Abstract:

Laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is different from conventional open hernia repair because of its unique surgical visual field and anatomical plane. Through personal experience with thousands of cases of laparoscopic inguinal herniorrhaphy, the authors extracted seven main essentials in TAPP approach and abbreviated them as “seven-step maneuver”. The “seven-step maneuver” is helpful for shortening surgery learning curve by fixing the surgery scenarios and simplifying the operation. It is recommended to be used in clinical practice.

Abstract:Objective: To investigate the feasibility and efficacy of single-port laparoscopic high hernia sac ligation with assistance of a self-made thread- attached puncturing needle in treatment of inguinal hernia in children. Methods: The clinical data of 47 pediatric patients with inguinal hernia treated during January 2012 to November 2014 were retrospectively analyzed. Of the patients, 23 cases underwent single-port laparoscopic high hernia sac ligation assisted by self-made thread- attached puncturing needle (laparoscopic group), with general anesthesia; 24 cases were subjected to conventional open hernia sac ligation (open surgery group), with continuous epidural anesthesia. The main clinical variables between the two groups of patients were compared. Results: All laparoscopic procedures were successfully performed, without any conversion to open surgery. In laparoscopic group compared with open surgery group, the operative time was shortened (8.26 min vs. 36.54 min), intraoperative blood loss was decreased (0.63 mL vs. 4.15 mL), length of postoperative hospital stay was reduced (1.39 d vs. 3.75 d), while the hospitalization cost was increased (6 682.18 yuan vs. 4 385.93 yuan), and all the difference had a statistical significance (all P<0.05). Postoperative complications occurred in none of the cases in laparoscopic group, but in 5 cases in open surgery group, which included scrotal hematoma in 3 cases and subcutaneous hematoma in 2 cases, and the overall incidence of postoperative complications had a statistical difference between the two groups (0 vs. 20.8%, P<0.05). No recurrence was found in either of the groups during follow-up period. Conclusion: Single-port laparoscopic high hernia sac ligation assisted by self-made thread- attached puncturing needle in treatment of pediatric inguinal hernia is safe and effective, with the advantages of minimal invasion, no visible scar and less complications.

Abstract:Objective: To evaluate the clinical efficacy and safety of prophylactic ilioinguinal neurectomy in open tension-free inguinal hernia repair. Methods: The randomized controlled trials estimating the clinical significance of prophylactic ilioinguinal neurectomy publically published before March 2017 were searched in several national and international databases. A meta-analysis was performed on the extracted data. Results: A total of 13 studies were included, involving 2 033 patients with 1 007 cases in nerve excision group and 1 026 cases in nerve preservation group. In nerve excision group compared nerve preservation group, the short- and mid-term postoperative pain (SMD=–0.54, 95% CI=–0.85––0.23; SMD=–0.25, 95% CI=–0.40––0.10) were significantly reduced (both P<0.05), but the long-term postoperative pain (SMD=–0.21, 95% CI=–0.47–0.05) showed no significant difference (P>0.05); all the short-, mid- and long-term rates of postoperative numbness (RD=0.00, 95% CI=–0.06 0.07; RD=0.01, 95% CI=–0.03 0.06; RD=0.00, 95% CI=–0.03–0.02) and sensory disturbance (RD=0.05, 95% CI=–0.03–0.12; RD=0.02, 95% CI=–0.02–0.06; RD=0.01, 95% CI=–0.02–0.04) showed no significant difference (all P>0.05); the incidence of minor postoperative complications (RR=0.71, 95% CI=0.48–1.06) also showed no significant difference (P>0.05). Conclusion: Prophylactic ilioinguinal neurectomy in open inguinal hernia repair can effectively reduce the short- and mid-term pain, with no increase of risk of abnormal sensations in the inguinal area.

