Radical Surgery For Cancer Research Articles

Acute exacerbation of interstitial lung disease after radical surgery for lung cancer: a case report

A 69-year-old male patient underwent a left upper lobectomy for lung cancer, showing slight interstitial changes in the lung before surgery. He suffered fever with cough and expectoration postoperatively, and high-resolution computed tomography (HRCT) of the thorax indicated that the interstitial lesion in the lung was aggravated. The course of the disease progressed rapidly, and treatment that included anti-infection and steroid pulse therapy was ineffective. We conducted a retrospective analysis of the clinical data and the process of diagnosis and treatment of this patient with acute exacerbation of interstitial lung disease (AE-ILD) after radical surgery for lung cancer. Patients with ILD should be given very careful consideration when selecting a therapeutic approach because interventions may aggravate AE-ILD, leading to a poor prognosis.

Surgical outcome of pulmonary artery reconstruction using the expanded polytetrafluoroethylene patch in patients with lung cancer.

Pulmonary artery reconstruction is sometimes utilized as an alternative to pneumonectomy in lung cancer surgery. We herein report our experience of pulmonary artery reconstruction using an expanded polytetrafluoroethylene (ePTFE) patch based on the surgical results and long-term outcome. Clinical records of lung cancer patients who underwent patch plasty were reviewed retrospectively. Between 2003 and 2017, pulmonary artery patch plasty were performed in 21 patients [18 males, 3 females; mean age 65 (range 47-79) years]. Induction chemoradiotherapy was performed in three patients. Bronchoplasty was performed in five patients. The pathologic stages were stage I in 3 patients, stage II in 6 and stage III in 12. Pneumonectomy, lobectomy and segmentectomy were performed in 2, 18 and 1 patient, respectively. The left upper lobe was the most frequent origin of lung cancer (15 patients). There was no reconstruction-related morbidity or mortality. The overall survival rate at 5years was 64.1% with a mean follow-up of 39.5months, and the survival rates for N0-1 and N2-3 were 80.8% and 28.6%, respectively. Patch angioplasty using the ePTFE sheet is a reliable procedure in radical surgery for lung cancer.

Competing Risk Analysis in Lung Cancer Patients Over 80Years Old Undergoing Surgery.

This study aimed to analyze cause-specific mortality in lung cancer patients over 80years old undergoing surgery. This retrospective, multi-institutional analysis included patients aged ≥ 80years who underwent radical surgery for primary lung cancer from January 1998 to December 2015. Preoperative clinical data, surgical results, survival, and cause of death were evaluated. Competing risk analysis for cause-specific mortality was performed. Of the 337 patients (median age 82years) enrolled and analyzed, 68.1% were male. There were 52 and 44 cancer-specific and non-cancer-specific deaths, respectively. On competing risk regression analysis, non-cancer-specific deaths were significantly associated with male sex (hazard ratio [HR]: 3.06, 95% confidence interval [CI]: 1.02-9.12, p = 0.046), coronary artery disease (HR: 2.49, 95% CI: 2.49 [1.14-5.47], p = 0.02), interstitial pneumonia (HR: 3.58, 95% CI: 1.73-7.40, p < 0.001), and pathological stage III (HR: 3.83, 95% CI: 1.44-10.13, p = 0.007). In contrast, cancer-specific deaths were significantly associated with limited resection (HR: 1.99, 95% CI: 1.02-3.89, p = 0.04) and pathological stage III (HR: 3.13, 95% CI: 1.44-6.80, p = 0.004). The 5-year cumulative incidences of lung cancer-specific and non-cancer-specific deaths were 18.0% and 15.9%, respectively. Prognostic factors for non-cancer-specific death were different from those of cancer-specific death, except for pathological stage. Each prognostic factor should be considered when deciding surgical indication and procedure and monitoring for pulmonary events during outpatient follow-up.

Influence of prophylactic antibiotic duration on postoperative pneumonia following pulmonary lobectomy for non-small cell lung cancer.

