Older liver grafts from donation after circulatory death are associated with impaired survival and higher incidence of biliary non-anastomotic structure.

BACKGROUND: Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past. But it has seemed to remain controversial in the last decade, as a result of modified clinical protocols, selected recipients, and advanced technology of organ perfusion and preservation. The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death (DCD). METHODS: A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups: using graft from older donor (aged ≥ 65 years, n = 87) and younger donor (age < 65 years, n = 857). Propensity score matching (PSM) was applied to eliminate selection bias. RESULTS: A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68% to 15.44% during the study period. The well-balanced older donor (n = 79) and younger donor (n = 79) were 1:1 matched. There were significantly more episodes of biliary non-anastomotic stricture (NAS) in the older donor group than the younger donor group [15/79 (19.0%) vs. 6/79 (7.6%); P = 0.017]. The difference did not reach statistical significance regarding early allograft dysfunction (EAD) and primary non-function (PNF). Older livers had a trend toward inferior 1-, 2-, 3-year graft and overall survival compared with younger livers, but these differences were not statistically significant (63.1%, 57.6%, 57.6% vs. 76.9%, 70.2%, 67.7%, P = 0.112; 64.4%, 58.6%, 58.6% vs. 76.9%, 72.2%, 72.2%, P = 0.064). The only risk factor for poor survival was ABO incompatible transplant (P = 0.008) in the older donor group. In the subgroup of ABO incompatible cases, it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group [6/8 (75.0%) vs. 3/14 (21.4%); P = 0.014]. CONCLUSIONS: Transplants with grafts from older donors (aged ≥ 65 years) after circulatory death are more frequently associated with inferior outcome compared to those from younger donors. Older grafts from DCD are more likely to develop NAS, especially in ABO incompatible cases.

Correlation between Vascular Endothelial Growth Factor C Expressior and Lymph Node Micrometastasis and Prognosis in Patients with pNO Esophageal Squamous Cell Carcinomas.

BACKGROUND/AIMS: The purpose of this study was to investigate the correlation between vascular endothelial growth factor C expression and lymph node micrometastasis and prognosis in patients with pN0 esophageal squamous cell carcinoma. METHODOLOGY: A total of 528 lymph nodes obtained from the 87 patients with pN0 esophageal squamous cell carcinoma who underwent Ivor-Lewis esophagectomy were reevaluated by reverse transcriptasepolymerase chain reaction to detect mucin 1 mRNA. Vascular endothelial growth factor C mRNA was detected in esophageal cancer issues also by re-evaluated by reverse transcriptasepolymerase chain reaction. RESULTS: Vascular endothelial growth factor C mRNA expression was correlated with tumor invasion (P < 0.01) and lymphatic invasion (P = 0.000). In univariate analysis by log-rank test, the 5-year survival rate in patients after operation was significantly associated with tumor invasion (P = 0.026), mucin 1 mRNA expression (P = 0.000) and vascular endothelial growth factor C mRNA expression (P = 0.020). The results of Cox regression multivariate analysis confirmed that tumor invasion status and mucin 1 mRNA expression were the independent relevant factors. CONCLUSION: Expression of vascular endothelial growth factor C is related to tumor invasion and lymphatic invasion and is not related to lymph node micrometastasis in patients with pN0 esophageal squamous cell carcinoma.

Congruence in symptom assessment between hepatocellular carcinoma patients and their primary family caregivers in China.

OBJECTIVES: The aims of this cross-sectional study were to explore the agreement in symptom evaluation results between patients and their family caregivers and to search for the possible factors influencing the agreement. METHODS: A convenience sample of 280 dyads consisting of hepatocellular carcinoma patients and their family caregivers was included in this study. All of them completed the symptom checklist of Chinese version of the M. D. Anderson symptom inventory and the evaluations of six common symptoms of hepatocellular carcinoma. RESULTS: The levels of agreement ranged from moderate to substantial. A number of factors associated with caregivers (particularly depression state, age, others helping to care for the patient or not, and the relationship with patient) and patients (traditional Chinese medicine treatment, religion, KPS scores, and educational levels) were significantly correlated with levels of disparity on some symptoms. CONCLUSION: The study illustrates that family caregivers of hepatocellular carcinoma patients can provide reasonable reports on patients' symptoms. Healthcare providers need to pay special and sufficient attention to the caregivers' depression.

