Purpose:To improve the methads of approach in s urgery of esophageal cancer ,increase resection rate of esophagectomy, decrease the remnant cancer in margin and mortality after operation, enhance the postoper ative effect. Methods:From Jan.1999 to Dec. 2002,we adopted different surgica l approach as in esophagectomy in 297cases with esophageal cancer, such as left posterior thoracotomy(group I), left posterior thoracotomy with cervical incisi on (group Ⅱ),right anterior thoracotomy (group Ⅲ), right posterior thoracotomy (group Ⅳ). Results:The rate of operative resection was 98.7%(293/297)an d for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ they were 98.2%(86/87)、98.1%(52/53)、98.5%(133/135) 、100%(22/22) respectively;operation-related mortality was 1.7%(5/297) and fo r groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 2.3%(2/87)、1.9%(1/53)、0.75%(1/135)、4.5%(1/22) respectively;the occurrence of remnant cancer was 3.8%(11/293) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 4.7%(4/86)、3.8%(2/52)、2.6%(3/133)、9.1%(2/22) respective ly;the rate of postoperative complication was 12.8%(38/297) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 17.2%(15/87)、9.4%(5/53)、11.1%(15/135)、13.6%(3/22) respectiv ely. In the number of lymph node resected , there was statistical difference bet ween groups Ⅲ, Ⅳ and Ⅰ, Ⅱ(P0.05).Conclusions:Right anterior thoracotomy, right posterior thoraco tomy were more satisfactory operative approaches in radical total thoracic esop hagectomy of esophageal carcinoma. Through these two approaches,we not only can resect mediastinal and abdominal lymph nodes radically, but can also decrease t he cancer of at the margin and mortality after operation.

Objective To elevate accuracy of CT T4 staging diagnosis of esophageal carcinoma, we analysed relativity between CT diagnosis and postoperational pathology for the tracheal, bronchial, carinate early invasion. Methods From 1996 to 2002, 49 patients with cervical and middle-upper segment esophageal carcinoma proved by esophagectomy and pathology, whom were taken cervical or thoracic CT scaning before operation. Comparison was studied between postoperational pathology and CT diagnosis of tumor early invasion of the trachea, bronchus and carina. Results Of 49 patients with esophageal carcinoma, 21 lesions were in the cervical esophagus, out of 18 cases with tracheal early invasion performed by CT scaning, 14 cases comfirmed by postoperational pathology; 28 lesions in the middle-upper segment of thoracic esophagus, out of 17 cases with tracheal, bronchial or carinate early invasion diagnosed by CT scaning, 14 cases testified by postoperational pathology. Tracheal, bronchial and carinate early invasion of esophageal carcinoma proved by CT did not accord with postoperational pathology completely. The sensitivity, specificity, and accuracy of CT diagnosis for the tracheal, bronchial and carinate early invasion of esophageal carcinoma were 93.3 %, 33.3 %, 76.2 % in cervical esophageal and 82.4 %, 72.7 %, 78.6 % in thoracic esophageal respectively. The contingency coefficients of preoperational CT scaning comparison with postoperational pathology are 0.52, 0.77 respectively. Conclusion Early invasion to the trachea, bronchus and carina identified by conventional CT procedure for patients with esophageal cancer was more accurate and specific in thoracic than that in cervical. Esophageal tumor early invasion to the trachea, bronchus and carina performed with CT corresponded to postoperational pathology in some measure. Operatablity did not completely depend on the invasion of the trachea, bronchus and carina of esophageal carcinoma performed with CT.

Objective MiRNA-10b is an important member of the MiRNA family , which has been proven that miRNA-10b can promote the growth and invasion of a variety of tumor cells .The aim of this study was to to investigate the effect and mechanism of miR-NA-10b on proliferation and invasion of low metastasis of lung cancer cell line (95-C). Methods The recombinant of miRNA-10b was transfected into 95-C by lipofectin method .The experiment set up 3 groups:blank control group , negative control group and miRNA-10b expression plasmid transfected group .MiRNA-10b expression level and KLF4mRNA expression level were detected by real-time fluores-cence quantitative PCR ( RTFQ-PCR) .The cell proliferation was detected by cell proliferation assay .The invasive ability of cell was de-tected by Transwell experiment .The expression of KLF4 protein was assessed by Western blot . Results At 48 hours after transfection, compared with blank control group (1.01 ±0.08) and negative control group (0.86 ±0.07), the miRNA-10b expression level in miRNA-10b expression plasmid transfected group (1.61 ±0.12) increased significantly (P<0.05) and there was no statistical difference between blank control group and negative control group (P>0.05).From the growth curve, the cell proliferation rate was obviously increased in miRNA-10b expression plasmid transfected group ([188.0 ±15.1]/HP) compared with the other two groups ([151.0 ±11.3]/HP), ([136.0 ±10.8]/HP) (P <0.05) and there was no statistical difference between these two groups ( P >0.05 ).Transwell result showed more cells transferred to the other side of Transwell compared with the other two groups ( P <0.05 ) and there was no statistical difference between these two groups (P >0.05).The expression of KLF4 protein decreased in miRNA-10b expression plasmid transfected group compared with the other two groups ( P<0.05).KLF4mRNA expression decreased, but the difference had no statistical significance (P>0.05). Conclusion MiRNA-10b might promote the pro-liferation and invasion of 95-C through down-regulation of KLF4 protein expression .

Objective To investigate the expressions of PTEN and p21 genes in Hazak patients with esophageal can-cer. Methods The expressions of PTEN and p21 genes were detected by RT-PCR in 48 samples (cancer tissues and nor-mal tissues) of patients with esophageal cancer. The relationship between the expressions of PTEN and p21 genes, tumor dif-ferentiation, TNM stage, clinical phase and lymph node metastasis were analyzed. Results The positive rates of PTEN gene were 75%and 45.8%in cancer and distant normal tissues. The expression of PTEN was significantly higher in cancer tis-sues than that of distant normal tissues (χ2=8.537,P＜0.05). The positive rates of p21 gene were 95.8%and 97.9%in cancer and distant normal tissues, and no significant difference between them (χ2=0.344,P>0.05). There was no correlation be-tween expressions of PTEN and p21and the tumor differentiation, the depth of invasion and lymph node metastasis in esopha-geal cancer. Conclusion PTEN and p21 genes are not the primary genes for the carcinogenesis of esophageal cancer in Hazak.

BACKGROUNDTo investigate the characteristics and patterns of lymph node metastasis in lung cancer, and to provide evidence for determining range of lymph node dissection.

METHODSOne hundred and five patients with lung cancer received complete resection combined with systematic lymph node dissection according to the mapping system developed by Naruke.

RESULTSA total of 801 lymph nodes were dissected from 105 lung cancer patients. The positive ratios of N1 and N2 were 15.9% and 14.9%, respectively. Twelve patients were found with skipping N2. These skipping N2 were located in 2, 4, 5, 6, 7 groups respectively. There was no significant relationship between size of primary tumor and lymph node metastasis. Small cell lung cancer showed the highest risk of lymph node metastasis. The metastatic rate of lymph node in adenocarcinoma was markedly higher than that in squamous cell carcinoma. Skipping mediastinal lymphatic metastasis was found more frequently in lower lobar tumors than that in upper lobar ones.

CONCLUSIONSLymph node metastasis of lung cancer may occur in multiple groups and multiple regions, even in a skipping pattern. Systematic lymph node dissection should be routinely performed in pulmonary resection for lung cancer.