Recent advances in the surgical treatment of pancreatic cancer

INTRODUCTIONPancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, and the aggressive biological nature of these tumors. The median survival time from diagnosis in unresectable tumors remains only 4 6 months.For those patients amenable to surgical resection over the last 20 years have seen marked improvements in postoperative mortality and morbidity, especially in specialist pancreatic centres 23. Despite these changes long-term survival remains low. with a total 5-year survival rate remaining less than 5%.Patients with ampullary cancer have a better 5-year survival of 40°%-60°%.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

Radiotherapy combined with surgical treatment for gastric cancer:a meta-analysis

Objective:We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer.Methods:Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative,intraoperative and postoperative),was compared with surgery alone in resectable gastric cancer were identified by searching Cochrane Library (Issue 2,2009),PubMed (Jan 1966-Jun 2009),EMBASE (Jan 1974-Jun 2009),Chinese Biomedical Literature Database (Jan 1978-Jun 2009),Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009),China National Knowledge Infrastructure (Jan 1994-Jun 2009) and Wanfang database (Jan 1997-Jun 2009) in English and Chinese languang.Two researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Our researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Results:Nine randomized controlled trials of 1 548 patients were selected for meta-analysis.Five randomized controlled trials were related with comparison of preoperative radiotherapy plus surgery with single surgery.Two randomized controlled trials were the comparative studies between surgery plus postoperative and single surgery.The meta-analysis results showed that:(1) compared with surgery alone,preoperative radiotherapy combined with surgery can increase 3 years (OR=1.78;95% CI 1.14-2.78,P=0.01),5 years (OR=1.67;95% CI 1.22-2.29,P=0.001),10 years (OR=1.64;95% CI 1.03-2.60,P=0.04) survival rate and resection rate (OR=2.15;95% CI 1.31-3.54,P=0.003);reduce the of tumor recurrence rate (OR=0.59;95% CI 0.37-0.92,P=0.02) and metastasis rate (OR=0.44;95% CI 0.27-0.73,P=0.001);(2) The tumor recurrent rates (OR=0.19,95% CI 0.03-1.14,P=0.07) and tumor metastasis rate (OR=0.09;95% CI 0.00-1.77,P=0.11) had no difference between single surgery group and peri-operative radiotherapy plus surgery group;(3) Postoperative radiotherapy compared with surgery alone had no significant effects on 1 year (OR=0.83;95% CI 0.60-1.15,P=0.26) and 3 years (OR=0.75;95% CI 0.51-1.11,P=0.15) survival rate compared with single surgery,but the 5-year survival rates (OR=0.57;95% CI 0.34-0.95,P=0.03) of the patients who received surgery alone was higher than those who received combined therapy.No difference of the tumor recurrence rate (OR=0.59;95% CI 0.33-1.05,P=0.07),tumor metestasis rate (OR=0.90;95% CI 0.51-1.59,P=0.71) and anastomotic leak (OR=0.98;95% CI 0.25-3.65,P=0.98) were observed between the two groups.Conclusion:Preoperative radiotherapy combined surgery is more rational and effective than surgery alone of gastric cancer.However,in terms of the clinical effects of perioperarive or postoperative radoiotherapy combined with surgery,much multicenter,largescale,high-quality,double-blind and rigorously designed studies would be needed than currently available in the future.

Application of mastoscopic in modified radical operation for preserving nipple-areolar complex

Objective: To probe the effect of mastoscopic in modified radical mastectomy operation for preserving nipple-areolar complex in the treatment of breast cancer. Methods: Thirty patients, with breast cancer of a diameter≤3 cm and a distance≥3 cm from the mammary areola were treated by mastoscopic from November 2003 to August 2006. After the lipoly- sis and suction of axillary fat, mastoscopic axillary lymph node dissection was performed. Results: The average operation time was 128.9 min (120–156 min), the intraoperative blood loss was 56 mL (30–100 mL). The mean lymph nodes harvested by endoscopy were 16 (6–34). Excellent cosmetic outcomes were obtained with symmetrical breast development and all the patients were satisfied with the treatment. Postoperative follow-up for 2–29 months (mean, 16.6 months) found no local recur-rence. Conclusion:This model of operation can protect the upper limb function and has value of aesthetics of the brisket. What’s more, improve the quality of survive of the patients.

