Predictive factors for lymph node metastasis in early gastric cancer

AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.

Surgical resection of a solitary para-aortic lymph node metastasis from hepatocellular carcinoma

Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.

Relationship between indoleamine 2,3-dioxygenase activity and lymphatic invasion propensity of colorectal carcinoma

AIM: To evaluate whether serum and tumor indoleamine 2,3-dioxygenase activities can predict lymphatic invasion(LI) or lymph node metastasis in colorectal carcinoma.METHODS: The study group consisted of 44 colorectal carcinoma patients. The patients were re-grouped according to the presence or absence of LI and lymph node metastasis. Forty-three cancer-free subjects without any metabolic disturbances were included into the control group. Serum neopterin was measured by enzyme linked immunosorbent assay. Urinary neopterin and biopterin, serum tryptophan(Trp) and kynurenine(Kyn) concentrations of all patients were determined by high performance liquid chromatography. Kyn/Trp was calculated and its correlation with serum neopterin was determined to estimate the serum indoleamine 2,3-dioxygenase activity. Tissue sections from the studied tumors were re-examined histopathologicallyand were stained by immunohistochemistry with indoleamine-2,3-dioxygenase antibodies.RESULTS: Neither serum nor urinary neopterin was significantly different between the patient and control groups(both p > 0.05). However, colorectal carcinoma patients showed a significant positive correlation between the serum neopterin levels and Kyn/Trp(r = 0.450, p < 0.01). Urinary biopterin was significantly higher in cancer cases(p < 0.05). Serum Kyn/Trp was significantly higher in colorectal carcinoma patients(p < 0.01). Lymphatic invasion was present in 23 of 44 patients, of which only 12 patients had lymph node metastasis. Eleven patients with LI had no lymph node metastasis. Indoleamine-2,3-dioxygenase intensity score was significantly higher in LI positive cancer group(44.56% ± 6.11%) than negative colorectal cancer patients(24.04% ± 6.90%),(p < 0.05). Indoleamine 2,3-dioxygenase expression correlated both with the presence of LI and lymph node metastasis(p < 0.01 and p < 0.05, respectively). A significant difference between the accuracy of diagnosis by using either total indoleamine-2,3-dioxygenase immunostaining score or of lymph node metastasis was found during the evaluation of cancer patients.CONCLUSION: Indoleamine-2,3-dioxygenase expression may predict the presence of unrecognized LI and lymph node metastasis and may be included in the histopathological evaluation of colorectal carcinoma cases.

Regional lymphadenectomy for gallbladder cancer: Rational extent, technical details, and patient outcomes

AIM: To define the rational extent of regional lymphadenectomy for gallbladder cancer and to clarify its effect on long-term survival. METHODS: A total of 152 patients with gallbladder cancer who underwent a minimum of "extended" portal lymph node dissection (defined as en bloc removal of the first-and second-echelon nodes) from 1982 to 2010 were retrospectively analyzed. Based on previous studies, regional lymph nodes of the gallbladder were divided into first-echelon nodes (cystic duct or pericholedochal nodes), second-echelon nodes (node groups posterosuperior to the head of the pancreas or around the hepatic vessels), and more distant nodes. RESULTS: Among the 152 patients (total of 3352 lymph nodes retrieved, median of 19 per patient), 79 patients (52%) had 356 positive nodes. Among nodepositive patients, the prevalence of nodal metastasis was highest in the pericholedochal (54%) and cystic duct (38%) nodes, followed by the second-echelon node groups (29% to 19%), while more distant node groups were only rarely (5% or less) involved. Disease-specific survival after R0 resection differed according to the nodal status (P < 0.001): most node-negative patients achieved long-term survival (median, not reached; 5-year survival, 80%), whereas among nodepositive patients, 22 survived for more than 5 years (median, 37 mo; 5-year survival, 43%). CONCLUSION: The rational extent of lymphadenectomy for gallbladder cancer should include the first-and second-echelon nodes. A considerable proportion of node-positive patients benefit from such aggressive lymphadenectomy.

