Methylated SDC2 testing in stool DNA for early screening of colorectal cancer in Shipai Town, Dongguan City / 中华胃肠外科杂志

Objective: To explore the utility of stool-based DNA test of methylated SDC2 (mSDC2) for colorectal cancer (CRC) screening in residents of Shipai Town, Dongguan City. Methods: This was a cross-sectional study. Using a cluster sampling method, residents of 18 villages in Shipai Town, Dongguan City were screened for CRC from May 2021 to February 2022. In this study, mSDC2 testing was employed as a preliminary screening method. Colonoscopy examination was recommended for individuals identified as high-risk based on the positive mSDC2 tests. The final screening results, including the rate of positive mSDC2 tests, the rate of colonoscopy compliance, the rate of lesions detection, and the cost-effectiveness of screening, were analyzed to explore the benefits of this screening strategy. Results: A total of 10 708 residents were enrolled and completed mSDC2 testing, giving a participation rate of 54.99% (10 708/19 474) and a pass rate of 97.87% (10 708/10 941). These individuals included 4 713 men (44.01%) and 5 995 women (55.99%) with a mean age of (54.52±9.64) years. The participants were allocated to four age groups (40-49, 50-59, 60-69, and 70-74 years), comprising 35.21%(3770/10 708), 36.25% (3882/10 708), 18.84% (2017/10 708), and 9.70% (1039/10 708) of all participants, respectively. mSDC2 testing was positive in 821/10 708 (7.67%) participants, 521 of whom underwent colonoscopy, resulting in a compliance rate of 63.46% (521/821). After eliminating of 8 individuals without pathology results, data from 513 individuals were finally analyzed. Colonoscopy detection rate differed significantly between age groups (χ2=23.155, P<0.001),ranging from a low of 60.74% in the 40-49 year age group to a high of 86.11% in the 70-74 year age group. Colonoscopies resulted in the diagnosis of 25 (4.87%) CRCs, 192 (37.43%) advanced adenomas, 67 (13.06%) early adenomas, 15 (2.92%) serrated polyps, and 86 (16.76%) non- adenomatous polyps. The 25 CRCs were Stage 0 in 14 (56.0%) individuals, stage I in 4 (16.0%), and Stage II in 7(28.0%). Thus, 18 of the detected CRCs were at an early stage. The early detection rate of CRCs and advanced adenomas was 96.77% (210/217). The rate of mSDC2 testing for all intestinal lesions was 75.05% (385/513). In particular, the financial benefit of this screening was 32.64 million yuan, and the benefit-cost ratio was 6.0. Conclusion: Screening for CRCs using stool-based mSDC2 testing combined with colonoscopy has a high lesion detection rate and a high cost-effectiveness ratio. This is a CRC screening strategy that deserves to be promoted in China.

Development of Clinical practice guidelines: procedure and standard / 中华胃肠外科杂志

In the last decade, the development of clinical practice guidelines in China has grown rapidly. However, with regards to the guidelines that have been established in the past, few were of high quality and in line with international standards. The main reason for this was that many clinical experts were not familiar with the procedures and rules of clinical guidelines before established, which lowered the quality seriously. Clinical practice guidelines are based on a clinical problem that is distilled into populations, interventions, comparison and outcome (PICO). After comprehensive systematic review, recommendations are made through evidence grading and strength of recommendation system. In addition, other issues should be noted such as pros and cons of the recommendation for specific population, preferences and values of the population, cost-effectiveness, and the health care system. A high-quality guideline requires multidimensional thinking (from clinicians, patients and policy makers), the implementation of a standard procedure (to ensure guidelines scientifically sound, honest and transparent), as well as the collaboration of multiple organizations (including experts, methodologists and policy makers).

