Pancreatic cancer–Laparoscopic resection

Objective: To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods: A comprehensive review of articles from PubMed was carried out. Results: Cur- rently, the advantages of a complete laparoscopic pancreatoduodenectomy (LPD) are still outweighed by the morbidity associ- ated with the procedure. However, laparoscopic distal pancreatectomy (LDP) offers patients benefits in terms of postoperative recovery and the length of hospital stay with similar morbidity and mortality to open surgery. Hand-assisted laparoscopic sur- gery can help to overcome the limitation of a complete laparoscopic surgery while maintaining a minimally invasive approach. Conclusion: Current literature suggests that laparoscopic resection of pancreatic cancer is feasible and safe in experienced hands. The hand-assisted laparoscopic surgery shows a promising future in pancreatic cancer surgery.     

术前支气管动脉灌注化疗在肺癌手术中的临床研究

Objective： How to improve the postoperative 5-year survival rate for lung cancer and to give more patients a chance of surgery have become research hotspots. The aim of this research is to evaluate the clinical and pathohistological responses and effects of preoperative bronchial artery infusion （BAI） chemotherapy in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： A total of 92 patients with locally advanced NSCLC were randomly divided into two groups. BAI group received BAI chemotherapy for 2 cycles before surgical resection. Surgery group received operation only. The complete resection rate and clinical response were compared between the two groups. Results： In the BAI group, the clinical response rate and the pathohistological response rate were 68.3% and 51.3%, respectively. The complete resection rate in the BAI group was 89.7%, which was significantly higher than that in the surgery group （72.5%） （P 〈 0.05）. The 1- and 2-year survival rate was 100.0% and 80.6% in the BAI group, and 94.1% and 60.0% in the surgery group. Conclusion： BAI neoadjuvant chemotherapy is safe and effective, which has a good clinical and pathohistological response. It might increase the complete resection rate of the tumor and improve the long term survival rate of stage Ⅲ NSCLC patients.     

胰腺癌:治疗性切除术

Resecting pancreatic cancer is the only chance for cure for this devastating disease . It increases survival significantly and may also contribute to a better quality of life . While median survival for patients with unresectable pancreatic cancer is only about 4-8 months, resective surgery improves prognosis to a median survival of 14-20 months and 5-year survival rates of up to 25% . A few studies compared curative resection versus incomplete （R1 and R2） resections whereas only one randomized trial was conducted comparing surgery versus chemoradiation . All these studies confirmed the survival benefit seen in the retrospective data analyses：     

胰腺癌:新辅助治疗

In spite of the high mortality in pancreatic cancer, significant progress is being made. This review discusses multimodality therapy for patients with pancreatic cancer. Surgical therapy currently offers the only potential monomodal cure for pancreatic adenocarcinoma. However only 10%-20% of patients present with tumors that are amenable to resection, and even after resection of localized cancers, long term survival is rare. The addition of chemoradiation therapy significantly increases median survival. To achieve long-term success in treating this disease it is therefore increasingly important to identify effective neoadjuvant/adjuvant multimodality therapies. Preoperative chemoradiation for potentially resectable pancreatic cancer has the following advantages： （1） neoadjuvant treatment would eliminate the delay of adjuvant treatment due to postoperative complications; （2） neoadjuvant treatment could avoid unnecessary surgery for patients with metastatic disease evident on restaging after neoadjuvant therapy; （3） downstaging after neoadjuvant therapy may increase the likelihood for negative surgical margins; and （4） neoadjuvant treatment could prevent peritoneal tumor cell implantation and dissemination caused during surgery. This review systematically summarizes the current status, controversies, and prospects of neoadjuvant treatment of pancreatic cancer.     

