Study of celiac artery variations and related surgical techniques in gastric cancer

AIM: To investigate celiac artery variations in gastric cancer patients and the impact on gastric cancer surgery,and also to discuss the value of the ultrasonic knife in reducing the risk caused by celiac artery variations.METHODS: A retrospective analysis was conducted to investigate the difference in average operation time,intraoperative blood loss, number of harvested lymph nodes, average postoperative drainage within 3 d,and postoperative hospital stay between the group with vascular variations and no vascular variations,and between the ultrasonic harmonic scalpel and conventional electric scalpel surgery group.RESULTS: One hundred and fifty-eight cases presented with normal celiac artery, and 80 presented with celiac artery variation(33.61%). The average operation time,blood loss, average drainage within 3 d after surgery in the celiac artery variation group were significantly more than in the no celiac artery variation group(215.7 ± 32.7 min vs 204.2 ± 31.3 min, 220.0 ± 56.7mL vs 163.1 ± 52.3 mL, 193.6 ± 41.4 mL vs 175.3± 34.1 mL, respectively, P < 0.05). In celiac artery variation patients, the average operation time, blood loss, average drainage within 3 d after surgery in the ultrasonic harmonic scalpel group were significantly lower than in the conventional electric scalpel surgery group(209.5 ± 34.9 min vs 226.9 ± 29.4 min, 207.5 ±57.1 mL vs 235.6 ± 52.9 mL, 184.4 ± 38.2 mL vs 205.0± 42.9 mL, respectively, P < 0.05), and the number of lymph node dissections was significantly higher than in the conventional surgery group(25.5 ± 9.2 vs 19.9 ±7.8, P < 0.05).CONCLUSION: Celiac artery variation increases thedifficulty and risk of radical gastrectomy. Preoperative imaging evaluation and the application of ultrasonic harmonic scalpel are conducive to radical gastrectomy.

Relationship between celiac artery variation and number of lymph nodes dissection in gastric cancer surgery

BACKGROUND Radical D2 lymphadenectomy for advanced gastric cancer as a standard procedure has gained global consensus. Mounting studies have shown that the number of lymph nodes dissection directly affects the prognosis and recurrence of gastric cancer. Our previous study showed that there was no obvious lymph node around the abnormal hepatic artery derived from the superior mesenteric artery. AIM To investigate the relationship between celiac artery variation and the number of lymph nodes dissection in gastric cancer surgery. METHODS The clinicopathological data of 421 patients treated with radical D2 lymphadenectomy were analyzed retrospectively. The difference of the number of lymph nodes dissection between the celiac artery variation group and the normal vessels group and the relationship with prognosis were analyzed. RESULTS Celiac artery variation was found in 110 patients, with a variation rate of 26.13%. Celiac artery variation, tumor staging, and Borrmann typing were factors that affected lymph node clearance in gastric cancer, and the number of lymph nodes dissection in patients with celiac artery variation was significantly less than that of non-variant groups (P < 0.05). Univariate analysis showed that there was no significant difference in survival time between the two groups (P > 0.05). Univariate and multiple Cox regression analysis showed that celiac artery variation was not a prognostic factor for gastric cancer (P > 0.05). Tumor staging, intraoperative bleeding, and positive lymph node ratio were prognostic factors for gastric cancer patients (all P < 0.05). CONCLUSION The number of lymph nodes dissection in patients with celiac artery variation was reduced, but there was no obvious effect on prognosis. Therefore, lymph nodes around the abnormal hepatic artery may not need to be dissected in radical D2 lymphadenectomy.

Relief Effect of Bevacizumab on Severe Edema Induced by Re-irradiation in Brain Tumor Patients

INTRODUCTION Brain edema is a serious clinical event and could cause various neurological symptoms such as dizziness and headache.Drugs frequently used to relieve brain edema include steroid,dehydrant （e.g.,mannitol）,and diuretics.But the effects of these drugs were limited in patients with severe edema.Bevacizumab has been applied in the treatment of cerebral radiation necrosis. Case studies have reported on the application of bevacizumab in the treatment of severe brain edema. In the present study,we describe significant effects of bevacizumab on severe brain edema in patients with re-irradiation.