Outcomes of surgical treatment for gastric cancer patients: 11-year experience of a Chinese high-volume hospital

Gastric cancer is one of the leading causes of cancer-related deaths worldwide. We report our experience with surgery-related parameters and survival outcomes at a single Chinese center. This study analyzed patients following gastric resection between 2000 and 2010, and overall survival was the primary end point. In this study, 1,936 patients who underwent gastrectomy were collected from 2000 to 2010. Curative gastrectomy (R0 resection) was performed in 86.6 % of patients. D1/D1+ lymphadenectomy was frequently performed from 2000 to 2005, and the proportion of D2/D2+ lymphadenectomy increased after 2006. The number of harvested lymph nodes was 10.1 ± 6.0 in 2000 and increased to 28.0 ± 10.5 in 2010. Serosa-invasive lesions (pT4) accounted for 67.9 % of all cases. The 1-year overall survival (OS), 2-year OS, and 3-year OS rates were 89, 74, and 63 %, respectively. Multivariate analysis identified R status, tumor location, macroscopic type, and tumor stage (pT stage and pN stage) as the independent risk factors for overall survival. The prognosis of gastric cancer patients in China remains dismal. To improve the survival outcomes, further efforts toward early detection and multi-disciplinary treatment are needed.

Comparison of ultrasonic scalpel versus conventional techniques in open gastrectomy for gastric carcinoma patients: a systematic review and meta-analysis

OBJECTIVES

To compare surgical efficacy and postoperative recovery of ultrasonic scalpel (USS) with conventional techniques for the resection of gastric carcinoma.

METHODS

A systematic search of major medical databases (PubMed, Embase, CCRT and CNKI) was conducted. Both randomized and non-randomized controlled trials (RCTs and nRCTs) were considered eligible. Operation time (OT), intraoperative blood loss (BL) and postoperative complications (POC) rates as well as postoperative hospitalization days, number of dissected lymph nodes, abdominal drainage volume and time for recovery of gastrointestinal functions were synthesized and compared.

RESULTS

Nineteen studies were included (7 RCTs and 12 nRCTs), in which 1930 patients were enrolled totally (946 in the USS group and 984 in the conventional group). Monopolar electrocautery and ligation were used as the conventional methods. Comparative meta-analysis showed perioperative outcomes were significantly improved using USS compared with conventional surgical instrumentation. OT was reduced from a weighted mean of 185.3 min in the conventional group to 151.0 min in the USS group (MD = -33.30, 95% CI [-41.75, -24.86], p<0.001) and intraoperative BL was decreased from a weighted mean of 217.9 ml in the conventional group to 111.6 ml in the USS group (MD = -113.42, 95% CI [-142.05, -84.79], p<0.001). Results from RCTs subgroup were consistent with those from nRCTs subgroup. The weighted cumulative risk of POC accounted for 8.9% (0%-25%) and 12.9% (5.5%-45%) in the USS and conventional groups, respectively. Pooled estimated results from nRCTs (OR = 0.54, 95% CI [0.27, 1.06], p = 0.07) and RCTs (RR = 0.75, 95% CI [0.44, 1.26], p = 0.27) showed no significant difference between the USS and control groups. Analysis of secondary outcomes showed the improvements of the USS group over control group regarding the number of dissected lymph nodes, postoperative hospitalization days, abdominal drainage volume and time for recovery of gastrointestinal functions.

CONCLUSION

Compared with conventional electrosurgery, the USS is a safe and effective technique with more short-term advantages in open surgery for gastric cancer.

Hydrodynamics-based transfection of rat interleukin-10 gene attenuates porcine serum-induced liver fibrosis in rats by inhibiting the activation of hepatic stellate cells