Surgical treatment effects in cancer of the cardia and esophagogastric junction

Objective： To evaluate the treatment effects of total gastrectomy （TG） and proximal gastrectomy （PG） for cancer of the cardia and esophagogastric junction. Methods： forty-five patients with cancer of the cardia and esophagogastric junction underwent surgical resection. Of them, 29 were treated using proximal gastrectomy and 16 total gastrectomy. The 3-year and 5-year survival rate and the postoperative complication rate and mortality rate were followed up and compared between the two groups. Results： The 3-year and 5-year survival rates of group PG were 44.8% and 20.7%, of group TG were 37.5% and 18.8%, respectively, and the differences were not statistically significant （X^2= 3.84, P 〉 0.05; X^2= 3.89, P 〉 0.05）. The postoperative complication and mortality rate of group PG were 13.7% and 6.8%, of group TG was all 6%, respectively. Conclusion： Proximal and total gastrectomy treatment effects can not significantly influence the prognosis of patients in progressive stage of cancer of cardia and esophagogastric junction.

神经内分泌肿瘤肝转移的外科干预策略

神经内分泌肿瘤是一组较罕见的肿瘤性疾病,可发生于身体多种脏器,具有高度肿瘤异质性,常形成以肝脏为最主要受累器官的继发性肿瘤并伴发类癌综合征。肝转移是造成神经内分泌肿瘤患者治疗失败的重要临床事件,通过及时、合理的外科干预有效控制病情发展、争取达到肿瘤无病状态或根治目标,有效延长患者总体生存,是近年来临床医师和研究者聚焦的重要课题。本文综合近年来国内外神经内分泌肿瘤肝转移的外科治疗策略和我国最新诊治指南,并结合笔者实际临床工作经验进行综述和讨论。

90例儿童颅内残留或复发性室管膜瘤的手术疗效分析

目的探讨儿童颅内残留或复发性室管膜瘤的手术治疗效果。方法回顾性分析2014年3月至2023年8月北京大学第一医院小儿外科收治的90例行外科手术治疗颅内残留或复发性室管膜瘤患儿的临床资料,其中32例为首次手术后肿瘤残留,58例为肿瘤复发;肿瘤位于后颅窝60例,小脑幕上23例,后颅窝肿瘤转移至侧脑室7例。术后通过门诊或电话方式进行随访,末次随访时间为2023年10月,获知患儿生存及后续治疗情况,通过头颅MRI检查评估患儿肿瘤是否再次复发或转移。结果90例患儿手术均顺利完成,其中肿瘤扩大全切除10例,全切除71例,近全切除9例。术后78例(86.7%)患儿出现并发症,其中发热70例,皮下积液39例,出现声音嘶哑、吞咽困难等后组脑神经损伤症状16例,面瘫13例;术后13例(14.4%)患儿因继发性脑积水行脑室-腹腔分流术,其中2例分别出现消化道大出血、心力衰竭于术后24h死亡;1例因术后并发肺炎出院后死亡。术后经病理学证实,69例患儿的肿瘤病理学诊断与首次诊断相同,其中世界卫生组织(WHO)2级5例,3级62例,2~3级2例;21例肿瘤病理学诊断与首次诊断不同,其中7例由WHO2级转为3级,1例由1级转为2级,9例由2~3级转为3级,4例由3级转为2级。87例患儿均获得临床随访,随访时间[M(范围)]为16个月(3~116个月)。49例患儿术后行首次或二次放疗,3例行单纯化疗3例行放疗和化疗。末次随访显示,27例患儿死于肿瘤复发或转移;存活的60例患儿中,局部再复发5例,脊髓转移2例。结论儿童颅内残留或复发性室管膜瘤的治疗效果欠佳,目前仍以手术切除辅助术后放疗为主要治疗手段。