Abstract:Objective: To investigate the clinical effect of laparoscopic minimally invasive surgery in treatment of incarcerated inguinal hernia in elderly patients. Methods: The clinical data of 132 elderly patients with incarcerated inguinal hernia treated in March 2014 to March 2016 were retrospectively analyzed. Of the patients, 66 cases underwent laparoscopic minimally invasive surgery (laparoscopic group), and the other 66 cases underwent traditional open tension-free hernia repair (traditional group). The main clinical variables between the two groups of patients were compared. Results: The preoperative general data and laboratory parameters showed no significant difference between the two groups (all P>0.05). In laparoscopic group compared with traditional group, the hospitalization cost was significantly increased (P<0.05) and the operative time showed no significant difference (P>0.05), but the variables that included intraoperative blood loss, number of pain sufferers, time to ambulation and length of hospital stay were all significantly superior (all P<0.05). The white blood cell count and levels of inflammatory mediators in both groups of patients were significantly increased at 24-h after operation compared with their preoperative values (all P<0.05), but the increasing amplitudes were significantly evident in laparoscopic group (caused by foreign objects such as patch and mesh-plug). The overall incidence of complications and recurrence rate in laparoscopic group were significantly lower than those in traditional group (4.55% vs. 15.15%; 4.55% vs. 18.18%, both P<0.05). Conclusion: Laparoscopic minimally invasive surgery is safe and effective in treatment of incarcerated inguinal hernia in elderly patients, with the advantages of minimally invasive, reduced complications and fast postoperative recovery.

Abstract:Objective: To investigate the risk factors for recurrence of oblique inguinal hernias in children after laparoscopic high ligation of the hernia sac. Methods: The clinical data of 306 children with oblique inguinal hernias undergoing laparoscopic high ligation of the hernia sac from January 2013 to January 2016 were collected. The risk factors affecting the postoperative recurrence of the pediatric patients were analyzed. Results: In these 306 patients (401 sides), recurrence occurred in 13 cases, and the recurrence rate was 3.24%. Univariate analysis showed that age, diameter of the deep inguinal ring and ligation thread were significantly associated with recurrence after laparoscopic high ligation of the hernia sac (χ2=6.275, 9.145, and 11.371, P=0.043, 0.010, and 0.001); multivariate Logistic regression analysis revealed that older age, large diameter of the deep inguinal ring and use of absorbable sutures were independent risk factors for recurrence after laparoscopic high ligation of the hernia sac (OR=3.466, 95% CI=1.432–8.389; OR=1.988, 95% CI=1.237–3.194; OR=1.089, 95% CI= 1.015–1.168, all P<0.05). Conclusion: Older age, large diameter of the deep inguinal ring and use of absorbable sutures are the main risk factors for recurrence of oblique inguinal hernias in children after laparoscopic high ligation of the hernia sac. In children with risk factors, the modified laparoscopic procedure should be considered, postoperative monitoring should be enhanced, and use of absorbable suture should be avoided to reduce the recurrence rate.

Abstract:Objective: To investigate the reversal effect of liver X receptor (LXR) agonist GW3965 on oxaliplatin (OXA) resistance in human colon cancer cells and its mechanism. Methods: OXA-resistant human colon cancer HCT116/L-OHP cells were established by stepwise exposure of human colon cancer HCT116 cells to increasing concentrations of OXA. The growth abilities and responses to OXA treatment between HCT116/L-OHP cells and their parent HCT116 cells were compared; the changes in OXA resistance and expressions of autophagy-related protein ATG-5, Beclin-1, p62 and LC3 in HCT-116/L-OHP cells after exposure to GW3965 for 48 h were determined. Results: The OXA-resistant HCT116/L-OHP cells were successfully established, as evidenced by the slightly decreased proliferative ability but significantly increased resistance to OXA in HCT116/L-OHP cells compared with their parent HCT116 cells (IC50: 244.99 μmol/L vs. 10.05 μmol/L, P<0.05), with a resistance index (RI) of 24.45. In HCT116/L-OHP cells after exposure to different concentrations (10, 20 and 30 μmol/L) of GW3965, the IC50 and RI to OXA were significantly decreased (all P<0.05), with a concentration-dependent manner (IC50: 199.49, 114.71 and 87.32 μmol/L; RI: 19.89, 11.40 and 8.69), and the reversal fold for the three concentrations was 1.23, 2.15 and 2.82 respectively; the expression levels of ATG-5 and Beclin-1 protein were significantly decreased, while the expression levels of p62 and LC3-II were significantly increased (all P<0.05), which all showed a concentration-dependent profile. Conclusion: LXR agonist GW3965 can reverse OXA resistance in human colon cancer cells, and the mechanism may be associated with its regulating the expression levels of the autophagy-related proteins.

