187 results on '"Jian Wei"'
Search Results
2. Appraisal of surgical outcomes and oncological efficiency of intraoperative adverse events in robotic radical gastrectomy for gastric cancer
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Liu, Zhi-Yu, primary, Zhong, Qing, additional, Wang, Zeng-Bin, additional, Shang-Guan, Zhi-Xin, additional, Lu, Jun, additional, Li, Yi-Fan, additional, Huang, Qiang, additional, Wu, Ju, additional, Li, Ping, additional, Xie, Jian-Wei, additional, Chen, Qi-Yue, additional, Huang, Chang-Ming, additional, and Zheng, Chao-Hui, additional
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- 2024
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3. Effect of sarcopenia on short-term and long-term outcomes of older patients with locally advanced gastric cancer: a multicenter study
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Zheng, Zi-Fang, primary, Lin, Guang-Tan, additional, Zhong, Qing, additional, Wu, Dong, additional, Lu, Jun, additional, Wang, Jia-Bin, additional, Chen, Qi-Yue, additional, Lin, Jian-Xian, additional, Cao, Long-Long, additional, Lin, Mi, additional, Zheng, Shu-Ping, additional, Xie, Jian-Wei, additional, Zheng, Chao-Hui, additional, Huang, Chang-Ming, additional, and Li, Ping, additional
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- 2023
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4. Clinical outcomes of endoscopic resection for the treatment of esophageal gastrointestinal stromal tumors: a ten-year experience from a large tertiary center in China
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Xu, Jia-Xin, primary, Chen, Tian-Yin, additional, Liu, Yan-Bo, additional, Xu, Xiao-Yue, additional, Chen, Wei-Feng, additional, Li, Quan-Lin, additional, Hu, Jian-Wei, additional, Qin, Wen-Zheng, additional, Cai, Ming-Yan, additional, Zhang, Yi-Qun, additional, and Zhou, Ping-Hong, additional
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- 2023
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5. Developing a modified textbook outcome for elderly patients with gastric cancer: a multi-center study
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Zhong, Qing, Zheng, Zi-Fang, Wu, Dong, Shang-Guan, Zhi-Xin, Liu, Zhi-Yu, Zheng, Lin-Yong, Lin, Jian-Xian, Chen, Qi-Yue, Wang, Jia-Bin, Xie, Jian-Wei, Lin, Mi, Lin, Wei, Zheng, Chao-Hui, Huang, Chang-Ming, and Li, Ping
- Abstract
Objective: Textbook outcome (TO) is widely recognized as a comprehensive prognostic indication for patients with gastric cancer (GC). This study aims to develop a modified TO (mTO) for elderly patients with GC. Methods: Data from the elderly patients (aged ≥ 65 years) in two Chinese tertiary referral hospitals were analyzed. 1389 patients from Fujian Medical University Union Hospital were assigned as the training cohort and 185 patients from Affiliated Hospital of Putian University as the validation cohort. Nomogram was developed by the independent prognostic factors of Overall Survival (OS) based on Cox regression. Results: In the training cohort, laparoscopic surgery was significantly correlated with higher TO rate (P< 0.05). Cox regression analysis revealed that surgical approach was also an independent factor of OS (P< 0.001), distinct from the traditional TO. In light of these findings, TO parameters were enhanced by the inclusion of surgical approach, rendering a modified TO (mTO). Further analysis showed that mTO, tumor size, pTNM staging, and adjuvant chemotherapy were independent prognostic factors associated with OS (all P< 0.05). Additionally, the nomogram incorporating these four indicators accurately predicted 1-, 3-, and 5-year OS in the training cohort, with AUC values of 0.793, 0.814, and 0.807, respectively, and exhibited outstanding predictive performance within the validation cohort. Conclusion: mTO holds a robust association with the prognosis of elderly patients with GC, meriting intensified attention in efforts aimed at enhancing surgical quality. Furthermore, the predictive model incorporating mTO demonstrates excellent predictive performance for elderly patients with GC.
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- 2024
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6. Robot-assisted versus laparoscopic-assisted gastrectomy among malnourished patients with gastric cancer based on textbook outcome
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Lin, Guang-Tan, Chen, Jun-Yu, Shang-Guan, Zhi-Xin, Fan, Deng-Hui, Zhong, Qing, Wu, Dong, Liu, Zhi-Yu, Jiang, Yi-Ming, Wang, Jia-Bin, Lin, Jian-Xian, Lu, Jun, Chen, Qi-Yue, Huang, Zhi-Hong, Lin, Ju-Li, Xie, Jian-Wei, Li, Ping, Huang, Chang-Ming, and Zheng, Chao-Hui
- Abstract
Background: Textbook outcome (TO) has been widely employed as a comprehensive indicator to assess the short-term prognosis of patients with cancer. Preoperative malnutrition is a potential risk factor for adverse surgical outcomes in patients with gastric cancer (GC). This study aimed to compare the TO between robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG) in malnourished patients with GC. Methods: According to the diagnostic consensus of malnutrition proposed by Global Leadership Initiative on Malnutrition (GLIM) and Nutrition Risk Index (NRI), 895 malnourished patients with GC who underwent RAG (n= 115) or LAG (n= 780) at a tertiary referral hospital between January 2016 and May 2021 were included in the propensity score matching (PSM, 1:2) analysis. Results: After PSM, no significant differences in clinicopathological characteristics were observed between the RAG (n= 97) and LAG (n= 194) groups. The RAG group had significantly higher operative time and lymph nodes harvested, as well as significantly lower blood loss and hospital stay time compared to the LAG group. More patients in the RAG achieved TO. Logistic regression analysis revealed that RAG was an independent protective factor for achieving TO. There were more adjuvant chemotherapy (AC) cycles in the RAG group than in the LAG group. After one year of surgery, a higher percentage of patients (36.7% vs. 22.8%; P< 0.05) in the RAG group recovered from malnutrition compared to the LAG group. Conclusions: For malnourished patients with GC, RAG performed by experienced surgeons can achieved a higher rate of TO than those of LAG, which directly contributed to better AC compliance and a faster restoration of nutritional status.
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- 2024
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7. Oncological outcomes of laparoscopic versus open radical total gastrectomy for upper-middle gastric cancer after neoadjuvant chemotherapy: a study of real-world data
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Hua-Long Zheng, Li-li Shen, Bin-bin Xu, Qi-Yue Chen, Jun Lu, Zhen Xue, null Jia-Lin, Jian-Wei Xie, Ping Li, Chang-Ming Huang, and Chao-Hui Zheng
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Surgery - Published
- 2023
8. Clinical outcomes of endoscopic resection for the treatment of esophageal gastrointestinal stromal tumors: a ten-year experience from a large tertiary center in China
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Jia-Xin Xu, Tian-Yin Chen, Yan-Bo Liu, Xiao-Yue Xu, Wei-Feng Chen, Quan-Lin Li, Jian-Wei Hu, Wen-Zheng Qin, Ming-Yan Cai, Yi-Qun Zhang, and Ping-Hong Zhou
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Surgery - Published
- 2023
9. Robotic spleen-preserving total gastrectomy shows better short-term advantages: a comparative study with laparoscopic surgery
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Zu-Kai Wang, Jian-Xian Lin, Fu-Hai Wang, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ze-Ning Huang, Ju-Li Lin, Hua-Long Zheng, Ping Li, Chao-Hui Zheng, and Chang-Ming Huang
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Treatment Outcome ,Robotic Surgical Procedures ,Stomach Neoplasms ,Gastrectomy ,Humans ,Lymph Node Excision ,Laparoscopy ,Surgery ,Organ Sparing Treatments ,Spleen ,Retrospective Studies - Abstract
Robotic surgery may be advantageous for complex surgery. We aimed to compare the intraoperative and postoperative short-term outcomes of spleen-preserving splenic hilar lymphadenectomy (SPSHL) during robotic and laparoscopic total gastrectomy.From July 2016 to December 2020, the clinicopathological data of 115 patients who underwent robotic total gastrectomy combined with robotic SPSHL (RSPSHL) and 697 patients who underwent laparoscopic total gastrectomy combined with laparoscopic SPSHL (LSPSHL) were retrospectively analyzed. A 1:2 ratio propensity score matching (PSM) was used to balance the differences between the two groups to compare their outcomes. The Generic Error Rating Tool was used to evaluate the technical performance.After PSM, the baseline preoperative characteristics of the 115 patients in the RSPSHL and 230 patients in the LSPSHL groups were balanced. The dissection time of the region of the splenic artery trunk (5.4 ± 1.9 min vs. 7.8 ± 3.6 min, P 0.001), the estimated blood loss during SPSHL (9.6 ± 4.8 ml vs. 14.9 ± 7.8 ml, P 0.001), and the average number of intraoperative technical errors during SPSHL (15.1 ± 3.4 times/case vs. 20.7 ± 4.3 times/case, P 0.001) were significantly lower in the RSPSHL group than in the LSPSHL group. The RSPSHL group showed higher dissection rates of No. 10 (78.3% vs. 70.0%, P = 0.104) and No. 11d (54.8% vs. 40.4%, P = 0.012) lymph nodes and significantly improved postoperative recovery results in terms of times to ambulation, first flatus, and first intake (P 0.05). The splenectomy rates of the two groups were similar (1.7% vs. 0.4%, P = 0.539), and there was no significant difference in morbidity and mortality within postoperative 30 days (13.0% vs. 15.2%, P = 0.589).Compared to LSPSHL, RSPSHL has more advantages in terms of surgical qualities and postoperative recovery process with similar morbidity and mortality. For complex SPSHL, robotic surgery may be a better choice.
