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@#Recently, sponsored by the Science Popularization Department of the China Anti Cancer Association, jointly organized by the Rehabilitation Branch of the China Anti Cancer Association and the Mijian Digital Cancer Patient Course Management Platform, and co-organized by the Science Popularization Special Committee of the China Anti Cancer Association, The "2022 White Paper on the Quality of Life of Chinese Lung Cancer Patients" has been officially released (herein after referred to as the "White Paper"), which mainly elaborates on the basic situation of Chinese lung cancer patients and the medical, social, and economic impacts caused by the disease. This article interprets the White Paper in order to help the public understand the real situation of lung cancer patients and provide important empirical evidence and valuable insights for the diagnosis, treatment, and rehabilitation of lung cancer in China.
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Objective:To evaluate salvage surgery in patients with early gastric cancer after noncurative endoscopic resection .Method:A total of 56 cases with early gastric cancer receiving salvage surgery after noncurative endoscopic resection were enrolled and the clinicopathological and follow-up information were analyzed to evaluate the necessity and safety of salvage surgery.Results:Among the 44(79%)patients with submucosal invasion, 38 (68%) were with SM2 (invasion submucosal invasion≥500 μm) according to the pathological results after endoscopic resection. 33 (59%)cases had positive margin. The rate of lymph node metastasis and positive residual tumor as found by salvage gastrectomy were 11% (6/56) and 25% (14/56) . In the multivariate analysis, deeper submucosal invasion resulted as independent risk factor for residual tumor( OR=1.001, 95% CI=1.000-1.002, P=0.036). Among the 12(21%)cases with postoperative complications, 3 (5%)underwent unplanned reoperations because of anastomotic or intra-abdominal bleeding. There was no difference in the number of retrieved lymph nodes and rate of postoperative complications between laparoscopic and open surgery(all P>0.05). Conclusion:For patients with the risk factors of lymph node metastasis after noncurative endoscopic resection, salvage surgery was necessary and laparoscopic approach was safe and feasible.
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The outbreak of novel coronavirus pneumonia occurred in Wuhan, Hubei province of China, at the end of 2019, and spread rapidly across the country. After the outbreak of this disease, the overwhelming majority of cities have launched the "first level response" and the regular diagnosis and treatment of cancer patients are greatly affected. The digestive systemic cancer is the most common malignancy. Most patients are diagnosed in the advanced stage with poor prognosis. The epidemic of novel coronavirus pneumonia poses new challenges to diagnosis and treatment of the patients with digestive system malignancies. Based on the fully understanding of the characteristics of digestive system tumors, we should change the treatment strategy and adopt more reasonable treatment strategy timely during the epidemic period to minimize the adverse effects of the epidemic of novel coronavirus pneumonia on the treatment.
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Objective@#To assess the safety, feasibility and short-term outcome of totally laparoscopic distal gastrectomy(TLDG).@*Methods@#Seventy-five patients who underwent laparoscopic distal gastrectomy in Cancer Hospital of Chinese Academy of Medical Science between August 2015 and April 2018 were enrolled in this study. A total of 46 laparoscopy-assisted distal gastrectomy (LADG) cases and 29 TLDG cases were included. The Short-term outcomes and safeties of the two groups were compared.@*Results@#The operation time of TLDG group was significantly longer than that of LADG group (207±41 vs. 156±34 min, P<0.001), while the length of wound was shorter in the TLDG group (3.6±0.6 vs. 5.8±0.8 cm, P<0.001). The time to first flatus in TLDG group was (3.3±0.6) days, significantly shorter than (3.7±0.8) days in LADG group (P=0.034). There were no significant differences between the two groups in the estimated blood loss, intraoperative blood transfusion, extraction of gastric tube, drainage tube removal, interval of the first time to eat semi-liquid food, postoperative hospital stays, surgical complications, number of retrieved lymph nodes, proximal and distal resection margin lengths (all P>0.05). The white blood cell count at postoperative day 1 in the TLDG group was (10.96±1.96) ×109/L, significantly lower than (12.49±3.46)×109/L of the LADG group (P=0.017). While the CRP level at postoperative day 1 in the TLDG group were lower than that of LADG group, no statistical difference was observed (P=0.072).@*Conclusions@#Our study shows that TLDG is safe and feasible. TLDG has better cosmesis, less blood loss, and faster recovery compared to LADG.
