AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a publi...AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients(11 women and eight men) were found to have GBC.The male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasion underwent Ⅳb + Ⅴ wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy.One patient with stage T1b GBC refused further surgery.Cases with Tis and T1a involvement were treated with cholecystectomy alone.One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone.Six of the nine patients with incidental diagnosis reached 5-year DFS.One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery.Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.CONCLUSION:Laparoscopic cholecystectomy does not affect survival if implemented properly.Reoperation should have two objectives:R0 resection and clearance of the lymph nodes.展开更多
BACKGROUND The standard treatment for advanced T2 gastric cancer(GC)is laparoscopic or surgical gastrectomy(either partial or total)and D2 lymphadenectomy.A novel combined endoscopic and laparoscopic surgery(NCELS)has...BACKGROUND The standard treatment for advanced T2 gastric cancer(GC)is laparoscopic or surgical gastrectomy(either partial or total)and D2 lymphadenectomy.A novel combined endoscopic and laparoscopic surgery(NCELS)has recently been proposed as a better option for T2 GC.Here we describe two case studies demonstrating the efficacy and safety of NCELS.CASE SUMMARY Two T2 GC cases were both resected by endoscopic submucosal dissection and full-thickness resection and laparoscopic lymph nodes dissection.This method has the advantage of being more precise and minimally invasive compared to current methods.The treatment of these 2 patients was safe and effective with no complications.These cases were followed up for nearly 4 years without recurrence or metastasis.CONCLUSION This novel method provides a minimally invasive treatment option for T2 GC,and its potential indications,effectiveness and safety needs to be further evaluated in controlled studies.展开更多
Aim: The short-term perioperative results of laparoscopic treatment of gallbladder (GB) carcinoma were evaluated to determine whether this technique can be a feasible treatment option. Methods: Ten patients with fundu...Aim: The short-term perioperative results of laparoscopic treatment of gallbladder (GB) carcinoma were evaluated to determine whether this technique can be a feasible treatment option. Methods: Ten patients with fundus/body GB tumors (GBTs) underwent laparoscopic liver resection (LLR) and lymph node dissection. Additionally, 124 patients underwent LLR for liver tumors. These 124 LLRs included 79 partial resections (PRs), 11 left lateral sectionectomies (LLSs), 25 anatomical resections (ARs), and 9 small ARs (SARs). The operation time (OT), intraoperative blood loss (BL), and postoperative length of hospital stay (LOS) were compared between the GBT and various LLR groups. Results: The median (range) OT in the GBT, PR, LLS, AR, and SAR groups was 298 (186-488), 245 (84-700), 328 (150-682), 458 (224-848), and 352 (274-696) min, respectively. The BL was 109 (10-500), 50 (0/uncountable-3,270), 100 (10-516), 375 (25-3,569), and 705 (35-1,920) mL, respectively. The LOS was 16 (8-105), 15 (5-254), 13 (11-52), 22 (8-44), and 15 (8-44) days, respectively. The OT and BL were significantly different between the GBT and AR groups. Conclusion:Laparoscopic surgery could be a good treatment option for GBTs suspected to be T1b/T2 GB carcinoma in the GB body/fundus without cystic duct invasion.展开更多
Despite declining incidence,gastric cancer remains one of the most common cancers worldwide.Early detection in population-based screening programs has increased the number of cases of early gastric cancer,representing...Despite declining incidence,gastric cancer remains one of the most common cancers worldwide.Early detection in population-based screening programs has increased the number of cases of early gastric cancer,representing approximately 50%of newly detected gastric cancer cases in Asian countries.Endoscopic mucosal resection and endoscopic submucosal dissection have become the preferred therapeutic techniques in Japan and Korea for the treatment of early gastric cancer patients with a very low risk of lymph node metastasis.Laparoscopic and robotic resections for early gastric cancer,including function-preserving resections,have propagated through advances in technology and surgeon experience.The aim of this paper is to discuss the recent advances in minimally invasive approaches in the treatment of early gastric cancer.展开更多
目的探讨T1b期胆囊癌(GBC)患者采用腹腔镜胆囊切除(LC)联合肝组织楔形切除、区域淋巴结清扫术治疗的临床效果。方法选取2016年2月至2020年1月在河南省人民医院接受治疗的T1b期GBC患者共计86例,以随机数字表法分为研究组(n=44,LC联合肝...目的探讨T1b期胆囊癌(GBC)患者采用腹腔镜胆囊切除(LC)联合肝组织楔形切除、区域淋巴结清扫术治疗的临床效果。方法选取2016年2月至2020年1月在河南省人民医院接受治疗的T1b期GBC患者共计86例,以随机数字表法分为研究组(n=44,LC联合肝组织楔形切除、区域淋巴结清扫术治疗)与对照组(n=42,LC治疗),对两组围手术期指标、疼痛程度[痛觉模拟评分法(VAS)]、肿瘤标志物、生活质量[世界卫生组织生存质量测定量表简表(WHOQOL-BREF)]、并发症发生率、生存率进行比较。结果研究组手术时间、胃肠功能恢复时间、住院时间长于对照组,且出血量多于对照组,差异有统计学意义(P<0.05);研究组术后24 h、72 h VAS评分与对照组比较,差异无统计学意义(P>0.05);两组术后72 h癌胚抗原(CEA)、血清糖类抗原19-9(CA19-9)水平降低,差异有统计学意义(P<0.05),但研究组与对照组比较,差异无统计学意义(P>0.05);两组术后1个月WHOQOL-BREF评分提高,且研究组评分高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率(11.36%)与对照组(7.14%)比较,差异无统计学意义(P>0.05);研究组术后3年生存率(36.36%)较对照组(16.67%)更高,差异有统计学意义(P<0.05)。结论LC联合肝组织楔形切除、区域淋巴结清扫术应用于T1b期GBC患者治疗中,能够提高生活质量,提高远期生存率,不会增加术后并发症,但手术时间更长,术中出血量更多,恢复时间更长。展开更多
文摘AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients(11 women and eight men) were found to have GBC.The male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasion underwent Ⅳb + Ⅴ wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy.One patient with stage T1b GBC refused further surgery.Cases with Tis and T1a involvement were treated with cholecystectomy alone.One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone.Six of the nine patients with incidental diagnosis reached 5-year DFS.One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery.Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.CONCLUSION:Laparoscopic cholecystectomy does not affect survival if implemented properly.Reoperation should have two objectives:R0 resection and clearance of the lymph nodes.
