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Objective:To explore the effect of tumor deposit (TD) on the prognosis of patients with stage Ⅲ colon cancer after radical resection.Methods:The clinicopathological data of patients with stage Ⅲ colon cancer after radical surgery at the Department of Gastrointestinal Surgery, Peking University People's Hospital from Jan to Dec 2015 were analyzed collected. Clinicopathological characteristics such as tumor location, degree of differentiation, mismatch repair status, lymphatic and venous invasion, and preoperative CEA and CA19-9 levels were used to study the effect of TD on the postoperative survival of patients.Results:Among the 155 patients with stage Ⅲ colon cancer, 37 (23.9%) had tumor deposits. The incidence of tumor deposits was higher in patients with intravascular tumor thrombus and preoperative serum CA19-9 elevation ( χ2=9.567, P=0.002; χ2=11.561, P=0.003); Patients with tumor deposits had worse overall survival and disease-free survival than those without cancer nodules (OS: P=0.029, DFS: P=0.025). Multivariate COX analysis found that tumor deposit was an independent risk factor for postoperative overall survival and disease-free survival ( HR=1.990, 95% CI: 1.032-3.835, P=0.040; HR=2.416, 95% CI : 1.205-3.820, P=0.009). Conclusions:Tumor deposit is an independent risk factor affecting postoperative overall survival and disease-free survival in patients with stage Ⅲ colon cancer. For patients with lymph node metastasis, incorporating TD into TNM staging can more accurately predict the postoperative prognosis.
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Objective:To investigate the clinicopathological characteristics and prognostic factors of Siewert Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospetcive cohort study was conducted. The clinicopathological data of 399 patients with AEG who were admitted to Peking University People′s Hospital from January 1998 to December 2015 were collected. There were 318 males and 81 females, aged 66(range, 19-87)years. Observation indicators: (1) clinicopathological characteristics of Siewert Ⅱ and Ⅲ AEG; (2) follow-up and survival; (3) prognostic factors analysis. Patients were followed up by telephone interview and outpatient examination to detect postoperative survival up to December 2018. 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(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to draw survival curves and calculate survival rates. Log-rank test was used for survival analysis. Univariate and multivariate analyses were done using the COX proportional hazard model. Results:(1) Clinicopathological characteristics of Siewert Ⅱ and Ⅲ AEG. Of 399 patients, 198 cases were Siewert Ⅱ AEG and 201 cases were Siewert Ⅲ AEG. There were 130 cases undergoing transthoracic radical AEG surgery, 172 cases undergoing trans-abdominal proximal gastrectomy and 97 cases undergoing transabdominal total gastrectomy. The age, tumor diameter, cases with surgical method as transthoracic radical AEG surgery, transabdo-minal proximal gastrectomy and transabdominal total gastrectomy, the number of positive lymph nodes, cases in tumor TNM stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were (65±10)years, (5.1±2.4)cm, 102, 68, 28, 17(range, 12?22), 20, 57, 117, 4 for patients with Siewert Ⅱ AEG, versus (62±12)years, (6.3±3.2)cm, 28, 104, 69,18(range, 14?27), 16, 41, 134, 10 for patients with Siewert Ⅲ AEG, showing significant differ-ences betweeen them ( t=2.83, ?3.82, χ2=66.97, U=17 407.05, 17 532.00, P<0.05). (2) Follow-up and survival. All 399 patients were followed up for 34(range, 2?160)months. The 5-year overall survival rate was 29.3% for patients with Siewert Ⅱ AEG, versus 37.0% for patients with Siewert Ⅲ AEG, showing no significant difference betweeen them ( χ2=1.46, P>0.05). The median survival time and 5-year overall survival rate were 29.0 months [95% confidence interval ( CI) as 23.4?34.6 months] and 22.9% for patients undergoing transthoracic radical AEG surgery, 43.0 months(95% CI as 33.9?52.1 months) and 34.7% for patients undergoing transabdominal proximal gastrectomy, 54.0 months (95% CI as 37.6?70.4 months)and 44.3% for patients undergoing transabdominal total gastrectomy, showing a significant difference in the survival among the 3 groups ( χ2=13.81, P<0.05). Of the 198 Siewert Ⅱ AEG patients, the 5-year overall survival rate was 24.6% for the 96 patients undergoing transabdominal surgery, versus 35.4% for the 102 patients undergoing transthoracic surgery, showing no significant difference in the survival between them ( χ2=3.10, P>0.05). Of the 201 Siewert Ⅲ AEG patients, the 5-year overall survival rate