Objective To explore the association of macrophages with carcinogenesis and development of gastric cancer. Method The related literatures at home and abroad were consulted and reviewed. Results The microenvironment of gastric cancer could induce the polarization of macrophages，and then the activated macrophages，especially the tumor associated macrophages，could in turn motivate the growth，invasion，and metastasis of tumor cells by secreting a series of active substances. Conclusions Macrophages，especially the tumor associated macrophages play an importantrole in the carcinogenesis and development of gastric cancer. Investigating the macrophages and their interaction with gastric cancer may lead to a profound understanding of carcinogenesis of gastric cancer as well as opening up a new prospectfor treatment.
Objective To investigate the significance and surgical skill for lymphadenectomy around common hepatic artery in gastric cancer. Methods Two hundred and fifty-seven cases with undergoing lymphadenectomy around common hepatic artery in gastric cancer between January 2001 and December 2006 were retrospectively reviewed. Experiences and understanding of dealing with this procedure in curative gastrectomy for gastric cancer were concluded. Results The number of dissected No.8 lymph node was 2.2±1.7, and the positive rate of No.8 lymph node was 30.35%. There were no lymphadenectomy related complications, such as anastomotic leakage, lymphatic fistula and postoperative hemorrhage in this series. Dissection around common hepatic artery lymph nodes along artery intrathecal space, division and ligation of left gastric vein at its root, and sufficient exposure of anatomic structures were important to dissection lymph nodes around the common hepatic artery. The exposure of anatomic structures included liberation of common hepatic artery by traction with the band, and the exposure of posterior side of pancreas by Kocher incision.Conclusion Being familiar with the anatomy around common hepatic artery, careful dissection, and attention to the surgical skill of lymphadenectomy are very important to improve the effectiveness of lymphadenectomy around common hepatic artery in gastric cancer.
ObjectiveTo compare clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopy-assisted gastrectomy (LAG) and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy. MethodThe clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed. ResultsAll procedures were completed successfully. There were no significant differences in the time of anastomosis〔(73.8±10.3) min versus (72.7±8.9) min, t=0.693, P=0.489〕 and the number of dissected lymph nodes (32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485) between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss〔(275.0±66.3) mL versus (364.3±75.7) mL, t=-7.419, P=0.000〕, the incision length〔(3.0±0.8) cm versus (7.3±1.7) cm, t=-19.354, P=0.000〕, the time to fluid diet〔(4.9±0.8) d versus (6.0±0.7) d, t=-8.750, P=0.000〕 and the time to flatus 〔(2.8±0.8) d versus (3.9±0.8) d, t=-8.388, P=0.000〕, the off-bed time〔(1.3±0.5) d versus (3.4±1.2) d, t=-14.118, P=0.000〕, and the hospital stay〔(9.8±1.2) d versus (13.0±1.5) d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score〔On day 1 postoperatively: (3.4±0.8) points versus (6.2±1.3) points, t=-15.509, P=0.000; on day 3 postoperatively: (1.7±0.6) points versus (4.0±0.8) points, t=-18.799, P=0.000〕 and the dosage of pain killers (1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000) in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7% (4/70). While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG. ConclusionsTotal laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.
Objective To clarify the most important factors affecting the survival of patient with gastric carcinoma. Methods 428 cases of resected gastric carcinoma were studied by using univariate analyses and multivariate regression analyses. Results The most significant factors influencing survival of these patients were peritoneal dissemination, Borrmann classification, type of operation, hepatic metastasis, size of tumor, location, lymph node metastasis and age. Conclusion The factors influencing survival in patient with gastric carcinoma after resection can be correctly analyzed by cox’s proportional hazard model.
