Objective:To explore the relevant anatomical factors in the pathogenesis of chronic dacryocystitis based on CT radiomics. Methods:A retrospective analysis was conducted on the general data and sinus CT materials of 85 patients with chronic dacryocystitis（case group） admitted to our department from December 2020 to December 2023, and 85 individuals undergoing physical examination（control group） during the same period. The differences in anatomical parameters between the two groups were compared to study the morphological characteristics of the nasolacrimal duct in patients with chronic dacryocystitis. Univariate and multivariate logistic regression analyses were used to explore the relevant anatomical factors in the pathogenesis of chronic dacryocystitis. Results:There were statistically significant differences（P<0.05） in the proportion of combined nasal septal deviation, the distance between the anterior and posterior ridges of the lacrimal fossa, the angle between the long axis of the nasolacrimal duct and the projection on the midsagittal plane, the maximum transverse diameter of the bony nasolacrimal duct, the maximum cross-sectional area of the bony nasolacrimal duct, and the thickness of the frontal process of the maxilla between the two groups. There were no statistically significant differences（P>0.05） in whether there was a combined high-position nasal septal deviation, whether there was a combined non-high-position nasal septal deviation, and whether there was a combined pneumatized middle turbinate. Multivariate analysis showed that nasal septal deviation, the distance between the anterior and posterior ridges of the lacrimal fossa, the angle between the long axis of the nasolacrimal duct and the projection on the midsagittal plane, and the maximum cross-sectional area of the bony nasolacrimal duct are independent anatomical factors affecting the pathogenesis of chronic dacryocystitis. Conclusion:Nasal septal deviation, a large distance between the anterior and posterior ridges of the lacrimal fossa, a large angle between the long axis of the nasolacrimal duct and the projection on the midsagittal plane, and a small maximum transverse diameter of the bony nasolacrimal duct are important anatomical bases for the pathogenesis of chronic dacryocystitis, providing a basis for an in-depth understanding of the disease occurrence.
Humans ; Retrospective Studies ; Male ; Female ; Dacryocystitis/diagnostic imaging* ; Tomography, X-Ray Computed/methods* ; Nasolacrimal Duct/diagnostic imaging* ; Chronic Disease ; Nasal Septum/diagnostic imaging* ; Middle Aged ; Adult ; Radiomics

The comparison between traditional Chinese medicine Jinzhen oral liquid (JZOL) and Western medicine in treating children with acute bronchitis (AB) showed encouraging outcomes. This trial evaluated the efficacy and safety of the JZOL for improving cough and expectoration in children with AB. 480 children were randomly assigned to take JZOL or ambroxol hydrochloride and clenbuterol hydrochloride oral solution for 7 days. The primary outcome was time-to-cough resolution. The median time-to-cough resolution in both groups was 5.0 days and the antitussive onset median time was only 1 day. This randomized controlled trial showed that JZOL was not inferior to cough suppressant and phlegm resolving western medicine in treating cough and sputum and could comprehensively treat respiratory and systemic discomfort symptoms. Combined with clinical trials, the mechanism of JZOL against AB was uncovered by network target analysis, it was found that the pathways in TRP channels like IL-1β/IL1R/TRPV1/TRPA1, NGF/TrkA/TRPV1/TRPA1, and PGE2/EP/PKA/TRPV1/TRPA1 might play important roles. Animal experiments further confirmed that inflammation and the immune regulatory effect of JZOL in the treatment of AB were of vital importance and TRP channels were the key mechanism of action.

