Different Roles of Tumor Marker Monitoring after Curative Resections of Gastric and Colorectal Cancers

We previously demonstrated that false-positive findings for tumor markers are frequently observed, and that the sensitivity of marker monitoring for early detection of the recurrence is low after curative resection of gastric cancer. The aim of this study was to investigate whether such characters are specific to gastric cancer. Serum carcinoembryonic antigen and/or carbohydrate antigen 19-9 were periodically assessed in 258 patients who underwent curative gastrectomy for gastric cancer (n = 161) or curative resection for colorectal cancer (n = 97). The frequency of false-positive findings for the tumor markers, the sensitivity of the marker monitoring for detection of the recurrence, and the characteristics of such cases were compared between these two cancer groups. During the median follow-up period of 30 months, recurrence developed in 14% of gastric cancer and 23% of colorectal cancer patients. A false positive with the tumor marker was frequently observed in patients after gastrectomy compared with after colorectal surgery. The sensitivity of the marker monitoring regarding early detection of recurrence was higher in patients with colorectal cancer than those with gastric cancer, especially in cases of advanced stage. As a result, the accuracy of marker monitoring for the detection of recurrence was higher in patients after the resection of colorectal cancer than that of gastric cancer. Surgeons and oncologists should thus be aware that the role of the tumor marker monitoring after a curative operation differs between patients with gastric and colorectal cancers.     

Influence of follow-up on health-related quality of life after radical surgery for colorectal cancer.

BACKGROUND: The possible benefit for patients of follow-up examinations after curative surgery for colorectal cancer is at present not proven. The purpose of this study was to evaluate the influence of follow-up examinations on health-related quality of life and to assess the attitude of the patients to check-ups. METHODS: A total of 350 patients who had had curative surgery for colorectal cancer and who had been subsequently randomized to either frequent follow-up or virtually no follow-up completed the Nottingham Health Profile and a second questionnaire assessing their attitude to the follow-up visits. RESULTS: The patients who were receiving more frequent follow-up had greater confidence in the check-ups, but the improvement in the health-related quality of life was only marginally better than that of those receiving few follow-up visits. CONCLUSION: The relatively small benefit for health-related quality of life does not justify expensive frequent routine examinations after surgery for colorectal cancer. The Nottingham Health Profile proved to be a reliable instrument within this patient group.     

Endoscopic variceal sclerotherapy in patients with Symmers periportal fibroses

This is a prospective study, carried out in patients with portal hypertension and bleeding oesophageal varices secondary to Symmers (Schistosomal) periportal fibroses, to determine the efficacy of sclerotherapy, the number of sessions needed to achieve full sclerosis, the complications associated with sclerotherapy and the incidence and risk factors for rebleeding. In total, 85 patients were studied with a mean age of 38 years, 76.5% were males. All underwent upper gastrointestinal endoscopy, had different grades of oesophageal varices and underwent intravariceal injection with 5% ethanolamine oleate until they achieved full sclerosis or were referred to surgery. Complications of sclerotherapy included oesophageal strictures, deep oesophageal ulcers, pleural effusion and ascites. Following obliteration of oesophageal varices, 3.5% and 20% developed new gastric varices and portal gastropathy, respectively. Rebleeding occurred in 32% - the only significant predictive risk factor for which was patients with GIII varices following the first sclerotherapy session. Varices recurred in 6% of patients after a mean follow-up period of one year. In total, 93% of our patients achieved full sclerosis after an average of four sessions, and 3.5% were referred for surgery. Three patients (3.5%) died, all from massive rebleeding. In conclusion, sclerotherapy is a safe effective method for treating patients with oesophageal varices due to periportal fibroses.     

