Comparison of clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer / 中华胃肠外科杂志

Objective: To compare the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) 18 to 75 years old; (2) gastric cancer proved by preoperative gastroscopy, CT and pathological results and tumor was suitable for D2 radical distal gastrectomy; (3) postoperative pathological diagnosis stage was T1-4aN0-3M0 (according to the AJCC-7th TNM tumor stage), and the margin was negative; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, and American Association of Anesthesiologists (ASA) grade 1 to 3; (5) no mental illness; (6) able to answer questionnaires independently; (7) patients agreed to undergo laparoscopic distal gastrectomy and signed an informed consent. Exclusion criteria: (1) patients with severe chronic diseases and American Association of Anesthesiologists (ASA) grade >3; (2) patients with other malignant tumors; (3) patients suffered from serious mental diseases; (4) patients received neoadjuvant chemotherapy or immunotherapy. According to the above criteria, clinical data of 200 patients who underwent laparoscopic distal gastrectomy at the Department of General Surgery of the First Affiliated Hospital of Army Medical University from January 2016 to December 2019 were collected. Of the 200 patients, 108 underwent uncut Roux-en-Y anastomosis and 92 underwent Billroth II with Braun anastomosis. The general data, intraoperative and postoperative conditions, complications, and endoscopic evaluation 1 year after the surgery were compared. Besides, the quality of life of two groups was also compared using the Chinese version of the European Organization For Research and Treatment of Cancer (EORTC) quality of life questionnaire-Core 30 (QLQ-C30) and quality of life questionnaire-stomach 22 (QLQ-STO22). Results: There were no significant differences in baseline data between the two groups (all P>0.05). All the 200 patients successfully underwent laparoscopic distal gastrectomy without intraoperative complications, conversion to open surgery or perioperative death. There were no significant differences between two groups in operative time, intraoperative blood loss, postoperative complications, time to flatus, time to removal of gastric tube, time to liquid diet, time to removal of drainage tube or length of postoperative hospital stay (all P>0.05). Endoscopic evaluation was conducted 1 year after surgery. Compared to Billroth II with Braun group, the uncut Roux-en-Y group had a significantly lower incidences of gastric stasis [19.8% (17/86) vs. 37.0% (27/73), χ(2)=11.199, P=0.024], gastritis [11.6% (10/86) vs. 34.2% (25/73), χ(2)=20.892, P<0.001] and bile reflux [1.2% (1/86) vs. 28.8% (21/73), χ(2)=25.237, P<0.001], and the differences were statistically significant. The EORTC questionnaire was performed 1 year after surgery, there were no significant differences in the scores of QLQ-C30 scale between the two groups (all P>0.05), while the scores of QLQ-STO22 showed that, compared to the Billroth II with Braun group, the uncut Roux-en-Y group had a lower pain score (median: 8.3 vs. 16.7, Z=-2.342, P=0.019) and reflux score (median: 0 vs 5.6, Z=-2.284, P=0.022), and the differences were statistically significant (all P<0.05), indicating milder symptoms. Conclusion: The uncut Roux-en-Y anastomosis is safe and reliable in laparoscopic distal gastrectomy, which can reduce the incidences of gastric stasis, gastritis and bile reflux, and improve the quality of life of patients after surgery.

Effect of peritoneum reconstruction on postoperative complications after laparoscopic low anterior resection for rectal cancer / 中华胃肠外科杂志

