Volume 30,Issue 10,2021 Table of Contents

1 Advances in laparoscopic digestive tract reconstruction for adenocarcinoma of the esophagogastric junction

HE Zirui , ZANG Lu

2021, 30(10):1127-1132. DOI: 10.7659/j.issn.1005-6947.2021.10.001

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Adenocarcinoma of the esophagogastric junction has become one of the malignant tumors of the upper digestive with most rapidly increasing incidence, and it also has a high distant metastasis rate and poor prognosis. Its special tumor location and epithelial origin determine the heterogeneity of its clinical features and different surgical strategies. Thanks to the deepening of functional surgery theory for gastric cancer in recent years, there are more anastomotic options for different tumor sites. Here, the authors, based on personal experience, introduce and discuss the status and progress of different methods of digestive tract reconstruction for different types of esophagogastric junction adenocarcinoma under laparoscopic surgery.

2 Clinical characteristics and prognosis analysis of patients with positive perineural invasion gastric cancer

SUN Mingming , QIAN Leimin , HUANG Jianming

2021, 30(10):1133-1141. DOI: 10.7659/j.issn.1005-6947.2021.10.002

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Background and Aims Perineural invasion (PNI) is one of the biological characteristics of local invasion and metastasis of gastric cancer, but its clinical value has not been paid much attention. The purpose of this study was to investigate clinicopathologic features in gastric cancer with PNI and the influence of PNI on prognosis of gastric cancer patients.Methods The clinicopathologic data of 543 patients with gastric cancer who underwent open radical gastrectomy were retrospectively analyzed. The patients were divided into PNI-positive group and PNI-negative group, and the differences in clinicopathologic variables between the two groups were compared. Propensity score matching was used to equalize the basic variables related to prognosis in the two groups. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard model was used to analyze the risk factors associated with postoperative survival of PNI-positive gastric cancer patients.Results The positive rate of PNI in gastric cancer patients was 21.18% (115/543). Before matching, there were statistically significant differences in terms of tumor size, tumor site, degree of tumor cell differentiation, tumor TNM stage, presence of vascular invasion, surgical resection scope and postoperative adjuvant chemotherapy between the two groups (all P<0.05). After matching, 65 patients were allocated to PNI-positive group and 98 patients allocated to PNI-negative group, and the baseline clinicopathologic data of the two groups were well matched (all P>0.05). The overall survival time (OS) of PNI-positive group was significantly shorter than that of PNI-negative group (median OS: 19 months vs. 49 months, P=0.002); subgroup analysis showed that positive PNI exerted no significant influence on OS in TNM stage I-II patients (P=0.432), but significantly reduced the OS in stage III patients (median OS: 18 months vs. 2 months, P<0.001). In PNI-positive patients, postoperative adjuvant chemotherapy exerted no significant influence on OS in stage I-II patients (P=0.975), but significantly prolonged the OS in stage III patients (median OS: 18 months vs. 2 months, P<0.001). Univariate analysis demonstrated that age (P=0.008), tumor TNM stage (P=0.034), and absence of postoperative adjuvant chemotherapy (P=0.006) were significantly associated with the prognosis of patients with PNI-positive gastric cancer. Multivariable analysis revealed that TNM stage III (HR=2.591, 95% CI=1.291-5.198, P=0.007) and absence of postoperative adjuvant chemotherapy (HR=0.345, 95% CI=0.184-0.649, P=0.001) were independent risk factors for the prognosis of PNI-positive gastric cancer.Conclusion The prognosis of PNI-positive gastric cancer patients is poor than that of PNI-negative ones, which is particularly obvious in those with TNM stage III disease. Aggressive postoperative adjuvant chemotherapy may be helpful for improving the outcomes of these patients.

