Ce Zhang

Nanfang Hospital, Shengcheng, Guangdong, China

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Publications (21)8.85 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The laparoscopic approach is rapidly becoming the preferred method of treatment for patients with early gastric cancer due to advantages of minimally invasive surgery. As laparoscopic experience has accumulated, laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy has become a valuable alternative for the treatment of patients with advanced gastric cancer. However, laparoscopic gastric surgery is demanding from a technical point of view, especially when a D2 lymphadenectomy is performed. Surgeons seeking to undertake LADG are concerned about unpredictable intraoperative bleeding that may occur during LADG. Comprehensive knowledge of the perigastric vascular anatomy is essential for LADG with D2 lymphadenectomy.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 02/2014; 17(2):188-191.
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    ABSTRACT: To explore regional anatomy of fasciae and spaces related to laparoscopic right hemicolectomy (LRC). Seven cadavers and 49 patients undergoing LRC for cancer were observed. Computed tomography (CT) images of patients and healthy individuals were reviewed. Between ascending mesocolon and prerenal fascia (PRF), there was a right retrocolic space (RRCS), which communicated in all directions. Anterior, posterior, medial, lateral, cranial, and caudal boundaries of the RRCS were ascending mesocolon, PRF, superior mesenteric vein, peritoneal reflexion at right paracolic sulcus, inferior margin of transverse part of duodenum, and inferior margin of the mesentery root, respectively. Between transverse mesocolon and pancreas and duodenum, there was a transverse retrocolic space (TRCS), which was bounded cranially by root of transverse mesocolon. On CT images of healthy individuals, PRF was noted as slender line of middle density, continuing to transverse fascia, and the retrocolic spaces were unidentifiable. For patients with right colon cancer, PRF and right retrocolic space might be easier to be identified. The RRCS and the TRCS are natural surgical spaces. The PRF is natural surgical plane in LRC for cancer.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 08/2012; 15(8):819-23.
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    ABSTRACT: To analyze the vascular anatomy and complications of the right colon under laparoscope. Videotapes of 55 laparoscopic extended right hemicolectomies with D3 lymphadenectomy were reviewed and the anatomic relationship and bleeding vessels were determined. The superior mesenteric vein, superior mesenteric artery, ileocolic artery, and middle colic artery were present in all the patients. The right colic artery was present in 45.5%(25/55) of the patients. The incidence of the gastrocolic venous trunk was 74.5%. The overall incidence of intraoperative bleeding was 43.6%. Vessels in the pre-pancreatic region including the right gastroepiploic artery, the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding than the middle colic vein and artery (16.4% vs. 14.5%). Intraoperative bleeding significantly prolonged the overall operative time and lymphadenectomy time. The vascular anatomy of the right colon is intricate and variable and laparoscopic extended right hemicolectomy with D3 lymphadenectomy is associated with a high risk of hemorrhage. Understanding the vessels anatomic relationship of the right colon is valuable to decrease vascular complication.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 04/2012; 15(4):336-41.
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    ABSTRACT: To explore the regional anatomy of the fasciae and spaces around the right-side colon from laparoscopic perspective, we observed the location, extension, and boundaries of the spaces around the right-side colon in seven cadavers and in 49 patients undergoing laparoscopic right hemicolectomy for cancer, and reviewed computed tomography images from patients and healthy individuals. Between the ascending mesocolon and prerenal fascia (PRF), there was a right retrocolic space (RRCS), which extended in all directions. The anterior, posterior, medial, lateral, cranial, and caudal boundaries of the RRCS were the ascending mesocolon, PRF, superior mesenteric vein, right paracolic sulcus, inferior margin of the duodenum, and inferior margin of the mesentery radix, respectively. Between the transverse mesocolon and the pancreas and duodenum, there was a transverse retrocolic space, which was enclosed cranially by the radix of the transverse mesocolon. In CT images, healthy PRF was noted as slender line of middle density, continuing to the transverse fascia. The retrocolic spaces was unidentifiable, unless they were filled with retroperitoneal lesions. The RRCS and transverse retrocolic space are natural surgical planes for laparoscopic right hemicolectomy for cancer. The boundaries of these fusion fascial spaces are the best access, and the PRF is the best guide.
