Objective The survival data of patients with colon cancer who were treated by laparoscopic-assisted surgery and open surgery three years after operation were analyzed and contrasted, which provided data to support the future treatment. Methods The 217 patients who were cured by laparoscopic-assisted surgery and 193 patients who were cured by open surgery were followed up, and the rates of local recurrence, metastasis, implantative, and survival were contrasted and analyzed. Results Three years after laparoscopic-assisted surgery and open surgery, the disease-free survival rate was 86.2% （187/217） and 85.5% （165/193）, respectively, and the overall survival rate was 91.2% （198/217） and 92.7% （179/193）, respectively, the difference between the two groups was not statistic significance（P＞0.05）. The differences of the rates of local recurrence, metastasis, and implantative between the two groups were not statistic significance（P＞0.05）. Conclusions Laparoscopic-assisted surgery is similar with open surgery in the rates of local recurrence, forward metastasis, and overall survival. So laparoscopic-assisted surgery is a safe and radical curative surgery.
ObjectiveTo evaluate the effects of combined TACE and PVC regarding the survival and diseasefree survival rate in hepatocellular carcinoma (HCC) patients. MethodsThe relevant articles were searchd by a database search of PubMed, EMBASE, Cochrane Library (CENTRAL) Databases, Web of Science, Sciencedirect, National Institute of Health Clinical Trials Database, CNKI, WANFANG Database, and VIP Database. The analysis of the data was performed using Revman 5.1 Software. ResultsBy searching and selecting, a total of ten articles met the inclusion criteria, of which 6 were in the postoperative group, and 4 were in the no-operative group. There were no statistical significance of heterogeneity in each group through subgroup analyzed. The pooled OR showed that combined TACE and PVC could significantly increase the 1-, 2-, and/or 3-year survival and disease-free survival rates compared with TACE alone for HCC patients. The pooled OR and 95% CI of the 1-, 2-and/or 3-year survival and disease-free survival rate, respectively, were as follows:In operative group, 1-year disease-free survival rate 2.09, 1.21-3.61; 3-year disease-free survival rate 3.62, 1.88-6.97; 1-year survival rate 2.25, 1.30-3.87; 3-year survival rate 1.96, 1.20-3.21. In no-perative group:1-year survival rate 3.90, 2.33-6.54; 2-year survival rate 5.30, 1.87-15.06. Conlusions Compared with TACE alone, postoperative adjuvant combined TACE and PVC can significantly increase the 1-, and 3-year survival and disease-free survival rates. For no-perative group, adjuvant combined TACE and PVC can significantly increase the 1-, and 2-year survival rates. Based on the limitations of this meta-analysis (this article is included in the high quality literature less), clinicians should be cautious by using our findings.
Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites (gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.
Objective To use a meta-analysis method to establish quantitatively the association between the HER-2/neu gene amplification/enhanced protein expression status and the 5-year post-operative survival rate or median survival time in women with epithelial ovarian carcinoma. Methods We searched and screened Chinese and English literature published since 1989 to collect all retrospective cohort studies on the prognostic significance of HER-2/neu status in this population. The survival data were analyzed using Ludwig’s centered signed rank and the DerSimonian-Laird method. Results In total, 25 studies involving 3 251 patients were included. HER-2/neu was positive in 27.1% (95%CI 0 to 54.8%) of patients, which was not related to the pathological stage, type or grade of epithelial ovarian carcinoma. In HER-2/neu positive cases, the median survival time was shortened by 0.65 years, and the 5-year survival rate was lowered. The hazard ratio (HR) for mortality was 1.22 (95%C 1.09 to 1.36). By subgroup analysis, HER-2/neu protein expression was found to be most significant in prognostic assessment. Patients with a b positive value of HER-2/neu had an increased HR for the 5-year survival; and platinum-based chemotherapy was demonstrated to be less effective in HER-2/neu positive ovarian carcinoma. Conclusion In gynecological oncology, it is reasonable to measure HER-2/neu as a routine pathological marker to predict a patient’s prognosis and to determine the most appropriate adjuvant chemotherapy regimen.
