ObjectiveTo summarize the clinical experience of 58 operations for biliary malignant tumor with da Vinci surgical system. MethodsFrom January 2009 to October 2010, 180 patients with hepatopancreaticobiliary and gastrointestinal disease underwent robotic surgeries by using da Vinci surgical system, including 58 patients with biliary malignant tumor. The case distribution, intra and postoperative data were analyzed. ResultsOf 58 patients, 3 patients with intrahepatic bile duct cystadenocarcinoma received wedge resections of liver. In 36 patients with hilar cholangiocarcinoma, anatomical left hemihepatectomies were performed in 3 cases, resection of extrahepatic duct and gallbladder bridge type biliary revascularization in 3 cases, resection of extrahepatic duct and biliary-enteric Roux-en-Y anastomosis in 14 cases, tumor resection and revascularization of hepatic portal bile duct in 1 case, palliative external drainage of intrahepatic bile duct in 5 cases, and Y-internal drainage of hepatic portal in 10 cases. In 10 patients with gallbladder carcinoma, resection of extrahepatic duct and gallbladder and biliaryenteric Roux-en-Y anastomosis in 2 cases, cholecystectmy in 3 cases, cholecystectmy and external drainage of intrahepatic bile duct in 1 case, cholecystectmy and Y-internal drainage by suspension of hepatic portal in 4 cases. A patient with middle bile duct cancer received radical resection of cholangiocarcinoma and biliary-enteric Roux-en-Y anastomosis. Of 8 patients with distal bile duct cancer, Whipple procedure were performed. Of 58 patients, 2 cases converted to hand-assistant procedure (3.4%). For all patients, operation time was (6.18±1.71) h, blood loss was (116.66±56.06) ml, blood transfusion was (85.55±38.28) ml, ambulation time was (9.10±2.91) h, feeding time was (14.95±4.35) h, and hospital stay was (12.81±4.29) d. Postoperative complications occurred in 8 cases (13.8%), including bile leakage (3 cases), wound bleeding (1 case), pancreatoenteric anastomotic leakage (2 cases), pulmonary infection (1 case), and renal failure (1 case). Of these 8 cases, 6 cases recovered smoothly and 2 cases die of severe pulmonary infection and renal failure after conservative treatment (3 or 4 weeks), therefore, the mortality of patients was 3.4%. In 36 patients with hilar cholangiocarcinoma, 19 cases died (on 2 monthes 4 cases, on 6 monthes 5 cases, on 10 monthes 8 cases, and on 12 monthes 2 cases after operation), 11 cases survival well (gt;26 monthes 4 cases, gt;22 monthes 3 cases, and gt;19 monthes 4 cases), and 6 cases required hospitalization. Of 10 patients with gallbladder carcinoma, 7 cases died (on 3 monthes 1 case, on 5 monthes 1 case, on 8 monthes 1 case, on 11 monthes 3 cases, and on 12 monthes 1 case after operation) and 3 cases survival (gt;17 monthes 2 cases, gt;13 monthes 1 case). In 8 cases undergoing pancreatoduodenectomy, 5 cases died (on 4 monthes 2 cases, on 6 monthes 2 cases, and 10 monthes 1 case after operation) and 3 cases survived well over 2 years. Three patients with intrahepatic bile duct cystadenocarcinoma survived over 1 year. Conclusionsda Vinci surgical system can carry out all kinds of surgery for biliary malignant tumor, especially prominent in the complicated surgeries for hepatic portal, which breaks through the restricted area of laparoscope in hepatobiliary malignant tumor.
Mitochondrial adenosine triphosphate (ATP) synthase is the key enzyme of mitochondrial oxidative phosphorylation reaction.The down-regulation of the mitochondrial ATP synthase is a hallmark of most human carcinomas, which is the embodiment of the bioenergetic signature of cancer in the performance of the decreased oxidative phosphorylation and increased aerobic glycolysis. Combining with the bioenergetic signature of cancer, studies showed that mitochondrial ATP synthase and multidrug resistance and adverse prognosis of tumor were closely related. Its mechanisms are related to post-transcriptional regulation of the ATP synthase,the hypermethylation of the ATP synthase gene and the inhibitor peptide of the mitochondrial ATP synthase, called ATP synthase inhibitory factor 1(IF1). In this review, we stress the biological characteristics of mitochondrial ATP synthase and the relationship between ATP synthase and multidrug resistance and prognosis of Malignant tumor, in order to find a new way for tumor therapy.
Abstract From August 1983 to June 1995, 15 cases of middle and upper 1/3 femoral malignant tumors were treated by removal of compete femur and functional reconstruction of both hip and knee. The key procedure was: arrested the artery and vein by rubber band with a nail put in the iliacbone, or exposed the atery and vein directly in the inguinal region. After the disarticulation of the hip and knee, the whole femur with the tumor was removed.Rotated the lower leg 180° and put an artificial femoral head on the upper endof tibia, kept the nerve, artery and vein intact or anastomosed the vessels. Three weeks after surgery, an artificial leg was put on and began to do functionalexercises. From 1～12 years follow-up, no mortality and no local recurrence or metastasis were noted. The function of the reconstructed hip and knee was satisfactory. This procedure could both provide a radical excision of the tumor and obtain a relatively good functioning hip and knee joints.
