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25 January 2019, Volume 24 Issue 01 Previous Issue    Next Issue

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Total iodine uptake in CT for predicting results of neoadjuvant chemotherapy in gastric cancer ZHANG Yang, ZHANG Huan, DING Bei, YUAN Fei, MA Qianchen, WANG Baisong, YAN Fuhua, DU Lianjun 2019, 24 (01):  33-39.  DOI: 10.16139/j.1007-9610.2019.01.008 Abstract ( 355 )   PDF (1126KB) ( 104 )   Objective To evaluate prospectively the total iodine uptake (TIU) from dual-energy computed tomography (DECT) in predicting treatment efficacy and progression-free survival (PFS) time in the patients with gastric cancers after neoadjuvant chemotherapy (NAC). Methods Forty-four patients with locally advanced gastric cancer were given DECT before and after NAC. Changes in percentage of tumor area (%ΔS), diameter (%ΔD), and density (%ΔHU) were calculated to evaluate the WHO, RESCIST, and Choi criteria. Changes in percentage of tumor volume (%ΔV) and TIU in portal phase (%ΔTIU-p) were also calculated to determine cut-off points by ROC curves. Correlations between criteria and histomorphologic tumor regression grade (Becker) and between criteria and PFS were analyzed. Results Patients were divided into responders group and non-responders group by ΔV (43.34%, P=0.002) and by ΔTIU-p (63.87%, P=0.002), respectively. Higher correlation was present between criteria %ΔTIU-p and Becker grade (r=0.602, P<0.001) and moderate correlation between criteria %ΔV and Becker grade (r=0.416, P=0.005), while no correlation between Becker grade and WHO criteria (r=0.075, P=0.627), RECIST criteria (r=0.270, P=0.077) and Choi criteria (r=0.238, P=0.120). There were statistical diffe-rences significantly in PFS time of the patients between responder group and non-responder group when using criteria %ΔTIU-p (P=0.001) or Choi criteria (P=0.013). Conclusions TIU-p could be used to predict pathological regression in patients with advanced gastric cancer after NAC. Criteria %ΔTIU-p would become the parameter to study PFS time after NAC. References | Related Articles | Metrics

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Comparison of clinicopathological features and prognosis in patients with gastric remnant cancer between anastomotic area and non anastomotic area HUA Zichen, WANG Lingquan, YAN Min, ZHU Zhenggang 2019, 24 (01):  40-44.  DOI: 10.16139/j.1007-9610.2019.01.009 Abstract ( 354 )   PDF (469KB) ( 109 )   Objective To investigate the location of gastric remnant cancer associated with clinicopathological features and prognosis of the patients with gastric remnant cancer. Methods Retrospective analysis was performed for 147 patients with gastric remnant cancer dividing into anastomotic group (90 cases) and non anastomotic group (57 cases) based on tumor in anastomotic area or not, who admitted to Ruijin Hospital Shanghai Jiao Tong University School of Medicine from January 2007 to December 2016. Clinicopathological characteristics and prognosis were compared between two groups. Results The patients in anastomotic group had longer interval from initial partial gastrectomy than that of patients in non anastomotic group [(245.29±189.53) months vs (157.66±149.11) months, P=0.004]. Patients in anastomotic group were associated with higher reconstruction of Billroth Ⅱ (71.4% vs 42.9%, P=0.001), higher distant metastasis (31.1% vs 12.3%, P=0.009) and lower rate of radical surgery (67.8% vs 84.2%, P=0.027) compared with patients in non anastomotic group. Three year survival rates was 30.0% and 55.6% for anastomotic group and non anastomotic group (P=0.006) and 5 year survival rate 4.4% and 28.1% respectively (P<0.001). It was shown by Kaplan-Meier curve that survival duration was significantly shorter in anastomotic group than in non anastomotic group (P=0.007). Conclusions Gastric remnant cancer located at anastomotic area was in later TNM staging, more distant metastasis, lower rate of radical resection and poorer prognosis compared with those at non anastomotic area. References | Related Articles | Metrics

