Surgical management of pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex nature and pathophysiological behaviour,surgical management continues to evolve.Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours,while lymphadenectomy remains a controversial subject.Different techniques,such as pancreas-preserving and minimally invasive approaches,continue to evolve and offer the same overall outcomes as open surgery.This comprehensive review describes in detail the current and most up-todate classification and staging of pancreatic neuroendocrine tumours,explores the rationale for nonsurgical and surgical management,and focuses on surgical treatment and more specifically,on minimally invasive approaches.

Solid pseudopapillary tumor of the pancreas:A systematic review of clinical,surgical and oncological characteristics of 1384 patients underwent pancreatic surgery

Background:Pancreatic solid pseudopapillary tumors(SPTs)are rare clinical entity,with low malignancy and still unclear pathogenesis.They account for less than 2%of exocrine pancreatic neoplasms.This study aimed to perform a systematic review of the main clinical,surgical and oncological characteristics of pancreatic SPTs.Data sources:MEDLINE/PubMed,Web of Science and Scopus databases were systematically searched for the main clinical,surgical and oncological characteristics of pancreatic SPTs up to April 2021,in accordance with the preferred reporting items for systematic reviews and meta-analyses(PRISMA)standards.Primary endpoints were to analyze treatments and oncological outcomes.Results:A total of 823 studies were recorded,86 studies underwent full-text reviews and 28 met inclusion criteria.Overall,1384 patients underwent pancreatic surgery.Mean age was 30 years and 1181 patients(85.3%)were female.The most common clinical presentation was non-specific abdominal pain(52.6%of cases).Mean overall survival was 98.1%.Mean recurrence rate was 2.8%.Mean follow-up was 4.2 years.Conclusions:Pancreatic SPTs are rare,and predominantly affect young women with unclear pathogenesis.Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.

Risk of appendiceal neoplasm in patients with appendix disorders

The most common appendicular disease is acute appendicitis,with a lifetime risk of 7%–8%.Complicated cases,which can occur in 2%–7%of patients,can signi-ficantly impact the severity of the condition and may require different manage-ment approaches.Nonoperative management with possible delayed appende-ctomy has been suggested for selected patients,however,there is a non-negligible risk of missing an underlying malignancy,which is reported to be as high as 11%.Diagnostic work-up is paramount to achieve optimal treatment with good results.

Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China

Background: Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs) are a heterogeneous group of rare tumors. Many issues in terms of epidemiologic features, pathogenesis, and treatment of GEP-NENs are still under discussion. Our study aimed to analyze the clinicopathologic characteristics and prognosis of Chinese patients with GEP-NENs.Methods: Complete clinicopathologic data and survival information of 1183 patients with GEP-NENs treated between 2005 and 2015 were collected from five medical centers in Guangdong Province, China. Patient survival was estimated using the Kaplan–Meier method and analyzed using the log-rank test; prognostic factors were analyzed using the Cox proportional hazards model.Results: The most common tumor location was the rectum(37.4%), followed by the pancreas(28.1%), stomach(20.7%), small intestine(7.2%), appendix(3.4%), and colon(3.3%). After initial definitive diagnosis, 1016(85.9%) patients underwent surgery. The 1-, 3-, and 5-year overall survival(OS) rates for the entire cohort were 87.9%, 78.5%, and 72.8%, respectively. The 3-year OS rates of patients with G1, G2, and G3 tumors were 93.1%, 82.7%, and 43.1%, respectively(P < 0.001). The 3-year OS rates of patients with stage I, II, III, and IV tumors were 96.0%, 87.3%, 64.0%, and 46.8%, respectively(P < 0.001). Patients with distant metastasis who underwent palliative surgery had a longer survival than those who did not(P = 0.003). Similar survival benefits of palliative surgery were observed in patients with neuroendocrine tumor(P y, M category, and sur= 0.031) or neuroendocrine carcinoma(P gery were found to be independent prog= 0.046). In multivariate analysis, age, grade, N categornostic factors.Conclusions: Patients with GEP-NENs who are women, younger than 50 years old, have smaller tumor size, have lower tumor grade, have lower T/N/M category, and who undergo surgery can have potentially longer survival time. Our data showed that surgery can improve the prognosis of GEP-NEN patients with distant metastasis. However, randomized controlled trials need to be conducted to establish the optimal criteria for selecting patients to undergo surgery.