Laparoscopic approach for hepatocellular carcinoma： where is the limit？

Hepatocellular cancer （HCC） is the sixth most common malignant tumor worldwide and the most common primary liver cancer （1）. Liver resection or liver transplantation is the therapeutic gold standards in patient with HCC. Due to advanced disease, extrahepatic metastases, or inadequate liver reserve, only 15% to 30% of patients with HCC can undergo to surgery （2）. Five-year risk of recurrence of HCC after resection is as high as 70% because the underlying chronic liver disease continues to put the patient at risk for the development of new cancer nodules （3）. Starting from the assumption that recurrence may be newly treated with surgery, laparoscopic approach is recommended,     

Current status and challenges in sentinel node navigation surgery for early gastric cancer

Although a number of feasibility studies for sentinel node (SN) concepts in gastric cancer have been conducted since 2000,there remains a debate regarding detailed detection techniques and oncological safety.Two important multicenter phase Ⅱ clinical trials were performed in Japan that used different methods and reached different conclusions;one confirmed acceptable results with a false-negative rate of 7％,and the other showed an unacceptably high false-negative rate of 46.4％.The Sentinel Node Oriented Tailored Approach (SENORITA) trial is a multicenter randomized controlled phase Ⅲ trial being performed in Korea.Patient enrollment is now complete and the long-term results are currently awaited.Recently,an image-guided SN mapping technique using infrared ray/fluorescence was introduced.This method might be a promising technology because it allows the clear visualization of SNs.With regard to the primary tumor,the non-exposed endoscopic wall-inversion surgery technique and non-exposure endolaparoscopic full-thickness resection with simple suturing technique have been reported.These methods prevent abdominal infection and tumor seeding and can be good alternatives to conventional laparoscopic gastric wedge resection.For indications,SN navigation surgery can be extended to patients who underwent non-curative endoscopic resection.Although a few studies have been performed on these patients,sentinel concepts may be beneficial to patients as they omit the need for additional gastrectomy.SN navigation surgery can lead to actual organ-preserving surgery and plays a key role in improving the quality of life of patients with early gastric cancer in the future.     

Long-term outcomes after laparoscopic colectomy

AIM:To evaluate long-term outcomes in a large series of patients who randomly received laparoscopic or open colorectal resection.METHODS:From February 2000 to December 2004,six hundred sixty-two patients with colorectal disease were randomly assigned to laparoscopic(LPS,n = 330) or open(n = 332) colorectal resection.All patients were analyzed on an intention-to-treat basis.Long-term follow-up was carried out every 6 mo by office visits.In 526 cancer patients five-year overall and disease-free survival were evaluated.Median oncologic follow-up was 96 mo.RESULTS:Eight(4.2%) LPS group patients needed conversion to open surgery.Overall long-term morbidity rate was 7.6%(25/330) in the LPS vs 11.1%(37/332) in the open group(P = 0.17).In cancer patients,fiveyear overall survival was 68.6% in the LPS group and 64.0% in the Open group(P = 0.27).Excluding stage Ⅳ patients,five-year local and distant recurrence rates were 32.5% in the LPS group and 36.8% in the Open group(P = 0.36).Further,no difference in recurrence rate was found when patients were stratified according to cancer stage.CONCLUSION:LPS colorectal resection was associated with a slightly lower incidence of long-term complications than open surgery.No difference between groups was found in overall and disease-free survival rates.     

Meta-analysis:prognostic value of survivin in patients with pancreatic cancer

Objective： The aim of the study was to conduct a systematic review of the literature evaluating survivin expres- sion in pancreatic carcinoma as a prognostic indicator. Methods： The relevant literatures were searched using PubMed, EMBASE, and Chinese Biomedicine Databases. A meta-analysis of the association between survivin expression and overall survival in patients with pancreatic cancer was performed. Studies were pooled and summary hazard ratios （HRs） were calculated. Subgroup analysis according to the location of survivin expression was also performed. Results： Seven eligible studies with a total of 448 patients were included in this study. Combined HR suggested that survivin expression had an unfavorable impact on survival of pancreatic cancer patients （HR = 1.65, 95% CI： 1.02-2.68）. When stratified according to the location of survivin expression, the combined HR showed that expression in the cytoplasm was significantly associated with poor prog- nosis of pancreatic cancer patients （HR = 2.09, 95% CI： 1.29-3.40）. In contrast, survivin expression in the nucleus was not significantly associated with poor prognosis （HR = 0.83, 95% CI： 0.24-2.81）, and the heterogeneity was highly significant （I2 = 87.2%, P = 0.005）. Conclusien： Survivin expression was associated with a poor prognosis in patients with pancreatic cancer. Cytoplasmic expression of survivin may be a prognostic factor for pancreatic cancer patients. Based on the current obtained data, there was no evidence that survivin expression in the nucleus had a significant impact on patients＇ overall survival.     

