ObjectiveTo explore the reasonable and feasible safe distance for radical resection of hepatic alveolar echinococcosis (HAE). MethodsLiver samples were collected prospectively from 20 HAE patients (from Jan. 2019 to Jun. 2019) undergoing liver resection in West China Hospital of Sichuan University. A total of three samples containing lesion and adjacent liver tissue were collected from each patient, which were divided into lesion group, 0 to0.5 cm liver tissue group (contained 0.5 cm), 0.5 to 1.0 cm liver tissue group (contained 1.0 cm), 1.0 to 1.5 cm liver tissue group (contained 1.5 cm), and 1.5 to 2.0 cm liver tissue group (contained 2.0 cm). Comparisons of the Cox1 expressionand the liver fibrosis area between HAE lesion and adjacent liver tissues were performed. ResultsBoth expression of Cox1 and fibrosis area in HAE lesion were significantly higher than those in the adjacent liver tissues (P<0.000 1). However, there was no significant difference among the four kinds of adjacent liver tissues (P>0.05). There was a significant positive correlation between the expression of Cox1 and the fibrosis area both in HAE lesion and adjacent liver tissues (P<0.05). ConclusionsBoth the expression of Cox1 and degree of the liver fibrosis are significant higher in HAE lesion comparing to adjacent liver tissues, however, no significant difference is found among adjacent liver tissues. Consequently, a safe distance of 0.5 cm may be reasonable and feasible on the basis of the criteria for sample collection in the study.
Objective To investigate the impact of conversion to open in laparoscopic rectal cancer radical resection (LRR) on postoperative recovery. Methods The data from Feb. 2003 to Feb. 2007 of 176 cases who were given LRR and 32 cases receiving conversion in LRR (CRR) were analyzed retrospectively, and were compared about operation time, hospitalization time, hospitalization expenses, intraoperative blood loss, recovery time of bowel movement and postoperative complications with 59 cases of open rectal cancer radical resection (ORR). Results There were no differences among LRR, CRR and ORR about operation time, hospitalization time, intraoperative blood loss and recovery time of bowel movement (Pgt;0.05). The hospitalization expenses of LRR and CRR were higher than that of ORR (P=0.001, P=0.001), there was no difference between CRR and LRR (P=0.843). But the postoperative complications rate of ORR was higher than those of LRR and CRR （P=0.023,P=0.004）. Conclusion Compared with ORR, LRR has relatively conversion rate, and then increases the hospitalization expenses.
We reviewed the clinical studies on drug therapy for gallbladder cancer and expounded on the current situation of conversion therapy for gallbladder cancer. Gallbladder cancer was usually diagnosed late, with high malignancy, low surgical resection rate, and poor prognosis. With the development of conversion therapy, systemic therapy combined with radical resection had effectively improved the surgical resection rate and prognosis of gallbladder cancer patients. At present, most of the published conversion therapies for gallbladder cancer were mainly retrospective researches, lacking large multicenter prospective research, and the treatment plan was still based on chemotherapy, lacking the research of targeted therapy in combination with immunotherapy. It is expected that more high-quality clinical trials can be made first-line recommendations for the conversion therapy of gallbladder cancer.
Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
ObjectiveTo evaluate the influence of clinical, pathological and treatment factors on the prognosis of thymic carcinoma patient accepted surgical treatment.MethodsRetrospective analysis was performed on 38 patients with thymic carcinoma undergoing surgical treatment between January 2008 and December 2017. The association between the prognostic factors including age, sex, thymectomy, radical resection, pathological type, TNM stage, Masaoka-Koga stage, tumor size, and survival was assessed using the Kaplan-Meier method.ResultsThe 5-year overall survival rate of our cohort was 51.9%. Kaplan-Meier univariate survival analysis showed that radical resection (P=0.003), TNM stage (P=0.038), Masaoka-Koga stage (P=0.033), and tumor size (P=0.030) were related to the prognosis of patients with thymic carcinoma. Radical resection was also validated as an independent prognostic factor in multivariate Cox analysis (P=0.009, hazard ratio 2.31, 95%CI 1.23-4.33).ConclusionRadical surgical treatment could improve the prognosis of patients with resectable thymic carcinoma.
