目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念赋能的以案例为基础教学法(casebased learning,CBL)在外科临床实习中的多维实践效果。方法将2023—2024年首都医科大学第四临床学院78名外科临床实习生随机分为试验组(...目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念赋能的以案例为基础教学法(casebased learning,CBL)在外科临床实习中的多维实践效果。方法将2023—2024年首都医科大学第四临床学院78名外科临床实习生随机分为试验组(n=39)和对照组(n=39)。试验组采用ERAS理念融合的多学科CBL教学法,设计涵盖“术前-术中-术后”全流程的标准化案例,结合情景模拟、动态反馈及团队协作;对照组采用传统CBL教学法。通过理论考核、技能操作、团队协作评分及教学满意度调查评价教学效果。结果试验组学生的理论考核成绩(89.4±5.1vs 84.2±6.3)分、技能考核评分(8.7±1.2 vs 7.6±1.4)分及团队协作能力(8.9±1.0 vs 7.3±1.3)分均显著高于对照组(P<0.05);教学满意度总分(17.8±1.5 vs 14.2±2.1)分亦优于对照组(P<0.05)。结论ERAS理念赋能的CBL教学法能够有效提升外科实习生的临床决策能力、操作技能及团队协作水平。展开更多
BACKGROUND Gastric mixed-adenoneuroendocrine carcinoma(G-MANEC)is a subtype of gastric cancer.Building upon prior research findings,we propose that tumours containing both neuroendocrine carcinoma(NEC)and adenocarcino...BACKGROUND Gastric mixed-adenoneuroendocrine carcinoma(G-MANEC)is a subtype of gastric cancer.Building upon prior research findings,we propose that tumours containing both neuroendocrine carcinoma(NEC)and adenocarcinoma(AC)components,with each component ranging from 1%to 99%of the tumour,be classified as a distinct entity.We hereby term this adenoneuroendocrine mixed gastric cancer(G-ANEC).Research on lymph node(LN)involvement in GMANEC has focused mainly on metastasis status,with limited studies on metastatic composition.AIM To investigate the LN metastasis patterns of G-ANEC,the clinicopathological features associated with these metastasis patterns,and to explore adjuvant chemotherapy regimens for G-ANEC.METHODS We analyzed 68 G-ANEC cases treated with radical surgery and confirmed LN metastasis at Peking University Cancer Hospital between August 2012 and June 2022.Utilizingχ2 tests in IBM statistical product and service solutions statistics and R software.RESULTS We identified three distinct LN metastasis patterns in G-ANEC that were significantly associated with the NEC proportion,tumour invasion depth,Lauren classification,and tumour location(P values:0.008,0.015,0.01,and 0.004,respectively).When the SOX/XELOX regimen was applied for adjuvant chemotherapy,patients with LN metastasis comprising only AC exhibited better overall survival(OS)(94.25±11.07 months vs 54.36±11.36 months)than did those with NEC.When LN metastasis components contained NEC,there was a trend towards improved OS(64±10.77 months vs 54.35±11.36 months)and disease-free survival(71.28±9.92 months vs 66.28±11.93 months)in patients treated with the etoposide and cisplatin compared to those receiving the SOX/XELOX regimen.CONCLUSION We found a significant correlation between the NEC percentage,tumour invasion depth,Lauren classification,and tumour location and LN metastasis patterns in G-ANEC.For G-ANEC,a lower proportion of NEC or AC in the primary lesion does not preclude the possibility of these components metastasizing to the LNs.Different adjuvant chemotherapy regimens should be administered on the basis of the varying components of LN metastasis in patients with G-ANEC.展开更多
Objective: This prospective cohort study explored factors related to postoperative pain in gastric cancer patients.Methods: A total of 236 patients who underwent gastrectomy were enrolled. All patients enrolled in the...Objective: This prospective cohort study explored factors related to postoperative pain in gastric cancer patients.Methods: A total of 236 patients who underwent gastrectomy were enrolled. All patients enrolled in the study completed the Hospital Anxiety and Depression Scale(HADS) questionnaire and Life Orientation Test-Revised(LOT-R) questionnaire on the day before surgery. Heat pain threshold(HPT), cold pain threshold(CPT) and pressure pain threshold(PPT) were measured for all patients one day prior to surgery and demographic details were collected. All patients were connected