Results Of Postoperative Pathological Examination Research Articles

Postoperative lymph node metastasis status and related factors in patients with early-stage, low-risk endometrial cancer assessed by the Mayo criteria

Objective: To investigate the postoperative lymph node metastasis status and related factors of patients with early-stage low-risk endometrial cancer evaluated by the Mayo criteria in order to make the preoperative evaluation more accurate. Methods: A total of 172 patients with early-stage low-risk endometrial cancer who underwent surgery in Sichuan Provincial Cancer Hospital from 2009 to 2018 and were evaluated as early low-risk according to the "Mayo criteria" were retrospectively enrolled, and were divided into lymph node metastasis group (7 cases) and non-metastasis group (165 cases) according to the results of postoperative pathological examination. The postoperative pathological examination results and prognosis of all patients were collected. The lymph node metastasis of the two groups was analyzed. The multiple logistic regression model was used to analyze the related factors of lymph node metastasis, and the area under the curve (AUC) of the relevant factors was calculated by using the receiver operating characteristic curve to predict the postoperative lymph node metastasis of patients. Results: The age of 172 patients was (53.0±8.6) years, and the follow-up [M(Q1,Q3)] was 64.1 (46.2, 91.4) months, among whom 2 relapsed and 1 died. Among the 7 patients with lymph node metastasis, 5 cases had pelvic lymph node metastasis, 1 case had pelvic lymph union and abdominal para-aortic lymph node metastasis, 1 case had isolated abdominal para-aortic lymph node metastasis, 3 cases had two lymph node metastases, and 4 cases had intrailiac lymph nodes being the most common metastasis site. Multivariate analysis showed that preoperative serum cancer antigen (CA) 125 was the relevant factor for postoperative lymph node metastasis, with an OR value (95%CI) of 1.022 (1.001-1.043) (P=0.042), with AUC (95%CI) of CA125 predicting lymph node metastasis of 0.850 (0.761-0.939) (P=0.002), and the optimal cut-off value of CA125 was 29.305 U/ml with the sensitivity of 85.7% and the specificity of 80.6%. Conclusions: When CA125>29.305 U/ml, patients with early-stage low-risk endometrial cancer assessed by the Mayo criteria, had an increased risk of lymph node metastasis. Therefore, adding preoperative serum CA125 level as an evaluation index on the basis of the classic "Mayo criteria" may help conduct more accurate preoperative evaluation and better identify early-stage low-risk EC patients.

Minimal invaziv paratiroidektomi. Tek merkez deneyimi.

Objective: Among endocrine diseases, primary hyperparathyroidism ranks third in frequency after diabetes mellitus and thyroid diseases 
 The aim of this study is to present the results of parathyroid adenoma surgery and the effectiveness of imaging methods in detecting parathyroid adenomas in our tertiary surgical clinic, where parathyroid surgery is frequently performed.
 Methods: Between January 2019 and March 2023, records of patients who underwent surgery in our clinic due to parathyroid adenoma were retrospectively scanned. Patient demographics, blood parameters, preoperative imaging results, surgical findings, and postoperative pathological examination results were recorded.
 Results: A total of 98 patients were included in the study. During surgery, it was observed that parathyroid adenomas were most commonly located in the right inferior position (48 patients, 49%) and secondarily in the left inferior position (30 patients, 30.6%).
 When examining the diagnostic accuracy rates of preoperative imaging studies in the localization of pathological parathyroid glands, it was found that the location of right inferior parathyroid adenomas was most accurately detected both in ultrasound examination and scintigraphic imaging results (30.6% and 36.7%, respectively). Parathyroid adenomas located adjacent to the isthmus were found to be least accurately detected both in ultrasound examination and scintigraphic imaging results (1% and 0%, respectively).

The efficacy and safety analysis of cervical and abdominal double single-port minimally invasive esophagectomy

Objective: To summarize the efficacy and safety of minimally invasive esophagectomy through cervical and abdominal double single-port. Methods: A total of 28 patients who underwent cervical and abdominal double single-port minimally invasive radical resection of esophageal cancer from January 2021 to October 2022 in the First Affiliated Hospital of Fujian Medical University were retrospectively collected, including 18 males and 10 females, aged 58-80 (72±4) years. All patients were placed in the supine position, the single port was operated through the cervical mediastinum first, then the single port was operated through the abdominal cavity, and finally the neck was anastomosed. The operative time, intraoperative blood loss, postoperative ambulation time, postoperative drainage tube removal time, postoperative complications, postoperative pathological examination results, postoperative discharge time of patients were recorded and followed. Results: In the included 28 patients, there were twenty-six patients successfully completed the cervical and abdominal double single-port minimally invasive radical resection of esophageal cancer, and two patients were transferred to the right thoracoscopic surgery due to oozing of blood and unclear visual field, without conversion to laparotomy or enlargement of the incision occurred. The operation time was 125 to 215 (152±32) minutes, including 43 to 100 (56±15) minutes in the mediastinum and 35 to 63 (40±5) minutes in the abdominal cavity. Intra-operative blood loss was 55-100 (45±20) ml. There were 8 to 14 (11±3) lymph nodes dissected in the mediastinum and 7 to 15 (9±3) lymph nodes dissected in the abdominal cavity. Twenty-eight patients were active in bed 1 to 2 days after surgery. The left cervical drainage tube was removed 2 days after surgery. There was no anastomotic fistula, anastomotic stenosis, pulmonary infection, chylothorax and stomach emptying disorder in the whole group. Pleural effusion occurred in 4 cases, all of them had pleural damage during the operation, and were cured after postoperative puncture and drainage; two cases had hoarseness and one case had cough after eating, all patients were discharged from hospital after eating liquid. Postoperative hospital median stay was [ M(Q1, Q3)] 7(6, 9) d. The postoperative pathological examination results of all patients were squamous cell carcinoma, and the postoperative pathological stage was pT1-3N0-1M0. The median postoperative follow-up was 25 (5, 35) months, and no patients had complications, recurrence, metastasis or death during the follow-up period. Conclusion: The cervical and abdominal double single-hole minimally invasive radical resection of esophageal cancer is safe and feasible, with good short-term efficacy, which provide an opportunity for radical surgery for patients with advanced age, poor cardiopulmonary function or insufficient thoracic conditions.