Although postoperative pneumonia after radical surgery for non-small cell lung cancer (NSCLC) carries a mortality risk, the duration of postoperative prophylactic antibiotics against pneumonia has not been elucidated. This study aimed to evaluate the influence of the duration of prophylactic antibiotics on postoperative pneumonia following radical surgery for NSCLC in patients who received antibiotics intraoperatively (short period) and in those who received antibiotics both intraoperatively and postoperatively (long period). A total of 477 patients who underwent radical lobectomy for NSCLC were analyzed retrospectively. Propensity score analysis generated two matched pairs of 152 patients in both the short and long period groups. After propensity score matching, the incidence of postoperative pneumonia following pulmonary lobectomy was significantly less in the long period group than in the short period group (3.9% vs. 16.4%, P<0.001). On logistic regression analysis, short period of prophylactic antibiotic administration was the independent risk factor for postoperative pneumonia (odds ratio: 6.82, P<0.001). Prophylactic antibiotic administration in both the intraoperative and postoperative periods reduced the incidence of pneumonia after pulmonary lobectomy for NSCLC.

Management of pancreatic head adenocarcinoma: From where to where?

Pancreatic head adenocarcinoma (PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC include higher frequencies of regional or distant lymph node metastases and vascular involvement, and positive resection margins in pancreatic and retroperitoneal tissues. Radical resections increase margin negativity and life expectancy; however, the extend of the surgery applied is controversial. Thus, western and eastern centers may use different approaches. Multiorgan, peripancreatic nerve plexus, and vascular resections have been discussed in relation to radical surgery for pancreatic cancer as have the roles of neoadjuvant and adjuvant therapy regimens. Determining the appropriate limits for surgery, standardizing definitions and surgical techniques according to guidelines, and centralizing pancreatic surgery within high-volume institutions to reduce mortality and morbidity rates are among the most important issues to consider. In this review, we evaluate the basic concepts underlying and the roles of radical surgery for PHAC, and lymphadenectomy, nerve plexus, retroperitoneal tissue, vascular, and multivisceral resections, total pancreatectomy, and liver metastases are discussed.

Laparoscopic modified lymphadenectomy in gastric cancer surgery using systematic mesogastric excision: a novel technique based on a concept.

Radical surgery for gastrointestinal cancer involves en bloc removal of the primary tumor and organ-specific mesenteries. However, the surgical concept and technique for lymphadenectomy during gastric cancer surgery remain unclear. We examined a novel technique for laparoscopic modified lymphadenectomy during gastric cancer surgery involving systematic mesogastric excision (SME) and focused on the topographic anatomy, surgical technique, and specimens. Our surgical technique involved the following: mesenterization by dissociating embryological planes, separating fat tissue containing lymph nodes from the pancreas and its associated vessels by tracing the intramesenteric dissectable layers, and dissecting the lymph node that is dependent on the D1+ criteria. Between October 2011 and September 2016, 227 patients underwent laparoscopic D1+ gastrectomy using SME. Of these, total gastrectomy was performed in 47 cases and distal gastrectomy was performed in 180 cases. The median operative time was 303min (range, 201-722min), and estimated blood loss was 50mL (range, 0-550mL). The median number of harvested lymph nodes was 54 (range, 18-163). There was no conversion to open surgery. SME was adapted for modified gastrectomy and is considered safe. Modified lymphadenectomy during gastrectomy is determined by the resection margin of the mesogastrium.

Risk factors of atrial fibrillation occurring after radical surgery of esophageal carcinoma