was 40.0% for the 173 patients undergoing transabdominal surgery, versus 16.1% for the 28 patients undergoing transthoracic surgery, showing a significant difference between them ( χ2=11.32, P<0.05). (3) Prognostic factors analysis. Results of univariate analysis showed that surgical method, pathological N staging, patholgical M staging were related factors for prognosis of Siewert Ⅱ and Ⅲ AEG ( hazard ratio=0.68, 1.25, 2.18, 95% CI as 0.54?0.86, 1.15?1.36, 1.28?3.73, P<0.05). Results of multivariate analysis showed that transthoracic approach, pathological stage N2?N3 and pathological stage M1 were independent risk factors for prognosis of Siewert Ⅱ and Ⅲ AEG ( hazard ratio=0.64, 1.25, 2.18, 95% CI as 0.51?0.80, 1.16?1.35, 1.28?3.70, P<0.05). Conclusions:Compared with Siewert Ⅲ AEG, Siewert Ⅱ AEG has a smaller tumor diameter, less positive lymph nodes, poorer prognosis. Transthoracic approach is preffered for the Siewert Ⅱ AEG. Transthoracic approach, pathological stage N2?N3 and pathological stage M1 are independent risk factors for prognosis of Siewert Ⅱ and Ⅲ AEG.
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Objective:To analyze the progress and promotion effect of the national multidisciplinary team(MDT) pilot project of digestive system tumor diagnosis and treatment, for the reference in promoting the popularition of tumor MDT model.Methods:The data of MDT project evaluation forms of 231 digestive system tumor MDT pilot hospitals in 2018(July 2017 to June 2018), 2019(July 2018 to June 2019)and 2020(July 2018 to June 2019)were obtained. The MDT of digestive system tumors, the development of outpatient and inpatient MDT, the distribution of cases, and the management, charging and regional radiation of MDT in the pilot hospital were analyzed. Descriptive analysis and frequency analysis were used for all the data.Results:With pilot hospitals of missing data excluded, the number of pilot hospitals included in the analysis from 2018 to 2020 was 227, 224 and 224, respectively.The number of pilot hospitals carrying out digestive system tumor MDT increased from 174 in 2018 to 222 in 2020, the number of outpatient and inpatient MDT cases increased from 48 332 and 61 823 to 72 493 and 106 899 respectively, and the proportion of pilot hospitals implementing the MDT management system increased from 159 to 214. In 2020, the average expenses of outpatient and inpatient MDT were mainly 200-500 yuan, and 135(60.3%) pilot hospitals became the leading MDT hospitals in the region.Conclusions:The MDT pilot project of digestive system tumors in China has achieved remarkable results.For example, the number of pilot hospitals carrying out MDT keeps increasing year by year, and the pilot hospitals have played a leading role in the region. In order to accelerate the coverage of the tumor MDT model, the authors suggested that the hospitals should optimize MDT in terms of patient accessibility, optimize management mode, promote the medical insurance reimbursement, and strengthen regional influence.
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Objective:To investigate clinicopathological characteristics and efficacy of conversion therapy in patients with metastatic gastric cancer.Methods:The clinicopathological and follow-up data of metastatic gastric cancer patients at the Department of Gastrointestinal Surgery of Peking University People's Hospital from Jan 2018 to Jun 2021 were retrospectively studied. Multivariate Logistic regression analysis was used to identify independent characteristics for pathological complete response (PCR). The influence of stage of metastatic gastric cancer and pathological response on prognosis were analyzed by Kaplan-Meier curve.Results:A total of 31 patients were enrolled, and 13 tumors located at the cardia or fundus, 8 at body, other 10 at pylorus or antrum . Baseline CT evaluation showed retroperitoneal lymph node metastasis in 10 cases, intraperitoneal metastasis in 10 cases, liver metastasis in 2 cases, adrenal and splenic metastasis in 1 case respectively, and multiple metastasis in 5 cases. After conversion therapy, 8 (26%) cases had pathological T0, 16 cases (52%) had pathological N0 and 7 cases (22%) had pathological complete response. Multivariate Logistic regression analysis showed retroperitoneal lymph node metastasis ( OR: 20.082, 95% CI: 2.141-188.315, P=0.009) was the only independent risk factor of PCR. Meanwhile, Kaplan-Meier curve showed pT0 improved disease-free survival significantly ( P=0.021). Conclusions:Metastatic gastric cancer patients with retroperitoneal lymph node metastasis alone had a tolerable conversion therapy effect. pT0 is a significant factor in improving prognosis.
