1.Application research of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early gastric cancer
Zhi ZHENG ; Zimeng WANG ; Rui XU ; Haiqiao ZHANG ; Zheng ZHANG ; Guotian RUAN ; Jie YIN ; Xiaoye LIU ; Jun CAI ; Guangyong CHEN ; Xiujing SUN ; Shengtao ZHU ; Peng LI ; Jun ZHANG ; Shutian ZHANG
Chinese Journal of Surgery 2025;63(7):587-596
Objective:To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer.Methods:This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024.Results:A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ( M(IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Conclusions:Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.
2.Predictive value of the percentage of Gleason pattern 4 in biopsy for adverse pathological features and biochemical recurrence after radical prostatectomy in ISUP grade group 2-3 non-metastatic prostate cancer
Haoyu WU ; Tianyu XIONG ; Yanning ZHANG ; Yunpeng FAN ; Tianyu ZHANG ; Zhanliang LIU ; Song JIN ; Guangyong CHEN ; Ping XIE ; Yinong NIU
Chinese Journal of Urology 2025;46(4):267-274
Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.
3.Diagnostic efficacy of methylene blue staining combined with light transmission method in endoscopic submucosal dissection samples of early gastric cancer
Mei JIA ; Kuiliang LIU ; Rui XU ; Bing YUE ; Yang GAO ; Xue MEI ; Guangyong CHEN
Chinese Journal of Digestive Endoscopy 2025;42(8):602-607
Objective:To explore the diagnostic efficacy of methylene blue staining combined with light transmission method (termed as light transmission and staining) in endoscopic submucosal dissection (ESD) specimens of early gastric cancer.Methods:A retrospective study was conducted on 75 specimens of early gastric cancer treated with ESD at Beijing Friendship Hospital, Capital Medical University from October 2021 to August 2023. Under a stereomicroscope, magnified observation and transmitted light transmission and staining observation were performed to compare the demarcation line (DL), irregular microvascular pattern (IMVP) and irregular microsurface pattern (IMSP) of the lesion, and the differences among histological types were compared. Furthermore, the false positive rate of surgical margin, the detection rate of undifferentiated cancer and multifocal lesions were compared against the 88 controls processed by traditional method.Results:Using the light transmission and staining method, DL, IMVP and IMSP were detected in 96.0% (72/75), 89.3% (67/75), and 98.7% (74/75), which was higher than 72.0% (54/75), 6.7% (5/75), and 26.7% (20/75) by using the magnified observation ( χ 2=8.036, P<0.001; χ 2=0.640, P<0.001; χ 2=0.369, P<0.001). There was no statistical difference in the coincidence rate of endoscopy and pathology between differentiated type, undifferentiated type and mixed type [92.2% (59/64), 50.0% (1/2), 77.8% (7/9), χ 2=5.145, P=0.055]. Compared to traditional methods, light transmission and staining could increase the detection rate of undifferentiated cancer [14.7% (11/75) VS 4.5% (4/88), χ 2=4.964, P=0.026] and reduce the false positive rate of surgical margins [1.3% (1/75) VS 11.4% (10/88), χ 2=4.585, P=0.032], but showed no statistical difference in the detection rate of multifocal lesions [5.3% (4/75) VS 0.0% (0/88), χ 2=2.841, P=0.094]. Conclusion:Light transmission and staining enhances pathological recognition of DL, IMVP and IMSP during specimen processing, improving detection of undifferentiated cancer and reducing false positive of margin.
