ObjectiveTo explore the risk factors of perioperative severe complications (Clavien-Dindo grade Ⅲ and above) after laparoscopic radical resection of colorectal cancer (CRC). MethodsThe clinicopathologic data of CRC patients who met the inclusion and exclusion criteria treated in the Shaanxi Provincial People’s Hospital from January 2018 to December 2020 were retrospectively analyzed. The univariate and multivariate logistic analyses were used to explore the risk factors of perioperative severe complications after the laparoscopic radical resection of CRC. ResultsAtotal of 170 eligible patients were included in this study, and the postoperative complications occurred in 45 patients, 24 of whom were severe complications. The univariate analysis results showed that the age (P<0.001), body mass index (BMI, P=0.047), age adjusted Charlson complication index (aCCI) score (P=0.002), American Association of Anesthesiologists (ASA) classification (P<0.001), prognostic nutritional index (PNI, P=0.011), preoperative anemia (P=0.011), operation numbers of surgeon (P=0.003), and operation time (P=0.026) were related to the perioperative severe complications in the patients underwent the laparoscopic radical resection of CRC. The statistic indexes of univariate analysis (P<0.05) combined with indexes of clinical significance were included in the multivariate analysis, the results showed that the ASA classification Ⅲ– Ⅳ (OR=3.536, P=0.027), BMI ≥25 kg/m2 (OR=3.228, P=0.031), preoperative anemia (OR=2.876, P=0.049), operation numbers of surgeon <300 (OR=0.324, P=0.046), and the operation time ≥300 min (OR=3.480, P=0.020) increased the probability of perioperative severe complications in the patients underwent the laparoscopic radical resection of CRC. ConclusionsThe results of this study suggest that clinicians should pay attention to the perioperative management of patients with CRC, such as adequately evaluating the preoperative status of patients by ASA classification, PNI, and aCCI to adjust the malnutrition of patients; after operation, the patients with BMI ≥25 kg/m2 and operation time more than 300 min should be paid more attention. At the same time, the surgeon should continuously accumulate the operation numbers and improve the operation proficiency so as to reduce the occurrence of perioperative severe complications after laparoscopic radical resection of CRC.
Objective To explore the feasibility and short-term effectiveness of the modified radical resection and reconstruction in the treatment of malignant proximal humerus tumor. Methods The relevant anatomic data from 30 normal adult shoulder joint MRI were measured to analyze the feasibility of modified radical resection and reconstruction surgery in the treatment of malignant proximal humerus tumor. Five patients with malignant proximal humerus tumor were treated by using the modified radical resection and reconstruction surgery between March 2012 and January 2016. There were 1 male and 4 females, aged from 9 to 69 years (median, 46 years). There were 4 cases of osteosarcoma (Enneking IIA in 2 cases and Enneking IIB in 2 cases) and 1 case of metastatic carcinoma (moderately differentiated adenocarcinoma). The disease duration was 7 to 12 months (mean, 9 months). Recurrence of tumor was observed after operation, and the shoulder function was assessed according to Enneking skeletal muscle tumor function scoring system. Results Radiographic results showed that modified radical resection and reconstruction surgery was feasible, which was in allowable range of the maximum longitudinal diameter ( < 29.8 mm) and depth ( < 4 mm). The operation was successfully completed in all 5 cases, and pathological examination suggested that purposes of radical resection had achieved. All patients were followed up 3 to 49 months (mean, 15.6 months). One patient had local recurrence at 12 months after operation, and a shoulder joint amputation was performed; the other 4 patients had good prosthesis survival. At last follow-up, the function of the shoulder joint was obviously recovered when compared with preoperative function; Enneking's skeletal muscle tumor function score was 25.8 points (range, 24 to 27 points). Conclusion Modified radical resection and reconstruction surgery is feasible for the treatment of proximal humerus tumor, and it can maintain a good early shoulder function.
We reviewed the clinical studies on drug therapy for gallbladder cancer and expounded on the current situation of conversion therapy for gallbladder cancer. Gallbladder cancer was usually diagnosed late, with high malignancy, low surgical resection rate, and poor prognosis. With the development of conversion therapy, systemic therapy combined with radical resection had effectively improved the surgical resection rate and prognosis of gallbladder cancer patients. At present, most of the published conversion therapies for gallbladder cancer were mainly retrospective researches, lacking large multicenter prospective research, and the treatment plan was still based on chemotherapy, lacking the research of targeted therapy in combination with immunotherapy. It is expected that more high-quality clinical trials can be made first-line recommendations for the conversion therapy of gallbladder cancer.