Value of ultrasound BI‑RADS classification in preoperative evaluation of the ultrasound‑guided Mammotome‑assisted minimally invasive resection of breast masses: A retrospective analysis.

The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification has been used for the diagnosis of breast masses for several decades and constantly updated, but the terminology used to describe breast ultrasound findings is still evolving and a great amount of large sample data is necessary to verify and improve ultrasound BI-RADS. The objective of the present study was to explore the value of ultrasound Breast Imaging Reporting and Data System (US BI-RADS) classification in the preoperative evaluation of the US-guided Mammotome-assisted minimally invasive resection of breast masses. A total of 1,028 patients with 1,341 breast masses from a single hospital were selected for retrospective analysis. All patients underwent minimally invasive resection using a US-guided Mammotome device, and postoperative pathological examinations were performed for all samples. The preoperative US BI-RADS classification and postoperative pathological examination results were compared and analyzed. A receiver operating characteristic (ROC) curve was used to analyze the preoperative evaluation efficacy of the US BI-RADS classification in US-guided Mammotome-assisted minimally invasive breast mass resection. Among the 1,341 breast masses that underwent resection, 1,307 were benign and 34 were malignant. The specificity, sensitivity, accuracy, positive predictive value and negative predictive value of the US BI-RADS classification in the preoperative diagnosis of malignant breast masses were 83.47, 100.00, 83.89, 13.60 and 100.00%, respectively, and the area under the ROC curve was 0.917. It may be concluded that the US BI-RADS classification has a good preoperative diagnostic performance and can provide an accurate assessment prior to Mammotome-assisted minimally invasive resection. It may help surgeons to make reasonable decisions for subsequent therapy and therefore is worthy of further clinical use.

Analysis of the diagnosis and treatment of 24 cases of hepatic perivascular epithelioid cell tumor

Objective: To investigate hepatic perivascular epithelioid cell tumor (PEComa) diagnosis and treatment plan. Methods: 24 cases diagnosed with PEComa clinical manifestations, serum alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), imaging findings, surgical methods, postoperative hospital stay, pathological results and prognosis were analyzed retrospectively from September 2015 to September 2020. Results: Majority of patients were females (79.2%), aged 41.5±11.4 years. Tumors were predominantly located in the right liver (50.0%). 76.7% of the cases were mostly clinically asymptomatic. AFP, CEA and CA199 indices were all negative. CT mostly showed low density tumor in the plain scan phase, enhanced in the enhancement phase, and enhanced and weakened in portal venous and equilibrium phase (66.7%). MRI manifestations of most tumors were hypointense on T1WI and hyperintense on T2WI (72.7%). B-ultrasound mostly showed hyperechoic mass in the tumor area with punctate vascular shadow (52.9%). Postoperative hospital stay was 9.0±2.4 days for laparoscopic surgery patients (n=13), 13.4±6.3 days for traditional laparotomy (hereinafter referred to as laparotomy, n=10), and 3 days for 1 patient with microwave ablation. All postoperative pathological results were positive for HMB45 and Melan-A. Follow-up results: 21 cases survived normally, with no tumor recurrence in the recent physical examination; two cases had tumor recurrence and they died two and three years after surgery, and one case was lost to follow-up. Conclusion: Hepatic PEComa more commonly occurs in middle-aged women, with no specific features for tumor markers and clinical manifestations. Some imaging findings are specific, so its features can be combined as a basis for diagnosis. Postoperative pathological examination results can confirm the diagnosis. Therefore, surgery remains the initial treatment plan. Microwave ablation and laparoscopic surgery are recommended as the preferred option because of shorter hospital stays and less trauma than open surgery.

Value of Transabdominal Combined Transvaginal Color Doppler Ultrasonography in the Distinguish between Uterine Adenomyoma and Uterine Fibroids.

Objective To investigate the value of transabdominal combined transvaginal color Doppler ultrasonography in the diagnosis of uterine adenomyoma. Methods A total of 80 patients with suspected uterine adenomyoma in our hospital from January 2019 to December 2021 were selected as the study subjects. All of them were examined by transabdominal color Doppler ultrasound (TA-CDUS) and transvaginal color Doppler ultrasound (TV-CDUS), and the postoperative pathological examination results were taken as the gold standard to analyze the diagnostic efficacy of different examination methods for uterine adenomyoma. Results By postoperative pathological biopsy, 46 cases (57.50%) were diagnosed as positive and 34 cases (42.50%) were diagnosed as negative, including 29 cases of uterine adenomyoma and 5 other cases. The sensitivity, accuracy, and negative predictive value of TA-CDUS combined with TV-CDUS in the diagnosis of adenomyoma were higher than those of TA-CDUS (P < 0.05), and the Kappa value between TA-CDUS and pathological diagnosis was 0.923, which was higher than the 0.615 between TV-CDUS and pathological diagnosis. TA-CDUS combined with TV-CDUS showed that there were significant differences in the distribution of Adier blood flow grades between patients with uterine adenomyoma and uterine fibroids (P < 0.05), and the Adier blood flow grades of patients with uterine adenomyoma were mainly grade 0 and grade I; and the resistance index (RI), peak systolic velocity (Vs), and pulsatile index (PI) in patients with uterine adenomyoma were higher than those in patients with uterine fibroids (P < 0.05). Conclusion Compared with TA-CDUS, TA-CDUS combined with TV-CDUS is more sensitive and accurate in the diagnosis of uterine adenomyoma and has a good consistency with pathological diagnosis results. Attention should be paid to the blood flow parameter values in the differential diagnosis of uterine fibroids.

