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Pancreatic neuroendocrine carcinoma: clinicopathological characteristics and prognosis

Baobao XIN ; Wenhui LOU ; Jianang LI ; Xu HAN ; Xuefeng XU

Chinese Journal of General Surgery.2015;30(5):352-356. doi:10.3760/cma.j.issn.1007-631X.2015.05.006

Objective To analyze the clinicopathological characteristics and the related factors influencing the prognosis of pancreatic neuroendocrine carcinoma.Methods The clinicpathological and follow-up data of 21 patients with pancreatic neuroendocrine carcinoma admitted between April 2000 and August 2013 in Zhongshan Hospital of Fudan University were analyzed retrospectively.The influence facts on patients' prognosis were analyzed statistically.Results Univariate analysis showed that age,stage,tumor size,degree of tumor differentiation and lymph node metastasis were factors separately influenced patients' survival.Multivariate analysis (Cox regression) revealed that age (P =0.019) was the only independent factor affecting the prognosis.Conclusions Patients with pancreatic neuroendocrine carcinoma were mostly non-functional and presented no specific clinical features.Tumors tended to metastasize and the prognosis was poor.Age was the independent factor affecting the prognosis.

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Treatment of ilioinguinal approach surgery associated acute iatrogenic deep venous thrombosis

Fanguo KONG ; Songhui HAN ; Yuejing LI ; Fengwei LIU

Chinese Journal of General Surgery.2015;30(4):268-271. doi:10.3760/cma.j.issn.1007-631X.2015.04.004

Objective To evaluate the treatment of ilioinguinal approach surgery associated acute iatrogenic deep venous thrombosis (DVT).Methods The clinical data and treatment of 11 patients with ilioinguinal approach surgery associated acute iatrogenic DVT were analyzed.Results These 11 patients initially suffered from complicated acetabulum fracture,7 cases were treated by single ilioinguinal approach surgery and the other 4 cases were combined with Kocher-Langenbeck approach.In 3 days after surgery,DVTs were found by Doppler sonography,and all the DVTs were proved having closed relationships with ilioinguinal approach through digital subtraction angiography(DSA):iliac-femoral veins appeared stenosis at ilioinguinal segment in all the 11 cases,DVTs were found distal to the stenosis in 9 cases,both sides in 2 cases (1 case combined extensive iliac vein emphraxis and the other case combined extensive femoral vein emphraxis).After retrievable inferior vena cava filters were implanted,11 patients received catheter-directed thrombolysis for 5-12 days.Complete thrombolysis was achieved in 8 cases and thrombi residual left in 3 cases.The iliac-femoral veins were recanalized completely.After (10 ± 4) month fellow-up,no DVT recurred and no PTS appeared.Conclusions Ilioinguinal approach surgery seriously effects iliac-femoral veins,and is a important precipitating factor of DVT.Early catheter-directed thrombolysis under the protection of inferior vena cava filter is an effective treatment.

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Association of genetic polymorphisms in the FGB promoter region with idiopathic deep venous thrombosis

Shengbin HAN ; Jian DONG ; Hui JIN ; Bin YANG ; Fang YIN ; Youli WANG

Chinese Journal of General Surgery.2015;30(4):272-275. doi:10.3760/cma.j.issn.1007-631X.2015.04.005

Objective To probe the association between possible single nucleotide polymorphism (SNP) in the FGB promoter region and idiopathic deep venous thrombosis.Methods A prospective analysis was performed in both IDVT group and control group (120 cases each) followed by a duplex examination using gene sequencing technique and restriction fragment length polymorphism (RFLP) in the promoter region of fibrinogen gene β.Possible SNPs in this region were detected arranged before HardyWeinberg equilibrium test and Linkage disequilibrium (LD) analyses.Ultimately,we compared the genotype frequencies between the two groups and undertook a multiple Logistic regression.Results Six kinds of SNPs were determined in the promoter region of β-fibrinogen gene:-148C/T,-249C/T,-455G/A,-854G/A,-993C/T and-1420G/A.A stronger linkage disequilibrium was confirmed between-993C/T and -455G/A (r2 =0.699) ;-993C/T and-148C/T (r2 =0.509) ;-455G/A and-148C/T (r2 =0.556).Statistical differences of genotype frequencies between two groups were observed in-148C/T,-249C/T,-455G/A and-1420G/A polymorphisms (all P ＜ 0.05).Conclusions The risk of IDVT was 4.579 times higher with every 1 g/L increase of fibrinogen concentration.Allele-148T,-455G and-1420A are IDVT risk factors.-993C/T may indirectly affect IDVT through linkage disequilibrium with-455G/A and-148C/T.

