Feasibility analysis on 3D laparoscopic surgery via transrectal extraction of specimens without abdominal incision in the treatment of slow transit constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of 3D laparoscopic surgery via transrectal extraction of specimens without abdominal incision in the treatment of slow transit constipation (STC).</p><p><b>METHODS</b>From May 2015 to January 2017, 8 STC patients (6 females and 2 males) with informed consent were selected to receive subtotal colectomy with 3D laparoscopy as the no-incision incision group, in which the initial part of ascending colon and rectum were end-to-end anastomosed directly after extraction of the specimen through the rectum. Twelve STC patients (9 females and 3 males) undergoing traditional subtotal colectomy with 3D laparoscopy were selected as the traditional group by case matching method (gender, age, BMI, the difference of receiving operation time less than 12 months, same surgeon team). Perioperative parameters (operation duration, intraoperative blood loss, exhausting time, postoperative hospital stay, complications, postoperative pain score and additional pain management), inflammation index at postoperative day 1 and day 3 (leukocyte, procalcitonin, interleukin 6, C-reactive protein), postoperative peritoneal infection, wound healing, short-term and long-term efficacy, patient satisfaction evaluation (subjective hundred-mark system) at postoperative one year were compared between two groups.</p><p><b>RESULTS</b>There were no significant differences between two groups in operation duration, intraoperative blood loss, exhausting time, postoperative hospital stay and morbidity of complication (all P>0.05). Significantly lower pain scores at postoperative 6-hour (median 3.0 vs. 4.5, U=23.0, P=0.042), lower ratio of additional analgesic at postoperative day 1(1/8 vs. 7/12, P=0.040) were found in the no-incision group. Leukocyte level at postoperative day 1 was significantly lower in the no-incision group [(11.0±3.5)×10/L vs. (14.7±3.6)×10/L, t=-2.281, P=0.035]. C-reactive protein concentration at postoperative day 3 was not significantly different between two groups but with different trend [median 78.1(0.1 to 154.0) mg/L vs. 22.0 (7.0 to 55.9) mg/L,U=33.0, P=0.047]. There were no significant differences of interleukin-6 and procalcitonin between two groups(all P>0.05). All the patients had follow-up for 14-31 months. Subjective effectiveness score was 90±9 in the no-incision group and 94±6 in the traditional group without significant difference(t=-1.099, P=0.286). No long-term complications associated with abdominal infection was observed in the no-incision group.</p><p><b>CONCLUSION</b>3D laparoscopic subtotal colectomy via transrectal extraction of specimens without abdominal incision in the treatment of STC has similar short-term and long-term efficacies compared with traditional laparoscopic assisted surgery, and does not increase the probability of abdominal contamination.</p>

Analysis of risk factors for bone metastasis after radical resection of colorectal cancer within 5 years / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.</p><p><b>METHODS</b>Clinical data of 1 749 patients with colorectal cancer, of whom 50(2.8%) patients developed metastasis to bone after operation, in the Department of Colorectal Surgery, Changhai Hospital of The Second Military Medical University from January 2001 to December 2010 were analyzed retrospectively. Univariate and multivariate analysis were performed to find the risk factors of metachronous bone metastasis from colorectal cancer using Chi square test and Logistic regression, respectively.</p><p><b>RESULTS</b>Of 50 colorectal cancer cases with bone metastasis, 29 were male and 21 were female. The age was ≥ 60 years old in 28 cases. Tumors of 36 cases were located in the rectum and of 14 cases located in the colon. Pathology examination showed 43 cases were adenocarcinomas, 7 cases were mucinous adenocarcinoma. Forty-two cases had T3-4 stage lesions, 30 cases had lymph node metastasis, 14 cases had pulmonary metastasis, and 5 cases had liver metastasis. Univariate Chi square test indicated that factors associated with the metachronous bone metastasis of colorectal cancer within 5 years were tumor site (χ=4.932, P=0.026), preoperative carbohydrate antigen 199 (CA199) level (χ=4.266, P=0.039), lymph node metastasis (χ=13.054, P=0.000) and pulmonary metastasis(χ=35.524, P=0.000). The incidence of bone metastasis in patients with rectal cancer (3.6%, 36/991) was higher compared to those with colon cancer (1.8%, 14/758). The incidence of bone metastasis in patients with higher(> 37 kU/L) preoperative serum CA199 level (4.9%, 12/245) was higher compared to those with lower serum CA199 level (2.5%, 38/1504). The incidence of bone metastasis in patients with lymph node metastasis(4.8%,30/627) and pulmonary metastasis (11.6%, 14/121) was significantly higher compared to those without lymph node metastasis (1.8%, 20/1122) and pulmonary metastasis(2.2%, 36/1628), respectively. Logistic multivariate analysis showed that rectal cancer(OR:0.508, 95%CI:0.268 to 0.963, P=0.038), lymph node metastasis (OR:2.291, 95%CI:1.273 to 4.122, P=0.006) and metachronous pulmonary metastasis(OR:4.796, 95%CI:2.473 to 9.301, P=0.000) were the independent risk factors of metachronous bone metastasis of colorectal cancer within 5 years.</p><p><b>CONCLUSION</b>Patients with rectal cancer, lymph node metastasis and metachronous pulmonary metastasis are high risk groups of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.</p>

