Objective
To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision.
Methods
A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups.
Results
The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008).
Conclusion
Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer.
MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared.
ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups.
ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.
Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
ObjectiveTo investigate the relationship between metastatic lymph node ratio (MLNR) and prognosis of patients after radical resection of distal gastric cancer.MethodsWe retrospectively analyzed the clinicopathological data of 408 patients undergoing radical resection of distal gastric cancer (D2 or D2+ lymph node dissection) in Department of Gastrointestinal Surgery in the Affiliated Hospital of Southwest Medical University, from January 2010 to January 2014. Then we explored the influence of MLNR on the prognosis after radical resection of distal gastric cancer.ResultsWithout distinguishing pTNM staging, the overall survival situation of patient with MLNR≥0.15 and patient with MLNR<0.15 was statistically significant (χ2=3.775, P=0.046); when patients with staging of pTNM Ⅰ, there was no statistically significant MLNR could be calculated; when patients with staging of pTNM Ⅱ, the overall survival situation of patient with MLNR≥0.14 and patient with MLNR<0.14 was statistically significant (χ2=3.110, P=0.029); when patients with staging of pTNM Ⅲ, the overall survival situation of patient with MLNR≥0.10 and patient with MLNR<0.10 was statistically significant (χ2=1.631, P=0.004). Multivariate analysis showed that depth of invasion (pT stage) and MLNR were independent prognostic factors for prognosis of patients after radical resection of distal gastric cancer (P<0.05).ConclusionMLNR is a good prognostic indicator for patients with distal gastric cancer after radical resection.
Objective
To analyze clinical value of early enteral nutrition following radical resection of gastric cancer.
Methods
Seventy-six patients with gastric cancer underwent radical resection from May 1, 2016 to July 1, 2016 in the West China Hospital of Sichuan University were included according to the inclusion criteria and exclusion criteria, then were randomly divided into observation group (36 cases) and control group (40 cases). The patients in the observation group received the enteral nutrition on day 2 following the surgery, in the control group received the conventional management. The gastrointestinal recovery and the adverse reaction were compared in these two groups. The preoperative and postoperative laboratory indicators and the body weight of the patients in both groups were analyzed.
Results
① The general data such as age, gender, and body weight had no significant differences in these two groups (P>0.05). ② The first anus exhaust time and the first defecation time of the observation group were significantly shorter than those of the control group (P<0.05). ③ The adverse reaction rate of the observation group was significantly lower than that of the control group (P<0.05). ④ On admission, the serum albumin, urea nitrogen, creatinine, and lymphocyte count had no significant differences in these two groups (P>0.05). On day 5 after the operation, the serum albumin of the observation group was significantly higher than that of the control group (P<0.05). ⑤ The body weight had no significant difference in these two groups before the operation (P>0.05), which in the observation group was significantly heavier than that of the control group on day 30 after the operation (P<0.05).
Conclusion
Preliminary results of limited cases in this study show that early enteral nutrition following radical resection of gastric cancer is safe and effective, it could promote gastrointestinal function resumption and effectively improve nutritional status.
Objective
To investigate the strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma.
Method
Reviewing the related literatures at home and abroad in recent years, to summarize the progress of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma.
Results
We should clear the postoperative bleeding time, extent, cause, and location, to help the clinician to choose the appropriate timing of intervention and treatment. The patients with early hemorrhage and mild degree hemorrhage could be treated conservatively. If patients with severe hemorrhage and hemodynamic disorders, surgical intervention must be decisive. Patients with late hemorrhage would have serious consequences, and these patients should receive interventional or surgical treatment as early as possible.
Conclusions
For patients with hilar cholangiocarcinoma after radical resection, doctors need to do accurate preoperative evaluation, meticulous operation, and intensive management after operation, to reduce the incidence of hemorrhage after radical resection of hilar cholangiocarcinoma. If the postoperative hemorrhage occurs, the cause, location, time, and degree of hemorrhage should be clearly defined to facilitate clinicians to make rapid clinical decisions and to develop treatment programs.