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- 2022
10. Single-incision versus four-incision laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II
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Shu-Hung Chuang, Kung-Kai Kuo, Shih-Chang Chuang, Shen-Nien Wang, Wen-Tsan Chang, Wen-Lung Su, Jian-Wei Huang, Po-Hsuan Wu, Hon-Man Chan, and Chi-Hang Kuok
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Surgery - Published
- 2022
11. Long-term prognosis of small gastric gastrointestinal stromal tumors with high histological grade: a longitudinal nested cohort study
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Tian-Yin Chen, Jia-Xin Xu, Wei-Feng Chen, Quan-Lin Li, Ming-Yan Cai, Jian-Wei Hu, Wen-Zheng Qin, Yuan Ji, Xiao-Yue Xu, Yi-Qun Zhang, and Ping-Hong Zhou
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Cohort Studies ,Treatment Outcome ,Gastrectomy ,Gastrointestinal Stromal Tumors ,Stomach Neoplasms ,Humans ,Surgery ,Prognosis ,Retrospective Studies - Abstract
Gastrointestinal stromal tumors (GIST) are mostly seen in the stomach. Clinical data on GISTs ≤ 2 cm with 5 mitosis/50 HPFs are limited. This study aimed to analyze small GISTs with high histological grades to gain a more comprehensive understanding of their clinical characteristics with long-term follow-up.This was a nested cohort study of patients with gastric GISTs ≤ 2 cm and 5 mitosis/50 HPFs. Individuals with endoscopically resected gastric specimens diagnosed as GISTs between January 2008 and July 2019 were enrolled. We analyzed baseline clinicopathological characteristics, perioperative characteristics, risk of recurrence, and metastasis during follow-up.A total of 55 patients diagnosed with gastric GISTs ≤ 2 cm and 5 mitosis/50 HPFs were enrolled. The mean tumor size was 1.6 ± 0.4 cm (median 1.7 cm, range 0.8-2.0 cm). ESD was performed in 33 patients (60.0%) and EFTR in 22 patients (40.0%). Mean mitotic figures were 8.9/50 HPFs. Postoperative bleeding in one patient (1.8%) was the only severe adverse event. The mean follow-up period was 61.2 ± 33.9 months (median 53 months, range 13-133 months). Five patients (5/55, 9.1%) received additional therapies, including partial gastrectomy and adjuvant Imatinib. Only two patients (2/55, 3.6%) showed signs of recurrence. We observed no significant difference regarding baseline clinical characteristics and recurrence among GISTs with mitosis 10/50 HPF and ≥ 10/50 HPF. No patient had signs of metastasis during follow-up.Endoscopic resection of gastric GISTs ≤ 2 cm with 5 mitosis/50 HPFs has a low risk of recurrence and metastasis in the long term. Endoscopic resection of GISTs is safe and feasible.
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- 2022
12. Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation
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Lu, Jun, Wu, Dong, Huang, Jiao-bao, Lin, Jia, Xu, Bin-bin, Xue, Zhen, Zheng, Hua-Long, Lin, Guo-sheng, Shen, Li-li, Li, Ping, Wang, Jia-Bin, Lin, Jian-Xian, Chen, Qi-Yue, Cao, Long-Long, Xie, Jian-Wei, Zheng, Chao-Hui, and Huang, Chang-Ming
- Abstract
Importance: It is largely unclear whether robotic distal gastrectomy (RDG) is cost-effective for locally advanced gastric cancer (LAGC). Objective: To evaluate the cost-effectiveness of RDG, laparoscopic distal gastrectomy (LDG), and open distal gastrectomy (ODG) for patients with LAGC. Design, setting, and participants: Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. A decision-analytic model was constructed to evaluate the cost-effectiveness of RDG, LDG, and ODG. Exposures: RDG, LDG, and ODG. Main outcomes and measures: Incremental cost-effectiveness ratio (ICER) and quality-adjusted life year (QALY). Results: This pooled analysis of two randomized controlled trials included 449 patients: 117, 254, and 78 patients in the RDG, LDG, and ODG groups, respectively. After IPTW, RDG demonstrated its priority in terms of less blood loss, postoperative length, and complication rate (all P< 0.05). RDG also showed higher QOL with more cost, representing an ICER of $85,739.73 per QALY and $42,189.53 per QALY compared to LDG and ODG, respectively. In probabilistic sensitivity analysis, RDG achieved the best cost-effectiveness for patients with LAGC only when the willingness-to-pay threshold was > $85,739.73 per QALY, which significantly exceeded 3 times Chinese per capita GDP. Furthermore, one of the most important factors was the indirect costs of robotic surgery in terms of the cost-effectiveness of RDG compared to that of LDG or ODG. Conclusions and relevance: Although improved short-term outcomes and QOL were seen in patients underwent RDG, the economic burden should be considered in the clinical decision-making regarding robotic surgery use for patients with LAGC. Our findings may vary in different health care settings and affordability.
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- 2023
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13. A prediction model and nomogram for technical difficulty of peroral endoscopic myotomy
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Liu, Xin-Yang, primary, Geng, Zi-Han, additional, Chen, Wei-Feng, additional, Xu, Mei-Dong, additional, Chen, Shi-Yao, additional, Zhong, Yun-Shi, additional, Zhang, Yi-Qun, additional, Ma, Li-Li, additional, Qin, Wen-Zheng, additional, Hu, Jian-Wei, additional, Cai, Ming-Yan, additional, Li, Quan-Lin, additional, and Zhou, Ping-Hong, additional
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- 2022
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14. Oncological outcomes of laparoscopic versus open radical total gastrectomy for upper-middle gastric cancer after neoadjuvant chemotherapy: a study of real-world data
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Zheng, Hua-Long, Shen, Li-li, Xu, Bin-bin, Chen, Qi-Yue, Lu, Jun, Xue, Zhen, Jia-Lin, Xie, Jian-Wei, Li, Ping, Huang, Chang-Ming, and Zheng, Chao-Hui
- Abstract
Background: Laparoscopic technique has been increasingly used in gastrectomy, but the safety and feasibility of the laparoscopic total gastrectomy (LTG) for advanced proximal gastric cancer (PGC) after neoadjuvant chemotherapy (NAC) is unclear. Methods: A retrospective analysis of 146 patients who received NAC followed by radical total gastrectomy at Fujian Medical University Union Hospital from January 2008 to December 2018 was performed. The primary endpoints were long-term outcomes. Results: The patients were divided into two groups: 89 were in the LTG group and 57 were in the open total gastrectomy (OTG) group. The LTG group had a significantly shorter operative time (median 173 min vs. 215 min, p< 0.001), less intraoperative bleeding (62 ml vs. 135 ml, p< 0.001), higher total lymph node (LN) dissections (36 vs 31, p= 0.043), and higher total chemotherapy cycle completion rate (≥ 8 cycles) (37.1% vs. 19.7%, p= 0.027) than OTG. The 3-year overall survival (OS) of the LTG group was significantly higher than that of the OTG group (60.7% vs. 35%, p= 0.0013). Survival with inverse probability weighting(IPW) correction for Lauren type, ypTNM stage, NAC schemes and the times at which the surgery was performed showed that there was no significant difference in OS between the two groups (p= 0.463). Postoperative complications (25.8% vs. 33.3%, p= 0.215) and recurrence-free survival (RFS) (p= 0.561) between the LTG and OTG groups were also comparable. Conclusion: In experienced gastric cancer surgery centers, LTG is recommended as the preferred option for such patients who performed NAC, owing to its long-term survival is not inferior to OTG, and it offers less intraoperative bleeding, better chemotherapy tolerance than conventional open surgery.
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- 2023
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15. A matched cohort study of the failure pattern after laparoscopic and open gastrectomy for locally advanced gastric cancer: does the operative approach matter?
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Hua-Long Zheng, Ping Li, Jia-Bin Wang, Chao-Hui Zheng, Chang-Ming Huang, Bin-Bin Xu, Dong Wu, Jun Lu, Jian-Xian Lin, Zhen Xue, and Jian-Wei Xie
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Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Gastroenterology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Stage (cooking) ,Retrospective Studies ,business.industry ,Hazard ratio ,Hepatology ,Treatment Outcome ,Propensity score matching ,Cohort ,Laparoscopy ,030211 gastroenterology & hepatology ,Surgery ,business ,Abdominal surgery - Abstract
Due to lacking evidence for confirming the efficacy of performing laparoscopic surgery for locally advanced gastric cancer (LAGC). Therefore, this study aimed to compare the static and dynamic failure patterns after laparoscopic gastrectomy (LG) and open gastrectomy (OG) in LAGC. A total of 1792 LAGC patients who underwent radical resection between January 2010 and January 2017 were divided into the LG group (n = 1557) and the OG group (n = 235). Propensity score matching was performed to balance the two groups. Dynamic hazard rates of failure were calculated using the hazard function. Early and late failure were defined as failure occurring before and after 2 years since surgery, respectively. A total of 1175 patients with LAGC were included after matching (LG group, n = 940; OG, n = 235). The failure rate of the whole cohort was 43.2% (508/1175), accounting for 41.4% (389/940) and 50.6% (119/235) in the LG and OG groups, respectively. Although the two groups showed no significant differences in failure rate for any failure type, landmark analysis showed a lower early distant recurrence rate in the stage IIa–IIIb subgroup of the LG group (OG versus LG: 30.3% versus 21.1%, P = 0.004). The dynamic hazard rate peaked at 9.4 months (peak rate = 0.0186) before gradually declining. In stage IIa–IIIb patients, the hazard rate of the OG group remained significantly higher than that of the LG group within the first 2 years in terms of distant recurrence (peak rate: OG versus LG, 0.0091 versus 0.0055). Given the differences in early failure between LG and OG, more intensive surveillance for distant recurrence within the first 2 years should be considered for patients with stage IIa–IIIb after OG.