BackgroundAtrial fibrillation (AF) is a common complication after radical surgery of esophageal cancer. The aim of this study was to explore AF risk factors after radical surgery of esophageal carcinoma.MethodThe data of 335 patients with esophageal cancer who were admitted in our hospital from January 2014 to August 2016 for the first time were retrospectively analyzed. We retrieved the papers in some data banks using the search terms including English and Chinese search terms, and obtained 13 factors which were mentioned in more than 6 papers. The 13 factors including age, gender, history of smoking, history of hypertension, history of peripheral vascular disease, history of cardiac stents or angina pectoris, preoperative pulmonary infection, preoperative brain natriuretic peptide (BNP) level, preoperative left ventricular diastolic dysfunction, operative method, lesion location, intraoperative blood transfusion, adhesion between lymph nodes and pericardium, underwent univariate and multivariate analyses.ResultsOf the 335 patients with esophageal cancer, 48 had AF within one week after operation. Univariate analysis indicated that the age (OR: 4.89; CI: 2.53–9.47, P: 0.000), gender (OR: 2.26; CI: 1.17–4.37, P: 0.013), history of peripheral vascular disease (OR: 2.29; CI: 1.06–4.92, P: 0.030), history of cardiac stents or angina pectoris (OR: 27.30; CI: 12.44–59.91, P: 0.000), preoperative BNP level (OR: 27.13; CI: 10.97–67.06, P: 0.000), preoperative left ventricular diastolic dysfunction (OR: 2.22; CI: 1.19–4.14, P: 0.012), operative method (OR: 2.09; CI: 1.002–4.380, P: 0.046), intraoperative blood transfusion (OR: 20.24; CI: 8.39–48.82, P: 0.000), and adhesion between lymph nodes and pericardium were risk factors (OR: 2.05; CI: 1.08–3.87, P: 0.024). Furthermore, multivariate analysis displayed that advanced age (OR: 5.044; CI: 1.748–14.554, P: 0.003), male (OR: 6.161; CI: 2.143–17.715, P: 0.001), history of cardiac stents or angina pectoris (OR: 48.813; CI: 13.674–174.246, P: 0.000), preoperative BNP > 100 (OR: 41.515; CI: 9.380–183.732, P: 0.000), open surgery (OR: 3.357; CI: 1.026–10.983, P: 0.045), intraoperative blood transfusion (OR: 58.404; CI: 10.777–316.509, P: 0.000), and adhesion between lymph nodes and pericardium (OR: 3.954; CI: 1.364–11.459, P: 0.011) were risk factors which could increase the incidence of postoperative AF.ConclusionWe should pay attention to the above risk factors in order to reduce the incidence of postoperative AF.

Robot-assisted orthotopic and heterotopic ovarian tissue transplantation techniques: surgical advances since our first success in 2000

To demonstrate the technical advances since the time we reported the first successful case in 2000 and our modern approach to autologous transplantation of frozen-thawed human ovarian tissue. A step-by-step video demonstration of three surgical approaches was created by editing the surgical footage obtained during ovarian transplantation procedures. Academic. Three patients who previously underwent ovarian tissue harvesting and cryopreservation before gonadotoxic cancer treatments or radical cancer surgery are presented. The illustrated techniques include robot-assisted orthotopic (technique 1) and heterotopic (technique 2) approaches using the da Vinci Xi (Intuitive Surgical) robotic system and a decellularized human extracellular tissue matrix (Alloderm; LifeCell Corp.) as a tissue scaffold, as well as a percutaneous autotransplantation approach (technique 3). Successful completion of procedures without complications and ovarian graft function with demonstration of E2 production and follicle development. All cases were completed without complications. Ovarian graft function was confirmed by E2 production, follicle growth by 10-14weeks after transplantation, and later embryo development. Since our first report of successful restoration of ovarian function after orthotopic transplantation of frozen-banked ovarian tissue in 2000 (1), followed by our first reports of subcutaneous heterotopic transplantation techniques (2, 3), ovarian tissue cryopreservation followed by subsequent transplantation has become a promising fertility preservation option for young women with cancer who do not have sufficient time to undergo oocyte or embryo cryopreservation and for prepubertal girls (4, 5). The same approach also has the advantage of restoring ovarian endocrine function and fertility without a need for assisted reproduction (6, 7). In the very first successful procedure that we reported in 2000, we used conventional laparoscopy, and the tissues were reconstructed and mounted on a polycellulose scaffold (Surgicel) (1, 7). Since then, we have made significant modifications in our surgical approach with potential improvements in outcomes. Here we illustrate three main techniques of ovarian tissue transplantation resulting in the restoration of ovarian function in all cases. In the first two cases, we illustrated the robot-assisted orthotopic and heterotopic approaches using Alloderm. Robotic ovarian transplantation may increase precision, provide more delicate graft handling, and reduce the time from tissue thawing to transplantation (6, 8). Alloderm is regenerated de-epithelized human cadaver skin, which consists of several extracellular matrix components. It has been safely used in the surgery and dentistry fields for enhancing tissue regeneration and vascularization (9, 10). Furthermore, our earlier laboratory work indicated the critical role of extracellular matrix in primordial follicle growth initiation and preantral follicle growth (11, 12). Prior to our use of Alloderm as part of ovarian transplant procedures, we tested it in human ovarian xenograft models and found Alloderm to incorporate well with ovarian tissue (8). Only after that test did we adopt it for use in ovarian transplants. The utility of the extracellular tissue matrix may thus enhance our ovarian autotransplantation techniques by facilitating ovarian reconstruction and potentially improving neovascularization. In fact, we have seen improved follicle growth and response to ovarian stimulation with the use of Alloderm in our first cases (8). We use heterotopic ovarian transplantation when the pelvis is not suitable for autotransplantation due to past radiation or scarring or when there are other medical contraindications for transplantation in the pelvis. The third technique we illustrated was percutaneous heterotopic ovarian autotransplantation. This is a simple approach that can be used in surgically high-risk patients, as it is done with local anesthesia or IV sedation and without entering abdominal cavity. Additionally, same approach can be utilized when there is heightened concern that the ovarian tissue may harbor a disease that can recur, requiring close surveillance and easier removal of the ovarian graft. While ovarian endocrine function and follicle growth are restored with efficiency using the percutaneous ovarian transplants, our initial experience suggests that oocyte quality may be impaired in SC locations (2, 3, 13). Hence that technique may be more suitable when the only purpose is restoration of ovarian endocrine function. However, we have encountered recurrent live births from spontaneous conceptions following SC ovarian transplants, prompting the question of whether the grafted tissue can augment the function of in situ menopausal ovary (13, 14). While ovarian cryopreservation and transplantation may no longer be considered experimental, there are many exciting questions remaining to be answered on the full potential of this procedure.