to a patient-controlled intravenous analgesia(PCIA) pump at the end of the surgery. The occurrence of postoperative pain was used as a dependent variable, and multivariate logistic regression analyses were conducted to screen for factors affecting postoperative pain.Results: In total, 83 patients(35.2%) had postoperative pain. Body mass index(BMI) ≥28 kg/m^(2) [odds ratio(OR): 2.67;95% confidence interval(95% CI): 1.07-6.67], total gastrectomy(OR: 2.64;95% CI: 1.42-4.91),preoperative anxiety score ≥8(OR: 2.37;95% CI: 1.12-5.02), heat pain threshold ≤4.9 s(OR: 2.14;95% CI:1.06-4.32), pressure pain threshold ≤4 g(OR: 2.05;95% CI: 1.05-4.03), and female gender(OR: 1.99;95% CI:1.04-3.83) were risk factors for postoperative pain.Conclusions: Obesity, wide range of gastrectomy, high preoperative anxiety, low HPT and PPT, and female gender are associated with increased risk for postoperative pain.展开更多
Objective:To explore the intraperitoneal free cancer cell(IFCC)detection value of negative enrichment and immune fluorescence in situ hybridization(NEimFISH)on chromosomes(CEN)8/17.Methods:To verify the reliability of...Objective:To explore the intraperitoneal free cancer cell(IFCC)detection value of negative enrichment and immune fluorescence in situ hybridization(NEimFISH)on chromosomes(CEN)8/17.Methods:To verify the reliability of NEimFISH,29 gastric cancer tumors,their adjacent tissues and greater omental tissues were tested.Our study then included 105 gastric cancer patients for IFCC.We defined patients as IFCC-positive if a signal was detected,regardless of the detailed cancer cell numbers.A comparison of clinicopathological features was conducted among IFCC groups.We also compared the diagnosis value and peritoneal recurrence predictive value among different detection methods.The comparison of IFCC number was also conducted among different groups.Results:A cutoff of 2.5 positive cells could distinguish all benign tissue samples and 97%of malignant tissue samples in our study.Compared to intestinal gastric cancer,patients with diffuse gastric cancer tended to have more IFCCs(6 vs.4,P=0.002).The IFCC counts were often higher in the lymphovascular invasion positive group than negative group(3 vs.1,P=0.022).All IFCC samples that were considered positive using conventional cytology were also found to be positive using NEimFISH.When compared to conventional cytology and paraffin pathology,NEimFISH had a higher IFCC positive rate(68.9%)and higher one-year peritoneal recurrence predictive value with area under the curve(AUC)of 0.922.Conclusions:Gastric cancer could be effectively diagnosed by NEimFISH.The IFCC number found using NEimFISH on CEN8/17 is closely associated with Lauren type and vascular invasion of cancer.NEimFISH is a reliable detection modality with a higher positive detection rate,higher one-year peritoneal recurrence predictive value and quantitative features for IFCC of gastric cancer.展开更多
The concept and strategy of advanced gastric cancer treatment have gradually undergone profound changes with the in-depth understanding of the biology and heterogeneous characteristics of gastric cancer.Moreover,the d...The concept and strategy of advanced gastric cancer treatment have gradually undergone profound changes with the in-depth understanding of the biology and heterogeneous characteristics of gastric cancer.Moreover,the development and application of new anticancer drugs,including chemotherapy drugs,molecularly targeted drugs and immunotherapy drugs for advanced gastric cancer are reported.The connotation of conversion therapy refers to the unresectable or borderline resectable tumors for surgical technical and/or oncological reasons,after active and effective chemotherapy and other comprehensive treatment,the primary gastric lesions can be reduced to a lower stage,while