[Study on the dynamic changes of peripheral platelet-to-lymphocyte ratio in the prognosis of neoadjuvant chemotherapy patients with gastric cancer].

Objective: To investigate the significance of platelet lymphocyte ratio (PLR) before and after neoadjuvant chemotherapy in advanced gastric cancer (AGC). Methods: The medical records of 247 AGC patients who underwent surgery between May 2015 and October 2016 were retrospectively reviewed. The relationship between PLR value and its changes before and after neoadjuvant therapy and clinicopathological features and prognosis was further analyzed. Results: △PLR was defined according to the different states of PLR before and after neoadjuvant therapy. If negative value was defined as"Reduced Group"(138) and positive value or 0 was defined as "Unreduced group"(109). There were statistical differences between the two groups of△PLR in tumor size, nerve invasion, presence or absence of vascular tumor thrombus, ypT staging, ypN staging, ypTNM staging, and pathological response (all P<0.05), but there was no statistical difference between age, gender, and postoperative adjuvant chemotherapy (all P>0.05). Survival analysis showed that the 5-year disease-free survival rates between the two groups were 39.0% and 54.0%, respectively (P=0.025); the 5-year overall survival rates between the two groups were 41.8% and 58.1%, respectively (P=0.035); the difference were statistically significant. Multivariate analysis showed that ypT3-4 stage, ypN3b stage and △PLR were independent risk factors for 5-year disease-free survival rate (HR=2.731/2.676, 95%CI: 1.026-7.268/1.014-6.985; HR=4.717, 95%CI: 1.922-11.579; HR=2.854, 95%CI: 1.117-4.124; all P<0.05) and 5-year overall survival rate (HR=3.226/2.655, 95%CI: 1.280-9.227/0.945-7.548; HR=4.550, 95%CI: 1.842-11.239; HR=2.897, 95%CI: 1.049-5.251; all P<0. 05). Conclusion: △PLR can better predict the prognosis of AGC patients receiving neoadjuvant chemotherapy.

[CT typing and surgical approach for adenocarcinoma of the esophagogastric junction].

Objective: To investigate the feasibility, safety and efficacy of preoperative CT in the classification of adenocarcinoma of the esophagogastric junction. Methods: A total of 517 consecutive patients from May 2012 to June 2016 with esophagogastric junction carcinoma in the department of general surgery of Henan Cancer Hospital was retrospectively analyzed, according to the clinical pathological data of three type four layer method and statistics of various types of surgery in patients with preoperative enhanced CT. Results: 517 patients were successfully received surgery, including 152 cases of type Ⅰ(131 cases of complete abdominal surgery, 21 cases of abdominal incision diaphragm in thoracic surgery), 239 cases of type Ⅱ (177 cases of complete abdominal surgery, 62 cases of abdominal incision diaphragm in thoracic surgery), Ⅲ/Ⅳ type choice of chest abdominal surgery in 126 cases. The operation time was (102±17) min, the amount of hemorrhage was (136±18) ml, the dominant anastomotic fistula happened in 16 cases, 5 cases of pancreatic fistula, 7 cases of intestinal obstruction, anastomotic stenosis in 3 cases, thoracic and abdominal sensation in 12 cases, all the complications were cured by conservative treatment. The average value of esophageal resection margin was(5.1±0.6)cm, 2 cases with positive residual tumor margin and average length of stay was (8.9±1.6)d. Conclusion: Using preoperative enhanced CT in the adenocarcinoma of the esophagogastric junction to choose surgical approach can ensure the safety margin. What's more, unnecessary thoracotomy is reduced which is expected to be a new classification method for the operation of esophagogastric junction cancer.

[The advantage of artery approach in lymph node sorting of rectal cancer].

Objective: To explore the technical advantages of artery approach in lymph node sortingofrectal cancer. Methods: Sixty patients with rectal cancer who treated in general surgery department of Henan provincial tumor hospitalfrom July 2015 to January 2016 were enrolled. Patientswere divided into two groupsrandomly.Lymph node sorting methods of control group andobservation group were the traditional method and the artery approach method respectively. The total number of lymph nodes, the average inspection number, the patients number of lymph nodes less than 12, the number of positive lymph nodes, the metastasis rate of the patients, the number of average diameter less than 5 mm, the number of the positive lymph nodes which average diameter less than 5 mm, the sorting time of lymph nodes, the total number of every stationand other indicators were collected and compared. Results: There wasa significant difference between the observation group and the control groupin the total number(553 vs 395, P<0.05), the number of positive ones(96 vs 54, P<0.05), average inspection number(18.43±5.93 vs 13.27±1.96, P=0.000), the sorting time (min) (14.1±2.5 vs 17.4±3.2, P=0.000), the average diameter less than 5 mm number(4.73±1.31 vs 1.23±1.14, P=0.000), the number of positive ones average diameter less than 5 mm(0.97±1.03 vs 0.20±0.55, P=0.010), the first(8.17±4.58 vs 5.07±1.96, P=0.000) and second station(6.57±1.87 vs 4.90±1.69, P=0.001)inspection number.The inspection number less than 12, the positive rate of lymph node, the metastatic rate of the patient and the inspection number of third station have no significant differences (all P≥0.05). Conclusion: Theartery approach method inrectal cancer lymph node inspectionhas many advantages such as simple operation, obtaining more lymph nodes and more accurate pathological staging.