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.

Worldwide practice in gastric cancer surgery

AIM: To evaluate the current status of gastric cancer surgery worldwide.METHODS: An international cross-sectional survey on gastric cancer surgery was performed amongst international upper gastro-intestinal surgeons. All surgical members of the International Gastric Cancer Association were invited by e-mail to participate. An English web-based survey had to be filled in with regard to their surgical preferences. Questions asked included hospital volume, the use of neoadjuvant treatment, preferred surgical approach, extent of the lymphadenectomy and preferred anastomotic technique. The invitations were sent in September 2013 and the survey was closed in January 2014.RESULTS: The corresponding specific response rate was 227/615(37%). The majority of respondents: originated from Asia( 5 4 %), performed > 2 1 gastrectomies per year(79%) and used neoadjuvant chemotherapy(73%). An open surgical procedure was performed by the majority of surgeons for distal gastrectomy for advanced cancer(91%) and total gastrectomy for both early and advanced cancer(52% and 94%). A minimally invasive procedure was preferred for distal gastrectomy for early cancer(65%). In Asia surgeons preferred a minimally invasive procedure for total gastrectomy for early cancer also(63%). A D1+ lymphadenectomy was preferred in early gastric cancer(52% for distal, 54% for total gastrectomy) and a D 2 lymphadenectomy was preferred in advanced gastric cancer(93% for distal, 92% for total gastrectomy) CONCLUSION: Surgical preferences for gastric cancer surgery vary between surgeons worldwide. Although the majority of surgeons use neoadjuvant chemotherapy, minimally invasive techniques are still not widely adapted.

Prognostic factors of minimally invasive surgery for gastric cancer: Does robotic gastrectomy bring oncological benefit?

BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.

Adenocarcinoma of gastric cardia in the elderly: Surgical problems and prognostic factors

AIM: To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors.METHODS: From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors' institution. They were divided into three groups with regard to age. Patients <70 and >60 year old (31) were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly (≥ 70 year old)and 58 younger patients (≤ 60 year old). The treatment was esophagectomy for type Ⅰ tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions.RESULTS: Laparotomy was carried out in 91 patients (83.4%), 38 in the elderly (74.5%) and 53 in younger patients (91.3%, P＜0.05). Primary resection was performed in 811 cases (89%) without significant differences between the two groups. Postoperative death was higher in the elderly (12.1%) than the other group (4.1%, P＜0.05), while morbidity was similar in both groups. A curative resection (R0) was performed in 59 patients (72.8%), 69.6% in the elderly and 75% in the younger group (P＞0.05). The overall 3- and 5-year survival rates were 26.7% and 117.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients (P = 0.1544). Survival rates were significantly associated with R0 resection,pathological node-positive category and tumor differentiation in both groups.CONCLUSION: As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.

Laparoscopic gastric cancer surgery:Current evidence andfuture perspectives

Laparoscopic gastrectomy has been widely accepted as a standard alternative for the treatment of early-stage gastric adenocarcinoma because of its favorable shortterm outcomes. Although controversies exist, such as establishing clear indications, proper preoperative staging, and oncologic safety, experienced surgeons and institutions have applied this approach, along with various types of function-preserving surgery, for the treatment of advanced gastric cancer. With technical advancement and the advent of state-of-the-art instruments, indications for laparoscopic gastrectomy are expected to expand as far as locally advanced gastric cancer. Laparoscopic gastrectomy appears to be promising; however, scientific evidence necessary to generalize this approach to a standard treatment for all relevant patients and care providers remains to be gathered. Several multicenter, prospective randomized trials in high-incidence countries are ongoing, and results from these trials will highlight the short- and long-term outcomes of the approach. In this review, we describe up-to-date findings and critical issues regarding laparoscopic gastrectomy for gastric cancer.

Prolonged hyperthermic intraperitoneal chemotherapy duration with 90 minutes cisplatin might increase overall survival in gastric cancer patients with peritoneal metastases

