Objective To evaluate the long-term efficacy of extended and standard surgery for carcinoma of head of pancreas by using meta-analysis. Methods Related articls （1990-2012） were searched in Pubmed， WOS， Embase， WanFang， SinoMed， and CNKI. Study on quality of these literatures were evaluated by using the Jadad score. The patients with pancreatic head carcinoma underwent extended radical resection and standard radical resection were classified to treatment group and control group， respectively. The mortality， morbidity， and survival rates of 1-， 3-， and 5-year after operation in the two groups were evaluated by using meta-analysis. Results A total of 11 studies fitted the selection crit-eria， including 744 patients. Among them 357 cases were in standard radical resection group and 387 cases in the extended radical resection group. The results of meta-analysis showed that： ①The morbidity after operation did not significantly differed between the extended radical resection group and standard radical resection group （OR=1.360， 95% CI=0.990-1.870， P=0.050）. ②The mortality of the two groups did not significantly differed （OR=0.870， 95% CI=0.430-1.760，P=0.700）. ③There were no significant differences in survival rates of 1-， 3-， and 5-year between the two groups （OR=0.880， 95% CI=0.450-1.720， P=0.710；OR=0.940， 95% CI=0.590-1.480，P=0.710；OR=1.000， 95% CI=0.600-1.67， P=1.000）. Conclusion Compared with standard radical resection， extended radical resection can not improve the survival rates of 1-， 3-， and 5-year after operation， and can’t reduce the mortality and morbidity after operation
Objective
To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer.
Methods
Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated.
Results
There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ2=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ2=5.894, P < 0.05;χ2=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05).
Conclusion
For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.
Objective To evaluate the influence of histopathological invasion on the survival prognosis of patients with unilateral retinoblastoma. Methods Seventyseven patients with unilateral retinoblastoma who were treated by primary enucleation were followed up after treatment. The patients were followed up for a median period of 49 months (range from 1 week to 89 months). The survival data were collected by follow-up appointment, telephone or letter. The Kaplan-Meier method was used to calculate the cumulative survival rate and curve comparison was done with the log-rank test including the degree of the optic nerve invasion, choroidal invasion, choroidal invasion with or without optic nerve invasion, as well as the anterior segment involvement or not. Results The two years survival rate was 88.31%. The survival rate of the group with tumor involvement in the cut end of optic nerve was 16.67%, and significantly lower than other groups with optic nerve involvement (chi;2=19.51, 18.42, 18.42, 14.39; P=0.000 0).The survival rate of the group with massive choroidal invasion and scleral involvement was 60.00% and significantly lower than the group without choroidal involvement (chi;2=7.69，P=0.005 5). The survival rate of the group with optic nerve involvement and massive choroidal invasion was 75.00%, and the survival rate of the group with optic nerve involvement and scleral or orbital invasion was 60.00%. The survival rate of those two groups were significantly lower respectively than the group only with optic nerve invasion（chi;2=4.25, P=0.039 3;chi;2=7.59, P=0.005 9）.There was no significant difference of survival rate between groups with or without anterior segments involvement (chi;2=0.05，P=0.823 5).Conclusions The risk factors for RB death include the surgical marginal involvement of optic nerve, massive choroidal invasion combined with optic nerve and scleral involvement. The anterior segment involvement has no effect on prognosis of patients with unilateral retinoblastoma.
Objective To evaluate the safety，efficacy，short- and long-term clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for non-small cell lung cancer （NSCLC）. Methods Clinical data of231 consecutive patients with NSCLC who underwent complete VATS lobectomy in the First Affiliated Hospital of NanjingMedical University between June 2006 and March 2011 were retrospective analyzed. There were 132 male and 99 femalepatients with their age of 15-81 （59.51±11.90） years. Preoperative cancer staging wasⅠa in 149 patients，Ⅰb in 50 patients，Ⅱa in 14 patients，Ⅱb in 13 patients and Ⅲa in 5 patients. There were 152 patients with adenocarcinoma，41 patients with squamous carcinoma，23 patients with bronchioalveolar carcinoma，5 patients with adenosquamous carcinoma，4 patients with large cell carcinoma，and 6 patients with other carcinoma. Follow-up data were statistically analyzed，and short-and long-term survival rates were calculated. Results No perioperative mortality was observed. Operation time was 60-370（199.14±51.04） minutes，and intraoperative blood loss was 10-2 300 （168.19±176.39） ml. Thirty-seven patients had postoperative complications including air leak，pulmonary infection，atelectasis，arrhythmia，subcutaneous emphysema andothers，who were all cured after conservative treatment. Mean number of dissected lymph nodes was 11.14±5.49，and meannumber of explored nodal stations was 3.66±1.52. There were 51 patients （22.08%） whose postoperative cancer staging wasmore advanced than preoperative cancer staging. Postoperative hospital stay was 3-36 （10.79±5.13） days. Primary causesof prolonged postoperative hospitalization included pulmonary air leak，pulmonary infection，preoperative concomitant chronic pulmonary diseases （COPD，asthma），and moderate to severe pulmonary dysfunction. A total of 228 patients werefollowed up for a mean duration of 40.83 months （22-82 months），and 3 patients were lost during follow-up. Overall 5-yearsurvival rates were 85.78%，52.54% and 32.70% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. Five-year cancerfreesurvival rates were 80.00%，45.37% and 20.99% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. ConclusionThe advantages of VATS lobectomy include smaller surgical incision，less injury and postoperative pain，quicker postoperative recovery and shorter hospital stay. Long-term survival rate is comparable to previous international and Chinese studies. VATS lobectomy can anatomically achieve complete tumor resection and systematic lymph node dissection. VATS lobectomy will become a standard surgical procedure for NSCLC patients.
