Abstract:

Abstract:Objective: To systematically evaluate the safety and degree of lymph node dissection of laparoscopic total gastrectomy for advanced gastric cancer. Methods: The randomized controlled trials or retrospective studies comparing laparoscopic total gastrectomy and open total gastrectomy for advanced gastric cancer were collected by searching several national and international databases. Data collection ended in May 2013. After screening for inclusion, data extraction, and quality assessment, Meta-analysis was performed by the RevMan 5.2 software. Results: Six studies were finally selected involving 1 115 patients, of whom 547 underwent laparoscopic surgery and 568 cases were subjected to open surgery. Results of the Meta-analysis showed that laparoscopic total gastrectomy versus open surgery for advanced gastric cancer reduced the incidence of complications, intraoperative blood loss and length of hospital stay; but prolonged the operative time (all P<0.05), and however, made no statistical difference in number of dissected lymph nodes (P>0.05). Conclusion: Compared with open surgery, laparoscopic total gastrectomy for advanced gastric cancer is superior in minimal invasion and safety, and can achieve a similar lymph node dissection effect.

Abstract:

Objective: To compare the short-term efficacy of the delta-shaped anastomosis and Billroth I anastomosis in laparoscopic radical distal gastrectomy. Methods: The records of 37 patients with early-stage gastric cancer undergoing laparosicopic radical distal gastrectomy in PLA General Hospital between 2009 and 2013 were selected. Of the patients, 14 cases received delta-shaped anastomosis (delta-shaped anastomosis group) and 23 cases were subjected to Billroth I anastomosis (Billroth I anastomosis group), and the relevant intraoperative and postoperative parameters between the two groups were compared. Results: In delta-shaped anastomosis group compared with Billroth I anastomosis group, the operative time was prolonged, but the intraoperative blood loss was reduced, duration of the analgesic pump therapy, and time to first flatus and suture removal were all shortened, and all the differences had statistical significance (all P<0.05); there was no statistical difference in length of hospital stay between the two groups (P>0.05). Postoperative pathology showed that the distance of the proximal and distal surgical margins from the tumor in delta-shaped anastomosis group was significantly longer than those in Billroth I anastomosis group (both P<0.05). No statistical difference was noted in incidence of postoperative complications and adverse reactions between the two groups (P>0.05). Conclusion: The delta-shaped anastomosis can, to a certain degree, reduce the trauma and pain in patients undergoing laparoscopic radical distal gastrectomy, decrease the operative difficulty of laparoscopic surgery and the risk of infection, and promote the recovery of gastrointestinal function of the patients.

Abstract:Objective: To compare the clinical effects between two approaches for management of blood vessels during laparoscopic gastric cancer surgery. Methods: The surgical video and clinical data 187 patients undergoing laparoscopic D2 radical gastrectomy for distal gastric cancer over the past 4 years were retrospectively analyzed. According to the methods used for management of blood vessels during operation, the patients were divided into method one group (n=89) and method two group (n=98). The major part of procedure of method one was performed by the primary surgeon alone, while the procedure of method two was completed by the close cooperation between the primary surgeon and the assistant surgeon. The pre-, intra- and postoperative conditions between the two groups of patients were compared. Results: The preoperative conditions between the two groups were comparable. No statistical difference was observed in number of lymph nodes identified at pathological examination, and the incidence of associated postoperative complications between the two groups (both P>0.05), while method two group was significantly superior to method one group with regard to operative time and intraoperative blood loss (both P<0.05). Conclusion: Through the close cooperation between the primary surgeon and the assistant surgeon, management of blood vessels can be quickly completed, the time for lymph node clearance is shortened, intraoperative blood loss is reduced, and with no decrease in quality of lymph node clearance, so it is recommended to be used in clinical practice.

