Abstract:

Objective: To study the relationship of different histological types and degrees of infiltration of gastric adenocarcinoma on lymph node metastasis.
Methods: The clinical data of 1 615 cases of gastric adenocarcinoma were analyzed retrospectively, and the rate and number of lymph node metastasis in different histological types and with different depths of invasion were statistically analyzed.
Results: There were 46 227 lymph nodes collected from 1 615 cases, with an average of 28.62 per case. Lymph node metastasis was found in 1 046(64.77%) cases of gastric cancer and 10 173(22.01%) lymph nodes. Different TNM stages showed different rates of metastasis: T1（M）2.78%, T1（SM）13.61%, T2 55.59%, and T3 84.84% respectively, while the metastatic rate for histolgically welldifferentiated carcinoma was 50.25%, and for lowdifferentiated earcinoma was 78.95%, and both had statistically significant difference(P＜0.001).
Conclusions: Metastasis of gastric adenocarcinoma has close relationship with different histological types,and as the depth of infiltrationis increased, the number and chances of lymph node metastasis are increased.

Abstract:

Objective: To explore a method for predicting peritoneal metastasis in gastric carcinoma patients.
Methods: Peritoneal washings and clinical data of 50 patients with gastric carcinoma and 10 patients with benign gastric diseases were collected. The CEA of peritoneal washings was detected by flow cytometry, the peritoneal lavage cytology(PLC) was examined by HE stain, and the clinical significance of the abovementioned data was analyzed.
Results: The positive rate of CEA in peritoneal washings of gastric carcinoma group was 54.0%(27 cases), the positive rate of CEA was significantly higher than the PLC detection rate (24%, 12 cases). The positive rate of CEA increased with the depth of tumor invasion，TNM staging and degree of peritoneum involvement increased.
Conclusions: Detection of CEA and other markers in peritoneal washings by flow cytometry can  be used to predict peritoneal metastasis of gastric carcinoma.

Abstract:

Objective: To determine the optimal cutoff value of  carcinoembryonic antigen (CEA) mRNA level for detection of  free cancer cells (FCC)  in peritoneal washes with realtime PCR and its clinical significance.
Methods: The CEA mRNA levels in peritoneal washes from 65 cases of gastric cancer were detected by realtime RTPCR. After 5year followup, cutoff value of CEA mRNA level was obtained with the ROC curve analysis and the relationship between FCC and prognosis with KaplanMeier method was studied.
Results: (1)With the ROC curve analysis, if the cutoff value of CEA mRNA level was31.21,the Youden’s index was the  highest.(2)The mean survival time (months) in group of FCC(+),(-)was 17.2 and  48.7 months respectively, The median survival was 8.1 and 60.0 months, respectively, with significant difference (P= 0.000).The 5year survival rate was  9.1% and67.4%，respectively. Compared with FCC(+) group, the FCC(-) group had significantly extended life span. COX regression showed that FCC was an independent prognostic factor.
Conclusions: (1) Our results suggest that the best cutoff value of CEA mRNA levels for detection of FCC in peritoneal washes is 31.2 copies/mL; (2) This study shows that FCC is an independent factor that affects prognosis. FCC(+) denotes the presence of intraoperative tumor dissemination and predicts a poor prognosis.

Abstract:

Objective: To evaluate the clinical value between peritoneal lavage cytology (PLC) and prognosis of gastric cancer.
Methods: The peritoneal lavage fluid of 60 gastric cancer patients and 12 noncancer patients were collected, different methods were used to examine the exfoliated cancer cells, and relationships between positive results and relative clinicopathological parameters were evaluated.
Results: The positive rate of PLC was 31.8%, and was positively correlated with the degree of histologic differentiation of gastric cancer (P＜0.05), depth of invasion (P＜0.01), stage of TNM (P＜0.05), and lymph node metastasis (P＜0.05),but was not related to size of tumor (P>0.05). The postoperative oneyear recurrence and survival rates of the positive and negative groups were significantly different(P＜0.05 and P＜0.01).
Conclusions: PLC could act as a standard for judging the invasive and metastatic state of cases of gastric cancer and predicting prognosis.

Abstract:

Objective: To study the clinicopathological features and treatment modality of patients with gastric remnant cancer after distal gastrectomy.
Methods: The data of 25 patients with gastric remnant cancer undergoing surgery during the recent 9 years were analyzed retrospectively.
Results: Patients with gastric remnant cancer showed a greater male predominance(5〖JP20〗∶1). The mean interval between previous gastrectomy and diagnosis of gastric remnant cancer was 24.5 years, ranging from 12 to 35 years.The primary operation was Billroth II reconstruction in 80% of the cases. R0 resection for gastric remnant cancer was performed in 14 cases, Palliative resection in 11 cases, and adjuvant chemotherapy in 18 cases. The 1, 3and 5year overall survival rate was 72.0%, 56.0% and 36.0%, respectively, while the respective survival rate was 78.5%, 71.4%, and 50.0% in radical surgery group, and 63.6%, 36.3% and 18.1% in palliative surgery group（P<0.05）. Overall 5year survival rate of patients in simple surgical therapy group and surgery combined with chemotherapy group was 44.4% and 14.5% (P<0.05), respectively.
Conclusions: An aggressive surgical approach plus chemotherapy is important to achieve better outcomes for patients with gastric remnant cancer.

