With the improvement of survival outcome by modern surgical treatment,more and more attention has been paid to the postoperative quality of life.As known,the most related factor of postoperative quality of life is the pattern of digestive tract reconstruction.Current evidences indicate that Roux-en-Y esophagojejunostomy + jejunal pouch has some advantages in total gastrectomy and Roux-en-Y gastrojejunostomy might be most suitable reconstruction in distal gastrectomy.Pylorns-preserving gastrectomy and proximal gastrectomy are only considered in early gastric cancer,i.e.predictive cTlcN0.Pylorus-preserving gastrectomy does not exactly superior to distal gastrectomy.Total gastrectomy with Roux-en-Y esophagojejunostomy is superior to proximal gastrectomy with esophagogastrostomy.For unresectable lower tumor with gastric outlet obstruction,gastric cancer Devine exclusion + gastrojejunostomy might be better than simple gastrojejunostomy,while stent placement is safer and suitable for predictively short-term survival,poor performance status or senility patients.However,the current available evidences of reconstruction in gastric cancer surgery is still poor in quality and more high-quality large-scale multi-center randomized controlled trials are required to resolve the controversies.

Objective To review the current researches about tumor necrosis factor-related apoptosis ligand (TRAIL) and its receptors in gastric carcinoma. Methods Relevant articles of researches on TRAIL and its receptors in gastric carcinoma were searched in electronic databases of PUB-MEDLINE and Chinese Journal Fulltext Database. Results The reported TRAIL expression level of gastric carcinoma was diverse, which was highly correlated to the histological differentiation degree, serosa invasion and lymph node metastasis. Its receptors DR4 and DR5 were both positive in gastric carcinoma tissue, while some researches reported DcR1 and DcR2 were also positive expressed. caspase-3, -8 and survivin were the important factors for regulation of TRAIL signal pathway. 5-Aza-CdR, doxorubicin, 5-fluorouracil, ?-TOS and X-ray irradiation might enhance the TRAIL-induced apoptosis of gastric carcinoma cells. Conclusion Gastric carcinoma may be potentially sensitive to TRAIL targeting therapy, but the mechanism of TRAIL-induced apoptosis is quite complex and is regulated by multi-factors. Up to now, there are still many issues to research further, such as how to efficiently enhance and regulate the TRAIL-induced apoptosis of gastric carcinoma, whether any potential toxicities existing, etc.

Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was (1 225.15?216.23) cm~3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm~3)=12.712?body weight (kg)+450.44〕 and body surface area 〔liver volume (cm~3)=876.02?body surface area (m~2)-297.17〕. The mean liver volume of Child A, B and C patients were (1 077.77?347.01) cm~3, (1 016.35?348.60) cm~3 and (805.73?208.85) cm~3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P

OBJECTIVE: To figure out the etiological factors and overall mortality of the patients with acute intestinal obstruction, and to explore the rational period of conservative therapy before operation. METHODS: Medical records of all the patients with acute intestinal obstruction admitted to West China Hospital from 1995 to 2002 were retrospectively reviewed. The etiology of the obstruction was categorized, and the correlation of mortality and time interval between conservative therapy and operation was analyzed. RESULTS: There were 705 patients with acute intestinal obstruction included. There were 71.1% of the obstruction lesions located on the small bowel, and 82.6% of the patients experienced simple obstruction. The most frequent cause was adhesions (62.0%), and next was neoplasms (23.7%). There were 57.6% of the patients underwent the surgical treatment. The overall mortality rate was 1.6%, and the mortality rates in conservative therapy and surgical intervention groups were 1.3% and 1.7% respectively. The intestinal necrosis rate was increased gradually with the prolongation of time interval between conservative therapy and operation, and the death might occur 24 hours after strangulation. CONCLUSION: The epidemiological transition to adhesive obstruction still exists in China, and it is similar to that in Western countries. In our experience, near half of the patients with simple obstruction may achieve palliation by conservative therapy. Surgical intervention is indicated for the patients with prolonged and non-palliated simple obstruction, or strangulation disease within the first 24 hours.

OBJECTIVETo investigate the feasibility and safety of Da Vinci surgical robot in the dissection of splenic hilar lymph nodes for gastric cancer patients with total gastrectomy.

METHODSClinical data of two cases who underwent total gastrectomy for cardia cancer at our department in January 2016 were analyzed retrospectively.

