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Hepato-gastroenterology 04/2013; 60(128). · 0.66 Impact Factor
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ABSTRACT: To report our experience using mini-laparotomy for the resection of rectal cancer using the total mesorectal excision (TME) technique.
Consecutive patients with rectal cancer who underwent anal-colorectal surgery at the authors' hospital between March 2001 and June 2009 were included. In total, 1415 patients were included in the study. The cases were divided into two surgical procedure groups (traditional open laparotomy or mini-laparotomy). The mini-laparotomy group was defined as having an incision length ≤ 12 cm. Every patient underwent the TME technique with a standard operation performed by the same clinical team. The multimodal preoperative evaluation system and postoperative fast track were used. To assess the short-term outcomes, data on the postoperative complications and recovery functions of these cases were collected and analysed. The study included a plan for patient follow-up, to obtain the long-term outcomes related to 5-year survival and local recurrence.
The mini-laparotomy group had 410 patients, and 1015 cases underwent traditional laparotomy. There were no differences in baseline characteristics between the two surgical procedure groups. The overall 5-year survival rate was not different between the mini-laparotomy and traditional laparotomy groups (80.6% vs 79.4%, P = 0.333), nor was the 5-year local recurrence (1.4% vs 1.5%, P = 0.544). However, 1-year mortality was decreased in the mini-laparotomy group compared with the traditional laparotomy group (0% vs 4.2%, P < 0.0001). Overall 1-year survival rates were 100% for Stage I, 98.4% for Stage II, 97.1% for Stage III, and 86.6% for Stage IV. Local recurrence did not differ between the surgical groups at 1 or 5 years. Local recurrence at 1 year was 0.5% (2 cases) for mini-laparotomy and 0.5% (5 cases) for traditional laparotomy (P = 0.670). Local recurrence at 5 years was 1.5% (6 cases) for mini-laparotomy and 1.4% (14 cases) for traditional laparotomy (P = 0.544). Days to first ambulation (3.2 ± 0.8 d vs 3.9 ± 2.3 d, P = 0.000) and passing of gas (3.5 ± 1.1 d vs 4.3 ± 1.8 d, P = 0.000), length of hospital stay (6.4 ± 1.5 d vs 9.7 ± 2.2 d, P = 0.000), anastomotic leakage (0.5% vs 4.8%, P = 0.000), and intestinal obstruction (2.2% vs 7.3%, P = 0.000) were decreased in the mini-laparotomy group compared with the traditional laparotomy group. The results for other postoperative recovery function indicators, such as days to oral feeding and defecation, were similar, as were the results for immediate postoperative complications, including the physiologic and operative severity score for the enumeration of mortality and morbidity score.
Mini-laparotomy, as conducted in a single-centre series with experienced TME surgeons, is a safe and effective new approach for minimally invasive rectal cancer surgery. Further evaluation is required to evaluate the use of this approach in a larger patient sample and by other surgical teams.
World Journal of Gastroenterology 10/2012; 18(37):5289-94. · 2.47 Impact Factor
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ABSTRACT: Acute bronchitis is one of the most common diagnoses made by primary care physicians. It is traditionally treated with antibiotics (although the evidence for their effectiveness is weak, and modest at best) and other even less effective treatments. Chinese medicinal herbs have also been used as a treatment.
This review aimed to summarise the existing evidence on the comparative effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4) which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 19 September 19, 2011), EMBASE (1988 to 19 September 2011) and CNKI and the Chinese Biomedical Database (CBM) (1980 to 19 September, 2011).
Randomised controlled trials (RCTs) comparing Chinese medicinal herbs with placebo, antibiotics or other Western medicines for the treatment of uncomplicated acute bronchitis.
At least two review authors independently extracted data and assessed trial quality.
In this updated review, 74 studies involving 6877 participants were reported as RCTs by the study authors. None of them met the inclusion criteria for this review. Out of the 74 trials, we identified 39 as non-RCTs and 35 compared different Chinese herbal medicines in the intervention and control groups.
There is insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. Trial design limitations of the individual studies meant that we could not draw any conclusions about the benefits of Chinese herbs for acute bronchitis. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence for these herbs, although adverse events were reported in some case reports.
Cochrane database of systematic reviews (Online) 01/2012; 2:CD004560. · 5.72 Impact Factor
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ABSTRACT: This study evaluates the application of fast track (FT) nasogastric decompression in patients who underwent anterior resection of rectal cancer. A randomized control trial was performed comparing the group with the fast track treatment (n = 57) and the group with traditional nasogastric decompression (n = 84). Preoperative characteristics and postoperative recovery indices were recorded and analyzed. The results indicate no significant differences in gender (P = 0.614), age (P = 0.653), tumor location (P = 0.113), and TNM stages (P = 0.054) were observed between the 2 groups. The differences in the type of resection, anastomosis, and adoption of protective colostomy were all not significant between the FT and the traditional group. During the first 24 hours after surgery, the volume of nasogastric drainage averaged 197 ml in the FT group and 155 ml in the traditional group (P = 0.197). The initiation of test-meal (P = 0.000), semiliquid diet (P = 0.002), and ordinary diet (P = 0.008) were all significantly shorter in the FT group. Furthermore, compared with the other group, the patients in the FT group enjoyed earlier removal of the abdominal drainage, urinary catheter, and shorter hospital stays (P = 0.000). Based on a correlation test, the duration of nasogastric decompression is related to the time of test-meal and semiliquid diet. The routine usage of nasogastric decompression in rectal surgery is unnecessary. The fast track procedure might help in facilitating postoperative functional and diet recovery, reducing the time of catheterization, and shortening hospital stay.
