OBJECTIVETo assess the value of gastric and hepatic surgical treatment in gastric cancer patients with liver metastasis and its prognostic implication.

METHODSLiterature search was performed in pubmed, Embase, Ovid, Springer-Link, Web of Science, CNKI, CBMdisc for clinical research published before March 2013 that compared gastrectomy alone to gastrectomy and hepatectomy. Inclusion criteria and exclusion criteria were performed. Quality assessment was based on NOS scale. Stata12.0 was used for statistical analysis.

RESULTSNine studies including 431 patients were enrolled for analysis, among whom 189 underwent gastrectomy and hepatectomy and 242 underwent gastrectomy alone. Gastrectomy and hepatectomy group had better survival(HR=0.50, 95%CI:0.34-0.72, z=3.66, P=0.000). There was a subgroup analysis. Gastrectomy with hepatectomy group had significant advantages in prognosis in four foreign studies(HR=0.28, 95%CI:0.18-0.44, z=5.77, P=0.000). There was no significant difference in five domestic studies (HR=0.74, 95%CI:0.55-1.00, z=1.95, P=0.051).

CONCLUSIONGastrectomy and hepatectomy in gastric cancer patients with liver metastasis improves long-term survival in select patients.

Gastrectomy ; Hepatectomy ; Humans ; Liver Neoplasms ; secondary ; surgery ; Prognosis ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo evaluate the efficacy of different treatments for synchronous liver metastasis from gastric cancer.

METHODSClinicopathological and follow-up data of 271 patients with synchronous liver metastasis from gastric cancer between January 1998 and November 2012 were analyzed retrospectively. Among 271 patients, 34 received surgery alone, 95 received chemotherapy alone, and 120 received combined therapy. The prognosis was compared.

RESULTSThe median survival time was 8 months (3-41 months) in the surgery group and the cumulative 1-, 3- and 5-year survival rates were 32.4%, 2.9% and 0. The median survival time was 7 months (3-50 months) in the chemotherapy group and the cumulative 1-, 3- and 5-year survival rates were 21.1%, 1.1% and 0 respectively. The median survival time was 11 months (3-84 months) in the combined group and the cumulative 1-, 3- and 5-year survival rates were 50.0%, 5.0% and 0.8% respectively. The differences among groups were all statistically significant (all P<0.05). Extent of lymph node metastasis, therapeutic strategies, and liver metastasis management were significantly independent prognostic factors for synchronous liver metastasis from gastric cancer.

CONCLUSIONSComprehensive treatment based on operation may improve the long-term survival of patients with synchronous liver metastasis from gastric cancer.

Humans ; Liver Neoplasms ; secondary ; therapy ; Lymphatic Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; therapy ; Survival Rate ; Treatment Outcome

Objective To explore the safety and economic benefits of day surgery laparoscopic cholecystectomy (LC/DS).Methods Clinical data of 5771 patients undergoing LC/DS and 2450 undergoing conventional laparoscopic cholecystectomy (CLC) in PLA General Hospital from November 2009 to January 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. In LC/DS group, there were 2204 males and 3567 females with the average age of (51±13) years old. In CLC group, there were 992 males and 1458 females with the average age of (51±13) years old. The hospitalization time and total medical expenses of two groups were compared by Mann-Whitney test. The ratio of conversion to laparotomy, postoperative complication, postoperative 24-hour discharge rate, and 30-day readmission rate were compared by Chi-square test.Results The ratio of conversion to laparotomy and 30-day readmission rate was respectively 0.36％, 0.49％ in LC/DS group and 0.16％, 0.49％ in CLC group, and no significant difference were observed (χ2=2.83, 0.00; P>0.05). The postoperative 24-hour discharge rate in LC/DS Group was 83.34％, significantly higher than 49.22％in CLC group (χ2=1020.30, P<0.05). The postoperative complication rate in LC/DS group was 6.59％, significantly lower than 14.56％ in CLC group (χ2=130.19, P<0.05). The hospitalization time and total medical expenses in LC/DS group was respectively [3.0(1.0-33.0)] d and [0.98(0.56-4.59)] million RMB, significantly lower than [5.0(1.0-36.0)] d and [1.40(0.38-2.95)] million RMB in CLC group (Z=-17.33,-45.40; P<0.05).Conclusions LC/DS is safe and effective. It can reduce the incidence of postoperative complications, shorten the hospitalization time and reduce the hospitalization cost of patients.

Objective To evaluate preoperative oral carbohydrate in patients receiving LC day surgery.Methods 117 patients undergoing LC day surgery in PLA General Hospital from Oct 2016 to Mar 2017 were evenly divided into three groups.Patients in group A took oral carbohydrate preoperatively,group B by iv glucose,group C by overnight fasting.The preoperative thristy and the indicators of inflammation,heart rate,blood glucose,serum insulin,insulin resistance index postoperatively were collected and compared.Results No patients suffered aspiration.There were no complications above Clavien Ⅰ level.Differences in insulin resistance index,fasting serum insulin were statistically significant between group A and group B (Z =-5.60,-4.78,P ＜ 0.05).That of insulin resistance index,fasting serum insulin and procalcitonin between group A and group C were statistically significant (Z =-2.65,-2.49,-4.02,P ＜0.05).Procalcitonin between group B and group C were statistically different (Z =-2.183,P ＜ 0.05).The preoperative thristy between group A and group B,group C were statistically different (x2 =6.47,P ＜ 0.05).Conclusions Preoperative oral carbohydrate intake is safe and feasible with the benefits of improving the quality of life in patients operated on LC day surgery.