Timing of radical surgery in patients with postoperative incidentally discovered gallbladder cancer / 中华肝胆外科杂志

Objective To compare the tumor characteristics and survival between postoperative incidentally discovered gallbladder cancer (ID-GBC) and preoperatively suspected gallbladder cancer (PS-GBC).Methods The data of 276 GBC patients who underwent surgical resection with curative intent between January 2004 and December 2014 at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed.Results The 1-,3-,and 5-year cumulative survival rates of the ID-GBC group (88.8％,52.2％,and 33.0％,respectively) were significantly better than those in the PS-GBC group (57.5％,25.7％,and 16.6％,P ＜ 0.05).In the ID-GBC group,multivariate analysis revealed that T staging,hepatic invasion and time interval from cholecystectomy to re-operation were independent prognostic factors.The overall survival (OS) in the group with the time interval within 2 weeks was significantly better than those in the other two groups (both P ＜ 0.05).However,there were no significant differences in OS between the groups with the time interval of 2 weeks to 1 month and more than 1 month (P ＞ 0.05).Conclusions Postoperative ID-GBC had significantly better survival outcomes than PS-GBC.Reoperation within two weeks in patients with ID-GBC is a good strategy.

Correlation between body mass index and prognosis of gallbladder cancer / 国际外科学杂志

Objective:To explore the relationship between body mass index (BMI) and clinicopathological features and prognosis of gallbladder cancer.Methods:The clinical and follow-up data of three hundred and eighty-six patients of gallbladder carcinoma were retrospectively, who were treated from January 2008 to December 2013 in the Department of Hepatobiliary Surgery, Eastern Hepatobiliary Hospital, Second Military Medical University. According to the guidelines for prevention and control of overweight and obesity in Chinese adults, the patients were divided into three groups: normal weight group(BMI<23.5 kg/m 2, 239 cases, accounting for 61.9%), overweight group (23.5 kg/m 2≤BMI<27.5 kg/m 2, 127 cases, accounting for 32.9%) and obesity group(BMI≥27.5 kg/m 2, 20 cases, accounting for 5.18%). The clinicopathological factors(gender, age, diabetes mellitus, hypertension, gallbladder related diseases, jaundice, tumor location, TMN, postoperative days, tissue differentiation, liver invasion, intraoperative blood transfusion, complications) of the three groups were compared, and the relationship between BMI and 5-year survival rate was analyzed. Measurement data with normal distribution were indicated as mean±standard deviation( Mean± SD), measurement data with skewed distribution were represented as M( P25, P75). Nonparametric rank sum test was used for measurement data. Categorical variables were compared by the chi-square test or Fisher probability method. The survival curve was drawn by the Kaplan-Meier method. The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model. Results:The median survival time of 386 patients with gallbladder cancer was 12.1 months. The overall survival rates of 1, 3 and 5 years were 51.8%, 25.2% and 16.8%, respectively. Univariate survival analysis showed that age, jaundice, accidental gallbladder cancer, tumor location, TMN, surgical method, tissue differentiation, liver invasion, intraoperative blood transfusion, and complications affected the 5-year survival rate ( χ2=12.24, 30.87, 37.01, 7.92, 104.23, 118.76, 12.05, 49.12, 6.85, 12.24, P<0.05). BMI was related to hypertension, but it had no significant effect on the 5-year survival rate. However, with the increase of BMI, the 5-year survival rate increased (16.3% vs 16.7% vs 23.3%, P=0.774). Multivariate survival analysis showed that surgical method( OR=1.441, 95% CI: 1.219-1.705), liver invasion( OR=1.625, 95% CI: 1.264-2.091), M stage( OR=1.664, 95% CI: 1.070-2.587), and N stage( OR=1.511, 95% CI: 1.218-1.875) were independent risk factors for prognosis in this group of patients ( P<0.05), and BMI was not an independent risk factor ( P=0.901). Conclusions:BMI has no significant effect on the prognosis of patients with gallbladder cancer. Obese patients with gallbladder cancer do not need to wait for weight loss before surgery.

Emergency diagnosis and treatment skills of acute abdomen / 国际外科学杂志

Acute abdomen is a common clinical disease and frequently-occurring disease. It has the characteristics of acute onset, rapid progress and many changes in clinical manifestations. It often involves multiple systems in treatment, and often requires multidisciplinary cooperation in diagnosis and treatment. As a first-line doctor, it is not easy to quickly diagnose and make correct decisions. Once it is handled improperly, it can lead to serious consequences. Although there are many related articles on the diagnosis and treatment of acute abdomen, with the continuous development of clinical diagnosis and treatment methods, it is still necessary to update the emergency diagnosis and treatment skills of acute abdomen. This article introduces the classification, characteristics, diagnosis, treatment of acute abdomen both inthe common population and special population, and hopes to cultivate the clinical diagnosis and treatment thinking of young doctors.

