Abstract:

Objective:To study the necessity and feasibility of periportal lymph node (No12p lymph node) clearance, and the relationship between No12p LN metastasis and clinicopathologic factors in advanced gastric cancer.
Methods: The clinical data of 51 patients with advanced gastric cancer were retrospective analyzed. The patients were divided into two groups: No12p LN clearance group and control group. In the clearance group, 30 cases underwent D2 or selective D3 operation with additional No12p LN dissection. The relationship between No12p LN metastasis and clinicopathologic factors was analyzed. The 21 cases in the control group underwent D2 or selective D3 operation without No12p LN dissection. The operation time, bleeding volume, the incidence of postoperative complications and average hospital stay time after operation, between the two groups were compared.
Results:In clearance group, a total of 552 lymph nodes, with an average of 18.4 per case, were removed, and, of them, 112 lymph nodes (21.24%) were found to be metastasis positive. Four of 30 patients (13.33%) had No12p LN metastasis. Metastasis rate of No12p LN was 16.67% in Borrmann types Ⅲ-Ⅳ, 25% in N2-3, 16.67% in T3-4, and 33.33% in cases of  tumor mass >4 cm, respectively. The positive No12p LN metastasis rate found in patients with Borrmann types Ⅲ-Ⅳ, N2-3, T3-4 and with tumor mass >4 cm was significantly higher than that in Borrmann typesⅠ-Ⅱ(0%), N0-1 (0%), T1-2 (0%) and tumor mass <4 cm (0%), respectively (P<0.05). The No12p LN metastasis was correlated with No5 lymph node metastasis, but had no evident correlation with histological type of cancer, or tumor located in body or occupied more than 1/3 area of the stomach. There were no significant differences between the two groups in operation bleeding volume and hospital stay time (P﹥0.05), but the operation time of the No12p LN clearance group was longer than that of the control group (P<0.05). The incidence of postoperative complications was 2 cases (6.67%) in No12p LN clearance group and 3 cases (14.29%) in control group. No serious complications or death attributed to surgery were found in any of the groups.
Conclusions:No12p LN clearance is feasible for advanced gastric cancer. The long-term clinical effects of No12p LN clearance on advanced gastric cancer remain to be identified by prospective and large sample studies.

Abstract:Objective:To evaluate the efficacy of pylorus-preserving gastrectomy(PPG) in the treatment of early gastric cancer (EGC). Methods:We reviewed the clinical data of 22 consecutive patients with EGC who received PPG treatment in our department from September 2007 to October 2009. Twenty two cases were all the early stage of gastric cancer, with 16 lesions located in the middle and the other 6 in the lower third of the stomach, all lesions were more than 5 cm above the pylorus, and all of which were applicable to PPG treatment. Results:There were no patients with postprandial symptoms during their postoperative stay in hospital, but twenty of them had hunger feeling (90.91%). During the follow-up study, two patients suffered postprandial symptoms, one of whom had upper abdominal distention and pain, and the other vomited. Eighteen patients had hunger feeling (81.82%). Conclusions:This study indicated PPG procedure is a good technique in the treatment of EGC of the middle portion of the stomach.It has ideal radical effect as well as satisfactory functional preservation of pylorus, which can be of benefit to patients′ rehabilitation.

Abstract:Objective:To investigate the regular patterns of postoperative recurrence of gastric cancer and evaluate the indicators of long-term prognosis. Methods:A total of 447 patients who underwent gastric cancer operation over a period of 25 years and had recurrece were divided into 2 groups: <2 years and 2-5 years, in accordance with the interval time of recurrence after the primary surgery . Survival rate was calculated by the Kaplan-Meier method and multivariate analysis was recorded by Cox. Model. Results:The postoperative recurrence rate of gastric cancer was 29.3% (447/1526), of which the 2 year recurrence was 69.8% (312/447), and 2-5 years recurrence accounted for 30.2% (135/447). Single-factor analysis showed that cumulative survival was significantly affected by tumor location, gross tumor type, pathological type, tumor stage, type of surgery, as well as the location (local or distant) of recurrence. Multi-factor analysis showed that tumor stage and gross characteristics of cancer were the independent factors of cumulative survival rate. Disease-free survival and disease-free progression-free survival were positively related to the survival period of patients. Conclusions:Patients with gastric cancer should be followed-up for at least five years; in the first two years, they should be examined every 3 months, and in the later 2-5 years, they should be examined every 6 months. A disease-free survival and disease-free progression-free survival can be used as indicatois of long-term cure and the best predictor of prognosis.

