Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computed tomography (MSCT) with serum amyloid A protein (SAA) or C-reactive protein (CRP) on the selection of operative procedures of rectal cancer under the multi-disciplinary team. Methods Prospectively enrolled patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to August 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+CRP group, both MSCT and CRP combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results All 165 patients were randomly assigned into MSCT+SAA group (n=83) and MSCT+CRP group (n=82). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 74.7%， 68.7%, 100% and 66.3%, respectively. For MSCT+CRP group, the accuracies of preoperative staging T, N, M and TNM were 72.0%, 86.6%, 100% and 81.7%, respectively. There were statistically significant differences in the accuracies of N staging and TNM staging between two groups (P＜0.05). However, there was no statistically significant difference of the accuracy of prediction to operative procedures between two groups (90.4% vs. 95.1%, Pgt;0.05). The pathological T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), preoperative serum level of SAA (P=0.010), serum level of CRP (P=0.042), and distance of tumor to the dentate line (P=0.011) were associated with the operative procedures. Conclusion Combinative assessment of MSCT+CRP could improve the accuracy of preoperative staging and operative procedures prediction, which may be superior to MSCT+SAA.
Objective To discuss the influence of combination of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) for preoperative assessment on colon cancer surgery strategy. Methods Ｔhe examination data of 110 patients diagnosed definitely as colon cancer in the West China Hospital of Sichuan University from Nov. 2007 to Nov. 2008 were studied prospectively, and randomly assigned into the MSCT+SAA group and MSCT group, respectively. Both MSCT and SAA combinative assessment were made for preoperative evaluation in MSCT+SAA group, while only MSCT was made preoperatively in MSCT group. Furthermore, the preoperative staging and prediction of operative procedures were compared with postoperative pathologic staging and practical of operative procedures, respectively. Results According to the inclusion criteria, 99 colon cancer patients were actually included into MSCT+SAA group (n=49) and MSCT group (n=50). The baseline characteristics of two groups were statistically identical. For MSCT+SAA group, The accuracies of preoperative staging T, N, M and TNM were 81.6%, 79.6%, 100% and 77.6%, respectively. For MSCT group, the corresponding rates were 82.0%, 60.0%, 98.0% and 62.0%, respectively. The difference of accuracies on staging N between two groups was observed statistically (χ2=4.498, P=0.034). There was also a statistically significant difference of the accuracy of prediction of operative procedures in MSCT+SAA group and MSCT group (95.9% vs. 82.0%, χ2=4.854, P=0.028). The preoperative staging N (P=0.008), M (P=0.010), TNM (P=0.009) and level of SAA (P=0.004) were related to the selection of operative procedures when analyzed the relationship between the operative procedures and multiple clinicopathologic factors in colon cancer. Conclusion The strategy of the combinative assessment of MSCT and SAA could advance the accuracy of preoperative staging, thus serve surgeon the more accurate prediction to surgery strategy in colon cancer.
Six-minute walk test (6MWT) is one of the cardiopulmonary exercise testing (CPET). It is not only used to assess the cardiac and pulmonary function of patients with chronic obstructive pulmonary disease (COPD), but also used to assess COPD patients’ health-related quality of life (HRQoL) or self-management in daily life. With the concept of enhanced recovery after surgery (ERAS) put forward, assessing patients’ preoperative cardiac and pulmonary function, establishing preoperative and early postoperative exercises standards, as well as assessing cardiac and pulmonary rehabilitation after surgery become much more important. CPET gets more attention from clinical surgeons. This study focuses on the clinical value and status of 6MWT in thoracic surgery.
A 55-year-old male patient was admitted to the hospital due to "recurrent chest pain for 8 months, with worsening symptoms for 2 weeks". After admission, comprehensive relevant examinations led to the consideration of a giant chronic left ventricular pseudoaneurysm caused by myocardial infarction with non-obstructive coronary arteries. Surgical treatment was performed at our hospital. We discuss the diagnosis and treatment of this patient.