Strategy and technique for simultaneous resection of rectal cancer and liver metastasis / 中华胃肠外科杂志

Rectal cancer with simultaneous liver metastasis is very common clinically. R0 surgical resection both for the original and metastatic tumor can achieve much better long-term oncological results. The operation types include traditional open procedures for both rectal cancer and liver metastatic resection; combination of laparoscopic resection of the rectal cancer and open procedure resection of the liver metastatic lesion; traditional laparoscopic-assisted rectal and liver metastatic tumor resection with small abdominal incision and total laparoscopic natural orifice specimen extraction surgery(NOSES) without abdominal incision. Due to the complexity of rectal anatomy and treatment strategy, leading to the difference from colon cancer with liver metastasis, and due to the effect of laparoscopic treatment, especially the 3D laparoscopy, patient selection for simultaneous resection should be well planned and individualized by surgeons based on conditions of themselves and patients.

Comparison of short-term outcomes of transrectal specimen extraction during laparoscopic sigmoid radical resection versus conventional laparoscopically assisted procedure / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the short-term outcomes between transrectal specimen extraction during laparoscopic sigmoid radical resection and conventional laparoscopy-assisted sigmoid radical resection.</p><p><b>METHODS</b>Sixteen patients(transrectal specimen extraction group,4 females and 12 males), who were planned to undergo laparoscopically assisted sigmoid radical resection with BMI<28 kg/mand were evaluated as T1-T3 tumor by iconography without distant metastasis, were selected to undergo transrectal specimen extraction during laparoscopic sigmoid radical resection from December 2015 to April 2016 in the Department of Anorectal Surgery of Changhai Hospital. The procedure of specimen extraction was as follows: Perineal anal expansion was performed. The rectum was cut in rectal distal ligature within the abdominal cavity. Telescope cover was placed through Trocar hole in right low abdomen and rectal stump was pulled out of the body through the anus to form an access tunnel. Planned resected bowel was placed in the tunnel and the specimen was dissociated and removed completely from anus. Each patient in transrectal specimen extraction group was individually matched with two patients who underwent laparoscopically assisted sigmoid radical resection by gender, age, BMI and date of surgery. The perioperative outcomes and pathological evaluation of surgical specimen of two groups were retrospectively collected and compared.</p><p><b>RESULTS</b>The differences of baseline data (gender, age, BMI, distance from tumor to anal verge measured by colonoscopy and clinical tumor category) between two groups were not significant (all P>0.05). Compared to laparoscopy-assisted group, transrectal specimen extraction group presented longer operation time [(140.6±8.3) minutes vs. (122.2±26.2) minutes, t=-3.629, P=0.001], and more blood loss[(43.8±9.2) ml vs. (35.3±10.2) ml, t=-2.795, P=0.008], but shorter time to first flatus [(43.1±8.3) hours vs. (52.0±11.4) hours, t=2.756, P=0.008] and lower pain score at operative day and the first postoperative day (3.8±0.8 vs. 4.8±1.1, t=3.558, P=0.001; 2.6±0.6 vs. 3.8±0.8, t=5.165, P=0.000). The case ratio of additional analgesia [6.3%(1/16) ns. 18.8%(6/32)], postoperative hospital stay [(6.8±3.4) days vs. (5.6±0.8) days] and postoperative morbidity of complication [12.5%(2/16) vs. 9.4%(3/32)] were not significantly different between the two groups (all P>0.05). Within postoperative 30-day follow-up, transrectal specimen extraction group had ileus in one patient and anastomotic leakage in one patient, and laparoscopy-assisted group had fat necrosis of assisted incision in two patients and gastric retention in one patient. There were also no significant differences in specimen length[(18.2±4.8) cm vs. (19.8±5.7) cm, P>0.05], tumor size [(4.0±1.2) cm vs. (4.4±1.5) cm, P>0.05] and number of harvested lymph node (14.6±2.6 vs. 16.0±3.0, P>0.05] between two groups. During follow-up of 7-10(mean 9) months of transrectal specimen extraction group and 2-16 (mean 7) months of laparoscopically assisted group, no tumor local relapse and distant metastasis were found in the both groups.</p><p><b>CONCLUSION</b>As compared to laparoscopy-assisted sigmoid radical resection, transrectal specimen extraction laparoscopic sigmoid radical resection has better short-term efficacy, meanwhile they have comparable oncologic clearance.</p>