Objective: To determine the effect of peritoneum reconstruction on postoperative complications after laparoscopic low anterior resection (LAR) for rectal cancer. Methods: Retrospective cohort study and propensity score matching were conducted. Case inclusion criteria: (1) pathologically confirmed rectal adenocarcinoma; (2) 18 to 80 years; (3) patients with middle to low rectal cancer undergoing laparoscopic LAR; (4) patients staging cT1-4aN0-2M0 or ycT1-4aN0-2M0 after neoadjuvant therapy; (5) the distance of 4-10 cm from tumor low margin to anal verge. Exclusion criteria: (1) abdominal surgery history (except appendicitis, cholecystitis, ectopic pregnancy); (2) anastomosis above the peritoneal reflection; (3) tumor distant metastasis or clinical staging of T4b during surgery; (4) conversion to open surgery; (5) severe incapacitating disease (American Society of Anesthesiologists classification IV or V, ASA). A total of 666 patients with middle to low rectal cancer undergoing laparoscopic LAR in The First Affiliated Hospital of Army Medical University from January 2017 to June 2020 were enrolled. There were 473 males and 193 females with the median age of 59 (18-80) years. Laparoscopic LAR with peritoneum reconstruction was performed in 188 cases (PR group), and laparoscopic LAR without peritoneum reconstruction was performed in 478 cases (NPR group). After 1:1 propensity score matching according to 1:1 based on age, gender, body mass index, TNM staging, ASA classification, intraoperative blood loss, distance from tumor low margin to anal edge, 153 cases were included in each group. Postoperative complications were classified according to Clavien-Dindo classification. Anastomotic leakage was defined and graded according to the International Study Group of Rectal Cancer (ISGRC) criteria. Results: After propensity score matching, there were no significant differences in baseline demographic characteristics between the 2 groups (all P>0.05), indicating that these two groups were comparable. (1) Operative conditions: All the patients in both groups completed operation successfully. Compared with the NPR group, the PR group had longer operation time [(181.3±60.3) minutes vs. (168.9±51.5) minutes, t=2.185, P=0.029], shorter postoperative median hospital stay [8 (7, 10) days vs. 9 (7, 11) days, Z=-2.282, P=0.022], and the differences were statistically significant (P<0.05). (2) Postoperative complications: The overall morbidity of postoperative complication in PR group and NPR group was 20.3% (31/153) and 24.2% (37/153) respectively, and the incidence of anastomotic leakage was 9.8% (15/153) and 11.1%(17/153) respectively, whose differences were not statistically significant (both P>0.05). Compared with NPR group, PR group had lower morbidity of grade III to IV complications [3.9% (6/153) vs. 11.1% (17/153), χ(2)=5.688, P=0.017] and lower secondary operation rate [1.3% (2/153) vs. 5.9% (9/153), χ(2)=4.621, P=0.032], the differences were statistically significant (both P<0.05). Though PR group had lower incidence of grade C anastomoic leakage [1.3% (2/153) vs. 3.9% (6/153), χ(2)=2.054, P=0.152], but the differences were not statistically significant. (3) Postoperative inflammation: The difference of the procalcitonin level of both PR and NPR groups at postoperative 1-d, 3-d, and 5-d was statistically significant (F=5.222, P=0.010) in time-dependent manner, while the difference was not significant in the interaction effect (P>0.05). No statistically significant differences in the C-reactive protein level between two groups at postoperative 1-d, 3-d, and 5-d were found (all P>0.05). Conclusion: Peritoneum reconstruction in laparoscopic LAR can decrease the morbidity of postoperative complication of grade III to IV and the reoperation rate, and plays an important role in controlling the inflammatory reaction, which has great clinical value.

Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience.</p><p><b>METHODS</b>Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology.</p><p><b>RESULTS</b>All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis.</p><p><b>CONCLUSION</b>Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.</p>

Robotic-assisted radical gastrectomy using da Vinci robotic system: a report of 41 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of da Vinci robotic-assisted radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>Forty-one patients with gastric cancer from Southwest Hospital between March 2010 and December 2011 underwent da Vinci robotic-assisted radical gastrectomy including total gastrectomy(n=12) and distal gastrectomy (n=29).</p><p><b>RESULTS</b>Conversion was required in two patients. One was converted to open surgery, and the other to conventional laparoscopic surgery. The remaining thirty-nine patients underwent da Vinci robotic-assisted radical gastrectomy successfully. The mean operative time was (285±61) min for total gastrectomy, and (225±39) min for distal gastrectomy. The mean blood loss was (180±157) ml in total gastrectomy, and (150±127) ml in distal gastrectomy. The mean number of harvested lymph nodes was 34.2±18.5. The mean time for gastrointestinal function recovery was (3.1±1.2) days. The time to ambulation was (2.7±1.5) days. The time to oral liquid intake was (3.7±1.5) days. Two patients had complication including wound infection and pneumonia. After follow up ranging from 1 to 21 months (median 11 months), 4 patients died from peritoneal metastasis, 1 survived with tumor, and the remaining 36 patients survived without disease.</p><p><b>CONCLUSIONS</b>da Vinci robotic-assisted radical gastrectomy is a feasible and safe surgical procedure with clear operation field, precise dissection, minimal trauma and fast recovery.</p>

