Key techniques and focal issues of digestive tract reconstruction in laparoscopic right hemicolectomy
Efficacy analysis of laparoscopic proximal gastrectomy with single-flap esophagogastrostomy in 7 cases of early gastric cancer
Nanoparticle-delivered siRNA combined with sonodynamic therapy for colon cancer
Analysis of the efficacy of enteral nutrition combined with step-up drainage in the treatment of acute necrotizing pancreatitis complicated by duodenal fistula
Application of mechanical principles in pancreaticoduodenectomy: "1-tube, 2-needle, 3-suture" pancreaticojejunostomy (with video)
Advancements and deliberation on the International Consensus Guidelines on Robotic Pancreatic Surgery (2023 Edition)
Innovation and development of robotic hepatobiliary and pancreatic surgery
Current development of paclitaxel nanoformulations and its application progress in biliary tract cancer
Observation and analysis of the morphological and ultrastructural characteristics of the intrahepatic cholangiocarcinoma cell line ICC-X1
Analysis of the safety and feasibility of laparoscopic surgery for repairing LC-related biliary injury
Effects and mechanisms of regorafenib combined with PD-L1 antibody on liver cancer xenograft in mice
Clinical characteristics and prognostic analysis of hepatic angiomyolipoma
Treatment strategies and risk factors for iliac limb occlusion after endovascular repair of abdominal aortic aneurysm
Feasibility and efficacy of using Castor stent for reconstruction of the left common carotid artery in aortic arch lesions
Results of the PATENCY clinical trial using the Longuette™ chimney stent-graft in thoracic endovascular aortic repair
Aortic intimal intussusception and intraoperative stent-graft-induced aortic intimal intussusception during TEVAR
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Chinese Society for Metabolic, Bariatric Surgery (CSMBS), Chinese Society for Gastroesophageal Reflux Disease (CSGERD), Japanese Society for Treatment of Obesity (JSTO), Korean Society for Metabolic, Bariatric Surgery (KSMBS)
2024,33(10):1547-1566, DOI: 10.7659/j.issn.1005-6947.2024.10.001
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Morbid obesity and its associated diseases have become one of the serious public health issues that the whole world needs to face together, and bariatric and metabolic surgery remains the most effective long-term weight control method to date. Among all bariatric and metabolic procedures, sleeve gastrectomy (SG) is currently the most widely used, but it is not a perfect procedure. One of the most severe issues that this surgical procedure faces is the potential worsening of pre-existing or the development of de novo gastroesophageal reflux disease (GERD) after surgery. However, there is currently a lack of high-level clinical trial evidence regarding the diagnosis and treatment of GERD in patients undergoing SG. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts from China, Japan, and the Republic of Korea with extensive experience in bariatric and metabolic surgery and GERD treatment reached a consensus on the diagnosis and treatment of GERD in SG patients using the Delphi method. This consensus includes a total of 59 consultation questions, with agreement reached on 44 of them. It is hoped that this consensus will not only serve as a reference for clinical diagnosis and treatment but also provide more potential directions for future high-quality clinical research.
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MAIMAITIAILI·Maimaitiming, WANG Hao, KELIMU·Abudureyimu
2024,33(10):1567-1571, DOI: 10.7659/j.issn.1005-6947.2024.10.002
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Foregut surgery has emerged as a new discipline in recent years, gaining attention at home and abroad. It mainly focuses on benign diseases of the stomach and esophagus, covering conditions such as gastroesophageal reflux disease, achalasia, and bariatric metabolic surgery. However, in some countries, foregut surgery also includes malignant diseases, such as esophageal and gastric cancers. Robotic surgery, one of the most advanced techniques available, is increasingly applied in clinical practice. The unique ergonomic design of robotic surgical systems allows surgeons to control the instruments with greater precision and finesse, thereby minimizing damage to surrounding vital tissues and organs. Robotic surgery is gradually becoming a major focal point in the field of anterior foregut surgery. However, its current limitations in China include high equipment and maintenance costs, as well as strict requirements for operator qualifications and operating room conditions. As robotic technology continues to develop and improve, it is expected that robot-assisted surgery will play an increasingly important role in foregut surgery, helping doctors improve the quality of surgery and provide better treatment outcomes for patients.
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CHEN Yikuan, WENG Junyong, LI Xinxiang
2024,33(10):1572-1579, DOI: 10.7659/j.issn.1005-6947.2024.10.003
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Fluorescence imaging technology was initially used for liver reserve function assessment and sentinel lymph node biopsy in breast cancer. Subsequently, its application across various fields of oncologic surgery has gained widespread recognition. Fluorescence laparoscopy combines the advantages of fluorescence imaging and minimally invasive techniques, demonstrating significant research value and promising application prospects in the auxiliary diagnosis and treatment of colorectal cancer (CRC). In laparoscopic CRC surgery, indocyanine green-near infrared imaging technology enhances the visualization of tumor lesions, facilitates lymph node tracing, and assesses anastomotic blood supply. In recent years, fluorescence laparoscopy has developed rapidly but remains in the exploratory stage. Minimally invasive surgical experts at home and abroad have summarized existing clinical experiences and developed a series of expert consensus guidelines for laparoscopic colorectal surgery. However, there is still no fully standardized protocol regarding indocyanine green dosage, concentration, administration method and timing, injection site, and learning curve. Therefore, further multicenter, large-scale clinical trials are needed to establish consistent guidelines, promoting the standardized and widespread application of this technology in disease diagnosis and treatment. Here, the authors introduce the development background, application progress, technical debates, and future prospects of fluorescence laparoscopy in colorectal surgery.
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PENG Xiaoyu, SHI Hekai, SONG Zhicheng, YANG Jianjun, GU Yan
2024,33(10):1580-1587, DOI: 10.7659/j.issn.1005-6947.2024.10.004
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In recent years, the emergence of technologies such as machine learning, natural language processing, artificial neural networks, and computer vision has provided essential means for the rapid development of artificial intelligence (AI). Compared to the extensive application of AI in fields like urology and cardiothoracic surgery, the use of AI in hernia and abdominal wall surgery remains very limited. Currently, AI in hernia and abdominal wall surgery is mainly applied in preoperative risk factor analysis, disease-assisted diagnosis, surgical complexity prediction, imaging analysis, robotic/non-robotic intraoperative assistance, postoperative complication and recurrence prediction, as well as education, training, and management. These applications hold great importance for improving the diagnosis and treatment of hernia and abdominal wall diseases. This paper summarizes the current application scenarios of AI in hernia and abdominal wall surgery, reviews the status of AI applications in this field at home and abroad, and discusses future development directions, aiming to provide a reference for advancing hernia and abdominal wall surgery.
