FACTORS AFFECTING REMOVAL AND PROGNOSIS OF THYMIC TUMORS

One hundred and ten cases of thymic tumors were intervened surgically, including 92 thymoma, 8 thymie earcinoid, and 10 thymic carcinoma. In this series, 50. 9 % of the cases were complicated with various syndromes, 44. 5 % with myasthenia gravis (MG). Resection rate was correlated with the size and invasion of the tumor. There was significant difference in resection rate among thymoma, thymic carcinoid and thymic carcinoma. The degree of invasiorl undoubtely influenced on resection. The 3-, 5- and 10- year suvival rate of the thymoma were 82. 7 %, 68. 1 % and 40. 0 %, respectively. The prognosis depended on the pathoioglcal classification and the severity of the neighbouring invasion, but MG had no sianificant effect on prognosis. Recurrence and metastasis of the tumor were the main cause of late death.     

Multimodality therapy including surgical resection for limited small cell lung cancer.

From 1975 through 1990, 199 patients with limited small cell lung cancer (LSCLC) were subjected to multimodality treatment including surgical resection combined with chemotherapy or chemoradiotherapy in our department. The median postoperative survival time of the 199 patients was 39 months, and the 5-year survival rate was 26%, which was decreased with increase of tumor-stage. In comparison of the survival time of patients in Stage Ⅰ and those in Stage Ⅲa, there was a significant difference (P<0.01). There were no significant differences in survival rate of 3 and 5 years between the patients receiving chemotherapy prior to or after surgical resection. The improvement in survival was documented by surgical resection combined with chemotherapy or chemoradiotherapy for LSCLC. The effect of multimodality treatment is correlated with tumor P-TNM staging, the involvement of lymph node, especially that of the mediastinal lymph node, is a negative factor influencing the prognosis. Surgical resection as an ini     

Apoxesis of primary tracheal tumor. A clinical analysis of 23 cases.

During a 17-year period, 23 patients with primary tracheal tumors underwent surgical treatment in the Department of Thoracic Surgery, PUMC Hospital (11 cases of benign tumor of the trachea, 12 cases of low malignancies). Fourteen times of apoxesis were performed in 11 patients with benign tumors who were followed up for an average of 6.3 years. Fifteen operations were performed in 12 cases including local resection of the tracheal wall and tumor in 4, and curettage of tumor plus electric cauterization on the basis in 10. Eight of 9 patients with adenoid cystic carcinoma received postoperative adjuvant irradiation, with a 5-year postoperative survival rate of 75% (6/8) and 3 cases survived over ten years. The desirability of apoxesis and local resection of tracheal tumor is discussed. The authors suggest that these two surgical patterns can be regarded as a simple and effective treatment for patients with primary tracheal tumors.

     

SURGICAL TREATMENT AND LATE RESULTS IN l,226 COLORECTAL CANCER CASES

1,226 cases of colorectal cancer were treated surgically between 1956-1978. 798 (65.09%) were rectal, 74.3% 0f which were located below the peritoneal reflection. Dukes C2 cases and cases with distant metastasis constituted 39.15To and Dukes' A cases 9.22%. Resectability rate was 75.1% (77.6% for rectal cancer). 32.96% of 619 cases of rectal excision had restorative resection. 84.8% 0f the combined excision for extraperi- toneal lesions in female patients were posterior pelvic exenteration. The overall operative mor- tality rate was 2.93%. Mortality rate of resec- tion was, 1.73(70 and that of rectal resection 0.8%。 and curative rectal resection 0.63%. Follow up rate was 94.13% The 5- and 10-year survival rates for rectal resection were 53.08To and 47.65%, for curative rectal resection 66.91To and 60.27To, and for Dukes' A cases 98.05% and 96.39%. The 5- and 10-year survival rates for colonic resec- tion were 59.79% and 52.18%, for curative colonic resection 72.79% and 62.06%, and for Dukes' A cases both 100%. Among factors affecting the- rapeutic results, local immunologic reaction of the host is also important, showing that the more lymphocytic infiltration in and around cancer, and the more follicular hyperplasia and sinus histiocytosis in regiona.l lymph nodes the better the prognosis. Anal preservation in radical re- section of rectal cancer and improving results in the treatment of extraperitoneal rectal cancer are discussed in detail.     