Influence of CO2 pneumoperitoneum pressures on the expression of adhesion molecules of gastric cancer cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the effect of different CO2 pneumoperitoneum pressures on the expression of adhesion molecules of human gastric cancer cell line MNK-45.</p><p><b>METHODS</b>MKN-45 cells in the experimental groups were exposed to simulated CO2 environment maintained at different pressures (1.2, 1.6, 2.0 kPa) for 4 hours. Control groups were exposed to room air. At the 0, 24, 48, 72, 96 hours after treatment, CD44v6, ICAM-1 and E-cadherin were detected by flow cytometry method.</p><p><b>RESULTS</b>CD44v6 and ICAM-1 expressions showed pattern of firstly elevating, then descending to normal under the pressures of 1.2 kPa and 1.6 kPa. The expressions were different from control group significantly at 24 and 48 hours (P<0.01), while the 72 hours expression showed no difference compared with the controls (P>0.05). E-cadherin expression decreased significantly right after treatment compared to the control (P<0.01), but recovered to the level of control at 48 hours (P>0.05). In the 2.0 kPa group the expression changes of CD44v6, ICAM-1 and E-cadherin were more remarkable. CD44v6 and ICAM-1 expressions were increased significantly compared to control right after treatment (P<0.05). E-cadherin expression was significantly decreased even at 48 hours compared to the controls (P<0.01).</p><p><b>CONCLUSION</b>In vitro CO2 pneumoperitoneum pressures have transient influence on the adhesion molecules expression of gastric cancer cell MKN-45, then those expressions can recover in a short-time.</p>

Effect of different CO2 pneumoperitoneum on IL-1β and IL-6 in abdominal cavity / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of different CO2 pneumoperitoneum on IL-1β and IL-6 in abdominal cavity.</p><p><b>METHODS</b>Fifty-six female SD rats were randomly divided into seven groups. One group was served as control and the others received CO2 pneumoperitoneum. Pneumoperitoneum was established at 0.67 kPa and 1.0 L/min gas flow for 1, 2 or 3 h with CO2 (group C1 h, C2 h, and C3 h, respectively). CO2 pneumoperitoneum was further established at 1.07 kPa and 1.0 L/min gas flow for 1 h (group C8p), at 0.67 kPa and 2.0 L/min gas flow for 1 h(group C2f), and at 0.67 kPa and 3.0 L/min gas flow for 1 h (group C3f). After the procedures, peritoneal fluid was collected to analyze the IL-1β and IL-6 level by ELISA method.</p><p><b>RESULTS</b>CO2 pneumoperitoneum caused peritoneal inflammatory reaction. With the increasing of duration and gas flow in CO2 pneumoperitoneum, the concentrations of IL-1β and IL-6 in group C2 h, C3 h and C3f were higher than those in group C1 h (P<0.05). On the other hand, the concentrations of IL-1β and IL-6 in peritoneal fluid did not change significantly when pressure was increased (P>0.05).</p><p><b>CONCLUSIONS</b>The inflammatory reaction in abdominal cavity after CO2 pneumoperitoneum may be attributed to duration and gas flow instead of the pressure within the standard pneumoperitoneum working pressures. Surgeons should reduce surgical duration and adopt low-velocity gas flow within normal working pressures in clinical practice.</p>