BACKGROUND Advanced gastric cancer with synchronous peritoneal metastases(GC-PM)is associated with a poor prognosis.Although cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS-HIPEC)is a promising approach,only a limited number of Western studies exist.AIM To investigate the clinicopathological outcomes of patients who underwent CRSHIPEC for GC-PM.METHODS A retrospective analysis of patients with GC-PM was conducted.All patients were seen at the Department of General and Visceral Surgery,Hospital Barmherzige Brüder,Regensburg,Germany between January 2011 and July 2021 and underwent CRS-HIPEC.Preoperative laboratory results,the use of neoadjuvant trastuzumab,and the details of CRS-HIPEC,including peritoneal carcinomatosis index,completeness of cytoreduction,and surgical procedures were recorded.Disease-specific(DSS),and overall survival(OS)of patients were calculated.RESULTS A total of 73 patients were included in the study.Patients treated with neoadjuvant trastuzumab(n=5)showed longer DSS(P=0.0482).Higher white blood cell counts(DSS:P=0.0433)and carcinoembryonic antigen levels(OS and DSS:P<0.01),and lower hemoglobin(OS and DSS:P<0.05)and serum total protein(OS:P=0.0368)levels were associated with shorter survival.Longer HIPEC duration was associated with more advantageous median survival times[60-min(n=59):12.86 mo;90-min(n=14):27.30 mo],but without statistical difference.To obtain additional data from this observation,further separation of the study population was performed.First,propensity score-matched patient pairs(n=14 in each group)were created.Statistically different DSS was found between patient pairs(hazard ratio=0.2843;95%confidence interval:0.1119-0.7222;P=0.0082).Second,those patients who were treated with trastuzumab and/or had human epidermal growth factor receptor 2 positivity(median survival:12.68 mo vs 24.02 mo),or had to undergo the procedure before 2016(median survival:12.68 mo vs 27.30 mo;P=0.0493)were removed from the original study population.CONCLUSION Based on our experience,CRS-HIPEC is a safe and secure method to improve the survival of advanced GC-PM patients.Prolonged HIPEC duration may serve as a good therapy for these patients.

Precision surgical approach with lymph-node dissection in early gastric cancer

The gravest prognostic factor in early gastric cancer is lymph-node metastasis,with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy,functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this operation.Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients.Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.

SOME PROBLEMS IN THE SURGICAL TREATMENT OF GASTRIC CANCER

Radical resections were performed in 177 cases of gastric cancer ( early cancer 31 cases and advanced cancer 146 cases). R1+ operation was performed in 10 cases and R2 or R3 was in 167. All patients were followed up to the end of the study with the 5-year survival rate of 57. 6%. In the patients with normal serosa, cancer was often located in the mucosa. In such situation, R1 or R1+ operation was advisiable. In the patients of reactive serosal types, the extent of operation should not be reduced. The serosa were often penetrated by cancer cells in diffusely infiltrated cancer, with a poor prognosis. If measures were not taken to destroy free cancer cells, the 5-year survival rate was very low inspite of radical operations. The number of lymph nodes metastasis was closely related to the biological behavior of primary cancer. Prognosis was good after R2 or R3 operation when the cancer was still within the gastric wall, Borrmann type 1,2,3 massive or nest growth patterns, and the number of lymph node metastasis was below 5 and within first station (n1) .If the number of lymph nodes metastasis was above 10, metastasis to the second (n2) or third station (n3), the cancer infiltrated to the serosa, Borrmann type 4, diffused growth pattern theprognosis was poor even R2 or R3 operations were performed.

Gastric partitioning for the treatment of malignant gastric outlet obstruction

BACKGROUND Gastric outlet obstruction(GOO)is one of the main complications in stage IV gastric cancer patients.This condition is usually managed by gastrojejunostomy(GJ).However,gastric partitioning(GP)has been described as an alternative to overcoming possible drawbacks of GJ,such as delayed gastric emptying and tumor bleeding.AIM To compare the outcomes of patients who underwent GP and GJ for malignant GOO.METHODS We retrospectively analyzed 60 patients who underwent palliative gastric bypass for unresectable distal gastric cancer with GOO from 2009 to 2018.Baseline clinicopathological characteristics including age,nutritional status,body mass index,and performance status were evaluated.Obstructive symptoms were graded according to GOO score(GOOS).Surgical outcomes evaluated included duration of the procedure,surgical complications,mortality,and length of hospital stay.Acceptance of oral diet after the procedure,weight gain,and overall survival were the long-term outcomes evaluated.RESULTS GP was performed in 30 patients and conventional GJ in the other 30 patients.The mean follow-up was 9.2 mo.Forty-nine(81.6%)patients died during that period.All variables were similar between groups,with the exception of worse performance status in GP patients.The mean operative time was higher in the GP group(161.2 vs 85.2 min,P<0.001).There were no differences in postoperative complications and surgical mortality between groups.The median overall survival was 7 and 8.4 mo for the GP and GJ groups,respectively(P=0.610).The oral acceptance of soft solids(GOOS 2)and low residue or full diet(GOOS 3)were reached by 28(93.3%)GP patients and 22(75.9%)GJ patients(P=0.080).Multivariate analysis demonstrated that GOOS 2 and GOOS 3 were the main prognostic factors for survival(hazard ratio:8.90,95%confidence interval:3.38-23.43,P<0.001).CONCLUSION GP is a safe and effective procedure to treat GOO.Compared to GJ,it provides similar surgical outcomes with a trend to better solid diet acceptance by patients.