Abstract:Objective:To investigate the safety and feasibility of partial splenectomy in radical gastrectomy for gastric cancer . Methods:The data of 12 patients with gastric fundus and cardia cancer undergoing radical gastrectomy with spleen preservation were analyzed . Ten cases had radical total gastrectomy and 2 cases and proximal radical subtotal gastrectomy. Results:All of the patients underwent D2 radical surgery . The mean operation time of total gastrectomy was (190±33) min, the proximal subtotal gastrectomy was (160±36) min. The mean number of dissected lymph nodes was （33.3±8）, the NO.10, 11 group lymph nodes were （5.1±2.0） in total gastrectomy; and （23.6±5.2） and （6.0±1.1） in proximal subtotal gastrectomy respectively. No pancreatic fistula ,splenic vein thrombosis or subphrenic abscess occurred . All patients were followed up for 6-34months and survived; 1 patient had liver metastasis , 2 cases had ascites due to peritoneal metastasis ,but the 3 cases were alive with tumor for 7~13 months, while all the others survived with no tumor recurrence. Conclusions:It is safe and feasible to apply partial splenectomy in radical gastrectomy for gastric cancer . Splenic function can be preserved,while RO resection of gastric cancer is accomplished.

Abstract:Objective:To observe the effect of early enteral nutrition in postoperative gastric cancer patients. Methods:There were 117 cases of postoperative gastic cancer patients who were divided randomly into enteral nutrition group(EN) or parenteral nutrition group(PN). Nutrition support was started 24 hours after the operation. Nutritional condition, immunological level and variables of clinical recovery were measured and compared after the operation. Results:EN group showed better immunological level and clinical recovery than the PN group (P<0.05); and the hostal stay of EN group was also shorter than that of PN group (P<0.05). Conclusions:Early enteral nutrition in postoperative gastric cancer patients can improve the patients immunological level and enhance the restoration of gastrointestinal function.

Abstract:Objective:To investigate the clinical value of laparoscopic gastric partial resection for gastric stromal tumors. Methods:The clinical data of 22 cases who underwent laparoscopic gastric partial resection for treatment of gastric stromal tumors from Apr 2009 to Oct 2010 in our hospital were analyzed restrospectively. Results:All cases were operated on successfully without conversion to open surgery. The biopsy of the edge of specimens were all tumor negative. The average operative time was 55min, the mean intra-operative blood loss was only 50-150 mL, gastrointestinal function resumed at 24-48h after surgery on average, the postoperative hospitalization was 3-7d, and no postoperative complications occurred. Conclusions:Laparoscopic partial gastric resection for gastric stromal tumors (1.5-3 cm diameter) is safe, and has the merits of little contamination, minimal invasion and rapid recovery.

Abstract:Objective: To evaluate the effect of CapeOX (capecitabine-oxaliplatin) new adjacent chemotherapy and hepatectomy on the patients with colorectal cancer and unresectable liver metastases. Methods:Fifty-one patients with liver metastases from colorectal cancer, which meeting defined criteria of unresectability. Frist, the patients received CapeOX new adjacent chemotherapy，and assessed every 2 weeks. Patients whose liver metastases became resectable after treatment with CapeOX were considered to undergo liver metastasectomy， and then continued on further treatment with CapeOX after surgery. The therapeutic effects, including surgical response，rate of hepatectomy，postoperative complications and recurrence， and survival state, were evaluated. The expression of epidermal growth factor receptor (EGFR) in the primary lesions of the patients was also analyzed. Results:These 51 patients received CapeOX new adjacent chemotherapy for 1-8 weeks (median therapeutic time was 4 weeks). In 22 patients (43.1%) the liver metastases responded to CapeOX treatment， and 15 of them (29.4%) underwent curative hepatectomy; 19 patients (37.2%) had no response to CapeOX treatment，and their median survival time was 12 months; the remaining 17 patients with stable disease or partial responses did not undergo curative surgery， and their median survival time was 19 months. Five of 15 patients who underwent curative hepatectomy had various complications， but no postoperative mortality. At median follow-up of 21 months in the hepatectomy group，relapse and death occurred in 6 and 4 cases respectively. The expression of EGFR was associated with the progression of the metastatic colorectal cancer. Conclusions:CapeOX new adjacent chemotherapy can convert the unresectable liver metastases to be resectable in some patients. The combination of CapeOX with radical excision may can improve the outcome in selected patients with metastatic colorectal cancer.

