Wang Jianwei

Three-Step Method for Lymphadenectomy in Gastric Cancer Surgery: A Single Institution Experience of 120 Patients

BACKGROUND Gastric cancer is one of the most common malignancies and a leading cause of cancer death. Complete resection is still the only treatment to offer a cure for patients with gastric cancer. Lymphadenectomy is the most important part of curative resection, but lymphadenectomy is also very difficult in gastric cancer surgery. The aim of this study was to report our 3-step method for lymphadenectomy and clarify its safety and value in gastric cancer. STUDY DESIGN A total of 120 consecutive patients underwent our 3-step method for lymphadenectomy at the Second Affiliated Hospital Zhejiang University College of Medicine between February 2006 and July 2007. The main surgical procedure was performed from right to left and from caudal to cranial. Clinical factors, surgical variables, postoperative morbidity, and hospital (30-day) mortality were analyzed retrospectively. RESULTS Total gastrectomy was performed in 41 patients; combined adjacent organ resection was performed in 9 patients. The mean operation time was 201.8 minutes, and the mean blood loss was 376.7 mL. The median postoperative hospital stay was 14.9 ± 4.3 days. A total of 3,569 lymph nodes (LNs) were removed and examined, and 2,879 were negative. More than 15 LNs were examined in all 120 patients. The median number of examined LNs was 29 (range 17 to 64; mean 29.7 ± SD 9.6) per patient, and the median number of positive LNs was 5 (range 0 to 37; mean 5.8 ± SD 7.1) per patient. The overall incidence of postoperative complications was 10.8%, and the rate of hospital death was 0%. The median follow-up period for those patients was 34.3 months (range 10 to 53 months), and the overall 3-year survival rate was 40.6%. CONCLUSIONS The 3-step method for lymphadenectomy is easy to perform and is a safe and useful procedure for gastric cancer surgery.

Peng’s pancreaticojejunal anastomosis (binding pancreaticojejunostomy) for the pancreatoduodenectomy —A new procedure ensuring no leakage

ObjectiveTo evaluate the safety and feasibility of a new operative procedure called binding pancreaticojejunostomy (BPJ) for the prevention of pancreatic leakage after pancreatoduodenectomy (PD).MethodsBinding pancreaticojejunostomy was performed in 100 patients from 1996 to 2000. During the operation, the cut end of the jejunum (3 cm) was everted, the everted mucosa of the jejunum was destroyed with carbolic acid. Meanwhile 3 cm long remnant of pancreas was isolated and sutured to 3 cm away form the jejunum cut end, care being taken not to penetrate the sero—muscular layer. Then, the everted jejunum was restituted to its normal position and the remnant of the pancreas was naturally pushed into the jejunal lumen for 3 cm. Finally, the surface of pancreatic remnant was closely in contact with destroyed jejunal mucosa surface, and a piece of absorbable thread was used to bind circumferentially this jejunum and the pancreatic remnant together, so no gap existed between the jejunal mucosa and pancreatic remnant.ResultsNo pancreatic leakage occurred in the 100 patients with BPJ.ConclusionBinding pancreaticojejunostomy procedure can effectively prevent the occurrance of anastomatic leakage and can be applied broadly.

Surgical Intervention for Hepatocellular Carcinoma with Bile Buct Thrombi

Objective: To summarize the experience of surgical intervention for hepatocellular carcinoma (HCC) with bile duct thrombi (BDT), and to evaluate the influence on prognosis.Methods: From 1994 to 2002, 15 patients with HCC and BDT who underwent surgical intervention were retrospectively analyzed.Results: The operative procedures included hepatectomy with removel of BDT (n=7), hepatectomy combined with extrahepatic bile duct resection (n=4), thrombectomy through choledochotomy (n=3), piggy back orthotopic liver transplantation (n=1). The 1- and 3-year survival rates were 73.3% and 40%, respectively. Two patients survived over 5 years.Conclusion: Surgical intervention was effective for patients with HCC and BDT. Operation for recurrent lesion can prolong survival period. Liver transplantation is a new treatment worthy of further investigation.