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2024,33(10):1588-1593, DOI: 10.7659/j.issn.1005-6947.2024.10.005
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The only curative method for abdominal wall hernias or defects, such as incisional hernia, traumatic abdominal wall hernia, and abdominal wall defect following the resection of malignant tumor, is surgical repair and reconstruction. Various repair and reconstruction techniques have undergone numerous advancements, leading to the emergence of new methods such as tissue structure separation, transversus abdominis release, and laparoscopic retromuscular or preperitoneal techniques. However, due to factors such as patient variability, the surgeon's technical experience, and materials, treatment outcomes are often suboptimal. Thus, the repair and reconstruction of abdominal wall defects, particularly complex abdominal wall hernia, remain challenging issues in the field of hernia and abdominal wall surgery. As a key factor in the development of hernia and abdominal wall surgery, material science is closely linked to the choice of repair and reconstruction methods. In recent years, advancements in material science have been rapid, evolving from simple structural tissue repair to the ultimate goal of achieving unified abdominal wall structure and function. The requirements for material properties have also shifted from mechanical strength to functional regeneration. The continuous pursuit of technical innovation will remain a focal point for hernia and abdominal wall surgeons for the foreseeable future.
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2024,33(10):1594-1599, DOI: 10.7659/j.issn.1005-6947.2024.10.006
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Stoma reversal surgery is usually performed 3 to 6 months after a temporary stoma creation to restore intestinal continuity. The high incidence of stoma site incisional hernia (SSIH) after stoma closure is a significant concern, as the development of SSIH not only increases psychological and financial burdens on patients but also significantly raises medical risks and societal costs. Therefore, reducing the incidence of SSIH is of great practical importance. The fundamental strategy is to accurately identify high-risk patients based on known risk factors, which include: female sex, age ≥ 68 years, colostomy, BMI ≥ 25 kg/m2, malignancy, emergency surgery, existing parastomal hernia, concurrent midline incisional hernia, and postoperative wound complications, and to implement preventive measures in advance. Given that the abdominal wall defect caused by the stoma resembles the condition of bowel herniation in incisional hernias, applying the principles of incisional hernia repair during stoma reversal surgery-particularly for high-risk patients-can be beneficial. This involves the prophylactic use of a mesh during abdominal closure to reinforce the abdominal wall, which may help prevent the occurrence of incisional hernia without increasing the risk of surgical site infections or other adverse events. However, there is still debate over the optimal type of mesh to use during stoma reversal. In summary, stoma reversal incisions differ from standard abdominal incisions, and employing hernia repair principles for their closure may be a crucial strategy in preventing the development of SSIH.
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2024,33(10):1600-1612, DOI: 10.7659/j.issn.1005-6947.2024.10.007
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Laparoscopic right hemicolectomy (LRC) has evolved over the past 30 years, and its oncological efficacy has validated by numerous high-quality studies. Researchers are exploring ways to enhance the quality and safety of LRC while maintaining oncological benefits. Clinical studies focused on surgical quality related to intraoperative anatomical concepts, anatomical planes, anatomical variations, and resection range have yielded significant results, leading to a more standardized and homogenized approach. However, there remains considerable debate on the ileocolonic digestive tract reconstruction during LRC. Currently, ileocolonic reconstruction can be divided into manual suturing and stapled anastomosis according to anastomosis techniques. According to anastomotic configuration, it can be divided into side-to-side, end-to-side, and end-to-end anastomoses. According to the position of the anastomotic operation, it can be divided into extracorporeal (via auxiliary incision) and intracorporeal (within the abdominal cavity) anastomoses. With the advancement of minimally invasive techniques and surgical instruments, intracorporeal side-to-side anastomosis using staplers is increasingly favored by surgeons. However, stapled anastomosis has not completely replaced manual suturing, and the debates over the advantages and disadvantages of these two techniques persist. Additionally, surgeons exhibit varying preferences for anastomotic configurations, and there is no consensus yet. Research on the pros and cons of intracorporeal versus extracorporeal anastomosis is more and more abundant and in-depth. Although high-quality studies addressing some of these issues have been published, some of the findings are controversial. This paper systematically examines the current state of research at home and abroad regarding various anastomosis techniques, the technical characteristics and selection criteria for different anastomotic configurations, and the pros and cons of intracorporeal versus extracorporeal anastomoses in terms of intraoperative handling, postoperative complications, oncological benefits, and healthcare costs. It also addresses key issues like whether to close the mesenteric hiatus. The purpose of this paper is to provide theoretical guidance for clinicians in selecting appropriate gastrointestinal reconstruction methods, optimizing surgical quality, and exploring new directions for clinical research.