ObjectiveTo review the clinical experience and evaluate the results in patients who underwent caudate lobectomy for malignant tumor at caudate lobe of liver. MethodsClinicopathological characteristics of 51 patients who underwent caudate lobectomy because of malignant tumors at caudate lobe of liver in our hospital from May 2007 to December 2013 were reviewed retrospectively, and operative detail, complication rate, and survival rate were described. ResultsThe cancer were resected successfully in 51 patients with malignant tumors at caudate lobe of liver. Thirty patients were performed isolated caudate lobectomy and 21 patients performed combined lobectomy. Of the 51 patients, 9 patients were treated with retrograde caudate lobectomy. The operation time was 180.0-360.0 min, with the average value of 244.0 min. The bleeding volume was 400.0-1 000.0 mL, with the average value of 630.0 mL. In all patients, there was no perioperative death and no postoperative bleeding happened, and 17 patients who suffered from interrelated complications were cured or got better by conservative treatments. Fifty-one patients were followed up for 6-60 months, and the median survival time was 38.0 months. During the follow-up period, 29 patients dead, 21 patients suffered from recurrence, and 12 patients suffered from metastasis. The cumulative survival rates of 1-, 3-, and 5-year were 76.1%, 54.7%, and 31.8% respectively after caudate lobectomy. ConclusionThe caudate lobectomy in treatment of malignant tumor at caudate lobe of liver is effective and feasible.
ObjectiveTo investigate the experience in the treatment of splnic malignant tumors with laparoscopy. MethodsThe clinical data of 51 patients with splnic malignant tumor who underwent splenectomy between January 2009 and July 2015 were retrospectively reviewed. Patients were divided into two groups based on the surgical method: Open splenectomy (OS group, n=18) and laparoscopic splenectomy (LS group, n=33). The preoperative, intraoperative and postoperative data of the patients were collected and analysed, the differences of each index during perioperative period (general information), intraoperative data (operative time, estimated blood loss, the size of spleen, intraoperaive transfusion) and postoprative situation (hospital stays, the first oral intake, postoperative pancreatic fistula, rehaemorrhagia, abdominal infection or pulmonary infection and the like) were compared. ResultsLS group compared with OS group, the operative time of LS group was significantly shorter than that of OS group [(103.64±16.92) min vs. (144.44±31.10) min, P=0.000〕, the amount of bleeding of LS group [M (Q25, Q75): 60 (50, 100)〕was significantly less than the OS group [M (Q25, Q75): 150 (115, 210)〕, P=0.000. The hospitalization time of LS group was significantly shorter than the OS group [(13.61±9.91) d vs. (9.03±3.09) d, P=0.017〕, and the LS group has a lower indication of the postoprative complications of fever and pulmonary infection (P=0.010 and P=0.003). Conciusions Laparoscopic splenectomy is feasible in the treatment of splenic malignant tumors, the employment of laparoscopy can shorten the operative time, has the advantages of less bleeding, the shorten hospital stays, lower indication of postoprative complications, and being worthy of further popularization and application.
ObjectiveTo investigate the relationship between family history of malignant tumor (FHOMT) and clinicopathological features of patients with sporadic papillary thyroid carcinoma (PTC), and to provide basis for individualized diagnosis and treatment.MethodsPatients admitted to the department of breast and thyroid surgery in Renmin Hospital of Wuhan University from January 1, 2017 to September 30, 2019 for thyroid surgery for the first time and pathologically diagnosed as PTC were collected. According to the presence or absence of FHOMT, tumor type and family member type, their clinicopathological features were compared.ResultsIn 2 123 patients, there were 1 932 patients without FHOMT and 191 patients with FHOMT. The most common FHOMT was the family history of lung cancer (1.80%). Compared with PTC patients without FHOMT, PTC patients with FHOMT had a later onset age (P=0.000), a lower proportion of central lymph node metastasis (P=0.004), and a lower ratio of capsule invasion (P=0.021). PTC patients with respiratory-related FHOMT had a later onset age (P=0.000). PTC patients with male first-degree relatives had a later onset age (P=0.000). And PTC patients whose first-degree relatives were female had a lower proportion of central lymph node metastasis (P=0.007).ConclusionThere are differences in onset age, central lymph node metastasis and capsule invasion between PTC patients with and without FHOMT.
