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    25 January 2023, Volume 28 Issue 01 Previous Issue    Next Issue
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    Editorial
    Progress and prospect of surgical comprehensive treatment of gastric cancer
    ZHU Zhenggang
    2023, 28 (01):  1-6.  DOI: 10.16139/j.1007-9610.2023.01.01
    Abstract ( 691 )   HTML ( 19 )   PDF (877KB) ( 442 )  

    Gastric cancer is one of the leading malignancies in China and in the world. Surgery is still the most important modality to cure gastric cancer. A series of clinical researches changed the traditional concept of surgery and avoided blindly expanding the scope of surgery. Laparoscopic surgery for both early and locally advanced gastric cancer achieved the same radical effect as open surgery. The key to further improve the efficacy of minimally invasive surgery is controlling indications, establishing a training system for surgical techniques and optimizing the relation between costs and benefits. The relationship between resection of organs and preservation of organ function should be balanced in the extended surgery for gastric cancer. Perioperative treatment of locally advanced gastric cancer would be advocated actively. Conversion therapy preoperatively for far-advanced gastric cancer is advocated. Palliative resection should be strictly controlled for the patients of far-advanced gastric cancer with extensive metastasis, and comprehensive treatment should be carried to prolong the life of patients.

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    Experts forum
    Hotspots in basic and translational research of gastric cancer
    LI Jianfang, YU Junxian, YAN Chao, ZHU Zhenggang, LIU Bingya
    2023, 28 (01):  7-16.  DOI: 10.16139/j.1007-9610.2023.01.02
    Abstract ( 467 )   HTML ( 13 )   PDF (1009KB) ( 425 )  

    The morbidity and mortality of gastric cancer are high, while the overall therapeutic effect is poor without satisfactory. Clinical obstacles, such as low early-diagnosis rate, tumor heterogeneity, lack of accurate classification and precise treatment, therapeutic resistance, recurrence and metastasis, are the key point issues to the lower efficacy in treatment of gastric cancer. In order to solve these clinical problems, it is necessary to devote more energy to the basic research of gastric cancer, including tumor genomics; gene editing; tumor microenvironment; inflammation, aging and tumor; cell differentiation disorders; autophagy and cell death; metabolic disorders; immunotherapy and drug development. This paper will summarize the clinical obstacles in the treatment of gastric cancer, and describe the directions of basic research on these clinical problems in future, so as to provide notions for the translational research of gastric cancer.

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    Current status and prospect of conversion therapy for far-advanced gastric cancer
    LU Yiming, XIONG Jianping, TIAN Yantao
    2023, 28 (01):  17-23.  DOI: 10.16139/j.1007-9610.2023.01.03
    Abstract ( 561 )   HTML ( 12 )   PDF (896KB) ( 409 )  

    The treatment of far-advanced gastric cancers has always been challenging. Due to the presence of metastases, stage Ⅳ gastric cancers are often difficult to achieve radical resection. Conversion therapy refers to non-surgical me-thods such as chemotherapy, targeted therapy, and immunotherapy to make the tumor shrink or even disappear in some areas, so that the patients who are unresectable originally can obtain the opportunity of R0 resection. At present, palliative surgery and symptomatic treatment are still the paramount methods for far-advanced gastric cancers, and no consensus has been reached on conversion therapy for gastric cancer. The main indicators for evaluating the effectiveness of conversion therapy for gastric cancer include R0 resection rate after conversion therapy, disease control rate and objective response rate of the response evaluation criteria in solid tumor (RECIST). The different treatment and schemes have different effects. The ultimate goal of conversion therapy is to strive for opportunity of R0 resection, so the rational implementation of surgery after conversion therapy is also a key issue. The four classifications proposed by Yoshida are the most commonly accepted basis for surgical decision. At present, the conversion therapy for far-advanced gastric cancer is still challenging with the lack of high-quality research. In-depth study of the tumor microenvironment and the development of new therapeutic approaches may be the major research direction in future.

