Objective: To assess the safety, efficacy and minimal invasiveness of totally laparoscopic distal gastrectomy (TLDG). Methods: The English literature comparing TLDG and laparoscopically assisted distal gastrectomy (LADG) publicly published from January 2007 to August 2013 were searched from several international online databases. After screening for inclusion, data extraction, and quality assessment, Meta-analysis was conducted by the Review Manager 5.2 software. Results: Five studies were finally included, with a total of 849 patients, of whom, 359 cases underwent TLDG and 490 cases were subjected to LADG. Results of Meta-analysis indicated that TLDG, compared with LADG, had decreased intraoperative blood loss, increased number of removed lymph nodes, and shortened length of time to postoperative flatus and first liquid intake (all P<0.05), but showed no significant difference in operative time, length of proximal surgical margin, length of postoperative hospital stay or incidence of complications (all P>0.05). Conclusion: TLDG is safe, effective and minimally invasive in treatment of distal gastric cancer, with no increase of postoperative complications.

Objective: To evaluate the clinical efficacy of laparoscopic total gastrectomy with D2 lymph node dissection in treatment of advanced gastric cancer. Methods: The clinical data of 126 patients with advanced gastric cancer undergoing total gastrectomy with D2 lymph node dissection from January 2005 to December 2011 were retrospectively analyzed. Of the patients, 59 cases received laparoscopic-assisted operation (laparoscopic group) while 67 cases were subjected to open surgery (laparotomy group), and the clinical efficacies between the two groups were compared. Results: The difference in operative time and hospitalization expenses between the two groups had no statistical significance (both P>0.05), but the parameters that included time to bowel function recovery and food intake, length of postoperative hospital stay, intraoperative blood loss, and size of incision in laparoscopic group were superior to those in laparotomy group (all P<0.05). The overall incidence of postoperative complications between the two groups showed no statistical difference (P>0.05), but the incidence of surgery-related complications in laparoscopic group was lower than that in laparotomy group (P<0.05); the length of proximal or distal surgical margin, and number of resected lymph nodes of the two group were similar (all P>0.05), and the difference in 1-, 3-, 5-year overall survival or free tumor survival between the two groups showed no statistical significance (all P>0.05). Conclusion: Laparoscopic total gastrectomy with D2 lymph node dissection for advanced gastric cancer is safe and effective.

Objective: To compare the efficacy between preoperative and postoperative docetaxel-based adjuvant chemotherapy for locally advanced gastric cancer (LAGC). Methods: From February 2011 to February 2012, 72 patients definitely diagnosed with LAGC were randomized into observational group and control group. Patients in observational group underwent preoperative chemotherapy, while those in control group were subjected to postoperative chemotherapy. Patients in both groups were followed up for 12 months after treatment, and the cycles of chemotherapy, surgical resection rate and pathological remission rate, as well as the incidence of adverse reactions and complications between the two groups were compared. Results: In total, 189 cycles of chemotherapy were performed for the two groups, in which observational group accounted for 62.43% (118/189), and control group accounted for 37.57% (71/189); one cycle chemotherapy administration accounted for 4.24% (5/118) in observational group, which was 22.54% (16/71) in control group, and all differences were statistically significant (both P<0.05). The complete response rate was 27.78% (10/36) and partial response rate was 63.89% (23/36) in observational group, which was 8.33% (3/36) and 38.89% (14/36) respectively in control group, and the differences were statistically significant (both P<0.05). The difference in surgical resection rate and lymph node removal between the two groups showed no statistical significance (both P>0.05). The incidence of adverse reactions was significantly lower in observational group than that in control group (P<0.05), while the incidence of complications and re-operation between the two groups had no statistical significance (both P>0.05). Conclusion: Preoperative docetaxel-based adjuvant chemotherapy can significantly improve the therapeutic efficacy for LAGC patients, improve the tolerance of patients to chemotherapy, and reduce adverse reactions.

Objective: To evaluate the feasibility of laparoscopic-assisted intersphincteric resection for ultra-low rectal cancer. Methods: The clinical data of 68 patients undergoing laparoscopic-assisted intersphincteric resection for ultra-low rectal cancer (laparoscopic group) between January 2010 and June 2012, along with 76 patients undergoing open intersphincteric resection for ultra-low rectal cancer (open surgery group) during the same period were retrospectively studied. The clinical parameters and efficacies between the two groups were compared. Results: Operations were successfully performed in all the 144 patients, and no open conversion was required in laparoscopic group. In laparoscopic group compared with open surgery group, the operative time was prolonged [(243.7±40.4) min vs. (150.5±32.1) min], but the intraoperative blood loss [(103.2±10.5) mL vs. (231.6±23.5) mL], number of cases with postoperative incision infection ( 1 vs. 8), time to flatus [(2.5±0.6) d vs. (4.6±0.5) d], and length of hospital stay [(10.5±0.4) d vs. (14.6±0.3) d] were all decreased, and all the differences had statistical significance (all P<0.05); the difference in number of resected lymph nodes, and number of cases who developed anastomotic fistula or intestinal obstruction, as well as the 1-year postoperative survival between the two groups had no statistical significance (all P>0.05). Conclusion: Laparoscopic-assisted intersphincteric resection for ultra-low rectal cancer is safe and efficient, and it also offers advantages such as minimal invasiveness and reduced postoperative incision infection.

Objective: To investigate the relations of pleiotrophin (PTN) expression and its serum level with colorectal cancer. Methods: The PTN mRNA and protein expression in tumor tissue specimens of 46 cases of colorectal cancer and in their adjacent tissue was determined by real-time PCR and Western blot, respectively, and the PTN level in the blood samples from 76 patients with colorectal cancer and 58 subjects undergoing health maintenance examination was measured by ELISA assay. Results: Both the PTN mRNA expression level and PTN protein positive expression rate in colorectal cancer tissue were significantly higher than those in the adjacent normal tissue (both P<0.05), and either the PTN mRNA expression level or PTN positive rate was not associated with age of the patients or histological type of the tumor (all P>0.05), but showed a significantly negative relation with TNM classification (all P<0.05).The serum PTN level in colorectal cancer patients was significantly higher than that in normal subjects (P<0.05). Conclusion: PTN expression is increased in colorectal cancer tissue and serum PTN level may be used as one of the diagnostic tests for colorectal cancer.

Objective: To investigate the clinical efficacy of left lateral hepatic lobectomy combined with choledochoscopic lithotomy for left intrahepatic duct stones. Methods: The clinical data of 52 patients with left intrahepatic duct stones treated from February 2009 to February 2013 were retrospectively analyzed. Of the patients, 27 cases undergoing left lateral hepatic lobectomy plus choledochoscopic lithotomy were taken as observational group, and another 25 cases undergoing left lateral hepatic lobectomy with choledocholithotomy served as control group. The intraoperative blood loss, operative time, postoperative complications and short-term efficacy between the two groups of patients were compared. Results: In observational group and control group, the intraoperative blood loss was (372.73±165.82) mL and (407.80 ± 202.77) mL, operative time was (191.63±38.84) min and (206.83±40.37) min, and incidence of postoperative complications was 11.1% and 16.0%, respectively, and all the differences had no statistical significance (all P>0.05). In observational group, the incidence of postoperative residual stones was lower and the excellent or good rate of treatment was higher than that in control group (3.70% vs. 20.0%; 92.59% vs. 80.0%), and the differences reached statistical significance (both P<0.05). Conclusion: Left lateral hepatic lobectomy plus choledochoscopic lithotomy for left intrahepatic duct stones is safe and effective, so it is appropriate for clinical use.