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Abstract:Objective: To assess the value of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Methods: Publicly published studies in both Chinese and English concerning laparoscopy-assisted D2 gastrectomy versus open D2 gastrectomy were collected, and then, data that included operative time, blood loss, number of dissected lymph nodes, time to first flatus and food intake, length of hospital stay, incidence of complications, mortality and recurrence between two groups of patients undergoing laparoscopy-assisted D2 gastrectomy and open D2 gastrectomy were compared by Meta-analysis. Results: Eight studies (1 065 patients) meeting inclusion criteria were finally selected. Compared with open surgery group, the intraoperative blood loss and incidence of complications were reduced, time to first flatus and food intake, and length of hospital stay were shortened, but operative time was prolonged (all P<0.05). There were no significant differences in the number of dissected lymph nodes, mortality, and recurrence rate between the two groups (all P>0.05). Conclusion: Laparoscopy-assisted D2 gastrectomy has the advantages of minimal invasion, faster recovery and fewer complications, and can achieve the same results and short-term efficacy as open radical operation.

Abstract:Objective: To investigate the efficacy of gastrectomy plus pancreaticoduodenectomy (PD) in treatment of locally advanced gastric cancer. Methods: The clinical data of 11 patients with stomach cancer undergoing gastrectomy plus PD due to pancreatic head or duodenal involvement during May 2005 to Jun 2012 were retrospectively analyzed. Results: Of the patients, 6 cases underwent distal subtotal gastrectomy with simultaneous PD, and 5 cases underwent distal subtotal gastrectomy plus PD and right hemicolectomy. No death occurred in the whole group of patients, and postoperative complications occurred in 4 cases, of whom, one case had biliary fistula, one had pancreatic fistula, one had intra-abdominal infection and one had wound infection. The 1-, 3- and 5-year survival rates were 68.2%, 34.1% and 22.7%, respectively. Conclusion: For stomach cancer patients with pancreaticoduodenal involvement, gastrectomy plus PD is an effective procedure as long as an R0 resection can be achieved.

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Objective: To investigate the application value of transposition of a transverse colon segment for gastric replacement after total gastrectomy in treatment of gastric carcinoma. Methods: One hundred and ninety-three gastric cancer patients requiring total gastrectomy were randomly divided into control group and observation group. Patients in control group underwent the conventional Schlatter’s or Roux-en-Y esophagojejunostomy for digestive tract reconstruction, while those in observation group received gastric reservoir construction of transverse colon transposition after total gastrectomy. The alterations in T-lymphocyte subsets, IL-2 level, and mediators of acute inflammation before operation and at postoperative day (POD) 1 and 9, as well as the mortality, incidence of postoperative complications and length of hospital stay between the two groups were compared. Results: There were no significant differences between the two groups in all parameters before operation and at POD 1 (all P>0.05). At POD 9, the percentage of CD4+ T cells, ratio of CD4+ to CD8+ T cells and IL-2 level in observation group were significantly increased, but the percentage of CD8+ T cells and levels of IL-6 and C-reactive protein (CRP) were significantly decreased compared with control group (all P>0.05). No differences were noted in postoperative death and incidence of postoperative complications between the two groups (both P>0.05), however, the average length of hospital stay in observation group was significantly shorter than that in control group (P<0.05). Conclusion: Transverse colon interposition for gastric reservoir is a safe procedure for reconstruction of alimentary tract, which is beneficial for improving the postoperative immune function in gastric cancer patients.