CCR7: A metastasis and prognosis indicator of postoperative patients with esophageal carcinoma.

BACKGROUND/AIMS: To investigate the expression of CC chemokine receptor 7 (CCR7) and its relationship to the metastasis and prognosis in esophageal squamous cell carcinoma (ESCC) after esophagectomy. METHODOLOGY: CCR7 expression was detected by immunohistochemistry. Kaplan-Meier method was performed to calculate the survival rate, Cox regression multivariate analysis was performed to determine independent prognostic factors. RESULTS: CCR7 expression rate in T1, T2 and T3 patients was 27.3%, 64.7% and 75.2%, respectively, the difference of CCR7 protein expression was statistically significant (p=0.000). The positive expression of CCR7 in patients with lymph node metastasis was significantly higher than those without metastasis (p=0.000). CCR7 expression correlated with significantly worsened 5-year survival for all patients as well as those with T2 and T3 tumors, N0 nodal status or N1 nodal status. The result of Cox analysis demonstrated that N stage, T stage and CCR7 expression were independent prognostic factors. CONCLUSIONS: CCR7 expression was detected in ESCC and was found to be significantly associated with T stage and lymph node metastasis. The 5-year survival rate was significantly lower in patients with CCR7 expression in those without. Invasion, lymph node metastasis and CCR7 expression were independent factors.

A 39-year-old man with dyspnoea, low forced expiratory volume and a large mass of the left hemithorax.

In patients with intrathoracic neoplasms, low forced expiratory volume (FEV1) can preclude surgical treatment. Here, we present a case of a giant solitary fibroma of the pleura (SFTP) successfully treated by surgical removal in spite of low FEV1. A 39-year-old male patient was referred to our hospital with dyspnoea and chest distress. Computed tomography (CT) showed a large mass in the left chest. Spirometry showed FEV1 1.4 L (39% of the expected value). Computed tomography scan-guided transcutaneous aspiration biopsy was performed on the patient, and microscopic examination of the specimen revealed spindle tumor cells with a background of abundant collagen. Complete surgical resection was accomplished. The tumor was large and encapsulated. It measured 28 cm × 20 cm × 18 cm. The definitive diagnosis obtained by histopathology after resection was benign SFTP. The patient felt no dyspnoea at discharge. Surgical treatment of SFTP should be considered even in patients with a huge tumor and with increased post-operative risk.

Curative effect comparison between Ivor-Lewis esophagectomy and left transthoracic esophagectomy in treatment of middle thoracic esophagus carcinoma.

BACKGROUND/AIMS: The aim of this study is to compare and evaluate the therapeutic efficacy of Ivor-Lewis esophagectomy and one incision esophagectomy through left thoracic and above aortic arch anastomosis approach (left transthoracic esophagectomy) in order to choose a proper surgical procedure to treat middle esophageal carcinoma. METHODOLOGY: Patients who underwent Ivor-Lewis esophagectomy (n=132) and who underwent left transthoracic esophagectomy (n=52) between January 2003 and June 2005 were included. The survival rate was calculated by Kaplan-Meier method and the prognostic risk factors were assessed by Cox regression analysis. RESULTS: Postoperative complications occurred in 43 patients (23.4%), with 31 patients (23.5%) and 12 patients (23.1%) in the Ivor-Lewis group and in the left transthoracic esophagectomy group, respectively. The overall 5-year survival rate was 36.4%, with 37.1% and 34.6% in the Ivor-Lewis group and in the left transthoracic esophagectomy group, respectively (p>0.05). In Cox regression analysis, T classification (HR=1.43, p=0.025) and N classification (HR=1.76, p=0.004) were the independent prognostic risk factors. CONCLUSIONS: Ivor-Lewis esophagectomy and left transthoracic esophagectomy are both feasible options to treat middle thoracic esophageal squamous cell carcinoma. Patients' individual condition is suggested to be taken into account when choosing the operative approach.

