Prognostic analysis of splenectomy in patients with advanced proximal gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluated the prognostic impact of splenectomy on patients with advanced proximal gastric cancer.</p><p><b>METHODS</b>The clinical records of 237 patients with advanced proximal gastric cancer who underwent D2 curative resection combined with splenectomy from January 1980 to June 2003 were analyzed retrospectively. Seventy-five patients presented with No.10 lymph nodes metastasis, while 162 patients did not. Potential patient prognostic factors were evaluated by univariate and multivariate analysis. The independent prognostic factors of patients were performed subgroup analysis.</p><p><b>RESULTS</b>The 5-year survival rate was 27.7% for patients with No.10 lymph nodes metastasis and 35.4% for patients without, the difference was statistically significant between the two groups (P < 0.05). On univariate analysis, lymph node metastasis, macroscopic appearance, depth of invasion, type of gastrectomy and No.10 lymph nodes metastasis were predictive factors of survival. The depth of invasion, type of gastrectomy and No.10 lymph nodes metastasis were independent prognostic factors. In the subgroup analysis, the survival rates of T3 patients with and without No.10 lymph nodes metastasis was 34.5% and 39.7%, respectively (P > 0.05). For patients undergoing total gastrectomy, survival rates were 31.2% and 36.7%, respectively (P > 0.05).</p><p><b>CONCLUSIONS</b>To improve patient prognosis, total gastrectomy with splenectomy should be recommended for patients with T3 proximal gastric cancer with No.10 lymph node metastasis.</p>

Efficacy of combined splenectomy in proximal gastric cancer with No.10 lymph node metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the impact on prognosis of D(2) lymphadenectomy combined with splenectomy in patients of advanced proximal gastric cancer with No.10 lymph node metastasis.</p><p><b>METHODS</b>Clinical data of 216 patients of advanced proximal gastric cancer with No.10 lymph node metastasis undergone D(2) curative resection in our hospital from January 1980 to December 2002 were analyzed retrospectively. Among them, 73 underwent simultaneous splenectomy (splenectomy group), while 143 without splenectomy (spleen-preserving group). The 5-year survival rate, the mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes, the complication morbidity and mortality were compared between the two groups.</p><p><b>RESULTS</b>The 5-year survival rates of splenectomy group and spleen-preserving group were 30.0% and 19.7% respectively, whose difference was significant(P<0.05). The mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes in splenectomy group were significantly greater than those in spleen-preserving group(P<0.05). Splenectomy, invasion depth and gastrectomy type were independent prognostic factors. The survival rates of T(3) patients in splenectomy group and spleen-preserving group were 38.7% and 18.9% respectively, whose difference was significant (P<0.05). The survival rates of patients undergone total gastrectomy in splenectomy group and spleen-preserving group were 33.4% and 20.7% respectively, whose difference was significant (P<0.05). The complication morbidity and mortality in splenectomy group were 24.7% and 4.1%, while in spleen-preserving group were 17.5% and 3.5% respectively, whose differences were not significant(P>0.05).</p><p><b>CONCLUSIONS</b>Splenectomy is benefit for No.10 lymph node dissection in patients with advanced proximal gastric cancer. To improve the prognosis, total gastrectomy combined with splenectomy should be recommended for patients of T(3) proximal gastric cancer with No.10 lymph node metastasis. Simultaneous splenectomy dose not increase the complication morbidity and mortality.</p>

Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum (No. 10 lymph nodes).</p><p><b>METHODS</b>The clinical records of 216 patients with advanced proximal gastric cancer and No. 10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy (splenectomy group), while 143 patients did not (spleen-preserving group). Five-year survival rates, mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.</p><p><b>RESULTS</b>The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group (chi(2) = 14.73, P < 0.05). The mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes in the splenectomy group were significantly greater than in the spleen-preserving group (P < 0.05). Multivariate analysis revealed that the depth of invasion, splenectomy, and type of gastrectomy were independent prognostic factors. The survival rate for T3 patients with and without splenectomy was 38.7% and 18.9%, respectively (chi(2) = 15.03, P < 0.05). For patients undergoing total gastrectomy, survival rates were 33.4% and 20.7%, respectively (chi(2) = 13.63, P < 0.05). Operative morbidity and mortality in splenectomy group was 24.7% and 4.1%, respectively, and in the spleen-preserving group was 17.5% and 3.5%, respectively. The differences were not statistically significant (P > 0.05).</p><p><b>CONCLUSIONS</b>Splenectomy is beneficial for No. 10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.</p>