Abstract:Objective:To evaluate the value of laparoscopic transanal pull-through resection and anastomosis for treatment of low rectal cancer. Methods:The clinical data of 12 patients with low ractal cancer undergoing laparoscopic transanal pull-through resection and anastomosis， were retrospective analysed. Of whom, the tumor located 1-3 cm from the dentate line， less than 4 cm in diameter， invasion of less than 1/2 the circumference of the lumen， localized within the bowel lumen，cell differentiation of high to moderate degree. All of the cases underwent total mesorectal excision (TME) under laparoscopic guidance; the rectum along with the tumor was pulled out from the anus and resected. Finally， the colorectal or coloanal anastomosis was made with stapler. Results: Laparoscopic pull-through resection and anastomosis were successfully performed in all 12 cases and without conversions to open surgery. The mean operation time was 200 min (160-240 min)， and the mean intraoperative blood loss was 40 ml (30-80 mL). In all cases， no residual tumor was found at resection margin. The time for recovery of gastrointestinal function and postoperative hospitalization was 36 to 60 h and 7 to 10 d respectively，and no anastomotic fistula or bleeding was observed.These 12 cases were followed-up for 12 to 18 months, no local relapse was observed. Conclusions:Laparoscopic transanal pull-through resection and anastomosis is an effective，simple and safe procedure，and can be as a good operation in treatment of early or middle clinical stage low rectal cancer with favorable histological types and relatively smaller size.

Abstract:Objective:To evaluate the value of laparoscopic resection for low rectal cancer. Methods: The clinical data of 71 cases of low rectal cancer treated from February 2002 to February 2007 were analyzed. The patients were divided into two groups according to different surgical procedure. There were 33 cases in laparoscopic resection group， and 38 cases in open procedure group. Results:The clinical characteristics of the two groups before operation were comparable(P>0.05). Laparoscopic resection was superior to open surgery in the following parameters: length of incision，surgical bleeding volume，time for oral intake ，duration of hospital stay，analgesic requirements，and number of dissected lymph nodes (P<0.05). No significant differences were noted between the two groups in rate of anal sphincter preservation，operative time，overall complications，distance of resected tumor distal margin above anal verge，1-year，3-year，5-year survival rate，and disease-free survival (P>0.05). Conclusions:Compared to open surgery，the laparoscopic procedure for low rectal cancer has better efficacy in short-term and is similar in long-term outcome.

Abstract:Objective:To explore the value of ultracision and LigaSure in laparoscopic radical surgery for low rectal cancer. Methods:Sixty-one cases with low rectal cancer underwent laparoscopic resection using ultracision and LigaSure including 40 cases of rectal anterior resection and 21 cases of abdominal perineal resection (Miles operation). Results:Laparoscopic resection was performed successfully in all patients without conversion to open surgery. The mean operation time was 210 min， average bleeding volume was 200 ml and average number of lymph nodes removed was 15.3. There was no complication after operation and with no residual tumor cells at resection margins (top and bottom) was detected. Conclusions: Laparoscopic radical surgery for low rectal cancer using ultracision and LigaSure is not only as effective as the conventional open surgery， but also can significantly reduce bleeding and operation time.

Abstract:Objective: To investigate serum level of hepatocyte growth factor (HGF) in patients with colorectal cancer and its relationship with colorectal cancer metastasis and prognosis， as well as its potential role being used as a tumor marker for colorectal cancer. Methods: Serum levels of HGF， carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) were determined in 65 cases of colorectal cancer and 20 cases of healthy volunteers by ELISA assay. Survival rates were caculated by Kaplan-Meier method. Survival analysis of each measured prognostic factor was conducted by Cox proportional hazard model. Results:The serum HGF level in colorectal cancer patients with lymph nodes metastasis， T3-4 stage tumor and liver metastasis was (0.37±0.11)，(0.32±0.29) and (0.43±0.10) ng/mL respectively，and each was significantly higher than that in healthy control ［(0.18±0.07) ng/mL， (P<0.05)］. Univariate analysis showed HGF levels significantly correlated with survival rate in colorectal cancer，and the higher the HGF level，the lower the survival rate. Conclusions:The serum HGF level is significantly associated with the development and metastasis of colorectal cancer, an elevated HGF level indicates a poor prognosis . Serum HGF potentially be used as a clinical indicator to predict metastasis and prognosis of colorectal cancer.