A Non-Linear Relationship between Preoperative Total Bilirubin Level and Postoperative Delirium Incidence after Liver Transplantation.

This study aimed to explore the correlation between preoperative total bilirubin (TBil) level and postoperative delirium (POD) in orthotopic liver transplantation (OLT). All the OLT consecutively performed between April 2019 and March 2021 were retrospectively reviewed with data retrieved from a prospectively collected database. Logistic regression model and generalized additive model were used to identify both linear and non-linear relationships between TBil and POD. A two-piecewise regression model was performed to calculate the saturation effect. Subgroup analyses were performed using stratified logistic regression models. A total of 402 recipients were enrolled. After fully adjusted for covariates, TBil was indicated to have a non-linear relationship with POD. The two-piecewise regression model showed the inflection point was 20 mg/dL. On the left side of the inflection point, the incidence of POD increased by 5% per 1 mg/dL increment of TBil (p = 0.026). On the right side of the inflection point, the effect size had no statistical significance (OR, 0.97; 95% CI, 0.90-1.05; p = 0.482). The relationship between preoperative TBil level and POD incidence is non-linear in OLT recipients. The incidence of POD is positively correlated with TBil level when it is below 20 mg/dL. A saturation effect is observed when TBil level reaches 20 mg/dL.

Breast-conserving in centrally located breast cancer patients confirmed safe by SEER based study.

BACKGROUND: Due to the lack of high-level data, there is still controversy over the oncological safety of breast conservation in patients with centrally located breast cancer. This study aimed to assess the safety of breast-conserving surgery in patients with centrally located breast cancer based on the data from the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: We collected data for all cases diagnosed with breast cancer who underwent breast-conserving surgery from 2012-2014 in the SEER database. The primary outcome of our study was disease-specific survival (DSS) and overall survival (OS). The PSM was used to eliminate the effects of non-random statistics. Chi-square test, Kaplan-Meier method and Cox proportional hazards regression model on univariate and multivariate analysis were used to analyze the data. RESULTS: Data from 79,214 patients who had undergone breast-conserving surgery were analyzed in this study, including those with breast cancer in the central region (n=3,128) and outside the central region (n=76,086). The DSS of central breast cancer patients and outside the central breast cancer patients was 58.1 months versus 58.0 months (P>0.05), respectively, while the OS of the 2 groups was 58.0 months versus 58.0 months (P>0.05), respectively. CONCLUSIONS: Breast cancer in the central region should not be contraindicated for breast conserving surgery and breast-conserving surgery can benefit a wider range of patients.

Mucin 1 and vascular endothelial growth factor C expression correlates with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis esophagectomy.

