Objective:To investigate the efficacy difference of totally laparoscopic total gastrectomy (TLTG) and laparoscopically assisted total gastrectomy (LATG) on radical gastrectomy for gastric cancer, and further to explore the safety and feasibility of totally laparoscopic esophagojejunostomy.Methods:PubMed, Web of Science, Wanfang and CNKI database were searched for all relevant articles regarding to TLTG versus LATG for gastric cancer published up to September 2019. The search keywords included: gastric/stomach cancer, total gastrectomy, totally/completely laparoscopic, laparoscopic-assisted/laparoscopy-assisted/laparoscopically assisted, esophagojejunostomy/esophagojejunal anastomosis. Meta-analysis was performed with RevMan 5.3 software.Results:A total of 258 articles were retrieved, and 11 studies were finally included after layer by layer screening, with a total sample size of 2421 cases, including 1115 cases in the TLTG group and 1306 cases in the LATG group. There were no statistical difference in age and gender between the two groups, while the mean BMI in the TLTG group was significantly higher than that in the LATG group ( P=0.01). Compared to the LATG group, shorter surgical incision ( P<0.001), less intraoperative blood loss ( P=0.003), larger number of retrieved lymph nodes ( P=0.04), less time to first oral intake ( P=0.03), and shorter postoperative hospital stay ( P=0.02) were found in the TLTG group. There were no significant differences in operation time, anastomotic time, tumor size, proximal resection margin length, postoperative pain score, time to first flatus, rate of postoperative anastomosis-related complication (including anastomotic fistula, stenosis and bleeding) and the overall incidence of postoperative complications ( P>0.05). Conclusions:Totally laparoscopic esophagojejunostomy is safe and feasible, and also suitable for obese patients. TLTG has advantages of minimally invasive, less intraoperative blood loss and easier access to lymph nodes compared to LATG. Totally laparoscopic gastrectomy will probably be the surgical trend for gastric cancer in the future.

Objective:To compare the effects between improved catheter extubation method and the traditional one on urination pain, urinary retention, first urination time and first urination volume, and to evaluate the advantage of the improved method.Methods:144 patients with indwelling catheters after operation in our department were randomly divided into observation group and control group, with 72 cases in each group. The control group returned to the ward after surgery and began to clamp the urinary tube to train the bladder function, the catheter was removed by traditional method. Observation group: urination reflex was evaluated before extubation, according to more than 250 ml urine in the urine bag. Pumping the saline of the gas bag and injecting back 0.5ml to keep the wall of the bag smooth, eventually the catheter was excreted when urinating. Urethral pain, urinary retention, first micturition time and first micturition volume of two groups were analyzed.Results:Urethral pain, urinary retention, first micturition time in observation group and control group were 1.47±1.48, (20.44±12.98) min, 95.8% (69/72) and 3.11±1.98, (28.03±27.00) min, 83.3% (60/72), respectively, and the difference between the two groups was statistically significant ( t value was -5.644, -2.148, χ2 value was 6.628, all P<0.05). The first micturition volume in observation group and control group were (258.6±41.57) ml and (248.14±48.82) ml, respectively, and there was no significant difference between the two groups ( t value was 1.377, P>0.05). Conclusion:The improved catheter extubation method could significantly reduce the urethral pain, shorten the time of the first urination, and improve the success rate of self-urination, which of clinical promotion.

Objective: To study the efficacy, safety and long-term outcomes of integrated strategy of bortezomib-based induction regimens followed by autologous hematopoietic stem cell (ASCT) and maintenance therapy in Chinese multiple myeloma (MM) patients. Methods: 200 MM patients receiving integrated strategy of bortezomib--based induction regimens followed by ASCT and maintenance therapy were retrospectively and prospectively analyzed from December 1. 2006 to April 30. 2018. Results: The complete remission rates (CR) and better than very good partial remission rates (VGPR) after induction therapy, transplantation and maintenance therapy were respectively 31% and 75.5%, 51.8% and 87.7%,73.6% and 93.4%. There was no difference between 4 cycles and more than 5 cycles induction chemotherapy. The negative rate of MRD detection by flow cytometry was 17.6% and 38.2% respectively after induction and 3 months after transplantation. The negative rate of MRD gradually increased during the maintenance therapy. The success rate of high dose CTX combined with G-CSF mobilization was 95.5% and transplantation related mortality (TRM) was zero. The median time to progress (TTP) was 75.3 months and the median overall survival (OS) was 99.5 months. TTP of patients obtaining CR and negative MRD after induction were longer that those of no CR and positive MRD. TTP and OS of patients receiving triple-drug induction and ASCT in early stage were longer than those of double-drug induction and ASCT in late stage. LDH≥240 U/L, high risk cytogenetics, ISS II+III stage and HBsAg positive were prognostic factors at diagnosis. However, only MRD and high risk cytogenetics were independent prognostic factors after transplantation and maintenance therapy. The clinical characteristics of patients of TTP ≥6 years were listed below: light-chain type M protein, ISS I stage, normal level of hemoglobin and platelet, normal LDH, HBsAg negative, chromosome 17p-negative, good response and sustained good response. Conclusions Integrated strategy of bortezomib-based induction regimens followed by ASCT and maintenance therapy can significantly improve the short-term and long-term efficacy. The prognostic factors of TTP in different disease stages were different. Response to treatment, especially MRD, played a more important role in prognostic factors.