Ⅰa期和Ⅰb期非小细胞肺癌综合治疗的远期效果

目的探讨综合治疗对Ⅰ(Ⅰa+Ⅰb)期非小细胞肺癌(NSCLC)长期生存的影响。方法手术切除Ⅰa期和Ⅰb期NSCLC 983例,比较综合治疗与单纯手术的治疗效果。结果全组5年生存率:Ⅰa期综合治疗组和单纯手术组分别为80.2%和79.3%;Ⅰb期分别为61.6%和64.5%。不同病理类型5年生存率:鳞癌:Ⅰa期单纯手术79.0%,手术+化疗84.2%,手术+放疗57.1%;Ⅰb期单纯手术67.0%,手术+化疗+放疗65.6%,手术+化疗65.2%,手术+放疗47.9%。腺癌:Ⅰa期单纯手术80.0%,手术+化疗85.7%;Ⅰb期单纯手术65.2%,手术+化疗+放疗16.7%,手术+化疗72.4%。腺鳞癌:Ⅰb期单纯手术39.0%;Ⅰb期手术+化疗59.6%。但上述各组5年生存率之间均未见统计学差异。结论手术+化疗治疗Ⅰa期鳞癌、Ⅰa和Ⅰb期腺癌以及Ⅰb期腺鳞癌效果比单纯手术好。因此,手术+化疗应成为该类病例的标准治疗模式。     

Maximal cytoreductive effort in epithelial ovarian cancer surgery

The surgical management of advanced epithelial ovarian cancer involves cytoreduction, or removal of grossly-evident tumor. Residual disease after surgical cytoreduction of ovarian cancer has been shown to be strongly associated with survival. The goal of surgery is "optimal" surgical cytoreduction, which is generally defined as residual disease of 1 cm or less. However, the designation of "optimal" surgical cytoreduction has evolved to include maximal surgical effort and no gross residual disease. In order to achieve this, more aggressive surgical procedures such as rectosigmoidectomy, diaphragm peritonectomy, partial liver resection, and video-assisted thoracic surgery are reported and increasingly utilized in the surgical management of advanced ovarian cancer. The role of maximal surgical effort also extends to the recurrent setting where the goal of surgery should be complete cytoreduction. Patient selection is important in identifying appropriate candidates for surgical cytoreduction in the recurrent setting. The purpose of this article is to review the role of maximum surgical effort in primary and recurrent ovarian cancer.     

骨盆径线及其他相关参数与前列腺癌根治术后尖部切缘阳性关系的探讨

目的:探讨骨盆径线及其他前列腺癌相关参数对前列腺癌根治术后前列腺尖部切缘阳性的影响。方法:回顾性研究2014至2017年于我院行前列腺穿刺活检确诊为前列腺癌,且无其他部位转移,符合手术指征的患者共120例。根据术前前列腺磁共振测量骨盆入口前后径、坐骨棘间径、前列腺尖深度、耻骨联合角。联合其他参数［年龄、体重指数（body mass index,BMI）、前列腺特异性抗原（prostate specific antigen,PSA）水平、前列腺体积、病理分期、根治术后标本Gleason评分、手术方式］,单因素分析各参数与前列腺尖端切缘阳性的关系,多因素回归分析确定独立危险因素。结果:前列腺尖部切缘阳性共35例,单因素回归分析显示:切缘阳性与切缘阴性组在患者年龄、BMI、前列腺体积、术前PSA水平、骨盆入口前后径、坐骨棘间径及耻骨联合角无明显统计学差异。多因素回归分析显示:前列腺尖部深度、根治术后标本Gleason评分、病理分期、手术方式为术后尖部切缘阳性的独立危险因素。结论:前列腺尖部深度,根治术后标本Gleason评分、病理分期、手术方式为前列腺尖部切缘阳性的独立危险因素。前列腺尖部深度大于等于28 mm,根治术后标本Gleason评分≥8分,病理分期在T2期以上以及选择开放性前列腺癌根治术的患者术后尖部切缘阳性率显著升高。我们可以通过术前MRI评估患者骨盆状况,选择合适的手术方式,结合病理分期及根治术后标本Gleason评分,为术后治疗方案的选择提供参考。     

Challenges to quality assurance of surgical interventions in clinical oncology trials: A systematic review