Abstract:

Objective: To investigation the action and mechanism of macrophage migration inhibition factor (MIF) in drug resistance of colorectal cancer. Methods: The 5-fluorouracil (5-FU)-resistant human colon cancer LoVo/5-FU cells were established by stepwise exposure of human colon cancer LoVo cells to increasing concentrations of 5-FU. The studied parameters included the sensitivity of cells to 5-FU (IC50), MIF protein expression, glucose uptake ability of cells, lactic dehydrogenase (LDH) activity of cells and lactate production from cultured cells supernatant, which were detected by CCK-8 assay, Western blot analysis, 2-NBDG method, microporous assay and kit assay, respectively. The differences in above parameters between LoVo/5-FU cells and their parent LoVo cells were compared, and changes in these parameters in LoVo/5-FU cells before and after MIF interference and overexpression by siRNA and lentivirus transfection, or inhibition of aerobic glycolysis by PFKFB3 inhibitor PFK-15 were examined. Results: The LoVo/5-FU cells were successfully constructed, which showed significantly increased MIF protein expression, IC50 to 5-FU, glucose uptake, LDH activity and lactate production level compared with their parent LoVo cells (all P<0.05). In LoVo/5-FU cells, the IC50 to 5-FU, glucose uptake, LDH activity and lactate production level were significantly decreased after MIF interference by siRNA, while those above parameters were significantly increased after MIF overexpression (all P<0.05). After inhibition of aerobic glycolysis by PFK-15, the IC50 to 5-FU, glucose uptake and lactate production level in LoVo/5-FU cells were significantly decreased (all P<0.05), but the LDH activity showed no significant change (P>0.05), and the same effects were exerted by PFK-15 in LoVo/5-FU cells with MIF overexpression (all P<0.05). Conclusion: MIF enhanced the resistance of LoVo cells to 5-FU by increasing the aerobic glycolysis.

Abstract:Objective: To investigate the miRNA-455-3p expression and its action on proliferation and apoptosis in gastric cancer cells. Methods: The miRNA-455-3p expression levels in normal gastric mucous cell line RGM-1 and five different types of gastric cancer cell lines (AGS, Hs746T, MGC-803, SGC-7901 and BSG-823) were determined by qRT-PCR method. In gastric cancer cells after transfection with miRNA-455-3p mimics, the cell proliferation was measured by CCK8 assay, the apoptosis was assayed by flow cytometry, the expressions of p27 kip1 and p21 were determined by Western blot analysis, and the activities of the caspase enzymes were analyzed by spectrophotometric method, respectively. Results: The miR-455-3p expression levels were significantly decreased in all the five types of gastric cancer cells compared with RGM-1 cells, which was most evident in AGS cells (all P<0.05). in AGS cells after transfection with miR-455-3p mimics, the proliferative ability was decreased, the apoptosis rate was increased, the p27 kip1 protein expression level was up-regulated, and the relative activities of caspase-3 and -9 were increased significantly (all P<0.05), while the p21 protein expression level and caspase-8 activity showed no significant changes (both P>0.05). Conclusion: miRNA-455-3p expression is down-regulated in gastric cancer cells, up-regulating its expression can inhibit proliferation and induce apoptosis in gastric cancer cells and the mechanism may be associated with its increasing p27 kip1 expression and enhancing caspase-3 and -9 activities.

