Background The clinical profiles of recurrent retroperitoneal liposarcoma (RLS) need to be explored. The recurrence patterns of RLS are controversial and ambiguous. Methods A total of 138 patients with recurrent RLS were finally recruited in the study. The analysis of overall survival (OS) and recurrence-free survival (RFS) was performed by Kaplan‒Meier analysis. To identify independent prognostic factors, all significant variables on univariate Cox regression analysis ( P ≤ 0.05) were subjected to multivariate Cox regression analysis. The corresponding nomogram model was further built to predict the survival status of patients. Results Among patients, the 1-, 3-, and 5-year OS rates were 70.7%, 35.9% and 30.9%, respectively. The 1-, 3- and 5-year RFS rates of the 55 patients who underwent R0 resection were 76.1%, 50.8% and 34.4%, respectively. The multivariate analysis revealed that resection method, tumor size, status of pathological differentiation, pathological subtypes and recurrence pattern were independent risk factors for OS or RFS. Patients with distant recurrence (DR) pattern usually had multifocal tumors (90.5% vs. 74.7%, P < 0.05); they were prone to experience changes of pathological differentiation (69.9% vs. 33.3%, P < 0.05) and had a better prognosis than those with local recurrence (LR) pattern. R0 resection and combined organ resection favored the survival of patients with DR pattern in some cases. Conclusions Patients with DR pattern had better prognosis, and they may benefit more from aggressive combined resection than those with LR pattern. Classifying the recurrence patterns of RLS provides guidance for individualized clinical management of recurrent RLS.

Background Immune checkpoint inhibitors (ICIs) have shown promising prospects in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma (GC/GEJC) immunotherapy, but their efficacy in neoadjuvant settings remains unclear. This study aimed to assess the efficacy and safety of integrating programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors into neoadjuvant chemotherapy (NACT) of GC/GEJC treatment. Methods PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and main oncology conference databases were systematically searched up to 19 November 2022, and randomized controlled trials (RCTs) and cohort studies that evaluated the efficacy and safety of PD-1/PD-L1 inhibitors plus NACT were included. The main outcomes were pathological complete response (pCR), major pathological response (MPR), R0 resection rate, and treatment-related adverse events (TRAEs). Results A total of 753 patients from 20 prospective studies were included in this meta-analysis. The pooled pCR and MPR rates from studies reporting were 21.7% [95% confidence interval (CI), 18.1%–25.5%] and 44.0% (95% CI, 34.1%–53.8%), respectively. The pooled incidence rate of total TRAEs was 89.1% (95% CI, 82.7%–94.3%), and the incidence rate of grade 3 to 4 TRAEs was 34.4% (95% CI, 17.8%–66.5%). The pooled R0 resection rate was reported to be 98.9% (95% CI, 97.0%–99.9%). Subgroup analysis has not found significant differences in efficacy and safety among different PD-1/PD-L1 inhibitors. Moreover, the efficacy in patients with positive PD-L1 expression (combined positive score ≥1) was comparable with that in the entire study population [pCR, 22.5% vs. 21.2% (p > 0.05); MPR, 48.6% vs. 43.7% (p > 0.05)]. Conclusion This systematic review and meta-analysis found that PD-1/PD-L1 inhibitors combined with NACT for locally advanced GC/GEJC were well tolerated and may confer therapeutic advantages. The integration of ICIs into NACT has shown the potential for application in any PD-L1 expression population.

