Gang Wang

Nanjing University, Nan-ching, Jiangsu Sheng, China

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Publications (12)11.15 Total impact

  • Bo Zhou · Gang Wang · Nanhai Peng · Xiandi He · Xiaoxiang Guan · Yun Liu ·
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    ABSTRACT: Background: Extensive preclinical evidence suggests that induced hypothermia can protect tissues from ischemia-reperfusion injury, reduce organ damage, and improve survival in the advanced stages of shock. Objectives: We assessed the effects of induced hypothermia on the hemodynamic parameters and coagulation capacity during hemorrhagic shock (HS) and fluid resuscitation, in a pig model of HS with multiple intestinal perforations. Material and methods: Pigs (n = 16) were randomized into 2 groups: a hypothermia (HT) group (n = 8, 34°C) and a normothermia (NT) group (n = 8, 38°C). Hypothermia to 34°C was induced with a cold blanket at the pre-hospital stage. Traumatic HS shock was induced using multiple intestinal perforations. Pulse indicator continuous cardiac output (PiCCO) was used to monitor hemodynamic changes. Coagulation capacity was measured using thromboelastography (TEG) at baseline as well as during resuscitation periods. Survival was documented for 72 h post-trauma. Results: Mortality in the hypothermic HS group was low, but there were no significant differences in mortality between the groups (mortality = 2/8 HT vs. 5/8 NT, p = 0.137). During hypothermia, the heart rate, extravascular lung water index (EVLWI), oxygen uptake index (VO2), and oxygen delivery index (DO2) in the HT group were significantly lower than those in the NT group. There were no significant differences between the 2 groups in the other hemodynamic indices or prothrombin time. Analyses of thromboelastometry at 34°C during hypothermia showed significant differences for reaction time (R) and alpha angle, but not for maximal amplitude (MA). Conclusions: Rewarming reversed the coagulation changes induced by hypothermia. Induced mild hypothermia (34°C) in the pre-hospital stage affects hemodynamic parameters and the coagulation system but does not worsen outcomes in a pig HS model. The hypothermia-induced coagulation changes were reversed during rewarming without evidence of harmful effects. Our results suggest that pre-hospital induced hypothermia can be performed carefully following major trauma.
    Advances in Clinical and Experimental Medicine 10/2015; 24(4):571-578. DOI:10.17219/acem/29044 · 1.10 Impact Factor
  • Zhi-Wei Jiang · Shu Zhang · Gang Wang · Kun Zhao · Jiang Liu · Li Ning · Jieshou Li ·
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    ABSTRACT: We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments. A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer. This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved. This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.
    Hepato-gastroenterology 03/2015; 62(138):518-23. DOI:10.5754/hge14693 · 0.93 Impact Factor
  • Zhi-Wei Jiang · Jiang Liu · Gang Wang · Kun Zhao · Shu Zhang · Ning Li · Jie-Shou Li ·
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    ABSTRACT: The aim of this study was to report on the feasibility of esophagojejunostomy reconstruction using a robot-sewing technique during a completely robotic total gastrectomy for gastric cancer. Between May 2011 and July 2012, 65 patients in whom gastric adenocarcinoma was diagnosed underwent a completely robotic total gastrectomy, including a robot-sewing esophagojejunal anastomosis. We demonstrated the surgical techniques with analysis of clinicopathologic data and short-term surgical outcomes. All robotic surgeries were successfully performed without conversion. Among the 65 patients, 46 were men and 19 were women. The mean age (± SD) was 57.8 ± 6.5 y. The mean total operative time (± SD), EJ anastomosis time (± SD), and blood loss (± SD) were 245 ± 53 min, 45 ± 26 min, and 75 ± 50 ml, respectively. The mean (± SD) post-operative hospital stay was 5.4 ± 2.5 d. One patient was readmitted for an intestinal obstruction and underwent re-operation 14 d post-operatively; he recovered uneventfully and was discharged 10 d post- operatively. During the follow-up, no patients developed an esophgojejunostomy stricture. A robot-sewing anastomosis for esophagojejunostomy reconstruction during robotic total gastrectomy for gastric cancer is feasible. Indeed, a robot-sewing anastomosis for esophagojejunostomy reconstruction may become a standard surgical technique during completely robotic total gastrectomy for gastric cancer.