ObjectiveIn light of the comprehensively implemented reform of medical insurance payments, this study analyzed the impact of the payment intervention and COVID-19 pandemic on hospitalization expenses for identical diseases between traditional Chinese medicine (TCM) and Western medicine hospitals, to provide evidence to promote high-quality coordinated development of hospitals and insurance while reducing patient load. MethodsFrom January 2014 to December 2020, we gathered data including 9 900 individual medical records of woman-related malignant tumors (WMT) from all 23 public hospitals in a district of Shanghai. We developed an interrupted time-series analysis model based on the above two interventions, to compare the inpatient average per-time expenses between different hospitals and different groups. ResultsThe average per-time expenses of WMT in Western hospitals changed from rising to declining after the policy intervention, and increased again during the pandemic. In TCM hospitals, the expenses continued to increase and fluctuated after the pandemic. ConclusionThe policy intervention has achieved a good effect on controlling the cost of Western hospitals, rather than the significant increase in TCM hospitals. Meanwhile, the COVID-19 pandemic has had a significant impact on hospitalization expenses. It’s urgent to develop a payment model that fits the development and characteristics of TCM, to control the unreasonable growth of expenses. Moreover, the financial compensation methods and supervision mechanism of public hospitals should be improved to effectively resist the threat of public health emergencies for the development of hospitals and the legitimate rights of patients.
Mucin antigen 4 (MUC4) is a molecular marker for some malignant tumors for early tumor diagnosis, prognosis and targeted therapy. It provides a new research direction in tumor diagnosis and treatment that will have a wide application prospect. In recent years, there has been a large number of research reports on the basic and clinical studies about MUC4, but the molecular imaging study about MUC4 is seldom reported. In this paper the recent research about MUC4 on basic and clinical studies is briefly reviewed, and it is expected to promote the development of tumor molecular imaging.
ObjectiveTo summarize the experience in the treatment of infection after limb salvage surgery for malignant tumor around knee joint, and explore the risk factor related to infection after limb salvage surgery.MethodsA clinical data of 212 patients with malignant tumor around the knee joint underwent limb salvage surgery between January 2008 and December 2017 were retrospectively analyzed. Among them, 14 cases had infection after limb salvage surgery. Two cases of acute infection were treated with sensitive antibiotics; 12 cases of chronic infection were treated with debridement and antibiotic bone cement occupying device implantation in the first stage, and prosthesis revision (8 cases), knee joint fusion (2 cases), or amputation (2 cases) in the second stage after infection control. The age, gender, preoperative chemotherapy cycle, bone marrow suppression, serum albumin, hemoglobin, operation time, postoperative drainage time, and blood transfusion volume were analyzed to screen the risk factors related to infection after limb salvage surgery. The infection and tumor recurrence were observed, and the limb function was evaluated by Enneking scoring system.ResultsThe univariate analysis showed that the preoperative chemotherapy cycle, bone marrow suppression, operation time, and postoperative drainage time were the influencing factors of postoperative infection (P<0.05). Multivariate analysis showed that the operation time, preoperative chemotherapy cycle, and postoperative drainage time were risk factors of postoperative infection (P<0.05). Among the 14 patients, 1 patient died of traffic accident at 6 months after the second stage operation, and 13 patients were followed up 12.2-48.0 months (mean, 19.9 months). Two cases of acute infection cured. Among the 11 patients with chronic infection, 2 cases of subluxation of the antibiotic bone cement occupying device after the first stage operation occurred; 9 cases of infection cured and 2 cases recurred. At 12 months after operation, except 1 case died by accident, the Enneking scores of the other 13 patients were 12-26, with an average of 20. At last follow-up, 1 case of lung metastasis was still alive, and no tumor metastasis or recurrence was found in the rest.ConclusionThe time of limb salvage surgery, preoperative chemotherapy cycle, and drainage time after limb salvage surgery are the risk factors of infection after limb salvage surgery. Early etiological examination and drug sensitivity test is the key to the treatment of infection. One-stage debridement combined with antibiotic bone cement occupying device can effectively cure infection and save patients’ limbs.
Objective To summarize the treatment and prognosis of malignant tumors with hepatic metastasis. Methods Review and analysis of recent relevant literatures at home and abroad of malignant tumors with liver metastasis, according to the different treatments were summarized. Evaluation of the patients’ clinically curative effect and survival situation was performed under different treatments. Results With the development of imaging and surgical techniques, and deeply understanding of malignant tumor, many malignant tumors with liver metastasis could be found and treated, and previous concept of treatment for malignant tumors with liver metastasis was also fundamentally changed, and radical resection of the primary lesions and liver metastasis was the best way to get clinically curative effect for the patients with malignant tumors with liver metastasis. The treatments of malignant tumors with liver metastasis also included radio frequency ablation (RFA), transarterial chemoembolization (TACE), chemotherapy,125I seed implantation, cryotherapy, stereotactic body radiation therapy (SBRT), laser-induced interstitial thermotherapy (LITT), gene targeting therapy, and so on. Conclusion Now for malignant tumors with liver metastasis, positive surgery and (or) individualized comprehensive treatment are taken more often, and they play positive role to prolong the survival and improve the prognosis of malignant tumors patients with liver metastasis.