Post operative upper gastrointestinal bleeding in the aged]

A 10-year experience with 2,441 patients over 65 years of age undergoing operations for non-upper gastrointestinal tracts was reviewed to evaluate both the incidence of postoperative upper gastrointestinal bleeding and the clinical risk factors associated with the complication. A total of 18 (0.7%, 7 males and 11 females) patients had overt postoperative upper gastrointestinal bleeding of non-variceal origin documented by endoscopic findings or blood transfusions. Of these, the complication developed in 10 (1.5%) of 646 patients after an operation for biliary or pancreatic disease, 1 (1.5%) of 64 for aneurysmal or obstructive arterial disease, 5 (1.1%) of 43 for colorectal cancer and 2 (0.3%) of 916 for hernia. The incidences of bleeding after an operation for obstructive jaundice (3.8%), for biliary or pancreatic malignancy (4.5%), and of unavoidable diversion colostomy for colorectal anastomosis (3.1%) were significantly higher than for non-jaundice (0.6%), for non-malignancy (1.1%) and of postoperative upper gastrointestinal bleeding in the present study. The origins of bleeding were gastric ulcer in 11, acute gastric mucosal lesion in 4, duodenal ulcer in 1 and other in 2. All cases of bleeding were treated and met success in hemostasis using H2-blockers. Of these, however, 5 patients died of multiple organ failure despite discontinued hemorrhage, prophylactic use of H2-blockers showed a decrease in occurrence of postoperative upper gastrointestinal bleeding in the present study.     

Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer

Background

Minimally invasive (MI) pancreatic surgery appears to be gaining popularity, but its implementation throughout Europe and the opinions regarding its use in pancreatic cancer patients are unknown.

Methods

A 30-question survey was sent between June and December 2014 to pancreatic surgeons of the European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association and 5 European national pancreatic societies. Incomplete responses were excluded.

Results

In total, 237 pancreatic surgeons responded. After excluding 34 incomplete responses, 203 responses from 27 European countries were included. 164 (81%) surgeons were employed at a university hospital, 184 (91%) performed advanced MI surgery and 148 (73%) performed MI distal pancreatectomy. MI pancreatoduodenectomy was performed by 42 (21%) surgeons, whereas 9 (4.4%) surgeons had performed more than 10 procedures. Robot-assisted MI pancreatic surgery was performed by 28 (14%) surgeons. 63 (31%) surgeons expected MI distal pancreatectomy for cancer to be inferior to open distal pancreatectomy concerning oncological outcomes. 151 (74%) surgeons expected to benefit from training in MI distal pancreatectomy and 149 (73%) were willing to participate in a randomized trial on this topic.

Conclusions

MI distal pancreatectomy is a common procedure, although its use for cancer is still disputed. MI pancreatoduodenectomy is still an uncommon procedure. Specific training and a randomized trial regarding MI pancreatic cancer surgery are welcomed.     

Laparoscopic surgery for cancer: are we ready?

Following feasibility studies more and more large prospective reports even randomised trials document the treatment of digestive cancer using a laparoscopic approach. While the spectre of port-site recurrences, once so alarming has faded, it has become a challenge for laparoscopic surgeons to provide long-term follow-up. There is good class II and III evidence that staging laparoscopy (SL) has a value for oesophageal, gastric, pancreatic and hepatobiliary cancer as well as for intra-abdominal lymphomas since it adds to primary staging and often alters the clinical stage of the disease and hence the management of the individual patient. For minimally invasive oesophagectomy and gastric cancer surgery several series have demonstrated shorter perioperative morbidity and hospital stay however at present most studies report smaller numbers of selected patients and long term follow up is rare. The laparoscopic resection of pancreatic malignancies is not reported to be feasible, safe or potentially beneficial for the patient while the curative resection of suspected early gallbladder cancer is a poor indication. Nevertheless laparoscopy is documented to be safe and applicable for small malignant liver lesions and the Lacy trial was significantly in favour of laparoscopy-assisted colectomy, predominantly for stage III disease. Bearing in mind that in many fields of digestive cancer surgery, laparoscopy should still be conducted as part of a trial, it is safe to say that "we are ready" for this revolution to arise.     