Where surgery forms the primary curative modality in surgical oncology trials the quality of this intervention has the potential to directly influence outcomes. Many trials however lack a robust framework to ensure surgical quality. We aim to report existing published challenges to quality assurance of surgical interventions within oncological trials. A systematic on-line literature search of Embase and Medline identified 34 relevant studies, including 19 RCTs, 11 further analyses of the primary RCTs, and 4 trial protocols. Inclusion criteria: oncological RCTs with a surgical intervention and/or associated publications relevant to the research question; ‘Challenges to quality assurance of surgery in clinical oncology trials’. Selected articles were assessed by two reviewers to identify reported challenges to quality assurance of surgical intervention within these trials. Reported challenges to surgical quality could be classified as those affecting credentialing, standardisation and monitoring of surgical interventions. Constraints of using case volume for credentialing surgeons; inter-centre variation in the definition and execution of interventions; insufficient training, and monitoring of surgical quality, were the most commonly encountered challenges within each of these three domains. Findings confirmed an inadequacy in the implementation and reporting of effective surgical quality assurance measures. The surgical community should enable implementation of agreed upon mitigating strategies to overcome challenges to surgical quality in oncology trials.     

A flexible endoscopic surgical system: first report on a conceptual design of the system validated by experiments

BACKGROUND: Surgery is a standard diagnostic and therapeutic procedure. However, its technical difficulty and invasiveness pose problems that are yet to be solved even by current surgical robots. Flexible endoscopes can access regions deep inside the body with less invasiveness than surgical approaches. Conceptually, this ability can be a solution to some of the surgical problems. METHODS: A flexible (surgical) endoscopic surgical system was developed consisting of an outer and two inner endoscopes introduced through two larger working channels of the outer endoscope. The concept of the system as a surgical instrument was assessed by animal experiments. RESULTS: Gastric mucosa of the swine could be successfully resected using the flexible endoscopic surgical system, thereby showing us the prospect and directions for further development of the system. CONCLUSION: The concept of a flexible endoscopic surgical system is considered to offer some solutions for problems in surgery.     

The many faces of surgical margins

Most variables associated with survival after cancer surgery are fixed when we see the patient. One variable over which we have control is the surgical margin. We begin by reviewing the definitions of a positive surgical margin, and then explore potential inaccuracies in obtaining a biopsy and reasons for recurrence after obtaining a free surgical margin. Research in improving the diagnostic accuracy of surgical margins is discussed. Finally, the prognostic significance of surgical margins is reviewed.     

脊柱转移癌的术前评估和手术方式评价

脊柱是恶性肿瘤骨转移最常见的部位,约占骨转移的2／3。有尸检报告显示70％的癌症患者伴有脊柱转移。其中,伴有脊髓压迫的脊柱转移癌患者占5％～14％。近年来,随着检测技术的进步,尤其是PET,CT的使用,脊柱转移癌的确诊率不断提高。在治疗方面,脊柱转移癌患者的管理理念也发生了转变,从单纯放、化疗逐渐演变为在放、化疗的基础上,积极进行外科手术治疗。试验证明,这种联合治疗比既往的单纯放、化疗对改善患者生存质量更有优势。     

高龄食管贲门癌的临床特点及外科治疗

目的 :总结高龄食管贲门癌患者的临床特点及外科治疗经验。方法 :对 1989年 6月 - 2 0 0 0年6月 2 4 9例 >70岁高龄食管贲门癌病例手术治疗资料作回顾性分析。结果 :高龄患者术前伴发病较多。手术切除率 97 2 % ,并发症发生率 5 1 0 % ,1、3、5年生存率分别为 80 6 %、4 0 5 %、2 9 1%。结论 :对高龄食管贲门癌患者外科治疗关键在于严格掌握手术适应证 ,做好术前准备 ,积极处理术后并发症     

University-based postresidency training programs in surgical oncology

The issue of postresidency training in surgical oncology engenders much debate, particularly as it impacts on general surgery training. With the goal of enhancing instruction in surgical oncology in the future, a survey was conducted to assess the role of surgical oncology programs and educational activities within university-based surgery training programs. The results of the study demonstrate an increased emphasis on surgical oncology training over the past five years. The findings also indicate that education activity in surgical oncology in all departments of surgery has increased greatly, as demonstrated by an increased number of specific teaching rounds and conferences. The impact of this increased awareness on the future of surgical oncology training is discussed.     