Anaplastic carcinoma of pancreas：report of 6 cases and literature review

Objective:To investigate clinicopathological features,diagnosis and treatment of anaplastic carcinoma of the pancreas and to review relevant literature on this entity. Methods..A retrospective clinical analysis was made in 6 cases of anaplastic pancreatic carcinomas admitted from 1989 to 2001. Results:Anaplastic pancreatic carcinoma was found in 5 men and 1 woman with a mean age of 61.5 years. Tumor location was in the head of the pancreas in 3 patients,body and tail in 3 cases. Tumors were surgically resected in all patients, by pancreaticoduodenectomy in 1, by pancreaticoduodenectomy combined resection and reconstruction of superior mesenteric vein (SMV) in 1, by pancreaticoduodenectomy combined resection and reconstruction of SMV and superior mesenteric artery (SMA) in 1,by distal pancreatectomy in 2,by distal pancreatectomy combined total gastrotectomy in 1. Liver metastasis was found in one patient. Follow-up suggested the prognosis was poor with a mean survival of 5.5 months after operation. All patients were dead with tumor recurrence and liver metastasis. Conclusion:Histologically,anaplastic pancreatic carcinoma is characterized by pleomorphic cell carcinoma consisting of pleomorphic giant/small cells and spindle cells,or osteoclast-like giant cell tumor composed of pleomorphic small cells,or pleomorphic giant cell carcinoma with osteoclastoid giant cells,and demonstrates aggressive biological behavior. Invasions to adjoined organ and metastasis are usual. The prognosis of this tumor appears to be very poor.     

Effect of multiple-phase regional intra-arterial infusion chemotherapy on patients with resectable pancreatic head adenocarcinoma

Background Regional intra-arterial infusion chemotherapy （RIAC） has been more valuable to improve prognosis and quality of life of patients with inoperable pancreatic adenocarcinomas, and adjuvant RIAC plays an important role in prolonging survival and reducing risk of liver metastasis after radical resection of pancreatic cancer, but the effect of preoperative or multiple-phase RIAC （preoperative combined with postoperative RIAC） for resectable pancreatic cancers has not been investigated. In this prospective study, the effect of multiple-phase RIAC for patients with resectable pancreatic head adenocarcinoma was evaluated, and its safety and validity comparing with postoperative RIAC were also assessed. Methods Patients with resectable pancreatic head cancer were randomly assigned to two groups. Patients in group A （n=-50） were treated with new therapeutic mode of extended pancreaticoduodenectomy combined with multiple-phase RIAC, and those in group B （n=-50） were treated with extended pancreaticoduodenectomy combined with postoperative RIAC in the same period. The feasibility, compliance and efficiency of the new therapeutic mode were evaluated by tumor size, serum tumor markers, clinical benefit response （CBR）, surgical complications, mortality and toxicity of RIAC. The disease-free survival time, median survival time, incidence of liver metastasis, survival rate at 1, 2, 3 and 5 years were also observed. Life curves were generated by the Kaplan-Meier method. Results The pain relief rate and CBR in group A was 80% and 84% respectively. Serum tumor markers decreased obviously and tumors size decreased in 26% of patients after preoperative RIAC in group A. No more surgical complications, mortality or severe systemic side effects were observed in group A compared with group B. The incidence of liver metastasis in group A was 34% which was lower than 50% in group B. The disease-free survival time and median survival time in group A were 15.5 months and 18 months respectively. The 1-, 2-, 3- and 5-year survival rates were 54.87%, 34.94%, 24.51% and 12.25% respectively. There was no significant difference of survival time or survival rates between two groups. Conclusions Multiple-phase RIAC is effective in combined therapy of resectable pancreatic head carcinomas by enhancing inhibition of tumor growth and reduction of liver metastasis, without negative effect on patients＇ safety or surgical procedure.     