Current perspectives on pancreatic serous cystic neoplasms:Diagnosis, management and beyond

Pancreatic cystic neoplasms have been increasingly recognized recently. Comprising about 16% of all resected pancreatic cystic neoplasms, serous cystic neoplasms are uncommon benign lesions that are usually asymptomatic and found incidentally. Despite overall low risk of malignancy, these pancreatic cysts still generate anxiety, leading to intensive medical investigations with considerable financial cost to health care systems. This review discusses the general background of serous cystic neoplasms, including epidemiology and clinical characteristics, and provides an updated overview of diagnostic approaches based on clinical features, relevant imaging studies and new findings that are being discovered pertaining to diagnostic evaluation. We also concisely discuss and propose management strategies for better quality of life.

Differences between main-duct and branch-duct intraductal papillary mucinous neoplasms of the pancreas

In the last decade,intraductal papillary mucinous neoplasms(IPMNs) have become commonly diagnosed.From a morphological standpoint,they are classified in main-duct IPMNs(MD-IPMNs) and branch-duct IPMNs(BD-IPMNs),depending on the type of involvement of the pancreatic ductal system by the neoplasm.Despite the fact that our understanding of their natural history is still incomplete,recent data indicate that MD-IPMNs and BD-IPMNs show significant differences in terms of biological behaviour with MD-IPMNs at higher risk of malignant degeneration.In the present paper,clinical and epidemiological characteristics,rates of malignancy and the natural history of MD-IPMNs and BD-IPMNs are analyzed.The profile of IPMNs involving both the main pancreatic duct and its side branches(combined-IPMNs) are also discussed.Finally,general recommendations for management based on these differences are given.

Gastric neuroendocrine neoplasms type 1: A systematic review and meta-analysis

BACKGROUND To date, the histopathological parameters predicting the risk of lymph node (LN) metastases and local recurrence, associated mortality and appropriateness of endoscopic or surgical resection in patients with gastric neuroendocrine neoplasms type 1 (GNENs1) have not been fully elucidated. AIM To determine the rate of LN metastases and its impact in survival in patients with GNEN1 in relation to certain clinico-pathological parameters. METHODS The PubMed, EMBASE, Cochrane Library, Web of Science and Scopus databases were searched through January 2019. The quality of the included studies and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS) in accordance with the Cochrane guidelines. A random effects model and pooled odds ratios (OR) with 95%CI were applied for the quantitative meta-analysis. RESULTS We screened 2933 articles. Thirteen studies with 769 unique patients with GNEN1 were included. Overall, the rate of metastasis to locoregional LNs was 3.3%(25/769). The rate of LN metastases with a cut-off size of 10 mm was 15.3% for lesions > 10 mm (vs 0.8% for lesions < 10 mm) with a random-effects OR of 10.5 (95%CI: 1.4 -80.8;heterogeneity: P = 0.126;I2 = 47.5%). Invasion of the muscularis propria was identified as a predictor for LN metastases (OR: 17.2;95%CI: 1.8-161.1;heterogeneity: P = 0.165;I2 = 44.5%), whereas grade was not clearly associated with LN metastases (OR: 2;95%CI: 0.3-11.6;heterogeneity: P = 0.304;I2 = 17.4%). With regard to GNEN1 local recurrence, scarce data were available. The 5-year disease-specific survival for patients with and without LN metastases was 100% in most available studies irrespective of the type of intervention. Surgical resection was linked to a lower risk of recurrence (OR: 0.3;95%CI: 0.1-1.1;heterogeneity: P = 0.173;I2 = 31.9%). The reported complication rates of endoscopic and surgical intervention were 0.6 and 3.8%, respectively. CONCLUSION This meta-analysis confirms that tumor size ≥ 10 mm and invasion of the muscularis propria are linked to a higher risk of LN metastases in patients with GNEN1. Overall, the metastatic propensity of GNEN1 is low with favorable 5- year disease-specific survival rates reported;hence, no clear evidence of the prognostic value of LN positivity is available. Additionally, there is a lack of evidence supporting the prediction of local recurrence in GNEN1, even if surgery was more often a definitive treatment.