Learning Curve for Using Intraoperative Neural Monitoring Technology of Thyroid Cancer

We investigated the learning curve for using intraoperative neural monitoring technology in thyroid cancer, with a view to reducing recurrent laryngeal nerve injury complications. Radical or combined radical surgery for thyroid cancer was performed in 82 patients with thyroid cancer and 147 recurrent laryngeal nerves were dissected. Intraoperative neural monitoring technology was applied and the “four-step method” used to monitor recurrent laryngeal nerve function. When the intraoperative signal was attenuated by more than 50%, recurrent laryngeal nerve injury was diagnosed, and the point and causes of injury were determined. The time required to identify the recurrent laryngeal nerve was 0.5–2 min and the injury rate was 2.7%; injuries were diagnosed intraoperatively. Injury most commonly occurred at or close to the point of entry of the nerve into the larynx and was caused by stretching, tumor adhesion, heat, and clamping. The groups are divided in chronological order; a learning curve for using intraoperative neural monitoring technology in thyroid cancer surgery was generated based on the time to identify the recurrent laryngeal nerve and the number of cases with nerve injury. The time to identify the recurrent laryngeal nerve and the number of injury cases decreased markedly with increasing patient numbers. There is a clear learning curve in applying intraoperative neural monitoring technology to thyroid cancer surgery; appropriate use of such technology aids in the protection of the recurrent laryngeal nerve.

Comparison of D2 and D2 plus radical surgery for advanced distal gastric cancer: a randomized controlled study