Diagnostic Value of Spiral CT and Magnetic Resonance Imaging Scanning in Gastric Cancer and Precancerous Lesions.

In order to explore the diagnostic value of spiral CT and magnetic resonance imaging scanning in gastric cancer and precancerous lesions, the author selected 56 gastric cancer patients treated in a medical center (group) as the experimental subjects, and all patients underwent MRI, multislice spiral CT scan, and enhanced CT scan two weeks before surgery; at the same time, the gastric cancer staging results of patients were diagnosed according to surgical pathology. All patients were examined under the condition of knowledge and performed breath-holding exercise before examination. The status, location, and extent of tumor lesions were evaluated. In comparison of T staging of gastric cancer patients with magnetic resonance scanning imaging and postoperative pathological examination results, among them, T staging of 3 patients did not match the results of pathological examination, the accuracy rates of T staging on magnetic resonance scanning imaging were T1 = 94.7%, T2 = 87.6%, T3 = 91.2%, and T4 = 94.7%, and the total accuracy was 92.1%. Comparison of helical CT scan imaging and postoperative pathological examination results is as follows. Among them, T staging of 8 patients did not match the results of pathological examination, 3 patients were ulcerative, 5 were protuberance, the accuracy rates of T staging in spiral CT scan imaging were T1 = 90.8%, T2 = 82.2%, T3 = 76.9%, and T4 = 87.6%, and the total accuracy was 84.5%. The total accuracy rate of imaging N staging was 77.5%, and the total accuracy rate of spiral CT scanning imaging N staging was 80.8%. The accuracy rates of M0 and M1 staging in magnetic resonance imaging were 100.0% and 96.5%, respectively, and the accuracy rates of M0 and M1 staging in spiral CT scan imaging were 96.5% and 96.5%, respectively. The accuracy rate of magnetic resonance imaging for the diagnosis of gastric cancer N staging was 77.4%, and the reason for the low accuracy rate was mainly because the enhancement effect was not obvious due to insufficient enhancement. The accuracy rate of spiral CT in diagnosing N staging of gastric cancer was 80.9%, which was mainly due to the small diameter of the middle celiac artery lymph nodes. Magnetic resonance and spiral CT scans have high value in the early diagnosis and staging of gastric cancer.

The Value of Nuclear Magnetic Resonance in Liver Nodular Lesions.

In order to analyze the value of contrast-enhanced ultrasound (CEUS) combined with functional magnetic resonance imaging (fMRI) in the early differential diagnosis of liver nodular lesions, the authors studied the value of MRI in liver nodular lesions. A total of 82 patients with liver nodular lesions admitted to the hospital were selected for retrospective analysis; all of them underwent CEUS and fMRI examinations, and taking a biopsy or postoperative pathological examination results as the gold standard, the diagnostic value of CEUS, fMRI single item, and the two combined examinations for liver nodular lesions was analyzed by four-table. The biopsy or postoperative pathological examination results showed that a total of 88 lesions were detected in 82 patients, including 51 patients with benign lesions, with 54 lesions, and 31 patients with malignant lesions, with 34 lesions. Taking biopsy or pathological examination results as the gold standard, the four-table analysis CEUS had a sensitivity of 79.63%, a specificity of 82.35%, an accuracy of 80.68%, and a Kappa value of 0.603 for diagnosing benign and malignant liver nodular lesions. The sensitivity of fMRI in diagnosing benign and malignant liver nodular lesions was 83.33%, the specificity was 85.29%, the accuracy was 84.09%, and the Kappa value was 0.672; the combined sensitivity of the two in the diagnosis of benign and malignant liver nodular lesions was 94.44%, the specificity was 91.18%, the accuracy was 93.18%, and the Kappa value was 0.856, both of which were superior to single detection, and the difference in accuracy was statistically significant (χ2 = 5.683, P < 0.05). CEUS and fMRI have a certain value in the differential diagnosis of liver nodular lesions; the combination of the two can improve the diagnostic sensitivity and accuracy, and has more clinical application value.

Exploration of CT Images Based on the BN-U-net-W Network Segmentation Algorithm in Glioma Surgery.

