Correlation between perioperative new onset atrial fibrillation and prognosis of colorectal cancer / 中华普通外科杂志

Objective:To investigate the correlation between perioperative new onset atrial fibrillation and the prognosis of colorectal cancer.Methods:This study involved 180 colorectal cancer patients undgoing radical resection at the Department of Gastrointestinal Surgery, Longyan First Hospital from Jan 2014 to Jan 2015. Among them, 47cases suffered from perioperative new onset atrial fibrillation.Results:The perioperative new onset atrial fibrillation group had a higher mean age and a higher mean postoperative C-reactive protein level than the control group ( t=-3.080, P=0.002; t=-2.184, P=0.030). Hence these patients had a longer hospital stay ( t=-5.072, P=0.001; t=-2.577, P=0.011). Multivariate analysis showed that postoperative new onset atrial fibrillation, high postoperative mean C-reactive protein level, poor tumor differenciation and late tumor stage were independent risk factors for the prognosis of colorectal cancer ( HR=1.835, P=0.018; HR=1.008 P=0.017; HR=1.950 P=0.046; HR=1.300, P=0.047). The median survival time of perioperative new onset atrial fibrillation group and control group were 59.05 months and 63.23 months, respectively ( P=0.005). Conclusions:Colorectal cancer patients suffering from perioperative new onset atrial fibrillation were more common among advanced age and high postoperative mean C-reactive protein level with higher all-cause mortality.

Influences of age-adjusted Charlson comorbidity index on prognosis of patients undergoing laparoscopic radical gastrectomy: a multicenter retrospective study / 中华消化外科杂志