Objective:To investigate the treatment and prognosis of patients of G3 non-functional pancreatic neuroendocrine tumors (pNETs) with proliferation index of Ki-67 <55%.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 15 G3 non-functional pNETs patients with proliferation index of Ki-67<55% who were admitted to Zhongshan Hospital of Fudan University from April 2014 to April 2020 were collected. There were 11 males and 4 females, aged (58±10)years. All patients underwent radical resection of the primary lesion. Obser-vation indicators: (1) treatment; (2) postoperative pathological characteristics; (3) follow-up. Measure-ment data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers. The Pearson correlation analysis was used to verify the correlation between variables. Kaplan-Meier method was used to draw survival curve and calculate survival rate. Log-Rank test was used for survival analysis. Results:(1) Treatment. All 15 G3 nonfunctional pNETs patients underwent radical resection of the primary lesion of pancreas, including 5 cases receiving pancreati-coduodenectomy, 10 cases receiving distal pancreatectomy with splenectomy. There were 5 patients with simultaneous liver oligometastasis who underwent combined segmental (lobectomy) hepatectomy. All 15 patients had negative tumor margin, and the operation time and volume of intraoperative blood loss of 15 patients was 120(90,210)minutes and 200(50,300)mL, respectively. None of patient had complications ≥Ⅲ grade of the Clavien-Dindo classification during the postoperative 30 days. Of the 15 patients, there were 5 cases receiving comprehensive treatment based on CAPTEM chemo-therapy (temozolomide combined with capecitabine), 2 cases receiving local interventional therapy, 2 cases receiving CAPTEM chemotherapy, 1 case receiving local interventional therapy combined with molecular targeted therapy, 1 case receiving local interventional therapy combined with long acting somatostatin therapy, 1 cases receiving long acting somatostatin therapy combined with molecular targeted therapy, and 3 cases without postoperative treatment. (2) Postoperative patholo-gical characteristics. The tumor diameter of 15 patients was 3.3(range, 0.5-6.0)cm. There were 2 cases with tumor diameter <2 cm, 13 cases with tumor diameter ≥2 cm. The number of lymph nodes dissected and number of lymph nodes metastatic was 6(4, 10) and 2(1,3) in 15 patients, respectively, including 12 cases with positive lymph node metastasis. Of the 15 patients, there were 5 cases with tumor invasion of adjacent organ, 5 cases with simultaneous liver metastasis, 8 cases with perineural invasion and 8 cases with vascular invasion. There were 3, 7, and 5 patients with stage Ⅱ, stage Ⅲ, and stage Ⅳ of pathological TNM staging, respectively. The proliferation index of Ki-67 and mitotic count was 32%±9% and (11±9)/10 high power field in the primary lesion of 15 patients, respectively, and there was no correlation between proliferation index of Ki-67 and mitotic count ( P>0.05). (3) Follow-up. All 15 patients were followed up after surgery for (55±24)months. The median survival time of 15 patients was 78(range, 43-113)months, with 1-, 3-, 5-year overall survival rate as 100%, 92%, 62%, respectively. During the follow up, 9 of the 15 patients underwent tumor recurrence, with the recurrence time as 20(14, 44)months. There were 8 patients died of tumor recurrence or metastasis. The median survival time was 86(range, 51-120)months in 5 patients receiving comprehensive treatment based on CAPTEM chemotherapy, versus 53(range, 45-60)months in 10 patients receiving other postoperative adjuvant therapy or without postoperative treatment, showing a significant difference between them ( χ2=4.21, P<0.05). Conclusion:The prognosis of patients of G3 nonfunctional pNETs with proliferation index of Ki-67<55% undergoing radical resection combined with postoperative comprehensive treatment based on CAPTEM chemotherapy in better than that of patients receiving other postoperative adjuvant therapy or without posto-perative treatment.