DIAGNOSIS AND TREATMENT OF STAGE-Ⅲ PERIPHERAL SQUAMOUS CELL CARCINOMA OF RIGHT UPPER LUNG

During a 12-year period, 44 patients were surgically treated for stage- Ⅲ penpberal squamous cell carcinoma of the right upper lobe. The mean time from the discovery of the shadow in the right upper lobe to the confirmation of the diagnosis was 2 months. All patients underwent the resection of the right upper lobe with the dissection of the right mediastinal lymph nodes, among them, 4 patients had sleeve lohectomy of the tight upper lobe. P-TNM staging: 23 cases were in stage-Ⅲ a, 21 cases in stage-Ⅲ b. The frequency of the postoperative complications was 20. 4%(9/44 cases). The 1-year survival rate of all patients was 61% (27/44 cases). None of stage -Ⅲb patients lived longer than 3 years. The postoperative 3-and 5-year survival rates of stage-Ⅲa cases were 65. 2% (15/23cases) and 21.7%(5/23 cases) respectively. In this article, the patients‘ clinical features, the causes of delayed-diagnosis, the operative and postoperative management were discussed. We suggest that the stage-Ⅲa patients should be given surgical treatment,whereas, for the patients of stage-Ⅲ b, palliative operation was given lust for the purpose of reliving the symptoms.     

Esophagus,cardia of stomach

<正>209244 Long-term effects of radical resection plus interstitial implantation of 125Ⅰ radioactive seeds in the treatment of cancer of cardia/Zhang Jijun(Dept Thorac Surg,359 Hosp PLA,Zhenjiang 212001)…∥Chin J Thorac Cardiovasc Surg.-2009,25(1).-26~28Objective To evaluate the long-term effect of interstitial implantation of radioactive iodine-125(125Ⅰ)seeds as an adjunctive technique to the radical resection in the treatment of cancer of cardia.Methods From March 2001 to March 2003,one hundred and eighteen patients with cancer of cardia underwent radial resection in our depatment.Fifty-seven patients(group A)were treated with resection plus interstitial implanttion of radioactive 125Ⅰ seeds during surgery,and 61 patients(group B) were treated with radical resection along.The rate of 3-year and 5-year survival,postoperative complications and mortality were compared between the two groups.Results The demographic data of the two groups were comparable,as well as metastatic status of the lymph nodes,cancer staging,and the type of operation.One hundred and thirteen patients were followed for 5 years.The overall rate of follow up was 95.8%,96.5% in group A and 95.1% in group B.The differences in the rates of 3-year and 5-year survival between group A(59.6% and 49.1%) and group B(41.0% AND 31.1%)were statistically significant(χ2=4.072,P<0.05,for the rate of 3-year survival;χ2=3.939,P<0.05,for the rate of 5-year survival).Postoperative complications,including anastomotic stricture,pancreatic fistula,anastomotic leakage,ileus and pulmonary infection,occurred in 5 patients of group A and in 4 patients of group B.The patients died postperatively,1 in group A and 2 in group B.The differences in the rates of postoperative complications and mortality between group A(8.8% and 1.8%)and group B(6.6% and 3.3%)were not statistically significant(χ2=0.111,P<0.05,for the rate of postoperative complications;χ2=0.333,P<0.05,for the mortality rate).There were 26 and 37 deaths in group A and B respe     

Breast

<正>209169 Analysis of the treatment and prognosis of recurrent breast phyllodes tumor/Fang Yi(Dept Abdomin Surg,Oncol Cancer Hosp(Institute),Chin Acad Med Sci,Beijing 100021)…∥Chin J Oncol.-2009,31(1).-72~74Objective To explore the methods of diagnosis,treatment and prognosis for patients with recurrent breast phyllodes tumor.Methods Clinicopathological data of 26 patients with pathologically proven recurrent phyllodes tumors treated from March 1972 to June 2006 were retrospectively analyzed.Results The mean age of the 26 cases was 45 years,and the median follow-up duration was 83 months.The mean overall survival time of this series was 96 months.The primary breast phyllodes tumor was ≥5 cm in 10 cases with a recurrence rate of 60.0%(6/10 cases);<5 cm in 16 cases with a recurrence rate of 31.3% 5/16(cases).After surgical removal of the breast primary tumor,the recurrent tumor was ≥5 cm in 14 cases with a re-recurrence rate of 35.7%(5/14 cases);<5 cm was in 12 cases with a re-recurrence rate of 50.0% (6/12 cases).There was no statistically significant relationship between the(primary and reccurent)tumor size and recurrence rate(P=0.094,P=0.383)or prognosis,(P=0.142,P=0.486).The benign or malignant nature of the breast phyllodes tumor was singificantly correlated with the rate of local re-recurrence(P=0.046)and prognosis(P=0.028).     