海信CAS辅助下高强度聚焦超声消融治疗晚期胰腺癌效果

目的探讨海信计算机辅助系统(CAS)辅助下高强度聚焦超声(HIFU)治疗胰腺癌的效果。方法选取2020年1月-2021年5月于我院拟行HIFU治疗的22例胰腺癌患者。术前采用海信CAS将二维CT图像进行三维重建,明确胰腺肿瘤与周围肠道、脏器的毗邻关系,通过实体瘤疗效评价标准评价局部消融疗效,并记录患者术后并发症发生情况。结果海信CAS数字化三维重建结果可清晰显示胰腺肿瘤与周围肠道、脏器的毗邻关系,协助实现精准消融。22例胰腺癌患者中完全缓解率为9.1%,部分缓解率为68.2%,疾病稳定率为13.6%,疾病进展率为9.1%。所有患者在HIFU术后均未出现胃肠道穿孔、急性胰腺炎、胰瘘及消化道出血等严重并发症,仅1例患者出现浅Ⅱ度皮肤灼伤。结论海信CAS辅助下HIFU治疗晚期胰腺癌效果较好,值得在临床推广。

不同免充气腔镜术式治疗甲状腺癌的效果比较

目的比较免充气经口腔前庭入路与免充气经腋窝入路对腔镜治疗甲状腺癌效果的影响。方法回顾性分析2019年1月至2023年6月中国科学技术大学附属第一医院西区(安徽省肿瘤医院)收治的95例单侧甲状腺癌患者的临床资料,其中45例患者选自同期行经腋窝入路腔镜手术患者,50例选自同期行经口腔前庭腔入路腔镜手术患者。比较2种手术方式的疗效。结果2组患者在手术时间、术中出血量、住院时间、术后3 d引流量、术后并发症及美容满意度方面比较,差异无统计学意义(P>0.05);经口腔前庭组中央区淋巴结清扫数目多于经腋窝组(P<0.05)。结论经口腔前庭入路腔镜甲状腺手术体表无瘢痕较经腋窝入路腔镜手术在中央区淋巴结清扫上更有优势。

Clinical Experience of Primary Retroperitoneal Tumor: Report of 600 Cases

Objective： To summarize the experience of management for primary retroperitoneal tumor （PRPT） and to analyze the factors influencing the outcome after operation. Methods： The data of 600 cases of PRPT in General Hospital of PLA were reviewed retrospectively. Results： Of 600 cases of PRPT, 546 were surgically treated. Among theme 369 were malignant and 177 benign. 366 cases were followed up for 1 month to 15 years. The 1-years 3-year, and 5-year survival rate in the patients subject to complete resection was 90.5%, 73.2% and 53.6%, respectively, and that in incomplete resection patients was 70.6%, 32.0%, 5.7% respectively （P〈0.01）. The Cox multi-various regression analysis revealed showed completeness of tumor resection, sex and histologic type were associated closely with local recurrence. Conclusion： Sufficient preoperative preparation and complete tumor resection play important roles for reducing recurrence and improving survival.

浅表食管癌内镜黏膜下剥离术与外科手术疗效对比的研究进展

浅表食管癌(SEC)的传统治疗以内镜治疗和外科手术治疗为主。外科手术是食管肿瘤治疗的标准方法,但其围手术期并发症发生率和病死率均较高。近年来,内镜黏膜下剥离术已取得较大进展,为SEC患者提供了有效的诊断和治疗方法。本文就SEC内镜黏膜下剥离术与外科手术的疗效对比和超出内镜黏膜下剥离术适应证的SEC的治疗策略作一综述,以期提高临床医师对SEC治疗的认知。