Oncometabolic surgery:Emergence and legitimacy for investigation

Studies on morbid obesity have shown remarkable improvement of diabetes in patients who have undergone bariatric operations.It was subsequently shown that these operations induce diabetes remission independent of the resultant weight loss;as a result,surgeons began to investigate whether operations for gastric cancer(GC)could have the same beneficial effect on diabetes as bariatric operations.It was then shown in multiple reports that followed that certain operations for GC were able to improve or even cure type 2 diabetes mellitus(T2 DM)in GC patients.This finding gave rise to the concept of"oncometabolic surgery",in which a patient diagnosed with both GC and T2 DM undergo a single operation with the purpose of treating both diseases.With the increasing incidence of T2 DM,oncometabolic surgery has the potential to improve the quality of life and even extend survival of many GC patients.However,because the GC patient population and the bariatric patient population are wildly different and because different GC operations have different properties,the effect of oncometabolic surgery must be carefully assessed and engineered in order to maximize benefit and avoid harm.This manuscript aims to summarize the findings made so far in the field of oncometabolic surgery and to provide an outlook regarding the possibility of oncometabolic surgery being incorporated into standard clinical practice.

Jejunostomy in the palliative treatment of gastric cancer:A clinical prognostic score

BACKGROUND Clinical stage IV gastric cancer(GC)may need palliative procedures in the presence of symptoms such as obstruction.When palliative resection is not possible,jejunostomy is one of the options.However,the limited survival of these patients raises doubts about who benefits from this procedure.AIM To create a prognostic score based on clinical variables for 90-d mortality for GC patients after palliative jejunostomy.METHODS We performed a retrospective analysis of Stage IV GC who underwent jejunostomy.Eleven preoperative clinical variables were selected to define the score categories,with 90-d mortality as the main outcome.After randomization,patients were divided equally into two groups:Development(J1)and validation(J2).The following variables were used:Age,sex,body mass index(BMI),American Society of Anesthesiologists classification(ASA),Charlson Comorbidity index(CCI),hemoglobin levels,albumin levels,neutrophil-lymphocyte ratio(NLR),tumor size,presence of ascites by computed tomography(CT),and the number of disease sites.The score performance metric was determined by the area under the receiver operating characteristic(ROC)curve(AUC)to define low and high-risk groups.RESULTS Of the 363 patients with clinical stage IVCG,80(22%)patients underwent jejunostomy.Patients were predominantly male(62.5%)with a mean age of 62.4 years old.After randomization,the binary logistic regression analysis was performed and points were assigned to the clinical variables to build the score.The high NLR had the highest value.The ROC curve derived from these pooled parameters had an AUC of 0.712(95%CI:0.537–0.887,P=0.022)to define risk groups.In the validation cohort,the diagnostic accuracy for 90-d mortality based on the score had an AUC of 0.756,(95%CI:0.598–0.915,P=0.006).According to the cutoff,in the validation cohort BMI less than 18.5 kg/m2(P<0.001),CCI≥1(P=0.001),ASA III/IV(P=0.002),high NLR(P=0.012),and the presence of ascites on CT exam(P=0.004)were significantly associated with the high-risk group.The risk groups showed a significant association with first-line(P=0.012),second-line chemotherapy(P=0.009),30-d(P=0.013),and 90-d mortality(P<0.001).CONCLUSION The scoring system developed with 11 variables related to patient’s performance status and medical condition was able to distinguish patients undergoing jejunostomy with high risk of 90 d mortality.