the metastatic lesions can be effectively controlled,to achieve R0 resection and improve the long-term survival rate.Current promising research results of conversion therapy are mostly from single-arm phase II clinical studies with small samples or retrospective studies.Conversion therapy still faces many challenges,including limited diagnostic and assessment methods,insufficient evidence of highly effective treatment regimens,difficulty in clarifying surgical indications,etc.Therefore,the integrated conversion therapy for advanced gastric cancer needs to be carried out with the close cooperation of a multidisciplinary team.Prospective,multi-center randomized controlled trial studies should be conducted in the future,and precision medicine such as molecular biology should be combined to provide better anticancer drug regimens and higher-level clinical evidence for conversion therapy of advanced gastric cancer.展开更多
Objective:The aim of this study was to prospectively compare double-tract reconstruction(DTR)and esophagogastrostomy(EG)after proximal gastrectomy(PG)regarding the incidence of reflux esophagitis,quality of life(QOL),...Objective:The aim of this study was to prospectively compare double-tract reconstruction(DTR)and esophagogastrostomy(EG)after proximal gastrectomy(PG)regarding the incidence of reflux esophagitis,quality of life(QOL),nutritional status and surgical safety.Methods:This study was a randomized controlled trial.Patients eligible for PG were enrolled and randomly assigned to the EG group and DTR group.The characteristics of patients,parameters for surgical safety,incidence of reflux esophagitis,nutrition status and QOL were collected and compared between the two groups.Univariate analysis and multivariate analysis were performed to determine the significant factors affecting the incidence of reflux esophagitis after PG.Results:Thirty-seven patients of the EG group and 36 patients of the DTR group were enrolled.The incidence of reflux esophagitis was significantly lower in the DTR group than in the EG group(8.3%vs.32.4%,P=0.019).The DTR group demonstrated a more favorable QOL than the EG group after PG.The nutritional status was balanced within the EG group and the DTR group.The operation time was longer in the DTR group than in the EG group(191 min vs.221 min,P=0.001),while surgical safety was similar in the two groups.Conclusions:Our research demonstrated that DTR is superior to EG after PG in terms of the incidence of reflux esophagitis and provides a more satisfactory QOL without increasing surgical complications or sacrificing nutritional status.展开更多
Objective:To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer(EGC).Methods:The clinicopathological data of 561 patients ...Objective:To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer(EGC).Methods:The clinicopathological data of 561 patients with EGC who underwent radical gastrectomy for gastric cancer at Peking University Cancer Hospital from November 2010 to November 2020 with postoperative pathological stage pT1 and complete examination data,were collected.Pearson’s Chi-square test was used and binary logistic regression was employed for univariate and multivariate analyses.Combined analysis of multiple risk and protective factors for lymph node metastasis(LNM)of EGC was performed.A negative predictive value(NPV)combination model was built and validated.Results:LNM occurred in 85 of 561 patients with EGC,and the LNM rate was 15.15%.NPV for LNM reached 100%based on three characteristics,including ulcer-free,moderately well differentiation and patient<65years old or tumor located at the proximal 1/3 of the stomach.Regarding lymphatic basin metastasis,multivariate analysis showed that the metastatic proportion of the left gastric artery lymphatic basin was significantly higher in male