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    Formation and improvement of surgery-based treatment system for gastric cancer
    ZHAO Fazhi, ZHAO Ping
    2023, 28 (01):  24-30.  DOI: 10.16139/j.1007-9610.2023.01.04
    Abstract ( 207 )   HTML ( 3 )   PDF (917KB) ( 266 )  

    The treatment of gastric cancer is based on surgical resction. The accumulation of clinical research and in-depth understanding of tumor constitute the cornerstone of gastric cancer treatment. Development of surgical technique and many approaches of treatment including laparoscopic technique and neoadjuvant therapy compensate the boundedness of simply surgery. This study summarized ①both theoretical and technological progress in surgery; ②combined with the current study situation of perioperative treatment; ③systematically expounded the formation and improvement of surgery-based treatment system for gastric cancer management.

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    Preoperative chemotherapy through intra-arterial combined with intra-venous administration in treatment of advanced gastric cancer
    LI Guoli, GUO Feilong
    2023, 28 (01):  31-35.  DOI: 10.16139/j.1007-9610.2023.01.05
    Abstract ( 242 )   HTML ( 3 )   PDF (858KB) ( 109 )  

    Perioperative chemotherapy has been an important part of the comprehensive treatment of advanced gastric cancer. Different from the conventional systemic chemotherapy, preoperative chemotherapy through intra-arterial combined with intra-venous further optimized delivery routes according to characteristics of different drugs on the basis of combination chemotherapy,which has been studied and practiced at our center for more than 20 years. In this review, we will introduce this chemotherapy from the aspects of theoretical basis, development process, treatment advantages, and clinical research. The clinical efficacy and possible treatment mechanisms will be discussed through looking back on both clinic and basic study.

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    Summary and prospect of perioperative comprehensive treatment for gastric cancer in China
    LIU Wentao, LIU Fukun
    2023, 28 (01):  36-41.  DOI: 10.16139/j.1007-9610.2023.01.06
    Abstract ( 457 )   HTML ( 10 )   PDF (860KB) ( 581 )  

    Most of the patients with gastric cancer in China have been at the middle and advanced stages during diagnostic and treatment with poor prognosis overall. Perioperative radiotherapy, chemotherapy, immune therapy and other comprehensive treatment methods for gastric cancer patients preoperative and intraoperation may reduce tumor staging, increase the rate of surgical resection and prolong the time of patient survival. Perioperative comprehensive treatment has developed more than 30 years in China. Many results from relevant research were gotten combined with laying down the consensus and guidelines, and applied to clinic in recent years. With the emergence and development of new technologies and new strategies for comprehensive treatment, perioperative comprehensive treatment and conversion therapy will improve at much extent the rate of survival for gastric cancer patients in China.

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    New progression of radiomics in diagnosis of gastric cancer
    ZHANG Huan, CHEN Yong
    2023, 28 (01):  42-48.  DOI: 10.16139/j.1007-9610.2023.01.07
    Abstract ( 746 )   HTML ( 7 )   PDF (826KB) ( 470 )  

    Gastric cancer is a common entity of malignant tumor in China with the third cause of mortality and morbidity among all malignancies. In recent years, radiomics has emerged as a quantitative tool for imaging analysis with the rise of artificial intelligence. Currently, radiomics has been applied in many aspects of gastric cancer. In this review, we will focus on the progression of radiomics in diagnosis of gastric cancer, and describe the role of radiomics in differential diagnosis, staging and detection of histopathological biomarkers in detail, to reveal the value of radiomics in the precision medicine of gastric cancer.

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    Nutritional therapy recommendations for patients with coronavirus disease 2019 (COVID-19) in Ruijin Hospital (2023 edition)
    SHI Yongmei, JIANG Yongmei, LUO Xi, JIN Qianwen, CHEN Erzhen
    2023, 28 (01):  49-52.  DOI: 10.16139/j.1007-9610.2023.01.08
    Abstract ( 231 )   HTML ( 4 )   PDF (919KB) ( 224 )  

    Nutritional support is one of the comprehensive treatments for the patients with novel coronavirus infection, especially for critically ill patients. Nutritional therapy needs to follow the standard process, which includes nutritional risk screening, assessment, intervention and monitoring. Nutrition intervention is recommended to follow the principle of "five-step" of nutritional therapy. Appropriated diet and evidence-based nutritional support should be given to improve the nutritional status and immunologic function of the patients, and to get best of overall clinical outcomes.