Objective:To investigate the clinical effect of the repair and reconstruction of severe foot trauma by microsurgical methods.Methods:Patients with severe foot trauma were admitted to Xinhua Hospital (Chongming), Affiliated with Shanghai Jiao Tong University School of Medicine, and Taizhou Hospital, Affiliated with Wenzhou Medical University in Zhejiang Province from November 2008 to October 2019. All patients were treated with orthotopic replantation using microsurgical anastomosis in emergency and precise microsurgical reconstruction in the second stage. A retrospective analysis of the clinical effect of the reconstructed appearance and function was performed. The evaluation and surgical design were carried out according to the characteristics of the injury site, range, plane, degree, etc., and adequate debridement and orthotopic replantation of residual tissue was performed under the microscope in emergency. Then regular follow-up was conducted to evaluate the postoperative efficacy, the degree of foot swelling, and the observation of foot activity and function.Results:A total of 23 patients with severe foot trauma were enrolled, including 15 males and 8 females, aged from 17 to 69 years old, with an average of 38.5 years old. Among them were the left foot in 10 cases and the right foot in 13 cases. 15 of the 23 patients survived orthotopic replantation. 2 cases of medial plantar skin necrosis were treated by skin graft in the second stage, 1 case of heel skin necrosis and 2 cases of anterior plantar skin necrosis with infection were repaired by flaps, and 3 cases of dorsal skin necrosis with infection combined with bone defect were repaired by flaps or osteocutaneous flap. After the operation, 23 patients were followed up for 6 to 48 months, with an average of 18.5 months. The wounds were completely healed, the color and elasticity were close to the surrounding normal skin, and there was no apparent swelling deformity on foot. The sensory function of the foot was all restored to grades S3-S4, with a small scar, and they walked freely without noticeable limping. The efficacy was evaluated according to a survival situation, color elasticity, appearance and morphology, donor scar, skin sensation, infection control, and patient recognition. 16 cases were satisfied with the outcomes, and 7 reported moderate. Skin swelling rating in the early stage was 1st degree in 3 cases, 2nd degree in 10 cases, 3rd degree in 8 cases, 4th degree in 2 cases; in the later stage was 1st degree in 15 cases, 2nd degree in 6 cases, 3rd degree in 2 cases. Foot function is assessed by the degree of postoperative pain, function of flexion and extension, degree of deformity, and walking ability, which is excellent in 3 cases, good in 13 cases, general in 7 cases, with a reasonable rate of about 69.6%(16/23).Conclusions:The microsurgical technique is one of the most effective methods to repair and reconstruct the function and appearance of the foot with severe trauma for now.

Objective:To investigate the clinical effect of the repair and reconstruction of severe foot trauma by microsurgical methods.Methods:Patients with severe foot trauma were admitted to Xinhua Hospital (Chongming), Affiliated with Shanghai Jiao Tong University School of Medicine, and Taizhou Hospital, Affiliated with Wenzhou Medical University in Zhejiang Province from November 2008 to October 2019. All patients were treated with orthotopic replantation using microsurgical anastomosis in emergency and precise microsurgical reconstruction in the second stage. A retrospective analysis of the clinical effect of the reconstructed appearance and function was performed. The evaluation and surgical design were carried out according to the characteristics of the injury site, range, plane, degree, etc., and adequate debridement and orthotopic replantation of residual tissue was performed under the microscope in emergency. Then regular follow-up was conducted to evaluate the postoperative efficacy, the degree of foot swelling, and the observation of foot activity and function.Results:A total of 23 patients with severe foot trauma were enrolled, including 15 males and 8 females, aged from 17 to 69 years old, with an average of 38.5 years old. Among them were the left foot in 10 cases and the right foot in 13 cases. 15 of the 23 patients survived orthotopic replantation. 2 cases of medial plantar skin necrosis were treated by skin graft in the second stage, 1 case of heel skin necrosis and 2 cases of anterior plantar skin necrosis with infection were repaired by flaps, and 3 cases of dorsal skin necrosis with infection combined with bone defect were repaired by flaps or osteocutaneous flap. After the operation, 23 patients were followed up for 6 to 48 months, with an average of 18.5 months. The wounds were completely healed, the color and elasticity were close to the surrounding normal skin, and there was no apparent swelling deformity on foot. The sensory function of the foot was all restored to grades S3-S4, with a small scar, and they walked freely without noticeable limping. The efficacy was evaluated according to a survival situation, color elasticity, appearance and morphology, donor scar, skin sensation, infection control, and patient recognition. 16 cases were satisfied with the outcomes, and 7 reported moderate. Skin swelling rating in the early stage was 1st degree in 3 cases, 2nd degree in 10 cases, 3rd degree in 8 cases, 4th degree in 2 cases; in the later stage was 1st degree in 15 cases, 2nd degree in 6 cases, 3rd degree in 2 cases. Foot function is assessed by the degree of postoperative pain, function of flexion and extension, degree of deformity, and walking ability, which is excellent in 3 cases, good in 13 cases, general in 7 cases, with a reasonable rate of about 69.6%(16/23).Conclusions:The microsurgical technique is one of the most effective methods to repair and reconstruct the function and appearance of the foot with severe trauma for now.

