Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
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Zhonghua Wei Chang Wai Ke Za Zhi · Dec 2019
[Analysis on the technical characteristics and clinical efficacy of robotic-assisted intersphincteric resection for patients with low rectal cancer].
Objective: To explore the technical characteristics and short-term clinical efficacy of robotic-assisted intersphincteric resection (ISR) for patients with low rectal cancer. Methods: A retrospective cohort study was used. Inclusion criteria: (1) rigid colonoscopy showed lower margin of the tumor ≤5 cm from the anal verge; (2) preoperative rectal MRI or endorectal ultrasound revealed staging T1-2, or T3 patients receiving concurrent chemoradiotherapy; (3) patients less than 70 years old with good function of anal sphincter before surgery; (4) no synchronous multiple primary carcinoma, and no distant metastasis; (5) the method of operation was agreed by the patient. ⋯ The patients were followed up for (22.1±10.6) months without local recurrence and distant metastasis. Eighteen patients were evaluated for anal function: Kirwan classification was grade I for 6 cases, grade II for 7 cases, grade III for 4 cases, and grade IV for 1 case; Wexner incontinence score was 8.6±0.8; 14 cases had good defecation control. Conclusion: The clinical efficacy of ISR with Da Vinci robot in the treatment of low rectal cancer is satisfactory.
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Zhonghua Wei Chang Wai Ke Za Zhi · Dec 2019
[Effect of enterostomy on analgesic pattern in patients with advanced digestive tract cancer].
Objective: To explore the effect of enterostomy on analgesic pattern in advanced digestive tract cancer. Methods: A retrospective cohort study was carried out, which was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (E2018026). Inclusion criteria were as follows: (1)age and gender were not limited; (2) all the gastrointestinal malignancies were confirmed histologically, and local recurrence or metastasis were confirmed by CT or MR; (3) numerical rating scale (NRS) ≥4 points, opioid analgesic drugs were required; (4) informed consents were signed by patients of their own. ⋯ Multivariate analysis of the application of laxative use showed that age (OR=0.281, 95% CI: 0.123-0.684, P=0.010) and ostomy (OR=2.621, 95% CI: 1.033-6.687, P=0.045) were independent factors affecting the use of lactulose laxatives. Conclusions: Enterostomy may affect the analgesic pattern in advanced digestive tract cancer. Patients with stoma are more likely to use fentanyl transdermal patches and younger patients with stoma do not need prophylactic use of laxatives.
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Zhonghua Wei Chang Wai Ke Za Zhi · Dec 2019
[Prognostic value and initial exploratory research on TNM staging method of tumor deposits in stage III colon cancer].
Objective: To investigate the effect of tumor deposits (TD) on the prognosis of patients with stage III colon cancer, and to explore whether TD number included into regional lymph node count can predict the prognosis more accurately. Methods: A retrospective cohort study was carried out. Case inclusion criteria: (1) primary colon cancer; (2) undergoing colon cancer radical operation; (3) definite pathological diagnosis; (4) colon cancer stage III according to AJCC 8th edition; (5) complete follow-up data; (6) without preoperative neoadjuvant treatment. ⋯ However, for 16 patients adjusted as stage IIIC (mTNM), 32 patients with unchanged stage IIIC with TD (TNM, AJCC 8th edition), and 63 stage IIIC cases without TD, the 5-year OS was 37.5%, 36.4%, and 41.3%, respectively without significant difference (P=0.707). Conclusions: TD presence and TD number are independent risk factors for prognosis of stage III colon cancerpatients. TNM staging evaluation with lymph node number including TD number can predict the prognosis of patients more accurately.
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Zhonghua Wei Chang Wai Ke Za Zhi · Sep 2019
[Similarities and differences in diagnosis and treatment of gastrointestinal stromal tumors between China, Japan and Korea: from expert consensus to cooperation prospect].
The great success of tyrosine kinase receptor inhibitor (TKI) in gastrointestinal stromal tumors(GIST) has promoted it to become a classic model of targeted cancer therapy in the era of precision medicine. Multidisciplinary diagnosis and treatment and whole-process scientific management are the key to clinical diagnosis and treatment of GIST. There are many expert consensuses or guidelines on diagnosis and treatment of GIST in the world. ⋯ In view of some pending problems in the diagnosis and treatment of GIST, the cooperative research between China, Japan and Korea may focus on the following aspects: (1) The value of surgery in the treatment of advanced GIST. (2) The detection of imatinib blood concentration in East Asian population and optimized rational use of targeted drugs in the oriental population. (3) Chinese researchers should optimize the strategy of endoscopic treatment of GIST, design rigorous domestic multi-center clinical trials, and provide convincing data, so as to obtain international recognition. (4) Other related studies may include the diagnosis and treatment of wild-type GIST, the value of Ki-67 in the pathological evaluation of GIST, laparoscopic surgery for gastric GIST, and the optimal duration of imatinib adjuvant therapy. Researchers in China should attach importance to the value of clinical trials, especially cooperative clinical research. Starting with improving data quality, we should welcome cooperation with an open and confident attitude and strive to promote the clinical practice and research of GIST to a new height.
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Zhonghua Wei Chang Wai Ke Za Zhi · Aug 2019
[Risk factors of coloanal anastomotic stricture after laparoscopic intersphincteric resection for low rectal cancer].
Objective: To evaluate the risk factors of coloanal anastomotic stricture after laparoscopic intersphincteric resection (Lap-ISR) for patients with low rectal cancer. Methods: A retrospective case-control study was performed to collect clinicopathological data from a prospective database (registration number: ChiCTR-ONC-15007506) at the Department of Colorectal Surgery, the Characteristic Medical center of PLA Rocket Force. From June 2011 to August 2018, a total of 144 consecutive patients with low rectal cancer who underwent Lap-ISR were enrolled in the study. ⋯ Univariate analysis showed that male (χ(2)=6.795, P=0.009), radiotherapy (χ(2)=13.330, P=0.001), operation type of ISR (χ(2)=7.996, P=0.013), and anastomotic leakage (χ(2)=10.198, P=0.004) were associated with the postoperative coloanal anastomotic stricture. Multivariate analysis further indicated that male (OR=5.975, 95% CI: 1.209-29.534, P=0.028), postoperative radiotherapy (OR=8.748, 95% CI: 2.397-31.929, P=0.001), and anastomotic leakage (OR=6.313, 95% CI: 1.834-21.734, P=0.003) were independent risk factor of postoperative coloanal anastomotic stricture. Conclusion: For male patients, or patients with postoperative radiotherapy or anastomotic leakage, close follow-up should be carried out to prevent postoperative coloanal anastomotic stricture following Lap-ISR.