胰腺癌术后胃瘫综合征风险预测模型构建及验证研究

目的构建胰腺癌术后胃瘫综合征(PGS)风险预测模型,并进行效果检验。方法采用便利抽样法,选取2020年1月-2022年1月我院收治的110例胰腺癌患者为研究对象,根据术后有无发生PGS分为PGS组29例和非PGS组81例,采用单因素、多因素Logistic回归分析筛选胰腺癌术后PGS的独立危险因素,据此构建风险预测模型,并检验模型预测效果。结果110例胰腺癌患者术后29例(26.36%)发生PGS,未发生PGS 81例(73.64%);多因素分析结果显示,围术期贫血、术后低蛋白血症、腹腔并发症、消化道重建方式、重度SAS是胰腺癌患者术后PGS的独立危险因素(P<0.05),手术时间<3h、术后使用生长抑素是胰腺癌患者术后PGS的保护性因素(P<0.05);预测模型Hosmer-Lemeshow拟合优度检验结果显示,χ^(2)=5.203,P=0.736;ROC曲线下面积为0.794(95%CI:0.750~0.837),灵敏度为0.823,特异度为0.850,最佳诊断值为0.743,C-index范围为0.818,预测准确率为81.81%。结论本研究在胰腺癌术后PGS危险因素的基础上构建风险预测模型具有良好拟合优度和区分能力,且准确度较高,为临床早期预防、早期筛选、早期治疗和干预胰腺癌术后PGS提供一定依据。

食管癌和贲门癌外科治疗的2019例临床分析

我院1978年1月20日-2003年5月12日对新疆不同民族的2019例食管癌和贲门癌患者施行了手术治疗。其中，食管癌1350例，贲门癌669例。少数民族患者占1138例（56．4％）。2019例中总切除率为90．3％（1824／2019）。食管癌切除率为92．3％（1246／1350）；贲门癌切除率为87．0％（582／669）。术后发生并发症174例（8．6％）。其中，胸内吻合口瘘34例（1．9％，34／1824），手术死亡34例（1．7％，34／2019）。初步研究结果提示，新疆不同民族发病情况不同，哈萨克族患病率最高。病例的选择及术前分期对手术能否达到根治切除甚为重要。

胃底贲门癌手术入路的探讨

目的探讨胃底贲门癌手术入路的最佳方法.方法将157例胃底贲门癌患者按手术入路分为经腹组(57例)和经胸组(100例),对比两组疗效.结果经腹组平均术中输血(164.91±36.83)m1,手术时间(219.04±10.72)min,住院时间(14.39±1.39)d,淋巴结清除数(6.04±2.84)个,未出现胸腔积液并发症,随访期间(3～60月)复发率22.80%;经胸组平均术中输血(575.50±40.12)ml、手术时间(286.40±7.94)min、住院时间(20.32±0.81)d,淋巴结清除数(3.62±2.56个),术后并发左侧胸腔积液15例,随访期间复发率41.00%,两组疗效有统计学差异.结论与经胸入路手术相比,胃底贲门癌经腹手术平均术中输血少、手术和住院时间短、淋巴结清除率高、肺部并发症少、术后复发率低,具有较好的临床疗效.

食管癌术前及术后早期胸胃排空功能的对比观察

目的:研究食管癌术后早期胸胃排空的生理机制。方法:应用放射性核素对38例食管癌术后患者进行术前及术后24 h的流食胃排空检查,分析胃半排空时间(GET 1/2)的变化。结果:术后未出现胃潴留症状。30例(78.9%)患者术后胃排空显著快于术前(P<0.01)。术前男性胃排空时间显著快于女性(P<0.05),而在术后男女性之间则无显著性差异(P>0.05)。结论在重力作用的影响下,术后早期胸胃对流食的排空较术前显著加快,胸胃只是作为无功能的连接管道而存在。

贲门癌经腹入路手术适应证的前瞻性研究

目的探讨贲门癌经腹入路手术的适应证,旨在规范贲门癌经腹入路手术适应证的选择标准。方法根据食管及贲门解剖、贲门癌病理特点、文献资料及临床经验,制定贲门癌经腹入路手术适应证标准,自2001年1月开始,对经腹入路手术治疗的贲门癌病例进行前瞻性研究。至2005年12月,共研究153例。结果符合适应证选择标准的贲门癌病例,经腹入路均能行根治手术,手术切除率100%。标本术后经病理学检查证实切缘均无癌细胞残留,共检出淋巴结781个,癌阳性率为78.75%(615/781)。全组均无吻合口瘘、胸腔积液及肺部感染等并发症,手术死亡率为0。随访期间发现腹腔内有癌转移灶者35例,复发率为22.88%,其中无吻合口复发、胸腔或纵隔转移病例。结论合理掌握贲门癌经腹手术适应证,既能达到根治效果,又能减轻患者创伤、负担及风险,具有重要临床意义。

