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1.
Medicine (Baltimore) ; 98(41): e17497, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593116

RESUMO

BACKGROUND: This study will systematically evaluate the psychological effects of advanced care (AC) on patients who received endoscopic gastric cancer resection (EGCR). METHODS: This study will search the following databases of Cochrane Library, Pubmed, EMBASE, Web of Science, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the present with no language limitation. All randomized controlled trials on assessing the psychological effects of AC for patients with EGCR will be included. RESULTS: This study will explore the psychological effects of AC on EGCR by assessing depression, anxiety, health-related quality of life, and adverse events. CONCLUSION: This study will summarize recent evidence for the psychological effects of AC on EGCR. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019139868.


Assuntos
Endoscopia/métodos , Gastrectomia/psicologia , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Ansiedade/epidemiologia , Ansiedade/psicologia , China/epidemiologia , Depressão/epidemiologia , Depressão/psicologia , Gastrectomia/efeitos adversos , Humanos , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 98(41): e17543, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593134

RESUMO

This study aims to investigate the adaptation process of the alimentary tract after distal gastrectomy and understand the impact of remnant stomach volume (RSV) on diet recovery.One year after gastrectomy, although patients' oral intake had increased, the RSV was decreased and small bowel motility was enhanced. Patients with a larger RSV showed no additional benefits regarding nutritional outcomes.We prospectively enrolled patients who underwent distal gastrectomy with Billroth II reconstruction to treat gastric cancer at a tertiary hospital cancer center between September 2009 and February 2012. Demographic data, diet questionnaires, computed tomography (CT), and contrast fluoroscopy findings were collected. Patients were divided into 2 groups according to the RSV calculated using CT gastric volume measurements (large vs small). Dietary habits and nutritional status were compared between the groups.Seventy-eight patients were enrolled. Diet volume recovered to 90% of baseline by the 36 postoperative month, and RSV was 70% of baseline at 6 months after surgery and gradually decreased over time. One year after surgery, small bowel transit time was 75% compared to the 1st postoperative month (P < .05); however, transit time in the esophagus and remnant stomach showed no change in any studied interval. Compared to patients with a small RSV, those with a large RSV showed no differences in diet volume, habits, or other nutritional benefits (P > .05).Diet recovery for distal gastrectomy patients was achieved by increased small bowel motility. The size of the remnant stomach showed no positive impact on nutritional outcomes.


Assuntos
Dieta/estatística & dados numéricos , Gastrectomia/métodos , Coto Gástrico/diagnóstico por imagem , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Adaptação Fisiológica , Idoso , Feminino , Motilidade Gastrointestinal/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Período Pós-Operatório , Estudos Prospectivos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X
3.
Rev Col Bras Cir ; 46(4): e20192256, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31576989

RESUMO

OBJECTIVE: to evaluate the clinical and pathological characteristics and survival of young patients with gastric cancer, regardless of the intention of treatment. METHODS: we conducted a retrospective analysis of all gastric cancer patients undergoing any surgical treatment between 2008 and 2017. We considered patients under 45 years old as young adults and those over 45 years old, as of advanced age. RESULTS: of the 875 patients evaluated, 84 (9.6%) were young adults and 791 (90.4%) were older. Younger patients were associated with female gender (p<0.001), lower Charlson score (p=0.002), ASA I/II (p<0.001), diffuse Lauren type (p<0.001) and poorly differentiated tumors (p<0.001). There was no difference between groups regarding treatment intention (palliative versus curative) (p=0.267) and cTNM clinical stage (p=0.120). Disease-free survival was worse in younger individuals (p=0.049), but overall survival was similar between groups (p=0.578). Multivariate analysis identified total gastrectomy, pT3/T4, pN+, and diffuse Lauren type as prognostic factors associated with worse disease-free survival and overall survival. Age was not an independent factor associated with worse prognosis. CONCLUSION: although younger patients had lower disease-free survival, overall survival was similar between groups, and age was not a significant independent prognostic factor.


Assuntos
Neoplasias Gástricas/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Intervalo Livre de Doença , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Adulto Jovem
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 913-915, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630485

RESUMO

A multicenter, randomized, controlled clinical trial of laparoscopic gastrectomy for locally advanced distal gastric cancer (CLASS - 01 trial, ClinicalTrials.gov registration number NCT01609309) confirmed that experienced surgeons could safely performed laparoscopic D2 distal gastrectomy for patients with locally advanced gastric cancer, with minimally invasive benefits and non-inferior oncological efficacy. This provides strong evidence of the treatment of locally advanced gastric cancer via laparoscopic approach, comparable to open surgery. In September 2019, "Standard Operation Procedure of Laparoscopic D2 Distal Gastrectomy for Locally Advanced Gastric Cancer: Consensus on CLASS-01 trial" was published in the Chinese Journal of Gastrointestinal Surgery, which was highly evaluated by Chinese and overseas experts. Under the situation of wide application of minimally invasive surgery, the CLASS group published a 10-year scientific research summary and released the "Standard Operation Procedure", which has landmark significance and has become the recognized Chinese standard of laparoscopic surgery for the treatment of gastric cancer world wide. This will guide the scientific development of laparoscopic gastric cancer surgery in China, avoiding abuse or inappropriate use of minimally invasive techniques, while ensuring the rational use with fully benefits to the patients with gastric cancer.