文摘BACKGROUND The standard treatment for advanced T2 gastric cancer(GC)is laparoscopic or surgical gastrectomy(either partial or total)and D2 lymphadenectomy.A novel combined endoscopic and laparoscopic surgery(NCELS)has recently been proposed as a better option for T2 GC.Here we describe two case studies demonstrating the efficacy and safety of NCELS.CASE SUMMARY Two T2 GC cases were both resected by endoscopic submucosal dissection and full-thickness resection and laparoscopic lymph nodes dissection.This method has the advantage of being more precise and minimally invasive compared to current methods.The treatment of these 2 patients was safe and effective with no complications.These cases were followed up for nearly 4 years without recurrence or metastasis.CONCLUSION This novel method provides a minimally invasive treatment option for T2 GC,and its potential indications,effectiveness and safety needs to be further evaluated in controlled studies.
文摘Aim: The short-term perioperative results of laparoscopic treatment of gallbladder (GB) carcinoma were evaluated to determine whether this technique can be a feasible treatment option. Methods: Ten patients with fundus/body GB tumors (GBTs) underwent laparoscopic liver resection (LLR) and lymph node dissection. Additionally, 124 patients underwent LLR for liver tumors. These 124 LLRs included 79 partial resections (PRs), 11 left lateral sectionectomies (LLSs), 25 anatomical resections (ARs), and 9 small ARs (SARs). The operation time (OT), intraoperative blood loss (BL), and postoperative length of hospital stay (LOS) were compared between the GBT and various LLR groups. Results: The median (range) OT in the GBT, PR, LLS, AR, and SAR groups was 298 (186-488), 245 (84-700), 328 (150-682), 458 (224-848), and 352 (274-696) min, respectively. The BL was 109 (10-500), 50 (0/uncountable-3,270), 100 (10-516), 375 (25-3,569), and 705 (35-1,920) mL, respectively. The LOS was 16 (8-105), 15 (5-254), 13 (11-52), 22 (8-44), and 15 (8-44) days, respectively. The OT and BL were significantly different between the GBT and AR groups. Conclusion:Laparoscopic surgery could be a good treatment option for GBTs suspected to be T1b/T2 GB carcinoma in the GB body/fundus without cystic duct invasion.
文摘Despite declining incidence,gastric cancer remains one of the most common cancers worldwide.Early detection in population-based screening programs has increased the number of cases of early gastric cancer,representing approximately 50%of newly detected gastric cancer cases in Asian countries.Endoscopic mucosal resection and endoscopic submucosal dissection have become the preferred therapeutic techniques in Japan and Korea for the treatment of early gastric cancer patients with a very low risk of lymph node metastasis.Laparoscopic and robotic resections for early gastric cancer,including function-preserving resections,have propagated through advances in technology and surgeon experience.The aim of this paper is to discuss the recent advances in minimally invasive approaches in the treatment of early gastric cancer.
文摘目的探讨T1b期胆囊癌(GBC)患者采用腹腔镜胆囊切除(LC)联合肝组织楔形切除、区域淋巴结清扫术治疗的临床效果。方法选取2016年2月至2020年1月在河南省人民医院接受治疗的T1b期GBC患者共计86例,以随机数字表法分为研究组(n=44,LC联合肝组织楔形切除、区域淋巴结清扫术治疗)与对照组(n=42,LC治疗),对两组围手术期指标、疼痛程度[痛觉模拟评分法(VAS)]、肿瘤标志物、生活质量[世界卫生组织生存质量测定量表简表(WHOQOL-BREF)]、并发症发生率、生存率进行比较。结果研究组手术时间、胃肠功能恢复时间、住院时间长于对照组,且出血量多于对照组,差异有统计学意义(P<0.05);研究组术后24 h、72 h VAS评分与对照组比较,差异无统计学意义(P>0.05);两组术后72 h癌胚抗原(CEA)、血清糖类抗原19-9(CA19-9)水平降低,差异有统计学意义(P<0.05),但研究组与对照组比较,差异无统计学意义(P>0.05);两组术后1个月WHOQOL-BREF评分提高,且研究组评分高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率(11.36%)与对照组(7.14%)比较,差异无统计学意义(P>0.05);研究组术后3年生存率(36.36%)较对照组(16.67%)更高,差异有统计学意义(P<0.05)。结论LC联合肝组织楔形切除、区域淋巴结清扫术应用于T1b期GBC患者治疗中,能够提高生活质量,提高远期生存率,不会增加术后并发症,但手术时间更长,术中出血量更多,恢复时间更长。
