RESUMEN

Gastrointestinal reconstruction is an important step in radical gastrectomy for gastric cancer. This article reviews the digestive tract reconstruction methods of total gastrectomy, distal gastrectomy, and proximal gastrectomy, and summarizes various functional preservation gastrectomy techniques that have been continuously developed in recent years. Finally, based on the author′s relevant experience, the surgical methods designed in total gastrectomy and distal gastrectomy are introduced.

RESUMEN

Objective:To investigate the clinical efficacy of total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction.Methods:The data of 18 patients who underwent total laparoscopic resection of gastric stromal tumors with cosmetic suture reconstruction from December 2020 to May 2023 in Zhejiang Provincial People′s Hospital were collected retrospectively, and their clinical efficacy was analyzed.Results:Twelve patients were asymptomatic and the tumor was found during physical examination. All patients underwent total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction without conversion to open surgery. The time to resume liquid diet was 1-3(1.67±0.35)days, the postoperative hospital stay was 4-12(6.89±2.54)days, and no postoperative complications occurred. Among them, 12 cases were at low risk and 6 cases were at medium risk. CD117 and DOG-1 were positively expressed in all cases. Four out of six patients at medium risk underwent genetic testing, and two patients with c-Kit gene Lys550-Val560 mutation were treated with Gleevec therapy after surgery. Gastrography performed one month after surgery showed that the shape of the stomach was similar to the preoperative shape, with good motility and unimpeded emptying.Conclusions:Total laparoscopic resection of gastric stromal tumors combined with cosmetic suture reconstruction can reduce postoperative gastrointestinal dilatation, esophageal and pyloric stenosis, and has a certain clinical value.

RESUMEN

Objective:To explore the feasibility and therapeutic effect of Roux-en-Y anastomosis through a small incision in laparoscopic distal gastrectomy for gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of 34 patients who underwent laparoscopic distal gastrectomy for gastric cancer through Roux-en-Y anastomosis through small incisions in the Gastrointestinal and Pancreatic Surgery Department of the Zhejiang Provincial People′s Hospital from August 2022 to May 2023.Results:Among the 34 patients, there were 27 males and 7 females, aged (63.6±14.6)years old. All cases underwent surgery successfully and there were no cases of conversion to open surgery. The reconstruction time of the digestive tract was (30.74±3.29)minutes, the intraoperative bleeding volume was (60.29±29.59)ml, the intraoperative lymph nodes were cleaned (32.00±11.00), the incision length of the specimen was (5.88±0.98)cm, the postoperative exhaust time was (1.88±0.73)days, and the postoperative hospitalization time was (11.94±3.87)days. There were no postoperative cases of anastomotic leakage, anastomotic stenosis, bleeding, or unplanned reoperation in patients. After a postoperative follow-up of 3-12 months, there were no recurrence or death cases, and no postoperative reflux cases during the follow-up period.Conclusions:Laparoscopic distal gastrectomy with Roux-en-Y anastomosis through a small incision can effectively reduce postoperative complications, especially the occurrence of postoperative reflux. In addition, this surgical procedure can simplify the surgical steps, shorten the surgical time, promote postoperative recovery, and improve postoperative quality of life.

RESUMEN

Objective:To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction, and evaluate its feasibility, safety during perioperative period, and advantages of anastomosis.Methods:A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023. Gender, age, body mass index (BMI), tumor location, tumor stage, tumor type and other related indicators were collected. The main parameters during the operation process were collected, including operation time, anastomosis time, intraoperative blood loss, postoperative recovery status, exhaust time, feeding time, complications related to anastomosis, and length of hospital stay. The differences between other digestive tract reconstruction methods such as Overlap method, reverse puncture method, and handmade anastomosis were compared and analyzed.Results:A total of 56 patients with gastric cancer were included in this study. The anastomosis time of the tubular instrument group was (42.3±15.7)min, which was superior to the handmade anastomosis group ( P<0.05). The operation time of the tubular instrument group was (176.3±25.8)min, which was superior to other methods (all P<0.05). The intraoperative blood loss of the tubular instrument group was (75.68±20.34)ml, which was less than other methods (all P<0.05). The exhaust time of the tubular instrument group was (2.6±0.2)d, which was similar to the Overlap method ( P>0.05), but earlier than the handmade anastomosis method and the reverse puncture method (all P<0.05). The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method, the reverse puncture method, and the Overlap method (all P>0.05). There were no significant differences in postoperative hospital stay, incision infection rate, and other complications related to anastomosis between groups (all P>0.05). Conclusions:The tubular instrument anastomosis method has a shorter operation time and a smaller incision compared to traditional laparotomy surgery. It has the advantages of laparoscopic assistance with intuitive and clear visualization during the operation, while also taking into account the convenience and safety of direct visualization under laparoscopy. It is a surgical method worthy of promotion.

