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Study of splenopancreatic-preserving dissection of No.10 and No.11 lymphatic nodes in radical resection for proximal gastric carcinoma.

Wei-hong SUN ; Xi-zeng HUI

Chinese Journal of Gastrointestinal Surgery.2006;9(2):131-132.

OBJECTIVETo investigate the feasibility of splenopancreatic-preserving dissection of No.10 and No.11 lymph nodes in radical resection for proximal gastric carcinoma.

METHODSThe data of 62 patients with proximal gastric carcinoma undergoing splenopancreatic-preserving dissection of No.10 and No.11 lymph nodes were analyzed retrospectively.

RESULTSThis splenopancreatic-preserving dissection was effective significantly. The incidences of lymphatic metastasis in No.10 and No.11 were 19.4% and 22.6% respectively, and the incidence of complications was 16.1%, significantly lower than that (40 %) of non-splenopancreatic-preserving dissection.

CONCLUSIONSThe splenopancreatic-preserving dissection of No.10 and No.11 lymph nodes is a safe and feasible method in radical gastrectomy for proximal gastric carcinoma. The surgical procedure is not difficult. With careful operation,the complete clearance of the lymph nodes can be obtained.

Adult ; Aged ; Feasibility Studies ; Female ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Pancreas ; Retrospective Studies ; Spleen ; Stomach Neoplasms ; pathology ; surgery

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Clinicopathological analysis of synchronous liver metastasis in gastric cancer and evaluation of surgical outcomes.

Yu-ming LI ; Wen-hua ZHAN ; Fang-hai HAN ; Yu-long HE ; Jun-sheng PENG ; Shi-rong CAI ; Jin-ping MA ; Gang ZHAO

Chinese Journal of Gastrointestinal Surgery.2006;9(2):127-130.

OBJECTIVETo analyze the clinicopathological factors affecting synchronous liver metastasis in gastric cancer,and evaluate its surgical outcome.

METHODSClinical data of 44 patients with synchronous hepatic metastasis from gastric cancer from Aug. 1994 to Feb. 2004 were reviewed retrospectively, and compared with those of 576 gastric cancer patients without hepatic metastasis to analyze the clinicopathological factors affecting synchronous liver metastasis from gastric cancer. The survivals after radical resection, palliative and exploratory operation were compared.

RESULTSUnivariate analysis revealed that ascites, pelvic and peritoneal seeding, serosal invasion, lymph node metastasis, involvement of neighboring organs, Borrmann types,depth of infiltration were correlated with synchronous hepatic metastasis from gastric cancer (P< 0.01). Logistic regression showed peritoneal seeding (P=0.003, OR=1.629), serosal infiltration (P=0.000, OR=3.000), lymph node metastasis (P=0.081, OR=1.689) were independent risk factors for synchronous hepatic metastasis from gastric cancer. Sixteen (36.4%) patients received radical excision, 15 (34.1%) patients palliative operation, and 13 (29.5 %) patients exploratory operation,and the median survival times were 19.5, 11.0 and 6.2 months respectively (P< 0.05).

CONCLUSIONSPeritoneal seeding,serosal infiltration, lymph node metastasis are most important risk factors for synchronous hepatic metastasis from gastric cancer. Radical resection of gastric primary lesion and hepatic metastases can significantly prolong survival time.

Aged ; Female ; Follow-Up Studies ; Gastrectomy ; Hepatectomy ; Humans ; Liver Neoplasms ; pathology ; secondary ; surgery ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate ; Treatment Outcome

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Ex vitro sentinel lymph node mapping in colorectal carcinoma.

Dao-jin CHEN ; Feng-qiang ZHOU ; Yi GAN

Chinese Journal of Gastrointestinal Surgery.2006;9(2):124-126.

OBJECTIVETo investigate the feasibility of ex vitro sentinel lymph node (SLN) mapping with methylene blue staining and its clinical value of predicting regional lymph node metastasis in colorectal cancer.

METHODSMethylene blue (1 ml) was injected submucosally around the tumor immediately after resection. After 2-5 minutes, the first blue-dyed lymph nodes, sentinel lymph nodes (SLNs), were harvested for pathological examination, and compared with the pathological results of other lymph nodes.