4.Predictive value of serum sCD163 and MFG-E8 for acute cholangitis in patients with obstructive jaundice caused by common bile duct stones
Ke WANG ; Guangyuan WANG ; Xianping CUI ; Guangyong LIU ; Guang HONG ; Lijuan LIU ; Wenying JIANG
Chinese Journal of General Surgery 2025;34(10):2198-2204
Background and Aims:Obstructive jaundice(OJ)caused by common bile duct stones(CBDS)is a major risk factor for acute cholangitis(AC).Early identification of high-risk patients is essential for improving prognosis.Soluble CD163(sCD163)and milk fat globule epidermal growth factor 8(MFG-E8)are associated with inflammatory diseases,but their predictive value for AC in CBDS-related OJ remains unclear.This study aimed to evaluate the predictive significance of serum sCD163 and MFG-E8 levels for AC in patients with CBDS-OJ.Methods:A total of 142 patients with CBDS-OJ admitted from January 2022 to June 2024 were included as the observation group,and 145 healthy individuals undergoing physical examination served as controls.Serum sCD163 and MFG-E8 levels were measured using ELISA.Based on the occurrence of AC within 24 hours after admission,patients with CBDS-OJ were divided into an AC group(n=48)and a non-AC group(n=94).Clinical variables and serological indicators were compared between groups.Multivariate logistic regression was used to identify independent factors associated with AC.Receiver operating characteristic(ROC)curves were generated to assess the predictive performance of sCD163,MFG-E8,and their combination.Results:Compared with the control group,patients with CBDS-OJ showed significantly elevated serum sCD163 levels and decreased MFG-E8 levels(both P<0.05).Within the observation group,the AC group had higher AST,ALT and sCD163 levels and lower MFG-E8 levels than the non-AC group(all P<0.05).Logistic regression identified elevated sCD163 as an independent risk factor(OR=3.478,P<0.001)and reduced MFG-E8 as a protective factor(OR=0.526,P=0.020)for AC.ROC analysis showed AUC values of 0.759 for sCD163,0.787 for MFG-E8,and 0.920 for their combined detection,with the combined model outperforming either marker alone(P<0.001).Conclusion:Serum sCD163 elevation and MFG-E8 reduction are closely associated with the development of AC in patients with CBDS-OJ.Combined detection of sCD163 and MFG-E8 provides superior predictive value and may serve as a useful tool for early risk stratification in clinical practice.
5.Effects of berberine on lipopolysaccharide induced proliferation,apoptosis,inflammation,and osteogenic dif-ferentiation of human periodontal ligament stem cells by regulating the NF-κB/NLRP3 signaling pathway
Guangyong HAO ; Xinyu ZHANG ; Ke LIU
Journal of Practical Stomatology 2025;41(6):768-773
Objective:To investigate the effects of berberine on the proliferation,apoptosis,inflammation,and osteogenic differen-tiation of human periodontal ligament stem cells(hPDLSCs)induced by lipopolysaccharide through regulating the NF-κB/NLRP3 signaling pathway.Methods:HPDLSCs with good growth status were separated into a blank group(without any treatment),a lipopolysaccharide group(1 μg/mL lipopolysaccharide,A group),a low concentration berberine(berberine-L)group(1 μg/mL lipopolysaccharide+25 μmol/L berberine,B group),a medium concentration berberine(berberine-M)group(1 μg/mL lipopolysac-charide+50 μmol/L berberine,C group),a high concentration berberine(berberine-H)group(1 μg/mL+100 μmol/L berberine,D group),and a berberine-H+Prostratin group(1 μg/mL lipopolysaccharide+100 μmol/L berberine+1 μmol/L Prostratin,E group).Subsequently,the cell proliferation,levels of interleukin-1β(IL-1β),IL-6,and tumor necrosis factor-α(TNF-α)in the supernatant,cell apoptosis,osteogenic differentiation ability,expression of osteogenic differentiation related genes[RUNX family transcription fac-tor 2(Runx2),osteopontin(OPN),osteocalcin(OCN)],and expression levels of NF-κB and NLRP3 mRNA were detected.Results:The number of mineralized nodules,cell proliferation rate,ALP content,OPN,OCN,and Runx2 protein expression in the lipopolysac-charide group were greatly reduced compared to the blank group,however,the levels of IL-1 β,IL-6,and TNF-α,apoptosis rate,NF-κB,and NLRP3 mRNA expression in the supernatant were greatly increased(P<0.05).After treating cells with different doses of berberine,the number of mineralized nodules,proliferation rate,ALP content,OPN,OCN,and Runx2 protein expression were greatly increased,the levels of IL-1β,IL-6,and TNF-α,apoptosis rate,NF-κB,and NLRP3 mRNA expression in the supernatant were greatly reduced,and the berberine-H group was the most great(P<0.05).After treatment with berberine-H combined with Prostratin,the number of mineralized nodules,proliferation rate,ALP content,OPN,OCN and Runx2 protein expression were greatly reduced compared to single berberine-H treatment,the levels of IL-1β,IL-6 and TNF-α,apoptosis rate,NF-κB,and NLRP3 mRNA expression in the supernatant were greatly increased(P<0.05).Conclusion:Berberine enhances lipopolysaccharide induced proliferation of hPDLSCs,inhibits apoptosis and inflammation,and promotes osteogenic differentiation by inhibiting the NF-κB/NLRP3 signaling pathway.
