【Abstract】 Objective To introduce the recent studies about the lymph node-targeted chemotherapy for gastric carcinoma. Methods The literatures on the lymph node-targeted chemotherapy for gastric carcinoma in recent years were collected and reviewed. Results The lymph node-targeted chemotherapy for gastric carcinoma was effective because it couled improve the drug concentrations in regional lymph node. Conclusion As a part of multiple treatments for gastric carcinoma, lymph node-targeted chemotherapy will be further developed.
Objective To study the relationship between angiopoietin and the angiogenesis of gastric carcinoma, and to investigate the inter-regulation effect between different vascular growth factors which exist in microenvironment of gastric carcinoma. Methods Literatures about angiopoietin and angiogenesis of gastric carcinoma were collected and reviewed. Results There is a relationship between the expression of angiopoietin in microcirculation and the angiogenesis of gastric carcinoma. Yet, it is still a disputable issue on the inter-regulation effect of different vascular growth factors. Conclusion Angiopoietin may play an important role in the processes of sprouting, development and apoptosis of the microvessel of gastric carcinoma.
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.
Objective To provide a current language for clinical and pathological discription of gastric cancer. Methods The literature in recent years on the distribution of lymph nodes and staging of gastric cancer were reviewed. Results The lymph nodes of gastric cancer are distributed near the blood vessel and organs of gastric milieu. To ensure radical gastrectomy rational and scientific, the anatomic structure of gastric milieu should be familiarized. Conclusion The excellent outcome of surgery will be achieved by the effective dissection and removel of lymph nodes in gastric cancer.
Objective To summarize functions and mechanisms of fibroblast activation protein (FAP) and its application in targeted therapy. Method Literatures about FAP in recent years were collected to make a review. Results Thereis an important relationship between the FAP and the dipeptidyl peptidase-Ⅳ. FAP has a serine protease activity and is an important immunosuppressive component in the tumor microenvironment. FAP participate in the pathological process of the neoplastic and the non-neoplastic diseases. In the targeted therapy, the enzyme inhibitors, antibodies, vaccines, and prodrugs of FAP had been extensively studied. Conclusion FAP have various functions and participates in pathological process of many diseases, and it is of great significance to research of tumor targeted therapy.
Objective To determine whether lymph node-targeted chemotherapy with carbon nanoparticles absorbing 5-FU affects expressions of bcl-2, bax and caspase-3 in gastric cancer tissues, metastatic lymph nodes and normal gastric mucosa. Methods Twenty-eight patients with gastric cancer in our department were divided into lymph node-targeted chemotherapy (LNTC) group and control group from October 2005 to August 2006. The patients were treated with carbon nanoparticles absorbing 5-FU before operation in LNTC group and those were operated directly in control group. The gastric cancer tissues, metastatic lymph nodes and normal gastric mucosa were collected after operation. The expressions of bcl-2, bax and caspase-3 in those tissues were determined by immunohistochemical technique. Results In LNTC group, the positive expression rate of bcl-2 in gastric cancer tissues and metastatic lymph nodes was significantly lower than those in control group (28.6% vs . 78.6% , 25.0% vs . 70.0% , P ＜ 0.05), the positive expression rate of bax (85.7% vs . 28.6% , 80.0% vs . 30.0% ) and caspase-3 (57.1% vs . 14.3% , 55.0% vs . 15.0% ) in gastric cancer tissues and metastatic lymph nodes was significantly higher than those in control group ( P ＜ 0.05). The positive expression rate of bcl-2, bax and caspase-3 in normal gastric mucosa was not significantly different between two groups ( P ＞ 0.05). Conclusion The lymph node-targeted chemotherapy with carbon nanoparticles absorbing 5-FU can down-regulate the expression of bcl-2 and up-regulate the expression of bax and caspase-3 in gastric cancer tissues and metastatic lymph nodes, and therefore by affecting the expression levels of these apoptosis molecules may be one of the ways to induce tumor cell apoptosis.
Objective To investigate the clinical characteristics， diagnosis， and treatment of gastric stromal tumor. Methods Clinical data of 217 patients with gastric stromal tumor from October 2007 to July 2011 were analyzed. Results The main clinical manifestation were abdominal pain， abdominal distension， bloody stools， abdominal mass， and so on. The tumour located at cardiac part， fundus of stomach， body of stomach， and pylorus part was 24 cases （11.0%）， 103 cases （47.5%）， 59 cases （27.2%）， and 31 cases （14.3%）， respectively. All the 217 patients underwent endoscopic or surgical resection and diagnosed by pathology and immunohistochemistry. The patients of high-low risk， low risk， intermediate risk， and high risk was 56 cases （25.8%）， 67 cases （30.9%）， 41 cases （18.9%）， and 53 cases （24.4%）， respectively. One hundred and forty patients were followed-up for 7-52 months （average 35 months）. Thirty-five patients of high risk were investigated about the drug treatment after the first operation：19 cases were treated by using imatinib （tumor progressed in 2 cases） and 16 patients were not （tumor progressed in 9 patients）. The rate of progression of patients treated by imatinib was significantly lower than another group （χ2=8.426， P=0.004）. In 11 patients with tumor progressed， tumor recurrnce in 4 cases， tumor recurrence with diffused abdominal cavity metastasis in 1 case， tumor metastasized to humerus in 1 case， metastasized to liver and abdominal cavity in 1 case， and metastasized to liver in 4 cases. Conclusions Gastric stormal tumor is lack of specific clinical manifestations. Complete excision of the tumor is the main therapy method， and imatinib can improve prognosis.