Objective:To investigate the influences of age-adjusted Charlson comorbidity index (ACCI) on prognosis of patients undergoing laparoscopic radical gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 242 gastric cancer patients who underwent laparoscopic radical gastrectomy in 19 hospitals of the Chinese Laparoscopic Gastrointestinal Surgery Study Group-04 study, including 54 patients in Fujian Medical University Union Hospital, 32 patients in the First Hospital of Putian City, 32 patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 31 patients in Zhangzhou Affiliated Hospital of Fujian Medical University, 17 patients in Nanfang Hospital of Southern Medical University, 11 patients in the First Affiliated Hospital with Nanjing Medical University, 8 patients in Qinghai University Affiliated Hospital, 8 patients in Meizhou People′s Hospital, 7 patients in Fujian Provincial Hospital, 6 patients in Zhongshan Hospital of Fudan University, 6 patients in Longyan First Hospital, 5 patients in the First Affiliated Hospital of Xinjiang Medical University, 5 patients in the First Hospital Affiliated to Army Medical University, 4 patients in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 4 patients in West China Hospital of Sichuan University, 4 patients in Beijing University Cancer Hospital, 3 patients in the First Affiliated Hospital of Xiamen University, 3 patients in Guangdong Provincial People′s Hospital, 2 patients in the First Affiliated Hospital of Xi′an Jiaotong University, from September 2016 to October 2017 were collected. There were 193 males and 49 females, aged 62(range, 23?74)years. Observation indicators: (1) age distribution, comorbidities and ACCI status of patients; (2) the grouping of ACCI and comparison of clinicopathological characteristics of patients in each group; (3) incidence of postoperative early complications and analysis of factors affecting postoperative early complications; (4) follow-up; (5) analysis of factors affecting the 3-year recurrence-free survival rate of patients. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative survival of patients up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametric rank sum test. The X-Tile software (version 3.6.1) was used to analyze the best ACCI grouping threshold. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-Rank test was used for survival analysis. The Logistic regression model was used to analyze the factors affecting postoperative early complications. The COX proportional hazard model was used for univariate and multivariate analyses of factors affecting the 3-year recurrence-free survival rate of patients. Multivariate analysis used stepwise regression to include variables with P<0.05 in univariate analysis and variables clinically closely related to prognosis. Results:(1) Age distribution, comor-bidities and ACCI status of patients. Of the 242 patients, there were 28 cases with age <50 years, 68 cases with age of 50 to 59 years, 113 cases with age of 60 to 69 years, 33 cases with age of 70 to 79 years. There was 1 patient combined with mild liver disease, 1 patient combined with diabetes of end-organ damage, 2 patients combined with peripheral vascular diseases, 2 patients combined with peptic ulcer, 6 patients combined with congestive heart failure, 8 patients combined with chronic pulmonary diseases, 9 patients with diabetes without end-organ damage. The ACCI of 242 patients was 2 (range, 0-4). (2) The grouping of ACCI and comparison of clinicopathological characteristics of patients in each group. Results of X-Tile software analysis showed that ACCI=3 was the best grouping threshold. Of the 242 patients, 194 cases with ACCI <3 were set as the low ACCI group and 48 cases with ACCI ≥3 were set as the high ACCI group, respectively. Age, body mass index, cases with preoperative comorbidities, cases of American Society of Anesthesiologists classification as stage Ⅰ, stage Ⅱ, stage Ⅲ, tumor diameter, cases with tumor histological type as signet ring cell or poorly differentiated adenocarcinoma and cases with tumor type as moderately or well differentiated adenocarcinoma, cases with tumor pathological T staging as stage T1, stage T2, stage T3, stage T4, chemotherapy cycles were (58±9)years, (22.6±2.9)kg/m 2, 31, 106, 85, 3, (4.0±1.9)cm, 104, 90, 16, 29, 72, 77, 6(4,6) in the low ACCI group, versus (70±4) years, (21.7±2.7)kg/m 2, 23, 14, 33, 1, (5.4±3.1)cm, 36, 12, 3, 4, 13, 28, 4(2,5) in the high ACCI group, showing significant differences in the above indicators between the two groups ( t=-14.37, 1.98, χ2=22.64, Z=-3.11, t=-2.91, χ2=7.22, Z=-2.21, -3.61, P<0.05). (3) Incidence of postoperative early complications and analysis of factors affecting postoperative early complications. Of the 242 patients, 33 cases had postoperative early complications, including 20 cases with local complications and 16 cases with systemic complica-tions. Some patients had multiple complications at the same time. Of the 20 patients with local complications, 12 cases had abdominal infection, 7 cases had anastomotic leakage, 2 cases had incision infection, 2 cases had abdominal hemorrhage, 2 cases had anastomotic hemorrhage and 1 case had lymphatic leakage. Of the 16 patients with systemic complications, 11 cases had pulmonary infection, 2 cases had arrhythmias, 2 cases had sepsis, 1 case had liver failure, 1 case had renal failure, 1 case had pulmonary embolism, 1 case had deep vein thrombosis, 1 case had urinary infection and 1 case had urine retention. Of the 33 cases with postoperative early complications, there were 3 cases with grade Ⅰ complications, 22 cases with grade Ⅱ complications, 5 cases with grade Ⅲa complications, 2 cases with grade Ⅲb complications and 1 case with grade Ⅳ complica-tions of Clavien-Dindo classification. Cases with postoperative early complications, cases with local complications, cases with systemic complications were 22, 13, 9 in the low ACCI group, versus 11, 7, 7 in the high ACCI group, respectively. There were significant differences in cases with postoperative early complications and cases with systemic complications between the two groups ( χ2=4.38, 4.66, P<0.05), and there was no significant difference in cases with local complications between the two groups ( χ2=2.20, P>0.05). Results of Logistic regression analysis showed that ACCI was a related factor for postoperative early complications of gastric cancer patients undergoing laparoscopic radical gastrectomy [ odds ratio=2.32, 95% confidence interval ( CI) as 1.04-5.21, P<0.05]. (4) Follow-up. All the 242 patients were followed up for 36(range,1?46)months. During the follow-up, 53 patients died and 13 patients survived with tumor. The 3-year recurrence-free survival rate of the 242 patients was 73.5%. The follow-up time, cases died and cases survived with tumor during follow-up, the 3-year recurrence-free survival rate were 36(range, 2-46)months, 29, 10, 80.0% for the low ACCI group, versus 35(range, 1-42)months, 24, 3, 47.4% for the high ACCI group. There was a significant difference in the 3-year recurrence-free survival rate between the two groups ( χ2=30.49, P<0.05). (5) Analysis of factors affecting the 3-year recurrence-free survival rate of patients. Results of univariate analysis showed that preoperative comorbidities, ACCI, tumor diameter, histological type, vascular invasion, lymphatic invasion, neural invasion, tumor pathological TNM staging, postoperative early complications were related factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy [ hazard ratio ( HR)=2.52, 3.64, 2.62, 0.47, 2.87, 1.90, 1.86, 21.77, 1.97, 95% CI as 1.52-4.17, 2.22-5.95, 1.54-4.46, 0.27-0.80, 1.76-4.70, 1.15-3.12, 1.10-3.14, 3.01-157.52, 1.11-3.50, P<0.05]. Results of multivariate analysis showed that ACCI, tumor pathological TNM staging, adjuvant chemotherapy were indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy ( HR=3.65, 11.00, 40.66, 0.39, 95% CI as 2.21-6.02, 1.40-86.73, 5.41-305.69, 0.22-0.68, P<0.05). Conclusions:ACCI is a related factor for post-operative early complications of gastric cancer patients undergoing laparos-copic radical gastrectomy. ACCI, tumor pathological TNM staging, adjuvant chemotherapy are indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy.