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- 2021
16. Robotic spleen-preserving total gastrectomy shows better short-term advantages: a comparative study with laparoscopic surgery
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Wang, Zu-Kai, primary, Lin, Jian-Xian, additional, Wang, Fu-Hai, additional, Xie, Jian-Wei, additional, Wang, Jia-Bin, additional, Lu, Jun, additional, Chen, Qi-Yue, additional, Cao, Long-Long, additional, Lin, Mi, additional, Tu, Ru-Hong, additional, Huang, Ze-Ning, additional, Lin, Ju-Li, additional, Zheng, Hua-Long, additional, Li, Ping, additional, Zheng, Chao-Hui, additional, and Huang, Chang-Ming, additional
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- 2022
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17. Single-incision versus four-incision laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II
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Chuang, Shu-Hung, primary, Kuo, Kung-Kai, additional, Chuang, Shih-Chang, additional, Wang, Shen-Nien, additional, Chang, Wen-Tsan, additional, Su, Wen-Lung, additional, Huang, Jian-Wei, additional, Wu, Po-Hsuan, additional, Chan, Hon-Man, additional, and Kuok, Chi-Hang, additional
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- 2022
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18. Reciprocity between lymphadenectomy quality and adjuvant chemotherapy compliance in gastric cancer: post hoc analysis of two randomized controlled trials
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Lin, Guang-Tan, primary, Chen, Jun-Yu, additional, Chen, Qi-Yue, additional, Zhong, Qing, additional, Zheng, Chao-Hui, additional, Li, Ping, additional, Xie, Jian-Wei, additional, Wang, Jia-Bin, additional, Lin, Jian-Xian, additional, Lu, Jun, additional, Cao, Long-long, additional, and Huang, Chang-Ming, additional
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- 2022
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19. Landscape of esophageal submucosal tunneling endoscopic resection-related adverse events in a standardized lexicon: a large volume of 1701 cases
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Xu, Jia-Qi, primary, Xu, Jia-Xin, additional, Xu, Xiao-Yue, additional, Yao, Lu, additional, Xu, Mei-Dong, additional, Chen, Shi-Yao, additional, Zhong, Yun-Shi, additional, Zhang, Yi-Qun, additional, Chen, Wei-Feng, additional, Hu, Jian-Wei, additional, Cai, Ming-Yan, additional, Yao, Li-Qing, additional, Li, Quan-Lin, additional, and Zhou, Ping-Hong, additional
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- 2022
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20. Long-term prognosis of small gastric gastrointestinal stromal tumors with high histological grade: a longitudinal nested cohort study
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Chen, Tian-Yin, primary, Xu, Jia-Xin, additional, Chen, Wei-Feng, additional, Li, Quan-Lin, additional, Cai, Ming-Yan, additional, Hu, Jian-Wei, additional, Qin, Wen-Zheng, additional, Ji, Yuan, additional, Xu, Xiao-Yue, additional, Zhang, Yi-Qun, additional, and Zhou, Ping-Hong, additional
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- 2022
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21. Short- and long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell cancer in patients with prior gastrectomy
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Jia-Qi Xu, Wei-Feng Chen, Li-Qing Yao, Yi-Qun Zhang, Jian-Wei Hu, Yun-Shi Zhong, Ming-Yan Cai, Wen-Zheng Qin, Mei-Dong Xu, Ping-Hong Zhou, Lili Ma, Shiyao Chen, and Quan-Lin Li
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Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Esophageal Neoplasms ,medicine.medical_treatment ,Operative Time ,Perforation (oil well) ,Postoperative Hemorrhage ,Postoperative Complications ,Gastrectomy ,Internal medicine ,medicine ,Humans ,Survival rate ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,Hepatology ,Esophageal cancer ,medicine.disease ,Surgery ,Survival Rate ,Treatment Outcome ,Esophageal stricture ,Esophageal Stenosis ,Balloon dilation ,Female ,Esophageal Squamous Cell Carcinoma ,Neoplasm Recurrence, Local ,business ,Abdominal surgery - Abstract
The surgery for esophageal cancer arising after prior gastrectomy is technically difficult with high morbidity and mortality. Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment for superficial SCC with high curative resection rate. But few studies are concerned about ESD under these circumstances. The aim of this study was to elucidate the short- and long-term outcomes of ESD for superficial esophageal squamous cell cancer (SCC) in patients with prior gastrectomy. From January 2009 to January 2019, 37 patients with prior gastrectomy who underwent ESD for superficial esophageal SCC were retrospectively enrolled at the Zhongshan Hospital, Fudan University in Shanghai, China. Rates of en bloc resection, complete resection, curative resection, incidence of postoperative bleeding, perforation and postoperative stricture were evaluated as short-term outcomes. Overall survival, and local recurrence-free survival were evaluated as long-term outcomes. The rate of en bloc resection, complete resection and curative resection were 94.6%, 86.5% and 78.4%, respectively. No perforation was observed. 1 (2.7%) patient experienced postoperative bleeding. During the median observation of 43 months, 3 (8.6%) patients experienced esophageal stricture, successfully managed by balloon dilation. 3(8.6%) patients had local recurrence after ESD with 5-year local recurrence-free survival rate of 91.4%. During the observation period, 4 patients died of other reasons. The 1, 3, 5-year overall survival rates were 97.1%, 97.1% and 91.4%. The short-term outcomes indicate ESD is technically difficult with lower resection completeness in patients after gastrectomy, while the long-term outcomes are rather favorable.
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- 2020
22. Single-incision versus four-incision laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II
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Shu-Hung, Chuang, Kung-Kai, Kuo, Shih-Chang, Chuang, Shen-Nien, Wang, Wen-Tsan, Chang, Wen-Lung, Su, Jian-Wei, Huang, Po-Hsuan, Wu, Hon-Man, Chan, and Chi-Hang, Kuok
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Male ,Adult ,Common Bile Duct ,Surgical Wound ,Humans ,Female ,Laparoscopy ,Bile Ducts ,Middle Aged ,Mirizzi Syndrome ,Retrospective Studies - Abstract
We developed laparoscopic transfistulous bile duct exploration (LTBDE) for Mirizzi syndrome (MS) McSherry type II in September 2011. Then, single-incision LTBDE (SILTBDE) was adopted as a preferred technique since August 2013. This retrospective study aims to analyze the outcome of LTBDE in 7.7 years and to compare SILTBDE with four-incision LTBDE (4ILTBDE).Seventeen consecutive patients underwent LTBDE for MS McSherry type II from September 2011 to May 2019. Transfistulous removal of the impacted stone(s), choledochoscopic bile duct exploration, and primary closure of the gallbladder remnant were performed without biliary drainage.The sex ratio is 12:5 (male: female) with an average age of 39.4 ± 10.3 (24-56) years. Ten patients (58.8%) had their diagnoses of MS established by preoperative imaging. According to the Csendes classification, three type II (17.6%), nine type III (52.9%), and five type IV (29.4%) were identified. The operative time was 264.8 ± 60.3 min (156-358 min). The stone clearance rate was 100%. The postoperative hospital stay was 4.7 ± 1.9 (2-10) days. No procedure was converted to an open operation. Two postoperative transient hyperamylasemia (11.8%) and one superficial wound infection (5.9%) occurred and all recovered well under conservative treatment (Clavien-Dindo grade I). During an average 2.2-year follow-up period, no biliary stricture or stone recurrence occurred. No significant difference exists between the SILTBDE and 4ILTBDE groups. Nevertheless, an insignificant trend of shorter postoperative hospital stay was observed in the former. A diagnosis of MS Csendes type IV implicates prolonged total and postoperative hospital stays (p 0.01).LTBDE is safe and efficacious for MS McSherry type II. It provides a simple solution for various types of MS and avoids undesirable complications following bilioenteric anastomosis. SILTBDE is comparable to 4ILTBDE for selected patients. Patients with MS Csendes type IV need more time to recover after surgery.
- Published
- 2021
23. A prediction model and nomogram for technical difficulty of peroral endoscopic myotomy
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Liu, Xin-Yang, Geng, Zi-Han, Chen, Wei-Feng, Xu, Mei-Dong, Chen, Shi-Yao, Zhong, Yun-Shi, Zhang, Yi-Qun, Ma, Li-Li, Qin, Wen-Zheng, Hu, Jian-Wei, Cai, Ming-Yan, Li, Quan-Lin, and Zhou, Ping-Hong
- Abstract
Background and aims: Peroral endoscopic myotomy (POEM) is a promising endoscopic technique for achalasia. We aimed to establish a regression model and develop a simple nomogram to predict the technical difficulty of POEM in a single center with large volume cases. Methods: 3385 achalasia patients treated with POEM were included, and the technical difficulty was systemically evaluated. All of them were randomized into the training cohort (n= 1693) or internal validation cohort (n= 1692). Then, the prediction model and nomogram were proposed based on multivariate logistic regression analysis in the training cohort and assessed in the validation cohort. Results: Of 3385 patients, technical difficulty happened in 417 (12.32%) cases. In the training stage, six factors were weighted based on the βcoefficient from the regression model, including age, disease duration, sigmoid esophagus, mucosal edema, submucosal fibrosis, and tunnel length. The patients were categorized into low-risk (< 0.1), medium-risk (0.1–0.25), and high-risk (> = 0.25) groups. Our score model performed satisfying discrimination with the areas under the receiver-operating characteristic curve (AUC) of 0.743 (95% confidence interval (CI), 0.701–0.785) and calibration with goodness of fit in the Hosmer–Lemeshow test (P= 0.088) in internal validation. Conclusions: The prediction model and nomogram demonstrated good performance in predicting the technical difficulty of POEM.