腹腔镜辅助胃底贲门癌根治术:附22例报告

目的探讨腹腔镜辅助下行D2式胃底贲门癌根治术的临床效果。方法回顾性分析3年间行腹腔镜辅助下胃底贲门癌根治术22例患者的临床资料。全组均行腹腔镜辅助下近端胃大部切除术。结果无中转开腹，平均手术时间188（162～270）min。术中平均出血182（100～260）mL。淋巴结清扫18．6（10～32）枚。术后患者平均胃肠道功能恢复时间78（48～140）h。1例肿瘤侵犯食管下段的患者术后发生吻合口瘘，经留置空肠营养管、抗炎、充分引流等处理后4周痊愈。无手术死亡。全组术后随访1—37个月，平均9．2个月，无复发转移病例。结论腹腔镜辅助下行D2式胃底贲门癌根治术方法可行，效果好，具有视野清晰、创伤小、出血少、恢复快等优点。

高龄食管癌、贲门癌患者食管切除术结果分析

目的：探讨高龄食管癌、贲门癌患者行食管切除术的危险性及手术死亡率与年龄的关系。方法：１９８５年～１９９０ 年对４４４ 例食管癌、贲门癌患者食管切除术，根据年龄段分为两组：Ⅰ组，年龄≥６５ 岁，５６ 例，Ⅱ组，年龄＜６５ 岁，３８８ 例，比较两组术前危险因素、手术合并症及死亡率、平均住院日和长期生存率。结果：两组病例术后死亡率（３－６ ％ ｖ２－８ ％ ） ，平均住院日（２３－３ 天ｖ２２－３ 天） ，５ 年及１０ 年生存率（３４－５ ％ ｖ ３６－８ ％ ，２４－１％ ｖ２５－７％ ） 均无显著性差别。结论：高龄食管癌贲门癌患者行食管切除术并不增加手术死亡率，而长期生存率与年轻者相比无差异。

食管癌贲门癌合并糖尿病的外科治疗

目的探讨食管、贲门癌合并糖尿病的手术治疗。方法回顾性总结23例食管贲门癌合并糖尿病的手术治疗经验。结果23例中食管癌17例,贲门癌6例;术前伴慢性阻塞性肺部疾病者4例,伴心血管疾病者5例,伴慢性肾功能衰竭1例;发现癌肿时糖尿病已明确者9例,另14例为术前检查所发现。空腹血糖5.9～14.6 mmoL/L;根治性切除18例,姑息性切除5例,切除率100%;术后胸部切口感染4例,发生低血糖休克1例;全组无手术死亡,均顺利渡过手术期。术前、术中、术后均用普通胰岛素控制糖尿病,补糖以5%等渗液体为主,按1U普通胰岛素5 g糖的比例补液,并按尿糖一个“+”:4U胰岛素的剂量追加,使患者尿糖控制在“+～++”,血糖保持在略高于正常水平。术后7天开始进食后改用口服降糖药。结论食管贲门癌合并糖尿病是一较严重的临床疾病,术后并发症发生率高,应予以重视,胰岛素的合理应用是治疗成功的关键。

应用流式细胞术检测胃癌患者术中腹腔冲洗液脱落细胞的临床研究

目的:应用流式细胞技术(flow cvtometry,FCM)对腹腔冲洗液进行DNA倍体分析,作为胃癌腹腔脱落癌细胞(exfoliat-ed canceF cells,,ECC)检测的辅助手段为临床提供依据方法:收集62例胃癌患者术中腹腔冲洗液,应用FCM进行脱落细胞DNA倍体分析,同时行腹腔冲洗液细胞学(peritoneal lavage eytologv,PLC)检查,比较二者的检测敏感度,并分析FCM与胃癌不同临床病理特征的相关性结果:62例胃癌腹腔冲洗液流式细胞术DNA倍体分析检测阳性率为67.74%,而PLC阳性率仅为33.87%,两组差异有统计学意义(P<0.001)肿瘤类型、浸润深度、受侵面积、淋巴结转移、脉管瘤栓、TNM分期与腹腔冲洗液异倍体肿瘤细胞相关(P均>0.05)在局限性胃癌、肿瘤浸润深度、浆膜受侵面积<10cm^2、淋巴结转移、无脉管瘤栓、TNM分期方面腹腔冲洗液FCM检测阳性率优于PLC(P均<0.05)结论:流式细胞术可作为胃癌患者术中检测ECC的有效辅助诊断手段。