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ZHANG Jie, LEI Xiaokang, WANG Xinjing, YANG Qian, CAO Xingxue, GU Meijia, WU Aiwen, WANG Lin
2024,33(10):1613-1622, DOI: 10.7659/j.issn.1005-6947.2024.10.008
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Background and Aims Preventive temporary stoma has been widely used in surgeries for rectal cancer as a simple and effective method to reduce the severity of postoperative anastomotic leakage. However, some patients with preventive temporary stomas cannot undergo reversal due to various factors, resulting in a permanent stoma. Permanent stomas remain a common adverse outcome in clinical practice, and the reasons behind this are not entirely clear. This study analyzes a continuous surgical sample from a single center to explore the risk factors for forming permanent stoma.Methods The clinical data of patients who underwent anal-preserving rectal cancer surgery with preventive temporary stoma in Gastrointestinal Cancer Center Ⅲ of Peking University Cancer Hospital from January 2020 to March 2023, with over 12 months of follow-up, were retrospectively collected. The occurrence of permanent stoma was analyzed, and the clinical variables of patients with permanent stoma were compared to those who underwent stoma reversal, along with an analysis of the risk factors for permanent stoma formation. Permanent stoma was defined as ostomy reversal failure for more than 12 months.Results A total of 299 patients were included, among which 268 (89.63%) underwent stoma reversal (stoma closure group), and 31 (10.37%) did not (permanent stoma group). Compared to the stoma closure group, the permanent stoma group had a higher incidence of distant organ metastasis at diagnosis (7.5% vs. 25.85%, P=0.003) and also had higher proportions of T3 and T4 stages, N2 stage, and clinical stage Ⅳ (all P<0.05) with an elevated overall postoperative complication rate (19.0% vs. 41.9%, P=0.003) as well as a higher rate of severe complications (1.1% vs. 9.7%, P=0.016) and an increased incidence of anastomotic leakage (4.9% vs. 19.4%, P=0.006). Logistic regression analysis revealed that the presence of distant organ metastasis at diagnosis (OR=5.41, 95% CI=1.80-16.27, P=0.003), and occurrence of anastomotic leakage (OR=4.44, 95% CI=1.15-17.09, P=0.030) were independent risk factors for the formation of permanent stomas.Conclusion At present, some patients still cannot undergo reversal of their preventive temporary stoma, resulting in permanent stoma. The formation of permanent stomas is closely related to a low tumor location, distant organ metastasis at diagnosis, and the occurrence of anastomotic leakage.
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ZHANG Xu, ZHANG Qing, GUO Shuai, LI Mu, WANG Yuanfa, LI Ze
2024,33(10):1623-1632, DOI: 10.7659/j.issn.1005-6947.2024.10.009
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Background and Aims Currently, surgery remains the primary treatment for colorectal cancer, while neoadjuvant therapy can transform initially unresectable lesions into resectable ones, improving patient prognosis. Bevacizumab combined with chemotherapy has shown promising efficacy for advanced metastatic colorectal cancer; however, the routine use of bevacizumab in neoadjuvant therapy for potentially resectable metastatic colorectal cancer patients remains controversial. Therefore, this study was performed to investigate the efficacy and safety of bevacizumab combined neoadjuvant therapy in patients with locally advanced rectal cancer (LARC).Methods The clinical data of LARC patients who received bevacizumab-combined neoadjuvant therapy in the Department of Colorectal and Gastrointestinal Oncology, Jilin Cancer Hospital, from 2021 to 2022, were retrospectively analyzed.Results A total of 45 patients were included, of whom 26 received the XELOX (oxaliplatin combined with capecitabine) + bevacizumab neoadjuvant regimen (chemotherapy plus bevacizumab group), and 19 received radiotherapy concurrent with XELOX and sequential bevacizumab neoadjuvant treatment (chemoradiotherapy plus bevacizumab group). Preoperative imaging evaluations showed tumor response rates of 84.61% and 94.74%, respectively, with a disease control rate of 100.0% in both groups. The CEA and CA19-9 levels significantly decreased compared to their pre-treatment levels in both groups (both P<0.05). In the chemotherapy plus bevacizumab group, all patients underwent Dixion resection with D2 lymphadenectomy, with 10 patients receiving preventive ileostomy. Postoperative pathology showed an average of 18.3 lymph nodes removed, with 2.1 metastatic nodes; tumor regression grade (TRG) was 0 in 2 cases (7.69%), 1 in 8 cases (30.77%), 2 in 10 cases (38.46%), and 3 in 6 cases (23.08%). In the chemoradiotherapy plus bevacizumab group, 15 patients underwent Dixion resection with D2 lymphadenectomy, 2 patients underwent Miles surgery, 1 patient was unable to undergo surgery due to severe pelvic adhesions, and another was unable to have resection due to pelvic floor adhesions found during surgery. Preventive ileostomy was performed in all 15 patients who had Dixion surgery. Postoperative pathology showed an average of 18.5 lymph nodes removed, with 1.6 metastatic nodes; TRG was 0 in 2 cases (10.53%), 1 in 7 cases (36.84%), 2 in 6 cases (31.58%), and 3 in 2 cases (10.53%). Surgical specimens in both groups showed negative proximal and distal margins, with no tumor residuals. A total of 55 neoadjuvant therapy-related adverse events occurred, all graded 1-2, without affecting subsequent treatment.Conclusion For LARC patients, bevacizumab-combined neoadjuvant therapy is safe and effective. Bevacizumab combined with chemotherapy can be selected, with radiotherapy as an option based on tumor location, to increase the probability of radical resection and sphincter-preserving opportunities.
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DUAN Kaipeng, LI Dongbao, LI Weikang, SUN Xiaotong, GU Lixing, WANG Pengbo, ZHOU Jin
2024,33(10):1633-1641, DOI: 10.7659/j.issn.1005-6947.2024.10.010
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Background and Aims In recent years, function-preserving proximal gastrectomy with reconstruction has become an important approach for the treatment of early gastric cancer. However, there is no standardized surgical technique, and the short- and long-term outcomes of various new procedures remain unclear. This study was performed to evaluate the safety and short-term efficacy of laparoscopic proximal gastrectomy plus esophagogastrostomy with single-flap technique for early gastric cancer.Methods The clinical data and follow-up records of 7 patients who underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy in the First Affiliated Hospital of Soochow University between December 2021 and December 2022 were retrospectively analyzed. Perioperative safety, postoperative reflux, anastomotic stricture at 6 months, and related nutritional parameters were assessed. The nutrition-related indicators of this group of patients were compared with those of 11 patients who underwent total gastrectomy with Roux-en-Y anastomosis for early gastric cancer during the same period.Results All 7 patients successfully underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy. The average operative time was (212.9±20.6) min, with anastomosis taking (54.7±10.5) min; the mean intraoperative blood loss was (28.6±9.0) mL. No Clavien-Dindo grade Ⅲ or higher complications were observed during hospitalization. None of the patients experienced significant reflux symptoms, although 1 patient developed anastomotic stricture 3 months after operation. There were no statistically significant differences in hemoglobin concentration, albumin level, prealbumin level, total protein concentration, and lymphocyte count between preoperative and 6-month postoperative measurements (all P>0.05). Compared to patients who underwent total gastrectomy with Roux-en-Y anastomosis, those who had the proximal gastrectomy with single-flap esophagogastrostomy showed a lower percentage decrease in body weight, skeletal muscle area at the third lumbar vertebra (L3), visceral fat area at L3, and hemoglobin concentration at 1 year after operation (all P<0.05).Conclusion Laparoscopic proximal gastrectomy with single-flap esophagogastrostomy is a safe and feasible surgical option for early gastric cancer, offering effective anti-reflux outcomes while minimizing the risk of anastomotic stricture. This procedure has a lower impact on postoperative nutritional status compared to total gastrectomy.