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Ovary is one of the common metastatic sites of gastric cancer. In the female patients, ovarian relapse is one of the most important causes of treatment failure for gastric cancer. The most likely mechanism of Krukenberg tumor development is via retrograde lymphatic spreading from gastric cancer. However, neither optimal treatment strategy nor standard treatment guideline for Krukenberg tumor from gastric cancer has been clearly established.The diagnostic key points consist of the previous or concomitant history of gastric cancer and the detection of ovarian solid tumors.The therapeutic regimens mainly include the metastasectomy, chemotherapy, radiotherapy and comprehensive treatment. Surgical resection of metastatic tumor combined with adjuvant chemotherapy can improve the prognosis and survival.
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Objective@#To identify the feasibility and efficacy of indocyanine green (ICG) used in laparoscopic gastrectomy for advanced gastric cancer patients.@*Methods@#From December 2018 to August 2019, the clinical data of 82 patients preoperatively diagnosed as advanced gastric cancer undergoing laparoscopic radical gastrectomy were retrospectively analyzed. These patients were divided into ICG group(n=38) and a historical control group (non-ICG group, n=44). The number of retrieved lymph nodes, operation time, blood loss, hospital stay, fever time, evacuation time and complications were compared between these two groups.@*Results@#The operation time [(172.8±45.8) min vs (162.6±45.7) min], blood loss [(80.1±91.9) ml vs (78.6±89.8) ml], hospital stay [(7.0±2.0) d vs (7.5±2.4) d], fever time [(2.3±1.2) d vs (2.9±1.9) d], evacuation time [(3.4±0.8) d vs (3.4±1.1) d] and incidence of complications (5.3% vs 9.1%) were not significantly different between the ICG and historical control groups (P>0.05). The number of retrieved lymph nodes in ICG group was significantly increased compared with that of the historical control group (46.5 vs 33.0, P=0.005).@*Conclusions@#The ICG method applied in lymph node dissection of laparoscopic radical gastrectomy is safe. Moreover, ICG might elevate the efficiency of regional lymph node dissection.
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Indocyanine green (ICG) has been used as a novel tracer for mapping lymph nodes in navigation surgeries for many malignant tumors. Recently, ICG is mainly applied in sentinel lymph node biopsy for early gastric cancer, while its application in advanced gastric cancer is less reported. It was reported that application of ICG in locating perigastric lymph nodes could elevate the efficiency of lymphadenectomy for advanced gastric cancer. Besides, recognizing small lymph nodes and dissecting certain lymph node stations are its unique advantages. However, some problems remain unsolved, as few relevant research has been done. Based on conceptions of minimal invasive and precision medicine, ICG may play an important role in improving the accuracy of laparoscopic surgery for advanced gastric cancer in the future.
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Objective@#The aim of this study was to explore the clinicopathologic characteristics and prognostic factors of Paget′s disease.@*Methods@#137 patients with Paget′s disease of the breast who were diagnosed in Cancer Hospital Chinese Academy of Medical Sciences between January 2007 and May 2016 were identified and included in the study, including 134 females and 3 males.@*Results@#The average age at onset of the disease was 51.8 years(range, 27-78 years). Among the 137 patients, 7 cases were Paget′s disease without any other underlying malignancy, who were alive during the follow-up period. The other 130 patients were diagnosed with Paget′s disease and underlying ductal carcinoma in situ (DCIS) or (and) with an invasive carcinoma. The positive expression rates of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) were 29.2%(40/137), 38.0%(52/137)and 78.1%(107/137), respectively. The two-year and five-year overall survival were 99.0%, 96.0%, and disease-free survival of two-year and five-year were 97.6%, 92.8%, respectively for all 137 patients. On survival analysis, longer course of disease, HER-2 positivity, tumor stage(T1-T4), and axillary lymph node metastasis were significantly associated with overall survival.@*Conclusions@#Paget′s disease of the breast is a slowly progressive malignancy with good prognosis. A longer course of disease, HER-2 positivity, tumor stage, axillary lymph node metastasis and distant metastasis were significantly associated with poor prognosis.
