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25 September 2018, Volume 23 Issue 05 Previous Issue    Next Issue

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Robotic-assisted radical resection in rectal cancer: a report of 179 cases ZHANG Tao, GU Yifei, ZHAO Ren, JI Xiaopin, SHI Yiqing, WU Huo, GAO Haoji, WU Haoxuan, CHEN Xianze, SONG Zijia, SHI Yi 2018, 23 (05):  413-417.  DOI: 10.16139/j.1007-9610.2018.05.008 Abstract ( 592 )   PDF (638KB) ( 109 )   Objective To investigate the feasibility and safety of robotic-assisted rectal cancer radical resection. Methods The clinical data of 179 patients with rectal cancer who underwent robotic-assisted radical resection using da Vinci® Robotic Surgical System in this hospital from September 2015 to January 2018 were retrospectively analyzed including 100 cases with the distal margin of tumor above peritoneal reflection and 79 cases below peritoneal reflection. Results All cases had robotic-assisted rectal cancer radical resection successfully. A total of 158 cases had radical resection with anus preservation. Both rectal cancer and hepatic metastasis were resected in 4 cases with stage Ⅳ. Mean operative time was（154±; 44） minutes and median blood loss was 50 mL with mean harvested lymph nodes of 15.4±; 5.4. Liquid diet recovered（4.0±; 2.1） days after operation. Mean hospital stay was（7.6±; 3.1） days postoperatively. There were 5 cases (2.79%) with surgical complications as anastomotic leak recovered without surgical intervention. Learning curve analysis showed that passing learning curve was 17 cases later. Conclusions It was indicated that robotic-assisted rectal cancer radical resection is feasible and safe combined with minimal invasion and fast recovery. References | Related Articles | Metrics

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Single-port and three-port laparoscopic radical resection in colorectal cancer： a retrospective study JIANG Yimei, LIU Kun, SHI Yiqin, SONG Zijia, LI You, ZHAO Ren 2018, 23 (05):  418-424.  DOI: 10.16139/j.1007-9610.2018.05.009 Abstract ( 511 )   PDF (1018KB) ( 37 )   Objective To evaluate the safety, feasibility and clinical efficacy of single-port laparoscopy in the treatment of colorectal cancer. Methods From January 2017 to December 2017, a retrospective study was conducted with patients diagnosed as colorectal cancer in Department of General Surgery Ruijin Hospital North Shanghai Jiao Tong University School of Medicine. Patients were divided into single-port group and three-port group. The operative time, intraoperative blood loss, lymph node harvest, postoperative complication rate, gastrointestinal recovery, local recurrence, distant metastasis were compared between two groups. Results There were 78 patients with laparoscopic radical resection of co-lorectal cancer including 40 cases in single-port group and 38 cases in three-port group. Four patients added port and 1 patient converted to open surgery in single-port group. Three patients in three-port group added port without conversion to open events. There were no ureter or vaginal injuries and no colostomy procedure during operation. The operative time was (106.38±; 30.21) min and (109.49±; 34.93) min, and intraoperative blood loss（59.62±; 11.93） mL and （42.63±; 6.62） mL and single-port group and three-port group respectively without statistical difference. There was significant difference of postoperative evacuation time between 2 groups [(3.15±; 1.08) d vs (3.97±; 1.03) d (P<; 0.01)]. Mean time of pain score (VAS) reduced to less than levelⅠwas (1.40±; 0.50) d vs (4.11±; 0.89) d in 2 groups respectively (P<; 0.01). Surgical margins in all cases were negative and the specimens all met the requirements of complete resection. The number of lymph nodes detected in 2 groups was (13.70±; 2.93) and (12.66±; 1.55) without statistical difference. There was no severer complication such as anastomotic leakage in all cases postoperatively, and 1 case with incision infection occurred in single-port group. No tumor recurrence or metastasis was observed during the period of follow-up from 6 to 18 month. Conclusions Single-port laparoscopic colorectal cancer surgery could be safe and radical same as three-port laparoscopic surgery with faster postoperative gastrointestinal recovery and shorter pain time. References | Related Articles | Metrics