    The American surgeon 11/2011; 77(11):1546-52. · 0.92 Impact Factor
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    ABSTRACT: To explore the regional anatomy of the rectum including the perirectal fasciae and spaces. Twenty-one cadavers (15 males and 6 females) were embalmed and their vessels were visualized by injection with color dye. From the cadavers, 30 hemipelvis and 6 three-quarter pelvis were harvested. The perirectal fasciae and spaces and the pelvic autonomic nerves were dissected and examined. Three tissue layers were dissected from the inside to the periphery including the proper rectal fascia enveloping the mesorectum, the presacral fascia, and the piriformis fascia fused with the sacral periosteum. The mesorectum comprised 2 parts with the classical posterolateral fat covered by the proper rectal fascia posterialy and the anterior fat covered by the posterior layer of Denonvilliers fascia anteriorly. Extending anteriorly to the anterior layer of Denonvilliers fascia, the presacral fascia bisected the space between the mesorectum and the piriformis fascia into the retrorectal space and the presacral space. The retrorectal space extended cranially to the left retrocolic space, anterior to the space between the 2 layers of Denonvilliers fascia(prerectal space). From the inside to the periphery, the proper rectal fascia, the presacral fascia, and the muscular fascia are distributed in an annular pattern around the mesorectum. The presacral fascia divides the perirectal space into 2 annular parts, the central retrorectal space and the peripheral presacral space. The retrorectal space is the ideal surgical plane for total mesorectal excision.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 11/2011; 14(11):882-6.
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    ABSTRACT: We performed a meta-analysis in an attempt to answer whether short-term outcomes and lymph nodes harvested after laparoscopy-assisted gastrectomy (LAG) are comparable to those reported after conventional open gastrectomy (COG). Prospective randomized clinical trials were eligible if they included patients with distal gastric cancer treated by LAG versus COG. End points were operating time, intra-operative blood loss, size of wound, overall post-operative complications, time to first flatus, time to start oral intake, hospital stay and lymph nodes harvested. Six trials including 668 patients were included. For four of the 13 end points, the summary point estimates favoured LAG over COG; there was a significant reduction in intra-operative blood loss (weighted mean difference (WMD) −115.60, 95% confidence interval (CI) −159.16 to −72.04, P < 0.00001), size of wound (WMD −5.27, 95% CI −8.94 to −1.60, P= 0.005), overall post-operative complications (odds ratio 0.55, 95% CI 0.35 to 0.85, P = 0.008) and hospital stay (WMD −2.65, 95% CI −4.97 to −0.32, P= 0.03) for LAG. However, the combined results of the individual trials show significant longer operating time (WMD 112.98, 95% CI 60.32 to 165.64, P < 0.0001) and significant reduction in lymph nodes harvested (WMD −4.79, 95% CI −6.79 to −2.79, P < 0.00001) in the LAG group. There was no significant difference between the two groups in time to first flatus, time to start oral intake, wound infection, intra-abdominal fluid collection and abscess, anastomotic stenosis and leakage and pulmonary complications. The results of this meta-analysis suggest that LAG for early distal cancer is a feasible and safe alternative to COG, with better short-term outcomes.
    ANZ Journal of Surgery 10/2011; 81(10):673-80. DOI:10.1097/SLE.0b013e31828e3e6e · 1.12 Impact Factor
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    ABSTRACT: To evaluate the accuracy of sentinel lymph node mapping(SLM) in patients with rectal cancer by single-photon emission computed tomography (SPECT-CT) lymphoscintigraphy and carbon nanoparticles suspension injection. Twelve patients with clinical T(1-2)N(0)M(0) rectal cancer were selected and locally injected with technetium-(99m)sulfur-colloid and carbon nanoparticles suspension by endoscope one day before surgery, followed by SPECT-CT scanning 1, 3 and 5 hours later. Radioactive isotope(RI) uptake of each sentinel node(SN) basin with location preoperatively determined by SPECT-CT was postoperatively calculated using gamma probe. Nodes with the highest RI uptake, the number of which was also pre-determined by SPECT-CT, was defined as SNs. Immunohistochemical cytokeratin staining was performed for all the SNs and non-SNs. The rate of sentinel node detection was 91.7%(11/12) with at least one SN(1-3) per patient. Ten cases showed metastasis-negative in SNs as well as all the resected regional nodes by immunohistochemical cytokeratin staining. Only one patient had positive nodes in both SN and non-SNs. The accuracy of SLM was 100%. SPECT-CT lymphoscintigraphy and carbon nanoparticles suspension injection can effectively detect the anatomic location and number of sentinel nodes, and improve the accuracy of SLM for rectal cancer.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2011; 14(5):352-5.