Impact of dissected lymph node number on the prognosis of advanced cancer of cardiac and stomach fundus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of dissected lymph node number on the prognosis of patients with advanced cancer of cardia and stomach fundus.</p><p><b>METHODS</b>Clinical data of 236 patients with advanced cancer of cardia and stomach fundus undergone D(2) radical resection were reviewed retrospectively. Five-year survival rate and post-operative complication rate were followed up and their relationships with dissected lymph node number were analyzed respectively.</p><p><b>RESULTS</b>The 5-year survival rate of the entire cohort was 37.5%. Among those patients with the same stage, the more lymph nodes (LNs) resected, the better survival outcomes achieved(Log-rank trend test P=0.0013). A cut point analysis yielded the ability to detect the significant survival differences. The best long-term survival outcomes were observed with LN counts of more than 20 for stage II(P=0.0136), more than 25 for stage III(P<0.0001), more than 30 for stage IV(P=0.0002) or more than 15 for the entire cohort (P=0.0024), with greatest comparative discrepancies. The post-operative complication rate was 15.7% and was not significantly correlated with dissected lymph node number(P=0.101).</p><p><b>CONCLUSIONS</b>The prognosis of patients with advanced cancer of cardia and stomach fundus is associated with the number of resected LNs when D(2) lymphadenectomy is carried out. Suitable increment of dissected lymph node number would not increase the post-operative complication rate.</p>

Prognosis analysis of surgical treatment for cancer of stomach fundus and cardia with invasion to body and tail of the pancreas / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors of surgical treatment for the cancer of stomach fundus and cardia with invasion to body and tail of the pancreas.</p><p><b>METHODS</b>A total of 135 patients with cancer of stomach fundus and cardia invading body and tail of the pancreas undergone surgical treatment were enrolled in this study. Twenty of them underwent laparotomy, while 115 underwent gastrectomy with pancreaticosplenectomy, even combined with the resection of other organs for macroscopic invasion to adjacent organs during surgery. The 3-,5-year survival rates, morbidity of postoperative complications and mortality were followed up. The prognostic factors were evaluated by univariate and multivariate analyses.</p><p><b>RESULTS</b>The median survival time of the patients undergone laparotomy was 4.7 months, of patients treated by gastrectomy combined with pancreaticosplenectomy was 30.5 months,and the difference was significant (chi(2)=403.8, P<0.01). The cumulative 3- and 5-year survival rates of the patients treated by gastrectomy combined with pancreaticosplenectomy were 48.3% and 26.6% respectively. Univariate analysis revealed that significant differences in prognosis of 115 patients undergone combined resection were demonstrated for the following factors: maximal dimension of tumor, macroscopic type, extent of lymph node metastasis according to the Japanese classification, No.10 or No.11 lymph node metastasis,curability and number of invaded organs.And histological depth of invasion, extent of lymph node metastasis according to the Japanese classification, number of invaded organs and curability were significant prognostic factors, examined as variables by multivariate analysis (Cox's proportional hazard model, forward stepwise selection LR method). The postoperative complication rate and mortality of 135 patients were 20.0% and 3.5% respectively.</p><p><b>CONCLUSIONS</b>For cancer located in stomach fundus and cardia with limited invasion to distal pancreas, gastrectomy combined with pancreaticosplenectomy should be performed to improve long-term outcomes. Best long-term survival outcomes would be attained if there are no lymph node metastases, or no incurable factors, or no other organ invasions.</p>