Port-Site Metastasis of Uterine Carcinosarcoma after Laparoscopy

We report a case of port-site metastasis after laparoscopic surgery for early stage uterine carcinosarcoma (UCS) and review the related literature. A 53-year-old woman with suspected uterine malignance underwent a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, infra-colic omentectomy, and pelvic lymphadenectomy resulting pathologically in a stage IA UCS. Twelve months later she developed a palpable abdominal-wall mass at the trocar site without other synchronous metastases. A mass resection was performed and it was pathologically diagnosed with port-site metastasis of UCS. When performing surgery for UCS, specimens should be carefully removed in case small pieces of the occult disseminated metastatic tissues are trapped between the outer surface of the trocar sleeve and the abdominal wall incisional canal. Despite the low incidence, a laparotomy might be considered rather than laparoscopy to prevent port-site metastasis and more gynecological oncology clinical practices might be relevant to the management of port-site metastasis.

Study on the relationship between tumor regression grade and lymph node regression grade / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between tumor regression grade (TRG) and lymph node regression grade (LRG) after neoadjuvant chemoradiotherapy (CRT) for rectal cancer and its clinical implication.</p><p><b>METHODS</b>Clinicopathological data of 176 rectal cancer patients undergoing radical excision after neoadjuvant CRT from January 2005 to December 2013 in our department were retrospectively analyzed.</p><p><b>INCLUSION CRITERIA</b>(1) Radiology indicated locally advanced low rectal cancer and patients had strong desire to preserve the sphincter before neoadjuvant CRT; (2) there was no definite metastatic lesion before neoadjuvant CRT; (3) patients received whole course of neoadjuvant CRT (regular radiotherapy plus synchronous fluorouracil-like drugs chemotherapy); (4) patients underwent radical operation after neoadjuvant CRT. Patients with short-course CRT and emergency surgery were excluded. TRG and LRG of postoperative specimens (including tumor and lymph nodes) were carried out based on the percentage of the fibrosis and the cancer residue. No cancer residue was defined as TRG1 and LRG1; rare cancer cell residue as TRG2 and LRG2; fibrosis growth over residual cancer as TRG3 and LRG3; residual cancer growth over fibrosis as TRG4 and LRG4; absence of regressive changes as TRG5 and LRG5; and normal lymph nodes as LRG0. Spearman correlation test was used to assess the correlation between TRG and LRG.</p><p><b>RESULTS</b>Of 176 patients, 111 were men and 65 were women. The mean age was (53.9±13.0) years. The number of patients with stage I(, II(, and III( before operation was 10, 49 and 62 while other 55 patients were unknown. Transabdominal low anterior resection (LAR) was performed in 118 cases and abdominal-perineal resection(APR) in 47 cases following the principle of total mesorectal excision (TME). Postoperative pathology of specimens revealed that the number of patients from TRG1 to TRG5 was 19 (10.8%), 25 (14.2%), 66 (37.5%), 47 (26.7%), 19 (10.8%), and from LRG0 to LRG5 was 35 (19.9%), 68 (38.6%), 10 (5.7%), 14 (8.0%), 15(8.5%), 34 (19.3%), respectively. TRG was correlated to LRG (P=0.005) while the Spearman correlation coefficient was only 0.24. The analysis of subgroup without LRG1 also showed that TRG was correlated to LRG(P=0.0005) and the Spearman correlation coefficient was 0.40.</p><p><b>CONCLUSIONS</b>TRG can not represent LRG. Therefore, both TRG and LRG should be assessed when evaluating the response of rectal cancer to neoadjuvant CRT.</p>