Abstract:Objective: To investigate the surgical complications in laparoscopic gastric cancer surgery as well as the prevention and treatment measures. Methods: The clinical data of 197 patients undergoing laparoscopic radical gastrectomy (laparoscopic group) from January 2009 to June 2013, and 275 patients who were subjected to open radical gastrectomy (laparotomy group) during the same period were retrospectively analyzed. The incidence of complications of the two groups was compared, and the influential factors for complications of laparoscopic gastric cancer surgery were analyzed. Results: There was no statistical difference between laparoscopic group and laparotomy group in incidence of operative complications (10.66% vs. 10.55%, P>0.05). The age, preoperative concomitant diseases and extent of lymph node metastasis of the patients, operative time, and surgeon experience were associated with the operative complications of laparoscopic gastric cancer surgery (all P<0.05). Conclusion: The occurrence of surgical complications in laparoscopic gastric cancer is associated with multiple factors. So it is necessary to pay attention to these factors and then according to the individual’s condition to design prevention and intervention strategies.

Abstract:

Objective: To investigate the relations of the change in body mass index (BMI) with the nutrition status and prognosis in elderly patients with gastric cancer. Methods: One-hundred and sixteen elderly patients (≥65 years of age) with gastric cancer were included. The BMI variation of the patients during the past one year before admission was calculated, their prognostic nutritional index (PNI) was calculated from the albumin value and total lymphocyte count, and then the association between BMI variation and PNI was analyzed using Pearson correlation analysis. The relations of BMI variation with the prognosis of the patients was evaluated through the ROC curve estimation, survival analysis and Cox regression model. Results: In these 116 elderly gastric cancer patients, the mean variation (reduction) value of BMI was (2.67± 2.11) kg/m2 and PNI was 44.18±9.31, and there was a significantly negative correlation between them (r=–0.87, P=0.003). The sensitivity and specificity of variation value of BMI for death prediction was 72.73% and 73.34% respectively, with a cutoff value of 3.36 kg/m2. The patients were divided into high BMI variation value group (value of BMI reduction≥3.36 kg/m2) and low BMI variation value group (value of BMI reduction<3.36 kg/m2) according to the cutoff value. The results from comparison between the two groups showed that variables that included PNI, degree of differentiation, tumor size, depth of invasion, lymph node metastasis, TNM stage, and degree of radical resection between two groups had statistical difference (all P<0.05); the survival rate in high BMI variation value group was significantly lower than that in low BMI variation value group (P<0.05); variation value of BMI was independent factor affecting the prognosis of elderly gastric cancer patients (HR=1.72, 95% CI=1.31–2.26, P=0.002). Conclusion: BMI variation can well reflect the inflammation-nutritional status of the elderly gastric cancer patients, and those with significant BMI reduction may face a poor prognosis.

Abstract:Objective: To investigate the visfatin expression in gastric cancer and its significance as well as its relation with p53. Methods: The expressions of visfatin and mutant p53 in 68 tissue specimens of gastric cancer and their adjacent normal gastric mucosa were examined by immunohistochemical staining, the relations of visfatin expression with the clinicopathologic factors and p53 expression were analyzed, and the influences of visfatin and p53 expression on the survival of the patients were also analyzed. The visfatin expression in different human gastric cell lines and normal gastric mucosal cells was detected by immunofluorescent assay and Western blot analysis respectively, and the alterations in proliferation and colony-forming ability as well as p53 expression were determined in gastric cancer cells after exposure to the visfatin specific inhibitor FK886. Results: The positive expression rate of either visfatin or p53 expression in gastric cancer tissue was significantly higher than that in normal gastric mucosa (both P<0.05), and both expressions were significantly associated with invasion depth, lymph node metastasis and TNM stage (all P<0.05), moreover, there was a significant positive correlation between visfatin and p53 expressions in gastric cancer tissue (r=0.404, P=0.001); the median survival time in patients with visfatin or p53 positive expression was significantly shortened compared with those with their opposite condition (both P<0.05), and the combination analysis of visfatin and p53 showed that the median survival time decreased in a descending order in patients with both negative expression, one of the two positive expression and both positive expression (χ2=15.83, P=0.000). Both results from immunofluorescence and Western blot showed that the visfatin expression levels in all studied gastric cell lines were significantly higher than that in normal gastric mucosal cells with varying degrees (all P<0.05), which was highest in BGC823 cells; after FK866 treatment, the proliferation and colony-forming ability were significantly decreased, and p53 protein expression was significantly up-regulated in BGC823 cells (all P<0.05). Conclusion: The visfatin expression is increased in gastric cancer tissue, which may synergistically interact with p53 to contribute to the progression of gastric cancer.

