The survival benefit of additional surgery after non-curative endoscopic resection of early gastric cancer is a matter of debate. This meta-analysis is intended to draw a convincing conclusion on this issue based on data currently available.

The aim of this study was to evaluate the safety and efficacy of en bloc right hemicolectomy with pancreaticoduodenectomy (RHCPD) for locally advanced right-sided colon cancer (LARCC).

Abstract Background: To evaluate the clinical outcomes of S-1 plus cisplatin (SC) for the treatment of patients with advanced gastric cancer (AGC). Methods: A systematic literature search was conducted by searching PubMed, the Cochrane Library, Embase, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), and WanFang Database, for all year up to January 2017. Pooled analyses of overall survival (OS), progress-free survival rates, and adverse events were performed. Results: A total of 8 random controlled trails (RCTs) consisting of 2699 patients with AGC were selected and included in this meta-analysis. The results of our meta-analysis showed that AGC patients who treated with SC regimen receive a similar OS (HR = 1.01, 95%CI: 0.86–1.18, P = .928), PFS (HR = 0.89, 95%CI: 0.72–1.09, P = .263), and overall response rate (HR = 0.88, 95%CI: 0.70–1.11, P = .283). However, SC regimen may increase the risk of 1 to 2 grade (OR = 1.128, 95%CI: 1.075–1.184, P = .000) and 3 to 4 grade (OR = 1.24, 95%CI: 1.01–1.52, P = .039) adverse events. Conclusion: SC chemotherapy showed no difference in survival compared with 5-FU- and S-1-based other therapy, but has a higher rate of adverse events compared with other chemotherapy regimens.

Background: Hepatic angiosarcoma is a rare malignant vascular tumor presenting unique treatment challenges. The aim of the present study was to determine the treatment and prognosis of this entity. Data sources: A systematic literature search was conducted using PubMed, Embase and Chinese Biomedical Literature database, to identify articles published from January 1980 to July 2017. Search terms were "hepatic angiosarcoma" and "liver angiosarcoma". Additional articles were retrieved through manual search of bibliographies of the relevant articles. Pooled individual data concerning the prognosis following various therapeutic modalities were analyzed. Results: A total of 75 articles involving 186 patients were eligible for inclusion. The median overall survival (OS) was 8 months, with 1-, 3-, and 5-year OS rates of 36.6%, 22.3%, and 12.0%, respectively. The median OS after partial hepatectomy (n = 86), chemotherapy (n = 36), liver transplantation (n = 17), and supportive care (n = 46) were 15, 10, 5 and 1.3 months, respectively. Small tumor size (< 10 cm) was the only significant favorable factor for OS after partial hepatectomy (P = 0.012). Conclusions: Despite the dismal prognosis, partial hepatectomy could prolong the survival of hepatic angiosarcoma patients, particularly those with tumors < 10 cm. Chemotherapy could be an option for unresectable disease. Liver transplantation is not a recommendable option for the management of this malignancy. (C) 2018 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

Primary duodenal adenocarcinoma (PDAC) is a rare malignancy. The aim of this study was to evaluate the published evidence for resection with curative intent in patients with PDAC. A literature search was conducted in PubMed and EMBASE databases for eligible studies that reported 5-year overall survival (OS) after surgical resection of PDAC from January 1990 to January 2018. Independent prognostic factors related to OS were evaluated using meta-analytical techniques. Odds ratio (OR) and hazard ratio (HR) with their 95% confidence interval (CI) were calculated as appropriate. Thirty-seven observational studies comprising a total of 1728 patients who underwent resection for PDAC were reviewed. The overall 30-day postoperative mortality was 3.2% (range, 0-16.0%) and the median 5-year OS was 46.4% (range, 16.6-71.1%). Surgical resection significantly improved the prognosis as compared with the palliative therapy (OR 15.76, P < 0.001). Lymph node metastasis (HR 2.58, P < 0.001), poor tumor differentiation (HR 1.43, P = 0.05), perineural invasion (HR 2.21, P = 0.002), and lymphovascular invasion (HR 2.18, 95% CI 1.18-4.03; P = 0.01) were found to be independently associated with decreased OS after surgical resection. The present study provides evidence that surgical resection can be performed safely for PDAC patients and offers a favorable long-term outcome. Tumor-specific factors have prognostic significance. (C) 2018 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.