Objective To determine the relationship between preoperative prognostic inflammatory and nutritional index (PINI) value and short-term prognosis in colorectal cancer. Methods Patients with colorectal cancer verified by pathologically examine were prospectively enrolled from April 2009 to June 2009. Serum alpha-1-acid glycoprotein, C-reactive protein, albumin and prealbumin were examined on day 3 before operation, and the value of preoperative PINI was calculated. The relationships between preoperative PINI and patho-TNM stage, complications, quality of life, and recurrence and metastasis after operation were analyzed. Results Total 38 patients with colorectal cancer underwent radical surgery were enrolled. Preoperative PINI value was 2.17±1.27. Preoperative PINI value was correlated with TMN stage and M stage: PINI value in patients of Ⅳ stage or M1 stage, were significantly higher than those in ones of Ⅰ, Ⅱ and Ⅲ stage （P＜0.001） or M0 stage （P＜0.001）. There was no significant correlation between preoperative PINI value and preoperative complications （Pgt;0.05）. Preoperative PINI value was correlated with postoperative diet, anorexia and overall quality of life: preoperative PINI value in patients with abnormal diet, anorexia or poor quality of life, were significantly higher than those in ones with normal diet (P=0.020), no-anorexia (P=0.020) or moderate (P=0.025) and well (P=0.020) quality of life. Conclusion Preoperative PINI value is an effective index to assess the short-term prognosis of colorectal cancer.
Preoperative evaluation is crucial for heart valvular surgery. This article discusses some issues that need to be emphasized: the impact of hypertension on the severity of aortic valve lesions, and how to improve the accuracy of clinical assessment; the identification of functional tricuspid regurgitation, in order to choose the appropriate surgical technique; the need for right ventricular function testing, and the use of risk scoring models, to better grasp surgical timing and indications and improve efficacy; and the importance of evaluating atrial mitral and/or tricuspid regurgitation complications in chronic atrial fibrillation, and making rational choices for interventional and surgical treatment.
ObjectiveBased on the current version of Database from Colorectal Cancer (DACCA), we aimed to analyze the preoperative specialized examination and evaluation of colorectal cancer.MethodsThe DACCA version selected for this data analysis was updated on July 25, 2019. The data items included: combined preoperative stage, integrating degree of combined preoperative stage, preoperative diagnostic intensity, accuracy of colonoscopy, tumorous type by biopsy, tumor differentiation by biopsy, completion of chest CT, CT stage, accuracy of CT stage, outcome of transrectal ultrasound, outcome of liver ultrasound, MRI stage, accuracy of MRI stage, outcome of PET-CT, outcome of bone scanning, diagnostic way at first visit, misdiagnosis and mistreatment. Characteristic analysis was performed on each selected data item.ResultsA total of 4 484 admitted data were filtered from the DACCA database. The effective data of accuracy of preoperative CT examination, evaluation of preoperative CT staging, preoperative MRI accuracy, preoperative MRI evaluation stage, the accuracy of preoperative transrectal ultrasound, preoperative liver ultrasound accuracy, the accuracy of preoperative bone scan, preoperative PET-CT accuracy, completion of colonoscopy, preoperative colonoscopy biopsy pathology type, strength of diagnosis, integrating degree of total preoperative staging, preoperative staging and pathological staging, factors of the first diagnosis, misdiagnosis and mistreatment were 3 877 (86.5%), 3 166 (70.6%), 3 480 (77.6%), 286 (6.4%), 3 607 (80.4%), 2 736 (61.0%), 3 570 (79.6%), 3 490 (77.8%), 3 847 (85.8%), 3 636 (81.1%), 3 981 (88.8%), 2 346 (52.3%), 2 209 (49.3%), 3 466 (77.3%), and 3 411 (76.1%), respectively. Among the preoperative CT stages, phase Ⅳ had the highest accuracy (86.6%), phase Ⅰ had the highest rate of underestimation (30.4%), and phase Ⅲ had the highest rate of overestimation (21.8%). Preoperative CT accuracy, excluding errors caused by too few data rows, was 66.8%–83.7% in other years. Among the preoperative MRI stages, stage Ⅳ showed the highest accuracy (89.1%), stage Ⅰ showed the highest rate of underestimation (33.3%), and stage Ⅲ showed the highest rate of overestimation (13.3%). Preoperative MRI evaluation accuracy gradually increased from 2016 to 2019. The accuracy of transrectal ultrasound, liver ultrasound, bone scan, and PET-CT were 287 (76.7%), 145 (99.3%), 301 (98.7%), and 15 (93.8%), respectively. The most pathological type under colonoscopy was adenocarcinoma, accounting for 82.2%. The lowest was stromal tumor and lymphoma, each below 0.1%. The diagnostic efficiency were 3 445 (86.5%) with grade A, 316 (7.9%) with grade B, and 220 (5.5%) with grade C. In the preoperative total staging, 109 data rows (4.9%) were appeared as stage Ⅰ, 615 (27.5%) as stage Ⅱ, 1 263 (56.6%) as stage Ⅲ, and 245 (11.0%) as stage Ⅳ. The preoperative total staging integrating degree in stage Ⅳ was the highest (98.7%), while the underestimate rate in stage Ⅱ was the highest (28.3%), and the overestimate rate in stage Ⅲ was the highest (20.6%). From 2008 to 2019, the integrating degree between preoperative comprehensive staging and final pathology staging ranged from 70.8% to 87.7%. Among the factors of the first diagnosis, digital examination was found the frequently (64.0%), followed by symptoms such as bleeding and obstruction (28.2%). Considering family history, the proportion of patients with colorectal cancer was the least (less than 0.1%). There were 442 cases (13.0%) of misdiagnosis and mistreatment behaviors, among which 207 cases (46.8%) were misdiagnosed as hemorrhoids.ConclusionsTo significantly improve the long-term survival rate of colorectal cancer patients requires preoperative imaging diagnosis efficiency and multi-factor evaluation staging to break through the limitation of development, so as to optimize the choice of treatment plan, increasing the prevalence of early screening for colorectal cancer, and reducing the rate of misdiagnosis and mistreatment at the first visit of colorectal cancer.
ObjectiveTo evaluate the feasibility and accuracy of a novel three dimensional (3D) preoperative simulation software in a clinical setting for patients undergoing precise hepatectomy. MethodsThe clinical data of 85 patients with hepatocellular carcinoma underwent precise hepatectomy were retrospectively studied. All the patients received CT screening and subsequent evaluation on the liver resection volume and margin and the percentage of resected tumor by 3D preoperative simulation software, which compared with the actual resection liver values. The operation plan was optimized by virtual hepatectomy. ResultsThe liver, tumor as well as blood vessel could be clearly showed and reconstructed by 3D preoperative simulation software. All the patients underwent precise hepatectomy. After operation ascites occurred in 3 patients on 2 d, moderate pleural effusion occurred in 2 patients on 2 d, and bile leakage appeared in 4 patients on 5 d, which were improved by conservative treatment. The length of stay in all patients ranged from 6 to 88 d (mean 23 d), and no recurrence and death occurred within 30 d of operation. The predicted resection liver volume was significantly correlated with the actual resection volume (r=0.960, Plt;0.001), and the difference between the mean volume of predicted and actual resection liver was not significant (896.7 ml vs. 819.1 ml， t=1.851, P=0.068). In addition, the predicted resection margin was also correlated with the actual resection margin (r=0.972, Plt;0.001), with the difference in the mean resection margin was not significant too (12.2 mm vs. 11.9 mm， t=1.143, P=0.256). No patients suffered from severe postoperative complications. ConclusionsThe 3D preoperative simulation software is able to evaluate and simulate liver resection accurately, which may contribute to a safe precise hepatectomy plan.