BackgroundRetroperitoneal liposarcoma (RLS) is a rare but severe disease. Repeated postoperative recurrence with multiple tumors is a therapeutic dilemma. The clinical outcomes and survival predictors of recurrent RLS with multiple tumors remain to be explored.MethodsPatients with recurrent RLS were retrospectively analyzed. Univariate and multivariate analysis was performed to find independent prognostic factors that were correlated with Overall survival (OS) or progression-free survival (PFS). Factors significant in univariate analysis were further included into multivariate Cox proportional hazards regression model. The nomogram model was built to predict the survival status of patients. Variables that were significant in multivariable analysis were added to the internally validated nomogram models. The analysis of OS and PFS was performed by Kaplan–Meier analysis and log-rank test.ResultsA total of 113 recurrent RLS patients with multiple tumors were enrolled in the study. The 1-, 3-, and 5-years OS (PFS) rates were 70.7% (76.1%), 35.9% (76.1%), and 30.9% (76.1%), respectively. Univariate and multivariate analyses showed that number of surgeries, resection methods, tumor size, status of pathological differentiation, pathological subtypes, and recurrence patterns were important prognostic factors for OS or PFS (each p < 0.05). Nomogram models were established to efficiently predict the prognostic status of patients. Patients with the local recurrence (LR) pattern had a poor prognosis and would derive no survival benefit from combined organ resection and R0/R1 resection (each p < 0.05).ConclusionRLS patients recurrence with multiple tumors had a poor prognosis. Those patients should be followed up more frequently after surgery. The strategies of aggressive resection may not improve the survival of patients with LR pattern in the retroperitoneum. Prognostic factors in the efficient nomogram models should be considered in the individualized clinical management of recurrent RLS with multiple tumors.

Objective:To analyze the perioperative clinical characteristics of patients with blunt abdominal trauma and open trauma，and to compare the differences during the clinical treatment process.Methods:A retrospective analysis method was used to collect clinical data of 87 patients with abdominal trauma between January 2011 and December 2017. Patients were divided into blunt trauma group（n=41 cases）and open trauma group（n=46 cases）according to whether there were open abdominal wounds. Statistical software SPSS26.0 was used for data analysis. Measurement data of normal distribution was expressed as（xˉ±s），and t-test was used for comparison between groups. Non-normally distribution quantitative data are showed by the median（interquartile range IQR），and the rank sum test was used for comparison between groups. P<0.05 was considered as statistically significant difference.Results:Among the injury factors，the main cause of injury in the blunt group was car accident injury，accounting for 46.3%，and the main cause of injury in the open group was knife stabbing，accounting for 56.5%. Multiple injuries were 58.5% in the blunt group and 23.9% in the open group，respectively. Compared with the open group，the ratio of neutrophils to lymphocytes before operation（3.31 vs. 2.35），hospitalization time（12 d vs.9 d），intraoperative blood loss（650 ml vs. 400 ml），and grade Ⅱ wound healing（34 cases vs. 28 cases），intraoperative blood transfusion（38 cases vs. 33 cases），intestinal-abdominal wall fistula（25 cases vs. 37 cases），postoperative complications ≤grade Ⅱ（23 cases vs. 36 cases），the differences were statistically significant（P<0.05）.Conclusion:Blunt abdominal trauma and open trauma have different clinical characteristics. In general，patients with blunt trauma are more severely injury，difficult to surgery，more serious postoperative complications，and more complicated during perioperative management. The diagnosis and treatment strategy of blunt trauma should be prepared differently.

Objective:To analyze the short-term outcomes between open and robotic gastrectomy for elderly gastric cancer patients and explore the independent factors which influenced postoperative complications after gastrectomy.Methods:A retrospective study was conducted. We collected clinical data of 161 elder patients (Age over 70 years) undergoing open or robotic gastrectomy in the department of general surgery, Chinese PLA General Hospital First Medical Center between May 2017 and May 2021 were collected. The characteristics of clinicopathological datas between two groups were not significantly different(P>0.05).Results:The operative time was significantly longer in the robotic group compared to the open group [(242.92±55.12) min vs. (170.37±43.15)min, P<0.001]. Although intraoperative bleeding was comparable between the robotic and open groups [100 ml (100-200) ml vs. 100 ml (10-200) ml, P=0.102], the proportion of bleeding ≥400 ml was significantly lower in the robotic group compared with the open group(4.8% vs. 15.4%), with a statistically significant difference (P=0.025). The difference between the robotic and open groups were not statistically significant in the aspect of the number of retrieved lymph nodes [(24.51±9.51) vs. (24.28±9.36), P=0.881], postoperative hospital stay [10.0 d (9.0-12.0) d vs. 9.1 d (8.6-11.0) d, P=0.094], 30 days postoperative complication rate (25.3% vs. 26.9%, P=0.815), severe complication rate (8.4% vs. 3.8%, P=0.228), anastomotic leakage rate (2.4% vs. 5.1%, P=0.363), and 30 days postoperative mortality (2.4% vs. 1.3%, P=0.597). Univariate and multifactorial analyses showed that age ≥80 years was an independent risk factor for postoperative complications in elderly patients with gastric cancer.Conclusions:Elderly patients who accepted robotic gastrectomy are safe and feasible. Over 80 years old is the independent risk factor of the postoperative complications after gastrectomy which needs to evaluate the surgical risk sufficiently.