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Artery bypass surgery and endovascular treatment for subclavian arterial sclerosis occlusion disease

Yixia QI ; Hengxi YU ; Yongquan GU ; Mingfei LI ; Lixing QI

Chinese Journal of General Surgery.2015;30(4):283-286. doi:10.3760/cma.j.issn.1007-631X.2015.04.008

Objective To investigate the safety and medium-and long-term effects of endovascular stenting,axilloaxillary bypass (AAB),carotid-subclavian bypass (CSB) in patients of subclavian arterial occlusion.Method From 2001 to 2013,311 consecutive patients with subclavian arteriosclerosis obliterans were treated with endovascular stenting (n =191),axilloaxillary bypass (n =96) or carotidsubclavian bypass(n =32).We collected patients' medical data,calculated patency of the graft or stent with life-table method and compared patency between three approaches with Log-rank.Results The incidence of perioperative complications was 4.1％ in the stenting group vs.11.5％ in AAB group vs.18.7％ in CSB group.There was significant statistical differences between the stenting group and bypass group about the incidence of perioperative complications.The primary patency rates at 1,3 and 5 years were 90.3％,84％,81.6％ in stenting group vs.95.3％,92.6％,88.9％ for AAB group vs.100％,96.4％,96.4％ for CSB group.There was significant statistical differences between the stenting group and bypass group about the primary patency rates.Conclusions Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian arteriosclerosis obliterans.However,effect of extrathoracic surgical bypass is more durable in the medium-and long-term.

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Resection of huge intraabdominal tumors along with involved inferior vena cava without reconstruction

Xuemin LIU ; Anpeng ZHANG ; Ji MIAO ; Shengli WU ; Jianhua SHI ; Yi LYU

Chinese Journal of General Surgery.2014;29(11):817-820. doi:10.3760/cma.j.issn.1007-631X.2014.11.001

Objective To evaluate the safety and feasibility of simple ligation and resection of the tumor involved inferior vena cava (IVC) without reconstruction during the resection of huge intraabdominal tumors.Methods From 2008 to 2011,4 cases of giant tumor encroaching on inferior vena cava underwent resection without IVC reconstruction.After resection,renal vein was not obstructed in patient 1 and 2.Tumor invaded the third patient's retrohepatic inferior vena cava,anastomosis was performed between the left hepatic vein and the opening of atrium dextrum with artificial vascular graft.The forth patient had right trisegmentectomy of the liver with retrohepatic inferior vena cava resection,anastomosis was performed between the left hepatic vein and the remaining inferior vena cava.Results All 4 patients had a successful operation without intraoperative massive bleeding and death.The postoperative complications included edema in one patient whose collateral circulation was damaged and bile leak in one.Ewin sarcoma patient died of tumor recurrence after a year,but there was no sign of poor renal function and other complications.Ligament fibroma patient had lower limb edema for a long time after the surgery,and tumor relapse for the fourth time in two years following resection.Conclusions When a giant tumor involving and invading IVC,undergoing resection,under the condition that the collateral circulations around IVC established completely,resection and ligation of the inferior vena cava along with huge tumor without IVC reconstruction is safe.This method saves operation time,increases the safety of surgery.