Expression of Na+-H+ exchanger 1 in human gastric carcinoma tissue and its clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To determine the expression of Na+/H+ exchanger 1(NHE1) in human gastric carcinoma tissue and to investigate the association between NHE1 expression and clinicopathological characteristics.</p><p><b>METHODS</b>The expressions of NHE1 mRNA and protein were detected in both gastric carcinoma tissue (n=60) and adjacent gastric mucosa tissue (n=30) by reverse transcription polymerase chain reaction (RT-PCR) and Western blot. The association between the expression and the clinicopathological characteristics was analyzed.</p><p><b>RESULTS</b>The relative expression levels of NHE1 mRNA and protein in gastric carcinoma tissue were 0.786+/-0.291 and 1.442+/-0.175, which were significantly higher than those in adjacent gastric mucosa tissue (0.369+/-0.052 and 0.348+/-0.029) (P<0.01). The expression of NHE1 mRNA was positively correlated with NHE1 protein in the gastric carcinoma tissue (r=0.264, P<0.05). The expressions of NHE1 mRNA and protein were associated with the depth of invasion, lymph node metastasis, and TNM staging (P<0.05). However, no statistical difference was found in age, gender, and tumor differentiation (P>0.05).</p><p><b>CONCLUSION</b>The expression levels of NHE1 mRNA and protein are significantly up-regulated in gastric carcinoma tissue, which may be involved in the development of gastric carcinoma.</p>

Connexin 43 expression in intraperitoneal free gastric cancer cells in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the association of connexin 43 (Cx43) in the intraperitoneal free gastric cancer cells and clinicopathological characteristics.</p><p><b>METHODS</b>Immunohistochemistry and immunofluorescence staining were used to detect connexin 43 in 75 paraffin-embedded gastric cancer tissues, matched paracancerous tissue, and intraperitoneal free gastric cancer cells.</p><p><b>RESULTS</b>The positive rates of Cx43 expression were 33.3% (25/75) in gastric cancer tissue specimens and 100% (75/75) in matched paracancerous tissue (P<0.01). The positive detection rate of free cancer cells in peritoneal lavage was 38.6% (29/75) and the positive rate of Cx43 in peritoneal free gastric cancer cells was 72.4% (21/29), which was significantly higher than that in gastric cancer tissue specimens (P<0.01). Significant association was observed of Cx43 expression of free gastric cancer cells with tumor infiltration and histological type (P<0.05).</p><p><b>CONCLUSION</b>Cx43 gene may be involved in the mechanism of peritoneal metastasis of gastric cancer.</p>

Effects of hypoxia-inducible factor-1α on human gastric cancer cell apoptosis under in vitro CO(2) pneumoperitoneum environment / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effect of hypoxia-inducible factor-1α (HIF-1α) on human gastric cancer cells apoptosis in simulated CO2 pneumoperitoneum environment.</p><p><b>METHODS</b>Applied closed box to simulated CO2 pneumoperitoneum environment under the pressure of 0, 5, 10 and 15 mm Hg (1 mm Hg = 0.133 kPa). Compared HIF-1α mRNA and protein expression of MKN-45 cells before and after silencing HIF-1α by RT-PCR and Western blot. Study the changes of bcl-2/bax expression in MKN-45 cells before and after silencing HIF-1α by immunohistochemistry. The apoptosis ratio of MKN-45 was measured by using Annexin V-FITC/PI double labelled staining.</p><p><b>RESULTS</b>In 15 mm Hg group, HIF-1α mRNA and protein expression of MKN-45 cells (1.48 ± 0.22, 1.34 ± 0.09) and HIF-1α protein expression in 10 mm Hg group (1.25 ± 0.10) were significantly higher than those in control group (0.55 ± 0.17, 0.83 ± 0.04) (P < 0.05). But there was no significant differences among 0, 5, 10 mm Hg group and control group in HIF-1α mRNA (P > 0.05); and no obvious difference was found among 0, 5 mm Hg group and the control group in HIF-1α protein expression (P > 0.05). In 15 mm Hg CO2 pressure, bcl-2/bax expression (0.78 ± 0.05) was obviously lower than that in the control group (1.43 ± 0.15) (P < 0.05) and the apoptosis ratio (11.70 ± 0.12) was significantly higher than the control group (0.22 ± 0.07) (P < 0.01) before silencing HIF-1α. But once HIF-1α was silenced, HIF-1α mRNA (0.52 ± 0.11), HIF-1α protein expression (0.92 ± 0.02), bcl-2/bax ratio (1.57 ± 0.04) and apoptosis ratio (0.45 ± 0.11) in MKN-45 were not significantly different between 15 mm Hg group and the control group (P > 0.05).</p><p><b>CONCLUSIONS</b>The apoptosis ratios of MKN-45 under 0, 5, 10 mm Hg CO2 pneumoperitoneum are comparable with that in the control group before the silencing of HIF-1α. The apoptosis ratio of MKN-45 is increased under 15 mm Hg CO2 pneumoperitoneum environment and HIF-1α may be one of the important factor to improve the apoptosis of human gastric cancer cell.</p>