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    Lecture
    Advances in diagnosis and molecular detection of EBV-positive gastric cancer and gastric cancer with lymphoid stroma
    DENG Shijie, YUAN Fei
    2023, 28 (01):  53-57.  DOI: 10.16139/j.1007-9610.2023.01.09
    Abstract ( 726 )   HTML ( 8 )   PDF (2082KB) ( 381 )  

    Epstein-Barr virus-positive gastric cancer, as well as gastric cancer with lymphoid stroma, are the special pathological subtypes of gastric cancer. The histological morphology, immunological and genetic characteristics between two subtypes are overlapped to some extent, however, they are not identical. Therefore, there were not only the confusion in the diagnosis for pathologists but also perplexity in clinical treatment and following research caused by two subtypes of gastric cancer. In this article, the two cancers and other similar diagnostic terms were introduced and compared in detail. The clinicopathological features, genetic variation, molecular detection, and treatment progress were summarized combined with both current controversies and future directions of research.

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    Original article
    Outer branched and inner branched endografts in treatment of Stanford type B aortic dissection: short-term results and computational fluid dynamics analysis
    BI Jiaxue, ZHU Henghao, WANG Duan, LIU Haofei, DAI Xiangchen
    2023, 28 (01):  58-66.  DOI: 10.16139/j.1007-9610.2023.01.10
    Abstract ( 438 )   HTML ( 5 )   PDF (13855KB) ( 130 )  

    Objective To evaluate the short-term outcomes of thoracic endovascular aortic repair (TEVAR) with outer branched and inner branched endografts in the treatment of Stanford type B aortic dissection (TBAD), and to analyze the effects of endografts on blood flow status of aortic dissection by computational fluid dynamics (CFD). Methods The clinical data of TBAD patients treated with outer branched endograft technology in outer branched endograft group and inner branched endograft technology in inner branched endograft group in Department of Vascular Surgery Tianjin Medical University General Hospital from May 2018 to December 2021 were collected, and the short-term results of two groups were analyzed retrospectively. Based on CT angiography images of patients in two groups, one typical case in each group was selected to construct personalized 3D model and CFD numerical simulation was performed. The parameters including flow field velocity distribution, wall pressure and wall shear stress (WSS) before and after surgery were compared and analyzed. Results A total of 55 cases with TBAD were enrolled, consisting of 49 cased in outer branched endograft group and 6 cases in inner branched endograft group. There was no statistical difference in baseline data between two groups, and surgical success rate were both 100%. Reconstruction of left subclavical artery(LSA) simple was 41(83.7%) cases in outer branched endograft group and all 6 cases in inner branched endograft group. In outer branched endograft group there were 5 cases with reconstruction of left common carotid artery (LCCA) combined with bridging carotic clavical artery, 2 cases with reconstruction of LCCA combined with LSA embolism, and 1 case with reconstruction of LCCA combined with LSA window. Four cases were lost during follow-up in outer branched endograft group. There were no significant differences in the aorta-related mortality rate (P=1.000), branch patency rate (P=1.000) and avoidance of secondary intervention of target vessels between the two groups during the perioperative period and follow-up period (P=0.298). After endograft implantation of two groups the flow field disturbance in dissection lesions improved significantly, aortic blood flow pattern restored normal, and local abnormally increased WSS decreased. However, the interference of inner branch on aortic arch and blood flow of branch was more obvious than that of outer branch. Conclusions Both outer branched endograft and inner branched endograft TEVAR for reconstruction of LSA had good short-term results in the treatment of TBAD. Compared with inner branched endograft, outer branched endograft has a higher anatomical fit and can restore the normal blood flow to a greater extent for aortic arch.