Protective measures in laparoscopic resection for upper or mid rectal cancer and sigmoid colon cancer with transrectal specimen extraction surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To introduce the use of a self-made specimen protective sleeve in laparoscopic resection for upper or mid rectal cancer and sigmoid colon cancer with transrectal specimen extraction surgery and the improvement of implantation method, so as to avoid and reduce bacterial contamination and tumor cell dissemination in abdominal cavity.</p><p><b>METHODS</b>During June 2015 and May 2017, 48 cases of high located rectal or sigmoid colon cancer were operated laparoscopically with natural orifices specimen extraction surgery (NOSES) using a self-made specimen protecting sleeve. Operation indication: (1) Rectum and sigmoid colon cancer with the distance of more than 6 cm from tumor inferior margin to dentate line. (2) The maximum diameter of intestine together with mesangial and tumor <7 cm by intraoperative judgment. (3) No anal and distal rectal surgery, no anorectal stenosis or lack of expansion capacity caused by trauma. (4) No ulcerative colitis, Crohn's disease or radiation proctitis. After transecting the rectum, the specimen protective sleeve was inserted through the right lower 12 mm main Trocar (This sleeve was tailored from the laparoscopic protective sleeve produced by China 3L Corporation, which was intercepted with 25-35 cm from one end of the sleeve according to the length of distal rectal retention. One end was ligated and the other was open with a ligature band. About 5 ml paraffin oil was used to rinse and lubricate during the operation). The rectal stump retained 7-8 cm in abdominal cavity. The transanal ligation part of the protective sleeve was cut off, then the stapler nail seat was inserted and specimen was pull out through the sleeve and rectum.</p><p><b>RESULTS</b>There were 30 males and 18 females. The average age was (64.5±14.1) years, the BMI was (25.4±3.9) kg/m, the tumor diameter was (3.3±1.1) cm, the maximum diameter of specimen was (5.4±1.5) cm and the length of specimen was (18.6±4.3) cm. Among these 48 cases, specimens of 36 patients were pulled out through inside of the sleeve easily, while specimens of 12 patients were quite difficult with resistance. Of 12 cases, 7 needed the help of transverse forceps, 4 needed to make 1 cm incision in pull-through bowel and insert a suction to decrease the volume of large specimens with gathering of gas and fluid, and 1 received small abdominal incision to remove specimen and perform intestinal reconstruction due to big specimen (the diameter of tumor and mesentery was 7.5 cm). Specimen tears of 6 patients didn't result in dissemination thanks to the specimen protecting sleeve. The operation time was (113.2±76.1) min, the bleeding amount was (38.5±17.3) ml, the time to first oral intake was (47.9±4.4) h, and the postoperative hospitalization length was (8.5±1.7) d. Anastomotic leakage occurred in 1 case (2.1%). No intra-abdominal and trocar infection, and obstruction were found.</p><p><b>CONCLUSION</b>The use of protective sleeve and the improvement of the method of intraperitoneal implantation can effectively reduce the abdominal contamination during the specimen extraction. It can be applied to big specimens as well.</p>

Risk factor analysis for brain metastasis after radical resection of colorectal cancer within 5 years / 第二军医大学学报

Objective To explore the risk factors of brain metastasis after radical resection of colorectal cancer within 5 years.Methods We retrospectively analyzed the clinical data of 1 104 patients with colorectal cancer in the Department of Colorectal Surgery of Changhai Hospital of Second Military Medical University from Jan.2003 to Dec.2011.Thirty of 1 104 cases (2.7％) had brain metastasis.All patients received radical resection of colorectal cancer,and the rectal cancer patients followed the total mesorectal excision (TME) principle.According to the TME stage,the patients of stage Ⅱ or later were treated with capecitabine combined with oxaliplatin (XELOX) or fluorouracil plus oxaliplatin (FOLFOX) chemotherapy.The clinicopathological features that might affect post-operative brain metastasis,including gender,age,tumor location,pre-operative serum carcino-embryonic antigen (CEA) level,tumor histological type,depth of tumor invasion,lymph node metastasis,pulmonary metastases and liver metastases,were analyzed by univariate analysis using Chi square test.Multivariate analysis was performed to search for the independent risk factors of brain metastasis from colorectal cancer using logistic regression.Results Univariate Chi square test indicated that the relative factors associated with the brain metastasis of colorectal cancer within 5 years were tumor location (x2=5.844,P=0.016),pre-operative CEA level (x2 =5.395,P =0.020),tumor histological type (x2 =4.950,P =0.026) and with pulmonary metastasis (x2=52.569,P=0.000).Multivariate analysis showed that the tumor location (OR=0.278,95％CI:0.095-0.817,P=0.020),pre-operative CEA level (OR=0.423,95％CI:0.192-0.933,P=0.033) and with pulmonary metastasis (OR=-10.814,95％CI:4.705-24.856,P=0.000) were the independent risk factors of brain metastasis of colorectal cancer within 5 years.Conclusion Patients with rectal cancer,higher pre-operative CEA level and pulmonary metastasis have a high risk of brain metastasis of colorectal cancer within 5 years.