肝内胆管癌手术治疗的预后影响因素分析

目的 探讨肝内胆管癌患者手术治疗后炎症细胞分布与预后的相关性及影响预后的相关因素.方法 纳入行手术根除治疗的肝内胆管癌患者60例,对患者的详细就诊资料、CD15、CD68炎性相关性因素及生存资料等进行相关性分析.结果 分化程度、肿瘤复发、TNM分期、CA199、术中输血、手术方式、肿瘤和手术部位、术前转氨酶水平的情况是影响胆管癌预后总生存时间的独立危险因素.炎症相关因子CD15、CD68的表达与患者的总生存时间有关(P<0.05).结论 肝内胆管癌手术治疗的预后与肿瘤的分化程度、肿瘤复发、TNM分期、CA199、术中输血、手术方式、肿瘤和手术部位、术前转氨酶水平具有相关性,局部的炎症状态CD15高表达、CD68低表达是影响胆管癌患者总生存时间的独立危险因素.     

非小细胞肺癌骨转移15例外科治疗分析

目的探讨非小细胞肺癌骨转移的患者切除肺原发肿瘤为主的综合治疗疗效.方法1995年～2002年间对15例非小细胞肺癌骨转移患者行肺叶切除术加术后综合治疗.结果手术切除肺原发肿瘤加术后综合治疗的15例患者与单纯内科治疗比较,提高了生存率,改善了生活质量.结论选择性的非小细胞肺癌骨转移手术切除肺原发肿瘤加术后综合治疗比单纯内科治疗疗效好.     

Operable breast cancer: How not to worsen the prognosis,especially in triple negative and stage II tumors

IntroductionOncological surgery must follow some fundamental principles to be truly curative, one of which is the resection of the tumor with surgical margins free of neoplasia. In breast cancer, surgery with positive margins should be expanded immediately. There are probably different intensities, between the stages and molecular subtypes of operable breast cancer, of worsening prognosis due to the surgical margin compromised by the neoplasia in women not submitted to the necessary enlargement of the positive surgical margin.Materials and.MethodsSeven hundred and forty-seven women with invasive ductal carcinoma of the breast, analyzing anatomical-pathological information, types of surgery, molecular subtypes, and the presence or absence of the surgical margin compromised by neoplasia.ResultsSixty-one (8.2%) patients had positive surgical margin, causing 2.85 times more risk of locoregional relapse compared to negative surgical margin by multivariate analysis. In subgroup analysis, among stages I, II and III, stage II was the most negatively impacted, with those patients presenting 2.42 times more risk of distant metastasis and 4.94 times more risk of locoregional relapses compared to negative surgical margin by multivariate analysis. Among the molecular subtypes, Triple Negative tumors with a positive surgical margin had 3.56 times more risk of death, 4.98 times more risk of distant metastasis and 5.55 times more risk of locoregional relapse compared to negative surgical margin by multivariate analysis.ConclusionsThe positive surgical margin, especially in Stage II and Triple-Negative breast cancer patients negatively impact the patient's evolution, increasing risk of distant metastasis and death.     

Sterile technique and the prevention of wound infection in office surgery--Part I

Surgical infection and associated complications are minimized by a combination of appropriate sterile technique and careful surgical technique. This review covers the essential elements of infection control for the office-based surgical practice. Recommendations are made concerning operating room facilities, instrument sterilization, and tray setup (Part I). Part II addresses surgical prepping, surgical technique, and prophylactic antibiotics.     

Robotics — The answer to the Achilles’ heel of VATS pulmonary resection

During the past decade,robotic surgical systems have been increasingly utilized to perform highly complex surgical procedures.In fact,the robotic-assisted approach to the treatment of many gynecological and urological surgical procedures has become the standard-of-care.The use of robotic surgical system in thoracic surgery is in its early development.Video-assisted thoracoscopic surgery(VATS)     

肝细胞癌合并胆管癌的临床分型以及手术方式选择对疾病预后的影响

目的 探讨肝细胞癌合并胆管癌的临床特征分型及手术治疗方式选择对远期效果的影响.方法 回顾性分析100例肝细胞癌合并胆管癌患者的就诊资料、肿瘤临床分型及手术方式、生存资料,手术方式有胆管切开取癌栓、肝癌切除并胆管癌切除、胆管支架置入引流等,分析不同手术方式对远期预后的影响.结果 100例确诊并进行根治手术治疗的患者有92例,其中肝细胞癌切除并胆管切口取癌栓的有38例,肝细胞癌切除并胆管癌切除的有48例,胆管支架植入引流的有6例,术后围手术期死亡的患者有9例,25例出现围手术并发症,术后1年、2年、3年的生存率分别为63.0％、25.0％、19.6％,生存期平均为(20.6 ±10.6)个月.通过单因素分析结果显示肝细胞癌合并胆管癌生存期与临床分型及手术方式选择有关.多因素分析结果显示手术方式的选择为影响生存期的独立因素.结论 手术方式的选择是影响肝细胞癌合并胆管癌治疗效果的重要因素.若能早期发现病灶并选择合理的手术方式进行根治,对于延长患者生存期具有重要的意义.     