ObjectiveTo investigate the feasibility, safety and clinical effect of total laparoscopic radical resection of hilar cholangiocarcinoma.MethodsRetrospectively summarized the 14 patients with hilar cholangiocarcinoma, who underwent total laparoscopic radical resection of hilar cholangiocarcinoma in the Affiliated Hospital of Xuzhou Medical University from April 2016 to June 2018. Collected the clinical data of those patients, including 7 cases of Bismuth type Ⅰ, 5 cases of Bismuth type Ⅱ, and 2 cases of Bismuth type Ⅲb.ResultsTotal laparoscopic radical resection of hilar cholangiocarcinoma were performed successfully in all 14 patients. The operative time was 190–400 min (median time of 285 min) and the amount of intraoperative blood loss was 100–500 mL (median amount of 175 mL). There was no death case during the perioperative period. Postoperative pathological results showed that all cases accorded with bile duct adenocarcinoma, resection margins of them were negative, amount of lymph node was detected 6–15 per case (median amount of 8 per case), and 3 patients were inspected with peritumoral lymph node metastasis. Two patients were combined with postoperative bile leakage, one of whom was complicated with an abdominal infection, and both were cured and discharged after conservative treatment. All patients were followed-up regularly within 3–24 months (median followed-up period of 16 months). One of them recurred within 12 months after the operation. The remaining patients have survived well so far.ConclusionUnder the operation of the experienced surgeon, total laparoscopic radical resection of hilar cholangiocarcinoma is safe, feasible and effective in the short term.
Objective To evaluate the long-term efficacy of extended and standard surgery for carcinoma of head of pancreas by using meta-analysis. Methods Related articls （1990-2012） were searched in Pubmed， WOS， Embase， WanFang， SinoMed， and CNKI. Study on quality of these literatures were evaluated by using the Jadad score. The patients with pancreatic head carcinoma underwent extended radical resection and standard radical resection were classified to treatment group and control group， respectively. The mortality， morbidity， and survival rates of 1-， 3-， and 5-year after operation in the two groups were evaluated by using meta-analysis. Results A total of 11 studies fitted the selection crit-eria， including 744 patients. Among them 357 cases were in standard radical resection group and 387 cases in the extended radical resection group. The results of meta-analysis showed that： ①The morbidity after operation did not significantly differed between the extended radical resection group and standard radical resection group （OR=1.360， 95% CI=0.990-1.870， P=0.050）. ②The mortality of the two groups did not significantly differed （OR=0.870， 95% CI=0.430-1.760，P=0.700）. ③There were no significant differences in survival rates of 1-， 3-， and 5-year between the two groups （OR=0.880， 95% CI=0.450-1.720， P=0.710；OR=0.940， 95% CI=0.590-1.480，P=0.710；OR=1.000， 95% CI=0.600-1.67， P=1.000）. Conclusion Compared with standard radical resection， extended radical resection can not improve the survival rates of 1-， 3-， and 5-year after operation， and can’t reduce the mortality and morbidity after operation
ObjectiveTo explore the risk factors of perioperative severe complications (Clavien-Dindo grade Ⅲ and above) after laparoscopic radical resection of colorectal cancer (CRC). MethodsThe clinicopathologic data of CRC patients who met the inclusion and exclusion criteria treated in the Shaanxi Provincial People’s Hospital from January 2018 to December 2020 were retrospectively analyzed. The univariate and multivariate logistic analyses were used to explore the risk factors of perioperative severe complications after the laparoscopic radical resection of CRC. ResultsAtotal of 170 eligible patients were included in this study, and the postoperative complications occurred in 45 patients, 24 of whom were severe complications. The univariate analysis results showed that the age (P<0.001), body mass index (BMI, P=0.047), age adjusted Charlson complication index (aCCI) score (P=0.002), American Association of Anesthesiologists (ASA) classification (P<0.001), prognostic nutritional index (PNI, P=0.011), preoperative anemia (P=0.011), operation numbers of surgeon (P=0.003), and operation time (P=0.026) were related to the perioperative severe complications in the patients underwent the laparoscopic radical resection of CRC. The statistic