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Objective: To investigate the influence of β-tubulin expression level in cancer tissues of gastric cancer patients on the efficacy of paclitaxel chemotherapy after radical gastrectomy. Methods: Cancer tissues from 332 patients with stomach cancer undergoing post-gastrectomy paclitaxel chemotherapy were collected. The β-tubulin mRNA expression in the cancer tissues was measured by RT-PCR, and then the relations of β-tubulin mRNA expression with the clinical characteristics of the patients were analyzed. In addition, the survival difference between two groups of patients with high and low β-tubulin expression was compared by Kaplan-Meier method. Results: β-tubulin mRNA expression in gastric cancer was unrelated to the age or gender of the patients, or the location and size of the tumors (all P>0.05), but was associated with the degree of differentiation, TNM stage, and lymphatic and distant metastasis (all P<0.05). The survival time of patients from high β-tubulin expression group was significantly shorter than that from low β-tubulin expression group (P<0.05). Conclusion: β-tubulin expression level in gastric cancer is closely related to the long-term survival of gastric cancer patients undergoing post-gastrectomy paclitaxel chemotherapy, and can be used as predictive index of prognosis.

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Objective: To determine the prognostic predictive value of preoperative Glasgow prognostic score (GPS) in rectal cancer patients after surgery. Methods: The clinical data of 219 patients with rectal cancer undergoing surgical treatment over the past six and a half years were reviewed. The related factors that affect prognosis were analyzed, and the patients were divided into score-2 group, score-1 group and score-0 group according to their preoperatvie GPS, to analyze the relations of GPS with the clinical features of the patients, and to compare the postoperative survivals among the 3 groups. Results: Univarate analysis showed that the preoperative levels of carcinoembryonic antigen (CEA), C reactive protein (CRP), and albumin, TNM classification and GPS were associated with the overall survival of the patients (all P<0.05); GPS of the patients was relevant to their preoperative levels of CEA, CA19-9, CA724, CRP, and albumin, Dukes’ stage and TNM classification (all P<0.05). Univariate Logistic regression analysis suggested that the preoperative levels of CEA, CA19-9, CA724, CRP, and albumin, differentiation degree of the tumor, Dukes’ stage and TNM classification and GPS were associated with the increased risk of postoperative death (all P<0.05), and further multivariate Logistic regression analysis identified that preoperative albumin level, differentiation degree, TNM classification and GPS were independent risk factors for postoperative death (all P<0.05). The 5-year survival rate of score-2, score-1 and score-0 group was 13.8%, 59.9% and 88.4% respectively, and the difference among them had statistical significance (P<0.001). Conclusion: Preoperative GPS can be used as a prognostic predictor for postoperative survival of rectal cancer patients.

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Objective: To compare the short-term efficacy of laparoscopic and open anterior resection for rectal cancer in patients with concomitant type 2 diabetes. Methods: The clinical data of 97 patients with concomitant type 2 diabetes undergoing anterior resection of rectal cancer at Chinese PLA General Hospital during past 2 years were retrospectively analyzed. Among the patients, 43 cases received laparoscopic surgery (laparoscopic group), and 54 cases were subjected to the traditional open surgery (open surgery group). The intra- and postoperative conditions between the two groups were compared. Results: Compared with open surgery group, the scenarios that included intraoperative blood loss, length of incision, time to flatus and food intake, and length of postoperative hospital stay were all significantly superior in laparoscopic group (all P<0.01). Moreover, the overall incidence of complications in laparoscopic group was lower than that in open surgery group (P=0.0479). There were no differences in operative time, number of dissected lymph nodes and number of patients requiring postoperative analgesia between the two groups (all P>0.05). Conclusion: Laparoscopic anterior resection can reduce the incidence of postoperative complications in rectal cancer patients complicated with type 2 diabetes, so it is safe and feasible, and can be considered as the first-choice procedure for those patients.

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Objective: To compare the clinical efficacy of simultaneous and staged resection for colon cancer with synchronous liver metastases. Methods: The clinical data of 36 patients with synchronous liver metastases from colon cancer were retrospectively analyzed. Of the patients, 16 cases underwent radical resection of colon cancer and simultaneous resection of liver metastases (simultaneous resection group), and the other 20 cases underwent radical resection of colon cancer and two-stage resection of liver metastases (staged resection group). The 1-, 3- and 5-year survival rates between the two groups were compared. Results: The 1-, 3-, and 5-year survival rate in simultaneous resection group was 87.5%, 37.5% and 18.8%, and in staged resection group was 65%, 10.0% and 0.0%, respectively. By comparison, the 1-year survival rates had no statistical difference between the two groups (P>0.05), but both 3- and 5-year survival rates in simultaneous resection group were significantly higher than those in staged resection group (both P<0.05). Conclusion: Simultaneous surgery can prolong the survival time of patients with synchronous liver metastases from colon cancer.

