Objective To evaluate the curative effectiveness and safety of transanal endoscopic microsurgery (TEM) vs. radical surgery (RS) for the patients with rectal malignant tumor, and to provide information for clinical research and practice. Methods Through computer searching The Cochrane Central Register of Controlled Trials, PubMed, OVID, CBM and CNKI from inception to April 2010, and hand searching relevant journals including Chinese Journal of Surgery and Chinese Journal of Evidence-Based Medicine, the randomized controlled trails (RCTs) and non-randomized controlled trails (NRCTs) comparing TEM with RS for rectal malignant tumor were collected. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using the Cochrane collaboration’s software RevMan 5.0. Results One RCT and four NRCTs met the selection criteria, involving 929 patients. The methodological quality of all trials was low with possibility of bias. The meta-analyses showed that: a) Three studies reported local recurrence in T1 stage patients. There was a significant difference in local recurrence between the two groups (OR=12.61, 95%CI 2.59 to 61.29, P=0.002); b) Two studies reported disease-free survival in T1 stage patients. There was no significant difference between the two groups in disease-free survival (OR=1.12, 95%CI 0.31 to 4.12, P=0.86); c) Three studies reported overall survival in T1 stage patients. There was no significant difference between the two groups (OR=1.09, 95%CI 0.57 to 2.08, P=0.80); and d) Three studies reported postoperative complications in T1 stage patients. There was a significant difference between the two groups in terms of complications (OR=0.05, 95%CI 0.02 to 0.10, Plt;0.00001). Conclusion For T1 stage patients, TEM is associated with less injury of tissue, less operative bleeding, short duration of hospital stay, and low incidence of postoperative complications. The disease-free and overall survivals are comparable to those of RS, but the local recurrence rate is higher. The role of TEM in T2 stage patients is still under discussion. However, the trails available for this systematic review are of lower methodological quality, and bias may exist due to NRCTs. Therefore, more high quality RCTs are required.
Objective To evaluate the status of lymph node metastasis and reasonable procedure in gastric cancer. Methods The incidence of metastases from gastric cancer to various regional lymph node stations was studied in 1 505 patients with gastric cancer. The patients underwent surgical resection from January 1995 to December 2004.Results Lymph node metastasis were observed in 928 of 1 505 cases (61.7%). Lymph node metastasis frequency was found in groups No.1 （32.9%），No.3 （28.7%）， No.2 （20.4%）， and No.7 （18.6%） at upper third stomach cancer；in groups No.3 （32.5%）， No.4 （24.7%）， No.7 （20.6%）， and No.1 （17.3%） at middle third stomach cancer； in groups No.6 （33.7%）， No.3 （31.3%）， No.4 （25.6%）， and No.7 （21.5%） at lower third stomach cancer. Conclusions Distribution of metastatic lymph node is clearly related to the location of the tumor. Anatomical extent of lymph node metastases in gastric cancer provid surgical guidance for surgeons.
Objective To discuss the differences of the effects on open colorectal cancer operation between using ultracision harmonic scalpel (UHS) and monopolar electrosurgery. Methods Fifty-nine patients from April to December in 2007, suffering colorectal cancer in the same treatment group, underwent open radical operation, 29 by GEN300 UHS (UHS group) and 30 by monopolar electrosurgery as control group. There was no significant difference between two groups among the factors of age, gender, tumor location, Dukes staging, gross morphology and degree of histological differentiation (Pgt;0.05). Results Shorter incision was applied in UHS group than in the control group. The mean operation time of UHS group and control group were 126 and 119 min, respectively (Pgt;0.05). The mean operative blood loss was 50 (20-140) ml in UHS group and 90 (40-200) ml in control group (Pgt;0.05). There were no significant differences among factors of bowel function recovery, mean hospitalization and incidence of complications between two groups (Pgt;0.05). The mean time for postoperative drainage fluid changing from bloody to serous was 8 (2-20) h in UHS group, however, 48 (16-80) h in control group (Plt;0.05). Conclusion In open colorectal cancer operation, benefits of using UHS are shorter incision and minimally invasiveness.