Liver fibrosis is the common pathological outcome for the majority of chronic liver diseases. Interleukin-10 (IL-10) is a cytokine that downregulates proinflammatory responses and has a modulatory effect on liver fibrogenesis. However, little is known regarding the effect of rat interleukin-10 (rIL-10) gene by hydrodynamics-based transfection (HBT) on liver fibrosis in rats. The aim of this study was to investigate the effect of the rIL-10 gene by HBT on the progression of liver fibrosis induced by porcine serum (PS) in rats and explore its possible mechanism. Plasmid-expressing rIL-10 was transferred into rats by HBT and immunohistochemistry and RT-PCR were used to detect the major organ expressing rIL-10. Liver fibrosis was induced in rats by intraperitoneal administration of PS for 8 weeks. Plasmid pcDNA3-rIL-10 solution was administered weekly by HBT starting at the 5th week. Liver function and hepatic histology were examined. The possible molecular mechanisms of rIL-10 gene therapy were assessed in liver tissue and hepatic stellate cells (HSCs) co-cultured with BRL cells (a hepatocyte line) in vitro. The results showed rIL-10 expression occurred mainly in the liver following rIL-10 gene transfer by HBT. Maintaining a stable expression of rIL-10 in serum was assessed by repeated administration. The rIL-10 gene treatment attenuated liver inflammation and fibrosis in PS-induced fibrotic rats, reduced the deposition of collagen and the expression of α-smooth muscle actin (α-SMA) in fibrotic rats. The in vitro experiment showed that the expression of a-SMA and procollagen type I in HSCs co-cultured with the BRL-transfected rIL-10 gene were significantly decreased. These findings indicate that rIL-10 gene therapy by HBT attenuates PS-induced liver fibrosis in rats and that its mechanism is associated with rIL-10 inhibiting the activation of HSCs and promoting the degeneration of collagen.

Comparison and Confirmation of Quantitative Trait Loci Conferring Partial Resistance to Rice Sheath Blight on Chromosome 9

Sheath blight (SB), caused by Rhizoctonia solani, is one of the worst rice (Orzya sativa) diseases worldwide. Resistance to the SB disease in rice is a complex trait controlled by quantitative trait loci (QTLs). Through map integration, we found several previously identified SB resistance (SBR) QTLs reported in inconsistent regions on the long arm of chromosome 9. Five of them were detected on 'Jasmine 85' (J85), 'Minghui 63' (MH63), and 'Lemont' (LMNT) rice and were designated qSB-9^J85-1, qSB-9^J85-2, qSB-9^MH63-1, qSB-9^MH63-2, and qSB-9^LMNT, respectively, in the present study. To further verify and physically map the five potential SBR QTLs, we introduced these SBR QTLs into a common susceptible variety (LMNT) and developed a few chromosomal segment substitution lines through marker-assisted selection. After artificial inoculation with the SB fungus, we were able to validate qSB-9^J85-2 but not the other four SBR QTLs; whereas, on MH63, an SBR QTL designated qSB-9^MH63-3 was confirmed in the region defined by markers Y83 and Y91.8 that included qSB-9^J85-2, covering approximately 1,235 kb. Both qSB-9^J85-2 and qSB-9^MH63-3 appeared to be dominant resistance genes and contributed to similar levels to SB resistance, reducing SB disease severity by approximately 1.0 on a 0-to-9 SB disease rating system. After comparing with another confirmed SBR QTL (qSB-9^TQ) from 'Teqing' rice (TQ), we conclude that qSB-9^J85-2, qSB-9^MH63-3, and qSB-9^TQ are probably controlled by the same allelic resistance genes. These results will accelerate the utilization of this major SBR QTL and its map-based cloning.

The co-localization of HBx and COXIII upregulates COX-2 promoting HepG2 cell growth

HBx is a multifunctional regulator that interacts with host factors to contribute to the development of hepatocellular carcinoma. In this study, to explore the co-localization of HBx and COXIII in HepG2 cells and to investigate the molecular mechanism of HBx in HepG2 cell growth promotion, we first constructed a HepG2 cell line stably expressing the HBx gene in vitro by lentivirus vectors. In addition, we found that HBx co-localized with the inner mitochondrial protein, COXIII, in HepG2 cells by confocal laser scanning microscopy. It led to changes of mitochondrial biogenesis and morphology, including upregulation of COXIII protein expression, increased cytochrome c oxidase activity and higher mitochondrial membrane potential. The upregulation of COX-2 caused by HBx through generation of mitochondrial reactive oxygen species promoted cell growth. Thus, we conclude that co-localization of HBx and COXIII leads to upregulation of COX-2 that promotes HepG2 cell growth. Such a mechanism provides deeper insights into the molecular mechanism of HBV-associated hepatocellular carcinoma.

Metastasis, risk factors and prognostic significance of splenic hilar lymph nodes in gastric adenocarcinoma

Background

The metastatic rate and risk factors of splenic hilar (No.10) lymph nodes (LNs) in gastric adenocarcinoma were still variable and uncertain, and the prognostic significance of No.10 LNs was also controversial. The aim of this retrospective study was to analyze the metastatic rate, risk factors and prognostic significance of No.10 LNs in gastric adenocarcinoma.