Male sexual function after D(3) lymphadenectomy combined with pelvic autonomic nerve preservation by laparoscopic and open surgery for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate male sexual function in a series of rectal cancer patients randomized to laparoscopic(LS) or open surgery(OS).</p><p><b>METHODS</b>Between June 2006 and October 2007, a total of 119 patients with rectal cancer were randomly assigned to laparoscopic(n=60) or open (n=59) resection group. All the patients were treated by D(3) lymphadenectomy combined with pelvic autonomic nerve preservation(PANP) technique. Sexual function was assessed by International Index of Erectile Function(IIEF) before surgery and on 3, 6 and 12 months after operation.</p><p><b>RESULTS</b>Sexual dysfunction rate of LS and OS at 3rd month after operation were 23.3% and 32.3% respectively, and 18.3% vs 27.1% after 6 months, and 11.6% vs 16.9% after 12 months. There were no significant difference between LS and OS in sexual dysfunction rate after surgery.</p><p><b>CONCLUSIONS</b>Laparoscopic D(3) lymphadenectomy combined with PANP is not associated with higher sexual dysfunction rate, and the sexual function after laparoscopic surgery is satisfactory.</p>

Effects of laparoscopy-assisted radical gastrectomy on the expression of intercellular adhesion molecule 1 and integrin beta(1) in peritoneal mesothelial cells and its significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the changes of the expression of intercellular adhesion molecule-1 (ICAM-1) and integrin beta(1) in peritoneal mesothelial cells during laparoscopy-assisted radical gastrectomy(LARG) and to explore the possible effects of LARG on the peritoneal metastasis.</p><p><b>METHODS</b>From April to August 2008, LARG was performed for 26 patients with gastric cancer (laparoscopy group), while 20 cases underwent open radical gastrectomy(open group). Peritoneum of right upper belly was collected at 3 operation time points(the beginning, 2 hours, 4 hours). The expressions of ICAM-1 and integrin beta(1) in peritoneal mesothelial cells at 3 time points were detected by immunohistochemistry.</p><p><b>RESULTS</b>With the operation prolonging, the expression of ICAM-1 and integrin beta(1) was increased gradually in both LARG and open groups. The expression of integrin beta(1) in two groups was obviously increased at 4-hour time point as compared to the beginning(P<0.05). Besides, there were no significant differences of these two adhesion molecules among the three operation time points between two groups(P>0.05).</p><p><b>CONCLUSIONS</b>Compared with open surgery, LARG is not associated with a greater effect on the expression of ICAM-1 and integrin beta(1) in peritoneal mesothelial cells, and may not promote peritoneal metastasis of gastric cancer through increasing the expression of adhesion molecule in peritoneal mesothelial cells.</p>

Effects of different CO2 pressure pneumoperitoneum on the migration and cytoskeleton in gastric cancer cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of CO(2) and He insufflation administered at different pressures on the migration and cytoskeleton of cultured human gastric cancer cells.</p><p><b>METHODS</b>The cultured gastric cancer cells MKN-45 were exposed to a CO(2) or He environment maintained at different pressures (12, 15 mm Hg). After 0, 2, 4, 6, 8 hours exposure to CO(2) or He environment, pH of the MKN-45 cells culture media was measured with blood gas analysis. The cell migration was detected with Transwell technology. The cell cytoskeleton was observed with laser confocal microscope.</p><p><b>RESULTS</b>The media pH was acid after exposure to CO(2) environment, while it was basic in the He group. The number of cells passing millipore in 12 mm Hg CO(2) or He insufflation pressure were not significantly different with control group (P>0.05), however in 15 mm Hg pressure CO(2) group, it was significantly decreased as compared to control group (P<0.01). The microfilament and microtubule in gastric cancer cell were ambiguous in 15 mm Hg pressure CO(2) group.</p><p><b>CONCLUSIONS</b>There are no obvious effects on the migration and cytoskeleton of MKN-45 cells under 12 mm Hg CO(2) insufflation pressure. The migration and cytoskeleton of MKN-45 cells can be inhibited in 15 mm Hg CO(2) pneumoperitoneum environment.</p>