Clinical and pathologic prognostic factors affecting local recurrence and overall survival in 1 166 rectal cancer resection patients / 中华普通外科杂志

Objective To explore the clinicopathologic factors impacting recurrence and survival in rectal cancer patients after radical resection.Methods Clinicopathologic data of 1 166 patients with rectal cancer in Changhai Hospital,were recruited between 2005 and 2010.Kaplan-Meier analysis and the logrank test were used to evaluate the effects of the pathology on patients' survival.Cox regression model was used to assess independent factors associated with clinical prognosis.Results The 1,3,5-year overall survival rates were 94.3％,81.2％ and 76.5％,median survival time was 53 months.328 patients had recurrence and metastases,with a median recurrence time of 18 months.The independent prognostic factors for overall survival time were CEA,CA19-9,tumor distance to dentate line,surgical modality,radical operation,tumor invasion,tumor differentiation,lymph node metastasis and postoperative treatment.Surgical treatment,radical operation or not,tumor invasion and lymph node metastasis were statistically significant associated with tumor recurrence and metastases.Conclusions The important factors inffuencing the prognosis of rectal cancer patients were CEA,CA19-9,tumor distance to dentate line,surgical modality,radial operation,tumor in vasion,tumor differentiation,lymph node metastasis,and post operative treatment.

Assessment of the risk factors relating to lymph node metastasis in rectal cancer after neoadjuvant chemoradiotherapy and the clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To identify the risk factors associated with lymph node metastasis in rectal cancer after neoadjuvant chemoradiotherapy (CRT).</p><p><b>METHODS</b>From January 2005 to December 2013, the clinical data of 178 patients with advanced rectal cancer undergoing radical excision after neoadjuvant CRT in our department were reviewed retrospectively. A total of 11 clinicopathologic factors relating to lymph node metastasis were studied using univariate and multivariate Logistic regression analyses.</p><p><b>RESULTS</b>There were 74(41.6%) cases with lymph node metastasis, while 104 cases without lymph node metastasis. Univariate analysis showed that age(P=0.000 2), post-CRT CEA level(P=0.011 2), ypT stage(P=0.000 0), pathologic type(P=0.004 0), and tumor regression grade(TRG)(P=0.033 8) were significantly associated with lymph node metastasis. Multivariate analysis showed that age(OR=2.385, 95% CI:1.372 ~ 4.147, P=0.002 1), post-CRT CEA level(OR=2.310, 95% CI:1.005 ~ 5.307, P=0.048 6) and ypT stage(OR=2.592, 95% CI:1.236 ~ 5.432, P=0.011 7) were independent risk factors. However, 15.8% of the patients who achieved TRG1 had lymph node metastasis and TRG failed to independently correlate with lymph node metastasis in rectal cancer after neoadjuvant CRT.</p><p><b>CONCLUSIONS</b>There was a higher ratio of lymph node metastasis in rectal cancer patients who were young, CEA≥5 μg/L or deep invasion after neoadjuvant CRT. Therefore, neoadjuvant CRT should be carefully considered in these patients.</p>