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    ABSTRACT: It was the aim of this study to develop a methodology for dissection in laparoscopic distal gastrectomy with D2 lymphadenectomy (D2 LDG) for gastric cancer. One-hundred and thirty-two patients with distal gastric cancer underwent D2 LDG with a novel sequence of lymph node dissection between August 2004 and June 2008. Live anatomy in each step was observed simultaneously to ensure and confirm the newly developed methodology. Dissections in LDG were standardized as sequential steps: Dividing the gastrocolic ligament and getting access to the prepancreatic space--lymph node dissection in the lower left area--lymph node dissection in the lower right area--lymph node dissection in the upper right area--lymph nodes dissection centrally--lymph node dissection between liver and stomach. All dissections were successfully performed in peripancreatic spaces and their extensions. Gastric vessels were located by special landmarks, traced along vascular trunks and bifurcations, and identified by fine dissection technique in vaginavasorum. Sequential dissection around the pancreas was an effective method for D2 LDG. It was ensured by anatomical knowledge in each step: Vessels and fascial spaces around a central landmark, the pancreas.
    Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 12/2010; 19(6):355-63. DOI:10.3109/13645706.2010.527775 · 1.18 Impact Factor
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    ABSTRACT: To construct a clinical database for laparoscopic colorectal surgery in Chinese population using computerized technique. A clinical database system was constructed and used in multi-/single-center studies on laparoscopic colorectal surgery. The data of more than 1200 cases in the Nanfang Hospital during the past year were collected retrospectively. The database was used as the platform for "Southern China Laparoscopic Colorectal Surgery Study Group (SCLCSG)" and was used in the first stage of the clinical research of "Multicenter retrospective study of laparoscopic and open procedure for colorectal cancer" among 11 hospitals in Southern China. In order to test the system, the database was also used in "comparative study on oncologic results of laparoscopic versus open radical resection for rectal carcinoma". The evaluation system is reliable and efficient. This system has established a clinical database for laparoscopic colorectal cancer surgery and can be widely applied for the clinical research for colorectal cancer.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 10/2010; 13(10):741-4.
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    ABSTRACT: In view of debate on the optimal surgical planes for total mesorectal excision, this study was designed to explore the regional anatomy of the perirectal fascia and spaces. Twenty-one cadavers (15 male and 6 female) were embalmed and their vessels visualized by injection with color dye. From the cadavers, 30 hemipelves and 6 three-quarter pelves were harvested. The perirectal fascia and spaces and the pelvic autonomic nerves were dissected and examined. Three tissue layers were dissected from the inside to the periphery: the proper rectal fascia enveloping the mesorectum, the presacral fascia, and the piriformis fascia fused with the sacral periosteum. The mesorectum comprised 2 parts: posterior, with the classical posterolateral fat covered by the proper rectal fascia; and anterior, with the anterior fat covered by the posterior layer of Denonvilliers fascia. Extending anteriorly to the anterior layer of Denonvilliers fascia, the presacral fascia bisected the space between the mesorectum and the piriformis fascia into the retrorectal space and the presacral space. The retrorectal space extended cranially to the left Toldt's space, anterior to the space between the 2 layers of Denonvilliers fascia. From the inside to the periphery, the proper rectal fascia, the presacral fascia, and the muscular fascia are distributed in an annular pattern around the mesorectum. The presacral fascia divides the perirectal space into 2 annular parts: the central retrorectal space and the peripheral presacral space. The retrorectal space is the ideal surgical plane for the total mesorectal excision.
    Diseases of the Colon & Rectum 09/2010; 53(9):1315-22. DOI:10.1007/DCR.0b013e3181e74525 · 3.20 Impact Factor
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    ABSTRACT: To develop a clinical database system of gastric cancer surgery integrated with data mining function for better management of clinical data and better performance of both retrospective and prospective studies. Core fields for clinical data were determined based on the JGCA(13th and 14th edition) and UICC gastric cancer staging system. Microsoft Visual Basic and VistaDB were used for programming. The database structure was designed according to data mining theory and clinical workflow. After one year of development and refinement, data of over 600 patients from our hospital were retrospectively entered, and function tests were satisfactory. This system was accepted as the database platform for the Chinese Laparoscopic Gastrointestinal Surgery Study Group (CLASS) and was successfully used in the first stage of the Multicenter Retrospective Study of the Feasibility of Laparoscopy for Gastric Cancer among 30 hospitals from both Mainland China and Hong Kong. The data mining function met the requirements, which could carry out complex search with visualized presentation. Descriptive analyses could be performed with the analysis function. Efficient communication among institutions could be executed by data import and export with excellent compatibility and without errors. The system has established a clinical database of approximately 4000 fields with data mining function. This system can be widely applied for the clinical research for gastric cancer.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2010; 13(7):510-5.