Endoscopic submucosal dissection for colorectal neoplasms

Although endoscopic submucosal dissection(ESD) gains acceptance as one of the standard treatments for esophageal and stomach neoplasms in Japan,it is still in the developing stage for colorectal neoplasms.In terms of indications,little likelihood of nodal metastasis and technical resectability are principally considered.Some of intramucosal neoplasms,carcinomas with minute submucosal invasion,and carcinoid tumors,which are technically unresectable by conventional endoscopic treatments,may become good candidates for ESD,considering substantial risks and obtained benefits.ESD as a staging measure to obtain histological information of the invasion depth and lymphovascular infiltration is acceptable because preoperative prediction is difficult in some cases.In terms of techniques,advantages of ESD in comparison with other endoscopic treatments are to be controllable in size and shape,and to be resectable even in large and fibrotic neoplasms.The disadvantages may be longer procedure time,heavier bleeding,and higher possibility of perforation.However,owing to refinement of the techniques,invention of devices,and the learning curve,acceptable technical safety has been achieved.Colorectal ESD is very promising and become one of the standard treatments for colorectal neoplasms in the near future.

Therapeutic strategies for gastroenteropancreatic neuroendocrine neoplasms: State-of-the-art and future perspectives

Although gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)have always been considered rare tumors,their incidence has risen over the past few decades.They represent a highly heterogeneous group of neoplasms with several prognostic factors,including disease stage,proliferative index(Ki67),and tumor differentiation.Most of these neoplasms express somatostatin receptors on the cell surface,a feature that has important implications in terms of prognosis,diagnosis,and therapy.Although International Guidelines propose algorithms aimed at guiding therapeutic strategies,GEP-NEN patients are still very different from one another,and the need for personalized treatment continues to increase.Radical surgery is always the best option when feasible;however,up to 80%of cases are metastatic upon diagnosis.Regarding medical treatments,as GEP-NENs are characterized by relatively long overall survival,multiple therapy lines are adopted during the lifetime of these patients,but the optimum sequence to be followed has never been clearly defined.Furthermore,although new molecular markers aimed at predicting the response to therapy,as well as prognostic scores,are currently being studied,their application is still far from being part of daily clinical practice.As they represent a complex disease,with therapeutic protocols that are not completely standardized,GEP-NENs require a multidisciplinary approach.This review will provide an overview of the available therapeutic options for GEP-NENs and attempts to clarify the possible approaches for the management of these patients and to discuss future perspectives in this field.

Update on surgical treatment of pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms(PNENs) are rare and account for only 2%-4% of all pancreatic neoplasms. All PNENs are potential(neurendocrine tumors PNETs) or overt(neuroendocrine carcinomas PNECs) malignant,but a subset of PNETs is low-risk. Even in case of low-risk PNETs surgical resection is frequently required to treat hormone-related symptoms and to obtain an appropriate pathological diagnosis. Low-risk PNETs in the body and the tail are ideal for minimallyinvasive approaches which should be tailored to the individual patient. Generally,surgeons must aim for parenchyma sparing in these cases. In high-risk and malignant PNENs,indications for tumor resection are much wider than for pancreatic adenocarcinoma,in many cases due to the relatively benign tumor biology. Thus,patients with locally advanced and metastatic PNETs may benefit from extensive resection. In experienced hands,even multi-organ resections are accomplished with acceptable perioperative morbidity and mortality rates and are associated with excellent long term survival. However,poorly differentiated neoplasms with high proliferation rates are associated with a dismal prognosis and may frequently only be treated with chemotherapy. The evidence on surgical treatment of PNENs stems from reviews of mostly singlecenter series and some analyses of nation-wide tumor registries. No randomized trial has been performed to compare surgical and non-surgical therapies in potentially resectable PNEN. Though such a trial would principally be desirable,ethical considerations and the heterogeneity of PNENs preclude realization of such a study. In the current review,we summarize recent advances in the surgical treatment of PNENs.

