Analysis of factors influencing postoperative gastrointestinal function recovery in patients undergoing hyperthermic intraperitoneal chemotherapy / 上海交通大学学报（医学版）

Objective · To investigate the effect of hyperthermic intraperitoneal chemotherapy on postoperative gastrointestinal function recovery in patients with gastrointestinal cancer. Methods · Sixty-two cases of gastrointestinal cancer patients were enrolled who accepted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, from July 2014 to June 2017. The gastrointestinal function of patients were evaluated according to the I-FEED scoring system. The patients were divided into normal recovery group (I-FEED score＜6, n=38) and delayed recovery group (I-FEED score ≥ 6, n=24). Univariate and multivariate Logistic analyses were performed on characteristic factors that may affect the recovery of postoperative gastrointestinal function including gender, age, presence of diabetes, preoperative albumin, and so on. Results · There were significantly differences in the preoperative serum albumin level (P=0.040), intraoperative bleeding (P=0.044), the time of extraction of the peritoneal cavity drainage tube (P=0.026), the time of urethral tube extraction (P=0.021) and the time of hospitalization (P=0.017) in the two groups of patients with normal or delayed gastrointestinal function recovery. Multivariate Logistic regression results suggested that preoperative serum albumin level may be beneficial for the recovery of postoperative gastrointestinal function (OR=0.84, 95％ CI 0.17-4.27, P=0.041).Conclusion · The preoperative serum albumin level can be used as an independent predictor of postoperative gastrointestinal functional recovery in patients with gastrointestinal cancer after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.

Resistance and treatment strategy of gastrointestinal stromal tumor target therapy / 中华胃肠外科杂志

Gastrointestinal stromal tumor(GIST) originates from interstitial cells of Cajal(ICCs). Tyrosine kinase inhibitors(TKI) such as imatinib and sunitinib, are effective agents besides surgery. However some GIST can become primarily or secondarily resistant to those drugs. The difference in gene mutation types and secondary gene mutation is the main cause. When the GIST is proved to be drug resistance, reasonable personal treatment strategies based on individualized medicine should be made to improve outcomes and quality of life.

Postoperative adjuvant radiotherapy for pancreatic carcinoma patients after radical resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To retrospectively investigate the difference in survival of pancreatic adenocarcinoma patients treated by radical surgery with or without adjuvant radiation therapy.</p><p><b>METHODS</b>Forty-four patients with pancreatic cancer underwent surgical resection with a curative intent, and were divided into two groups: surgery alone (n = 24) or surgery combined with postoperative external beam radiotherapy (EBRT) (n = 20). Survival as an endpoint was analyzed between the two groups.</p><p><b>RESULTS</b>All 44 patients completed their scheduled treatment. The median survival time of the patients treated with radical resection alone was 379 days versus 665 days for those treated with combined therapy. The 1-, 3-, 5-year survival rates of the patients treated with radical resection alone were 46.3%, 8.3%, 4.2% versus 65.2%, 20.2%, 14.1% for the patients treated with combined therapy, respectively, with a significant difference between the two groups (P = 0.017). The failures in local-regional relapse were significantly lower in the postoperative EBRT group than that in the surgery alone group (P < 0.05), while the additional postoperative radiation therapy did not increase the complication rate (P > 0.05).</p><p><b>CONCLUSION</b>Postoperative external beam radiation therapy can improve the survival in patients with pancreatic adenocarcinoma.</p>

Single-dose ceftriaxone versus multiple-dose cefuroxime for prophylaxis of surgical site infection / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the effects and pharmacoeconomics of single-dose of ceftriaxone versus 3-day cefuroxime prophylaxis in patients undergoing gastric or colorectal resection.</p><p><b>METHODS</b>Three hundred and five consecutive patients with gastric or colorectal cancer from 5 medical centers were randomly divided into ceftriaxone group (n = 153, receiving intravenously 1 g ceftriaxone 0.5 - 1 h prior to operation only) and cefuroxime group (n = 152, receiving 0.75 g cefuroxime preoperatively and the same dose q8h for 3 d). The patients' intra- and postoperative status, adverse responses and infectious complications were observed and documented, and pharmacoeconomic parameters were analyzed.</p><p><b>RESULTS</b>The disease distribution, operative procedures and patients' conditions in the 2 groups were comparable. No adverse responses to the test antibiotics were observed. Postoperative infectious complications occurred in 7 cases in the ceftriaxone group (4.58%) and 14 cases in the cefuroxime group (9.21%), respectively (P = 0.992), among which, 12 cases were surgical site infections (incisional, intra-abdominal): 2 cases in the ceftriaxone group (1.31%), and 10 cases in the cefuroxime group (6.58%), (chi(2) = 5.607, P = 0.018). The direct cost related to prevention and treatment of surgical site infections was 283.5 RMB in the ceftriaxone group and 811.1 RMB in the cefuroxime group (Z = 14.51, P = 0.000).</p><p><b>CONCLUSION</b>Both ceftriaxone and cefuroxime are safe and effective for prevention of surgical site infections. Single-dose ceftriaxone prophylaxis is sufficient for gastric and colorectal operations, with a better cost-effectiveness ratio.</p>