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    ABSTRACT: To analyze the learning curve for an experienced laparoscopic colorectal surgeon in performing to laparoscopic D2 gastrectomy for gastric cancer. From July 2004 to July 2009, 70 patients undergoing laparoscopic D2 gastrectomy performed by a single surgical team were retrospectively evaluated. The patients were divided into groups A to G (n=10) based on the surgery date, and the operation time, estimated blood loss (EBL), conversion to open surgery, number of lymph nodes harvested, complications, and recovery indicators were compared. No statistical differences were found among the groups in age, gender, gastrectomy approach, EBL, number of lymph nodes harvested, time to flatus, or postoperative hospital stay (P>0.05). No significant differences were found in the operation time between groups A and B (P=0.999) or among the other 5 groups (P>0.05), but the operation time in groups A (300.00-/+104.59 min) and B (261.00-/+40.50 min) were significantly longer than that in the other 5 groups (C: 191.30-/+23.11 min, D: 188.60-/+31.38 min, E: 181.10-/+20.18 min, F: 167.50-/+32.81 min, and G: 161.30-/+29.03 min). Compared with that in group A, the time to liquid diet decreased significantly in the remaining 6 groups (P<0.05). Conversion to open surgery occurred in two cases (2.86%, both in group B), 2 patients in group B and another 2 in group C developed intraoperative complications, and one in group C had postoperative complication, with the total incidence of complication of 7.14% in this series. A well-trained laparoscopic colorectal surgeon, by following the standard surgical procedures, are likely to overcome the learning curve smoothly after performing approximately 20 cases of laparoscopic D2 gastrectomy for gastric cancer.
    Nan fang yi ke da xue xue bao = Journal of Southern Medical University 05/2010; 30(5):1095-8.
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    ABSTRACT: To evaluate the feasibility, safety, radicality and short-term outcome of laparoscopic total mesorectal excision(TME) in comparison with open procedure for the middle-lower rectal cancer. From November 2005 to October 2008, 93 patients with middle-lower rectal cancer received laparoscopic total mesorectal excision (LTME group), while 105 patients underwent conventional open TME (OTME group). The operative procedures, clinicopathological data and short-term outcome were collected and compared between the 2 groups. (1) Comparison of surgical procedures. The demographic data of LTME and OTME groups were comparable (P >0.05). Four (4.3%) patients were converted to open procedure in LTME group. The anal sphincter preserved procedure accounted for 82.8% in LTME group and 81.9% in OTME group. The difference was not significant (P >0.05). (2) Comparison of perioperative surgical data. The mean operating time was (164.6+/-35.6) min in LTME group, significantly longer than that in OTME group (141.9+/-29.4) min (P <0.001). The operative blood losses were (51.4+/-20.2) ml and (180.0+/-64.7) ml in LTME and OTME group respectively, the difference was significant (P <0.001). The analgesia requirement, time for bowel movement retrieval, time to liquid food intake, time to resuming early activity and hospital stay in LTME group were significant lower or shorter than those in OTME group (P <0.001). There was no operative death in both groups. (3) Comparison of operative complications. The overall morbidity rate was 11.8% in LTME group, and 12.4% in OTME group, the difference was not significant (P >0.05). The major complications were equivalent between two groups. (4) Comparison of specimen. No significant differences were observed between two groups in terms of specimen length, lymph node harvest and negative distal margin. (5) Follow-up results. The mean follow-up time was 19 months. The recurrent rate and overall survival rate were 4.4% and 97.8% in LTME group, with no significant difference compared to those in OTME group (7.3% and 97.9%, P >0.05). Laparoscopic TME for middle-low rectal cancer is safe and feasible, and can potentially offer all the benefits of a minimally invasive approach and achieve satisfactory oncological outcome,which may lead to a better future of the TME technique.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 11/2009; 12(6):573-6.