Changes of peritoneal free gastric cancer cells and its significance in patients after laparoscopic radical gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of laparoscopic radical gastrectomy on gastric cancer through comparison of peritoneal free gastric cancer cells detecting rates between laparoscopic and open radical gastrectomy.</p><p><b>METHODS</b>Sixty-three patients received laparoscopic gastrectomy and 61 patients received open gastrectomy between April 2006 and June 2008 were included in this study. The peritoneal lavage fluid in those patients before and after the operation was collected. The cancer cell cytology and carcinoembryonic antigen (CEA) mRNA were detected with those samples. The relationship between peritoneal free gastric cancer cells and the area of cancer-invaded serosa was also observed.</p><p><b>RESULTS</b>The positive rate of cytology in laparoscopic surgery was 25.4% in the peritoneal fluid after the operation, while it was 29.5% in the open surgery, there was no significant difference between the two groups (P > 0.05). The positive rate of CEA mRNA in the peritoneal fluid after the operation in the laparoscopic group was 41.3%, and was 40.3% in the open group (P > 0.05). The area of cancer-invaded serosa in patients with positive cytology before and after the operation in the laparoscopic group was (16.2 +/- 2.2) cm(2), and it was (17.6 +/- 3.0) cm(2) in their counterparts in the open surgery group, while it was (5.3 +/- 0.8) cm(2) in patients with negative cytology before and after the operation. The area of cancer-invaded serosa was positively correlated with the positive rate of cytology(R(2) = 0.874, P = 0.000).</p><p><b>CONCLUSIONS</b>Laparoscopic radical gastrectomy is not associated with a greater risk for peritoneal dissemination of cancer cells than the open technique.</p>

Laparoscopic resection of gastric stromal tumors: report of 30 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment efficacy of laparoscopic resection of gastric stromal tumors.</p><p><b>METHODS</b>The clinical data of 30 patients with laparoscopic resection of gastric stromal tumors from Apr. 2004 to Apr. 2006 were retrospectively analyzed.</p><p><b>RESULTS</b>The preoperative diagnosis of gastric stromal tumors mainly relied on gastroscope, ultrasound gastroscope, barium meal and abdominal CT scan. Tumor size ranged from 2 to 10 cm. Surgical procedures included laparoscopic wedge resection for 22 patients, laparoscopic distal gastrectomies for 6 patients, and laparoscopic proximal gastrectomies for 2 patients. All operations were successful, with an average operation time of 120+/-35 min and a blood loss of 5-200 ml. Postoperative length of stay was 4-10 days. No recurrence had occurred during 3-24 months follow-up.</p><p><b>CONCLUSION</b>Laparoscopic resection of gastric stromal tumors is a safe and reliable procedure, with quick postoperative recovery and minimal invasion.</p>

A modified method of laparoscopic side-to-side esophagojejunal anastomosis after laparoscopic total gastrectomy: a report of 12 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the method of alimentary reconstruction after laparoscopic total gastrectomy.</p><p><b>METHODS</b>The clinical data of 12 patients undergone laparoscopic total gastrectomy and side- to- side esophagojejunal anastomosis from Feb. 2006 to Oct. 2006 were analyzed retrospectively.</p><p><b>RESULTS</b>Laparoscopic side- to- side esophagojejunal anastomosis was successfully performed in 12 patients. The mean operation time was (247.0+/- 13.1) min and the anastomosis time was (43.5+/- 10.4) min. Bleeding volume during operation was (107.5+/- 44.9)ml. The distance between anastomosis and proximal margin of tumor was (3.4+/- 1.2)cm. There was no postoperative death, fistula or anastomotic stenosis occurred after short- term follow- up.</p><p><b>CONCLUSION</b>The modified laparoscopic side- to- side esophagojejunal anastomosis is a safe, less challenging and more economic method of alimentary reconstruction after laparoscopic total gastrectomy.</p>