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Evaluation of tumor blood supply and efficacy of preoperative chemotherapy using CT value in patients with gastric cancer YE Chen, XU Qinmei, XIANG Xiaosong, ZHOU Changsheng, LI Guoli 2019, 24 (01):  45-50.  DOI: 10.16139/j.1007-9610.2019.01.010 Abstract ( 513 )   PDF (944KB) ( 136 )   Objective To evaluate the clinical utility of computed tomography (CT) value to assess tumor blood supply in patients with local late stage of gastric cancer. Methods Since September 2013, the patients with local late stage of gastric cancer admitted to our hospital have been studied. After CT examination of association of cancer with adjacent organs and blood vessels, the patients who could be resected were treated with radical dissection of gastric cancer. The others who could not be resected were treated with preoperative chemotherapy before surgical treatment. CT values in lesions in both portal venous phase and plain phase were calculated and adjusted to aorta CT(AACT) values. The patients with preoperative chemotherapy were administered intra-arterial and intravenous chemotherapy combined with oral S-1 and the chemotherapeutic response was evaluated. Results By November 2017, 300 cases with gastric cancer were treated inclu-ding 179 patients with direct surgery and 121 cases with preoperative chemotherapy. The ages of patients were(59.03±10.82) years, and AACT value was 0.574 1±0.118 3. There was no significant difference in AACT values of tumor in gender, tumor location and general type (P>0.05). In terms of histological types, there were statistically significant differences in AACT values of pathological type between well and poor differentiated adenocarcinoma (P=0.024), between well differentia-ted adenocarcinoma and signet ring cell carcinoma (P=0.001) and between poor differentiated adenocarcinoma and signet ring cell carcinoma (P=0.030), respectively. There were 87 cases in tumor response group with AACT value (0.628 6±0.192 2) and 34 cases in non-response group with AACT value (0.494 5±0.245 1) and significant difference in AACT values was present between two groups (P<0.001). Preoperative chemotherapy had better effect for the tumor with abundant blood supply. The threshold 0.516 4 of AACT value had sensitivity 80.5% and specificity 67.6% of chemotherapy effect respectively. The area under the receiver operating characteristic curve was 0.758. Conclusions The well differentiated gastric cancer would be more abundant blood supply. The patients with local unresectable gastric cancer with high AACT value may have abundant tumor blood supply and have better results from preoperative chemotherapy and opportunity of surgery. References | Related Articles | Metrics

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Abdominal dual tube drainage with continuous irrigation in treatment of pancreatic fistula after pancreatoduodenectomy LI Wei, XU Zhiwei 2019, 24 (01):  51-54.  DOI: 10.16139/j.1007-9610.2019.01.011 Abstract ( 577 )   PDF (448KB) ( 277 )   Objective To investigate the effect of abdominal dual tube drainage with continous irrigation in the treatment of pancreatic fistula after pancreatoduodenectomy. Methods The cases with postoperative pancreatic fistula after pancreaticoduodenectomy from both Department of Hepatobiliary Surgery, The PLA 101 Hospital and Department of Pancrea-tic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine from January to December 2017 were inclu-ded in this study. A total of 78 cases were divided into 2 groups, study (n=39) and control (n=39). The patients were trea-ted by abdominal dual tube drainage with continuous irrigation in study group and drainage with intermittent irrigation in control group. The other treatments were similar in two groups. Abdominal drainage with irrigation duration, the postoperative duration of hospital stay and rate of complication during drainage were compared between two groups. Results During abdominal drainage with irrigation, there were 8 cases found complication in control group including 2 cases of multiple organ failure improved after ICU treatment. Four cases with abdominal abscess were cured with puncture and drainage. Delayed abdominal hemorrhage was found in one case identified to be splenic artery rupture by digital subtraction angio-graphy and treated by embolization. Abdominal massive bleeding was seen one case in 2 groups respectively because of higher negative pressure of drainage and treated by urgent laparotomy. The rate of complication in study group was lower than in control group (P<0.05). The patients in study group had shorter duration of abdominal drainage with irrigation (26.0 days vs. 29.2 days) and shorter postoperative duration of hospital stay (29.0 days vs. 31.8 days) with significant statistical difference when compared with the patients in control group (P<0.01). Conclusions In the treatment of pancreatic fistula after pancreaticoduodenectomy, abdominal dual tube drainage with continuous irrigation may have lower complication rate due to lower negative pressure of drainage and reduce postoperative hospital stay. References | Related Articles | Metrics