Background: Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy. We conducted a systematic review and meta-analysis to assess the evidence available on the long-term outcomes of cHCC-CC patients after either hepatectomy or liver transplantation (LT). Data Sources: Relevant studies published between January 20 0 0 and January 2018 were identified by searching PubMed and Embase and reviewed systematically. Data were pooled using a random-effects model. Results: A total of 42 observational studies involving 1691 patients (1390 for partial hepatectomy and 301 for LT) were included in the analysis. The median tumor recurrence and 5-year overall survival (OS) rates were 65% (range 38%-100%) and 29% (range 0-63%) after hepatectomy versus 54% (range 14%-93%) and 41% (range 16%-73%) after LT, respectively. Meta-analysis found no significant difference in OS and tumor recurrence between LT and hepatectomy groups. Conclusion: Hepatectomy rather than LT should be considered as the prior treatment option for cHCC-CC. (C) 2018 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

Little is known about the clinical outcome of pancreaticoduodenectomy (PD) for locally advanced gastric cancer invading the duodenum and/or pancreas. The aim of this study was to define the clinical outcome and prognostic determinants of PD for locally advanced gastric cancer through a systematic review and pooled analysis of relevant data in the literature. A total of 13 articles involving 69 patients were eligible for inclusion. Postoperative morbidity and mortality were 59.4% and 1.4%, respectively. Overall 5-year survival and median survival were 39.3% and 26 months, respectively. Positive peritoneal lavage cytology represented the only independent prognostic factor for the poor outcome at multivariate analysis (hazard ratio 3.470, 95% confidence interval 1.011-11.909; P = 0.048). In summary, PD is a feasible option for locally advanced gastric cancer invading the duodenum and/or pancreas with an acceptable operative risk and offers survival benefits in selected patients.

The impact of tumor size on prognosis for surgically treated patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. A systematic review and meta-analysis was performed to evaluate this issue.

Background: Pancreatic fistula (PF) is the major cause for morbidity and mortality following pancreaticoduodenectomy. The primary aim of this study was to compare the occurrence rate of postoperative PF between isolated Roux-en-Y reconstruction (RYR) and conventional reconstruction (CR) after pancreaticoduodenectomy. Methods: Data of 43 patients who underwent RYC were compared with those of a pair matched equal number of patients undergoing CR. We also performed a meta-analysis of comparative studies of the two procedures. Results: The case-matched analysis showed no significant difference in PF occurrence between RYR and CR groups (23.3% versus 25.6%; P = 0.80). Meta-analysis of 1498 patients further confirmed this finding, showing a pooled odds ratio of 1.14 (95% confidence intervals, 0.82-1.58; P = 0.43). Conclusion: The use of RYR for pancreaticojejunostomy does not seem to decrease the occurrence rate of postoperative PF in patients undergoing pancreaticoduodenectomy. (C) 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

BACKGROUND: Perioperative blood transfusion may be associated with negative clinical outcomes in oncological surgery. A meta-analysis of published studies was conducted to evaluate the impact of blood transfusion on short-and long-term outcomes following liver resection of colorectal liver metastasis (CLM). MATERIALS AND METHODS: A systematic search was performed to identify relevant articles. Data were pooled for meta-analysis using Review Manager version 5.3.RESULTS: Twenty-five observational studies containing 10621 patients were subjected to the analysis. Compared with non-transfused patients, transfused patients experienced higher overall morbidity (odds ratio [OR], 1.98; 95% confidence intervals [CI] = 1.49-2.33), more major complications (OR, 2.12; 95% CI = 1.26-3.58), higher mortality (OR, 4.13; 95% CI = 1.96-8.72), and longer length of hospital stay (weighted mean difference, 4.43; 95% CI = 1.15-7.69). Transfusion was associated with reduced overall survival (risk ratio [RR], 1.24, 95% CI = 1.11-1.38) and disease-free survival (RR, 1.38, 95% CI= 1.23-1.56).CONCLUSION: Perioperative blood transfusion has a detrimental impact on the clinical outcomes of patients undergoing CLM resection.

Background: The beneficial effect of surgical resection for hepatic metastasis from gastric cancer (HMGC) remains elusive. This study was conducted to analyze surgical outcomes of HMGC and determine the prognostic factors associated with survival.Results: The in-hospital mortality rate was zero, and the overall morbidity rate was 56%. The overall 1-, 3-, and 5-year survival rate after surgery was 87.5%, 47.6%, and 21.7%, respectively, with a median survival time of 34.0 months. Multiple liver metastases (hazard ratio [HR] = 1.998; 95% confidence interval [CI] = 1.248-3.198; P = 0.004) and >= T3 stage of the primary gastric cancer (HR = 2.065; 95% CI = 1.201-3.549; P = 0.009) were independent prognostic determinants in the multivariate analysis.Materials and Methods: Data on surgical resection of 96 patients with HMGC at six institutions in China were analysed retrospectively. Prognostic factors were assessed by multiple stepwise regression analysis using the Cox model.Conclusions: Surgical resection for HMGC is feasible and beneficial to long-term survival in selected patients.