Assuntos
Gastrectomia/normas , Laparoscopia/normas , Neoplasias Gástricas/cirurgia , China , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Excisão de Linfonodo , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 916-919, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630486

RESUMO

The CLASS group's vision carries out "research, standardization and promotion of new technologies for laparoscopic gastric cancer surgery, cooperation, mutual benefit, hand in hand to the international academic frontier, leading the scientific development of minimally invasive surgery for gastric cancer in China, and benefiting people's health with high-level clinical research". In the past ten years, CLASS group has become a pioneering force in promoting the progress of laparoscopic surgery for gastric cancer in China. The successful implementation of the CLASS - 01 trail has created a new standard in the clinical research of minimally invasive gastrointestinal surgery and cultivated a high - level surgical clinical research team all over the country. After the successful CLASS - 01 trial, the trials from CLASS - 02 to - 05 has been successfully implemented, CLASS - 06 to - 10 series are in an orderly advancement. On the tenth anniversary of the establishment of the CLASS group, we would like to thank the help from peer, review the development process, look forward to future cooperation, and work together to create a new situation of minimally invasive surgery.


Assuntos
Gastrectomia/métodos , Laparoscopia/normas , Neoplasias Gástricas/cirurgia , China , Gastrectomia/normas , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 926-931, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630488

RESUMO

Gastric cancer is a common malignant tumor of digestive system. D2 procedure is recognized as the standard operation for advanced gastric cancer at present. However, controversies still exist in the standardization and quality control of surgical procedures. Total mesorectal excision (TME) and complete mesocolic excision (CME) based on the membrane anatomy perfectly solve these problems in the treatment for colorectal cancer. However, the complexity of mesogastrium determines that TME and CME cannot be easily transplanted to the treatment of gastric cancer. The practical membrane anatomy in gastric cancer surgery is just emerging and its impact on the treatment of gastric cancer is immeasurable. By reviewing the evolution and embryonic development of digestive system, and combining with actual operation, this paper analyzes and redefines several key issues such as traditional Toldt space, Gerota fascia and complete mesenteric excision. On this basis, we propose a novel and feasible surgical procedure named regional en bloc mesogastrium excision (rEME) for distal gastric cancer. The concept of en bloc mesogastrium excision (EME) based on membrane anatomy may have some influences on the lymph node grouping from the 'Japanese Classification of Gastric Carcinoma'. Performance of EME may reduce the controversies about the group of lymph nodes and their borders. EME in the infra-pyloric region weakens the significance of subdivision of No.6 lymph nodes into No.6a, No.6v and No.6i. More studies are needed in the construction of a mature theoretical system for practical membrane anatomy in gastric surgery.


Assuntos
Gastrectomia/métodos , Excisão de Linfonodo/métodos , Mesentério/patologia , Mesentério/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Gastrectomia/normas , Humanos
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 955-960, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630493

RESUMO

Objective: To evaluate the incidence of intraoperative vascular injury (IVI) and associated anatomical features during laparoscopy - assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Methods: A descriptive cohort study was performed. Clinical data and operational videos of 278 consecutive gastric cancer patients who underwent LADG with D2 lymphadenectomy for gastric cancer at Department of General Surgery of Nanfang Hospital between January 2010 and December 2017 were retrospectively analyzed. IVI and vascular anatomy during lymphadenectomy were observed and recorded in the following four scenes: scene I: No. 4sb and No.4d of lower left (tail of pancreas) area; scene II: No.6 of lower right (subpyloric) area; scene III: No.5 and No.12a of upper right (suprapyloric) area; scene IV: No. 7, No. 8a, No. 9, No. 11p of central area posterior to the gastric body. IVI was defined as the injury of main perigastric vessel requiring additional procedure for hemostasis such as electrocauterization, gauze compression, clipping or suture. Results: Among 278 patients, 125 (45.0%) had IVI. Two cases of IVI required conversion to open operation and the injuried vascular was left gastric artery (LGA) and right gastric artery (RGA), respectively. Higher incidence of IVI was found in scene II (92/278, 33.1%) and scene IV(39/278, 14.0%). More common IVI was observed in right gastroepiploic vein (RGeV, 57/278, 20.5%) and left gastric vein (LGV, 33/278, 11.9%). The right gastroepiploic vessels were observed in all 278 patients, including 3 (1.1%) cases with 2 RGeVs, and 2 cases with 2 right gastroepiploic arteries (RGeA). RGA was observed clearly in 265 (95.3%) patients, whose ramification pattern was as follows: from proper hepatic artery (PHA, 223/265, 84.2%), from gastroduodenal artery (GDA, 16/265, 6.0%), from left hepatic artery (LHA, 12/265,4.5%), from the crossing of PHA and GDA (8/265, 3.0%), and 6 (2.3%) patients with 2 RGAs simultaneously from PHA and GDA, respectively. The most common injury of RGA (4/12) occurred in LHA. Excluding 2 cases of conversion to open surgery due to intraoperative hemorrhage, among 276 patients, LGV was observed in 270 patients (97.1%), whose drainage pattern was as follows: into the portal vein (PV, 148/270, 54.8%), into the spleen vein (SV, 56/270, 20.7%), into the junction of these two veins (52/270, 19.3%), into left portal vein (LPV, 8/270, 3.0%), meanwhile 6 patients had 2 LGVs simultaneously, including LGVs of 5 cases into PV and SV, and of 1 case into PV-SV junction and SV. The most common IVI was found in those patients with two LGVs (4/6). Conclusions: IVI during LADG with D2 lymphadenectomy is common. The highest risk of IVI is found in scene II and scene IV. Attentions should be paid to anatomic variation of vessels, especially the RGeV, LGV and RGA.


Assuntos
Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Lesões do Sistema Vascular/etiologia , Gastrectomia/métodos , Humanos , Complicações Intraoperatórias , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Estudos Retrospectivos , Lesões do Sistema Vascular/cirurgia , Gravação em Vídeo
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 984-989, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630498

RESUMO

Objective: To study the sensitivity of multi-slice spiral CT in the diagnosis of lymph node metastasis in different lymph node stations of gastric cancer. Methods: A retrospective series of case study was employed in the research. Inclusion criteria: (1) patients undergoing preoperative abdominal CT scan plus enhanced examination, and data in the image archiving and communication system of Sun Yat-sen University Cancer Center; (2) patients undergoing total or subtotal gastrectomy plus D2 or D1+ lymphadenectomy, with more than 15 harvested lymph nodes and more than 1 metastatic lymph node confirmed by postoperative pathology; (3) WHO pathological classification defined as gastric adenocarcinoma; (4) no history of lymph node tuberculosis, giant lymph node hyperplasia, lymphoma or other diseases resulting in enlarged lymph nodes; (5) no history of gastrectomy; (6) no preoperative neoadjuvant therapy. Clinicopathologic data of gastric cancer patients at the Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center from January 2009 to December 2012 were retrospectively analyzed. Using the pathologically positive lymph nodes as a reference, the sensitivity of CT-positive lymph nodes was calculated (total number of positive image lymph nodes/total number of positive pathological lymph nodes) and complete coincidence rate (number of case defined as complete coincidence/number of case with positive pathologic lymph nodes; complete coincidence indicated that the number of positive image lymph nodes was consistent with the number of positive pathologic lymph nodes in each lymph node station). The χ(2) test was used to compare the sensitivity of CT in the diagnosis of lymph node metastasis in each lymph node station. Results: A total of 228 patients with pathology-proven gastric cancer were enrolled in the study, including 147 male and 81 female. The overall sensitivity of CT in diagnosis of metastatic lymph nodes in gastric cancer was 68.7% (1769/2576). The sensitivity of CT in diagnosis of lymph node metastasis of groups 1 to 8 from high to low was group 3 [81.1% (506/624)], group 7 [73.9% (246/333)], group 2 [70.3% (111/158)], group 6 [68.7% (248/361)], group 4 [68.1% (262/385)], group 8 [60.4% (116/192)], group 1 [53.8% (155/288)], group 5 [47.1% (82/174)]. The CT diagnostic sensitivity of group 3 was significantly higher than the overall level (χ(2)=37.689, P<0.001). The CT diagnostic sensitivity of group 5 was significantly lower than the overall level (χ(2)=34.387, P<0.001). The CT diagnostic sensitivity of group 1 was also significantly lower than the overall level (χ(2)=25.918, P<0.001). Significant differences were not found in the CT diagnostic sensitivity of group 2, 4, 6, 7, 8 compared with the overall level (all P>0.05). The complete coincidence rate was 56.9% (536/942) between pathological positive lymph nodes and CT positive lymph nodes. The highest complete coincidence rate was observed in group 3 (68.0%, 123/181) and the lowest was in group 1 (41.4%, 46/111), whose difference was statistically significant (χ(2)=9.673, P=0.002). Conclusion: The sensitivity of CT in diagnosis of lymph nodes in different lymph node stations of gastric cancer is different.


Assuntos
Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Neoplasias Gástricas/diagnóstico por imagem , Feminino , Gastrectomia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada Espiral
9.
Medicine (Baltimore) ; 98(38): e16980, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567933

RESUMO

RATIONALE: Gastric glomus tumor (GGT) is a rare gastrointestinal tumor and its preoperative imaging features are significant to make a correct diagnosis, while the assessment of the pathological and immunohistochemical characteristics of the specimen are the main methods used for its diagnosis. This study introduces the clinical uniqueness, endoscopic ultrasonography, radiology, histology and immunohistochemistry results of a patient with GGT to discuss the imaging and clinico-pathological features, diagnosis and differential diagnosis of GGT. PATIENT CONCERNS: The patient expressed a complaint concerning an "intermittent abdominal pain for 4 months". DIAGNOSES: The patient was diagnosed with gastric stromal tumor according to the clinical manifestations and imaging examination before the operation. The pathological examination of an intra-operative frozen sample confirmed the benign nature of the tumor, while post-operative immunohistochemistry results indicate the presence of a GGT. The postoperative histology revealed a tumor tissue composed of irregular blood vessels and glomus cells of same size with interstitial hyaline and mucoid degeneration. Immunohistochemical staining showed positivity for SMA (+), vimentin (3+), CD 34 (vascular +), and Factor VIII (vascular +). INTERVENTIONS: The tumor was completely removed by surgery. OUTCOMES: The patient recovered well, and was discharged from the hospital. Five months after the operation, a normal gastric mucosa was observed by gastroscopic examination. LESSONS: Most of the GGTs are benign lesions, surgical resection is the preferred treatment and they result in a good prognosis. However, malignant GGT should be treated as soon as possible because of its metastatic potential and recurrence. Adjuvant radiotherapy or chemotherapy might be useful after operation.


Assuntos
Tumor Glômico/cirurgia , Neoplasias Gástricas/cirurgia , Diagnóstico Diferencial , Endossonografia , Tumor Glômico/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/diagnóstico por imagem
10.
Zhonghua Yi Xue Za Zhi ; 99(32): 2497-2500, 2019 Aug 27.
Artigo em Chinês | MEDLINE | ID: mdl-31484275

RESUMO

Objective: To investigate the feasibility of surgical treatment of port-site metastasis after laparoscopic radical resection of gastric cancer. Methods: The clinical and follow-up data of five patients with port-site metastases after laparoscopic radical resection of gastric cancer at Zhejiang Provincial People's Hospital between January 2014 and January 2018 were retrospectively analyzed. Results: Port-site metastases occurred within 6 months after gastrointestinal tumor resection in three patients, 10 months after the operation in one patient, and 30 months after the operation in one patient, respectively. Metastasis to the abdominal cavity or distant metastasis was excluded before the surgical treatment of the port-site metastases, and all patients recovered well after the operation. No incisional infection or hernia occurred. By December 2018, two patients died (they survived for 13 and 24 months, respectively) and three patients survived. The follow-up duration ranged from 7 to 19 months. Conclusions: Surgical resection of port-site metastases is not difficult due to their superficial location. Surgical treatment can improve the prognosis of patients without abdominal or distant metastasis/recurrence.


Assuntos
Laparoscopia , Neoplasias Gástricas , Humanos , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
11.
Anticancer Res ; 39(9): 5033-5038, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519611

RESUMO

BACKGROUND: Robotic surgical systems have advantages over laparoscopic surgery. The object of this study was to assess patients' postoperative outcomes after robotic distal gastrectomy (RDG) compared to laparoscopic distal gastrectomy (LDG). PATIENTS AND METHODS: We retrospectively evaluated 21 and 119 patients who underwent RDG and LDG, respectively, for stage I gastric cancer. Short-term outcomes were compared including drain amylase levels and quality of life using a post-gastrectomy syndrome questionnaire. RESULTS: No patients experienced pancreatic fistula or anastomosis-related complications following RDG. The rate of overall complications tended to be lower in patients undergoing RDG. In addition to drain amylase level, inflammatory findings were lower after RDG than LDG. Patients undergoing RDG experienced a better quality of life and less dissatisfaction in daily life. CONCLUSION: RDG is feasible and produced highly-satisfactory results for early gastric cancer. We believe that the effective use of robotic surgery will increase safety and precision in minimally invasive surgery.


Assuntos
Gastrectomia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/diagnóstico , Resultado do Tratamento
12.
Am Surg ; 85(8): 794-799, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560299

RESUMO

There has been increasing utilization of minimally invasive surgical approaches. This study evaluates the effect of surgical approach on total lymph node harvest in gastrectomy. Patients undergoing gastrectomy for gastric adenocarcinoma between 2007 and 2018 were reviewed retrospectively. Data collected included age, gender, race, BMI, neoadjuvant therapy, tumor stage, surgical approach, and total number of lymph nodes harvested. The total number of harvested lymph nodes for open, laparoscopic, and robotic gastrectomy was compared using the Kruskal-Wallis test for univariate analysis and a Poisson regression model for multivariable analysis. One hundred four patients were identified. Median node harvest for open, laparoscopic, and robotic approaches were 16, 17, and 36, respectively. Multivariable analysis controlling for gender, BMI, pathological T stage, and year of operation demonstrates that surgical approach is statistically significantly associated with lymph node harvest (F = 83.4, P < 0.0001). In multivariable analysis, robotic approach was associated with greater lymph node harvest than both open (P < 0.0001) and laparoscopic (P < 0.0001) approaches, whereas laparoscopic approach was associated with greater lymph node harvest than open (P < 0.0001) approach. These data demonstrate that for patients undergoing gastrectomy for gastric adenocarcinoma at our institution, robotic approach is associated with greater lymph node harvest than both laparoscopic and open approaches.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Gástricas/patologia
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(9): 807-811, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31550817

RESUMO

A prospective, multicenter, randomized controlled trial (CLASS-01) of laparoscopic versus open surgery for locally advanced distal gastric cancer provides high-level evidence-based evidence for minimally invasive surgery for locally advanced gastric cancer. The findings showed that the experienced surgeons could perform laparoscopic D2 distal gastrectomy for locally advanced gastric cancer safely and effectively, with significant minimally invasive advantages, which attracting extensive attention in the academic community. In order to correctly understand and scientifically apply the results of this research in clinical practice, this paper summarized the research consensus of CLASS-01 trail for readers, including relevant definitions, surgical indications, device preparation, perioperative management, surgical principles and standards as well as the operational processes and quality control. The relevant standard procedures in this paper are the consensuses which were reached between the researchers when writing the CLASS-01 research plan. The basic principles referred to the international and domestic treatment guidelines and at the same time fully considered the actual situation of laparoscopic gastric cancer surgery in China. It has crucial guiding significance for the scientific development and rational promotion of laparoscopic surgery for gastric cancer in China.


Assuntos
Gastrectomia , Laparoscopia , Neoplasias Gástricas , China , Consenso , Gastrectomia/métodos , Humanos , Laparoscopia/normas , Estudos Prospectivos , Neoplasias Gástricas/cirurgia
14.
Zhonghua Wai Ke Za Zhi ; 57(10): 38-43, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510731

RESUMO

Objective: To evaluate the accuracy of endoscopic titanium clip localization combined with CT three-dimensional reconstruction for the control of incision margin in early gastric cancer under laparoscopy. Methods: A prospective analysis was made for gastric cancer whose lesions were located in the middle of the stomach and T stage was 1 to 2 from October 2017 to January 2019 at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital. Totally 25 patients were eventually enrolled in the study. There were 17 males and 8 females aging of (63.6± 7.2) years (range: 48 to 77 years). All cases were treated with titanium clip localization under endoscope combined with CT three-dimensional (3D) reconstruction to construct a virtual panorama of gastric cavity and lesions, and to design surgical margins. Laparoscopic surgical resection was performed according to the surgical margins designed before operation. The distance from the gastric angle to the origin of the minor curvature of the incisional margin, the distance from the gastric angle to the the center of lesion and the distance of the upper incision margin were measured under three-dimensional CT reconstruction and under actual specimen. Paired t test was used to compare the three distances measured by two methods. Results: The measured distances from the gastric angle to the center of the lesion and the proximal incisional margin under 3D reconstruction CT were according to the measured values of actual specimens ((2.67±1.38) cm vs. (2.83±1.56) cm, t=1.51, P=0.14; (5.23±0.60) cm vs. 5 cm, t=1.93, P=0.07); the measured distances from the gastric angle to the origin of the minor curvature of the incisional margin under CT 3D reconstruction were different with the measured values of solid specimens ((5.94±0.94) cm vs. (6.37±0.90) cm, t=3.52, P=0.00). Conclusion: The method of titanium clip localization combined with CT 3D reconstruction can provide a feasible laparoscopic localization method and incision edge solution for T1 to 2 gastric central cancer.


Assuntos
Margens de Excisão , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Gastrectomia , Gastroscopia , Humanos , Imagem Tridimensional , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X
15.
Medicine (Baltimore) ; 98(37): e17154, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517859

RESUMO

INTRODUCTION: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a heterogeneous group of epithelial neoplasms originating from the diffuse neuroendocrine cell system of the gastrointestinal tract and pancreas. They are very rare, especially in pediatric age, and vary widely in terms of clinical presentation, malignant potential, and prognosis. PATIENT CONCERNS: A 9 years' old, white female child presented with abdominal pain and diarrhea mixed with bright red blood lasting 2 days followed by hematemesis. DIAGNOSIS: Routine laboratory tests revealed microcytic anemia. Upper endoscopy showed a 20-mm polypoid lesion in the posterior wall of the duodenal bulb. Biopsy specimens were taken and histologic analysis showed a well-differentiated neuroendocrine tumor G1, with a ki-67 index <2%, an expression of chromogranine A (CgA), synaptophysin and somatostatin receptor type 2A (SSTR2A). Endoscopic ultrasound showed a 21-mm hypoechoic, hypervascular lesion involving the mucosal, submucosal, and muscular layers and a 15-mm hypoechoic round periduodenal lymph node. Gallium-68-somatostatin receptor positron emission tomography (PET with Ga-DOTATOC) showed one area of tracer uptake in the duodenum and other one near the duodenum compatible with the primary tumor site and a lymph node respectively. All the tests confirmed the diagnosis of a GEP-NET of the duodenal bulb, with a single lymph-node metastasis. INTERVENTIONS: The patient underwent an open duodenal wedge resection. OUTCOMES: The follow-up at 6, 24, and 36 months and then yearly after surgery for a total of 42 months showed no evidence of recurrence. CONCLUSION: Duodenal neuroendocrine tumors represent 1% to 3% of all GEP-NETs. They are rare in adults and extremely rare in children. Therefore, the diagnostic and therapeutic approach should be multidisciplinary, including laboratory, endoscopic, and specific imaging tests and strictly follows guidelines, to avoid misdiagnosis and inadequate treatments. Although the prognosis is benign in most cases, they can present with metastases. Therefore, a careful follow-up is extremely important.


Assuntos
Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/cirurgia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Criança , Diagnóstico Diferencial , Duodeno , Feminino , Humanos , Neoplasias Intestinais/patologia , Metástase Linfática/diagnóstico , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/patologia
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 729-735, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422610

RESUMO

Objective: To explore the feasibility of assessing complications registration through medical information. Methods: A descriptive case series study was performed to retrospectively collect medical information and complication registration information of gastric cancer patients at Department of Gastrointestinal Cancer Center Ward I, Peking University Cancer Hospital from November 1, 2016 to March 1, 2017 (the first period), and from November 1, 2018 to March 1, 2019 (the second period). Case inclusion criteria: (1) adenocarcinoma confirmed by gastroscopy and biopsy; (2) patients undergoing open surgery or laparoscopic radical gastrectomy; (3) complete postoperative medical information and complication information. Patients who were directly transferred to ICU after surgery and underwent emergency surgery were excluded. Because difference of the complication registration procedure at our department existed before and after 2018, so the above two periods were selected to be used for analysis on enrolled patients. The prescription information during hospitalization, including nursing, medication, laboratory examination, transference, surgical advice, etc. were compared with the current Standard Operating Procedure (SOP, including preoperative routine examinations, inspection, perioperative preventive antibiotic use, postoperative observational tests, inspection, routine nutritional support, prophylactic anticoagulation, and prophylactic inhibition of pancreatic enzymes, etc.) for gastric cancer at our department. Medical order beyond SOP was defined as medical order variation. Postoperative complication was diagnosed using the Clavien-Dindo classification criteria, which was divided into I, II, IIIa, IIIb, IVa, IVb, and V. Medical order variation and complication registration information were compared between the two periods, including consistence between medical order variation and complication registration, missing report, underestimation or overestimation of medical order variation, and registration rate of medical order variation [registration rate = (total number of patients-number of missing report patients)/total number of patients], severe complications (Clavien-Dindo classification ≥ III), medical order variation deviating from SOP and the corresponding inferred grading of complication. The data was organized using Microsoft Office Excel 2010. Results: A total of 177 gastric cancer patients were included in the analysis. The first period group and the second period group comprised 89 and 88 cases, respectively. The registrated complication rate was 23.6% (21/89) and 36.4% (32/88), and the incidence of severe complication was 2.2% (2/89) and 4.5% (4/88) in the first and the second period, respectively. The complication rate inferred from medical order variation was 74.2% (66/89) and 78.4% (69/88), and the incidence of severe complication was 7.9% (7/89) and 4.5% (4/88) in the first and second period, respectively. In the first and second period, the proportions of medical order variation in accordance with registered complication were 36.0% and 45.5% respectively; the proportion of underestimation, overestimation and missing report were 5.6% and 4.5%, 4.5% and 4.5%, 53.9% and 45.5%, respectively; the registration rate of medical order variation was 46.1% and 54.5%; the number of case with grade I complications inferred from medical order variation was 34 (38.2%) and 25 (28.4%), respectively; and the number of grade II was 12 (13.5%) and 15 cases (17.0%), respectively. The reason of the missing report of medical order variation corresponding to grade I complication was mainly the single use of analgesic drugs outside SOP, accounting for 76.5% (26/34) and 64.0% (16/25) in the first and second period respectively, and that corresponding to grade II complication was mainly the use of non-prophylactic antibiotics, accounting for 9/12 cases and 5/15 cases, respectively. Conclusions: Medical information can evaluate the morbidity of complication feasibly and effectively. Attention should be paid to routine registration to avoid specific missing report.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/efeitos adversos , Registros Médicos/normas , Sistema de Registros/normas , Neoplasias Gástricas/cirurgia , Estudos de Viabilidade , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 736-741, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422611

RESUMO

Objective: To identify the risk factors of perioperative complications after radical gastrectomy for gastric cancer. Methods: A retrospective case-control study was performed. Case inclusion criteria: (1) patients undergoing radical gastrectomy (D2); (2) primary gastric cancer without distant organ metastasis confirmed by postoperative pathology; (3) no neoadjuvant chemotherapy before surgery. Patients with peritoneal tumor dissemination found during operation, undergoing palliative operation due to distant metastasis, and undergoing combined organ resection and those without complete clinicopathological data were excluded. According to the above criteria, 426 patients with gastric cancer at our department from January 2015 to June 2017 were included in this study. Of 426 patients, 285 were male and 141 were female with a mean age of (55.4±9.7) years. According to the "Japan Clinical Cancer Research Group (JCOG) classification criteria for postoperative complications of gastric cancer", patients with grade II and higher complications were classified as complication group, and patients with no complication or grade I complication were classified as non-complication group. Baseline data were compared between two groups. Associations of perioperative complication with gender, age, body mass index, preoperative routine laboratory test, American Society of Anesthesiologists (ASA) classification, activities of daily living (ADL) assessment, past medical history as well as preoperative conditions (hypertension and/or diabetes), surgical resection procedure, incision type, operation time, intraoperative blood loss/body mass ratio were examined. Univariate analysis was performed using χ(2) test and the Wilcoxon rank sum test to screen the statistically significant variables associated with perioperative complications. The significant variables were included in multivariate logistic regression analysis to identify risk factors of perioperative complication. Results: Grade II or higher complications after surgery were developed in 97 patients (22.8%), which included anastomotic leakage in 18 cases (4.2%), postoperative bleeding in 9 cases (2.1%), abdominal abscess in 5 cases (1.2%), intestinal obstruction in 5 cases (1.2%), pancreatic leakage in 1 case (0.2%), and other adverse events in 59 cases (13.8%). Univariate analysis suggested that the gender, age, ADL, incision type, intraoperative blood loss/body mass ratio, and operation time were associated with perioperative complication (all P<0.05). Multivariate analysis revealed that elder age (OR=1.033, 95% CI:1.013-1.053, P=0.013), incision type of laparotomy (OR=2.091, 95% CI:1.247-3.508, P=0.004), longer operation time (OR=1.004, 95% CI:1.001-1.007, P=0.001) and higher ratio of intraoperative blood loss/body mass (OR=1.100, 95% CI: 1.039-1.163, P=0.031) were risk factors for postoperative complications. Conclusion: Attention should be paid to those cases with elder age, laparotomy incision, longer operation time and higher ratio of intraoperative blood loss/body mass, and perioperative management after gastrectomy should be improved.


Assuntos
Gastrectomia/efeitos adversos , Neoplasias Gástricas/cirurgia , Idoso , Análise Fatorial , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 742-747, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422612

RESUMO

Objective: To investigate the morbidity and treatment of early postoperative complications after laparoscopic D2 radical gastrectomy for gastric cancer, and to explore the risk factors. Methods: A case-control study was performed to retrospectively collect clinicopathological data of 764 patients undergoing laparoscopic D2 radical gastrectomy for gastric cancer at our department between January 2015 and December 2017. Patient inclusion criteria: (1) gastric cancer diagnosed by preoperative electronic gastroscopy and biopsy, and confirmed by postoperative pathology; (2) without invasion into adjacent organs by preoperative evaluation of tumors; (3) tumors without definite liver and distant metastasis; (4) R0 resection of gastric cancer and standard D2 lymph node dissection; (5) patients with informed consent. Exclusion criteria: (1) unperformed laparoscopic D2 radical resection; (2) other types of gastric tumor confirmed by pathology; (3) cases with incomplete clinical data. Complication occurring within two weeks after laparoscopic D2 gastrectomy was defined as early postoperative complication. Patients were divided into two groups: non-complication group (693 cases) and complication group (71 cases) according to the occurrence of complications after operation. The clinicopathological data of two groups were analyzed and compared with t test and χ(2) test, and the factors of P < 0.2 were included in the multivariate logistic regression model to analyze the risk factors of postoperative complications. Results: Of 764 patients, 71 (9.3%) developed early postoperative complications, with median onset time of 3 (1 to 11) days. Surgical complications accounted for 7.9% (60/764), including 13 cases (1.7%) of abdominal hemorrhage, 12 cases (1.6%) of anastomotic leakage, 10 cases (1.3%) of incision infection, 8 cases (1.0%) of anastomotic bleeding, 7 cases (0.9%) of gastric stump weakness, 4 cases (0.5%) of abdominal infection, 4 cases (0.5%) of duodenal stump leakage and 2 cases (0.3%) of small intestinal obstruction. Non-surgical complications accounted for 1.4% (11/764), including 6 cases (0.8%) of pulmonary infection and 5 cases (0.7%) of cardiovascular disease. Two cases (0.3%) died of sepsis caused by severe abdominal infection; 9 cases (1.2%) recovered after receiving the second operation, among whom 5 cases were abdominal hemorrhage, 2 cases were anastomotic leakage and 2 cases were duodenal stump leakage; the remaining patients were healed with conservative treatment. Compared with patients without complications, patients with complications had higher proportions of BMI ≥24 kg/m(2) [42.3% (30/71) vs. 24.2%(168/693), χ(2)=10.881, P=0.001], comorbity [64.8% (46/71) vs. 33.5% (232/693), χ(2)=27.277, P<0.001], combined organ resection [70.4% (50/71) vs. 20.5% (142/693), χ(2)=85.338, P<0.001], and pTNM stage of III [70.4% (50/71) vs. 40.1% (278/693), χ(2)=24.196, P<0.001], meanwhile had longer time to postoperative flatus [(4.2±2.1) days vs. (2.9±1.2) days, t=4.621, P=0.023], longer hospital stay [(34.6±12.6) days vs. (14.2±6.2) days, t=9.862, P<0.001] and higher hospitalization cost [(126.8±64.5) thousand yuan vs. (85.2±35.8) thousand yuan, t=11.235, P<0.001]. Multivariate analysis showed that BMI ≥24 kg/m(2) (OR=3.762, 95% CI: 1.960-8.783, P=0.035), accompanying disease (OR=8.620, 95% CI: 1.862-29.752, P<0.001), combined organ resection (OR=6.210, 95% CI: 1.357-21.568, P=0.026), and pTNM stage (OR=4.752, 95% CI: 1.214-12.658, P<0.001) were the independent risk factors of postoperative complications. Conclusions: Laparoscopic D2 radical gastrectomy is a safe and effective approach for gastric cancer. Most early postoperative complications can obtain satisfactory efficacy after conservative treatment. Perioperative management should be strengthened for those patients with high BMI, accompanying diseases, combined organ resection, and advanced pTNM stage.


Assuntos
Gastrectomia/efeitos adversos , Neoplasias Gástricas/cirurgia , Humanos , Laparoscopia , Excisão de Linfonodo , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 762-766, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422615

RESUMO

Objective: To evaluate the efficacy of reinforcement on duodenal stump using single purse-string suture during laparoscopic radical gastrectomy for gastric cancer in preventing duodenal stump leakage. Methods: A descriptive cohort study was conducted to retrospectively collect clinical data of 211 patients with gastric adenocarcinoma who underwent laparoscopic radical gastrectomy with Roux-en-Y or Billroth Ⅱ reconstruction and reinforcement on duodenal stump using laparoscopic single purse-string suture in Zhongshan Hospital of Fudan University between January 2013 and December 2016. Of 211 patients, 136 were male and 75 were female with mean age of (57.5±11.1)(24 to 87) years. Tumors locating at gastric upper 1/3, middle 1/3 and low 1/3 were found in 62, 68 and 81 patients respectively. Eighty-three cases underwent total gastrectomy, 128 underwent distal subtotal gastrectomy, 107 underwent Roux-en-Y reconstruction and 104 underwent Billroth II reconstruction. The procedure of reinforcement on duodenal stump using single purse-string suture during laparoscopic radical gastrectomy was as follows: (1) after cutting the duodenal stump to about 2.0 cm in length, use a 3-0 single-strand absorbable suture to make a muscle layer purse at a distance of 1.0 to 1.5 cm from the duodenal stump; (2) use the purse line to make a slipknot; (3) push the duodenum stump into the purse with a needle holder or grasper; (4) tighten the knot of the purse string, and then make 4 to 5 knots for reinforcement. Postoperative complications were defined and graded according to the Clavien-Dindo grading criteria, and the incidence of early complications was recorded. Clinicopathologic features and postoperative outcomes were analyzed. Results: All patients completed operations successfully. The mean time of laparoscopic single purse-string suture was (5.1±1.6) (3.6 to 10.2) minutes. Postoperative early complication occurred in 31 cases (14.7%), of whom 27 cases developed surgery-related complications (12.8%), including 7 cases (3.3%) of peritoneal infection, 6 (2.8%) of pancreatic leakage, 4 (1.9%) of wound infection, 4 (1.9%) of gastroplegia, 2 (0.9%) of peritoneal hemorrhage, 2 (0.9%) of intestinal obstruction, 2 (0.9%) of lymphatic leakage, and no duodenal stump leakage; while 4 cases (1.9%) developed internal non-surgical complication, including 3 cases (1.4%) of pulmonary infection and 1 (0.5%) of cardiovascular event. The patient with peritoneal hemorrhage was healed after re-operation and all other patients were discharged uneventfully after conservative treatment. Four cases (1.9%) developed complications beyond grade III a of Clavien-Dindo criteria. Conclusion: Reinforcement on duodenal stump using laparoscopic single purse-string suture during laparoscopic radical gastrectomy with Roux-en-Y or Billroth II reconstruction is simple and effective, and can prevent the risk of development of duodenal stump leakage.


Assuntos
Adenocarcinoma/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/prevenção & controle , Duodeno/cirurgia , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Adulto Jovem
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 767-773, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422616

RESUMO

Objective: To compare the clinical efficacy of proximal gastrectomy with double tract reconstruction (PG-DT) and total gastrectomy with Roux-en-Y reconstruction (TG-RY) for proximal gastric cancer. Methods: The retrospective study was conducted. Clinicopathological data of 132 patients with proximal gastric cancer confirmed by pathology who underwent PG-DT (n=51) or TG-RY (n=81) by the same surgeon team in Southwest Hospital of Army Military Medical University between January 2006 and December 2016 were collected. Patients with preoperative neoadjuvant therapy, non-R0 resection and non-adenocarcinoma confirmed by pathology were excluded. Observation indicators included intraoperative (operation time and blood loss); postoperative (time to flatus, hospital stay, total complications, metastasis of lymph nodes around distal side of stomach from cases undergoing TG-RY), follow-up (long-term hemoglobin level, incidence of anemia, and survival) parameters. Survival analysis was conducted using the Kaplan-Meier method, and Log-rank test was used to compare survival difference between two groups. Results: No statistically significant differences were found between two groups in the baseline data, including age, gender, BMI, hemoglobin level before operation, postoperative TNM stage, tumor size and histological differentiation between two groups (all P>0.05). There were no significant differences between PG-DT and TG-RY in intraoperative blood loss [200 (200) ml vs. 200 (195) ml, Z=-1.860, P=0.063], time to flatus [(2.7±1.0) days vs. (2.6±1.1) days, t=0.225, P=0.823], postoperative hospital stay [10(3) days vs. 10 (4) days, Z=-0.449, P=0.654] and morbidity of perioperative complications [5.9% (3/51) vs. 8.6% (7/81), χ(2)=0.081, P=0.775]. Compared with the TG-RY group, PG-DT group had longer total operative time [294 (97) minutes vs. 255 (71) minutes, Z=-3.148, P=0.002]. The hemoglobin data of 42 patients with PG-DT and 56 patients with TG-RY were collected 1 year after operation. The incidence of anemia in PG-DT group was lower than that of TG-RY group [64.2%(27/42) vs. 82.1% (46/56), χ(2)=4.072, P=0.045], and PG-DT group had higher level of hemoglobin than TG-RY group [(114.4±16.3) g/L vs. (106.6±15.0) g/L, t=2.435, P=0.017]. There were 4 cases (4/81, 4.9%) with metastasis of lymph nodes around distal side of stomach in TG-RY group. All of these 4 tumors were T4 in depth and were more than 5 cm in diameter. The median follow-up period was 26 (1 to 110) months. One-year, 3-year and 5-year survival rates were 93.2%, 65.3% and 55.0% in PG-DT group, and 85.8%, 63.8% and 47.2% in TG-RY group, respectively without significant difference (χ(2)=0.890, P=0.345). Conclusions: Compared with TG-RY, PG-DT has the same safety and feasibility for proximal gastric cancer. Although the operative time is a little longer than TG-RY, PG-DT has advantages in improving the postoperative hemoglobin level.


Assuntos
Adenocarcinoma/cirurgia , Anastomose Cirúrgica/métodos , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Anastomose em-Y de Roux , Humanos , Estimativa de Kaplan-Meier , Estudos Retrospectivos , Resultado do Tratamento
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