6.Predictive value of serum sCD163 and MFG-E8 for acute cholangitis in patients with obstructive jaundice caused by common bile duct stones
Ke WANG ; Guangyuan WANG ; Xianping CUI ; Guangyong LIU ; Guang HONG ; Lijuan LIU ; Wenying JIANG
Chinese Journal of General Surgery 2025;34(10):2198-2204
Background and Aims:Obstructive jaundice(OJ)caused by common bile duct stones(CBDS)is a major risk factor for acute cholangitis(AC).Early identification of high-risk patients is essential for improving prognosis.Soluble CD163(sCD163)and milk fat globule epidermal growth factor 8(MFG-E8)are associated with inflammatory diseases,but their predictive value for AC in CBDS-related OJ remains unclear.This study aimed to evaluate the predictive significance of serum sCD163 and MFG-E8 levels for AC in patients with CBDS-OJ.Methods:A total of 142 patients with CBDS-OJ admitted from January 2022 to June 2024 were included as the observation group,and 145 healthy individuals undergoing physical examination served as controls.Serum sCD163 and MFG-E8 levels were measured using ELISA.Based on the occurrence of AC within 24 hours after admission,patients with CBDS-OJ were divided into an AC group(n=48)and a non-AC group(n=94).Clinical variables and serological indicators were compared between groups.Multivariate logistic regression was used to identify independent factors associated with AC.Receiver operating characteristic(ROC)curves were generated to assess the predictive performance of sCD163,MFG-E8,and their combination.Results:Compared with the control group,patients with CBDS-OJ showed significantly elevated serum sCD163 levels and decreased MFG-E8 levels(both P<0.05).Within the observation group,the AC group had higher AST,ALT and sCD163 levels and lower MFG-E8 levels than the non-AC group(all P<0.05).Logistic regression identified elevated sCD163 as an independent risk factor(OR=3.478,P<0.001)and reduced MFG-E8 as a protective factor(OR=0.526,P=0.020)for AC.ROC analysis showed AUC values of 0.759 for sCD163,0.787 for MFG-E8,and 0.920 for their combined detection,with the combined model outperforming either marker alone(P<0.001).Conclusion:Serum sCD163 elevation and MFG-E8 reduction are closely associated with the development of AC in patients with CBDS-OJ.Combined detection of sCD163 and MFG-E8 provides superior predictive value and may serve as a useful tool for early risk stratification in clinical practice.
7.Effects of berberine on lipopolysaccharide induced proliferation,apoptosis,inflammation,and osteogenic dif-ferentiation of human periodontal ligament stem cells by regulating the NF-κB/NLRP3 signaling pathway
Guangyong HAO ; Xinyu ZHANG ; Ke LIU
Journal of Practical Stomatology 2025;41(6):768-773
Objective:To investigate the effects of berberine on the proliferation,apoptosis,inflammation,and osteogenic differen-tiation of human periodontal ligament stem cells(hPDLSCs)induced by lipopolysaccharide through regulating the NF-κB/NLRP3 signaling pathway.Methods:HPDLSCs with good growth status were separated into a blank group(without any treatment),a lipopolysaccharide group(1 μg/mL lipopolysaccharide,A group),a low concentration berberine(berberine-L)group(1 μg/mL lipopolysaccharide+25 μmol/L berberine,B group),a medium concentration berberine(berberine-M)group(1 μg/mL lipopolysac-charide+50 μmol/L berberine,C group),a high concentration berberine(berberine-H)group(1 μg/mL+100 μmol/L berberine,D group),and a berberine-H+Prostratin group(1 μg/mL lipopolysaccharide+100 μmol/L berberine+1 μmol/L Prostratin,E group).Subsequently,the cell proliferation,levels of interleukin-1β(IL-1β),IL-6,and tumor necrosis factor-α(TNF-α)in the supernatant,cell apoptosis,osteogenic differentiation ability,expression of osteogenic differentiation related genes[RUNX family transcription fac-tor 2(Runx2),osteopontin(OPN),osteocalcin(OCN)],and expression levels of NF-κB and NLRP3 mRNA were detected.Results:The number of mineralized nodules,cell proliferation rate,ALP content,OPN,OCN,and Runx2 protein expression in the lipopolysac-charide group were greatly reduced compared to the blank group,however,the levels of IL-1 β,IL-6,and TNF-α,apoptosis rate,NF-κB,and NLRP3 mRNA expression in the supernatant were greatly increased(P<0.05).After treating cells with different doses of berberine,the number of mineralized nodules,proliferation rate,ALP content,OPN,OCN,and Runx2 protein expression were greatly increased,the levels of IL-1β,IL-6,and TNF-α,apoptosis rate,NF-κB,and NLRP3 mRNA expression in the supernatant were greatly reduced,and the berberine-H group was the most great(P<0.05).After treatment with berberine-H combined with Prostratin,the number of mineralized nodules,proliferation rate,ALP content,OPN,OCN and Runx2 protein expression were greatly reduced compared to single berberine-H treatment,the levels of IL-1β,IL-6 and TNF-α,apoptosis rate,NF-κB,and NLRP3 mRNA expression in the supernatant were greatly increased(P<0.05).Conclusion:Berberine enhances lipopolysaccharide induced proliferation of hPDLSCs,inhibits apoptosis and inflammation,and promotes osteogenic differentiation by inhibiting the NF-κB/NLRP3 signaling pathway.