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Objective:To investigate the short term efficacy of laparoscopic assisted transanal total mesorectal excision (taTME) for low rectal cancer.Methods:The prospective study was conducted. The clinicopathological data of 80 patients who underwent laparoscopic assisted taTME for low rectal cancer in 8 medical centers，including 27 cases in the First Affiliated Hospital of Jilin University，16 cases in the Daping Hospital of Army Medical University，15 cases in the Beijing Friendship Hospital of Capital Medical University，10 cases in the Peking University Cancer Hospital，7 cases in the Peking Union Medical College Hospital of Chinese Academy of Medical Sciences，2 cases in the Peking University People′s Hospital，2 cases in the Liaoning Cancer Hospital Institute，1 case in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine，from August 2017 to September 2018 were collected. Observation indicators：(1) clinical data of enrolled patients；(2) surgical situations；(3) postoperative histopathological examination；(4)postoperative complications and hospitalization. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and (or) percentages. Results:(1) Clinical data of enrolled patients：a total of 80 patients were selected for eligibility. There were 59 males and 21 females，aged from 53 to 79 years，with a median age of 61 years. (2）Surgical situations：all 80 patients underwent surgery successfully，including 73 cases undergoing low anterior resection，4 cases undergoing Hartmann operation，1 case undergoing intersphincteric and abdominoperineal resection，1 case undergoing other operations and 1 case missing operation information. Nineteen of the 80 patients underwent transabdominal and transanal operations simultaneously. The operation time of 80 patients was 255 minutes (range，211?305 minutes). Of 80 patients，77 cases had the volume of intraoperative blood loss ≤500 mL，3 cases had the volume of intraoperative blood loss >500 mL，44 cases underwent instrumental anastomosis，24 cases underwent manual anastomosis，12 cases were missing anastomosis information，66 cases had specimens been taken out through anus，2 cases had specimens been taken out through Pfannens-tiel incision，10 cases had specimens been taken out through other ways，2 cases were missing the information of specimens removal ways，57 cases underwent preventive stoma，32 cases under-went anal canal indwelling，30 cases underwent free of splenic flexure and 2 cases were converted to open surgery. (3) Postoperative histopathological examination：of 80 patients，68 cases had the integrity of mesorectal specimens with complete，5 cases had the integrity of mesorectal specimens with near complete，1 case had the integrity of mesorectal specimens with not complete，6 cases were missing the information of integrity of mesorectal specimens，1 case had rectal perforation，1 case had positive circumferential margin and 1 case had positive distal margin. The number of lymph node dissected and diameter of tumor were 12(range，9?16) and 3.0 cm(range，1.9?4.0 cm) of 80 patients. Four of 80 patients achieved pathological complete remission. Cases with tumor stage as T0 stage，Tis stage，T1 stage，T2 stage，T3 stage or T4 stage of the pT staging，cases with tumor stage as N0 stage，N1 stage or N2 stage of the pN staging，cases with tumor stage as M0 stage or M1 stage of the pM staging were 4，2，11，24，35，4，55，21，4，75，5 of 80 patients. (4) Postopera-tive complications and hospitalization：8 of 80 patients underwent anastomotic leakage，including 2 cases with grade A anastomotic leakage，4 cases with grade B anastomotic leakage and 2 cases with grade C anastomotic leakage.Seven of 80 patients underwent intestinal obstruction. The 2 cases with grade A anastomotic leakage were improved after symptomatic drug treatment，the 4 cases with grade B anastomotic leakage were improved after treatment with antibiotics or catheter drainage and the 2 cases with grade C anastomotic leakage were improved after operation. The duration of hospital stay of 80 patients was 14 days(range，11?21 days). No patient died during hospitalization.Conclusion:Laparoscopic assisted taTME for low rectal cancer is safe and feasible，which has a good short term efficacy.
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With certain advantages of superior surgical fields and better chances for anus reservation, transanal total mesorectal excision (TaTME) is a novel surgical approach for low rectal cancer. Guidelines recommend multidisciplinary team (MDT) work as a clinical routine for standardized treatment of rectal cancer. Indication of TaTME depends on multidisciplinary discussion including preoperative staging, prediction of recurrence risks. Standardized preoperative evaluation by MDT and decisions after MDT discussion are the guarantee for the stan-dardized implementation and reasonable promotion of TaTME. Meanwhile, as a procedure for improving local efficacy of rectal cancer, TaTME could save a part of patients with low rectal cancer the trouble of neoadjuvant chemoradiotherapy based on accurate staging by radiologists. That might upgrade status of colorectal surgeons in the MDT and contribute to optimize both curative effects and health economics.