Objective: To examine the influence factors of short-term recurrence after complete surgical resection of retroperitoneal liposarcoma. Methods: The clinicopathological data of retroperitoneal liposarcoma at Department of General Surgery, the First Medical Center, People's Liberation Army General Hospital from January 2000 to January 2020 were retrospectively analyzed. There were 60 males and 31 females, aged (52.1±9.9) years (range: 30 to 84 years). Tumor recurrence within 12 months after complete resection was defined as short-term recurrence, and tumor recurrence more than 12 months was defined as non-short-term recurrence. The t test, rank-sum test, χ2 test and Fisher exact test were conducted for inter-group comparison. Logistic regression analysis was used to analyze the independent influence factors for the short-term recurrence of retroperitoneal liposarcoma after complete resection. The Kaplan-Meier curve was used to calculate the recurrence-free survival, and the Log-rank test was adopted for the comparison between the groups. Results: The univariate analysis results showed that irregular tumor morphology, multiple pathological subtypes, pathological scores>3, and multiple primary tumors are influence factors for short-term recurrence after complete resection of retroperitoneal liposarcoma (χ2: 4.422 to 7.773, all P<0.05). Regression analysis of the above risk factors showed that multiple primary tumors was the independent risk factor (OR=2.918, 95%CI: 1.127 to 7.556, P=0.027). In the short-term recurrence group, Kaplan-Meier curve analysis showed that patients with multiple primary tumors had a shorter median recurrence time than patients with unifocal tumor (6 months vs. 9 months, P=0.028). Conclusions: Multiple primary tumor is an independent risk factor for short-term recurrence after complete resection of retroperitoneal liposarcoma. It suggests that the frequency of follow-up after surgery should be increased for such patients.

Objective: To explore the independent risk factors of lymph node metastasis (LNM) in early gastric cancer, and to use nomogram to construct a prediction model for above LNM. Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) primary early gastric cancer as stage pT1 confirmed by postoperative pathology; (2) complete clinicopathological data. Exclusion criteria: (1) patients with advanced gastric cancer, stump gastric cancer or history of gastrectomy; (2) early gastric cancer patients confirmed by pathology after neoadjuvant chemotherapy; (3) other types of gastric tumors, such as lymphoma, neuroendocrine tumor, stromal tumor, etc.; (4) primary tumors of other organs with gastric metastasis. According to the above criteria, 1633 patients with early gastric cancer who underwent radical gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital First Medical Center from December 2005 to December 2020 were enrolled as training set, meanwhile 239 patients with early gastric cancer who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital Fourth Medical Center from December 2015 to December 2020 were enrolled as external validation set. Risk factors of LNM in early gastric cancer were identified by using univariate and multivariate logistic regression analyses. A nomogram prediction model was established with significant factors screened by multivariate analysis. Area under the receiver operating characteristic curve (AUC) was used for assessing the predictive value of the model. Calibration curve was drawn for external validation. Results: Among 1633 patients in training set, the mean number of retrieved lymph nodes was 20 (13-28), and 209 patients (12.8%) had lymph node metastasis. Univariate analysis showed that gender, resection range, tumor location, tumor morphology, lymph node clearance, vascular invasion, lymphatic cancer thrombus, tumor length, tumor differentiation, microscopic presence of signet ring cells and depth of tumor invasion were associated with LNM (all P<0.05). Multivariate analysis revealed that females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa, and poor differentiation were independent risk factors for LNM in early gastric cancers (all P<0.05). Receiver operating characteristic curve indicated that AUC of training set was 0.818 (95%CI: 0.790-0.847) and AUC of external validation set was 0.765 (95%CI: 0.688-0.843). The calibration curve showed that the LNM probability predicted by nomogram was consistent with the actual situation (C-index: 0.818 in training set and 0.765 in external validation set). Conclusions: Females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa and poor differentiation are independent risk factors for LNM of early gastric cancer. The establishment of a nomogram prediction model for LNM in early gastric cancer has great diagnostic value and can provide reference for treatment selection.