RESUMEN

Objective:To compare the clinical efficacy and quality of life of patients between Billroth Ⅱ+ Braun anastomosis and simple Billroth Ⅱ anastomosis in digestive tract reconstruction after laparoscopic distal gastric cancer radical resection.Methods:A retrospective analysis was performed on clinical data of 68 patients who underwent laparoscopic distal gastric cancer radical resection in Jinjiang Municipal Hospital from January 2019 to January 2022. Forty patients who underwent Billroth Ⅱ+ Braun anastomosis were included in the observation group, and 28 patients who underwent simple Billroth Ⅱ anastomosis were included in the control group. Perioperative indicators and postoperative indicators one year after surgery were collected to observe the safety and efficacy of patients after surgery.Results:There were no significant differences in operation time, intraoperative bleeding volume, postoperative exhaust time, time to remove gastric tube and drainage tube, and postoperative hospital stay between the two groups (all P>0.05). There were also no significant differences in postoperative complications between the two groups ( P>0.05). One year after surgery, the incidence of food retention and residual gastritis in the observation group were lower than those in the control group (all P<0.05), while there were no significant differences in the incidence of bile reflux and reflux esophagitis between the two groups (all P>0.05). One year after surgery, nutritional evaluation showed that the total protein decline and prognostic nutritional index (PNI) in the observation group were lower than those in the control group, with significant differences (all P<0.05). The incidence of bloating and reflux symptoms in the observation group one year after surgery was lower than that in the control group, with significant differences (all P<0.05). Conclusions:Billroth Ⅱ+ Braun anastomosis is a safe method for digestive tract reconstruction after laparoscopic distal gastric cancer resection, which can improve patients′ quality of life after surgery.

RESUMEN

The incidence of upper gastric cancer and esophagogastric junction cancer is gradually increasing. The safety of proximal gastrectomy has been proven and widely used in clinical practice. Traditional esophageal gastric anastomosis can lead to severe reflux esophagitis after surgery, which affects patients′ quality of life. In recent years, with the continuous popularization of laparoscopy in gastric cancer radical surgery, clinicians are constantly innovating and exploring anti-reflux digestive tract reconstruction methods after proximal gastrectomy, but there is no standard consensus yet. This article reviews the research progress of anti-reflux reconstruction after laparoscopic proximal gastrectomy, combining with the latest clinical research results, aiming to provide references for colleagues and maximize patient benefits.

RESUMEN

The incidence rate and mortality rate of gastrointestinal malignant tumor are high all over the world, which seriously affects human life and health. With the continuous popularization and deepening of the concept of transformation therapy, many clinical practices, especially some multicenter clinical studies, have proved that there are still opportunities for the treatment of some advanced tumors and can obtain good survival benefits. Moreover, in recent years, a series of changes have taken place in the fields of tumor cognition, surgical technology, diagnosis, chemotherapy and biological immunotherapy, resulting in changes in the choice of tumor treatment. This paper briefly reviews the transformation treatment of advanced gastrointestinal malignant tumors in liver metastasis, lymphatic metastasis and peritoneal metastasis in recent years, in order to make the transformation treatment more scientific and standardized in practice by summarizing the relevant research results at home and abroad.