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Fast-track surgery is the basis for the use of new medical evidence to optimize the management of perioperative patients.The surgeon forms a set of perioperative treatments by integrating and applying these new evidences to reduce the physical and psychological stress response of patients,and to speed up the rehabilitation of patients.Fast-track Surgery has been used in the treatment of a variety of diseases,including cardiac surgery,total knee replacement,and colorectal surgery.Gastric cancer was the fourth in the most common cancer sorts and the second in death rate in the world.Surgery is a milestone in the treatment of gastric cancer,and is the only effective means to cure.Fast-track surgeryy in the treatment of gastric cancer is still constantly improving.This article reviews the application of fast-track surgery in gastric cancer surgery.
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Objective@#To investigate the safety and efficacy of the Weitan Waifu patch on the postsurgical gastroparesis syndrome (PGS) of gastrointestinal cancer.@*Methods@#The multi-center, double-blind, randomized controlled trial was conducted with superiority design. Patients with PGS of gastrointestinal cancer diagnosed in 4 AAA hospitals and the abdominal symptom manifested as cold syndrome by Chinese local syndrome differentiation were recruited. These patients were randomly divided into two groups according to 1∶1 proportion. Placebo or Weitan Waifu patch was applied in control group or intervention group, respectively, based on the basic treatments, including nutrition support, gastrointestinal decompression, promoting gastric dynamics medicine.Two acupuncture points (Zhongwan and Shenque) were stuck with placebo in control group or patch in treatment group. The intervention course was 14 days or reached the effective standard.@*Results@#From July 15, 2013 to Jun 3, 2015, 128 participants were recruited and 120 eligible cases were included in the full analysis set (FAS), and 60 cases in each group. 88 cases were included in the per-protocol set (PPS), including 45 cases in the treatment group and 43 cases in the control group. In the FAS, the clinical effective rate in the treatment group was 68.3%, significantly superior than 41.7% of the control group (P=0.003). The medium time of effective therapy in the treatment group was 8 days, significantly shorter than 10 days in the control group (P=0.017). In the FAS, 3 adverse events occurred in the treatment group, including mild to moderate decrustation, pruritus and nausea. The incidence rate of adverse events was 5.0% (3/60) and these symptoms were spontaneously remitted after drug withdrawal. No severe adverse events were observed in the control group. There was no significant difference between these two groups (P=0.244).@*Conclusion@#Weitan Waifu patch is a safely and effectively therapeutic method for patients with PGS (cold syndrome) of gastroenterological cancer.@*Trial registration@#International Standard Randomized Controlled Trial Number Register, ISRCTN18291857
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<p><b>OBJECTIVE</b>To evaluate the value of intraoperative fine needle aspiration cytology (IFNAC) examination in the diagnosis of pancreatic lesions.</p><p><b>METHODS</b>The clinicopathological data of 491 patients with pancreatic lesions treated in our hospital from May 1998 to June 2013 were retrospectively analyzed. Their clinical features, IFNAC findings, pathological results after IFNAC examination and related complications were summarized. The factors affecting the aspiration biopsy accuracy were analyzed using logistic regression and multi factor analysis.</p><p><b>RESULTS</b>491 patients with pancreatic lesions were examined by IFNAC. Among them, cancer cells were found in 434 cases (positive), and were not found in 57 cases (negative). Among the 310 cases who underwent surgical operation, postoperative pathology confirmed 209 cases of pancreatic ductal adenocarcinoma, 8 cases of pancreatic cystadenocarcinoma, 23 cases of solid pseudopapillary tumor of the pancreas, 15 cases of pancreatic neuroendocrine tumor, 14 cases of intraductal papillary mucinous tumor, 2 cases of primary pancreatic gastrointestinal stromal tumor, 17 cases of pancreatic serous cystadenoma, and 22 cases of chronic mass-forming type pancreatitis. The IFNAC test showed a sensitivity of 97.9% (425/434), and specificity of 89.5% (51/57). The IFNAC examination-related complications were pancreatic leakage in a total of 12 patients which were cured after treatment. No bleeding complication was observed. Logistic multivariate analysis showed that tumor size, cystic degeneration, lymph node metastasis and associated chronic pancreatitis are independent factors affecting the IFNAC examination of pancreatic carcinoma.</p><p><b>CONCLUSIONS</b>IFNAC examination has a high sensitivity and specificity, and with a good safety in clinical use. IFNAC can be used as a powerful tool for the diagnosis of pancreatic cancer, with a high clinical value in use. In the cytology-negative cases, cytology alone can not rule out the diagnosis of pancreatic cancer. Through repeated sampling and combined with intraoperative frozen section pathology can improve the diagnostic accuracy.</p>