Efficiency of D2 radical resection combined with splenectomy in T3 cancer of upper stomach / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the efficacy and influence of D2 radical resection combined with splenectomy in T3 cancer of upper stomach.</p><p><b>METHODS</b>From January 1980 to June 2002, 613 patients with T3 cancer of upper stomach received D2 radical resection. Of these cases, 102 underwent simultaneous splenectomy (splenectomy group), while 511 did not (spleen-preserved group). The metastatic rate of lymph nodes in splenic hilum and along the splenic artery (No. 10, No. 11), 5-year survival rates, recurrence rate, the postoperative complication rate and mortality rate were followed up and compared in the two groups.</p><p><b>RESULTS</b>The metastasis rate of No. 10 was 23.5% for splenectomy group and 14.9% for spleen-preserved group (P < 0.05). No significant difference was found in No. 11 metastasis between the two groups. The 5-year survival rate of splenectomy group was 39.8%, and was 32.3% in spleen-preserved group (P > 0.05). The recurrence rate of splenectomy group was 55.9%, and was 60.3% in spleen-preserved group (P > 0.05). In the splenectomy group, the 5-year survival rates were similar between patients with and without No. 10 metastasis (P > 0.05). The postoperative complication rate and mortality rate of the splenectomy group were 19.6% and 4.9%, and were 13.7% and 3.1% in the spleen-preserved group, respectively; and no significant difference was found between the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>D2 radical excision combined splenectomy should be recommended for stage T3 cancer of upper stomach when suspected with No. 10, No. 11 lymph nodes metastasis. Simultaneous splenectomy would not increase the postoperative complication rate and mortality rate.</p>

Clinicopathological features and long-term results of surgical therapy of early gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate factors implicated in the relapse of early gastric cancer (EGC), and to explore the mode of lymphadenectomy (over-D(1) vs D(2)) for EGC patients.</p><p><b>METHODS</b>The data of 161 EGC patients, diagnosed from Jul. 1979 to Aug. 2004, were investigated in the study retrospectively.</p><p><b>RESULTS</b>One hundred and sixty-one EGC cases accounted for 6.0% of the total gastric cancer cases during the same period (161/2694). D(2) lymphadenectomy were performed in 112/161 cases, and over-D(1) in 49/161. Among these cases, 9 developed distant metastases (7 in liver and 2 in bone), 3 local recurrences in remaining gastric, and 3 lymph node metastases. The 5 and 10-year survival rates were 90.7% and 89.8% respectively. The risk factors associated with recurrence included lymph node metastases, depth of invasion, lymphatic involvement, number of tumors, vessel involvement, tumor size, age and lymphadenectomy (P<0.05) through univariate analysis. Further multivariate analysis showed that lymph node metastases, vessel involvement, gross type and extent of lymphadenectomy as independent effective factors for recurrence. Compared with over-D(1) mode, D(2) mode conferred a significantly increased cumulative survival for cancer invaded the submucosa. No significant difference in cumulative survival for mucosa invasive EGC was found between over-D(1) and D(2) modes.</p><p><b>CONCLUSIONS</b>Lymph node metastases and vessel involvement act as independent risk factors for recurrence of EGC. Adversely, protrusion lesion and D(2) lymphadenectomy are shown as protection factors for recurrence of EGC. Standard D(2) lymphadenectomy should be carried out in EGC with submucosal invasion or positive sentinel nodes or depressed lesions (IIc + III).</p>

Association of -160(C-->A) polymorphism in CDH1 gene with gastric cancer risk in Fujian Chinese population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>CDH1, encoding E-cadherin, is an important tumor suppressor gene. The present study aims to investigate the association of -160(C-->A) polymorphism in CDH1 gene with susceptibility to gastric cancer in Fujian province.</p><p><b>METHODS</b>One hundred and two patients from independent families and 101 healthy control subjects were analyzed. Genotype analysis was performed through polymerase chain reaction-based denaturing high performance liquid chromatography. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression model.</p><p><b>RESULTS</b>The frequencies of -160(C-->A) polymorphism CC, CA and AA genotype in case group and controls were 58(56.9%), 38(37.3%)ì6(5.9%) and 55(54.5%), 41(40.6%), 5(5%), respectively. AA genotype did not present a significantly increased risk for gastric cancer (OR=1.12; 95% CI:0.32-3.95). No association was found between A allele and clinicopathological characteristics of gastric cancer.</p><p><b>CONCLUSION</b>-160(C-->A) polymorphism in CDH1 gene promoter region may not be in association with genetic susceptibility to gastric cancer in Chinese population from Fujian.</p>