3 Prognostic value of the systemic immune-inflammation index in patients with gastric cancer: a Meta-analysis

ZHOU Faquan , CHEN Shi , SUN Hongyu , TANG Lijun

2021, 30(10):1142-1150. DOI: 10.7659/j.issn.1005-6947.2021.10.003

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Background and Aims The systemic immune inflammation index (SII) is considered to be a new inflammatory and prognostic mark, but its relationship with the prognosis of gastric cancer patients is still controversial. Therefore, this study was conducted to evaluate the association between SII and the prognosis of gastric cancer patients through systematic review and Meta-analysis, so as to provide evidence-based medical information for clinical decision-making.Methods The cohort studies on the relationship between SII and the prognosis of gastric cancer patients were collected by searching PubMed, EMBASE, web of science and Cochrane library databases. The retrieval time was from the database inception of to July 28, 2020. After the literature screening, data extraction and assessment of bias risk of the included studies by two independent researchers, the data were analyzed by Stata 12.0 software.Results A total of 12 retrospective cohort studies were included, including 7 244 patients. Meta-analysis showed that the overall survival (OS) and disease-free survival (DFS)/recurrence free survival (RFS) were shortened in gastric cancer patients with higher SII value (HR=1.28, 95% CI=1.16-1.41, P<0.001; HR=1.34, 95% CI=1.06-1.70, P=0.013). Subgroup analyses stratified by country, treatment method and sample size all showed that higher SII value was associated with shorter OS (all P<0.05). When the SII value reached or exceeded the cut-off value of 600, the higher SII was associated with shortened OS (HR=1.56, 95% CI=1.34-1.80, P<0.001), but when the SII value was lower than cut-off value of 600, there is no significant association between SII and OS (P>0.05). When the study time was ≥ 6 years, the higher SII value was associated with the shorter OS (HR=1.65, 95% CI=1.21-2.25, P<0.001), but there was no significant association between SII and OS when the study time was less than 6 years (P>0.05). In addition, patients with higher SII value were associated with advanced TNM stage (OR=2.45, 95% CI=1.75-3.44, P<0.001), increased risk of lymph node metastasis (OR=1.72, 95% CI=1.27-2.32, P<0.001), large tumor size (OR=2.45, 95% CI=1.75-3.44, P<0.001), and poor differentiation (OR=2.45，95% CI=1.75-3.44，P<0.001).Conclusion SII value can be used as a prognostic marker for gastric cancer patients, and those with relatively high SII value may face an unfavorable prognosis. However, the above conclusion still needs to be verified by more high-quality studies, due to the limitations in the number and quality of the included studies.

4 Safety analysis of application of intraperitoneal chemotherapy port in NIPS chemotherapy for peritoneal carcinomatosis in gastric cancer

DING Ping'an , YANG Peigang , GUO Honghai , TIAN Yuan , ZHENG Tao , LIU Yang , ZHANG Zhidong , WANG Dong , LI Yong , ZHAO Qun

2021, 30(10):1151-1159. DOI: 10.7659/j.issn.1005-6947.2021.10.004

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Background and Aims The results of clinical practice confirmed that the effect of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) for peritoneal carcinomatosis in patients with gastric cancer is significantly superior to that of traditional lone systemic chemotherapy. In order to carry out the intraperitoneal chemotherapy safely and effectively, the intraperitoneal chemotherapy access port must be properly operated and managed. This study was conducted to explore the complications and preventive measures of intraperitoneal chemotherapy port placement in gastric cancer patients with peritoneal carcinomatosis.Methods The clinical data of gastric cancer patients undergoing an intraperitoneal chemotherapy port placement for NIPS from January 2018 to June 2020 were reviewed, and the complications as well as their causes and treatment measures after intraperitoneal chemotherapy port placement were summarized.Results A total of 1 634 patients underwent laparoscopic exploration combined with cytological examination of abdominal cavity exfoliation, by which, 137 cases (8.38%) were found having peritoneal metastases (P₁CY₁) and 189 cases (11.57%) were found to be positive for abdominal exfoliation cytology (P₀CY₁). All the 326 patients with peritoneal carcinomatosis underwent an intraperitoneal chemotherapy port placement during the operation, and the median time for intraperitoneal chemotherapy after the operation was 11.6 (0.9-26.3) months. In the whole group of patients, complications associated with intraperitoneal chemotherapy port occurred in 57 cases (17.48%), among which, infection (5.21%) and bending or kinking of the catheter (2.15%) were the main complications, followed by catheter displacement (1.84%), port cavity hematoma (1.84%), incision dehiscence (1.53%), subcutaneous masses (1.23%), catheter obstruction (1.23%), catheter rupture (0.61%), fluid extravasation (0.61%), port turnover (0.61%), and port cavity tumor seeding (0.61%). The median interval between the intraperitoneal chemotherapy port placement and the occurrence of complications was 5.4 (0.3-13.4) months. Univariate analysis found that the patient's age, presence of diabetes mellitus, experience of the surgeon, and preoperative anemia or hypoproteinemia were factors for the occurrence of postoperative complications (all P<0.05). Multivariate analysis showed that the surgeons with experience less than 30 cases (OR=8.317, 95% CI=2.023-11.883, P=0.008) was an independent risk factor for postoperative complications in patients with abdominal wall chemotherapy.Conclusion The application of intraperitoneal chemotherapy port in NIPS for peritoneal carcinomatosis of gastric cancer is safe and feasible, but attention should be paid to the associated complications, and corresponding prevention and treatment strategies should be adopted for different complications. A specialized operator with adequate experience is essential for ensuring patients undergoing an intraperitoneal chemotherapy port placement to uneventfully transition through the perioperative period.

