INTRODUCTIONAlthough the long-term postoperative survival rateof gastric cancer(GC) patients has been improvedsignificantly since the local dissection of lymph nodewas widely used in China,yet the low curativeresectio...INTRODUCTIONAlthough the long-term postoperative survival rateof gastric cancer(GC) patients has been improvedsignificantly since the local dissection of lymph nodewas widely used in China,yet the low curativeresection rate and the high recurrence rate fromperitoneal and hepatic metastases hinder it fromfurther improvement.To alter the currentunsatisfactory status of GC treatment,a展开更多
BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still controversial.Hence,risk factors for portal vein tumor thrombosis(...BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still controversial.Hence,risk factors for portal vein tumor thrombosis(PVTT) in SHCC are obscure.The present study was designed to address this issue.METHOD:Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni-and multi-variate analyses.RESULTS:Univariate analysis showed that PVTT,tumornode-metastasis(TNM) stage,Edmondson-Steiner grade and preoperative serum alpha-fetoprotein(AFP) level were associated with the overall and disease-free survival,whereas tumor size only influenced the overall survival.In multivariate Cox regression tests,Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and diseasefree survival.In addition,the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with PVTT.Among them,only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression analysis.Additionally,AFP,the sole preoperative factor for PVTT,was not adequately sensitive and specific.CONCLUSIONS:Factors relating to post-surgical prognosis and PVTT in SHCC are all tumor-related.Of these,EdmondsonSteiner grade and TNM stage might be of particular importance in survival analysis.In addition,accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult.展开更多
AIM To compare endoscopic submucosal dissection(ESD) outcomes between Eastern and Western countries.METHODS A systematic review and meta-analysis was performed using Pub Med,MEDLINE,Web of Science,CINAHL and EBM revie...AIM To compare endoscopic submucosal dissection(ESD) outcomes between Eastern and Western countries.METHODS A systematic review and meta-analysis was performed using Pub Med,MEDLINE,Web of Science,CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection,en bloc or R0 resection rates. Secondary outcomes were complication rates,local recurrence rates and procedure times. RESULTS Overall,238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESDon 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative,en bloc,and R0 resection in the Eastern studies; 82%(CI: 81%-84%),95%(CI: 94%-96%) and 89%(CI: 88%-91%) compared to Western studies; 71%(CI: 61%-81%),85%(CI: 81%-89%) and 74%(CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries(0.53%; CI: 0.10-1.16) compared to Eastern countries(0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries(110 min vs 77 min).CONCLUSION Eastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.展开更多
BACKGROUND:Adenocarcinoma of the pancreas exhibits aggressive behavior in growth,inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%.Curative resection is the only potential ...BACKGROUND:Adenocarcinoma of the pancreas exhibits aggressive behavior in growth,inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%.Curative resection is the only potential therapeutic opportunity. DATA SOURCES:A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma. RESULTS:Despite recent advances in chemotherapy,radio-therapy or even immunotherapy,surgery still remains the major factor that affects the outcome.The initial promising performance in Japan gave conflicting results in Western countries for the extended and more radical pancreatectomy; it has failed to prove beneficial.Four prospective,randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended resection.The exact lymph node status,including malignant spread and the total number retrieved as well as the lymph node ratio,is the most important prognostic factor.Positive lymph nodes after pancreatectomy are present in 70%.Paraaortic lymph node spread indicates poor prognosis. CONCLUSIONS:Undoubtedly,a standard lymphadenectomy including>15 lymph nodes must be no longer preferred in patients with the usual head location.The extended lymphadenectomy does not have any place,unless in randomized trials.In cases with body or tail location,the radical antegrade modular pancreatosplenectomy gives promising results.Nevertheless,accurate localization and detailed examination of the resected specimen are required for better staging.展开更多
目的观察结直肠癌肝转移（colorectal cancer with liver metastasis,CRCLM）患者行根治性切除的疗效,分析影响术后肝转移瘤复发的危险因素。方法回顾性分析我院1993-2013年收治的行根治性切除术的结直肠癌肝转移患者164例资料,绘制其...目的观察结直肠癌肝转移（colorectal cancer with liver metastasis,CRCLM）患者行根治性切除的疗效,分析影响术后肝转移瘤复发的危险因素。方法回顾性分析我院1993-2013年收治的行根治性切除术的结直肠癌肝转移患者164例资料,绘制其术后远期生存率及无瘤生存率曲线。对影响术后肝转移瘤复发的因素分别进行单因素分析和多因素分析。结果术后第1、2、3、5年生存率分别为90.9%、72.1%、57.1%和26.0%,中位生存期为32（1~162）个月;术后第1、2、3、5年无瘤生存率分别为49.4%、38.4%、25.0%和14.0%,中位无瘤生存时间为12个月。术后并发症发生率为16.5%,术后30 d死亡率为1.2%。术后肝转移瘤复发率为46.3%,其中,边缘复发5例（6.6%）,同一肝段复发7例（9.2%）,邻近肝段复发7例（9.2%）,远隔肝段复发13例（17.1%）,多发肝段复发44例（57.9%）。各复发类型相比差异无统计学意义（P=0.062）。单因素分析显示原发瘤分化程度（P=0.035）、癌胚抗原（carcino-embryonic antigen,CEA）（P=0.013）、原发瘤区域淋巴结转移（P=0.043）和肝转移瘤切缘（P=0.012）与术后肝转移瘤复发相关;多因素分析显示原发瘤分化程度（P=0.021）和CEA（P=0.015）为影响术后肝转移瘤复发的独立危险因素。结论结直肠癌肝转移根治性切除术后远期生存率高,原发瘤分化程度和术前血浆CEA水平为影响术后肝转移瘤复发的独立危险因素。展开更多