BackgroundThe optimal extent of lymph node (LN) dissection for advanced distal gastric cancer remains controversial. The present study compared the safety and efficacy of extended LN dissection (D2 plus) with standard D2 radical surgery for advanced distal gastric cancer.MethodsEligible patients were enrolled and randomly assigned into two groups: D2 group and D2 plus group. Patients in the D2 group received standard D2 LN dissection, while patients in the D2 plus group received an additional nos. 8p, 12b, 13, and 14v LNs dissection. The clinicopathological and surgical data of these two groups were compared, and the factors that may influence survival were analyzed.ResultsSeventy patients were enrolled, out of which 64 patients were analyzed. There were no significant differences in the operative time, blood loss, and complications between the two groups. In the D2 plus group, the positive rate of the nos. 12b, 13, and 14v LN was 3.1%, 9.4%, and 12.5%, respectively. The positive rate of the no. 13 LN correlated with the duodenal involvement, while the positive rate of the no. 14v LN correlated with no. 6 LN metastasis. The survival analysis indicated that among patients with duodenum involvement, the 3-year disease-free survival rate of the D2 plus group was significantly better than that of the D2 group.ConclusionDuodenum involvement and positive no. 6 LN were high-risk factors of advanced distal gastric cancer. D2 plus radical surgery turned out to be safe and feasible, and may improve the prognosis of these patients. However, further clinical trials are still warranted.Trial registrationThis study is registered with ClinicalTrials.gov as NCT01836991, registered on 22 April 2013.

Clinical Application of Enhanced Recovery After Surgery in Perioperative Period of Laparoscopic Colorectal Cancer Surgery.

To investigate the clinical application value of enhanced recovery after surgery (ERAS) combined with the laparoscopic technique in the radical resection of colorectal cancer. A total of 200 patients undergoing laparoscopic radical surgery for colorectal cancer from June 2014 to June 2017 were selected and randomly divided into ERAS group (n = 100) and conventional (CON) group (n = 100). The ERAS group adopted enhanced recovery approach after surgery for perioperative treatment, while the CON group adopted a CON approach. The operation time, blood loss, first exhaust time, first defecation time, extubation time, complication rate (incision infection, pneumonia, gastric retention, anastomotic leakage, intestinal obstruction, etc.), scores of visual analog scale (VAS) 1, 3, and 7 days after surgery, and nutritional status (albumin, total protein) 1, 3, and 7 days after surgery were compared and analyzed. Compared with the CON group, the ERAS group had significantly shorter first exhaust time, first defecation time, and extubation time (all P < .05). The incidence of overall complications in the ERAS group was less than those in the CON group (P < .05); and albumin and total protein were significantly higher in the ERAS group than in the CON group (both P < .05). ERAS combined with laparoscopic techniques for the treatment of colorectal cancer is a safe and feasible practice. It not only promoted the recovery of gastrointestinal function but also improved the perioperative nutritional status of patients.

Sevoflurane Effect on Cognitive Function and the Expression of Oxidative Stress Response Proteins in Elderly Patients undergoing Radical Surgery for Lung Cancer

To investigate the effects of sustained inhalation of sevoflurane on cognitive function and the expression of oxidative stress response proteins such as NADPH oxidase subunits NOX2 and NOX4 in elderly patients undergoing radical surgery for lung cancer. An experimental study. Department of Anesthesiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, China, from February 2016 to October 2017. Elderly patients who underwent radical surgery for lung cancer were divided into the sevoflurane group and the propofol group, with 52 cases in each group. Sustained inhalation of sevoflurane and propofol was administered to maintain anesthesia in the respective groups. Cognitive function and lung function parameters were compared between the two groups. Serum S100 &beta; levels and expression of NOX2 and NOX4 proteins in peripheral blood mononuclear cells of the two groups were determined. At 24 hours after surgery, the lung function indices of the sevoflurane group such as FEV1, FVC and VC were higher than those of the propofol group (p<0.001, p=0.008 and p=0.002, respectively). At the end of the surgery and at 24 hours after surgery, the MMSE scores of the sevoflurane group were higher than the propofol group (all p<0.001). S100 levels were lower than the propofol group (p=0.003 and p<0.001, respectively). Levels of NADPH oxidase subunits NOX2 and NOX4 proteins in peripheral blood mononuclear cells of the sevoflurane group were lower than the propofol group (p=0.033, p<0.001, p<0.001and p<0.001, respectively). Compared with intravenous anesthesia with propofol, general anesthesia with sevoflurane inhalation has little effect on the short-term cognitive function in elderly patients undergoing radical surgery for lung cancer, and can effectively improve lung function. The mechanism may be related to the reduction of the expression of NOX2 and NOX4 proteins.