Methods

From August 2007 to December 2011, 205 patients who were diagnosed with primary gastric adenocarcinoma and underwent total or proximal gastrectomy plus No.10 LNs dissection in West China Hospital were enrolled. Clinicopathological features and survival outcomes were retrospectively analyzed.

Results

Mean numbers of harvested LNs and metastatic LNs were 34.8±12.6 (15–73) and 8.7±10.8 (0–67), respectively. The proportion of cases with positive No.10 LNs was 8.8% (18/205). In all 204 dissected No.10 LNs, 47 LNs (23.0%) were metastatic. In 52.2% (107/205) patients, the dissected splenic hilar tissues were histologically determined as only fat tissues but without LNs structure. Histological evidence of LNs structure was found in 98 (47.8%) patients with 18.4% (18/98) metastatic No.10 LNs. In multivariate logistic regression analysis, metastasis of No.10 LNs was significantly correlated with No.4sa LNs (p = 0.010) and pN stage (p = 0.012). Regarding survival analysis, 199 (97.1%) patients were followed up (0.6–74.8 months). In all patients with R0 resection, metastatic No.10 LNs caused significantly worse prognosis both in Kaplan-Meier (p = 0.006) and Cox regression analysis (p = 0.031).

Conclusions

Although the metastatic rate of No.10 LNs was 8.8%, dissection of No.10 LNs might be meaningful due to the poor prognosis of positive cases. And attentions should be also paid to its correlated factors including pN stage and No.4sa LNs.

Quantitative comparisons of summary receiver operating characteristics (sROC) curves among conventional serological tumor biomarkers for predicting gastric cancer in Chinese population

The objective of this study is to quantitatively analyze the predictive strength among the conventional serological tumor biomarkers for gastric cancer in Chinese population. Thirty-three hospital-based case-control studies were searched out through Chinese databases and PubMed during 1999-2009. Gastric cancer cases and healthy volunteers or benign gastric diseases controls were detected of any of serological CA724, CA242, CEA, CA199, CA125, or CA153. Areas under the curve (AUC) and optimal Q indexes of summary receiver operating characteristics (sROC) curves were quantitatively compared. The summary positive and negative likelihood ratios (sLR + and sLR-) were pooled. Totally, 2,390 gastric cancer cases and 2,893 controls were analyzed. CA724 and CA242 both had the greatest AUCs (0.88), respectively, followed by the combination CA724 + CEA + CA199 (0.85), CA125 (0.82), CEA (0.80), and CA199 (0.76), but all of them had no statistical significance to CA153 (negative control) by Z tests, possibly due to relatively great standard errors. The results of Q index analyses were similar to those of AUCs, that CA724 and CA242 had the optimal strength. The sLR + of CA724 (16.08, 95 % confidence interval (CI) 7.86-32.86) or CA242 (11.03, 95 % CI 7.12-17.08) was strong to judge the gastric cancer status based on its positive result. The combination of CA724 + CEA + CA199 had the prior sLR- (0.33, 95 % CI 0.25-0.43) to the others. Serological CA724 or CA242 has predictive effect for screening gastric cancer and can be recommended into the screening program of population-based or symptomatic cases. However, prospective epidemiological studies are required before confirmative conclusion.

Safety and Survival Benefit of Surgical Management for Elderly Gastric Cancer Patients

BACKGROUND/AIMS

To study the safety and survival outcome of surgical management for elderly gastric cancer patients.

METHODOLOGY

Patients proven of gastric cancer who aged 80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients' characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness.

RESULTS

Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. Median ages were 81 years in surgery group and 83 year in non-surgery group. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p = 0.797). Clinical-pathological T stage was 6 T1, 5 T2, 14 T3 and 23 T4 cases for surgery and 7 T1, 6 T2, 3 T3, 7 T4 and 21 TX cases for non-surgery. Clinical-pathological node status was 18 N0, 7 N1, 6 N2, 7 N3 and 10 NX cases for surgery and 10 N0, 3 N1, 3 N2, 3 N3 and 25 NX cases for non-surgery. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and non-surgery, respectively (p = 0.006). Incidence of postoperative complications was 25.0% and postoperative hospital mortality was 2.1%. The 2-year survival rates were 30.8% and 8.0% for surgery and none-surgery, respectively (HR = 3.023, p = 0.001), and the 3-year survival rates were 17.6% and 0% for surgery and non-surgery, respectively (HR = 3.680, p = 0.001). In M0 subgroup, 2-year survival rate was 35.7% and 0.0% for surgery and non-surgery groups, respectively (HR = 3.98, p = 0.022).

