ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
ObjectiveTo evaluate the value of real-time indocyanine green fluorescence imaging navigation (ICG-FIN) in laparoscopic rectal cancer surgery. MethodsThe patients who adopted ICG-FIN during laparoscopic rectal cancer surgery in the Department of Anorectal Surgery of Xuzhou Central Hospital from April 2022 to June 2023 according to the inclusion and exclusion criteria (ICG-FIN group) were collected, meanwhile matching (1∶1) of patients who did not adopt ICG-FIN during laparoscopic surgery from January 2021 to May 2022 (control group). The general data, surgical conditions, intraoperative and postoperative outcomes between the two groups were compared. ResultsThere were 62 patients in the ICG-FIN group and 62 patients in the control group. There were no statistical differences in the gender, age, body mass index, comorbidities, and so on between the two groups (P>0.05). The tumor localization, lymph node tracing, fluorescence imaging of the intended resection of intestinal tract and anastomotic site were observed in the ICG-FIN group. Seven patients (11.3%) had changed in the intended resection of intestinal anastomotic line during surgery, while there were no changes of the surgical plan in the control group. There were no statistical differences (P>0.05) in terms of surgical method, operative time, intraoperative bleeding, proportion of ileostomy, time of the first postoperative exhaust, postoperative hospital stay, and incidence of short-term complications between the two groups. Compared with the control group, the incidence of anastomotic leakage was lower (P=0.012), and the number of lymph nodes cleaned was more (P=0.016) in the ICG-FIN group. However, there was no statistical difference in the number of positive lymph nodes detected between the two groups (P=0.343). ConclusionsAccording to the results of this study, ICG-FIN is a reliable and effective method during laparoscopic rectal cancer surgery, which can accurately localize tumor, trace and guide lymph node dissection. Real-time evaluation of intestinal blood flow perfusion is of great practical value in reducing anastomotic leakage.
Objective To investigate the significance and surgical skill for lymphadenectomy around common hepatic artery in gastric cancer. Methods Two hundred and fifty-seven cases with undergoing lymphadenectomy around common hepatic artery in gastric cancer between January 2001 and December 2006 were retrospectively reviewed. Experiences and understanding of dealing with this procedure in curative gastrectomy for gastric cancer were concluded. Results The number of dissected No.8 lymph node was 2.2±1.7, and the positive rate of No.8 lymph node was 30.35%. There were no lymphadenectomy related complications, such as anastomotic leakage, lymphatic fistula and postoperative hemorrhage in this series. Dissection around common hepatic artery lymph nodes along artery intrathecal space, division and ligation of left gastric vein at its root, and sufficient exposure of anatomic structures were important to dissection lymph nodes around the common hepatic artery. The exposure of anatomic structures included liberation of common hepatic artery by traction with the band, and the exposure of posterior side of pancreas by Kocher incision.Conclusion Being familiar with the anatomy around common hepatic artery, careful dissection, and attention to the surgical skill of lymphadenectomy are very important to improve the effectiveness of lymphadenectomy around common hepatic artery in gastric cancer.