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Humans , Biopsy, Fine-Needle , Biopsy, Needle , Carcinoma, Pancreatic Ductal , Diagnosis , Pathology , Cystadenoma, Serous , Diagnosis , Pathology , Frozen Sections , Pancreas , Pathology , Pancreatic Neoplasms , Diagnosis , Pathology , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Objective To review our experience in the diagnosis and treatment of nonfunctional islet cell tumors(NICT).Method The clinicopathological data of 26 cases of NICT were retrospectively analysed and the medical literature was reviewed.Results In addition to the 26 cases seen in our center,there were 569 cases published in 37 articles in the medical literature.In China,NICT was more common in women.The male to female ratio was about 3 ∶ 7.The mean age of onset of the disease was 35 years old.Most NICT were solitary and malignant,surgery was effective in prolonging long-term survival.Conclusions NICT is rare and it had no specific clinical presentation.BUS and CT are useful for diagnosis and surgery is effective.
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Pancreatic cancer was one of common malignant tumors of the digestive tract, early diagnosis of which was difficult and surgical resection rate was low. The prognosis was poor, and its incidence increased year by year. Conventional treatment of pancreatic cancer includes surgery, radiotherapy and chemotherapy, but 90％ of the patients had lost the surgical opportunity when they see a doctor, and not sensitive to radiotherapy and chemotherapy. Relative to these traditional treatments, gene therapy is an innovative approach for the treatment of pancreatic cancer and had attracted wide attention in recent years. Many gene therapy drugs for pancreatic cancer had now entered Ⅰ / Ⅱ clinical trials. The gene therapy techniques for pancreatic cancer included antisense gene therapy, suicide gene therapy, immune gene therapy, and oncolytic virus therapy. In this article, we reviewed recent advances in gene therapy for pancreatic cancer.
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Objective To discuss the diagnosis and treatment of splenic harmatoma(SH). Methods The clincial data of three cases of SH treated in our hospital from January 1997 to December 2007 were collected,and the other 17 cases which were published from January 1997 to December 2007 in the Chinese biological and medical lit-erature database were reviewed. The clinical manifestation,pathological findings,diagnosis and treatment of these 20 patients were analyzed. Results The main symptoms were abdominal pain or discomfort and abdominal mass in 13 cases(13/20). All 20 patients underwent surgical treatment with good recovery without severe complications and re-currence. Conclusions The definite diagnosis of SH depends on postoperative pathological findings. Complete surgi-cal resection is the best treatment for SH with favourable prognosis.
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Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.
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Objective To investigate the feasibility of sigrnoid coloplasty for patients after resection of middle or low rectal carcinoma, and to evaluate the defecation function after the operation. Methods Forty-three patients with middle or low rectal cancer who had been admitted to the cancer Hospital of the Chinese Academy of Medical Sciences from January 2007 to January 2008 received sigrnoid coloplasty after rectal carcinoma resection (treatment group), and another 43 patients who had been admitted during the same period received colonic J pouch reconstruction (control group). The feasibility and safety of the 2 surgical procedures and postoperative defecation function were assessed. All data were processed by t test, chi-square test or Fisher exact probability. Results The sigmoid coloplasty was successfully performed in all patients in treatment group, while the reconstruction of the J pouch failed in 4 patients in the control group. Three patients in each group underwent temporary transverse colostomy. The incidences of postoperative complications in treatment group and control group were 7% (3/43) and 9% (4/43), respectively, with no statistical difference between the 2 groups (X2 =0. 282, P > 0.05). The median frequency of defecation in treatment group was 2.0 ± 1.5 per 24 hours, which was significantly less than 2.5 ± 1.0 in control group (X2 = 1. 242, P > 0.05). The fecal incontinence scores in treatment group and control group were 1.7 ± 0. 7 and 1.6 ± 0.8, respectively, with no statistical difference between the 2 groups (t = 0. 285, P > 0. 05). Conclusion Sigmoid coloplasty has similar benefits to colonic J pouch reconstruction, while sigmoid eoloplasty is relatively feasible, effective and safe for low colorectal or coloanal anastomosis.