Objective:To compare short-term efficacy of robotic versus 3D laparoscopic-assisted D2 radical distal gastrectomy in gastric cancerpatients and those with different body mass index (BMI).Method:A retrospective cohort study was performed. Inclusion criteria:(1) gastric cancer proved by preoperative pathological results and tumor location was suitable for D2 radical distal gastrectomy; (2) no distal metastases such as in liver, kidney or abdominal cavity, and no direct invasion to the pancreas or colon on preoperative imaging; (3) postoperative pTNM stage ranged from I to III; (4) no conversion to open surgery or change of surgical procedure during operation; (5) complete clinicopathological data. Patients with severe chronic diseases, other malignant tumors, tumor invasion of other organs or distant metastases, benign gastric tumors, gastrointestinal stromal tumors and recurrent gastric cancer were excluded. According to the above criteria, 531 patients who underwent robotic or 3D laparoscopic-assisted distal gastrectomy at the General Surgery Department of Chinese PLA General Hospital from January 2016 to December 2019 were enrolled. Among them, 344 patients underwent 3D laparoscopic-assisted distal gastrectomy (3D-LADG group), including 250 males, 94 females, 66 cases (19.2%) with a BMI ≥ 25 kg/m 2, and 278 cases (80.8%) with a BMI < 25 kg/m 2, and 187 patients underwent robotic-assisted distal gastrectomy (RADG group), including 122 males, 65 females, 69 cases (36.9%) with a BMI≥25 kg/m 2 and 118 cases (63.1%) with a BMI < 25kg/m 2. There were no significant differences in baseline characteristics between the two groups (all P > 0.05). Operative indicators, postoperative recovery, pathological characteristics and complication rate were compared between the two groups. Subgroup analysis stratified BMI was also performed. Results:Compared with RADG group, 3D-LADG group presented more harvested lymph nodes (29.1±12.4 vs. 25.2±9.0, t=4.238, P<0.001), shorter postoperative hospital stay [8.0 (7.0 to 10.0) days vs. 10.0 (9.0 to 11.0) days, Z=-6.205, P<0.001], less operative cost [(3.6×10 4±1.1×10 4) yuan vs. (6.2×10 4±3.5×10 4) yuan, t=-9.727, P<0.001], less cost of hospitalization [8.6×10 4(7.5×10 4 to 10.0×10 4) yuan vs. 12.8×10 4(11.7×10 4 to 14.1×10 4) yuan, Z=-15.997, P<0.001] and longer first flatus time [(3.9±1.0) days vs. (3.4±1.2) days, t=4.271, P<0.001], whose differences were all statistically significant (all P<0.05). While there were no statistically significant differences in operation time, intraoperative blood loss, overall complication rate [10.8%(37/344) vs. 12.8%(24/187), χ 2=0.515, P=0.473] and severe complications rate [2.0%(7/344) vs. 3.2%(6/187), χ 2=0.294, P=0.588] between 3D-LADG group and RADG group (all P>0.05). In BMI<25 kg/m 2 group, propensity score matching (PSM) was used to reduce bias of baseline characteristics. After PSM, 3D-LADG group presented higher proportion of intraoperative blood loss <50 ml [26.7% (31/116) vs. 8.6% (10/116), χ 2=13.065, P<0.001], more harvested lymph nodes [30.3±12.2 vs. 25.3±9.5, t=-3.192, P=0.002] and shorter postoperative hospital stay [9.0 (7.0 to 10.0) days vs. 10.0 (9.0 to 11.0) days, Z=-4.275, P<0.001] compared with RADG group, while other perioperative indicators showed no statistically significant differences between the two groups (all P>0.05). In BMI≥25 kg/m 2 group, 3D-LADG group presented higher proportion of intraoperative blood loss >200 ml [18.2% (12/66) vs. 1.4% (1/69), χ 2=10.853, P=0.001] and shorter postoperative hospital stay [8.0 (6.0 to 10.0) days vs. 9.0 (8.0 to 10.5) days, Z=-3.039, P=0.002] compared with RADG group, while other perioperative indicators also showed no statistically significant differences between the two groups (all P>0.05). Conclusion:It is safe and feasible to perform 3D-LADG and RADG for patients with gastric cancer. The short-term efficacy of both is similar.