    Hepato-gastroenterology 03/2015; 62(138):323-6. DOI:10.5754/hge14694 · 0.93 Impact Factor
  • Bo Zhou · Gang Wang · Shuofei Yang · Xiandi He · Yun Liu ·
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    ABSTRACT: The aim of this systematic review was to determine the effect of amino acid infusions on core body temperature and shivering. We searched the PubMed, EMBASE, CINAHL, and Cochrane Register of Controlled Trials databases to identify randomized controlled trials that met the inclusion criteria. A total of 11 eligible trials involving 506 participants were identified. Amino acid infusions were associated with shorter periods of mechanical ventilation and hospitalization and less perioperative shivering, mechanical intubation, and hospitalization in surgical patients without hepatic, renal, or severe metabolic disorders. It is recommended that infusions are warmed before administration to avoid further decrease in core body temperature. Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
    Journal of PeriAnesthesia Nursing 11/2014; 29(6). DOI:10.1016/j.jopan.2014.04.003 · 0.94 Impact Factor
  • Min Li · Gang Wang · Bo Zhou · Xianfeng Xia · Ning Li ·
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    ABSTRACT: Objective: Long intestinal tube splinting (LITS) is useful for clinically reducing the recurrence of adhesive small bowel obstruction (ASBO). However, a controversy exists whether LITS aggravates intestinal adhesions. This study evaluated the postoperative effects of LITS relative to simple enterolysis on intestinal adhesions in an experimental porcine model. Methods: A porcine model (n = 24) of dense intestinal adhesion was established by abrading the ileal wall with sterile P240 sandpaper. Enterolysis was performed on postoperative day 14. Animals were randomly divided into a group that underwent enterolysis only (control; n = 12) and those who underwent LITS as well as enterolysis (LITS; n = 12). The long intestinal tube was removed on post-LITS day 14, after abdominal radiography. All animals were euthanized on postenterolysis day 28 for assessment of intestinal adhesions using a semiquantitative macroscopic grading scale, hematoxylin-eosin histology, and hydroxyproline assay. Results: Prior to enterolysis, the experimentally induced intestinal adhesions of the two groups were similar in extent and severity. On postenterolysis day 28 the LITS and control groups were comparable with regard to adhesion loop length (p = .440), macroscopic adhesion severity (p = .820), serosal fibrosis grading (p = .450), and hydroxyproline content of the adhesion ileal segment (p = .630). Conclusion: Placement of the long intestinal tube did not aggravate intestinal adhesions over that of simple enterolysis in this intestinal adhesion porcine model.
    Journal of Investigative Surgery 06/2014; 27(3):169-175. DOI:10.3109/08941939.2013.863986 · 1.16 Impact Factor
  • Jiang Liu · Hu Ruan · Kun Zhao · Gang Wang · Min Li · Zhiwei Jiang ·
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    ABSTRACT: Objective: To compare the short-term clinical outcomes of laparoscopic and da Vince robotic radical gastrectomy for gastric cancer and evaluate the safety and efficacy of robotic system. Methods: Clinical data of 200 consecutive gastric cancer patients undergoing radical gastrectomy, including 100 cases of robotic (RRG group) and 100 cases of laparoscopic (LRG group), in our department from January 2012 to May 2013 were retrospectively analyzed. Reconstruction of the alimentary tract was achieved using extracorporeal method through a minilaparotomy in LRG group, and intracorporeal robot-sewn anastomosis in RRG group. Comparative analysis between the two groups for intraoperative factors (conversion, blood loss, operative time, incision length), oncologic outcomes (TMN stage, lymph node dissection, margin) and postoperative parameters (ventilation time, hospital stay, complications, mortality) was performed. Result: There was only 1 conversion in LRG group. As compared to LRG group, RRG group was associated with less blood loss[(60±16) vs. (98±17) ml, P=0.005], longer operative time [(215±46) vs. (188±52) min, P=0.001], shorter incision length [(4.2±1.7) vs. (8.9±2.6) cm, P=0.028], and shorter postoperative hospital stay [(4.5±2.6) vs. (5.7±3.1) d, P=0.018] in RRG group. While there were no significant differences in other aspects between the two groups, such as number of harvested lymph nodes, distance to upper or lower margin of tumor, postoperative bowel function recovery, and postoperative complication morbidity. Conclusion: Robotic radical gastrectomy is feasible and safe for gastric cancer, and has better short-term and oncologic outcomes compared with laparoscopic radical gastrectomy.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2014; 17(5):461-4.