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Objective: To determine the risk factors affecting the survival of patients with colorectal cancer liver metastases after surgical resection. Methods: The clinical and follow-up data of 54 patients with colorectal cancer liver metastases undergoing surgical treatment were reviewed. The associated factors were examined by univariate and multivariate analyses. Results: The univariate analysis showed that the degree of differentiation of the primary tumor, lymph node metastasis, number and size of the liver metastases, surgical approach and whether the postoperative comprehensive treatment was given were associated with the prognosis of the patients (all P<0.05). The multivariate analysis identified that surgical approach, lymph node metastasis and the degree of differentiation of the primary tumor were the major risk factors (all P<0.05). Conclusion: Early detection and radical resection followed by intensive postoperative treatment are critical to improve long-term outcomes in these patients.

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Objective: To observe the impact of exogenous growth hormone (GH) on the axis of GH/insulin-like growth factor I (IGF-I)/insulin-like growth factor binding protein (GFBP) in colon cancer-bearing nude mice. Methods: Nude mice xenograft models of human colon cancer were established by using human colon cancer HCT116 cells. Subsequently, 48 tumor-bearing mice were equally randomized into normal saline treatment group (NS group), fluorouracil treatment group (FU group), GH treatment group (GH group) and FU plus GH treatment group (FU+GH group), and all treatment regimens were continued for 6 days. Mice were sacrificed to collect the blood and tumor xenograft samples at 24 and 72 h after the termination of regimens with 6 mice in each group. The serum contents of GH, IGF-I and IGFBP-3 were determined by ELISA assay, and the mRNA expressions of IGF-I, IGF-I receptor (IGF-IR) and IGFBP-3 in xenograft were detect by RT-PCR method. Results: The results of ELISA showed that the serum levels of GH, IGF-I and IGFBP-3 were significantly increased in GH group and FU+GH group compared with either NS group or FU group at 24 h after regimen discontinuation (all P<0.05); at 72 h after regimen discontinuation, the serum levels of GH and IGF-I were similar among groups (both P>0.05), but the IGFBP-3 levels in GH group and FU+GH group were still higher than that in NS group or FU group (all P<0.05). The results of RT-PCR showed that the mRNA expressions of IGF-I and IGF-IR were obviously decreased but IGFBP-3 mRNA expression was markedly increased in tumor xenografts in either GH group or FU group or FU+GH group compared with NS group at 24 h after regimen discontinuation; at 72 h after regimen discontinuation, both IGF-I and IGF-IR mRNA expressions were similar among groups, but IGFBP-3 mRNA expressions in above three groups were still higher than that in NS group. Conclusion: The alteration in GH/IGF/IGFBP axis resulting from short-term exogenous GH application exerts no growth-promoting effect on tumor xenograft of human colon cancer.

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Objective: To investigate microRNA-451 (miR-451) expression in colorectal cancer (CRC) tissues and its clinical significance. Methods: The miR-451 expression in tumor tissues and normal mucosa samples obtained from 40 CRC patients, as well as 8 different CRC cell lines were examined by real-time quantitative reverse transcription-PCR (RT-qPCR). The relations of miR-451 expression with clinicopathologic profiles of CRC were analyzed. Results: Compared with normal mucosal tissues, miR-451 expression level was significantly reduced in either CRC tissues or all the CRC cell lines (all P<0.05). Comparison between groups divided by clinicopathologic profiles showed that the miR-451 expression difference was associated with the histologic classification and degree of differentiation of the tumor, and its expression level was lowest in mucinous adenocarcinoma and poorly differentiated adenocarcinoma (both P<0.05). Conclusion: The miR-451 expression in CRC tissues is generally decreased, and the decreasing degree is related to the histologic classification and differentiation of the tumor.

