AIM:To conduct a meta-analysis comparing laparoscopic total gastrectomy(LTG)with open total gastrectomy(OTG)for the treatment of gastric cancer.METHODS:Major databases such as Medline(PubMed),Embase,Academic Search Pr...AIM:To conduct a meta-analysis comparing laparoscopic total gastrectomy(LTG)with open total gastrectomy(OTG)for the treatment of gastric cancer.METHODS:Major databases such as Medline(PubMed),Embase,Academic Search Premier(EBSCO),Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL)in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013.Evaluated endpoints were operative,postoperative and oncological outcomes.Operative outcomes included operative time and intraoperative blood loss.Postoperative recovery included time to first fatus,time to first oral intake,hospital stay and analgesics use.Postoperative complications comprised morbidity,anastomotic leakage,anastomotic stenosis,ileus,bleeding,abdominal abscess,wound problems and mortality.Oncological outcomes included positive resection margins,number of retrieved lymph nodes,and proximal and distal resection margins.The pooled effect was calculated using either a fixed effects or a random effects model.RESULTS:Fifteen non-randomized comparative studies with 2022 patients were included(LTG-811,OTG-1211).Both groups had similar short-term oncological outcomes,analgesic use(WMD-0.09;95%CI:-2.39-2.20;P=0.94)and mortality(OR=0.74;95%CI:0.24-2.31;P=0.61).However,LTG was associated with a lower intraoperative blood loss(WMD-201.19 mL;95%CI:-296.50--105.87 mL;P<0.0001)and overall complication rate(OR=0.73;95%CI:0.57-0.92;P=0.009);fewer wound-related complications(OR=0.39;95%CI:0.21-0.72;P=0.002);a quicker recovery of gastrointestinal motility with shorter time to frst fatus(WMD-0.82;95%CI:-1.18--0.45;P<0.0001)and oral intake(WMD-1.30;95%CI:-1.84--0.75;P<0.00001);and a shorter hospital stay(WMD-3.55;95%CI:-5.13--1.96;P<0.0001),albeit with a longer operation time(WMD 48.25 min;95%CI:31.15-65.35;P<0.00001),as compared with OTG.CONCLUSION:LTG is safe and effective,and may offer some advantages over OTG in the treatment of gastric cancer.展开更多
AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed ...AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed with SPT of the pancreas in our institution.Of these patients,16 were male.The patients were divided into two groups based on gender:female(group 1)and male(group 2).The groups were compared with regard to demographic characteristics,clinical presentations,surgical strategies,complications and follow-up outcomes.RESULTS:Male patients were older than female patients(43.1±12.3 years vs 33.1±11.5 years,P=0.04).Tumor size,location,and symptoms were comparable between the two groups.All patients,with the exception of one,underwent complete surgical resection.The patients were regularly followed up.Themean follow-up period was 58 mo.Two female patients(1.7%)developed tumor recurrence or metastases and required a second resection,and two female patients(1.7%)died during the follow-up period.CONCLUSION:Male patients with SPT of the pancreas are older than female patients.There are no significant differences between male and female patients regarding surgical strategies and prognosis.展开更多