18F]-FDG-PET in the diagnostics of gastrointestinal tumors

Positron emission Tomography (PET) with 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) is a functional imaging technique with increasing value in special diagnostic fields of gastrointestinal tumours. In the initial staging of esophageal and gastric cancer, FDG-PET is useful in the staging of patients with advanced but local resectable disease. The detection of distant metastases results in an up-staging, and these patients should not be treated by surgery. Furthermore, FDG-PET is sufficient for monitoring early therapy responses after neoadjuvant treatment and enables one to select non-responders who may benefit from therapy alterations. Major indications for FDG-PET in patients with rectal carcinoma are therapy monitoring and diagnosis of relapses, especially the differentiation between tumour and scar and also the localisation of tumour manifestations in cases with increasing tumour markers. FDG-PET is very efficient in the imaging of pulmonal and hepatic metastases of colorectal cancer but not in lymph node staging. In diagnostic procedures for pancreatic carcinoma, FDG-PET can be recommended to explore the dignity of pancreatic lesions and in the imaging of tumour relapses. For gastrointestinal stroma tumours, FDG-PET is useful for the monitoring of therapy and the initial staging. For imaging of hepatocellular carcinoma and carcinoma of the gall bladder, FDG-PET is not sufficient.     

Association of cholecystectomy with abdominal cancers

Five hundred and eighty-five randomly selected patients with abdominal cancer were examined with respect to previous cholecystectomy in the following groups: upper gastrointestinal (gastric or esophageal) cancer; biliary or pancreatic cancer; colorectal cancer, and urologic (renal, pelvic or ureteral) cancer. The frequency of cholecystectomy in each of these cancer groups was compared with that of cholecystectomy in the general population of the region from which the cancer patients came; the latter frequency was estimated in a previous epidemiological autopsy study. In all the gastrointestinal cancer groups studied there was a statistically significantly higher frequency of cholecystectomy than in the general population. In addition, the time interval from cholecystectomy to diagnosis of the cancer was determined. A trimodal distribution of this time interval was observed. The apex of the first peak was about 5, the second about 15, and the third about 23 years after cholecystectomy. Within the first period there was a statistically significant accumulation of biliary, and especially pancreatic, cancer (p = 0.007), and within the second and third periods an accumulation, though not statistically significant, of colorectal cancers (p = 0.07). Of the patients operated on ten years or less before the diagnosis of cancer, 96% were operated on for organic gallbladder disease. It seems that symptoms of upper gastrointestinal cancer, and especially of biliary or pancreatic cancer, may be misinterpreted as symptoms of cholepathy, and this may occur even when organic gallbladder disease is present. Furthermore, cholecystectomy might be a predisposing factor for the development of colorectal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Tumour M2-pyruvate kinase: a gastrointestinal cancer marker

BACKGROUND: Gastrointestinal cancer tumour markers are valuable in the detection of recurrence following resection or in monitoring response to chemotherapy. CEA, CA19-9, CA-50 and CA72-4 are currently available but are nonspecific and have a low sensitivity. 'Tumour M2-pyruvate kinase' was described by Eigenbrodt around 1985. In cancers the active tetrameric form of the M2 isoenzyme of pyruvate kinase converted to an inactive dimeric form by direct interaction with oncoproteins to channel glucose carbons into DNA synthesis. This review summarizes the current knowledge of this unique tumour marker with regard to its biochemistry, assay and potential use as a diagnostic and screening tool in gastrointestinal cancer. METHODS: A literature search was conducted for entries from 1980 to 2005 using PubMed and NeLH databases using tumour M2-pyruvate kinase, faecal tumour M2-pyruvate kinase, tumour metabolism, tumour markers and carcinoembryonic antigen as keywords. A total of 56 references relevant to tumour M2-pyruvate kinase were retrieved. Eighteen references were clinical studies involving plasma/faecal tumour M2-pyruvate kinase and gastrointestinal cancer. The remaining 38 references were clinical/nonclinical trials and reviews on tumour metabolism and plasma/faecal tumour M2-pyruvate kinase assay. Seven of the 18 clinical studies involved faecal M2-pyruvate kinase. Three of the 11 plasma tumour M2-pyruvate kinase studies were non-English language and were excluded. The sensitivity, specificity, positive predictive and negative predictive value for plasma/serum tumour M2-pyruvate kinase in the detection of gastrointestinal cancer was determined for each of the remaining eight studies. Data for gastrointestinal cancer M2-pyruvate kinase were compared with other gastrointestinal cancer markers. Data from three of the eight studies using a diagnostic cut-off value of 15 U/ml for ethylenediaminetetraacetic acid (EDTA) plasma tumour M2-pyruvate kinase were analysed together as a small meta-analysis. RESULTS: At a diagnostic cut-off value of 15 U/ml for tumour M2-pyruvate kinase in EDTA plasma the sensitivity, specificity, positive predictive and negative predictive value was 57.3, 89, 85.7 and 64.8%, respectively, for colorectal cancers, 62.1, 89, 88 and 64%, respectively, for gastric/oesophageal cancers and 72.5, 89, 58 and 94%, respectively, for pancreatic cancers. As a faecal marker for colorectal cancers, faecal tumour M2-pyruvate kinase has a sensitivity of 73-92% at a cut-off value of 4 U/ml as against 50% sensitivity for Guaiac faecal test. CONCLUSION: Circulating tumour M2-pyruvate kinase is more commonly elevated in oesophageal, gastric and colorectal cancer patients than conventional tumour markers. Faecal M2-pyruvate kinase is a sensitive marker of colorectal cancer. The clinical role of tumour M2-pyruvate kinase in gastrointestinal cancer management should be investigated in large-scale clinical trials.     

