Compared with distal gastrectomy, pylorus-preserving gastrectomy is less invasive which can decrease incidence of dumping syndrome, diarrhea and body weight lost, cholecystitis and gallstone, reflux gastritis and esophagitis and remnant gastric cancer. Based on new Japanese Gastric Cancer Treatment Guideline and new progression in the world, we give a review mainly basic characteristics, indications, operation details and short- and long-time outcomes after pylorus-preserving gastrectomy.
Gastrectomy ; methods ; Gastric Stump ; pathology ; Gastroenterostomy ; Humans ; Organ Sparing Treatments ; Pylorus ; surgery ; Stomach Neoplasms ; surgery

Rectal cancer is a common malignant tumor. In China, low rectal cancer accounts for more in rectal cancer. Surgery currently remains at the center of any potentially curable case. With the rapid development of surgical techniques and progress of pathology research in low rectal cancer, sphincter-preserving surgery has been widely used in the treatment of low rectal cancer. This review is to summarize the current literatures pertaining to sphincter-preserving surgery, including distal resection margin, neoadjuvant therapy, indications, and postoperative complications.
Anal Canal ; surgery ; Humans ; Neoadjuvant Therapy ; Organ Sparing Treatments ; Rectal Neoplasms ; surgery

Animals ; Echinococcosis, Hepatic ; pathology ; surgery ; Humans ; Male ; Organ Sparing Treatments ; methods ; Spleen ; pathology

Intersphincteric resection (ISR) has been performed as an ultimate sphincter-sparing strategy in selected patients with low rectal cancer. Accumulating evidence suggests that ISR may be an interesting alternative to abdominoperineal resection to avoid a permanent stoma without compromising oncological outcomes. However, bowel dysfunction is a most common consequence of ISR not to be neglected. To date, limited clinical research has reported functional and quality of life outcomes according to patient-reported outcome measures. Also, data concerning management of low anterior resection syndrome are scarce due to lack of quality evidence. Therefore, this review provides an up-to-date summary of systematic assessment (including function, quality of life, manometry and morphology) and bowel rehabilitation for ISR patients. Postoperative anal function is often assessed by a combination of scales, including the Incontinence Assessment Scale, the Gastrointestinal Function Questionnaire, the Specific LARS Assessment Scale and the Faecal Diary. The condition-specific Quality of Life Scale is more appropriate for Quality-of-life measures in fecal incontinence after ISR. Patients' physiological function after ISR can be assessed using water- or high-resolution solid-state anorectal manometry. Anatomical and morphological changes can be assessed using defecography and 3D endorectal ultrasound. Electrical stimulation and biofeedback, pelvic floor exercises, rectal balloon training, transanal irrigation and sacral neuromodulation are all options for post-operative rehabilitation.
Humans ; Rectal Neoplasms/surgery* ; Postoperative Complications ; Anal Canal/surgery* ; Quality of Life ; Organ Sparing Treatments ; Fecal Incontinence

The progress in the idea and technology of rectal cancer improve the rate of sphincter-preservation, while bowel dysfunction is the major problem puzzling patients after sphincter-preserving operation. Recent researches reveal bowel dysfunction is closely associated with the postoperative change of anatomy, nerve damage and sphincter functional injury based on the mechanism of defecation function change through the analysis of anatomy, physiology and dynamics. This paper summarizes the mechanism and epidemiology of bowel dysfunction after rectal cancer operation, and elucidate the role of such mechanism in treatment and prevention of above bowel dysfunction.
Anal Canal ; surgery ; Humans ; Intestinal Diseases ; etiology ; Intestine, Small ; physiopathology ; Organ Sparing Treatments ; Postoperative Complications ; Rectal Neoplasms ; surgery

No abstract available.
Female ; Humans ; Hysterectomy/*methods ; *Organ Sparing Treatments ; Pelvis/*innervation ; Rectum/*innervation ; Urinary Bladder/*innervation ; Uterine Cervical Neoplasms/*surgery ; Uterus/*innervation

OBJECTIVE: To explore the indications and the effective treatment methods of laryngeal function preserva tion in aged patients with hypopharyngeal carcinoma. METHOD: Clinical data about 41 patients with hypopharygeal carcinoma were analysed. These patients were more than or equal to 60 and were treated from January 2006 to December 2011. Among them, 25 cases were treated with laryngeal functions preserved and the hypopharynx defect was immediately re paired by the adjacent tissue flap or (and) the pactoralis major myocutaneous flap according to the size of defect after tumor resecting. The survival rate was calculated by Kaplan-Meier method. RESULT: In 25 patients with laryngeal function preservation, 16 cases were 60-69 years old, 6 cases were 70-79 years old and 3 cases were 80-88 years old. The tumour located at lateral wall of pyriform sinus in 14 cases, at anterior wall of pyriform sinus in 3 cases, at inside wall of pyriform sinus in 3 cases, at upper side wall of hypopharynx invading tonsil or tongue base in 3 cases, at posterior hypopharyngeal wall in 2 cases. The average length of post-operation stay was 22.2 days. Eight cases suffered from post-operative complications (32%), including of pharyngeal fistula in six cases and pulmonary infection in two cases. The respiratory function and pronunciation were all restored, in 25 cases, among which 20 cases removed tracheostomy tube about 3 months after surgery. 2 cases were missed after 1-year followed up. 2 cases died of local tumor recurrence. 4 cases died of neck recurrence. 8 cases died of pulmonary matastasis. The 1-year and 3-year survival rate of the disease in the group was 67.5% and 43.9% respectively. CONCLUSION As the aged cases of hypopharygeal carcinoma are choosed appropriately and repaired feasibly, surgery for the disease with laryngeal function retention may be safe and effective.
Aged ; Aged, 80 and over ; Female ; Humans ; Hypopharyngeal Neoplasms ; physiopathology ; surgery ; Larynx ; physiology ; surgery ; Male ; Middle Aged ; Organ Sparing Treatments ; methods

