Objective To explore the comprehensive treatment of synchronous double cancers of the esophagus and stomach. Methods The treatment procedures of 8 patients with synchronous double cancers of the esophagus andstomach admitted in the Department of Digestive Tumor Surgery of The Hospital of Traditional Chinese Medicine of Jiangsu Province between Oct. 2006 to Feb. 2013 were analyzed. Some experience of comprehensive treatment of synch-ronous double cancers of the esophagus and stomach was explored. Results Eight cases of synchronous double cancers of the esophagus and stomach were all diagnosed by endoscopic biopsy. According to the results of CT and endoscopic ultrasonography assessment， lesions which were staged earlier than T1a were cured by endoscopic mucosal resection（6 cases， including 4 cases of esophagus cancer and 2 cases of gastric cancer）， and resection operation （1 cases of esop-hagus cancer）. The lesions staged later than T2 were treated by preoperative neoadjuvant chemoradiation， surgery， and adjuvant chemoradiation after operation （8 cases， including 2 cases of esophagus cancer and 6 cases of gastric cancer）， and simple operation （1 case）. Eight patients had been followed-up for 10-76 months （averaged 41.3 months）. Six patients survived without recurrence and metastasis during the followed-up， 1 patient died in 7 months after operation， and 1 patient relapsed in 20 months after operation. Conclusions Individually designed comprehensive treatment using neo-chemotherapy， intervention chemotherapy， radio-chemotherapy， radical resction surgery， adjuvant chemotherapy， and endoscopic mucosal resection can treat synchronous double cancers of the esophagus and stomach effectively. Impr-actical pursuit for radical surgery will not result in good prognosis
Abstract： Objective To investigate the clinical application of tubular stomach in cervical esophageal reconstruction after esophagectomy for esophageal cancer. Methods A total of 850 patients with esophageal cancer who underwent esophagectomy through cervico-thoraco-abdominal（3-field）approach between January 2007 and January 2009 in North Jiangsu Hospital were allocated into the tubular stomach group（group A, n=425） and the whole stomach group （group B, n=425）by operation order. Group A included 287 male and 138 female patients with their average age of 58.2±11.5 years. Among them, 27 patients had upper esophageal cancer, 346 patients had middle esophageal cancer and 52 patients had lower esophageal cancer. Group B included 298 male and 127 female patients with their average age of 58.5±12.8 years. Among them, 33 patients had upper esophageal cancer, 338 patients had middle esophageal cancer, and 54 patients had lower esophageal cancer. Operation time, postoperative length of hospital stay and the incidence of anastomotic leakage, anastomotic stricture, intra-thoracic stomach syndrome and reflux esophagitis of the two groups were compared. Results All the patients recovered uneventfully with no in-hospital death. There was no statistical difference in operation time （175.0±12.8 min vs.171.0±10.5 min，t=1.702，P＞ 0.05）and postoperative length of hospital stay （16.0±8.5 d vs.16.3±8.8 d，t=1.773，P＞ 0.05） between the two groups. During follow-up of six months, the rates of anastomotic leakage（χ2=5.550，P＜ 0.05）, intra-thoracic stomach syndrome （χ2=10.500，P＜ 0.05）and reflux esophagitis（χ2=9.150，P＜ 0.05） of group A were significantly lower than those of group B. There was no significant difference in the incidence of anastomotic stricture （χ2=0.120，P＞ 0.05） between the two groups. Conclusion Tubular stomach is better than whole stomach for cervical esophageal reconstruction after esophagectomy for esophageal cancer since it is more physiologically and anatomically complied. It can decrease the incidence of anastomotic leakage, intra-thoracic stomach syndrome, reflux esophagitis and improve the postoperative quality of life.
ObjectiveTo investigate the effect of stomach intestinal pylorus sparing surgery in metabolic surgery for weight loss.MethodThe literatures about stomach intestinal pylorus sparing surgery were reviewed by searching domestic and foreign literatures.ResultsIn recent years, stomach intestinal pylorus sparing surgery had been gradually applied in clinical practice. Compared with other weight-loss surgeries, it had better clinical effects in weight reduction and blood glucose control. It not only provided a new surgical treatment for patients with severe obesity, but also promoted the development of weight-loss metabolic surgery.ConclusionAs a new metabolic surgery, stomach intestinal pylorus sparing surgery is safe and feasible for weight loss.