Objective:Gastric cancer in adolescents is rare, with only a few cases reported in the literature. The purpose of this study is to investigate the clinicopathological features and prognostic factors of gastric cancer in adolescents aged 10-24 years.Methods:A case-controlled study was performed. The clinicopathological data of gastric cancer patients aged 10-24 years who were treated at the First Medical Center of Chinese PLA General Hospital from February 2000 to February 2017 were retrospectively collected and compared with those patients over 40 years old at the same period, which were randomly selected in a ratio of 1:2. All the patients were followed up until June 2019 and Cox proportional hazard model was used to analyze prognostic factors in the adolescent patients.Results:A total of 63 adolescent gastric cancer patients (0.4% of all 14 794 gastric cancer patients) were enrolled, including 31 males (49.2%) and 32 females (50.8%), with a mean body mass index of (19.5±4.3) kg/m 2. Before diagnosis, Only 35 cases (55.6%) had warning symptoms such as weight loss, ascites, obstruction, hematemesis, black stool, etc.; 5 cases (7.9%) had a family history of gastrointestinal tumor. The median duration of symptoms before diagnosis was 3 months. At diagnosis, 58 cases (92.1%) were poorly differentiated, 57 cases (90.5%) were T3-4 stage, 19 cases (30.2%) were signet ring cell cancer or mucous adenocarcinoma, 57 cases (90.5%) had lymph node metastasis, and 36 cases (57.1%) had distant metastasis. Twenty-nine patients (46.0%) underwent radical surgery, 12 patients underwent palliative surgery, 5 patients underwent exploratory laparotomy, 17 patients were unable to operate due to late stage. Of 56 cases (88.9%) with TNM stage Ⅲ-Ⅳ, 51 patients (81.0%) received chemotherapy. Of the 126 patients over 40 years old, 98 cases (77.8%) were male and 28 cases (22.2%) were female, and the mean body mass index was (23.8±3.2) kg/m 2. There were 60 cases (47.6%) with low differentiation, 90 cases (71.4%) with T3-4, 16 cases (12.7%) with signet ring cell cancer and mucous cell cancer, 79 cases (62.7%) with lymph node metastasis, and 12 cases (9.5%) with distant metastasis. A total of 115 cases (91.3%) underwent radical surgery. Of 74 cases (58.7%) with TNM stage Ⅲ-Ⅳ, 67 cases received (53.2%) chemotherapy. The 63 adolescent gastric cancer patients had lower body mass index, and higher proportion in female, poorly differentiation, signet ring cell cancer and mucous cell cancer, T3-4 stage, lymph node metastasis, distant metastasis, TNM stage Ⅲ-Ⅳ and receiving chemotherapy compared with 126 gastric cancer patients over 40 years old (all P<0.05). Among the 63 adolescent gastric cancer patients, 52 cases (82.5%) were followed up with median follow-up time of 72.1 (36.1, 100.8) months, and the median survival time was 10.4 months (95% CI: 6.5-15.1). The 1-year, 3-year and 5-year survival rates were 44.2%, 25.0% and 18.0%, respectively. Univariate analysis showed that the depth of tumor invasion (HR=7.15, 95% CI:1.71-29.89, P=0.007), lymph node metastasis (HR=6.00, 95% CI:1.42 - 25.42, P=0.015), distant metastasis (HR=7.25, 95% CI: 3.25 - 16.18, P<0.001), TNM stage (HR=5.49, 95% CI: 1.67-18.12, P=0.005) and tumor resection (HR=0.18, 95% CI: 0.09-0.37, P<0.001) were the risk factors affecting the prognosis of adolescent gastric cancer patients. Multivariate survival analysis showed that distant metastasis was an independent factor for gastric cancer survival in adolescents (HR=3.67, 95% CI: 1.32-10.19, P=0.012). Conclusions:Gastric cancer in adolescents is insidious and progresses rapidly. Most of them are in the advanced stage at diagnosis and have low rate of radical excision.

