Abstract:自从腹腔镜在胃癌治疗中应用以后，短期的治疗效果与传统开腹手术相比，患者术后在生活质量上有所提高。然而，腹腔镜胃癌手术对生存质量的长期的改善作用仍在争论中。这可能由于腹腔镜下胃癌手术与开放手术有着相同的胃切除及淋巴结清扫范围造成的。为了提高胃癌手术患者长期的生存质量而又不影响复发与生存，通过腹腔镜行胃功能保留手术及最小范围的淋巴清扫使肿瘤无残留的方式是应该被考虑的。为了达到这个目的，前哨淋巴结活检（SNB）的概念被提出来。在敏感性方面SNB的结果在不同的机构是有差异性和不令人满意的，然而最近来自日本的多中心研究给我们提供了乐观的结果。目前在韩国，前哨淋巴结导航方法研究小组对应用SNB保留胃功能手术的方法进行III期试验，在这之前，参与机构在标准化及克服SNB学习曲线的质量管理研究已经在进行中。如果SNB及保留胃功能的手术可以在III期试验中证实，那么这种方式因其不影响复发与生存可能取代早期胃癌患者的标准胃切除及淋巴结清扫术，成为早期胃癌的一种更好的外科治疗选择。

Abstract:目前治疗晚期胃癌的方法为开腹胃切除及D2淋巴结清扫并在术后行S-1或卡倍他滨加奥沙利铂辅助化疗。然而III期胃癌患者的预后并不理想。为了提高生存率，需要加大化疗药物的剂量。鉴于患者接受二联或三联化疗的顺应性差，新辅助化疗将是一个充满前景的方法。目前在东亚国家，正进行多项III期临床试验用于评估新辅助化疗效果。另一方面，手术治疗方法已倾向于行腹腔镜手术。在日本和韩国已经进行了多项III期临床试验评估腹腔镜辅助远端胃切除（LADG）在早期和晚期患者中的疗效。因此，未来标准治疗肿瘤位于中、下1/3晚期胃癌的候选方案由综合治疗组成，包括新辅助化疗及随后的LADG。只要新辅助化疗是按标准实施，随后的腹腔镜胃切除术的可行性、安全性及长期生存率是有保障的。在这个背景下，我们实施了一项随机II期临床试验比较新辅助化疗后LADG和开腹远端胃切除术（ODG）治疗胃癌的疗效。

Abstract:Objective: To compare the safety and efficacy of 1aparoscopic and conventional open surgery for distal stomach cancer in Chinese patients. Methods: The literature of randomized controlled trials (RCTs) comparing 1aparoscopic and open surgery for distal stomach cancer in Chinese patients was retrieved by searching the national and international databases from their inception date to May 2013. Meta-analysis was performed by using Revman 5.2 software. Results: Six RCTs involving 555 patients were finally selected, with 278 cases in laparoscopic surgery group and 277 cases in open surgery group. The results of Meta-analyses showed that the intraoperative blood loss, time to the first flatus and food intake, length of postoperative hospital stay, length of incision, number of patients using analgesics, and incidence of postoperative complications were significantly reduced in laparoscopic surgery group compared with open surgery group (all P<0.05); but the operative time was prolonged and number of the removed lymph nodes was decreased in laparoscopic surgery group versus open surgery group (all P<0.05). Conclusion: Laparoscopic distal radical gastrectomy is safe and reliable with less perioperative complications, faster postoperative recovery and shortened length of hospital stay, but with a prolonged operative time and decreased lymph node clearance.