  • Xian Yu · Guo-Xin Li · Jiang Yu · Ce Zhang · Ya-Nan Wang
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    ABSTRACT: OBJECTIV: To evaluate the effect of laparoscopic surgery in resection of suspected gastrointestinal stromal tumors. METHODS: A retrospective analysis was conducted among 50 patients with suspected gastrointestinal stromal tumors. All the patients underwent laparoscopic tumor resection. Thirty-eight of the patients had a preoperative diagnosis of gastric submucosa tumor by gastroscopy, and 12 had a diagnosis of small intestinal tumor by small intestinal endoscopy. The surgical procedure, operative time, estimated blood loss, time for passage of flatus, time for eating, postoperative hospital stay, operative complications, pathology and the results of follow-up were analyzed. RESULTS: In these cases, the mean operative time was 90.84-/+26.69 min, with the mean estimated blood loss of 57.80-/+67.48 ml, mean time for passage of flatus of 50.90-/+18.87 h, mean time for eating of 2.94-/+0.79 days, and postoperative hospital stay of 8.62-/+3.56 days. No patient developed surgical complications, and all the lesions showed negative results on the margins of the resection. CONCULSION: As a minimally invasive surgical approach, laparoscopic resection of suspected gastrointestinal stromal tumors reduces the intraoperative blood loss, promotes postoperative recovery of the patients and achieves R0 resection without causing serious complications.
    Nan fang yi ke da xue xue bao = Journal of Southern Medical University 08/2009; 29(7):1423-5.
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    ABSTRACT: To observe the effect of laparoscopy-assisted and open distal gastrectomies on the perioperative levels of C-reactive protein (CRP) and visceral proteins in patients with gastric cancer. T Fifty-three patients with gastric cancer were randomized into two groups to receive laparoscopic surgery (n=26) or open surgery (n=27). The CRP levels were measured preoperatively and at 1, 2, 3 and 7 days after the operation. The levels of the visceral proteins including albumin (ALB), prealbumin (PRE), transferrin (TRF) and retinal-binding protein (RbP) were assayed before and at 3 and 7 days after the operation. Compared with the preoperative levels, the CRP levels in both groups were significantly increased on days 1, 2, and 3 after the operation (P<0.05), with the highest level occurred on day 2 postoperatively. The postoperative CRP levels were significantly lower in the laparoscopic group than in the open surgery group (P<0.01). The levels of ALB, PRE, TRF, and RbP were significantly decreased after operation in both groups (P<0.01) without significant differences between the two groups (P>0.05). Compared with open surgeries, laparoscopy-assisted distal gastrectomy for gastric cancer causes minimal surgical trauma and mild inflammatory responses to allow the recovery of the levels of the visceral proteins.
    Nan fang yi ke da xue xue bao = Journal of Southern Medical University 08/2009; 29(8):1596-8.
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    ABSTRACT: To investigate the effect of laparoscopic-assisted resection of rectal carcinoma on perioperative levels of C-reactive protein (CRP), immunoglobulins(Ig) and complements. Fifty-four patients with rectal carcinoma were divided into laparoscopic group (n=26) and open operation group(n=28) according to the patients' will. C-reactive protein (CRP), IgG, IgA, IgM, C(3), C(4) and CH(50) of peripheral blood were assayed preoperatively and on the 1st, 2nd, 3rd and 7th day postoperatively. Compared with the preoperative period, the CRP levels in both groups were significantly increased on the 1st, 2nd, and 3rd day(P<0.01) and peaked on the 2nd day postoperatively. The postoperative CRP levels were significantly lower in the laparoscopic group than those in the open operation group(P<0.01). After operation, the immunoglobulin levels were significantly decreased in both groups(P<0.01), and there were no significant differences in IgG and IgM. The levels of C(3), C(4) and CH(50) were significantly decreased after operation in both groups(P<0.05) and returned to the preoperative levels during postoperative 48-72 hours in laparoscopic group. Laparoscopic-assisted resection of rectal carcinoma results in less wound, lower levels of stress response, and less effect on immune function compared to open surgery, which recovers the immune function of patients more rapidly after operation.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2009; 12(4):357-60.