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Objective:To investigate the role of indocyanine green(ICG) fluorescence imaging in laparoscopic anterior resection for rectal cancer.Methods:A retrospective analysis was performed on 7 patients who had undergone laparoscopic anterior resection with the use of ICG fluorescence imaging at Peking University People′s Hospital between Oct 2018 and Mar 2019. The clinicopathological variables, surgical factors, short-term outcome and complications were analyzed.Results:The median operation time was 185 min. The median estimated blood loss was 50 ml. The median time from ICG injection to anastomotic perfusion was 45 s. One patient received extended proximal resection of bowel due to poor perfusion as suggested by ICG imaging. The median time to soft diet was 4 days, and the median hospital stay was 8 days. The median number of lymph nodes harvested was 16. There were no major complications in all these patients. No adverse events related to ICG were recorded.Conclusions:ICG fluorescence imaging was safe and effective in detecting insufficient blood supply around newly established bowel anastomsis, hence potentially reducing the anastomotic leakage rate.
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Objective:To investigate the incidence and influencing factors of anastomotic leakage after anterior resection (AR) for rectal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 1 243 patients with rectal cancer who were admitted to 3 medical centers between August 2008 and July 2017 were collected, including 512 in the Beijing Friendship Hospital of Capital Medical University, 480 in the Cancer Hospital of Chinese Academy of Medical Sciences, 251 in the Peking University People′s Hospital. There were 734 males and 509 females, aged from 25 to 89 years, with an average age of 65 years. All patients underwent AR for rectal cancer. Observation indicators: (1) surgical situations and incidence of postoperative anastomotic leakage; (2) influencing factors for postoperative anastomotic leakage. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using the Logistic regression model based on factors with P<0.10 in the univariate analysis. Results:(1) Surgical situations and incidence of postoperative anastomotic leakage: all the 1 243 patients with rectal cancer underwent successfully AR including 219 undergoing defunctioning stoma and 1 024 undergoing non-defunctioning stoma, of which 70 patients had postoperative anastomotic leakage, with a total incidence rate of 5.632%(70/1 243). The incidence rates of grade A anastomotic leakage, grade B anastomotic leakage, and grade C anastomotic leakage were 27.1%(19/70), 21.4%(15/70), 51.4%(36/70), respectively. (2) Influencing factors for postoperative anastomotic leakage: results of univariate analysis showed that gender, surgical procedure, volume of intra-operative blood loss, and pathological metastasis staging were related factors for anastomotic leakage after AR ( χ2=8.518, 6.548, 10.834, 4.501, P<0.05). Results of multivariate analysis based on factors with P<0.10 in the univariate analysis showed that male and volume of intraoperative blood loss≥100 mL were independent risk factors for anastomotic leakage after AR [ odds ratio ( OR)=2.250, 1.949, 95% confidence interval ( CI): 1.281-3.952, 1.142-3.324, P<0.05)]; defunctioning stoma was an independent protective factor for anastomotic leakage after AR ( OR=0.449, 95% CI: 0.201-1.001, P<0.05). Subgroup analysis on effects of defunctioning stoma versus non-defunctioning stoma on grade of anastomotic leakage showed that percentage of grade C anastomotic leakage for defunctioning stoma group was 14.3%(1/7), versus 55.6%(35/63) for non-defunctioning stoma group, with a significant difference between the two groups ( χ2=9.570, P<0.05). Conclusions:Male and volume of intraoperative blood loss≥100 mL are independent risk factors for anastomotic leakage after AR. Defunctioning stoma is an independent protective factor for anastomotic leakage after AR. For male patients and patients with large volume of intraoperative blood loss, defunctioning stoma is recommended to reduce the incidence of postoperative anastomotic leakage.
