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25 May 2018, Volume 23 Issue 03 Previous Issue    Next Issue

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Effectiveness of preliver transplantation transarterial chemoembolization therapy in treatment of hepatocellular carcinoma beyond UCSF criteria TONG Hui, ZHANG Jiaqiang, ZHU Zhecheng, PENG Chenghong, LI Tao 2018, 23 (03):  241-246.  DOI: 10.16139/j.1007-9610.2018.03.012 Abstract ( 513 )   PDF (689KB) ( 113 )   Objective: To assess the safety and effectiveness of preliver transplantation transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) beyond UCSF criteria. Methods: We retrospectively analyzed the clinical data of 83 patients with HCC beyond UCSF criteria, who were divided into TACE group and control group. The postoperative acute rejection, biliary complications, vascular complications, tumor free survival rate and overall survival rate between two groups were compared. Results: There were (2.0±1.3) preliver transplantation TACE procedures with the period of (15.7±8.4) d between final TACE treatment and liver transplantation. There was no significant difference in postoperative acute rejection, biliary complications and hepatic artery embolism between TACE group and control group(P>0.05). The tumor free survival rate and overall survival rate in TACE group were significantly higher than those in control group (P<0.05). Stratification analysis revealed that the 1-, 3-, 5-year tumor free survival rate and overall survival rate of the patients with complete response or partial response were much higher than those of the patients without response(P<0.05). The 1-, 3-, 5-year tumor free survival rate and overall survival rate were significantly higher in the patients with HCC which satisfied UCSF criteria after TACE than those in the patients with HCC still beyond UCSF criteria(P<0.05). Conclusions: Preliver transplantation TACE can prolong tumor free survival time and overall survival time, and is safe with only one case of hepatic artery embolism. References | Related Articles | Metrics

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Experience of portal vein embolization for two-stage precise hepatectomy JIN Shengjie, FAN Yiqun, BAI Dousheng, JIANG Guoqing, QIAN Jianjun, YAO Jie, WANG Xiaodong, GAO Zhihui, ZHANG Chi 2018, 23 (03):  247-251.  DOI: 10.16139/j.1007-9610.2018.03.013 Abstract ( 331 )   PDF (584KB) ( 98 )   Objective: To discuss the application of portal vein embolization in two-stage precise hepatectomy. Methods: Clinical data of 7 patients who underwent two-stage precise hepatectomy after percutaneous transhepatic portal vein embolization guided by ultrasound and digital subtraction angiography were analyzed in this study. There were 3 cases in liver cirrhosis group and 4 cases in without liver cirrhosis group. Liver function and liver volume were detected in each group before and after portal vein embolization, and the effect of two-stage surgical resection was examined. Results: Percutaneous transhepatic portal vein embolization was successfully performed in all 7 patients. Future liver remnant increased and hepatic hypertrophy was found in 6 patients who completed two-stage precise hepatectomy afterward. Non-embolized liver hypertrophy was not enough to the conditions for two-stage hepatectomy after 8 weeks in the other patient of colorectal cancer with liver metastases. The patient underwent the therapy of associating liver partition and portal vein ligation for staged hepatectomy in other hospital. In both groups liver function was abnormal at the first day after the percutaneous transhepatic portal vein embolization (P<0.05) and recovered to normal 3-7 days later. No severe complication was found in this study. Conclusions: Portal vein embolization is safe and feasible, and increases the volume of future liver remnant significantly. It can provide the opportunity of two-stage precise hepatectomy. References | Related Articles | Metrics

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Epidemiology of gallbladder stone disease in Shanghai WANG Qihan, ZHANG Zhongwen, WU Jian, CAI Qiang, SUN Haidong, CAI Qu, JIANG Zhaoyan, HAN Tianquan, ZHANG Shengdao 2018, 23 (03):  252-257.  DOI: 10.16139/j.1007-9610.2018.03.014 Abstract ( 598 )   PDF (600KB) ( 287 )   Objective: To investigate the prevalence of gallbladder stone disease(GSD) in Shanghai and analyze the risk factors associated with GSD. Methods: The cross-section survey was carried out from August 2010 to July 2011. We enrolled 15 256 habitants in three districts of Shanghai (8 617 male and 6 639 female), aged between 20-79 years old. The relevant clinical data of the subjects were collected by questionnaire, physical examination and biochemical analysis. GSD was diagnosed by type-B ultrasonography. T test and Logistic stepwise regression were performed to analyze the risk factors associated with GSD. Results: ① The prevalence of GSD was 7.02% in this survey, which was slight higher in females than in males (8.10% vs 6.19%, P<0.05) and increased with age (P<0.05). ② The rate of cholecystectomy was 2.48% in total, almost twice in females than in males (3.42% vs 1.75%, P<0.05), and increased with age as well (P<0.05). ③ Logistic stepwise regression analysis showed that female, older, presence of fatty liver disease, family history, hypertension and increased body mass index (BMI) were the risk factors for GSD. Conclusions: Our survey showed that the prevalence of GSD was 7.02% and the cholecystectomy rate was 2.48% in Shanghai population. Gender, age, fatty liver disease, family history, hypertension and BMI were the risk factors associated with GSD. References | Related Articles | Metrics

