RESUMO
Objective:To analyze the interim clinical efficacy of laparoscopic and open distal gastrectomy for gastric cancer in elderly patients.Methods:The prospective randomized controlled study was conducted. The clinicopathological data of 102 patients aged ≥65 years who underwent distal gastrectomy for gastric cancer in the Nanfang Hospital of Southern Medical University from September 2014 to May 2018 were collected. After excluding 6 patients, 96 patients were finally included. Based on random number table, patients were allocated into two groups. Patients undergoing laparoscopic distal gastrectomy were allocated into laparoscopic group, and patients undergoing open distal gastrectomy were allocated into open group, respectively. Obser-vation indicators: (1) grouping situations of the enrolled patients; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect complications in the postoperative 30 days up to July 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( P25, P75) or M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the non-parameter Mann-Whitney U test. Results:(1) Grouping situations of the enrolled patients: a total of 96 patients were selected for eligibility. There were 66 males and 30 females, aged from 65 to 85 years, with a median age of 69 years. There were 49 of 96 patients in the laparoscopic group and 47 patients in the open group. (2) Intraoperative situations: patients in the two groups underwent distal gastrectomy successfully with D 2 lymphadenectomy, without intra-operative conversion to laparotomy. The volume of intraoperative blood loss and surgical incision length were 50 mL(50 mL,100 mL) and (7.1±1.7)cm for the laparoscopic group, respectively, versus 100 mL(100 mL,200 mL) and (19.1±1.7)cm for the open group, showing significant differences between the two groups ( Z=?3.779, t=?34.880, P<0.05) . (3) Postoperative situations: the number of lymph node dissected, time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative first liquid food intake, time to postoperative first semi-liquid food intake, time to drainage tube removal, duration of postoperative hospital stay were 49(35,62), 1.9 days(1.3 days,2.9 days), 2.6 days(2.2 days,2.9 days), 3.4 days(2.7days,4.0 days), 5.9 days(4.7 days,7.7 days), 4.9 days(3.5 days,6.8 days), 7.7 days(6.7 days,8.9 days) for the laparoscopic group, respectively, versus 40(27,51), 2.5 days (1.8 days,3.3 days), 2.6 days(2.2 days,2.9 days), 3.9 days(2.9 days,5.7 days), 4.9 days(3.9 days, 5.9 days), 6.3 days(4.7 days,8.9 days), 8.7 days(6.9 days,11.7 days), showing significant differences between the two groups ( Z=?2.354, ?2.210, ?2.743, ?2.474, ?2.906, ?2.503, ?2.359, P<0.05). (4) Follow-up: patients in the two groups received 30 days of follow-up. During the follow-up, 8 patients in the laparoscopic group had postoperative complications, including 1 case with Clavien-Dindo grade Ⅰ complications, 7 cases with Clavien-Dindo grade Ⅱ complications, and no patient with Clavien-Dindo grade Ⅲ complications. Thirteen patients in the open group had postoperative complications, including 2 cases with Clavien-Dindo grade Ⅰ complications, 10 cases with Clavien-Dindo grade Ⅱ complications, and 1 case with Clavien-Dindo grade Ⅲ complications. There was no significant difference in the above indicators between the two groups ( χ2=1.135, 1.973, 1.054, P>0.05). The overall complication rate was 16.3%(8/49) and 27.7%(13/47) for the laparoscopic group and open group, respectively, showing no significant difference between the two groups ( χ2=1.803, 99.7% confidence interval as ?∞ to 2.4%, P>0.05). The upper limit of 99.7% confidence interval was less than non-inferiority level of 15%, interim analysis of which showed that the complication rate of the laparoscopic group was non-inferior to the open group. Conclusion:For elderly patients undergoing laparoscopic or open distal gastrectomy for gastric cancer, laparoscopic surgery does not increase intraoperative or postoperative complications, and has advantages of minimally invasiveness, fine operation, quicker recovery, and shorter hospital stay. Registry: this study was registered at clinicaltrials.gov in United States, with the registry number of NCT02246153.
RESUMO
Objective To explore the clinical efficacy of dendritic cell activated and cytokine induced killer cell ( DCIK ) combined chemotherapy in treatment of patients with advanced esophageal squamous carcinoma. Methods 60 patients with advanced esophageal squamous carcinoma were selected as the research subjects, they were divided into observation group (32 cases) and control group (28 cases) by random number method.The obser-vation group was given DCIK combined systemic chemotherapy treatment, while the control group was only given chemotherapy.The short-term efficacy,life quality improvement,the immune indexes and the adverse reactions were compared in the two groups 1 month after treatment.Results The short-term efficacy in the observation group was significantly better than the control group(Z=2.807,P<0.05),and the control rate was significantly higher than control group(χ2 =4.133,P<0.05).The life quality in the observation group was significantly better than the control group(Z=2.373,P<0.05),and the effective rate of the observation group was also higher than the control group (χ2 =6.459,P<0.05).The CD3+CD1+8 ,CD3+CD5+6 rates after treatment in the observation group were significantly increased than before treatment (t=7.394,P<0.05),which were significantly higher than the control group(t=-4.564,P<0.05).Conclusion DCIK cell combined chemotherapy not only can improve the immune function in patients with advanced esophageal squamous carcinoma,but also can improve the clinical symptoms and short-term life quality,which has significant clinical application value.
RESUMO
Objective To study the high risk factors of anastomotic leakage after colon cancer surgery ,so as to provide evidence for the prevention of anastomotic leakage. Methods Fifty-three patients with anastomotic leakage after colon cancer surgery of 916 cases were selected as research objects,then the correlation between systemic factors,local factors and occurrence of anastomotic leakage was analyzed and studied. Results The correlation between age, ASA grade, serum hemoglobin, red blood cell, total protein, fasting blood glucose of systemic factors except for sex and occurrence of anastomotic leakage was obvious (P< 0.05). There was correlation between the methods of anastomosis, anastomotic tension, setting position of drainage tube, intestinal obstruction, abdominal infection and degree of tumor differentiation except for with or without chemotherapy and radiotherapy and occurrence of anastomotic leakage(P < 0.05). Conclusion The high risk factors of anastomotic leakage after colon cancer surgery are multiple,and well various work should be done during perioperative period.
RESUMO
Objective To study the diagnosis and surgical treatment of thyroid microcarcinoma. Methods The authors reviewed 53 cases of thyroid cancer, which were diagnosed during and after surgery from December 1993 to January 2002,including 42 cases of thyroid microcarcinoma. Results Out of the 53 cases,35 cases were diagnosed during surgery by frozen section method while the other 18 cases were postoperatively diagnosed by pathological examinations;complicated carcinomatous conversion in contralateral lobe was found in 2 cases and neck lymphatic metastasis in 3 cases; lobectomy plus excision of isthmus was performed in 35 cases, 7 of which simultaneously underwent neck lymph node clearance,and unilateral lobectomy or unilateral or bilateral subtotal lobectomy was adopted in the remaining cases. Recurrence in 2 cases was found during a follow-up period for 2 months～96 months (mean,46 months) in 35 cases, and no fatal cases occurred. Conclusions A high rate of missed diagnosis of thyroid microcarcinoma is present. Thyroid microcarcinoma should be surgically removed.
RESUMO
2(38.2 vs 34.4 months, P=0.214).The 1, 2 and 3-year local control rates were 84.0%, 72.9% and 56.7%, respectively.Conclusion:When given a sufficient combination of modality treatment for selected elderly patients with esophageal carcinoma, the tolerance and therapeutic efficacy were not significantly worse than those of younger patients.Therefore, combined chemoradiotherapy for elderly patients is worthy of further study.