Abstract:Objective: To investigate the clinical efficacy of laparoscopy-assisted D2 radical distal gastrectomy and the intraoperative perigastric vascular anatomy. Methods: Forty-five patients with gastric cancer who underwent laparoscopy-assisted D2 radical distal gastrectomy between June 2011 and June 2013 were reviewed, and the clinical efficacy and intraoperative perigastric vascular anatomy were analyzed. Results: Laparoscopic procedure was successfully completed in 43 of the 45 patients. The average operative time was (178.75±44.32) min, intraoperative blood loss was (100±50) mL, number of dissected lymph nodes was 27.55±7.52, time to bowel function recovery and ambulation was (3.2±1.1) and (2.5±1.0) d, and length of postoperative hospital stay was (11.5±7.5) d, respectively. The incidence of postoperative complications was 9.3%. In regard to vascular anatomy of the stomach, the left gastrcepiploic vessels were mainly seen originating from the distal third of splenic artery that was located in the anterior pancreatic space of the superior border of pancreatic tail; the superior mesenteric vessels were mainly located in the retropancreatic space of the inferior border of pancreatic neck, anterior to the uncinate process of pancreas and the horizontal part of the duodenum; right gastroepiploic vessels were mainly found in stomach mesenteries inferior to gastric pylorus and anterior to pancreatic head, but presented many variations; the coeliac trunk and its branches were mainly located in retropancreatic space of the superior border of pancreatic body, and the gastropancreatic fold, splenopancreatic fold and hepatopancreatic fold were anatomic landmarks for locating the left gastric artery, splenic artery and common hepatic artery, respectively. Conclusion: Laparoscopic D2 radical gastrectomy for distal gastric cancer is safe and feasible, and the strong knowledge of anatomy and the location of the perigastric vessels is crucial for surgical success.

Abstract:Objective: To make a preliminary evaluation for the short-term efficacy of hand-assisted laparoscopic radical gastrectomy. Methods: The clinical and follow-up records of 100 stomach cancer patients undergoing hand-assisted laparoscopic radical gastrectomy from December 2010 to July 2012 were retrospectively analyzed. Results: Hand-assisted laparoscopic radical gastrectomy was performed in 102 patients, of whom 100 cases were completed successfully and two cases (1.96%) were converted to open procedure. Among the 100 laparoscopic patients, gastrectomy was performed in 53 cases, distal gastrectomy in 39 cases, and proximal gastrectomy in 8 cases; 4 cases underwent combined cholecystectomy, 2 cases underwent combined partial resection of the left lateral lobe, and one case underwent combined splenectomy plus resection of pancreatic body and tail. The average length of incision was (6.81±0.29) cm, blood loss was (244.10±117.02) mL, operative time was (172.28±24.02) min, number of lymph nodes obtained for pathological examination was 17.10±5.70, and length of postoperative hospital stay was (10.20±3.84) d, respectively. No perioperative death occurred and the incidence of postoperative complications was 9% (9/100). The postoperative follow–up period ranged from one month to 12 months, and 6 cases (6%) were lost to follow-up. Simultaneous liver metastases were found in 3 cases, heterochronic lymph node metastasis occurred in one case, and local recurrence developed in one case, respectively. Conclusion: Hand-assisted laparoscopic D2 radical surgery for gastric cancer is safe and reliable with favorable short-term outcome, and it may not increase the chance of intra-abdominal metastases.

Abstract:Objective: To evaluate the feasibility and efficacy of laparoscopy-assisted radical gastrectomy for elderly obese patients with gastric cancer. Methods: Retrospective study was conducted in the clinical data of 26 obese elderly patients (obese group) undergoing laparoscopy-assisted radical gastrectomy from September 2008 to September 2012, and 67 non-obese elderly patients (non-obese group) who underwent laparoscopy-assisted radical gastrectomy during the same period. Results: The operative time in obese group was significantly longer than that in non-obese group [(231.2±51.4) min vs. (208.5±53.6) min, P=0.039], but no statistical differences were observed between the two groups in terms of intraoperative blood loss or length of postoperative hospital stay (both P>0.05). The incidences of postoperative complications between the two groups showed no significant difference (23.1% vs. 22.4%, P=0.589), and all the immunological parameters on postoperative day 1, 3 and 5 between the two groups showed no significant difference (all P>0.05). The score of postoperative physical condition in obese group was higher than that in non-obese group (P<0.05), while the scores of postoperative dyspnea and fatigue in obese group were lower than those in non-obese group (both P<0.05), but all other scores for assessment of quality of life had no significant difference between the two groups (all P>0.05). Eighty-eight patients (90.3%) were followed up for 2-48 months.. The 1-, 2- and 4-year survival rate in obese group was 91.3%, 78.2% and 65.2% , and in non-obese group was 93.4%, 77.7% and 62.3% respectively, which had no statistical difference between the two groups (χ2=0.011, P=0.916). Conclusion: Obesity may cause a prolonged operative time for laparoscopic radical gastrectomy in elderly patients, but may not influence operative safety and short-term efficacy.