CONGENITAL EXPRESSION OF mdr-1 GENE IN FRESH CANCER TISSUES FROM SEVERAL HIGH-INCIDENCE NEOPLASMS WITHOUT PREOPERATIVE CHEMOTHERAPY

Objective: The purpose of the present study is to detect characteristics of primary expression of mdr 1 gene in several neoplasms which has high morbidity in clinic. Methods: 151 resected samples, which are pathologically malignant and clinically untreated before operation, were obtained from Anyang Cancer Hospital. All of them were investigated with RT PCR for the expression of mdr 1 gene and correlated each other. Besides, we evaluated the advantages of RT PCR in this study. Results: The mdr 1 gene expression rate of these 151 samples, including cancers of stomach and gastric cardia (n=51), esophagus (n=46), colorectum (n=16), breast (n=15), thyroid (n=10), lung (n=9), uterine cervix (n=4), was 33.3%, 37%, 31.3%, 13.2%, 40%, 55%, 0%, respectively. Conclusion: Compared with other methods, RT PCR for studying mdr 1 gene expression had certain advantages in simplicity, reliability, and accuracy. Overexpression of mdr 1 gene in these neoplasms suggested that cases should be distinguished before treatment according to MDR of tumor and to choose effective drugs for individual cancer patient.

Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement

Background:There are no clearly defined indications for pancreas-preserving duodenectomy.The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving duodenectomy.Methods:Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included.We divided the series according to indication:scenario 1,primary duodenal tumors;scenario 2,tumors of another origin with duodenal involvement;and scenario 3,emergency duodenectomy.Results:We included 35 patients.Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis,limited duodenectomy in 7,and third+fourth duodenal portion resection in 27.The indications for scenario 1 were gastrointestinal stromal tumor(n=13),adenocarcinoma(n=4),neuroendocrine tumor(n=3),duodenal adenoma(n=1),and adenomatous duodenal polyposis(n=1);scenario 2:retroperitoneal desmoid tumor(n=2),recurrence of liposarcoma(n=2),retroperitoneal paraganglioma(n=1),neuroendocrine tumor in pancreatic uncinate process(n=1),and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage(n=1);and scenario 3:aortoenteric fistula(n=3),duodenal trauma(n=1),erosive duodenitis(n=1),and biliopancreatic limb ischemia(n=1).Severe complications(Clavien-Dindo≥IIIb)developed in 14%(5/35),and postoperative mortality was 3%(1/35).Conclusions:Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors,and is a technical option for some tumors with duodenal infiltration or in emergency interventions.

Collision Neoplasms of the Vermiform Appendix

Neoplasms of the vermiform appendix represent 1% of all gastrointestinal tumors, with epithelial and neuroendocrine histological subtypes being the most frequent. When two or more neoplasms with different components originate synchronically in the appendix with clear margin between them, it is called a collision tumor, with exceptional cases being reported in literature. The purpose is to present two new cases of collision tumors of the appendix and perform a review of the published literature. Two cases of an 82-year-old female and a 41-year-old male with collision tumors of the vermiform appendix are presented, with clinical presentation, radiological evaluation and surgical treatment exposed. Our results are compared with other published reports. In accordance with the other reported cases, both patients presented with low-grade appendiceal mucinous neoplasm (LAMN). Female patient with synchronous goblet cell carcinoma managed with a completion right colectomy and Hyperthermic intraperitoneal chemotherapy (HIPEC) and the other patient with well-differentiated neuroendocrine (NET) tumor managed with laparoscopic appendectomy without adjuvant treatment. Since very few cases have been reported, no diagnostic and therapeutic consensus and guidelines exist up to date. We agree that local, regional, and systemic therapies should be chosen according to the tumor that represents the worst prognosis.