Abstract:Objective:To investigate the multiple molecular targeted agent, sorafenib, in human gastric cancer SGC-7901 cell proliferation, apoptosis and P-ERK expression, and explore its possible mechanism. Methods:MTT method was used to detect antiproliferative ratio of sorafenib on human gastric cancer SGC-7901 cell; immunocytochemical method for detection of gastric cancer cells P-ERK protein expression; and flow cytometry to analyze gastric cancer cell apoptosis. Results:Sorafenib obviously inhibited proliferation of gastric cancer cells and showed time-dose-dependent effects (P<0.05). When gastric cancer SGC-7901 cells were treated with sorafenib, immunocytochemistry showed that P-ERK expression was significantly decreased (P<0.05); flow cytometry showed that the SGC-7901 cell apoptosis rate increased (P<0.05). Conclusions:Sorafenib can significantly inhibit human gastric cancer SGC-7901 cell growth in vitro; the main mechanism is the inhibition of P-ERK expression, and thereby inhibit their proliferation and promote apoptosis.

Abstract:Objective:To investigate the inhibitory effect of short hairpin RNAs (shRNAs) on tissue factor (TF) for affecting the invasion of gastric cancer. Methods: According to the principle of RNAi design， pSUPER/TF-siRNA expression vector was constructed， the recombinant plasmid shRNA was transfected into SGC-7901 cells (human gastric cancer cell line) with lipofectamine 2000. The mRNA and protein expression level of TF in SGC-7901 cells before and after transfection was determined by RT-PCR and Western blot respectively. The invasion ability in vitro was analyzed using Boyden chamber invasion assay. Results:The recombinant vector was constructed correctly， which was identified by double restriction enzymes digestion. The results of RT-PCR and Western blot showed that both mRNA and protein expression of TF were decreased significantly in SGC-7901 cells after transfected with pSUPER/TF-siRNA (P<0.05). Boyden chamber invasion assay showed that cell number of pSUPER/TF-siRNA/SGC-7901 invading through Matrigel filter was decreased significantly compared with that of pSUPER/SGC-7901 and SGC-7901 (P<0.05). Conclusions:TF is involved in the progression of gastric cancer， and it may be a new therapeutic target for gastric cancer.

Abstract:Objective:To study the effect of miR-193b on metastasis and invasion of gastric carcinoma cell line BGC823 and its mechanism. Methods:The difference of microRNA expression of gastric cancer cell BGC823 before and after the cells treated by TGF-β1 was detected by miRNA array, and the changes of biological behavior of gastric cancer BGC823 cell line after transfection with miR-193b inhibitor was measured by migration, invasion and metastasis test. Results:There was 6 differential microRNA profile expression after TGF-β1 treatment of BGC823.Transfection of miR-193b inhibitor enhanced the ability of migration, invasion and metastasis of gastric carcinoma cell line BGC823. Conclusions:TGF-β1 can enhance the ability of migration, invasion and metastasis of gastric carcinoma cell line BGC823 through decreasing the expression of miR-193b.

Abstract:Objective:To investigate the effects of RhoA gene silencing by RNA interference on the growth of LoVo colon cancer cells transplanted into nude mice. Methods:The eukaryotic expression vectors of shRNA targeting RhoA were constructed and transfected into LoVo cells. The stable cell colons of RhoA silencing were selected， and the expression of RhoA protein was determined by Western blot. The nude nice were transplanted by subcutaneous inoculation with stably transfected RhoA shRNA plasmid, empty vector and untransfected LoVo cells， respectively. The weight and volumes of tumors were measured 4 weeks after transplantation. The expressions of RhoA, VEGF and MMP-2 in tumor tissue were examined by immunohistochemical staining. Results:The weight and volume of tumor in RhoA shRNA group was significantly lower than that of two control groups (P<0.01). The immunohistochemical results demonstrated that the expressions of RhoA, VEGF and MMP-2 protein were all significantly decreased compared with two control groups (P<0.01). Conclusions:RhoA gene silencing can inhibit the growth of LoVo cell xenograft tumnor in vivo.