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    Clinical evaluation of endoscopic linea alba plication in treatment of postpartum diastasis recti abdominis muscles
    HE Kai, TANG Ying, ZHOU Xiuling, ZHU Yulan, FU Xiaojian, ZHU Yanfeng, DING Hong, YAO Qiyuan, CHEN Hao
    2023, 28 (01):  67-71.  DOI: 10.16139/j.1007-9610.2023.01.11
    Abstract ( 411 )   HTML ( 5 )   PDF (1307KB) ( 202 )  

    Objective To conduct a retrospective study on the clinical efficacy with endoscopic linea alba plication (ELAP) in the treatment of postpartum diastasis recti abdominis muscles. Methods Clinical data was collected to study the patients with postpartum diastasis recti abdominis muscles treated by ELAP in our hospital from January 2018 to December 2021. The operation was performed successfully in 48 cases. One case was lost follow-up and 47 cases were included in this study. Mean age was (34.9±4.2) years with body mass index (BMI) (20.1±2.0) kg/m2. The index of patients included general data, intraoperative data and postoperative recovery. Follow-up was done through out-patient examination and B-mode ultrasonography until to March 2022. Results The inter-rectus distance (IRD) in umbilical area (M3) shown by ultrasound examination was (41.6±8.2) mm. There were 10 cases combined with umbilical hernia and 2 cases with linea alba hernia. ELAP was performed under general anesthesia. All hernia rings were closed by suturing. The operative time was (130.9±36.0) min. Visual analog scale was (1.2±0.6) on the 1st postoperative day with postoperative hospital stay (1.5±0.9) d. Two cases had mild seroma postoperatively with puncture and absorption under B-ultrasound guiding. Remaining cases were without operative complications such as bleeding and infection of incision. Followed up of 47 cases was completed in the period of median 15(12, 26) months. One case had mild pain in the operative site and cured after non-operative treatment. Ultrasound examination in the other case showed 57.0 mm of IRD in M3 area preoperative and normal in the follow-up of 1 month postoperative. However, there was mild recurrence on 3 months of follow-up showing IRD 21.0 mm. Conclusions ELAP could be considered safe and effective in the treatment of postpartum diastasis recti abdominis muscle.

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    Retrospective study on sugammadex for reversal of neuromuscular blockade after radiofrequency ablation of hepatic carcinoma under general anesthesia
    ZHANG Hui, GONG Ling, GUO Qian, LUO Yan
    2023, 28 (01):  72-76.  DOI: 10.16139/j.1007-9610.2023.01.12
    Abstract ( 288 )   HTML ( 8 )   PDF (883KB) ( 220 )  

    Objective To investigate the effect of sugammadex for reversal of neuromuscular blockade postoperatively in the patients with CT guided radiofrequency ablation of hepatic carcinoma under general anesthesia. Methods The clinical data of 220 patients with radiofrequency ablation of hepatic carcinoma under general anesthesia from November 2019 to February 2022 in our hospital were retrospectively analyzed. Patients were divided into sugammadex group (group S) with 108 patients and neostigmine group (group N) with 112 patients based on choice of neuromuscular blockade reversal. All was by intravenous anesthesia in two groups with same anesthesia induction and maintenance. Group S received intravenous sugammadex 2 mg/kg at the end of the surgery and group N neostigmine 2 mg combined with atropine 0.5-1.0 mg. Time to spontaneous breathing, time of tracheal extubation, period of postanesthesia care unit(PACU) stay and postoperative hospital stay between 2 groups were compared combined with rate of atelectasis examined by CT scan within 10 min after extubation, liver function 24 h postoperatively and pulmonary complication. Results The time to spontaneous breathing, time of extubation, and period of PACU stay in group S decreased significantly compared with those in group N (P<0.05). Both rate of atelectasis [35 (32.4%) vs. 59 (52.7%)]within 10 min after extubation and rate of pulmonary complication [4 (3.7%) vs. 11 (9.8%)] postoperatively decreased (all P<0.05). The liver function 24 h postoperatively in both groups was significantly higher than those before operation (P<0.05) without significant difference between two groups (P>0.05). Conclusions Sugammadex could reverse neuromuscular blockade more quickly and lowering the rates of early postoperative atelectasis and pulmonary complication of the patients with hepatic radiofrequency ablation.