文摘INTRODUCTIONAlthough the long-term postoperative survival rateof gastric cancer(GC) patients has been improvedsignificantly since the local dissection of lymph nodewas widely used in China,yet the low curativeresection rate and the high recurrence rate fromperitoneal and hepatic metastases hinder it fromfurther improvement.To alter the currentunsatisfactory status of GC treatment,a
基金supported by a grant from the Beijing Municipal Fund for Key Disciplines,China (100230446)
文摘BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still controversial.Hence,risk factors for portal vein tumor thrombosis(PVTT) in SHCC are obscure.The present study was designed to address this issue.METHOD:Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni-and multi-variate analyses.RESULTS:Univariate analysis showed that PVTT,tumornode-metastasis(TNM) stage,Edmondson-Steiner grade and preoperative serum alpha-fetoprotein(AFP) level were associated with the overall and disease-free survival,whereas tumor size only influenced the overall survival.In multivariate Cox regression tests,Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and diseasefree survival.In addition,the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with PVTT.Among them,only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression analysis.Additionally,AFP,the sole preoperative factor for PVTT,was not adequately sensitive and specific.CONCLUSIONS:Factors relating to post-surgical prognosis and PVTT in SHCC are all tumor-related.Of these,EdmondsonSteiner grade and TNM stage might be of particular importance in survival analysis.In addition,accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult.
文摘AIM To compare endoscopic submucosal dissection(ESD) outcomes between Eastern and Western countries.METHODS A systematic review and meta-analysis was performed using Pub Med,MEDLINE,Web of Science,CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection,en bloc or R0 resection rates. Secondary outcomes were complication rates,local recurrence rates and procedure times. RESULTS Overall,238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESDon 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative,en bloc,and R0 resection in the Eastern studies; 82%(CI: 81%-84%),95%(CI: 94%-96%) and 89%(CI: 88%-91%) compared to Western studies; 71%(CI: 61%-81%),85%(CI: 81%-89%) and 74%(CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries(0.53%; CI: 0.10-1.16) compared to Eastern countries(0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries(110 min vs 77 min).CONCLUSION Eastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.
文摘BACKGROUND:Adenocarcinoma of the pancreas exhibits aggressive behavior in growth,inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%.Curative resection is the only potential therapeutic opportunity. DATA SOURCES:A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma. RESULTS:Despite recent advances in chemotherapy,radio-therapy or even immunotherapy,surgery still remains the major factor that affects the outcome.The initial promising performance in Japan gave conflicting results in Western countries for the extended and more radical pancreatectomy; it has failed to prove beneficial.Four prospective,randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended resection.The exact lymph node status,including malignant spread and the total number retrieved as well as the lymph node ratio,is the most important prognostic factor.Positive lymph nodes after pancreatectomy are present in 70%.Paraaortic lymph node spread indicates poor prognosis. CONCLUSIONS:Undoubtedly,a standard lymphadenectomy including>15 lymph nodes must be no longer preferred in patients with the usual head location.The extended lymphadenectomy does not have any place,unless in randomized trials.In cases with body or tail location,the radical antegrade modular pancreatosplenectomy gives promising results.Nevertheless,accurate localization and detailed examination of the resected specimen are required for better staging.
文摘目的观察结直肠癌肝转移（colorectal cancer with liver metastasis,CRCLM）患者行根治性切除的疗效,分析影响术后肝转移瘤复发的危险因素。方法回顾性分析我院1993-2013年收治的行根治性切除术的结直肠癌肝转移患者164例资料,绘制其术后远期生存率及无瘤生存率曲线。对影响术后肝转移瘤复发的因素分别进行单因素分析和多因素分析。结果术后第1、2、3、5年生存率分别为90.9%、72.1%、57.1%和26.0%,中位生存期为32（1~162）个月;术后第1、2、3、5年无瘤生存率分别为49.4%、38.4%、25.0%和14.0%,中位无瘤生存时间为12个月。术后并发症发生率为16.5%,术后30 d死亡率为1.2%。术后肝转移瘤复发率为46.3%,其中,边缘复发5例（6.6%）,同一肝段复发7例（9.2%）,邻近肝段复发7例（9.2%）,远隔肝段复发13例（17.1%）,多发肝段复发44例（57.9%）。各复发类型相比差异无统计学意义（P=0.062）。单因素分析显示原发瘤分化程度（P=0.035）、癌胚抗原（carcino-embryonic antigen,CEA）（P=0.013）、原发瘤区域淋巴结转移（P=0.043）和肝转移瘤切缘（P=0.012）与术后肝转移瘤复发相关;多因素分析显示原发瘤分化程度（P=0.021）和CEA（P=0.015）为影响术后肝转移瘤复发的独立危险因素。结论结直肠癌肝转移根治性切除术后远期生存率高,原发瘤分化程度和术前血浆CEA水平为影响术后肝转移瘤复发的独立危险因素。