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- 2023
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24. Reciprocity between lymphadenectomy quality and adjuvant chemotherapy compliance in gastric cancer: post hoc analysis of two randomized controlled trials
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Guang-Tan Lin, Jun-Yu Chen, Qi-Yue Chen, Qing Zhong, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-long Cao, and Chang-Ming Huang
- Subjects
Stomach Neoplasms ,Chemotherapy, Adjuvant ,Humans ,Lymph Node Excision ,Surgery ,Lymph Nodes ,Prognosis ,Retrospective Studies ,Randomized Controlled Trials as Topic ,Neoplasm Staging - Abstract
To investigate the effect of intraoperative lymph node (LN) dissection and postoperative adjuvant chemotherapy on the overall survival (OS) of gastric cancer (GC) patients and their reciprocity.LN noncompliance was defined as the absence of more than one LN station, as described in the protocol for D2 lymphadenectomy in the Japanese Gastric Cancer Association. The definition of adjuvant chemotherapy (AC) noncompliance was that the chemotherapy planned dose does not meet the requirements.Kaplan-Meier survival curves showed that the OS of patients with major LN noncompliance was significantly lower than that of patients with nonmajor LN noncompliance, and the OS of AC noncompliance patients was significantly lower than that of AC compliance patients. If there was nonmajor LN noncompliance during surgery, the OS of patients with AC compliance was significantly higher than that of patients with AC noncompliance (P = 0.035). In the case of major LN noncompliance during surgery, there was no statistically significant difference in OS between those with AC compliance and those with AC noncompliance (P = 0.682). Multivariate Cox regression analysis including AC noncompliance indicated that major LN noncompliance was an independent prognostic factor for poor OS (P = 0.012), while AC noncompliance was not an independent prognostic factor for OS (P = 0.609).Adequate lymph node dissection and adjuvant chemotherapy are both key steps to improve the awful prognosis of GC patients. Adjuvant chemotherapy may fail to remedy the poor prognosis caused by major LN noncompliance.
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- 2021
25. Landscape of esophageal submucosal tunneling endoscopic resection-related adverse events in a standardized lexicon: a large volume of 1701 cases
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Jia-Qi Xu, Jia-Xin Xu, Xiao-Yue Xu, Lu Yao, Mei-Dong Xu, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Wei-Feng Chen, Jian-Wei Hu, Ming-Yan Cai, Li-Qing Yao, Quan-Lin Li, and Ping-Hong Zhou
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Treatment Outcome ,Endoscopic Mucosal Resection ,Esophageal Neoplasms ,Stomach Neoplasms ,Gastric Mucosa ,Operative Time ,Humans ,Surgery ,Retrospective Studies - Abstract
Submucosal tunneling endoscopic resection (STER) has been widely applied for esophageal submucosal tumors. This large volume study aims to provide a standard landscape of STER-related AEs for reference.1701 patients with esophageal SMTs undergoing STER were included at Zhongshan Hospital, Fudan University. Data of clinical characteristics and adverse events were collected and analyzed in depth. Adverse events were recorded by ASGE lexicon and graded by ASGE grading/Clavien-Dindo system. Risk factors for major AEs were analyzed by univariate and multivariate logistic regression.Three hundred and twenty (18.8%) patients with 962 cases of adverse events were observed. Accordingly, 84 (5.0%) were classified as major AEs (moderate and severe) by ASGE grading and 37 (2.2%) were classified as major AEs (grades III-V) by Clavien-Dindo grading. First 1 year operation, distance 6 cm from incision to tumor, piecemeal resection, partially extraluminal location, mucosal injury, and operation time 60 min were included in the risk score model for major AEs of STER, with 57.1% sensitivity and 87.5% specificity.STER was a safe procedure for diagnosis and treatment of esophageal SMTs with a total 18.8% incidence of AEs, among which only 5.0% were major AEs requiring therapeutic measurements.
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- 2021
26. Is three-dimensional laparoscopic spleen preserving splenic hilar lymphadenectomy for gastric cancer better than that of two-dimensional? Analysis of a prospective clinical research study
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Ru-Hong Tu, Chao-Hui Zheng, Qing Zhong, Jian-Xian Lin, Qi-Yue Chen, Ju-Li Lin, Mi Lin, Jian-Wei Xie, Jia-Bin Wang, Long-Long Cao, Jun Lu, Ze-Ning Huang, Hua-Long Zheng, Ping Li, Zhi-Yu Liu, and Chang-Ming Huang
- Subjects
Male ,medicine.medical_specialty ,Intraclass correlation ,medicine.medical_treatment ,030230 surgery ,law.invention ,03 medical and health sciences ,Imaging, Three-Dimensional ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,Gastrectomy ,Stomach Neoplasms ,law ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Laparoscopy ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Hepatology ,Dissection ,Lymph Node Excision ,Female ,030211 gastroenterology & hepatology ,Surgery ,Lymphadenectomy ,Radiology ,Complication ,business ,Organ Sparing Treatments ,Spleen ,Abdominal surgery - Abstract
Three-dimensional (3D) systems for laparoscopy provide surgeons with additional information on spatial depth not found in two-dimensional (2D) systems. This study enrolled 156 spleen-preserving splenic hilar lymphadenectomy (LSPSHL) patients in a randomized controlled trial (ClinicalTrials.gov Identifier NCT02327481) at the department of gastric surgery at Fujian Medical University Union Hospital between January 2015 and April 2016. The short-term efficacies were compared between the treatment groups. The unedited videos of 80 LSPSHL (40 procedures each for 3D and 2D) were rated for technical performance using the Generic Error Rating Tool. The data for 156 LSPSHL patients indicate that the estimated blood loss (EBL) (3D vs 2D = 66.3 vs. 99.0, P = 0.046) was significantly less in the 3D group. The postoperative recovery and complication rates were similar (P > 0.05). And there were no deaths within 30 days of surgery. Two observers analyzed 80 videos of LSPSHL. The results showed that there were fewer grasping-errors made in the 3D group than in the 2D group when dissecting the inferior pole region of spleen (IPRS) (P = 0.016) and the superior pole region of spleen (SPRS) (P = 0.022). Additionally, the inter-rater reliability was high regarding grasping-errors in the IPRS (intraclass correlation coefficient (ICC) 0.92) and in the SPRS (ICC 0.83). The ICC for the total number of errors was 0.82. The mean of errors in the 3D group (3D vs. 2D = 20.7 vs. 23.5, P = 0.022) was less than the 2D group. Compared with 2D LSPSHL, 3D technology reduces EBL and technical errors during splenic hilar dissection.
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- 2019
27. Potential survival benefits of open over laparoscopic radical gastrectomy for gastric cancer patients beyond three years after surgery: result from multicenter in-depth analysis based on propensity matching
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Huang, Ze-Ning, primary, Ma, YuBin, additional, Chen, Qi-Yue, additional, Zheng, Chao-Hui, additional, Li, Ping, additional, Xie, Jian-Wei, additional, Wang, Jia-Bin, additional, Lin, Jian-Xian, additional, Lu, Jun, additional, Cao, Long-Long, additional, Lin, Mi, additional, Tu, Ru-Hong, additional, Lin, Ju-Li, additional, Zheng, Hua-Long, additional, and Huang, Chang-Ming, additional
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- 2021
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28. A good preoperative immune prognostic index is predictive of better long-term outcomes after laparoscopic gastrectomy compared with open gastrectomy for stage II gastric cancer in elderly patients
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Lin, Guo-Sheng, primary, Huang, Xiao-Yan, additional, Lu, Jun, additional, Wu, Dong, additional, Zheng, Hua-Long, additional, Xu, Bin-Bin, additional, Zheng, Chao-Hui, additional, Li, Ping, additional, Xie, Jian-Wei, additional, Wang, Jia-Bin, additional, Lin, Jian-Xian, additional, Chen, Qi-Yue, additional, Cao, Long-Long, additional, Lin, Mi, additional, Tu, Ru-Hong, additional, Lin, Guang-Tan, additional, Huang, Ze-Ning, additional, Lin, Ju-Li, additional, and Huang, Chang-Ming, additional
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- 2021
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29. Laparoscopic anterior hepatic transection for resecting lesions originating in the paracaval portion of the caudate lobe (with videos)
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Sun, Tian-ge, primary, Wang, Xiao-jun, additional, Cao, Li, additional, Li, Jian-wei, additional, Chen, Jian, additional, Li, Xue-song, additional, Liao, Ke-xi, additional, Cao, Yong, additional, and Zheng, Shu-guo, additional
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- 2021
- Full Text
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30. Potential survival benefits of open over laparoscopic radical gastrectomy for gastric cancer patients beyond three years after surgery: result from multicenter in-depth analysis based on propensity matching
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Ju-Li Lin, Jian-Wei Xie, Ru-Hong Tu, Yu-Bin Ma, Hua-Long Zheng, Qi-Yue Chen, Chao-Hui Zheng, Long-Long Cao, Jun Lu, Chang-Ming Huang, Ping Li, Mi Lin, Ze-Ning Huang, Jian-Xian Lin, and Jia-Bin Wang
- Subjects
medicine.medical_specialty ,LDG ,Article ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Muticenter ,Propensity Score ,Retrospective Studies ,Radical gastrectomy ,business.industry ,Cancer ,Hepatology ,medicine.disease ,Surgery ,Serous fluid ,Treatment Outcome ,030220 oncology & carcinogenesis ,Landmark analysis ,Propensity score matching ,RMST ,Propensity matching ,Lymph Node Excision ,ADGC ,030211 gastroenterology & hepatology ,Laparoscopy ,business ,Survival benefits ,Abdominal surgery - Abstract
Background The oncologic efficacy of laparoscopic versus open surgery for advanced distal gastric cancer (ADGC) beyond 3 years after surgery remain obscure. Methods A total of 1256 patients with ADGC at two teaching institutions in China from April 2007 to December 2014 were enrolled. The general data of the two groups were identified to enable rigorous estimation of propensity scores. Restricted mean survival time (RMST) and Landmark analysis was used to compare survival. Results After matching 461 patients each in the open distal gastrectomy (ODG) and laparoscopic distal gastrectomy (LDG) groups, they were included into analysis. The 3- and 5-year overall survival (OS) and disease-free survival were comparable in two groups. RMST-stratified analysis showed that the 3-year RMST of ODG group was similar to that of LDG group in patients with cT4a (− 1.38 years, p = 0.163) or with cT4a and tumor size > 5 cm, whereas the 5-year RMST had significant differences between groups in cT4a patients(− 8.36 years, P = 0.005) or cT4a and tumor size > 5 cm patients(4.67 years, P = 0.042). In patients with cT4a and tumors > 5 cm, the number of peritoneal recurrences was significantly fewer in the ODG group than in the LDG group (4 vs. 17, P = 0.033), and the peritoneal recurrence time and multiple-site recurrence time were both later in the ODG group. Conclusion By reducing recurrence, ODG achieves a better survival for GC patients with serous infiltration and tumors larger than 5 cm beyond 3 years after surgery. The present findings can serve as a reference for surgical options and the setting of follow-up time point for clinical studies.