AIM: To investigate the impact of preoperative acute pancreatitis(PAP) on the surgical management of periampullary tumors.METHODS: Fifty-eight patients with periampullary tumors and PAP were retrospectively analyzed. ...AIM: To investigate the impact of preoperative acute pancreatitis(PAP) on the surgical management of periampullary tumors.METHODS: Fifty-eight patients with periampullary tumors and PAP were retrospectively analyzed. Thirtyfour patients who underwent pancreaticoduodenectomy(PD) and 4 patients who underwent total pancreatectomy were compared with a control group of 145 patients without PAP during the same period.RESULTS: The preoperative waiting time was significantly shorter for the concomitant PAP patients who underwent a resection(22.4 d vs 54.6 d, p < 0.001)compared to those who did not. The presence of PAP significantly increased the rate of severe complications(Clavien grade 3 or higher)(17.6% vs 4.8%, p = 0.019)and lengthened the hospital stay(19.5 d vs 14.5 d,p = 0.006). A multivariate logistic regression analysis revealed that PAP was an independent risk factor for postoperative pancreatic fistula(OR = 2.91; 95%CI:1.10-7.68; p = 0.032) and severe complications(OR =4.70; 95%CI: 1.48-14.96; p = 0.009) after PD. There was no perioperative mortality.CONCLUSION: PAP significantly increases the incidence of severe complications and lengthens thehospital stay following PD. PD could be safely performed in highly selective patients with PAP.展开更多
Objective： To explore the effects and mechanism of glycogen synthase kinase 3β （GSK-313） inhibitor （2＇Z,3＇E）-6-bromo-indirubin-3＇-oxime （BIO） on drug resistance in colon cancer cells. Methods： The colon c...Objective： To explore the effects and mechanism of glycogen synthase kinase 3β （GSK-313） inhibitor （2＇Z,3＇E）-6-bromo-indirubin-3＇-oxime （BIO） on drug resistance in colon cancer cells. Methods： The colon cancer SW480 and SW620 cells were treated with BIO, 5-fluorouracil （5-FU） and BIO/5-FU, separately. Cell cycle distribution, apoptosis level and efflux ability of rhodamine 123 （Rh123） were detected by flow cytometry. The protein expressions of P-glycoprotein （P-gp）, multidrug resistance protein 2 （MRP2）, thymidylate synthase （TS）, β-catenin, E2F-1 and βcl-2 were detected by Western blot. β-catenin and P-gp were stained with double immunofluorescence and observed under a confocal microscope. Results： BIO up-regulated β-catenin, P-gp, MRP2 and TS, enhanced the efflux ability of Rh123, decreased Bcl-2 protein and gave the opposite effect to E2F-1 protein in SW480 and SW620 ceils. Furthermore, BIO significantly inhibited cell apoptosis, increased S and G2/M phase cells, and reduced the cell apoptosis induced by 5-FU in SW480 cells, whereas the effects were slight or not obvious in SW620 cells. Conclusion： GSK-3β was involved in drug resistance regulation, and activation of β-catenin and inhibition of E2F-1 may be the most responsible for the enhancement of 5-FU chemotherapy resistance induced by GSK-β inhibitor β10 in colon cancer.展开更多
BACKGROUND D2 lymph node dissection for advanced gastric cancer is advocated,and station 8p lymph node should be considered in selected patients,which is,however,technically difficult.AIM To introduce a new and easy-t...BACKGROUND D2 lymph node dissection for advanced gastric cancer is advocated,and station 8p lymph node should be considered in selected patients,which is,however,technically difficult.AIM To introduce a new and easy-to-perform procedure for dissection of the lymph nodes superior to the pancreas.METHODS A series of patients who underwent laparoscopic gastrectomy for gastric cancer were retrospectively included with utilization of a new procedure for superior pancreatic lymphadenectomy(LND)with portal vein priority via the posterior common hepatic artery approach(SPLD-PPPH)based on a newly defined portal triangle.The surgical outcome of the patients,as well as the efficacy and safety of SPLD-PPPH are reported.RESULTS A total of 51 patients were included with most of them being male(n=34,66.7%).According to the 8th edition of AJCC TNM staging,there were four(7.8%)patients in stage I,13(25.5%)in stage II,33(64.7%)in stage III and one(2.0%)in stage IV.The average duration for LND was about 1 h(67.7±6.9 min).After surgery,four patients developed morbidities,but all were treated successfully with no perioperative mortality.Among the 51 patients included,the percentage of patients who had lymph node metastasis at station 8p was 9.8%.Of note,with a total of 14 lymph nodes harvested at station 8p,the incidence of nodal metastasis was 14.3%.CONCLUSION About one in 10 patients with advanced gastric cancer had nodal metastasis at station 8p.The new approach of SPLD-PPPH is safe and effective for D2+LND during laparoscopic radical gastrectomy.展开更多