CONCLUSION

The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.

[Down-regulation of Notch1 by small interfering RNA enhances chemosensitivity to gemcitabine in pancreatic cancer cells through activating apoptosis activity]

OBJECTIVE

To investigate the effect of down-regulation of Notch1 by Notch1 small interfering RNA (siRNA) on chemosensitivity to gemcitabine in pancreatic cancer cells and its mechanism.

METHODS

Notch1 siRNA was transfected to pancreatic cancer cell lines AsPC-1, BxPC-3, MIAPaCa-2 and Panc-1. The transfected pancreatic cancer cells were treated with 10 μmol/L gemcitabine in vitro. The relative quantity of Notch1 mRNA of pancreatic cancer cells was detected by real-time PCR. The inhibition rates of gemcitabine-treated cells were evaluated by CCK-8 method. The expression of Bax protein was examined by Western blot, and the caspase 3 activity was detected by CaspACETM assay system kit.

RESULTS

The relative quantity of Notch1 mRNA was the highest in BxPC-3 cell line and the lowest in Panc-1 cells. The inhibition rates of gemcitabine treated-cells were significantly higher in Notch1 siRNA transfection groups than in corresponding siRNA control groups (AsPC-1: 67.5±6.7 vs 47.5±6.8; BxPC-3: 90.5±4.4 vs 70.2±4.2; MIAPaCa-2: 80.9±5.7 vs 58.1±6.0; Ps<0.05), with the overexpression of protein Bax. The activity of caspase 3 was also significantly increased in Notch1 siRNA transfection groups compared with corresponding siRNA control groups (AsPC-1: 28.90±2.70 vs 12.82±3.44; BxPC-3: 59.87±6.77 vs 27.27±11.88; MIAPaCa-2: 29.34±4.06 vs 14.59±4.25; P<0.05).

CONCLUSION

Inhibition of Notch signaling pathway by Notch1 siRNA can enhance chemosensitivity to gemcitabine in pancreatic cancer cells through activating apoptosis activity．

Effect of intravenous injection of recombinant IL-10 gene vector on expression of TNF-α, PDGF-β and COX-2 in experimental fibrosis in rats

AIM: To study the effect of intravenous injection of recombinant IL-10 (rIL-10) gene vector on the expression of tumor necrosis factor-α (TNF-α), platelet derivative growth factor-β (PDGF-β) and cyclooxygenase-2 (COX-2) in pig serum-induced experimental liver fibrosis in rats.

METHODS: Thirty SD rats were divided into a normal control and a fibrosis model group. The normal control group was intraperitoneally injected with 0.5 mL of normal sodium twice a week for 8 wk, while the fibrosis model group was injected with equal volume of pig serum for the same duration. At the beginning of the 5^th week, the fibrosis model group was further randomly divided into a fibrosis model subgroup, a rIL-10 gene therapy subgroup and an empty vector control subgroup. Rats in the normal control group and fibrosis model subgroup were injected with Ringer's solution (as a reagent control) via the tail vein weekly, the rIL-10 gene therapy subgroup was injected with rIL-10 plasmid pcDNA3-rIL-10, and the empty vector control subgroup was injected with empty vector pcDNA3. All rats were sacrificed at the end of the 8^th week, and liver tissue samples were collected to observe pathological changes in liver tissue by HE staining and to detect the expression of TNF-α, PDGF-β and COX-2 in liver tissue by immunohistochemistry.

RESULTS: Histopathology analysis proved that experimental liver fibrosis was induced successfully with pig serum. Compared with the fibrosis model subgroup and empty vector control subgroup, the rIL-10 gene therapy subgroup showed mild liver cell degeneration, decreased inflammatory cell infiltration and collagen deposition. Compared with the normal control group, the expression of TNF-α, PDGF-β and COX-2 was significantly increased in the fibrosis model subgroup and empty vector control subgroup (0.2206 ± 0.0434, 0.2217 ± 0.0518 vs 0.1860 ± 0.0104; 0.2891 ± 0.0417, 0.2818 ± 0.0272 vs 0.2514 ± 0.0228; 0.2174 ± 0.0429, 0.2117 ± 0.0221 vs 0.1987 ± 0.0106, all P < 0.01). Compared with the fibrosis model subgroup and empty vector control subgroup, the expression of TNF-α, PDGF-β and COX-2 was significantly reduced in the rIL-10 gene therapy subgroup (0.2048 ± 0.0124 vs 0.2206 ± 0.0434, 0.2217 ± 0.0518; 0.2513 ± 0.0165 vs 0.2891 ± 0.0417, 0.2818 ± 0.0272; 0.1961 ± 0.0142 vs 0.2174 ± 0.0429, 0.2117 ± 0.0221, all P < 0.01).

