We reviewed the clinical studies on drug therapy for gallbladder cancer and expounded on the current situation of conversion therapy for gallbladder cancer. Gallbladder cancer was usually diagnosed late, with high malignancy, low surgical resection rate, and poor prognosis. With the development of conversion therapy, systemic therapy combined with radical resection had effectively improved the surgical resection rate and prognosis of gallbladder cancer patients. At present, most of the published conversion therapies for gallbladder cancer were mainly retrospective researches, lacking large multicenter prospective research, and the treatment plan was still based on chemotherapy, lacking the research of targeted therapy in combination with immunotherapy. It is expected that more high-quality clinical trials can be made first-line recommendations for the conversion therapy of gallbladder cancer.
ObjectiveTo evaluate the influence of clinical, pathological and treatment factors on the prognosis of thymic carcinoma patient accepted surgical treatment.MethodsRetrospective analysis was performed on 38 patients with thymic carcinoma undergoing surgical treatment between January 2008 and December 2017. The association between the prognostic factors including age, sex, thymectomy, radical resection, pathological type, TNM stage, Masaoka-Koga stage, tumor size, and survival was assessed using the Kaplan-Meier method.ResultsThe 5-year overall survival rate of our cohort was 51.9%. Kaplan-Meier univariate survival analysis showed that radical resection (P=0.003), TNM stage (P=0.038), Masaoka-Koga stage (P=0.033), and tumor size (P=0.030) were related to the prognosis of patients with thymic carcinoma. Radical resection was also validated as an independent prognostic factor in multivariate Cox analysis (P=0.009, hazard ratio 2.31, 95%CI 1.23-4.33).ConclusionRadical surgical treatment could improve the prognosis of patients with resectable thymic carcinoma.
ObjectiveTo investigate the risk factors affecting the occurrence of infectious complications after radical gastrectomy for gastric cancer, and to establish a risk prediction Nomogram model. MethodsThe clinicopathologic data of 429 primary gastric cancer patients who underwent radical resection for gastric cancer at the Second Department of General Surgery of Shaanxi Provincial People’s Hospital between January 2018 and December 2020 were retrospectively collected to explore the influencing factors of infectious complications using multivariate logistic regression analyses, and to construct a prediction model based on the results of the multivariate analysis, and then to further validate the differentiation, consistency, and clinical utility of the model. ResultsOf the 429 patients, infectious complications occurred in 86 cases (20.05%), including 53 cases (12.35%) of pulmonary infections, 16 cases (3.73%) of abdominal infections, 7 cases (1.63%) of incision infections, and 10 cases (2.33%) of urinary tract infections. The results of multivariate logistic analysis showed that low prognostic nutritional index [OR=0.951, 95%CI (0.905, 0.999), P=0.044], long surgery time [OR=1.274, 95%CI (1.069, 1.518), P=0.007], American Society of Anesthesiologists physical status classification (ASA) grade Ⅲ–Ⅳ [OR=9.607, 95%CI (4.484, 20.584), P＜0.001] and alcohol use [OR=3.116, 95%CI (1.696, 5.726), P＜0.001] were independent risk factors for the occurrence of infectious complications, and a Nomogram model was established based on these factors, with an area under the ROC of 0.802 [95%CI (0.746, 0.858)]; the calibration curves showed that the probability of occurrence of infectious complications after radical gastrectomy predicted by the Nomogram was in good agreement with the actual results; the decision curve analysis showed that the Nomogram model could obtain clinical benefits in a wide range of thresholds and had good practicality.ConclusionsClinicians need to pay attention to the perioperative management of gastric cancer patients, fully assess the patients’ own conditions through the prediction model established by prognostic nutritional index, surgery time, ASA grade and alcohol use, and take targeted interventions for the patients with higher risks, in order to reduce the risk of postoperative infectious complications.