Long-term therapeutic effects of total gastrectomy in cancer of the cardia and stomach fundus / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate total gastrectomy for the treatment of cancer of the cardia and stomach fundus.</p><p><b>METHODS</b>Five hundred and thirteen patients with cancer of the cardia and stomach fundus underwent radical resection. Of them, 326 were treated using total gastrectomy (group TG); and 187, using proximal gastrectomy (group PG). The 5-year and 10-year survival rates and the postoperative complication rate and mortality rate were followed up and compared in the two groups.</p><p><b>RESULTS</b>The 5-year and 10-year survival rates of group TG were 43.6% and 24.5%, of group PG were 33.9% and 14.1%, respectively, and the difference was statistically significant (chi(2) = 4.421, P < 0.05, chi(2) = 5.726, P < 0.05). The postoperative complication rate and mortality rate of group TG were 14.7% and 3.1%, of group PG were 10.2% and 2.1%, respectively, and the difference was not statistically significant (chi(2) = 1.796, P > 0.05, chi(2) = 0.082, P > 0.05).</p><p><b>CONCLUSIONS</b>To improve long-term therapeutic effects, total gastrectomy should be recommended for stage III patients with cancer of the cardia and stomach fundus when tumor size is bigger than 3.0 cm or lymph node metastasis occur. The postoperative complication rate and mortality rate should not be increased and the esophagitis of gastroesophageal reflux should be avoided in the patients treated using total gastrectomy.</p>

A prospective randomized study on the method of reconstruction after total gastrectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To find an ideal reconstruction method after total gastrectomy.</p><p><b>METHODS</b>With 12 healthy persons as control, a total of 120 gastric cancer patients received their digestive tract reconstruction after total gastrectomy were randomized into Roux-en-y esophagojejunostomy group (A), P pouch with Roux-en-y esophagojejunostomy group (B), Hunt-Lawrence esophagojejunostomy group (C), and jejunal interposition esophagojejunostomy group (D). After operation, quality of life, prognosis nutrition index (PNI), body weight, serum nutritional parameters, gastrointestinal hormone level and immunological state were evaluated.</p><p><b>RESULTS</b>The quality of life, PNI, body weight and serum nutritional parameters (SI, TS and Hb) were better in group D than those in groups A, B and C (P < 0.05). The cholecystokinin (CCK) level and NK cell, CD(4)(+) cell, CD(8)(+) cell and CD(4)/CD(8) ratio in group D, being similar to the control group, were significantly higher than groups A, B and C (P < 0.05).</p><p><b>CONCLUSION</b>Modified jejunal interposition esophagojejunostomy is a reasonable reconstruction method. The construction of "P" pouch, reserving foods as the stomach, can preserve the duodenal passage and secretion of the gastrointestinal hormones, which results in better digestion of the food and absorption of the nutrients. This method simplifies the operation and guarantee the blood supply of interpositioned jejunum without causing ischemia at the anastomotic orifice.</p>

Therapeutic effects of operation in tumor invades adjacent structures cancer of cardia and stomach fundus / 中华外科杂志

<p><b>OBJECTIVE</b>To study the best style of operation in the treatment of tumor invades adjacent structures (T(4)) cancer of the cardia and stomach fundus.</p><p><b>METHODS</b>Two hundred and one patients with T(4) cancer of the cardia and stomach fundus underwent operation. Of them, 31 were treated by laparotomy, and 170 by combined resection of the involved organs. The 3- and 5-year survival rates and the postoperative complication rate and mortality rate were analyzed in the patients who had under gone combined resection of the involved organs.</p><p><b>RESULTS</b>The median survival of the patients undergoing combined resection of the involved organs (29.3 months) was significantly longer than that of those receiving laparotomy (4.9 months). The 3- and 5-year survival rates of 170 patients who had under gone combined resection of the involved organs were 46.2% and 22.8%, respectively. The 3- and 5-year survival rates of patients undergoing total gastrectomy and proximal gastrectomy were 54.9% and 29.2% and 32.2% and 12.5%, respectively, and the difference was statistically significant (chi(2) = 7.589, P < 0.01;chi(2) = 5.792, P < 0.05).The postoperative mortality rate and complication rate were 4.1% and 24.1%, respectively.</p><p><b>CONCLUSIONS</b>The patients without liver metastasis, widespread nodal involvement, peritoneal dissemination and local focus allowed by an en bloc combined resection in T(4) cancer of cardia and stomach fundus should undergo gastrectomy with a combined resection of the involved organs. Total gastrectomy should be performed to improve the curative effect.</p>