Abstract:Objective: To evaluate the efficacy and adverse reactions of the modified DCF regimen for first-line therapy of advanced gastric cancer. Methods: During June 2008 to June 2011, 48 primarily treated patients with advanced gastric cancer underwent the DCF regimen that consisted of docetaxel (75 mg/m2 intravenous drip on day 1), cisplatin (20 mg/m2/day intravenous drip on day 1 to 3), and 5-fluorouracil (750 mg/m2/day continuous intravenous infusion on day 1 to 5). Every 21 d constituted one cycle of treatment, and at least two cycles were required for efficacy evaluation. Results: The deadline of follow-up was February 2013, and no patient was lost to follow-up. In the entire group of patients, the overall response rate (ORR) was 29.2% (14/48) and disease control rate (DCR) was 87.5%, while specifically, complete remission (CR) was achieved in one case (2.1%), partial remission (PR) was obtained in 13 cases (27.1%), stable disease (SD) was seen in 28 cases (58.3%), and disease progression (PD) occurred in 6 cases (12.5%). The median time to progression (TTP) was 6.9 months and median overall survival (OS) was 12.5 months, respectively. The major adverse events were myelosuppression, gastrointestinal reactions and alopecia, and the incidence of granulocytopenia was 66.7% (32/48) with III-IV degree accounting for 21.8 (7/32), and thrombocytopenia was 20.8% (10/48) with III-IV degree; no treatment-related death such as serious infection or bleeding occurred. Post-chemotherapy KPS score was an independent influential indicator for prognosis. Conclusion: Modified DCF regimen for first-line therapy of advanced gastric cancer shows definite efficacy and good tolerance.

Abstract:Objective: To analyze the survival and prognostic factors in T4 gastric cancer patients after radical resection. Methods: Retrospective analysis was conducted in 183 T4 gastric cancer patients with complete clinical and follow-up data, who underwent radical resection from January 2007 to December 2011. Results: In the entire group of patients, the 1-, 3- and 5-year cumulative survival rate was 92%, 60% and 42%, respectively. Univariate analysis showed that the metastatic lymph node ratio, pN stage, depth of invasion and histological type were significantly associated with the survival of the patients (all P<0.05). Multivariate analysis revealed that the metastatic lymph node ratio, pN stage, and depth of invasion were the independent risk factors for the prognosis of the patients (all P<0.05). Conclusion: Metastatic lymph node ratio, pN stage and depth of invasion are important factors affecting the postoperative survival of T4 gastric cancer patients undergoing radical resection.

