Objective To improve the diagnosis and treatment of primary adenocarcinoma of the duodenum. MethodsLiteratures were reviewed.ResultsThe morbidity of primary duodenal adenocarcinoma was low and its clinical manifestation had no characteristics.The most effective methods in the diagnosis of the disease were gastrointestinal radiography and endoscopy with the accuracy of 88% and 89% respectively.The disease could be cured by resection of the lesion. The selection of operative type depended on the stage and position of the tumor.Radical resection and tumor stage played an important role in the prognosis.Conclusion Early diagnosis and rational operation are the major ways to improve the resectability and to modify the therapeutic result.
ObjectiveTo systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. ResultsA total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=−19.85, 95%CI (−37.20, −2.51), P=0.02] and shorter postoperative hospital stay [MD=−1.23, 95%CI (−2.38, −0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=−6.20, 95%CI (−7.68, −4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). ConclusionPG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.
ObjectiveTo summarize the current advancement of adenocarcinoma of the esophagogastric junction (AEG) and improve the knowledge and cognition about AEG and find a feasible treatment strategy.Method Relevant literatures about current advancement of AEG published domestically and abroad recently were collected and reviewed. Results AEG had obvious differences from other parts of stomach tumors in anatomy, physiology, and pathology. The study of AEG in definition, biology origin, classification, lymph node metastasis and other aspects had basically reached a consensus. But for the surgical approach, the extent of resection, lymph node dissection or the way of the digestive tract reconstruction was controversial for a long time. Conclusions AEG as a kind of independent disease is increasing hazard to human health．By far, the most effective treatment is surgical resection, and how to choose the surgical method needs to be further researched.
【Abstract】Objective To investigate the CT imaging features of metastatic hepatic adenocarcinomas from the digestive tract by using multidetectorrow helical CT (MDCT) with pathological correlation. Methods CT and clinical data of 36 patients with pathologically proven metastatic hepatic adenocarcinomas from the digestive tract were retrospectively reviewed. The primary tumors included 10 cases of gastric cancer, 1 duodenal cancer, 18 colonic carcinoma, 7 rectal cancer. All patients underwent MDCT plain scan and contrastenhanced dualphase scanning of upper or whole abdomen. The appearances of hepatic metastatic lesions on MDCT images at various enhancement phases were carefully observed. Results On plain CT scan 32 cases （88.9%） presented multiple nodules of low density at different sizes, 3 cases （8.3%） showed a single low-density nodule, and 1 case presented with a cystic mass. On contrast-enhanced scan, 4 cases (11.1%) showed faintly enhanced rim around the nodules on arterial phase; on portal venous phase 29 cases (80.6%) presented slight ringlike enhancement at the periphery of the nodule while the nodule core was markedly hypodense with intermediate soft tissue density area in between, giving rise to the typical appearance of “bull’seye” sign. Three cases (8.3%) showed no enhancement on either phase images. Conclusion The ring-like enhancement and the appearance of “bull’s-eye” on portal venous phase was characteristic CT features of metastatic hepatic adenocarcinoma from digestive tract.
ObjectiveTo compare the clinical efficacy of different surgical approaches for Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). MethodsThe clinical data of the patients with Siewert type Ⅱ AEG who received sugeries in the Department of Thoracic Surgery of Gansu Provincial People's Hospital from August 2014 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the surgical approach: a transabdominal group (transabdominal diaphragmatic esophageal hiatus approach) and a combined group (thoracoabdominal combined with right thoracic approach). Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term efficacy of the two groups. Results A total of 87 patients were enrolled. There were 48 patients (31 males and 17 females, with an average age of 60.85±8.47 years) in the transabdominal group, and 39 patients (25 males and 14 females, with an average age of 61.13±8.51 years) in the combined group. There was no statistical difference between the two groups in the baseline indicators such as gender, age, tumor size and stage (P>0.05). Compared with the combined group, the operation time, intraoperative blood loss, postoperative bed rest time, postoperative total drainage volume were shorter or less, and the visual analogue scale score on the 3rd day after surgery were lower in the transabdominal group (P<0.05). However, the total number of lymph nodes dissected, the number of thoracic lymph nodes dissected and the number of positive thoracic lymph nodes in the combined group were larger than those in the transabdominal group, and the differences were statistically significant (P=0.001). The median survival time in the combined group and transabdominal group was 25.85 months and 20.86 months, respectively. The 3-year overall survival rate of the combined group was higher than that of the transabdominal group (46.2% vs. 38.9%, χ2=5.995, P=0.014). However, there was no statistical difference between the two groups in the postoperative catheter time, esophageal and gastric resection margin distance, number of abdominal lymph nodes dissected, number of positive abdominal lymph nodes, or incidence of postoperative complications (P>0.05). ConclusionFor patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction, thoracoabdominal combined with right thoracic approach is safe and effective, and has advantages in thoracic lymph node dissection, bringing more benefits to the patients, so it is recommended to be popularized in clinical practice.