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Retrospective study of timing of early enteral nutrition on prognosis in patients with severe acute pancreatitis ZHOU Lei, CHEN Ying, YAO Yi, ZHAO Bing, YANG Zhitao, CHE Zaiqian, FEI Jian, SHENG Huiqiu, MAO Enqiang, CHEN Erzhen 2019, 24 (01):  55-59.  DOI: 10.16139/j.1007-9610.2019.01.012 Abstract ( 432 )   PDF (586KB) ( 90 )   Objective To investigate the effect of early enteral nutrition (EN) at different time points on the clinical outcomes of severe acute pancreatitis (SAP). Methods A total of 174 patients with SAP admitted from January 2013 to December 2016 were studied retrospectively. The cases after screening were divided into group A (<5 d) and group B（5-14 d）in the final analysis according to the initial time of EN. They were analyzed for change in acute physiology and chronic health evaluation (APAHCE) Ⅱ score and sequential organ failure assessment (SOFA) score, length of hospital stay, operative rate, mortality and complications rate including acute kidney injury (AKI), acute respiratory distress syndrome, sepsis, abdominal compartment syndrome and pancreatic pseudocyst. Results A total of 98 cases were included finally. Fifty-one cases were in group A and 47 in group B. On the day of admission, there was no significant difference in APACHE Ⅱ score and SOFA score between 2 groups (P>0.05). APACHE Ⅱ scores and SOFA scores of cases in 2 groups were significantly lower on day 14 and 28 compared to those on admission day (P<0.05) and those scores on day 14 and 28 in group A were lower than in group B. On day 28, the reduction of SOFA score was significantly greater in group A than that in group B (P<0.05). The significant lower rate of acute kidney injury (AKI) in group A was found when compared with that in group B (P<0.05), but no difference was present in the rates of other complication including acute respiratory distress syndrome, sepsis, abdominal compartment syndrome and pancreatic pseudocyst(P>0.05). The cases in group A had significantly lower operative rate and lower 60-day mortality compared with those in group B (P<0.05). However, the difference in length of hospital stay and 28-day mortality was not seen between 2 groups (P>0.05). Conclusions The different time points patients with SAP initiated early EN within 5 days of admission had lower rate of AKI, lower operative rate and lower 60-day mortality compared with those initiated EN after 5 days. Early initiation of EN within 5 days also significantly reduced APACHE Ⅱ score and SOFA score, in which the decrease of SOFA score was more prominent. It recommends to start EN early in patients with SAP. References | Related Articles | Metrics

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Pharmacodynamics of rocuronium in geriatric and middle-aged patients XIA Yimeng, FAN Qiuwei, XU Yue, YU Buwei 2019, 24 (01):  60-64.  DOI: 10.16139/j.1007-9610.2019.01.013 Abstract ( 380 )   PDF (527KB) ( 127 )   Objective To investigate the muscle relaxation by a loading dose followed repeat of rocuronium in elderly patients with ASA Ⅱ-Ⅲ including longevity old patients ≥90 years, middle old patients 75-89 years and young old patients 60-74 years and in middle-aged patients 45-59 years with ASA Ⅱ. Methods Longevity old patients (n=20), middle old patients (n=20) and young old patients (n=20) were investigated with middle-aged patients (n=20) as control. Anesthesia was induced with intravenous midazolam 0.02 mg/kg, sufentanyl 0.4 μg/kg and propofol 1.5-2.0 mg/kg. Intubation was done after the first twitch (T1) disappeared following train of four stimuli after a loading dose of rocuronium 0.5 mg/kg intravenously within 10 seconds. Anesthesia was maintained with propofol at a rate of 5-12 mg/(kg·h) by infusion pump with intravenous bolus of sufentanyl. The first twitch (Tc) as control was measured before rocuronium was administered. Muscle relaxation was maintained with increment of rocuronium 0.1 mg/kg when T1 returned to 25% of Tc. Results ①There was significant difference in onset time, no response time and time of 25% recovery of T1/Tc after induction dose of rocuronium between elderly patients and middle-aged patients (P<0.05). Onset time was shorter in elderly patients than in middle-aged patients (P<0.05) which related with age, and shortest in longevity old patients. No response time and time of 25% reco-very of T1/Tc were longer in elderly patients than in middle-aged patients (P<0.05), and longest in longevity old patients. ②No response time and time of 25% recovery of T1/Tc increased with increasing in numbers of incremental doses. The duration was longer in elderly patients than in middle-aged patients which related with age. ③Neostigmine shortened the time of 75% recovery of T1/Tc in all of the patients significantly (P<0.05). Duration of 75% recovery of T1/Tc was longer in elderly patients than in middle-aged patients which related with age. Conclusions Onset time of rocuronium was shorter in elderly patients including longevity old patients, middle old patients and young old patients than in middle-aged patients. No response time and time of 25% recovery of T1/Tc were longer in elderly patients than in middle-aged patients. The duration increased with increasing numbers of incremental doses. References | Related Articles | Metrics