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With certain advantages of superior surgical fields and better chances for anus reservation,transanal total mesorectal excision (TaTME) is a novel surgical approach for low rectal cancer.Guidelines recommend muhidisciplinary team (MDT) work as a clinical routine for standardized treatment of rectal cancer.Indication of TaTME depends on multidisciplinary discussion including preoperative staging,prediction of recurrence risks.Standardized preoperative evaluation by MDT and decisions after MDT discussion are the guarantee for the startdardized implementation and reasonable promotion of TaTME.Meanwhile,as a procedure for improving local efficacy of rectal cancer,TaTME could save a part of patients with low rectal cancer the trouble of neoadjuvant chemoradiotherapy based on accurate staging by radiologists.That might upgrade status of colorectal.surgeons in the MDT and contribute to optimize both curative effects and health economics.
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Objective To investigate SIRT2 expression and its significance in colorectal cancer liver metastasis.Methods The expression level of SIRT2 was detected in 25 cases of colorectal cancer tissues and corresponding liver metastasis tissues and another 60 cases of colorectal cancer tissues and corresponding adjacent normal tissues by immunohistochemical method.The clinicopathologic correlations of SIRT2 expression were performed using chi-square test.Kaplan-Meier method was used to evaluate the overall survival.Transwell method was used to evaluate invasiveness of SW480 cell line.qRT-PCR was applied to assess expression level of E-cadherin and MMP2.Results SIRT2 expression significantly decreased in colorectal cancer liver metastases (3.6 ±0.5 vs.6.5 ±0.8,t =15.37,P ＜0.01).The low expression level of SIRT2 was significantly associated with tumor differentiation (x2 =7.475,P =0.024).Patients with low SIRT2 expression had a shorter overall survival than those with high SIRT2 expression [(42.5 ±6.0)mon vs.(60.5 ±5.4)mon,x2 =5.493,P =0.019].Multivariate analysis showed that SIRT2 expression and distant metastasis were the two factors that were independently associated with prognosis.Overexpression of SIRT2 significantly weakened the invasive ability of SW480 cell line.Conclusion Downregulation of SIRT2 predicts poor prognosis of patients with colorectal cancer for enhancing tumor cell invasive ability.
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Indocyanine green (ICG) fluorescence imaging has been widely used in surgery. In colorectal surgery specifically, more and more studies have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion, and its use may decrease the incidence of anastomotic leakage. Meanwhile, indocyanine green can also be used to mark the location of lesion, identify sentinel lymph nodes, protect the ureter, and so on. It can also provide detection and guidance in the operation of peritoneal metastasis and liver metastasis of colorectal cancer. The application of indocyanine green fluorescence imaging can offer great value for surgery through improving the accuracy and outcomes of oncological resections. According to existing studies, we are still at an early application stage of indocyanine green fluorescence imaging technology in colorectal surgery. Lacking prospective randomized controlled studies, neither standards nor guidelines for injection dosage, site and observation period are satisfactory. Therefore, deep researches and establishment of standardized operational procedure are required to enhance the safety and accuracy of tumor resection and improve outcomes.
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Thanks to endoscopic assistance and the pressure effect of pelvic pneumoperitoneum, transanal total mesorectal excision (taTME) can better expose the surgical field of distal mesorectal space, and may have a prospect for the preservation of pelvic nerves and organ function. The transanal minimally invasive surgery (TAMIS) platform may decrease the injury of internal anal sphincter and protect anal function. Current data show that taTME procedure has similar results on postoperative anal function, urinary function and sexual function compared to transabdominal TME procedure. The early impaired anal function after taTME may be related to the transanal approach itself, implement of single port and the learning curve, but the anal function can improve with time. Regarding the protection of urinary and sexual function, the beginners should be familiar with the course of pelvic nerves, the anatomical landmarks and the technical points during the dissection upward, and try to avoid the injury of the pelvic plex trunk and pelvic splanchnic nerves. TaTME is different from natural orifice transluminal endoscopic surgery (NOTES), while the latter focuses on the minimally invasive principle, the former focuses on the oncological safety and nerve protection. We should combine the advantages of transanal and transabdominal approaches to achieve the final goal of surgical quality improvement and organ function preservation.