Objective:The storage of medical data has been digitized in China, but a unified and structured model has not yet been established. The standardized collection, analysis and sorting of tumor clinical data is the foundation of improving the standard of tumor diagnosis and treatment. Therefore, establishing a database platform of gastric cancer (GC) is an urgent need to integrate data resources and improve the level of diagnosis and treatment. The population economics indexes of GC patients in the last 20 years are analyzed in a single-center GC database. The medical records were structured by natural language processing technology. Authors aim to investigate the clinical pathological characteristics, staging and survival of the GC patients with gastrectomy.Method:A retrospective cohort study was carried out. Clinicopatological data of patients receiving surgical treatment from 2000 to 2019 were retrospectively collected. According to the gastric cancer TNM staging guidelines from the Union for International Cancer Control and the American Joint Committee on Cancer (UICC/AJCC) 8th edition, the structured gastric cancer clinicopathological data were re-evaluated and interpreted. The Kaplan-Meier method and the log-rank test were used to compare survival rate among different groups of patients with complete follow-up data of 2010-2016.Results:Clinicopathological data of 13 492 GC patients were enrolled. The ratio of men to women in the whole group was 3.25:1.00, including 10 320 men with average onset age of 59.68 years, which was basically stable in recent 20 years, and 3172 women with average onset age of 55.93 years, which presented a trend of average increasement of 0.17 year per year. The average hospitalization duration for GC patients showed a decreasing trend year by year, which was 13.87 days in 2019. Average hospitalization cost for GC patients was increasing year by year, with a peak of 83 600 CNY in 2017 and 75 400 CNY in 2019. By natural language identification and exclusion criteria screening, a total of 7218 GC patients obtained structured clinicopathological information. Analysis on clinicopathological characteristics of 3626 GC patients in the last 5 years showed that the average diameter of tumor was (4.44±2.61) cm; the average number of harvested lymph node was 24.30±13.29; the proportion of surgical methods were as following: open surgery in 1398 cases (38.55%), laparoscopic surgery in 1856 cases (51.19%) and robotic surgery in 372 cases (10.26%). The postoperative pathological stage was as following: IA in 658 cases (18.15%), IB in 318 cases (8.77%), IIA in 559 cases (15.42%), IIB in 543 (14.98%), III A in 632 (17.43%), III B in 612 cases (16.88%), III C in 276 cases (7.61%), and IV in 28 cases (0.77%). Complete follow-up data of 3431 patients from 2010 to 2016 were presented. The 1-, 3- and 5-year survival rates were 82%, 69% and 60%, respectively for the whole group. The 1-, 3- and 5-year survival rates for patients undergoing laparoscopic surgery were 83%, 70% and 64%, respectively, and for those undergoing open surgery were 81%, 67% and 56%, respectively, and the difference between the two groups was not statistically significant ( P=0.109). The 5-year survival rate of GC patients with different AJCC stages was as following: 88% in IA, 77% in IB, 70% in II A, 62% in II B, 44% in III A, 32% in III B, 22% in III C, and 17% in IV. Conclusion:This study provides basic data for the establishment of comprehensive diagnosis and treatment model of multicenter, shedding light on the improvement of comprehensive treatment of GC in China.