Abstract:Objective:To investigate the expression of carbonic anhydrase Ⅱ(CAⅡ) in colorectal cancer(CRC), and the correlation with the carcinogenesis, development and clinical pathological aspects of CRC. Methods:CAⅡ was detected in paired fresh samples of 12 CRC and the mucosa distant to cancer (normal mucosa) with Western Blot. Then the expression of CAⅡ was detected in paired samples of 64 CRC and normal mucosa, 27 polyps, and 20 metastatic lymph nodes with immunohistochemistry. The differences among them were analyzed. The correlation of CAⅡ expression with the location, differentiation and clinical pathological stage of CRC was also analyzed. Results:Western Blot analysis showed that the intensity of CAⅡ/tubulin in normal mucosa and CRC was 2.48±1.68 and 1.33±1.28, respectively （P=0.027）.Immunohistochemistry analysis showed that the expression scores of CAⅡ in normal mucosa（2.81±0.48）, polyp(including hyperplasic polyp and adenoma, (2.56±0.51) and CRC（1.30±0.89） were stepwisely down-regulated significantly（P＜0.05）. However, the expression of CAⅡ in lymph node metastasis（1.35±0.67） was similar to its primary tumor（P＞0.05）. The expression of CAⅡin CRC had no significant difference among different cancer locations, differentiation or TNM stages（P＞0.05）. Conclusions:The down-regulation of CAⅡ is an early event of CRC carcinogenesis. It has no correlation with differentiation, TNM stage or metastasis.

Abstract:Objective:To investigate the clinical characteristics and treatment of congenital esophageal atresia(CEA). Methods:The records of 18 children who suffered from CEA and were treated in our hospital from 2002 to 2009 were analyzed.Surgery was refused in 5 cases and the others underwent operation. Results:Among the13 operated children who underwent one stage ligation of esophagotracheal fistula+esophagectomy and end to end anastomosis，11 were cured，4 suffered anastomotic stricture which was relieved by balloon dilation,and 2 children had anastomotic leakage，one of which was cured by conservative treatment and the other by reoperation .Two children died，one from respiratory failure 3 days after operation and the other from anastomotic leakage and heart failure at 6 days after operation. Conclusions:Early diagnosis,prevention and aggressive treatment of complications are the key facetors to improve the outcome of congenital esophageal atresia.

Abstract:Objective:To explore the causes， clinical characteristics and treatment of acute perforation of colon. Methods:The clinical data of 22 cases of acute colonic perforation from treated Feb 2007 to Feb 2010 Were retrospectively analysed. Results:The etiology of perforation was cancer in 54.5%(12/22)， trauma in 27.3%(6/22)，fecal impaction in 9.1%(2/22)， diverticulitis in 4.5%(1/22)，and intussusception in 4.5%(1/22).The location of perforation: cecum accounted for 31.8%(7/22)， transverse colon for 18.2%(4/22)， descending colons for 9.1%(2/22)，and sigmoid colon for 40.9%(9/22).All cases underwent emergency surgery，with one-stage operation in 7cases(31.8%), staged operation in 11 cases(50.0%), and permenent colostomy in 4(18.2%). After surgery， 6 cases had pulmonary infection， of which 2 cases with pleural effusion were improved by paracentesis， 2 cases with ARDS were improved by mechanical ventilation,and 2 cases with subphrenic abscess were improved by ultrasound-guided drainage.There were 10 cases of wound infection， of which 7 cases were cured by dressing change and 3 cases with abdominal incision dehiscence underwent resuture. One case with enterocutaneous fistula was treated by colostomy.Of the 20 cases，18 cases(81.8%) were cured， 2cases(9.1%)died from septic shock and MOF，and 2 cases(9.1%) were discharged against-advice. Conclusions:Improving the understanding of this disorder，early diagnosis， prompt and proper surgical procedure are the keys to improve the treatment effect of colonic perforation.