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Humans , Learning Curve , Natural Orifice Endoscopic Surgery , Rectal Neoplasms , Rectum , General Surgery , Transanal Endoscopic SurgeryABSTRACT
Objective To investigate the influence of mismatch repair status on clinicopathological characteristics and prognosis in patients with colon cancer.Methods Patients who underwent radical excision for colon cancer between Nov 2012 and Mar 2016 at Peking University People's Hospital were enrolled.Clinicopathological data and prognosis were collected.Multivariate analysis were used to identify independent characteristics of MMR-deficient colon cancer.The influence of MMR-deficient on prognosis of colon cancer were analyzed through Kaplan-Meier curve.Results The overall rate of MMR-deficient in colon cancer was 17.1％ (51/299).Multivariate logistic regression analysis showed that low differentiation (OR =3.555,95％ CI:1.685-7.640,P ＜ 0.001),right-sided colon cancer (OR =5.645,95％ CI:2.483-14.715,P ＜ 0.001) and UICC Stage Ⅰ-Ⅱ (OR =4.099,95％ CI:1.863-9.840,P ＜0.001) were associated with MMR-deficient colon cancer.Conclusion Low differentiation,right-sided colon cancer and UICC Stage Ⅰ-Ⅱ were more common in MMR-deficient colon cancer.
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B lymphocytes are not the only source of Igs,instead,various non-B cell types,including the normal epithelial cells and cancer cells,also own the ability to produce different types of Igs.The non-B cell derived Igs possess their own characteristics.For instance,they are highly conserved in V (D)J rearrangement patterns;each Ig has its own rearrangement pattern of the variable region of IgH.The non-B Igs are closely related with tumors.They are highly expressed in different tumors,including clear cell renal cell carcinoma,lung cancer,breast cancer,and they act as a tumor promoter through different mechanisms.As to the digestive system tumors,several digestive organs or their corresponding tumors could produce Igs,such as stomach,liver,pancreas,small intestine and colon.The Igs derived from these organs may participate in the innate immune responses,as well as the tumorigenesis processes.A more detailed study on the non-B cell derived Igs may provide new therapeutic targets for malignant tumors,including tumors from digestive system.
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Objective To investigate the mechanism of lnc-AC079612.1-1∶1 in the metastasis of colorectal cancer by regulating miR-1915 expression and provide a theoretical basis for new therapeutic targets of colon cancer.Methods Continuously harvested 3 pairs of primary tumor and hepatic metastases of patients with synchronous colon cancer with liver metastasis.LncRNA + mRNA Human Gene Expression Microarray V4.0 and 4 × 180K Expression Microarray were used to detect the Expression profile of LncRNA in primary colon cancer and matched liver metastases.The detection of expression profile chip was used to find some lncRNAs that may be closely associated with colon cancer liver metastasis,and through the literature retrieval,the author preliminarily analyzed the co-expression encoding genes of lncRNAs,in order to find lncRNAs that may play key roles in the process of colon cancer liver metastasis.The effect of lnc-AC079612.1.1-1∶1 on the proliferation capacity of colon cancer cell lines was detected in SW480 cell lines and SW620 cell lines of colon cancer through CCK-8 experiment.Effects of lnc-AC079612.1.1-1∶1 on the migration and invasion of colon cancer cells were examined by Transwell cell invasion assay.Through TargetScan,Miranda,LNCipedia and other web tools,miRNAs that may bind to lncRNA and o-6-methylguanine-DNA methyl transferase (MGMT) were predicted.Double luciferase reporter gene assay was used to detect the interaction between miR-1915 andlnc-AC079612.1.1-1 ∶ 1.SPSS 22.0 statistical software was used to analyze the data.The measurement data were expressed as ((x) ± s).T test was compared between the two groups,and multiple groups were compared with F test.Results The expression of lnc-AC079612.1-1 ∶ 1 was 3.94 times higher in the liver metastases than in the primary tumor,and expression of MGMT was 3.74 times higher in the liver metastases than in the primary tumor.The results showed that there was a significant co-expression relationship between the lncRNA and o-6-methylguanine DNA transferase (MGMT) gene,and the co-expression correlation coefficient was 0.994 (P ＜ 0.001).The over expression of lnc-ac079612.1.1-1∶1 could significantly enhance the proliferation capacity of SW480 and SW620 cell lines of colon cancer through the CCK-8 experiment.The over expression of lnc-ac079612.1.1-1:1 could promote the invasion and metastasis of SW480 and SW620 cell lines of colon cancer through Transwell cell invasion experiment.MirR-1915-3p was the only miRNA that predicted to be combined with lnc-ac079612.1-1∶1 and MGMT through TargetScan,Miranda,LNCipedia and other web tools.Lnc-ac079612.1.1-1∶1 was found to bind to miR-1915 by double luciferase assay.Conclusion Lnc-ac079612.1.1-1∶ 1 may participate in the liver metastasis process of colon cancer by regulating MGMT,and may play a role in the liver metastasis of colon cancer through the action of mir-1915 on MGMT.