ObjectiveTo investigate the relationship between metastatic lymph node ratio (MLNR) and prognosis of patients after radical resection of distal gastric cancer.MethodsWe retrospectively analyzed the clinicopathological data of 408 patients undergoing radical resection of distal gastric cancer (D2 or D2+ lymph node dissection) in Department of Gastrointestinal Surgery in the Affiliated Hospital of Southwest Medical University, from January 2010 to January 2014. Then we explored the influence of MLNR on the prognosis after radical resection of distal gastric cancer.ResultsWithout distinguishing pTNM staging, the overall survival situation of patient with MLNR≥0.15 and patient with MLNR<0.15 was statistically significant (χ2=3.775, P=0.046); when patients with staging of pTNM Ⅰ, there was no statistically significant MLNR could be calculated; when patients with staging of pTNM Ⅱ, the overall survival situation of patient with MLNR≥0.14 and patient with MLNR<0.14 was statistically significant (χ2=3.110, P=0.029); when patients with staging of pTNM Ⅲ, the overall survival situation of patient with MLNR≥0.10 and patient with MLNR<0.10 was statistically significant (χ2=1.631, P=0.004). Multivariate analysis showed that depth of invasion (pT stage) and MLNR were independent prognostic factors for prognosis of patients after radical resection of distal gastric cancer (P<0.05).ConclusionMLNR is a good prognostic indicator for patients with distal gastric cancer after radical resection.
Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
Objective To compare the clinical efficacy and safety of different surgical methods in the treatment of early-stage gallbladder carcinoma (GBC). Methods The clinical data of 43 patients with early-stage GBC who received treatment in Peking University People’s Hospital from Jan. 2010 to Dec. 2016 were retrospectively analyzed. According to the surgical methods, the patients were divided into laparoscopic cholecystectomy (LC)+lymph node dissection (LND)+radiofrequency ablation (RA) group, open cholecystectomy (OC)+LND+RA group, and OC+LND+liver resection (LA) group. Operation duration, intraoperative blood loss, postoperative hospital stay, surgical complications, and long-term survival were compared among the 3 groups. Results All the 43 patients performed successful surgery without perioperative death. ① Operation duration and postoperative hospital stay. The differences of operation duration and postoperative hospital stay among the 3 groups were statistically significant (P<0.05). Compared with the LC+LND+RA group, operation duration and postoperative hospital stay of the OC+LND+RA group and the OC+LND+LR group were longer (P<0.017), but there was no statistically significant difference between the OC+LND+RA group and the OC+LND+LR group (P>0.017). ② Intraoperative blood loss. The difference of intraoperative blood loss among the 3 groups was statistically significant (P<0.001). Compared with the OC+LND+LR group, the intraoperative blood loss was lower in the LC+LND+RA group and the OC+LND+RA group (P<0.017), but there was no significant difference between the LC+LND+RA group and the OC+LND+RA group (P=0.172). ③ Postoperative complications. There was no significant difference in the incidence of postoperative complications among the 3 groups (P=0.326). ④ Long-term survival. There was no significant difference in survival curves among the 3 groups (P=0.057). Conclusions The method of cholecystectomy combined with LND and RA of gallbladder bed can achieve the radical effect on early-stage GBC (Tis–T2). Laparoscopic surgery, in particular, has shorter operation duration and faster recovery.