Pancreatic cancer–Neoadjuvant therapy

In spite of the high mortality in pancreatic cancer, significant progress is being made. This review discusses multimodality therapy for patients with pancreatic cancer. Surgical therapy currently offers the only potential monomodal cure for pancreatic adenocarcinoma. However only 10%–20% of patients present with tumors that are amenable to resection, and even after resection of localized cancers, long term survival is rare. The addition of chemoradiation therapy significantly increases median survival. To achieve long-term success in treating this disease it is therefore increasingly important to identify effective neoadjuvant/adjuvant multimodality therapies. Preoperative chemoradiation for potentially resectable pancreatic cancer has the following advantages: (1) neoadjuvant treatment would eliminate the delay of adjuvant treatment due to postoperative complications; (2) neoadjuvant treatment could avoid unnecessary surgery for patients with metastatic disease evident on restaging after neoadjuvant therapy; (3) downstaging after neoadjuvant therapy may increase the likelihood for negative surgical margins; and (4) neoadjuvant treatment could prevent peritoneal tumor cell implantation and dissemination caused during surgery. This review systematically summarizes the current status, controversies, and prospects of neoadjuvant treatment of pancreatic cancer.     

Laparoscopic liver resection: Current role and limitations

Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.     

Surgery of extra-axial tumors of the cerebral base

Because of the complex structure of the cranial base and its close proximity to cranial nerves and vessels, surgery in this area is associated with considerable risk of morbidity and mortality. Multiple approaches to each part of the cranial base have been developed over the past few decades, ranging from small modifications of more traditional approacbes to complex and sophisticated new techniques. However, experience has shown that optimal outcome is achieved if the selected approach is not associated with significant approach-related morbidity. Furthermore, not all cranial base tumors can be cured by surgery. The selection of operative approach and the goal of surgery should be part of the whole treatment strategy. The attempt to achieve complete resection can, therefore, be justified only if the associated long-term morbidity is minimal.     

Folate-chitosan-gemcitabine core-shell nanoparticles targeted to pancreatic cancer

Objective：Human pancreatic cancer is one of the most common clinical malignancies.The effect of comprehensive treatment based on surgery is general.The effects of chemotherapy were not obvious mainly because of lack of targeting and chemoresistance in pancreatic cancer.This study aimed to investigate the effects of folate receptor （FR）-mediated gemcitabine FA-Chi-Gem nanoparticles with a core-shell structure by electrostatic spray on pancreatic cancer.Methods：In this study,the levels of expression of FR in six human pancreatic cancer cell lines were studied by immunohistochemical analysis.The uptake rate of isothiocyanate-labeled FA-Chi nanoparticles in FR high expression cell line COLO357 was assessed by fluorescence microscope and the inhibition rate of FA-Chi-Gem nanoparticles on COLO357 cells was evaluated by MTT assay.Moreover,the biodistribution of PEG-FA-ICGDER02-Chi in the orthotopic pancreatic tumor model was observed using near-infrared imaging and the human pancreatic cancer orthotopic xenografts were treated with different nanoparticles and normal saline control.Results：The expression of FR in COLO357 was the highest among the six pancreatic cancer cell lines.The FR mainly distributed on cell membrane and fewer in the cytoplasm in pancreatic cancer.Moreover,the absorption rate of the FA-Chi-Gem nanoparticles was more than the Chi nanoparticles without FA modified.The proliferation of COLO357 was significantly inhibited by FA-Chi-Gem nanoparticles.The PEG-FA-ICGDER02-Chi nanoparticles were enriched in tumor tissue in human pancreatic cancer xenografts,while non-targeted nanoparticles were mainly in normal liver tissue.PEG-FA-Gem-Chi significantly inhibited the growth of human pancreatic cancer xenografts （PEG-FA-Gem-Chi vs.Gem,t=22.950,P=0.000）.Conclusions：PEG-FA-FITC-Chi nanoparticles might be an effective targeted drug for treating human FR-positive pancreatic cancer.     