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    ABSTRACT: To evaluate the safety, feasibility, and efficacy of robotic gastrectomy for gastric cancer using da Vinci surgical system. A total of 120 patients who underwent robotic gastrectomy using da Vinci surgical system for gastric cancer from May 2010 to April 2012. Data regarding surgical and early oncological outcomes were systematically collected in a specific database for statistical analysis. There were 74 males and 46 females, with a mean age of 58.5 (22-80) years old. The type of robotic operation included 62 distal subtotal gastrectomies, 35 total gastrectomies, and 23 proximal gastrectomies. Reconstruction of the alimentary tract was achieved using extracorporeal method through a minilaparotomy in 55 cases, and intracorporeal robot-sewn anastomosis in 65 cases. There was 1 conversion (0.9%). The operative time was (245±50) min and the docking time (17±5) min. The blood loss was (70±45) ml. The number of harvested lymph nodes was 22.5±10.7. The resection margins were negative in all surgical specimens. The postoperative pathological stage consisted of stage I B in 24 cases, stage II in 28, stage III A in 47, and stage III B in 21. Six patients (5%) developed postoperative complication including 1 case of duodenal stump leakage, 2 cases of esophagus-gastric leakage, 1 case of small bowel obstruction, 1 case of delayed gastric empting, and 1 case of abdominal bleeding. All the complications were cured by reoperation or conservative therapy, and there were no postoperative 30-day deaths. The postoperative hospital stay was (6.3±2.6) days. Robotic gastrectomy for the treatment of gastric cancer is a feasible and safe procedure, and is advantageous in terms of lymphadenectomy and alimentary tract reconstruction.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 08/2012; 15(8):801-3.
  • Hua-feng Pan · Hu Ruan · Kun Zhao · Gang Wang · Liang Li · Zhi-wei Jiang ·
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    ABSTRACT: To summarize the clinical experience of transanal specimen extraction and introduce how to achieve the rectum reconstruction in robotic rectal cancer surgery. Clinical data of 15 cases undergoing rectal cancer resection with the da Vinci robotic system in Jinglin Hospital between February 2012 and May 2012 were analyzed retrospectively. There were 9 males and 6 females with a mean age of (61.5±9.2) years old. All the cases underwent robotic surgery successfully without intraoperative conversion. The average operative time was (154.7±10.6) min with minimal blood loss (17.3±6.5) ml. The time to first flatus was (2.3±0.8) days postoperatively. The postoperative hospital stay was (3.3±0.6) days. The mean number of lymph node harvested from the surgical specimen was (15.0±1.2). All the resection margins were negative. All the patients had postoperative follow-up ranging from 4 to 8 weeks. There were no postoperative infection, anastomotic leak, incision hernia, or short-term deaths. da Vinci robotic system greatly reduces the difficulty of the rectal cancer surgery with its unique light source system and flexible equipment operation.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 08/2012; 15(8):807-9.
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    ABSTRACT: It has been demonstrated that colon operation combined with fast-track (FT) surgery and laparoscopic technique can shorten the length of hospital stay, accelerate recovery of intestinal function, and reduce the occurrence of post-operative complications. However, there are no reports regarding the combined effects of FT colon operation and laparoscopic technique on humoral inflammatory cellular immunity. This was a prospective, controlled study. One hundred sixty-three colon cancer patients underwent the traditional protocol and open operation (traditional open group, n=42), the traditional protocol and laparoscopic operation (traditional laparoscopic group, n=40), the FT protocol and open operation (FT open group, n=41), or the FT protocol and laparoscopic operation (FT laparoscopic group, n=40). Blood samples were taken prior to operation as well as on days 1, 3, and 5 after operation. The number of lymphocyte subpopulations was determined by flow cytometry, and serum interleukin-6 and C-reactive protein levels were measured. Post-operative hospital stay, post-operative morbidity, readmission rate, and in-hospital mortality were recorded. Compared with open operation, laparoscopic colon operation effectively inhibited the release of post-operative inflammatory factors and yielded good protection via post-operative cell immunity. FT surgery had a better protective role with respect to the post-operative immune system compared with traditional peri-operative care. Inflammatory reactions, based on interleukin-6 and C-reactive protein levels, were less intense following FT laparoscopic operation compared to FT open operation; however, there were no differences in specific immunity (CD3+ and CD4+ counts, and the CD4+/CD8+ ratio) during these two types of surgical procedures. Post-operative hospital stay in patients randomized to the FT laparoscopic group was significantly shorter than in the other three treatment groups (P<0.01). Post-operative complications in patients who underwent FT laparoscopic treatment were less than in the other three treatment groups (P<0.05). There were no significant differences between the four treatment groups regarding readmission rate and in-hospital mortality. The laparoscopic technique and FT surgery rehabilitation program effectively inhibited release of post-operative inflammatory factors with a reduction in peri-operative trauma and stress, which together played a protective role on the post-operative immune system. Combining two treatment measures during colon operation produced better protective effects via the immune system. The beneficial clinical effects support that the better-preserved post-operative immune system may also contribute to the improvement of post-operative results in FT laparoscopic patients.