Methodology for scientific evaluation of palliative surgery

Measuring the success of surgical palliation is not straightforward.To measure the benefits as well as limitations of surgical palliation,surgeons need outcome assessments other than the existing traditional measures of 30-day surgical morbidity and mortality and 5-year survival. This article delineates a scientific method of evaluating and measuring surgical palliation and shares techniques and pitfalls of assessment gained from prior experience.     

The surgical management of lung cancer

Since the introduction of the pneumonectomy as a technically feasible strategy for the treatment of lung cancer, surgical resection has played a pivotal role in the management of early stage non-small cell lung carcinoma (NSCLC). In the last two decades, surgical, medical, and radiation oncologists have produced a growing body of evidence to support the combination of neoadjuvant or adjuvant treatments with standard surgical resection, to improve disease-free and overall survival for specific patient subgroups. Furthermore, alternatives to aggressive surgical management have evolved for patients who are medically inoperable due to compromised pulmonary function or other comorbidities. In this review, surgical options and multimodal treatment strategies are discussed, as well as completed and ongoing clinical trials addressing the surgical management of NSCLC.     

The privileges and the responsibilities of a surgical oncologist

A surgical oncologist should teach at the undergraduate or postgraduate level, play a leadership role in oncology in either the community hospital or in an academic institution, encourage or participate in basic or clinical oncologic research, and foster interdisciplinary cooperation with the other oncologic specialists. The surgical oncologist should take an active role in educating the general surgical community through programs of the American College of Surgeons Commission on Cancer. Professional recognition of Surgical Oncology should be secured through the examination of surgical oncologists. The privilege of being a surgical oncologist carries with it the responsibility of recognition, certification, increased research effort and team involvement for optimal cancer care.     

Sterile technique and the prevention of wound infection in office surgery--Part II

Surgical infection and associated complications are minimized by a combination of appropriate sterile technique and careful surgical technique. This review covers the essential elements of infection control for the office-based surgical practice. Recommendations are made concerning operating room facilities, instrument sterilization, and tray set-up (Part I, J Dermatol Surg Oncol 14:1364-1371, 1988). Part II addresses surgical prepping, surgical technique, and prophylactic antibiotics.     

Utilization and Outcomes of Surgical Castration in Comparison to Medical Castration in Metastatic Prostate Cancer

BackgroundAndrogen deprivation therapy (ADT) is the gold standard for metastatic prostate cancer, which can be achieved either by surgical or medical castration. In this study, we evaluated the trends of utilization of surgical castration and also assess the survival differences of patients who underwent surgical castration when compared with those who underwent medical castration.Materials and MethodsThe National Cancer Database was used to identify patients with metastatic prostate cancer from 2004 to 2014. Cochran-Armitage tests were used to assess temporal trends in the proportion of patients receiving surgical castration relative to medical castration. Logistic and Cox regression models were utilized to estimate the odds of utilization of surgical castration and the effect of castration on overall survival (OS).ResultsA total of 33,585 patients with metastatic prostate cancer were identified; 31,600 (94.1%) had medical castration, and 1985 (5.9%) underwent surgical castration. There was significant decline in the trend of utilization of surgical castration from 8.6% in 2004 to 3.1% in 2014. On multivariable analysis, being of a non-Caucasian race, having lower median income levels, having non-private insurance, and earlier years of diagnosis were found to be associated with increased odds of choosing surgical castration over medical castration. Notably, the odds of surgical castration were lower at academic centers. On univariable analysis, a survival difference between castration modality was evidenced (P < .01); 5-year OS for medical castration and surgical castration were 24.3% and 18.2%, respectively. However, on multivariable analysis, there was no OS difference between surgical castration and medical castration (P = .13).ConclusionsIn this large contemporary analysis, the utilization of surgical castration has declined over time, with no OS difference when compared with medical castration. Increasing the utilization of surgical castration could help reduce health care expenditures. With rising health care costs, patients and physicians need to be aware of treatment options and their financial implications.