The diagnosis and treatment of gastric cancer is a systematic and frameworking medical task in a multidisciplinary manner. New models, new technologies, new regimens, and new drugs have been developed to explore the best strategies to improve the survival of patients with gastric cancer. Here we discussed the research progress and guideline updates in four aspects, including the accurate staging-classification-based treatment strategy, the quality control in the surgery, the rational perioperative neoadjuvant-adjuvant therapies, and molecular classification joint with precision medicine. The purpose is to further promote the standardized gastric cancer management in China and emphasize its importance. From the updates of knowledge and the transformation of understanding and recognition, to the quality improvement, it’s critical to reduce the heterogeneity of the quality of gastric cancer management in China, as well as enhance adherence to guidelines and consensuses.
ObjectiveTo review the lymph node metastasis pattern and its dissection value among adenocarcinoma of the esophagogastric junction (AEG) patients, in order to assist suitable individualized lymph node dissection strategies for diverse AEG patients. MethodsThe reports about lymph node metastasis and the value of dissection of AEG worldwide in recent years were retrieved and summarized. ResultsThe sites with higher lymph node metastasis rate of AEG included No.1, No.2, No.3, No.7 lymph nodes, etc. and sites with higher lymph node metastasis rate often benefit from dissection. Lymph node metastasis was related to factors such as tumor size and location, and lymph node dissection at individual sites is still controversial. ConclusionThe lymph node dissection range of AEG is highly controversial, especially for Siewert type Ⅱ AEG, which still requires prospective multicenter studies to prove.
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.
ObjectiveTo summary the study results of the Sichuan Gastric Cancer Early Detection and Screening Research Program (SIGES). MethodsIn the past 10 years, SIGES program conducted a series of clinical and clinical epidemiological studies on the current situation and strategies of gastric cancer prevention and control in China, which provided evidence for supply-side structural reform to improve the gastric cancer prevention and control. We collected related studies and made a review. ResultsSIGES program systematically and specifically studied carcinogenic pathogens, risk factors, screening strategies, as well as critical technique and system construction of tertiary prevention for gastric cancer. The main results supported that Helicobacter pylori was highly correlated with precancerous atrophic gastritis and gastric cancer. Oncoviruses, such as Epstein-Barr virus, hepatitis B virus, human cytomegalovirus, human papillomavirus, John Cunningham virus were correlated with the risk of gastric cancer, and should be paid further attention in the prevention and screening strategy of gastric cancer. Ethnicity, domicile, and family history of gastric cancer were also correlated with gastric cancer and gastric cancer-related risk factors, so it was suggested to include in the personalized evaluation criteria system of high-risk groups for gastric cancer. ConclusionsAt present, the prevention and control of gastric cancer in China has achieved substantial achievements, but the burden of gastric cancer keeps heavy. It is still necessary to conduct further scientific research on critical technique or issues in designing prevention and control strategies.
Assembling medical aid teams (MATs) from the provinces outside Hubei was an important China-specific approach to dealing with public health emergencies during the coronavirus disease 2019 (COVID-19) pandemic in Hubei. In integrally taking over the COVID-19 intensive care wards in Wuhan, the Joint 7th and 8th Sichuan COVID-19 MATs applied the methods of modern hospital management to complete the medical task, concerning four key points as guidance by the Communist Party of China, system and regulation establishment, organization construction, and discipline persistence. This paper makes a theoretical summary on the basic management of the Joint 7th and 8th Sichuan COVID-19 MATs, and it is hoped that more COVID-19 MATs could summarize and share their successful management experiences in order to enrich and improve the management theory of MAT.
Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was （1 225.15±216.23） cm3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm3)=12.712×body weight (kg)+450.44〕 and body surface area 〔liver volume (cm3)=876.02×body surface area (m2)-297.17〕. The mean liver volume of Child A, B and C patients were （1 077.77±347.01） cm3, (1 016.35±348.60) cm3 and (805.73±208.85) cm3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P＜0.05); while liver volume change ratio was higher in Child C patients (P＜0.05). Conclusion Liver volume variation of cirrhotic patients can be quantitatively assessed by 16 slices helical CT volume measurement and standard liver volume equation. The change of the liver volume is correlated with the severity of liver cirrhosis.
Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis with perforation remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.
ObjectiveTo systematically review the methods, characteristics, and indications of technique for retraction of liver and evaluate their application effects during the laparoscopic radical gastrectomy for gastric cancer, so as to provide reference for clinicians to choose the most suitable liver retraction method. MethodThe relevant research literature on the application of liver retraction method both domestically and internationally during the laparoscopic radical gastrectomy was reviewed and compared. ResultsThe main liver retraction methods that were used both domestically and internationally included V-shaped retraction, W-shaped retraction, medical adhesive retraction, and liver dilator retraction. Among them, the V-shaped, W-shaped, and liver dilator retraction techniques had been improved according to the situation, but these retraction techniques had their own advantages and disadvantages and could not be completely replaced by each other. ConclusionsCurrently, there is no absolutely ideal retraction method that is simple, safe, and effective. The specific choice of liver retraction technology needs to be selected based on the patient’s specific physical conditions, considering the safety, effectiveness, and rationality of this method.
Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used in clinical setting, and is one of the optional treatment for peritoneal surface tumors. It can be used as adjuvant therapy to prevent peritoneal recurrence after gastric or colorectal cancer resection, or to treat those diseases with peritoneal metastasis alone through cytoreductive surgery +HIPEC or HIPEC alone, based on a multidisciplinary model. The updates of European HIPEC-related clinical trials, GASTRIPEC, GASTRICHIP, PRODIGE 7, PROPHYLOCHIP, COLOPEC, COMBATAC, were reported at the 11th International Workshop on Peritoneal Surface Malignancy. In those trials, there was no definitive result surporting that HIPEC treatment might bring survival benefits to patients with gastric or colorectal cancer. However, long-term follow-up results remain to be seen, and some studies are still recruiting. Although several studies were designed as phase Ⅲ trials, the overall sample size was small-scaled. In addition, in the trials, diagnostic laparoscopy were widely used in gastric or colorectal cancer patients, which was helpful to improve staging accuracy and optimizing treatment strategies. The indications for HIPEC therapy (peritoneal cancer index) and technical issues (duration, temperature, approach, and agents) need further investigate.
Objective To review the current researches about tumor necrosis factor-related apoptosis ligand (TRAIL) and its receptors in gastric carcinoma. Methods Relevant articles of researches on TRAIL and its receptors in gastric carcinoma were searched in electronic databases of PUB-MEDLINE and Chinese Journal Fulltext Database. Results The reported TRAIL expression level of gastric carcinoma was diverse, which was highly correlated to the histological differentiation degree, serosa invasion and lymph node metastasis. Its receptors DR4 and DR5 were both positive in gastric carcinoma tissue, while some researches reported DcR1 and DcR2 were also positive expressed. caspase-3, -8 and survivin were the important factors for regulation of TRAIL signal pathway. 5-Aza-CdR, doxorubicin, 5-fluorouracil, α-TOS and X-ray irradiation might enhance the TRAIL-induced apoptosis of gastric carcinoma cells. Conclusion Gastric carcinoma may be potentially sensitive to TRAIL targeting therapy, but the mechanism of TRAIL-induced apoptosis is quite complex and is regulated by multi-factors. Up to now, there are still many issues to research further, such as how to efficiently enhance and regulate the TRAIL-induced apoptosis of gastric carcinoma, whether any potential toxicities existing, etc.