Screening of genes related to the prognosis of gastric cancer and the efficacy of 5-fluorouracil based on bioinformatics method / 肿瘤研究与临床

Objective:To screen biomarkers related to the prognosis of gastric cancer and the efficacy of 5-fluorouracil based on the bioinformatics method.Methods:Gastric cancer datasets like GSE54129, GSE79973 and GSE51725 based on GPL570 platform were downloaded from Gene Expression Omnibus (GEO) database. Genes related to the overall survival (OS) of the top 500 gastric cancer patients were downloaded from GEPIA2 online gene expression profile.GEO2R was used to identify the differentially expressed genes (DEG) between gastric cancer tissues and adjacent normal tissues, STRING database was used to build protein-protein interaction networks (PPI) and to identify the key genes, the enrichment analysis of gene ontology (GO)and Kyoto Encyclopedia of Genes and Genomes (KEGG) was made by using OmicShare. Kaplan-Meier Plotter was used to calculate the value of key genes in predicting the OS of gastric cancer patients. All patients were divided into the high expression group and low expression group according to the optimal cut-off value of gene expression level.Results:A total of 59 DEG were screened, including 39 up-regulated genes and 20 down-regulated genes. The key up-regulated genes including homeodomain transcription factors 2(PITX2), hepatocyte growth factor (HGF), fibroblast growth factor 1 (FGF1), transforming growth factor β 2 (TGFB2), thromobospondin 1 (THBS1) were analyzed by using PPI. Survival analysis results showed that the OS of gastric cancer patients with low expression of FGF1, HGF, PITX2 and TGFB2 genes was better (all P < 0.01); the OS of gastric cancer patients with low expression of THBS1 gene was poor, while the difference was not statistically significant ( P > 0.05). The patients with low expression of RIEG1 gene who received 5-fluorouracil-based chemotherapy regimen had the better OS ( P < 0.01),while those with THBS1 and HGF low expression had the worse OS ( P < 0.05). It was found that key genes might promote the development of gastric cancer by participating in the regulation of TGF- β signaling pathway, Rap1 signaling pathway, MAPK signaling pathway, PI3K-Akt signaling pathway, Hippo signaling pathway, Ras signaling pathway and focal adhesion pathway. Conclusions:Bioinformatics analysis shows that the expressions of FGF1, HGF, PITX2 and TGFB2 genes are related to the prognosis of gastric cancer, and the expressions of RIEG1, THBS1 and HGF are related to the efficacy of 5-fluorouracil, which may be used as a predictive marker of fluorouracil chemosensitivity in patients with gastric cancer.

Progress in diagnosis of bone metastasis of prostate cancer / 中南大学学报(医学版)

The diagnosis of bone metastasis of prostate cancer (PC) is of great significance to the treatment and prognosis of patients with PC.Bone scan is the most commonly used in the early diagnosis of bone metastasis, but its specificity is low and there is a high false positive.In recent years, with the in-depth study of the application of CT, MRI, emission computed tomography (ECT), positron emission computed tomography/computed tomography (PET/CT) and deep learning algorithm-convolutional neural networks (CNN) in the diagnosis of bone metastasis, the combined application of various auxiliary parameters in the diagnosis of bone metastasis has significantly been improved. The therapeutic effect of PC patients with bone metastasis can also be evaluated, which is expected to achieve the treatment of bone metastasis as well as diagnosis. By systematically expounding the research progress of the above-mentioned techniques in the diagnosis of bone metastasis, it can provide clinicians with new methods for the diagnosis of bone metastasis and improve the diagnostic efficiency for bone metastasis.