A gist of gastrointestinal stromal tumors: A review

Gastrointestinal stromal tumors (GISTs) have been recognized as a biologically distinctive tumor type, different from smooth muscle and neural tumors of the gastrointestinal tract (GIT). They constitute the majority of gastrointestinal mesenchymal tumors of the GIT and are known to be refractory to conventional chemotherapy or radiation. They are defined and diagnosed by the expression of a proto-oncogene protein detected by immunohistochemistry which serves as a crucial diagnostic and therapeutic target. The identification of these mutations has resulted in a better understanding of their oncogenic mechanisms. The remarkable antitumor effects of the molecular inhibitor imatinib have necessitated accurate diagnosis of GIST and their distinction from other gastrointestinal mes-enchymal tumors. Both traditional and minimally invasive surgery are used to remove these tumors with minimal morbidity and excellent perioperative outcomes. The revolutionary use of specific, molecularlytargeted therapies, such as imatinib mesylate, reduces the frequency of disease recurrence when used as an adjuvant following complete resection. Neoadjuvant treatment with these agents appears to stabilize disease in the majority of patients and may reduce the extent of surgical resection required for subsequent complete tumor removal. The important interplay between the molecular genetics of GIST and responses to targeted therapeutics serves as a model for the study of targeted therapies in other solid tumors. This review summarizes our current knowledge and recent advances regarding the histogenesis, pathology, molecular biology, the basis for the novel targeted cancer therapy and current evidence based management of these unique tumors.     

胰腺癌:姑息性支架术治疗

Pancreatic cancer remains a common and very lethal malignancy with a median survival of approximately 6 months. Surgical resection offers the only potentially curative approach but many patients （80% or more） are ineligible for this kind of therapy, because of age, comorbidities, or locally advanced or metastatic disease that does not benefit from resection. Thus, for many patients with pancreatic cancer treatment remains palliative and endoscopic therapy to relieve bile duct or gastric outlet obstruction becomes of special importance. Although both surgical and non surgical palliative procedures can relieve biliary and duodenal obstruction particularly endoscopic treatment with plastic prostheses or self expanding metal stents was shown to be not only highly effective but also to be burdened with only few complications. The present article summarizes the palliative endoscopic treatment in patients with non resectable pancreatic cancer.     

Detection of K-ras Gene Point Mutation＇s Style in Human Pancreatic Cancer Cell Line PANC-1 by PCR-SSP

Objective： To detect the style of K-ras gene point mutation in human pancreatic cancer cell line PANC-1 and decide the bp sequence of Ras target position interfered by RNA. Methods： Three kinds of special sequence primers （SSP） for polymerase chain reaction （PCR） with regard to the mutation styles （OAT, COT and GOT） at codon 12 of K-ras were used to study the human pancreatic cancer cell line PANC-1. The amplification products were studied with polyacrylamine gel electrophoresis to detect the style of point mutation. Results： The style of K-ras gene point mutation at codon 12 was OAT in human pancreatic cancer cell line. Conclusion： PCR-SSP is rapid, convenient and high specific. The results provide a basis for further gene therapy by RNA interference for pancreatic cancer.     

Lung Cancer Survival Improvement through Surgical Intervention in PUMCH Hospital

Objective： To investigate and evaluate improvement of lung cancer survival after surgical intervention in PUMC hospital during the last 15 years. Methods： From January 1989 to December 2003, 1574 lung cancer cases underwent surgical treatment and followed up. All cases in this series were divided into two groups according to time period： group A （1999-2003） and group B （1989-1998）. The difference in the survival rate between groups A and B was compared. Results： The morbidity and mortality in group A was decreased significantly in comparison to group B （11.2% vs. 19.2%, 1.06% vs. 1.93%, respectively）. However, the 3-year and 5-year survival rate was increased from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively. A significant improvement in survival was observed in patients with stage Ⅰ, Ⅱ and ⅢA, but not in those with stage ⅢB and Ⅳ. Also, patients with lobectomy had more satisfactory results than those receiving exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection. Conclusion： Lobectomy plus systematic mediastinal lymph nodes dissection has become the standard mode for resectable lung cancer. Combination of complete resection along with lymph nodal dissection, and postoperative adjuvant chemotherapy based on platinum/3^rd generation chemotherapy medicine, has preliminarily been justified, proving an important approach for effective improvement in long-term survival of non-small cell lung carcinoma.     