RESUMEN

Objective:To investigate the clinical effect of enteral nutrition support in the transformation therapy of advanced gastric cancer.Methods:Eighty-two patients with advanced gastric cancer treated by transformation in Zhejiang Provincial People′s Hospital from September 2019 to August 2021 were analyzed retrospectively. 41 patients in the observation group were treated with enteral nutrition support on the basis of routine transformation treatment; 41 patients in the control group received only routine transformation treatment. The nutritional related indexes such as prealbumin, total serum protein and albumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before treatment and on the 7th day after the end of 3-cycle transformation treatment, and the above indexes and transformation success rate of the two groups were compared. Results:There was no significant difference in prealbumin, total serum protein, albumin, CD4 + , CD8 + , CD4 + /CD8 + between the two groups before treatment (all P>0.05). On the 7th day after three cycles of transformation treatment, the above indexes in the observation group were higher than those in the control group, with significant difference (all P<0.05). The success rate of transformation in the observation group was higher than that in the control group ( P<0.05). Conclusions:The rational use of enteral nutrition support in the transformation treatment of patients with advanced gastric cancer can significantly improve the nutritional status and immune function of patients, increase the tolerance to chemotherapy and improve the success rate of transformation.

RESUMEN

Objective:To evaluate the clinical effect of laparoscopic surgery after transformation therapy for patients with stage Ⅳ gastric cancer.Methods:Clinical data of 55 patients with stage Ⅳ gastric cancer underwent transformation therapy at Zhejiang Provincial People′s Hospital from January 2018 to January 2021 were reviewed retrospectively. All patients had distant metastasis and underwent multi-disciplinary treatment (MDT) directed transformation therapy. 21 patients was appraised to have indications of laparoscopic exploration. Of which 18 patients underwent D2 radical laparoscopic gastrectomy, 1 patient underwent gastrojejunostomy and 2 patient underwent laparoscopic biopsy. The remission of patients after conversion therapy and the related intraoperative and postoperative indicators were analyzed.Results:After the transformation therapy, there were 2 cases of complete response (CR), 22 cases of partial response (PR), 14 cases of stable disease (SD) and 17 cases of progressive disease (PD). The objective response rate was 69.09%(38/55). 18 cases finally completed laparoscopic gastric cancer surgery (1 case converted to laparotomy), including total gastrectomy in 10 cases, distal gastrectomy in 8 cases, and R0 resection in 12 cases (R0 resection rate 12/18). In all 18 cases, the surgical time was (223±28)min, the intraoperative blood loss was (100±48)ml, and the number of lymph nodes resected was (28±8). The median postoperative hospital stay was 12(10.25, 19.25)d. After surgery, there were 2 cases of grade Ⅲ complications, 5 cases of grade Ⅱ complications and 1 case of grade Ⅰ complications. There was no perioperative death. The 1-year survival rate was 12/18. The median progression-free survival time was 11 months and the median overall survival time was 19 months.Conclusions:Laparoscopic surgery for stage Ⅳ gastric cancer after transformation therapy is safe and clinical effect is fine.

RESUMEN

Objective:To verify the transforming therapeutic efficacy of apatinib combined with oxaliplatin + tegiol (SOX regimen) in advanced gastric cancer with peritoneal metastasis.Methods:Using the method of descriptive case series study, the data of gastric cancer patients with peritoneal metastasis treated in Zhejiang Provincial People′s Hospital and Shulan (Hangzhou) Hospital from March 2016 to August 2021 were collected and treated with apatinib combined with SOX regimen. Oxaliplatin 130 mg/m 2, intravenous drip, day 1; Apatinib mesylate tablets 500 mg/d, oral, once a day, 1-21 days; Teggio: calculate the dosage according to the body surface area (<1.25 m 2, 40 mg; 1.25-1.50 m 2, 50 mg; >1.50 m 2, 60 mg). Take it orally for 1-14 days, twice a day. From the first day of chemotherapy, a cycle of 3 weeks. The short-term efficacy was evaluated every 2 cycles. After that, the multidisciplinary treatment team will decide whether the conversion operation can be accepted. When the requirements of surgical resection were met, the operation will be carried out after 1 cycle of drug withdrawal. Results:The median survival time (MST) of 23 patients was 14.1 months (95% CI: 12.3-16.4); The median overall survival (OS) after transformation therapy was 19.1 months (95% CI: 15.5-22.8). After transformation therapy, 14 cases of partial remission (PR), 3 cases of stable disease (SD) and 6 cases of progression disease (PD) in 23 patients, and the objective remission rate (ORR) was 73.9%(17/23). 12(52.2%) patients underwent surgery after transformation therapy. The 1-year OS of 12 patients was (17.0±1.5)months; Among them, 5 cases underwent R0 resection, and the R0 resection rate was 5/12. Conclusions:Transformation treatment with apatinib combined with oxaliplatin + tegio (SOX regimen) in advanced gastric cancer can achieve a high R0 resection rate with better conversion effect.