Evaluation value of preoperative peripheral blood lymphocyte-to-monocyte ratio on the prognosis of patients with stage III colon cancer / 中华胃肠外科杂志

OBJECTIVE@#To investigate the evaluation value of preoperative peripheral blood lymphocyte-to-monocyte ratio (LMR) on the prognosis of patients with stage III colon cancer undergoing radical resection and postoperative adjuvant chemotherapy.@*METHODS@#Electronic medical record were retrospectively retrived for stage III colon cancer patients who underwent radical surgery at Sun Yat-sen University Cancer Center from December 2007 to December 2013. Inclusion criteria were pathologically comfirmed colon adenocarcinoma, complete clinicopathological data, and postoperative XELOX (oxaliplatin + capecitabine) chemotherapy with follow-up of at least 3 months. Patients with neoadjuvant anti-tumor therapy, infectious disease, other malignant tumors and death of non-tumor causes within 3 months after operation were excluded. A total of 258 patients were included in this retrospective cohort study, including 146 males and 112 females with median age of 55 (22 to 85) years. Tumors of 100(38.8%) patients were located in the right hemicolon, and of 158 (61.2%) in the left hemicolon. Tumors of 194(75.2%) patients were highly and moderately differentiated, and of 64 (24.8%) were poorly differentiated. According to the TNM tumor pathological stage of AJCC 7th edition, 196 (76.0%) patients were stage IIIA to IIIB, and 62(24.0%) patients were stage IIIC. The median preoperative CEA was 3.8 (0.3 to 287.5) μg /L and the median cycle of the adjuvant chemotherapy was 6 (1 to 8). The cut-off value of preoperative LMR in prediction of 3-year overall survival (OS) outcome was determined by receiver operating characteristic (ROC) curve analysis. All patients were divided into low LMR group and high LMR group according to the critical value. Clinicopathological characteristics between the two groups were compared by using chi-square test or Fisher's exact test as appropriate. The 3-year disease-free survival and overall survival rate were estimated with the Kaplan-Meier method, and differences between two groups were assessed with the log-rank test. Univariate and multivariate analyses were performed through Cox regression model.@*RESULTS@#ROC curve showed that the cut-off value of preoperative LMR in predicting 3-year overall survival was 4.29. Then 143 patients were divided into low LMR group (LMR4 cm [60.1% (86/143) vs. 33.0% (38/115), χ²=18.748, P<0.001]. During a median follow-up of 46.0 (range, 3.0 to 74.0) months, 3-year disease-free survival rate was 83.8% in high LMR group and 78.9% in low LMR group, which was not significantly different (P=0.210). While 3-year overall survival rate in low LMR group was significant lower than that in high LMR group (86.6% vs. 97.2%, P=0.018). Univariate analysis revealed that preoperative low LMR (HR=2.841, 95%CI: 1.146 to 7.043, P=0.024), right hemicolon cancer (HR=2.865, 95%CI: 1.312 to 6.258, P=0.008) and postoperative adjuvant chemotherapy≥6 cycles (HR=0.420, 95%CI: 0.188 to 0.935, P=0.034) were the risk factors for poor overall survival. Multivariate analysis identified that preoperative low LMR (HR=2.550, 95%CI: 1.024 to 6.347, P=0.004) and right hemicolon cancer (HR=2.611, 95%CI: 1.191 to 5.723, P=0.017) were the independent risk factors for overall survival.@*CONCLUSIONS@#Preoperative peripheral blood LMR level represents an effective prognostic predictor for patients with stage III colon cancer receiving radical therapy. Low LMR indicates the poor prognosis and such patients require aggressive postoperative treatment strategy.

Association of inflammatory indices with the severity of urinary sepsis: analysis of 70 cases / 南方医科大学学报