CONCLUSION: rIL-10 gene treatment attenuates pig serum-induced liver fibrosis in rats possibly by reducing the expression of TNF-α, PDGF-β and COX-2 in liver tissue.

The feasibility and safety of early removal of nasogastric tube after total gastrectomy for gastric cancer

BACKGROUND/AIMS

To evaluate the feasibility and safety of early removal of nasogastric tube after total gastrectomy for gastric cancer.

METHODOLOGY

Data of 142 gastric cancer patients who underwent total gastrectomy from January 2011 to March 2012 were retrospectively collected and analyzed. Early removal ER group n=57 of nasogastric tube was defined as removal within postoperative 48 h, and conventional placement CP group n=85 of nasogastric tube was defined as removal till flatus and less than 300 cc gastric juice drainage. Outcome measures included postoperative temperature, hospital stay length, days to passage of flatus, days to semi-liquid diet, postoperative complications and mortality.

RESULTS

No statistically significant difference was found between the ER group and the CP group in postoperative highest temperature p=0,456 the incidence of temperature over 38.5C p=0,772 postoperative hospital stay length p=0,102 and time to flatus p=0,163 There was no death or reoperation in patients of both groups. There were no significant differences in postoperative complications between the two groups 22,8% vs 30,6%, p=0,309 There was no anastomotic leakage, hemorrhage or stenosis. There was a trend of decreased risk of postoperative pneumonia in the ER group 10,5% vs 21,2% despite no significance p=0,097 CONCLUSIONS: The early removal of nasogastric tube within postoperative 48 h after total gastrectomy is feasible and safe in common practice and might also have a potential benefit in preventing postoperative pneumonia.

Quality of life following laparoscopic-assisted distal gastrectomy for gastric cancer

BACKGROUND/AIMS

This study investigated quality of life (QoL) of patients 6 months after surgery for early or advanced gastric cancer.

METHODOLOGY

Between June, 2006 and December, 2009, 39 patients undergoing laparoscopic assisted distal gastrectomy (LADG) and 35 patients undergoing open distal gastrectomy (ODG) were enrolled. All the patients completed a validated questionnaire (EORTC QLQ-C30) and site specific module (QLQ-STO22) after surgery. Clinicopathological characteristics were compared and the patients' QoL were emphasized.

RESULTS

There were no significant differences between the two groups in age, comorbidities, curative degree, tumor stage, etc. In terms of QLQ-C30 items, significantly better role, cognitive, emotional and social functioning in the LADG group were identified as well as a significant lower incidence rate of constipation. Physical functioning, dyspnea, pain, fatigue, insomnia, diarrhea, financial difficulties and global health status, were not significantly different between the two groups. With respect to QLQ-STO22 items, LADG associated with lower incidence of reflux symptoms and better body image. However, there were no significant differences on symptoms of dysphagia, pain, eating restrictions, dry mouth, change of taste, anxiety and hair loss. QoL stratified by Billroth II reconstruction procedure gave similar results except for role functioning and body image, LADG had higher score compared with ODG.

CONCLUSIONS

Long-term follow-up results suggest that LADG might help improve the QoL in patients with gastric cancer. Well-designed large scale randomized controlled trials are needed.

Docetaxel, cisplatin and fluorouracil (DCF) regimen compared with non-taxane-containing palliative chemotherapy for gastric carcinoma: a systematic review and meta-analysis

BACKGROUND

Gastric carcinoma (GC) is one of the highest cancer-mortality diseases with a high incidence rate in Asia. For surgically unfit but medically fit patients, palliative chemotherapy is the main treatment. The chemotherapy regimen of docetaxel, cisplatin and 5-fluorouracil (DCF) has been used to treat the advanced stage or metastatic GC. It is necessary to compare effectiveness and toxicities of DCF regimen with non-taxane-containing palliative chemotherapy for GC.