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WANG Min, WANG Dong, LI Xiaojie, XU Xixia, ZHAO Xuefeng, ZHANG Zhidong
2024,33(10):1642-1653, DOI: 10.7659/j.issn.1005-6947.2024.10.011
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Background and Aims Preoperative sarcopenia is a syndrome characterized by reduced skeletal muscle mass and strength, and it is associated with various adverse postoperative outcomes. Gastric cancer patients may experience transient or persistent postoperative cognitive dysfunction (POCD), which significantly impacts their quality of life and prognosis. However, it remains unclear whether this complication is linked to sarcopenia. Therefore, this study was conducted to investigate further the impact of preoperative sarcopenia on postoperative complications and long-term outcomes in patients undergoing radical gastric cancer surgery, with a particular focus on the relationship between sarcopenia and POCD, in order to provide insights for preoperative assessment and postoperative management of gastric cancer patients.Methods The clinical data of gastric cancer patients who underwent radical surgery in the Third Department of Surgery at the Fourth Hospital of Hebei Medical University between January 2014 and January 2015 were retrospectively collected. Patients were divided into the sarcopenia and non-sarcopenia groups based on preoperative L3 skeletal muscle index, handgrip strength, and gait speed measurements. The clinicopathologic characteristics of sarcopenic patients, as well as the impact of sarcopenia on short-term clinical outcomes and long-term prognosis, were analyzed. Additionally, factors influencing the development of POCD were determined.Results A total of 320 gastric cancer patients were included, of whom 59 (18.44%) were diagnosed with sarcopenia. Compared with the non-sarcopenia group, sarcopenic patients had significantly lower bady mass index, serum total protein, serum albumin, and hemoglobin levels, with a higher proportion of patients aged ≥60 years, NRS 2002 score ≥3, comorbid pulmonary disease, and those undergoing open surgery (all P<0.05). After balancing the baseline characteristics of the two groups using propensity score matching (PSM), each group included 59 patients. The analysis revealed that the overall incidence of postoperative complications was higher in the sarcopenia group than in the non-sarcopenia group (54.24% vs. 32.20%, P=0.016). The sarcopenia group also had a significantly higher incidence of Clavien-Dindo grade Ⅱ-Ⅳ complications and postoperative infectious complications (27.12% vs. 5.08%, P=0.001; 33.90% vs. 15.25%, P=0.019). The average hospital stay was significantly longer for sarcopenic patients (12.54±4.7 d vs. 7.68±3.8 d, P=0.005). Additionally, the 5-year overall survival (OS) and disease-free survival (DFS) rates were lower in the sarcopenia group compared to the non-sarcopenia group (both P<0.05). Cox multivariate analysis showed that sarcopenia, tumor pT stage, and tumor pN stage were independent risk factors for 5-year OS and DFS. At the same time, adjuvant chemotherapy was a protective factor for prognosis (all P<0.05). Among the 118 patients after PSM, 34 (28.81%) were diagnosed with POCD. Logistic multivariate regression analysis indicated that preoperative sarcopenia, the number of preoperative comorbidities, and anesthesia duration of ≥2 h were independent risk factors for POCD, while intraoperative use of dexmedetomidine was a protective factor (all P<0.05).Conclusion Preoperative sarcopenia is closely associated with unfavorable postoperative outcomes and the development of POCD in patients undergoing radical gastric cancer surgery. Clinicians should emphasize the detection of sarcopenia during preoperative evaluation and implement proactive interventions and postoperative management strategies to improve clinical outcomes and long-term survival rates.
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LI Zhuo, CHEN Zhen, WANG Huaqiang, XIAO Zhigang
2024,33(10):1654-1666, DOI: 10.7659/j.issn.1005-6947.2024.10.012
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Background and Aims Sonodynamic therapy (SDT) is an emerging tumor treatment method that primarily utilizes low-intensity ultrasound (US) to activate sonosensitizers, leading to the production of cytotoxic reactive oxygen species (ROS) that kill cells. This study was conducted with an attempt to develop a novel nanoparticle (NPs) formulation containing a sonosensitizer and the small interfering RNA (siRRS1) of tumor-related gene RRS1 to observe its anticancer effects on colon cancer, to provide new strategies for colon cancer treatment.Methods RRS1 RNA-Seq data were downloaded from the TCGA and GEO databases, and clinical pathological data were collected from 80 patients with colon cancer at Hunan Provincial People's Hospital. The expression of RRS1 in colon cancer and its relationship with prognosis were analyzed. The proliferation and apoptosis of colon cancer cells transfected with siRRS1 were observed. The sonosensitizer tetra (4-carboxyphenyl) porphyrin (TCPP), gene carrier DSPE-PEI, and siRRS1 were assembled into TCPP@DSPE-PEI-siRRS1 NPs (T@D-siRRS1 NPs). After structural characterization and examination of cellular uptake and ROS generation capabilities in vitro, the anticancer effects of T@D-siRRS1 NPs on colon cancer were assessed in cell experiments and tumor-bearing mouse models.Results Both database analysis and clinical specimen testing indicated that RRS1 expression in colon cancer tissues was higher than that in adjacent normal tissues, and high expression was associated with poor prognosis (HR=1.88, 95% CI=1.27-2.79, P=0.002). Univariate and multivariate analyses showed that RRS1 mRNA expression was an independent risk factor for overall survival in colon cancer patients (HR=1.354, 95% CI=1.447-2.215, P=0.031). Knockdown of RRS1 significantly reduced the proliferation capacity of colon cancer cells and increased apoptosis (both P<0.05). Characterization results showed that the particles were uniform and stable; T@D-siRRS1 NPs entered cells through endocytosis, where TCPP could generate singlet oxygen (1O?) under ultrasound irradiation. Subsequent in vitro and in vivo experimental results demonstrated that transfection with NPs carrying siRRS1 or TCPP (T@D-control siRNA, T@D-siRRS1) combined with US resulted in varying degrees of growth inhibition in colon cancer cells, with the T@D-siRRS1 NPs+US treatment showing the strongest effect (all P<0.05). Moreover, no significant damage was observed in the vital organs of mice treated with T@D-siRRS1 NPs+US.Conclusion T@D-siRRS1 NPs plus US integrate SDT and gene therapy, producing an effective synergistic cytotoxic effect on colon cancer cells. Additionally, T@D-siRRS1 NPs demonstrate good safety and biocompatibility, suggesting potential for clinical application.