Influence of CD4+ and CD25+ T regulatory cell on mouse bearing gastric tumor in vivo / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of CD4+ CD25+ regulatory T cells(Treg cells) on mouse gastric cancer.</p><p><b>METHODS</b>Treg cell in mouse spleen bearing gastric tumor was tested in different time points. Magic cell sorting(MACS) method was used to purify mouse Treg cells and the Treg cells were injected into mouse bearing gastric tumor with different dosage. After 3 weeks, the tumor size and tumor cell apoptosis rate were measured.</p><p><b>RESULTS</b>Treg existed in normal mouse spleen with a rate of (3.86+/-0.07)%. In tumor model this percentage increased gradually and was (4.12+/-0.13)% after 3 weeks, which was significantly higher than that in control. When Treg cell applied in mouse reached 2.0 x 10(5), the tumor size enlarged significantly(P=0.013) and tumor cell apoptosis rate decreased significantly (P=0.012).</p><p><b>CONCLUSIONS</b>Treg cell is associated with gastric cancer progress in mouse tumor model. Treg cell can promote gastric cancer growth and decrease tumor apoptosis. The anti- Treg GITR can improve anti- tumor effects.</p>

Effects of Tiam 1 antisense oligodeoxynucleotides transfection on the morphology and invasive migration potential of gastric cancer cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of T lymphoma invasion and metastasis inducing factor 1 antisense oligodeoxynucleotides (Tiam 1 ASODN) transfection on the morphology and invasive migration potential of gastric cancer cells.</p><p><b>METHODS</b>The higher invasive and migratory subgroup (M(H)) were separated from human gastric cancer cell line MKN-45 (M(0)) by laminin adhesion method in vitro. Tiam 1 ASODN was transfected into M(H) cells with liposome, and the expression of Tiam 1 mRNA and protein was determined by RT-PCR and flowcytometry respectively. The changes in morphology, the invasive and migratory potential between Tima 1 ASODN transfected M(H) cells and no transfected M(H) cells were observed by HE stain, cytoskeletal protein stain, scanning electronic microscope (SEM) and Boyden chamber test.</p><p><b>RESULTS</b>Compared with the control, the expression of Tiam 1 mRNA and protein in M(H) cells was significantly decreased after transfected with 0.43 micromol/L ASODN(P< 0.01). The invasive and migratory potential of M(H) cells in vitro was also much more decreased than that of no transfected cells (P< 0.05 or P< 0.01). At the same time, transfected M(H) cells had less membrane surface projections, fewer or shorter pseudopodia, less irregular cytoskeletal network and less spotted-like actin bodys than no transfected M(H) cells did.</p><p><b>CONCLUSION</b>Tiam 1 ASODN transfection can effectively suppress the expression of Tiam 1 in gastric cancer cells and impair its invasive and migratory potential in vitro, which may be fulfilled through modulating the reconstruction of cytoskeleton and decreasing the deforming and migratory potential of gastric cancer cells.</p>