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Objective: To investigate the effects of VEGF-C antisense RNA on the in vivo growth of colorectal carcinoma LoVo cells. Methods: Twenty nude mice were equally randomized into experimental group and control group. Mice in experimental group were inoculated with anti-sense VEGF-C transfected LoVo cells, and those in control group were inoculated with empty plasmid transfected LoVo cells. The growth of the tumor xenografts in mice was observed. Finally, mice were sacrificed at 21 d after inoculation, and the microlymphatic density (MLD) and microvessel density (MVD) in tumor xenograft tissues were measured through immunohistochemical staining. Results: There was no difference in tumor formation rates between the two groups (both were 100%). The volumes of the implanted tumor in experimental group and control group were (382.0±152.8) mm3 and (454.2±148.7) mm3 at 14 d post-inoculation, and were (745.0±250.9) mm3 and (1 574.4±506.2) mm3 at 21 d post-inoculation respectively, and the differences between them had statistical significance (both P<0.05). Both MLD and MVD in the tumor tissues from experimental group were significantly lower than those from control group [(11.75±2.22)/0.72 mm2 vs. (28.50±2.65)/0.72mm2, (47.75±2.99)/0.72 mm2 vs. (53.73±3.50)/0.72 mm2] (both P<0.05). Conclusion: The growth of colorectal carcinoma LoVo cell xenografts in nude mice can be suppressed by VEGF-C antisense RNA transfection and that may also inhibit the lymphangiogenesis and angiogenesis in tumor xenografts.

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Objective: To construct the plasmid expression vector that expresses short hairpin RNA (shRNA) against CXC chemokine receptor 1(CXCR1). Methods: Three shRNA expression vectors targeting CXCR1 gene and one negative control (non-targeting sequence) expression vector were designed and constructed according to the mRNA sequence of CXCR1 gene and RNA interference design guidelines. After identification with restriction enzyme digestion and sequencing analysis, these vectors were transfected into gastric cancer MKN45 cells in vitro, and then the CXCR1 mRNA and protein expressions in the cells were detected by RT-PCR and Western blot analysis. Results: As identified by enzyme digestion and sequencing analysis, all the three shRNA eukaryotic expression plasmid vectors targeting CXCR1 gene were successfully constructed. Compared with untransfected MKN45 cells or MKN45 cells transfected with negative control vector, both mRNA and protein levels of CXCR1 were significantly reduced in MKN45 cells transfected with any of the three shRNA vectors (all P<0.05). Conclusion: The successful construction of plasmid expression vector encoding shRNA against CXCR1 may provide a preliminary step for further investigation of the role of CXCR1 in gastric cancer and experimental targeted therapy.

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Objective: To investigate the relations of the E-cadherin and Slug expression in gastric cancer tissues with the pathologic features of the tumor and prognosis in patients. Methods: The E-cadherin and Slug expression in the cancer tissues from 82 gastric cancer patients were measured by immunohistochemical staining, and the relationships between their expressions and the pathologic features as well as survival of the patients were analyzed. Results: Of the patients, E-cadherin expression was preserved in 47.6%, and Slug was positive in 39.0%. Differential expression of E-cadherin was associated with N classification of the patients, and the difference in Slug positive expression rate was relevant to the gender, and N and M classification (all P<0.05). In group of patients with preserved E-cadherin expression, Slug expression was related to N and M classification, venous invasion, hematogenous metastasis and peritoneal recurrence, while in group of patients with reduced E-cadherin expression, Slug expression was connected with T classification (all P<0.05). The 5-year survival rate in patients with preserved E-cadherin expression was higher than that in patients with reduced E-cadherin expression (79.5% vs. 60.5%), and in patients with positive Slug expression was lower than that in those with negative Slug expression (59.4% vs. 74.0%) (both P<0.05). In E-cadherin expression preserved group, the 5-year survival rate in patients with Slug positive expression was lower than that in patients with Slug negative expression (48.4% vs. 87.5%) (P<0.05), which in E-cadherin expression reduced group showed no difference (58.3% vs. 68.4%) (P>0.05). Conclusion: Both E-cadherin and Slug expressions in gastric cancer tissue are mainly related to the TNM classification of the tumor, and the Slug positive expression may predict a poor outcomes in patients with preserved E-cadherin expression.