METHODS

PubMed, EmBase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases were searched to select relative randomized controlled trials (RCTs) comparing DCF to non-taxane-containing chemotherapy for patients with palliatively resected, unresectable, recurrent or metastatic GC. Primary outcome measures were 1-year and 2-year overall survival (OS) rates. Secondary outcome measures were median survival time (MST), median time to progression (TTP), response rate and toxicities.

RESULTS

Twelve RCTs were eligible and 1089 patients were analyzed totally (549 in DCF and 540 in control). DCF regimen increased partial response rate (38.8% vs 27.9%, p = 0.0003) and reduced progressive disease rate (18.9% vs 33.3%, p = 0.0005) compared to control regimen. Significant improvement of 2-year OS rate was found in DCF regimen (RR = 2.03, p = 0.006), but not of 1-year OS rate (RR = 1.22, p = 0.08). MST was significantly prolonged by DCF regimen (p = 0.039), but not median TTP (p = 0.054). Both 1-year OS rate and median TTP had a trend of prolongation by DCF regimen. Chemotherapy-related mortality was comparable (RR = 1.23, p = 0.49) in both regimens. In grade I-IV toxicities, DCF regimen showed a major raise of febrile neutropenia (RR = 2.33, p<0.0001) and minor raises of leucopenia (RR = 1.25, p<0.00001), neutropenia (RR = 1.19, p<0.00001), and diarrhea (RR = 1.59, p<0.00001), while in other toxicities there were no significant differences.

CONCLUSION

DCF regimen has better response than non-taxane containing regimen and could potentially improve the survival outcomes. The chemotherapy-related toxicity of DCF regimen is acceptable to some extent.

Spread and development of laparoscopic surgery for gastric tumors in mainland China: initial experiences

BACKGROUND/AIMS

To introduce the initial experience of the laparoscopic surgery for gastric tumors in mainland China.

METHODOLOGY

A key Chinese full-text database was comprehensively searched for eligible reports on laparoscopic gastric surgery from 1991 to 2009. Outcomes of laparoscopic gastrectomy for gastric cancer were extracted for pooling estimate.

RESULTS

In the period 2003-2008, the amount of relevant journal papers sharply increased (p<0.001). Analysis included 67 reports (no randomized controlled trial, 4 case control studies and the remnant of case series or case reports); 74.6% of the reports were from institutions in the Eastern China region. Finally 542 patients of gastric cancer were analyzed. Early gastric cancer (TNM stage Ia/Ib) was only 30.0%. D2/D2+ lymphadenectomy was performed in 69.0% patients. The combined overall complication and mortality rates were 10.9% and 0.4%, respectively. The incidence of conversion to open surgery and reoperation were 4.1% and 1.1%, respectively. The long-term outcome of 5-year survival rate was unavailable.

CONCLUSIONS

Laparoscopic gastric surgery has spread rapidly and developed in mainland China during recent several years. The initial experiences from mainland China showed that postoperative complication and mortality rates of laparoscopic gastrectomy for gastric cancer were acceptable and comparable to Japanese and Korean trials.

Total vs. proximal gastrectomy for proximal gastric cancer: a systematic review and meta-analysis

BACKGROUND/AIMS

To compare effectiveness between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer.

METHODOLOGY

PubMed, Embase, Cochrane library and Chinese CNKI databases were searched to select eligible studies comparing TG to PG for proximal gastric cancer. Outcome measures included overall survival, recurrence, mortality and morbidity rates, as well as nutritional states. Meta-analyses were performed by RevMan 5.0.

RESULTS

One randomized controlled trial and 7 retrospective studies involving 1077 patients were included. Meta-analysis showed no significant difference of 5-year overall survival rate (OR=0.89, p=0.53). However, TG achieved a lower recurrence rate (Peto OR=0.53, p=0.004). PG experienced higher morbidity risk (OR=0.11, p<0.00001), concerning higher risks of reflux esophagitis (OR=0.04, p<0.00001) and anastomotic stenosis (OR=0.14, p<0.00001) in a short period. TG performed longer operation time (p=0.002) and more blood loss (p<0.00001). Operative mortality and nutritional states were comparable without significant differences.

CONCLUSIONS

Based on current retrospective evidences, TG and PG had similar overall survival outcome for proximal gastric cancer, but TG showed lower recurrence rate. PG with gastroesophagostomy had higher incidence of reflux esophagitis and anastomotic stenosis. TG can be recommendation for proximal gastric cancer, although more high-quality trials are still expected.