Current status of surgical management of patients with gastroenteropancreatic neuroendocrine neoplasms

Neuroendocrine neoplasms(NENs)of the gastroenteropancreatic system are rare and heterogeneous tumours,yet with increasing prevalence.The most frequent primary sites are the small intestine,rectum,pancreas,and stomach.For a localized disease,surgical resection with local lymph nodes is usually curative with good overall and disease free survival.More complex situation is the treatment of locally advanced lesions,liver metastases,and,surprisingly,small asymptomatic tumours of the rectum and pancreas.In this review,we focus on the current role of surgical management of gastroenteropancreatic NENs.We present surgical approach for the most frequent primary sites.We highlight the role of endoscopic surgery and the watch-and-wait strategy for selected cases.As liver metastases pose an important clinical challenge,we present current indications and contraindications for liver resection and a role of liver transplantation for metastatic NENs.

Role of surgical treatments in high-grade or advanced gastroenteropancreatic neuroendocrine neoplasms

Over the last 40 years,the incidence and prevalence of gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)have continued to increase.Compared to other epithelial neoplasms in the same organ,GEP-NENs exhibit indolent biological behavior,resulting in more chances to undergo surgery.However,the role of surgery in high-grade or advanced GEP-NENs is still controversial.Surgery is associated with survival improvement of well-differentiated highgrade GEP-NENs,whereas poorly differentiated GEP-NENs that may benefit from resection require careful selection based on Ki67 and other tissue biomarkers.Additionally,surgery also plays an important role in locally advanced and metastatic disease.For locally advanced GEP-NENs,isolated major vascular involvement is no longer an absolute contraindication.In the setting of metastatic GEP-NENs,radical intended surgery is recommended for patients with low-grade and resectable metastases.For unresectable metastatic disease,a variety of surgical approaches,including cytoreduction of liver metastasis,liver transplantation,and surgery after neoadjuvant treatment,show survival benefits.Primary tumor resection in GEP-NENs with unresectable metastatic disease is associated with symptom control,prolonged survival,and improved sensitivity toward systemic therapies.Although there is no established neoadjuvant or adjuvant strategy,increasing attention has been given to this emerging research area.Some studies have reported that neoadjuvant therapy effectively reduces tumor burden,improves the effectiveness of subsequent surgery,and decreases surgical complications.

Impact of technology on indications and limitations for transanal surgical removal of rectal neoplasms

Transanal surgery has and continues to be well accepted for local excision of benign rectal disease not amenable to endoscopic resection. More recently, there has been increasing interest in applying transanal surgery to local resection of early malignant disease. In addition, some groups have started utilizing a transanal route in order to accomplish total mesorectal excision(TME) for more advanced rectal malignancies. We aim to review the role of various transanal and endoscopic techniquesin the local resection of benign and malignant rectal disease based on published trial data. Preliminary data on the use of transanal platforms to accomplish TME will also be highlighted. For endoscopically unresectable rectal adenomas, transanal surgery remains a widely accepted method with minimal morbidity that avoids the downsides of a major abdomino-pelvic operation. Transanal endoscopic microsurgery and transanal minimally invasive surgery offer improved visualization and magnification, allowing for finer and more precise dissection of more proximal and larger rectal lesions without compromising patient outcome. Some studies have demonstrated efficacy in utilizing transanal platforms in the surgical management of early rectal malignancies in selected patients. There is an overall higher recurrence rate with transanal surgery with the concern that neither chemoradiation nor salvage surgery may compensate for previous approach and correct the inferior outcome. Application of transanal platforms to accomplish transanal TME in a natural orifice fashion are still in their infancy and currently should be considered experimental. The current data demonstrate that transanal surgery remains an excellent option in the surgical management of benign rectal disease. However, care should be used when selecting patients with malignant disease. The application of transanal platforms continues to evolve. While the new uses of transanal platforms in TME for more advanced rectal malignancy are exciting, it is important to remain cognizant and not sacrifice long term survival for short term decrease in morbidity and improved cosmesis.