Ferritin above 100 mcg/L could rule out colon cancer, but not gastric or rectal cancer in patients with involuntary weight loss

ABSTRACT: BACKGROUND: A tenth of patients with involuntary weight loss (IWL) have gastrointestinal cancer. Ferritin is the first parameter to be modified during the process leading to iron deficiency anaemia, therefore it should be the most sensitive. The aim of this study was to assess the ability of ferritin to rule out gastrointestinal cancer in patients with involuntary weight loss. METHODS: All consecutive patients with IWL admitted in a secondary care university hospital were prospectively studied. Ferritin, haemoglobin with erythrocyte indices and serum iron were recorded for all patients. The reference standard was bidirectional endoscopy and/or 6 months follow-up. RESULTS: 290 patients were included, a quarter had cancer, of which 22 (7.6%) had gastrointestinal cancer (8 gastric cancer, 1 ileum cancer, 13 colorectal cancer). Ferritin had the best area under the curve (AUC), both for gastrointestinal cancer (0.746, CI: 0.691-0.794), and colorectal cancer (0.765, CI: 0.713-0.813), compared to the other parameters of iron deficiency. In the diagnosis of colorectal cancer, ferritin with a cut-off value of 100 mcg/L had a sensitivity of 93% (CI: 69-100%), and negative likelihood ratio of 0.13, with a negative predictive value of 99% (96-100%), while for gastrointestinal cancer, the sensitivity was lower (89%, CI: 67-95%), with a negative likelihood ratio of 0.24. There were three false negative patients, two with gastric cancer, and one with rectal cancer. CONCLUSION: In patients with involuntary weight loss, a ferritin above 100mcg/L could rule out colon cancer, but not gastric or rectal cancer.     