ObjectiveTo review the current situation of total knee arthroplasty (TKA) used in young patients with osteoarthritis.
MethodsThe recent literature in the treatment of osteoarthritis with TKA in young patients was extensively reviewed. The characteristics, curative effect, and postoperative satisfaction degree of TKA in young patients were analyzed and summarized.
ResultsYoung patients have longer life expectancy and higher activity, which may lead to much higher expectation of the TKA. Comparing with elderly patients, young patients obtain equal or better effectiveness after TKA, but they are likely to not be satisfied with the effects because of low survival rate of the prosthesis. At present, continuous development of implant design, prosthesis material, and operation technique are in progress to reduce wear, hence to prolong the implant survivorship so as to meet the desire of young patients. However, the studies of the big samples and long-term follow-up are required to confirm the clinical advantages of such developments.
ConclusionWith the trend of TKA in young patients, surgeons should have a good understanding of the patients' demands, select suitable prosthesis and give appropriate preoperative counseling to build up an objective expectation of curative effect, which will lead to a better doctor-patient relationship.
Objective
To study the effect of platelet-rich plasma (PRP) on the survival and quality of fat grafts in the nude mice so as to provide a method and the experimental basis for clinical practice.
Methods
Fat tissue was harvested from the lateral thigh of a 25-year-old healthy woman and the fat was purified by using saline. The venous blood was taken from the same donor. PRP was prepared by centrifugation (200 × g for 10 minutes twice) and activated by 10% calcium chloride (10 : 1). Then 24 female nude mice [weighing (20 ± 3) g, 5-week-old] were allocated randomly to the experimental group and the control group (12 mice per group). Each subcutaneous layer of two sides of the back (experimental group) was infiltrated with 0.8 mL fat tissue-activated PRP mixtures (10 : 2); the control group was infiltrated with 0.8 mL fat tissue-saline mixtures (10 : 2); 0.14 mL activated PRP and 0.14 mL saline were injected into the experimental group and the control group respectively at 5 and 10 days after the first operation. At 15, 30, 90, and 180 days after the first operation, the samples were harvested for gross and histological observations.
Results
All nude mice survived to the end of the experiment. No inflammation and abscess formation of the graft were observed. Experimental group was better than control group in angiogenesis, liquefaction, and necrosis. The grafted fat weight and volume in the experimental group were significantly larger than those in the control group at 15, 30, and 90 days (P lt; 0.05); but there was no significant difference between the 2 groups at 180 days (P gt; 0.05). Histological observation showed good morphological and well-distributed adipocytes, increasing vacuoles, few necrosis and calcification in the experimental group; but disordered distribution, obvious necrosis, and calcification in the control group. The necrosis area ratio of the experimental group was significantly lower than that of the control group (P lt; 0.05), and the number of micro-vessels was significantly higher in the experimental group than in the control group at 15 and 180 days (P lt; 0.05).
Conclusion
The method of repeatedly using the PRP within 180 days in assisting fat grafts can obviously improve the survival and quality.