patients compared with female patients(65.96%vs.38.89%,P<0.05).The proportion of right gastroepiploic artery lymphatic basin metastasis in patients with a maximum tumor diameter>2 cm was significantly greater than that noted in patients with a maximum tumor diameter≤2 cm(60.78%vs.28.13%,P<0.05).Conclusions:Characteristics of lymph node stations/basins metastasis will facilitate precise lymph node resection.The NPV for LNM reaches 100%based on the following two conditions:young and middle-aged EGC patients,well-differentiated tumors,and without ulcers;or well-differentiated tumors,without ulcers,and tumors located in the proximal stomach.These findings can be used as the recommended indications for functionpreserving curative gastrectomy and sentinel lymph node navigation surgery.展开更多
文摘目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念赋能的以案例为基础教学法(casebased learning,CBL)在外科临床实习中的多维实践效果。方法将2023—2024年首都医科大学第四临床学院78名外科临床实习生随机分为试验组(n=39)和对照组(n=39)。试验组采用ERAS理念融合的多学科CBL教学法,设计涵盖“术前-术中-术后”全流程的标准化案例,结合情景模拟、动态反馈及团队协作;对照组采用传统CBL教学法。通过理论考核、技能操作、团队协作评分及教学满意度调查评价教学效果。结果试验组学生的理论考核成绩(89.4±5.1vs 84.2±6.3)分、技能考核评分(8.7±1.2 vs 7.6±1.4)分及团队协作能力(8.9±1.0 vs 7.3±1.3)分均显著高于对照组(P<0.05);教学满意度总分(17.8±1.5 vs 14.2±2.1)分亦优于对照组(P<0.05)。结论ERAS理念赋能的CBL教学法能够有效提升外科实习生的临床决策能力、操作技能及团队协作水平。
基金Supported by the National Key Research and Development Program of China,No.2023YFF1204702the National Natural Science Foundation of China,No.82173151+2 种基金Capital’s Funds for Health Improvement and Research,No.CFH 2022-4-1025Beijing Hospitals Authority Clinical Medicine Development of Special Funding,No.XMLX202119Science Foundation of Peking University Cancer Hospital,No.PY202329.
文摘BACKGROUND Gastric mixed-adenoneuroendocrine carcinoma(G-MANEC)is a subtype of gastric cancer.Building upon prior research findings,we propose that tumours containing both neuroendocrine carcinoma(NEC)and adenocarcinoma(AC)components,with each component ranging from 1%to 99%of the tumour,be classified as a distinct entity.We hereby term this adenoneuroendocrine mixed gastric cancer(G-ANEC).Research on lymph node(LN)involvement in GMANEC has focused mainly on metastasis status,with limited studies on metastatic composition.AIM To investigate the LN metastasis patterns of G-ANEC,the clinicopathological features associated with these metastasis patterns,and to explore adjuvant chemotherapy regimens for G-ANEC.METHODS We analyzed 68 G-ANEC cases treated with radical surgery and confirmed LN metastasis at Peking University Cancer Hospital between August 2012 and June 2022.Utilizingχ2 tests in IBM statistical product and service solutions statistics and R software.RESULTS We identified three distinct LN metastasis patterns in G-ANEC that were significantly associated with the NEC proportion,tumour invasion depth,Lauren classification,and tumour location(P values:0.008,0.015,0.01,and 0.004,respectively).When the SOX/XELOX regimen was applied for adjuvant chemotherapy,patients with LN metastasis comprising only AC exhibited better overall survival(OS)(94.25±11.07 months vs 54.36±11.36 months)than did those with NEC.When LN metastasis components contained NEC,there was a trend towards improved OS(64±10.77 months vs 54.35±11.36 months)and disease-free survival(71.28±9.92 months vs 66.28±11.93 months)in patients treated with the etoposide and cisplatin compared to those receiving the SOX/XELOX regimen.CONCLUSION We found a significant correlation between the NEC percentage,tumour invasion depth,Lauren classification,and tumour location and LN metastasis patterns in G-ANEC.For G-ANEC,a lower proportion of NEC or AC in the primary lesion does not preclude the possibility of these components metastasizing to the LNs.Different adjuvant chemotherapy regimens should be administered on the basis of the varying components of LN metastasis in patients with G-ANEC.