TONGUE MICROSURGICAL RECONSTRUCTION IN PATIENTS WITH ORAL CANCER. FUNCTIONAL OUTCOMES

Objectives: present our experience tongue microsurgical reconstruction in patients with oral caner Т2-Т4аN+M0. Material and methods: prospective study of cases reconstruction of oropharyngeal zone defects after radical operations for cancer from 2015 to 2017 in microsurgery department P. Hertsen Moscow Oncology Research Institute. Total 18 patients included in our study. We used flaps for reconstruction of post-resection defects: small intestine flap (2), radial forearm flap (10), thoracodorsal flap (2) chimeric thoracodorsal flap LDM+ serratus anterior muscle (4). Results: Reconstruction was successfully completed in 94 % of patients. In all cases was not flap necrosis. Mean follow-up was 16 months. Patients were free air - 89%. Patients were able to feed entirely by mouth - 83%. Speech function was completely restored in 82% of patients after operation. Spontaneous sensory re-innervation occurred in 35% of cases. One patient noted motor neuronal re-innervation. By the end of the 6th month after the operation, speech function was completely restored in 82% of patients. Conclusions: Attention to the principles of tongue reconstruction and knowledge of the range of available reconstructive options can result in more favorable functional outcomes.

The risk trajectory between preoperative fasting glucose and common digestive tract cancer-specific mortality in the FIESTA cohort involving 6865 Chinese patients.

Backgrounds: High blood glucose or hyperglycemia is an established risk factor for the development and progression of cancer at many sites, whereas data on the relevance between low blood glucose or hypoglycemia and cancer survival are lacking.Aims: We aimed to assess the shape of risk trajectory between preoperative fasting glucose and postoperative digestive cancer-specific mortality in Chinese.Methods: In total, 6865 patients who underwent radical surgery for esophageal cancer (n=2535), gastric cancer (n=3012) and colorectal cancer (n=1318) during 2000-2010 were followed up as of December 2015. All patients received neither chemotherapy nor radiotherapy before and after the surgery. Optimal cutoff points were determined using survival tree analysis.Results: The median follow-up time was 44.9 months (range: 0.5-188.9 months), with 1065 deaths from esophageal cancer, 1331 from gastric cancer and 412 from colorectal cancer. Using fasting glucose (4.36, 6.09] mmol/L as the reference group, hazard ratios for fasting glucose ≤4.36, (6.09, 8.95], (8.95, 11.5] and >11.5 mmol/L were 1.35 (95% confidence interval: 1.19, 1.54), 2.82 (2.57, 3.11), 3.56 (3.10, 4.08) and 4.27 (3.67, 4.97), respectively (p<0.001).Conclusions: Our findings indicate a U-shaped risk trajectory between preoperative fasting glucose and digestive tract cancer-specific mortality in Chinese. Further external validation is warranted.

Minimally invasive surgery improves short-term outcomes of nerve-sparing radical hysterectomy in patients with cervical cancer: a propensity-matched analysis with open abdominal surgery.

ObjectivesNerve-sparing radical hysterectomy has been implemented in order to reduce pelvic floor dysfunctions in women undergoing radical surgery for cervical cancer. Here, we aimed to investigate if the adoption of laparoscopic surgery impacts on patients' outcomes.MethodsData of consecutive patients affected by cervical cancer who had laparoscopic nerve-sparing radical hysterectomy were matched 1:1 with an historical cohort of patients undergoing open procedure. A propensity-score matched algorithm was applied.ResultsThirty-five patients' pairs (70 patients: 35 undergoing laparoscopic vs. 35 undergoing open abdominal nerve-sparing radical hysterectomy) were included. Demographic and baseline oncologic characteristics were balanced between groups. Patients undergoing laparoscopic surgery had similar operative time than patients undergoing open abdominal procedures (249 [±91.5] vs. 223 [±65.0] minutes; p=0.066). Laparoscopic approach correlated with lower blood loss (30.5 [±11.0] vs. 190 [90.4] mL; p<0.001) and shorter hospital stay (3.2 [±1.2] vs. 5.4 [2.0] days; p=0.023). Patients undergoing laparoscopy experienced a lower 30-day pelvic floor dysfunction rate than patients having open surgery. Moreover, they experienced shorter recovery of bladder function than patients having open procedures (median, 7 vs. 9 days; p=0.004, log-rank test).ConclusionLaparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients undergoing nerve-sparing radical hysterectomy.