Minimally invasive neuronavigator-guided microsurgery and photodynamic therapy for gliomas

In order to evaluate the effectiveness ofneuronavigator-guided microsurgery and keyhole technique for the resection of gliomas, a total of 60 patients with gliomas were exactly located by using neuronavigator during microsurgery. Forty deep-seated gliomas were resected through a keyhole operative approach. Thirty out of the 60 cases were subjected to photodynamic therapy （PDT） after tumor resection. The therapeutic effectiveness of all the cases was recorded and analyzed. The resuits showed that glioma was totally resected in 52 cases （86.7%）, subtotally in 5 （8.3%）, and most partially in 3 （5%）. Neurological deficits occurred postoperatively in 4 cases. One patient died of multiple system organ failure 4 days after operation. It was concluded that the application of minimally invasive technique could dramatically decrease surgical complications following resection of glioma, and its combination with PDT could obviously improve the quality of life of patients and prolong the survival time.     

类癌106例临床分析

目的：了解类癌的分布变化及临床特点。方法：对106例类癌手术患者进行回顾性分析。结果：类癌最多见于肺(56．6％)，其次为直肠(18．9％)、胃(10．4％)、胸腺(4．7％)，类癌患者局部淋巴结转移率36．8％，远处脏器转移率7．5％，类癌综合征发生率为4．7％，多原发癌发生率3．8％，手术切除率90．1％。结论：类癌发生以肺部类癌最常见；类癌综合症少见，多见于肺类癌；类癌手术切除率高，预后相对较好。     

肺不典型类癌的CT表现分析

目的探讨肺不典型类癌的临床和CT特征,进一步认识该病,提高诊断正确率。方法收集本院经术前CT扫描和病理证实的肺不典型类癌8例,对其CT征象、临床表现和病理结果进行回顾性分析。结果 8例肺不典型类癌均为单发病灶,6例咳嗽,其中3例伴咳血丝痰或咯血;另2例体检发现;均未见类癌综合征。1例纵隔淋巴结转移,4例远处转移。CT表现周围型6例,均有分叶,其中2例呈典型＂冰山征＂表现;中央型2例,均伴有阻塞性肺炎和肺不张。钙化2例,空洞未见。病灶平均直径4.8cm,增强后5例见中重度强化。结论肺不典型类癌临床症状无明显特异性,CT常表现为周围型单一病灶,分叶多见,出现钙化为一重要特征,＂冰山征＂表现有助于诊断。     

直肠类癌的诊断与治疗

目的 探讨直肠类癌的诊断与治疗.方法 回顾性分析我院2000年1月至2009年12月收治直肠类癌16例临床资料,并复习近年有关文献.结果 下腹痛11例（68.8%）,大便带血和次数增多各3例（各占18.8%）,全部经肠镜检查发现肿块大小平均为8.8mm,其中≤10 mm占81.3%,距肛门平均6.8 cm,其中≤8cm占87.5%,术前诊断直肠类癌仅25%,多数诊断为其他病,术后病理检查诊断为直肠类癌,14例实施直肠癌根治术,2例用肠镜行局部摘除术,无手术死亡,术后5年生存率为69.2%.结论 直肠类癌术前诊断困难,误诊率高,常规行肛门指诊和肠镜加病理学检查是提高诊断率的关键,手术切除仍为直肠类癌的首选治疗.     

结肠类癌8例报道

本文报道8例结肠类癌,常见的发病部位在盲肠和升结肠。因结肠类癌和腺癌在临床表现和X线方面很难鉴别,所以术前确诊较为困难,给合文献复习,我们认为类癌综合征的存在和尿中5-HIAA测定在本病的术前诊断中有重要价值。其治疗方法是手术切除,预后与术时有无转移有关,本文还讨论了类癌综合征及类癌的病理。     

气管、支气管低度恶性肿瘤的外科治疗（附30例报告）

手术治疗原发性气管、支气管低度恶性肿瘤３０例,占同期手术治疗原发性肺部恶性肿瘤的２．９５％（３０／１０１６）。其中支气管类癌１２例,粘液表皮样痛１０例,腺样囊性场８例。术前病史平均为１６个月．手术切除率为９６．７％（２９／３０）．术后５年生存率为５２．６％（１０／１９）．本组病例中,粘液表皮样癌的恶性度最高。作者赞同废弃传统的“支气管腺瘤”这一名称。对各型肿瘤的临床病理特点进行了讨论。     

Long-term outcomes of surgical treatment for pulmonary carcinoid tumors: 20 years’ experience with 131 patients

Background  Bronchial carcinoids are rare malignant neuroendocrine neoplasms. Some issues regarding surgical treatment of bronchial carcinoids remain controversial, including the role of bronchoplastic surgery and necessity of systematic lymphadenectomy.