Abstract:Objective: To investigate thrombospondin 2 (THBS2) expression in gastric cancer tissue and its relations with the angiogenesis and prognosis of gastric cancer. Methods: Using tissue microarray and immunohistochemical technology, the expressions of THBS2, VEGF, MMP-2 and MMP-9, and the CD34-labeled microvessel density (MVD) in 120 specimens of gastric cancer tissue and 36 specimens of tumor adjacent normal gastric mucosal tissue were detected. In addition, the THBS2 expression in the tumor tissues from 40 gastric cancer patients with the overall survival time ≥10 years (long survival group) and 30 gastric cancer patients with the overall survival time ≤3years (short survival group) was determined by the same method, and the THBS2 expression difference between the two groups was compared. Results: In gastric cancer tissue, the positive THBS2 expression rate was significantly lower while the positive expression rate of VEGF, MMP-2 and MMP -9 and the MVD value were significantly higher than those in normal mucosal tissue (all P<0.05). The MVD value in gastric cancer tissues with positive THBS2 expression was significantly lower than those with negative THBS2 expression, which in gastric tissues with positive VEGF expression was significantly higher than in those with negative VEGF expression (both P<0.05). THBS2 expression had negative correlation with the expressions of VEGF, MMP-2 and MMP-9 in gastric cancer tissues (r=–0.574, –0.447, and –0.599, all P<0.01). The positive THBS2 expression rate in gastric cancer tissues in long survival group was significantly higher than that in gastric cancer tissues in short survival group (P<0.05). Conclusion: THBS2 expression is down-regulated in gastric cancer tissue, which may affect the angiogenesis and prognosis of gastric cancer through promoting the expressions of VEGF, MMP-9 and MMP-2.

Abstract:Objective: To investigate the expression of miR-150 and miR-134 in colorectal cancer and colorectal adenoma and evaluate the significance. Methods: The miR-150 and miR-134 expressions in 40 tissue specimens of colorectal cancer along with their adjacent normal mucosa and 29 tissue specimens of colorectal adenoma were determined by real-time quantitative reverse transcription-PCR (qRT-PCR). Results: Compared with normal mucosal tissue, the miR-150 expression was significantly increased in colorectal adenoma, while was significantly decreased in colorectal cancer (both P<0.05); the miR-134 expression was significantly decreased in colorectal adenoma (P<0.05), but showed no obvious difference in colorectal cancer (P>0.05). The miR-150 expression level was significantly related to the histological type and degree of differentiation of colorectal cancer (P=0.033, P=0.041), while the miR-150 expression level was irrelevant to any of the clinicopathologic factors of colorectal cancer (all P>0.05). Conclusion: miR-150 expression is down-regulated in colorectal cancer, suggesting that miR-150 may probably have a potential anti-tumor activity; both miR-150 and miR-134 expression are abnormal in colorectal adenoma, suggesting that they may be closely related to the occurrence of colorectal adenoma.

Abstract:Objective: To investigate the expressions of HSP27 and claudin-10 in colorectal carcinoma (CRC) and the clinical significance. Methods: The expressions of HSP27 and claudin-10 in 50 specimens of CRC tissue, 25 specimens of colorectal adenoma (CRA) tissue, and 50 specimens of normal colorectal mucosal tissue were determined by immunohistochemical staining. The relationship between HSP27 and claudin-10 expressions in CRC, and the relations of HSP27 and claudin-10 expressions with clinicopathological factors and prognosis of the CRC patients were analyzed. Results: In CRC, CRA and normal colorectal mucosal tissue, the positive expression rate of HSP27 was 54%, 20% and 16% respectively, with statistical significance (P<0.001), and the positive expression rate of claudin-10 was 72%, 56% and 54% respectively, with no statistical difference (P>0.05). There was a positive correlation between HSP27 and claudin-10 expressions in CRC tissue (r=0.318, P=0.024). Univariate analysis showed that positive HSP27 expression was associated with lymph node metastasis (P<0.05), and the positive claudin-10 expression was related to tumor diameter, invasion depth and lymph node metastasis (all P<0.05). Survival analysis showed that the mean survival time in CRC patients with positive HSP27 or claudin-10 expression was significantly shorter than in those with its negative expression (both P<0.05). Multivariate analysis showed that the HSP27 and claudin-10 expressions together with lymph node metastasis were the independent risk factors for the prognosis of the CRC patients. Conclusion: HSP27 expression is up-regulated in CRC tissue, which may probably be synergistic with claudin-10 to exert important effect on lymph node metastasis in CRC.