Abstract:

Objective: To evaluate the effects of paclitaxel liposome and 5fluorouracil(5FU), cisplatin(CDDP) as preoperative regional intraarterial infusion chemotherapy in advanced gastric cancer(AGC).
Methods: Eightyfour patients with clinical stagesⅡ-Ⅳgastric carcinoma were submitted to preoperative regionalarterial infusion chemotherapy. The regimen consisting of paclitaxel liposome 135 mg/m,cisplatin 60 mg/m and 5FU 1 000 mg/m,was administrated 7-10days before operation. Another 78 patients with similar GC staging, treated during the same period, underwent routine surgery directly. The response of the primary tumor to neoadjuvant chemotherapy and chemotherapy toxicity, and differences in outcome were observed of the 2 groups.
Results: Among the 78 patients undergoing surgery directly, 48 cases(61.5%)had curative resection,and the 1 year survival rate was 74.3%. All 84 patients of the neoadjuvant chemotherapy group completed the planned regimen of chemotherapy and surgery successfully. The most common related adverse effects In neoadjurant group were grade 1-2 gastrointestinal reactions and bone marrow depression.in neoadjurant group, 66 cases(78.5%) underwent curative  resection, and the 1 year survival rate was 80.9%, but, compared to comtrol group, there was no significant difference in survival rate (P=0.283).
Conclusions: Neoadjuvant intraarterial infusion chemotherapy(5fluorouracil, paclitaxel liposome and cisplatin) has been wellrated; it appears to improve the resectable rate of the AGC patients. However, the shortterm outcome of the 2 groups was not significantly different, which may be related to the small number of cases and limited followup period,and this needs continued further investigation.

Abstract:

Objective: To study the outcome of surgical therapy of perforation of gastric cancer.
Methods: The clinical data of 37 cases with perforation of gastric carcinoma  which  underwent different surgical procedures were analyzed retrospectively. Among them, 24 cases underwent partial gastrectomy,8 cases underwent radical mastectomy,4 cases had repair of perforation. 1 case received nonoperative therapy.
Results: The preoperative diagnotic rate was 24.3%,and misdiagonsis rate was 75.7%. The perioperative mortality rate was 5.4%, including 1 case that underwent repair of perforation. The postoperative  complication rate of patients undergoing palliative gastrectomy, radical gastric cancer operation and repair of perforation was  41.7%, 25.0% and 75.0%, respectively,and the mean survival time was 25 months, 29 months and 3.0 months, respectively.The partial gastrectomy and radical mastectomy patients had significantly better outcomes than those who underwent repair of perforation or received nonoperative therapy.
Conclusions:   For patients with perforation of gastric cancer with resectable lesions and who are in good general coaditon, a onestage radical gastric resection or palliative subtotal gastrectomy can be performed.

Abstract:

Objective: SELDI-TOF-MS technology was used to contrastly analyse the changes of protein expression profiles of gastric cancer cells after TGF-β1 stimulation, and provide theoretical and experimental foundation for screening different significant proteins.
Methods: Serial subcultivation gastric cancer cells BGC823, MKN45, and SGC7901 cultured in vitro  were grouped into test and control groups.TGF-β1 was added to the test group, but  not to control group.Cell culture fluid was collected and centrifuged after cultured 24h, and crossing with WCX2 protein chip to detect protein differences. 
Results: When the test group was compared with control group, we found:(1) thirteen different proteins in BGC823 cells after TGF-β1 stimulaton, and their M/Z were M4294,M4932,M4945,M4972, M4991, M5015, 5036, M5060, M5153, M5180, M5197, M8577, and M8784, respectively; (2) eighteen different proteins in MKN45 cells after TGF-β1 stimulaton,and their M/Z were M4292,M4931,M4945，M4972，M4990, M5014, M5152, M5178, M7055, M8190, M8570, M8652, M8670, M8780, M9963, M10098, M10523, and M11653, respectively; (3) eight difference proteins in SGC7901 cells after TGF-β1 stimulation, and their M/Z were M4945，M4972，M4992，M5015, M5180, M7056, M8573, and M8604, respectively. By comparing three protein expression profiles of gastric cancer cells after TGF-β1 treatment,we found two significcant proteins with common differences,that had M/Z of M4945 and M4972, respectively.
Conclusions: The biological markers whose M/Z is M4945,M4972 with gastric cancer characteristic and associated with TGF-β1 have been screened,which can be as the basis for early prediction and clinical diagnosis research on metastasis and invasiveness of gastric cancer.