Methods  This retrospective study involved 131 consecutive patients surgically treated for carcinoid tumors at Shanghai Chest Hospital between March 1990 and August 2010.

Results  Eighty-nine (67.9%) of the patients were male, and the mean age was 46 years, ranging from 17 to 81 years. Preoperative fiberoptic bronchoscopy was performed in all patients. Endoscopic biopsy was performed in 100 patients with central tumors, and 70 (70%) patients were diagnosed as bronchial carcinoid. The resections performed consisted of 31 pneumonectomie, 32 lobectomies, 26 bilobectomies, 34 sleeve lobectomies, six bronchoplastic procedures without lung resection, and two segmentectomies. During a median of 87 months follow-up, there were nine recurrences including three local recurrences and 6 distant recurrences. No bronchial recurrences were observed. The 3-, 5- and 10-year overall survival rates of pneumonectom and bronchoplastic surgery (including sleeve lobectomy and bronchoplastic procedure without lung resection) were 93.2%, 81.0% and 69.4%, 97.5%, 91.9% and 70.0%, respectively. Multivariate Cox regression indicated that histology and nodal status were significant independent prognostic factors.

Conclusions  Bronchoplastic surgery should be considered whenever possible for central carcinoids. Systematic lymphadenectomy is recommended for bronchial carcinoid patients. Histology and nodal status were significant independent prognostic factors of overall survival of patients with bronchial carcinoid.

     

消化道类癌的诊治（附35例临床分析）

目的：探讨消化道类癌的诊断、分类和治疗方法。方法：３５例消化道类癌根据其来源可分为前肠、中肠、后肠３类。全组病人根据病情采用多种手术方式。８例伴有进展期肝转移的病人采用全身化疗或肝动脉栓塞化疗。结果：全部病人确诊依靠病理检查。临床误诊率达７１．４％。随访２９例五年生存率为８２．７％。结论：判断类癌良恶性应综合考虑以下７个因素，即肿瘤大小、肿瘤位置、肿瘤浸润深度、多中心性肿瘤、肿瘤侵犯血管的程度、转移及类癌综合征。在治疗中，应根据类癌的良恶性决定手术范围，对已有远处转移者仍应争取切除原发病灶，对多发性肝转移者应首选介入放射下肝动脉插管栓塞化疗。     

支气管类癌的外科诊治（附11例报告）

目的总结分析支气管类癌的临床特点、诊断、治疗方式方法及其疗效。方法回顾性分析697例肺部肿瘤中11例类癌患者的临床资料,并复习文献进行讨论。结果本组11例患者均行手术治疗,其中9例行肺叶切除术,2例行袖状切除术;11例患者术后病理检查确诊为支气管类癌;全组无围手术期死亡。结论支气管类癌的临床症状缺乏特征性改变,最终确诊须靠病理检查,手术治疗预后较好。     

卵巢囊性成熟性畸胎瘤并发类癌3例报告及文献复习

目的：探讨卵巢囊性成熟性畸胎瘤并发类癌的临床特点、诊断思路、治疗方法及预后,总结该类疾病的基本特征,提高临床医生对该病的认识。方法：患者因体检发现一侧卵巢肿物入院,行相关肿瘤标记物检查均未见异常,术前诊断为卵巢瘤,2例患者行患侧附件切除术,1例行患侧肿瘤剥除术。结果：3例患者手术顺利,术后病理诊断均为卵巢成熟性囊性畸胎瘤并发类癌,术后恢复良好,随访15个月未见复发及转移。结论：卵巢囊性成熟性畸胎瘤并发类癌术前极易误诊。患侧附件切除术是治疗该种疾病较为常见的手术方式,预后较好。