Total vs. proximal gastrectomy for proximal gastric cancer: a systematic review and meta-analysis

BACKGROUND/AIMS

To compare effectiveness between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer.

METHODOLOGY

PubMed, Embase, Cochrane library and Chinese CNKI databases were searched to select eligible studies comparing TG to PG for proximal gastric cancer. Outcome measures included overall survival, recurrence, mortality and morbidity rates, as well as nutritional states. Meta-analyses were performed by RevMan 5.0.

RESULTS

One randomized controlled trial and 7 retrospective studies involving 1077 patients were included. Meta-analysis showed no significant difference of 5-year overall survival rate (OR=0.89, p=0.53). However, TG achieved a lower recurrence rate (Peto OR=0.53, p=0.004). PG experienced higher morbidity risk (OR=0.11, p<0.00001), concerning higher risks of reflux esophagitis (OR=0.04, p<0.00001) and anastomotic stenosis (OR=0.14, p<0.00001) in a short period. TG performed longer operation time (p=0.002) and more blood loss (p<0.00001). Operative mortality and nutritional states were comparable without significant differences.

CONCLUSIONS

Based on current retrospective evidences, TG and PG had similar overall survival outcome for proximal gastric cancer, but TG showed lower recurrence rate. PG with gastroesophagostomy had higher incidence of reflux esophagitis and anastomotic stenosis. TG can be recommendation for proximal gastric cancer, although more high-quality trials are still expected.

Prognostic value of cancer stem cell marker CD133 expression in gastric cancer: a systematic review

Objective

To investigate the correlation between CD133-positive gastric cancer and clinicopathological features and its impact on survival.

Methods

A search in the Medline and Chinese CNKI (up to 1 Dec 2011) was performed using the following keywords gastric cancer, CD133, AC133, prominin-1 etc. Electronic searches were supplemented by hand searching reference lists, abstracts and proceedings from meetings. Outcomes included overall survival and various clinicopathological features.

Results

A total of 773 gastric cancer patients from 7 studies were included. The median rate of CD133 expression by immunohistochemistry (IHC) was 44.8% (15.2%–57.4%) from 5 studies, and that by reverse transcription polymerase chain reaction (RT-PCR) was 91.3% (66.7%–100%) from 4 studies. The accumulative 5-year overall survival rates of CD133-positive and CD133-negative patients were 21.4% and 55.7%, respectively. Meta-analysis showed that CD133-positive patients had a significant worse 5-year overall survival compared to the negative ones (OR = 0.20, 95% CI 0.14–0.29, P<0.00001). With respect to clinicopathological features, CD133 overexpression by IHC method was closely correlated with tumor size, N stage, lymphatic/vascular infiltration, as well as TNM stage.

Conclusion

CD133-positive gastric cancer patients had worse prognosis, and was associated with common clinicopathological poor prognostic factors.

Primary pancreatic leiomyosarcoma: a retrospective analysis of clinical characteristics and prognosis of this rare disease

BACKGROUND/AIMS

Primary pancreatic leiomyoarcoma (PLMS) is a rare disease; its clinical characters and prognosis are poorly demonstrated. This study aimed to investigate the tumor's clinical characters and to reveal the true outcome.

METHODOLOGY

A retrospective review of both Chinese and worldwide PLMS patients were performed. Data was collected and analyzed and overall survival was described by Kaplan-Meier curve.

RESULTS

In total, there were 9 cases identified in China and 55 cases identified in the worldwide literature. Incidence rate was general equal in gender and had an increased trend with age(mean +SD: 55+14 years). Abdominal pain, mass and weight loss were the most common presentations, mean tumor size was 10cm (SD 7.2cm) and most of them presented as a solid mass. Forty six cases accepted operation, 33 of which obtained a radical resection. Median overall survival time was 27 months.The patients who accepted radical resection had an obviously improved prognosis over non-resectable patients.

CONCLUSIONS

PLMS commonly occurred in the mid-age people and there was lack of specific non-invasive methods for precise preoperative diagnosis.PLMS has a much better prognosis compared with pancreatic ductal adenocarcinoma. Radical resection is the only hope for improving the outcome of this malignancy.

[Clinical research of the sentinel lymph node in patients with early gastric cancer]

OBJECTIVE

To assess the value of carbon nanoparticles which mapping sentinel lymph node (SLN) and predict the status of lymph node metastasis status in the early gastric cancer (EGC), and to explore the SLN distribution.