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2024,33(10):1667-1678, DOI: 10.7659/j.issn.1005-6947.2024.10.013
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Background and Aims Gastric cancer is a highly prevalent malignant tumor worldwide, with a high incidence rate that makes it a significant contributor to global cancer mortality. Studies have found that FAM49B is significantly upregulated in most tumors, including gastric cancer. However, the role of FAM49B in the occurrence and development of gastric cancer remains largely unknown. Therefore, this study explores the role and mechanisms of FAM49B in gastric cancer, aiming to provide new avenues for gastric cancer treatment.Methods Based on TCGA and GEO databases, the analyses of FAM49B expression, survival, immune infiltration, gene set enrichment, and protein-protein interaction (PPI) networks were conducted. Gastric cancer clinical samples were collected, and immunohistochemistry, qRT-PCR, and Western blot were used to assess FAM49B expression levels and analyze their relationship with patients' clinicopathological factors. In vitro experiments analyzed FAM49B expression in gastric cancer cell lines, using CCK-8, EdU, Transwell, and flow cytometry assays to examine the effects of FAM49B on gastric cancer cell proliferation, migration, invasion, and cell cycle process.Results Bioinformatic analysis showed that FAM49B was significantly overexpressed in gastric cancer tumor tissues, with high FAM49B expression closely related to M1/M2 macrophage polarization, and patients with high FAM49B expression in gastric cancer had better prognosis. Enrichment analysis revealed that the high FAM49B expression group was enriched in the p53 signaling pathway, while the low FAM49B expression group was enriched in the ERBB signaling pathway. PPI network analysis indicated a strong interaction between FAM49B and proteins such as FAM49A, ACTN1, THSD4, RAC3, and EGFR. In both gastric cancer tissues and cell lines, FAM49B mRNA and protein expression were significantly upregulated (both P<0.05). FAM49B expression showed an inverse correlation with tumor size and gastric cancer invasion depth (both P<0.05). After FAM49B knockdown, gastric cancer cell proliferation and migration abilities significantly increased, while FAM49B overexpression had the opposite effect (both P<0.05). Knockdown of FAM49B reduced the percentage of cells in G1 phase and increased the percentage in S phase, accompanied by downregulated expression of cyclin E1 and cyclin D1, while FAM49B overexpression led to an increase in G1 phase cells and a decrease in S and G2 phase cells, with upregulation of cyclin E1 and cyclin D1 (both P<0.05). Additionally, after FAM49B knockdown, N-cadherin, vimentin, and c-myc expression increased, while p53 expression decreased, whereas FAM49B overexpression produced the opposite effect on these proteins in gastric cancer cells.Conclusions FAM49B is highly expressed in gastric cancer but exhibits tumor-suppressing effects. Its mechanisms may be related to the regulation of macrophage polarization, epithelial-mesenchymal transition, and the p53 pathway.
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WANG Qinxi, ZHANG Jiong, CHE Kangming
2024,33(10):1679-1687, DOI: 10.7659/j.issn.1005-6947.2024.10.014
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Background and Aims Studies have shown that miR-199b-3p is downregulated in gastric cancer tissues, while cysteine-rich transmembrane BMP regulator 1 (CRIM1) is upregulated in these tissues. However, the role and mechanism of miR-199b-3p in the biological behavior of gastric cancer cells are still unclear, as is its potential association with CRIM1. Therefore, this study was conducted to investigate whether there is an interaction between miR-199b-3p and CRIM1 and how they affect the function of gastric cancer cells.Methods qRT-PCR and immunohistochemistry were used to detect the expression levels of miR-199b-3p and CRIM1 in gastric cancer tissues and adjacent non-cancerous tissues. Gastric cancer MGC803 cells were used to assess changes in cell proliferation, invasion/migration abilities, and apoptosis rates after overexpression of miR-199b-3p (using miR-199b-3p mimics) or knockdown of CRIM1 (using si-CRIM1). Bioinformatics analysis was used to predict the targeting relationship between miR-199b-3p and CRIM1, which was further validated by dual-luciferase reporter assay and confirmed through Western blot analysis.Results The results of qRT-PCR indicated that, compared to adjacent non-cancerous tissues, miR-199b-3p expression was significantly lower in gastric cancer tissues, while CRIM1 expression was higher (both P<0.05). Immunohistochemistry results demonstrated positive expression of CRIM1 in cancerous tissues, while it was negative in non-cancerous tissues. Overexpression of miR-199b-3p or CRIM1 knockdown resulted in decreased proliferation and invasion/migration abilities of MGC803 cells, along with increased apoptosis rates (all P<0.05). Bioinformatics prediction and dual-luciferase reporter assays confirmed that CRIM1 is a target of miR-199b-3p. Western blot analysis showed that CRIM1 expression was significantly reduced after transfection with miR-199b-3p mimics (P<0.05).Conclusion CRIM1 is a target gene of miR-199b-3p, which can inhibit the proliferation, invasion, and migration of gastric cancer cells while promoting apoptosis by targeting and regulating CRIM1 activity. The miR-199b-3p/CRIM1 pathway may serve as a potential therapeutic target for gastric cancer.