This study aimed to explore the application value of computed tomography (CT) imaging features based on the deep learning batch normalization (batch normalization, BN) U-net-W network image segmentation algorithm in evaluating and diagnosing glioma surgery. 72 patients with glioma who were admitted to hospital were selected as the research subjects. They were divided into a low-grade group (grades I-II, N = 27 cases) and high-grade group (grades III-IV, N = 45 cases) according to postoperative pathological examination results. The CT perfusion imaging (CTPI) images of patients were processed by using the deep learning-based BN-U-net-W network image segmentation algorithm. The application value of the algorithm was comprehensively evaluated by comparing the average Dice coefficient, average recall rate, and average precision of the BN-U-net-W network image segmentation algorithm with the U-net and BN-U-net network algorithms. The results showed that the Dice coefficient, recall, and precision of the BN-U-net-W network were 86.31%, 88.43%, and 87.63% respectively, which were higher than those of the U-net and BN-U-net networks, and the differences were statistically significant (P < 0.05). Cerebral blood flow (CBF), cerebral blood volume (CBV), and capillary permeability (PMB) in the glioma area were 56.85 mL/(min·100 g), 18.03 mL/(min·100 g), and 8.57 mL/100 g, respectively, which were significantly higher than those of normal brain tissue, showing statistically significant differences (P < 0.05). The mean transit time (MTT) difference between the two was not statistically significant (P > 0.05). The receiver operating characteristic (ROC) curves of CBF, CBV, and PMB in CTPI parameters of glioma had area under the curve (AUC) of 0.685, 0.724, and 0.921, respectively. PMB parameters were significantly higher than those of CBF and CVB, and the differences were statistically obvious (P < 0.05). It showed that the BN-U-net-W network model had a better image segmentation effect, and CBF, CBV, and PMB showed better sensitivity in diagnosing glioma tissue and normal brain tissue and high-grade and low-grade gliomas, among which PBM showed the highest predictability.

695 METASTASIS OF THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODE AS PREDICTOR FOR CERVICAL LYMPH NODE DISSECTION IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Lymph node(LN)metastasis is a common metastasis mode of esophageal squamous cell carcinoma (ESCC). The purpose of this study is to explore whether recurrent laryngeal nerve LNs metastasis can be used as a predictor of cervical LN dissection. Methods The postoperative pathological examination results of patients with ESCC who underwent three-field LN dissection in Sichuan Cancer Hospital from January 2010 to January 2016 were retrospectively collected to explore the relationship between the recurrent laryngeal nerve LN metastasis and cervical LN metastasis. At the same time, analyzed survival data to determine whether cervical LN dissection should be performed on patients with thoracic ESCC. Results Among all the study subjects, 53.3% (72/135) patients had metastasis in the thoracic recurrent laryngeal nerve LNs, and 36.3% (49/135) patients had metastasis in the cervical LN. 44.4% (32/72) Patients with metastasis in the thoracic recurrent laryngeal nerve LN tended to have a high incidence of cervical LN metastasis (P = 0.035). Subgroup analysis showed that 60% (81/135) patients had upper thoracic ESCC, and 46.9% (38/81) patients had cervical LN metastasis (P = 0.002). Survival analysis showed that patients with cervical LN metastasis had poor survival (P &amp;lt; 0.001). Multivariate analysis showed that bilateral recurrent laryngeal nerve LN metastasis was an independent risk factor for survial(P = 0.029). Conclusion Patients with bilateral recurrent laryngeal nerve LN metastasis in upper thoracic ESCC can be used as a predictor of cervical LN dissection.

Diagnostic Value of Multimodal Magnetic Resonance in Cervical Cancer Staging and Pelvic Lymph Node Metastasis

Objective. To investigate the diagnostic value of multimodal magnetic resonance imaging (MRI) in cervical cancer patients with disease stage lymph node metastasis. Method. A total of 46 patients diagnosed with cervical cancer admitted to our hospital from January 2018 to December 2020 were selected. All the patients were confirmed by postoperative pathological examination. Figo staging and lymph node metastasis were determined based on the pathological examination results. Multimodal MRI examination was used to complete conventional MRI plain scan, diffusion weighted imaging (DWI) and dynamic enhanced scanning (DCE). Multimodal MRI staging results, lymph node metastasis and pathological results were compared. To evaluate the diagnostic value of multimodal MRI in cervical cancer patients. Result. According to the results of postoperative pathological examination, stage I patients accounted for 26.1%(12/46), stage II patients accounted for 43.5%(20/46), stage III patients accounted for 17.4%(8/46), and stage IV patients accounted for 10.9%(5/46). Multimodal MRI showed stage I in 13 cases, stage II in 18 cases, stage III in 10 cases, and stage IV in 5 cases. Compared with postoperative pathological examination results, the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of multimodal MRI in patients with stage IV cervical cancer were all 100.00%, which were higher than those in patients with stage III, II and I cervical cancer (P<0.05). A total of 131 lymph nodes were examined in 46 patients after surgery, of which 63 lymph nodes had metastasis and 68 lymph nodes had no metastasis. After multimodal MRI examination, 60 lymph nodes were diagnosed with metastasis, with diagnostic accuracy of 93.1% and sensitivity of 95.00%. The diagnostic specificity was 91.56%. Conclusion. Multimodal MRI examination has a high accuracy in the diagnosis of the disease stage and lymph node metastasis of cervical cancer patients, and can clearly and comprehensively display the lesions and effectively identify the disease stage. It can be used as an important means for the diagnosis of cervical cancer and is worthy of clinical promotion.

Analysis and Evaluation of Ultrasound Imaging Features and Pathological Results of Ovarian Cancer

To compare and analyze the relationship between the characteristics of ultrasound images of ovarian cancer and the results of postoperative pathological examination. A retrospective analysis of 206 patients with suspected ovarian cancer confirmed by surgical pathology was taken as the research object. The location, size, morphology, partition and wall nodules, cystic solidity, and signal characteristics of the tumor were observed and compared with the results of postoperative pathological examination evaluation and analysis to improve the early clinical diagnosis of ovarian cancer patients. By regression analysis of the histological examination of patients with ovarian tumors of different ages and the proportion of cox postoperative recurrence risk regression models, 154 of 206 ovarian tumor patients were ovarian cancer. There were significant differences in pathological types, lesion locations, maximum diameter lengths, and internal echo in patients with ovarian malignant tumors at different ages (p &lt; 0.05). Ultrasound of ovarian cancer shows that the tumor has large tumor body, strong echo, cyst wall has protrusions, and peripheral and internal blood flow that is mainly high-speed and low-resistance. The sensitivity, specificity, and accuracy of ultrasound for ovarian cancer diagnosis are 84.38%, 66.67%, 81.01%. The accuracy, specificity, and sensitivity of early diagnosis of clinical ovarian cancer patients by ultrasound imaging features provide sufficient imaging evidence to further promote the clinical judgment of benign and malignant tumors, which is beneficial to doctors’ clinical treatment of ovarian cancer patients. The early diagnosis and the higher clinical value were shown.