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Relationship between Cortactin expression level and tumor budding in colorectal cancer LIU Kun, LUO Fangxiu, FANG Xuqian, SHI Yiqing, JIANG Yimei, CHEN Peizhan, ZHAO Ren 2018, 23 (05):  425-429.  DOI: 10.16139/j.1007-9610.2018.05.010 Abstract ( 447 )   PDF (1005KB) ( 132 )   Objective To evaluate Cortactin expression level in the patients with colorectal cancer(CRC) and tumor budding related with the clinical characteristics. Methods The expression of Cortactin and tumor budding levels were detected in 97 CRC patients and the correlations of Cortactin and tumor budding with clinical characteristics were determined. Results Cortactin expression level was significantly related with T stage(P=0.017) and N stage(P<; 0.001) of CRC patients. The patients with higher Cortactin expression level were younger than those with lower Cortactin expression (P=0.043). The tumor budding level was significantly related with T stage (P=0.031), plasma CEA level (P=0.038) and the risk factors of CRC (P=0.008). There was relationship between Cortactin level and tumor budding level in patients with CRC(P=0.011). Conclusions Cortactin expression would be related significantly with the tumor budding of CRC patients. Higher expression of Cortactin suggests the patients poorer prognostic by the mechanism that Cortactin promotes tumor budding and progression of CRC. References | Related Articles | Metrics

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Clinical efficacy of delta-shaped esophagojejunostomy using overlap method in laparoscopic total gastrectomy and proximal gastrectomy for gastric cancer YAN Chao, LIU Wentao, YANG Zhongyin, NI Zhentian, XU Wei, LI Chen, YAN Min, ZHU Zhenggang 2018, 23 (05):  430-436.  DOI: 10.16139/j.1007-9610.2018.05.011 Abstract ( 418 )   PDF (1433KB) ( 184 )   Objective To investigate the feasibility and safety of clinical application of delta-shaped esophagojejunostomy using overlap method in laparoscopic total gastrectomy and proximal gastrectomy for gastric cancer. Methods The clinical data of 9 patients with gastric cancer who underwent laparoscopic radical gastrectomy from October 2017 to March 2018 was retrospectively analyzed. There were 4 cases with proximal gastric cancer using laparoscopic radical proximal gastrectomy with double-tract reconstruction and 5 cases including 1 case with proximal gastric cancer and 4 cases with middle third gastric cancer using laparoscopic total gastrectomy with Roux-en-Y reconstruction. All cases underwent delta-shaped esophagojejunostomy using modified overlap method. Results All delta-shaped esophagojejunostomy using overlap method was performed successfully. Total operative time was(273.9±; 48.2) min and the time for delta-shaped overlap esophagojejunostomy was (40.9±; 13.3) min. Intraoperative blood loss was (58.9±; 43.4) mL and the mean lymph nodes harvested was 27.1±; 11.8. The microscopic resection margin was cancer-free in all 9 cases. The time to first postoperative flatus and liquid diet was (2.5±; 0.9) d and (4.8±; 1.3) d, respectively. Postoperative hospital stay was (7.9±; 1.8) d. No postoperative complication was found in all cases. Conclusion Delta-shaped esophagojejunostomy using modified overlap method in laparoscopic total gastrectomy and proximal gastrectomy for gastric cancer would be feasible and safe, and deserves clinical practice. References | Related Articles | Metrics

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Treatment of lower extremity deep venous thrombosis after inguinal hernia surgery LI Jian, WU Biao 2018, 23 (05):  437-439.  DOI: 10.16139/j.1007-9610.2018.05.012 Abstract ( 718 )   PDF (407KB) ( 108 )   Objective To assess the treatment of lower extremity deep venous thrombosis (LEDVT) after inguinal hernia surgery. Methods A total of 2 835 patients with inguinal hernia underwent herniorrhaphy from January 2012 to December 2017. There were 7 patients who suffered LEDVT after hernia surgery and the rate of LEDVT was 0.25%. Results One case with LEDVT involved both lower extremities, 4 cases in left lower extremity and 2 cases in right lower extremity. All 7 cases were discharged from hospital after anticoagulant therapy and symptomatic treatment. There was no pulmonary embolism and no mortality. Conclusions It is important to pay attention to LEDVT during the perioperative period of inguinal hernia.Prevention, diagnosis and management of LEDVT after inguinal hernia surgery was reviewed and become the key measures for LEDVT. References | Related Articles | Metrics

