Objective: To compare the short-term efficacy of the delta-shaped anastomosis and Billroth I anastomosis in laparoscopic radical distal gastrectomy. Methods: The records of 37 patients with early-stage gastric cancer undergoing laparosicopic radical distal gastrectomy in PLA General Hospital between 2009 and 2013 were selected. Of the patients, 14 cases received delta-shaped anastomosis (delta-shaped anastomosis group) and 23 cases were subjected to Billroth I anastomosis (Billroth I anastomosis group), and the relevant intraoperative and postoperative parameters between the two groups were compared. Results: In delta-shaped anastomosis group compared with Billroth I anastomosis group, the operative time was prolonged, but the intraoperative blood loss was reduced, duration of the analgesic pump therapy, and time to first flatus and suture removal were all shortened, and all the differences had statistical significance (all P<0.05); there was no statistical difference in length of hospital stay between the two groups (P>0.05). Postoperative pathology showed that the distance of the proximal and distal surgical margins from the tumor in delta-shaped anastomosis group was significantly longer than those in Billroth I anastomosis group (both P<0.05). No statistical difference was noted in incidence of postoperative complications and adverse reactions between the two groups (P>0.05). Conclusion: The delta-shaped anastomosis can, to a certain degree, reduce the trauma and pain in patients undergoing laparoscopic radical distal gastrectomy, decrease the operative difficulty of laparoscopic surgery and the risk of infection, and promote the recovery of gastrointestinal function of the patients.

Objective: To investigate the relations of the change in body mass index (BMI) with the nutrition status and prognosis in elderly patients with gastric cancer. Methods: One-hundred and sixteen elderly patients (≥65 years of age) with gastric cancer were included. The BMI variation of the patients during the past one year before admission was calculated, their prognostic nutritional index (PNI) was calculated from the albumin value and total lymphocyte count, and then the association between BMI variation and PNI was analyzed using Pearson correlation analysis. The relations of BMI variation with the prognosis of the patients was evaluated through the ROC curve estimation, survival analysis and Cox regression model. Results: In these 116 elderly gastric cancer patients, the mean variation (reduction) value of BMI was (2.67± 2.11) kg/m2 and PNI was 44.18±9.31, and there was a significantly negative correlation between them (r=–0.87, P=0.003). The sensitivity and specificity of variation value of BMI for death prediction was 72.73% and 73.34% respectively, with a cutoff value of 3.36 kg/m2. The patients were divided into high BMI variation value group (value of BMI reduction≥3.36 kg/m2) and low BMI variation value group (value of BMI reduction<3.36 kg/m2) according to the cutoff value. The results from comparison between the two groups showed that variables that included PNI, degree of differentiation, tumor size, depth of invasion, lymph node metastasis, TNM stage, and degree of radical resection between two groups had statistical difference (all P<0.05); the survival rate in high BMI variation value group was significantly lower than that in low BMI variation value group (P<0.05); variation value of BMI was independent factor affecting the prognosis of elderly gastric cancer patients (HR=1.72, 95% CI=1.31–2.26, P=0.002). Conclusion: BMI variation can well reflect the inflammation-nutritional status of the elderly gastric cancer patients, and those with significant BMI reduction may face a poor prognosis.

Objective: To investigate the efficacy of different nutritional support regimens used during hyperthermic intraperitoneal chemoperfusion (HIPEC) for patients with advanced gastric cancer and malignant ascites. Methods: Forty eligible patients were randomly designated to parenteral nutrition group (PN group) and parenteral nutrition plus enteral nutrition group (PN+EN group), with 20 cases in each group. Patients in PN group underwent HIPEC with simultaneous PN support and those in PN+EN group underwent HIPEC with simultaneous PN+EN support. The alterations in nutritional and immunological parameters before and after treatment, incidence of adverse reactions, time to gastrointestinal function recovery, length of hospital stay and treatment-related costs between the two groups were compared. Results: The nutritional and immunological parameters showed no significant difference between the two groups before treatment (all P>0.05). In both groups, the nutritional and immunological parameters were decreased at 4 and 7 d after treatment compared with the values before treatment, some of which showed a recovery trend in 7 d. The alteration levels in each nutritional parameter showed no obvious difference between the two groups (all P>0.05), but the recovery levels in all immunological parameters at 7 d after treatment in PN+EN group were significantly better than those in PN group (all P<0.05). Further, the time to bowel function recovery and length of hospital stay were shortened, and the treatment-related cost was reduced in PN+EN group compared with PN group (all P<0.05). No statistical difference was observed in incidence of adverse reactions between the two groups (P>0.05). Conclusion: During HIPEC for patients with advanced gastric cancer and malignant ascites, the PN plus EN support can help improve the immune function and promote the gastrointestinal recovery of the patients, and save medical cost.

Objective: To assess the clinical value of transanal drainage in treatment of anastomotic leakage after anus-preserving resection for mid/lower rectal cancer. Methods: The clinical data of 21 patients developing anastomotic leakage after anus-preserving resection for mid/lower rectal cancer from January 2010 to October 2013 were retrospectively analyzed. Of the patients, 9 cases received transanal drainage (observational group), and 12 cases underwent abdominal drainage tube irrigation only (control group), and the associated clinical parameters were compared between the two groups. Results: All patients in the two groups recovered and were discharged from the hospital. None of the patients in observational group required a colostomy, but 2 cases in control group underwent colostomy attributed to conservative treatment failure, however, the difference did not reach a statistical significance (P=0.122). The difference in total length of hospital stay between the two groups had no statistical significance (P=0.061), but the length of post-fistula hospital stay and hospitalization cost in observational group were lower than those in control group, and the differences had statistical significance (P=0.012, P=0.031). Follow-up was conducted for 2 months to 3 years, and no statistical difference was noted between the two groups in incidence of postoperative symptoms such as constipation, diarrhea, anal discomfort (P=0.066). Conclusion: Transanal drainage can be used as an important method for treatment of anastomotic leakage after anus-preserving resection for mid/lower rectal cancer, which has the advantages of shortening the length of post-fistula hospital stay, reducing hospitalization cost, and high patients’ acceptance.