Application value of different lymph node staging system in predicting prognosis of patients with intrahepatic cholangiocarcinoma

Objective: To examine the value of number of metastatic lymph nodes(NMLN), lymph node ratio(LNR) and log odds of metastatic lymph nodes(LODDS) in assessing the prognosis of patients with intrahepatic cholangiocarcinoma(ICC). Methods: The clinical and pathological data of 440 ICC patients who underwent curative-intent resection in 10 of Chinese hepatobiliary surgery centers from January 2010 to December 2018 were collected, and the deadline of follow-up was April 30th, 2019. Among them, 205 were males and 235 were females, with age of (57.0±9.9) years (range:23-83 years).Eighty-five cases (19.3%) had intrahepatic bile duct stones, and 98 cases (22.3%) had chronic viral hepatitis.The Kaplan-Meier method was used for survival analysis. The univariate and multivariate analysis were implemented respectively using the Log-rank test and Cox proportional hazard model. Results: A total of 440 patients underwent curative-intent resection and lymphadenectomy.R0 resection were achieved in 424 cases (96.4%) and R1 resection were in 16 cases (3.6%). The results of postoperative pathological examination showed that high, moderate and poor differentiation was 4.2%(18/426), 60.6%(258/426) and 35.2%(150/426), respectively.Adenocarcinoma was seen in 90.2%(397/440) and non-adenocarcinoma was seen in 9.8%(43/440), respectively. T stage: 2 cases (0.5%) with Tis, 83 cases(18.9%) with T1a, 97 cases(22.0%) with T1b, 95 cases(21.6%) with T2, 122 cases (27.7%) with T3 and 41 cases(9.3%) with T4.The overall median survival time was 24.0 months, and the 1-,3-, and 5-year survival rate was 74.3%, 37.7% and 18.3%, respectively. Lymphatic metastasis occurred in 175 patients(39.8%), the median total number of TNLE(M(Q(R))) was 6(5), the median number of NMLN was 0(1), the median number of LNR was 0 (0.33) and the median number of LODDS was -0.70(-0.92). Rerults of univariate analysis showed that combined stones, pathological differentiation, vascular invasion, LODDS, margin and T staging affected the prognosis (all P<0.05). Rerults of multivariate analysis showed that pathological differentiation, LODDS, margin, and T staging were independent risk factors affecting the prognosis of ICC patients (all P<0.05). Conclusion: LODDS could be used as an optimal prognostic lymph node staging index for ICC, and it is also an independent risk factor for survival after curative intent resection.

Analysis of consistency between core needle biopsy of musculoskeletal or soft tissue mass under guidance of ultrasound and postoperative pathological examination results

Objective To investigate the consistency and clinical significance of ultrasound-guided core needle biopsy(CNB) for patients with musculoskeletal or soft tissue masses and postoperative pathological examination results. Methods A total of 66 patients with musculoskeletal or soft tissue masses who underwent CNB and surgical resection of the lesions were collected. The consistency of CNB and surgical pathological examination was determined using Kappa test. Results The success rate of puncture in all 66 patients was 100.0%. The pathological accuracy rate, support rate, negative rate and total effective rate of CNB under ultrasound guidance were 72.7%(48/66), 19.7%(13/66), 7.6%(5/66) and 92.4%(61/66), respectively. There was a strong consistency between CNB pathology and surgical pathology (κ=0.909, P Conclusion The ultrasound-guided CNB pathological diagnosis for muscle, bone and soft tissue masses has better agreement with the pathological diagnosis of surgical specimens, and provides a good basis for the preparation and choice of operation modes.

Clinical efficacy of modified totally laparoscopic intra-gastric surgery for submucosal tumors adjacent to the gastric cardia or pylorus