Laparoscopic-assisted radical gastrectomy: a report of 105 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of laparoscopic-assisted radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>One hundred and five patients with gastric cancer received laparoscopic-assisted radical gastrectomy, radical total gastrectomy were performed in 7 cases, proximal gastrectomy in 27 cases, proximal gastrectomy combined with splenectomy in 3 cases and distal gastrectomy in 68 cases.</p><p><b>RESULTS</b>One hundred and five cases had laparoscopic-assisted radical gastrectomy successfully. The mean operation time was 381 +/- 91 (300 - 435) min for total gastrectomy, 279 +/- 73 (212 - 390) min for proximal gastrectomy, 312 +/- 64 (265 - 405) min for proximal gastrectomy combined with splenectomy, 281 +/- 69 (230 - 360) min for distal gastrectomy, respectively. The mean blood loss was 260 +/- 202 (20 - 900) ml in total gastrectomy, 200 +/- 153 (20 - 400) ml in proximal gastrectomy, 333 +/- 116 (200 - 400) ml in proximal gastrectomy combined with splenectomy, 140 +/- 82 (20 - 450) ml in distal gastrectomy, respectively. The mean number of harvested lymph nodes was 34.2 +/- 20.5 (8 - 83). The mean time for gastrointestinal function recovery was 3.5 +/- 1.4 (2 - 5) days, 3.0 +/- 1.6 (2 - 6) days for patients' taking normal activity, 4.9 +/- 1.7 (3 - 7) days for taking liquid food. The short-term efficiency was obvious.</p><p><b>CONCLUSIONS</b>Laparoscopic-assisted radical gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.</p>

Transcription regulation of 5-Aza-2'-deoxycytidine on maspin gene demethylation in RKO human colorectal cell line / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To detect the methylation status of 5'CpG island in the core promotor of maspin gene in RKO human colorectal cell line,and to explore the transcription regulation of DNA 5'CpG island demethylation on maspin tumor suppressor gene and its effect on the growth of cancer cell.</p><p><b>METHODS</b>The status of 5 'CpG island methylation of maspin gene in RKO human colorectal cell line was analyzed using methylation specific polymerase chain reaction (MSP). After treated with a specific demethylating agent, 5-Aza-2'-deoxycytidine, reverse transcription polymerase chain reaction (RT- PCR) was used to examine maspin gene expression. Cell proliferation was evaluated using MTT assay,distribution of cell cycle and rate of apoptosis were determined using flow cytometry.</p><p><b>RESULTS</b>The 5'CpG island methylation in the core promotor of maspin gene was detected in RKO human colorectal cell line. After treatment with three different concentration of 5-aza-2'-deoxycytidine, the expression of maspin mRNA increased 10.89, 16.91, 23.97 times respectively. MTT array showed the proliferation activity of RKO cell line was obviously reduced after 5-aza-2'-deoxycytidine treatment. The cells were arrested in G(0)/G(1) phase,and the apoptosis rates were 5.17%, 8.71% and 11.23% respectively compared with control group.</p><p><b>CONCLUSION</b>The 5'CpG island methylation is probably responsible for maspin expression silencing in RKO human colorectal cell line, 5-aza-2'-deoxycytidine may effectively cause demethylation and inhibit the growth of tumor cell by reactivating the gene transcription silenced by aberrant hypermethylation.</p>

Inhibitive effects of gastric cancer cell-dendritic cell fusion vaccine on tumor cell proliferation cycle / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the inhibitive effects of gastric cancer cell-dendritic cell fusion vaccine on tumor cells of proliferation cycle.</p><p><b>METHODS</b>Peripheral blood mononuclear cells were separated from gastric cancer patients and co-cultured with granulocyte macrophage colony stimulating factors(GM-CSF), interleukin-4(IL-4) and tumor necrosis factor-alpha(TNF-alpha) to generate mature dendritic cells. The dendritic cells and SGC7901 cells were fused by polyethylene glycol, and the pure fusion cells were screened out by selective culture systems. The inhibitive effects of gastric cancer cell-dendritic cell fusion vaccines on tumor cell proliferation cycle in vivo and in vitro were detected by flow cytometry.</p><p><b>RESULTS</b>Treated with the fusion vaccine in vitro, the percentages of G(0)/G(1), S and G(2)/M cells of tumor cells were (76.77+/- 4.38)%, (16.50+/- 2.90)% and (6.73+/- 1.59)% respectively. There were significant differences in the percentages of different cell cycle tumor cells between the tumor cells treated with the fusion vaccine and those co-cultured with dendritic cell or T cells alone(P< 0.01). The proliferative index of the tumor cells treated with the fusion vaccine was 23.34+/- 3.51, significantly lower than those co-cultured with dendritic cell and controls (P< 0.05).</p><p><b>CONCLUSIONS</b>Fusion vaccines can affect cell cycle of the tumor cells, thus inhibit tumor cell proliferation and growth.</p>