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Clinical significance of Crk expression in gastric cancer FENG Runhua, SAH K. Birendra, LU Sheng, YUAN Fei, XU Haimin, LIU Bingya, YAN Min, LI Chen, ZHU Zhenggang 2018, 23 (03):  258-262.  DOI: 10.16139/j.1007-9610.2018.03.015 Abstract ( 416 )   PDF (718KB) ( 85 )   Objective: To evaluate the expression of adaptor protein Crk in gastric cancer and the associations with clinicopathological characteristics and prognosis of gastric cancer. Methods: The expression of Crk protein of matched tumor and adjacent tissues in 368 patients with gastric cancer was analyzed by immunohistochemistry. The relation of Crk protein expression with clinicopathological characteristics and clinical outcome was evaluated. Results: Compared with adjacent non-tumor tissues, Crk protein was significantly up-regulated in tumor tissues (P<0.05). An elevated Crk protein expression statistically related with aggressive clinicopathological characteristics significantly including larger tumor size (P<0.05), deeper local invasion (P<0.05), more lymph node metastasis (P<0.05) and advanced TNM stage (P<0.05). Gastric cancer patients with higher expression of Crk protein had poorer prognosis (P<0.05). Multivariate analysis showed that higher level of Crk protein was an independent unfavorable prognostic factor of gastric cancer. Conclusions: Crk protein may be associated with tumor progression in gastric cancer and may predict unfavorable prognosis of gastric cancer as a novel molecular marker. References | Related Articles | Metrics

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MicroRNA-21 higher expression in cancer tissues elevates lymph node metastasis: a meta-analysis HONG Yongzhi, LIU Xiaoyang, WANG Jin, ZHAO Liang, ZHAO Peng 2018, 23 (03):  263-270.  DOI: 10.16139/j.1007-9610.2018.03.016 Abstract ( 342 )   PDF (731KB) ( 93 )   Objective: To explore the association of abnormal microRNA-21(miR-21) expression in cancer tissues with lymph node metastasis. Methods: We searched PubMed, Web of Science, EMbase and CBM databases until October 2017 to retrieve the relevant articles on miR-21 expression in cancer tissues and lymph node metastasis. Random-effects model was adopted to calculate OR and 95%CI of the risk of lymph node metastasis in the group of miR-21 higher expression and the group of lower expression. The statistical analyses including heterogeneity tests, sensitivity analysis and publication bias were performed in this meta-analysis. Results: A total of 16 studies involving 1 492 cases revealed that higher expression of miR-21 in cancers was found to be associated with lymph node metastasis (pooled OR=2.01, 95%CI=1.36-2.97, P<0.001). According to subgroup analysis, it was indicated that miR-21 higher expression was significantly related to the risk of lymph node metastasis for cancer in digestive system (OR=2.22, 95%CI=1.49-3.30), bladder cancer and cervical cancer (OR=5.48, 95%CI=1.84-16.30), <60 cases (OR=2.39, 95%CI=1.44-3.98), ≥60 cases (OR=1.78, 95%CI=1.04-3.05), respectively. Conclusions: It is shown in this meta-analysis that the risk of lymph node metastasis in patients was associated with higher miR-21 expression. The subgroup analysis indicated that miR-21 expression may serve as a mole-cular marker for lymph node metastasis in digestive system tumors and bladder cancer and cervical cancer. References | Related Articles | Metrics