Abstract:Objective: To investigate the influences on quality of life and prognosis of patients with advanced proximal gastric cancer undergoing different surgical methods. Methods: Clinical data of 110 patients with proximal gastric cancer admitted during the past 4 years were retrospectively analyzed. Of the patients, 53 cases underwent proximal radical gastrectomy with distal gastric preservation plus double-tract reconstruction that included end-to-side esophagojejunal anastomosis, side-to-side anastomosis of remnant stomach and jejunum, and end-to-side jejunojejunal anastomosis (double-tract anastomosis group), and the other 57 patients underwent conventional total gastrectomy plus esophagojejunal Roux-en-Y anastomosis (Roux-en-Y anastomosis group). Results: The 1-, 3- and 5-year survival rate in double-tract anastomosis group was respectively 99.4%, 67.3%, and 15.7%, in Roux-en-Y anastomosis group was 98.6%, 65.7% and 17.2%, respectively, and the difference between the two groups was of no statistical significance (P>0.05). Double-tract anastomosis group showed better results than Roux-en-Y anastomosis group in terms of prevention of the dumping syndrome and reflux esophagitis (both P<0.05), while no difference was found between the two groups in other aspects such as postoperative obstruction, hemorrhage and infection (all P>0.05). At one year after surgery, the alterations of body weight, plasma total protein, albumin and hemoglobin in double-tract anastomosis group were significantly better than those in Roux-en-Y anastomosis group (all P<0.05). Conclusion: The procedure of distal gastric preservation and double-tract jejunal anastomosis to esophagas and remnant stomach meets operation standards, does not violate the principles of the treatment of proximal gastric cancer, and also improves the patients’ quality of life. So, it is a relatively ideal reconstruction method following radical gastrectomy for proximal gastric cancer.

Abstract:Objective: To compare the sensitivity to chemotherapeutic agents between the tumor cells from primary and metastatic site in nude mice with orthotopic implantation of human gastric cancer. Methods: Orthotopic xenograft models of human gastric cancer were established in nude mice by intra-gastric wall inoculation of the fragments of tumor mass derived from SGC7901 cells which were subcutaneously grown in the donor mice. After metastases formation, the disaggregated tumor cells from primary site and liver metastases were collected, and the in vitro sensitivities of the cells to seven chemotherapy drugs that included fluorouracil (5-FU), cisplatin (CDDP), oxaliplatin (L-OHP), epirubicin (eADM), mitomycin (MMC), vincristine (VCR) and methotrexate (MTX) were determined by sulforhodamine B (SRB) assay. Results: Orthopotic mouse models of stomach cancer were established successfully. The rate of primary tumor formation following orthopotic implantation was 100%, and the liver metastasis rate was 75%. Among the seven drugs, the inhibition rates of L-OHP and VCR for the tumor cells from primary site were higher than those from metastases, while the inhibition rates of eADM and MMC for the tumor cells from metastases were higher than those from primary site (all P<0.05); the inhibition rates of 5-FU, L-OHP, MTX for the tumor cells between primary and metastatic sites had a positive correlation (r=0.5203, 0.4424 and 0.3851, all P<0.05). Conclusion: Chemotherapy sensitivity varies between the tumor cells from primary site and hepatic metastasis in nude mice with orthotopic implantation of stomach cancer, so the treatment for liver metastasis that is based on the drug sensitivity testing results from the primary tumor may not be accurate.

Abstract:Objective: To investigate the relationship between β-adrenergic receptors (β-ARs) and NF-κB pathway as well as its downstream invasion-related factors in gastric cancer cells. Methods: Gastric cancer BGC-823 and SGC-7901 cells were exposed to different concentrations of propranolol (10, 30 and 100 μmol/L) and isoproterenol (50, 100 and 200 μmol/L) for 24 h, respectively. Subsequently, the mRNA expressions of vascular endothelial growth factor (VEGF), cyclooxygenase 2 (COX-2), matrix metalloproteinase 2 (MMP-2) and matrix metalloproteinases 9 (MMP-9) were measured by RT-PCR method, and the protein expressions of above factors as well as NF-κB p65 were determined by Western blot analysis. Results: Compared with untreated control cells, propranolol caused concentration-dependent decreases of the mRNA expressions of VEGF, COX-2, MMP-2 and MMP-9, while isoproterenol resulted in concentration-dependent increases of the mRNA expressions of the above factors in the two types of treated cells (all P<0.05). Compared with control cells, in the two types of treated cells, the protein expressions of above factors along with NF-κB p65 were significantly down-regulated after propranolol treatment, while opposite results were seen after isoproterenol treatment, and all the responses were concentration-dependent (all P<0.05). Conclusion: β-ARs are closely related to invasion and metastasis of stomach cancer, and the mechanism may be probably associated with its action of increasing the activity or expressions of NF-κB pathway and its downstream invasion-related factors.

