Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
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Zhonghua Wei Chang Wai Ke Za Zhi · Nov 2020
Randomized Controlled Trial[Effect of open-lung ventilation strategy on oxygenation-impairment during laparoscopic colorectal cancer resection].
Objective: After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection. ⋯ During ventilation, the patients in the OLS group had higher PaO(2)/FiO(2) [T(1): (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T(2): (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q(S)/Q(T) [ T(1): (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T(2): (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T(0): (6±3) cm H(2)O vs. (10±2) cm H(2)O, t=7.421, P<0.001; T(2): (13±3) cm H(2)O vs. (17±4) cm H(2)O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO(2)/FiO(2) [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q(S)/Q(T) [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion: The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.
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Zhonghua Wei Chang Wai Ke Za Zhi · Nov 2020
[Establishment and validation of a predictive nomogram model for advanced gastric cancer with perineural invasion].
Objective: Peripheral nerve invasion (PNI) is associated with local recurrence and poor prognosis in patients with advanced gastric cancer. A risk-assessment model based on preoperative indicators for predicting PNI of gastric cancer may help to formulate a more reasonable and accurate individualized diagnosis and treatment plan. Methods: Inclusion criteria: (1) electronic gastroscopy and enhanced CT examination of the upper abdomen were performed before surgery; (2) radical gastric cancer surgery (D2 lymph node dissection, R0 resection) was performed; (3) no distant metastasis was confirmed before and during operation; (4) postoperative pathology showed an advanced gastric cancer (T2-4aN0-3M0), and the clinical data was complete. ⋯ External verification showed a C-index of 0.828 from the model. The calibration curve showed that the predictive results were good in accordance with the actual results (P=0.415). Conclusion: A nomogram model constructed by CEA, tumor length, Lauren classification (mixed, diffuse), cT stage, and lymph node metastasis can predict the PNI of advanced gastric cancer before surgery.