ObjectiveTo assess the long-term effectiveness and safety of autologous bone marrow mononuclear cells (BM-MNC) transplantation in the treatment of critical diabetic lower arteriosclerosis obliterans (ASO). MethodsBetween January 2007 and January 2010, 61 patients with critical diabetic lower ASO were treated with standard medical therapies in 29 cases (control group) or with standard medical therapies and autologous BM-MNC transplantation in 32 cases (treatment group). There was no significant difference in gender, age, disease duration, Fontatine stage, glucose (GLU), triglyceride (TG), total cholesterol (CHOL), low-density lipoprotein-cholesterol (LDL-C), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between 2 groups (P>0.05). The endpoints were overall survival (OS) and amputation-free survival (AFS). The risk indexes for ASO were observed and compared between 2 groups before and after treatments. ResultsThe patients were followed up 2-36 months, and no malignant tumor occurred. The OS rate, OS time, AFS rate, and AFS time were 82.76% (24/29), (32.31±9.08) months, 37.50% (9/24), and (21.28±13.35) months in the control group and were 78.13% (25/32), (32.47±6.96) months, 68.00% (17/25), and (28.38±9.48) months in the treatment group;all indexes showed no significant differences (P>0.05). OS rate, OS time, AFS rate, and AFS time showed no significant differences between 2 groups at the other time (P>0.05) except AFS time at 1 year, which was significantly short in the control group than the treatment group (t=2.806, P=0.007). At the endpoint of follow-up, the indexes of GLU, TG, CHOL, LDL-C, HbA1c, SBP, and DBP showed no significant differences between before and after treatments and between 2 groups (P>0.05) in 49 survival patients (24 in control group and 25 in treatment group). ConclusionAutologous BM-MNC transplantation is safe and effective in the treatment of critical diabetic lower ASO, which can significantly improve AFS rate and prolong AFS time with no risks.
ObjectiveTo compare the clinical efficacy of modified Ivor-Lewis esophagectomy, which preserves azygos vein, thoracic duct and peripheral tissues, and classic Ivor-Lewis esophagectomy, which resects these tissues, in the treatment of esophageal cancer, so as to evaluate whether it is necessary to resect azygos vein, thoracic duct and peripheral tissues in esophagectomy for esophageal cancer.MethodsPatients scheduled for surgical treatment of thoracic esophageal cancer in Department of Thoracic Surgery of Sichuan Cancer Hospital from June 2011 to June 2013 were randomly assigned to the retention group and the resection group, each including 100 patients. The retention group included 87 males and 13 females with an average age of 60.53±7.72 years. In the resection group, there were 80 males and 20 females with an average age of 60.69±7.69 years. Patients in the two groups were compared for the duration of surgery, intraoperative blood loss, postoperative thoracic drainage volume, postoperative complications, and number of dissected lymph nodes, etc. Postoperative relapse and survival rates at 1, 3 and 5 years postoperatively were also followed up and compared for patients in the two groups.ResultsThere was no statistical difference between the two groups in general patient characteristics, number of dissected lymph nodes, or postoperative pathological stage, etc. (P>0.05). Compared to the resection group, there were shorter duration of surgery, less intraoperative blood loss, and less thoracic drainage volume in the first 3 days following surgery in the retention group, with statistical differences (P<0.05). There was no statistical difference between the two groups in type or site of relapse or metastasis (P>0.05). The survival rates at 1, 3, and 5 years postoperatively was 78.7% vs. 81.3%, 39.4% vs. 37.5%, and 23.4% vs. 17.7%, respectively, in the retention group and the resection group, with no statistical difference (P>0.05).ConclusionModified Ivor-Lewis esophagectomy preserving azygos vein, thoracic duct and peripheral tissues could reduce surgical trauma, would not increase postoperative relapse or metastasis, and could produce long-term efficacy comparable to that of extended resection.