RESUMEN

The incidence rate of gastrointestinal tumors is high, and it is the most common tumor in general surgery. Due to the characteristics of the disease and surgery, patients are often accompanied by malnutrition of varying degrees during the perioperative period. This will increase the risk of operation, surgical complications and mortality, reduce the susceptibility to radiotherapy and chemotherapy and the quality of life of patients. Therefore, good perioperative nutritional screening and nutritional support treatment will effectively improve the clinical outcome of patients with gastrointestinal cancer. This article mainly introduces the progress in screening, evaluation and evaluation of nutritional status in perioperative period of gastrointestinal tumor, as well as the timing of perioperative nutritional support treatment, selection of indications and implementation methods.

RESUMEN

Objective:To study the short-term effect of early application of intestinal microecological therapy after gastric cancer surgery.Methods:A retrospective analysis was made on 96 patients with early and middle stage gastric cancer who underwent surgical treatment in the department of gastrointestinal surgery of Shulan (Hangzhou) Hospital from June 1, 2020 to May 31, 2021. Among them, 48 patients in the observation group were given enteral nutrition support treatment in the early stage after operation and intestinal microecological preparation, while the control group of 48 patients in the early postoperative were given enteral nutrition support. The serum total protein, albumin, prealbumin and other nutrition related indexes and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before and 7 days after operation. The clinical indexes such as the time of first anal exhaust and the incidence of infectious complications were recorded. Results:There was no significant difference between the two groups in preoperative serum total protein, albumin, prealbumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + ( P>0.05). 7 days after operation, the above indexes in the observation group were significantly higher than those in the control group (all P<0.05). The anal exhaust recovery time of observation group was faster ( P<0.05); There was no significant difference in the incidence of postoperative infectious complications between the two groups ( P>0.05). Conclusions:Early application of intestinal microecological agents in patients with gastric cancer after operation can significantly improve the nutritional status and immune function, promote the recovery of intestinal function, and will not increase the incidence of complications.

RESUMEN

Intestinal fistula is one of the most common and serious complications of abdominal surgery and trauma. Once intestinal fistula occurs, it will produce pathological and physiological changes that are not directly related to the primary disease, leading to abdominal infection, bleeding, electrolyte imbalance, malnutrition, multiple organ dysfunction and other serious consequences, resulting in the increase of treatment difficulty, length of stay, cost of hospitalization and mortality. Therefore, it is very important to carry out prediction and early diagnosis in the early stage of intestinal fistula, and then implement comprehensive diagnosis and treatment strategy. This article mainly expounds the current situation of the diagnosis and treatment of intestinal fistula from its causes, clinical manifestations, diagnosis methods and treatment measures, and looks forward to the future treatment direction of intestinal fistula from the perspective of interdisciplinary and cross regional cooperation.

RESUMEN

Objective:To explore the relationship between the level of C-reactive protein/serum albumin ratio (CAR) and early postoperative anastomotic leakage in patients with colorectal cancer.Methods:From September 2016 to September 2019, all colorectal cancer patients who were treated in gastrointestinal surgery of Jinjiang hospital in Fujian Province were collected for retrospective analysis. The baseline data of the patients were collected. The blood C-reactive protein (CRP), procalcitonin (PCT) and serum albumin (ALB) were monitored on the first, third, fifth and seventh days after operation, and the results were statistically analyzed.Results:There was no significant difference in baseline data such as age, body mass index (BMI), operation time and intraoperative hemorrhage between the anastomotic leakage group and the non anastomotic leakage group ( P>0.05), but the hospitalization time of the anastomotic leakage group was longer than that of the non anastomotic leakage group ( P<0.05). The CRP level on the 3rd and PCT level on the 5th day after operation in the anastomotic leakage group were higher than those in the non anastomotic leakage group, with significant difference ( P<0.05). The CAR value on the 3rd and 5th day after operation in the anastomotic leakage group was higher than those in the non anastomotic leakage group with significant difference ( P<0.05). Conclusions:CAR can predict early anastomotic leakage in patients with colorectal cancer.