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    ABSTRACT: To explore living anatomy of pancreas and peripancreatic spaces,as well as their implications on laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer. Living observation was carried out in 132 patients diagnosed as distal gastric cancer and undergoing laparoscopic gastrectomy with D(2) lymphadenectomy. Spaces between greater omentum and transverse mesocolon continued to pre-pancreatic and retro-pancreatic spaces at inferior margin of pancreas. The pre-pancreatic and retro-pancreatic spaces continued each other at inferior and superior margin of pancreas and extended in all directions. Left gastroepiploic vessels were located in pre-pancreatic spaces at superior margin of pancreatic tail. In retro-pancreatic space at inferior margin of pancreatic neck, superior mesenteric veins were located. In retro-pancreatic spaces or in gastric mesenteries inferior to gastric antrum, right gastroepiploic vessels were located. In spaces between gastric antrum and pancreatic heads, gastroduodenal arteries were located and traced to locate common hepatic arteries. In retro-pancreatic spaces at superior margin of pancreatic body, common hepatic arteries, left gastric arteries,celiac arteries and splenic arteries were located. Hepatopancreatic folds and gastropancreatic folds were landmarks respective to locate common hepatic arteries and left gastric arteries. The aforementioned vessels and spaces in their vagina vasorum continued each other and united as a whole. Laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer is carried out in macroscopic surgical planes of pre-pancreatic space and retro-pancreatic space, as well as their extensions in all directions, and in microscopic surgical planes of spaces in vagina vasorum of perigastric vessels which continue each other, under the guidance of central landmarks of pancreas and concrete landmarks of vessel trunks and their furcations.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 04/2009; 12(2):117-20.
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    ABSTRACT: To evaluate the safety and feasibility of laparoscopic surgery following neoadjuvant chemoradiotherapy (CRT) for mid-low rectal cancer. A retrospective analysis was conducted among 24 patients with mid-low rectal cancer who received laparoscopic total mesorectal excision (TME) after neoadjuvant CRT. Another 24 patients with mid-low rectal cancer were randomly selected form those undergoing primary laparoscopic TME to serve as the control group. The clinical data and surgical data of the two groups of patients were collected and analyzed comparatively. TME after CRT resulted in significantly lower lymph node yield compared with the control group (7.08-/+6.5 vs 12.5-/+4.1, P<0.05). The two groups were comparable in the operative time, intraoperative blood loss, intestinal function recovery, positive surgical margins, rate of conversion to open surgery, and occurrence of intra- and postoperative complications. Laparoscopic surgery of mid-low rectal cancer after neoadjuvant CRT can be safe and feasible and produce surgical effects comparable to exclusive laparoscopic surgery.
    Nan fang yi ke da xue xue bao = Journal of Southern Medical University 04/2009; 29(4):754-6.
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    ABSTRACT: To compare the recurrence between laparoscopic resection and conventional open resection for colorectal cancer with meta-analysis. Eligible articles were identified by searches of MEDLINE, EMBASE and the Cochrane database between January 1991 and January 2007 using the terms (laparoscopy, surgery, minimal invasive, colon, intestine, large, colectomy, colonic neoplasms, rectal neoplasms and randomized controlled trial). Prospective randomized clinical trials were eligible if they included patients with colorectal cancer treated by laparoscopic surgery versus open surgery followed-up by recurrence. Data were extracted from these trials by three independent reviewers. Ten trials with recurrence information of 2474 patients were involved. In the combined results, no significant difference in the OR for overall recurrence between the laparoscopic surgery and open surgery group was found (OR 0.95, 95%CI 0.76 to 1.19, P=0.64). Stratified by recurrence type, the combined results of the individual reports showed no significant differences for local recurrence (OR 0.79, 95%CI 0.50 to 1.25,P=0.32), distant metastasis (OR 0.89, 95%CI 0.62 to 1.28, P=0.54) and port-site or wound-site recurrence (OR 1.04,95%CI 0.21 to 5.27,P=0.96) between the two surgical techniques. The recurrence rates for patients with colorectal cancer treated by laparoscopic surgery do not differ significantly from those by open surgery. Longer follow up studies will further define outcomes comparing the two techniques in the treatment of colorectal cancer.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 10/2008; 11(5):414-20.