目的:探讨新辅助化疗后机器人胃癌根治术后近期并发症的相关危险因素,以期为有效预防术后并发症拓展思路.方法:回顾收集2012年11月至2020年10月行新辅助化疗后机器人胃癌根治术的89例胃癌患者的临床资料与病理资料.并发症分级按照Clavien-Dindo系统进行评价.采用二元logistic回归分析影响新辅助化疗后机器人胃癌根治术术后并发症的危险因素,将单因素分析中P<0.2的影响因素纳入多因素logistic回归分析.总体生存及无进展生存采用Kaplan-Meier法分析并绘制生存曲线,组间比较采用log-rank检验.结果:89例患者被纳入该项研究,26例(29.2％)于术后30 d内出现Clavien-Dindo分级≥Ⅱ级的术后并发症;8例(9.0％)出现严重并发症(Clavien-Dindo分级≥Ⅲa级),分别为3例吻合口漏、1例腹腔出血、3例呼吸功能障碍、1例因肺炎围手术期死亡.多因素分析结果显示,手术时间>280 min(OR=3.409,95％CI:1.144-10.163,P=0.028)与存在腹部手术史(OR=4.888,95％CI:1.265-18.888,P=0.021)是影响患者术后并发症发生的独立危险因素.术后有并发症与无并发症患者的3年总体生存率分别为52.4％与59.4％,差异无统计学意义(P=0.355);3年无病生存率分别为38.6％与57.4％,差异亦无统计学意义(P=0.400).结论:新辅助化疗后机器人胃癌根治术操作安全、可行,对于有腹部手术史、手术时间>280 min的患者,新辅助化疗后应谨慎选择机器人胃癌根治术.

BACKGROUND:Neoadjuvant chemotherapy (NACT) combined with surgery is regarded as an effective treatment for advanced gastric cancer (AGC). Laparoscopic surgery represents the mainstream of minimally invasive surgery. Currently, surgeons focus more on surgical safety and oncological outcomes of laparoscopic gastrectomy after NACT. Thus, we sought to evaluate short- and long-term outcomes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) after NACT.AIM:To compare the short and long-term outcomes between LTG and OTG for AGC after NACT.METHODS:We retrospectively collected the clinicopathological data of 136 patients who accepted gastrectomy after NACT from June 2012 to June 2019, including 61 patients who underwent LTG and 75 who underwent OTG. Clinicopathological characteristics between the LTG and OTG groups showed no significant difference. SPSS 26.0, R software, and GraphPad PRISM 8.0 were used to perform statistical analyses.RESULTS:Of the 136 patients included, eight acquired pathological complete response, and the objective response rate was 47.8% (65/136). The LTG group had longer operation time (P = 0.015), less blood loss (P = 0.003), shorter days to first flatus (P < 0.001), and shorter postoperative hospitalization days (P < 0.001). LTG spent more surgical cost than OTG (P < 0.001), while total hospitalized cost of LTG was less than OTG (P < 0.001). 21 (28.0%) patients in the OTG group and 14 (23.0%) in the LTG group had 30-d postoperative complications, but there was no significant difference between the two groups (P = 0.503). The 3-year overall survival (OS) rate was 60.6% and 64.6% in the LTG and OTG groups, respectively [hazard ratio (HR) = 0.859, 95% confidence interval (CI): 0.522-1.412, P = 0.546], while the 3-year disease-free survival (DFS) rate was 54.5% and 51.8% in the LTG and OTG group, respectively (HR = 0.947, 95%CI: 0.582-1.539, P = 0.823). Multivariate cox analysis showed that body mass index and pTNM stage were independent risk factors for OS while vascular invasion and pTNM stage were independent risk factors for DFS (P < 0.05).CONCLUSION:After NACT, LTG shows comparable 30-d postoperative morbidity as well as 3-year OS and DFS rate to OTG. We recommend that experienced surgeons select LTG other than OTG for proper AGC patients after NACT.