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LIANG Zhiqiang, LIU Fuheng, ZENG Bing, GAN Wenchang, HOU Zehui, YUAN Zhilong, ZHOU Taicheng, LI Yingru, CHEN Shuang
2024,33(10):1688-1696, DOI: 10.7659/j.issn.1005-6947.2024.10.015
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Background and Aims The repair of giant incisional hernia is challenging, as closing the significant defect in the abdominal wall can lead to life-threatening complications like abdominal compartment syndrome (ACS). Botulinum toxin type A (BTA) can temporarily relax the abdominal wall muscles, facilitating defect repair, while preoperative progressive pneumoperitoneum (PPP) can increase intra-abdominal volume, reducing intra-abdominal pressure caused by hernia content reintegration. Combining BTA with PPP for the preoperative preparation of giant incisional hernia repair may have a complementary effect. This study was conducted to evaluate the clinical value of combining BTA and PPP in the repair of giant abdominal incisional hernia.Methods The clinical data of 213 patients with giant abdominal incisional hernia treated at the Sixth Affiliated Hospital of Sun Yat-sen University from December 2015 to December 2019 were retrospectively analyzed. Two weeks after receiving combined BTA and PPP treatment, changes in bilateral abdominal wall muscle, intra-abdominal adhesions, abdominal circumference, abdominal cavity volume, and hernia sac volume ratio were assessed using CT. Intraoperative details, incidence of complications, and postoperative follow-up outcomes were recorded.Results Following combined BTA and PPP treatment, CT scan showed a significant extension of bilateral lateral abdominal wall muscles towards the midline in all 213 patients, with an average increase of 2.45 (1.53-3.29) cm on the left side and 2.54 (1.68-3.40) cm on the right side; muscle thickness was reduced by an average of 0.84 (0.64-1.00) cm on the left and 0.82 (0.62-1.05) cm on the right, the average distance between viscera and the abdominal wall increased to (7.52±1.78) cm, with a mean increase of 6.1 (4.2-6.9) cm; the mean increase in abdominal cavity volume was 1 802 (1 494.98-2 316.26) mL, and the hernia sac volume ratio decreased by an average of 9% (6%-12%), all changes were statistically significant (P<0.05). Post-PPP CT scan revealed no abdominal adhesions in 18 patients (8.45%), while 195 patients (91.55%) had varying degrees of adhesions, including 39 cases (18.31%) of sheet adhesions and 156 cases (73.24%) of mixed adhesions. Adhesions mainly consisted of omentum and intestinal tissues in 59.15% of cases. There were 43 cases (20.19%) of grade I complications during the BTA-PPP process, including abdominal pain (28 cases), shoulder pain (9 cases), subcutaneous emphysema (6 cases), and dyspnea (3 cases). Dyspnea improved with oxygen therapy, while other complications required no special intervention. All 213 patients successfully underwent laparoscopic incisional hernia repair without conversion to open surgery or organ resection for volume reduction. Fascial closure was achieved in 209 cases (98.12%), with 4 cases (1.88%) having incomplete defect closure. The average time for adhesiolysis was 28 (11.00-44.50) min, with a total operative time of 178.0 (132.50-255.00) min and an average blood loss of 20 (10-30) mL. The median intra-abdominal pressure (IAP) after operation was between 10 mmHg (9.00-12.00 mmHg), Among them, 47 cases (22.07%) had IAP exceeding 12 mmHg, and after implementing proactive measures such as diuresis and diachoresis to reduce intra-abdominal contents, the IAP in these patients decreased to below 12 mmHg. No severe complications such as skin flap necrosis or ACS were observed. There were no deaths within postoperative 30 d, and during a follow-up period of 26 (16.50-33.00) months, 13 cases (6.10%) had surgical site events, including infections in 5 cases (2.35%), seromas in 7 cases (3.29%), and hematoma in 1 case (0.47%), with no hernia recurrence.Conclusion The combination of BTA and PPP not only aids in identifying abdominal wall adhesion areas, improving preoperative surgical planning and enhancing surgical safety, but also significantly increases abdominal cavity volume and extends lateral abdominal wall muscles, facilitating the closure of giant incisional hernia defects and reducing the incidence of severe postoperative complications like ACS. This approach is worthy of clinical promotion.
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REN Zhen, WEI Xiaohan, LIU Hu, PAN Chen, WU Lisheng
2024,33(10):1697-1704, DOI: 10.7659/j.issn.1005-6947.2024.10.016
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Background and Aims Parastomal hernia is a common complication after colostomy, with a high incidence rate. Laparoscopic Sugarbaker repair is currently the mainstream surgical approach for treating parastomal hernia. However, compared to other abdominal wall hernia repair techniques, the recurrence rate of parastomal hernia after laparoscopic Sugarbaker repair remains relatively high. Furthermore, the recurrence rate after surgery for recurrent parastomal hernias is significantly higher than that after the initial surgery, with inadequate lateral mesh coverage being one of the major contributing factors. This study was performed to analyze the efficacy of two-point mark-guided laparoscopic Sugarbaker repair in patients with terminal colostomy parastomal hernia, so as to provide evidence-based references for clinical practice.Methods The clinical data of 120 patients with terminal colostomy parastomal hernia, who underwent laparoscopic Sugarbaker repair guided by the two-point mark of mesh at the Department of Hernia and Obesity Surgery, the First Affiliated Hospital of the University of Science and Technology of China, from January 2015 to December 2023, were retrospectively collected. The parastomal hernias were classified according to the European Hernia Society classification. Postoperative symptomatic and radiological recurrence rates were analyzed, as well as the incidence of complications such as bowel obstruction, stoma infection, and intestinal fistula in recurrent and non-recurrent patients.Results Of the 120 patients, 2 (1.7%) were lost to follow-up. The mean follow-up duration was 48 (6-96) months. The postoperative symptomatic recurrence rate was 5.1% (6/118), and the radiological recurrence rate was 6.8% (8/118). There were no statistically significant differences between recurrent (n=8) and non-recurrent patients (n=110) in terms of sex, age, body mass index (BMI), or hernia defect size (all P>0.05), but the operative time in recurrent patients was longer than that in non-recurrent patients (P<0.05). The overall postoperative complication rate was 8.5% (10/118), including stoma skin-mucosa separation (3 cases), stoma infection (2 cases), delayed bowel obstruction (2 cases), early bowel obstruction (1 case), hernia sac effusion (1 case), and delayed fistula formation in the hernia sac cavity (1 case). According to the Clavien-Dindo classification, there were 6 cases of grade Ⅱ, 3 cases of grade IIIa, and 1 case of grade Ⅳ complications. There were no statistically significant differences between patients with and without complications regarding sex, BMI, hernia defect size, operative time, and comorbidities (all P>0.05); however, patients with complications were older than those without (P<0.05).Conclusion The application of laparoscopic Sugarbaker repair under the guidance of two-point mesh identification can effectively reduce the recurrence rate of parastomal hernia and It has high clinical applicability.