RESUMEN

Objective:To explore the role of negative pressure drainage in the treatment of duodenal stump fistula after gastrectomy.Methods:The data of 36 patients with duodenal stump fistula admitted in our department from January 2016 to January 2020 were analyzed retrospectively. According to the drainage mode of patients with intestinal fistula, the patients were divided into negative pressure drainage group (observation group) and conventional rubber tube drainage group (control group), 18 cases in each group. The incidence of complications and healing time of intestinal fistula in the two groups were observed.Results:There was no significant difference ( P>0.05) in the incidence of complications between the observation group (5.56%) and the control group (11.11%). There was a significant difference in the mean healing time between the observation group [(12.83±6.25)days] and the control group [(23.33±4.64)days] ( P<0.05). Conclusions:Negative pressure drainage is beneficial to the healing of duodenal stump fistula, and does not improve the incidence of postoperative complications. It is safe and effective. It can be used as a conventional drainage for gastrectomy.

RESUMEN

To investigate the safety and efficacy of laparoscopic splenectomy and portaazygous devascularization, we studied laparoscopic splenectomy and porto-azygos devascularization patients within the peri-operative period. Clinical data and curative effect are detailed alongside statistical analysis. The laparoscopic splenectomy and porto-azygos devascularization operation time was 2.56 + 0.62 hours. The intraoperative bleeding and anal exhaust time was 149.5 + 32.7ml 3.47 + 1.32 days, and the hospitalization time was 5.05 + 1.22 days. When the spleen volume was greater than or equal to 1.5 liters, the rate of open abdominal surgery increased significantly. After 1, 2, 3, and 4 years of follow-up, cumulative recurrence bleeding rates were 0, 5.20%, 9.98%, and 15.83%, respectively. Laparoscopic splenectomy and pericardial devascularization is safe, effective, and feasible, and it can be confirmed by enhanced spiral computed tomography (CT). Whether spleen volume greater than 1.5L is suited to laparoscopic surgery requires further research.

RESUMEN

<p><b>OBJECTIVE</b>To explore the NEK-6 expression in gastric cancer tissue and its relationship with clinicopathological features.</p><p><b>METHODS</b>Fluorescent quantification PCR and Western blotting were used to examine the NEK-6 expression in 36 samples of fresh gastric cancer tissues and para-cancer gastric mucosal tissues, human gastric cancer cell lines(BGC-823, MKN-28, SGC-7901, MGC-803, HGC-27, AGS), and human normal gastric epithelial cell line (GES-1). Gastric cancer cell lines with the highest expression level were selected to perform the invasion and migration tests, and the effect of down-regulated NEK-6 expression by siRNA transfection on above invasion and migration tests were observed. Meanwhile NEK-6 expression in 94 paraffin samples of gastric cancer tissues was examined by immunohistochemistry and its positivity was compared among different clinicopathologic features.</p><p><b>RESULTS</b>Fluorescent quantification PCR revealed gastric cancer tissues had significantly higher NEK-6 expression than para-cancer tissues(0.002 80±0.001 36 vs. 0.001 91±0.001 48, P<0.05), NEK-6 expression was up-regulated in 31 gastric cancer tissues (86.1%), and human gastric cancer cell lines had significantly higher NEK-6 expression than GES-1 cells, among whom BGC-823 and AGS cell lines were the highest. Invasion and migration tests showed that as compared to negative siRNA control group, ability of invasion and migration in BGC-823 and AGS cells after siRNA transfection was obviously decreased. In 94 paraffin samples, positive expression rate of NEK-6 was 60.6%(57/94), and NEK-6 expression was significantly associated with gastric cancer distant metastasis, lymph nodes metastasis and TNM staging(all P<0.05).</p><p><b>CONCLUSIONS</b>NEK-6 expression is up-regulated in gastric cancer tissues, which is significantly associated with distant metastasis, lymph nodes metastasis and TNM staging. Down-regulation of NEK-6 expression can inhibit the ability of invasion and migration in gastric cancer cells.</p>

