【Abstract】 Objective To investigate the expression patterns of vascular endothelial growth factor (VEGF) mRNA as markers for isolated tumor cells in the peripheral blood of patients with hepatocellular carcinoma (HCC) following liver transplantation, and to evaluate the correlation between VEGF and the recurrence and metastasis of HCC following liver transplantation. Methods In this prospective study, 97 patients were divided into four groups according to the pathological results: HCC following liver transplantation group (HCC+LT group, n=53), advanced HCC group (n=8), benign liver diseases group (n=26) and healthy volunteers group (n=10), among which the 53 cases in HCC group were collected from April, 2002 to December, 2003. RNA was purified from the peripheral blood of the other 44 control patients and also from the patients in HCC group before, during and after liver transplantation in order to study the expression specificity of VEGF mRNA in HCC patients and its dynamic change during perioperative period. The correlation between VEGF and the tumor recurrence and metastasis was also analyzed by fluorescent quantitative reverse transcriptase and polymerase chain reaction (FQ RT-PCR). Results VEGF mRNA could be used as marker of isolated tumor cells for its high specificity. The positive rate of VEGF mRNA in HCC group and in advanced HCC group were 37.5% and 75.0%, respectively, which were significantly higher than that in benign liver diseases group (11.5%) and healthy volunteers group (10.0%), P＜0.01. The presence of preoperative VEGF mRNA and the consistent presence of postoperative VEGF mRNA might be relevant with the recurrence and metastasis HCC following liver transplantation （P＜0.01）. Conclusion The presence of preoperative VEGF mRNA and the consistent presence of postoperative VEGF mRNA may predict the recurrence and metastasis HCC following liver transplantation.
【 Abstract 】 Objective To study the mRNA expression of BC047440 gene in multiplicate malignant tumor tissues and the corresponding adjacent tissues, and to investigate its roles in the carcinogenesis and development of malignant tumors. Methods Forty-eight cases of malignant tumor tissues and their adjacent non-cancerous tissues were examined. The mRNA expression of BC047440 gene in those tissues of liver cancer, cholangiocarcinoma, gastric cancer, carcinoma of large intestine, glioma, and breast cancer were measured by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). Results ① The mRNA expressions of BC047440 gene in liver cancer, gastric cancer, cholangiocarcinoma and carcinoma of large intestine were significantly higher than those in their adjacent non-cancerous tissues (Plt;0.05 or 0.01). BC047440 gene were highly expressed in both glioma and its adjacent tissues (Pgt;0.05), and poorly expressed in both breast cancer and its adjacent tissues (Pgt;0.05). ② There were close relationships between BC047440 gene expression and clinicopathologic findings of liver cancer, including tumor size and portal vein invasion (Plt;0.05). ③ There were also close relationships between BC047440 gene expression and different clinical stages in alimentary canal cancers (Plt;0.05). Conclusion The over expression of BC047440 gene may be related with the growth, infiltration and metastasis of some malignant tumors, including liver cancer, cholangiocarcinoma, gastric cancer, carcinoma of large intestine and glioma.
Objective To investigate the role of KiSS-1 gene in the metastatic process of carcinoma of gallbladder and the clinicopathologic significance of KiSS-1 gene expression in carcinoma of gallbladder. Methods Pathological specimens from 59 gallbladder carcinoma tissues (13 hepatic invasion and 13 lymphatic invasion tissues were included), matched with 7 para-tumor and 6 normal gallbladder tissues, were examined for the expression of KiSS-1 gene by tissue microarray technique and immunohistochemistry (EnVision). Results The positive rate of KiSS-1 expression was down-regulated (P＜0.05) in tumor tissues, as compared with normal and para-tumor tissues. In carcinoma of gallbladder, the expression of KiSS-1 had no relationship with the gender, age, tumor size, histological grade or differentiation, and metastasis of lymph node, while was associated with the depth of infiltration, invasion of liver and the clinical stages (Nevin). In Ⅰ+Ⅱ, Ⅲ+Ⅳ and Ⅴ stage, the positive rates of KiSS-1 were 92.3%, 57.1% and 27.8% respectively, with an undeniably clear lowering tendency (P=0.002). Conclusion Down-regulating expression of KiSS-1 is closely associated with the processes of genesis, invasion and metastasis in carcinoma of gallbladder, and may participate in regulating these processes.
ObjectiveTo summarize recent research advancement on radically surgical therapy of carcinoma of the body and tail of pancreas． MethodsRelevant literatures about radically surgical therapy of carcinoma of the body and tail of pancreas were collected and reviewed． ResultsRecent experimental researches indicated that distal pancreatectomy was the common used surgical way to treat carcinoma of the body and tail of pancreas. Besides， spleenpreserving distal pancreatectomy, distal pancreatectomy with en bloc celiac axis resection, and laparoscopic distal pancreatectomy were also the choices to the treatment of carcinoma of the body and tail of pancreas. ConclusionThe surgical way to treat carcinoma of the body and tail of pancreas has advanced for these years, but furthermore development requires more great efforts.