RESULTSTwo male patients were 62 and 55 years old respectively, with preoperative diagnosis as cT2-3N0M0 and cT1-2N0M0 gastric cancer by gastroscope and biopsy, and both received robotic total gastrectomy spleen-preserving splenic hilar lymph node dissection successfully. The operative time for splenic hilar lymph node dissection was 30 min and 25 min respectively. The intraoperative estimated blood loss was both 100 ml, while the number of total harvested lymph node was 38 and 33 respectively. One dissected splenic hilar lymph node and fatty tissues in two patients were proven by pathological examinations. There were no anastomotic leakage, pancreatic fistula, splenic infarction, intraluminal bleeding, digestive tract bleeding, aneurysm of splenic artery, and other operation-associated complications. Both patients suffered from postoperative pneumonia, and were cured by conservative therapy.

CONCLUSIONThe robotic spleen-preserving splenic hilar lymph node dissection is feasible and safe, but its superiority needs further evaluation.

Blood Loss, Surgical ; Dissection ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Lymph Nodes ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Robotic Surgical Procedures ; Spleen ; Stomach Neoplasms ; surgery

Neoadjuvant chemotherapy combined with radical gastrectomy is one of the most important parts of the multimodality therapy strategies for locally advanced gastric cancer. With the development of laparoscopic technique in recent decades, laparoscopic technique plays a more and more important role in the surgical treatment of gastric cancer. Neoadjuvant chemotherapy, as a part of comprehensive treatment of gastric cancer, has gained more and more clinical supports and been recommended for guidelines. With the development of laparoscopic technique and clinical evidence, laparoscopic operation for advanced gastric cancer has been applied more and more widely. However, the safety and efficacy of laparoscopic resection following neoadjuvant chemotherapy, as a new treatment modality, still needs prospectively high-level researches to verify. Therefore, we will discuss some key points of laparoscopic gastrectomy after neoadjuvant chemotherapy based on the CLASS 03a trial, which is led by the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, the Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, and Chinese Laparoscopic Gastric Surgery Study Group. The CLASS 03a trial aims to confirm surgical and oncological safety of laparoscopy distal D2 radical gastrectomy for locally advanced stage gastric cancer patients (cT3~4a, N-/+, M0) who completed neoadjuvant chemotherapy. On the base of CLASS 03a trial, this article elucidates the choice of neoadjuvant chemotherapy for gastric cancer and proposes some associated problems about neoadjuvant chemotherapy combined with laparoscopic gastric cancer operation.

The development of evidence-based medicince should be an important milestone from the empirical medicine to the evidence-driving modern medicine. With the outbreak in biomedical data, the rising big data analysis can efficiently solve exploratory questions or decision-making issues in biomedicine and healthcare activities. The current problem in China is that big data analysis is still not well conducted and applied to deal with problems such as clinical decision-making, public health policy, and should not be a debate whether big data analysis can replace evidence-based medicine or not. Therefore, we should clearly understand, no matter whether evidence-based medicine or big data analysis, the most critical infrastructure must be the substantial work in the design, constructure and collection of original database in China.
China ; Decision Making ; Evidence-Based Medicine ; Humans

Objective: To compare the safety and efficacy between proximal gastrectomy and total gastrectomy and to ascertain the optimized procedure for patients with upper third gastric cancer through meta-analysis. Methods: The English literatures about proximal gastrectomy and total gastrectomy for upper third gastric cancer were searched from PubMed, EMBASE, the Cochrane Library and the Web of Science database and then collected. The quality of enrolled studies was independently assessed by two researchers according to the Newcastle-Ottawa Scale for retrospective studies and Jadad scale for RCT studies. The basic information of the literature and related clinical indicators were extracted. The primary endpoints were 5-year overall survival rate and recurrence rate. The secondary endpoints were operative time, intraoperative blood loss, morbidity of postoperative complication, incidence of anastomotic stenosis and incidence of reflux esophagitis. Considering the influence of tumor staging on postoperative clinicopathological features and prognosis, a subgroup analysis was performed on the literatures including cases of early gastric cancer and those including cases of tumor stage I to IV. Statistical analyses were carried out by the "metafor" and "meta" software packages from RevMan 5.3 software and R software (V3.2.4). Results: Twenty-five literatures involving 3667 patients (proximal gastrectomy for 1483, total gastrectomy for 2184) were finally enrolled for analysis, including 24 retrospective studies with ≥ 5 points and 1 RCT with 3 points, and all the literatures were of high quality. A total of 2516 cases of early gastric cancer were enrolled in 18 articles, including 1027 with proximal gastrectomy and 1489 with total gastrectomy. A total of 1151 cases with stage I to IV were enrolled in 7 articles, including 456 in proximal gastrectomy group and 695 in total gastrectomy group. Five-year survival rate was not significantly different for patients with early gastric cancer between the proximal gastrectomy group and total gastrectomy group (OR=1.16, 95% CI: 0.72 to 1.86, P=0.54). Similarly, there was no significant difference for patients with stage I to IV between the proximal gastrectomy group and the total gastrectomy group (OR=1.19, 95% CI: 0.92 to 1.53, P=0.18). Recurrence rate of early gastric cancer patients was not significantly different between the proximal gastrectomy group and the total gastrectomy group (OR=0.40, 95% CI: 0.05 to 3.16, P=0.39).However, the recurrence rate of the proximal gastrectomy group was higher than that of the total gastrectomy group in patients with stage I to IV (OR=1.55, 95% CI: 1.09 to 2.19, P<0.01), whose difference was statistically significant. There was no significant differences in postoperative complication between the groups, both in patients with early gastric cancer, and in those with stage I to IV (both P>0.05). The incidences of postoperative anastomotic stenosis (OR=3.57, 95% CI: 1.82 to 6.99, P<0.01) and reflux esophagitis (OR=2.83, 95% CI: 1.23 to 6.54, P=0.01) in the proximal gastrectomy group were significantly higher than those in the total gastrectomy group in patients with early gastric cancer. Conclusions There is no significant difference in long-term survival outcomes between total gastrectomy and proximal gastrectomy for upper gastric tumors. However,incidence of anastomotic stenosis and reflux esophagitis, and tumor recurrence rate after total gastrectomy are significantly lower. The total gastrectomy is recommended as the first choice for advanced upper gastric tumor.