Abstract:

Objective: To explore the effect and mechanism of wortmannin  on the human gastric carcinoma cells.
Methods: SGC7901 cells were treated with 10nmol/L,30nmol/L and 60nmol/L of wortmannin,a specific inhibitor of AKT, for different time periods. Cell viability was estimated by MTT assay. Western blot was used to detect the level of NF-κB neucleoprotein and reverse transcriptasepolymerase chain reaction(RT-PCR) was used to determine transcription of NF-κB mRNA.
Results: All three different concentrations of wortmannin could inhibit the growth of SGC7901 cells,and the depression effect obviously depended on time and drug dose(P＜0.01 and P＜0.05).However, the cell viability was no change in the control group(P＞0.05). As the action time of wortmannin was prolonged, neucleoprotein and mRNA expression of NF-κB significantly decreased compared with the control (P＜0.05).
Conclusions: The findings suggest that wortmannin can inhibit the growth of gastric carcinoma SGC7901 cells,and the action may depend on an AKT/NF-κB pathway in gastric carcinoma cells.

Abstract:

Objective: To study molecular biology and clinicopathologic characters of peritoneal metastasis of advanced gastric cancer and their relationship to prognosis.
Methods: Based on the molecular biology and the clinicopathologic characters and prognosis  single-factor analysis of relevant factors and risk assessment was made in  193 cases of gastric cancer.
Results: The younger the patient was with the earlier the time of occurrence of peritoneal metastasis of gastric cancer. There was a high expression of ICAM-1 and MMP-2, but low expression of TIMP-1 and p53 in gastric cancer patients with peritoneal metastasis.
Conclusions: ICAM-1,MMP-2,  TIMP-1 and p53 can well predict the occurrence of metastasis and the prognosis of patients with gastric cancer, and these factors can be used for preoperative assessment of the development of metastasis of gastric cancer.

Abstract:

Objective: To study the mothods in detecting  sentinel lymph node (SLN) and lymph node micrometastasis in patients with colorectal cancer and their clinical significance.
Methods: Sixty patients with colorectal cancer undergoing lymphatic mapping using methylene blue staining (group I) was analysed. The SLN was identified and removed, and the micro-metastases in sentinel lymph node were detected with HE and immunohistochemical staining technique. Other  sixty patients previously treated by direct radical lymphadenectomy were taken as comtrol group(gronp II).
Results: Fifty-four SLN were successfully identifed in group I,with a detection rate of 90.0%, which was higher than that of control group (24/60,40%)(P<0.05); in group I,  thirty-six positive SLN were dectected by HE staining, and six micro-metastases (33.3%) were found in eighteen negative SLN by use of Cytokeratin 20 immuno-histochemical staining.
Conclusions: The success rate achieved by combining methylene blue staining and cytokeratin 20 immunohistochemical staining in detecting SLN and lymph node microstasis is higher than that achieved by using either technique mentioned above alone.

Abstract:

Objective: To explore the value of lymphatic mapping (LM) and sentinel lymph node(SLN) analysis in laparoscopic colectomy for colon carcinoma. 
Methods: Thirty-two patients with clinically localized colonic neoplasms were subjected to submucosal injection of isosulfan blue dye (0.5-1.0 mL) via a colonoscope during operation. Blue-stained lymphatics were visualized through the laparoscope and followed to the SLN, which was tagged. The colectomy was completed in standard fashion. All lymph nodes were stained by hematoxylin and eosin, and multiple sections of each SLN were examined by immunohistochemical (IHC) staining using cytokeratin antibody. 
Results: At least one SLN was identified laparoscopically in all patients. The SLN accurately predicted the tumor status of the nodal basin in 94% of cases. In 8 cases (25%), an unexpected lymphatic drainage pattern altered the extent of mesenteric resection. 〖JP2〗The SLN was negative by HE staining in 4 (13%) cases,  which were demonstrated positive for micrometastases through immunohistochemical staining.
Conclusions: SLN mapping during laparoscopic colon resection can alter the margins of resection and in combination with immunohistochemical staining may improve staging, which may more accurately assign patients to prospective protocols.