ObjectiveTo discuss the pattern of lymph node metastasis for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction and its appropriate surgical approach. MethodsWe retrospectively analyzed the clinical data of 162 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction who underwent curative resection in West China Hospital of Sichuan University from January 2007 through February 2010. The patients were divided into three groups based on their surgical approach, including 96 patients in a left thoracic group, 20 patients in an Ivor-Lewis group and 46 patients in an abdominal group. ResultsThere were 120 patients with lymph node metastasis. The lymph node metastatic rate was 74.1%. Simple thoracic lymph node metastasis was observed only in 2 patients (1.7%), 98 patients (81.7%) with simple abdominal lymph node metastasis, and 20 patients (16.6%) with both capacity lymph node metastasis. The thoracic approaches had an advantage in dissection lower mediastinal lymph node over the abdominal approach, while for the abdominal lymph node the result was reversed. There are 11 groups of lymph node with a more than 10% metastatic rate. ConclusionsThe abdominal lymph nodes are the dominating metastatic area of Siewert type Ⅱ AEG, but some important groups of lower mediastinal lymph node should be removed. In terms of curative resection of tumor, the Ivor-Lewis operated by a thoracic surgeon who is more familiar with the abdominal lymph node may be a reasonable choice.
Objective To explore the feasibility and clinical effect of the nano-carbon particles in laparoscopic operation for adenocarcinoma of esophagogastric junction. Methods From 2008 to 2011， 119 patients with adenocar-cinoma of esophagogastric junction who underwent the laparoscopic operation were divided into study group （n=56） and control group （n=63）. The nano-carbon particle was injected into the subserosa around the tumor using the injection needle made by ourselves for lymphatic tracing before the laparoscopic operation in the study group， while no tracer was given in the control group. The indexes of lymph nodes， operation time， intraoperative blood loss， and postoperative hospital stay were compared in two groups. Results The nano-carbon particle was injected into the subserosa around the tumor successfully in the study group. The numbers of dissected lymph nodes and metastatic lymph nodes in the study group were significantly more than those in the control group （dissected lymph nodes：20.52±4.51 versus 16.44±3.80， t=5.341，P=0.000；metastatic lymph nodes：8.88±3.15 versus 6.49±2.49， t=4.602， P=0.000）. There were no statistical diff-erences in the intraoperative blood loss， operation time， and postoperative hospital stay in two groups 〔intraoperative blood loss：（97.50±27.52） ml versus （96.03±22.83） ml， t=0.318， P=0.751；operation time：（221.07±24.25） min versus （230.48±38.54） min， t=-1.570， P=0.119；postoperative hospital stay （10.82±1.67） d versus （10.29±1.33） d， t=1.945， P=0.054〕. Conclusions Injection of the nano-carbon particles using the injection needle made by ourselves is feasible in laparoscopic operation for adenocarcinoma of esophagogastric junction. It can increase number of dissected lymph nodes without increasing operation time， intraoperative blood loss， and postoperative hospital stay.
Surgery is an accepted standard in the treatment of adenocarcinoma of esophagogastric junction (AEG), but the efficacy of surgery alone for locally advanced AEG is limited. In-depth studies concerning combined therapy for AEG have been carried out worldwide, including neoadjuvant chemotherapy (nCT), neoadjuvant chemoradiotherapy (nCRT), perioperative chemotherapy (pCT), postoperative chemoradiotherapy, etc. Significantly, the contribution of nCRT and pCT to improving the prognosis of locally advanced AEG patients has been shed light on. Compared with that, multimodality treatment for AEG patients is not well established in China. An attempt was thus made to take an overview of the evidence-based research advance regarding integrated therapy of AEG.
Objective To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction （AEG） and upper-middle gastric cancer. Methods Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of arch-preserved jejunum to resolve the anastomosis tension problem in our hospital from Dec. 2012 to Apr. 2013 were analyzedretrospectively， and surgical experience was summarized. Results The maximal and actual extended lengths were （7.75±1.75） cm （4-10 cm） and （5.95±1.82） cm （3-9 cm） respectively， with the utilization percentage of （77.91±16.60）% （50.0%-100.0%）. These patients hadn’t suffered postoperative mortality and severe complications， such as anastomosis leakage， stenosis， hemorrhage， and so on. Besides， there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection. Conclusion Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.
ObjectiveTo explore the correlation between expression of thyroid transcription factor-1 (TTF-1) and gene mutation of epidermal growth factor receptor (EGFR) in patients with resectable lung adenocarcinoma (LAC). Method Sixty-seven LAC patients who underwent surgical resection in the Department of Cardiothoracic Surgery of Shanghai No.6 Hospital and Department of Thoracic Surgery, Renji Hospital, School of Medicine of Shanghai Jiaotong University from June 2009 to December 2012 were enrolled in this study. There were 40 male and 27 female patients with their age of 37-79 (56.7±1.8) years. TTF-1 expression was detected by immunohistochemistry. EGFR gene mutation was examined with mutant-enriched polymerase chain reaction. The correlation between TTF-1 expression and EGFR gene mutation was analyzed with corrected chi-square test. ResultsAmong the 67 LAC samples, 57 samples were TTF-1 positive and 10 samples were TTF-1 negative. There was EGFR gene mutation in 44 samples. EGFR gene mutation rate was 73.7% (42/57) in TTF-1 positive patients and 20.0% (2/10) in TTF-1 negative patients. The sensitivity of TTF-1 expression to predict EGFR mutation was 95.5%, and the specificity was 34.8%. ConclusionEGFR gene mutation rate is higher in LAC patients with positive TTF-1 expression. Positive TTF-1 expression can be used to predict EGFR gene mutation in LAC patients.