MR多模态成像在直肠癌TN分期及手术方式选择中的应用

目的探讨MR多模态成像在直肠癌TN分期及手术方式选择中的应用价值。方法回顾性分析我院2020年1月—2022年5月396例直肠癌患者的MR征象,以此进行术前TN分期并模拟制定手术方式,分析手术前后TN分期的准确性,并比较拟定手术方式与实际手术方式的一致性。结果MR多模态成像辅助术前拟定直肠癌T分期的符合率为90.15%,与术后病理结果的一致性较高(K=0.82,P<0.01),且对于T2~T4分期的诊断准确率较高;N分期的符合率为71.46%,与术后病理结果的一致性适中(K=0.53,P<0.01)。MR多模态成像辅助拟定手术方式的符合率为89.14%,与实际术式一致性较高(K=0.79,P<0.01),且对于直肠癌各种术式拟定的准确率均较高。结论MR多模态成像对直肠癌的术前TN分期以及手术方式的制定有较高的临床价值。

改良单孔加一孔腹腔镜右半结肠癌根治术的临床效果

目的探讨改良单孔加一孔腹腔镜(single-incision plus one-port laparoscopic surgery,SILS+1)右半结肠癌根治术的安全性及有效性。方法采用回顾性病例对照研究。选取2019年1月到2024年6月我院收治的行SILS+1右半结肠癌根治术患者34例。其中对照组23例,行经典的SILS+1右半结肠癌根治术,切口采用3~4 cm绕脐切口+左中腹1.2 cm戳孔;研究组11例,行改良SILS+1右半结肠癌根治术,切口采用3~4 cm下腹部横切口+左中腹1.2 cm戳孔。比较两组的手术时间、出血量、淋巴结清除数量、术后首次肛门排气时间、术后1 d疼痛视觉模拟评分(visual analogue scale,VAS)、术后住院时间等。结果两组出血量、淋巴结清除数量、术后首次肛门排气时间无明显差异(P>0.05);手术时间、术后1 d的VAS及术后住院时间有差异,研究组优于对照组(P<0.05)。结论改良单孔(下腹部横切口)加一孔(左中腹1.2 cm戳孔)腹腔镜右半结肠癌根治手术安全有效,且较绕脐切口手术时间及术后住院时间更短,术后疼痛更轻,手术切口更加美观和隐蔽,值得临床推广应用。

原发性腹膜后平滑肌肉瘤初次术后影响生存期的因素分析

目的分析初次手术后对原发性腹膜后平滑肌肉瘤患者生存期的影响因素,并了解其临床特征。方法搜集2018年1月—2023年1月67例原发性腹膜后平滑肌肉瘤患者的临床资料进行回顾性分析。根据患者的手术情况、年龄、性别、病理类型及其他相关因素,对其生存期进行统计和分析。符合正态分布的计量资料以xˉ±s表示、采用t检验;计数资料以%表示、采用χ2检验。对影响患者预后因素的分析采用单因素分析,其中差异有统计学意义的因素采用多因素Logistic回归分析。结果67例患者的平均生存期为(18.25±2.41)个月,病理证实肿瘤类型均为平滑肌肉瘤。生存分析显示,年龄>60岁、肿瘤最大径>10 cm、肿瘤分期Ⅲ~Ⅳ期、肿瘤分化程度低~差、肿瘤累及其他脏器均是影响患者术后生存期的危险因素(P均<0.05);性别、体质量指数、吸烟史、饮酒史、手术方式对患者的生存期无明显影响(P均>0.05)。经多因素Logistic回归分析,表明年龄≥60岁、显微镜下切缘看到肿瘤细胞(R1切除)、肿瘤最大径≥10 cm、肿瘤分期Ⅲ~Ⅳ期、肿瘤低~差分化、肿瘤累及其他脏器均是影响原发性腹膜后平滑肌肉瘤初次手术后生存率的独立危险因素。结论患者年龄、肿瘤最大径、肿瘤分期等是影响患者预后的主要因素,准确评估这些影响因素有助于指导临床决策,进一步改善患者的预后结果。

