Different from Japan and Korea,the gastric cancer cases in China are mostly advanced gastric cancer cases.Surgical radical gastrectomy,as the primary method in treating gastric cancer patients has achieved enormous development in recent years,especially laparoscopic radical gastrectomy.Whereas,laparoscopic radical gastrectomy in treatment of advanced gastric cancer remains controversial.The heated debates are mainly focusing on the indications,choosing of surgical approaches and reconstruction methods,completion of laparoscopic D2 lymphadenectomy,short-term postoperative outcomes and long-term oncologiceffectiveness.In this article,current status of laparoscopic radical gastrectomy in treatment of advanced gastric cancer and results of relevant clinical trials were reviewed.

Laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection is still difficult to accomplish,which restrains its application in total gastrectomy for advanced proximal gastric cancer.Based on our anatomical understanding of pre- and retropancreatic spaces,features of splenic vessels and distribution of perigastric lymph nodes,we combined the characteristics of laparoscopic surgery and developed a novel technique for laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection through retropancreatic space.The key lies in mobilization of the splenic pedicle through retropancreatic space,dissection of peri-vascular lymph nodes in sequence of trunk-to-branch,in-sheath vascularization of the splenic vessels.From August 2009 to December 2010,this technique was performed on 6 patients in Nanfang hospital.The initial results suggested that this technique could be safe and feasible for skillful surgeons.Further studies on the application of this technique in total gastrectomy for advanced proximal gastric cancer would be needed.

ObjectiveTo evaluate the safety and feasibility of esophagojejunostomy using transorally inserted anvil ( OrVilTM ) after laparoscopic total gastrectomy for gastric cancer.MethodsThe clinical data of 8 patients with advanced gastric cancer who were admitted to the Nanfang Hospital of Southern Medical University from January 2011 to Febuary 2012 were retrospectively analyzed.Laparoscopic total gastrectomy + D2 lymph node dissection was first performed,and then esophagojejunostomy was completed using OrVilTM. Perioperative condition and prognosis of the patients were analyzed.ResultsAll the procedures were completed successfully,with no complications occurred.There was no extension of the incisiou during operatiou.The mean operation time,anvil inserting time and volume of operative blood loss were (203 + 38 ) minutes,( 10 -+ 4) minutes and ( 106 ± 18 )ml,respectively.Tumor-free proximal margins were confirmed by pathological examination in all the patients.The mean time to first flatus,time to liquid and semi-liquid diet and duration of hospital stay were (3.5 ± 1.3 )days,(5.5 ± 2.9 ) days,( 7.5 ± 3.2) days and ( 11.5 ± 3.5 ) days.The mean time of follow-up was 10 months ( rauge,1-14 months),no anatomosis-related complications were observed.Conclusion Esophagojejunostomy using OrVilTM after laparoscopic total gastrectomy for gastric cancer is safe and feasible.

For further maximizing the minimally invasive benefits for colorectal cancer patients, laparoscopic surgeons have been dedicating to improve the surgery through single-port (SILES) or natural orifice transluminal endoscopic surgery (NOTES), which is supported by amount of single-port devices and flexible laparoscopic instruments.Many small sample studies of single institution have suggested that SILES for colorectal cancer has similar oncological outcomes with conventional laparoscopic surgery (CLS), could improve the cosmetic results, and is more minimally invasive than CLS. However, evidences of advantages for SILES are limited, because of there has been only 4 published studies of prospective randomized clinical trial so far. Due to the technical difficulties and long learning curves, SILES and NOTES are relatively hard to be widely promoted. Thus, a balance between minimally invasive pursuit and laparoscopic technical challenge should be sought. In this way, modified SILES and reduced-port laparoscopic surgery have emerged in recent years, which might be minimally invasive solutions with lower technical demanding for laparoscopic colorectal cancer surgeries. Adding a port as the surgeon′s dominant operation channel improved the collisions or overlapping of instruments with movement to reduce the technical difficulties. SILS+ 1 is safe and feasible, would be supported by more and more evidences.

Objective: To evaluate the short-term and oncologic outcomes of single-incision plus one port laparoscopic surgery (SILS+ 1) for sigmoid colon and upper rectal cancer. Methods: The clinic data of 46 patients with sigmoid colon and upper rectal cancer underwent SILS+ 1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from September 2013 to September 2014 were retrospectively reviewed (SILS+ 1 group). After generating 1∶1 ration propensity scores given the covariates of age, gender, body mass index, American Society of Anesthesiologists score, surgeons, tumor location, the distance of tumor from anal, tumor diameter, and pathologic TNM stage, 46 patients with sigmoid colon and upper rectal cancer underwent conventional laparoscopic surgery (CLS) in the same time were matched as CLS group. The baseline characteristics and short-term outcomes were compared using t test, χ² test or Wilcoxon signed ranks test. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival. Results: The two study groups were well balanced with respect to the baseline characteristics of the propensity score derivation model. As compared to the CLS group, patients in SILS+ 1 group had a smaller incision ((6.9±1.1) cm vs. (8.4±1.2) cm, t=6.502, P=0.000), less estimated blood loss (20(11) ml vs. 50(30) ml, Z=2.414, P=0.016), shorter intracorporeal operating time ((67.0±25.8) minutes vs. (75.5±27.7) minutes, t=2.062, P=0.042) and significantly faster recovery course including shorter time to first ambulation ((46.7±20.3) hours vs. (78.6±28.0) hours, t=6.255, P=0.000), shorter time to first oral diet ((64.7±28.8) hours vs. (77.1±30.0) hours, t=2.026, P=0.047), shorter time of postoperative hospital stay ((7.8±2.2) days vs. (6.5±2.2) days, t=2.680, P=0.009), and lower postoperative visual analogue scale scores (F=4.721, P=0.032). No significant difference was observed in total operating time, postoperative morbidity, first time to flatus and defecation, analgesic use, number of retrieved lymph nodes and resection margin. During the median follow-up period of 33 months (ranging from 7 to 39 months) , there was no significant difference between the two groups in terms of 3-year disease-free survival (SILS+ 1: 91.3%, CLS: 93.4%, P=1.000). The recurrence rates of SILS+ 1 group and CLS groups were 8.7% (4/46) and 6.5% (3/46), respectively. Conclusion For experienced CLS surgeons, the SILS+ 1 for sigmoid colon and upper rectal cancer would be easiness, safe and efficient alternative.

