The Japan Clinical Oncology Group has recently conducted large scale clinical trials with findings that have revealed pivotal strategies for the treatment of resectable gastric cancer surgery.These findings include th...The Japan Clinical Oncology Group has recently conducted large scale clinical trials with findings that have revealed pivotal strategies for the treatment of resectable gastric cancer surgery.These findings include the fact that D3 lymphadenectomy does not improve survival rates when compared to D2 lymphadenectomy,and it is not recommended for resectable gastric cancer.Also,a transhiatal approach is recommended,instead of the left thoraco-abdominal approach,for the treatment of adenocarcinoma of the esophago-gastric junction or gastric cardia which has invaded≤3 cm of the esophagus.Gastrectomy with splenectomy and bursectomy had been recommended as a part of the D2 lymphadenectomy.However,the results of the recent clinical trials revealed that splenectomy should be avoided in total gastrectomy with D2 lymphadenectomy for proximal gastric cancer and that bursectomy should be avoided in gastrectomy with D2 lymphadenectomy for resectable gastric cancer.Both splenectomy and bursec-tomy were found to be unable to improve survival,but instead increased operative morbidity.These trials revealed that the above-mentioned invasive and aggressive procedures did not provide sufficient survival benefits and that gastric cancer surgery may be trending from an“invasive to less invasive”and“aggressive to more conservative”approach.展开更多
AIM: To evaluate the effect of bursectomy on overall survival, recurrence-free survival and safety of patients with gastric cancer by performing a meta-analysis.
Radical gastrectomy with extended lymph node dissec tion and prophylactic resection of the omentum, peri toneum over the posterior lesser sac, pancreas and/o spleen was advocated at the beginning of the 1960 s in Japa...Radical gastrectomy with extended lymph node dissec tion and prophylactic resection of the omentum, peri toneum over the posterior lesser sac, pancreas and/o spleen was advocated at the beginning of the 1960 s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursaomentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.展开更多
BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylacti...BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital.Between January 2010 and December 2020,954 patients underwent elective primary THR by two contemporary arthroplasty surgeons,one excising the bursa and the other not(at the time of THR).All patients received the same post-operative rehabilitation and were followed up for 1 year.We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis.Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not.A total of 5 patients(incidence 0.5%)developed trochanteric bursitis following THR;4 of whom had undergone bursectomy as part of their surgical approach,1 who had not.There was no statistically significant difference between the two groups(Z value 1.00,95%CI:-0.4%to 1.3%,P=0.32).There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR;all of whom were treated with THR and synchronous trochanteric bursectomy,and 7 had resolution of their lateral buttock pains but 1 did not.CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis.However,it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.展开更多
目的:对关节镜下修补外伤性与非外伤性肩袖损伤的患者,回顾性地评价行肩峰成形术或肩峰下滑囊切除对术后临床效果的影响。方法:将复旦大学附属华山医院2016年1月至2020年7月收治并进行关节镜下肩袖修补术的肩袖损伤患者,按有无外伤病史...目的:对关节镜下修补外伤性与非外伤性肩袖损伤的患者,回顾性地评价行肩峰成形术或肩峰下滑囊切除对术后临床效果的影响。方法:将复旦大学附属华山医院2016年1月至2020年7月收治并进行关节镜下肩袖修补术的肩袖损伤患者,按有无外伤病史,分为创伤组或非创伤组。所有患者术中行肩峰成形术或肩峰下滑囊切除术。术后患者定期随访至少12个月。术前、术后记录患者的Constant-Murley、美国肩肘外科协会评分(American shoulder and elbow surgeons'form,ASES)、美国加州大学洛杉矶分校(University of California,Los Angels,UCLA)评分、视觉模拟评分(visual analogue scale,VAS)及肩关节活动度。比较创伤性与非创伤性肩袖损伤,接受肩峰成形术与接受肩峰下滑囊切除术患者的术前、术后临床功能。结果:共114例患者入组本研究(创伤组50例患者、非创伤组64例患者)。创伤组中41例患者(41/50,82.0%)、非创伤组中43例患者(43/64,67.2%)在肩袖修补术中接受了肩峰成形术,其余患者行肩峰下滑囊切除术。在术后12个月,创伤组及非创伤组患者的Constant-Murley评分、ASES评分、VAS评分及肩关节活动度均较术前明显改善。对于创伤组,接受肩峰成形术患者的术后功能、活动度与接受肩峰下滑囊切除患者无明显差异。然而对于非创伤组,接受肩峰成形术患者较肩峰下滑囊切除患者在Constant-Murley评分(83.6分vs.81.6分,P=0.03)、ASES评分(89.0分vs.80.1分,P<0.01)、UCLA评分(31.1分vs.29.2分,P=0.03)、VAS疼痛评分(1.2分vs.2.1分,P<0.01),外展角度(160.0°vs.151.7°,P=0.03)及外旋角度(60.1°vs.53.3°,P=0.03)均显著改善。结论:关节镜下修补非外伤性肩袖损伤术中,进行肩峰成形术较肩峰下滑囊切除术可达到更好的关节功能及活动度。展开更多