Abstract:

Objective: To screen out the protein showing most significant differential expression in colorectal cancer (CRC) tissues through proteomic technique, and then to analyze its relation with the disease profile. Methods: The surgical specimens from 83 CRC patients were collected, which included the CRC tissues, normal colonic mucosal tissues, metastatic lymph nodes and concomitant benign colonic polyps from some of the patients. Proteomics analysis that consisted of 2D differential gel electrophoresis (2D DIGE) and matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS) was performed in CRC and normal colonic mucosa tissues. The protein of interest was validated by Western blot analysis in CRC and normal colonic mucosal tissues along with different CRC cell lines, after it was identified. The expression of this protein was also determined by immunohistochemical staining in the paraffin-embedded specimens of CRC tissue, normal mucosal tissue, benign polyp and lymph node metastasis. Western blot was performed to observe the changes of the protein expression in CRC cell lines after induction of differentiation by sodium butyrate (NaB). Results: The results of 2D DIGE analysis and MALDI-TOF-MS identification showed that the expression abundance of selenium binding protein 1 (SELENBP1) in CRC tissue was significantly decreased (2.54 folds) compared with mucosal tissue (P<0.01). Western blot analysis showed that the SELENBP1 expression level in CRC tissue was significantly lower than that in their paired normal mucosal tissue (0.76±0.37 vs. 1.46±0.56) (P<0.001), and SELENBP1 expression was generally decreased in CRC cell lines. Immunohistochemistry analysis showed that the expression scores of SELENBP1 protein in CRC and normal mucosal tissue were 1.25±0.78 and 2.02±0.77 respectively, with statistical significance (P<0.001); in well, moderately and poorly differentiated CRC tissues were 1.75±0.53, 1.29±0.41 and 0.89±0.49 respectively, with statistical significance (P<0.05); no statistical difference was found among different stages of CRC tissues, between benign polyp and normal mucosal tissue or between metastatic lymph node and primary tumor (all P>0.05). The SELENBP1 expressions in all the tested CRC cell lines were significantly increased following NaB induced differentiation (all P<0.05). Conclusion: SELENBP1 suppression is decreased in CRC tissue, and its decrease is associated with the degree of poor differentiation of CRC, but irrelevant to disease progression and lymph node metastasis.

Abstract:

Objective: To investigate the ADAM23 and αvβ3 expressions in colorectal cancer and their relations with liver metastases and other clinicopathologic features. Methods: The protein and mRNA expressions of ADAM23 and αvβ3 in 53 specimens of colorectal cancer and their adjacent tissue, and 20 specimens of benign disease colorectal tissue were detected by immunohistochemical staining and RT-PCR method. The relations of their protein expressions with the clinicopathologic features were analyzed. Results: The positive expression rates of both ADAM23 protein and mRNA were significantly lower in colorectal cancer tissues than those in adjacent tissues and benign disease colorectal tissues (all P<0.05), whereas the positive expression rates of both αvβ3 protein and mRNA were significantly higher in colorectal cancer tissues than those in adjacent tissues and benign disease colorectal tissues (all P<0.05). There was a negative correlation between the protein expressions of ADAM23 and αvβ3 in colorectal cancer (χ2=10.3390; r=–0.637, P<0.01). The protein expressions of ADAM23 and αvβ3 were not related with age, sex, or degree of differentiation, but significantly associated with clinical stage, lymph node metastasis and liver metastasis (all P<0.05). In addition, ADAM23 protein expression was also relevant to depth of tumor infiltration (P<0.05). Conclusion: ADAM23 expression is decreased while αvβ3 expression is increased in colorectal cancer, and both are associated with colorectal cancer liver metastases and other unfavorable clinical outcomes.