目的 总结结肠冗长症合并结直肠癌的临床病理特征,并文献复习结肠冗长症与结直肠癌的关系.方法 回顾性分析兰州大学第一医院普外一科2011年1月至2012年12月期间收治的17例结肠冗长症合并结直肠癌患者的临床资料.结果 184例结直肠癌患者中合并结肠冗长症17例(9.24％),合并家族性息肉病恶变2例(1.09％),合并遗传性非息肉病性结直肠癌l例(0.54％),合并炎症性肠病1例(0.54％).合并结肠冗长症的比例较高(P＜0.05).其中术前经结肠气钡灌肠检查诊断为结肠冗长症5例,术中诊断为结肠冗长症12例.所有患者均行手术治疗,切除结肠13～80 cm,平均33.8 cm.术后发生肺部感染、切口液化1例,腹水1例,肠瘘1例,骶前感染1例.术后17例患者均获随访,随访时间6～12个月,中位数为10个月.随访期间,1例患者于术后1年出现卵巢转移.结论 结肠冗长症合并顽固性便秘可能是结直肠癌发病的高危因素.

目的 探讨消脓汤联合抗生素治疗术后腹腔残余感染的临床效果.方法 选取兰州大学第一医院2011年1月至2012年12月收治的术后腹腔残余感染患者60例作为研究对象,按随机数字表法随机分为联合消脓汤组(n=30)和单纯抗生素组(n=30).联合消脓汤组给予抗生素(头孢哌酮钠他唑巴坦钠)联合消脓汤治疗,单纯抗生素组单纯应用抗生素治疗.观察并比较治疗后两组患者血象复常时间、体温恢复正常时间,腹痛消失时间、脓肿消失时间,患者住院时间及疗效.结果 与单纯抗生素组相比,联合消脓汤组患者血象复常时间、体温复常时间、腹痛消失时间、脓肿消失时间及住院时间均显著缩短(t=16.331,4.739,10.756,6.224,5.464,P＜0.05);联合消脓汤组临床疗效显著优于单纯抗生素组(z =3.554,P＜0.05).结论 抗生素联合消脓汤治疗术后腹腔残余感染较单纯应用抗生素治疗更有效.

Objective To systematically review the effectiveness and safety of alanyl-glutamine dipeptide for severe acute pancreatitis(SAP).Methods Such databases as MEDLINE,EMbase,CENTRAL,VIP,WanFang Data,CBM and CNKI were electronically searched from inception to October,2012 for randomized controlled trials on alanyl-glutamine dipeptide for SAP.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality.hen,meta-analysis was performed using RevMan 5.2.Results Five trials were included involving a total of 227 patients.he results of meta-analysis showed that: compared with the control group,the alanyl-glutamine dipeptide group had the lower incidence of SAP complications(RR=0.41,95%CI 0.20 to 0.82),the lower incidence of infected pancreatic necrosis(RR=0.12,95%CI 0.02 to 0.89),less time for alleviating bellyache(MD= –0.90,95%CI –1.72 to –0.08).here was a tendency in decreasing SAP mortality(RR=0.15,95%CI 0.02 to 1.19) and lessening the recovery time of blood amylase(SMD=0.37,95%CI –0.04 to 0.79).Conclusion Current evidence shows that,alanyl-glutamine dipeptide can lower the incidence of complications and the incidence of infected pancreatic necrosis,and shorten the time for alleviating bellyache in SAP patients.Due to the limited quality of the included studies,the above conclusion needs to be veriied by more high quality studies.

AIM:To assess the impact of preoperative neoadjuvant bevacizumab (Bev) on the outcome of patients undergoing resection for colorectal liver metastases (CLM).METHODS:Eligible trials were identified from Medline, Embase, Ovid, and the Cochrane database. The data were analyzed with fixed-effects or random-effects models using Review Manager version 5.0.RESULTS:Thirteen nonrandomized studies with a total of 1431 participants were suitable for meta-analysis. There was no difference in overall morbidity and severe complications between the Bev + group and Bev - group (43.3% vs 36.8%, P = 0.06; 17.1% vs 11.4%, P = 0.07, respectively). Bev-related complications including wound and thromboembolic/bleeding events were also similar in the Bev + and Bev - groups (14.4% vs 8.1%, P = 0.21; 4.1% vs 3.8%, P = 0.98, respectively). The incidence and severity of sinusoidal dilation were lower in patients treated with Bev than in patients treated without Bev (43.3% vs 63.7%, P < 0.001; 16.8% vs 46.5%, P < 0.00, respectively).CONCLUSION:Bev can be safely administered before hepatic resection in patients with CLM, and has a protective effect against hepatic injury in patients treated with oxaliplatin chemotherapy.