Objective To explore the clinical therapeutic value of pancreatoduodenectomy in patients with carcinoma of ampulla of Vater (AVC). Methods The clinical data of 195 patients with AVC between March 1995 and March 2009 in this hospital were analyzed retrospectively. All the patients were divided into non-surgery group (n＝51), palliative surgery group (n＝96), and resection group (n＝48) according to the treatment methods. Results The 1-year, 3-year, and 5-year survival rates in the resection group were higher than those in the non-surgery group and the palliative surgery group (Plt;0.01). However, the incidence of complications in the resection group was higher than that in the nonsurgery group or the palliative surgery group (Plt;0.05). The radical resection rates, 1-year, 3-year, and 5-year survival rates of carcinomas of head of pancreas were significantly lower than those of carcinomas of the terminal of common bile duct or carcinomas of duodenal papilla (Plt;0.05, Plt;0.01). There was no significant difference of the perioperative mortality, complications rate, 1-year, 3-year, or 5-year survival rate between preoperative drainage jaundice group and preoperative nondrainage jaundice group (Pgt;0.05). The perioperative mortality in the resection group above the age of 70 years old was higher than that of less than or equal to 70 years old （Plt;0.05）. Compared with the non-surgery group or palliative surgery group, there were significant increasement of the incidence of serious or deadly perioperative complications in the resection group (Plt;0.05). Conclusions Surgical resection remains one of the most important measures of the treatment of AVC, in particular, the radical pancreatoduodenectomy is the only effect way for AVC, thus significantly prolonging the patient’s postoperative survivals and significantly improving the qualities of life.
ObjectiveTo compare the efficacy between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of carcinoma of head of pancreas. MethodsClinical data of 60 patients with locally advanced carcinoma of head of pancreas who underwent pancreaticoduodenectomy in our hospital from October 2004 to October 2009 were collected, of which 26 patients were in LPD group and 34 patients were in OPD group. ResultsOperative time and hospitalization expense of patients in LPD group were both longer or more than those of OPD group (P<0.05), but blood loss, time of starting activity, time of aeration, time of pulling out the drainage tube, time of pulling out the stomach tube, time of absolute resting on bed, and hospitalization time in LPD group were all shorter or lower than those of OPD group (P<0.05). There were 25 patients suffered with postoperative complications, including 10 patients in LPD group and 15 patients in OPD group, and there was no significant difference between the 2 groups in total incidence of postoperative complication (P>0.05). But in the specific postoperative complication, the incidences of pancreatic fistula and biliary fistula of LPD group were higher than those of OPD group (P<0.05), but incidences of incision infection, pulmonary infection, and systemic infection were all lower than those of OPD group (P<0.05). All patients were followed up for 1-60 months with the median time of 21.5 months. During the follow-up period, in LPD group, 24 patients suffered with recurrence, 20 patients suffered with tumor metastasis, and 24 patients died; in LPD group, 31 patients suffered with recurrence, 25 patients suffered with tumor metastasis, and 31 patients died. There were no significant difference between the 2 groups in the recurrence rate, metastasis rate, mortality, and survival situation (P>0.05). ConclusionsFor carcinoma of head of pancreas, postoperative recovery and infection complications of LPD are significantly superior than those of OPD. But compared with the OPD, it has no obvious advantage in reducing the pancreatic fistula, biliary fistula, delayed gastric emptying, and other complications, and it also has no obvious advantage in improving the long-term survival situation too.
Forty-five pancreatoduodenectomies had been performed in our hospital from 1981 to 1994, of which 35 cases were diagnosed as carcinomas of Vater’s ampulla or pancreatic head, and 10 (cases) as benign lesions. Through analysis of misdiagnosed cases, the authors emphasize that it is important to take correct history of jaundiced patients in detail according to the character of the jaundice and associated symptoms before any operation done. Secondly, all clinical materials must be thoroughly collected and special examinations for diagnosis should be chosen scientifically to avoid relying only on one sort of examination result as diagnostic standard. Thirdly, during operation the area of pancreatic head should be explored carefully and any lesions in doubt should be examined pathologically by puncture biopsy and frozen section to avoid misdiagnosis and thus performing pancreatoduodenectomy.
ObjectiveTo assess the feasibility of the treatment of unresectable late pancreatic cancer with laparoscopic choledochojejunostomy and gastric bypass. MethodsFrom June 2000 to December 2003, laparoscopic choledochojejunostomy and gastric bypass were successfully performed in 15 patients with unresectable late pancreatic cancer. Endoscopic nosobiliary drainage (ENBD) was performed before the operation. ResultsAll procedures were completed laparoscopically. Jaundice and hepatic function of the patients were obviously improved after the bypass. Oral nutrition was recovered after operation. The mean operative time was (100±26) min (range 70-200 min); the mean operative blood loss was (60±15) ml (range 30-120 ml); the bowel function recovery was on the 3rd-5th postoperative day; the average hospital stay was (8.1±0.7) days (range 6-13 days). Incision infection ocurred in one patient. No operative complications occurred in other patients. ConclusionTreatment of unresectable late carcinoma of the pancreas with laparoscopic choledochojejunostomy and gastric bypass aided by ENBD is a minimally invasive technique with less postoperative pain，shorter hospital stay, lower procedurerelated morbidity,and better oral nutrition. The life quality of patients with late pancreatic cancer can be obviously improved.
One hundred and twenty eight patients with intestinal obstruction due to cancer of left lemicolon are presented. In this series 71 patients suffered from partial intestinal obstruction and 57 patients from complete obstruction, the latter were in later Dukes stages, with lesser resectability of the tumor and higher mortality. The transition from partial obstruction to complete obstruction takes a slow course. Purgatives and coarse fibered food should not be given to the patients with partial obstruction, or else will induce acute obstruction. Several types of operation for partial and complete obstruction are discussed. Methods and results of intraoperative colonic irrigation are presented. The authors believe that intraoperative colonic irrigation is a good emergency management for cancer obstruction of the left colon. Complication of this disease are also discussed.