BACKGROUND: The purpose of the present study was to investigate the risk factors associated with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis esophagectomy based on the detection of Mucin 1 mRNA and vascular endothelial growth factor (VEGF) C mRNA. METHODS: The subjects were 82 patients with pN0 esophageal cancer who underwent Ivor-Lewis esophagectomy with two-field lymph node dissection from January 2001 to January 2005. A total of 501 lymph nodes obtained from these patients were re-evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR) to detect mucin l (MUC1) mRNA; VEGF-C mRNA was also detected in esophageal cancer issues by RT-PCR. The diagnosis of lymph node micrometastasis (LNMM) was based on the detection of MUC1 mRNA. The Kaplan-Meier method was used to calculate the survival rate and lymph nodal metastatic rate, the log-rank test was performed to compare the recurrence rate, and Cox regression multivariate analysis was performed to determine independent prognostic factors. RESULTS: MUC1 mRNA was detected in 29 lymph nodes from 23 patients, which accounted for 5.79% of all the 501 lymph nodes and 28.05% of all 82 patients, respectively. Vascular endothelial growth factor C mRNA was identified in esophageal cancer issues from 42 (51.22%) patients. The overall 3- and 5-year survival rates of 82 patients were 78.0 and 51.2%, respectively. First recurrence exhibiting lymph nodal metastasis was recognized in 37 patients (45.1%) in the first 3 years after operation. The lymph node metastatic rate in patients in the first 3 years after operation was significantly associated with T status (p < 0.05) and the lymph node metastatic rate of the patients with LNMM was significantly higher than that of the patients without LNMM (p < 0.01). The lymph node metastatic rate of the patients with VEGF-C mRNA expression in esophageal cancer tissues was significantly higher than that of the patients without VEGF-C mRNA expression (p < 0.01).The results of multivariate analysis confirmed that VEGF-C mRNA expression in esophageal cancer tissues, LNMM, and T status in patients with N0 esophageal cancer were independent relevant factors for 3-year lymph node metastatic recurrence after Ivor-Lewis esophagectomy. CONCLUSIONS: Vascular endothelial growth factor C mRNA expression in esophageal cancer tissues, LNMM, and T status in patients with N0 esophageal cancer were independent risk factors for 3-year lymph node metastatic recurrence after Ivor-Lewis esophagectomy. Adjunctive therapy might be beneficial in controlling the locoregional recurrence and elevated healing rates for certain patients.

High-level CXCR4 expression correlates with brain-specific metastasis of non-small cell lung cancer.

BACKGROUND: Brain-specific metastasis occurs frequently in lung cancer, and the mechanism is still unclear. The present study was designed to investigate the correlation between CXCR4 expression and brain-specific metastasis of non-small cell lung cancer. METHODS: The brain metastatic tumors and lung cancer tissues from 32 patients with solitary brain metastasis of non-small cell lung cancer (M1 group), who underwent combined surgical treatment from January 1998 to June 2008, and 32 paired patients without distant metastasis (M0 group) and 30 patients with primary brain tumor, were examined by immunohistochemistry to detect the expression of CXCR4 protein. The difference of CXCR4 expression was compared by the McNemar χ(2) test or Fisher's exact test. Estimation of survival was calculated with the Kaplan-Meier method, and the statistical differences were analyzed with the log-rank test. RESULTS: Overexpression of CXCR4 protein was observed in 29 (90.6%) M1 non-small cell lung cancers and in all (100%) brain metastatic tumors, which was significantly higher than that in the paired M0 non-small cell lung cancer and the primary brain tumors, respectively (p = 0.000). The 3- and 5-year cumulative survival rates of patients with solitary brain metastasis of lung cancer were 21.9 and 12.5%, significantly lower than the corresponding survival rates of M0 group patients (p = 0.005). CONCLUSIONS: CXCR4 protein was highly overexpressed in M1 non-small cell lung cancer and brain metastatic tumors, which indicated that high-level CXCR4 expression correlates with brain-specific metastasis of non-small cell lung cancer.

Liver Transplantation for Acute-on-Chronic Liver Failure Associated With Acute Necrotizing Pancreatitis: A Case Report.

Liver transplantation (LT) for acute-on-chronic liver failure (ACLF) accompanied by acute necrotizing pancreatitis is still unclear. We have a reported case of LT for ACLF associated with acute necrotizing pancreatitis. The postoperative multiorgan dysfunction and secondary infection were successfully managed under close supervision. The patient was a 47-year-old man with chronic hepatitis B virus infection presented with ACLF and acute necrotizing pancreatitis. After receiving LT from a deceased donor, the patient's liver functioning rapidly reverted to a normal level, and the acute pancreatitis was simultaneously stabilized. However, the patient later developed multiorgan dysfunction secondary to multidrug resistant bacteria infection, which was treated successfully with repeated percutaneous drainage, sensitive antibiotics, continuous renal replacement therapy, microbial balance, and best supportive care. LT can be considered for ACLF associated with acute necrotic pancreatitis without absolute contraindication. Moreover, we recommend a close observation of possible postoperative severe infection, and cautious multidisciplinary management was needed for the prevention of organ dysfunction.

Targeting MUC1-C reverses the cisplatin resistance of esophageal squamous cell carcinoma in vitro and in vivo.