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Objective To explore clinieopathologieal features and prognosis in a high grade malignancy group of colorectal mueinous carcinoma, signet-ring cell carcinoma and low-differentiated carcinoma. Methods Retrospective analysis and follow-up were made on 148 patients with colorectal mucinous carcinoma, 55 patients with signet-ring cell carcinoma and 281 low- differentiated carcinoma treated in our hospital from 1988 to 2006. Obtained data were analyzed by SPSS13.0. Related factors underwent x2 analysis, survival analysis were estimated using Kaplan-Meier method and compared using the Log-rank test. Results Coloreetal signet-ring cell carcinoma were significantly different from mucinous carcinoma and low- differentiated carcinoma in gender, age, tumor location, bowel obstruction, operative modus, tumor embolism, tumor infiltration and lymph node metastasis(x2 = 7, 67,38.4,86.0,14.5,93.7,17.3,62. 1,24. 4,56.17 ,P <0.05). Median survival time was 24 months in signet-ring cell carcinoma, 47 months in mueinous carcinoma and 49 months in low- differentiated carcinoma. The difference is of significance(x2 = 21.3, P < 0.05). Conclusions Clinicopathological characteristics and prognosis of colorectal signet-ring cell carcinoma, mueinous carcinoma and low- differentiated carcinoma is of significant difference(P < 0.05). Malignancy of signet-ring cell carcinoma is higher with worse prognosis.
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Objective To explore the clinical diagnosis and management of hepatecellular adenoma(HA). Methods Seventeen HA cases treated in our hospital from Janurary 1986 to June 2007 were studied retrospectively.The clinical and pathologic data were reviewed. Results Of 17 patients,9 were male and 8 were female with median age of 46 years.None of the female patients had a history of oral contraceptives.Most patients were agymptomatic.Preoperative liver function test and AFP serum test were normal.Preoperative imaging study yielded deftnite diagnosis in only a fraction of patients.All 17 cases underwent surgical resection and the postoperative course is uneventful.All cases were followed up ranging from 6 to 252 months.Recurrence was not found.Pathology reported atypical hyperplagia in 2 cases and with malignant transformation in 1 case. Conclusions The diagnosis of HA is exclusive and dependent on clinical data,laboratory test and radiography.HA has a tendency to malignancy.Surgery is recommended in all cases.
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Objective To discover the value of endoscopi c ultrasonography (EUS) in predicting the resectability of pancreatic carcinoma.Methods Thirty-eight consecutive patients were prospectively i nvestigated using EUS to determine the tumor resectability. Two specialists eval uated the EUS findings in each of the patients prospectively. All patients were explored and their resectability noted. In the meantime, we compared the accurac y of EUS diagnosis with that of CT, MRI and sonography respectively.Results Ten out of 38 cases with pancreatic carcinoma were cons idered to be resectable by EUS with a positive predictive value of 80 0% in com parison with surgical findings. EUS also had high correlation with surgical resu lts in assessing un-resectability of pancreatic carcinoma, the negative predic tive value is 96 4%. There was 1 false negative and 2 false-positive assessmen ts (sensitivity, 88 9% and specificity, 93 1%). The accuracy of EUS was the hi ghest. The diagnostic accuracy of EUS, CT, MRI and sonography were 97 4%, 94 6 %, 89 5% and 73 7% respectively.Conclusion It is an effective method to use endoscopic ultrason ography in predicting the resectability of pancreatic carcinoma before operation .