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    Application of simple support bracket combined with one stitch suture in terminal ileostomy of rectal cancer
    HU Lei, XU Yalong, LIU Shaojun, HE Yiren, LIU Liu, ZHU Zhiqiang
    2023, 28 (01):  77-82.  DOI: 10.16139/j.1007-9610.2023.01.13
    Abstract ( 363 )   HTML ( 6 )   PDF (2139KB) ( 96 )  

    Objective To investigate the feasibility and effect of simple support bracket combined with one stitch suture in terminal ileostomy of two stomas during anus-preserving radical resection in low rectal cancer patients. Methods Retrospectively analysis was performed for rectal cancer patients with high risk factors for postoperative anastomotic leakage, who admitted to the Department of General Surgery our hospital from December 2019 to May 2021. The patients underwent laparoscopic-assisted low rectal cancer radical resection and terminal ileostomy. There were two groups including 35 patients in the group of simple bracket combined with one stitch suture, and 35 patients in the group of conventional suture. Preoperative and postoperative clinical data were analyzed. Results General data of two groups were similar. No difference statistical significantly in the rate of postoperative stoma‐related complications between the two groups ((P>0.05). All patients were without any severe complications. All stomas were successfully closed. The time of first-stage ileostomy (13.77±2.02) min vs. (22.66±3.64) min (P<0.001), second-stage stoma closure time (88.14±28.03) min vs. (103.29±30.96) min (P=0.04), and postoperative total time in hospital (14.54±2.32) d vs. (17.34±4.57) d (P=0.002) were shorter in simple bracket combined with one stitch suture group; both total cost in the hospital of first-stage operation (42 057.98±4 938.69) yuan vs. (44 728.46±5 223.62) yuan (P=0.03), and second-stage stoma closure blood loss (17.94±9.83) mL vs. (25.86±8.24) mL (P=0.001) lower compared with that in conventional suture group. Conclusions Simple support bracket combined with one stitch suture ileostomy did not increase postoperative stoma-related complications compared with conventional suture. However, it decreased the time for both first-stage ileostomy and second-stage stoma closure, and total cost in hospital. Therefore, it could be used for prophylactic ileostomy in low rectal cancer.

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    Comparative analysis between air-free trans-axillary laparoscopic thyroidectomy and open thyroidectomy
    LIAO Wenqiang, LI Qinyu, YUAN Jianming, WU Weize, WANG Mingliang
    2023, 28 (01):  83-87.  DOI: 10.16139/j.1007-9610.2023.01.14
    Abstract ( 298 )   HTML ( 6 )   PDF (2095KB) ( 124 )  

    Objective To compare the clinical efficacy between air-free trans-axillary laparoscopic thyroidectomy and open thyroidectomy. Methods A retrospective analysis was performed on the data of both 96 patients who underwent air-free trans-axillary laparoscopic thyroidectomy (laparoscopic group) and 232 patients who underwent open thyroidectomy (open group) from August 2015 to July 2020. Comparative analysis were performed on operative data, the postoperative data of recovery and complications between two groups. Results The operative time in laparoscopic group was longer significantly than that in open group [(168±23) min vs. (95±18) min, P=0.022]. There was no significantly difference in the rate of recognition of recurrent laryngeal nerve between two groups (100.0% vs. 99.1%, P=0.138). The rate of recognition of both superior (98.0% vs. 97.0%, P=0.003) and inferior parathyroid glands (95.8% vs. 99.1%, P=0.028) in laparoscopic group was higher significantly than those in open group. The amount of drain of the first day after operation in laparoscopic group was more significantly than that in open group[(42±22) mL vs. (25±10) mL, P=0.006]. The postoperative length of hospital stay in laparoscopic group was longer significantly [(2.8±0.6) d vs. (1.8±1.2) d, P=0.016]. The cost of hospital stay was (13 186±1 015) yuan vs. (12 632±1 456) yuan (P=0.365) and the rate of postoperative complication was 10.4% vs. 9.1%(P=0.126), which all showed no significant difference between two groups. Conclusions Air-free trans-axillary laparoscopic thyroidectomy could be feasible and safe, and have better appearance. However, both operative time and hospital stay were longer.

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