Emergency diagnosis and treatment skills of acute abdomen / 国际外科学杂志

Acute abdomen is a common clinical disease and frequently-occurring disease.It has the characteristics of acute onset,rapid progress and many changes in clinical manifestations.It often involves multiple systems in treatment,and often requires multidisciplinary cooperation in diagnosis and treatment.As a first-line doctor,it is not easy to quickly diagnose and make correct decisions.Once it is handled improperly,it can lead to serious consequences.Although there are many related articles on the diagnosis and treatment of acute abdomen,with the continuous development of clinical diagnosis and treatment methods,it is still necessary to update the emergency diagnosis and treatment skills of acute abdomen. This article introduces the classification,characteristics,diagnosis,treatment of acute abdomen both inthe common population and special population,and hopes to cultivate the clinical diagnosis and treatment thinking of young doctors.

Clinical features and prognosis analysis of gallbladder cancer after radical resection in elderly patients / 国际外科学杂志

Objective To clarify the characteristics and postoperative benefit of gallbladder carcinoma in elderly patients (≥ 65 years old).Methods Two hundred and seventy-three patients of gallbladder carcinoma were collected,who were treated intent resection from January 2004 to December 2012 in the Department of Hepatobiliary Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University.More than 65 years old was defined as the elderly,else was defined as the younger.The clinical-pathological features and prognosis of 85 elderly patients(elderly group) and 188 younger patients (younger group) were retrospectively analyzed.The survival of patients were followed up by telephone or outpatient.The incidence of hypertension,incidence of diabetes,TNM staging,and median CA19-9 were compared between the two groups.Continuous variables using a two-sample t test or Mann-Whitney U test.Categorical variables were compared by the Chi-square test or Fisher probability method.The survival curve was drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model.Results The incidence of hypertension,incidence of diabetes,TNM stage ratio (Ⅲ + Ⅳ/Ⅰ + Ⅱ),and CA19-9 median in the elderly group were 30.6％,11.8％,27.6 and 69.3 U/ml,respectively.The differences in the younger group were 13.8％,4.8％,7.9 and 28.2 U/ml,respectively,with statistically significant difference between the two groups (all P ＜ 0.05).The incidence of complications was 54.1％ in the elderly group and 48.9％ in the younger group,with no significant difference between the two groups (P =0.302).The median survival of the elderly group was 28.01 months,and the median survival of the younger group was 36.20 months,with no statistical difference between the two groups (P =0.131).Cox analysis showed that independent prognostic risk factors for the elderly patients with gallbladder cancer included liver invasion (HR =2.386,95％ CI:1.379-4.127,P =0.002) and lymph node metastasis (HR =1.866,95 ％ CI:1.100-3.167,P =0.021).Conclusions Radical resection is safe and feasible for elderly patients with gallbladder carcinoma.Age is not a contraindication for surgery.Radical resection can get the same benefits as young people.Liver invasion and lymph node metastasis are independent risk factors affecting the prognosis of the elderly patients with gallbladder carcinoma.

Clinical significance of joint application of carcinoembryionic and carbohydrate antigen 19-9 for improving the prognostic prediction in patients with gallbladder cancer / 国际外科学杂志

Objective To investigate the clinical significance of joint application of carcinoembryionic and carbohydrate antigen 19-9 for improving the prognosis of patients with gallbladder cancer.Methods A retrospective analysis of clinical-pathological features and prognosis were conducted including 390 patients with gallbladder cancer,who were treated from January 2003 to December 2013 at Eastern Hepatobiliary Surgery Hospital of Second Military Medical University.The clinical value of joint application of careinoembryionic and carbohydrate antigen 19-9 in prognosis was explored.The survival of patients was followed up by telephone or outpatient.Continuous variables were indicated as median (average) and categorical variables were expressed as number(n).Mann-Whitney U test was applied for continuous variables.Categorical variables were compared by the Chi-square test or Fisher probability method.The survival curve was drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model.Results Of the 390 patients,327 had complete data.The median (range) follow-up time was 49 (1-123) months.Both carcinoembryionic and carbohydrate antigen 19-9 could be used to predict prognosis of gallbladder cancer.A linear combination of carcinoembryionic and carbohydrate antigen 19-9 was significantly better(0.9365) than carbohydrate antigen 19-9 (0.7619) as well as carcinoembryionic (0.7937) alone in term of specificity.Preoperative blood test carcinoembryionic and carbohydrate antigen 19-9 nature showed double-negative group had the best prognosis,with a median survival of 27.06 months,R0 radical rate was 86.1％.Doublepositive group had the worst prognosis,with a median survival of 6.17 months,R0 radical rate was 45.1％.Conclusions Combinations of pretherapeutic tumor makers carcinoembryionic and carbohydrate antigen 19-9 can improve the accuracy of predicting prognostic in patients with gallbladder cancer,and the clinical application is practical.