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GOU Longfei, CHEN Hao, HU Yanfeng, YU Jiang, DENG Haijun
2024,33(10):1705-1713, DOI: 10.7659/j.issn.1005-6947.2024.10.017
Abstract:
From September 26 to 28, 2024, the 11th Korean International Gastric Cancer Week (KINGCA WEEK 2024), a prestigious academic conference in the field of gastric cancer, was held in Seoul. Organized by the Korean Gastric Cancer Association, the conference featured one main venue, 18 sub-venues, and 16 thematic symposiums, including 100 invited presentations and four keynote speeches, attracting 788 experts and scholars from around the world. Additionally, the conference set 16 themes and received 425 submissions from 24 countries, including Republic of Korea, China, Japan, and the United States. After a review process, 365 submissions were accepted, which included eight plenary oral presentations, 78 oral reports, and 279 poster presentations. The conference covered many hot topics in gastric cancer diagnosis and treatment, with a particular focus on surgical-related areas such as treatment strategies for metastatic gastric cancer, an international consensus meeting on the conversion therapy for stage Ⅳ gastric cancer, future research directions of the Korean Laparoendoscopic Gastrointestinal Surgery Study Group, the development of new surgical instruments and equipment, and key issues in lymph node dissection, resection, and reconstruction during minimally invasive gastric cancer surgeries. Furthermore, our team was invited to present two oral reports on "the application of artificial intelligence in minimally invasive gastric cancer surgery". This report aims to detail the dynamics and hotspots related to surgical treatment for gastric cancer, providing valuable references and insights for domestic surgical peers.
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CHEN Hao, LI Yuanliang, ZHANG Haogang, QIAO Pengfei
2024,33(10):1714-1723, DOI: 10.7659/j.issn.1005-6947.2024.10.018
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Gastrointestinal malignant tumors are common worldwide, particularly gastric cancer (GC) and colorectal cancer (CRC), with complex and not fully understood molecular mechanisms behind their occurrence and progression. Treatment typically involves a comprehensive approach centered on surgery, which, despite achieving good outcomes, still faces challenges due to high recurrence rates and low survival rates impacting patient health. N6-methyladenosine (m6A) is the most abundant internal modification in mRNAs and plays a crucial role in regulating RNA post-transcriptional modifications and downstream functions. Fat mass and obesity-associated protein (FTO) was the first identified m6A demethylase capable of removing dynamic, reversible m6A modifications. During the development of gastrointestinal malignancies, FTO regulates the expression of specific genes, affecting tumor cell proliferation and metastasis; modulates the expression of tumor-related cytokines and immune-related molecules, influencing the tumor microenvironment; and plays a significant role in sensitivity and resistance to chemotherapy. FTO is upregulated in most types of GC, indicating poor prognosis. High FTO expression enhances GC cell migration and invasion, increases chemoresistance, promotes tumor stem cell proliferation and differentiation, and inhibits apoptosis, thus facilitating GC progression. In CRC, many studies show that FTO is upregulated in tissues and cells, promoting CRC progression by enhancing cell proliferation, migration, invasion, and resistance to chemotherapy. Low FTO expression can also elevate m6Am levels in CRC cell cytoplasmic mRNA, promoting tumor stem cell proliferation, differentiation, tumor formation, and increasing resistance. In contrast, high FTO expression inhibits tumor stem cell proliferation and differentiation. FTO is also upregulated in other gastrointestinal tumors like pancreatic and esophageal cancers, where high expression promotes progression and indicates poor prognosis. FTO has both promoting and inhibitory effects on liver and biliary malignancies. As research confirms FTO's widespread oncogenic role in the gastrointestinal tract, developing FTO inhibitors and related drugs offers new avenues for treating gastrointestinal malignancies. Currently identified agents like CS1, omeprazole, and mupirocin significantly inhibit CRC and GC progression by directly or indirectly suppressing FTO. Tumors can evade immune surveillance through FTO-mediated mechanisms, suggesting that blocking FTO-mediated immune escape and enhancing the antitumor effects of immune cells could provide treatment options for gastrointestinal malignancies. Targeting FTO in combination with immunotherapy to inhibit GC and CRC growth and metastasis and reduce resistance presents broad therapeutic prospects.
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YANG Hongmei, FENG Zixuan, XU Zixun, WANG Gangyi, WU Huan, FANG Rui, CHEN Ping
2024,33(10):1724-1730, DOI: 10.7659/j.issn.1005-6947.2024.10.019
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The gut microbiota plays a crucial role in maintaining overall health. Dysbiosis of the gut microbiota can promote the occurrence and progression of tumors, especially hepatobiliary and pancreatic tumors, by affecting intestinal homeostasis, gut metabolism, and immune function. Therefore, a better understanding of the role of the gut microbiome in the development and progression of hepatobiliary and pancreatic tumors may provide opportunities for developing new prevention and treatment strategies for patients with these malignancies. This article reviews recent research on the role of gut microbiota in the development and progression of hepatobiliary and pancreatic malignancies, aiming to provide a reference for future studies.