Analysis of the factors in the disease-free interval of metachronous pulmonary metastasis from rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the factors in the disease-free interval (DFI) of metachronous pulmonary metastasis from rectal cancer.</p><p><b>METHODS</b>Clinical data of 92 patients with metachronous pulmonary metastasis from rectal cancer in the Department of Colorectal Surgery at the Changhai Hospital of the Second Military Medical University from January 2001 to December 2013 were analyzed retrospectively. Univariate and multivariate analysis were performed to find the factors affecting disease-free interval of metachronous pulmonary metastasis from rectal cancer using Log-rank test and Cox proportional hazards model, respectively.</p><p><b>RESULTS</b>The median age of all the cases was 61 (range, 26-81) years. Of the 92 cases, 59 were males and 33 were females. Thirty-six cases were confirmed to have <5 cm distance from lower margin to dentate line. Forty-four cases were examined to have 5 μg/L carcinoembryonic antigen(CEA) level. Of these cases reviewed pathologically, 69 cases were adenocarcinoma, 23 were mucinous adenocarcinoma; 19 cases had stage T1-2 lesions, 73 had stage T3-4 lesions; 43 cases had stage N0 metastasis, 49 had stage N1-2 metastasis. Thirty cases received preoperative radiotherapy, 63 cases received postoperative chemotherapy. The median follow up time of all the cases was 62(range, 3-140) months. The DFI of all the cases was (25.9±21.0) months. Univariate Log-rank test indicated that the factors associated with the disease-free interval of metachronous pulmonary metastasis of rectal cancer were location of the tumor(χ(2)=4.496, P=0.034), preoperative CEA level (χ(2)=5.553, P=0.018), T stage (χ(2)=5.796, P=0.016), N stage (χ(2)=6.780, P=0.009), preoperative neoadjuvant radiotherapy (χ(2)=11.718, P=0.001) and postoperative adjuvant chemotherapy (χ(2)=9.214, P=0.002). A shorter distance from lower margin to dentate line(<5 cm), a lower preoperative CEA level(<5 μg/L), advanced T stage lesions(T3-4), advanced N stage metastasis(N1-2), no use of preoperative radiotherapy and use of postoperative chemotherapy were associated with shorter DFI of patients with metachronous pulmonary metastasis from rectal cancer. Multivariate analysis showed that N stage(OR=0.525, 95% CI: 0.309-0.891, P=0.017), location of the tumor (OR=1.770, 95% CI:1.115-2.812, P=0.016) and preoperative neoadjuvant radiotherapy (OR=1.976, 95% CI:1.228-3.401, P=0.006) were the independent risk factors associated with the disease-free interval of metachronous pulmonary metastasis from rectal cancer.</p><p><b>CONCLUSIONS</b>Advanced N stage, low location of the tumor and no use of preoperative neoadjuvant radiotherapy are risk factors of shorter disease-free interval of metachronous pulmonary metastasis from rectal cancer.</p>

Association of microRNA101 expression with clinicopathologic features and prognosis in colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the microRNA101(miR101) expression and its clinical significance in colorectal cancer.</p><p><b>METHODS</b>Tissue microarrays containing 56 specimens of normal mucosa, 51 adenoma and 735 colorectal cancer were examined by locked nucleic acid in-situ hybridization(LNA-ISH) for miR101 expression. Relationship between miR101 expression and clinicopathologic parameters and prognosis of colorectal cancer patients were analyzed. Fresh frozen tissues containing 5 specimens of normal mucosa, 5 adenoma and 47 colorectal cancer were examined by RT-PCR to verify the accuracy of LNA-ISH.</p><p><b>RESULTS</b>Expression of miR101 increased gradually from normal mucosa, adenoma to stage I colorectal cancer (all P<0.01), and decreased gradually from stage II(, stage III( to stage IIII( colorectal cancer (all P<0.01). Overexpression of miR101 was related with lower incidence of lymph node metastasis, lower metastasis rate, higher differentiation and lower recurrence rate (all P<0.01). Multivariate survival analysis demonstrated that miR101 expression was an independent prognostic factor of overall survival (HR=0.550, 95% CI: 0.351-0.863) and disease free survival(HR=0.562, 95% CI: 0.397-0.794) in colorectal cancer patients. Overexpression of miR101 predicted a better prognosis in colorectal cancer patients.</p><p><b>CONCLUSIONS</b>Expression of miR101 is associated with the genesis and development of colorectal cancer, and may serve as an independent prognostic factor for colorectal cancer patients.</p>

Practice and investigation of clinical teaching mode of standardized treatment in colorectal cancer for fellows in training / 中华胃肠外科杂志

A new clinical teaching mode of standardized treatment in colorectal cancer for fellows in training is reported here with good results. This one-year program included medical ethics education, humanistic management, pre job training, clinical thinking mode, surgery teaching, and computerized teaching. This new clinical teaching mode with distinct features is effective and introduced in this article.