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Objective To introduce and analyze the status of tumor multidisciplinary team (MDT) model application in primary hospitals.Methods MDT discussion decision-making and implementation of Nanpi People's Hospital from June 2013 to July 2015 were retrospectively analyzed.Results A total of 251 cases were recruited into the MDT discussion.Among them,233 primarily diagnosed cases reached MDT decision-making and 159 cases took the decision,118 cases achieved the purpose (74.2％),41 cases failed (25.8％).Yet in 74 cases not following the decision,11 cases achieved the desired purpose (14.9％),while 63 cases didn't meet the desired purpose (85.1％),the difference was statistically significant (x2 =71.97,P ＜ 0.01).Ultrasound interventional biopsy,enhanced CT scan,CT guided puncture,intraoperative frozen section examination in malignant tumor patients had significantly increased after MDT applied,the difference was statistically significant (all P ＜ 0.05).The annual new rural cooperative medical system referral rate in malignant tumor patients dropped sharply (x2 =19.86,P ＜ 0.01) Conclusions Doctors and cancer patients can benefit from MDT diagnosis and treatment model,which is worth generalization.
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Objective To investigate the association between extramural vascular invasion (EMVI) detected by multi-detectors computed tomography (MDCT) with contrast enhanced (ceMDCT) and clinicopathologic characteristics in patients with colon cancer.Methods Between February 2009 and December 2013,patients with histologically proven primary colon cancer and undergoing curative resection were included in this retrospective study.According to American Joint Committee on Cancer TNM staging system,patients of stage Ⅱ and Ⅲ were included in this study.EMVI status detected by MDCT (ctEMVI) was defined according to the EMVI scores.Chi-square test was used to analyze the association between clinicopathologic characteristics and ctEMVI.Results 165 stage Ⅱ and stage Ⅲ patients were included in this study as confirmed by pathology based on AJCC.Positive ctEMVI was demonstrated in 51 patients (34.5％,51/165).There were significant association between positive ctEMVI and age ＜ 65 years (x2 =4.810,P =0.031),ceMDCT defined tumor stage (x2 =17.911,P =0.000),ceMDCT defined metastatic lymph node (x2 =5.436,P =0.022),tumor size≥5 cm (x2 =3.799,P =0.036) and pathological T stage (x2 =13.346,P =0.001).Conclusions EMVI,detected by ceMDCT,is significantly associated with age,tumor size and T staging in colon cancer.
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Total mesorectal excision (TME) is a mile-stone procedure in the history of rectal cancer surgery, but the exposure of surgical field of distal rectum is usually poor in patients with male, obese and narrow pelvis, which may lead to tumor residue and relative complications. Recently, a new technique called transanal TME (taTME) is considered to solve the above problems, but most medical centers are still in the learning curve of this procedure. Therefore, anatomical planes and landmarks of taTME for rectal cancer and prophylaxis of intraoperative complications are induced in this paper, which includes posterior plane: angle of anus and distal mesorectum and bleeding of mesorectum; rectosacral fascia and presacral bleeding; lateral and posterior-lateral plane: posterior branches of pelvic plexus and damage of anal function; anterior plane: vessel branches of neurovascular bundle and bleeding. Familiarity with the specific anatomical planes and landmarks plays an important role in shortening the learning curve, decreasing the complications, increasing the success rate of operation and standardization of taTME.