Abstract:Objective:To explore the methods of surgical treatment of huge duodenal diverticulum. Methods:The clinical data of six cases of huge duodenal diverticulum treated in our hospital and the Surgical Hospital, Heidelberg University during the period of Sep.2008 to Oct.2010 were retrospectively analysed. Results:Of them, four cases underwent duodenal diverticulectomy and transgastric duodenostomy, other two cases were operated by Billroth-II gastrectomy and cholangio-enterostomy. After operation, no complications, such as pancreatic fistula, biliary fistula, duodenal fistula or acute pancreatitis,occured. The patients were folloed-up three months to one and a half years after the operation, and none of the patients experienced any discomfort in the right upper abdomen or any other complications. Conclusions:It is reasonable to adopt duodenal diverticulectomy and transgastric duodenostomy for huge duodenal diverticula. This operation is safe and the complications are few.

Abstract:Objective: To study the dignosis and treatment of isolated cecal necrosis. Methods:The aetiology, diagnosis, treatment and outcome of 12 cases of isolated cecal necrosis were analysed retrospecively. Results:Among the 12 cases, 7 were male and 5 female. The average age was 68.1 years 9 cases had diabetes, 7 had coronary heart disease and 11 had hypertension. The clinical manifestations were shifting or persistent right lower abdominal pain and right lower abdominal peritoneal irritation. Eight cases were diagnosed preoperatively as acute appendicitis and 4 cases as abdominal pain of unknown origin.All of them underwent operation and their cecum was found to be partially gangrenous. The diameter of the lesion was 2-4 cm(average 2.7 cm). Ileocecal resection was performed in all cases. All the patients were discharged without any complications except 2 cases had incisional wound infection. During a follow-up of 8-87 months(mean:56.7months)， 7 patients died of myocardial infarction at 10-36months(mean:16.3months) after operation. The other 5 patients were alive. Conclusions:Isolated cecal necrosis is rare and difficult to be diagnosed. Diagnostic laparoscopy could be applied, if necessary to clinch the diagnosis. Whether surgical treatment is needed or not, depends on the individual case. The pathogenesis of this disease may be related with myocardial infarction.

Abstract:Objective: To investigate the safety and effectiveness of using fast track surgery in elderly patients′ colorectal surgery. Methods:The clinical data of 72 patients older than 65 years with colorectal cancer were retrospectively analyzed. All patients were treated by “fast-track” rehabilitation program perioperatively that included short fasting time，avoidance of mechanical bowel preparation and without nasogastric tubes， making preoperative carbohydrate loading，use of epidural analgesia combined with general anaesthesia，minimized use of abdominal drains，and early oral feeding and ambulation. Results:Of the patients treated with the concept of “fast-track” rehabilitation， 76.4% were able to have liquids orally on the first day after surgery， 88.9% able to have liquids orally on the 2nd day after surgery, and 73.6% had semi-liquid orally on the 3rd postoperative day. The mean time of the first bowel movement was 2.4 days. Only 9 patients (12.5%) had general complications， and 10 patients (13.9%) had local complications， including 1 patient (1.4%) with anastomotic leakage. Average postoperative hospital stay was 5.6 days (range 1-46 d), but 5 patients (6.9%) were readmitted within 30 days. Conclusions:Using the “fast-track” rehabilitation program on elderly patient is not only feasible but also can accelerate postoperative recovery and reduce the duration of hospital stay.

Abstract:Objective:To investigate the particularities of surgical treatment of schizophrenia patients with cholecystolithiasis. Methods:The clinical data of 35 schizophrenic patients with cholecystolithiasis treated in our department in past 5 years were analyzed retrospectively. Results:The psychiatric symptoms in all patients were effectively controlled before surgery, and being able to recognize their physical illness and accepted the surgical procedure. All operations were carried out under general anesthesia, included 6 laparoscopic cholecystectomies and 29 open cholecystectomies (5 cases from laparoscopic operation conversion to open surgery). The psychiatric symptoms occurred in 17 patients after surgery, but all the 17 patients were well controlled through psychotherapy and antipsychotic medication as well as safety care. All patients were discharged after recovery without postoperative complications. Conclusions:For schizophrenic patient with cholecystolithiasis, special attention should be paid to the particularities in the perioperative management and surgical treatment. Furthermore, cooperation with the psychiatrist is necessary.