Application of intracorporeal uncut Roux-en-Y anastomosis in digestive tract reconstruction after laparoscopic total gastrectomy / 中华胃肠外科杂志

OBJECTIVE@#To explore the safety, feasibility and short-term efficacy of intracavitary uncut Roux-en-Y (URY) anastomosis in digestive tract reconstruction following laparoscopic total gastrectomy (LTG).@*METHODS@#From November 2015 to January 2018, 67 gastric cancer patients underwent intracavitary URY following LTG to reconstruct the digestive tract at Oncological Surgery Department of Fujian Provincial Hospital. There were 41 males and 26 females with age of 50 to 81 (61.9±7.4) years and body mass index (BMI) of (23.4±3.2) kg/m². Among 67 patients, 19 were gastric cardia carcinomas, 33 were gastric body carcinomas, and 15 were gastric fundus carcinomas; tumor size was (3.4±2.3) cm; 22 were Borrmann type I, 15 were type II, 21 were type III, and 19 were type IV; 29 were highly or moderately differentiated adenocarcinoma, 23 were lowly differentiated adenocarcinoma, and 15 were signet-ring cell carcinoma. After conventional laparoscopic D2 radical gastrectomy, the duodenum was closed and dissociated at 2 cm below the pyloric ring using the Echelon-flex endoscopic articulated linear Endo-GIA stapler, and the esophagus was dissociated above the esophagogastric junction (EGJ).URY and digestive tract reconstruction were performed under the direct vision of laparoscope: (1) Side-to-side esophagojejunostomy: An incision of 0.5 cm was made in the left lower edge of the esophageal closed end; jejunum about 25 cm distal away from the Treitz ligament was elevated to the lower end of esophagus; another incision of 0.5 cm was made in the contralateral of mesenteric side; both arms of the linear Endo-GIA stapler were inserted into the windows opened through esophagus and jejunum respectively to complete side-to-side anastomosis. The common opening of esophagus and jejunum was closed to complete esophagojejunostomy, forming the chyme outflow tract. (2) Side-to-side Braun jejunojejunostomy: Incisions of 0.5 cm were made in the proximal jejunum about 10 cm away from the esophagojejunal anastomosis and 35-40 cm away from the contralateral of mesenteric side of distal jejunum respectively for proximal-distal side-to-side jejunojejunostomy. The common opening was closed to form the biliopancreatic duodenal juice outflow tract. (3) Closure of the input loop jejunum in the esophagojejunal anastomosis: The input loop jejunum 2-3 cm away from the esophagojejunal anastomosis was closed using the non-blade linear stapler (ATS45NK), and the biliopancreatic duodenal juice reflux was blocked. Clinical data of these patients were collected for retrospective case series study. Surgical and digestive tract functional recovery, perioperative complications, as well as postoperative nutritional status were observed. Moreover, related indexes, such as anastomosis function and tumor recurrence were evaluated through endoscopic and imaging examinations during postoperative follows-up.@*RESULTS@#All the 67 patients completed the surgery successfully. The mean operative time was (259.4±38.5) minutes, digestive tract reconstruction time was (38.2±13.2) minutes, intraoperative blood loss was (73.4±38.4) ml, and number of harvested lymph node was 36.2±14.2. The mean distance from upper resection margin to upper tumor edge was (3.3±1.2) cm, distance from upper resection margin to dentate line was (1.2±0.7) cm, and 1 case had positive upper incisal margin, which became negative after the second resection. Moreover, the average length of the auxiliary incision was (3.2±0.4) cm. The mean postoperative intestinal exhaust time was (52.8±26.4) hours, time to liquid diet was (64.8±28.8) hours, and postoperative hospital stay was (8.4±2.5) days. The morbidity of postoperative complication was 10.4%(7/67). Among these 7 cases, 4 cases were grade IIIa of Clavien-Dindo classification, including 2 with esophagojejunal anastomosis leakage, 1 with duodenal stump leakage, and 1 with abdominal infection, and all these patients were recovered after conservative treatment. All the 67 patients were followed up. The mean nutrition index 12 months after surgery was 53.4±4.2, diameter of esophagojejunal anastomosis was (3.9±0.6) cm, the incidence of Roux-en-Y stasis syndrome was 3.0% (2/67), and the incidence of reflux esophagitis was 4.5% (3/67). No patient had recanalization of the closed input loop of esophagojejunal anastomosis, anastomotic stenosis, obstruction, or tumor recurrence at anastomosis.@*CONCLUSION@#Intracavitary URY anastomosis following LTG for digestive tract reconstruction is safe and feasible, leading to fast postoperative recovery of digestive tract function and favorable short-term efficacy.

The expression of BCORL1 and E-cadherin in gastric carcinoma and their correlation analysis / 重庆医学

Objective To investigate the expression of BCORL1 and E-cadherin and their correlation analysis in gastric carcino-ma .Methods We freshly collected 58 samples of surgically resected paired gastric carcinoma and normal tumor-adjacent tissues and detected BCORL1 and E-cadherin expression in the samples using immunohistochemical staining .The correlation between BCORL1 and E-cadherin protein expression was analysed .Results The protein expression of BCORL1 in gastric carcinoma tissues was sig-nificantly upregulated compared to those of the normal tumor-adjacent tissues(60 .3% vs .17 .2% ,P=0 .000) ,but expression of E-cadherin in gastric carcinoma tissues was significantly lower than those in the normal tumor-adjacent tissues (27 .6% vs .63 .8% , P=0 .000) .Clinicopathological analysis suggested that EphA2 and E-cadherin protein expression were associated with histopatho-logical differentiation ,depth of invasion ,lymph node metastasis and TNM stage(P<0 .05) .BCORL1 was significantly negative cor-related with E-cadherin protein in gastric carcinoma(r= -0 .571 ,P=0 .002) .Conclusion The high-expression of BCORL1 is cor-related with malignant clinicopathological characteristics ,and BCORL1 is negative associated with E-cadherin ,suggesting that BCORL1 promotes tumor progression and metastasis through transcriptional regulating E-cadherin in gastric carcinoma .

Expression and significance of aquaporin-1 in breast carcinoma / 中国普通外科杂志

Objective To explore the expression and the significance of aquaporin 1(AQP1) in breast carcinoma tissues.Methods Specimcns of breast carcinoma tissues of 40 cases and the non-cancerous adjacent tissues of 10 cases were obtained immediately after surgery,and expression of aquaporin1 in htese tissues was examined by RT-PCR technique.Results AQP1mRNA expression level in breast tumor tissues was 0.8957?0.0428,that in non-cancerous adjacent tissues was 0.3401?0.0549,and there was significant difference between them(P