Abstract:Objective: To investigate the efficacy of using band lifting method (lifting the rectal canal with a band) in laparoscopy-assisted anterior resection for mid- and low-rectal cancer. Methods: The clinical data of 73 patients undergoing laparoscopy-assisted anterior resection for mid- and low-rectal cancer (Dixon surgery) from April 2016 to April 2017 in the Department of General Surgery of Anhui Provincial Hospital Affiliated to Anhui Medical University were retrospectively analyzed. Of the patients, 31 cases underwent laparoscopy- assisted Dixon surgery using band lifting method (bowel lifting group) and 42 cases underwent conventional laparoscopy- assisted Dixon surgery (conventional group). The main clinical variables between the two groups of patients were compared. Results: The preoperative data between the two groups of patients were comparable. In bowel lifting group compared with conventional group, no significant difference was found in terms of intraoperative blood loss, number of prophylactic ileostomy, positive rate of rectal balloon expulsion test, time to postoperative gas passage, time to postoperative liquid intake, length of postoperative hospital stay, incidence of anastomotic fistula and overall complications, and postoperative pathology (all P>0.05), while as for other aspects, except the prolonged operative time (192 min vs. 169 min), all the variables that included the median number of laparoscopic stapler cartridge used (1 vs. 2), proportion of anastomotic reinforcement requirement (3.2% vs. 19.0%), division and closure of the intestinal canal (80.6% vs. 28.6%) and medical cost (38 200 yuan vs. 41 300 yuan) were showed significant superiority (all P<0.05). Conclusion: Band lifting is an effective measure for assisting laparoscopy-assisted anterior resection for mid- and low-rectal cancer.

Abstract:Objective: To compare the efficacy of 3D laparoscopic and open radical resection in treatment of obstructive colorectal cancer after transanal endoscopic tube decompression. Methods: The clinical data of 96 patients with obstructive colorectal cancer undergoing surgical treatment from May 2011 to June 2013 were retrospectively analyzed. Of the patients, all cases received transanal endoscopic tube decompression before surgery, and then 50 cases underwent 3D laparoscopic radical resection for colorectal cancer (laparoscopic group) and 46 cases underwent open radical resection for colorectal cancer (open surgery group). The main clinical variables between the two groups of patients were compared. Results: The preoperative data had comparability between the two groups. In laparoscopic group versus open surgery group, the average operative time (5.9 h vs. 5.2 h, P<0.05) was prolonged and overall hospitalization cost (33 000 yuan vs. 27 000 yuan, P<0.05) was increased significantly, but the average time to postoperative gas passage (2.4 d vs. 3.0 d, P<0.05), time to postoperative urethral catheter removal (2.7 d vs. 3.9 d, P<0.05) and length of hospital stay (15.2 d vs. 23.8 d, P<0.05) were all shortened significantly. The incidences of anastomotic leakage, incision infection, intra-abdominal abscess and ileus showed no significant difference between the two groups (all P>0.05). The 3-year disease-free survival rates were not significantly different between the two groups (80.0% vs. 82.6%, P=0.744). Conclusion: For obstructive colorectal cancer after tube decompression, 3D laparoscopic surgery offers fast postoperative recovery and is similar to open surgery in terms of perioperative complications and outcomes. It can be considered as an alternative procedure for obstructive colorectal cancer.

Abstract:Objective: To investigate the application value of combined detection of serum carcinoembryonic antigen (CEA) and carbohydrate antigen CA19-9, CA125, CA724, CA211 and CA242 in diagnosis of gastric cancer peritoneal metastasis. Methods: The values of tumor markers in 89 gastric cancer patients treated in the Affiliated Xinhua Hospital, School of Medicine, Shanghai Jiaotong University from December 2015 to December 2016 were collected. Of the patients, 17 cases had peritoneal metastasis (metastasis group) and 72 cases did not have peritoneal metastasis (non-metastasis group). The diagnostic efficiencies of the single and combined detection of these tumor markers were evaluated through establishing Logistic regression model, drawing ROC curves and calculating the areas under the curve (AUC). Results: The positive detection rates of CA125, CA211 and CA724 in metastasis group were significantly higher than those in non-metastasis group (all P<0.05), while the positive detection rates of the other three tumor markers showed no significant difference between the two groups (all P>0.05). In single detection, the AUC of CA125 for diagnosis of gastric cancer peritoneal metastasis was biggest, which was significantly different from the other five tumor markers (all P<0.05); the AUC of combined detection of CA125, CA724 and CA211 or combined detection of the six tumor markers was significantly greater than that of any single detection (all P<0.05), but the AUC showed no significant difference between them (0.964 vs. 0.949, P=0.866). Conclusion: CA125 can be as a predictor for peritoneal metastasis of gastric cancer, and its detection in combination with CA724, CA125 and CA211 can provide effective information for clinical identification of gastric cancer peritoneal metastasis, but has no significant value in combination with other tumor markers.