BACKGROUND: The efficacy of chemotherapeutic treatment of esophageal squamous cell carcinoma (ESCC) is limited by drug resistance during. This severely compromises the long-term survival rate of patients. Therefore, reversing chemotherapy resistance in ESCC may improve the therapeutic outcome. Here, we investigated the molecular mechanism of MUC1-C, the C-terminal transmembrane subunit of MUC1 (a transmembrane heterodimer protein), and its role in the reversal of cisplatin sensitivity in ESCC cells. METHODS: We assessed the efficacy of GO-203, a cell-penetrating peptide, as a chemotherapeutic target of MUC1-C using cell proliferation, colony-forming, and transwell assays. Apoptosis was analyzed in GO-203-treated cells by flow cytometry. Tumor xenograft assay was performed in nude mice to corroborate our in vitro findings. RESULTS: GO-203 treatment inhibited cell proliferation and restrained the migration and invasion of cisplatin-resistant ESCC. Moreover, targeting MUC1 resulted in enhanced apoptosis in GO-203-treated cells. These in vitro pro-apoptotic and anti-proliferative effects of GO-203 in combination with cisplatin were validated by in vivo models. Significantly smaller tumor volumes were observed in ESCCs-xenografted nude mice treated with GO-203 in combination with cisplatin compared with mice treated with monotherapy or their control counterparts. We found that blocking MUC1-C with GO-203 significantly reversed the cisplatin resistance in ESCC via modulating Akt and ERK pathways. CONCLUSIONS: Our findings suggest that GO-203 may hold potential as an ancillary therapeutic molecule and a chemosensitizer to improve the outcomes of cisplatin-based chemotherapy especially in patients with cisplatin-resistant ESCC.

Therapeutic efficacy comparison of two surgical procedures to treat middle thoracic esophageal carcinoma.

BACKGROUND: The aim of this study was to evaluate the therapeutic efficacy of two surgical procedures used to treat middle thoracic esophageal squamous cell carcinoma and compare the results. METHODS: A total of 167 patients with middle thoracic esophageal squamous cell carcinoma were included in the study, including 102 patients who underwent Ivor-Lewis esophagectomy and another 65 who underwent dual-incision esophagectomy through the left chest and neck (Dual-incision). The Kaplan-Meier method was used to calculate the survival rate, and Cox regression analysis was performed to identify prognostic risk factors. RESULTS: Perioperative complications occurred in 35 patients (21%). The incidence rate of recurrent laryngeal nerve injury and anastomotic leakage was higher in the Dual-incision group (p < 0.05), and the incidence rate of gastric retention was higher in the Ivor-Lewis group. However, there were no statistically significant differences. The 3-year local recurrence rate was 37.3% in the Ivor-Lewis group and 40% in the Dual-incision group (p > 0.05). The overall 5-year survival rate was 34.6%; the rates of the Ivor-Lewis group and the Dual-incision group were 36.0 and 32.3%, respectively (p > 0.05). The Cox analysis indicated that the pTNM staging was an independent prognostic risk factor (p = 0.00, hazard ratio = 2.69). CONCLUSIONS: Both Ivor-Lewis esophagectomy and Dual-incision esophagectomy through the left chest and neck are options for treating middle thoracic esophageal squamous cell carcinoma. It is suggested that a patient's individual condition be taken into account when choosing the operative approach.

Pancreas transplantation in the mouse.

BACKGROUND: Pancreas transplantation is the only established treatment to achieve long-term normoglycemia and insulin independence in patients with insulin-dependent diabetes mellitus. However, many complications both during and post-transplantation have limited the progress of pancreas transplantation. Mice are the widely used laboratory animals that have been used to establish pancreas transplant models. The pathogenesis and the treatment of pancreas allograft rejection have been studied during the last twenty years. This review introduces four different mouse pancreas transplantation models established by different centers. DATA SOURCES: We reviewed the three mostly reported mouse pancreas transplantation models in the literature (PubMed), and compared them with a novel mouse model established at our center. RESULTS: In this review, four different models of mouse pancreas transplantation were compared in terms of surgical technique, immediate success rate, advantages and disadvantages. CONCLUSIONS: The mouse model is a useful tool to study pancreas transplantation-related diseases and their treatment. The findings from this model help to improve human pancreas transplantation in the future.