Excision of head and neck tumors combined with carotid artery resection without arterial blood vessel reconstruction

OBJECTIVE To summarize our clinical experience in treating 31 patients with neck masses undergoing carotid artery resection without arterial anastomosis （vascular reconstruction） in Tianjin Cancer Hospital during a period from 1979 to 2002. METHODS Preoperatively, patients were instructed to apply pressure to the carotid artery. Tumor excision combined with carotid artery resection （TECCAR） was conducted after an accurate testing of valid cerebral blood supply and compensation. RESULTS Among the study patients, 17 were male and 14 female, with the age ranging from 14 to 58 years. Of the 31 cases, 23 were carotid body tumors （8 malignant）, 2 vagal body tumors （1 malignant）, 4 carotid aneurysms, and 2 were metastatic tumors from the cervix involving carotid artery. Of the patients, a subtotal resection of the head and neck masses was conducted in 22 cases. Intraoperative death did not cerebrovascular complications occur, and postoperative CNS or （CVC） were not found. CONCLUSION TECCAR without arterial anastomosis is a safe and feasible procedure. In addition, this method of surgery has more advantages in comparison to an arterial anastomosis： i） Tumor resection was more complete, ii） Complications such as thrombus, infection, and lethal hemorrhage etc., were rare after surgery; iii） Postoperative radiotherapy, if needed, would be safe and acceptable; iv） It was a more simplified operational procedure.     

Endoscopic transnasal craniotomy and the resection of craniopharyngioma

OBJECTIVES/HYPOTHESIS： To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma. STUDY DESIGN： Observational, retrospective cohort study. METHODS： Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics （age, sex, follow-up）, tumor factors （size, position extension, previous surgery）, type of repair （pedicled mucosal flaps, free mucosal grafts）, and outcomes （visual, endocrine, and surgical morbidity） were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma （defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach）.     

Serum protein fingerprint of patients with pancreatic cancer by SELDI technology

Objective： To study the serum protein fingerprint of patients with pancreatic cancer and to screen for protein molecules closely related to pancreatic cancer during the onset and progression of the disease using surface-enhanced laser desorption and ionization time of fight mass spectrometry （SELDI-TOF-MS）. Methods： Serum samples from 20 pancreatic cancers, 20 healthy volunteers and 18 patients with other pancreatic diseases. WCX magnetic beans and PBSII-C protein chips reader （Ciphergen Biosystems Ins.） were used. The protein fingerprint expression of all the Serum samples and the resulting profiles between cancer and normal were analyzed with BiomarkerWizard system. Results： Agroup ofproteomic peaks were detected. Four differently expressed potential biomarkers were identified with the relative molecular weights of 5705 Da, 4935 Da, 5318 Da and 3243 Da. Among them, two proteins with m/z5705, 5318Da down-regulated, and two proteins with m/z 4935, 3243 Da were up-regulated in pancreatic cancers. Conclusion： SELDI technology can be used to screen significant proteins of differential expression in the serum of pancreatic cancer patients. These different proteins could be specific biomarkers of the patients with pancreatic cancer in the serum and have the potential value of further investigation.     

从直肠癌保肛手术局部复发的形式探讨TME与扩大根治术的互补性

Objective： To investigate the difference and complementarity between total mesorectal excision （TME） and radical resection in relation to postoperative local recurrence in patients receiving anus-reserve operation on rectal cancer. Methods： Clinical data of 81 cases during a period from 1975 to 2001 were retrospectively analyzed. Results： In the 81 cases with local recurrence, 49 of them laid to anastomosis and mesorectum, 17 lymph nodes and 15 multi-site relapse. The choice of operative procedure included abdominoperineal resection in 58 cases, Hartmann＇s operation in 4 cases, simple double-pelvic stoma in 12 cases, exploration in 7 cases, and total pelvic or rear-pelvic resection in combination with other organs in 6 cases. The rate of resection was 84.0% （68/81）. 32 cases reached clinical radical degree, and the rate of radical resection was 39.5% （32/81）. The 5-year survival rate was 34.4% （11/32）. Conclusion： Based on actual condition of the patients, attention to radical resection and total mesorectal excision are necessary, and reasonable adoption of the operative procedure could reduce the local recurrence of rectal cancer.