RESUMEN

Nowadays more and more biologists and immunologists focus on Galectin-1 due to the in -depth study of Galectins.As one of the important member of Galectins,Galectin-1 distributes widely,exists in a variety of tissues and cells,involves in cell adhesion,proliferation,apoptosis and inflammatory reaction,and results in a variety of physiological and pathological process.Recent studies have found that Galectin-1 expression in a variety of malignant tumor with a close relationship with tumor occurrence,invasion,development,anti-tumor immunity,and metastasis.It may be a potentially new target for cancer and inflammation therapies.This present paper reviews the current research about Galectin-1 and tumor progression.

RESUMEN

<p><b>OBJECTIVE</b>To investigate the application of home enteral nutrition (HEN) in patients with advanced gastric cancer and its impact on the quality of life.</p><p><b>METHODS</b>Data of 60 consecutive patients with advanced gastric cancer, who could not underwent operation and had relapse metastasis, from June 2010 to June 2012 were retrospectively analyzed. According to familial nutritional pattern, these 60 patients were divided into HEN group (25 cases) receiving home enteral nutritional support and control group (35 cases). HEN patients were supported through jejunostomy tube or nasal gastric tube. Control patients were supported through total parental nutrition or purely eating respectively. All the patients received intravenous chemotherapy and evaluated by Karnofsky index and Spitzer system in the first, third, sixth and twelfth month. In the sixth month, patients were also examined by EORTC QLQ-C30.</p><p><b>RESULTS</b>No significant differences were found between the two groups according to 8 elements containing age, sex, BMI, etc. A total of 53 patients died within one year, including 21 in HEN group and 32 in control group. The Karnofsky scales showed that HEN group scored meanly 57.4, 39.6 and 28.2 in the third, sixth and twelfth month respectively, which were significantly higher than those of control group (45.3, 29.2 and 20.1, P=0.041, P=0.012 and P=0.015 respectively). The Spitzer scales showed that HEN group scored meanly 5.12, 4.04 and 2.54 on average in the third, sixth and twelfth month respectively, which were significantly higher than those of control group (4.32, 3.01 and 1.97, P=0.048, 0.035 and P=0.024 respectively). The EROTC QLQ-C30 scales showed that HEN group scored higher than control group in functional scales (P<0.05), and lower in the symptom scales of short breathing, pain and tired (P=0.025, P=0.044, P=0.036 respectively), while higher in diarrhea (P=0.047).</p><p><b>CONCLUSIONS</b>The quality of life of patients with advanced gastric cancer declines gradually with the nutritional status deteriorating. HEN can be applied to improve the nutritional status and quality of life.</p>

Asunto(s)

RESUMEN

Objective To investigate the relationship between positive peritoneal exfoliated cancer cells and the clinicopathological features of patients with hepatocellular carcinoma before any invasive treatment.Methods Of the 92 patients with hepatocellular carcinoma who underwent laparotomy,ascites fluid was collected in the patients with peritoneal ascites; and peritoneal lavage fluid was collected in those patients without peritoneal ascites.Then,shedded cancer cells in these fluid samples were detected.Results The positive rates of peritoneal cancer cells were associated with the TNM stage,tumor location and tumor size.The positive detection rate of cancer cells in TNM stage Ⅲ and Ⅳ was significantly higher than stage Ⅰ and Ⅱ (38.1％ vs 8.0％ ; P =0.0005).The positive detection rate was higher in tumors located closer to the surface (P =0.0 002),and with larger diameter (P =0.00 007).Conclusion Peritoneal cancer cells were significantly correlated with tumor stage,tumor location and size in hepatocellular carcinoma.