Background: Surgery with total gastrectomy and D2 lymph node dissection (LND) has been recommended as the standard treatment for patients with advanced upper and middle gastric carcinoma and/or Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG). However, whether the No. 10 lymph node (No. 10 LN, also known as splenic hilar LN) should be dissected in total gastrectomy remains controversial. We aimed to evaluate whether the No. 10 LND with spleen preservation has survival benefit for patients with gastric cancer and/or AEG who underwent the total gastrectomy. Methods: The PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and American Society of Clinical Oncology.org (ASCO.org) were electronically searched to identify eligible studies. The primary outcome was the survival rate, and secondary outcomes included the disease-free survival (DFS) rate and side effects. The Review Manager 5.3.5 software was used for the meta-analysis. The odds ratio (OR) and mean difference with 95% confidence interval (CI) were calculated. The statistical heterogeneity was assessed using chi-square (chi(2)) and I-2 tests. Results: Eight studies enrolling a total of 4,131 patients were eligible for our review. The meta-analysis results demonstrated that the No. 10 LND group was significantly better than the non-No. 10 LND group in terms of the 3- (OR =0.71, 95% CI: 0.62-0.81, P<0.00001) and the 5-year (OR =0.66, 95% CI: 0.58-0.75, P<0.00001) survival rates but not in the 1-year survival rate (OR =0.91, 95% CI: 0.75-1.11, P=0.36). The DFS rates in the No. 10 LND group were significantly increased after 1 (OR =0.76, 95% CI: 0.61-0.93, P=0.008), 3 (OR =0.69, 95% CI: 0.60-0.81, P<0.00001), and 5 (OR =0.66, 95% CI: 0.56-0.76, P<0.00001) years compared with those in the non-No. 10 LND group. Discussion: Evidence shows that the No. 10 LND with spleen preservation can improve the survival and the DFS rates for patients with gastric cancer and/or Siewert type II/III AEG who underwent the total gastrectomy. High-quality prospective trials are expected.

Pancreatic cancer is one of the most common malignant tumors in the world currently,the morbidity and mortality have increased year by year.Early diagnosis and treatment of pancreatic cancer is particularly important for improving patient survival.With the rapid development of minimally invasive techniques,the diagnosis and treatment of pancreatic cancer has also changed from the traditional way.Based on the experience of pancreatic cancer and the current research progress of pancreatic cancer.This article reviews the progress of diagnosis and treatment of pancreatic cancer in minimally invasive background.

Objective To discuss the value of fast track surgery(FTS)in perioperative period of laparoscopic colon resection. Methods We selected 200 cases of laparoscopic colon resection in our hospital from September 2013 to September 2015. The cases were randomly divided into either traditional group(control group)or fast track surgery group(FTS group),with 100 cases in each group.The time to flatus, time to defecation, time to intake semi-liquid diet, length of hospital stay, and postoperative complications were compared. Results As compared with the control group,the FTS group had shorter flatus time[(28.0 ±4.4) h vs.(40.9 ±5.4)h,t=-18.520,P=0.000],shorter defecation time[(38.8 ±5.3)h vs.(50.7 ±4.3)h,t=-17.436,P=0.000],shorter time to semi-liquid diet[(2.3 ±0.8)d vs.(4.2 ±0.7)d, t=-17.874, P=0.000], shorter postoperative hospital stay[(6.2 ±1.3)d vs.(9.2 ±1.6)d, t =-14.552, P=0.000], and lower incidence of postoperative pulmonary infection(6% vs.20%, χ2=8.665, P =0.003). Conclusion Fast track surgery combined with laparoscopy accelerates gastrointestinal functional recovery,being helpful for patient's postoperative recovery.