《肿瘤外科学年鉴:肝外胆管癌和胆囊癌临床诊疗指南》推荐意见

胆道恶性肿瘤是一类发病率低但侵袭性强的消化道肿瘤,主要包括肝内胆管癌、肝外胆管癌和胆囊癌,常常伴随着局部进展或远处转移等特征。对于局部可切除的患者而言,手术往往是首选的治疗方法。然而,即便患者接受根治性手术其术后复发风险依然很高。因此,对于胆道恶性肿瘤患者而言,通常需要采取多种治疗模式,包括手术切除、全身治疗(如靶向治疗、化学治疗、免疫治疗)以及/或局部治疗的综合方案。随着胆道恶性肿瘤领域的逐渐发展,对于外科肿瘤学家而言,了解并掌握最新的外科诊疗策略以及最佳患者的选择和管理体系至关重要。鉴于治疗的复杂性和诊疗技术不断发展的特点,美国肿瘤外科学权威期刊《肿瘤外科学年鉴》于近期发表了关于肝胆肿瘤的实践诊疗指南,主要包括肝细胞癌、肝内胆管癌、肝外胆管癌和胆囊癌,旨在为肝胆肿瘤患者的临床管理和决策制定提供更多基于循证医学的证据。限于篇幅和不同侧重点,本文着重介绍该指南中关于肝外胆管癌和胆囊癌的评估要点和临床治疗的相关建议,以供临床参考。

经尾侧联合中线入路应用于腹腔镜右半结肠癌D3根治术的效果

目的:探讨经尾侧联合中线入路应用于腹腔镜右半结肠癌D3根治术的效果。方法:选取2023年10月—2024年3月邵武市立医院收治的82例拟使用腹腔镜右半结肠癌D3根治术治疗的结肠癌患者作为研究对象,将患者随机分为对照组(n=41)与观察组(n=41)。观察组使用经尾侧联合中线手术入路,对照组使用常规中线手术入路,两组术后均观察1周。比较两组手术指标、术后恢复情况、肿瘤标志物[糖类抗原199(CA199)、癌胚抗原(CEA)]水平及术后1周内并发症发生情况。结果:两组术中淋巴结清扫数目、术后首次排便时间比较,差异无统计学意义(P>0.05);与对照组相比,观察组手术时长、术后首次排气时间、拔除引流管时间较短,术中出血量较少,差异有统计学意义(P<0.05)。术后1周,两组CEA、CA199水平均下降,且与对照组相比,观察组较低,差异有统计学意义(P<0.05)。两组术后1周内并发症发生率比较,差异无统计学意义(P>0.05)。结论:经尾侧联合中线入路应用于腹腔镜右半结肠癌D3根治术,可有效减少术中出血量,缩短手术时间,同时加快术后胃肠道功能恢复,降低肿瘤标志物水平,且安全性与中线入路相当。

生物染色剂定位与示踪技术在乳腺外科中的应用

通过对生物染色剂定位与示踪技术在乳腺区段切除术、乳头溢液选择性溢液导管切除术、乳腺钙化灶导丝定位切除术、乳腺癌前哨淋巴结活检术、淋巴结反向示踪引导腋窝淋巴结清扫术/前哨淋巴结活检术、乳腺癌保乳术、腔镜乳腺癌保乳术、腔镜乳腺皮下腺体切除术等术式中的应用进行分类和归纳总结,探讨生物染色剂定位与示踪技术在提高乳腺手术的精准性及微创性方面的优势,旨在为提高乳腺手术的精细化程度及改善术后外观效果提供参考。

Analysis on relative factors of lymph node metastasis and pattern of postoperative locoreginal relapse of esophageal carcinoma