Carbon Nanoparticles for Identifying Lymph Nodes during Surgery in Colorectal Cancer: A Meta-Analysis

Aim: To investigative the efficacy of carbon nanoparticles (CNs) to identify the lymph nodes during radical surgery in colorectal cancer. Method: The MEDLINE, EMBASE and Cochrane Library databases were searched electronically to identify the studies that compared the use of CNs (CN group) with control group in patients undergoing colorectal cancer radical surgery (from January 2009 to November 2018). The primary outcome was the number of retrieved central lymph nodes. Results: This meta-analysis identified 2 randomized controlled trials and 5 non-randomized controlled trials. Compared with the control group, the CN group resulted in an average of 7.16 more lymph nodes removed per patient (WMD = 7.16, 95% CI = 3.76 to 10.57, p p = 0.02), and 15.1 ml less blood loss during operation (WMD = -15.11, 95% CI = -23.15 to -7.06, p p = 0.87), there was 1.45 times more metastatic lymph of the stained nodes in CN group than in the control group (OR = 1.45, 95% CI = 1.13 to 1.85, p 5 mm were detected significantly more in the CN group than in the control group (OR = 2.15, 95% CI = 1.77 to 2.63, p s higher risk of metastasis. Further high quality RCT is needed to verify these conclusions.

The clinical application of Mixed Reality Holographic image in hepatectomy- 1 case report

Introduction: To explore the clinical application of Mixed Reality Holographic image in perioperative period of hepatectomy. Method: The clinic-pathological data of one case in TongJi Hospital of hepatectomy using Mixed Reality Holographic image were analyzed retrospectively. This was a patient with liver metastasis after radical operation for gastric cancer. It was planned to perform left hemihepatectomy. Preoperative Mixed Reality Holographic image was reconstructed to formulate operation mode and confirm resection range. Result: Mixed Reality Holographic image can clearly display the range of tumor and ubiety between tumor and vessels Conclusion: Mixed Reality holographic image can be safely and effectively applied in hepatectomy.

Effect of ulinastatin on postoperative outcomes in elderly patients undergoing thoracoscopic radical operation for lung cancer

Objective To evaluate the effect of ulinastatin on postoperative outcomes in elderly patients undergoing thoracoscopic radical operation for lung cancer. Methods Sixty patients of both sexes, aged 65-80 yr, weighing 40-85 kg, of American Society Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for thoracoscopic radical operation for lung cancer, were divided into 2 groups(n=30 each)using a random number table method: ulinastatin group(group UTI)and normal saline group(group NS). Ulinastatin 0.5×104 U/kg was intravenously infused within 1 h before skin incision in group UTI, while the equal volume of normal saline was given instead in group NS.Central venous blood samples were collected at 30 min before skin incision(T0), 30 min after start of surgery(T1), and 1 h and 1, 3 and 5 days after surgery(T2-5)for determination of the expression of CD42a+ , HLADR+ and CD14+ in monocytes(using the flow cytometry), plasma concentrations of interleukin-6(IL-6), IL-8 and tumor necrosis factor-alpha(TNF-α)(by enzyme-linked immunosorbent assay), and the plasma C-reactive protein(CRP)concentration(by immunoturbidimetry). The ratios of monocyte-platelet adhesion(CD42a+ /CD14+ )and monocyte activation function(HLADR+ /CD14+ )were calculated.Cognitive function was assessed and scored on day 1 before operation and day 7 after operation, and the incidence of postoperative cognitive dysfunction(POCD)was calculated using Z score. Results Compared with group NS, the CD42a+ /CD14+ ratio was significantly decreased at T1-3, the HLADR+ /CD14+ ratio was increased at T3, 4, the concentrations of plasma IL-6, IL-8, TNF-α and CRP were decreased at T1-5, and the incidence of POCD was decreased in group UTI(P<0.05). Compared with the baseline value at T0, the HLADR+ /CD14+ ratio was significantly decreased at T2-4 in group UTI, the HLADR+ /CD14+ ratio was decreased at T2-5, and the CD42a+ /CD14+ ratio was increased at T1, 2 and T4, 5 in group NS, and the concentrations of plasma IL-6, IL-8, TNF-α and CRP were increased at T1-5 in the two groups(P<0.05). Conclusion Ulinastatin can promote postoperative outcomes in the elderly patients undergoing thoracoscopic radical operation for lung cancer. Key words: Trypsin inhibitors; Thoracoscopy; Aged; Prognosis