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Objective: To investigate the expressions of uPA and vimentin protein in hepatocellular carcinoma (HCC) and their clinicopathologic significance. Methods: The expressions of uPA and vimentin protein in HCC along with their paired adjacent tissues (88 cases) and normal liver tissues (8 cases) were determined by immumohistochemical staining. The relations of the expressions of the both proteins with the clinicopathologic characteristics of HCC patients, and the correlation between themselves were analyzed. Results: The positive expression rates of uPA and vimentin protein in HCC tissues were 63.6% and 72.7% respectively, and both were significantly higher than those in their adjacent tissues (27.3% and 15.9%) and normal liver tissue (12.5% and 12.5%) (all P<0.0125). The expressions of uPA and vimentin protein in HCC were associated with the presence of portal vein tumor thrombus and liver capsule invasion (all P<0.05), and there was a positive correlation between the expressions of uPA and vimentin protein in HCC tissues (r=0.227, P=0.034). Conclusion: The expressions of uPA and vimentin protein in HCC are positively correlated and both positive expressions are associated with the unfavorable clinical characteristics of the patients.

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Objective: To investigate the effect of curcumin on the proliferation and apoptosis, as well as on expression of nuclear factor κB (NF-κB) in human hepatocellular carcinoma HepG-2 cells. Methods: The inhibition rate of cell proliferation was determined by CCK-8 assay after HepG-2 cells were exposed to different concentrations of curcumin (10, 25, 50 and 100 μmol/L) for different time periods (16, 24 and 48 h). Cell apoptosis was detected by flow cytometry following exposure of HepG-2 cells to μmol/L curcumin for 24 h. The NF-κB p65 expression in HepG-2 cells was measured by Western blot analysis after treatment with different concentrations of curcumin (10, 25, 50 and 100 μmol/L) for 24 h. Results: Curcumin significantly inhibited the proliferation of HepG-2 cells in a time- and concentration-dependent manner (all P<0.05). The apoptosis rate of HepG-2 cells was significantly increased after curcumin treatment versus untreated HepG-2 cells (P<0.05). The NF-κB p65 expression in HepG-2 cells was down-regulated in a concentration-dependent manner after incubation with gradient concentrations of curcumin. Conclusion: Curcumin can inhibit the growth and promote apoptosis of HepG-2 cells, and the mechanism may be associated with its blockage of NF-κB pathway.

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Objective: To assess the clinical value of endoscopic submucosal dissection (ESD) for sessile colorectal lesions. Methods: The clinical data of 17 patients with large sessile colorectal lesion that was detected by enteroscopy and underwent ESD were retrospectively analyzed. Results: ESD was successfully performed in all the 17 patients. The average operative time was (68±21) min, and average diameter of the lesions was (3.0±1.5) cm. Intraoperative bleeding occurred in 4 patients and postoperative delayed bleeding occurred in 3 patients, which were all resolved by using hot biopsy forceps, APC or titanium clip under enteroscope. Bowel perforation occurred during operation in 2 patients, which in one case was sutured with titanium clip under enteroscope and the other case was treated by open bowel repair. The postoperative pathology study verified that 3 cases were tubular adenoma, 4 were villous adenoma, 2 were low-grade intraepithelial neoplasia, 3 were high-grade intraepithelial neoplasia, 2 were hyperplastic polyps, 1 was carcinoid 1, and 2 were early cancer (T1N0M0). All patients were cured and discharged from hospital, and no recurrence was noted during follow-up for 2–27 months. Conclusion: ESD is a safe and feasible procedure for sessile colorectal lesions; it has the advantages of minor trauma, quick recovery and no abdominal scar and its use is recommended.