5 Effects of enhanced recovery after surgery on tumor cell immunity, inflammatory factors and stress hormones in patients undergoing laparoscopic radical gastrectomy

DAI Chun , TAN Ming , DING Yongbin , HUA Shaolai , MO Guangpei , SHI Juncheng , HOU Feicheng

2021, 30(10):1160-1167. DOI: 10.7659/j.issn.1005-6947.2021.10.005

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Background and Aims It has been proven that enhanced recovery after surgery (ERAS) offers advantages for patients undergoing surgery. However, the effects of ERAS on cellular immune function and stress response at the molecular level in patients undergoing radical gastrectomy are still rarely reported. Therefore, this study was conducted to investigated the effects of ERAS concept and protocol on tumor cell immunity, inflammatory factors and stress hormones in patients undergoing laparoscopic radical gastrectomy.Methods From January 2018 to December 2020, 90 patients with gastric cancer undergoing laparoscopic radical gastrectomy were selected and divided into ERAS group (43 cases) and control group (47 cases). The patients in ERAS group received ERAS perioperative management, while those in control group received the traditional perioperative management. The general clinical data (sex, age, BMI, ASA grade, TNM stage, and tumor size), surgery related variables (surgical procedure, anastomosis method, operative time, intraoperative blood loss, and lymph node dissection), and postoperative variables (time to postoperative ambulation, time to postoperative anal gas passage, length of hospitalization, and postoperative complications) were compared between the two groups. The percentages of positive immunoregulatory cells (CD3⁺CD4⁺T cells, CD3⁺CD8⁺T cells and CD16⁺CD56⁺NK cells), negative immunoregulatory cells [granulocytic myeloid-derived suppressor cells (G-MDSC), monocytic myeloid-derived suppressor cells (M-MDSC) and regulatory T cells (Treg)] and regulatory B cells (Breg) in the peripheral blood at 1 and 7 d after operation, as well as the levels of stress response indexes that included cortisol (COR), adrenocorticotropic hormone (ACTH), epinephrine (EPI) and C-reactive protein (CRP) and the inflammatory factors that included the interleukin-6 (IL-6) before and 24 h after operation were compared between the two groups.Results There was no significant difference in terms of sex, age, BMI, ASA grade, TNM stage, tumor size, surgical procedure, anastomosis method, operative time, intraoperative blood loss and number of lymph node dissection between ERAS group and control group (all P>0.05). Both times to postoperative ambulation and first postoperative anal gas passage in ERAS group were significantly earlier than those in control group (25.01 h vs. 37.01 h, P=0.000; 74.51 h vs. 135.31 h, P=0.000), the length of hospitalization in ERAS group was significantly shorter than that in control group (7.01 d vs. 9.81 d, P=0.000), and the overall incidence rate of postoperative complications in ERAS group was significantly lower than that in control group (9.3% vs. 19.1%, P=0.027). At 1 and 7 d after operation, the percentages of CD3⁺CD4⁺T cells, CD3⁺CD8⁺T cells and CD16⁺CD56⁺NK cells in ERAS group were higher than those in control group, while the percentages of G-MDSC, M-MDSC and Treg cells as well as Breg cells in ERAS group were lower than those in control group (all P<0.05). There was no significant difference in concentrations of COR, ACTH and EPI as well as CRP and IL-6 between ERAS group and control group before operation (all P>0.05), but above parameters were significantly lower in ERAS group than those in control group at 24 h after operation (all P<0.05).Conclusions Using ERAS concept during perioperative period of laparoscopic radical gastrectomy can decrease the interference of surgical trauma on cellular immunity, enhance the positive immune regulation, inhibit negative immune regulation, and reduce the inflammatory and stress responses.