indexes of univariate analysis (P<0.05) combined with indexes of clinical significance were included in the multivariate analysis, the results showed that the ASA classification Ⅲ– Ⅳ (OR=3.536, P=0.027), BMI ≥25 kg/m2 (OR=3.228, P=0.031), preoperative anemia (OR=2.876, P=0.049), operation numbers of surgeon <300 (OR=0.324, P=0.046), and the operation time ≥300 min (OR=3.480, P=0.020) increased the probability of perioperative severe complications in the patients underwent the laparoscopic radical resection of CRC. ConclusionsThe results of this study suggest that clinicians should pay attention to the perioperative management of patients with CRC, such as adequately evaluating the preoperative status of patients by ASA classification, PNI, and aCCI to adjust the malnutrition of patients; after operation, the patients with BMI ≥25 kg/m2 and operation time more than 300 min should be paid more attention. At the same time, the surgeon should continuously accumulate the operation numbers and improve the operation proficiency so as to reduce the occurrence of perioperative severe complications after laparoscopic radical resection of CRC.
Objective To investigate the strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Method Reviewing the related literatures at home and abroad in recent years, to summarize the progress of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Results We should clear the postoperative bleeding time, extent, cause, and location, to help the clinician to choose the appropriate timing of intervention and treatment. The patients with early hemorrhage and mild degree hemorrhage could be treated conservatively. If patients with severe hemorrhage and hemodynamic disorders, surgical intervention must be decisive. Patients with late hemorrhage would have serious consequences, and these patients should receive interventional or surgical treatment as early as possible. Conclusions For patients with hilar cholangiocarcinoma after radical resection, doctors need to do accurate preoperative evaluation, meticulous operation, and intensive management after operation, to reduce the incidence of hemorrhage after radical resection of hilar cholangiocarcinoma. If the postoperative hemorrhage occurs, the cause, location, time, and degree of hemorrhage should be clearly defined to facilitate clinicians to make rapid clinical decisions and to develop treatment programs.
Objective To compare the clinical efficacy and safety of different surgical methods in the treatment of early-stage gallbladder carcinoma (GBC). Methods The clinical data of 43 patients with early-stage GBC who received treatment in Peking University People’s Hospital from Jan. 2010 to Dec. 2016 were retrospectively analyzed. According to the surgical methods, the patients were divided into laparoscopic cholecystectomy (LC)+lymph node dissection (LND)+radiofrequency ablation (RA) group, open cholecystectomy (OC)+LND+RA group, and OC+LND+liver resection (LA) group. Operation duration, intraoperative blood loss, postoperative hospital stay, surgical complications, and long-term survival were compared among the 3 groups. Results All the 43 patients performed successful surgery without perioperative death. ① Operation duration and postoperative hospital stay. The differences of operation duration and postoperative hospital stay among the 3 groups were statistically significant (P<0.05). Compared with the LC+LND+RA group, operation duration and postoperative hospital stay of the OC+LND+RA group and the OC+LND+LR group were longer (P<0.017), but there was no statistically significant difference between the OC+LND+RA group and the OC+LND+LR group (P>0.017). ② Intraoperative blood loss. The difference of intraoperative blood loss among the 3 groups was statistically significant (P<0.001). Compared with the OC+LND+LR group, the intraoperative blood loss was lower in the LC+LND+RA group and the OC+LND+RA group (P<0.017), but there was no significant difference between the LC+LND+RA group and the OC+LND+RA group (P=0.172). ③ Postoperative complications. There was no significant difference in the incidence of postoperative complications among the 3 groups (P=0.326). ④ Long-term survival. There was no significant difference in survival curves among the 3 groups (P=0.057). Conclusions The method of cholecystectomy combined with LND and RA of gallbladder bed can achieve the radical effect on early-stage GBC (Tis–T2). Laparoscopic surgery, in particular, has shorter operation duration and faster recovery.