Controversy and progress on whether to retain left colonic artery in radical resection of rectal cancer / 中华胃肠外科杂志

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guideline 2019 recommended that lymph node dissection for advanced rectal cancer should include the lymphatic adipose tissue at the root of the inferior mesenteric vessels, but the ligation site of the inferior mesenteric artery (IMA) was not determined, and the NCCN guideline did not indicate clearly whether to retain the left colonic artery (LCA). Controversy over whether to retain LCA is no more than whether it can reduce the incidence of anastomotic complications or postoperative functional damage without affecting the patients' oncological outcome. Focusing on the above problems, this paper reviews the latest research progress. In conclusion, it is believed that the advantages of retaining LCA are supported by most studies, which can improve the blood supply of the proximal anastomosis, and technically can achieve the same range of lymph node dissection as IMA high ligation. However, whether it affects the survival of patients, reduces the incidence of anastomotic leakage, and improves the quality of life of patients, more high-quality evidence-based medical evidence is still needed.

Clinical significance of SIRT1 expression in invasion and metastasis of esophageal squamous cell carcinoma / 天津医药

Objective To observe the expression of silent information regulator 1(SIRT1)in esophageal squamous cell carcinoma,and its relationship with invasion and metastasis of esophageal squamous cell carcinoma and its effect on survival and prognosis.Methods The clinical and pathological data of 104 patients with esophageal cancer who underwent radical esophagectomy at the Affiliated Tumor Hospital of Xinjiang Medical University from January to December 2009 were retrospectively reviewed. Immunohistochemical method (EnVision method) was used to detect the expression of SIRT1 in cancer tissues and adjacent tissues. The clinicopathological features of different SIRT1 expressions were compared. The factors affecting the prognosis of the patients with esophageal cancer were analyzed.Results The positive expression rate of SIRT1 protein was significantly higher in esophageal squamous cell carcinoma tissues than that in adjacent tissues(61.54% vs. 29.81%, χ2=21.100, P<0.05). The expression of SIRT1 in esophageal squamous cell carcinoma was significantly correlated with vascular infiltration(VI),infiltration depth(pT),lymph node metastasis(pN)and clinical stage(pTNM)(P<0.05).Univariate survival analysis showed that the overall survival time(OS)was significantly lower in patients with SIRT1 positive expression than that of patients with negative expression(Log-rank χ2=10.065,P<0.05).SIRT1 positive expression, lymph node metastasis,deep tumor infiltration,late clinical stage and vascular infiltration showed poor prognosis(P<0.05). Cox multivariate regression analysis showed that SIRT1 positive expression, lymph node metastasis, depth of invasion and clinical stage were independent prognostic factors for esophageal squamous cell carcinoma. The prognosis of patients with deep tumor invasion, lymph node metastasis, late clinical stage and high expression of SIRT1 was worse. Conclusion SIRT1 is highly expressed in esophageal squamous cell carcinoma, and which is closely related to the invasion and metastasis of esophageal squamous cell carcinoma and has an effect on the prognosis of patients.