2013 Vol.25(4)

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Peritonectomy HIPEC—contemporary results, indications
David L. Morris
2013, 25(4): 373-374. doi: 10.3978/j.issn.1000-9604.2013.07.03
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Original Article
Sandwich ELISA for detecting urinary Survivin in bladder cancer
Xuefeng Li, Yaming Wang, Jianjun Xu, Qingyun Zhang
2013, 25(4): 375-381. doi: 10.3978/j.issn.1000-9604.2013.08.11
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ObjectiveSurvivin as a tumor marker in the diagnosis of bladder cancer has not been completely confirmed yet and there are few reports about using Survivin enzyme-linked immunosorbent assay (ELISA) kit to detect the urine of bladder cancer patients. This study aimed to develop a Survivin ELISA and validate its value in the detection of bladder cancer.MethodsThrough square matrix titration, different combinations of coating antibody and detecting antibody, a Survivin ELISA was constructed. This assay was evaluated according to intra-assay precision, inter-assay precision and minimum detectable dose (MDD). Survivin levels were detected and analyzed in 102 bladder cancer patients and 102 healthy people by established ELISA. Then cutoff value was defined according to the analysis of receiver operating characteristic (ROC) curve. The sensitivity and specificity of detection were calculated on the basis of cutoff value to diagnose bladder cancer patients. Furthermore, the value of Survivin expression detected by ELISA among different clinicopathological characteristics of patients was also compared.ResultsThrough optimization of different conditions, intra-assay precision was 8.39%, inter-assay precision 8.57% and MDD 0.0625 ng/mL in this assay. When the optical density at 450 nm (OD450) was 0.09, it could get the optimized diagnostic cutoff value. According to this value, the sensitivity and specificity of diagnosis in bladder cancer patients were 70.6% and 89.2%, respectively. The associations between patients’ clinical variables and OD450 were not significant except tumor numbers in patients.ConclusionsThis experiment has preliminarily developed a Survivin ELISA and confirmed Survivin as a biomarker which owned a practical and significant value in the diagnosis of bladder cancer.
Clinical diagnosis and treatment of alpha-fetoprotein-negative small hepatic lesions
Yiyao Xu, Xin Lu, Yilei Mao, Xinting Sang, Haitao Zhao, Shunda Du, Haifeng Xu, Yongliang Sun, Huayu Yang, Tianyi Chi, Zhiying Yang, Shouxian Zhong, Jiefu Huang
2013, 25(4): 382-388. doi: 10.3978/j.issn.1000-9604.2013.08.12
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ObjectiveWe examined 103 cases over the last five years and discussed diagnosis and treatment of alpha-fetoprotein (AFP)-negative small hepatic lesions.Background: Small hepatic lesions (less than 2 cm in diameter) usually have no typical imaging characteristics and therefore are difficult to diagnose, especially when AFP tests provide a negative result.MethodsA total of 103 patients with AFP-negative small hepatic lesions from January 2003 to December 2008 were retrospectively reviewed. Differential diagnosis was performed by digital subtraction angiography (DSA), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), contrast-enhanced ultrasound (CEUS), or positron emission tomography-computed tomography (PET-CT) based on the multiplicity of lesions. Ninety-four patients with suspected cancers underwent partial hepatectomy. Clinical data were collected from hospital records and follow-up questionnaires.ResultsHepatocellular carcinoma (HCC) diagnostic sensitivity of DSA, DCE-MRI, CEUS and PET-CT was 88.2%, 93.9%, 88.9% and 88.9%, respectively. The surgery-related complication rate was 6.4%. Prognosis was good, with 1- and 3-year survival rates of 98.8% and 76.1%, respectively.ConclusionsDSA, DCE-MRI, CEUS and PET-CT are valuable for diagnosis of small hepatic lesions. Partial hepatectomy is a preferred surgical procedure. Surgery for small liver cancers usually has little risk and good prognosis, therefore it can be actively applied in suspected HCC cases.