基金Supported by UK/China Postgraduate Scholarships for Excellence,an NIHR Translational Research Fellowship and a Royal College of Surgeons of England-Ethicon Research Fellowship grant
文摘AIM:To conduct a meta-analysis comparing laparoscopic total gastrectomy(LTG)with open total gastrectomy(OTG)for the treatment of gastric cancer.METHODS:Major databases such as Medline(PubMed),Embase,Academic Search Premier(EBSCO),Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL)in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013.Evaluated endpoints were operative,postoperative and oncological outcomes.Operative outcomes included operative time and intraoperative blood loss.Postoperative recovery included time to first fatus,time to first oral intake,hospital stay and analgesics use.Postoperative complications comprised morbidity,anastomotic leakage,anastomotic stenosis,ileus,bleeding,abdominal abscess,wound problems and mortality.Oncological outcomes included positive resection margins,number of retrieved lymph nodes,and proximal and distal resection margins.The pooled effect was calculated using either a fixed effects or a random effects model.RESULTS:Fifteen non-randomized comparative studies with 2022 patients were included(LTG-811,OTG-1211).Both groups had similar short-term oncological outcomes,analgesic use(WMD-0.09;95%CI:-2.39-2.20;P=0.94)and mortality(OR=0.74;95%CI:0.24-2.31;P=0.61).However,LTG was associated with a lower intraoperative blood loss(WMD-201.19 mL;95%CI:-296.50--105.87 mL;P<0.0001)and overall complication rate(OR=0.73;95%CI:0.57-0.92;P=0.009);fewer wound-related complications(OR=0.39;95%CI:0.21-0.72;P=0.002);a quicker recovery of gastrointestinal motility with shorter time to frst fatus(WMD-0.82;95%CI:-1.18--0.45;P<0.0001)and oral intake(WMD-1.30;95%CI:-1.84--0.75;P<0.00001);and a shorter hospital stay(WMD-3.55;95%CI:-5.13--1.96;P<0.0001),albeit with a longer operation time(WMD 48.25 min;95%CI:31.15-65.35;P<0.00001),as compared with OTG.CONCLUSION:LTG is safe and effective,and may offer some advantages over OTG in the treatment of gastric cancer.
基金Supported by Special Fund of Ministry of Health for Medical Research in the Public Interest,No.201202007
文摘AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed with SPT of the pancreas in our institution.Of these patients,16 were male.The patients were divided into two groups based on gender:female(group 1)and male(group 2).The groups were compared with regard to demographic characteristics,clinical presentations,surgical strategies,complications and follow-up outcomes.RESULTS:Male patients were older than female patients(43.1±12.3 years vs 33.1±11.5 years,P=0.04).Tumor size,location,and symptoms were comparable between the two groups.All patients,with the exception of one,underwent complete surgical resection.The patients were regularly followed up.Themean follow-up period was 58 mo.Two female patients(1.7%)developed tumor recurrence or metastases and required a second resection,and two female patients(1.7%)died during the follow-up period.CONCLUSION:Male patients with SPT of the pancreas are older than female patients.There are no significant differences between male and female patients regarding surgical strategies and prognosis.