Clinical significance of CA19-9 in diagnosis of digestive tract tumors

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日本血吸虫病对胃癌和结直肠癌发生的影响

目的探讨日本血吸虫病对胃癌及结直肠癌发生发展的影响。方法收集2014年1月-2018年12月皖南医学院弋矶山医院收治的合并血吸虫病及不合并血吸虫病的胃癌和结直肠癌患者临床资料,分成血吸虫病胃癌组和非血吸虫病胃癌组、血吸虫病结直肠癌组和非血吸虫病结直肠癌组。采用单因素分析和多因素logistic回归分析对胃癌和结直肠癌发病危险因素进行分析,探索血吸虫病对胃癌和结直肠癌发生发展的影响。对32例血吸虫病合并结直肠癌患者以及68例非血吸虫病结直肠癌患者进行电话随访,获取患者生存情况,计算并比较两组患者生存率。结果血吸虫病胃癌组患者113例、非血吸虫病胃癌组患者3741例,两组患者性别构成比、年龄、幽门螺杆菌感染率差异均有统计学意义(P均<0.05)。logistic回归分析表明,年龄、幽门螺杆菌感染和合并血吸虫病是胃癌发病的独立危险因素(P均<0.05)。血吸虫病结直肠癌组患者184例、非血吸虫病结直肠癌组患者2205例,两组年龄、性别构成比、有饮酒史者比例、粪便隐血阳性者比例差异均有统计学意义(P均<0.05);两组结直肠癌表型均以溃疡型居多,但非血吸虫病结直肠癌组浸润型和隆起型患者比例明显高于血吸虫病结直肠癌组(P=0.003)。logistic回归分析结果显示,年龄(P=0.003)、性别(P=0.002)、表型(P=0.005)以及合并血吸虫病(P=0.029)是结直肠癌的独立危险因素。经随访,血吸虫病结直肠癌患者5年生存率(68.90%)高于非血吸虫病结直肠癌患者(46.40%),其死亡患者平均年龄[(66.33±3.08)岁]亦高于后者[(56.29±1.94)岁],差异均有统计学意义(P均<0.05)。结论血吸虫病可能改变结直肠癌发病机制,导致血吸虫病和非血吸虫病结直肠癌患者在流行病学、临床特征以及5年生存率方面存在差异。血吸虫病流行区年龄>60岁的男性,且伴有不明原因贫血者,应定期进行消化道内镜检查和其他检查,以排除消化道肿瘤的可能性。     

The Vienna classification of gastrointestinal epithelial neoplasia

BACKGROUND: Use of the conventional Western and Japanese classification systems of gastrointestinal epithelial neoplasia results in large differences among pathologists in the diagnosis of oesophageal, gastric, and colorectal neoplastic lesions. AIM: To develop common worldwide terminology for gastrointestinal epithelial neoplasia. METHODS: Thirty one pathologists from 12 countries reviewed 35 gastric, 20 colorectal, and 21 oesophageal biopsy and resection specimens. The extent of diagnostic agreement between those with Western and Japanese viewpoints was assessed by kappa statistics. The pathologists met in Vienna to discuss the results and to develop a new consensus terminology. RESULTS: The large differences between the conventional Western and Japanese diagnoses were confirmed (percentage of specimens for which there was agreement and kappa values: 37% and 0.16 for gastric; 45% and 0.27 for colorectal; and 14% and 0.01 for oesophageal lesions). There was much better agreement among pathologists (71% and 0.55 for gastric; 65% and 0.47 for colorectal; and 62% and 0.31 for oesophageal lesions) when the original assessments of the specimens were regrouped into the categories of the proposed Vienna classification of gastrointestinal epithelial neoplasia: (1) negative for neoplasia/dysplasia, (2) indefinite for neoplasia/dysplasia, (3) non-invasive low grade neoplasia (low grade adenoma/dysplasia), (4) non-invasive high grade neoplasia (high grade adenoma/dysplasia, non-invasive carcinoma and suspicion of invasive carcinoma), and (5) invasive neoplasia (intramucosal carcinoma, submucosal carcinoma or beyond). CONCLUSION: The differences between Western and Japanese pathologists in the diagnostic classification of gastrointestinal epithelial neoplastic lesions can be resolved largely by adopting the proposed terminology, which is based on cytological and architectural severity and invasion status.     

Second cancer during long-term survival after resection of biliary tract carcinoma

Curative surgery for biliary tract malignancy has improved the prognosis of patients; however, during long-term follow up after extensive surgery, four of our patients (two with gallbladder carcinoma and two with bile duct carcinoma) developed a second primary cancer (one each in the duodenum, skin, descending colon, and lung). Regular examination of the upper gastrointestinal tract, colorectum, and lungs, and testing for tumor markers (carcinoembryonic antigen and CA19-9) were performed as follow-up studies. As a result, the second cancers were all found at a relatively early stage and all four patients are still alive 6–14 years after the initial operation. A review of the annual autopsy reports over the last 5 years in Japan showed that the incidence of second cancer was 14.8% in patients with gallbladder carcinoma and 13.5% in those with bile duct carcinoma. Furthermore, the rate of second gastric and colorectal carcinoma was significantly higher in patients with primary bile duct cancer than in those with primary gallbladder cancer. In conclusion, the incidence of a second cancer after resection of biliary tract malignancy is more than 10%, but this second cancer can be detected relatively easily and treated at an early stage during the course of regular long-term follow up for the first cancer.     