We reviewed the clinical studies on drug therapy for gallbladder cancer and expounded on the current situation of conversion therapy for gallbladder cancer. Gallbladder cancer was usually diagnosed late, with high malignancy, low surgical resection rate, and poor prognosis. With the development of conversion therapy, systemic therapy combined with radical resection had effectively improved the surgical resection rate and prognosis of gallbladder cancer patients. At present, most of the published conversion therapies for gallbladder cancer were mainly retrospective researches, lacking large multicenter prospective research, and the treatment plan was still based on chemotherapy, lacking the research of targeted therapy in combination with immunotherapy. It is expected that more high-quality clinical trials can be made first-line recommendations for the conversion therapy of gallbladder cancer.
Objective
To understand status of technical realization, present development, faced problems, and application prospects of reduced-port laparoscopic surgery for rectal cancer, and to analyze safety and feasibility so as to provide theoretical and practical basis for clinical application and promotion.
Method
By searching the databases such as Medline, Embase, and Wanfang, etc., the relevant literatures about reduced-port laparoscopic surgery for rectal cancer were collected and reviewed.
Results
At present, the most common reduced-port laparoscopic surgery was the 1-port laparoscopic surgery, 2-port laparoscopic surgery, and 3-port laparoscopic surgery. The 1-port laparoscopic surgery had the effects of minimal invasiveness and cosmesis, but it was difficult to perform. The 2-port laparoscopic surgery for rectal cancer preserved as far as possible the effect of minimal invasiveness, the difficulty of procedure was reduced greatly, which was easy to be learnt and promoted. The experience of the 3-port laparoscopic surgery for rectal cancer contributed to the technical development of the 1-port laparoscopic surgery, with no need for the assisted incision for intraoperative specimen. The reduced-port laparoscopic surgery for rectal cancer was technically feasible and safe, which possessed the equal or better short-term outcomes as compared with the conventional 5-port laparoscopic or open surgery beside the radical resection for rectal cancer. However, the stringent technique for the laparoscopic surgery was necessary and it needed to overcome the learning curve.
Conclusions
Reduced-port laparoscopic surgery has some obvious advantages in minimal invasiveness, cosmesis, and enhanced recovery. More large-sample, multi-center, randomized controlled trials are eager to further confirm safety, effectiveness, and feasibility of reduced-port laparoscopic surgery for rectal cancer.
Esophageal carcinoma is one of the most common malignant tumor, a serious threat to human health. In the early and middle esophageal carcinoma patients, surgery is the only expected treatment to cure esophageal carcinoma. Traditional surgery of esophageal cancer needs thoracotomy and laparotomy, which has great trauma and high incidence of complications. So surgeons are looking for a minimally invasive surgical methods alternative to traditional esophagectomy. Video-mediastinoscopy is used to free middle and upper esophagus, as a minimally invasive surgical method, it is used in radical resection of esophageal cancer gradually. This article reviews the recent progress and the related research results in the application of mediastinoscopy in the radical resection of esophageal cancer. It is found that mediastinoscopy assisted the radical resection of esophageal cancer is a safe and feasible operation. It provides a feasible treatment option for early and middle stage esophageal cancer patients with pulmonary insufficiency who can not be resected by thoracoscopy.
ObjectiveTo evaluate feasibility of laparoscopic radical resection and re-resection for suspicious and incidental gallbladder cancer.MethodsWe searched PubMed and other databases, reviewed relevant literatures and summarized from aspects like whether efficacy comparable to laparotomy and enough lymph node dissection could be achieved through laparoscopy, timing of reoperation for incidental gallbladder cancer.ResultsLaparoscopic radical resection and re-resection were theoretically and technically feasible, but its efficacy and timing of re-resection were controversial, and its long-term efficacy needed further discussions in multi-center and large-scale cohort studies.ConclusionsLaparoscopy shows prospects of resection and re-resection for suspicious and incidental gallbladder cancer. Tentative explorations could be done in properly selected patients by well-experience medical centers and to achieve efficacy comparable to laparotomy is the fundamental principle.