ObjectiveTo analyze the effect of different drainage modes on the postoperative thoracic drainage after video-assisted thoracoscopic surgery for radical resection of lower lung carcinoma.MethodsA total of 183 patients with non-small cell lung cancer who received biportal thoracoscopic anatomical lower lobectomy combined with mediastinal lymph node dissection in the First Affiliated Hospital of Xi'an Jiaotong University from August 2017 to August 2019 were enrolled, including 113 males and 70 females, aged 31-77 (56.5±6.4) years. The patients were randomly divided into three groups, including an anterior axillary line group, a mid-axillary line group and a modified anterior axillary line group. Clinical efficacy of the three groups was compared.ResultsNo significant difference among these three groups in terms of gender, age, surgical site, pathological type, pathological staging, postoperative chest wall subcutaneous emphysema, postoperative pain score, and postoperative hospital stay was found (P>0.05). There were significant differences among the patients in terms of postoperative pleural effusion, re-insertion of chest tube or aspiration, total liquid quantity of thoracic drainage, drainage time and chest wall incision stitches time (P<0.05). The anterior axillary line group had higher risk of postoperative pleural effusion than the other groups (P<0.05). The occurrence of postoperative pleural effusion and rate of reposition of chest tube or aspiration were significantly reduced in the modified anterior axillary line group (P<0.05).ConclusionChest drainage tube with large diameter (24F) in the 5th intercostal space of the anterior axillary line combined with another micro-tube (8.5F) in the 7th or 8th intercostal space of the inferior scapular angle line can shorten drainage time to reduce postoperative pain, reduce the occurrence of postoperative pleural effusion, and shorten the time of surgical incision stitches.
Objective To analyze clinical value of early enteral nutrition following radical resection of gastric cancer. Methods Seventy-six patients with gastric cancer underwent radical resection from May 1, 2016 to July 1, 2016 in the West China Hospital of Sichuan University were included according to the inclusion criteria and exclusion criteria, then were randomly divided into observation group (36 cases) and control group (40 cases). The patients in the observation group received the enteral nutrition on day 2 following the surgery, in the control group received the conventional management. The gastrointestinal recovery and the adverse reaction were compared in these two groups. The preoperative and postoperative laboratory indicators and the body weight of the patients in both groups were analyzed. Results ① The general data such as age, gender, and body weight had no significant differences in these two groups (P>0.05). ② The first anus exhaust time and the first defecation time of the observation group were significantly shorter than those of the control group (P<0.05). ③ The adverse reaction rate of the observation group was significantly lower than that of the control group (P<0.05). ④ On admission, the serum albumin, urea nitrogen, creatinine, and lymphocyte count had no significant differences in these two groups (P>0.05). On day 5 after the operation, the serum albumin of the observation group was significantly higher than that of the control group (P<0.05). ⑤ The body weight had no significant difference in these two groups before the operation (P>0.05), which in the observation group was significantly heavier than that of the control group on day 30 after the operation (P<0.05). Conclusion Preliminary results of limited cases in this study show that early enteral nutrition following radical resection of gastric cancer is safe and effective, it could promote gastrointestinal function resumption and effectively improve nutritional status.
Objective To summarize the application and progress of common autologous organ transplantation (AOT) techniques. Method A literature review and summary of previous and recent studies on common AOT was performed, including autologous liver transplantation, autologous kidney transplantation and intestinal autotransplantation techniques. Results AOT solved the issues of bleeding that cannot be controlled by in vivo resection of lesions, difficulties in vascular reconstruction, and the inability to radically resect lesions, and extended the indications for treatment of partially diseased conditions. Conclusions The AOT technique has an ameliorating effect on the tight donor situation in China, providing more potential donors. And the application of the AOT technique effectively avoids the usage of postoperative immunosuppressive drugs and the progression of lesions due to waiting for allogeneic organ transplantation. However, the clinical benefit in malignant tumors remains to be further investigated.
Objective To investigate the strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Method Reviewing the related literatures at home and abroad in recent years, to summarize the progress of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Results We should clear the postoperative bleeding time, extent, cause, and location, to help the clinician to choose the appropriate timing of intervention and treatment. The patients with early hemorrhage and mild degree hemorrhage could be treated conservatively. If patients with severe hemorrhage and hemodynamic disorders, surgical intervention must be decisive. Patients with late hemorrhage would have serious consequences, and these patients should receive interventional or surgical treatment as early as possible. Conclusions For patients with hilar cholangiocarcinoma after radical resection, doctors need to do accurate preoperative evaluation, meticulous operation, and intensive management after operation, to reduce the incidence of hemorrhage after radical resection of hilar cholangiocarcinoma. If the postoperative hemorrhage occurs, the cause, location, time, and degree of hemorrhage should be clearly defined to facilitate clinicians to make rapid clinical decisions and to develop treatment programs.