6 Expression and prognostic significance of nuclear transcription factor HMBOX1 in colorectal cancer

HE Chengzhi , QI Wenjing , WANG Hui , DU Tianming , WANG Zhihui , WANG Xiangyang

2021, 30(10):1168-1174. DOI: 10.7659/j.issn.1005-6947.2021.10.006

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Background and Aims Nuclear transcription factor homeobox containing protein 1 (HMBOX1) has different expression patterns in different tumors. And it is closely related to the prognosis of glioma, ovarian cancer, gastric cancer and hepatocellular carcinoma. However, the expression of HMBOX1 and its prognostic significance in colorectal cancer have not been study. Therefore, this study was conducted to investigate the expression of HMBOX1 in colorectal cancer and its relationship with prognosis.Methods The cancer tissue specimens and clinical data of 90 patients who underwent colorectal cancer resection from January 2012 to January 2014 were collected. The expression of HMBOX1 in colorectal cancer tissue was detected by immunohistochemical staining. According to the results of immunohistochemistry, the tissues were divided into high HMBOX1 expression group and low HMBOX1 expression group. The differences in clinicopathologic characteristics and prognosis were analyzed, and the risk factors influencing the postoperative tumor-free survival rate and overall survival rate of colorectal cancer patients were also determined.Results There were 54 (60.0%) cases in high HMBOX1 expression group and 36 (40.0%) cases in low HMBOX1 expression group. The high expression of HMBOX1 was significantly associated with TNM stage, N classification, M classification and histological differentiation (all P<0.05), but irrelevant to age, sex and T classification (all P>0.05). The 1-, 3- and 5-year disease-free survival rates and 1-, 3- and 5-year overall survival rates in high HMBOX1 expression group were all significantly lower than those in low HMBOX1 expression group (all P<0.05). Univariate analysis showed that III-IV stage, N₂, M₁ and high HMBOX1 expression were influencing factors for tumor-free survival rate, and multivariate analysis revealed that III-IV stage, M₁ and high HMBOX1 expression were independent risk factors for tumor-free survival (all P<0.05). Univariate analysis showed that III-IV stage, M₁, poor differentiation and high HMBOX1 expression were influencing factors for overall survival, and multivariate analysis revealed that III-IV stage, low differentiation and high HMBOX1 expression were independent risk factors for overall survival (all P<0.05).Conclusion In colorectal cancer, the expression of HMBOX1 is closely related to the malignant biological properties. It can be used as an index for postoperative prognostic prediction of colorectal cancer patients, and those with high HMBOX1 expression may face a unfavorable prognosis.

7 Noninvasive gastrostomy based on magnetic compression technique: an experimental study in rat models

ZHANG Miaomiao , JI Lin , GAI Jingci , LEI Fengping , LIU Peinan , WANG Yirui , LAN Ting , ZHANG Hanzhi , LI Heng , LU Yi , YAN Xiaopeng

2021, 30(10):1175-1183. DOI: 10.7659/j.issn.1005-6947.2021.10.007

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Background and Aims Gastrostomy is a common operation in general surgery. Traditional gastrostomy has been gradually replaced by endoscopic gastrostomy and X-ray gastrostomy due to the great surgical trauma. However, the implementation process requires the assistance of endoscopic system or X-ray machine, and the procedure is complicated. Based on the assumption of performing a noninvasive gastrostomy by magnetic compression technique, this study was conducted to verify the feasibility and safety of this assumption in rat models using a self-designed and developed magnet device for gastrostomy.Methods According to the anatomical characteristics and size of rat digestive tract, the parent and daughter magnets made from Ndfeb and suitable for rat gastrostomy were designed and produced. The magnitude of the magnetic force between the parent and daughter magnets was tested by electronic universal testing machine. In 10 SD rats, the daughter magnet was inserted into the stomach through mouth after anesthesia and the parent magnet was placed in the left upper abdomen. After the two magnets automatically latched onto each other, the attraction status was confirmed by abdominal X-ray. After operation, the rats were raised in a single cage, the survival status, time of magnet detachment, and complications during magnets retention were observed. The animals were sacrificed 2 weeks after the operation, and the gastrostomy specimens were obtained to observe the formation of the gastrostomy under naked eye and light microscope.Results Both the self-designed and produced parent and daughter magnets were cylindrical shaped and made from N42 sintered Ndfeb, with nickel plating on the surface. The diameter and height of the daughter magnet were 5 mm and 3 mm, and the diameter of the parent magnet were 6 mm and 5 mm, respectively. The mass of the daughter magnet and parent magnet were 0.410 g and 1.035 g respectively. The maximum adhesive force of the parent and daughter magnets was 4.36 N in direct contact, and the magnetic force of the magnets decreased with the increase of displacement. The daughter magnets were successfully inserted into the stomach of all the 10 rats after anesthesia. After the parent magnets were placed in the left upper abdomen of rats, the daughter and parent magnets were rapidly attracted to each other. Abdominal X-ray examination showed that the magnets stuck in right position. All rats survived after operation. During the period of retention of the parent and daughter magnets, there were no accidents such as magnetic displacement and separation of the magnets occurred, and no complications such as digestive tract obstruction and abdominal infection occurred in all experimental animals. The magnets were detached and the gastrostomy channel was established 10 to 13 days after operation. Two weeks after the operation, the adhesion between stomach and abdominal wall around the fistula stoma was firmly healed, and there was no exudation and adhesion in the abdominal cavity. The specimens of the fistula stoma were obtained, naked-eye observation found that the fistula stoma was well formed, and the tissue structure of the fistula was clear under HE and Masson staining and light microscope.Conclusion The magnet device for gastrostomy based on magnetic compression technique is cleverly designed, easy to process and low cost. The establishment of non-invasive gastrostomy in rats by this method is simple, safe and feasible, and the tissues of each layer of the fistula can heal well. The next step is to carry out experiments in large animals that are more similar to human anatomy to verify its feasibility and evaluate the long-term effects of the fistula formation. Clinical trials of this technique are expected in the future after optimization of the design of magnets and the operating procedure.

8 Clinical characteristics of adult Amyand's hernia: a systematic review

XU Zhaohui , QU Hui , REN Yanying , GONG Zezhong , LI Hezhu , ZHANG Fan , CHEN Xin

2021, 30(10):1184-1196. DOI: 10.7659/j.issn.1005-6947.2021.10.008

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Background and Aims Amyand's hernia is a special type of inguinal hernia, and there is currently no uniform treatment standard. This study was conducted to provide a basis for reducing complications of this condition and improving prognosis of the patients by systematically evaluating its clinical characteristics and related surgical strategies.Methods The studies concerning Amyand's hernia in adults published since January 1, 2000 to date were collected by comprehensively searching several domestic and foreign online databases. After literature screening, relevant data extraction, bias assessment and crosschecking by two independent reviewers according to the inclusion and exclusion criteria, a systematic review was performed.Results A total of 141 studies were included involving 184 adult patients with Amyand's hernia, and the most majority of papers was contributed by the authors from China and the highest number of papers was published by the journal of Hernia, respectively. In terms of clinical features, male patients accounted for 91.8%, with a median onset age of 60 years, and the median onset age in women was 69 years; 89.1% of them had a right hernia and 8.9% had a recurrent hernia; a total of 75 patients failed to access the relevant information; the remaining 109 patients consisted of 104 indirect hernias, 4 direct hernias, and 1 saddle hernia; 25.7% of the patients were diagnosed before surgery, and the diagnostic accuracy of ultrasound, CT and their combination were 23.1% (6/26), 75.0% (33/44), and 62.5% (5/8), and one case was diagnosed by enema. With regard to the treatment, 42 patients underwent elective procedures, 122 cases received emergency operation, and 20 cases had no treatment information; 45.6% of cases underwent mesh repair, 50% of cases underwent endogenous repair, and 4.4% of cases did not undergo repair or delayed repair; 80.9% of cases underwent appendectomy and the appendix was preserved in remaining of them; there were Losanoff and Basson type 1 or 2 lesion in 140 cases and type 3 or 4 lesion in 35 cases verified by intraoperative findings, and 12 cases had combined appendix tumors. As for the outcomes, the median length of postoperative hospital stay was 4 d, a total of 125 patients were followed up with a median time of 6 months, and 17 cases had complications (6 cases of pulmonary infection or embolic disease, 5 cases of surgical site infection, 3 cases of seroma, 3 cases of recurrence, 1 case of urinary retention), all of them were emergency surgery patients.Conclusion The adult Amyand's hernia is a rare type of inguinal hernia, which is difficult to distinguish from the incarcerated or strangulated hernia. It usually requires an emergency surgery. The treatment of Amyand's hernia should be individualized based on intraoperative conditions, with the fundamental principle of avoiding the infection of the implanted mesh. Further basic and clinical research on Amyand's hernia should be encouraged for improving the treatment efficacy and the prognosis of the patients.

9 Analysis of clinical diagnosis and treatment of obturator hernia: a report of 5 cases

YANG Yongguang , CHEN Weifeng , DENG Chunmei , CHEN Weice , ZHANG Yi , CHEN Ming , LIN Manzhou

2021, 30(10):1197-1202. DOI: 10.7659/j.issn.1005-6947.2021.10.009

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Background and Aims Obturator hernia is a clinically rare external abdominal hernia, characterized by low preoperative diagnosis rate and high mortality rate. This article was conducted to analyze and summarize the etiology, clinical characteristics and diagnosis and treatment methods of obturator hernia by reviewing the treated cases with obturator hernia, so as to provide reference for diagnosis and treatment of this condition.Methods The clinical data of 5 cases of obturator hernia admitted to the Affiliated Hospital of Guangdong Medical University between January 2011 and January 2021 were retrospectively analyzed.Results Of the 5 cases of obturator hernia (involving 4 patients, in whom one female patient was diagnosed as left and right obturator hernia successively within half a year), one case was male and four cases were females; except for one case with a preoperative diagnosis of right inguinal hernia and an ipsilateral occult obturator hernia was found during operation, the other four cases were first diagnosed with acute mechanical intestinal obstruction. There were 3 cases of left obturator hernia and 2 cases of right obturator hernia; 3 cases underwent pelvic CT examination and obturator hernia was diagnosed before the operation, and 2 cases were identified during operation. Except one case underwent selective operation, the other cases underwent emergency laparotomy. There were 4 cases with small bowel incarceration, in whom one case underwent small bowel resection due to ischemic necrosis after incarceration, and the remaining 3 cases were reintroduced spontaneously or assisted by laparoscopy under intestinal anesthesia. In the repair method, 2 cases were closed by direct suture of obturator orifice with 3-0 Prolene, one case underwent open tension-free repair, and the other 2 cases underwent transabdominal preperitoneal approach (TAPP). After operation, one patient died in the ICU on the second day after surgery due to infectious shock, and the other 4 cases (3 patients) were cured and discharged. All cured patients were followed up after surgery. The follow-up time was 1 to 5 years, with a median time of (3.0±2.2) years. There was no recurrence of obturator hernia during the follow-up period.Conclusion The possibility of obturator hernia should be considered when elderly women have acute mechanical intestinal obstruction of unknown cause. The abdominopelvic CT examination is helpful for preoperative diagnosis. Surgery should be performed as soon as possible after definite diagnosis, and laparoscopic exploration and repair is recommended if the patients' condition allowed.

10 Value of peripheral blood SP-D, SP-A and IL-1β in prediction and severity evaluation of acute lung injury in traumatic enterorrhexis patients after surgery

WANG Qi , GAO Ming , GE Weiwei , SUN Yuansong

2021, 30(10):1203-1211. DOI: 10.7659/j.issn.1005-6947.2021.10.010

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Background and Aims Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) always occurs in patients with traumatic enterorrhexis (TE) after surgery, which is life-threatening. So, selecting the appropriate indicators for early prediction and severity evaluation is of great importance This study was conducted to investigate the value of dynamic detection of surfactant protein-D (SP-D), surfactant protein-A (SP-A) and interleukin-1β (IL-1β) in peripheral blood for early prediction and severity evaluation of ALI/ARDS in TE patients after surgery.Methods The clinical data of 78 TE patients treated from August 2019 to December 2020 were retrospective analyzed. Of the patients, no postoperative lung injury occurred in 52 cases (control group), postoperative ALI occurred in 15 cases (ALI group) and ARDS occurred in 11 cases (ARDS group). The clinical data and the dynamic changes in serum levels of SP-D, SP-A and Il-1β in the three groups of patients were analyzed. The early prediction value and severity evaluation efficiency of each variable for occurrence of ALI/ARDS in TE patients after surgery were determined by receiver operating characteristic (ROC) curve and correlation analysis.Results There were no significant differences in age, sex, BMI, injury factors, injury site, operative time and intraoperative blood loss among the three groups (all P>0.05), while the mechanical ventilation time, procalcitonin (PTC) level, lung injury prediction score (LIPS) and lung injury score (LIS) were successively increased, and the oxygenation index was successively decreased in the order of control group, ALI group and ARDS group, and all differences had statistical significance (all P<0.05), The serum levels of SP-D, SP-A and IL-1β in ALI group before and at 1, 4, 7 d after surgery were successively and continuously increased in the order of control group, ALI group and ARDS group, and except no statistical significance was reached in SP-A level between ALI group and ARDS group at 7 d after surgery (P>0.05), all remaining differences had statistical significance (all P<0.05). ROC curve analysis showed that the area under curve of early prediction by either SP-D, SP-A or IL-1β for the occurrence of ALI/ARDS (0.800, 0.919 and 0.755/0.902, 0.931 and 0.957) was higher than the that of PCT (0.739/0.721) and LIPS score (0.851/0.788), the parallel combined test of the three parameters significantly increased the sensitivity of ALI/ARDS prediction to 0.997 and 0.988, and the series combined test of the three parameters significantly increased the specificity of ALI/ARDS prediction to 0.999 and 0.997. Correlation analysis revealed that SP-D, SP-A and IL-1β were negatively correlated with oxygenation index (r=-0.504, -0.657 and -0.717, all P<0.01) and positively correlated with LIS score (r=0.471, 0.654 and 0.634, all P<0.01).Conclusion All the levels of SP-D, SP-A and IL-1β in peripheral blood have certain value in early predicting the occurrence of ALI/ARDS and evaluating disease severity in TE patients after surgery. Their combined detection has a higher prediction and evaluation accuracy.

11 Prognostic analysis and clinical evaluation of patients with different pathological types of retroperitoneal liposarcoma

HUANG Kun , ZHAO Pingwu , BAI Dou , YANG Xuelan , WANG Jin

2021, 30(10):1212-1228. DOI: 10.7659/j.issn.1005-6947.2021.10.011

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Abstract:
Background and Aims Retroperitoneal liposarcoma is a rare type of soft tissue sarcoma with low incidence, poor prognosis, and limited treatment options. The prognosis of patients with different pathological types is quite different, and there is a lack of large sample clinical research evidence for this group of patients. So, the clinical individualized treatment plan is difficult to establish. The purpose of this study was to explore the prognostic factors for patients with different pathological types of retroperitoneal liposarcoma, and to determine the application values of surgery, radiotherapy and chemotherapy for them.Methods The data of patients with retroperitoneal liposarcoma diagnosed by pathology and with complete follow-up record from 1975 to 2016 were retrieved from the SEER database, and the eligible cases were selected according to the inclusion and exclusion criteria. Using the ICD-O-3 classification, the patients were divided into five types that included well-differentiated liposarcoma, dedifferentiated liposarcoma, myxoid/round cell liposarcoma, pleomorphic liposarcoma and mixed liposarcoma. The differences of cancer-specific survival (CSS) and overall survival (OS) among patients with different pathological types were compared. The influencing factors for CSS and OS of the patients were analyzed.Results A total of 2 296 patients with retroperitoneal liposarcoma were included. Of them, 917 cases were well-differentiated liposarcoma, 847 cases were dedifferentiated liposarcoma, 302 cases were myxoid/round cell liposarcoma, 135 cases were pleomorphic liposarcoma and 95 cases were mixed liposarcoma. The median follow-up was 42 months (IQR: 13~90 months). The estimated 5-year OS were 74.99% (95% CI=71.65-78.01) for well-differentiated liposarcoma, 42.83% (95% CI=38.87-46.73) for dedifferentiated liposarcoma, 50.13% (95% CI=47.02-58.86) for myxoid/round cell liposarcoma, 34.69% (95% CI=26.39-43.11) for pleomorphic liposarcoma, and 57.67% (95% CI=46.43-67.37) for mixed liposarcoma, respectively. Log-rank test showed that difference was statistically significant among them (χ²=211.54, P<0.0001). The estimated 5-year CSS were 87.98% (95% CI=85.23-90.25) for well differentiated liposarcoma, 57.78% (95% CI=50.46-61.85) for dedifferentiated liposarcoma, 64.99% (95% CI=58.64-70.62) for myxoid/round cell liposarcoma, 46.02% (95% CI=36.22-55.25%) for pleomorphic liposarcoma, 67.33% (95% CI=55.71-76.53) for mixed liposarcoma, respectively. Log-rank test showed that the difference was statistically significant among them (χ²=227.92, P<0.000 1). Cox multivariate analysis of different pathological types showed that age was an independent factor affecting the prognosis of patients of all pathological types (all P<0.05). In well-differentiated liposarcoma patients, both radical and non-radical operation improved the OS (radical operation: HR=0.42, 95% CI=0.19-0.92, P=0.031; non-radical operation: HR=0.40, 95% CI=0.18-0.88, P=0.023) and CSS (radical operation: HR=0.32, 95% CI=0.16-0.63, P=0.001; non-radical operation: HR=0.23, 95% CI=0.12-0.44, P=0.001); chemotherapy reduced the OS (HR=2.29, 95% CI=1.54-3.40, P<0.001) and CSS (HR=3.55, 95% CI=2.16-5.83, P<0.001). In dedifferentiated liposarcoma patients, both radical and non-radical operation improved the OS (radical operation: HR=0.25, 95% CI=0.18-0.35, P<0.001, non-radical operation: HR=0.34, 95% CI=0.24-0.47, P<0.001) and CSS (radical operation: HR=0.22, 95% CI=0.15-0.33, P<0.001; non-radical operation: HR=0.31, 95% CI=0.21-0.45, P<0.001); radiotherapy improved the CSS (HR=0.75, 95% CI=0.57-0.99, P=0.043); chemotherapy reduced the OS (HR=1.33, 95% CI=1.05-1.69, P=0.018) and CSS (HR=1.64, 95% CI=1.24-2.18, P=0.001). Radiotherapy improved the OS (HR=0.66, 95% CI=0.47-0.92, P=0.015) and CSS (HR=0.54, 95% CI=0.34-0.84, P=0.007) in patients with myxoid/round cell liposarcoma.Conclusion Age is an independent risk factor affecting the prognosis of patients with different pathological types of retroperitoneal liposarcoma. For the treatment of retroperitoneal liposarcoma, individualized treatment should be made under the guidance of pathological classification. Surgical resection is the best treatment for well differentiated and dedifferentiated liposarcoma. For the choice of surgical methods, the general condition of the patients should be comprehensively evaluated. R₀ resection is not necessary in patients with well-differentiated liposarcoma. R₁ resection or local treatment (including microwave, radiofrequency, etc.) can also improve the OS and CSS in patients with well-differentiated liposarcoma. For dedifferentiated liposarcoma, R₀ resection should be achieved. Radiotherapy is the best treatment for myxoid/round cell liposarcoma, and it is also an important supplement to the treatment of dedifferentiated liposarcoma. In well-differentiated and dedifferentiated pathological types, chemotherapy will increase the risk of death.