腹膜后肿瘤的解剖结构复杂、手术切除范围广,因此其手术并发症通常较严重.并发症的管理对于患者术后的恢复、住院花费、生存率等具有重要影响.目前关于腹膜后肿瘤外科手术治疗并发症的系统性研究鲜有报道,为预防和减少腹膜后肿瘤手术并发症的发生,提高手术疗效,本文以回顾文献的方式,就腹膜后肿瘤手术并发症的发生情况及防治策略进行综述.

背景 高龄是胃癌术后近期并发症的独立危险因素.近年来,微创胃癌手术已成为高龄胃癌患者的手术方式,但目前对于高龄患者微创胃癌根治术术后并发症影响因素的研究相对较少.目的 分析高龄胃癌患者微创胃癌根治术术后近期并发症及影响因素.方法 采用回顾性研究,收集2017年4月-2021年4月492例于解放军总医院第一医学中心普通外科医学部行微创胃癌根治术且年龄≥70岁患者(包括2D腹腔镜、3D腹腔镜及机器人手术)的临床病历资料,通过单因素及多因素分析探究影响术后30 d并发症的独立危险因素.结果 492例中103例(20.9％)出现Clavien-Dindo分级≥Ⅱ级的术后并发症;24例出现Clavien-Dindo分级≥Ⅲa级的并发症,严重并发症发生率为4.9％;2例围术期死亡(1例腹腔出血,1例肺栓塞),围术期死亡率0.4％.单因素分析结果显示,脉管侵犯、年龄≥80岁、术中出血量≥200 mL与高龄胃癌患者微创胃癌根治术术后30 d内并发症相关(P均<0.05),微创手术方式(腹腔镜、3D腹腔镜或机器人)与术后并发症无明显相关性(P=0.096).多因素logistic分析结果显示,脉管侵犯(OR=1.985;95％CI:1.267～3.110;P=0.003)、术中出血量≥200 mL(OR=2.120;95％CI:1.193～3.769,P=0.010)与高龄胃癌患者微创胃癌根治术术后30 d内并发症独立相关.结论 高龄胃癌患者行微创胃癌根治术安全可行,近期疗效确切.脉管侵犯、术中出血量≥200 mL与高龄胃癌患者微创胃癌根治术术后30 d内并发症独立关联,应对此类患者加以重视,术前充分评估以降低并发症发生率.

Background This study aimed to classify relapsed retroperitoneal liposarcoma (RLS) as new primary (NP) or true recurrence (TR) and to assess the implications for therapeutic management of these classifications. Methods Patients with recurrent RLS were classified as NP if the relapse was different from the former tumor’s pathology subtype and anatomical location. Kaplan-Meier curves were adapted to estimate relapse-free survival (RFS), and logistic regression analysis was used to explore the factors related to NP.Results Total 177 patients with relapsed RLS were included in this study. The median tumor sizes were 16 cm (IQR, 13-22 cm, NP) and 18 cm (IQR, 12-25 cm, TR) (P=0.003). Multifocal tumors (89.2% vs 73.8%, P=0.011) and multiple pathology subtypes (52.7% vs 31.1%, P=0.004) were more common in the NP group and tended to invade wider anatomical areas (85.1% vs 71.8%, P=0.037). The median RFS was 17 months (IQR, 7-35 months) in the NP group and 12 months (IQR, 5-23 months) in the TR group, and NP patients showed a longer RFS than TR patients (P=0.004). When the log-rank test was conducted, low-grade pathology, tumor growth rate ≤ 1.25 cm/month and tumor size ≤ 16.5 cm had a significant influence on the NP phenomenon (P=0.015, 0.019, and 0.028, respectively). Logistic regression analysis illustrated that current surgeries, pathology subtype varieties and pathology grade were independent risk factors for NP (P=0.017, 0.019, and 0.025, respectively).Conclusion NP patients have longer RFS than TR patients, and their tumors tend to have multiple pathology subtypes and tumors and are more likely to invade wider anatomical areas. This classification contributes to a better understanding of RLS and provides new evidence for different therapeutic management of relapsed tumors.