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<p><b>OBJECTIVE</b>To investigate the risk factors of low anterior resection syndrome (LARS) after anal sphincter preserving surgery (SPS) for rectal cancer patients.</p><p><b>METHODS</b>Clinicopathological and follow-up data of rectal cancer patients who underwent SPS from January 2010 to June 2014 in Department of Gastroenterological Surgery, Peking University People's Hospital, were retrospectively analyzed. Patients receiving permanent colostomy and local resection were excluded. Meanwhile, during October 2014 and March 2015, the enrolled patients were asked to fill out a specially designed questionnaire for LARS through face-to-face interview or telephone inquiry, according to the chronological order of operation. Based on the score of questionnaire, patients were divided into three groups: 0-20 points: non LARS; 21-29: minor LARS; 30-42: major LARS. The demographic and clinicopathologic features were compared among groups and the risk factors of major LARS were tested by logistic regression analysis.</p><p><b>RESULTS</b>A total of 100 patients (61 males, 39 females) completed the bowel function survey, with an average age of 66.2(41-86) years, 33 patients <60 years versus 67 patients ≥60 years. No significant difference was observed in age distribution (P=0.204). Interval from operation to first follow-up was more than 1 year in 70 patients, and the median follow-up was 23 months. Thirty-seven patients were non LARS, 18 were minor LARS and 45 were major LARS. No significant differences in clinicopathological data (all P>0.05) were observed among three groups except radiotherapy history (P=0.025), tumor location(P=0.000) and distance from anastomotic site to anal verge(P=0.008). After comparison of non LARS group combined with minor LARS group versus major LARS, re-analysis of risk factors showed that radiotherapy history (RR=5.608, 95%CI:1.457 to 21.584, P=0.006), distance from tumor lower margin to anal verge (RR=0.125, 95%CI:0.042 to 0.372, P=0.000), distance from anastomotic site to anal verge (RR=0.255, 95%CI:0.098 to 0.665, P=0.004) and preventive ileostomy history(RR=3.643, 95%CI:1.058 to 12.548, P=0.032) were associated with major LARS. One potential risk factor detected in combined analysis was female (RR=2.138, 95%CI: 0.944 to 4.844, P=0.078). Multivariate analysis revealed that female (RR=2.654, 95%CI: 1.005 to 7.014, P=0.049), radiotherapy history (RR=10.422, 95%CI:2.394 to 45.368, P=0.002) and distance from tumor lower margin to anal verge ≤7 cm (RR=8.935, 95%CI:2.827 to 28.243, P=0.000) were independent risk factors of major LARS.</p><p><b>CONCLUSIONS</b>LARS is a significant problem in most rectal cancer patients after SPS. The risk of major LARS increases on condition of radiotherapy, low tumor position and female. When dealing with these patients, preventive measures should be taken into consideration during SPS.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anal Canal , Pathology , General Surgery , Anastomosis, Surgical , Colon , General Surgery , Defecation , Physiology , Factor Analysis, Statistical , Follow-Up Studies , Long Term Adverse Effects , Epidemiology , Radiotherapy , Rectal Neoplasms , Pathology , General Surgery , Rectum , General Surgery , Retrospective Studies , Risk Assessment , Methods , Risk Factors , Sex Factors , Surveys and Questionnaires , SyndromeABSTRACT
<p><b>OBJECTIVE</b>To explore the feasibility and safety of transperineal single-port laparoscopy assisted exralevator abdominoperineal excision(TPSP-ELAPE).</p><p><b>METHODS</b>Three cases (2 males and 1 female) who underwent TPSP-ELAPE at lithotomy position in the Peking University People's Hospital from January to February 2016 were analyzed retrospectively. The mean age was(55.3±7.2) years. Mean body mass index (BMI) was (23.0±1.3) kg/m(2). Mean distance between tumor and anal verge was (1.8±0.3) cm. Abdominal procedure was done firstly and then perineal procedure under lithotomy position. Abdominal procedure was performed by routine laparoscopy with 5 trocars. TPSP-ELAPE procedure was performed in perineal procedure. The perineal defect was closed by purse string, followed by spindle incision around the anus. Perianal skin and subcutaneous tissue was dissected until the junction between extra anal sphincter and levator ani muscle under direct vision. Perineal skin was sutured with double purse string by 2-0 prolene, and single port canal was placed inside in order to close perineal defect. The pneumoperitoneal pressure was set to 10 mmHg and laparoscopy and instrument was placed through the single-port canal. Space between isochioanal fossa and levator ani muscle was exposed by the contraction of laparoscopic clam. Lateral and posterior side was mobilized firstly. The anterior was dissected under the help of vaginal examination and contraction by abdominal group. The levator ani muscle was divided near the initial site, and negative resection margin was confirmed in the operation. Specimen was exteriorized through the perineum.</p><p><b>RESULTS</b>The mean intraoperative blood loss of three cases was (123.3±25.2) ml. The total operative time was (296.7±25.1) minutes. The time used by the perineal group was (196.7±20.8) minutes. The volume of drainage was (39.0±10.1) ml at the third day after operation. The time to first stoma output was (2.3±0.6) days. The perineal drainage removal time was (7.7±0.6) days. The circumferential resection margins were negative in all specimens, and there were no perioperative complications.</p><p><b>CONCLUSION</b>TPSP-ELAPE is feasible and safe, which could avoid turning over the patient and facilitate anesthesia. It follows the anatomic plane of open ELAPE procedure with minimally invasive advantage.</p>