Robotic surgery for multi-visceral resection in locally advanced colorectal cancer:Techniques,benefits and future directions

Colorectal cancer accounts for 10%of diagnosed cancers globally and often presents as advanced disease,necessitating aggressive treatment.With both younger and healthier elderly patients being diagnosed,as well as potentially the need for salvage therapy post total neoadjuvant treatment,surgical options for cure include pelvic exenteration.Whilst typically performed via an open approach,there has been an increased utilisation of minimally invasive techniques including robotic surgery.Offering smaller in-cisions,reduced postoperative pain,and quicker recovery time than open surgery,robotic techniques have demonstrated lower blood loss,shorter hospital stays,and reduced morbidity.Moreover,the er-gonomic design of robotic systems provides surgeons with comfort during long procedures and increased precision.It also offers an increased opportunity for organ preservation and reconstruction whilst maintaining adequate oncological outcomes.As robotic technology continues to evolve and combines with artificial intelligence,it is poised to play an even more significant role in the management of complex colorectal cancer cases,improving survival and long-term outcomes.

乳腺癌改良根治术后血清sEC、s-CD105水平与复发转移的相关性分析

目的分析乳腺癌改良根治术后血清可溶性E-钙黏连蛋白(sEC)、可溶性内皮糖蛋白105(sCD105)水平与复发转移的关系。方法选取2017年2月—2020年3月在无锡市第二人民医院行乳腺癌改良根治术的124例乳腺癌患者为研究对象。术后测定患者血清sEC、s-CD105水平,并随访3年,统计复发转移情况。比较复发转移组与未复发转移组患者血清sEC、s-CD105水平,采用多因素逐步Logistic回归分析影响乳腺癌改良根治术后复发转移的因素,绘制受试者工作特征(ROC)曲线分析血清sEC、s-CD105预测乳腺癌改良根治术后复发转移的价值。结果截至随访结束,12例失访,剩余112例患者中复发转移15例。复发转移组患者血清sEC、s-CD105水平均高于未复发转移组(P<0.05)。多因素逐步Logistic回归分析结果显示,肿瘤分期高[OR=5.171(95%CI:2.128,12.567)]、分化程度低[OR=4.899(95%CI:2.016,11.909)]、血清sEC水平高[OR=3.540(95%CI:1.456,8.602)]、血清s-CD105水平高[OR=3.673(95%CI:1.511,8.927)]均是影响乳腺癌改良根治术后复发转移的危险因素(P<0.05)。ROC曲线分析结果显示,血清s EC、s-CD105单独及联合预测乳腺癌改良根治术后复发转移的敏感性分别为66.67%(95%CI:0.387,0.870)、73.33%(95%CI:0.448,0.910)、86.67%(95%CI:0.584,0.977);特异性分别为70.10%(95%CI:0.598,0.788)、77.32%(95%CI:0.675,0.850)、85.57%(95%CI:0.766,0.916);曲线下面积分别为0.734(95%CI:0.639,0.828)、0.747(95%CI:0.645,0.849)、0.892(95%CI:0.825,0.959)。结论乳腺癌改良根治术后血清sEC、s-CD105水平与复发转移有关,两者联合预测术后复发转移效能良好。