Objective: We aimed to study the relative factors of lymph node metastasis of esophageal carcinoma, and to analyze the distribution rule of lymph node metastasis of post esophagectomy patients for guiding the radiotherapy. Methods: To collect the patients' data (102 cases) in our hospital from 2001 to 2009, who were found lymph node metastasis confirmed by pathologic in a certain period of time after esophageal cancer surgery. The factors affected the lymph node metastasis in esophageal cancer were analysed by single logistic regression and Logistic Regression Method. To analyze the rule of post-operative lymph node metastasis in different regions, according to the lymph node partition, in accordance with paragraphs of esophageal cancer in different groups. Results: Of the 102 patients after esophageal cancer surgery, who were confirmed by pathological examination, 50 cases had positive lymph node metastasis and 52 cases had negative, the lymph node metastasis rate was 49.0%. Lymph node metastasis rates of different depth, length and paragraph of tumor invasion had statistical difference (P < 0.05). The impact on lymph node metastasis rates of the different age and degree of differentiation had no statistical difference (P > 0.05). Multivariate analysis showed that the lesion length, depth of invasion and paragraph of tumor were meaningful factors affecting the lymph node metastasis. Of the 102 patients, 132 sites node metastasis were found by imaging study and histopathology with lower neck and supraclavicular node 59 (44.70%), upper mediastinum node 51 (38.64%), A-P windows node 1 (0.76%), anterior mediastinum node 1 (0.76%), Subcarinal node 5 (3.79%), paraesopha- geal node 3 (2.27%), hilar node 3 (2.27%), abdominal node 9 (6.82%). Conclusion: The length and depth of invasion, and paragraph of esophageal cancer are meaningful factors that affect the lymph node metastasis. The longer of lesion, deeper of infiltration and lower of paragraph, the easier to get independently lymph node metastasis. The postoperative lymph node metastasis was mainly distributed in the lower neck and supraclavicular region and upper mediastinal region, which is the focus of postoperative radiotherapy.

经颈侧胸锁乳突肌后下入路无注气腔镜甲状腺手术

目的探究经颈侧胸锁乳突肌后下入路无注气腔镜甲状腺手术的有效性与安全性。方法回顾性分析2022年12月~2023年3月收治的10例行经颈侧胸锁乳突肌后下入路无注气腔镜甲状腺手术患者,所有患者行术前穿刺活检考虑甲状腺乳头状癌,记录患者手术时间、出血量、术后恢复、并发症及随访情况。结果10例患者均顺利完成手术,平均手术时间4 h 39 min,平均出血量16 ml,平均术后住院时间4.6 d,无明显并发症,术后随访3个月,未诉明显颈部不适。结论经颈侧胸锁乳突肌后下入路无注气腔镜甲状腺手术安全性良好,患者术后恢复快,外观满意度高,颈部舒适感好。

喉梭形细胞鳞状细胞癌的临床病理特点分析

目的 总结和分析喉梭形细胞鳞状细胞癌(spindle cell squamous carcinoma,Spc-SCC)的临床及病理特点,以期加深临床对该肿瘤的的认识,提升诊疗水平。方法 回顾性分析2017年4月~2021年4月于首都医科大学附属北京同仁医院耳鼻咽喉头颈外科诊治的12例Spc-SCC患者临床表现、病理及预后资料,10例行单纯手术治疗,1例术后行放、化疗,1例单纯放疗。利用SPSS软件,Kaplan-Meier法行统计学分析。结果 10例病理标本中可见梭形细胞/肉瘤样成分和上皮细胞成分共存,以梭形细胞成分为主,2例仅见梭形细胞成分。免疫组化染色均可见角蛋白CK的表达。随访3~63个月,2例患者死亡,1例死于局部复发大出血,1例为仅行放疗患者,余10例患者截至随访结束未见肿瘤复发及转移征象。1年、3年、5年生存率分别为91.7%、83.3%、83.3%。结论 病理学检查是Spc-SCC的主要确诊方式,手术切除为其主要的治疗手段。