Abstract:Objective: To investigate the golgi phosphoprotein 3 (GOLPH3) expression in colorectal cancer tissues and its relation with prognosis of colorectal cancer. Methods: The GOLPH3 along with the c-Myc and P27 expressions in 123 specimens of colorectal cancer were determined by immunohistochemical staining, and the relations of GOLPH3 expression with the clinicopathologic features, the c-Myc and P27 expressions and the prognosis of the patients were analyzed. Results: The positive expression rate of GOLPH3 in these colorectal cancer tissues was 60.2% (74/123). The positive GOLPH3 expression was significantly related to tumor invasion depth, TMN stage, lymph metastasis and distant metastasis as well as c-Myc expression (all P<0.05), but irrelevant to sex, age, tumor size, differentiation, CEA level and P27 expression (all P>0.05). The GOLPH3 expression was positively correlated with c-Myc expression in colorectal tissue (r=0.263, P<0.05). The 5-year overall survival rate was 56.9% for the entire group of patients, was 48.6% for patients with positive GOLPH3 expression and 69.4% for those with negative GOLPH3 expression. Univariate survival analysis showed that the survival rate in patients with positive GOLPH3 expression was significantly lower than that in patients with negative GOLPH3 expression (P<0.05). Conclusion: GOLPH3 expression may have a synergistic action with c-Myc in colorectal cancer and those with positive GOLPH3 expression may face an unfavorable prognosis.

Abstract:Objective: To investigate the expressions of miRNA-21, miRNA-135b and miRNA-141 in colon cancer and their significance. Methods: The expressions of the three miRNAs in colon cancer tissues and their adjacent normal colonic mucosal tissues, as well as in the plasma of colon cancer patients and healthy controls were determined by fluorescent real-time quantitative PCR. The relations of the three miRNAs with clinicopathologic factors of colon cancer patients were analyzed. Results: The expression levels of the three miRNAs in colon cancer tissue were all significantly higher than those in adjacent colonic mucosal tissue, and in plasma of colon cancer patients were all significantly higher than those in plasma of healthy controls (all P<0.05). In colon cancer patients, the miR-21 expression level was significantly related to TNM stage and invasion depth, the miR-135b expression level was significantly associated with TNM stage and lymph node metastasis, and the miR-141 expression level was significantly linked to TNM stage, invasion depth and lymph node metastasis (all P<0.05). The miRNA21 showed no obvious correlation between its expression level in colon cancer tissue and plasma of the colon cancer patients (r=0.459, P=0.072), but either miRNA135b or miRNA-141 had a positive correlation between its expression level in colon cancer tissue and plasma of the colon cancer patients (r=0.686, P=0.042; r=0.742, P=0.026). Conclusion: The expressions of miRNA-21, miRNA-135b and miRNA-141 are all up-regulated in colon cancer patients, and they may be closely related to the recurrence and development of this cancer, as well as could be potential tumor markers or therapeutic targets.

Abstract:Objective: To investigate the effect of microRNA-139-5p (miR-139-5p) expression in colorectal cancer and its influence on migration and invasion ability of colorectal cancer cells. Methods: The expression alteration of miR-139-5p in colorectal cancer tissue and different colorectal cancer cell lines were detected by using fluorescent quantitative PCR. The influence of miR-139-5p transfection or miR-139-5p inhibitor treatment on migration and invasion ability of colorectal cancer cells were detected by Boyden chamber assay and wound healing assay. The target gene of miR-139-5p was predicted by bioinformatics analysis and was identified by luciferase reporter assay, and then the influence of miR-139-5p transfection on its target gene expression was determined by Western blot analysis. Results: The miR-139-5p mRNA expressions in both colorectal cancer tissue and colorectal cancer cell lines were significantly decreased compared with corresponding control (all P<0.05). The migration and invasion ability in colorectal cancer DLD1 and HCT116 cells were significantly decreased after miR-139-5p transfection and were significantly increased after miR-139-5p inhibitor treatment (all P<0.05). Bioinformatics analysis showed that Notch1 was the potential target gene of miR-139-5p which was then identified by luciferase reporter assay. Western blot results showed that Notch1 protein expressions in DLD1 and HCT116 cells were significantly down-regulated after miR-139-5p transfection (both P<0.05). Conclusion: MiR-139-5p may inhibit the migration and invasion of cancer cells through regulating its target gene Notch1, so the down-regulated miR-139-5p may play an important role in the occurrence and development colorectal cancer.

