curative surgery in two hospitals from 2010 to 2015 were analyzed retrospectively. Among the 98 patients enrolled in this study, 55 were male and 43 were female. The median age was 61 years. According to receiving anatomical hepatectomy or not, the 98 cases were divided into two groups: non-anatomical hepatectomy(n=30) and anatomical hepatectomy(n=68). The surgical results were compared between the two groups.Survival curves were plotted by the Kaplan-Meier method and compared by the log-rank test. The influence of each prognostic factor identified by univariate analysis was multivariate analysis by Cox′s proportional hazard regression. Results: The duration of surgery was significantly prolonged in the anatomical hepatectomy group((196.4±94.9)minutes vs. (166.2±65.7)minutes, P=0.027), while there was no significant difference in terms of other surgical results such as intraoperative blood transfusion, postoperative morbidity and mortality rate. Compared to non-anatomical hepatectomy, anatomical hepatectomy significantly improved long-term survival results(14 months vs. 11 months)(χ²=4.641, P=0.031). Single variable analysis indicated that tumor differentiation, tumor numbers, T stage, N stage, anatomical hepatectomy and adjuvant therapy significantly affected overall survival. Multivariate analysis demonstrated that tumor numbers(HR=0.522, 95% CI: 0.259-0.974, P=0.042) and anatomical hepatectomy(HR=1.858, 95%CI: 1.092-3.161, P=0.022) were two independent prognostic factors for overall survival. Conclusion Compared to non-anatomical hepatectomy, anatomical hepatectomy performed for intrahepatic cholangiocarcinoma is not only safe but also beneficial for long-term survival.

Background::Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates. The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies.Methods::The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved. A case-control analysis was conducted at our department. Patients with advanced GBC who underwent HPD (HPD-GBC group) were compared with a control group (None-HPD-GBC group). Baseline characteristics, preoperative treatments, tumor pathologic features, operative results, and prognosis were assessed.Results::Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department. Significant postoperative complications (grade III or greater) and postoperative pancreatic fistula were observed in 24 (42.1%) and 15 (26.3%) patients, respectively. One postoperative death occurred in the present study. Overall survival (OS) was longer in patients with advanced cholangiocarcinoma than in those with GBC (median survival time [MST], 31 months vs. 11 months; P < 0.001). In the subgroup analysis of patients with advanced GBC, multivariate analysis demonstrated that T4 stage tumors ( P = 0.012), N2 tumors ( P = 0.001), and positive margin status ( P = 0.004) were independently associated with poorer OS. Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors ( P < 0.001). Conclusion::HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced high-volume center. For patients with advanced GBC without an N2 or T4 tumor, HPD can be a preferable treatment option.

Objective To prepare cisPLLAtin-loaded polylactic acid/cnts , and to study the anti-tumor effect of 5-FU-PLLA-CNTs on human gastric carcinoma cell lines (MGC803 and MNK45). Methods 5-FU-PLLA-CNTs were prepared with ultrasound emulsification. The morphology of 5-FU-PLLA-CNTs was determined by scanning electron microscope (SEM), and its drug loading and drug release curve in vitro were detected by UV-Vis-NIR spectrophotometer. Cells were divided into experiment, positive control and negative control groups. CCK8 method was used to test the cytotoxic effect of 5-FU-PLLA-CNTs in different concentrations on MGC803 and MNK45 cell proliferation. Flow cytometry was employed to measure the apoptotic rate of MGC803 and MNK45 cells before and after the intervention of 5-FU-PLLA-CNTs. Results Deep layer film of 5-FU-PLLA-CNTs was successfully established, whose drug-load rate was (4.54 ±0.43)%, entrapment rate was (21.56 ±2.36)%. In vitro release test showed release rate within 24 h of 5-FU-PLLA-CNTs was 23.9% in a aslowly increasing manner, and accumulating release rate was 85.3% at day 31. CCk8 experiment revealed , as compared to control group, 5-FU-PLLA-CNTs significantly inhibited the proliferation of two cell lines in dose-dependent and time-dependent manner. The best 5-FU-PLLA-CNTs concentration of inhibition for human gastric cancer cell lines was 1 mg/well. Flow cytometry indicated the apoptotic rate of MGC803 and MNK45 cells in experiment group treated by 1 mg/well 5-FU-PLLA-CNTs significantly increased as compared to negative control group (P<0.05), while the difference was not significant as compared to positive control group (P>0.05). Conclusion The 5-FU-PLLA-CNTs has good drug sustained-release capacity, and can significantly kill and inhibit the proliferation of MGC803 and MNK45 cell lines.