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Single-incision plus one laparoscopic surgery in treatment of rectal cancer: a preliminary study LI Jun, LI You, SHI Yiqing, LIU Kun, JIANG Yimei, SONG Zijia, ZHAO Ren 2019, 24 (01):  65-69.  DOI: 10.16139/j.1007-9610.2019.01.014 Abstract ( 492 )   PDF (588KB) ( 134 )   Objective To assess feasibility and safety of single-incision plus one laparoscopic surgery (SILS+1) in radical treatment of rectal cancer combined with analysis of short-term clinical and oncological outcomes. Methods Clinical data were studied retrospectively with 20 patients who underwent radical rectal cancer resection through SILS+1 from September 2013 to January 2018 in our department. A propensity score matching approach was used on pooled the data of 62 cases with single-incision laparoscopic surgery of rectal cancer at a radio of 1∶1 as control group of 20 cases after matching the demographic information of the patients and body mass index, American Society of Anesthesiologists score (≤2/>2) and TNM (0-Ⅰ/Ⅱ/Ⅲ) stage. Clinical data and operative results were analyzed between SILS+1 group and control group. Results No significant differences were observed in operative time, blood loss, tumor size, retrieved lymph node, length of incision, postoperative hospital stay between SILS+1 group and control group. However, SILS+1 group showed significantly shorter distance of rectal cancer from the anal verge (P<0.05). The median follow-up period was 24.5 months in SILS+1 group and 26.5 months in control group. There was no recurrent case in both groups. Conclusions SILS+1 for rectal cancer is feasible and safe, and can be used to treat rectal cancer more near from the anal verge. References | Related Articles | Metrics

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Effect of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy LUO Ying, QIAN Jiemin, CHEN Xiaowei, MA Haiyan, XU Ping, LIU Linna, NI Qiang 2019, 24 (01):  70-74.  DOI: 10.16139/j.1007-9610.2019.01.015 Abstract ( 436 )   PDF (548KB) ( 176 )   Objective To investigate the effects of carbon dioxide pneumoperitoneum and patients position on hemodynamic during laparoscopic cholecystectomy. Methods A total of 57 patients (24 male,33 female) aged (59.42+12.97) years with American Society of Anesthesiologists score Ⅰ-Ⅱ undergoing laparoscopic cholecystectomy were enrolled in this study. Continuous non-invasive arterial pressure monitoring system(CNAP) was used. Hemodynamic indexes including heart rate (HR), arterial systolic blood pressure (SAP), arterial diastolic pressure (DAP), mean arterial pressure (MAP), cardiac output (CO), stroke volume (SV), peripheral vascular resistance (SVR) and pulse pressure variation degree (PPV) were recorded by CNAP after entering operating room(T0), at 5 min after endotracheal intubation(T1), after artificial pneumoperitoneum(T2), on the left side of the head high 20 degree position which is re-Trendelenburg position (rT position) (T3) and 15 minutes after establishment of pneumoperitoneum (T4). Results SAP was significantly lower at T1 compared with at T0, restored to basal level at T2 and T3, and was higher at T3 compared with at T1 and T2 (P<0.05). DAP was significantly higher at T2 than at T1, and higher at T3 compared with at T0, T1, T2 and T4 (P<0.05). MAP at T3 was the highest when compared with those at other time points (P<0.05). CO decreased at from T2 to T4 compared at T0 and T1 (P<0.05). SV was significantly lower at T2 compared with at T0, and lower at T3 compared with at both T0 and T1(P<0.05). SVR was significantly higher at T2 and T4 than at both T0 and T1, and higher at T3 than at from T0 to T2 (P<0.05). PPV was higher at T2 and T4 than at both T0 and T1, higher at T3 than at T0, T1 and T4 (P<0.05). HR showed no obvious change in 5 time points. Conclusions Carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy may decrease CO and SV, and elevate SVR and PPV, but has no effect on blood pressure. Carbon dioxide pneumoperitoneum combined with rT position would elevate SVR further so there is obvious changes in blood pressure. References | Related Articles | Metrics