RESULTSOf the total 32 patients, 57 SLNs were successfully identified in 30 patients with an average of 1.9 nodes per person. The successful labeling rate was 93.8% (30/32). Among the 13 patients with positive SLNs, there were 5 patients with positive non-SLNs and 8 patients with negative Non-SLNs. Among the 17 patients with negative SLNs, there were 15 patients with negative non-SLNs and 2 patients with positive Non-SLNs. The accuracy of SLNs for regional lymph node metastasis was 93.3% (28/30), the false negative rate was 11.8% (2/17), and the specificity was 100% (13/13).

CONCLUSIONSEx vitro sentinel lymph node mapping with methylene blue staining in colorectal carcinoma is technically feasible and can effectively reflect the metastatic situation of regional lymph nodes.

Adult ; Colorectal Neoplasms ; pathology ; Feasibility Studies ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Methylene Blue ; Middle Aged ; Sentinel Lymph Node Biopsy ; methods

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Extended radical resection with nerve-preservation for rectal cancer.

Xin-shu DONG ; Hai-tao XU ; Zhi-gao LI ; Zhi-wei YU ; Bin-bin CUI

Chinese Journal of Gastrointestinal Surgery.2006;9(2):121-123.

OBJECTIVETo investigate the clinical value of extended radical resection with nerve- preservation for rectal cancer.

METHODNinety-eight patients with rectal cancer received extended radical resection with nerve- preservation in our hospital. The questionnaire were used to collect the data of the patients urination and sexual function. The survival was analyzed retrospectively.

RESULTS62.3% (61/98) of the patients could erect normally and 57.1% (56/98) of the patients had normal sexual function. The average time of catheterization in 57 patients was 60 hours, the residual urine volume (RUV) was 28 ml and the max-micturition-desire urine volume was 400 ml. The 5-year survival rate of those who underwent extended radical resection with nerve-preservation was 61.2%.

CONCLUSIONExtended radical resection with nerve-preservation,which could decrease the incidences of post-operative urination and sexual dysfunction, and have not affect the survival, was the most optimal operation for rectal cancer.

Adult ; Female ; Humans ; Hypogastric Plexus ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Rectum ; innervation ; surgery ; Retrospective Studies ; Treatment Outcome

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Analysis of recurrence and prognosis after surgical resection for I stage lower rectal carcinoma.

Dong-bing ZHAO ; Jian-jun BI ; Ji-dong GAO ; Yong-fu SHAO ; Ping ZHAO

Chinese Journal of Gastrointestinal Surgery.2006;9(2):117-120.

OBJECTIVETo investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for I stage lower rectal carcinoma.

METHODSThe related clinicopathologic factors for recurrence and prognosis of 166 patients with I stage lower rectal carcinoma after surgical resection were retrospectively analyzed using univariate and multivariate methods.

RESULTSA total of 138 patients with I stage lower rectal carcinoma received radical resection according to the operative rules of total mesorectal excision (TME). Ninety-three patients received abdominoperineal resection (APR) operation, 45 patients received sphincter preserving operation, and 28 patients received local excision. The local recurrence rates were 6.5% (6/93), 2.2% (1/45), 17.9% (5/28), respectively . Histological differentiation and operative procedures were associated with local recurrence. The 5-year survival rates were 91.1% in APR group, 95.5% in sphincter preservation group and 82.6% in local resection group. Univariate analysis revealed that histological differentiation and local recurrence were correlated with prognosis. Multivariate analysis revealed that local recurrence was the most important prognostic factor for I stage lower rectal carcinoma.

CONCLUSIONSRadical resection of I stage lower rectal carcinoma has low recurrence rate and better prognosis. Sphincter preserving operation and local excision must be strictly selected in proper patients.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

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Transsphincteric surgery of rectal lesions: a report of 120 cases.

Hui-zhong QIU ; Guo-le LIN ; Bin WU ; Yi XIAO

Chinese Journal of Gastrointestinal Surgery.2006;9(2):114-116.

OBJECTIVETo generalize the clinical use of transsphincteric operation (Mason operation) for rectal lesions.

METHODSClinical data of 120 patients with middle and lower rectal lesions who underwent Mason operation from Aug. 1990 to Aug. 2005 were analyzed retrospectively.