OBJECTIVE@#To analyze the association of the clinical inflammatory indices with the severity of urinary sepsis.@*METHODS@#We reviewed the clinical data of 70 patients with urinary sepsis treated in our hospital between January, 2013 and April, 2018. All the patients were diagnosed in line with the Guidelines for Diagnosis and Treatment of Urological Diseases in China (2014 edition), including 22 patients with sepsis, 12 with hypotension and severe sepsis, 17 with septic shock, and 19 with critical septic shock. White blood cell count (WBC), neutrophil percentage (N%), platelets (PLT), fibrinogen (FIB), Ddimer, interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were examined in all the cases and compared among the 4 groups. The correlations of these inflammatory markers with the severity of sepsis were analyzed using logistic regression analysis.@*RESULTS@#The 4 groups of patients showed significant differences in N%, PLT, D-dimer, and PCT ( < 0.05) but not in CRP (>0.05). Kruskal-Wallis Pairwise comparisons showed that the N% and PCT in patients with sepsis differed significantly from those in the other 3 groups; platelets in patients with sepsis differed significantly from those in patients with septic shock and critical septic shock; D-dimer differed significantly between patients with sepsis and those with septic shock. Among the 4 groups, the median levels of PLT decreased and PCT and N% increased with the worsening of sepsis. Logistic regression analysis indicated that PCT (=0.186, =0.000), N% (=0.047, =0.035) and PLT (=-0.012, =0.003) were significantly correlated with the severity of sepsis in these patients.@*CONCLUSIONS@#PCT, PLT and N% are all significantly correlated with the severity of sepsis, and their combined detection can be informative for assessing the severity of sepsis to facilitate clinical decisions on treatment.

Totally laparoscopic π-shape esophageal jejunostomy vs.laparoscopic assisted end-to-side esophageal jejunostomy in radical D2 total gastrectomy for gastric cancer / 中华普通外科杂志

Objective To evaluate laparoscopic π-shaped esophageal jejunostomy vs.laparoscopic assisted end-to-side esophageal jejunostomy in]D2 radical total gastrectomy for middle third gastric cancer.Methods From July 2015 to July 2017,154 patients undergoing laparoscopic D2 radical total gastrectomy were divided into group of laparoscopic assisted end-to-side esophageal jejunostomy (92 cases) and the group of totally laparoscopic π-shaped esophageal jejunostomy (62 cases).Results The group of totally laparoscopic π-shaped esophageal jejunostomy was not statistically different in tumor pathology and postoperative complications with laparoscopic assisted group,but was better than the later in anastomotic reconstruction surgery time (21 ± 3) min vs.(30 ± 3) min,t =17.56,P =0.000,incision length (6.7 ±1.1) cm vs.(10.5 ± 1.7) cm,t =15.72,P =0.000 and anastomotic complications (3％ vs.13％,x2 =4.320,P =0.038).Conclusions Totally laparoscopic π-shape esophageal jejunostomy is safe,feasible,better than hand assisted procedures.

Endoscopic metallic stent followed by elective laparoscopic surgery for malignant colorectal obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of endoscopic metallic stent as a bridge to elective laparoscopic surgery in patients with malignant colorectal obstruction.</p><p><b>METHODS</b>Clinical data of 63 patients with obstructive colorectal cancer who underwent endoscopic metallic stent insertion under radiologic monitoring at the Longyan First Hospital between June 2012 and August 2016 were analyzed retrospectively. After complete remission of the obstruction, all the patients received multi-disciplinary team (MDT) evaluation to make the further treatment strategy. The subsequent surgery included open and laparoscopic procedures, and the short-term efficacy of these two procedures was compared.</p><p><b>RESULTS</b>There were 30 male and 33 female patients with age of 30 to 90 (mean 67) years, including 3 cases of ascending colon cancer, 4 cases of transverse colon cancer, 12 cases of descending colon cancer, 26 cases of sigmoid cancer, and 19 cases of rectal cancer. Only one patient (1.6%) developed sigmoid perforation at 3 hours after stent placement, and underwent emergency laparotomy with Hartmann procedure. The remaining 62 patients had bowel movements. After MDT evaluation, 10 patients (16.1%) were treated with palliative chemotherapy because they were unfit for surgery or for diffuse distant metastases. A total of 52 patients underwent radical surgery after a mean interval from stent insertion of 10 days (7-20 days), including open (n=18, including two cases with conversion to open surgery) and laparoscopy (n=34). The baseline data between open and laparoscopy groups were similar (all P>0.05). Primary anastomosis was successfully performed in all the patients without preventive stoma. Compared to open group, laparoscopy group had faster bowel movement [(2.88±1.06) d vs. (4.05±2.43) d, P=0.022] and shorter postoperative hospital stay [(7.85±0.96) d vs. (9.82±4.41) d, P=0.002]. There were no statistically significant differences in operative time, intraoperative blood loss, number of harvested lymph node, and postoperative complication rate between two groups (all P>0.05).</p><p><b>CONCLUSIONS</b>Endoscopic metallic stent placement can effectively remove malignant colorectal obstruction, and thus enables surgeons to perform an elective radical surgery, avoiding emergency surgery with stoma and unnecessary surgery for patients with distant metastasis. In the era of enhanced recovery after surgery, the endoscopic metallic stent placement combined with laparoscopic procedures, as a less invasive alternative, is effective and safe.</p>