    Journal of Gastrointestinal Surgery 05/2012; 16(7):1379-88. DOI:10.1007/s11605-012-1880-z · 2.80 Impact Factor
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    ABSTRACT: Background/Aims: Fast track (FT) rehabilitation programmes have demonstrated advantages over traditional perioperative care after open colonic surgery; however, their contribution in recovery after laparoscopic colonic surgery is not clearly defined. This study was conducted to estimate the value of FT rehabilitation programme in laparoscopic colonic resections. Methodology: This is a randomized prospective controlled clinical trial. Ninety-nine consecutive patients underwent elective laparoscopic colonic resection between February 2008 and March 2009. Forty-nine patients received FT multimodal rehabilitation programme as FT group and 50 patients underwent traditional perioperative care as non-FT group. Postoperative hospital stay, return of gastrointestinal function, postoperative complications were recorded. Results: Postoperative hospital stay was shorter in the FT group, a median duration of 4.0 days versus 5.0 days in the non-FT group (p<0.01). Gastrointestinal functional recovery occurred 1 day earlier in FT group (passage of flatus after 2.0 days vs. 3.0 days, p<0.01). There were no significant differences in complications within 30 postoperative days (12% in FT group vs. 20% in non-FT group, p=0.295). Conclusions: When applied after laparoscopic colonic surgery, FT rehabilitation programme is feasible, safe and may lead to accelerated functional recovery and reductions in postoperative hospital stay.
    Hepato-gastroenterology 02/2012; 59(119). DOI:10.5754/hge11957 · 0.93 Impact Factor
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    ABSTRACT: To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer. One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge, while 104 consecutive patients underwent conventional care after resection of colorectal cancer. Their gastrointestinal functions, postoperative complications and hospital stay time were recorded. The restoration time of gastrointestinal functions in the patients was significantly faster after fast-track rehabilitation program than after conventional care (2.1 d vs 3.2 d, P<0.01). The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (13.2% vs 26.9%, P<0.05). Also, the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (6.6% vs 15.4%, P<0.05). The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care (5 d vs 7 d, P<0.01). No significant difference was observed in the re-admission rate 30 d after fast-track rehabilitation program and conventional care (3.8% vs 8.7%). The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.
    World Journal of Gastroenterology 02/2011; 17(5):671-6. DOI:10.3748/wjg.v17.i5.671 · 2.37 Impact Factor
  • Gang Wang · Zhi-wei Jiang · Yang Bao · Li-fei Xie · Jie-shou Li ·
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    ABSTRACT: To investigate the efficacy and safety of fast-track surgery(FTS) in patients with colorectal cancer. One hundred and sixteen patients with colorectal cancer underwent colorectal operation between June 2006 and May 2008. FTS procedures were used in these patients during the study period. Data were retrospectively analyzed pertaining to post-operative hospital stay and operative complications. The median postoperative hospital stay was (5.6+/-5.4)(range 1-54) d. Fourteen patients(12.1%) had postoperative complications, in which the rate of anastomotic leakage and wound infection was 1.7% and 2.6% respectively. 30-day readmission rate was 1.7%, and the 30-day mortality was 0.9%. Fast-track surgery is feasible in an unselected patient population undergoing elective colorectal cancer resection without compromising surgical outcomes.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2010; 13(5):342-5.