Objective To explore the clinical efficacy of modified totally laparoscopic intra-gastric surgery for the treatment of submucosal tumors adjacent to the cardia or pylorus. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 48 patients with gastric submucosal tumors adjacent to the cardia or pylorus between September 2014 and March 2018 were collected. There were 22 males and 26 females, aged from 38 to 78 years, with an average age of 58 years. Patients were performed multi-port or single-port modified laparoscopic intra-gastric surgery. Observation indicators: (1) surgical treatments; (2) postoperative recovery; (3) results of postoperative pathological examination; (4) follow-up. Patients were followed up by outpatient examination and telephone interview to detect the postoperative complications and tumor metastasis and recurrence up to June 2018. Measurement data with normal distribution were expressed as Mean±SD and measurement data with skewed distribution were described as M (range). Count data were represented as absolute number or percentage. Results (1) Surgical treatments: 48 patients underwent modified totally laparoscopic intra-gastric surgery successfully, including one patient combined with proximal gastrectomy, without conversion to open surgery. Of the 48 patients, 43 underwent multi-port modified laparoscopic intra-gastric surgery and 5 underwent single-port modified laparoscopic intra-gastric surgery. The operation time and volume of intraoperative blood loss were 68 minutes (range, 45-110 minutes) and 20 mL (range, 5-100 mL). The oncologic evaluation of 48 patients: 48 patients had complete resection of tumors, without tumor rupture. The tumor diameter and distance from margin to tumor were 32 mm (range, 20-40 mm) and 6 mm (range, 5-10 mm). (2) Postoperative recovery: the time for initial oral intake and duration of postoperative stay were 2.8 days (rang, 1.0-5.0 days) and 5.3 days(range, 3.0-11.0 days). There were 4, 3, 1 and 1 patients complicated with surgical infection, delayed gastric emptying, sub-phrenic hydrops and digestive leakage respectively in the 48 patients. (3) Results of postoperative pathological examination: the distance from tumor margin to gastric cardia or pylorus, tumor diameter, circumferential resection margin were 15 mm (range, 0-30 mm), 24 mm (range, 10-65 mm), 6 mm (range, 5-10 mm), respectively. Growth patterns of cancer in the 48 patents included 27 of intraluminal type, 12 of intermural type, 9 of mixed type. Pathological types of 48 patients: there were 26 patients with leiomyoma, 9 with gastrointestinal stromal tumor, 4 with other rare tumors, 2 with carcinoid, 2 with mucosa-associated lymphoma, 2 with inflammatory fibrous polyps, 2 with gastritis cystica profunda, 1 with ectopic pancreas. (4) Follow-up: 41 of the 48 patients were followed up for 3-48 months, with a median follow-up time of 22 months. No tumor recurrence was detected in 37 of 41 patients by 3 times of gastroscopy and no stenosis or dysfunction of cardia or pylorus was detected in 39 patients by 2 times of upper gastrointestinal imaging (one patient undergoing two examinations) . During the follow-up, there was no surgery-related complication or tumor-specific death. Conclusion Modified totally laparoscopic intra-gastric surgery is safe and feasible for the treatment of gastric submucosal tumors adjacent to the cardia or pylorus. Key words: Submucosal tumors; Intra-gastric surgery; Cardia; Pylorus; Laparoscopy

Application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer

Objective To investigate the application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Methods The retrospective and descriptive study was conducted. The clinical data of a 49-year-old male patient with esophageal cancer who was admitted to the Fujian Medical University Union Hospital in November 2018 were collected. The patient underwent closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. In the thoracic part, esophageal separation and thoracic lymph node dissection were performed with closed pneumothorax, semi-lateral position and multi suspension methods. In the abdominal part, gastric separation and lymph node dissection were accomplished with lifting of liver lobe and respective separation of greater curvature and lesser curvature of stomach. The operation time, volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal, volume of thoracic drainage fluid, postoperative complications, postoperative pathological examination results, time for discharge from hospital and results of follow-up were observed. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients after operation up to February 2019. Count data were described as absolute number. Results The patient underwent successfully closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. The operation time and volume of intraoperative blood loss was 310 minutes and 120 mL. The patient resumed out-of-bed activities at 2 days after operation. The abdominal drainage tube, thoracic closed drainage tube and right cervical drainage tube were removed at 2 days after operation with fasting, acid suppression, nutritional support. The thoracic Abel drainage tube and the left cervical drainage tube were removed at 5 days after operation. The volume of thoracic drainage fluid was 550 mL. No obvious sign of anastomotic leakage was found on esophageal angiography at 5 days after operation. The patient recovered well after operation without hoarseness, pulmonary infection and chylothorax. The postoperative examination result of the patient showed mid-thoracic esophageal squamous cell carcinoma (pT3N1M0G3 ⅢB stage). The patient was discharged at 8 days after operation. The patient was followed up for 3 months, and was able to engage in light physical activity. CT reexamination showed no sign of local recurrence or distant metastasis of the tumor. Conclusion Closed single-port thoracoscopic and laparoscopic radical esopahgectomy for esophageal cancer is safe and feasible, with good short-term efficacy. Key words: Esophageal neoplasms; Esophageal cancer; Radical surgery; Thoracoscopy; Laparoscopy; Single port

Clinical effects and prognostic analysis of radical surgery for primary gallbladder cancer

Clinical effects and prognostic analysis of radical surgery for primary gallbladder cancer

Clinical efficacy of pericardial devascularization combined with splenectomy and partial gastric fundus resection in the treatment of portal hypertension-induced severe gastric varices complicated with gastrorenal shunt