Objective:To compare short-term efficacy of robotic versus 3D laparoscopic-assisted D2 radical distal gastrectomy in gastric cancerpatients and those with different body mass index (BMI).Method:A retrospective cohort study was performed. Inclusion criteria:(1) gastric cancer proved by preoperative pathological results and tumor location was suitable for D2 radical distal gastrectomy; (2) no distal metastases such as in liver, kidney or abdominal cavity, and no direct invasion to the pancreas or colon on preoperative imaging; (3) postoperative pTNM stage ranged from I to III; (4) no conversion to open surgery or change of surgical procedure during operation; (5) complete clinicopathological data. Patients with severe chronic diseases, other malignant tumors, tumor invasion of other organs or distant metastases, benign gastric tumors, gastrointestinal stromal tumors and recurrent gastric cancer were excluded. According to the above criteria, 531 patients who underwent robotic or 3D laparoscopic-assisted distal gastrectomy at the General Surgery Department of Chinese PLA General Hospital from January 2016 to December 2019 were enrolled. Among them, 344 patients underwent 3D laparoscopic-assisted distal gastrectomy (3D-LADG group), including 250 males, 94 females, 66 cases (19.2%) with a BMI ≥ 25 kg/m 2, and 278 cases (80.8%) with a BMI < 25 kg/m 2, and 187 patients underwent robotic-assisted distal gastrectomy (RADG group), including 122 males, 65 females, 69 cases (36.9%) with a BMI≥25 kg/m 2 and 118 cases (63.1%) with a BMI < 25kg/m 2. There were no significant differences in baseline characteristics between the two groups (all P > 0.05). Operative indicators, postoperative recovery, pathological characteristics and complication rate were compared between the two groups. Subgroup analysis stratified BMI was also performed. Results:Compared with RADG group, 3D-LADG group presented more harvested lymph nodes (29.1±12.4 vs. 25.2±9.0, t=4.238, P<0.001), shorter postoperative hospital stay [8.0 (7.0 to 10.0) days vs. 10.0 (9.0 to 11.0) days, Z=-6.205, P<0.001], less operative cost [(3.6×10 4±1.1×10 4) yuan vs. (6.2×10 4±3.5×10 4) yuan, t=-9.727, P<0.001], less cost of hospitalization [8.6×10 4(7.5×10 4 to 10.0×10 4) yuan vs. 12.8×10 4(11.7×10 4 to 14.1×10 4) yuan, Z=-15.997, P<0.001] and longer first flatus time [(3.9±1.0) days vs. (3.4±1.2) days, t=4.271, P<0.001], whose differences were all statistically significant (all P<0.05). While there were no statistically significant differences in operation time, intraoperative blood loss, overall complication rate [10.8%(37/344) vs. 12.8%(24/187), χ 2=0.515, P=0.473] and severe complications rate [2.0%(7/344) vs. 3.2%(6/187), χ 2=0.294, P=0.588] between 3D-LADG group and RADG group (all P>0.05). In BMI<25 kg/m 2 group, propensity score matching (PSM) was used to reduce bias of baseline characteristics. After PSM, 3D-LADG group presented higher proportion of intraoperative blood loss <50 ml [26.7% (31/116) vs. 8.6% (10/116), χ 2=13.065, P<0.001], more harvested lymph nodes [30.3±12.2 vs. 25.3±9.5, t=-3.192, P=0.002] and shorter postoperative hospital stay [9.0 (7.0 to 10.0) days vs. 10.0 (9.0 to 11.0) days, Z=-4.275, P<0.001] compared with RADG group, while other perioperative indicators showed no statistically significant differences between the two groups (all P>0.05). In BMI≥25 kg/m 2 group, 3D-LADG group presented higher proportion of intraoperative blood loss >200 ml [18.2% (12/66) vs. 1.4% (1/69), χ 2=10.853, P=0.001] and shorter postoperative hospital stay [8.0 (6.0 to 10.0) days vs. 9.0 (8.0 to 10.5) days, Z=-3.039, P=0.002] compared with RADG group, while other perioperative indicators also showed no statistically significant differences between the two groups (all P>0.05). Conclusion:It is safe and feasible to perform 3D-LADG and RADG for patients with gastric cancer. The short-term efficacy of both is similar.