基金supported by Peking University Medicine Seed Fund for Interdisciplinary Research (No. BMU 2020MX028)Braun Anesthesia science research fund (No. BBFD-2011-006)。
文摘Objective: This prospective cohort study explored factors related to postoperative pain in gastric cancer patients.Methods: A total of 236 patients who underwent gastrectomy were enrolled. All patients enrolled in the study completed the Hospital Anxiety and Depression Scale(HADS) questionnaire and Life Orientation Test-Revised(LOT-R) questionnaire on the day before surgery. Heat pain threshold(HPT), cold pain threshold(CPT) and pressure pain threshold(PPT) were measured for all patients one day prior to surgery and demographic details were collected. All patients were connected to a patient-controlled intravenous analgesia(PCIA) pump at the end of the surgery. The occurrence of postoperative pain was used as a dependent variable, and multivariate logistic regression analyses were conducted to screen for factors affecting postoperative pain.Results: In total, 83 patients(35.2%) had postoperative pain. Body mass index(BMI) ≥28 kg/m^(2) [odds ratio(OR): 2.67;95% confidence interval(95% CI): 1.07-6.67], total gastrectomy(OR: 2.64;95% CI: 1.42-4.91),preoperative anxiety score ≥8(OR: 2.37;95% CI: 1.12-5.02), heat pain threshold ≤4.9 s(OR: 2.14;95% CI:1.06-4.32), pressure pain threshold ≤4 g(OR: 2.05;95% CI: 1.05-4.03), and female gender(OR: 1.99;95% CI:1.04-3.83) were risk factors for postoperative pain.Conclusions: Obesity, wide range of gastrectomy, high preoperative anxiety, low HPT and PPT, and female gender are associated with increased risk for postoperative pain.
基金supported by the National Science Foundation for Young Scientists of China (No. 81802735)
文摘Objective:To explore the intraperitoneal free cancer cell(IFCC)detection value of negative enrichment and immune fluorescence in situ hybridization(NEimFISH)on chromosomes(CEN)8/17.Methods:To verify the reliability of NEimFISH,29 gastric cancer tumors,their adjacent tissues and greater omental tissues were tested.Our study then included 105 gastric cancer patients for IFCC.We defined patients as IFCC-positive if a signal was detected,regardless of the detailed cancer cell numbers.A comparison of clinicopathological features was conducted among IFCC groups.We also compared the diagnosis value and peritoneal recurrence predictive value among different detection methods.The comparison of IFCC number was also conducted among different groups.Results:A cutoff of 2.5 positive cells could distinguish all benign tissue samples and 97%of malignant tissue samples in our study.Compared to intestinal gastric cancer,patients with diffuse gastric cancer tended to have more IFCCs(6 vs.4,P=0.002).The IFCC counts were often higher in the lymphovascular invasion positive group than negative group(3 vs.1,P=0.022).All IFCC samples that were considered positive using conventional cytology were also found to be positive using NEimFISH.When compared to conventional cytology and paraffin pathology,NEimFISH had a higher IFCC positive rate(68.9%)and higher one-year peritoneal recurrence predictive value with area under the curve(AUC)of 0.922.Conclusions:Gastric cancer could be effectively diagnosed by NEimFISH.The IFCC number found using NEimFISH on CEN8/17 is closely associated with Lauren type and vascular invasion of cancer.NEimFISH is a reliable detection modality with a higher positive detection rate,higher one-year peritoneal recurrence predictive value and quantitative features for IFCC of gastric cancer.