Frontiers of medicine. 09/2011; 5(3):306-9.
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ABSTRACT: Pneumonia is an acute inflammation of the lungs and treatments differ depending on the type and severity. Corticosteroids can influence immune regulation, carbohydrate metabolism, protein catabolism, electrolyte balance and stress response. However, the benefits of corticosteroids for patients with pneumonia remains unclear.
To assess the efficacy and safety of corticosteroids in the treatment of pneumonia.
We searched Cochrane Central Register of Controlled Clinical Trials (CENTRAL) (The Cochrane Library 2010, Issue 11) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to December week 4, 2010), EMBASE (1974 to December 2010), the China National Knowledge Infrastructure (CNKI) (1978 to December 2010) and VIP (1986 to December 2010).
Randomised controlled trials (RCTs) assessing the effectiveness of corticosteroids for pneumonia.
Three review authors selected studies. We telephoned the trial authors to confirm the randomisation method used. We extracted and analysed the methodological details and data from the included studies.
We included six studies including 437 participants in the review. Two studies were of high methodological quality and three were of poor quality. All studies involved small numbers of participants. Two small studies provided weak evidence that corticosteroids did not significantly reduce mortality (Peto odds ratio (OR) 0.26; 95% CI 0.05 to 1.37), but accelerated the resolution of symptoms or time to clinical stability, and decreased the rate of relapse of the disease. Steroids can improve the oxygenation and reduce the need for mechanical ventilation in severe pneumonia. There was no significant difference between treatment groups with regards to the time to discharge from the intensive care unit (ICU). There were insufficient data to report the time to pneumonia resolution and admission to ICU. Typical adverse events associated with corticosteroid therapy were infrequent.
In most patients with pneumonia, corticosteroids are generally beneficial for accelerating the time to resolution of symptoms. However, evidence from the included studies was not strong enough to make any recommendations.
Cochrane database of systematic reviews (Online) 01/2011; · 5.72 Impact Factor
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ABSTRACT: To investigate the genetic polymorphisms of interleukin-1B (IL-1B) and interleukin-1 receptor antagonist gene (IL-1RN) in gastric cancer, and to explore the relationships of these genetic polymorphisms to the susceptibility of gastric cancer.
The polymorphisms of IL-1B and IL-1RN genes were analyzed by PCR-restriction fragment length polymorphism (PCR-RFLP) after extracting the genomic DNA from 140 gastric cancer patients and 165 age- and sex-matched healthy controls.
The polymorphisms of IL-1B promoter region -31, -511 and +3954 locus have no significant difference between gastric cancer patients and healthy subjects. Four kinds of polymorphisms of IL-1RN were found as 2R/2R, 2R/4R, 3R/4R and 4R/4R, and the frequency in gastric cancer patients were 0.7%, 15.7%, 2.9% and 80.7%, respectively, while the frequency in healthy controls were 0, 5.5%, 0 and 94.5%, respectively. Compared to 4R/4R genotype, a 3.37 fold increased risk of gastric cancer were found in 2R/4R genotype, but the difference was not significant (P = 0.557, chi2 = 2.076). IL-1RN 2R allele frequencies in gastric cancer and healthy controls were 8.6% and 2.7%, respectively, which showed the risk to be gastric cancer increased 3.4 times, but the difference was not significant (P = 0.781, chi2 = 0.494).
There is no evidence to support that the polymorphism of IL-1B and IL-1RN gene had relationship with gastric cancer. However, the risk of developing gastric cancer might be raised when the IL-1RN 2R allele exist.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 11/2010; 41(6):1039-43.
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ABSTRACT: To explore the impact of postoperative recovery and short term quality of life in the patients with colorectal cancer in fast track model.
There were 122 patients enrolled into this prospective study in Gastrointestinal Surgery Center, West China Hospital of Sichuan University, from October 2008 to January 2009, and 121 patients completed the whole study. The patients were divided into the fast track group (62 cases) and the tradition track group (59 cases), postoperative recovery and the QLQ-C30 scores were evaluated at one week after the surgery.