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- 2020
31. A good preoperative immune prognostic index is predictive of better long-term outcomes after laparoscopic gastrectomy compared with open gastrectomy for stage II gastric cancer in elderly patients
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Ru-Hong Tu, Jian-Xian Lin, Chao-Hui Zheng, Jian-Wei Xie, Ju-Li Lin, Dong Wu, Bin-Bin Xu, Ping Li, Chang-Ming Huang, Long-Long Cao, Jun Lu, Guo-Sheng Lin, Mi Lin, Qi-Yue Chen, Jia-Bin Wang, Guang-Tan Lin, Ze-Ning Huang, Xiao-yan Huang, and Hua-Long Zheng
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Population ,Gastroenterology ,Gastrectomy ,Stomach Neoplasms ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,education ,Survival rate ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Cancer ,Hepatology ,medicine.disease ,Prognosis ,Treatment Outcome ,Cohort ,Propensity score matching ,Surgery ,Laparoscopy ,business - Abstract
It remains inconclusive whether laparoscopic gastrectomy (LG) has better long-term outcomes when compared with open gastrectomy (OG) for elderly gastric cancer (EGC). We attempted to explore the influence of the immune prognostic index (IPI) on the prognosis of EGCs treated by LG or OG to identify a population among EGC who may benefit from LG. We included 1539 EGCs treated with radical gastrectomy from January 2007 to December 2016. Propensity score matching was applied at a ratio of 1:1 to compare the LG and OG groups. The IPI based on dNLR ≥ cut-off value (dNLR) and sLDH ≥ cut-off value (sLDH) was developed, characterizing two groups (IPI = 0, good, 0 factors; IPI = 1, poor, 1 or 2 factors). Of the 528 EGCs (LG: 264 and OG: 264), 271 were in the IPI = 0 group, and 257 were in the IPI = 1 group. In the entire cohort, the IPI = 0 group was associated with good 5-year overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.003) compared to the IPI = 1 group; no significant differences in 5-year OS and PFS between the LG and OG groups were observed. In the IPI = 1 cohort, there was no significant difference in OS or PFS between the LG and OG groups across all tumor stages. However, in the IPI = 0 cohort, LG was associated with longer OS (p = 0.015) and PFS (p = 0.018) than OG in stage II EGC, but not in stage I or III EGC. Multivariate analysis showed that IPI = 0 was an independent protective factor for stage II EGC receiving LG, but not for those receiving OG. The IPI is related to the long-term prognosis of EGC. Compared with OG, LG may improve the 5-year survival rate of stage II EGC with a good IPI score. This hypothesis needs to be further confirmed by prospective studies.
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- 2020
32. Laparoscopic middle-hepatic-vein-guided anatomical hemihepatectomy in the treatment of hepatolithiasis: a 10-year case study
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Liao, Ke-xi, primary, Chen, Lin, additional, Ma, Li, additional, Cao, Li, additional, Shu, Jie, additional, Sun, Tian-ge, additional, Li, Xue-song, additional, Wang, Xiao-jun, additional, Li, Jian-wei, additional, Chen, Jian, additional, Cao, Yong, additional, and Zheng, Shu-guo, additional
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- 2021
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33. A matched cohort study of the failure pattern after laparoscopic and open gastrectomy for locally advanced gastric cancer: does the operative approach matter?
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Lu, Jun, primary, Wu, Dong, additional, Xu, Bin-Bin, additional, Xue, Zhen, additional, Zheng, Hua-Long, additional, Xie, Jian-Wei, additional, Wang, Jia-Bin, additional, Lin, Jian-Xian, additional, Li, Ping, additional, Zheng, Chao-Hui, additional, and Huang, Chang-Ming, additional
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- 2021
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34. Controlled hypertension under hemostasis prevents post-gastric endoscopic submucosal dissection bleeding: a prospective randomized controlled trial
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Lin, Sheng-Li, primary, Gao, Ping-Ting, additional, Ni, Wen-Kai, additional, Li, Quan-Lin, additional, Chen, Wei-Feng, additional, Zhang, Yi-Qun, additional, Hu, Jian-Wei, additional, Qin, Wen-Zheng, additional, Cai, Ming-Yan, additional, Ren, Zhong, additional, Zhong, Yun-Shi, additional, Yao, Li-Qing, additional, Chen, Shi-Yao, additional, Xu, Mei-Dong, additional, Ma, Li-Li, additional, and Zhou, Ping-Hong, additional
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- 2021
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35. Controlled hypertension under hemostasis prevents post-gastric endoscopic submucosal dissection bleeding: a prospective randomized controlled trial
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Zhong Ren, Ping-Hong Zhou, Yi-Qun Zhang, Shiyao Chen, Li-Qing Yao, Meidong Xu, Jian-Wei Hu, Yun-Shi Zhong, Wen-Zheng Qin, Quan-Lin Li, Shengli Lin, Lili Ma, Ping-Ting Gao, Wei-Feng Chen, Wenkai Ni, and Ming-Yan Cai
- Subjects
medicine.medical_specialty ,Endoscopic Mucosal Resection ,medicine.drug_class ,Forceps ,Proton-pump inhibitor ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Stomach Neoplasms ,Medicine ,Humans ,Prospective Studies ,Univariate analysis ,Hemostasis ,business.industry ,Surgery ,Early Gastric Cancer ,Blood pressure ,030220 oncology & carcinogenesis ,Hypertension ,030211 gastroenterology & hepatology ,business ,Gastrointestinal Hemorrhage ,Abdominal surgery - Abstract
Endoscopic submucosal dissection (ESD) is a prominent minimally invasive operative technique for treating early gastrointestinal tumors but can result in postoperative bleeding. We conducted a randomized controlled trial to determine whether increasing blood pressure under hemostasis during gastric ESD to identify potential bleeding spots reduces the risk of post-ESD bleeding. In this randomized, controlled, single-blinded clinical trial, 309 patients with early gastric cancer who were admitted to a hospital to undergo ESD were recruited from March 2017 to February 2018 and were randomized into intervention and control groups. In the control group, patients underwent normal ESD. In the intervention group, we increased patients’ blood pressure to 150 mmHg for 5 min using a norepinephrine pump (0.05 μg/kg/min initial dose) after the specimen was extracted during the ESD operation to identify and coagulate potential bleeding spots with hot biopsy forceps. Our primary outcome was the incidence of postoperative bleeding over 60-day follow-up. The incidence of post-ESD bleeding was lower in the intervention group (1.3%, 2/151) than in the control group (10.1%, 16/158, p = 0.01). Deeper tumor invasion was associated with a higher risk of post-ESD bleeding (5.3% in mucosal/submucosal layer 1 group vs. 12.5% in submucosal layer 2/muscularis propria group, p
- Published
- 2020
36. High preoperative modified frailty index has a negative impact on short- and long-term outcomes of octogenarians with gastric cancer after laparoscopic gastrectomy
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Chao-Hui Zheng, Jian-Xian Lin, Qi-Yue Chen, Ping Li, Mi Lin, Jun Lu, Hua-Long Zheng, Ru-Hong Tu, Jian-Wei Xie, Long-Long Cao, Jia-Bin Wang, and Chang-Ming Huang
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medicine.medical_specialty ,Frailty Index ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Postoperative Period ,Prospective Studies ,Pathological ,Aged, 80 and over ,Frailty ,business.industry ,Cancer ,Laparoscopic gastrectomy ,Odds ratio ,Hepatology ,Prognosis ,medicine.disease ,030220 oncology & carcinogenesis ,Cohort ,Laparoscopy ,030211 gastroenterology & hepatology ,Surgery ,business ,Abdominal surgery - Abstract
The proportion of elderly patients who undergo surgery has rapidly increased. However, clinical indicators that predict outcomes are limited. Frailty is thought to estimate physiological reserves, although its use has not been evaluated in laparoscopic surgical patients. This study aimed to evaluate the significance of preoperative modified frailty index (PMFI) in octogenarians undergoing a laparoscopic gastrectomy.We reviewed prospectively collected data from 119 patients with gastric cancer (GC) aged 80 years or older who underwent a radical laparoscopic gastrectomy (RLG) between January 2007 and December 2012. Three baseline frailty traits were measured using routine preoperative laboratory data: albumin 3.4 g/dL, haematocrit 35%, and creatinine 2 mg/dL. Patients were categorized by the number of positive traits as follows: low preoperative modified frailty index (LPMFI): 0-2 traits and high preoperative modified frailty index (HPMFI): 3 traits. We compared patient characteristics, operative outcomes, pathological results, morbidity, and survival.A total of 43 (36.1%) patients were considered HPMFI, and 76 (63.9%) patients were considered LPMFI. HPMFI was associated with an increased risk of postoperative complications (HPMFI group: odds ratio 2.506; 95% CI, 1.113-5.643, P = 0.027). With a median follow-up of 39.0 months, the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 47.9, 34.3, and 51.7%, respectively. Significant differences were observed in OS (HPMFI group, 37.2%; LPMFI group, 53.9%; P = 0.038) and RFS (HPMFI group, 23.3%; LPMFI group, 40.5%; P = 0.012) between the groups, but no difference was found for CSS (HPMFI group, 43.5%; LPMFI group, 56.4%; P = 0.078).HPMFI based on an easily calculable preoperative measure may be useful for predicting postoperative complications and have a negative impact on 3-year OS and RFS after an RLG in octogenarians. Therefore, HPMFI can serve as a low-cost, simple screen for high-risk individuals who might suffer more than expected during the postoperative period after an RLG.