RESULTSThere were 61 cases with villous adenoma including 26 with cancerization, 25 cases with rectal cancer including 16 cases with early rectal cancer, and 17 with submucosal tumor. Of the 103 patients with rectal tumor, 98 underwent partial rectectomy, 5 segmental rectectomy. The postoperative complications included incision infection in two cases (1.6%), fistula in 4 cases (3.3%). Three patients (3.0%) had postoperative local recurrence. 90.2% of the rectal cancer patients (46/51) survived more than five years after Mason operation.

CONCLUSIONMason operation is satisfactory because of good exposure and simple access to the rectum, which is suitable for those lesions that could be locally resected on the mid and low rectum.

Adult ; Aged ; Aged, 80 and over ; Anal Canal ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

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Efficacy of intersphincteric resection in the sphincter-preserving operation for ultra-lower rectal cancer.

Zhen-jun WANG ; Xiao-bo LIANG ; Xin-qing YANG ; Bin YANG ; Yan-ting HUANG

Chinese Journal of Gastrointestinal Surgery.2006;9(2):111-113.

OBJECTIVETo evaluate the clinical efficacy of intersphincteric resection in the sphincter- preserving operation for ultra-lower rectum cancer.

METHODSThirty-one rectal cancer patients with the distal edge of the tumour less than 2 cm from the dentate line were evaluated. Eighteen advanced rectal cancer patients received preoperative chemo-radiation. Total mesorectal excision (TME) was performed with the rectum immobilized down, and the puborectal ligament and partial levator cut to the level of the dentate line. In some well-exposed patients, it was possible to further immobilize the rectum between the external sphincter ring and the rectum inner sphincter wall. In anal approach,good exposure was attained and the cut-line was made vertically to the anal canal 2 cm below the lower edge of the tumor, and further intersphincteric immobilization was made upright. Colon or colon pouch were anastomosed to the distal anal wall.

RESULTSThere was no peri-operative death. Thirty patients had good fecal control. Twenty-nine patients showed no evidence of recurrence or metastasis after follow-up for 12 months. Recurrence occurred in one case 1 year after operation. Another one had higher CEA 19.9 level, but without evidence of metastasis.

CONCLUSIONRadical resection can be attained and anal sphincter preserved by intersphincter resection which is an alternative sphincter-preserving operation.

Anal Canal ; surgery ; Follow-Up Studies ; Humans ; Mesentery ; surgery ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Treatment Outcome

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Changes of sphincter preserving rate in lower rectal cancer and analysis of their related factors.

Jian-ping WANG ; Xiao-jian WU ; Xin-ming SONG ; Lei WANG ; Mei-jin HUANG ; Ping LAN

Chinese Journal of Gastrointestinal Surgery.2006;9(2):107-110.

OBJECTIVETo analyze the factors related to sphincter preserving(SP) operation for lower rectal cancer.

METHODSClinicopathological data of 316 patients with lower rectal cancer 1-5 cm from the anorectal line who underwent surgical resection from Aug. 1994 to Nov. 2005 were analyzed. The whole period was divided into two period based on the introduction of TME in Jan. 1999. The SP rates, leakage between the two period were compared.

RESULTSThe SP rate increased significantly from 44.9 % in period I (Aug. 1994-Dec. 1998) to 76.2 % in period II (Jan. 1999-Nov. 2005)(P=0.000). The factors significantly influencing SP were the distance from the anorectal line, sex, period, circumference of intramural spread, histological differentiation (P< 0.05). Significant differences were detected between the two period in sex, volume of blood transfusion, Dukes' stage (P< 0.05). The rate of leakage were 2.7 % and 1.3 % in the two period (P > 0.05).

CONCLUSIONSOver 12 years, the SP rate of rectal cancers 1-5 cm from the anorectal line was significantly increased and volume of blood transfusion reduced obviously due to the introduction of TME. These surgical techniques, however, have no effect on the operating time and leakage rates.

Anal Canal ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery

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Review and choice for gastric cancer expanded operation or gastric cancer shrink operation.

Jun-qing CHEN

Chinese Journal of Gastrointestinal Surgery.2006;9(1):8-10.

Gastrectomy ; Humans ; Stomach Neoplasms ; surgery ; Treatment Outcome

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Improve level of diagnosis treatment and academic research of gastric cancer in China.

Wen-hua ZHAN

Chinese Journal of Gastrointestinal Surgery.2006;9(1):5-7.

China ; Humans ; Stomach Neoplasms ; diagnosis ; therapy

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