Objective To evaluate the feasibility and efficacy of head-medial approach in laparoscopic anterior resection of rectal carcinoma(Dixon)with preservation of the left colonic artery(LCA). Methods From April 2012 to March 2014,22 patients with rectal carcinoma(clinical stage Ⅰ,ⅡandⅢA)received laparoscopic Dixon surgery.The inferior mesenteric artery(IMA)and the branches were dissected through head-medial approach,from the ligament of Traitz,then the posterior space of descending colon, and to the posterior space of sigmoid colon.The lymph nodes and perivascular adipose tissue were dissected through the vasa vasorum approach.The LCA was retained by transecting the IMA inferior to the left colonic artery. Results The operation was successfully completed in all the 22 cases.The operative time ranged from 110 to 280 min, with a mean of 150 min.The mean intraoperative hemorrhage was 25 ml(range,10-75 ml).None of the patients had perforation of the rectum, injuries to blood vessel, ureter or adjacent organs,or anastomotic tension.The number of dissected lymph nodes surrounding the IMA ranged from 4 to 8,with a mean of 6.2.The postoperative pathological outcomes showed 5 cases of highly differentiated adenocarcinoma, 10 cases of moderately differentiated adenocarcinoma,and 7 cases of poorly differentiated adenocarcinoma.The dissected lymph nodes in the base of the IMA showed no cancer cell metastasis but there were 2 positive mesenteric lymph nodes.None of patients had anastomotic leakage.Follow-ups were conducted for 9-36 months with an average of 17.2 months in 22 cases, and no long-term postoperative complications and local recurrence occurred in all the cases. Conclusions Head-medial approach laparoscopic anterior resection of rectal carcinoma with preservation of the LCA is safe and feasible.This surgical approach preserves more supplying vessels and prevents anastomotic leakage without increasing the anastomotic tension or affecting lymph node dissection surrounding the IMA.

Laparoscopic pancreatic surgery is one of the most sophisticated and advanced applications of laparoscopy in the current surgical practice. The adoption of laparoscopic pancreaticoduodenectomy (LPD) has been relatively slow due to the technical challenges. The aim of this study is to review and characterize our successful LPD experiences in patients with distal bile duct carcinoma, periampullary adenocarcinoma, pancreas head cancer, and duodenal cancer and evaluate the clinical outcomes of LPD for its potential in oncologic surgery applications.We retrospectively analyzed the clinical data from 14 patients who underwent LPD from August 2013 to February 2015 in our institute.We presented our LPD experience with no cases converted to open surgery in all 14 cases, which included 10 cases of laparoscopic digestive tract reconstruction and 4 cases of open digestive tract reconstructions. There were no deaths during the perioperative period and no case of gastric emptying disorder or postoperative bleeding. The other clinical indexes were comparable to or better than open surgery.Based on our experience, LPD could be potentially safe and feasible for the treatment of early pancreas head cancer, distal bile duct carcinoma, periampullary adenocarcinoma, and duodenal cancer. The master of LPD procedure requires technical expertise but it can be accomplished with a short learning curve.

Background and objective: A systematic review was conducted to evaluate whether or not antiviral therapy with nucleotide/nucleoside analogs (NA) have survival benefit for patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative treatment.Methods: An electronic search of PubMed, EMBASE, and the Cochrane Library was performed to identify comparative studies in which the adjuvant effects of NA for patients with HBV-related HCC after curative treatment were evaluated. Primary outcome included survival rate, and secondary outcomes included tumor recurrence rate and side effects. Review Manager 5.1.6 software was used for meta-analysis.Results: Twelve studies involving 6682 patients were included in our review. Meta-analysis results demonstrated that significant differences favoring the antiviral treatment groups were observed in 1-year survival rate (RR: 0.65, 95% CI: 0.53-0.79, P < 0.0001), 3-year survival rate (RR: 0.58, 95% CI: 0.46-0.74, P < 0.0001), and 5-year survival rate (RR: 0.56, 95% CI: 0.43-0.74, P < 0.0001) compared with the control group. After NA was administered, recurrence was significantly reduced after one year (RR: 0.77, 95% CI: 0.64-0.93, P = 0.006) and three years (RR: 0.81, 95% CI: 0.71-0.93, P = 0.002) but not after five years (RR: 0.94, 95% CI: 0.76-1.16, P = 0.55) compared with non-NA therapy.Conclusion: Current evidence showed that antiviral therapy with NA could improve survival and reduce early recurrence for patients with HBV-related HCC after curative treatment. More high quality prospective trials are expected. (C) 2015 Elsevier Masson SAS. All rights reserved.