8.Predictive value of the percentage of Gleason pattern 4 in biopsy for adverse pathological features and biochemical recurrence after radical prostatectomy in ISUP grade group 2-3 non-metastatic prostate cancer
Haoyu WU ; Tianyu XIONG ; Yanning ZHANG ; Yunpeng FAN ; Tianyu ZHANG ; Zhanliang LIU ; Song JIN ; Guangyong CHEN ; Ping XIE ; Yinong NIU
Chinese Journal of Urology 2025;46(4):267-274
Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.
9.Diagnostic efficacy of methylene blue staining combined with light transmission method in endoscopic submucosal dissection samples of early gastric cancer
Mei JIA ; Kuiliang LIU ; Rui XU ; Bing YUE ; Yang GAO ; Xue MEI ; Guangyong CHEN
Chinese Journal of Digestive Endoscopy 2025;42(8):602-607
Objective:To explore the diagnostic efficacy of methylene blue staining combined with light transmission method (termed as light transmission and staining) in endoscopic submucosal dissection (ESD) specimens of early gastric cancer.Methods:A retrospective study was conducted on 75 specimens of early gastric cancer treated with ESD at Beijing Friendship Hospital, Capital Medical University from October 2021 to August 2023. Under a stereomicroscope, magnified observation and transmitted light transmission and staining observation were performed to compare the demarcation line (DL), irregular microvascular pattern (IMVP) and irregular microsurface pattern (IMSP) of the lesion, and the differences among histological types were compared. Furthermore, the false positive rate of surgical margin, the detection rate of undifferentiated cancer and multifocal lesions were compared against the 88 controls processed by traditional method.Results:Using the light transmission and staining method, DL, IMVP and IMSP were detected in 96.0% (72/75), 89.3% (67/75), and 98.7% (74/75), which was higher than 72.0% (54/75), 6.7% (5/75), and 26.7% (20/75) by using the magnified observation ( χ 2=8.036, P<0.001; χ 2=0.640, P<0.001; χ 2=0.369, P<0.001). There was no statistical difference in the coincidence rate of endoscopy and pathology between differentiated type, undifferentiated type and mixed type [92.2% (59/64), 50.0% (1/2), 77.8% (7/9), χ 2=5.145, P=0.055]. Compared to traditional methods, light transmission and staining could increase the detection rate of undifferentiated cancer [14.7% (11/75) VS 4.5% (4/88), χ 2=4.964, P=0.026] and reduce the false positive rate of surgical margins [1.3% (1/75) VS 11.4% (10/88), χ 2=4.585, P=0.032], but showed no statistical difference in the detection rate of multifocal lesions [5.3% (4/75) VS 0.0% (0/88), χ 2=2.841, P=0.094]. Conclusion:Light transmission and staining enhances pathological recognition of DL, IMVP and IMSP during specimen processing, improving detection of undifferentiated cancer and reducing false positive of margin.
10.Application research of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early gastric cancer
Zhi ZHENG ; Zimeng WANG ; Rui XU ; Haiqiao ZHANG ; Zheng ZHANG ; Guotian RUAN ; Jie YIN ; Xiaoye LIU ; Jun CAI ; Guangyong CHEN ; Xiujing SUN ; Shengtao ZHU ; Peng LI ; Jun ZHANG ; Shutian ZHANG
Chinese Journal of Surgery 2025;63(7):587-596
Objective:To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer.Methods:This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024.Results:A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ( M(IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Conclusions:Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.

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