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2024,33(10):1731-1739, DOI: 10.7659/j.issn.1005-6947.2024.10.020
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背景与目的 肠瘘是指胃肠道与其他空腔脏器、体腔或体腔外存在异常通道，胃肠道内容物由此通道流向其他脏器、体腔或体腔外，并继发感染、体液丢失、内环境稳态失衡、器官损害、营养不良等一系列问题的疾病。肠瘘的处理在临床上是一个非常棘手的问题，病死率较高。消化液的收集与回输、肠内营养支持治疗等技术的开展可明显改善患者营养状态，提高疾病预后。对于高流量小肠瘘患者的消化液经盲肠回输目前国内罕有相关报道。本文报告1例经结肠镜辅助经皮穿刺结肠造瘘消化液回输患者的诊疗经过，并结合相关文献报道，对结肠消化液回输技术及结肠重吸收功能进行分析总结，以期对临床工作提供经验和借鉴。方法 回顾性分析新疆维吾尔自治区第三人民医院2023年10月收治的1例复杂小肠高流量空气瘘患者的临床资料及诊疗过程，结合国内外文献探讨经皮穿刺结肠造瘘消化液回输技术联合分段式肠内营养支持技术治疗复杂小肠高流量空气瘘的安全性和有效性。结果 患者因肠系膜动脉栓塞致小肠坏死在外院行部分小肠切除+端端吻合术，术后发生小肠空气瘘转入我院。患者入院时合并恶病质，全身和腹腔感染，电解质紊乱（低钾血症、低钠血症），肝功能不全，凝血酶原时间延长，并伴有间断发热、切口局部感染、肺部感染、腹腔感染、双下肢浮肿。患者给予抗感染、肠外营养联合经鼻空肠营养管分段式肠内营养治疗14 d，输液量4 500 mL/d。因消化液高流量外漏，上述临床表现无明显改善。于第14天联合结肠镜辅助经皮穿刺结肠造瘘消化液回输治疗。治疗第21天上述临床表现明显好转，输液量2 500 mL/d，经盲肠造瘘回输消化液1 000 mL/d，经鼻空肠营养管输注百普利1 000 mL/d。治疗第28天，患者恶病质改善，感染、电解质、肝功能、凝血酶原时间等指标均恢复正常，并且无发热、肺部感染、腹腔感染、双下肢浮肿，切口局部肉芽新鲜。输液量1 000 mL/d，经鼻空肠营养管输注营养液1 000 mL/d。患者随后行肠切除术+腹壁重建术，术后顺利出院。结论 经皮穿刺结肠造瘘消化液回输技术联合分段式肠内营养支持治疗技术是复杂小肠高流量空气瘘一种安全有效的治疗手段。
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2024,33(10):1740-1746, DOI: 10.7659/j.issn.1005-6947.2024.10.021
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背景与目的 骨骼肌减少在接受胃癌根治术尤其是全胃切除术（TG）的患者中很常见，且与感染升高、术后并发症增加相关，最终导致患者生存率及生活质量降低。本文评估新辅助化疗联合TG对进展期胃癌患者骨骼肌的影响。方法 回顾性分析中南大学湘雅医院在2016年5月—2020年5月期间接受新辅助化疗（希罗达+奥沙利铂）联合TG的56例进展期胃癌患者的临床资料。收集患者新辅助化疗前、后与腹腔镜TG后3个阶段的第三腰椎（L3）骨骼肌质量指数（SMI）数据，以及患者的人口统计学、临床和生化指标，分析患者SMI的变化以及各项指标与患者SMI的关系。结果 单因素分析显示，男性的SMI平均值高于女性（48.77 cm2/m2 vs. 36.52 cm2/m2，P<0.001），而肿瘤分期、手术史与合并症以及相关营养、生化指标与SMI之间无明显关系（均P>0.05）；男性年龄与SMI呈负相关（rpearson=-0.31，P<0.05），而女性的年龄与SMI之间无明显相关（rpearson=0.08，P>0.05）；体质量指数与SMI呈正相关（P<0.05）。患者新辅助化疗前SMI为（43.96±8.33）cm2/m2，在新辅助治疗联合TG后，SMI呈下降趋势，尤其是在TG术后，分别为（43.18±8.33）cm2/m2、（40.76±8.52）cm2/m2，后者较新辅助化疗前差异有统计学意义（P<0.05）。相关的营养指标，包括白蛋白和血红蛋白，与SMI变化趋势相似。此外，新辅助化疗对患者血象、肝肾功能均有明显影响。结论 新辅助化疗联合TG对进展期胃癌患者的骨骼肌含量有不良影响，SMI可作为重要的营养评估指标，临床可通过CT影像学诊断肌肉减少为特定人群的营养和护理指导提供理论依据，从而改善患者的生活质量和预后。
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2024,33(10):1747-1750, DOI: 10.7659/j.issn.1005-6947.2024.10.022
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背景与目的 术后乳糜漏（CA）是腹部外科手术并发症之一，治疗棘手。营养干预是促进CA愈合的关键措施，但缺乏规范化的营养治疗方案。本研究旨在评价CA患者专用特殊全营养配方制剂对腹部外科手术CA的治疗效果。方法 回顾性分析48例腹部外科手术后CA患者的临床资料，其中23例采用含中链脂肪酸组件的特殊全营养配方制剂进行营养干预（观察组），另外25例采用无脂饮食，未使用该营养制剂（对照组）。比较两组患者的相关临床指标。结果 两组患者的年龄、性别、BMI差异均无统计学意义（均P>0.05），观察组3 d CA的引流量明显低于对照组（437.16 mL vs. 455.59 mL，P=0.018），且观察组CA首次缓解时间明显短于对照组（7.32 d vs. 9.31 d，P=0.037）。对照组1例（4.0%）CA首次缓解后复发。对照组所有患者均在术后出现了视黄醇结合蛋白及前白蛋白下降，而观察组患者视黄醇结合蛋白及前白蛋白水平有不同程度上升，仅有39.1%（9/23）及30.4%（7/23）的患者出现了下降，差异有统计学意义（均P<0.05）。观察组患者住院时间明显短于对照组（14.39 d vs. 16.76 d，P=0.047），对照组有1例（4.0%）带管出院，观察组患者均拔除腹腔引流装置后出院。结论 CA患者专用特殊全营养配方制剂可减少CA漏出，改善患者术后营养状况，缩短住院时间。