EFEMP2 Suppresses the Invasion of Lung Cancer Cells by Inhibiting Epithelial-Mesenchymal Transition (EMT) and Down-Regulating MMPs.

BACKGROUND: Epidermal growth factor-containing fibulin-like extracellular matrix protein 2 (EFEMP2), also known as fibulin-4, MBP1 and UPH1, is an extracellular matrix protein associated with a variety of tumors. The purpose of this study was to investigate the prognostic value and the function of EFEMP2 in lung cancer. METHODS: The mRNA and protein expression of EFEMP2 in lung normal and cancer tissues, lung cancer cell lines (A549, H460, H1299 and H1650) and normal epithelial cell line BEAS-2B were evaluated by immunohistochemistry, RT-qPCR and Western blotting. The Public databases (Oncomine and Kaplan-Meier plotter) were used to investigate the prognostic value of EFEMP2 in lung cancer. RNA interference (RNAi) and overexpression transfection were performed to detect the effects of EFEMP2 up- or down-regulation on lung normal and cancer cell proliferation, invasion and metastasis in vitro and in vivo. RESULTS: EFEMP2 was lowly expressed in lung cancer tissues and cells, and its low expression was associated with malignant phenotype and poor prognosis of lung cancer. The same conclusion had been drawn from the Public databases. EFEMP2 overexpression significantly inhibited the invasion of lung cancer cells, hampered the process of EMT, and decreased the expression and activity of MMP2 and MMP9, while EFEMP2 knockdown remarkably enhanced the invasion of lung cancer cells, promoted EMT, and increased the expression and activity of MMP2 and MMP9. CONCLUSION: The low expression of EFEMP2 was detected in lung cancer and was positively correlated with the poor prognosis of patients. EFEMP2 was a tumor suppressor gene that inhibited the progress of lung cancer, which suggested a new research objective for the future studies.

Metastasis-associated protein 1 (MTA1) overexpression is closely associated with shorter disease-free interval after complete resection of histologically node-negative esophageal cancer.

BACKGROUND: The purpose of the present study was to investigate the expression of metastasis-associated protein 1 (MTA1) and its relationship to the disease-free interval after resection of pathologic N0 (pN0) esophageal squamous cell cancer (ESCC). METHODS: The subjects were 90 patients who successfully underwent complete resection of pN0 ESCC between May 2001 and May 2003. Immunohistochemical staining for MTA1 protein was performed using the avidin-biotin peroxidase complex method. Log-rank test was performed to compare the disease-free interval, and Cox regression multivariate analysis was performed to judge independent prognostic factors. RESULTS: Metastasis-associated protein 1 overexpression was detected in 40 esophageal cancer tissues. Disease-free interval was significantly associated with MTA1 protein overexpression (p = 0.015). The overall 5-year survival rate was 45.6%, the 5-year survival rate of patients with MTA1 protein overexpression was significantly lower than that of those without overexpression (25.0 versus 62.0%; p < 0.001). The results of multivariate analysis confirmed that T status and MTA1 protein overexpression were independent prognostic factors. CONCLUSIONS: Metastasis-associated protein 1 overexpression was detected in pN0 ESCC and was significantly correlated with shorter disease-free interval. T status and MTA1 protein overexpression were both independent prognostic factors. These findings suggested MTA1 might be a predictor of relapsing phenotype and a prognostic factor in esophageal cancer.

Management and surgical resection for tumors of the trachea and carina: experience with 32 patients.

