Effects of cytoreductive surgery combined with hyperthermic perfusion chemotherapy on prognosis of patients with advanced gallbladder cancer

BACKGROUND Gallbladder cancer(GC)is a common malignant tumor and one of the leading causes of cancer-related death worldwide.It is typically highly invasive,difficult to detect in the early stages,and has poor treatment outcomes,resulting in high mortality rates.The available treatment options for GC are relatively limited.One emerging treatment modality is hyperthermic intraperitoneal chemotherapy(HIPEC).HIPEC involves delivering heated chemotherapy directly into the abdominal cavity.It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions,aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity.AIM To determine the effects of cytoreductive surgery(CRS)combined with HIPEC on the short-term prognosis of patients with advanced GC.METHODS Data from 80 patients treated at the Punan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed.The control group comprised 44 patients treated with CRS,and the research group comprised 36 patients treated with CRS combined RESULTS The baseline data of the research and control groups were similar(P>0.05).Six days after surgery,the alanine aminotransferase,aspartate aminotransferase,total bilirubin,and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups(P<0.05).However,the values did not differ between the two groups six days postoperatively(P>0.05).Similarly,the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups(P<0.05),but they did not differ between the groups six days postoperatively(P>0.05).Furthermore,the research group had fewer postoperative adverse reactions than the control group(P=0.027).Finally,a multivariate Cox analysis identified the tumor stage,distant metastasis,and the treatment plan as independent factors affecting prognosis(P<0.05).The three-year survival rate in the study group was higher than that in the control group(P=0.002).CONCLUSION CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.

EPIDEMIC STRENGTH OF CARDIA AND DISTANT STOMACH CANCER IN THE HIGH RISK REGION OF ESOPHAGEAL CANCER AND THEIR IMPLICATION TO EDOSCOPIC SCREENING

Objective： To discuss the epidemic strength of cardia and distant stomach cancers in the high risk region of esophageal cancer along the south Taihang mountain such as in Shexian, Linxian, and Cixian Counties, and to clarify the tasks for the control of upper gastrointestinal tract cancer as a whole in the region. Methods： Comparisons of incidence and mortality rates of esophageal, cardia and stomach cancers were made between Cixian, Linxian and Shexian Counties with reference to detection rates of cancer in situ and precancerous lesions of the three upper gastrointestinal cancers by endoscopic screening. The screening was performed from 1999 through 2004 in the three adjacent counties including a total of 6233 local residents aged 40 to 69 years old. Results： The incidence rates for cardia cancer for the male and female from 2000 through 2004 were 69.9 and 41.5, and the mortality rates were 54.3 and 33.2 respectively in Shexian County. Esophageal, cardia, and stomach cancers constitute about 70～80 percent of all malignant disease by incidence or mortality rates. Endoscopic survey with iodine staining can effectively detect squamous cell precancerous lesions in the esophagus, but the method is inadequate for the detection of adeno precancerous lesions of the cardia and stomach. Conclusion： The south Taihang mountain region is a high risk area not only for esophagus cancer, but also for cardia and stomach cancers. To control upper gastrointestinal tract cancers as a whole in the region, special attention should be paid to the control of cardia and stomach cancers. Presently, to find effective screening methods for detecting cardia and stomach precancerous lesions is especially important.

Small hepatocellular carcinoma: current status and prospects

Background: More than two decades have gone by since the early report of resection for small hepatocel- lular carcinoma (HCC), which resulted in improved prognosis of HCC. Objective: To review the past and recent data, and prospect the future in this field. Data sources: Literature and recent data from the Liver Cancer Institute of Fudan University, Shang- hai, China. Data synthesis: 1232 patients with small HCC from the institute were analyzed between 1960-1984 (n= 107) and 1985-1999 (n=1125). The increase of li- mited resection rate from 69.5 % to 82.5 % contribu- ted in part to the increase of resectability from 76.6 % to 95.5 %, decrease of operative mortality from 2.4 % to 1.2 %, and improvement of 5-year sur- vival after resection (from 53.1% to 64.0%). The 5-year survival was higher after limited resection than after lobectomy, being 64.4 % versus 55.9%. The 5-year survival after resection was superior to that after cryosurgery and other regional cancer therapies (32.8 %). However, molecular studies found that biological characteristics were only slightly better in small HCC than in large HCC. Conclusions: Resection remains the treatment choice for small HCC with compensated liver function, while regional cancer therapies and liver transplanta- tion are alternatives for patients with incompensated liver function. Biological characteristics remain the leading factor influencing prognosis of small HCC.

Cancer field surgery for locoregional tumor control of cervical carcinoma

As the current standard,surgery is applied to treat early-stage cervical cancer and selected post-irradiation pelvic relapses.Surgical therapy for local disease is based on a model of unlimited isotropic cancer cell propagation and dissection artifacts such as subperitoneal“ligaments”and“spaces”.For regional disease,the role of traditional surgery is diagnostic and eventually cytoreductive.However,the isotropic local tumor propagation model has to be rejected due to numerous inconsistencies with clinical facts.Likewise,the“ligament and space”approach to the subperitoneum is too crude and variable to accurately cover both local spread and intercalated lymph node metastases of cervical cancer.The ontogenetic cancer field model is fully in line with the locoregional spread patterns of carcinoma of the female genital tract.Developmentally derived(ontogenetic)anatomy enables unbiased and accurate dissection of the complex tissue structures within the subperitoneum.Cancer field surgery founded on these insights has a high potential to improve the treatment outcome of cervical carcinoma.