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- 2018
37. Short- and long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell cancer in patients with prior gastrectomy
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Xu, Jia-Qi, primary, Hu, Jian-Wei, additional, Chen, Wei-Feng, additional, Xu, Mei-Dong, additional, Zhong, Yun-Shi, additional, Chen, Shi-Yao, additional, Zhang, Yi-Qun, additional, Ma, Li-Li, additional, Qin, Wen-Zheng, additional, Cai, Ming-Yan, additional, Yao, Li-Qing, additional, Zhou, Ping-Hong, additional, and Li, Quan-Lin, additional
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- 2020
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38. Does three-dimensional surgery affect recurrence patterns in patients with gastric cancer after laparoscopic R0 gastrectomy? Results from a 3-year follow-up phase III trial
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Lu, Jun, primary, Xu, Bin-bin, additional, Zheng, Zhi-fang, additional, Xie, Jian-wei, additional, Wang, Jia-bin, additional, Lin, Jian-xian, additional, Chen, Qi-yue, additional, Cao, Long-long, additional, Lin, Mi, additional, Tu, Ru-hong, additional, Huang, Ze-ning, additional, Zheng, Chao-hui, additional, Huang, Chang-ming, additional, and Li, Ping, additional
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- 2020
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39. Well-designed retrospective study versus small-sample prospective study in research based on laparoscopic and open radical distal gastrectomy for advanced gastric cancer
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Wang, Jia-Bin, primary, Zhong, Qing, additional, Chen, Qi-Yue, additional, Lin, Guang-Tan, additional, Liu, Zhi-Yu, additional, Huang, Xiao-Bo, additional, Xie, Jian-Wei, additional, Lin, Jian-Xian, additional, Lu, Jun, additional, Cao, Long-Long, additional, Lin, Mi, additional, Tu, Ru-Hong, additional, Huang, Ze-Ning, additional, Lin, Ju-Li, additional, Zheng, Hua-Long, additional, Zheng, Chao-Hui, additional, Huang, Chang-Ming, additional, and Li, Ping, additional
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- 2019
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40. A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video)
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Quan-Lin Li, Mei-Dong Xu, Jian-Wei Hu, Lei Ge, Wei-Feng Chen, Yi-Qun Zhang, Yuan Chu, Ping-Hong Zhou, Li-Qing Yao, and Tao Chen
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Adult ,Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Gastrointestinal Stromal Tumors ,Operative Time ,Closure (topology) ,Endoscopic mucosal resection ,Resection ,03 medical and health sciences ,Defect closure ,0302 clinical medicine ,Stomach Neoplasms ,medicine ,Humans ,Full thickness resection ,Aged ,Leiomyoma ,business.industry ,En bloc resection ,Middle Aged ,Surgery ,Loop closure ,030220 oncology & carcinogenesis ,Feasibility Studies ,Operative time ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal (GI) lesions originating from the muscularis propria layer. Successful closure of the wall defect is a critical step.The aim of this study was to evaluate the feasibility and efficacy of a novel and simplified endoscopic grasp-and-loop (GAL) closure method using an endo-loop assisted with grasping forceps for defect closure.From January 2015 to March 2016, 13 patients with submucosal tumors (SMTs) originating from the muscularis propria (MP) layer underwent EFTR and were enrolled in this study. After successful tumor resection, an endo-loop was anchored onto the circumferential margin of the gastric defect with grasping forceps assistance and tightened gently. Patient characteristics, tumor size, en bloc resection, and postoperative complications were evaluated.Of the 13 lesions in the stomach, two were located in the greater curvature of the mid-upper body, 11 were located in the fundus. The endoscopic GAL closure method was successfully performed after EFTR in all the 13 patients without laparoscopic assistance. The mean procedure time was 43.5 min (range 20-80 min), while the GAL closure procedure took a mean of 9.4 min (range 3-18 min). The mean resected lesion size was 1.5 cm (range 0.5-3.5 cm). Pathological diagnoses of these lesions were 11 gastrointestinal stromal tumors (GISTs) and two leiomyomas. No major adverse events occurred during or after the procedure. All the patients were discharged after a mean time of 2.4 days (range 1-4 days). No residual lesion or tumor recurrence was found during the follow-up period (median, 5 months; range, 1-15 months).The endoscopic GAL closure method is feasible, effective, and safe for closing the gastric defect after EFTR in patients.
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- 2017
41. Randomized, controlled trial comparing clinical outcomes of 3D and 2D laparoscopic surgery for gastric cancer: an interim report
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Jian-Xian Lin, Jun Lu, Long-Long Cao, Jian-Wei Xie, Ru-Hong Tu, Jia-Bin Wang, Chang-Ming Huang, Chao-Hui Zheng, Qi-Yue Chen, Hua-Long Zheng, Ping Li, and Mi Lin
- Subjects
Adult ,Male ,Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,Adenocarcinoma ,030230 surgery ,law.invention ,03 medical and health sciences ,Imaging, Three-Dimensional ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,Gastrectomy ,Stomach Neoplasms ,law ,Internal medicine ,medicine ,Humans ,Postoperative Period ,Prospective Studies ,Pathological ,Lymph node ,Aged ,business.industry ,General surgery ,Cancer ,Postoperative complication ,Length of Stay ,Middle Aged ,Hepatology ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,Laparoscopy ,business ,Abdominal surgery - Abstract
In this study, we evaluated the short-term outcomes following three-dimensional (3D) or two-dimensional (2D) laparoscopic surgery for patients with gastric cancer. There is a lack of prospective evidence regarding the safety and efficacy of 3D versus 2D laparoscopic surgery for patients with gastric cancer. Therefore, we conducted a phase III single-center, prospective, randomized, controlled trial to compare 3D and 2D laparoscopic surgery for patients with gastric cancer. We compared operation time, intraoperative blood loss, number of lymph node dissections, morbidity, and mortality between the 3D and 2D groups following laparoscopic surgery for gastric cancer. The study is registered at ClinicalTrials.gov with ID number NCT02327481. A total of 228 patients were randomized (3D group 115 cases; 2D group 113 cases) between January 1, 2015 and September 1, 2015. Seven patients who underwent exploratory operations were excluded. Finally, a total of 221 patients were analyzed (3D group 109 cases, 2D group 112 cases). There were no significant differences between the two groups regarding the clinical pathological characteristics, operating time (3D vs. 2D, 184 ± 36 vs. 178 ± 37 min, P = 0.288), number of lymph node dissections (36 ± 14 vs. 37 ± 13, P = 0.698), time to first ambulation (2.27 ± 1.60 vs. 2.04 ± 0.84, P = 0.18), flatus (3.89 ± 1.49 vs. 3.69 ± 1.12, P = 0.255), liquid diet (4.88 ± 1.88 vs. 4.79 ± 1.57, P = 0.684), or duration of postoperative hospital stay (12.52 ± 4.83 vs. 12.63 ± 7.32, P = 0.903). The postoperative complication rates of the 3D and 2D groups were 18.3 and 16.1%, respectively, P = 0.723. No patients died during the postoperative hospital stay. However, the intraoperative blood loss in the 3D group was significantly lower than the 2D group (58 ± 75 vs. 78 ± 72 ml, P = 0.047). There was no significant difference in operation time and number of lymph node harvested between the 3D and 2D groups; however, 3D laparoscopic surgery may reduce the intraoperative blood loss compared to 2D procedure. Therefore, we conclude that this trial is safe and is thus ongoing.