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Esophagofundostomy in combination with esophagogastric devascularization for the treatment of portal hypertension

Zhiyong WANG ; Junjing ZHANG ; Jianliang QIAO ; Xingkai MENG

Chinese Journal of General Surgery.2014;29(11):828-830. doi:10.3760/cma.j.issn.1007-631X.2014.11.004

Objective To evaluate the effect of esophagofundostomy combined with devascularization for the treatment of portal hypertension.Methods From February 2009 to August 2013,30 cases (research group) underwent esophagofundostomy combined with devascularization,while 56 cases (control group) were treated by devascularization only.Splenectomy was performed in all patients.Results There was no perioperative mortality in either group.The difference of postoperative serum bilirubin,albumin and blood platelet was not statistically significant (t =1.13、0.23、1.53,all P ＞ 0.05) ; The incidence of hepatic encephalopathy in research group and control group was 3％ and 11％,respectively,three years mortality was 14％ and 24％,respectively (x2 =0.61、1.22,all P ＞0.05).The rebleeding rate in research group was lower than control group,there was a significant difference (x2 =4.61,P ＜ 0.05).Research group was superior to control group in improving esophageal-gastric varices and there was a significant difference (P ＜ 0.05).Conclusions Compared with devascularization,esophagofundostomy combined with devascularization is more effective in reducing esophageal-gastric varices and prevention of rebleeding.

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MRI diagnosis of Wernicke encephalopathy after major surgical operation

Ying DONG ; Chuntao YE ; Ming JI ; Wei LIU

Chinese Journal of General Surgery.2014;29(11):843-846. doi:10.3760/cma.j.issn.1007-631X.2014.11.008

Objective To analyze MRI imaging features of patients with Wernicke encephalopathy after major surgical operation.Methods Clinical data including cranial MRI features were reviewed on five patients of Wernicke encephalopathy after major surgical operation from Jan 2012 to Nov 2013.Results The clinical features of patients with Wernicke encephalopathy after major surgical operation were noncharacterized and most of them had no specific value for diagnosis except for a definite history of vit B1 insufficiency.MRI imaging showed abnormal signal in the medial thalamus,third ventricle,surrounding area of the aqueduct of midbrain,column of fornix and the dorsal midbrain and pons ; Lesions were showed with long T1 and long T2 signal intensity and high signal intensity on fluid-attenuated inversion recovery (FLAIR),and high signal intensity on DWI(b equals 1 000 s/mm2).ADC value in all lesions increased from [(0.46-0.59) ×10-3 mm2/s] before treatment to [(0.81-1.10) ×10-3 mm2/s] after vit B1 supplement.Conclusions Wernicke encephalopathy has typical MRI imaging presentations.Early diagnosis and timely supplement of vitamin B1 can improve the prognosis.

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The extent of axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes

Liguang WEI ; Hua KANG ; Tao HAI ; Jiang ZHU ; Yajun WANG

Chinese Journal of General Surgery.2014;29(11):847-849. doi:10.3760/cma.j.issn.1007-631X.2014.11.009

Objective To explore the extent of axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes.Methods In this series,95 patients underwent complete axillary lymph node dissection (CALND) following positive sentinel lymph nodes identified and 97 patients underwent partial axillary lymph node dissection (PALND) at the absence of positive sentinel lymph nodes.The influence of different extent of axillary lymph node dissection was evaluated.Results The positive rate of level(Ⅰ + Ⅱ) non-sentinel lymph nodes (NSLN) and level Ⅲ lymph nodes was 68.4％ and 29.5％,respectively,in CALND group.In PALND situation,57.9％ CALND cases would have changed pathologic stage from pN1 to pN2 or pN3.But with level Ⅲ lymph node dissection followed PALND,only 2.1％ cases had changed pathologic stage from pN2 to pN3.Multivariate logistic regression showed that the number of positive SLNs (OR =2.157) and positive rate of SLNs (OR =10.374) were risk factors for having positive level Ⅲ lymph nodes.CALND needed longer operation time and larger postoperative drainage volume.Conclusions In cases of breast cancer with ≥ 3 positive sentinel lymph nodes,complete axillary lymph node dissection should be considered.