Allogeneic hematopoietic stem cell transplantation for patients with acute leukemia
Yan Chen, Yajing Xu, Gan Fu, Yi Liu, Jie Peng, Bin Fu, Xiaoyu Yuan, Hongya Xin, Yan Zhu, Qun He, Dengshu Wu, Yigang Shu, Xiaolin Li, Xielan Zhao, Fangping Chen
2013, 25(4): 389-396. doi: 10.3978/j.issn.1000-9604.2013.07.01
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ObjectiveThe purposes of this study were to assess the efficacy of allogeneic hematopoietic stem cell transplantation (HSCT) for acute leukemia (AL) and analyze the factors affecting the prognosis of these patients.MethodsThe clinical and follow-up data of 93 AL patients (median age, 30 years) undergoing allogeneic HSCT in Xiangya Hospital over the past 12 years were collected, and the potential factors affecting the efficacy and prognosis of allogeneic HSCT patients were determined.ResultsHematopoietic reconstitution was achieved in 90 patients. At the last follow-up, the incidences of severe acute graft versus host disease (aGvHD) and extensive chronic GvHD (cGvHD) were 14.0% and 20.0%, the 3-year cumulative incidence of transplantation related mortality (TRM) and relapse rate were 16.8%±6.1% and 21.3%±6.7%, and the estimated 3-year overall survival (OS) and disease-free survival (DFS) of the patients were 64.6%±5.4% and 56.5%±5.5%, respectively. Univariate analysis indicated that age older than 40 years, HLA mismatch, and severe lung infection within the first 100 days after transplantation were risk factors for severe aGvHD, age older than 40 years, HLA mismatch, severe lung infection within the first 100 days after transplantation, and severe aGvHD were risk factors for TRM, high-risk AL and lack of cGvHD were risk factors for relapse (all P<0.05). Survival estimation showed that HLA mismatch, severe lung infection occurring within the first 100 days post-transplantation, high-risk AL severe aGvHD and lack of cGvHD were risk factors associated with poor prognosis (all P<0.05). Further multivariate analyses revealed that severe lung infection within the first 100 days post-transplantation, severe aGvHD and lack of cGvHD were independent risk factors for unfavorable outcomes (all P<0.05).ConclusionsAllogeneic HSCT can improve the DFS of AL patients, and severe lung infection within the first 100 days post-transplantation, severe aGvHD and lack of cGvHD are independent risk factors affecting the prognosis.
Value of pre-treatment biomarkers in prediction of response to neoadjuvant endocrine therapy for hormone receptor-positive postmenopausal breast cancer
Min Ying, Yingjian He, Meng Qi, Bin Dong, Aiping Lu, Jinfeng Li, Yuntao Xie, Tianfeng Wang, Benyao Lin, Tao Ouyang
2013, 25(4): 397-404. doi: 10.3978/j.issn.1000-9604.2013.08.01
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ObjectiveTo determine the predictive ability of biomarkers for responses to neoadjuvant endocrine therapy (NET) in postmenopausal breast cancer.MethodsConsecutive 160 postmenopausal women with T1-3N0-1M0 hormone receptor (HR)-positive invasive breast cancer were treated with anastrozole for 16 weeks before surgery. New slides of tumor specimens taken before and after treatment were conducted centrally for biomarker analysis and classified using the Applied Imaging Ariol MB-8 system. The pathological response was evaluated using the Miller & Payne classification. The cell cycle response was classified according to the change in the Ki67 index after treatment. Multivariable logistic regression analysis was used to calculate the combined index of the biomarkers. Receiver operating characteristic (ROC) curves were used to determine whether parameters may predict response.ResultsThe correlation between the pathological and cell cycle responses was low (Spearman correlation coefficient =0.241, P<0.001; Kappa value =0.119, P=0.032). The cell cycle response was significantly associated with pre-treatment estrogen receptor (ER) status (P=0.001), progesterone receptor (PgR) status (P<0.001), human epidermal growth factor receptor 2 (Her-2) status (P=0.050) and the Ki67 index (P<0.001), but the pathological response was not correlated with these factors. Pre-treatment ER levels [area under the curve (AUC) =0.634, 95% confidence interval (95% CI), 0.534-0.735, P=0.008] and combined index of pre-treatment ER and PgR levels (AUC =0.684, 95% CI, 0.591-0.776, P<0.001) could not predict the cell cycle response, but combined index including per-treatment ER/PR/Her-2/Ki67 expression levels could (AUC =0.830, 95% CI, 0.759-0.902, P<0.001).ConclusionsThe combined use of pre-treatment ER/PgR/Her-2/Ki67 expression levels, instead of HR expression levels, may predict the cell cycle response to NET.