- Published
- 2016
42. Well-designed retrospective study versus small-sample prospective study in research based on laparoscopic and open radical distal gastrectomy for advanced gastric cancer
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Chao-Hui Zheng, Ju-Li Lin, Ru-Hong Tu, Jian-Wei Xie, Zhi-Yu Liu, Long-Long Cao, Jun Lu, Jian-Xian Lin, Xiao-Bo Huang, Ping Li, Qi-Yue Chen, Qing Zhong, Hua-Long Zheng, Guang-Tan Lin, Ze-Ning Huang, Chang-Ming Huang, Jia-Bin Wang, and Mi Lin
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Laparoscopic surgery ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Urology ,Disease-Free Survival ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Propensity Score ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Proportional hazards model ,business.industry ,Retrospective cohort study ,Hepatology ,Middle Aged ,Treatment Outcome ,030220 oncology & carcinogenesis ,Propensity score matching ,Multivariate Analysis ,030211 gastroenterology & hepatology ,Surgery ,Female ,Laparoscopy ,Neoplasm Recurrence, Local ,business ,Abdominal surgery - Abstract
Well-designed retrospective studies (RSs) and small-sample prospective studies (PSs) evaluating the efficacy of interventions have received much attention. This study was designed to evaluate the differences between well-designed RSs and small-sample randomized controlled trials based on the efficacy of laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) for advanced gastric cancer (GC). The clinicopathological data of 1360 patients with GC who underwent DG were analysed. After propensity score matching (1:1), 380 cases (ODG = 190, LDG = 190) were finally selected in a RS. Meanwhile, data from 120 patients (ODG = 60, LDG = 60) who enrolled in a PS were analysed. In the PS, the LDG group had less intraoperative blood loss, shorter time to first flatus, and shorter time to fluid diet than the ODG group. In the RS, the LDG group had less intraoperative blood loss, and a shorter postoperative hospital stay than the ODG group. In the PS, the 3-year overall survival (OS) rate was 83.3% in the LDG group and 83.2% in the ODG group (p = 0.877). In the RS, the 3-year OS rate was 68.7% in the LDG group and 66.6% in the ODG group (p = 0.752). No significant interactions were observed between the two groups and any of the variables examined, either in the PS or RS. The recurrence patterns were similar in the two groups. Furthermore, Cox regression analysis showed that surgical method (LDG/ODG) was not a prognostic factor affecting OS or DFS, either prospectively or retrospectively. The oncologic efficacy of laparoscopic and open distal gastrectomy for advanced GC is comparable. Well-designed RSs can be similar to small sample of PSs in assessing long-term oncologic outcomes of surgical interventions, but the short-term outcomes obtained should be treated with caution.
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- 2019
43. Does three-dimensional surgery affect recurrence patterns in patients with gastric cancer after laparoscopic R0 gastrectomy? Results from a 3-year follow-up phase III trial
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Jian-Xian Lin, Chao-Hui Zheng, Ru-Hong Tu, Bin-Bin Xu, Jian-Wei Xie, Zhi-Fang Zheng, Qi-Yue Chen, Ze-Ning Huang, Chang-Ming Huang, Ping Li, Mi Lin, Long-Long Cao, Jun Lu, and Jia-Bin Wang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Time Factors ,Lymphovascular invasion ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030230 surgery ,Gastroenterology ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Age Factors ,Cancer ,Retrospective cohort study ,Chemoradiotherapy, Adjuvant ,Hepatology ,Middle Aged ,medicine.disease ,Clinical trial ,Surgery, Computer-Assisted ,Multivariate Analysis ,030211 gastroenterology & hepatology ,Surgery ,Laparoscopy ,Neoplasm Recurrence, Local ,business ,Abdominal surgery ,Follow-Up Studies - Abstract
Numerous studies have shown that the short-term efficacy of three-dimensional (3D) laparoscopic radical gastrectomy (LG) is comparable to that of two-dimensional (2D)-LG. Whether 3D-LG affects the recurrence patterns of gastric cancer (GC) patients has not been investigated. From January 2015 to April 2016, a total of 419 patients were recruited for a phase III clinical trial (NCT02327481), which compared the short-term outcomes between the 2D and 3D groups. The long-term efficacy including recurrence patterns was compared between the 2D and 3D groups in this retrospective study. Multivariate analyses were performed to determine whether 3D-LG affects the recurrence patterns. Ultimately, 401 patients were analyzed (197 in the 2D-LG group and 204 in the 3D-LG group), and no differences were observed in the clinicopathological data between the two groups. There were no significant differences between the two groups in the recurrence types, first recurrence time or recurrence-free survival (RFS) (all p > 0.05). According to the 7th American Joint Committee on Cancer tumor-node-metastasis (TNM) staging system, both groups were stratified into pathological stages I, II, and III. The stratified analysis showed no significant differences in RFS or overall survival (OS) among patients in each subgroup (all p > 0.05). The multivariate analysis of RFS showed that tumor diameter, pTNM stage, lymphovascular invasion, and adjuvant chemotherapy were independent factors (all p
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- 2019
44. Effect of peroral endoscopic myotomy in geriatric patients: a propensity score matching study
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Li-Qing Yao, Jian-Wei Hu, Yun Wang, Xin-Yang Liu, Shiyao Chen, Jing Cheng, Wei-Feng Chen, Ming-Yan Cai, Ping-Hong Zhou, Yun-Shi Zhong, Quan-Lin Li, Wen-Zheng Qin, Zuqiang Liu, Yi-Qun Zhang, and Mei-Dong Xu
- Subjects
Myotomy ,Adult ,Male ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Achalasia ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Interquartile range ,Internal medicine ,medicine ,Humans ,Adverse effect ,Propensity Score ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Perioperative ,Length of Stay ,Middle Aged ,medicine.disease ,Endoscopy ,Esophageal Achalasia ,Treatment Outcome ,030220 oncology & carcinogenesis ,Propensity score matching ,Gastroesophageal Reflux ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Abdominal surgery - Abstract
Peroral endoscopic myotomy (POEM) is a safe and effective approach for achalasia. However, the safety, feasibility, perioperative and long-term efficacy in treating geriatric patients has not been well evaluated. Data of 2367 patients diagnosed with achalasia and treated with POEM in the Endoscopy Center, Zhongshan Hospital, Fudan University from August 2010 to December 2017 were retrospectively reviewed. Last follow-up was in December 2018. Propensity score matching based on baseline characteristics was used to adjust for confounding. With a caliper of 0.01 in propensity scoring, 139 patients aged ≥ 65 years were matched at a 1:2 ratio with 275 patients aged
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- 2019
45. Early unplanned reoperations after gastrectomy for gastric cancer are different between laparoscopic surgery and open surgery
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Jia-Bin Wang, Chang-Ming Huang, Ze-Ning Huang, Jian-Wei Xie, Long-Long Cao, Jun Lu, Jian-Xian Lin, Ru-Hong Tu, Chao-Hui Zheng, Mi Lin, Qi-Yue Chen, Ping Li, and Ju-Li Lin
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Laparoscopic surgery ,Male ,Reoperation ,medicine.medical_specialty ,health care facilities, manpower, and services ,medicine.medical_treatment ,Anastomosis ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,health care economics and organizations ,Aged ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Incidence ,Perioperative ,Middle Aged ,Surgery ,Hemostasis ,Female ,Laparoscopy ,business ,Body mass index ,Abdominal surgery - Abstract
To compare the differences in occurrence rates, time intervals, main causes, and management strategies of early unplanned reoperations (EUROs) after gastrectomy for gastric cancer (GC) between laparoscopic and open surgery. From Jan. 2005 to Dec. 2014, 2608 and 1516 patients underwent laparoscopic-assisted gastrectomy (LAG) and open gastrectomy (OG), respectively. Perioperative outcomes and risk factors for EURO were analyzed. The overall EURO rate was 1.3%, and the rate in LAG and OG groups was 1.1% and 1.6%, respectively. The EURO rate after 24 h postoperatively was significantly lower in LAG group than in OG group (p = 0.019). No significant correlation was identified between laparoscopic surgery and EURO rate (p = 0.157); age > 70 (p = 0.028), body mass index (BMI) > 25 kg/m2 (p = 0.009), and estimated blood loss > 100 ml (p = 0.029) were independent risk factors for EURO. The main cause of EURO was intra-abdominal bleeding, anastomotic bleeding, and anastomotic leakage in LAG group; and intra-abdominal bleeding, anastomotic leakage, and intestinal obstruction in OG group. The proportion of patients with intra-abdominal bleeding requiring EURO was markedly higher in LAG group than in OG group (p = 0.043). Transverse mesocolonic vessels and spleen were the most common bleeding sites necessitating EURO in LAG and OG groups, respectively. Six of 28 (21.4%) patients with EUROs in LAG group underwent laparoscopic procedure (p = 0.025). Mortality in patients requiring EURO was 3.6% and 20.8% in LAG and OG groups, respectively (p = 0.084). Compared to open surgery, laparoscopic surgery does not increase the incidence of EURO in patients undergoing gastrectomy for GC; however, laparoscopic surgery is associated with a lower EURO rate after 24 h postoperatively and a higher proportion of patients with intra-abdominal bleeding requiring EURO than open surgery. Effective and accurate intraoperative hemostasis for intra-abdominal vessels and anastomotic sites will help further reduce the incidence of EURO following LAG within 24 h postoperatively.
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- 2018
46. A good preoperative immune prognostic index is predictive of better long-term outcomes after laparoscopic gastrectomy compared with open gastrectomy for stage II gastric cancer in elderly patients
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Lin, Guo-Sheng, Huang, Xiao-Yan, Lu, Jun, Wu, Dong, Zheng, Hua-Long, Xu, Bin-Bin, Zheng, Chao-Hui, Li, Ping, Xie, Jian-Wei, Wang, Jia-Bin, Lin, Jian-Xian, Chen, Qi-Yue, Cao, Long-Long, Lin, Mi, Tu, Ru-Hong, Lin, Guang-Tan, Huang, Ze-Ning, Lin, Ju-Li, and Huang, Chang-Ming
- Abstract
Background: It remains inconclusive whether laparoscopic gastrectomy (LG) has better long-term outcomes when compared with open gastrectomy (OG) for elderly gastric cancer (EGC). We attempted to explore the influence of the immune prognostic index (IPI) on the prognosis of EGCs treated by LG or OG to identify a population among EGC who may benefit from LG. Methods: We included 1539 EGCs treated with radical gastrectomy from January 2007 to December 2016. Propensity score matching was applied at a ratio of 1:1 to compare the LG and OG groups. The IPI based on dNLR ≥ cut-off value (dNLR) and sLDH ≥ cut-off value (sLDH) was developed, characterizing two groups (IPI = 0, good, 0 factors; IPI = 1, poor, 1 or 2 factors). Results: Of the 528 EGCs (LG: 264 and OG: 264), 271 were in the IPI = 0 group, and 257 were in the IPI = 1 group. In the entire cohort, the IPI = 0 group was associated with good 5-year overall survival (OS) (p= 0.001) and progression-free survival (PFS) (p= 0.003) compared to the IPI = 1 group; no significant differences in 5-year OS and PFS between the LG and OG groups were observed. In the IPI = 1 cohort, there was no significant difference in OS or PFS between the LG and OG groups across all tumor stages. However, in the IPI = 0 cohort, LG was associated with longer OS (p= 0.015) and PFS (p= 0.018) than OG in stage II EGC, but not in stage I or III EGC. Multivariate analysis showed that IPI = 0 was an independent protective factor for stage II EGC receiving LG, but not for those receiving OG. Conclusion: The IPI is related to the long-term prognosis of EGC. Compared with OG, LG may improve the 5-year survival rate of stage II EGC with a good IPI score. This hypothesis needs to be further confirmed by prospective studies.