Objective To investigate the clinical features of non-small cell lung cancer (NSCLC) patients with long-term survival and the related factors for treatment. Methods A retrospective analysis of clinical features, treatment factors, and survival was performed for 963 patients with pathologically confirmed stage Ⅳ NSCLC between January 2010 and December 2015 from Department of Thoracic Oncology, West China Hospital, Sichuan University. Results The median overall survival (OS) of the 963 patients was 20.8 months, and the 1-, 3-, 5-, and 7-year survival rates were 72.0%, 21.4%, 15.2%, and 4.8%, respectively. There were 81 patients in the long-term survival group (OS>60 months) and 882 in the non-long-term survival group (OS<60 months). Previous surgery, thoracic radiotherapy and epidermal growth factor receptor (EGFR) gene positive significantly increased the 5-year actual survival rate, reducing the risk of death by 62.0%, 58.8%, and 58.1%, respectively. Compared with the non-long-term survival group, more patients in the long-term survival group received two or more means of treatment including surgery, thoracic radiotherapy, and targeted therapy (28.4% vs. 11.6%, P<0.001) and more patients benefited from fourth- or further-line treatment (24.7%vs. 11.1%, P<0.001). Cox multivariate regression analysis indicated that performance status [hazard ratio (HR)=1.388, 95% confidence interval (CI) (1.199, 1.608), P<0.001] , N stage [HR=1.160, 95%CI (1.058, 1.272), P=0.002] , EGFR gene status [HR=0.588, 95%CI (0.469, 0.738), P<0.001] , previous surgery [HR=0.626, 95%CI (0.471, 0.832), P=0.001] , and thoracic radiotherapy [HR=0.592, 95%CI (0.480, 0.730), P<0.001] were independent prognostic factors of OS. Conclusions Good performance status, early N staging, EGFR mutation, previous surgery, and thoracic radiotherapy are important prognostic factors affecting the survival of advanced NSCLC patients. Long-term survival benefits from combined treatment and effective further-line therapies.
Abstract： Objective To evaluate the clinical significance of bilateral supraclavicular lymph node dissection after esophagectomy for patients with intrathoracic esophageal carcinoma. Methods A total of 197 patients with esophageal carcinoma but no obvious supraclavicular lymph node metastasis who underwent esophagectomy in Zhongshan Hospital of Xiamen University from March 1997 to September 2004 were included in this study. All the patients were divided into 2 groups， the control group and the study group. In the control group (non-supraclavicular lymphadenectomy group)， there were 96 patients including 62 males and 34 females with their age of 40-69 （55.2±3.1） years， who received 2-field lymphadenectomy (intrathoracic lymphatic drainage area and left paracardial lymph nodes) without supraclavicular lymph node dissection. In the study group (supraclavicular lymphadenectomy group)， there were 101 patients including 68 males and 33 females with their age of 41-68 （53.8±4.5） years， who received 3-field lymphadenectomy including intrathoracic lymphatic drainage area， left paracardial lymph nodes and bilateral supraclavicular lymph node dissection. Postoperative survival rate， lymph node metastasis rate， anastomotic site recurrence rate， and long-term supraclavicular lymph node metastasis rate were compared between the 2 groups. Results The overall 5-year survival rate of all the patients was 39.59% （78/197）. There was no statistical difference in 5-year survival rate between the 2 groups ［37.50％ （36/96） vs. 41.58％（42/101）， P＞0.05］. However， the 5-year survival rate of the patients with esophageal carcinoma in the upper third of the esophagus in the study group was significantly higher than that of the control group ［38.10％（8/21） vs. 29.17％ （7/24）， P＜0.05］. The intrathoracic lymph node metastasis rate （14.58% vs. 12.87%）， abdominal lymph node metastasis rate （6.25% vs. 7.92%）and anastomotic site recurrence rate （5.20% vs. 5.94%）of the control group and study group were not statistically different （P＞0.05）. However， long-term supraclavicular lymph node metastasis rate of the study group was significantly lower than that of the control group （2.97％ vs. 8.33％， P＜0.05） Conclusion Bilateral supraclavicular node dissection can significantly increase postoperative survival rate and decrease long-term supraclavicular lymph node metastasis rate of patients with esophageal carcinoma in the upper third of the esophagus.