Abstract:

目的：观察大肠癌区域引流淋巴结中CD4+CD25+调节性T细胞（Treg）情况及其与白细胞介素10（IL-10）和转化生长因子β1（TGF-β1）水平的关系。方法：用免疫组化法检测大肠癌患者（淋巴结转移32例，无转移28例）区域引流淋巴结中CD4+CD25+的表达（Treg细胞数目）；ELISA法检测外周血血清IL-10和TGF-β1水平；分析Treg数目与IL-10和TGF-β1水平的相关性。结果：CD4+CD25+在淋巴结转移患者阳性淋巴结中呈高表达，阴性淋巴结中呈低表达，而在无转移患者淋巴结中几乎无表达；淋巴结转移患者阳性淋巴结CD4+CD25+的OD值明显高于阴性淋巴结与无转移患者淋巴结（P=0.012；P=0.002），转移患者的阴性淋巴结与无转移患者淋巴结OD值差异未达统计学意义（P=0.115）。淋巴结转移患者外周血血清IL-10，TGF-β1水平均明显高于无转移患者（P=0.003；P=0.004）。患者淋巴结CD4+CD25+的OD值与血清IL-10或TGF-β1浓度之间均呈明显正相关（r=0.683，P=0.000；r=0.532，P=0.000）。结论：大肠癌患者区域引流淋巴结中Treg细胞水平与淋巴结转移密切相关，血清IL-10或TGF-β1水平可作为监测淋巴结转移的指标。

Abstract:Objective: To compare the clinical efficacies between laparoscopic and conventional open surgery for rectal cancer. Methods: Literature search for randomized controlled trials (RCTs) comparing laparoscopic surgery to conventional open surgery for rectal cancer over the past 20 years was performed. The studies were screened according to the inclusion criteria, and then Meta-analysis was performed by using Review Manager 5.1 software. Results: Fourteen RCTs involving 2 114 patients were finally selected, with 1 111 cases in laparoscopic surgery group and 1 003 cases in open surgery group. Compared with open surgery group, in laparoscopic surgery group, the intraoperative blood loss, time to postoperative gastrointestinal function recovery and ambulation, length of hospital stay and wound infection were reduced, and all the differences reached statistical significance (all P<0.05). The incidence of operative complications that included ureteral injury, uroschesis, intestinal obstruction, anastomotic fistula, and incisional hernia showed no statistical difference between the two groups (all P>0.05). The number of removed lymph nodes, length of specimen, rate of positive circumferential resection margin, and incidence of local recurrence, tumor implantation of the incision or puncture hole, and distant metastasis, as well as the 3- and 5-year overall survival, and 3- and 5-year disease free survival between the two groups had no statistical difference (all P>0.05). Conclusion: Laparoscopic rectal cancer surgery has the similar efficacy in oncological outcomes as the conventional open surgery, with the advantages of reduced intra-operative blood loss, rapid postoperative recovery and shorter hospital stay. So it may be used as a standard procedure for rectal cancer.

Abstract:Objective: To compare the clinical efficacies between laparoscopic and traditional open Ladd’s procedure for intestinal malrotation. Methods: Publicly published studies comparing laparoscopic and open Ladd’s procedure in treatment of intestinal malrotation were collected. The operative time, time to food intake, length of hospital stay and postoperative complications between patients treated by the two methods were compared by Meta-analysis. Results: Four studies involving 454 subjects were adopted for Meta-analysis after screening, in which 89 patients receiving laparoscopic Ladd’s procedure (laparoscopic surgery group) and 365 patients undergoing open Ladd’s procedure (open surgery group). Compared with open surgery group, in laparoscopic surgery group, the operative time was not prolonged (P>0.05), but time to food intake, length of hospital stay and incidence of postoperative ileus were all reduced significantly (all P<0.05), and the incidence of postoperative volvulus was not increased (P>0.05). Conclusion: Laparoscopic Ladd’s procedure for intestinal malrotation has the advantages of faster postoperative recovery and fewer complications compared with open procedure.