BACKGROUND: The purpose of the present study was to investigate the complications, long-term survival, and management lessons learned after surgical resection for patients with primary tumors of the trachea and carina and locally advanced lung cancer directly infiltrating the carina. METHODS: A retrospective study was performed by our department on 32 patients undergoing surgical resection for primary tumors of the trachea and carina and locally advanced lung cancer directly infiltrating the carina between June 1986 and June 2003. RESULTS: Various surgical modalities were performed according to the tumor location and extent: tracheal resection in 10 cases, carinal resection and reconstruction in 4 cases, carinal right upper lobectomy in 8 cases, carinal pneumonectomy in 4 cases, and partial tangential resection of the tracheal wall in 6 cases. Cardiopulmonary bypass was required in two patients for nearly complete obstruction of the trachea. Resected tumors included six distinct histologic types. Perioperative mortality was 9.4% (3/32). Major complications occurred in 31.3% (10/32) of the patients. The overall 1-, 3-, and 5-year survival rates were 87.5%, 56.3%, and 40.6%, respectively. Patients with primary tracheal and carinal tumors experienced a 5-year survival of 55.0% compared to 16.7% for those with locally advanced lung cancer directly infiltrating the carina (P < 0.05). CONCLUSIONS: Surgical resection is the most effective treatment of choice for primary tumors of the trachea and carina. With careful patient selection and meticulous surgical and anesthesia techniques, the operative mortality and complications are acceptable, and long-term survival can be achieved.

[The long-term outcome and prognostic analysis of surgically treated patients with trachea tumors].

OBJECTIVE: To investigate and evaluate the clinical features, diagnostic methods, surgical management of trachea tumors in order to improve patients outcome. METHODS: Clinical data of 32 patients with trachea tumors surgically treated from June 1986 to June 2005 were retrospectively analyzed. There were 22 male and 10 female patients. The age ranged from 14 to 63 years old with a median of 48 years old. The surgical procedures performed were resection and reconstruction of trachea in 10 cases, right or left pneumonectomy and carinal resection and reconstruction in 8 cases, right sleeve upper lobectomy, carinal resection and reconstruction of trachea and carina in 8 cases, and carina resection and reconstruction with tumor removal through tracheal windows 6 cases. The tracheal defect was repaired with a Teflon flap in two patients. Cardiopulmonary bypass was used in 2 patients during surgery. RESULTS: The histological examination of resected lesions revealed squamous cell carcinoma in 19 cases, adenoid cystic carcinoma in 8 cases, adenocarcinoma in 2 cases, carcinoid in 2 cases, leiomyosarcoma in 1 case and adenoma in 1 case. One case had infection of thoracic cavity and 3 cases experienced temporary cardiac arrhythmia. There was no operative death. The follow-up periods were from 5 months to 3 years. The 1, 2 and 3 year survival rates were 93.7%, 59.4% and 50.0% respectively. CONCLUSIONS: Squamous cell carcinoma adenoid cystic carcinoma are the most common in trachea tumors. Preoperative bronchoscope examination and chest CT scan can provide valuable diagnostic data. Proper choice of surgical procedure is important for improved patients' outcome.

[The patterns and prognostic factors of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma].

OBJECTIVE: To investigate the patterns of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors. METHODS: Three hundred and sixty-eight patients with the middle thoracic esophageal squamous cell carcinoma from January 1998 to January 2003 were reviewed. There were 289 male and 79 female patients. The age ranged from 38 to 79 years, with a mean of 56 years. Preoperative clinical stage was stage I to III, and all patients underwent Ivor-Lewis esophagectomy with two-field lymphadenectomy. Follow-up was completed for all patients with a mean time of 68 months. Survival rate was calculated by Kaplan-Meier method. COX regression analysis was performed to identify risk prognostic factors. RESULTS: Abdominal lymph node metastasis occurred in 58 (15.8%) patients, with 36.2% (21/58) of them being in stage T1 or T2. Skipping abdominal lymph node metastasis was recognized in 13.8% (8/58) patients, with all of them being in stage T1 or T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic lymph node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was bad, and nobody could survive over 5 years.COX analysis showed that 5 or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis. CONCLUSIONS: Abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma occurs frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis is poor, especially those with more positive nodes and distant abdominal node metastasis.