DNA repair gene XRCC1 polymorphisms and susceptibility to childhood acute lymphoblastic leukemia: a meta-analysis
Juan Du, Cong Lu, Guohui Cui, Yan Chen, Jing He
2013, 25(4): 405-415. doi: 10.3978/j.issn.1000-9604.2013.08.02
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ObjectiveTo estimate the relationship between genetic polymorphisms of X-ray repair cross-complementing group 1 (XRCC1) and the susceptibility to childhood acute lymphoblastic leukemia (ALL).MethodsRelevant case-control studies were enrolled in the meta-analysis. We applied Rev Man 4.2 software to pool raw data and test studies’ heterogeneity and to calculate the incorporated odds ratio (OR) and 95% confidence interval (95% CI).ResultsOur data showed that the OR for the Gln allele of the Arg399Gln polymorphism, compared with the Arg allele, was 1.35 (95% CI, 1.16-1.57; P<0.0001) for childhood ALL patients. Similarly, the homozygous genotype Gln/Gln and heterozygous genotype Arg/Gln both significantly increased the risk of childhood ALL compared with the wild genotype Arg/Arg (OR =1.58; 95% CI, 1.13-2.21; P=0.008; OR =1.51; 95% CI, 1.21-1.87; P=0.0002). The dominant model of Arg399Gln was associated with childhood ALL risk (OR =1.54; 95% CI, 1.25-1.89; P<0.0001). The ethnic subgroup analysis demonstrated that the Gln allele in all five ethnic groups was prone to be a risk factor for childhood ALL just with different degrees of correlation while Arg194Trp SNP showed a protective or risk factor or irrelevant thing in different races.ConclusionsXRCC1 399 polymorphism may increase the risk of childhood ALL. Different ethnic groups with some gene polymorphism have different disease risks.
PIK3CA mutation in Chinese patients with lung squamous cell carcinoma
Jinglin Yu, Hua Bai, Zhijie Wang, Zhigang Wei, Xiaosheng Ding, Jianchun Duan, Lu Yang, Meina Wu, Yuyan Wang, Jie Wang
2013, 25(4): 416-422. doi: 10.3978/j.issn.1000-9604.2013.08.03
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ObjectiveTo investigate PIK3CA mutation in Chinese patients with lung squamous cell carcinoma (LSCC) and explore their relationship with clinicopathological profiles.MethodsTumor samples from 123 cases of LSCC were included in this study. PIK3CA mutations in exon 9 and 20 were screened by pyrosequencing and confirmed by clone sequencing or amplification refractory mutation system (ARMS). Denaturing performance liquid chromatography (DHPLC) was employed for evaluation of EGFR mutation in exon 19, 21 and KRAS mutation.ResultsPIK3CA mutations were found in 3 (2.4%) patients. The mutation type included E545K, E452Q and H1047R. Of these three patients, one coupled with EGFR mutation, and the other two coupled with PIK3CA amplification. All the three patients shared the same clinicopathologic characteristics: male, less than 60 years old, had smoke history, stage III and carried wild-type KRAS.ConclusionsThe frequency of PIK3CA mutation is low in Chinese patients with LSCC. The mutational status of PIK3CA is not mutually exclusive to EGFR mutation.