ObjectiveTo summarize the experience in the treatment of anastomotic leakage after laparoscopic D2 radical gastrectomy.MethodThe clinicopathologic data of 11 patients with anastomotic leakage after the laparoscopic D2 radical gastrectomy in the Nanchong Central Hospital from May 2016 to January 2018 were analyzed retrospectively.ResultsAmong the 11 patients with anastomotic leakage, 3 were grade Ⅱ leakages and 8 were grade Ⅲa leakages. There were no symptoms in the 3 cases of anastomotic leakage, which were confirmed only by the gastrointestinal radiography and were healed after 7 d of conservative treatment. Among the 8 patients with the clinical symptoms, 5 cases were treated by the endoscopic drainage and negative pressure suction for 60–90 d, 3 cases were treated by the endoscopic covered stent, 2 cases were cured after 30–60 d, and 1 case died of massive bleeding after 45 d.ConclusionsDue to differences of location, time, limitation, and size of anastomotic leakage after laparoscopic D2 radical gastrectomy, individualized treatment should be performed according to specific situation of patients in local treatment. Endoluminal covered stent has certain clinical application value.
Objective
To discuss the clinical manifestations, diagnosis, and treatment of hepatoid adenocarcinoma of the stomach.
Methods
By summarizing the multi-disciplinary team results of 1 patient with hepatoid adenocarcinoma of the stomach, who underwent surgery in West China Hospital in October 2017, as well as reviewing the related literatures, to explore the clinicopathological features of hepatoid adenocarcinoma of the stomach.
Results
The clinical features of hepatoid adenocarcinoma of the stomach were often accompanied by early liver metastasis and alpha fetoprotein (AFP) significantly increased, which were easily misdiagnosed as primary hepatocellular carcinoma. The histopathological features of hepatoid adenocarcinoma of the stomach were characterized by two structures: hepatocellular carcinoma and adenocarcinoma.
Conclusion
Hepatoid adenocarcinoma of the stomach is a special type of gastric adenocarcinoma, and radical operation is the main treatment, but the prognosis of it is poor.
Endoscopic bariatric treatment (EBT) is an effective method for the treatment of obesity. The principle of weight loss is similar to metabolic bariatric surgery. It can be classified as a food restriction (stomach-targeted) and malabsorption (small intestine-targeted). At present, a lot of EBT devices had been cleared by the US Food and Drug Administration to treat obesity, while the EBT in China lagged behind Western countries. Hence, we reviewed the current stomach-targeted EBT, aiming to provide a reference for the supplement of obesity treatment methods and the development of EBT in China.
Objective
To compare short-term quality of life and postoperative complications in esophageal squamous cell carcinoma patients with different routes reconstruction after McKeown esophagectomy.
Methods
The clinical data of 144 patients with esophageal squamous cell carcinoma who received McKeown esophagectomy in Shanghai Chest Hospital from January 2016 to October 2016 were retrospectively reviewed. Among them 93 patients accepted retrosternal approach (a RR group, 71 males and 22 females at an average age of 63.5±7.7 years) and 51 patients accepted posterior mediastinal approach (a PR group, 39 males and 12 females at an average age of 62.3±8.0 years). Short-term surgical outcomes were compared and a Quality of Life Questionnaire of Patients Underwent Esophagectomy 1.0 was performed at postoperative 1st and 3rd month.
Results
There was no difference in two groups in sex, age, Body Mass Index (BMI), and location and clinical stage of tumors (P>0.05). The neoadjuvant therapy was more performed in the RR group (16.1%vs. 5.9%, P=0.075). There were more robot-assisted esophagecctomy operations performed in the PR group (52.9% vs. 45.2%, P=0.020). No significant difference was noted in operation duration, intraoperative blood loss or length of ICU stay between the RR and PR groups (251.3±59.1 min vs. 253.1±27.7 min, P=0.862; 223.7±75.1 ml vs. 240.0±75.1 ml, P=0.276; 3.7±6.6 d vs. 2.3±2.1 d, P=0.139). The patients in the PR group had more lymph nodes dissected and shorter hospital stay (P<0.001). Rate of R1/2 resection was higher in the RR group (12.9%vs. 5.9%, P=0.187). No surgery-related mortality was observed in both groups. The anastomotic leak and the anastomotic stricture was higher in the RR group than that in the PR group (25.8% vs. 5.9%, P=0.003). No significant difference was found between the two groups in the quality of life at postoperative 1st and 3rd month. However, the quality of life at postoperative 3rd month significantly improved in both groups (P<0.001). Compared with the PR group, the dysphagia was more severe in the RR group at postoperative 1st month (3.3±1.5 vs. 2.6±1.1, P=0.007), while the reflux symptom was lighter at postoperative 3rd month (3.0±1.8 vs. 3.6±1.6, P=0.045).