Fascin⁃1 mRNA联合肿瘤标志物对结直肠腺癌患者术后淋巴结转移和生存预后的评估价值

目的探讨Fascin⁃1 mRNA联合肿瘤标志物对结直肠腺癌患者术后淋巴结转移和生存预后的评估价值。方法选取2018年2月至2021年7月于淮南东方医院集团总院接受手术治疗患者97例作为研究对象,术后检测患者血清Fascin⁃1 mRNA、糖类抗原199(CA199)、肿瘤标志物癌胚抗原(CEA)水平,术后随访12个月。根据是否发生淋巴结转移分为淋巴结转移组(n=34)与无淋巴结转移组(n=63),比较两组血清Fascin⁃1 mRNA、CA199与CEA表达水平;根据随访12个月患者生存情况分为死亡组(n=37)与生存组(n=60),比较两组临床资料与Fascin⁃1 mRNA、CA199、CEA水平,进行单、多因素分析,绘制ROC曲线检验Fascin⁃1 mRNA、CA199、CEA对结直肠腺癌患者术后淋巴结转移与生存预后的诊断效能。结果淋巴结转移患者血清CA199、CEA与Fascin⁃1 mRNA表达水平均高于无淋巴结转移患者,差异具有统计学意义(t=4.299、4.271、4.492,P<0.05);死亡组与生存组患者肿瘤大小、TNM分期、术后是否接受化疗、有无淋巴结转移、CA19⁃9、CEA、Fascin⁃1 mRNA水平比较差异具有统计学意义(χ^(2)=5.167、5.167、2.428、9.488,t=4.360、4.497、6.993,P<0.05);多因素logistic回归分析结果显示淋巴结转移、CA19⁃9、CEA、Fascin⁃1 mRNA表达水平为结直肠腺癌患者术后12月生存预后独立影响因素(P<0.05);ROC曲线结果显示Fascin⁃1 mRNA联合CA199、CEA检测均对术后淋巴结转移和生存预后的AUC分别为0.940、0.989,敏感度分别为0.882、0.946,特异度分别为0.857、0.983。结论Fascin⁃1 mRNA、CA199、CEA对结直肠腺癌患者术后淋巴结转移和生存预后具有良好的预测价值,三项指标联合可提高预测价值。

食管癌血管生成与淋巴结转移的关系

目的 探讨食管癌血管生成与淋巴结转移的关系。方法 采用免疫组织化学的方法检测了 1994～ 1995年手术切除的 5 0例食管癌病人石蜡标本中微血管密度和血管内皮生长因子及其受体蛋白的表达。其中有食管旁淋巴结转移者 18例 ,胃左动脉旁淋巴结转移 15例。光镜下行 MVD、VEGF、F1t、KDR蛋白表达细胞的计数。结果 食管旁和胃左动脉旁淋巴结转移组的微血管密度 (MVD)、血管内皮生长因子 (VEGF)、血管内皮生长因子受体 (F1t、KDR)蛋白表达均高于未转移组。结论 食管癌中 MVD、VEGF、F1t、KDR蛋白表达与肿瘤转移行为密切相关 ,有可能作为判定肿瘤生物学行为、转移潜能及预后的指标。

USP22蛋白在甲状腺乳头状癌中的表达及临床意义

目的探讨泛素化特异性蛋白酶22(USP22)在甲状腺乳头状癌、甲状腺腺瘤和结节性甲状腺肿中的表达情况,分析其与临床病理参数的关系。方法应用免疫组织化学方法检测惠州市中心人民医院2010-2015年收治的10例结节性甲状腺肿、20例甲状腺腺瘤和60例甲状腺乳头状癌组织中USP22蛋白的表达,分析其与性别、年龄、肿物大小、多灶性、包膜浸润和Ⅵ区淋巴结转移等临床病理特征的关系。结果 USP22在甲状腺乳头状癌组织中的表达高于甲状腺腺瘤组织及结节性甲状腺肿组织,差异有统计学意义(P<0.05);USP22的表达与Ⅵ区淋巴结转移和肿瘤大小有关(P<0.05),而与性别、年龄、多灶性、包膜浸润等特征无关(P>0.05)。结论与结节性甲状腺肿和甲状腺腺瘤相比,USP22在甲状腺乳头状癌组织细胞中高表达,其高表达与肿瘤大小和Ⅵ区淋巴结转移有关。USP22蛋白可能是一种新的预测甲状腺乳头状癌预后的肿瘤标记物以及生物治疗靶点。

Comparative Study between Robotic Total Thyroidectomy with Central Lymph Node Dissection via Bilateral Axillo-breast Approach and Conventional Open Procedure for Papillary Thyroid Microcarcinoma

Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.

达芬奇机器人行乳腺癌内乳淋巴结链清扫一例

da VinciSi外科手术系统是21世纪微创外科诊疗技术的重大进展之一，高清、立体和微观放大的视野，精确、灵巧和严密的操作模式是其典型的特征，相对腔镜，其可以在微小切口下，实现了前所未有的精准操作，到达狭窄手术部位，安全、有效的完成各类手术。

机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤

目的探讨机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤的临床应用价值。方法回顾性分析2010年5月至2014年4月上海瑞金医院应用达芬奇机器人辅助胰头十二指肠切除术治疗的38例胰头部恶性肿瘤患者临床资料。其中男25例，女13例；平均年龄（59±10）岁。所有患者均签署知情同意书，符合医学伦理学规定。采用“五孔法”置入3枚机器人专用套管（Trocar）及1枚镜头Trocar和1枚辅助Trocar，放入机器人臂，机器人辅助下行胰头十二指肠切除术。观察患者围手术期情况，包括手术时间、术中出血量、手术情况、术后并发症和生存情况等。结果38例均顺利完成，完全切除（ R0）切除率97%（37/38），R1切除率3%（1/38），中位手术时间413（210～520）min，术中出血量320（50～1100）ml，淋巴结清扫数15（2～24）个。术后住院时间20（7～36） d，术后并发症发生率42%（16/38），其中胰瘘8例、胆瘘2例、术后感染6例。术后生存时间25（3～42）个月，无瘤生存时间14（5～28）个月。结论采取机器人辅助胰头十二指肠切除术切除胰头部恶性肿瘤安全、可行。