Surgical experience improves the long-term results of Nissen fundoplication

BACKGROUND: Nissen fundoplication relieves symptoms of gastro-oesophageal reflux and effectively heals oesophagitis. During long-term follow-up some cases of recurrent reflux are seen. We investigated the possibility that long-term cure of gastro-oesophageal reflux after fundoplication is influenced by the surgeon's experience and focused interest, in line with results of surgery for rectal, gastric, and breast cancer. METHODS: One hundred and five consecutive patients were evaluated a median of 77 months after open Nissen-Rossetti fundoplication for erosive oesophagitis. Follow-up included personal interviews and upper gastrointestinal endoscopy by an investigator not previously involved in the patients' treatment. The surgeons were classified as experienced (>10 of the operations in the series), less experienced (<10 operations), or trainees. RESULTS: Of the most experienced surgeons' patients, 97% had no or at most mild reflux symptoms at follow-up, compared with 88% of the of less experienced surgeons' patients (P = 0.04). Healing of erosive oesophagitis was commoner when the operations were performed by experienced specialist surgeons (88% versus 72%; P = 0.04). The reoperation rate fell as the surgeons' experience increased, from 12% to 4%. CONCLUSIONS: Surgery for gastro-oesophageal reflux should be centralized to units specializing in the techniques and with sufficient annual numbers of operations to optimize results. This policy becomes especially advisable as laparoscopic surgery increases the numbers of treated patients.     

Effectiveness and safety of a laparoscopic training system combined with modified reconstruction techniques for total laparoscopic distal gastrectomy

BACKGROUND Total laparoscopic distal gastrectomy(TLDG) is increasing due to some advantages over open surgery, which has generated interest in gastrointestinal surgeons. However, TLDG is technically demanding especially for lymphadenectomy and gastrointestinal reconstruction. During the course of training, trainee surgeons have less chances to perform open gastrectomy compared with that of senior surgeons.AIM To evaluate an appropriate, efficient and safe laparoscopic training procedures suitable for trainee surgeons.METHODS Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were reviewed. The trainees were taught a laparoscopic view of surgical anatomy, standard operative procedures and practiced essential laparoscopic skills. The TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee skills. Early surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by trainees. Learning curves were used to assess the utility of our training system.RESULTS Five trainees performed a total of 52 TLDGs(56.5%), while 40 TLDGs were conducted by two trainers(43.5%). Except for depth of invasion and pathologic stage, there were no differences in clinicopathological characteristics. Trainers performed more D2 gastrectomies than trainees. The total operation time was significantly longer in the trainee group. The time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two groups. No difference was found in postoperative complications between the two groups. The learning curve of the trainees plateaued after five TLDG cases.CONCLUSION Preparing trainees with a laparoscopic view of surgical anatomy, standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG safely and feasibly.     

Synchronous gastric cancer in primary sporadic colorectal cancer patients in Korea