Objective To investigate the expression of transcription factor e2f-1 in the different development stages of gastric cancer, the relationships between clinicopathologic characteristics and e2f-1 expression status, as well as its influences on the prognosis. Methods The operative samples from primary lesion of 121 patients who underwent radical resection for gastric cancer were detected by SABC immunohistochemical staining. The relationships of e2f-1 expression with clinicopathologic characteristics and with the prognosis were observed by univariate, multivariate and relative analyses. Results The total positive expression rate of e2f-1 in all patients was 38.8% （47/121）. With the advancement of gastric cancer, the level of e2f-1 expression in TNMⅠ-Ⅳ stage was gradually decreased (r=－0.320， Plt;0.05)： Ⅰa stage with 62.5% （10/16）， Ⅰb with 47.1% （8/17）， Ⅱwith 55.0% （11/20）， Ⅲa with 40.0% （8/20）， Ⅲb with 27.3% （6/22）， Ⅳ with 15.4% （4/26）. The expression of e2f-1 was significantly negative correlated with tumor diameter, depth of infiltration, lymph node metastasis ratio, and N stage （Plt;0.05）. The multivariate analysis revealed that either histology type, or survival time was respectively an independent factor for e2f-1 expression （Plt;0.05）. Log-Rank test showed the relative factors to survival included N stage, tumor diameter, tumor position, lymph node metastasis ratio, depth of infiltration, and TNM stage （Plt;0.05）. Cox survival analysis found that both of later N stage and e2f-1 higher expression were independent prognostic factors （Plt;0.05）. The higher e2f-1 expression was related to a poor survival in TNM stageⅠand Ⅱ patients （r=－0.304, Plt;0.05）, the prognosis of patients with e2f-1 positive expression was worse than that of patients with negative expression （χ2=13.437， Plt;0.05）, and there was no statistic relationship between the expression of e2f-1 and prognosis in stage Ⅲ and Ⅳ patients （Pgt;0.05）. Conclusions e2f-1, as a useful marker, seems to be an indication for the malignant behavior in relatively earlier gastric cancer, in which the e2f-1 positive expression shares a significantly poor survival. And the lower expression of e2f-1 has been identified in later advanced gastric cancer, the more malignances in advanced gastric cancer might associate with a lower expression of e2f-1.
ObjectiveTo investigate the rule of lymph node metastasis in early gastric cancer (EGC) so as to provide a reasonable treatment. MethodsWe retrospectively analyzed the clinical data of 118 EGC patients who had been treated from January 2006 to December 2012,and a total of 8 potential factors associated with occurrence of EGC were evaluated by univariate analysis and multivariate logistic regression analysis. ResultsThe univariate analysis showed that ulcer,tumor size,depth of invasion and lymphatic involvement were correlated with lymph node metastasis (P<0.05).Multivariate logistic regression analysis showed that presence of an ulcer (OR=2.872),tumor of 3.0 cm or larger than that (OR=2.351),tumor invasion into the submucous layer (OR=3.461) and invasion into the lymphatic tubes (OR=1.784) were found to be independent risk factors. ConclusionLymph node metastasis of EGC is correlated with many factors,so EGC treatment choice should be made reasonably based on strict screening to exclude various risk factors before taking surgery.
Objective To investigate the clinicopathological characteristics of proximal gastric cancer (PGC). MethodsThe clinical course and pathologic feature of 118 PGC patients were analyzed, and compared with those of 310 distal gastric cancer (DGC) patients. ResultsThe incidence of PGC was lower than DGC, the percentage of Ⅲ,Ⅳ stages and undifferentiated type in the PGC group were significantly higher than in DGC. For the surgical procedure, patients in the PGC had significantly higher percentages of total gastrectomy and other organ resection than in DGC. The percentage of patients with positive margin and lymph node metastasis in PGC was also significantly higher than in DGC. Esophageal invasion and lymph node metastasis were much more in PGC. The 5year survival of patients with PGC was significantly lower than that with DGC. No significant differences were found between the two groups with respect to the mortality rates and complications. Conclusion The relatively poor prognosis associated with PGC is mainly from advanced cases and esophageal invasion. Early detection and treatment is the most important strategy to improve the survival of patients with PGC.