ObjectiveTo explore the value on excision of subpyloric (No.6 group) lymph nodes of stomach by detection of metastatic rate and metastasis of lymph nodes of No.6 group and its subgroups. MethodsThe clinical data including complete information on No.6 group and its subgroups lymph nodes in 80 patients underwent gastrectomy and subpyloric lymph nodes dissection for gastric cancer from January 2006 to December 2009 were retrospectively analyzed. Referring to the right gastroepiploic vein, the No.6 lymph nodes were divided into three subgroups (No.6a, No.6b, and No.6c subgroup), and the relationship between the metastasis of No.6 lymph nodes and clinicopathologic features as well as the metastasis of No.7, No.8a， and No.9 lymph nodes were analyzed by logistic regression analysis. ResultsThe metastatic rate of No.6 group lymph nodes was 41.3% (33/80) and with 26.0% (108/415) of the resected lymph nodes involved. The metastatic rate of lymph nodes in No.6a subgroup (7.5%, 6/80) was significantly lower than that in No.6b (16.3%, 13/80) and No.6c subgroup (36.3%, 29/80), Plt;0.001. The metastasis of the resected lymph nodes in No.6a, No.6b, and No.6c subgroup was 25.0% (8/32), 17.6% (13/74), and 28.2% (87/309), respectively, and the difference was not significant (P=0.292). The metastasis of lymph nodes in No.6a subgroup was correlated to T stage (P=0.042) and N stage (P=0.006). The metastasis of lymph nodes in No.6b subgroup was correlated to N stage (P=0.002) and TNM stage (P=0.013). The metastasis of lymph nodes in No.6c subgroup was correlated to differentiation degree of tumor (P=0.008), T stage (P=0.003), N stage (P=0.000), and TNM stage (P=0.000). The logistic regression analysis showed that the metastasis of lymph nodes was correlated to the metastasis of No.8a lymph nodes (P=0.023) and N stage (P=0.002) in No.6 group, the metastasis of No.8a lymph nodes (P=0.018) in No.6a subgroup, N stage (P=0.005) in No.6b subgroup, and the metastasis of No.8a lymph nodes (P=0.016) and N stage (P=0.004) in No.6c subgroup. ConclusionAttentions should be paid to the complete dissection of subpyloric lymph nodes in gastric cancer surgery, especially for the lymph nodes of No.6a and No.6b subgroups.
Objective To investigate the effect and surgical skill of ultracision harmonic scalpel in curative gastrectomy for patients with gastric carcinoma. Methods From January 2007 to May 2008, the data of 152 patients who were treated by curative gastrectomy with ultracision harmonic scalpel were analyzed retrospectively. Results The mean operative time was (189.5±24.2) min. Compared with the conventional operation, the number of harvested lymph nodes (mean: 30.4±11.6) in patients treated with ultracision harmonic scalpel was increased. The application of ultracision harmonic scalpel could shorten the operation time, decrease the intraoperative blood loss and make the operation field clear. There were no postoperative complications, such as anastomotic leakage, lymphatic leakage and massive hemorrhage. And there was no death in this series. Conclusion The usage of ultracision harmonic scalpel which could improve the curative degree of lymphadenectomy is safe in curative gastrectomy for patients with gastric carcinoma.
目的 探討小腸間質瘤的臨床表現、病理免疫組織化學特征與治療方法。 方法 回顧性分析2007年1月－2011年7月70例小腸間質瘤患者的臨床表現，免疫組織化學特征及治療手段。 結果 小腸間質瘤患者并無特異性臨床表現，主要臨床表現包括腹痛、腹脹、血便，腹部包塊等。極低風險5例，低風險18例，中風險13例，高風險34例。免疫組織化學顯示CD117、DOG1、CD34、S-100、平滑肌肌動蛋白（SMA）、增殖細胞核抗原（Ki-67）、人結蛋白（Desmin）的陽性率分別為95.7%（67/70）、100%（11/11）、51.4%（36/70）、5.7%（4/70）、12.9%（9/70）、60.0% （42/70）、0% （0/70）。治療上主要以手術完整切除為主，伊馬替尼主要用于無法切除，轉移或中、高危險度的患者。 結論 小腸間質瘤患者臨床表現缺乏特異性表現，發現時往往腫瘤較大、風險度高，選擇合理的輔助檢查方法可以提高其檢出率，目前手術是首選的治療方式。