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Objective: To investigate the etiology, clinical characteristics and management of spontaneous perforation of the sigmoid colon in elderly patients. Methods: The clinical data of 21 elderly patients with definite diagnosis of spontaneous perforation of the sigmoid colon from November 2007 to October 2012 were retrospectively analyzed. Results: Of the patients, 12 cases were males and 9 were females with an average age of 47 (62–73) years. The majority of these patients were admitted for acute abdominal pain, all of them had experienced habitual constipation of varying degrees, and 3 cases developed septic shock before surgery. In the entire group of 21 patients, only 4 cases were diagnosed as sigmoid colonic perforation, and the misdiagnosis rate was 80.95%. All of the 21 patients underwent Hartmann's procedure and, after surgery, there were still 3 cases who developed septic shock that was resolved after aggressive anti-infective and anti-shock supportive therapies; wound infection and pulmonary infection occurred in 8 and 6 cases respectively, which were cured by anti-infective and symptomatic treatment; 3 cases were complicated by multiple organ dysfunction syndrome (MODS), and one of them was cured after emergent care, while the other 2 cases died from perforation of the retroperitoneal sigmoid colon. Nineteen patients were cured and discharged from the hospital, and their sigmoid colostomy was closed 3–6 months later. Conclusion: The clinical manifestations of spontaneous perforation of the sigmoid colon in old patients are not specific, and abdominal paracentesis, X-ray, and digital anorectal examination are helpful for the diagnosis. Increased understanding of this condition, early diagnosis and intervention including aggressive anti-shock and anti-infective therapy, maintenance of water-electrolyte and acid-base balance, and early surgical and symptomatic treatment, as well as prophylaxis of complications are important to ensure the recovery of these patients.

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mTOR and its signal pathway components are closely related to recurrence and metastasis of gastric cancer, so the targeted drugs against mTOR combined with chemotherapy agents show great application potentials for avoiding the recurrence and metastasis of gastric cancer. In this paper, the authors present the recent progress in the mechanisms underlying mTOR signaling pathway-mediated recurrence and metastasis of gastric cancer.

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Gastric cancer prognostic factors, namely the general clinical factors and pathologic factors, include sex, age, tumor site, tumor size, Borrmann classification, histologic classification, depth of invasion, lymphatic metastasis with metastatic ratio, number of negative lymph nodes, distant metastasis, TNM stage, and vascular invasion. In this paper, the authors address the research progress regarding the above prognostic factors for gastric cancer.

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In recent years, fast track surgery (FTS) as a frontier concept has been increasingly used in patients with gastrointestinal surgery. Because most indexes of gastrointestinal FTS are established on the basis of postoperative gastrointestinal tract function recovery, or are characterized by accelerating postoperative recovery of gastrointestinal tract function, so the authors reviewed the progress in clinical application of FTS for acceleration of gastrointestinal function recovery during perioperative management of gastrointestinal surgery.

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目的：比较腹腔镜和传统开腹行胆囊切除术对患者肠道黏膜通透性的影响。方法：2011年1月—2011年12月行胆囊切除术的患者64例随机分为腹腔镜胆囊切除（LC）组和开腹胆囊切除(OC)组，每组32例。两组患者分别于手术前、手术后第2，6天测定两组患者尿乳果糖与甘露醇的比值(L/M) 、血浆谷氨酰胺（Gln）水平、血浆D-乳酸水平和血清内毒素水平。结果：与术前比较，两组患者术后L /M，血浆D-乳酸水平，细菌内毒素水平显著升高（P<0.01），血浆Gln水平显著降低（P<0.01）；术后患者L/M，血浆D-乳酸水平，血清内毒素水平LC组较OC组低，血浆Gln水平LC组较OC组高，均有统计学差异（P<0.01）。结论：LC对行胆囊切除术患者肠黏膜通透性功能具有明显保护作用。