Apatinib has been demonstrated to be effective and safe among patients with gastric cancer failing after at least two lines chemotherapy. This study aimed to evaluate its effectiveness and safety of low‐dose apatinib for the treatment of gastric cancer in real‐world practice. We performed a prospective, multicenter observation study in a real‐world setting. Patients with advanced gastric cancer more than 18 years old were eligible and received low‐dose apatinib (500 mg or 250mg per day) therapy. The median progression‐free survival (PFS), median overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety were assessed. Between September 2017 and April 2019, a total of 747 patients were enrolled. The mPFS was 5.56 months (95% CI 4.47‐6.28), and mOS was 7.5 months (95% CI 6.74‐8.88). Four patients achieved complete response, 47 achieved partial response, and 374 patients achieved stable disease. The ORR was 6.83% and DCR was 56.89%. In addition, multivariate Cox regression analysis indicated that hand‐foot syndrome was one independent predictor for PFS and OS. The most common adverse events (AEs) at any grade were hypertension (36.55%), proteinuria (10.26%), hand‐foot syndrome (33.53%), fatigue (24.9%), anemia (57.35%), leukopenia (44.49%), thrombocytopenia (34.21%), and neutropenia (53.33%). Grade 3‐4 AEs with incidences of 5% or greater were anemia (13.97%), thrombocytopenia (7.14%), and neutropenia (6.67%). No treatment‐related death was observed during the treatment of apatinib. The prospective study suggested that low‐dose apatinib was an effective regimen for the treatment of advanced gastric cancer with tolerable or controlled toxicity in real world. Trial registration: NCT03333967.

Background: Activated circulating endothelial cells (aCECs) have been indicated as a potential biomarker for cancerous angiogenesis in varieties of malignancies. Furthermore, several studies have exhibited aCECs were related with progression-free survival (PFS) and overall survival (OS) in anti-angiogenesis therapy. Anlotinib is a TKI of VEGFR1/2/3, FGFR1-4, PDGFR a/b, and c-Kit. As a third-line and above treatment on advanced NSCLC, Anlotinib has shown an affirmatory efficacy in ALTER0303 controlled trial. Herein we investigated the connection between aCECs and PFS, OS and metastases burden in the trial. Method: Blood samples were collected at baseline (pre-therapeutically), the 7th, 15th, 21th, 42nd, 63rd day of Anlotinib or placebo. aCECs was measured by Flow Cytometry. Receiver-operating characteristics (ROC) analysis was used to determine a cutoff value of baseline aCECs counts to divide them into high and low groups. The predicting value of aCECs for PFS was investigated by univariate survival analysis. Chi-square test for baseline aCECs counts and patients' clinical characteristics before Anlotinib or placebo treatment was performed. Result: aCECs were obtained in 78 patients (Anlotinib n¼49). No significant difference in baseline characteristics was found between two arms (P>0.05). High baseline aCECs count was statistically in connection with more metastatic lesions (>3) (c 2 ¼ 4.905,P¼0.027). 49 Anlotinib treated patients were divided into 35 and 14 according to the ratio of minimal aCECs counts at every time point and baseline (aCECs min/baseline), as <1 and 1. Median follow-up was 8.6 months. Patients with min/baseline<1 had longer median PFS than ones with min/baseline>1 (193 vs.124 days, HR¼0.439, 95%CI 0.211-0.912, P¼0.023. shown in Table1). However, no significant relation between PFS and aCECs min/baseline was found in control arm. Conclusion: Decreased aCECs during an initial period of Anlotinib therapy may predict longer PFS and baseline aCECs count may be related with the number of metastatic lesions.

BACKGROUND Retroperitoneal cysts are rare and usually asymptomatic abdominal lesions. Epidermoid cysts are frequent benign cutaneous tumors, but retroperitoneal localization of these cysts does not occur very often. CASE SUMMARY We report a case report of a 25-year-old woman with a giant mass in the abdominal cavity. Because imaging examination indicated that the mass probably originated from the pancreas, the mass was considered a solid pseudopapillary tumor of the pancreas (SPTP). However, surgery revealed a retroperitoneal epidermoid cyst located behind the pancreas neck and the root of the superior mesenteric artery (SMA). We performed complete resection of the tumor. Postoperative pathology showed an epidermoid cyst. The patient fared well after two months of follow-up. CONCLUSION Surgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts. Retroperitoneal epidermoid cysts around the pancreas are easily misdiagnosed as cystic SPTPs. Surgeons should pay particular attention to preoperative diagnosis to reduce severe surgical complications and improve the quality of life of patients.

Surgical resection remains the gold standard treatment for gastric cancer; however, the rate of post-operative complications remains unsatisfactory. Although the majority of complications are treatable, it remains unknown whether the long-term survival of patients is affected and what type of complications affect prognosis. In the present study, the modified Clavien-Dindo classification system was used to examine the incidence of early complications along with the related risk factors following radical gastrectomy (RG) and to determine the effects of such complications on long-term prognosis. For this purpose, 525 gastric cancer patients with RG were analyzed retrospectively. The results revealed that age [odds ratio (OR), 1.781; P=0.013], pre-operative comorbidity (OR, 1.765; P=0.020), blood loss (OR, 2.153; P=0.001) and the type of surgery (OR, 3.137; P<0.001) were identified as independent risk factors associated with post-surgery complications. Blood loss (OR, 13.053; P=0.013) and the resection type (OR, 7.936; P= 0.047) were identified as independent risk factors for severe complications. The 5-year overall survival (OS) rate of patients in the severe complication group was 35%, which was significantly worse than that of patients in the non-severe complication group (61.8%). Severe complications (hazard ratio, 1.595; P=0.107) were not found to be independent risk factors associated with the 5-year OS. On the whole, the present study demonstrates that complications following RG were significantly related to age, pre-operative comorbidity, blood loss and the type of surgery. Severe complications were distinctly affected by blood loss and the resection type. The 5-year OS of patients in the severe complication group was significantly worse than that of patients in the non-severe complication group; however, severe complications were not found to be independent risk factors associated with long-term survival.