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Laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer in primary hospital GUO Jian, CHEN Chao, ZHOU Guoqiang, HAN Fu, LI Xuefeng, SHI Zhiliang 2018, 23 (03):  271-273.  DOI: 10.16139/j.1007-9610.2018.03.017 Abstract ( 330 )   PDF (325KB) ( 38 )   Objective: To explore the feasibility of laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer in primary hospital and examine the outcomes compared to open surgery. Methods: The patients with advanced gastric cancer were divided into laparoscopic group and open group each 40 cases in our hospital from January 2016 to March 2018. Retrospective analysis was performed for short-term clinical results. Results: The operating time, blood loss, first flatus time, out of bed time and first feeding time in laparoscopic group were(183.71±16.08) min, (64.02±10.69) mL, (3.08±0.61) d, (2.88±0.70) d, (3.10±0.71) d, respectively with the statistical difference when compared to those in open group (P<0.05). The retrieved lymph node and the length of distal and proximal resection margins away from the cancer were (30.70±8.84), (4.73±1.16) cm and (7.10±1.14) cm without significant difference statistically between two groups(P>0.05). The rate of incision infection and pulmonary infection in open group was higher than that in laparoscopic group(P<0.05). However, the difference between two groups was not present in the anastomotic bleeding and leakage and gastroparalysis (P>0.05). Conclusion: Laparoscopic-assisted gastrectomy has similar curative effect compared to open surgery with the advantages of less blood loss and quicker recovery. References | Related Articles | Metrics

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Analysis of different types of endoleak after endovascular repair for abdominal aortic aneurysm: a report of 272 cases KANG Pengfei, MAO Le, ZHU Ting, FU Weiguo 2018, 23 (03):  274-278.  DOI: 10.16139/j.1007-9610.2018.03.018 Abstract ( 475 )   PDF (832KB) ( 101 )   Objective: To investigate the risk factors for endoleaks after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: A total of 272 patients with AAA undergoing EVAR from January 2014 to October 2015 were retrospectively analyzed. The patients were followed up at postoperative 3, 6, 12, 24, and 36 months. The endoleak incidence and the association of endoleak with clinical characteristics, stent graft type and anatomic geometry of aneurysm neck were analyzed. Results: The incidence of endoleaks after EVAR in 272 patients with AAA was 15.8% (43/272) with 7.4% (20/272), 6.2% (17/272), 1.5% (4/272) and 0.7% (2/272) for type Ⅰ, Ⅱ, Ⅲ+Ⅳ and Ⅴ (endotension), respectively-Type Ⅰ endoleak was found mostly during 3-month of follow-up, and the other endoleaks during 12-month of follow-up or longer. Short proximal neck length of aneurysm (<1.5 cm), oversize degree (>45°), irregular shape, and high calcification (>25%) were significantly associated with an increased incidence of type Ⅰa endoleak (P<0.05). Patent inferior mesenteric artery and ≥2 crime arteries were the risk factors for type Ⅱ endoleak (P<0.05). Clinical characteristics, including age, ASA status, smoking status, and comorbidities such as hypertension, diabetes, coronary artery disease and pulmonary disease had no impact on endoleak. However, stent graft type was associated with the incidence of overall endoleak significantly (P=0.047). Endurant showed to be used with the lowest incidence of endoleak (10.7%) when compared with other stent graft types. Conclusions: To avoid endoleak, physicians should evaluate the characteristics of AAA and assess the risks for endoleak when planning an EVAR. References | Related Articles | Metrics

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Postoperative symptoms of esophageal cancer: mixed methods research HU Yanxia, WU Beiwen, LI Hecheng, FANG Qiong 2018, 23 (03):  279-285.  DOI: 10.16139/j.1007-9610.2018.03.019 Abstract ( 364 )   PDF (638KB) ( 100 )   Objective: Mixed methods research was used to analyze the common symptoms of patients with esophageal cancer postoperatively and some associated factors. Methods: A mixed method study was done utilizing qualitative and quantitative data. Semi-structured interview for symptoms was performed with 20 patients with esophageal cancer after operation. The symptoms experience model was used as theoretical framework for questionnaire and 114 cases with esophageal cancer after operation were selected for survey of symptoms frequency and intensity and harassment. Results: The quantitative study showed the incidence of all 11 symptom was more than 50% including thirsty, phlegm and cough. The 5 symptoms arranged thirsty, fatigue, cough, angular and phlegm according to frequency. The 5 symptoms arranged thirsty, difficult sputum, cough, fatigue and phlegm according to severity, and thirsty, difficult sputum, cough, phlegm and fatigue according to harassment. Cough had higher incidence in the patients with small cell lung cancer based on pathological examination. Da Vinci surgical procedure was superior to the thoracoscope surgery with hoarse and insomnia less severe and hoarse less harassment (P<0.05). The patients with middle esophageal cancer had cough and fatigue of more frequency and phlegm more severe (P<0.05). Qualitative study showed the patients had several symptoms and complaint unclear. Conclusions: The esophageal cancer patients experienced a variety of symptoms after surgery. Precise surgery can reduce some symptom severity. References | Related Articles | Metrics