Abstract:Objective: To investigate the grades of Clavien-Dindo classification of complications after minimally invasive surgery for gastric cancer and the influential factors. Methods: The clinical data of 332 patients undergoing laparoscopy gastrectomy from January 2006 to March 2016 were retrospectively analyzed. The postoperative complications were assessed by Clavien-Dindo classification, and the influential factors for postoperative complications were analyzed. Results: In the 332 patients, postoperative complications occurred in 48 cases (14.5%), of whom, the Clavien-Dindo classification of complications was classified as grade I in 1 case (2.1%), grade II in 36 cases (75.0%), grade IIIa in 3 cases (6.3%), grade IIIb in 7 cases (14.6%) and grade IVa in 1 case (2.1%). The complications included anastomotic fistula in 19 cases (39.6%), intestinal obstruction in 6 cases (12.5%), intraperitoneal infection in 6 cases (12.5%), anastomotic hemorrhage in 5 cases (10.4%), intraperitoneal hemorrhage in 4 cases (8.3%), delayed gastric emptying in 4 cases (8.3%), duodenal stump fistula in 3 cases (6.3%), anastomotic stenosis in 3 cases (6.3%), lymphatic fistula in 2 cases (4.2%) and wound infection in 1 case (2.1%); some patients had multiple complications. Results of multivariate logistic regression analysis showed that BMI equal to or greater than 24.0 kg/m2, concomitant underlying diseases, Billroth II anastomosis and Roux-en-Y gastro- or esophago-jejunostomy were independent risk factors for postoperative complications (all P<0.05); the grades of Clavien-Dindo classification were significantly different between patients with different BMI, with or without underlying diseases and with different anastomosis methods (all P<0.05). Conclusion: In patients undergoing laparoscopy gastrectomy, the majority of postoperative complications belong to grade II of Clavien-Dindo classification and anastomotic fistula is the most common one. BMI, concomitant underlying diseases and anastomosis methods are independent factors for postoperative complications.

Abstract:Objective: To investigate the risk factors for bleeding after endoscopic submucosal dissection (ESD) in treatment of gastric gastrointestinal stromal tumor (GIST). Methods: The clinical data of 124 patients with gastric GIST undergoing ESD from February 2011 to May 2017 in Renmin Hospital of Wuhan University were retrospectively analyzed. The risk factors for hemorrhage after ESD for gastric GIST were determined by univariate and multivariate unconditional logistic regression analysis. Results: Of the 124 patients enrolled, postoperative bleeding occurred in 10 cases (8.06%). Results of the univariate logistic regression analysis showed that histories of liver cirrhosis, coronary heart disease, old brain infarcts and atrial fibrillation were significantly associated with bleeding after ESD for gastric GIST (all OR>1, P<0.05); further multivariate logistic regression analysis revealed that histories of liver cirrhosis, coronary heart disease, old brain infarcts and atrial fibrillation were independent risk factors for bleeding after ESD for gastric GIST (all OR>1, P<0.05). Conclusion: The histories of liver cirrhosis, coronary heart disease, old brain infarcts and atrial fibrillation are risk factors for bleeding after ESD for gastric GIST. Therefore, the preoperative assessment should be optimized and the pre- and postoperative management should be enhanced in patients with these risk factors, so as to reduce the incidence of postoperative bleeding.