METHODS

Forty five patients with EGC, who underwent surgical treatment, were enrolled. At the completion of exploratory laparotomy, 1 mL solution of carbon nanoparticles was injected subserosally in the gastric wall 4-6 sites around the primary tumor during surgery in all patients. The first stained lymph nodes were defined as the SLN. Postoperative SLN and dissection of the lymph node was sent for histopathological examination.

RESULTS

Carbon nanoparticles were applied in 45 EGC patients for mapping SLN and 43 cases (95.6%) were observed with positive stain. 53 pieces of SLN were detected, average (1.23 +/- 0.53) pieces for one person. 11 of the 43 patients (25.6%) developed lymph node metastasis, through the SLN histopathological examination, 3 cases (7.0%) were false negative, the accuracy and sensitivity of the prediction of regional lymph node metastasis status was 93.0% and 72.7%, respectively. The false negative and negative predictive value was 27.3% and 91.4%. There were significant differences between the mucosal cancer group and submucous cancer group in the diameter of tumor (P = 0.042) and the rate of lymph node metastasis (P = 0.001). There were no significant differences between the two groups in the accuracy and sensitivity (P > 0.05). In 36 cases of gastric cancer patients, 23 SLN positive cases (63.9%) were detected in third group.

CONCLUSIONS

The dyeing rate, accuracy and sensitivity of carbon nanoparticles mapping SLN for EGC were high. Carbon nanoparticles mapping SLN can more accurately predict perigastric lymph node metastasis status in patients with EGC.

[Prognostic analysis of 349 cases with gastrointestinal stromal tumor]

OBJECTIVE

To investigate the prognostic factors of gastrointestinal stromal tumor (GIST).

METHODS

Clinical data of 349 cases of GIST patients in our hospital between January 2006 and September 2011 were analyzed retrospectively and the prognostic factors were evaluated.

RESULTS

335 patients underwent R0 resection and 14 with palliative resection. With a follow-up of 288 (82.5%) patients (median: 33 months, range 3-72 months), 61 patients with progressed were observed and 33 of them died. Unconditional logistic regression analysis showed that tumor location (P = 0.003, OR = 1.412, 95% CI: 1.125-1.772), risk classification (P = 0.011, OR = 2.930, 95% CI: 1.278-6.716) and use of imatinib treatment (P = 0.009, OR =0.291, 95 CI: 0.115-0.734) were independent factors for post-operative recurrence or metastasis. Survival analysis of 128 patients between January 2006 and December 2008, Cox regression analysis demonstrated diameter (P = 0.034, OR = 2.328, 95% CI: 1.065-5.089), risk classification (P = 0.015, OR = 3.031, 95% CI: 1.236-7.428) and use of imatinib treatment (P = 0.011, OR = 0.259, 95% CI: 0.091-0.734) were independent prognosis factors.

CONCLUSIONS

No specific clinical manifestation was observed for GIST. Tumor location, diameter, risk classification and imatinib treatment could influence on prognosis. Radical resection combined with imatinib treatment could improve the prognosis.

Short-term versus long-term administration of single prophylactic antibiotic in elective gastric tumor surgery

BACKGROUND/AIMS

To evaluate short-term versus long-term single prophylactic antibiotic for elective gastric tumor surgery.

METHODOLOGY

Patients in a single surgical team undergoing elective gastric tumor surgery were enrolled from November 2009 to December 2010. The included patients were aged from 18 to 70 years without conditions as severe comorbidity, preoperative infectious diseases, antibiotic administration 48 h before surgery, exploratory laparotomy only or combined colorectal resection, neoadjuvant chemotherapy, or steroid administration before surgery. The overall and infection-related postoperative complications and also economic outcomes were analyzed. The software SPSS 17.0 and TreeAge Pro 2007 were used for statistics.

RESULTS

Patients (n=158 (45 vs. 113)) were enrolled in short-term and long-term groups. No death cases occurred. Overall postoperative complication rates were 8.9% and 8.0%, respectively (p=1.000). The rates of infection related complications were 8.9% and 4.4%, respectively (p=0.231). No surgical site infection (SSI) occurred in the short-term group, whereas SSI was 1.8% in the long-term group. Total hospitalization cost (THC) of short-term branch was 36,557RMB per patients and preferable against 39,523RMB of long-term branch. Incremental cost-effectiveness analysis showed there was a 10 times interval between the extra healthcare expenditure of benefit and harm.

CONCLUSIONS

Short-term administration did not increase the risk of postoperative complications and was more cost-effective.