Objective To evaluate the preliminary efficacy and safety of XELOX combined with trastuzumab in the transformation therapy of human epidermal growth factor receptor 2 (HER2) positive elderly patients with advanced gastric cancer. Methods The clinical and surgical data of 21 patients with HER2 positive elderly patients with advanced gastric cancer who were treated with XELOX combined with trastuzumab in our Hospital from February 2019 to February 2021 were retrospectively analyzed, and the remission of patients after conversion therapy and the relevant indicators during and after surgery were observed. Results After the conversion therapy, there were 2 cases (9.5%) of complete remission, 13 cases (61.9%) of partial remission, and 6 cases (28.6%) of stable disease, the remission rate of the conversion therapy was 71.4% (15/21). After conversion treatment, 21 patients underwent laparoscopic exploration, of which 20 patients (95.2%) underwent R0 resection, simple exploration 1 case. In all 21 cases, the operative time was 124–185 min, with a median of 152 min. The intraoperative blood loss was 100–210 mL, with a median of 120 mL. The number of lymph nodes cleared was 12–54, with a median of 32. The duration of indwelling gastrointestinal decompression was 51–134 h, with a median of 102 h. The recovery time of gastrointestinal function was 70–98 h, with a median of 78 h. The drainage time in the abdominal operation area was 4–9 days, with a median of 6 days. Postoperative hospital stay was 7–13 days, with a median of 8 days. There were 2 cases of Grade IIIA complications (1 case of incomplete intestinal obstruction and 1 case of pulmonary infection) and 2 cases of Grade II complications (1 case of incision fat liquefaction and 1 case of jugular catheter infection) after operation. All patients were followed up for 3–36 months, with a median of 16.8 months. The median progression-free survival time was 12.4 months and the median overall survival time was 20.5 months. Conclusion For HER2 positive elderly patients with advanced gastric cancer, XELOX combined with trastuzumab transformation therapy is effective and safe.
Objective To investigate the effectiveness of a modified double keystone design perforator island flap in repairing large skin and soft tissue defects in the posterior midline lumbar region following extensive excision for Bowen disease. Methods A retrospective analysis was conducted on the clinical data of 9 patients with Bowen disease in the posterior midline lumbar region admitted between January 2020 and June 2024. There were 4 males and 5 females; ages ranged from 55 to 80 years, with a mean age of 68.9 years. Lesions were located at L1-5 levels and concentrated near the midline posterior to the spinous processes. And the lesions were confined to the skin and subcutaneous tissue. The size of residual defects following extensive excision ranged from 6.0 cm×5.5 cm to 10.0 cm×8.5 cm. The modified double keystone design perforator island flaps were designed with the defect as the center. Subcutaneous and adipose tissues were dissected without incising the deep fascia, while preserving perforator vessels. The bilateral flaps were advanced toward the midline using V-Y advancement sutures; the size of unilateral flap ranged from 8.5 cm×3.5 cm to 15.0 cm×6.0 cm. The donor sites were directly sutured. Results Operations were successfully completed in all 9 cases. The operation time ranged from 80 to 100 minutes (mean, 90 minutes); intraoperative blood loss ranged from 20 to 80 mL (mean, 41.1 mL); and the length of hospital stay ranged from 9 to 15 days (mean, 10.4 days). All flaps survived, with only 1 case of mild fat liquefaction at the recipient site. All patients were followed up 9-18 months (mean, 12.4 months). All flaps were similar in texture, thickness, and color to the surrounding skin, with no obvious “cat’s ear” deformity observed. The lumbar mobility was normal, with no sensation of tightness or pain. At last follow-up, the subjective satisfaction, as assessed by the visual analogue scale (VAS) score, ranged from 7 to 10, with a mean of 8.7. No tumor recurrence was observed during follow-up. Conclusion For large defects resulting from extensive resection of Bowen disease in the posterior midline lumbar region, the use of a modified double keystone design perforator island flap offers the advantages of reliable blood supply, uniform tension distribution, no need for skin grafting, and minimal trauma at donor site.