Abstract:Objective: To investigate the therapeutic effect of integrin receptor antagonist cilengitide on intestinal fibrosis in rats. Methods: Twenty-one SD rats were equally randomized into control group, model group and cilengitide treatment group, Intestinal fibrosis model was induced in rats in the latter two groups by continuous intracolonically injection with increasing doses of trinitrobenzene sulfonic acid (TNBS) in 45% ethanol solution for 6 weeks, and rats in cilengitide treatment group simultaneously received daily intraperitoneal injection of cilengitide, while those in the other two groups were given normal saline of the same volume in the same administration manner. During the experimental period, the general conditions were observed and the changes in body weight were recorded in each group of rats. The rat colonic tissue specimens were harvested after 6 weeks, the intestinal inflammation and collagen deposition were examined and the levels of TGF-β1, collagen type Iα1 mRNA and collagen type I protein in colonic tissues were measured. Results: Except for control group, rats in the other two groups showed poor general conditions and an initial decrease and subsequent increase in body weight, but the general conditions in rats in cilengitide treatment group were better than those in model group, and the amplitude of later body weight gain in rats in cilengitide treatment group was significantly greater than that in model group (P<0.05); rats in these two groups had evident chronic inflammation and deposition of collagen fibers in the colonic tissues, but the histopathological score and collagen fiber content in cilengitide treatment group were significantly lower than those in model group (both P<0.05). Compared with control group, the colonic levels of total TGF-β1 and activated TGF-β1, and levels of collagen type Iα1 mRNA and collagen type I protein were significantly increased in rats in the other two groups, but the levels of activated TGF-β1, collagen type Iα1 mRNA and collagen type I protein in cilengitide treatment group were significantly lower than those in model group (all P<0.05). Conclusion: Cilengitide can attenuate intestinal fibrosis through inhibiting TGF-β1 activation resulting from its integrin receptor antagonizing effect.

Abstract:

Objective: To investigate the efficacy of different nutritional support regimens used during hyperthermic intraperitoneal chemoperfusion (HIPEC) for patients with advanced gastric cancer and malignant ascites. Methods: Forty eligible patients were randomly designated to parenteral nutrition group (PN group) and parenteral nutrition plus enteral nutrition group (PN+EN group), with 20 cases in each group. Patients in PN group underwent HIPEC with simultaneous PN support and those in PN+EN group underwent HIPEC with simultaneous PN+EN support. The alterations in nutritional and immunological parameters before and after treatment, incidence of adverse reactions, time to gastrointestinal function recovery, length of hospital stay and treatment-related costs between the two groups were compared. Results: The nutritional and immunological parameters showed no significant difference between the two groups before treatment (all P>0.05). In both groups, the nutritional and immunological parameters were decreased at 4 and 7 d after treatment compared with the values before treatment, some of which showed a recovery trend in 7 d. The alteration levels in each nutritional parameter showed no obvious difference between the two groups (all P>0.05), but the recovery levels in all immunological parameters at 7 d after treatment in PN+EN group were significantly better than those in PN group (all P<0.05). Further, the time to bowel function recovery and length of hospital stay were shortened, and the treatment-related cost was reduced in PN+EN group compared with PN group (all P<0.05). No statistical difference was observed in incidence of adverse reactions between the two groups (P>0.05). Conclusion: During HIPEC for patients with advanced gastric cancer and malignant ascites, the PN plus EN support can help improve the immune function and promote the gastrointestinal recovery of the patients, and save medical cost.