Recurrent orbital space-occupying lesions: a clinicopathologic study of 253 cases
Weiqiang Tang, Yan Hei, Lihua Xiao
2013, 25(4): 423-429. doi: 10.3978/j.issn.1000-9604.2013.08.04
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ObjectiveTo analyze the clinical features, histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.MethodsA retrospective study was carried out in 253 consecutive patients with recurrent orbital space-occupying lesions treated by surgical excision in the Institute of Orbital Diseases, the General Hospital of the Armed Police Force from January 2009 to December 2010.ResultsThe patients included 123 males and 130 females aged 2 to 78 years (mean, 36.2 years), and the last recurrence interval after operation ranged from 1 month to 40 years (median, 4.75 years). Of all the cases, 159 (62.8%), 65 (25.7%), 20 (7.9%), 8 (3.2%) and 1 (0.4%) had previously experienced once, twice, three, four and six times of surgeries, respectively. Among them, 29 (11.5%) cases had recurred 3 times or over, and 37 (14.6%) cases got recurrence in 10 or more years postoperatively. Most of the patients with local recurrence presented with various clinical manifestations, while 31 (12.3%) cases were symptom-free. Two hundred and thirty-one (91.3%) cases underwent surgical removal of the recurrent orbital lesions, and another 22 (8.7%) cases had to receive the exenteration of orbit. Categories of these recurrent orbital lesions after operation were as follows: lacrimal gland tumors, 65 (25.7%) cases; vasogenic diseases, 54 (21.3%) cases; neurogenic tumors, 42 (16.6%) cases; secondary tumors, 24 (9.5%) cases; orbital inflammation, 21 (8.3%) cases; myogenic tumors, 14 (5.5%) cases; fibrous and adipose tumors, 12 (4.7%) cases; lympho-hematopoietic tumors, 7 (2.8%) cases; bone or cartilage tumors, 7 (2.8%) cases; orbital cysts, 6 (2.4%) cases; and indefinitely differentiated tumor, 1 (0.4%) case. The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma, hemangiolymphangioma, lacrimal gland adenoid cystic carcinoma, meningioma, inflammatory pseudotumor, neurofibroma, sebaceous gland carcinoma, vascular malformation, rhabdomyosarcoma and hemangioma.ConclusionsThe variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions. The lacrimal gland epithelial tumor is most prone to relapse after resection, and early and longer-term postoperative follow-up is needed.
Review Article
Argonaute protein as a linker to command center of physiological processes
Kaifa Wei, Lingjuan Wu, Yanhui Chen, Yina Lin, Yanmei Wang, Xiaoyao Liu, Daoxin Xie
2013, 25(4): 430-441. doi: 10.3978/j.issn.1000-9604.2013.08.13
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MicroRNAs (miRNAs) post-transcriptionally regulate gene expression by binding to target mRNAs with perfect or imperfect complementarity, recruiting an Argonaute (AGO) protein complex that usually results in degradation or translational repression of the target mRNA. AGO proteins function as the Slicer enzyme in miRNA and small interfering RNA (siRNA) pathways involved in human physiological and pathophysiological processes, such as antiviral responses and disease formation. Although the past decade has witnessed rapid advancement in studies of AGO protein functions, to further elucidate the molecular mechanism of AGO proteins in cellular function and biochemical process is really a challenging area for researchers. In order to understand the molecular causes underlying the pathological processes, we mainly focus on five fundamental problems of AGO proteins, including evolution, functional domain, subcellular location, post-translational modification and protein-protein interactions. Our discussion highlight their roles in early diagnosis, disease prevention, drug target identification, drug response, etc.
The role of circadian rhythm in breast cancer
Shujing Li, Xiang Ao, Huijian Wu
2013, 25(4): 442-450. doi: 10.3978/j.issn.1000-9604.2013.08.19
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The circadian rhythm is an endogenous time keeping system shared by most organisms. The circadian clock is comprised of both peripheral oscillators in most organ tissues of the body and a central pacemaker located in the suprachiasmatic nucleus (SCN) of the central nervous system. The circadian rhythm is crucial in maintaining the normal physiology of the organism including, but not limited to, cell proliferation, cell cycle progression, and cellular metabolism; whereas disruption of the circadian rhythm is closely related to multi-tumorigenesis. In the past several years, studies from different fields have revealed that the genetic or functional disruption of the molecular circadian rhythm has been found in various cancers, such as breast, prostate, and ovarian. In this review, we will investigate and present an overview of the current research on the influence of circadian rhythm regulating proteins on breast cancer.
Surgical Technique
Laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer (Billroth II anastomosis)
Hanhui Yao, Qiang Huang, Zhiqiang Zhu, Wei Liang
2013, 25(4): 451-452. doi: 10.3978/j.issn.1000-9604.2013.07.02
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Laparoscopic radical gastrectomy has been increasingly applied in China. However, how to reduce surgery-related trauma, shorten operative time and achieve the long-term prognosis equal to the conventional open surgery is still hot research topics. Along with the change in learning curve and the optimization of endoscopic techniques, laparoscopic lymph node dissection can achieve or even exceed the extent that can be achieved in open surgery. Therefore, it has gradually replaced the conventional digestive tract reconstruction using an auxiliary incision. By completing the laparoscopic digestive tract reconstruction with EndoGIA, we describe the laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer (Billroth II anastomosis).