Objective To evaluate the status of lymph node metastasis and reasonable procedure in gastric cancer. Methods The incidence of metastases from gastric cancer to various regional lymph node stations was studied in 1 505 patients with gastric cancer. The patients underwent surgical resection from January 1995 to December 2004.Results Lymph node metastasis were observed in 928 of 1 505 cases (61.7%). Lymph node metastasis frequency was found in groups No.1 （32.9%），No.3 （28.7%）， No.2 （20.4%）， and No.7 （18.6%） at upper third stomach cancer；in groups No.3 （32.5%）， No.4 （24.7%）， No.7 （20.6%）， and No.1 （17.3%） at middle third stomach cancer； in groups No.6 （33.7%）， No.3 （31.3%）， No.4 （25.6%）， and No.7 （21.5%） at lower third stomach cancer. Conclusions Distribution of metastatic lymph node is clearly related to the location of the tumor. Anatomical extent of lymph node metastases in gastric cancer provid surgical guidance for surgeons.
ObjectiveTo evaluate the effect of preoperative regional intraarterial infusion chemotherapy on the prognosis of advanced gastric cancer. MethodsThe clinical data of 80 patients who underwent curative resection for advanced gastric cancers were summarized.Among them,33 patients carried out preoperative regional intraarterial infusion chemotherapy were as the interventional chemotherapy group,and the remaining 47 patients were the control group.Eleven factors including clinical and pathological data,treatment procedures and molecular biological makers that contributed to the longterm survival rate were analyzed by Cox multivariate regression analysis.ResultsThe 5year survival rate of the interventional group was 59.3%,and the control group 47.6%.There was significant difference between two groups (P＜0.05).Multivariate regression analysis revealed that the preoperative regional intraarterial infusion chemotherapy was one of the independent factors affecting the longterm survival of patients with advanced gastric cancers.ConclusionThe preoperative regional intraarterial infusion chemotherapy has important value for improving the prognosis of gastric cancer.
Objective To analyze the clinicopathologic characteristics of remnant gastric cancer （RGC）. Methods The clinical data of 114 patients with RGC treated in The Second Affiliated Hospital of Northern Sichuan MedicalCollege and The General Hospital of Chinese People’s Liberation Army from March 2000 to May 2008 were reviewed and analyzed retrospectively. The clinicopathologic characteristics between the patients with primary benign diseases and those with malignant diseases were evaluated. Results A total of 114 cases，the age was （62.6±11.3） years，and the males versus females was 4.7∶1.0. Most patients （76.2%，64/84） were diagnosed at advanced stages （consistent with pT），and the proportion of pT1 stage cases was only 23.8% （20/84），tumor invasion pT4 was 60.7% （51/84）. It was more common that tumor directly invaded adjacent organs or structures （27.4%，23/84），lymph nodes positive （42.9%，36/84），and distant metastasis （27.2%，31/114）. The location of distant metastasis was usually confined in the abdominal cavity （93.5%，29/31），and the peritoneum disseminated was the most commonly structures （67.7%，21/31）. Histologically，the incidence of poorly differentiated adenocarcinoma （76.7%，79/103） was the mostly histologic grade as well as the diffuse type （78.6%，81/103） was the mostly Laurén classification. Between the patients with primary benign diseases and those with initial malignant disease，the initial gastrectomy or the methods of reconstruction had significantly differences （both P=0.000）. The median time from initial resection to development of RGC was 30.0 years in the patients with original benign disease，contrary to 3.3 years in those with previous malignant disease （P=0.000）. Both primary diseases （benign or malignant） and the age at initial gastrectomy were the major influencing factors for the time of RGC developed （P＜0.05）. For pathohistology characters，except signet-ring cell carcinoma （P=0.045）， pT4b （P=0.049），pN stage （P=0.025），and Borrmann classification （P=0.005），there were no significant differences between the patients with previous benign diseases and those with original malignant disease，as well as the resectability rate，curative resection （R0） rate，and overall survival rate （P＞0.05）. Conclusions It is almost unaffected by originalbenign diseases or malignant diseases for clinicopathologic characteristics including the treatment option and prognostic factors.It is necessary and feasibility to form a pattern of endoscopic follow-up for RGC.