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- 2022
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47. Potential survival benefits of open over laparoscopic radical gastrectomy for gastric cancer patients beyond three years after surgery: result from multicenter in-depth analysis based on propensity matching
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Huang, Ze-Ning, Ma, YuBin, Chen, Qi-Yue, Zheng, Chao-Hui, Li, Ping, Xie, Jian-Wei, Wang, Jia-Bin, Lin, Jian-Xian, Lu, Jun, Cao, Long-Long, Lin, Mi, Tu, Ru-Hong, Lin, Ju-Li, Zheng, Hua-Long, and Huang, Chang-Ming
- Abstract
Background: The oncologic efficacy of laparoscopic versus open surgery for advanced distal gastric cancer (ADGC) beyond 3 years after surgery remain obscure. Methods: A total of 1256 patients with ADGC at two teaching institutions in China from April 2007 to December 2014 were enrolled. The general data of the two groups were identified to enable rigorous estimation of propensity scores. Restricted mean survival time (RMST) and Landmark analysis was used to compare survival. Results: After matching 461 patients each in the open distal gastrectomy (ODG) and laparoscopic distal gastrectomy (LDG) groups, they were included into analysis. The 3- and 5-year overall survival (OS) and disease-free survival were comparable in two groups. RMST-stratified analysis showed that the 3-year RMST of ODG group was similar to that of LDG group in patients with cT4a (− 1.38 years, p= 0.163) or with cT4a and tumor size > 5 cm, whereas the 5-year RMST had significant differences between groups in cT4a patients(− 8.36 years, P= 0.005) or cT4a and tumor size > 5 cm patients(4.67 years, P= 0.042). In patients with cT4a and tumors > 5 cm, the number of peritoneal recurrences was significantly fewer in the ODG group than in the LDG group (4 vs. 17, P= 0.033), and the peritoneal recurrence time and multiple-site recurrence time were both later in the ODG group. Conclusion: By reducing recurrence, ODG achieves a better survival for GC patients with serous infiltration and tumors larger than 5 cm beyond 3 years after surgery. The present findings can serve as a reference for surgical options and the setting of follow-up time point for clinical studies.
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- 2022
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48. Laparoscopic middle-hepatic-vein-guided anatomical hemihepatectomy in the treatment of hepatolithiasis: a 10-year case study
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Liao, Ke-xi, Chen, Lin, Ma, Li, Cao, Li, Shu, Jie, Sun, Tian-ge, Li, Xue-song, Wang, Xiao-jun, Li, Jian-wei, Chen, Jian, Cao, Yong, and Zheng, Shu-guo
- Abstract
Background: This retrospective 10-year case study evaluated the perioperative results and long-term efficacy of laparoscopic middle-hepatic-vein-guided hemihepatectomy (L-MHV-H) and traditional anatomical hemihepatectomy (TAH) in the treatment of hepatolithiasis (HL). Methods: From January 2010 to December 2019, 99 patients with regional HL underwent laparoscopic anatomical hemihepatectomy (LAH) at our centre, including 43 patients in the L-MHV-Hgroup and 56 patients in the TAHgroup. Results: All patients in both groups were Child–Pugh grade A before operation. No significant between-group differences in general information, stone distribution, comorbidities, history of previous abdominal surgery or co-occurrence of gallstones and common bile duct stones were observed. The L-MHV-H groupexhibited a higher intraoperative stone clearance rate (95.3% vs. 75.0%, p= 0.014) and a lower postoperative complication rate (10.1% vs. 48.2%, p= 0.005) compared with the TAHgroup. In the median follow-up time of 60 months (range 6–125 months), the L-MHV-Hgroup had lower stone recurrence (2.3% vs. 19.6%, p= 0.013) and cholangitis recurrence (2.3% vs. 17.9%, p= 0.034) rates. No significant between-group differences in the other results were observed. Conclusions: L-MHV-His safe and feasible for HL with certain advantages over TAHin improving the intraoperative stone clearance rate, reducing postoperative complication incidence and reducing stone and cholangitis recurrence rates.
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- 2022
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49. A matched cohort study of the failure pattern after laparoscopic and open gastrectomy for locally advanced gastric cancer: does the operative approach matter?
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Lu, Jun, Wu, Dong, Xu, Bin-Bin, Xue, Zhen, Zheng, Hua-Long, Xie, Jian-Wei, Wang, Jia-Bin, Lin, Jian-Xian, Li, Ping, Zheng, Chao-Hui, and Huang, Chang-Ming
- Abstract
Background: Due to lacking evidence for confirming the efficacy of performing laparoscopic surgery for locally advanced gastric cancer (LAGC). Therefore, this study aimed to compare the static and dynamic failure patterns after laparoscopic gastrectomy (LG) and open gastrectomy (OG) in LAGC. Methods: A total of 1792 LAGC patients who underwent radical resection between January 2010 and January 2017 were divided into the LG group (n= 1557) and the OG group (n= 235). Propensity score matching was performed to balance the two groups. Dynamic hazard rates of failure were calculated using the hazard function. Early and late failure were defined as failure occurring before and after 2 years since surgery, respectively. Results: A total of 1175 patients with LAGC were included after matching (LG group, n= 940; OG, n= 235). The failure rate of the whole cohort was 43.2% (508/1175), accounting for 41.4% (389/940) and 50.6% (119/235) in the LG and OG groups, respectively. Although the two groups showed no significant differences in failure rate for any failure type, landmark analysis showed a lower early distant recurrence rate in the stage IIa–IIIb subgroup of the LG group (OG versus LG: 30.3% versus 21.1%, P= 0.004). The dynamic hazard rate peaked at 9.4 months (peak rate = 0.0186) before gradually declining. In stage IIa–IIIb patients, the hazard rate of the OG group remained significantly higher than that of the LG group within the first 2 years in terms of distant recurrence (peak rate: OG versus LG, 0.0091 versus 0.0055). Conclusion: Given the differences in early failure between LG and OG, more intensive surveillance for distant recurrence within the first 2 years should be considered for patients with stage IIa–IIIb after OG.
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- 2022
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50. Comparison of short-term and long-term efficacy of laparoscopic and open gastrectomy in high-risk patients with gastric cancer: a propensity score-matching analysis
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Qi-Yue Chen, Jia-Bin Wang, Ru-Hong Tu, Ping Li, Jian-Xian Lin, Chao-Hui Zheng, Long-Long Cao, Jun Lu, Jian-Wei Xie, Zhi-Fang Zheng, Bin-Bin Xu, Ze-Ning Huang, Chang-Ming Huang, Mi Lin, and Ju-Li Lin
- Subjects
Laparoscopic surgery ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Kaplan-Meier Estimate ,030230 surgery ,Adenocarcinoma ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Gastrectomy ,Risk Factors ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Propensity Score ,Survival rate ,Aged ,Retrospective Studies ,business.industry ,Confounding ,Cancer ,Middle Aged ,medicine.disease ,Survival Rate ,Propensity score matching ,Multivariate Analysis ,T-stage ,030211 gastroenterology & hepatology ,Surgery ,Female ,Laparoscopy ,business ,Abdominal surgery - Abstract
To determine whether laparoscopic surgery can be used in high-risk patients with gastric cancer.The clinicopathological data of 3743 patients with primary gastric adenocarcinoma, collected from January 2007 to December 2014, were retrospectively analyzed. Patients who had ≥ 1 of the following conditions were defined as high-risk patients: (1) age ≥ 80 years; (2) BMI ≥ 30 kg/mA total of 1296 patients were included in PSM. After PSM, no significant difference in clinicopathological data was observed between the LG group (n = 341) and the OG group (n = 341). The operative time (181.70 vs. 266.71 min, p 0.001) and blood loss during the operation (68.11 vs. 225.54 ml, p 0.001) in the LG group were significantly lower than those in the OG group. In the LG and OG groups, postoperative complications occurred in 39 (11.4%) and 63 (18.5%) patients, respectively, p = 0.010. Multivariate analysis showed that laparoscopic surgery was an independent protective factor against postoperative complications (p = 0.019). The number of risk factors was an independent risk factor for postoperative complications (p = 0.021). The 5-year overall survival rate in the LG group was comparable to that in the OG group (55.0 vs. 52.0%, p = 0.086). Hierarchical analysis further confirmed that the LG and OG groups exhibited comparable survival rates among patients with stages cI, pI, cII, pII, cIII, and pIII (all p 0.05).For high-risk patients with gastric cancer, LG not only exhibits better short-term efficacy than OG but also has a comparable 5-year survival rate to OG.
- Published
- 2018
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