OBJECTIVETo investigate the safety and efficacy of postoperative intraperitoneal hyperthermic perfusion chemotherapy(IHPEC) following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis.

METHODSBetween March 2010 and October 2013, 37 patients with advanced gastric cancer were treated by IHPEC(cisplatin 100 mg, 5-fluorouracil 1000 mg and saline 2000 mL) following laparoscopic palliative resection in our department between March 2010 and October 2013 were analyzed retrospectively. Short-term efficacy and adverse reactions were observed.

RESULTSComplete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD) were found in 18, 4, 8 and 7 cases respectively, and the total progression-free rate was 59.5%(22/37). The significant improved, improved, stable and progressive cases of Karnofsky performance status were 6, 13, 10 and 8 respectively, and the rate of improved and stable cases was 78.4% (29/37). Serious adverse reactions (class III ( or IIII) were noted in 3 cases (8.1%), including 2 cases of abdominal pain (class III), 1 case of nausea and vomiting.

CONCLUSIONSThe modality of IHPEC adopting cisplatin plus 5-fluorouracil regimen following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis is technically feasible and safe, which has certain effect on postponing the progression of gastric cancer.

Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cisplatin ; Fluorouracil ; Humans ; Laparoscopy ; Palliative Care ; Peritoneal Neoplasms ; drug therapy ; secondary ; surgery ; Remission Induction ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; surgery

Compared to that with laparoscopic assisted approach, intracorporeal anastomosis with totally laparoscopic radical total gastrectomy has the advantages of smaller incision, and better vision for operation, and may also be fit for patients with large size lesion, high-located lesions, or obesity. It remains controversial though several surgeons have reported the safety and feasibility of intracorporeal anastomosis with totally laparoscopic total gastrectomy. This review describes the recent technical advances in intracorporeal anastomoses with totally laparoscopic total gastrectomy, focusing on the reconstruction skills and indications. Current data on totally laparoscopic total gastric resection for gastric carcinoma revealed that all digestive tract reconstructions were performed with esophagus-jejunum Roux-en-Y anastomosis, and different reconstruction techniques of such Roux-en-Y anastomosis have certain advantages and disadvantages. Surgeons should make choice based on tumor location, esophageal diameter and personal skills in order to achieve maximal benefit to patients.
Anastomosis, Roux-en-Y ; methods ; Gastrectomy ; methods ; Humans ; Laparoscopy ; methods ; Stomach Neoplasms ; surgery

OBJECTIVETo evaluate the application value of three risk-stratification criteria in domestic GIST risk assessment.

METHODSThe clinical data of 144 patients with GIST who were admitted to our hospital from January 2008 to December 2010 were analyzed retrospectively. 144 cases of GISTs were evaluated for their biologic potential by the risk-stratification criteria of Fletcher, NIH2008, and among those, 119 cases of GISTs were evaluated by the risk-stratification criteria of Miettinen. Fletcher and Miettinen criteria were compared by Kaplan-Meier survival analysis. The Logistic regression model was established to analyze the comparison of Miettinen and NIH2008 criteria.

RESULTS(1) According to Fletcher criteria in the intermediate risk GISTs, the recurrence-free survival (RFS) of non gastric(small intestinal, rectal and so on) GISTs and gastric GISTs were statistically different (P=0.001). According to Miettinen criteria, in the risk subgroup of GISTs, the recurrence-free survival of different location of GISTs had no statistical difference(P>0.05); (2)Logistic regression model judgment rate: Miettinen criteria (89.4)>NIH2008 criteria (85.2).

CONCLUSIONFletcher criteria is simple and easy to use, but may misjudge the prognosis of the GIST in different part; Miettinen criteria may be a potential supplementary way of NIH2008 criteria in domestic GIST risk assessment.

Adult ; Aged ; Aged, 80 and over ; China ; Female ; Gastrointestinal Stromal Tumors ; mortality ; pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate ; Young Adult

OBJECTIVETo compare the long-term oncological outcomes of laparoscopic and open resection of rectal cancers.

METHODSBetween January, 2003 and December, 2008, 514 patients with rectal cancer were admitted in our hospital, among whom 186 underwent laparoscopic tumor resection and 238 received open radical resection of the tumors. The long-term survival of the patients and the recurrence pattern were compared between the two groups.

RESULTSThe median follow-up of the patients was 48.54∓28.76 months. No significant differences were found between the two groups in the local recurrence rate (3.9% vs 5.5%, P=0.284), 5-year overall survival (69.4% vs 61.3%, P=0.067), or the 5-year disease-free survival rates (67.7% vs 60.7%, P=0.110). Both the 5-year overall survival and progression-free survival of the patients in stage IV were better in the laparoscopic group than in the open surgery group (P<0.05).

CONCLUSIONLaparoscopic resection of rectal cancer can achieve long-term oncological outcomes comparable to those of conventional open surgery.

Aged ; Female ; Humans ; Laparoscopy ; Laparotomy ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome