Application value of nano carbon lymph tracing technique in the radical resection of gallbladder cancer: a prospective study

Objective To investigate the effects of the extent of regional lymph node dissection on the prognosis of patients with T4 gallbladder carcinoma. Methods The retrospective cohort study was conducted. The clinicopathological data of 64 patients with T4 gallbladder carcinoma who underwent radical cholecystectomy in the 4 medical centers between January 2013 and December 2016 were collected, including 31 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University, 16 in the First Affiliated Hospital of Xi′an Jiaotong University, 11 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 6 in the Affiliated Hospital of North Sichuan Medical College. There were 27 males and 37 females, aged from 35 to 77 years, with a median age of 59 years. Sixty-four patients underwent radical cholecystectomy and regional lymph node dissection. According to the extent of intraoperative lymph node dissection, 25 patients (13 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University, 6 in the First Affiliated Hospital of Xi′an Jiaotong University, 4 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 2 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct, hepatoduodenal ligament, back of head of pancreas, next to common hepatic artery and celiac trunk were allocated into the extended dissection group, 39 patients (18 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University, 10 in the First Affiliated Hospital of Xi′an Jiaotong University, 7 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 4 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct and hepatoduodenal ligament were allocated into the control group. Observation indicators: (1) postoperative complications; (2) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival up to January 2018. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated with the independent-sample t test. Count data were represented as absolute number or percentage, and comparison between groups was analyzed using the chi-square test and Fisher exact probability. The survival curve was drawn using the Kaplan-Meier method, and the comparison of survival rates was done by the Log-rank test. Results (1) Postoperative complications: 64 patients with T4 gallbladder carcinoma underwent successful radical cholecystectomy and regional lymph node dissection, without intraoperative death. Twelve patients had different degrees of postoperative complications. Four of 7 patients undergoing extended radical cholecystectomy had postoperative complications. Twenty-five patients in the extended dissection group were cured by conservative treatment, including 4 with intraperitoneal infection and 2 with pancreatic leakage, with a complication incidence of 24.0%(6/25). Thirty-nine patients in the control group were cured by conservative treatment, including 5 with intraperitoneal infection and 1 with gastric retention, with a complication incidence of 15.4%(6/39). There was no statistically significant difference in the complication incidence between the two groups (χ2=0.284, P>0.05). (2) Follow-up and survival situations: 64 patients were followed up for 1-60 months. The postoperative overall median survival time was 11 months. The postoperative median survival time, 1-, 3- and 5-year cumulative survival rates were respectively 18 months, 80%, 16%, 9% in the extended dissection group and 8 months, 21%, 4%, 0 in the control group, with a statistically significant difference in the prognosis between the two groups (χ2=14.744, P<0.05). Conclusions On the premise of practiced surgical skill, extended regional lymph node dissection cannot increase incidence of surgical complication in patients with T4 gallbladder carcinoma after radical resection. Actively extending lymph node dissection up to near common hepatic artery, peri-celiac trunk and back of head of pancreas can improve long-term survival and prognosis. Key words: Biliary tract neoplasms; Gallbladder carcinoma, stage T4; Radical resection; Regional lymph node dissection; Multi-center; Retrospective research

Objective To evaluate a novel lymph node(LN) sorting method on surgical resected sample guided by nanometer carbon staining and principle following the supplying artery tributory in right-sided colon carcinoma. Methods From May 2015 to June 2016, 51 patients were randomly divided into two groups adopting traditional LN sorting method and that of a combination of nanometer carbon and artery guided. The final LN status were compared between the 2 groups. Results The total LN number and the positive LN in novel method group were higher than control group(437 vs. 349, 70 vs. 54). The dissection time used, the number of harvested positive LN that was 0.05) between the two groups. Conclusions Use of nanometer carbon development combined with artery approach facilitates LN sorting, yielding more positive LNs, and increating the accuracy of pathological staging in right-sided colon cancer . Key words: Colonic neoplasms; Lymph nodes; Nanometer carbon

Objective To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors. Methods The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model. Results (1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level, tumor diameter, pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.451, 4.900, 8.256, 4.419, 5.858, P 0.05), but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3% vs. 30.4%, χ2=5.828, P<0.05). (3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis. ① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months, with a range from 3.2 to 82.7 months. The postoperative 2-year overall survival rate was 68.8%, and the postoperative 2-year disease-free survival rate was 56.3%. ② For the 64 patients with T3 stage gallbladder adenocarcinoma, univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (χ2=4.012, 8.837, P<0.05). The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (χ2=6.361, P<0.05). Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.244, 0.382, 95%CI: 0.088-0.674, 0.176-0.831, P<0.05). ③ Survival analysis: range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 64 patients with T3 stage gallbladder adenocarcinoma, the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8% and 69.7%, versus 51.6% and 41.9% of the patients undergoing standard lymph node dissection (χ2=8.837, 6.361, P<0.05). (4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. ① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months, with a range from 1.1 to 70.3 months. The postoperative 2-year overall survival rate was 34.8%, and the postoperative 2-year disease-free survival rate was 30.4%. ② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma, univariate analysis showed that preoperative ALP level, lymph node metastasis, range of hepatectomy, and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.288, 4.574, 12.960, 4.106, P<0.05). The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ2=7.364, 10.582, P<0.05). Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102, 0.153, 95%CI: 0.012-0.880, 0.033-0.718, P<0.05). ③ Survival analysis: range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma, the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5% and 75.0%, versus 6.7% and 6.7% of the patients undergoing hepatic wedge resection (χ2=12.960, 10.528, P<0.05). Conclusions Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer. The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma. Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma. Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection, and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy. Key words: Biliary neoplasms; Gallbladder cancer, stage T3; Gallbladder adenocarcinoma; Gallbladder adenosquamous carcinoma; Lymph node dissection; Prognostic analysis

Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer. Methods The retrospective cross-sectional descriptive study was adopted. The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected. The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients, and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection. The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination. Observation indicators included (1) operation situations, including surgical procedures, operation time, volume of intraoperative blood loss and number of lymph node dissected, (2) postoperative situations, including time for out-off-bed activity, time for diet intake, time of drainage tube removal, occurrence of complications and duration of hospital stay, (3) results of postoperative pathological examination, including tumor stage and surgical margin, (4) postoperative adjuvant treatment, (5) follow-up situation including the survival of patients, tumor recurrence and metastasis. The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015. Count data were represented as average (range). Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection+ lymph node dissection at N1 region. Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection+ Roux-en-Y hepaticojejunostomy, without perioperative death.The average operation time, average volume of intraoperative blood loss and average number of intraoperative lymph node dissected were 238 minutes (range, 178-430 minutes), 250 mL (range, 200-600 mL) and 7 (range, 4-15), respectively. (2) The patients got out-off-bed activity and normal diet intake at postoperative day 2, with a average time of drainage tube removal of 3 days (range, 0-25 days) and an average duration of hospital stay of 5 days (range, 3-28 days). Two patients with complications were cured by symptomatic treatment. (3) Results of postoperative pathological examination showed that all the patients received R0 resection, and pathological stage showed that 12 patients were detected inⅠB stage, 10 inⅡstage, 7 in ⅢA stage and 1 in ⅢB stage. (4) One patient in ⅢB stage (pT3N1M0 stage ) received gemcitabine+ cisplatin chemotherapy and other patients didn't receive the adjuvant treatment. (5) All the patients were followed up for a median time of 16 months (range, 4-32 months), without tumor recurrence and metastasis at Trocar puncture site. There were 25 patients with tumor-free survival and 5 patiens died of tumor recurrence. Conclusion Laparoscopic radical resection of gallbladder cancer is technically safe and feasible, with a satisfactory short-term outcome. Key words: Gallbladder neoplasms; Radical resection; Laparoscopy

Objective To explore the expression of liver fatty acid binding protein (L-FABP) in tissues of hilar cholangiocarcinoma and the relationship between expression of L-FABP and clinicopathological factors and prognosis of the patients. Methods The retrospective case-control study was conducted. The clinicopathological data of 132 patients with hilar cholangiocarcinoma who were admitted to the Navy General Hospital between January 2003 and January 2013 were collected. The expression of L-FABP in tumor tissues and adjacent tissues of hilar cholangiocarcinoma and normal bile duct tissues were respectively detected by immunohistochemistry. Observation indicators: (1) expression of L-FABP by immunohistochemistry; (2) relationship between clinicopathological factors of patients and expression of L-FABP in tumor tissues; (3) follow-up and survival situations; (4) prognostic analysis of patients after radical resection of hilar cholangiocarcinoma. Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival time up to June 2017. Count data were described as percentage and compared using the chi-square test. The survival time was calculated by the Kaplan-Meier method. Measurement data with skewed distribution were described as M (range). The univariate analysis and multivariate analysis were respectively done using the nonparametric test and COX regression model. Results (1) Expression of L-FABP by immunohistochemistry: the positive expressions of L-FABP were located in the cytoplasm. The low, moderate and high expression rates of L-FABP in tumor tissues were respectively 11.36%(15/132), 71.97%(95/132) and 16.67%(22/132), and positive-staining cells showed platy and / or diffuse distribution; the low, moderate and high expression rates of L-FABP in adjacent tissues of hilar cholangiocarcinoma were respectively 77.27%(102/132), 7.58%(10/132) and 15.15%(20/132), and positive-staining cells showed scattered or platy distribution, with a weaker staining intensity compared with tumor tissues; there was no positive expression in normal bile duct tissues. There was a statistically significant difference in expressions of L-FABP among tumor tissues and adjacent tissues of hilar cholangiocarcinoma and normal bile duct tissues (χ2=5.423, P 5 cm , with a statistically significant difference (χ2=10.171, P< 0.05). (3) Follow-up and survival situations: 132 patients were followed up for 5-90 months, with a median time of 33 months. During the follow-up, postoperative overall median survival time of 132 patients was 31 months. (4) Prognostic analysis of patients after radical resection of hilar cholangiocarcinoma: results of univariate analysis showed that tumor differentiation, lymph node metastasis and expressions of L-FABP in tumor tissues were related factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma (Z=1.845, 3.156, 1.243, P<0.05). Results of multivariate analysis showed that tumor differentiation, lymph node metastasis and expressions of L-FABP in tumor tissues were independent factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma (odds ratio=0.431, 1.806, 3.692, 95% confidence interval: 0.292-0.693, 0.974-2.973, 1.875-11.364, P<0.05). Conclusions The high expression of L-FABP in tumor tissues is significantly correlated with the tumor diameter. Tumor differentiation, lymph node metastasis and expressions of L-FABP in tumor tissues are independent factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma. Key words: Hilar cholangiocarcinoma; Liver fatty acid binding protein; Expressions; Radical resection; Prognosis

The incidence of gallbladder cancer has been increasing. Radial resection is still the most promising curable treatment for patients with gallbladder cancer. Although the techniques required for laparoscopic radical resection of gallbladder cancer have matured, the number of reports is also on the rise, and laparoscopic radical resection of gallbladder cancer is still controversial. To standardize laparoscopic radical resection of gallbladder cancer, the Biliary Surgery Branch, Chinese Society of Surgery, Chinese Medical Association, together with the Chinese Medical Doctor Association in Chinese Committee of Biliary Surgeons, gathered experts to formulate recommendations and consensus on laparoscopic radical resection of gallbladder cancer. This consensus includes several parts: safety, preoperative evaluation, indications, surgical team, positioning of patient and trocars, intraoperative frozen examination, lymph node dissection, liver resection,bile duct resection, etc. Furthermore, suggestions on the principle of treatment, surgical procedures, and precautions were also provided for patients with delayed diagnoses of gallbladder cancer undergoing resection. This consensus aims to offer valuable suggestions for the standardization of laparoscopic radical resection of gallbladder cancer.

The use of robotic or laparoscopic surgery for gallbladder cancer (GBC) is increasing, with reported advantages over conventional open surgery. The purpose of this study was to compare the perioperative outcomes and postoperative overall survival (OS) associated with robotic radical resection (RRR) and laparoscopic radical resection (LRR) for GBC. A total of 109 patients with GBC who underwent radical resection with the same surgical team between January 2015 and December 2023 were enrolled, with 21 patients in the RRR group and 88 cases in the LRR group. A 1:1 propensity score matching (PSM) algorithm was used to compare the surgical outcomes and postoperative prognosis between the RRR and LRR groups. Logistic regression analysis was used to identify the risk factors of postoperative overall survival (OS) and complications of Clavien-Dindo (C-D) Grades III-IV. The median follow-up time was 46 (inter-quartile range, IQR 29-70) months for the LRR group and 16 (IQR 12-34) months for the RRR group. After PSM, the baseline characteristics of the RRR and LRR groups were generally well balanced, with 21 patients in each group. RRR was associated with significantly decreased intraoperative bleeding [100.00 (50.00, 200.00) mL vs 200.00 (100.00, 300.00) mL] and higher number of lymph nodes (LNs) yield [12.00 (9.00, 15.50) vs 8.00 (6.00, 12.00)]. The two groups showed comparable outcomes in terms of the incidence of biliary reconstruction, the range of liver resection, the length of operation, the incidence of postoperative morbidity, the incidence of C-D Grades III-IV complications, number of the days of drainage tubes indwelling and postoperative hospital stay, and mortality by postoperative days 30 and 90. After PSM, the 1-, 2-, and 3-year overall survival rates were 78, 70, and 37%, respectively, in the RRR group, and 71, 59, and 48%, respectively, in the LRR group (P = 0.593). Multivariate analysis showed that the preoperative TB level ≥ 72µmol/L and biliary reconstruction were found to be the independent risk factors of C-D Grades III-IV complications. T3 stage was identified to be the risk factor for postoperative OS. Compared with LRR, RRR showed comparable perioperative outcomes in terms of length of operation, and postoperative complications, recovery, and OS. In our case series, RRR of GBC can be accomplished safely and tends to show less intraoperative bleeding and higher LNs yield.

Objective To explore the application value of carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy. Methods The retrospective cohort study was conducted. The clinicopathological data of 56 patients with adenocarcinoma of esophagogastric junction who underwent preoperative chemoradiotherapy in the Peking University Cancer Hospital from January 2014 to November 2017 were collected. There were 52 males and 4 females, aged from 22 to 76 years, with an average age of 62 years. Among 56 patients undergoing total gastrectomy and D2 lymphadenectomy, 17 using carbon nanoparticle lymph node staining and 39 using traditional lymph node sorting were respectively allocated into observation group and control group. Observation indicators: (1) treatment situations; (2) detection of lymph nodes; (3) perioperative complications; (4) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated by the independent sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was evaluated by the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data was analyzed using the nonparametric rank sum test. Results (1) Treatment situations: patients in both groups were successfully treated with concurrent chemoradiotherapy based on intensity modulated radiotherapy before operation. Radical gastrectomy with D2 lymphadenectomy was successfully performed after chemoradiotherapy, and Roux-en-Y esophagojejunostomy was used to reconstruct the digestive tract during operation. The operation time and volume of intraoperative blood loss were respectively (217±58)minutes and (112±60)mL in the observation group, and (235±65)minutes and (119±77)mL in the control group, with no statistically significant difference between the two groups (t=1.017, 0.341, P>0.05). (2) Detection of lymph nodes: the average number of harvested lymph nodes, average number of radiation target lymph nodes, and average number of peritarget lymph nodes were respectively 32±10 , 21±8, and 7±4 in the observation group, and 22±7, 16±5, 5±3 in the control group, with statistically significant differences between the two groups (t=4.138, 2.881, 2.401, P 0.05). (3) Perioperative complications: 6 and 18 patients in the observation group and the control group had complications, respectively, with no statistically significant difference between the two groups (χ2=0.570, P>0.05). Patients with complications were improved after drug treatment and local treatment without second operation. No local or systemic adverse reactions caused by carbon nanoparticles was observed during and after operation in the observation group. (4) Follow-up: 56 patients were followed up for 5-65 months, with a median follow-up time of 32 months. There were 14 and 6 patients in the observation group and the control group with tumor recurrence or metastasis, respectively, showing no significant difference between the two groups (χ2=0.002, P>0.05). Conclusion Carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy can increase the number of harvested lymph nodes. Key words: Neoplasms of esophagogastric junction; Adenocarcinoma of esophagogastric junction; Preoperative chemoradiotherapy; Carbon nanoparticles; Lymph nodes sorting; Radical gastrectomy with D2 lymphadenectomy

Objective To evaluate the clinical value of carbon nanoparticles suspension in gallbladder carcinoma lymphadenectomy. Methods 21 cases of gallbladder carcinoma who received radical resection from January 2008 to August 2013 were randomly divided into experimental group (11 cases received carbon nanoparticles injection into the subserosa around the tumor before operation) and control group (10 cases did not receive any tracer). The number of dissected lymph nodes, black-stained lymph nodes and positive lymph nodes were analyzed. Results A total of 138 lymph nodes were resected in experiment group, average 12.546±5.047 lymph nodes per patient, which was significantly more than that in control group in which there were overall 87 lymph nodes, average 8.700±2.497 lymph nodes per patient (t=2.176, P=0.042). The blacken rate of lymph nodes in experimental group was 56.522 % (78/138). There were 46 metastasis lymph nodes out of 79 blacken lymph nodes, and the positive rate was significantly higher than that of non-blacken lymph nodes [58.228 % (46/79) vs 38.983 % (23/59), P=0.039]. There was no local or systemic adverse reaction occurred in experimental group. Conclusions Carbon nanoparticles suspension maybe helpful for lymphadenectomy during radical gallbladder carcinoma dissection to reduce operating damage and be safe. Key words: Gallbladder carcinoma; Carbon nanoparticles; Lymphadenectomy; Lymphatic tracer

Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT examination to predict the prognosis of patients after colorectal cancer operation. Methods The retrospective cross-sectional study was adopted. The clinicopathological data of 80 patients with colorectal cancer who were admitted to the First Hospital of Nanjing Medical University from March 2007 to October 2015 were collected. Eighty patients received first preoperative 18F-FDG PET/CT examination and underwent operations under decisions of patients and their families, and then adjuvant chemotherapy were performed according to the patients′ condition. Observation indicators included: (1) preoperative imaging examination, (2) situations of treatment and follow-up, (3) analysis of prognostic factors. The patients were followed up by outpatient examination and telephone interview once every 3 months within postoperative 1 year, once every half a year within postoperative 2 years and then once a year up to May 2016. The follow-up included tumor recurrence or progression and survival of patients. Tumor-free survival time was from postoperative day 1 to tumor recurrence or progression and death or end of follow-up. Overall survival time was from postoperative day 1 to death or end of follow-up. Measurement data with skewed distribution were represented as M (Qn) and M (range). The optimal cutoff point of tumor-free survival of maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolism of volume (MTV) and total lesion of glycolysis (TLG) were investigated using the ROC curve analysis, and calculating area under the curve (AUC). The median was used as a cutoff point if there was smaller AUC. The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis, and COX proportional hazards model for multivariate analysis. Results (1) Results of preoperative imaging examination: results of PET/CT in patients with colorectal cancer showed there were circumscribed thickening of bowel wall, intestinal cavity strictures, fuzzy fat space around the some lesions, enlarged lymph node and 18F-FDG uptake increased abnormally. The SUVmax, SUVmean, MTV and TLG of 80 patients were 11.83(4.26, 35.42), 7.06(2.38, 20.92), 20.47 cm3(1.29 cm3, 161.50 cm3) and 138.58(14.17, 857.89), respectively. ROC curve showed that the AUC of SUVmax , SUVmean, MTV and TLG were 0.453, 0.448, 0.815 and 0.749 [95% confidence interval (CI): 0.307-0.600, P>0.05; 0.303-0.594, P>0.05; 0.717- 0.913, P<0.05; 0.635- 0.863, P<0.05], respectively. The median SUVmax (11.83) and SUVmean(7.06) were used as the cutoff points due to smaller AUC of SUVmax and SUVmean. The cutoff point of MTV was 18.79 cm3 (sensitivity=86.2% and specificity=68.3%), and the cutoff point of TLG was 142.05 (sensitivity=75.9% and specificity=70.7%). (2) Situations of treatment and follow-up: among 80 patients, 13 underwent the radical resection of colorectal cancer and resection of liver metastasis and 67 underwent radical resection of colorectal cancer. Sixty-two patients received postoperative chemotherapy, including 45 with chemotherapy regimens of capecitabine and 17 with fluorouracil. Eighty patients were followed up for 41.8 months (range, 6.5-109.1 months ). During the follow-up, 29 patients had tumor recurrence or progression, and 19 patients were dead. The median tumor-free survival time, 1-, 3- and 5-year tumor-free survival rates in 80 patients were 19.5 months (range, 2.0-109.1 months), 73.7%, 36.3% and 18.8%, respectively. The median overall survival time, 1-, 3- and 5-year overall survival rates were 31.8 months (range, 3.3-109.1 months), 76.3%, 37.5% and 20.0%, respectively. (3) Analysis of prognostic factors: results of univariate analysis showed that tumor location, N staging, M staging, clinical staging, postoperative chemotherapy, MTV and TLG were relative factors affecting postoperative tumor-free survival rate (HR=3.469, 5.325, 5.295, 8.605, 2.630, 7.388, 5.155, 95% CI: 1.522-7.906, 2.256-12.568, 2.405-11.657, 2.969-24.937, 1.063-6.504, 2.550-21.403, 2.178-12.204, P<0.05). The tumor location, tumor differentiation, N staging, M staging, clinical staging, MTV and TLG were relative factors affecting postoperative overall survival rate (HR=2.697, 2.814, 3.083, 2.916, 4.193, 5.450, 4.876, 95% CI: 1.011-7.197, 1.121-7.062, 1.166-8.149, 1.140-7.454, 1.386-12.678, 1.581-18.786, 1.727-13.766, P<0.05). In multivariate analysis, stage Ⅲ-Ⅳ of clinical staging and TLG≥142.05 were independent risk factors affecting postoperative tumor-free survival rate (HR=9.879, 3.569, 95% CI: 1.854-22.836, 1.127-11.306, P<0.05). The stage M1, stage Ⅲ-Ⅳ of clinical staging and TLG≥142.05 were independent risk factors affecting postoperative overall survival rate (HR=4.522, 9.315, 10.120, 95% CI: 1.223-16.717, 1.338-24.864, 2.385-12.947, P<0.05). Conclusion TLG through 18F-FDG PET/CT examination is an independent prognostic factor affecting postoperative tumor-free survival rate and overall survival rate in patients with colorectal cancer after curative resection, and it has certainly reference value for prognosis. Key words: Colorectal neoplasms; Prognosis; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Objective To study carbon nanoparticles lymphatic tracer to guide surgery for gallbladder cancer. Methods 120 patients with gallbladder cancer were randomized into two groups: the experimental group (n=60) and the control group (n=60). For the experimental group, 0.1 ml carbon nanoparticles was injected at 4~6 locations subserosally around the cancerous site intraoperatively. Stained lymph nodes were used as markers to guide lymphadenectomy. The resected specimens were carefully dissected, and then the lymph nodes were studied according to their positions by histopathological examinations. Results Various degrees of stained lymph nodes were seen in the specimens. In the experimental group, the number of lymph nodes (12.0±3.8), and metastatic lymph nodes (6.3±3.3) per patient were obviously higher than those in the control group (9.2±3.6、4.4±2.8), respectively, (P<0.05). There were significant differences (P<0.05) in postoperative disease-free survival and overall survival. Conclusions Intraoperative injection of carbon nanoparticles enhanced lymph node clearance and increased the number of lymph nodes and metastatic lymph nodes dissected, which helped to guide pathological staging. There were significant improvements in disease-free survival and overall survival of these patients with gallbladder cancer after surgery. Key words: Nano carbon; Lymphatic tracer technology; Gallbladder cancer; Lymphadenectomy

Objective To explore the value of expanded radical resection for gallbladder cancer located respectively at body and bottom of the gallbladder and at the neck.Methods In this study,91 cases of gallbladder cancer were macropathologically divided into two groups, one with the lesion at the body and bottom of the gallbladder and the other at the neck, survival analysis was made accordingly. Three different kinds of resection were performed: the expanded radical resection, the standard radical resection and palliative operation. Results The overall median survival rate of patients undergoing expanded radical operation was significantly longer than that of the cases doing other two procedures, that was 27. 1 ± 2. 4,10. 7 ±2. 2,4. 7 ±2.2 (months) respectively for body and bottom cancer, and 8.5 ±2. 1,6. 7 ± 1.9,3.1 ± 1.1 (months) respectively for neck cancer. For cancer at the body and bottom RO was achieved by expanded radical resection in 16/18(88％ ) cases and by standard radical resection in 7/12(58％ ) cases, while for cancer at the neck it was in 6/16(38％ ) cases, and in 3/13 (23％)cases only. Conclusions The median survival time is longer and RO resection rate is higher in patients with the cancer at the body and bottom than these at the neck of the gallbladder. Key words: Gallbladder neoplasms ; Neoplasms staging; Jaundice; Surgical procedures,operative

Objective To evaluate lymph node dissection effect after using carbon nanoparticles in laparoscopic radical resection for rectal cancer. Methods Eighty patients accepted laparoscopic radical resection for rectal cancer in People′s Hospital of Beijing Daxing District from August 2016 to August 2017 were selected. They were randomly assigned as carbon nanoparticles group and control group, with forty patients in each group. Patients in carbon nanoparticles group received rejection of carbon nanoparticles into submucosal layer at the inferior border and lateral wall of tumor under enteroscopy guidance at two different times (16~18 hours before operation and during operation), and there were twenty patients at each time. Resection range was determined according to the location of tumor. Surgical specimens were delivered to department of pathology within thirty minutes after tumors were resected, and special person was assigned to assist lymph node sorting. Results The amount of detecting lymph node in carbon nanoparticles group was more than control group (t=3.32, P 0.05). Conclusions The application of carbon nanoparticles can increase the amount of detecting lymph nodes during laparoscopic radical resection for rectal cancer, and black dyed lymph nodes which are traced by carbon nanoparticles have higher positive rate. The effect of rejecting carbon nanoparticles sixteen~eighteen hours before operation is confirmed, also it is helpful to arrange clinical work, so this technique deserves generalization and application. Key words: Laparoscopes; Rectal neoplasms; Carbon nanoparticles; lymphatic trace; Lymph node positive rate

Objective To investigate the effect of carbon nanoparticles tracer technique in radical resection of pancreatic cancer. Methods From June 2013 to December 2016, a retrospective analysis was performed in 52 patients with pancreatic cancer treated in our hospital, the patients were divided into carbon nanoparticle group and control group, 26 cases in each group, carbon nanoparticle lymphatic tracer was used in carbon nanoparticle group during operation. Statistical analysis was performed by SPSS 22.0 software, the perioperative indicators, number of lymph nodes and survival time were expressed as mean±standard deviation, and were examined by using t test. The positive lymph node ratio and post-operative complication rate were examined by using chi square test. The survival rate were examined by using Kaplan-Meier test. A P value of <0.05 was considered as significant difference. Results There were no significant differences in the operation time, amount of post-operation drainage, intraoperative blood loss and average hospitalization time between the two groups (P>0.05). The average number of lymph nodes in carbon nanoparticle group (26.3±2.5) was significantly more than that (19.4±1.7) in the control group, and the number of lymph nodes whose diameter were less than 5 mm was significantly more than that in the control group[(8.1±1.7) vs. (5.3±1.0)], the average number of positive lymph nodes in carbon nanoparticle group (11.4±3.1) was significantly more than that (5.9±1.5) in control group; The mean required time for lymph nodes detection in carbon nanoparticle group (20.4±3.6) min was significantly shorter than that in control group (31.8±5.1) min. The positive lymph node ratio in carbon nanoparticle group (19.5%, 168/860) was significantly higher than that in control group (15.7%, 115/733). The rate of black-dyed lymph nodes in carbon nanoparticle group was (71.2%, 612/860). The positive lymph node ratio of black-dyed lymph nodes (24.1%, 148/612) was significantly higher than that of non-black-dyed lymph nodes(8.1%, 20/248) and the control group (P<0.05). The 1-, 2-, 3- years survival rate in carbon nanoparticle group were higher than those in control group (P<0.05). The mean survival time of carbon nanoparticle group(25.0±13.3 months) was significantly more than that of the control group (15.3±13.0 months) (P<0.05). Conclusion The application of carbon nanoparticles tracer technique in radical resection of pancreatic cancer can reach good effect, which increased the number of lymph node and positive lymph node dissection rate, improved the survival time and prognosis of patients. Key words: Pancreatic Neoplasms; Nanotubes, Carbon; Lymph Nodes; Pancreatectomy

Clinicopathological features of long-term survivors after radical resection for gallbladder cancer