Abstract:

Objective: To explore the clinical value of colonoscopy in laparoscopic resection of colorectal neoplasms.
Methods: A total of 28 patients with colorectal neoplasms underwent laparoscopic resection. All patients received colonoscopy for neoplasm localization, and to observe anastmotic leakage and anastmotic bleeding after anastomosis,and any concomitant colorectal polyps were treated by local excision via colonoscopy.
Results: All lesions were successfully oriented and resected. There weve no conversions to open surgery. The mean operation time was 190(120-230)minutes, and the average postoperative hospital stay was 9.5(7-12)days. The intraoperation colonoscopy discovered anastmotic leakage（n=1）,anastmotic bleeding（n=1）and proximal colon adenomatous polyps（n=3）. The main  postoperative complication only occurred in one case of fat liquefaction of abdominal incision; there was no bleeding, leakage or stenosis of anastomosis postoperatively. Postoperative pathological examination revealed no residual tumor or infiltration of tumor cells in resection margin.
Conclusions: Colonoscopy could quickly and accurately determine the extent of neoplasms during  laparoscopic resection of colorectal neoplasms, and fill up a shortcoming in laparoscopic resection.It could decrease exfoliation of tumor cells into abdominal cavity,tumors can be completely and radically removed, the anastomotic sites can be accurately observed, and bleeding or leakage of anastomosis can be effectively prevented and treated. This method is worthy of widespread application.

Abstract:

Objective: To investigate the feasibility of biomedical fibrin glue in laparoscopic treatment of peptic ulcer perforation.
Methods: A total of 126 patients with peptic ulcer perforation were randomly divided into two groups (63 in each group).Biomedical fibrin glue was used in treatment group, and routine treatment was used in control group.The total volume of drainage after operation,rate of intestnial fistula and adhesions, allergy reaction,time of drainage tube removal,and average hospotal stay time were observed in both groups.
Results: There was no allergic reaction in treatment group.Total volume of drainage in treatment group was(65.3±7.5)mL,and (110.2±9.6)mL in control group,with a significant difference between the two groups(P<0.01).Four  fistula occurred in control group and none in treatment group (P<0.05).Time of drainage tube removal was (25.4±3.2)h in treatment group, and (49.4±3.5)h in control group (P<0.01).Average hospital stay time was (4.3±1.2)d in treatment group, and(6.5±1.4)d in control group (P<0.01).
Conclusions: Use of biomedical fibrin glue has a difinite effect on laparoscopic repair of peptic ulcer perforation; it can seal the injured site, promote ulcer healing and prevent gastric or intestinal leakage and intestinal adhesions, There are no allergic reactions associated with its use.

Abstract:

Objective: To observe the clinical effects and complications of laparoscopic Nissen fundoplication (LNF) in treatment of gastroesophageal reflux disease (GERD).
Methods:  From November 2006 to November 2008, 109 consecutive patients with GERD were treated by LNF. The clinical records of these patients were retrospectively analyzed.
Results: All patients, except one case converted to laparotomy because of bleeding from short gastric vessel.  The mean operation time was 〖JP2〗68.1 min (30-245 min); mean intraoperative blood loss was 30.0 mL (5-450 mL); and mean postoperative hospital stay was 4.2 d(2-8 d).Postoperatively, 102 patients were  followed-up for 3 to 27 months, and among them, 99 patients (97.1%) had complete resolution of their digestive symptoms such as regurgitation and heartburn, 2 patients (2.0%) had symptoms markedly relieved, and 1 patient (0.9%) had not improved. Postoperative complications included severe dysphagia in 2 cases, bloating in 1 case，diarrhea in 2 cases and postoperative hiatal hernia in 1 case.
Conclusions:  Laparoscopic Nissen fundoplication is a minimally-invasive, safe and effective procedure in the treatment of gastroesophageal reflux disease.

Abstract:

Objective: To investigate the effects of early application of somatostatin in non-surgical treatment of adhesive intestinal obstruction. Methods: A total of 131 cases of different types of intestinal obstruction due to adhesions were treated in our hospotal during the recent seven years, The 131 patients were divided into treatment group (71 cases, Stilamin treatment) and control group (60 cases, only conventional treatment). Patients in treatment group were give conventional treatment together with stilamin 6mg given by intravenous drip 24 h continuously, average 3.9 (2-6.5）days. The efficacy between the two groups after treatment was compared.
Results: The gastrointestinal decompression fluid from the treatment group was significantly less than that of the control group, ［(227±152) mL/d, (522±186) mL/d,  respectively (P<0.05)］. Abdominal pain, abdominal distension, and passage of flatus were significantly improved in treatment group than that in control group (P<0.05). The two groups had no difference in rate of conversion to operation (P＞0.05).  There was one case of intestinal necrosis in treatment group which was significantly less than 6 cases in control group (P<0.05). KPS scores of the treatment group and  the control group were 57±6 and 44±8, respectively (P<0.05).
Conclusions: Basic conventional therapy plus early intravenous infusion of somatostatin can markedly improve the  clinical symptoms of  various types of intestinal obstruction. Moreover，it can reduce the incidence of intestinal necrosis，but does not reduce the operation rate.