Laparoscopic gastrectomy for distal gastric cancer
Donglei Zhou, Liesheng Lu, Xun Jiang
2013, 25(4): 453-454. doi: 10.3978/j.issn.1000-9604.2013.07.04
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This video presents a standard D2 laparoscopic-assisted gastrectomy for distal gastric cancer. The lymph node dissection of each station is performed as required in the standardized procedure of distal gastrectomy, followed by the Billroth II anastomosis through a small incision.
Total laparoscopic-assisted radical gastrectomy (D2+) with jejunal Roux-en-Y reconstruction
Weidong Zang, Wenju Liu, Cheng Wei, Shifu Liu, Guodong Zhao
2013, 25(4): 455-456. doi: 10.3978/j.issn.1000-9604.2013.08.05
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Total laparoscopic-assisted radical gastrectomy and the jejunal Roux-en-Y anastomosis were performed to treat cancer of the upper gastric body and fundic region. In the case of open anastomosis during total laparoscopic-assisted radical gastrectomy, an incision of 6-8 cm would be required due to the need for placing the stapler anvil. If using the Roux-en-Y procedure, however, the incision could be reduced to as small as 4-5 cm without increasing the length of operation and intraoperative bleeding that favors postoperative recovery.
Pylorus- and vagus-nerve-preserving partial gastrectomy (D2 dissection)
Jian Zhang, Liang Cao, Zhenglin Wang, Chi Zhang, Xiang Hu
2013, 25(4): 457-459. doi: 10.3978/j.issn.1000-9604.2013.08.08
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Pylorus- and vagus nerve-preserving partial gastrectomy is important in improving the prognosis of early gastric cancer surgery, reducing surgical complications and improving the quality of life for such patients. In the present case, pylorus- and vagus nerve-preserving partial gastrectomy was performed using the bipolar electrocautery dissection technique combined with D2 dissection along the lesser sac.
Laparoscopic-assisted radical gastrectomy for distal gastric cancer
Yian Du, Xiangdong Cheng, Zhiyuan Xu, Litao Yang, Ling Huang, Bing Wang, Pengfei Yu, Ruizeng Dong
2013, 25(4): 460-462. doi: 10.3978/j.issn.1000-9604.2013.08.15
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A 48-year-old female patient was diagnosed with a superficial depressed type early gastric cancer (type IIc) of 1.0 cm at the gastric angle as indicated by gastroscopy. Laparoscopic-assisted greater omentum-preserving D2 radical gastrectomy was performed in combination with Billroth I reconstruction under general anesthesia for the distal gastric cancer on April 5, 2013. The postoperative recovery was satisfying without complications. The patient was discharged seven days after surgery.
Delta-shaped anastomosis in totally laparoscopic D2 radical distal gastrectomy
Jun Zhang
2013, 25(4): 463-464. doi: 10.3978/j.issn.1000-9604.2013.08.06
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With less injury and faster postoperative recovery, laparoscopic techniques have been widely applied in D2 radical gastrectomy for distal gastric cancer. Billroth I anastomosis is a common reconstruction procedure in D2 radical gastrectomy for distal gastric cancer. The delta-shaped anastomosis, an intra-abdominal Billroth I reconstruction, has been increasingly applied by gastrointestinal surgeons. This surgical video demonstrates the delta-shaped anastomosis in laparoscopic-assisted D2 radical gastrectomy for distal gastric cancer.
Station 10 lymph node dissections in laparoscopic-assisted spleen-preserving radical gastrectomy for advanced proximal gastric cancer
Yong Li, Junjiang Wang
2013, 25(4): 465-467. doi: 10.3978/j.issn.1000-9604.2013.08.18
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D2 gastric resection has been increasingly recognized as the optimal surgical treatment for advanced gastric cancer. Dissection of the station 10 splenic lymph nodes is required in the treatment of advanced proximal gastric cancer. Based on vascular anatomy and anatomical plane of fascial space, integrated with our experience in station 10 splenic lymph node dissection in open surgery and proven skills of laparoscopic operation, we have successfully mastered the surgical essentials and technical keypoints in laparoscopic-assisted station 10 lymph node dissection.