Objective To investigate the clinical efficacy of pericardial devascularization (PCDV) combined with splenectomy and partial gastric fundus resection (PGFR) in the treatment of portal hypertension-induced severe gastric varices complicated with gastrorenal shunt (GRS). Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 18 patients with portal hypertension-induced severe gastric varices complicated with GRS who were admitted to the Fujian Provincial Hospital from January 2010 to December 2015 were collected. According to the stage of technical development, open surgery or laparoscopic surgery was selected based on patients′ and their family's wishes. Observation indicators: (1) surgical and postoperative recovery situations; (2) postoperative pathological examination; (3) follow-up and survival. The follow-up using outpatient examination and telephone interview was performed once every 3 months within 1 year postoperatively and once every 6 months after 1 year to detect long-term complications and survival up to June 2017. The reexaminations of gastroscopy, enhanced scan of X-ray computed tomography (CT) on the epigastric region or magnetic resonance imaging (MRI) were done at 1 month postoperatively for detecting resection of fundus ventriculi varicosity. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). The survival rate was calculated by the Kaplan-Meier method. Results (1) Surgical and postoperative recovery situations: 18 patients underwent successful PCDV combined with splenectomy and PGFR, including 12 with open surgery and 6 with laparoscopic surgery (1 with conversion to open surgery due to intraoperatively uncontrollable bleeding). There was no perioperative death. The operation time, volume of intraoperative blood loss, recovery time of gastrointestinal function, time of postoperative drainage-tube removal and duration of hospital stay were (192±20)minutes, (280±30)mL, (33±6)hours, 8 days (range, 5-9 days), 8 days (range, 5-12 days) in 12 patients with open surgery and (208±40)minutes, (210±10)mL, (28±5)hours, 7 days (range, 5-26 days), 7 days (range, 5-10 days) in 6 patients with laparoscopic surgery, respectively. One patient with laparoscopic surgery had intraoperative condensed erythrocyte infusion with 2 U. Seven, 1, 0 patients with open surgery and 4, 1, 1 patients with laparoscopic surgery were respectively complicated with pleural effusion, delayed gastric emptying and pancreatic leakage in level A, and they were cured by conservative treatment. (2) Postoperative pathological examination: results of postoperative pathological examination in 18 patients showed that a large number of varicose veins in the mucous and serosal layers of gastric fundus and moderate or severe hepatic cirrhosis. (3) Follow-up and survival: 18 patients were followed up for 8-78 months with a median time of 39 months. The gastroscopy and enhanced scan of X-ray CT at 1 month postoperatively showed that no varicose veins in the gastric fundus. During the follow-up, there was no recurrence of gastric varices with GRS and esophageal stenosis. Of 4 patients with portal vein thrombosis, 1 died of portal hypertensive gastropathy-induced upper gastrointestinal bleeding due to stop taking warfarin, and other 3 patients had portal vein patency by warfarin therapy. One patient was complicated with liver cancer at 32 months postoperatively and received radiofrequency ablation therapy. Two patients died, including 1 dying of hepatic failure at 35 months postoperatively and 1 dying of advanced liver cancer at 54 months postoperatively. The 1-, 3- and 5-year overall survival rates of 18 patients were respectively 93.8%, 84.4% and 70.3%. Conclusion The PCDV combined with splenectomy and PGFR is safe and effective in the treatment of portal hypertension-induced severe gastric varices with GRS, with a dissemination value for appropriate patients. Key words: Liver cirrhosis; Portal hypertension; Gastric varices; Gastrorenal shunt; Partial gastrectomy; Pericardial devascularization; Splenectomy; Laparoscopy

Clinical efficacy of pancreaticoduodenectomy combined with venous resection via inferior mesenteric vein pathway for resectable pancreatic cancer

Objective To investigate clinical efficacy of pancreaticoduodenectomy combined with venous resection via inferior mesenteric vein (IMV) pathway for resectable pancreatic cancer with superior mesenteric vein (SMV) and / or anterior wall of portal vein (PV) involvements. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 38 resectable pancreatic cancer patients who underwent pancreaticoduodenectomy with venous resection via IMV pathway in the West China Hospital of Sichuan University between January 2013 and January 2017 were collected. The tumors of 25 patients were BR-PV type (simplex SMV and / or PV involvements), and tumors of 13 patients were BR-A type (SMV, celiac trunk and / or hepatic artery involvements). The pancreaticoduodenectomy via IMV pathway was the same as traditional surgery in organs resection and lymph node dissection, the difference was cutting off the pancreas at a junction between IMV and splenic vein when using IMV pathway. Observation indicators: (1) intraoperative and postoperative situations; (2) results of postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to January 2018. Measurement data with skewed distribution were described as M (range). The survival curve was drawn by the Kaplan-Meir method, and Log-rank test was used for survival analysis. Results (1) Intraoperative and postoperative situations: 38 patients underwent intraoperative segmental resection of PV and / or SMV, including 30 with end-to-end anastomosis in situ and 8 with artificial vessel interposition anastomosis. Two of 38 patients were intraoperatively combined with common hepatic artery resection and end-to-end anastomosis in situ. There was no intraoperative celiac trunk resection. The operation time and volume of intraoperative blood loss of 38 patients were respectively 320 minutes (range, 280-520 minutes) and 530 mL (range, 420-650 mL). The incidence of total complications (Clavien-Dindo Ⅲ and above) of 38 patients was 18.4%(7/38), and some patients were combined with multiple complications, including 6 with pulmonary infection, 4 with pancreatic fistula (B and C grade), 4 with intra-abdominal infection, 3 with delayed gastric emptying, 2 with postoperative bleeding and 2 with venous thrombosis. Five patients were cured by postoperative symptomatic treatment, and 2 with postoperative bleeding died of worsened condition after reoperation. The mortality at 90 days postoperatively and duration of hospital stay were respectively 5.3%(2/38) and 12 days (range, 9-52 days). (2) Results of postoperative pathological examination: the R0 resection rate of 38 patients was 81.6%(31/38). The R0 resection rate of 25 patients in BR-PV type was 92.0%(23/25), and resection margin of pancreatic leading edge < 1 mm was in 2 patients without R0 resection; R0 resection rate of 13 patients in BR-A type was 8/13, and resection margin of pancreatic leading edge < 1 mm was in 2 patients and resection margin of SMV < 1 mm was in 4 patients (1 margined with resection margin of multiple sites < 1 mm) of patients without R0 resection. The resection margins of pancreatic trailing edge, venous cut edge and pancreatic cut edge in patients with BR-PV type and BR-A type were more than and equal to 1mm. The venous infiltration rate in patients with BR-PV type and BR-A type was respectively 100.0%(25/25) and 9/13. (3) Follow-up and survival situations: 38 patients were followed up for 6-40 months, with a median time of 15 months, and survival time was 18 months (range, 6-40 months). The survival time and 1-, 2- and 3-year cumulative survival rates were respectively 23 months (range, 8-40 months), 89.5%, 33.1%, 22.1% in 25 patients with BR-PV type and 16 months (range, 6-25 months), 83.9%, 16.8%, 0 in 13 patients with BR-A type. The tumor-free survival time and 1- and 2-year cumulative tumor-free survival rates were respectively 15 months (range, 5-30 months), 63.0%, 7.5% in patients with BR-PV type and 9 months (range, 4-18 months), 11.5%, 0 in patients with BR-A type. Conclusion For resectable pancreatic cancer with SMV and / or anterior wall of PV involvements, pancreaticoduodenectomy combined with venous resection via IMV pathway could avoid injury of SMV and / or PV, and increase negative rates of venous and pancreatic resection margins. Key words: Pancreatic neoplasms; Borderline resectable pancreatic cancer; Resectable pancreatic neoplasms; Pancreaticoduodenectomy; Combined venous resection; Inferior mesenteric vein pathway