具有低度恶性潜能的多房囊性肾肿瘤的临床病理特征及预后

目的:分析具有低度恶性潜能的多房囊性肾肿瘤(multilocular cystic renal neoplasm of low malignant potential,MCRNLMP)患者的临床病理特征与预后,对比接受不同手术方式的具有低度恶性潜能的多房囊性肾肿瘤患者的临床病理特征。方法:回顾性收集2010年1月至2023年9月北京大学第三医院收治的行根治性肾切除术或者保留肾单位手术且术后病理明确为具有低度恶性潜能的多房囊性肾肿瘤患者的临床资料,获取其基本临床特征、术后病理结果及预后。根据手术方式将患者分为根治性肾切除术组及保留肾单位手术组,并比较两组患者的临床病理特征差异。结果:共纳入35例患者,诊断时的中位年龄为53.0(39.0~62.0)岁,其中23例为男性(65.7%),12例为女性(34.3%)。9例患者接受了根治性肾切除术(25.7%),26例患者接受了保留肾单位手术(74.3%)。35例患者的临床T分期均未超过T2a期。中位手术时间145.0 min,中位估计术中出血量20.0 mL。术后中位住院天数6.0 d。术后病理结果均未提示肾窦侵犯、肉瘤样变、肾上腺侵犯及淋巴结侵犯。将患者根据手术方式分为保留肾单位手术组和根治性肾切除术组,并对两组的临床病理特征进行对比,差异均无统计学意义。除1例患者失访外,其余患者均获随访,随访时间8~111个月,中位随访时间70.5个月,仅1例患者因非肿瘤原因死亡,其余患者均无肿瘤转移或复发。结论:具有低度恶性潜能的多房囊性肾肿瘤患者的预后较好;对于具有低度恶性潜能的多房囊性肾肿瘤,接受保留肾单位手术和根治性肾切除术的患者临床病理学特征差异无统计学意义。

瑞马唑仑对腹腔镜结直肠癌根治术患者细胞免疫功能和术后恢复质量的影响

目的评价瑞马唑仑用于全身麻醉对腹腔镜结直肠癌根治术患者细胞免疫功能及术后恢复质量的影响。方法选择择期腹腔镜结直肠癌根治术患者60例,男36例,女24例,年龄18~80岁,BMI 185~280 kg/m^(2),ASAⅠ或Ⅱ级。按照随机数字将患者分为两组:瑞马唑仑组(R组)和丙泊酚组(P组),每组30例。麻醉诱导:R组静脉注射瑞马唑仑0.2~0.3 mg/kg,推注时间大于1 min,P组静脉注射丙泊酚10~20 mg/kg,待患者意识消失即MOAA/S评分为1~2分后,两组静脉注射舒芬太尼0.3~0.5μg/kg和顺式阿曲库铵0.15~0.2 mg/kg完成气管插管。麻醉维持:R组静脉泵注瑞马唑仑10~20 mg·kg^(-1)·h^(-1),P组静脉泵注丙泊酚40~120 mg·kg^(-1)·h^(-1),两组协同静脉泵注瑞芬太尼0.1~0.2μg·kg^(-1)·min^(-1),间断静脉注射顺式阿曲库铵,术中维持BIS 40~60。记录麻醉诱导前、术毕即刻、术后24、72 h T细胞亚群CD3^(+)、CD4^(+)、CD8^(+)和NK细胞,并计算CD4^(+)/CD8^(+),记录麻醉诱导前、插管即刻、切皮即刻、术毕即刻、拔管即刻的HR、MAP、SpO2、BIS,术中心血管不良事件发生率和血管活性药物使用率。记录麻醉诱导前、术后24、72 h 15项恢复质量(QoR-15)量表评分,苏醒时Riker评分和Ramsay评分,苏醒时间、拔管时间、PACU停留时间、术后首次肛门排气时间、术后住院时间和术后24 h内恶心呕吐、嗜睡的发生率。结果与P组比较,R组术毕即刻、术后24 h NK、CD3^(+)、CD4^(+)细胞明显升高(P<0.05),术毕即刻HR明显增快、MAP明显升高(P<0.05),术中低血压、心动过缓发生率和血管活性药物使用率明显降低(P<0.05),术后24、72 h QoR-15评分明显升高(P<0.05)。两组苏醒时Riker评分和Ramsay评分差异无统计学意义。结论与丙泊酚比较,瑞马唑仑全身麻醉对腹腔镜结直肠癌根治术患者围术期免疫功能影响更小,术中低血压、心动过缓发生率更低,术后恢复质量更高。