目的:探讨重症急性胰腺炎患者并发腹腔感染的抗感染治疗药学监护内容和模式。方法:结合重症急性胰腺炎治疗原则及并发症处理原则,分析治疗方案,为1例重症急性胰腺炎并发腹腔感染的患者制订个体化的药学监护计划并实施全程药学监护。结果:从初始预防感染、经验性及目标性治疗方案的制定、抗感染治疗停药时机的制定以及通过药学监护避免了可能发生的严重不良反应。结论:对重症急性胰腺炎并发腹腔感染患者实施药学监护,可优化抗感染治疗方案,在感染控制后及时停药,并且通过及时发现可能存在的药物相互作用而避免了严重后果的出现,提高了药物治疗的安全性和有效性。

Objective To evaluate the efficacy and safety of intraoperative mesenchymal chemotherapy with 5-FU implants in radical gastrectomy of advanced gastric cancer.Methods From January 2008 to September 2009,102 patients with historically proven advanced gastric cancer were enrolled in our department and were allocated to undergo either radical gastrectomy and intraoperative mesenchymal chemotherapy with 5-FU implants 800 mg(treatment group,n=51),or radical gastrectomy alone(control group,n=51).The postoperative complications and recurrence rate between two groups were compared.Results There were no significant differences on the volume of abdominal cavity drainage,count of white blood cells,albumin level,and gastrointestinal adverse events between the two groups(P > 0.05).After a median follow-up of 28 months,the local recurrence rate was lower among patients in treatment group than that in control group(16.3% vs.39.1%,P < 0.05),the survival rate of 3-year was higher in treatment group than that in control group(85.8% vs.67.3%,P<0.05).Conclusions Compared with the control group,there are no significant adverse reactions on patients with advanced gastric cancer who were implanted fluorouraci1 implants during operation,which can reduce local recurrence rates and improve the survival rates.

OBJECTIVE: To evaluate the efficacy and safety of domestic meropenem in the prevention of abdominal infection in patients with severe acute pancreatitis. METHODS: Randomized double-blind controlled trails were adopted. Patients with severe acute pancreatitis were randomly divided into trial group and control group. Trial group received domestic meropenem 500 mg t.i.d. for 7～14 days, and control group received imported imipenem/cilastatin 500 mg t.i.d. for 7～14 days. Their vital signs, APACHEⅡ score, blood routine, liver function and renal function, as well as objective signs such as nausea, vomiting, abdominal pain and distension were recorded. The mortality and incidence ofinfection were analyzed statistically. RESULTS: 28 patients of trial group and control group were enrolled respectively. 27 patients of trial group and 25 patients of control group could receive curative effect evaluation, and 25 patients in each group could receive safety evaluation. The incidences of abdominal infection in trial group and control group were 14.8% and 16.0% respectively (P0.05). The incidences of adverse drug reaction in trial group and control group were 20.0% and 24.0% respectively (P0.05). CONCLUSION: Domestic meropenem has the same effect as imported imipenem/cilastatin in the prophylactic antibiotics treatment of severe acute pancreatitis.

探讨了腹腔镜辅助下左半结肠癌根治术的临床疗效.分析了兰州大学第一医院自2008年1月至2010年12月收治的54例左半结肠癌患者随机分为观察组(腹腔镜治疗组)和对照组(开腹手术治疗组)各27例,比较两组患者的手术治疗效果.54例患者手术均成功,对所有患者行15个月随访,腹腔镜组存活率为96.29％ (26/27),开腹手术组存活率为92.59％ (25/27),两组比较差异不大(P＞0.05)；两组患者的手术时间、出血量、肠功能恢复时间、下床活动时间比较差异明显(P＜0.05).腹腔镜下左半结肠癌根治术作为治疗降结肠及乙状结肠癌的方法具有手术创伤小、患者恢复快、并发症少的优点.

<正>患者男,69岁,因"右上腹胀痛伴呕吐1个月余"于2011年5月31日入院。入院查体:皮肤巩膜无黄染,全身浅表淋巴结无肿大;肝脏肋下未触及,剑突下4cm,质地软,无结节感,胆囊可触及,有压痛。超声示:肝右叶可探及一大小约170mm×60mm的异常回声包块,以中等回声为著,并可见不均匀分布的无回声区,边界清,似有包膜,形态不规则,其内可见血流信号。CT(图1)示:胆囊窝及肝下极腹腔内占位性病变,考虑:(1)胆囊癌;(2)胆囊多发结石。肝右叶及肝下包块穿刺病理活检:低分化腺癌。实验室检查:甲胎蛋白(AFP)199.30ng/ml,癌胚抗原(CEA)70.40ng/ml,肝功能指标正常。