Conclusion
The two different routes reconstruction after McKeown esophagectomy are both safe and feasible. The anterior mediastinal approach increases the risk of anastomotic leak, but with low incidence of reflux symptom.
ObjectiveTo systematically evaluate the efficacy of tubular stomach and whole stomach reconstruction in the treatment of esophageal cancer.MethodsWe searched PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM databases to collect the randomized controlled trial (RCT) studies on the efficacy comparison between tubular stomach and total gastric reconstruction of esophagus in esophagectomy from their date of inception to May 2019. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of Twenty-nine RCTs were included, and 3 012 patients were involved. The results of meta-analysis showed that the postoperative complications such as anastomotic fistula [RR=0.64, 95%CI (0.50, 0.83), P=0.000 6], anastomotic stenosis [RR=0.65, 95%CI (0.50, 0.86), P=0.002], thoracic gastric syndrome [RR=0.19, 95%CI (0.13, 0.27), P<0.001], reflux esophagitis [RR=0.23, 95%CI (0.19, 0.30), P<0.001], gastric emptying disorder [RR=0.39, 95%CI (0.27, 0.57), P<0.001] and pulmonary infection [RR=0.44, 95%CI (0.31, 0.62), P<0.001] were significantly reduced, and the postoperative quality of life score and satisfaction were higher at 6 months and 1 year in the tubular stomach group (P<0.05). In terms of intraoperative blood loss and postoperative hospital stay, they were better in the tubular stomach group than those in the whole stomach group (P<0.05). However, there was no statistically significant difference between the two groups in operation time, postoperative gastrointestinal decompression time, postoperative closed drainage time, postoperative 1-year, 2-year and 3-year survival rate, postoperative quality of life score at 3 weeks and 3 months, and postoperative life satisfaction at 3 weeks.ConclusionThe tubular stomach is more advantageous than the whole stomach in the reconstruction of esophagus after esophagectomy.
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
ObjectiveTo systematically review the complications and quality of life (QoL) in patients with esophageal cancer after esophagectomy using gastric tube.
MethodsRandomized controlled trials (RCTs) about the postoperative complications and QoL of patients using gastric tube and the whole stomach reconstruction were electronically searched in PubMed, EMbase, The Cochrane Library, Web of Knowledge, CBM, CNKI, VIP and WanFang Data from inception to September 30th, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 10 RCTs involving 1 085 patients were included. The results of meta-analysis showed that, in terms of postoperative complications, the incidences of reflux esophagitis (OR=0.19, 95%CI 0.12 to 0.32, P < 0.000 01) and intrathoracic stomach syndrome (OR=0.11, 95%CI 0.04 to 0.32, P < 0.000 1) with gastric tube were significantly lower than those of the whole stomach; in terms of QoL, the scores of QoL in the 6th month (MD=18.71, 95%CI 7.72 to 29.71, P=0.000 9) and in the 12th month (MD=22.95, 95%CI 8.21 to 37.69, P=0.002) with gastric tube were significantly higher than those of the whole stomach. In terms of satisfaction degree of QoL, the satisfaction degree of QoL in the 6th month (OR=1.78, 95%CI 1.10 to 2.88, P=0.02) and the 12th month (OR=2.73, 95%CI 1.67 to 4.47, P < 0.000 1) with gastric tube were both significantly higher than those of the whole stomach.
ConclusionCompared with the whole stomach reconstruction, the method of gastric tube reconstruction has beneficial effects in reducing the incidences of postoperative complications (such as reflux esophagitis, intrathoracic stomach syndrome) and improves patients' QoL. But there are many uncertain factors about postoperative anastomotic complication and its influence on patients' long-term QoL remains uncertain. Thus, further studies should be conducted.