ObjectiveTo assess value of preoperative clinical data and enhanced CT imaging features in predic-tion of microvascular invasion (MVI) and early recurrence (recurrence in one year) after curative resection for hepatoce-llular carcinoma (HCC). MethodsA retrospective analysis was conducted for 150 patients with HCC who underwent curative tumor resection in West China Hospital of Sichuan University from April 2014 to May 2015. The roles of preoperative CT characteristics and clinical data on MVI and early recurrence after curative tumor resection were evaluated by univariate and multivariate analyses. Resultscompared with HCC with no MVI and no early recurrence after curative resection, univariate analysis results showed that HCC with MVI and early recurrence had larger tumor size (P=0.002, P=0.005), a higher proportion of non-smooth tumor margin (P<0.001, P<0.001), and tumor multifocality (P=0.005, P=0.038), HCC with MVI had a higher proportion of incomplete tumor capsule (P=0.032), HCC with early recurrence had a higher proportion of incomplete and absence tumor capsules (P=0.038) and a faster washout on portal venous phase-the percentage attenuation ratio on the portal venous phase (P=0.049) and relative washout ratio on the portal venous phase (P=0.020) were higher. A multivariate logistic regression analysis results showed that non-smooth tumor margin (OR=7.075, P<0.001; OR=4.125, P<0.001) and tumor multifocality (OR=3.290, P=0.008; OR=2.354, P=0.047) were the independent predictors for MVI and early recurrence after curative tumor resection, HCC with early recurrence also had a faster washout on the portal venous phase (OR=1.023, P=0.017). ConclusionNon-smooth tumor margin and tumor multifocality are independent risk factors for MVI and early recurrence after curative tumor resection, and HCC with early recurrence has a faster washout on portal venous phase. Preoperative enhanced CT imaging could predict MVI and early recurrence after curative tumor resection and CT imaging findings are helpful to choose reasonable treatment and predict prognosis.
ObjectiveTo explore the influencing factors of textbook outcomes (TO) after radical resection for hepatic alveolar echinococcosis (HAE). MethodsClinical data from 427 patients diagnosed with HAE at the Ganzi Branch of West China Hospital, Sichuan University, between 2015 and 2022, were retrospectively collected. The least absolute shrinkage and selection operator regression (LASSO) was first used to screen potential influencing factors for achieving TO (predictive model A). Univariate and multivariate logistic regression analysis were then used to explore the influencing factors of TO (predictive model B). A Nomogram was further constructed and validated. ResultsA total of 427 patients who successfully underwent radical liver resection were included, of which 174 patients (40.7%) achieved TO. Compared to the non-TO group, patients in the TO group had higher proportions of WHO PNM stage of P 1+2 [62.6% (109/174) vs 42.3% (140/253)], N0 [77.0% (134/174) vs 63.6% (161/253)], lesion diameter≤10 cm [77.0% (134/174) vs 64.8% (164/253)], albumin-bilirubin index (ALBI) ≤–2.6 [70.1% (122/174) vs 59.3% (150/253)], and minor liver resection [71.8% (125/174) vs 50.2% (127/253)], higher prealbumin (181 mg/L vs 169 mg/L) and albumin (39 g/L vs 38 g/L) levels, shorter postoperative hospital stay (15 d vs 19 d), and lower hospitalization costs (51 727 RMB vs 62 715 RMB), P<0.05. LASSO regression analysis indicated that P stage, lesion diameter, ALBI, and liver resection method were potential influencing factors for achieving TO after HAE surgery (model A), P<0.05. The TO rate for P 1+2 stage was higher than that of P 3+4 stage, the TO rate for lesion diameter ≤ 10 cm was higher than that of lesion diameter >10 cm, the TO rate for ALBI ≤–2.6 was higher than that of ALBI >–2.6, and the TO rate for minor liver resection was higher than of major liver resection. Multivariate logistic regression analysis showed that P stage (OR=1.800, P=0.025) and liver resection method (OR=1.974, P<0.001) were influencing factors for achieving TO (model B). The TO rates for P1+2 stage and minor liver resection were higher. Predictive model A demonstrated higher accuracy and stability compared to predictive model B (AUC: 0.754 vs 0.712, C-index: 0.756 vs 0.707). ConclusionsAmong patients undergoing radical resection for HAE, less than half achieved TO. Striving to achieve TO can significantly shorten the length of hospital stay and effectively reduce medical costs. The TO predictive model based on P stage, lesion diameter, ALBI, and liver resection method is superior to the model based solely on P stage and liver resection method.
Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.
ObjectiveTo summarize the research progress of risk factors related to early recurrence and late recurrence of hepatocellular carcinoma (HCC) after radical resection.MethodsReviewed and summarized recent literatures on factors related to early and late recurrence of HCC after radical resection.ResultsRadical resection was the most effective treatment for HCC, but the postoperative recurrence rate was high, which seriously affected the treatment effect. Current research divided the recurrence after radical resection of HCC into early recurrence (≤2 years) and late recurrence (>2 years). Early recurrence was considered to be mainly caused by intrahepatic metastasis (IM), which was related to the tumor itself, while late recurrence was mainly caused by multicentric occurrence (MO) and was related to background liver factors. Factors of the tumor itself, including tumor diameter and number, invasion of tumor large vessels and microvessels, anatomical and non-anatomical resection, tumor margin, residual liver ischemia (RLI), intermittent total entry hepatic blood flow interruption method (IPM), the expression level of circulating microRNA in serum and long-chain non-coding RNA, circulating tumor cells, and circulating tumor DNA were related to early recurrence; background liver factors, including liver cirrhosis, high viral load, and liver inflammatory activity, were associated with late recurrence.ConclusionsBoth the tumor factors associated with early recurrence and the background liver factors associated with late recurrence can affect the recurrence after radical resection of HCC.
Objective To investigate the strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Method Reviewing the related literatures at home and abroad in recent years, to summarize the progress of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Results We should clear the postoperative bleeding time, extent, cause, and location, to help the clinician to choose the appropriate timing of intervention and treatment. The patients with early hemorrhage and mild degree hemorrhage could be treated conservatively. If patients with severe hemorrhage and hemodynamic disorders, surgical intervention must be decisive. Patients with late hemorrhage would have serious consequences, and these patients should receive interventional or surgical treatment as early as possible. Conclusions For patients with hilar cholangiocarcinoma after radical resection, doctors need to do accurate preoperative evaluation, meticulous operation, and intensive management after operation, to reduce the incidence of hemorrhage after radical resection of hilar cholangiocarcinoma. If the postoperative hemorrhage occurs, the cause, location, time, and degree of hemorrhage should be clearly defined to facilitate clinicians to make rapid clinical decisions and to develop treatment programs.
Objective To explore the feasibility and short-term effectiveness of the modified radical resection and reconstruction in the treatment of malignant proximal humerus tumor. Methods The relevant anatomic data from 30 normal adult shoulder joint MRI were measured to analyze the feasibility of modified radical resection and reconstruction surgery in the treatment of malignant proximal humerus tumor. Five patients with malignant proximal humerus tumor were treated by using the modified radical resection and reconstruction surgery between March 2012 and January 2016. There were 1 male and 4 females, aged from 9 to 69 years (median, 46 years). There were 4 cases of osteosarcoma (Enneking IIA in 2 cases and Enneking IIB in 2 cases) and 1 case of metastatic carcinoma (moderately differentiated adenocarcinoma). The disease duration was 7 to 12 months (mean, 9 months). Recurrence of tumor was observed after operation, and the shoulder function was assessed according to Enneking skeletal muscle tumor function scoring system. Results Radiographic results showed that modified radical resection and reconstruction surgery was feasible, which was in allowable range of the maximum longitudinal diameter ( < 29.8 mm) and depth ( < 4 mm). The operation was successfully completed in all 5 cases, and pathological examination suggested that purposes of radical resection had achieved. All patients were followed up 3 to 49 months (mean, 15.6 months). One patient had local recurrence at 12 months after operation, and a shoulder joint amputation was performed; the other 4 patients had good prosthesis survival. At last follow-up, the function of the shoulder joint was obviously recovered when compared with preoperative function; Enneking's skeletal muscle tumor function score was 25.8 points (range, 24 to 27 points). Conclusion Modified radical resection and reconstruction surgery is feasible for the treatment of proximal humerus tumor, and it can maintain a good early shoulder function.