Efficacy of preoperative short course radiotherapy before laparoscopic radical resection for middle and low locally advanced rectal cancer / 中华普通外科杂志

Objective To analyse the effect with or without short course radiotherapy before laparoscopc surgery for middle and low locally advanced rectal cancer.Methods Clinical and pathological data of 145 patients confirmed with stage T3 or T4 middle and low locally advanced rectal cancer by pathology were retrospectively analyzed.69 cases were in preoperative short course radiotherapy group and 76 cases went directly to laparoscopic surgery.Results There was no statistical difference in the operation time,(140 ± 17) min vs.(136 ± 17) min,t =-3.04,P =0.761,for blood loss,(65 ±38)ml vs.(76 ±33)ml,t =-1.72,P =0.086.Less abdominal perineal resection was performed in preoperative short term radiotherapy group than in upfront surgery group,though the difference was not statistically significant (P =0.600).Postoperative complications were 16％ and 16％ respectively,x2 =0.001,P =0.98.The 2 year local recurrence rate was 6％ and 17％ respectively,x2 =2.246,P =0.035.There was no significant difference in 2 year distant metastasis rate between the two groups,x2 =0.000,P =0.99,nor the difference in 2 year's survival rate,87％ vs.87％,x2 =0.000,P =0.986.Conclusions Preoperative short course radiotherapy can reduce the local recurrence rate of middle and low locally advanced rectal cancer,without increasing the difficulty of operation and postoperative complications,but long time survival fails to improve.

Endoscopic and pathological features of colorectal serrated adenoma: comparison with traditional adenoma / 中华消化内镜杂志

Objective To analyze the differences in endoscopic and pathological features between colorectal serrated adenoma (SA) and colorectal traditional adenoma.Methods The endoscopic and pathological features of 80 cases of SA and 160 cases of traditional adenoma diagnosed from June 2008 to October 2013 were retrospectively analyzed.Results The SA patients were younger than the traditional adenoma patients (57.5 VS 62.3,P =0.003 8).The lesions of SA were mostly located in rectosigmoid colon (60％),while the traditional adenoma could be found in rectosigmoid colon (45％),ascending colon (20％) and descending colon (19％).There were significant differences in the lesion's location between two kinds of adenoma (P ＜ 0.05).There were no differences in gender,the size of lesion or endoscopic classification.In terms of the pathological features,SA had the serrated structure,whereas tubular,tubulovillous and villous structure were found in traditional adenoma.Cancer could be found in 1.9％ of SA,which was lower than that of traditional adenoma (P ＜ 0.05).Conclusion Serrated adenoma is different from traditional adenoma on the patient's age,lesion's location and pathological features.It is an unique kind of adenoma with potential malignancy,which should be emphasized in clinical practice.

Endoscopic ultrasonograghy in diagnosis and treatment of gastrointestinal neuroendocrine neoplasms / 中华消化内镜杂志

Objective To investigate the value of endoscopic ultrasonograghy (EUS) in diagnosis and treatment of gastrointestinal neuroendocrine neoplasm (GI-NEN).Methods We retrospectively summarized the clinical data of 44 patients with GI-NEN which were confirmed by pathology and immunohistochemistry,and analyzed the EUS features and the follow-up data of patients who received EUS exam and EUS-assisted endoscopic resection.Results A total of 47 neoplasms were detected in 44 patients,in which 41 were confirmed as neuroendocrine tumors (NET) and 6 were neuroendocrine carcinoma (NEC).Under EUS,all 41 NET appeared as hypoechoic lesions with regular edge and homogeneous echographic pattern,and 18 were originated from mucosal layer and 23 from submucosal layer,which was all confirmed by pathological evaluation.All 41 NET lesions received EUS-assisted endoscopic resection,in which 17 were treated by ESD/EMR and 24 by high frequency electrotomy.Follow-up endoscopy was performed at 3-6 and 12 month after operation,which showed no residual or recurrence.Conclusion EUS may accurately determine the invasion depth of GI-NEN lesions,and provide important information for adapting appropriate treatment strategies,which has highly clinical practice value in the diagnosis and treatment of GI-NEN.