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.

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>

Experimental study about the impact of the regeneration of interstitial cell of Cajal on gastric emptying in rats undergoing Roux-en-Y gastrojejunostomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of the regeneration of interstitial cell of Cajal (ICC) on the conduction of slow wave and gastric emptying in rats undergoing Roux-en-Y gastrojejunostomy.</p><p><b>METHODS</b>Twenty male SD rats were randomly divided into experimental group and control group. The experimental group consisted of ten rats undergoing Roux-en-Y gastrojejunostomy. The control group only underwent pyloric transection and anastomosis. Gastric scintigraphy was performed in the two groups respectively to measure the half time of gastric emptying (t1/2) at sixteen weeks after the surgical manipulations, and then the myoelectrical activities near the gastrojejunal anastomosis were recorded. The study also observed the regeneration of ICC by the electron microscopy. The data of the 2 groups was compared by t test.</p><p><b>RESULTS</b>In the sixteenth postoperative week, the t1/2 was (23.5 ± 4.5) minutes for rats in the Roux-en-Y group and (10.2 ± 2.3) minutes for those in the control group, indicating delayed gastric emptying in the Roux-en-Y group (t=7.978, P=0.000), accompanied with the abnormal myoelectrical activities near the gastrojejunal anastomosis. The morphological detection showed that ICC near the gastrojejunal anastomosis regenerated and reconstructed their network in the rats of the experimental group.</p><p><b>CONCLUSION</b>The abnormal myoelectrical activities near the gastrojejunal anastomosis, basing on the regeneration and reconstruction of ICC, may make a significant delay on the gastric emptying.</p>

Effect of community general health management on outcome of hypertension / 中华健康管理学杂志

Objective To investigate the effect of health management on hypertension control.Methods Patients with high blood pressure and hypertensive risk factors were selected from two communities in Suzhou City of Jiangsu Province.The subjects were then randomly assigned to 2 groups(63 in each group).One group received comprehensive health management for the prevention and treatment of hypertension,and the other group received traditional anti-hypertensive treatment.Systolic blood pressure (SBP),diastolic blood pressure(DBP),and medicine cost were compared at 1 year.Results In the health management group,blood pressure and its related risk factors were effectively controlled,and the mean SBP or DBP was(130.06 ± 17.51)mm Hg or(81.81 ± 8.75)mm Hg(1 mm Hg =0.133 kPa),respectively.The cost of anti-hypertensive medicine of the health management group was largely decreased.Conclusion General health management shows a better anti-hypertensive effect than traditional therapy.