Abstract:Objective: To investigate the diagnosis, surgical treatment and prognostic factors of primary malignant tumors of the duodenum. Methods: The clinical data of 88 patients with primary malignant duodenal tumors treated during January 2008 to December 2015 were analyzed retrospectively. Results: Of the patients, the tumors in 5 cases located in the duodenal bulb, in 69 cases located in the descending portion, in 9 cases located in the horizontal portion and 5 cases located in the ascending portion, and among them, the tumors in 62 cases located within the duodenal papilla area of descending part, which accounted for 89.86% of those in the descending portion; the tumor types were classified as adenocarcinoma in 56 cases (63.64%), malignant stromal tumor in 20 cases (22.73%), carcinoid tumor in 6 cases (6.82%) and other tumors in 6 cases (6.82%); the histological types were divided into well differentiated in 34 cases (38.63%), moderately differentiated in 28 cases (31.82%), poorly differentiated in 19 cases (21.59%) and undifferentiated in 7 cases (7.95%). Clinical manifestations of the patients included abdominal pain, abdominal distention, jaundice, vomiting and upper gastrointestinal hemorrhage, which showed no specificity. The preoperative correct diagnosis rate by endoscopy, hypotonic duodenograph, ultrasound and CT was 83.54% (66/79), 80.00% (20/25), 30.56% (11/36) and 47.72% (42/88) respectively. Sixty patients underwent pancreaticoduodenectomy, 8 patients received segmental duodenectomy, and 5 cases were subjected to subtotal gastrectomy plus duodenal bulb resection and 15 patients had palliative bypass surgery. The overall 1-, 3-, and 5-year survival rate for the whole group of patients was 82.34%, 54.79%, and 28.98% respectively, and for patients receiving pancreaticoduodenectomy was 100%, 68.12%, 42.04% and for those undergoing segmental duodenectomy was 100%, 61.96% and 0; the postoperative survival time of patients after palliative bypass surgery was 6 to 24 months; the survival rate in patients with duodenal stromal tumors was significantly higher than that in patients with duodenal adenocarcinoma (χ2=7.237, P=0.007). Univariate analysis showed that depth of tumor invasion, tumor differentiation, lymphatic involvement and surgery type were significantly related to the postoperative survival of the patients (all P<0.05); multivariate analysis revealed that depth of tumor invasion, lymphatic involvement and surgery type were independent factors for the prognosis of the patients (all P<0.05). Conclusion: Primary malignant duodenal tumors frequently occur in peripapilla area of descending duodenum and mainly are adenocarcinoma, for which, duodenoscopy and hypotonic duodenograph are the major diagnostic methods, and pancreaticoduodenectomy is the first choice of treatment.

Abstract:Objective: To compare the short-term efficacy of totally laparoscopic gastrectomy (TLG) and laparoscopy-assisted gastrectomy (LAG). Methods: The data of 435 patients with gastric cancer treated in the Department of Gastrointestinal Surgery of the Second Affiliated Hospital, Nanchang University from May 2013 to May 2016 were collected. Of the patients, 207 cases underwent TLG (TLG group), and 228 cases underwent LAG (LAG group). The main clinical variables between the two groups of patients were compared. Results: The preoperative data between the two groups of patients were comparable, and operations were successfully performed in all cases without any open conversion. In TLG group compared with LAG group, the number of resected lymph nodes showed significant difference (23.64 vs. 24.69, P=0.14), while the operative time (204.34 min vs. 214.65 min), anastomosis time (33.00 min vs. 38.86 min), intraoperative blood loss (185.20 mL vs. 210.02 mL), and the incision length (3.88 cm vs. 8.05 cm), time to postoperative ambulation (1.71 d vs. 2.59 d), time to first gas passage (2.63 d vs. 3.51 d), the first and third day postoperative pain score (3.01 vs. 4.86; 1.88 vs. 3.53), and length of postoperative hospital stay (12.23 d vs. 15.96 d ) were all significantly reduced (all P<0.05). There were no significant differences in incidence of postoperative complications (2.4% vs. 2.6%, P=0.89) and median survival time during a 12-month follow-up (11.07 months vs. 10.91 months). Conclusion: TLG is safe and effective, and its short-term efficacy in superior to that of LAG.