Correlation analysis of IL-4, IL-10 and APN levels with postoperative infection of colorectal cancer.

Changes in expression levels of serum interleukin-4 (IL-4), IL-10 and adiponectin (APN) in patients with postoperative infection of colorectal cancer were studied. The clinical data of 159 patients receiving radical surgery for colorectal cancer in Xiangyang No. 1 People's Hospital, Hubei University of Medicine from January 2014 to December 2017, were retrospectively analyzed. A total of 67 patients with postoperative infection were enrolled into the infection group, while the remaining 92 patients without infection were enrolled into the non-infection group. The expression levels of serum IL-4, IL-10 and APN of patients were detected via enzyme-linked immunosorbent assay. The correlation of IL-4, IL-10 and APN levels with stage of colorectal cancer were explored by the Spearmans correlation analysis. The expression levels of IL-4 and IL-10 in the infection group were significantly higher than those in the non-infection group at day 3 after surgery (P<0.05). The expression level of APN in the infection group was lower than that in the non-infection group at day 3 after surgery (P<0.05). The serum IL-4 and IL-10 levels in pulmonary infection was higher and the serum IL-10 level in pulmonary infection was higher than those in incision infection and abdominal infection (P<0.05). The IL-4 and IL-10 levels in patients with colorectal cancer in the infection group at day 3 after surgery had a significant positive correlation with the stage of colorectal cancer (r=0.9357, P<0.001; r=0.9717, P<0.001), and the APN level in patients with colorectal cancer in the infection group at day 3 after surgery had a significant negative correlation with the stage of colorectal cancer (r=−0.9736, P<0.001). The serum IL-4 and IL-10 levels in patients with postoperative infection of colorectal cancer are positively correlated with the stage of cancer, while the serum APN level was negatively correlated with the stage of cancer.

Recurrence Patterns and Outcomes of Salvage Surgery in Cases of Non-Curative Endoscopic Submucosal Dissection without Additional Radical Surgery for Early Gastric Cancer

Background/Aims: The outcomes of salvage surgery for recurrence after non-curative endoscopic submucosal dissection (ESD) without additional radical surgery for early gastric cancer (EGC) remain unclear. We determined the recurrence patterns and outcomes of salvage surgery in such cases using data from a multicenter, retrospective study. Methods: Of 15,785 patients who underwent ESD for EGC at 19 participating institutions between January 2000 and August 2011, 1,969 failed to meet the current curative criteria after ESD. Of these, 905 patients received no additional treatment. We evaluated the pattern of recurrence, clinical course after salvage surgery, and long-term survival rate for these patients. Results: Over a median 64-month follow-up period, recurrence was detected in 27 patients. Two patients with missing data were excluded. Three, seven, and 15 (60%) patients showed intragastric relapse, regional lymph node metastasis, and distant metastasis, respectively. The first line of treatment for recurrence in 1, 7, 6, and 11 patients was endoscopic treatment, salvage surgery, chemotherapy, and best supportive care, respectively. One patient survived without recurrence for 31 months after salvage surgery, one died of acute myocardial infarction 1 month after salvage surgery, and 5 showed recurrence at 0, 2, 3, 5, and 30 months after salvage surgery and eventually succumbed to the disease. The median survival times for all patients with recurrence and the 7 patients who underwent salvage surgery were 5 months after recurrence and 7 months after salvage surgery, respectively. Conclusion: The survival rate after salvage surgery for recurrence after non-curative ESD without additional radical surgery for EGC is quite low, with distant metastasis being the most common recurrence pattern in these cases.