OBJECTIVETo investigate the feasibility and efficacy of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer.

METHODSClinical data of 19 cases who underwent the laparoscopic clockwise modularized lymphadenectomy for gastric cancer (clockwise group) from July 2016 to September 2016 were analyzed retrospectively. The clockwise modularized lymphadenectomy included the fixed operative order, detailed procedure and requirement of lymphadenectomy, which mainly reflected in assisting the exposure of operative field and dissection of lymph nodes through suspending the liver and banding the greater omentum, as well as proposing the requirements and attentions for the dissections of each station of lymph nodes to facilitate the quality control of lymphadenectomy. The operative time, intraoperative complications, intraoperative estimate blood loss, number of total harvested lymph nodes, morbidity and postoperative recovery, were compared with the data of another 19 cases who received traditional lymphadenectomy from January 2016 to June 2016 (control group).

RESULTSThe baseline data were comparable between two groups. All the patients were performed successfully by laparoscopy without conversion and intraoperative complications. The operative time, intraoperative estimated blood loss and number of total harvested lymph node were (278.4±29.9) min, (91.1±41.6) ml and 38.2±15.1 in clockwise group, and were (296.7±30.3) min, (102.2±32.2) ml and 37.0±12.3 in control group without significant differences (all P>0.05). However, the mean number of retrieved No.11p lymph nodes was 2.2±1.8 in clockwise group, which was significantly higher than that in control group (0.8±1.0) (P=0.013). Four patients in each group suffered from pulmonary infections, who were cured by conservative therapies. There was no anastomotic leakage, intraperitoneal hemorrhage, intraperitoneal infection or intestinal obstruction in each group.

CONCLUSIONThe clockwise modularized lymphadenectomy can contribute to the facilitation of the retraction and exposure, decrease of the surgical duration and intraoperative blood loss, and radicalization of lymph node dissection, especially for the lymph nodes dissection around the celiac trunk.

Blood Loss, Surgical ; prevention & control ; statistics & numerical data ; Convalescence ; Gastrectomy ; methods ; Humans ; Intraoperative Complications ; epidemiology ; Laparoscopy ; methods ; Lymph Node Excision ; methods ; statistics & numerical data ; Lymph Nodes ; surgery ; Operative Time ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

The surgical treatment for adenocarcinoma of esophagogastric junction (AEG) involves thoracic and abdominal cavities. With no general consensus on the surgical treatment modality for AEG in China, the understanding and surgical practice of AEG are controversial between thoracic and gastrointestinal surgeons. Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition) was released in September 2018 by the Chinese expert panel including 19 thoracic surgeons and 20 gastrointestinal surgeons. The formulation and publication of this consensus has increased homogeneity of the understanding of the disease in different disciplines to a certain extent, and has facilitated standardized surgical treatment for adenocarcinoma of esophagogastric junction. The consensus was based on the best available clinical evidence and the latest national and international guidelines and consensus. Several rounds of discussion and voting were conducted. Finally, 27 statements on surgery-related recommendations and 9 issues requiring further investigation were reached in the consensus, which basically cover the fields and research hotspots of surgical treatment for adenocarcinoma of esophagogastric juncton. This review will explain in details the Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction.
Adenocarcinoma ; surgery ; China ; Consensus ; Esophageal Neoplasms ; surgery ; Esophagogastric Junction ; surgery ; Humans ; Stomach Neoplasms ; surgery