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Ultrasound-guided fine needle aspiration biopsy for TI-RADS 4 thyroid nodules TAN Xingli, PENG Shiyi, ZHOU Zhiying 2019, 24 (01):  75-78.  DOI: 10.16139/j.1007-9610.2019.01.016 Abstract ( 592 )   PDF (437KB) ( 153 )   Objective To study the value of ultrasound-guided fine needle aspiration biopsy (FNAB) in diagnosing TI-RADS 4 thyroid nodules. Methods A retrospective analysis was conducted on the data of 217 patients with 221 thyroid nodules of TI-RADS 4 by ultrasound-guided FNAB. The cases were divided into TI-RADS 4A group, TI-RADS 4B group and TI-RADS 4C group. Postoperative pathological results were taken as gold standard and Kappa consistency test was used to evaluate the consistency of ultrasound-guided FNAB with postoperative pathological results. The specificity, sensitivity, negative and positive predictive values of ultrasound-guided FNAB were gotten based on postoperative pathological results as standard. Results The Kappa values were 0.86 of TI-RADS 4A group, 0.77 of TI-RADS 4B group and 0.82 of TI-RADS 4C group, respectively. All values were more than 0.75. Specificity, sensitivity, negative and positive predictive values of ultrasound-guided FNAB were 98.1%, 77.8%, 96.2%, 88.0% in TI-RADS 4A group; 90.6%, 86.0%, 88.9%,88.1% in TI-RADS 4B group; and 83.3%, 98.3%, 83.3%, 98.3% in TI-RADS 4C group. Higher consistence was seen between with postoperative pathological results and ultrasound-guided FNAB results (P<0.01). Conclusions Combination of TI-RADS classification and ultrasound-guided FNAB can increase the accuracy of ultrasound diagnosis of TI-RADS 4 thyroid nodules. References | Related Articles | Metrics

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Reoperative thyroid surgery: a report of 110 cases SHEN Xiaohui, DING Jiazeng, CHEN Haizhen, CUI Ang, CHEN Xi 2019, 24 (01):  79-84.  DOI: 10.16139/j.1007-9610.2019.01.017 Abstract ( 724 )   PDF (543KB) ( 144 )   Objective To analyze the surgical indication and type and postoperative complication of reoperation for thyroid carcinoma retrospectively. Methods A total of 110 cases with thyroid reoperations performed by same thyroid surgeon group in our hospital were studied between January 2014 and December 2017. The indication of reoperation and postoperative complication, pathological diagnosis and interval duration between two operations were analyzed. Results The indications of reoperation of all 110 cases were recurrent thyroid carcinoma. The median interval between two operations was 11.5 (2-336) months with 54 cases (49.1%) less than 12 months. Thirty cases with recurrent thyroid carcinoma, of which 17 cases (56.7%) were bilateral and 10 cases (33.3%) were multifocal, had reoperation. There were 50 cases with thyroid reoperation for central lymph node dissection including 7 cases diagnosed as central lymph nodes metastasis and 6 cases as both central and lateral lymph nodes metastasis, in which 6 cases (85.7%) and 4 cases (66.7%) were confirmed by postoperative pathology respectively. The other 37 cases had usual central lymph node dissection for recurrent thyroid carcinoma in which 18 cases (48.6%) were found lymph node metastasis by postoperative pathology. A total of 73 cases were diagnosed as lateral lymph node metastasis and had lateral lymph node dissection, in which 67 cases (91.8%) were confirmed by postoperative pathology. Twenty cases (27.4%) in 73 cases had supplemented lateral lymph node dissection for metastasis. Post-reoperation complication was analyzed including thyroidectomy, central lymph node dissection and lateral lymph node dissection. There were 52 cases with thyroidectomy during reoperation including 48 cases with unilateral resection and 4 cases with bilateral resection. Eight cases (22.9%) in 35 cases with thyroidectomy and 6 case (46.2%) in 13 cases with residual thyroid resection were found postoperative complications. Postoperative complication was present in all 4 cases with bilateral resection. Fifteen cases (30.0%) in 50 cases with central lymph node dissection had postoperative complication including 2 cases (20.0%) in 10 cases with unilateral re-dissection and 5 cases (18.5%) in 27 cases in unilateral dissection without previous lymph node dissection and 8 cases (61.5%) in 13 cases with bilateral central lymph node dissection. As to 73 cases with lateral lymph node dissection, postoperative complication was seen in 15 cases (32.6%) of 46 cases with unilateral lymph node dissection and 2 cases (28.6%) of 7 cases with bilateral lymph node dissection and 3 cases (15.0%) of 20 cases with supplemented lateral lymph node dissection. Conclusions Reoperation would be secondary injury to the patients with thyroid carcinoma both psychologically and physically and risk of postoperative complication increases. The first operation for thyroid carcinoma should be standardized. The diagnosis and localization of pre-reoperation could be clear and reoperation might be avoided as less as possible. References | Related Articles | Metrics