背景 胃癌是一种十分常见的肿瘤,由于缺乏早期诊断的分子标志,多数胃癌发现时已是中晚期.因此,亟需探索更加有效的预测和治疗靶点以改善胃癌患者的病情.目的 探讨敲低长链非编码RNA CCAT2(long non-coding RNA CCAT2,lncRNA CCAT2)对胃癌细胞糖酵解水平以及细胞增殖能力的影响.方法 采用siRNA敲低胃癌细胞系BGC-823、HGC-27内lncRNA CCAT2的表达水平,酶标比色法检测乳酸、ATP、丙酮酸含量以及葡萄糖摄取速度,Western blot检测糖酵解相关蛋白的表达水平.CCK-8和EdU(5-ethynyl-2-deoxyuridine)实验检测胃癌细胞的增殖能力.结果 靶向lncRNA CCAT2的siRNA成功转染进入BGC-823、HGC-27胃癌细胞系并敲低lncRNA CCAT2表达水平,ATP、乳酸、丙酮酸含量以及葡萄糖摄取速度均明显下降(P<0.05).Western blot检测结果显示,葡萄糖转运蛋白1、己糖激酶2、磷酸甘油酸变位酶1、乳酸脱氢酶ɑ的表达水平均明显下调(P<0.05).CCK-8和EdU实验结果显示,敲低lncRNA CCAT2后胃癌细胞的增殖能力受到明显抑制(P<0.05).结论 lncRNA CCAT2是胃癌细胞糖代谢重编程的调节靶点,敲低CCAT2可以抑制其糖酵解水平和细胞增殖能力.

Objective:To analyze the short-term outcomes and factors influencing the postoperative complications of elder patients with gastric cancer under robotic gastrectomy.Methods:Clinical data of 167 elder patients undergoing robotic gastrectomy in the department of general surgery, Chinese PLA General Hospital First Medical Center between Apr. 2016 and Apr. 2021 were retrospectively analyzed. We used univariate and multivariate analysis to find the factors affecting the 30-days postoperative complications.Results:49 of 167 patients (29.3%) had Clavien-Dindo classification ≥ grade Ⅱ postoperative complications. 14 patients(8.4%) had Clavien-Dindo classification ≥ grade Ⅲa complications. Univariate analysis showed that vascular invasion, intraoperative blood loss ≥400 ml, NRS2002 score ≥3, BMI(body mass index)≥25 kg/m2 and aCCI(age-adjusted charlson comorbidity index)score≥4 were associated with the 30-day postoperative complications in elderly patients with gastric cancer under robotic gastrectomy (P< 0.05). Multivariate analysis showed that vascular invasion, intraoperative blood loss ≥400 ml, BMI≥25 kg/m2 and aCCI score≥4 were independent risk factors for 30-days postoperative complications in elderly patients with significant difference.Conclusions:Elderly patients who accepted robotic gastrectomy are safe and feasible. The independent risk factors for 30-days postoperative complications are vascular invasion, intraoperative blood loss ≥400 ml, BMI≥25 kg/m2 and aCCI score≥4. For patients with above risk factors, surgeons need to pay more attention to avoid complications by sufficient preoperative evaluation.