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    ABSTRACT: To compare the pharmacokinetics and tissue distribution of 5-fluorouracil administered intraperitoneally with two isotonic carrier solutions: HAES-steri (neotype 6% hydroxyethyl starch), a novel carrier solution with middle molecular weight and physiologic saline (0.9% sodium chloride solution), a traditional carrier solution for intraperitoneal chemotherapy, in rats. A total of 60 Sprague Dawley rats were randomized into groups according to the carrier solution administered. Each group was further randomized according to the intraperitoneal dwell period (1, 3, 6, 12, 18 and 24 h). At the end of the procedure the rats were killed, the peritoneal fluid was withdrawn completely and quantitated. Drug concentrations in peritoneal fluid, plasma, and tissues were determined by high-performance liquid chromatography. The mean volumes remaining in the peritoneal cavity were significantly higher with HAES-steri than those with physiologic saline at 1, 6, 12, 18, and 24 h (P = 0.047, 0.009, 0.005, 0.005 and 0.005 respectively, the percentages of remaining peritoneal fluid volume were 89.9 +/- 5.6 vs 83.4 +/- 4.9, 79.9 +/- 2.8 vs 56.2 +/- 15.7, 46.8 +/- 5.5 vs 24.7 +/- 9.7, 23.0 +/- 2.8 vs 0.0 +/- 0.0 and 4.2 +/- 1.7 vs 0.0 +/- 0.0 respectively). Mean concentrations in peritoneal fluid were significantly higher with HAES-steri than those with physiologic saline at 3, 12 and 18 h (P = 0.009, 0.009 and 0.005 respectively, the concentrations were 139.2768 +/- 28.2317 mg/L vs mg/L, 11.5427 +/- 3.0976 mg/L vs 0.0000 +/- 0.0000 mg/L and 4.7724 +/- 1.0936 mg/L vs 0.0000 +/- 0.0000 mg/L respectively). Mean plasma 5-fluorouracil concentrations in portal vein were significantly higher with HAES-steri at 3, 12, 18 and 24 h (P = 0.009, 0.034, 0.005 and 0.019 respectively, the concentrations were 3.3572 +/- 0.8128 mg/L vs 0.8794 +/- 0.2394 mg/L, 0.6203 +/- 0.9935 mg/L vs 0.0112 +/- 0.0250 mg/L, 0.3725 +/- 0.3871 mg/L vs 0.0000 +/- 0.0000 mg/L, and 0.2469 +/- 0.1457 mg/L vs 0.0000 +/- 0.0000 mg/L respectively), but significantly lower at 1 h (P = 0.009, the concentrations were 4.1957 +/- 0.6952 mg/L vs 7.7406 +/- 1.2377 mg/L). There were no significant differences in the plasma 5-fluorouracil in inferior caval vein at each time-point. 5-fluorouracil concentrations were significantly greater with HAES-steri at 18 h in gastric tissue (P = 0.016, the concentrations were 0.9486 +/- 0.8173 mg/L vs 030392 +/- 0.0316 mg/L), at 18 h in colon (P = 0.009, the concentrations were 0.1730 +/- 0.0446 mg/L vs 0.0626 +/- 0.0425 mg/L), at 3, 6, 12 and 24 h in liver (P = 0.009, 0.013, 0.034 and 0.013 respectively, the concentrations were 0.6472685 +/- 0.5256 mg/L vs 0.1554 +/- 0.1043mg/L, 0.8606826 +/- 0.7155 mg/L vs 0.0014 +/- 0.0029 mg/L, 0.0445 +/- 0.0330 mg/L vs 0.0797 +/- 0.1005 mg/L and 0.0863 +/- 0.0399 mg/L vs 0.0034 +/- 0.0075 mg/L respectively) and at 18 h in lung (P = 0.009, the concentrations were 0.0886 +/- 0.0668 mg/L vs 0.0094 +/- 0.0210 mg/L). There were no differences in 5-fluorouracil concentrations in renal tissue at each time-point. The use of intraperitoneal 5-fluoro-uracil with HAES-Steri carrier solution provides a pharmacokinetic advantage for a local-regional killing of residual tumor cells and improve the accumulated penetrability of 5-fluorouracil with decreased systemic toxicity. Further clinical feasibility studies on the use of HAES-steri as carrier solution for intraperitoneal chemotherapy with 5-fluorouracil are warranted.
    World Journal of Gastroenterology 05/2008; 14(14):2179-86. · 2.43 Impact Factor

Publication Stats

63 Citations
8.85 Total Impact Points

Institutions

  • 2008–2011
    • Nanfang Hospital
      Shengcheng, Guangdong, China
  • 2006–2011
    • Southern Medical University
      • • Department of General Surgery
      • • Institute of Clinical Anatomy
      Shengcheng, Guangdong, China