Background and aims Colorectal cancer has been reported to be the malignancy most frequently associated with gastric cancer in Korea. The aim of this study was to define the frequency and clinical characteristics of synchronous gastric cancer detected at preoperative esophagogastroduodenoscopy (EGD) in colorectal cancer patients. Materials and methods This prospective study analyzed the EGD results from 1,542 consecutive colorectal cancer patients who underwent surgery from January 2003 to December 2005 at the Center for Colorectal Cancer, National Cancer Center, Korea. Results Of the 1,542 cases, 1,155 (74.9%) underwent EGD at our center and 387 underwent EGD at other hospitals within 6 months before surgery. Of the 1,542 cases, synchronous gastric cancers were detected in 31 cases (2.0%). Of these 31 cases, 26 had early gastric cancer (EGC; 83.9%) and 5 had advanced gastric cancer. Ten (38.5%) of the 26 EGC cases were managed using endoscopic mucosal resection. Compared to colorectal cancer patients without synchronous gastric cancer, the group of patients with synchronous gastric cancer was older (65.5 ± 9.6 vs 58.4 ± 11.3 years, p = 0.001) and had a greater proportion of males (77.4 vs 59.4%, p = 0.043). Conclusion This study found that 2% of Korean sporadic colorectal cancer patients had synchronous gastric cancer. A preoperative EGD for colorectal cancer patients is likely to greatly assist in the diagnosis of synchronous gastric cancer at an early stage and the implementation of appropriate minimally invasive treatment. Presented at the Tenth Congress of Asian Federation of Coloproctology, Singapore, March 24–26, 2005.     

Report of 24 Left-Sided Portal Hypertension Cases: A Single-Center Prospective Cohort Study

Our aim was to analyze patients diagnosed with left-sided portal hypertension prospectively and to document the complications at follow-up. Twenty-four patients with isolated splenic vein thrombosis (diagnosed by ultrasonography or angiography or intraoperatively) and/or isolated fundal varices (diagnosed by endoscopy or endosonography) were involved in this study. Demographics, clinical presentation, diagnostic and therapeutic procedures, and morbidity and mortality were recorded in their follow-up. There were 11 and 13 left-sided portal hypertension cases associated with pancreatic diseases and nonpancreatic disorders, respectively. Chronic abdominal pain and gastrointestinal bleeding were the two most common complaints. All patients except one had isolated esophageal (2 cases) or fundal (21 cases) varices. Thirteen patients had splenomegaly on ultrasonography. On Doppler sonography, the splenic vein could be evaluated in 21 of the 24 patients (9 and 6 had complete and partial occlusion, respectively, and 6 had patent blood flow). Urgent intervention with therapeutic endoscopy and splenectomy was performed for two patients each. Medical therapy was begun for three patients according to the underlying diseases. Three patients underwent elective surgery. Two patients were lost to follow-up after the first visit and the mean follow-up of the remaining 22 patients after diagnosis of left-sided portal hypertension was 20 months. Only one patient (with pancreas cancer) had gastrointestinal bleeding at follow-up. All patients with pancreas and gastric cancer died within 2–12 months. Left-sided portal hypertension has various etiologies. It may be difficult to diagnose this entity both endoscopically and radiologically. Treatment should be directed at the underlying diseases. Recurrent hemorrhage due to left-sided portal hypertension is not usual and the prognosis depends mainly on the underlying etiology.     

广州地区胰腺癌相关抑郁症的临床发病状况调查

目的 探讨我国广州地区胰腺癌相关抑郁症的临床发病状况.方法 采用多中心、前瞻性调查设计,纳入2007年6月至2009年6月广州地区4家医院收治的50例胰腺癌、60例肝癌、50例食管癌、50例胃癌及52例结直肠癌住院患者.采用汉密顿抑郁量表-24(HAMD-24)评估患者的抑郁状况.结果 胰腺癌伴发抑郁症的发生率为78.0%(39/50),显著高于肝癌的60.0%(36/60)、胃癌的36.0%(18/50)、食管癌的24.0%(12/50)、结直肠癌的19.2%(10/52)(P值均＜0.05).其中胰腺癌患者中有24.0%(12/50)为严重抑郁症,明显高于肝癌的10.0%(6/60)、胃癌的4.0%(2/50)、食管癌及结直肠癌患者的0(P值均＜0.05).胰腺癌晚期患者抑郁症发生率为94.3%,明显高于早期患者的46.7%(P＜0.01);接受化疗患者的抑郁症发生率为92.3%,显著高于手术患者的62.5%(P＜0.05).结论 与消化系统其他癌症相比,胰腺癌相关抑郁症的临床发生率最高,且抑郁程度较重.