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In-vitro study of glycogen synthase kinase-3β on regulation of migration, invasion and epithelial-mesenchymal transition in pancreatic cancer cells

Wei ZHOU ; Meng ZHANG ; Xiaochuan WANG ; Yongfeng LI ; Heshui WU ; Chunyou WANG ; Tao LIU

Chinese Journal of General Surgery.2014;29(11):853-856. doi:10.3760/cma.j.issn.1007-631X.2014.11.011

Objective To explore the role of GSK-3β in migration,invasion,metastasis and epithelial-mesenchymal transition of pancreatic cancer in vitro.Methods Lentiviral interference was used to inhibit the expression of GSK-3β in pancreatic cancer cells.Western blotting was used to detect expression of GSK-3β phosphorylation molecules and epithelial-mesenchymal transition and invasion related molecule.Scratch test and transwell test were adopted to detect the effect of GSK-3β inhibition on cell migration and invasion in pancreatic cancer cells.Luciferase reporter gene test was used to detect the effect of GSK-3β inhibition on NF-κB binding activity.Results Inhibition of GSK-3β expression significantly restrain migration,invasion and epithelial-mesenchymal transformation.Migration inhibitory rate was 59.1％ ±6.4％ in ASPC-1 group and 55.9％ ± 7.3％ in PANC-1 group.GSK-3β inhibition affected the activity of NF-κB,the binding activity decreased to 24.8％ ± 3.1％ and 31.5％ ±5.4％,respectively (all P ＜ 0.05).Conclusions GSK-3β participates in the regulation of migration,invasion,and epithelialmesenchymal transition of pancreatic cancer.GSK-3β inhibition could surpress proliferation,invasion and epithelial-mesenchymal transformation,and NF-κB might be the key molecule in the regulation of pancreatic malignant behavior.

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Correlation between left iliac vein compression and left limb deep vein thrombosis

Feng CHEN ; Hui GUO ; Xianhua ZHU ; Chengchao LI ; Qingwen YUAN ; Jixin XIONG

Chinese Journal of General Surgery.2014;29(12):897-900. doi:10.3760/cma.j.issn.1007-631X.2014.12.001

Objective By using computer tomography (CT) to evaluate the left common iliac vein (LCIV) minor diameter and stenosis in deep vein thrombosis (DVT) patients and normal population,and to explore the correlation between LCIV compression and left-sided DVT.Methods Measurement and calculation of LCIV minor diameter and stenosis were conducted in 19 right-sided DVT,60 left-sided DVT and 218 control subjects.Multiple factors regression analysis was used to study the correlation of LCIV minor diameter and stenosis with left-sided DVT.Results In control group,51.8％ had greater than 50％ compression of LCIV,and 24.3％ had greater than 70％ compression.LCIV diameter in women [(4.7 ± 2.7) mm] was significantly smaller than that of men [(6.6 ± 3.3) mm,P ＜ 0.05)].LCIV diameter in leftsided DVT [(2.4 ± 1.0) mm] was significantly smaller than that in control group [(5.4 ± 3.1) mm,P ＜0.001)] or right-sided DVT [(6.2 ± 1.8) mm,P ＜0.01].LCIV stenosis in left-sided DVT [(78 ±8) ％]was higher than that in control group [(49 ±25)％,P ＜0.01)] or right-sided DVT [(38 ±21)％,P ＜0.01)].The odds of left DVT increased by a factor of 2.69 for each millimeter decrease in LCIV diameter (P ＜ 0.001,95％ CI 1.91-3.77),and 2.78 for each ten percent increase in LCIV stenosis (P ＜ 0.001,95％ CI 1.95-3.96).With LCIV stenosis ＞75％,the risk of left DVT was associated with an 11.10-fold increase,and with LCIV diameter ＜ 2.5 mm,the risk was associated with a 13.57-fold increase.Conclusions LCIV compression was an independent risk factor for left-sided DVT.Patients with severe LCIV compression were at high risk for left-sided DVT.

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