Objective To study the efficacy of ultrasound-guided minimally invasive neurosurgery in patients with intracranial tumors.Methods Forty-two patients with intracranial tumors,admitted to our hospital and performed ultrasound-guided minimally invasive neurosurgery from April 2010 to April 2012,were chosen in our study; their clinical data and treatment efficacy were retrospectively analyzed.Results No postoperative infection,iatrogenic cerebral hemorrhage or secondary nerve dysfunction appeared in all the patients.Postoperative imaging showed that complete resection was achieved in 40 patients (95.24％),subtotal resection in 2 patients (4.76％) and residues of the most tumors in 0 (0％).Only 1 patient recurred 2 years after the operation.Conclusion It is accurate for Ultrasound-guided minimally invasive neurosurgery in patients with cranial tumors,having less trauma,higher eradication rate and better prognosis.

OBJECTIVETo clarify the important clinicopathological and therapeutical factors affecting the prognosis of patients with gastroesophageal junction carcinoma.

METHODSData of 514 cases with gastroesophageal junction carcinoma who underwent surgical treatment from September 1995 to January 2007 was retrospectively analyzed. Relevant prognostic factors were studied with univariate and multivariate analysis.

RESULTSFor all 514 cases (424 men and 90 women), the median age was 63 years. The 1-, 3- and 5-year survival rates of this group were 74.8%, 42.1% and 29.1%, respectively. Gross type, TNM classification, histological type, vascular invasion and extent of surgical resection affected patients' survival remarkably. There was no significant difference in survival between operative approaches (via laparotomy or left thoracotomy) (P > 0.05). Long-term survival was similar between proximal subtotal gastrectomy and total gastrectomy in advanced cases (P > 0.05). For stage II and III tumors, patients with neoadjuvant chemotherapy had better prognosis than those without (P < 0.05). Cox multivariate regression analysis revealed TNM classification and vascular invasion were independent prognostic factors.

CONCLUSIONSTNM classification and vascular invasion are independent prognostic factors for gastroesophageal junction carcinoma. Neoadjuvant chemotherapy may improve prognosis of the patients with stage II and III tumors. Radical resection should be achieved with rational surgical procedures tailored by tumor position, size, staging and so on.

Adult ; Aged ; Aged, 80 and over ; Carcinoma ; pathology ; surgery ; Esophagogastric Junction ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo observe the clinicopathological characteristics of gastric cancer with pathological complete response(pCR) following neoadjuvant chemotherapy.

METHODSData of gastric cancer patients who received neoadjuvant chemotherapy from 2002 to 2008 in the Beijing Cancer Hospital were reviewed. Five cases were found to have pCR. The slides were reviewed by two experienced pathologists independently. Histological structure, morphology of tumor cells, morphology and quantity of stromal cells were evaluated.

RESULTSStructure of the gastric wall was distinguishable in all the 5 cases, while distortion and rupture of muscular layer were found in 2 cases. Exudative inflammatory reaction was present in the whole gastric wall including the serosa layer. Three patients had ulcerative lesions with epithelial layer shedding, and atypical hyperplasia was found around the border of the ulcer, and vascular endothelial cells were swollen. Residual distorted necrotic tumor cells resided in 1 case only and no residual tumor cells was present in the other 4 patients. Significant hyperplasia of fibroblasts was present in 4 cases, large amount of lymphocytes infiltration in 3 cases including concurrent plasma cell infiltration in 1 case, multinucleated giant cell reaction in the muscular layer of 1 case, and foam cells aggregation in 1 case with mucinous adenocarcinoma. In addition, there were 2 cases with pCR had lymph node metastasis.

CONCLUSIONSFor cases with pCR following neoadjuvant chemotherapy, heterogeneity of stromal cells reaction is found in previous tumor site. Furthermore, the response of primary tumor does not necessarily parallel to that of lymph nodes.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoadjuvant Therapy ; Stomach Neoplasms ; drug therapy ; pathology

OBJECTIVETo study the status of splenic hilar lymph nodes(No.4sa, No.10 or No.11d lymph nodes) metastasis and to investigate the proper dissection technique in patients with advanced gastric cancer.

METHODSA retrospective study was performed to investigate 590 patients who underwent D2 curative proximal or total gastrectomy for gastric carcinoma from January 2006 to December 2009. Clinicopathological factors such as sex, age, location of the primary tumor, tumor sizes, gross type, depth of invasion, microscopic classification, neoadjuvant chemotherapy and the metastasis of adjacent lymph node were analyzed with univariate and multivariate analysis. Influence of combined splenectomy or pancreatectomy on lymph node dissection was also investigated.