BACKGROUND: Proton beam radiotherapy (PBT) has shown to provide high radiation dose to tumors and to save surrounding normal tissues because of its physical characteristics, Bragg peak. In the current study, we report the early outcomes for pediatric patients with intracranial gliomas treated with PBT and compared PBT plan (pencil beam scanning and double scattering) with intensity modulated radiotherapy (IMRT) plan and three dimensional-conformal radiotherapy (3D-CRT) plan.METHODS: Clinical data from 18 consecutive children with intracranial gliomas who underwent PBT from May 2007 to April 2012 was collected. The median follow-up duration was 16 months (range 6-69).RESULTS: There were 9 patients with brain stem glioma, 2 patients with optic pathway glioma, 2 patients with low grade glioma (LGG), 2 patients with anaplastic astrocytoma (AA) and 3 patients with glioblastoma multiforme (GBM). The median overall survival for patients with brain stem glioma was 11 months. Patients with optic pathway glioma, LGG or AA were all alive without progression except one patient. Among patients with GBM, one patient had no evidence of disease 25 months after PBT. When PBT plan was compared to those of IMRT and 3D-CRT for patients with LGG or AA and one patient with brain stem glioma by DVH analysis, PBT showed better sparing effect on normal tissue compared to IMRT and 3D-CRT, especially in low dose area.CONCLUSION: PBT could be delivered safely and effectively to pediatric patients with gliomas. For confirming the clinical benefits of PBT, further follow-up is necessary.
Astrocytoma ; Brain Stem ; Child ; Follow-Up Studies ; Glioblastoma ; Glioma ; Humans ; Organ Sparing Treatments ; Pediatrics ; Proton Therapy ; Protons

OBJECTIVE: To analyze relevant factors for recurrence of ovarian endometriosis after conservative surgery.
 METHODS: A cohort study was performed on 310 patients who had performed conservative surgery for ovarian endometriosis. All patients underwent clinical interview. The relevant factors included: age at surgery, clinical symptom and signs, medical history, gynecologic examination, preoperative gravidity, complication, adenomyosis, American Society for Reproductive Medicine (ASRM) scores, post-operative drug therapy, post-operative gravidity and so on. The logistic regression analysis was performed to determine the predictive factors for recurrence of endometriosis.
 RESULTS: The relevant factors by univariate analysis were determined. The history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, intraoperative ASRM scores, complication of adenomyosis and operation time were the risk factors; whereas pre- and post-operative gravidity, post-operative drug therapy, and age at surgery were the protective factors. Meanwhile, the relevant factors by multivariate analysis were also confirmed. The history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, and intraoperative ASRM scores were the risk factors; whereas post-operative gravidity, post-operative drug therapy, pre-operative gravidity, and age at surgery were the protective factors.
 CONCLUSION The risk factors for recurrence of ovarian endometriosis are history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, intraoperative ASRM scores, whereas the protective factors are pre- and post-operative gravidity, post-operative drug therapy and age at surgery.
Cohort Studies ; Endometriosis ; surgery ; Female ; Humans ; Laparoscopy ; Organ Sparing Treatments ; Ovary ; pathology ; Postoperative Period ; Recurrence ; Risk Factors ; Treatment Outcome

Prevention of intraoperative incidental injuries during radical operation for rectal cancer and management of postoperative complication are associated with successful operation and prognosis of patients. This paper discusses how to prevent such intraoperative incidental injuries and how to manage postoperative complication. (1) Accurate clinical evaluation should be performed before operation and reasonable treatment decision should be made, including determination of the distance from transection to lower margin of the tumor, T and M staging evaluated by MRI, fascia invasion of mesorectum, metastasis of lateral lymph nodes, metastatic station of mesentery lymph node, association between levator ani muscle and anal sphincter, course and length of sigmoid observed by Barium enema, length assessment of pull-through bowel. Meanwhile individual factors of patients and tumors must be realized accurately. (2) Injury of pelvic visceral fascia should be avoided during operation. Negative low and circumference cutting edge must be ensured. Blood supply and adequate length of pull-down bowel must be also ensured. Urinary system injury, pelvic bleeding and intestinal damage should be avoided. Team cooperation and anesthesia procedure should be emphasized. Capacity of handling accident events should be cultivated for the team. (3) intraoperative incidental injuries during operation by instruments should be avoided, such as poor clarity of camera due to spray and smog, ineffective instruments resulted from repeated usage. (4) As to the prevention and management of postoperative complication of rectal cancer operation, prophylactic stoma should be regularly performed for rectal cancer patients undergoing anterior resection, while drainage tube placement does not decrease the morbidities of anastomosis and other complications. After sphincter-preserving surgery for rectal cancer, attentions must be paid to the occurrence of anastomotic bleeding, pelvic bleeding, anastomotic fistula, ileus, intestinal necrosis and anastomotic stenosis. After sphincter-preserving surgery for rectal cancer, if small amount of bleeding happens, titanium clamp or electric coagulation can be used; if delayed pelvic bleeding occurs obviously, embolism should be applied. Conservative treatment may be used for the non-carcinomatous ileus. When small anastomotic stenosis is found, local treatment is available (finger dilation, balloon expansion, transanal radiated cutting or resection), and for severe stenosis, transadominal operation is required.
Anal Canal ; Digestive System Surgical Procedures ; adverse effects ; Humans ; Iatrogenic Disease ; prevention & control ; Organ Sparing Treatments ; Postoperative Complications ; Prognosis ; Rectal Neoplasms ; surgery ; Surgical Stomas