基金Supported by Special research Fund for Public Welfare Industry of Health,No.201202007
文摘AIM: To investigate the impact of preoperative acute pancreatitis(PAP) on the surgical management of periampullary tumors.METHODS: Fifty-eight patients with periampullary tumors and PAP were retrospectively analyzed. Thirtyfour patients who underwent pancreaticoduodenectomy(PD) and 4 patients who underwent total pancreatectomy were compared with a control group of 145 patients without PAP during the same period.RESULTS: The preoperative waiting time was significantly shorter for the concomitant PAP patients who underwent a resection(22.4 d vs 54.6 d, p < 0.001)compared to those who did not. The presence of PAP significantly increased the rate of severe complications(Clavien grade 3 or higher)(17.6% vs 4.8%, p = 0.019)and lengthened the hospital stay(19.5 d vs 14.5 d,p = 0.006). A multivariate logistic regression analysis revealed that PAP was an independent risk factor for postoperative pancreatic fistula(OR = 2.91; 95%CI:1.10-7.68; p = 0.032) and severe complications(OR =4.70; 95%CI: 1.48-14.96; p = 0.009) after PD. There was no perioperative mortality.CONCLUSION: PAP significantly increases the incidence of severe complications and lengthens thehospital stay following PD. PD could be safely performed in highly selective patients with PAP.
基金supported by the Sci-Tech Project Foundation of Guangdong Province(No.2009B080800023)
文摘Objective： To explore the effects and mechanism of glycogen synthase kinase 3β （GSK-313） inhibitor （2＇Z,3＇E）-6-bromo-indirubin-3＇-oxime （BIO） on drug resistance in colon cancer cells. Methods： The colon cancer SW480 and SW620 cells were treated with BIO, 5-fluorouracil （5-FU） and BIO/5-FU, separately. Cell cycle distribution, apoptosis level and efflux ability of rhodamine 123 （Rh123） were detected by flow cytometry. The protein expressions of P-glycoprotein （P-gp）, multidrug resistance protein 2 （MRP2）, thymidylate synthase （TS）, β-catenin, E2F-1 and βcl-2 were detected by Western blot. β-catenin and P-gp were stained with double immunofluorescence and observed under a confocal microscope. Results： BIO up-regulated β-catenin, P-gp, MRP2 and TS, enhanced the efflux ability of Rh123, decreased Bcl-2 protein and gave the opposite effect to E2F-1 protein in SW480 and SW620 ceils. Furthermore, BIO significantly inhibited cell apoptosis, increased S and G2/M phase cells, and reduced the cell apoptosis induced by 5-FU in SW480 cells, whereas the effects were slight or not obvious in SW620 cells. Conclusion： GSK-3β was involved in drug resistance regulation, and activation of β-catenin and inhibition of E2F-1 may be the most responsible for the enhancement of 5-FU chemotherapy resistance induced by GSK-β inhibitor β10 in colon cancer.
文摘BACKGROUND D2 lymph node dissection for advanced gastric cancer is advocated,and station 8p lymph node should be considered in selected patients,which is,however,technically difficult.AIM To introduce a new and easy-to-perform procedure for dissection of the lymph nodes superior to the pancreas.METHODS A series of patients who underwent laparoscopic gastrectomy for gastric cancer were retrospectively included with utilization of a new procedure for superior pancreatic lymphadenectomy(LND)with portal vein priority via the posterior common hepatic artery approach(SPLD-PPPH)based on a newly defined portal triangle.The surgical outcome of the patients,as well as the efficacy and safety of SPLD-PPPH are reported.RESULTS A total of 51 patients were included with most of them being male(n=34,66.7%).According to the 8th edition of AJCC TNM staging,there were four(7.8%)patients in stage I,13(25.5%)in stage II,33(64.7%)in stage III and one(2.0%)in stage IV.The average duration for LND was about 1 h(67.7±6.9 min).After surgery,four patients developed morbidities,but all were treated successfully with no perioperative mortality.Among the 51 patients included,the percentage of patients who had lymph node metastasis at station 8p was 9.8%.Of note,with a total of 14 lymph nodes harvested at station 8p,the incidence of nodal metastasis was 14.3%.CONCLUSION About one in 10 patients with advanced gastric cancer had nodal metastasis at station 8p.The new approach of SPLD-PPPH is safe and effective for D2+LND during laparoscopic radical gastrectomy.