Abstract:Objective: To investigate the difference in intra- and postoperative situations between totally laparoscopic and open radical gastrectomy, and the influential factors for complications. Methods: The clinical data of 330 gastric cancer patients undergoing radical gastrectomy from January 2014 to January 2017 were retrospectively analyzed. Of the patients, 150 cases underwent totally laparoscopic surgery (laparoscopic surgery group), and the other 180 cases underwent open surgery (open surgery group). The main clinical variables and complications were compared between the two groups of patients, and the influential factors for complications were analyzed. Results: The preoperative data were comparable between the two groups of patients. In laparoscopic surgery group compared with open surgery group, the operative time was prolonged, but the intraoperative blood loss, time for bowel function recovery and length of hospital stay were all significantly reduced (all P<0.05); the number of lymph node resection showed no significant difference (P>0.05). The overall incidence of postoperative complications in laparoscopic surgery group was significantly lower than that in open surgery group (8.67% vs. 32.22%, P<0.05), which was mainly responsible for the significantly reduced incidence of surgical complications such as intestinal obstruction, intra-abdominal hemorrhage, and incision infection (6.67% vs. 31.66%, P<0.05), but not for the incidence of non-surgical complications that showed no significant difference between the two groups (13.32% vs. 8.34%, P>0.05). Univariate analysis showed that age, BMI, operative time, preoperative levels of serum protein and hemoglobin, tumor size, lymph node metastasis and preoperative concomitant diseases were influential factors for the occurrence of complications (all P<0.05). Conclusion: Totally laparoscopic radical gastrectomy has the advantages of minor trauma and quick postoperative recovery, and also has better control of the overall complications than open surgery. So it is recommended to be used in clinical practice.

Abstract:There are mainly two types of preclinical models available for experimental research of colorectal cancer at present, namely, colorectal cancer cell lines (CCL), and patient-derived tumor xenografts (PDTX). They have many advantages in understanding the pathogenesis of colorectal cancer, but meanwhile inevitably possess some limitations and flaws. The newly developed organoid models not only play significant role in inducing intestinal stem cell differentiation and mimicking intestinal diseases, but also in anti-colorectal cancer drug screening and investigations of cancer signaling pathways, and may become a next-generation preclinical models for cancer research. The organoid models could be supplemented with CCL and PDTX for further improvement of the basic research of colorectal cancer. Here, the authors review the role and progress of organoid models in colorectal cancer research.

Abstract:Pedicled jejunal flap and colon transplantation are two commonly used surgical procedures for esophageal reconstruction in esophageal cancer patients with a history of gastrectomy or esophagogastrectomy. Although the choice proportions of the two approaches are equivalent, the proportion of using pedicled jejunal flap has been gradually increased. The incidences of graft loss and anastomotic leakage are similar between the two procedures, but the mortality rate after colon transplantation seems to be higher than that after jejunal flap transplantation. Therefore, the optimal method for reconstruction is still controversial at present. The authors address the issues of these concerns.

Abstract:

Background: The most common symptoms of upper gastrointestinal (UGI) diseases are epigastric pain and heartburn, nausea and vomiting, regurgitation and dysphagia. Endoscopic examination is the most reliable method for assessing UGI evaluation. Methods: Malignant tumors detected in UGI endoscopies performed between Dec 31, 2015 and Jan 1, 2011 were included in our study. Age, gender, indication for endoscopy, tumor site, tumor type, stage of disease and type of treatment data were recorded. Results: According to the analysis of five-year patient data; 39 (1.17%) of 3,309 cases had malignancy in the UGI endoscopy. The average age of malignancy detected cases were 63.4 years (range, 33–88 years). In the malignancy positive group; 35 (1%) cases had gastric and 4 (0.12%) cases had esophagus tumors. According to the gastric localization of tumors, 12 of cases were distal, 10 were proximal, 7 were middle and 4 were linitis plastica. Two of the cases had previous gastric surgery and the gastric malignancy of these cases was localized at the gastrojejunostomy site. The most frequent symptoms were abdominal pain, anemia, dyspepsia, bleeding, weight loss, obstruction and dysphagia in patients with gastric cancer. Two (5.7%) of the cases had previous gastrectomies because of benign causes. Malignant tumors were detected in the remnant tissue of these cases. The percentage of over 50-year-old patients was 89.7% in UGI malignancy detected patients. Three percent of gastric cancers were stage I, 18% of them were stage II, 25% of them were stage III and 53% of the cases were stage IV. Seventy-five percent of esophageal cancer cases had systemic metastases. Conclusions: Malignity is rarely detected among the patients from general surgery outpatient clinic, on whom UGI endoscopy is performed. But it is not different from the literature. Most of the malignancies are at advanced stage. In older age patients, endoscopy should be recommended even there are nonspecific symptoms. In the presence of alarm symptoms, UGI endoscopy should be recommended without considering the age.