文摘The concept and strategy of advanced gastric cancer treatment have gradually undergone profound changes with the in-depth understanding of the biology and heterogeneous characteristics of gastric cancer.Moreover,the development and application of new anticancer drugs,including chemotherapy drugs,molecularly targeted drugs and immunotherapy drugs for advanced gastric cancer are reported.The connotation of conversion therapy refers to the unresectable or borderline resectable tumors for surgical technical and/or oncological reasons,after active and effective chemotherapy and other comprehensive treatment,the primary gastric lesions can be reduced to a lower stage,while the metastatic lesions can be effectively controlled,to achieve R0 resection and improve the long-term survival rate.Current promising research results of conversion therapy are mostly from single-arm phase II clinical studies with small samples or retrospective studies.Conversion therapy still faces many challenges,including limited diagnostic and assessment methods,insufficient evidence of highly effective treatment regimens,difficulty in clarifying surgical indications,etc.Therefore,the integrated conversion therapy for advanced gastric cancer needs to be carried out with the close cooperation of a multidisciplinary team.Prospective,multi-center randomized controlled trial studies should be conducted in the future,and precision medicine such as molecular biology should be combined to provide better anticancer drug regimens and higher-level clinical evidence for conversion therapy of advanced gastric cancer.
基金supported by the Beijing Municipal Administration of Hospitals Incubating Program(No.PX2019039)。
文摘Objective:The aim of this study was to prospectively compare double-tract reconstruction(DTR)and esophagogastrostomy(EG)after proximal gastrectomy(PG)regarding the incidence of reflux esophagitis,quality of life(QOL),nutritional status and surgical safety.Methods:This study was a randomized controlled trial.Patients eligible for PG were enrolled and randomly assigned to the EG group and DTR group.The characteristics of patients,parameters for surgical safety,incidence of reflux esophagitis,nutrition status and QOL were collected and compared between the two groups.Univariate analysis and multivariate analysis were performed to determine the significant factors affecting the incidence of reflux esophagitis after PG.Results:Thirty-seven patients of the EG group and 36 patients of the DTR group were enrolled.The incidence of reflux esophagitis was significantly lower in the DTR group than in the EG group(8.3%vs.32.4%,P=0.019).The DTR group demonstrated a more favorable QOL than the EG group after PG.The nutritional status was balanced within the EG group and the DTR group.The operation time was longer in the DTR group than in the EG group(191 min vs.221 min,P=0.001),while surgical safety was similar in the two groups.Conclusions:Our research demonstrated that DTR is superior to EG after PG in terms of the incidence of reflux esophagitis and provides a more satisfactory QOL without increasing surgical complications or sacrificing nutritional status.
基金Beijing Hospitals Authority Clinical Medicine Development of Special Funding(No.XMLX202119)Open Project funded by Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education/Beijing(No.2022 Open Project-6)。
文摘Objective:To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer(EGC).Methods:The clinicopathological data of 561 patients with EGC who underwent radical gastrectomy for gastric cancer at Peking University Cancer Hospital from November 2010 to November 2020 with postoperative pathological stage pT1 and complete examination data,were collected.Pearson’s Chi-square test was used and binary logistic regression was employed for univariate and multivariate analyses.Combined analysis of multiple risk and protective factors for lymph node metastasis(LNM)of EGC was performed.A negative predictive value(NPV)combination model was built and validated.Results:LNM occurred in 85 of 561 patients with EGC,and the LNM rate was 15.15%.NPV for LNM reached 100%based on three characteristics,including ulcer-free,moderately well differentiation and patient<65years old or tumor located at the proximal 1/3 of the stomach.Regarding lymphatic basin metastasis,multivariate analysis showed that the metastatic proportion of the left gastric artery lymphatic basin was significantly higher in male patients compared with female patients(65.96%vs.38.89%,P<0.05).The proportion of right gastroepiploic artery lymphatic basin metastasis in patients with a maximum tumor diameter>2 cm was significantly greater than that noted in patients with a maximum tumor diameter≤2 cm(60.78%vs.28.13%,P<0.05).Conclusions:Characteristics of lymph node stations/basins metastasis will facilitate precise lymph node resection.The NPV for LNM reaches 100%based on the following two conditions:young and middle-aged EGC patients,well-differentiated tumors,and without ulcers;or well-differentiated tumors,without ulcers,and tumors located in the proximal stomach.These findings can be used as the recommended indications for functionpreserving curative gastrectomy and sentinel lymph node navigation surgery.