Objective:Gastric cancer in adolescents is rare, with only a few cases reported in the literature. The purpose of this study is to investigate the clinicopathological features and prognostic factors of gastric cancer in adolescents aged 10-24 years.Methods:A case-controlled study was performed. The clinicopathological data of gastric cancer patients aged 10-24 years who were treated at the First Medical Center of Chinese PLA General Hospital from February 2000 to February 2017 were retrospectively collected and compared with those patients over 40 years old at the same period, which were randomly selected in a ratio of 1:2. All the patients were followed up until June 2019 and Cox proportional hazard model was used to analyze prognostic factors in the adolescent patients.Results:A total of 63 adolescent gastric cancer patients (0.4% of all 14 794 gastric cancer patients) were enrolled, including 31 males (49.2%) and 32 females (50.8%), with a mean body mass index of (19.5±4.3) kg/m 2. Before diagnosis, Only 35 cases (55.6%) had warning symptoms such as weight loss, ascites, obstruction, hematemesis, black stool, etc.; 5 cases (7.9%) had a family history of gastrointestinal tumor. The median duration of symptoms before diagnosis was 3 months. At diagnosis, 58 cases (92.1%) were poorly differentiated, 57 cases (90.5%) were T3-4 stage, 19 cases (30.2%) were signet ring cell cancer or mucous adenocarcinoma, 57 cases (90.5%) had lymph node metastasis, and 36 cases (57.1%) had distant metastasis. Twenty-nine patients (46.0%) underwent radical surgery, 12 patients underwent palliative surgery, 5 patients underwent exploratory laparotomy, 17 patients were unable to operate due to late stage. Of 56 cases (88.9%) with TNM stage Ⅲ-Ⅳ, 51 patients (81.0%) received chemotherapy. Of the 126 patients over 40 years old, 98 cases (77.8%) were male and 28 cases (22.2%) were female, and the mean body mass index was (23.8±3.2) kg/m 2. There were 60 cases (47.6%) with low differentiation, 90 cases (71.4%) with T3-4, 16 cases (12.7%) with signet ring cell cancer and mucous cell cancer, 79 cases (62.7%) with lymph node metastasis, and 12 cases (9.5%) with distant metastasis. A total of 115 cases (91.3%) underwent radical surgery. Of 74 cases (58.7%) with TNM stage Ⅲ-Ⅳ, 67 cases received (53.2%) chemotherapy. The 63 adolescent gastric cancer patients had lower body mass index, and higher proportion in female, poorly differentiation, signet ring cell cancer and mucous cell cancer, T3-4 stage, lymph node metastasis, distant metastasis, TNM stage Ⅲ-Ⅳ and receiving chemotherapy compared with 126 gastric cancer patients over 40 years old (all P<0.05). Among the 63 adolescent gastric cancer patients, 52 cases (82.5%) were followed up with median follow-up time of 72.1 (36.1, 100.8) months, and the median survival time was 10.4 months (95% CI: 6.5-15.1). The 1-year, 3-year and 5-year survival rates were 44.2%, 25.0% and 18.0%, respectively. Univariate analysis showed that the depth of tumor invasion (HR=7.15, 95% CI:1.71-29.89, P=0.007), lymph node metastasis (HR=6.00, 95% CI:1.42 - 25.42, P=0.015), distant metastasis (HR=7.25, 95% CI: 3.25 - 16.18, P<0.001), TNM stage (HR=5.49, 95% CI: 1.67-18.12, P=0.005) and tumor resection (HR=0.18, 95% CI: 0.09-0.37, P<0.001) were the risk factors affecting the prognosis of adolescent gastric cancer patients. Multivariate survival analysis showed that distant metastasis was an independent factor for gastric cancer survival in adolescents (HR=3.67, 95% CI: 1.32-10.19, P=0.012). Conclusions:Gastric cancer in adolescents is insidious and progresses rapidly. Most of them are in the advanced stage at diagnosis and have low rate of radical excision.