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.
The isolated gastric neurofibroma is a rare disease and is difficult to be diagnosed before operation. Six patients with this disease were admitted to our hospital from 1992 to 1995. The methods of diagnosis included being alert to this disease, ultrasonic gastroscope and immunopathologic examination, especially the latter. It should be differentiated from carcinoma, leiomyoma,and lymhposarcoma of the stomach. Two of these patients received laparoscopic local resection of the tumor, and the others partial gastric resection.
Objective To systematically review the current situation of health economics evaluation of gastric cancer screening. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect the health economics evaluation studies on gastric cancer screening from January 1st, 1975 to September 30th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Then, qualitative analysis was performed. Results A total of 44 studies were included. Most of the targeted populations of the study were high-risk groups in areas with a high incidence of gastric cancer. Screening methods such as endoscopy and Helicobacter pylori infection detection were mainly evaluated in those studies. According to the results, about 47% of the studies evaluated a single screening method. A total of 35 studies showed that they established models, however, only a few calibrated the models. Conclusion Most studies of gastric cancer screening reviews neither calibrate the results nor consider the effect of smoking on the progression of gastric cancer. Those evaluated screening programs are limited.
From 1987 to 1993, 12 cases of primary gastric malignant lymphoma (PGML) were hospitalized. The incidence of PGML was 1.9% of gastric malignancies during the same period. There were 5 cases in stage Ⅰ, 4 in stage Ⅱ, 1 in stage Ⅲ, and 2 in stage Ⅳ. The preoperative diagnosis of PGML was difficult because the incidence of PGML is low, the symptoms are nonspecific, and the radiologic and fibrogastroscopic character were very similar to those of gastric carcinoma and peptic ulcer disease. The surgical treatment of PGML is disccused.
Objective To investigate the expression of suppressor gene Runt-related transcription factor 3 (Runx3) in gastric carcinoma and its relationship with clinicopathologic parameters. Methods RT-PCR and Western blot were used to determine the mRNA expression and protein expression of Runx3 gene in primary tumor and corresponding normal tissues respectively in 52 patients with gastric carcinoma. The relationship between Runx3 expression and clinicopathologic parameters was analyzed. Results RT-PCR and Western blot analysis in 52 patients with gastric carcinoma showed down-regulation of Runx3 mRNA and Runx3 protein in 59.6% (31/52) and 48.1% （25/52） of the primary tumors tested, and in none of the normal tissues (P＜0.05) respectively. There was a significant negative correlation between the expression level of Runx3 gene and the clinicopathologic parameters such as tumor size, differentiation, infiltrative depth, lymph node metastasis and TNM stage (P＜0.05， P＜0.01). Runx3 gene transcription was coincident with its protein expression (r=0.840, P＜0.01）. Conclusion The expression of Runx3 gene is down-regulated in gastric carcinoma, which suggests that Runx3 gene plays an important role in carcinogenesis and the progression of gastric carcinoma. It may be a new target of diagnosis and treatment of gastric carcinoma.
ObjectiveTo compare clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopy-assisted gastrectomy (LAG) and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy. MethodThe clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed. ResultsAll procedures were completed successfully. There were no significant differences in the time of anastomosis〔(73.8±10.3) min versus (72.7±8.9) min, t=0.693, P=0.489〕 and the number of dissected lymph nodes (32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485) between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss〔(275.0±66.3) mL versus (364.3±75.7) mL, t=-7.419, P=0.000〕, the incision length〔(3.0±0.8) cm versus (7.3±1.7) cm, t=-19.354, P=0.000〕, the time to fluid diet〔(4.9±0.8) d versus (6.0±0.7) d, t=-8.750, P=0.000〕 and the time to flatus 〔(2.8±0.8) d versus (3.9±0.8) d, t=-8.388, P=0.000〕, the off-bed time〔(1.3±0.5) d versus (3.4±1.2) d, t=-14.118, P=0.000〕, and the hospital stay〔(9.8±1.2) d versus (13.0±1.5) d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score〔On day 1 postoperatively: (3.4±0.8) points versus (6.2±1.3) points, t=-15.509, P=0.000; on day 3 postoperatively: (1.7±0.6) points versus (4.0±0.8) points, t=-18.799, P=0.000〕 and the dosage of pain killers (1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000) in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7% (4/70). While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG. ConclusionsTotal laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.
Objective To assess the safety and effect of different intravenous chemotherapic regimens in patients with gastric carcinomas who had received gastrectomy. Method A systematic review of all the relevant randomized controlled trials (RCTs) was performed. RCTs were identified from Medline and Embase (1980-2001.4), Chinese Bio-medicine Database (1990-2001.1). Literature references were checked at the same time. We included randomized andquasi-randomized trials in patients with confirmed gastric carcinomas who had received gastrectomy comparing the effect of intravenous chemotherapy after gastrectomy with that of gastrectomy alone.Results Twenty trials involving 4 171 patients were included. Meta-analysis was done with fixed effects model. Heterogeneity analyses was performed also. The effects of intravenous chemotherapy with 5FU + MCCNU, 5FU + MMC, 5FU + BCNU or FAM after gastrectomy were failed to show have better effects than that of surgery alone. There were eleven trials which detailed the side effects according to the toxicity grade by WHO standard. The side effects halting treatment were haematologic and biochemical toxicity, debilitating nausea and vomiting. There were twenty-two patients died of chemotherapic toxicity. Conclusions Based on the review, there is no enough evidence to show that intravenous chemotherapy after gastrectomy have positive treatment effect on gastric cancer.
Objective To investigate the effect of mRNA expression of gelatinase A on the invasion and metastasis of human gastric carcinoma (HGC). MethodsThirtysix cases of HGC were examined by in situ hybridization technique. ResultsPositive expression rates of gelatinase A in the normal gastric tissue, peritumor tissue and HGC were 8.3%,35.7% and 83.3% respectively （P＜0.01）. The positive rates of gelatinase A in the group with serosal invasion and lymph node metastasis were 93.1% and 90.6%, much higher than those in the group with negative ones (42.9% and 25.0%).By in situ hybridization, gelatinase A mRNA was showed to be expressed in the extracellular matrix of tumor tissues,which surrounded the invasive margin of cancer tissues. The positive cells at these sites were mainly tumorinfiltrating macrophages. Conclusion There is good correlation between gelatinase A mRNA expression and the invasion, metastasis of HGC. So it can be used as a useful marker for invasion and metastasis of HGC.
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.
To investigate the diagnosis, pathological characteristics and clinical treatment of gastric eosinophilic granuloma (GEG). Twenty two cases with GEG diagnosed by operation and pathology were analyzed. In this series 14 cases subjected to partial gastrectomy, 6 cases to subtotal gastrectomy, 1 case to total gastrectomy, and 1 case to radical gastrectomy. After 1-10 years of follow-up, 1 case, who was combined with gastric carcinoma at the first operation, died of the recurrence and extensive metastasis of gastric carcinoma on the 4th year after operation, 2 cases were reoperated on the 2nd or 6th year respectively after operation for forward complication, and the others recoverd well. The authors consider that gastrofiberscopic diagnosis is key to lessen the preoperative misdiagnosis, and the scope of dissection mainly depends on the size and type of focus. It is no need for extensive dissection.