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Study on prediction of postoperative pancreatic fistula after pancreaticoduodenectomy and distal pancreatectomy WANG Weishen, ZHAN Qian, WANG Wei, DENG Xiaxing, SHEN Baiyong, PENG Chenghong 2018, 23 (05):  440-445.  DOI: 10.16139/j.1007-9610.2018.05.013 Abstract ( 450 )   PDF (499KB) ( 113 )   Objective To investigate application of predictive scoring system for postoperative pancreatic fistula (POPF) issued by Division of Pancreatic Surgery Chinese Medical Association in 2017. Methods The data of 249 patients who received pancreaticoduodenectomy (PD) and 156 patients received distal pancreatectomy(DP) at our hospital from January 2014 to December 2016 were retrospectively studied. The risk factors associated with POPF were analyzed. Predictive scoring system was constructed using 4 factors including pancreatic texture, pathologic result of tumor, diameter of pancreatic duct and operative blood loss. Receiver operating characteristic (ROC) curve analysis was performed to evaluate sensitivity and specificity of predictive scoring system for prediction of POPF. Results A total of 31 (31/249,12.4%) patients undergoing PD had POPF. The results from univariate analysis showed that pancreatic texture, pathologic result of tumor, diameter of pancreatic duct and operative blood loss were risk factors of POPF of PD. ROC curve analysis showed area under the curve (AUC) of predictive scoring system 0.894 for PD (P<; 0.001, 95%CI：0.839-0.949) with sensitivity of 83.9% and specificity of 77.1%. There were 44 (44/156, 28.2%) patients undergoing DP with POPF. Diameter of pancreatic duct and operative blood loss were risk factor of POPF after DP from univariate analysis and AUC of predictive scoring system was 0.567 (P=0.190, 95%CI：0.467-0.668) with sensitivity of 84.1% and specificity of 27.7%. Conclusions The predictive scoring system POPF by Division of Pancreatic Surgery in 2017 could accurately predict the occurrence of POPF after PD, but not for POPF after DP, which needs further study. References | Related Articles | Metrics

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Clinicopathological study on thyroid papillary carcinoma associated with Hashimoto′s thyroiditis AN Xiaofei, LÜ Tian, LIU Zhuoran, DI Zhongmin 2018, 23 (05):  446-449.  DOI: 10.16139/j.1007-9610.2018.05.014 Abstract ( 531 )   PDF (401KB) ( 94 )   Objective To analyze the clinicopathological characteristics in the patients with papillary thyroid carcinoma (PTC) and Hashimoto′s thyroiditis(HT). Methods A total of 1 416 patients with single lobe of PTC who underwent total thyroidectomy in Department of Surgery Ruijin Hospital were included in this study from January 2014 to December 2016. According to the preoperative concentration of thyroid globulin antibody and thyroid peroxidase antibody in serum, the patients were divided into group of PTC with HT (group A) and group of PTC without HT (group B). Based on the postoperative pathological examination, the patients were evaluated bilateral thyroid cancer involvement, tumor size, invasion of thyroid capsule, multifocality and central lymph node metastasis. Results There were 31.78% (450/1 416) patients with PTC and HT. The patients with contralateral PTC in group A was 53.78% and 42.34% in group B with statistical difference (P<; 0.001). Multifocality was 28.22% in group A and 22.77% in group B (P=0.027). Microcarcinoma (diameter<; 1 cm) was 51.11% in group A higher than that in group B (44.51%) significantly (P=0.020). However, invasion of thyroid capsule was lower in group A than that in group B (6.89% vs 10.77%) (P=0.021). There was no significant difference in central lymph node metastasis between two groups. Conclusions In patients with PTC and HT, tumor might be more likely bilaterally involved and multifocal and total thyroidectomy should be recommended to avoid residual cancer due to insufficient surgical resection. References | Related Articles | Metrics

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Associations analysis between Staphylococcus in milk and clinical features of lactational mastitis TAO Yingna, WAN Hua, ZHONG Shanshan, FENG Jiamei, GAO Qingqian 2018, 23 (05):  450-455.  DOI: 10.16139/j.1007-9610.2018.05.015 Abstract ( 448 )   PDF (521KB) ( 255 )   Objective To investigate association between Staphylococcus spp. including species and the clinical features of lactational mastitis. Methods From June 2016 to May 2017, 63 patients with lactational mastitis in Department of Breast Shuguang Hospital Affiliated to Shanghai Traditional Chinese Medicine University were included in this study. A total of 126 milk samples were collected from bilateral breast of the patients for bacterial culture of milk. Correlation between Staphylococcus and clinical features was studied using Spearman correlation and association rule analysis with Apriori algorithm. Results The correlation was present between the results of bacterial culture of milk and clinical feature of the patients with lactational mastitis. The clinical features were related to Staphylococcus spp, or Staphylococcus aureus, but not to Staphylococcus epidermidis or Staphylococcus lentus. Only negative result of bacterial culture of milk was associated to the features such as VAS score of breast pain, redness and swelling, tenderness. However, the support degree of association of negative bacterial milk was lower than that of association of Staphylococcus. Conclusions Bacterial culture of milk should be the effective approach to diagnose lactational mastitis. The correlation between Staphylococcus spp. and clinical features of lactational mastitis might be based on the different pathogenicity of genus. References | Related Articles | Metrics