文摘The Japan Clinical Oncology Group has recently conducted large scale clinical trials with findings that have revealed pivotal strategies for the treatment of resectable gastric cancer surgery.These findings include the fact that D3 lymphadenectomy does not improve survival rates when compared to D2 lymphadenectomy,and it is not recommended for resectable gastric cancer.Also,a transhiatal approach is recommended,instead of the left thoraco-abdominal approach,for the treatment of adenocarcinoma of the esophago-gastric junction or gastric cardia which has invaded≤3 cm of the esophagus.Gastrectomy with splenectomy and bursectomy had been recommended as a part of the D2 lymphadenectomy.However,the results of the recent clinical trials revealed that splenectomy should be avoided in total gastrectomy with D2 lymphadenectomy for proximal gastric cancer and that bursectomy should be avoided in gastrectomy with D2 lymphadenectomy for resectable gastric cancer.Both splenectomy and bursec-tomy were found to be unable to improve survival,but instead increased operative morbidity.These trials revealed that the above-mentioned invasive and aggressive procedures did not provide sufficient survival benefits and that gastric cancer surgery may be trending from an“invasive to less invasive”and“aggressive to more conservative”approach.
基金Supported by Special Scientific Research Program of the National Health and Family Planning Commission of China,No.20130206
文摘AIM: To evaluate the effect of bursectomy on overall survival, recurrence-free survival and safety of patients with gastric cancer by performing a meta-analysis.
文摘Radical gastrectomy with extended lymph node dissec tion and prophylactic resection of the omentum, peri toneum over the posterior lesser sac, pancreas and/o spleen was advocated at the beginning of the 1960 s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursaomentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.
文摘BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital.Between January 2010 and December 2020,954 patients underwent elective primary THR by two contemporary arthroplasty surgeons,one excising the bursa and the other not(at the time of THR).All patients received the same post-operative rehabilitation and were followed up for 1 year.We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis.Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not.A total of 5 patients(incidence 0.5%)developed trochanteric bursitis following THR;4 of whom had undergone bursectomy as part of their surgical approach,1 who had not.There was no statistically significant difference between the two groups(Z value 1.00,95%CI:-0.4%to 1.3%,P=0.32).There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR;all of whom were treated with THR and synchronous trochanteric bursectomy,and 7 had resolution of their lateral buttock pains but 1 did not.CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis.However,it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.
文摘目的:对关节镜下修补外伤性与非外伤性肩袖损伤的患者,回顾性地评价行肩峰成形术或肩峰下滑囊切除对术后临床效果的影响。方法:将复旦大学附属华山医院2016年1月至2020年7月收治并进行关节镜下肩袖修补术的肩袖损伤患者,按有无外伤病史,分为创伤组或非创伤组。所有患者术中行肩峰成形术或肩峰下滑囊切除术。术后患者定期随访至少12个月。术前、术后记录患者的Constant-Murley、美国肩肘外科协会评分(American shoulder and elbow surgeons'form,ASES)、美国加州大学洛杉矶分校(University of California,Los Angels,UCLA)评分、视觉模拟评分(visual analogue scale,VAS)及肩关节活动度。比较创伤性与非创伤性肩袖损伤,接受肩峰成形术与接受肩峰下滑囊切除术患者的术前、术后临床功能。结果:共114例患者入组本研究(创伤组50例患者、非创伤组64例患者)。创伤组中41例患者(41/50,82.0%)、非创伤组中43例患者(43/64,67.2%)在肩袖修补术中接受了肩峰成形术,其余患者行肩峰下滑囊切除术。在术后12个月,创伤组及非创伤组患者的Constant-Murley评分、ASES评分、VAS评分及肩关节活动度均较术前明显改善。对于创伤组,接受肩峰成形术患者的术后功能、活动度与接受肩峰下滑囊切除患者无明显差异。然而对于非创伤组,接受肩峰成形术患者较肩峰下滑囊切除患者在Constant-Murley评分(83.6分vs.81.6分,P=0.03)、ASES评分(89.0分vs.80.1分,P<0.01)、UCLA评分(31.1分vs.29.2分,P=0.03)、VAS疼痛评分(1.2分vs.2.1分,P<0.01),外展角度(160.0°vs.151.7°,P=0.03)及外旋角度(60.1°vs.53.3°,P=0.03)均显著改善。结论:关节镜下修补非外伤性肩袖损伤术中,进行肩峰成形术较肩峰下滑囊切除术可达到更好的关节功能及活动度。