RESULTSThe overall ratio of metastatic lymph node(positive lymph nodes/lymph nodes harvested) in the splenic hilum was 17.5%(99/565). The positive rates of No.4sa, No.10, No.11d lymph nodes were 17.8% (41/230), 13.9%(29/209), and 22.8%(29/127), respectively. A total of 7.1%(42/590) of the patients had lymph node metastasis in the splenic hilum. Multivariable logistic regression analysis showed that age, tumor size, depth of tumor invasion, positive metastasis of No.4sb lymph node were independent risk factors for lymph node metastasis in the splenic hilum region. When comparing patients undergoing combined splenectomy or pancreatectomy(n=23) and those who did not undergo combined organ resection (n=553), the ratios of metastatic lymph node in the splenic hilum were 14.8%(4/27) and 17.2%(91/527), respectively, and the difference was not statistically significant(P>0.05). The postoperative complication rates were 26.1%(6/23) and 5.4%(30/553), respectively, and the difference was statistically significant(P<0.05). The operative mortality rates were 4.3% and 0.9%, respectively, and the difference was not statistically significant(P>0.05).

CONCLUSIONSMetastasis to lymph nodes in the splenic hilum region in patients with gastric cancer possesses a certain pattern, and it is associated with tumor location, size, depth of invasion, and metastasis in No.4sb. Combined resection of the spleen or pancreas does not result in increased number of harvested lymph nodes or positive lymph nodes, yet is associated with higher complication rate. Therefore, combined organ resection should be meticulous.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Retrospective Studies ; Spleen ; pathology ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo evaluate the effect of perioperative imatinib mesylate (IM) therapy for patients with initial resectable primary local advanced gastrointestinal stromal tumor (GIST) at intermediate or high risk on R0 resection rate and the prognosis.

METHODSForty-eight above GIST patients between December 2001 and February 2012 were divided into 2 groups: neoadjuvant group (15 cases, pre- and post-operation IM therapy) and adjuvant group (33 cases, post-operative IM therapy). R0 resection rate, complication rate, disease-free survival (DFS) and overall survival (OS) were analyzed and compared between the two groups.

RESULTSThe maximal tumor diameter and average tumor diameter were larger in neoadjuvant group as compared to adjuvant group (11.2 cm vs. 7.7 cm, P=0.005; 9.1 cm vs. 6.2 cm, P=0.014). The response rate of preoperative IM therapy was 93.3% (14/15). The R0 resection rate was 86.7% and 84.8% (P=1.000), and the complication rate was 13.3% and 9.1% (P=0.642) in neoadjuvant and adjuvant group respectively. The 3-year DFS was 55% and 41% (P=0.935), and 5-year OS was 83% and 75% (P=0.766) in neoadjuvant and adjuvant group respectively.

CONCLUSIONSResectable primary local advanced GIST at intermediate or high risk with larger tumor diameter receiving perioperative IM therapy can achieve the same R0 resection rate, complication rate, DFS and OS as the GIST with smaller diameter receiving operation first. Perioperative IM therapy has potential advantage.

Adult ; Aged ; Benzamides ; therapeutic use ; Chemotherapy, Adjuvant ; Female ; Gastrointestinal Neoplasms ; drug therapy ; Gastrointestinal Stromal Tumors ; drug therapy ; Humans ; Imatinib Mesylate ; Male ; Middle Aged ; Perioperative Care ; Piperazines ; therapeutic use ; Prognosis ; Pyrimidines ; therapeutic use ; Retrospective Studies

Humans ; Carcinoma, Mucoepidermoid/pathology* ; Breast/pathology*

Objective To investigate the protein expression of phosphatidylinositol 3-kinase (PI3K), phosphorylated Akt B (p-Akt) and p-mTOR in human gliomas, and evaluate their clinical significance in clinicopathological status and prognosis of these patients with gliomas. Methods Eighty-eight patients, admitted to our hospital from September 2004 to September 2008, were chosen in our study; these patients were performed surgical resection and the samples were pathologically confirmed as gliomas. Another 20 samples, cut from the normal brain tissue were adopted as controls.Immunohistochemistry was employed to examine the protein expression of PI3K, p-AKT and p-mTOR.Then, the correlation of their expression with the clinicopathological features of the gliomas and prognosis of the patients was further analyzed. Results The positive expression rates of PI3K in gliomas and normal brain tissues were 68.18% (60/88) and 18.18% (16/88), respectively; those of p-AKT were 73.86% (65/88) and 17.05% (15/88), respectively;, those of p-mTOR were 75.00% (66/88) and 18.18% (16/88), respectively; the expression levels of these 3 proteins were all significantly higher than those in normal brain tissues (PI3K: x2=14.028, P=0.009; p-AKT: x2=15.132, P=0.008 and mTOR:x2=15.293, P=0.008). The positive expression rates of PI3K, p-AKT and p-mTOR were significantly different in the gliomas with pathological grades, different scores of Karnofsky performance status and different clinical stages (P＜0.05). In addition, the 5-year overall survival rate in PI3K-positive group,p-AKT-positive group and p-mTOR-positive group was significantly lower than in those negative groups (PI3K: x2=8.381, P=0.026; p-AKT: x2=12.923, P=0.011; mTOR: x2=13.252, P=0.013). Conclusion PI3K/Akt/mTOR signal transduction pathway is over-activated in gliornas, which is closely correlated to the grade-malignancy; and the positive expression of PI3K, p-AKT and p-mTOR may predict the poor prognosis of the patients with gliomas.