Abstract:Objective: To investigate the relationship between changes of the plasma cytokine levels and the occurrence of postoperative ileus in patients after radical resection for colorectal cancer. Methods: One hundred consecutive patients undergoing radical resection for sigmoid or rectal cancer were selected. Venous blood samples were drawn from the patients on postoperative day (POD) 1, 3 and 5 for measurement of the plasma levels of procalcitonin (PCT), C-reactive protein (CRP) and tumor necrosis α (TNF-α). The subjects were divided into ileus group and non-ileus group according to whether an ileus was present, and the pre-, intra- and postoperative conditions, as well as the levels of above cytokines were compared between the two groups. Results: Ileus occurred in 8 of the patients on POD 10 to 15. The time to first flatus passage in ileus group was significantly longer than that in non-ileus group, but other variables that included age, sex, body mass index, tumor site, intraoperative blood loss, operative time and length of postoperative hospital stay showed no significant difference between the two groups (all P>0.05). The PCT levels on POD 1 and 3 were not significantly different between the two groups (P>0.05), but it was remarkably increased on POD 5 in ileus group and the difference reached significant significance versus non-ileus group (P=0.014). The changes of postoperative CRP and TNF-α level in the two groups showed a similar tendency, and the differences between the two groups at each time point had no statistical significance (all P>0.05). Conclusion: Increased plasma PCT level may be a laboratory indicator for early prediction of the occurrence of postoperative ileus following colorectal carcinoma surgery.

Abstract:Objective: To investigate the clinical characteristics, diagnostic method and surgical procedures of duodenal gastrointestinal stromal tumors (DGISTs), and the relations of postoperative survival with various clinical factors. Methods: The clinical data of 46 DGIST patients admitted in Xiangya Hospital over the past 11 years were retrospectively analyzed. Results: Among the DGIST patients, the major symptoms were upper alimentary tract hemorrhage and abdominal distending pain or discomfort, and the most commonly involved region was the descending part of the duodenum. Twenty-two patients received local tumor excision (LE), 16 patients underwent segmental duodenectomy (SD), 6 patients were subjected to pancreaticoduodenectomy (PD), and two patients refused operative treatment (one died and one was lost to follow-up). Forty-four patients were followed up after surgery, at which time, 28 cases had survived, 6 cases and died, and 10 cases were lost to follow-up. Postoperative complications occurred in 4 patients; one of them developed duodenal fistula after LE and recovered after conservative treatment, and three cases developed pancreatic fistula following PD, of whom, one died of hemorrhagic shock and the other two recovered after conservative treatment. The mean survival time was (35.4±28.7) months, and the differences in postoperative survival among the groups divided according to gender, age, tumor size, tumor recurrence risk classification, tumor location and surgical procedures showed no statistical significance (all P>0.05). Conclusion: CT, endoscopy and ultrasound endoscopy are the main approaches for preoperative diagnosis of DGISTs. Complete resection is the primary treatment for this condition and the postoperative survival is not associated with gender, age, tumor size, tumor recurrence risk classification, tumor location or surgical procedures.

Abstract:In this paper, the authors address the advances in D2 radical resection for advanced gastric cancer, including the scope of lymph node dissection, value and necessity of clearance of several important lymph groups, cutting-edge technology and safety of the dissections, laparoscopic techniques, and sentinel lymph node as well as gastric cancer micrometastasis.

Abstract:With the deepening of understanding of tumor markers, a variety of tumor markers have been found differentially expressed in stomach cancer. In this paper, the authors address the application of tumor markers in treatment and prognostic estimation of stomach cancer, with the purpose of providing support for clinical assessment and treatment planning.