Background Intravascular tumor thrombi are mainly found in patients with liver cancer or renal carcinoma but rarely occur in those with rectal cancer. Case presentation This is a case report of a 58-year-old woman with a swollen right lower extremity 14 months after radical resection for rectal cancer. Although ultrasonography indicated the presence of deep venous thrombosis (DVT) located in the right common iliac vein, interventional angiography showed that a circular mass, considered a tumor thrombus, was located in the right common iliac vein. The tumor thrombus was cured by interventional therapy, and the pathological report confirmed that the metastatic tumor thrombus originated from the rectal cancer. The patient underwent concurrent chemoradiotherapy and systemic therapy. However, right lung, retroperitoneum, and 2nd sacral vertebral metastases were discovered during follow-up. Conclusion The correct diagnosis of a tumor thrombus and its differentiation from DVT can prevent incorrect treatment and prolong the survival of patients with rectal cancer.

With the advancement of imaging and pathological diagnostic methods, it is not uncommon to see synchronous gastrointestinal stromal tumors (GIST) and other primary cancers, the most common of which are synchronous gastric cancer and gastric GIST. However, synchronous advanced rectal cancer and high-risk GIST in the terminal ileum are extremely rare, and they are easily misdiagnosed as rectal cancer with pelvic metastases due to their special location near iliac vessels. Herein, we report a 55-year-old Chinese woman with rectal cancer. Preoperative imaging revealed a middle and lower rectal lesion with a right pelvic mass (considered possible metastasis from rectal cancer). Through multidisciplinary discussions, we suspected the possibility of rectal cancer synchronous with a GIST in the terminal ileum. Intraoperative exploration by laparoscopy revealed a terminal ileal mass with pelvic adhesion, a rectal mass with plasma membrane depression, and no abdominal or liver metastases. Laparoscopic radical proctectomy (DIXON) plus partial small bowel resection plus prophylactic loop ileostomy was performed, and the pathological report confirmed the coexistence of advanced rectal cancer and a high-risk ileal GIST. The patient was treated with the chemotherapy (CAPEOX regimen) plus targeted therapy(imatinib) after surgery, and no abnormalities were observed on the follow-up examination. Synchronous rectal cancer and ileal GIST are rare and easily misdiagnosed as a rectal cancer with pelvic metastases, and careful preoperative imaging analysis and prompt laparoscopic exploration are required to determine the diagnosis and prolong patient survival.

Background Microwave ablation (MWA) via ultrasound guidance is an important tool in the treatment of liver metastases. The most common postoperative complications are abdominal hemorrhage and bile leakage, whereas thrombosis in the suprahepatic inferior vena cava (IVC) is very rare, and clinical management is very difficult when the head end of the thrombus reaches the right atrium. Case presentation This is a case report of a 52-year-old man with hepatic metastasis 21 months after radical resection of rectal cancer. After chemotherapy combined with targeted therapy, metastasis in segment IV (S4) of the liver was treated with microwave ablation. Two months after treatment, the hepatic metastasis in S4 showed a microwave ablation zone on MRI.Enhanced MRI showed venous thrombosis located in the left hepatic vein and IVC, and the head of the thrombus reached the right atrium. After two weeks of anticoagulation and thrombolytic treatment, the follow-up MRI showed that the venous thrombus had nearly disappeared. Conclusion When liver metastases are close to the hepatic vein, clinicians should pay attention to the occurrence of hepatic vein and IVC thrombosis following MWA; through early diagnosis and anticoagulation, pulmonary thromboembolism (PTE) can be minimized.

BACKGROUND Common diseases after radical gastrectomy include cholecystitis and pancreatitis, but the sudden onset of acute appendicitis in a short period following radical gastrectomy is very rare, and its clinical symptoms are easily misdiagnosed as duodenal stump leakage. CASE SUMMARY This is a case report of a 77-year-old woman with lower right abdominal pain 14 d after radical resection of gastric cancer. Her pain was not relieved by conservative treatment, and her inflammatory markers were elevated. Computed tomography showed effusion in the perihepatic and hepatorenal spaces, right paracolic sulcus and pelvis, as well as exudative changes in the right iliac fossa. Ultrasound-guided puncture revealed a slightly turbid yellow-green fluid. Laparoscopic exploration showed a swollen appendix with surrounding pus moss and no abnormalities of the digestive anastomosis or stump; thus, laparoscopic appendectomy was performed. The patient recovered well after the operation. Postoperative pathology showed acute purulent appendicitis. The patient continued adjuvant chemotherapy after surgery, completing three cycles of oxaliplatin plus S-1 (SOX regimen). CONCLUSION Acute appendicitis in the short term after radical gastrectomy needs to be differentiated from duodenal stump leakage, and early diagnosis and surgery are the most important means of treatment.