Analysis of risk factors associate with lymph node metastasis of T1 and T2 rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors associated with lymph node metastasis of T1 and T2 rectal cancer.</p><p><b>METHODS</b>Clinicopathological data of 576 patients with stage T1 to T2 rectal cancer without serosal invasion confirmed by pathology undergoing curative resection in Changhai Hospital from January 1999 to December 2013 were analyzed retrospectively. The relationship of clinicopathological factors of overall patients and stage T1 patients with lymph node metastasis was analyzed by univariate or multivariate analysis.</p><p><b>RESULTS</b>The lymph node metastasis rate of stage T2 rectal cancer was significantly higher than that of stage T1[22.9% (108/463) vs. 9.7%(11/113), P=0.002], and the difference of stage T2a and T2b was not significant[22.0%(38/173) vs. 23.4% (68/290), P=0.733]. Multivariate analysis showed that poor differentiation(HR=1.54, 95% CI:1.12 to 2.13), abnormal carbohydrate antigen (CA) 199 level (HR=2.05, 95% CI:1.16 to 3.62), ulcerative mass (HR=1.58, 95% CI:1.05 to 2.39) and invasion of muscle (of inner ring muscle HR=3.55, 95% CI:1.79 to 7.02; of outer longitudinal muscle, HR=2.35, 95% CI:1.21 to 4.60) were independent risk factors of lymph node metastasis in patients with stage T1-T2 rectal cancer(all P<0.05). Meanwhile poor differentiation(HR=4.43, 95% CI:1.51 to 13.03), abnormal carcinoembryonic antigen(CEA) level (HR=4.66, 95% CI:1.18 to 20.11) and ulcerative mass (HR=6.23, 95% CI:1.51 to 25.66) were risk factors of lymph node metastasis in patients with stage T1 rectal cancer.</p><p><b>CONCLUSION</b>Poor differentiation, preoperative high CA199, ulcerated tumor, invasion of inner ring muscle or outer longitudinal muscle are risk factors of lymph node metastasis in patients with stage T1-T2 rectal cancer, while the invasion depth of muscularis propria is not risk factor. Besides, poor differentiation, abnormal CEA level, ulcerated tumor are risk factors of lymph node metastasis in stage T1 rectal cancer patients, which can be used as reference for local excision in patients with stage T1 rectal cancer.</p>

Mechanism exploration and future prospects of antiangiogenic agents improving tumor blood supply and oxygenation / 中华胃肠外科杂志

The growth and metastasis of tumor is angiogenesis-dependent. Antiangiogenic agents have been clinically used to treat malignant tumors with the mechanisms of regressing tumor vasculature and inhibiting vascular recurrence which restrain tumor growth and metastasis. Clinical evidences indicate that antiangiogenic agents combined with chemotherapy or radiotherapy potentiate the effects of treatment. However, radiation therapy and chemotherapy depend on ample blood flow to the tumor to deliver oxygen and drugs. Theoretically, it is paradoxical with evidences that these therapies work together rather than against each other. "Vascular normalization" theory was raised to explain this paradox. And accumulating data show that antiangiogenic agents transiently "normalize" tumor vasculature before causing vascular regression, so that improve tumor blood supply and increase tissue oxygenation. New views and challenges about antiangiogenic agents come out with the discovery of "normalization window". In this review, we summarized the mechanism, related researches and future prospects of antiangiogenic agents improving blood supply and oxygenation.

Application and evaluation of pouch configuration in rectal surgery / 中华胃肠外科杂志

Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term (2 years after surgery), since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time, and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement will result in prolonged operation time and increased treatment cost. Therefore, the value of colonic pouch in low rectal anastomosis is being questioned, and its application diminishes gradually. For patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) after total colectomy, ileal pouch anal anastomosis (IPAA) can reduce fecal frequency and improve patients' quality of life in both short-term and long-term, by increasing the volume of the neo-rectum and altering intestinal motility. For these reasons, IPAA is the first surgical choice for UC and FAP.

Comparison of oncologic clearance and long-term outcomes of laparoscopic surgery versus open surgery in radical resection of rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the oncologic clearance and long-term outcomes between laparoscopic surgery and open surgery in radical resection of rectal cancer.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1184 cases with rectal cancer undergoing radical resection from July 2005 to December 2011 were analyzed retrospectively. According to the surgical method, cases were divided into laparoscopy group (104 cases) and open group(1080 cases). Demographics, number of harvested lymph nodes, distance between distal margin and tumor, incidence of anastomotic complications, disease-free survival (DFS) and overall survival(OS) were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in the number of harvested lymph nodes (15.5 vs. 14.4, P>0.05), length of distal margin (2.5 cm vs. 2.1 cm, P>0.05) and incidence of anastomotic complications (1.9% vs. 1.9%, P>0.05) between the two groups. And there were no significant differences in DFS and OS between the two groups (both P>0.05). The 3-year and 5-year DFS in laparoscopy group were 79.0% and 69.3%, and were 78.0% and 72.5% in open group. The 3-year and 5-year OS in laparoscopy group were 93.5% and 81.2%, which were 87.6% and 80.7% in open group. There were no significant differences in DFS and OS after stratification by TNM stage.</p><p><b>CONCLUSION</b>The oncologic clearance and long-term outcomes after laparoscopic surgery are comparable with open surgery in radical resection of rectal cancer.</p>