Abstract： Objective To investigate prognosis factors of primary small cell carcinoma of the esophagus （PSCCE）, and to optimize the treatment strategy of PSCCE. Method We retrospectively analyzed clinical data of 15 patients （13 males and 2 females with an age of 57.7±2.3 years） with middle thoracic PSCCE in West China Hospital from June 2005 to February 2010. We searched ISI and MEDLINE from April 2001 to February 2010 to extract clinical data of 139 PSCCE patients with 94 males and 45 females with an age of 63.3±10.7 years. We analyzed prognosis factors of the 139 patients including gender, age, tumor location, pathological type, lesions stage and treatment strategy by Kaplan-Meier. Difference in survival curves between limited disease patients and extended disease patients was tested by log-rank test. Results Among the 15 patients, 14 patients had limited disease, and 1 patient had extended disease. Their data were not included in survival analysis because the follow-up was incomplete. Among the 139 patients, 88 patients had limited disease with their 2-year survival rate of 31.8% （28/88）. Fifty-one patients had extended disease with their 2-year survival rate of 7.8% （4/51）. The 2-year survival rate between limited-disease patients and extended-disease patients was statistically different（P＜0.05）. Radiation therapy in combination with chemotherapy had significant influence on the survival rate of patients with either local lesions or advanced lesions（P＜ 0.05）, while other factors such as gender, age and tumor location had no significant influence on their survival rate（P＞0.05）. Conclusion Chemotherapy is the fundamental treatment of PSCCE, which plays an important role in reducing PSCCE preoperative staging and restraining PSCCE postoperative recurrence and metastasis. Surgery and radiation therapy are effective for patients with local lesions. Local treatment in combination with chemotherapy is effective for patients with limited disease. Radiation therapy in combination with chemotherapy is the standard therapy for patients with extended lesions,
Abstract： Objective To evaluate the clinical significance of bilateral supraclavicular lymph node dissection after esophagectomy for patients with intrathoracic esophageal carcinoma. Methods A total of 197 patients with esophageal carcinoma but no obvious supraclavicular lymph node metastasis who underwent esophagectomy in Zhongshan Hospital of Xiamen University from March 1997 to September 2004 were included in this study. All the patients were divided into 2 groups， the control group and the study group. In the control group (non-supraclavicular lymphadenectomy group)， there were 96 patients including 62 males and 34 females with their age of 40-69 （55.2±3.1） years， who received 2-field lymphadenectomy (intrathoracic lymphatic drainage area and left paracardial lymph nodes) without supraclavicular lymph node dissection. In the study group (supraclavicular lymphadenectomy group)， there were 101 patients including 68 males and 33 females with their age of 41-68 （53.8±4.5） years， who received 3-field lymphadenectomy including intrathoracic lymphatic drainage area， left paracardial lymph nodes and bilateral supraclavicular lymph node dissection. Postoperative survival rate， lymph node metastasis rate， anastomotic site recurrence rate， and long-term supraclavicular lymph node metastasis rate were compared between the 2 groups. Results The overall 5-year survival rate of all the patients was 39.59% （78/197）. There was no statistical difference in 5-year survival rate between the 2 groups ［37.50％ （36/96） vs. 41.58％（42/101）， P＞0.05］. However， the 5-year survival rate of the patients with esophageal carcinoma in the upper third of the esophagus in the study group was significantly higher than that of the control group ［38.10％（8/21） vs. 29.17％ （7/24）， P＜0.05］. The intrathoracic lymph node metastasis rate （14.58% vs. 12.87%）， abdominal lymph node metastasis rate （6.25% vs. 7.92%）and anastomotic site recurrence rate （5.20% vs. 5.94%）of the control group and study group were not statistically different （P＞0.05）. However， long-term supraclavicular lymph node metastasis rate of the study group was significantly lower than that of the control group （2.97％ vs. 8.33％， P＜0.05） Conclusion Bilateral supraclavicular node dissection can significantly increase postoperative survival rate and decrease long-term supraclavicular lymph node metastasis rate of patients with esophageal carcinoma in the upper third of the esophagus.
Objective The survival data of patients with colon cancer who were treated by laparoscopic-assisted surgery and open surgery three years after operation were analyzed and contrasted, which provided data to support the future treatment. Methods The 217 patients who were cured by laparoscopic-assisted surgery and 193 patients who were cured by open surgery were followed up, and the rates of local recurrence, metastasis, implantative, and survival were contrasted and analyzed. Results Three years after laparoscopic-assisted surgery and open surgery, the disease-free survival rate was 86.2% （187/217） and 85.5% （165/193）, respectively, and the overall survival rate was 91.2% （198/217） and 92.7% （179/193）, respectively, the difference between the two groups was not statistic significance（P＞0.05）. The differences of the rates of local recurrence, metastasis, and implantative between the two groups were not statistic significance（P＞0.05）. Conclusions Laparoscopic-assisted surgery is similar with open surgery in the rates of local recurrence, forward metastasis, and overall survival. So laparoscopic-assisted surgery is a safe and radical curative surgery.
Objective
To compare the clinical effect of continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) in the treatment of severe acute renal failure (ARF).
Methods
A hundred patients with severe ARF treated between May 2011 and December 2014 were chosen to be the study subjects. According to the order of admission, they were divided into control group and observation group with 50 patients in each. Patients of the control group underwent IHD, while those in the observation group underwent CRRT. Serum creatinine (Scr), blood urea nitrogen (BUN), endogenous creatinine clearance rate (Ccr), treatment effective rate and survival rate were compared between the two groups before and after the treatment.
Results
Scr, BUN and Ccr were all improved after treatment in both the two groups. However, Scr, BUN and Ccr in the observation group [(225.1±162.7) μmol/L, (14.2±9.3) mmol/L, (23.4±10.5) mL/min] were significantly better than those in the control group [(588.4±183.6) μmol/L, (29.1±10.4) mmol/L, (15.9±8.2) mL/min]. The treatment effective rate and patients’ survival rate in the observation group were respectively 60% and 70%, both significantly higher than those in the control group (40% and 52%) All the differences were significant (P<0.05).
Conclusion
CRRT is superior in the treatment of severe ARF with a higher survival rate of the patients, which is worthy of clinical promotion.