Abstract:

Objective: To assess the clinical value of transanal drainage in treatment of anastomotic leakage after anus-preserving resection for mid/lower rectal cancer. Methods: The clinical data of 21 patients developing anastomotic leakage after anus-preserving resection for mid/lower rectal cancer from January 2010 to October 2013 were retrospectively analyzed. Of the patients, 9 cases received transanal drainage (observational group), and 12 cases underwent abdominal drainage tube irrigation only (control group), and the associated clinical parameters were compared between the two groups. Results: All patients in the two groups recovered and were discharged from the hospital. None of the patients in observational group required a colostomy, but 2 cases in control group underwent colostomy attributed to conservative treatment failure, however, the difference did not reach a statistical significance (P=0.122). The difference in total length of hospital stay between the two groups had no statistical significance (P=0.061), but the length of post-fistula hospital stay and hospitalization cost in observational group were lower than those in control group, and the differences had statistical significance (P=0.012, P=0.031). Follow-up was conducted for 2 months to 3 years, and no statistical difference was noted between the two groups in incidence of postoperative symptoms such as constipation, diarrhea, anal discomfort (P=0.066). Conclusion: Transanal drainage can be used as an important method for treatment of anastomotic leakage after anus-preserving resection for mid/lower rectal cancer, which has the advantages of shortening the length of post-fistula hospital stay, reducing hospitalization cost, and high patients’ acceptance.

Abstract:Objective: To assess the clinical efficacy of complete mesocolic excision (CME) in treatment of colon cancer. Methods: Sixty-two patients with colon cancer were equally designated to two groups, and underwent CME radical resection (CME group) and traditional radical resection (traditional group), respectively. The relevant clinical variable between the two groups were compared. Results: In CME group compared with traditional group, the intraoperative blood loss was significantly reduced (P<0.05), but the differences in operative time, and time to flatus and defecation had no statistical significance (all P>0.05). The distance of either the proximal or distal surgical margin from the tumor showed no statistical difference between the two groups (both P>0.05). The number of resected lymph nodes in stage-III patients in CME group was significantly greater than that in traditional group (P<0.05), but number of positive lymph nodes in stage-III patients did not reach a statistical difference between the two groups (P>0.05). No statistical difference was noted in incidence of complications between the two groups (P>0.05), but the recurrence rate in CME group was significantly lower than that in traditional group (6.45 vs. 22.58, P<0.05). Conclusion: CME radical resection can increase the number of lymph nodes resected without risk of increased complications, and thereby may help improve the prognosis of colon cancer patients.

Abstract:Objective: To compare the incidence of perioperative complications and long-term efficacy between laparoscopic and open surgery in treatment of Crohn’s disease (CD). Methods: The relevant non-randomized controlled trials (nRCTs) were collected by searching several Chinese and English online databases. The studies were screened, data were extracted, and the quality was evaluated according to the Cochrane Reviewers Handbook 5.0, and then Meta-analysis was made by using RevMan 5.2 software. Results: Twenty-three nRCTs were finally included involving 2 101 patients, of whom, 1 006 cases underwent laparoscopic surgery (laparoscopic surgery group) and 1 095 underwent open surgery (open surgery group). Results of Meta-analysis showed that the incidence of perioperative complications was significantly decreased in laparoscopic surgery group compared with open surgery group (RR=0.74, 95% CI=0.6-0.91, P=0.004); in long-term follow-up, the incidence of postoperative incisional hernia in laparoscopic surgery group was significantly lower than that in open surgery group (RR=0.21, 95% CI=0.07-0.68, P=0.009), while the disease recurrence rate and incidence of bowel obstruction had no statistical difference between the two groups (both P>0.05). Conclusion: For CD, laparoscopic surgery is superior to open surgery in reducing perioperative complications and postoperative incisional hernia.

Abstract:Radical gastrectomy with D2 lymph node dissection is a widely performed procedure for resectable advanced stomach cancer, however, its effect is still not satisfactory. With a deeper understanding in the metastasis process of cancer and the embryologic and anatomic aspects of the stomach, en bloc mesogastric excision (EME) proposed in recent years may be of great significance in improving the postoperative prognosis of stomach cancer. In this paper, the authors address the current research and application status of EME.

Abstract:Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the GI tract. Surgical resection remains the only curative treatment for GIST, and is also beneficial for patients with localized resectable recurrent GIST. Gene test is not only important for diagnosis of GIST, but also valuable for estimating the response of GIST to target drug therapy and the prognosis. Here, the authors address the progress in these issues.