Expression of long non-coding RNA associated with radiotherapy-resistance in colorectal cancer cell lines with different radiosensitivity / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To screen long non-coding RNA (lncRNA) associated with radiosensitivity in colorectal carcinoma cell lines.</p><p><b>METHODS</b>Colony formation assay was performed in colorectal cancer cell lines HT29, SW480, RKO, Lovo and HCT116 after irradiation with different radiation doses. Radiation sensitivity of these 5 cell lines was detected through survival fraction at 2 Gy (SF2 value). High-throughput lncRNA chip was used to screen lncRNA genes with expression differences more than 2 folds among SW480, RKO and Lovo. Further experiment on the expression differences of lncRNAs selected was conducted by realtime PCR.</p><p><b>RESULTS</b>The radiosensitivity order of these 5 cell lines from low to high (SF2 value from high to low) was HT29 (0.83 ± 0.03), SW480 (0.69 ± 0.02), RKO(0.53 ± 0.02), Lovo (0.47 ± 0.05), HCT116 (0.32 ± 0.03) (P < 0.01). Five lncRNAs associated with radiation sensitivity were screened. Among them, expression levels of R05532, NR_015441, and NR_033374 were positively correlated with radiation resistance(all P < 0.01), and expression levels of the other 2 lncRNAs, NR_073156 and AA745020, were not correlated with radiation resistance of colorectal cancer cells (both P>0.05).</p><p><b>CONCLUSIONS</b>lncRNA R05532, NR_015441 and NR_033374 may be used as the predictive marker of radiosensitivity of colorectal cancer cells. Higher expression of these genes shows radiation resistance.</p>

Expression and significance of topoisomerase Ⅱα in colorectal caner / 国际外科学杂志

Objective To determine the relationship between expression of topoisomerase Ⅱ α and clinicopathological factors,overall survival in colorectal caner.Methods Expression of topoisomerase Ⅱ α was measured using EnVision immunohistochemistry in 490 colorectal cancer patients.The relationship between topoisomerase Ⅱ α expression and various clinicopathological parameters was analyzed.Kaplan-Meier analyses and multivariate analyses were used to evaluate the significance of topoisomerase Ⅱ α expression in prognosis prediction.Results Overexpression of topoisomerase Ⅱ α was found to be related with lower T stage ( P =0.042 ),lower N stage ( P =0.038 ),and possibly with lower recurrence rate ( P =0.053 ).Kaplan- Meier analyses showed that overexpression of topoisomerase Ⅱ α was related with prolonged overall survival (P =0.022 ) and prolonged disease-free survival ( P =0.036).Multivariate analyses showed that elevated serum CEA ( P ＜ 0.001 ),elevated serum CA199 ( P =0.002 ),poor differentiation ( P =0.001 ),advanced Dukes stage ( P ＜ 0.001 ) and lower expression of topoisomerase Ⅱ α( P =0.017 ) were independent predictive factors for poor prognosis.Conclusions Expression of topoisomerase Ⅱ α is a favorable predictive factor for colorectal cancer,and would be useful in prognosis prediction and treatment selection for early colorectal cancer and malignant colorectal polyps,especially when it is used in combinations with serum CEA,CA199 and differentiation.

Upper-gastrointestinal polyps found in cases of familial adenomatous polyposis / 中华普通外科杂志

ObjectiveTo discuss the incidence,endoscopic manifestion and pathological features of the upper-gastrointestinal polyps ( stomach and deodenum) in FAP patients. MethodsDuring 2004 -2010 a total 57 FAP patients at Changhai Hospital underwent screening for polyps in upper-gastrointestinal tract by gastroscopy and sideward-viewing duodenoscopy. Biopsies were taken on the polypoid lesions.ResultsGastric polyps were found in 38 patients (67％).Most polyps were located at gastric body and antrum,the pathologic diagnosis was hyperplastic. Duodenal polyps were found in 12 patients (21％) including 7 cases of adenomatous polys. ConclusionsUpper- gastrointestinal polyps are the most common extra-colonic manifestion in FAP. Most stomach polyps are located at gastric body and antrum and are hyperplastic.Polyps at duodenum may be adenomatous,which is a precusor of carcinoma.