Radical gastrectomy for D2 distal gastric cancer
Ping Dong
2013, 25(4): 468-470. doi: 10.3978/j.issn.1000-9604.2013.08.07
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Curettage and aspiration in splenic hilar lymph node dissection for spleen-preserving radical D2 gastrectomy
Wei Wang, Lijie Luo, Yansheng Zheng, Jin Wan
2013, 25(4): 471-473. doi: 10.3978/j.issn.1000-9604.2013.08.10
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D2 radical gastrectomy is the standard procedure for gastric cancer in the middle or upper part of the stomach. According to the latest Japanese treatment guidelines for gastric cancer, dissection of the splenic hilar lymph nodes is required during the radical treatment for this condition. This study reports a D2 radical total gastrectomy employing the curettage and dissection techniques, in which the resection of the anterior lobe of transverse mesocolon, vascular denudation and splenic hilar lymph node dissection were successfully completed.
Laparoscopic distal gastrectomy with D2 dissection for advanced gastric cancer
Jiang Yu, Yanfeng Hu, Tao Chen, Tingyu Mou, Xia Cheng, Guoxin Li
2013, 25(4): 474-476. doi: 10.3978/j.issn.1000-9604.2013.08.09
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The successful application of the laparoscopic distal gastrectomy with D2 dissection for gastric cancer requires adequate understanding of the anatomic characteristics of peripancreatic and intrathecal spaces, the role of pancreas and vascular bifurcation as the surgical landmarks, as well as the variations of gastric vascular anatomy. The standardized surgical procedures based on distribution of regional lymph node should be clarified.
Spleen-preserving splenic lymph node dissection in radical total gastrectomy
Zhigang Jie, Zhengrong Li, Yi Cao, Yi Liu, Mengmeng Jiang, Liangqing Lin, Guoyang Zhang
2013, 25(4): 477-478. doi: 10.3978/j.issn.1000-9604.2013.08.16
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Radical gastrectomy has been recognized as the standard surgical treatment for advanced gastric cancer, and essentially applied in a wide variety of clinical settings. The thoroughness of lymph node dissection is an important prognostic factor for patients with advanced gastric cancer. Splenic lymph node dissection is required during D2 radical gastrectomy for upper stomach cancer. This is often accompanied by removal of the spleen in the past few decades. A growing number of investigators believe, however, that the spleen plays an important role as an immune organ, and thus they encourage the application of a spleen-preserving method for splenic hilum lymph node dissection.
D2 plus radical resection combined with perioperative chemotherapy for advanced gastric cancer with pyloric obstruction
Yian Du, Xiangdong Cheng, Zhiyuan Xu, Litao Yang, Ling Huang, Bing Wang, Pengfei Yu, Ruizeng Dong
2013, 25(4): 479-481. doi: 10.3978/j.issn.1000-9604.2013.08.17
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A patient with advanced gastric cancer complicated with pyloric obstruction was treated using D2 + radical resection combined with perioperative chemotherapy, and had satisfying outcomes. The perioperative chemotherapy regimen was Taxol and S1 (tegafur, gimeracil, and oteracil). Three cycles of neoadjuvant chemotherapy were delivered before surgery, and three cycles of adjuvant therapy after surgery. PR was achieved after chemotherapy. D2 + dissection of stations 8p, 12b, 12p, 13 and 14v lymph nodes was performed on September 10, 2012.
Case Report
Retreatment of a patient who presented with synchronous multiple primary colorectal carcinoma: report of a case
Zheng Jiang, Shan Muhammad, Xishan Wang
2013, 25(4): 482-485. doi: 10.3978/j.issn.1000-9604.2013.08.20
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It is well known that one-stage resection of synchronous multiple primary colorectal carcinoma is an ideal choice if the patient’s physical condition is not bad. Detailed examination of the whole intestinal tract is very important for patients with colorectal cancer, which could prevent patients from receiving repeat treatment to a great extent. We present a case report of a patient with synchronous primary colorectal cancer. Because pre- or intra-operative examination is not sufficient at his first consultation, the patient had undergone multiple operations after receiving chemotherapy, radiotherapy and intestinal stent insertion, which results in peritoneal adhesions formation. The preoperative placement of prophylactic ureteral catheters facilitated recognition of ureters in operation that assure the prevention of ureteral injuries. If not aware of the importance of detailed preoperative examination and standardized treatment can lead to wrong treatment as in this case. Prophylactic ureteral catheters might assist in their immediate recognition.