ObjectiveTo evaluate the metastasis feature and the dissecting value of cervicothoracic lymph node for middle esophageal squamous carcinoma. MethodsA total of 303 patients admitted to the Rugao Boai Hospital(107 patients) and the Rugao People's Hospital (196 patients) received the stapled cervical esophagogastrostomy via different thoracic approach according to the admission order number between March 2005 and February 2013. There were 290 patients with Ro resections including 149 patients by Ivor-Lewis approach (an Ivor-Lewis group) and 141 patients by Sweet approach (a Sweet group). The data of lymph nodal dissection and PTNM stage and follow-up of the two groups were analyzed. ResultsThe number of positive lymph nodes dissected from the cervicothoracic junction in the IvorLewis group was significantly greater than that in own upper abdomen (Z=3.12, P<0.05) and that in the cervicothoracic junctionin in the Sweet group (Z=3.30, P<0.05). The lymph node metastasis rate of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen(χ2=10.76, P<0.05)and that in the cervicothoracic junction in the Sweet group (χ2=7.34, P<0.05). The lymph node ratio (LNR) of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen (χ2=11.67, P<0.05) and that in the cervicothoracic junction in the Sweet group (χ2=5.99, P<0.05). The proportion of patients which PTNM were Ⅲa or Ⅲb as N＞N1 in the Ivor-Lewis group was significantly higher than that in the Sweet group(χ2=5.59, P<0.05). After surgery of 1 year, 3 years, 5 years, the rate of lymph node local recurrence and the total rate of tumor metastasis or recurrence in the Ivor-Lewis group were significantly lower than in the Sweet group (P<0.05). The survival rate in the Ivor-Lewis group was significantly greater than that in the Sweet group (P<0.05). ConclusionThe cervicothoracic junction has a higher incidence of lymphatic metastasis, which transfer intensity is greater than that of upper abdomen. The extended cervicothoracic lymph node dissection should be indeed indispensible to increase of radical resection and the accuracy of PTNM stage and to improve the long term survival for middle esophageal carcinoma.
ObjectiveTo explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. MethodsThe clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. ResultsAll the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). ConclusionsEndoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.
ObjectiveTo assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. MethodsThe medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. ResultsThe upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. ConclusionThe effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.
Objective To investigate efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer. Methods Seventy-three patients underwent D3 radical resection of rectal cancer with pelvic autonomic nerve preservation from March 2015 to October 2016 in the People’s Hospital of Pengzhou City were collected, then were divided into a laparoscopic surgery group (38 cases) and an open surgery group (35 cases) according to the choice of operation. The intraoperative and postoperative indexes were compared between these two groups, and the urination and sexual functions at preoperation and on month 1 after operation for male patient with rectal cancer were evaluated. Results ① The age, gender, tumor diameter, TNM stage, and tumor location had no significant differences between these two groups (P>0.05). ② Compared with the open surgery group, the intraoperative blood loss was less (P<0.05), but the operation time was longer (P<0.05) in the laparoscopic surgery group. The number of lymph node dissection had no significant difference between these two groups (P>0.05). ③ The anal exhaust time and hospitalization stay in the laparoscopic surgery group were significantly shorter than those in the open surgery group (P<0.05), and the incidences of postoperative infection, intestinal adhesion, and intestinal obstruction were significantly lower in the laparoscopic surgery group as compared with the open surgery group (P<0.05). ④ The IPSS score of urination function and the IIEF-5 score of sexual function on month 1 after operation had no significant differences between these two groups (P>0.05), but compared with the preoperative points, the IPSS score was significantly increased, the IIEF-5 score was significantly decreased in the same group (P<0.05). Conclusion The preliminary results of limited cases in this study show that laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer is safe and effective, it has some advantages of mild invasion, lower complication rate, and fast covery.
Objective To provide a current language for clinical and pathological discription of gastric cancer. Methods The literature in recent years on the distribution of lymph nodes and staging of gastric cancer were reviewed. Results The lymph nodes of gastric cancer are distributed near the blood vessel and organs of gastric milieu. To ensure radical gastrectomy rational and scientific, the anatomic structure of gastric milieu should be familiarized. Conclusion The excellent outcome of surgery will be achieved by the effective dissection and removel of lymph nodes in gastric cancer.
Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer, and the relation between No.12b lymph node metastasis and clinicopathologic factors. Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively, both of which were all plus No.12b lymph node dissections. The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed. Results No death attributed to operation or severe operative complications were found. There were 12 cases (20.00%) with No.12b lymph node metastasis. The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types, N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25% (10/32), 30.30% (10/33) and 29.73% (11/37), which were significantly higher than those in Borrmann Ⅰ-Ⅱ types 〔7.14% （2/28）〕, N0-1 〔7.41% （2/27）〕 and T1-2 〔4.35% （1/23）〕 respectively (Plt;0.05). There was no relationship between tumor size and No.12b lymph node metastasis. Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer. Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.