12 Research progress in application of tumor mutation burden in gastric cancer

WEI Jiangpeng , YU Pengfei , YANG Jun , WANG Weidong , GAO Ruiqi , YANG Xisheng , LI Xiaohua , JI Gang

2021, 30(10):1229-1234. DOI: 10.7659/j.issn.1005-6947.2021.10.012

[Abstract](966) [HTML](684) [PDF 536.52 K](1546)

Abstract:
Gastric cancer is one of the most common malignant tumors in clinical practice, and has a high incidence rate and high mortality rate. In recent years, a great progress has been made in the immunotherapy of gastric cancer with immune checkpoint inhibitors (ICIs). However, the overall effective rate of monotherapy is still low, and it is often accompanied by different degrees of immune related adverse reactions. Therefore, it is urgent to find accurate and reliable biomarkers to screen patients with potential benefits from immunotherapy. Tumor mutation burden (TMB), which is characterized by the number of tumor gene mutations, has shown a correlation with the efficacy of ICIs. Here, the authors review the associations of TMB with the clinicopathologic characteristics of gastric cancer, and the prediction of immunotherapy efficacy as well as other biomarkers.

13 Research progress on influencing factors for the pathogenesis of colorectal adenoma

WU Riga , SONG Xiaobiao , LIANG Yonggui , DONG Fan , NIU Fanyan , LI Pengda , LIANG Zhi , DONG Zhenyu , WANG Jijun

2021, 30(10):1235-1244. DOI: 10.7659/j.issn.1005-6947.2021.10.013

[Abstract](954) [HTML](1200) [PDF 697.30 K](1965)

Abstract:
Colorectal cancer is the third most common malignant tumor and the fourth major cause of cancer-related death in the world, which poses a serious threat to human health. The occurrence and development of colorectal cancer is a multi-step and multi-factor process, which involves the activation, mutation, inactivation and deletion of many tumor regulatory factors through a variety of signal pathways. Studies have shown that about 80% of colorectal cancer evolves from colorectal adenomas, and this process takes an average of about 10 years. Therefore, studying the factors affecting the occurrence and development of colorectal adenoma can reduce or avoid the risk factors, and meanwhile allow full play to the advantages of the protective factors, and then affect the occurrence of colorectal adenoma and ultimately reduce the occurrence of colorectal cancer. Based on the research progress at home and abroad, the authors address the risk factors and protective factors for the pathogenesis of colorectal adenoma from many aspects.

14 Gastric cancer with splenic hydatid disease: a case report with literature review

WANG Yongjin , GUO Chengwang , LIU Xingji , NIE Peng

2021, 30(10):1251-1256. DOI: 10.7659/j.issn.1005-6947.2021.10.015

[Abstract](1172) [HTML](939) [PDF 1.42 M](1308)

Abstract:
背景与目的 包虫病在牧区是较为常见的人畜共患病，常发生在人体的肝、肺、脾、脑及腹腔等器官。而在临床上孤立性的脾囊性包虫病较为罕见，特别是合并恶性肿瘤就更为少见。目前国内外对该类合并症的研究甚少，本文对1例非疫区胃癌合并原发性脾囊性包虫病的临床表现、诊断和鉴别诊断及治疗措施等方面进行分析总结，为非疫区包虫病合并恶性肿瘤的处理提供相关的参考和思路。方法分析本院收治的1例非疫区胃癌合并原发性脾囊性包虫病的临床表现、诊断和鉴别诊断以及治疗措施等临床病历资料，并复习相关国内外文献。结果患者上腹部胀痛不适1个月余，经胃镜及病检证实为胃癌，彩超检查提示脾脏囊性病变，进一步经详细病史询问、查体、CT检查后诊断为局部进展期胃癌、脾脏囊性包虫病，经积极术前准备，并综合考虑肿瘤根治性及脾脏包虫的根治性处理后，进行“D₂淋巴结清扫术、根治性全胃切除、食管-空肠Roux-en-Y吻合、脾切除术、自体脾片移植术”的手术治疗，术中注意防范包虫囊肿破裂并保留了部分脾脏功能，术后病理学证实为胃癌（pT₃N₁M₀）合并脾囊性包虫病，并给予辅助化疗6周期和抗寄生虫治疗3个月。术后3个月监测外周血IgA、IgM、IgG水平均在正常范围内，说明患者免疫功能恢复正常。术后半年行CT检查时发现脾窝处有大小不等结节，考虑脾片成活组织。现患者术后15个月无肿瘤及包虫复发及腹腔播散。结论胃癌合并原发性脾囊性包虫病在临床上是较为罕见的合并症，尤其在非疫区更为少见。在处理该类合并症时应该兼顾肿瘤和包虫治疗的特殊性，术前着重进行病史询问及完善相关检查以明确诊断；制定详细的术前治疗方案、术中相关准备及手术方案；术后应继续加强抗肿瘤及包虫的治疗和随访。

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Volume 30,Issue 10,2021 Table of Contents

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