The fast track group showed earlier recovery than the tradition group in first aerofluxus [(3.96 +/- 1.40) d vs. (5.66 +/- 3.11) d, P < 0.05], first intake [(3.12 +/- 1.93) d vs. (5.96 +/- 3.23) d, P < 0.05], first ambulation [(2.05 +/- 1.16) d vs. (5.13 +/- 1.36) d, P < 0.05] and in-hospital time post-operation [(7.85 +/- 5.31) d vs. (10.11 +/- 3.37) d, P < 0.05]. The incidence of wound infection (1.61% vs. 6.78%, P < 0.05) and intestinal obstruction (1.61% vs. 8.47%, P < 0.05) in fast track were significantly lower than those in the traditional track group. The general health of fast track in C30 is better too (80.46 +/- 15.54 vs. 76.58 +/- 15.28, P < 0.05). In the functional assessment of C30, the physical function (87.35 +/- 5.12 vs. 85.02 +/- 8.70, P < 0.05) and emotional function (90.00 +/- 0.00 vs. 85.35 +/- 12.39, P < 0.05) both were better in the fast track group. In the symptom assessment of C30, fast track group is less fatigue (71.70 +/- 2.86 vs. 87.12 +/- 10.80, P < 0.05) and pain (71.78 +/- 3.76 vs. 77.63 +/- 8.33, P < 0.05). Better sleep (75.78 +/- 11.68 vs. 82.70 +/- 19.40, P < 0.05) and less loss of appetite(73.24 +/- 8.60 vs. 78.02 +/- 16.42, P < 0.05) were found in fast track group.
The fast track group manifested faster in postoperative recovery and can improve the quality of life in postoperative patients with colorectal cancer.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 05/2010; 41(3):509-12.
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ABSTRACT: To assess the relationship between the incidence and prognostic significance of mesorectal involvement.
328 cases of rectal cancer resected with total or subtotal mesorectal excision in our hospital from Jan. 1997 to Dec. 1998 were followed up and analyzed in this study. The neoplastic foci were identified at the pathologic examination of the mesorectum.
Neoplastic mesorectal metastasis was found in 234 cases (71.3%); node involvement in 59.8% and microscopic foci involvement in 36% of all cases (isolated in 11.6%, microfoci alone without any kind of other mesorectal involvement). Microscopic deposits were found in 10.3% of TNM Stage I tumors, in 18.4% of Stage II and in 45.1% of Stage III cancers. Five-year disease-free survival rate (49.6% vs. 91.4%) were observed in patients with mesorectal involvement, compared with those without deposits.
The incidence of neoplastic foci in the mesorectum seem to affect prognosis, even in early staged tumors. The presence of mesorectal foci should be considered an index in modifying the conventional staging of the rectal tumor.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 04/2006; 37(2):295-7.
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ABSTRACT: To evaluate the clinical necessity of postoperative gastrointestinal decompression after operation on lower digestive tract.
Three hundred and sixty-eight patients who required excision and anastomosis of lower digestive tract were randomly divided into two groups, with or without receiving gastrointestinal decompression after operation. Clinical therapeutic efficacy and complications were compared between two groups.
The volume of gastrointestinal suction ranged from 10 ml to 520 ml each day after operation, and was less on the first day than those on the second and the third day after operation in decompression group. There was no significant difference in the average girth between two groups before and after operation. The average girths were shorter before operation than those after operation in two groups (P< 0.001). There was no significant difference in postoperative defecation and urination time between two groups (P > 0.05). The complication rate was significantly higher in decompression group than that in non-decompression group (28% vs. 8.2%, P< 0.001). The incidence of pharyngolaryngitis was up to 23.1% in decompression group. There was no difference in hospital stay between the two groups after operation.
The recovery of patients who receive excision and anastomosis of lower digestive tract will benefit from non-gastrointestinal decompression.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2005; 8(3):203-5.
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ABSTRACT: To discuss the clinical significance of postoperative gastrointestinal decompression in operation on lower digestive tract.
Three hundred and sixty-eight patients with excision and anastomosis of lower digestive tract were divided into two groups, i.e. the group with postoperative gastrointestinal decompression and the group without postoperative gastrointestinal decompression. Clinical therapeutic outcome and incidence of complication were compared between two groups. Furthermore, an investigation on application of gastrointestinal decompression was carried out among 200 general surgeons.
The volume of gastric juice in decompression group was about 200 mL every day after operation. Both groups had a lower girth before operation than every day after operation. No difference in length of the first passage of gas by anus and defecation after operation was found between two groups. The overall incidence of complications was obviously higher in decompression group than in non-decompression group (28% vs 8.2%, P<0.001). The incidence of pharyngolaryngitis was up to 23.1%. There was also no difference between two groups regarding the length of hospitalization after operation. The majority (97.5%) of general surgeons held that gastrointestinal decompression should be placed till passage of gas by anus, and only 2.5% of surgeons thought that gastrointestinal decompression should be placed for 2-3 d before passage of gas by anus. Nobody (0%) deemed it unnecessary for placing gastrointestinal compression after operation.
Application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce gastrointestinal tract pressure and has no obvious effect on preventing postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial to the recovery of patients without undergoing gastrointestinal decompression.
World Journal of Gastroenterology 08/2004; 10(13):1998-2001. · 2.47 Impact Factor