Efficacy analysis of neoadjuvant chemotherapy for resectable locally advanced adenocarcinoma of the esophageal-gastric junction

Objective To investigate the clinical efficacy of neoadjuvant chemotherapy (oxaliplatin + capecitabine, XELOX) for the resectable locally advanced adenocarcinoma of esophageal-gastric junction (AEG). Methods The prospective study was conducted. The clinicopathological data of 106 locally advanced AEG patients who were admitted to the Cancer Hospital of Shantou University Medical College from January 2011 to December 2014 were collected. All the patients were divided into the treatment group and control group by single blind, randomized, controlled random number table. Patients underwent preoperative neoadjuvant chemotherapy (XELOX) + surgery + postoperative adjuvant chemotherapy (XELOX) in the treatment group and surgery + postoperative adjuvant chemotherapy (XELOX) in the control group. Total gastrectomy + Roux-en-Y esophagojejunostomy + D2 lymphadenectomy were applied to patients by the same team of doctors. Observation indicators: (1) treatment situations; (2) results of postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination was performed to detect the postoperative tumor recurrence or metastasis and patients′ survival up to February 2017. Measurement data with normal distribution were represented as ±s, and comparisons between groups were evaluated with the t test. Measurement data with skewed distribution were described as M (range) and analyzed by the nonparametric test. Comparisons of count data were analyzed using the chi-square test. The ordinal data were compared using the nonparametric test. Survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method and survivals were compared using the Long-rank method. Results One hundred and six patients were screened for eligibility, including 54 in the treatment group and 52 in the control group. (1) Treatment situations: ① preoperative neoadjuvant chemotherapy: 54 in the treatment group received 2-4 cycle neoadjuvant chemotherapy. During the chemotherapy, gastrointestinal reaction, grade 1-2 granulocytopenia, elevated alanine transaminase (ALT) and grade 3 granulocytopenia were detected in 21, 17, 8, 1 patients, and 7 patients had no adverse reaction. The complete response(CR), partial response (PR), stable disease (SD) and progressive disease (PD) of neoadjuvant chemotherapy in the treatment group were detected in 4, 27, 20 and 3 patients, respectively. Of 54 patients in the treatment group, 4, 13, 25 and 12 were in grade 0, 1, 2 and 3 of response to preoperative chemotherapy, respectively. ② Surgical situations: preoperative carcinoembryonic antigen (CEA) in the treatment and control groups were respectively 4.71 μg/L (range, 0.20-36.19 μg/L) and 14.09 μg/L (range, 0.71-178.20 μg/L), with a statistically significant difference between groups (Z=-1.92, P 0.05). ③ Postoperative adjuvant chemotherapy: all the patients completed the postoperative adjuvant chemotherapy. The granulocytopenia, elevated ALT and gastrointestinal reaction occurred in 25, 5, 28 patients in the treatment group and 21, 7, 30 patients in the control group, respectively, with no statistically significant difference between groups (χ2=0.38, 0.47, 0.36, P>0.05). Some of the patients were merged with multiple adverse reactions. (2) Results of postoperative pathological examination: maximum tumor dimension, cases with lymphovascular invasion, perineural invasion, T0, T2, T3, T4 (T stage), stage 0, Ⅰ, Ⅱ and Ⅲ (TNM stage) were respectively (3.6±1.4)cm, 5, 10, 4, 10, 20, 20, 4, 7, 15, 28 in the treatment group and (4.5±1.7)cm, 24, 30, 0, 2, 13, 37, 0, 1, 12, 39 in the control group, with statistically significant differences between groups (t=-2.88, χ2=18.14, 17.30, Z=14.74, 8.13, P 0.05). There was a statistically significant difference in cases with local recurrence between groups (χ2=4.41, P<0.05) The tumor-free survival time and overall survival time in the treatment group were respectively 29 months (range, 8-72 months), 38 months (range, 10-72 months) in 31 patients with CR and PR and 11 months (range, 3-68 months), 18 months (range, 4-68 months) in 23 patients with SD and PD, showing statistically significant differences in tumor-free and overall survival times (χ2=5.27, 7.72, P<0.05). Conclusion Neoadjuvant chemotherapy with oxaliplatin and capecitabine is safe and effective for patients with the resectable locally advanced AEG, it can also decrease tumor stage and reduce local recurrence, but fail to demonstrate a survival benefit. Key words: Adenocarcinoma of esophagogastric junction; Locally advanced; Neoadjuvant chemotherapy