Comparison of local immune microenvironment between liver-metastasis colorectal cancer and non-liver-metastasis colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the difference of local immune microenvironment in primary tumors between liver-metastasis and non-liver-metastasis cohort in stage III to IIII colorectal cancer patients.</p><p><b>METHODS</b>Tumor samples from 167 patients of colorectal cancer were harvested, who received tumor resection for the first time in The First Affiliated Hospital of Sun Yat-sen University from 2000 to 2005. Patients were divided into two groups according to liver metastasis or not. Expressions of 18 immune markers, including CD3, CD4 and CD8 were examined and quantified by immunohistochemistry staining.</p><p><b>RESULTS</b>No significant differences of gender, age, BMI, tumor differentiation, pathology type and preoperative CEA level were found between the two groups. The expressions of CD8, CD45RO, IL-17, tryptase and FAS were lower in liver-metastasis group as compared to non-liver-metastasis group (all P<0.05).</p><p><b>CONCLUSIONS</b>Decrease of the number of T lymphocyte and mast cell may play an important role in local infiltration of immune microenvironment of stage III to IIII colorectal cancer with liver metastasis.</p>

Interpretation of some hot topics in consensus on diagnosis and treatment of inflammatory bowel disease in China(2012) / 中华胃肠外科杂志

Inflammatory bowel disease (IBD) has become a common ailment in China in the past decade. At present, the level of diagnosis and treatment of inflammatory bowel disease in China still falls behind Western countries, while the incidence increases rapidly. Chinese IBD Working Group made a new consensus on diagnosis and treatment of inflammatory bowel disease in 2012. This article is to interpret some key issues in the consensus.

Meta-analysis of efficacy and safety on neoadjuvant therapy for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the value of neoadjuvant therapy for resectable rectal cancer and the impact on postoperative complications.</p><p><b>METHODS</b>Literature search was performed in PubMed, Ovid, Web of Science, Springer-Link and Elsevier ScienceDirect for randomized controlled trials published before May 2010 that compared neoadjuvant therapy with surgery alone or postoperative adjuvant therapy. The computer search was supplemented with hand search of reference lists for available primary studies. Inclusion criteria and quality assessment were performed.</p><p><b>RESULTS</b>Eleven studies including 7407 patients were enrolled for analysis. Neoadjuvant therapy group had significant advantages in local recurrence (OR=0.43, 95%CI:0.37-0.50, P<0.01), distant recurrence (OR=0.85, 95%CI:0.76-0.95, P<0.01), 5-year overall survival (RR=1.15, 95%CI:1.04-1.28, P<0.01), and sphincter-saving surgery (RR=1.48, 95%CI:1.17-1.87, P<0.01). There were no significant difference in postoperative mortality rate(OR=1.20, 95%CI:0.68-2.13, P=0.53) and anastomotic complications (OR=1.04, 95%CI:0.73-1.48, P=0.84).</p><p><b>CONCLUSION</b>Neoadjuvant therapy improves local control, distant recurrence and long-term survival without increasing postoperative complications.</p>

Laparoscopic colorectomy versus open colorectomy for elderly patients over 80 years old: a meta-analysis of safety and efficacy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical safety and efficacy of laparoscopic versus open colorectal resection in octogenarians. Methods Studies comparing laparoscopic colorectal resection with open colorectal resection in octogenarians were identified from the Medline, Embase, Ovid, and Cochrane databases from 1990 to 2012. The methodological quality of the selected studies was assessed to determine studies suitable for inclusion. Meta-analysis was performed by fixed or random effects model.</p><p><b>RESULTS</b>Five observational studies with a total of 685 patients (330 laparoscopic colorectal resections and 355 open colorectal resections) were identified. Laparoscopic colorectal resection was associated with a prolonged operative time (WMD=27.89, P<0.01) and a lower rate of overall complications (OR=0.58, P<0.01), wound infection (OR=0.50, P<0.05), cardiovascular complication(OR=0.53, P<0.05), quicker bowel function return (WMD=-0.83, P<0.01), and shorter length of hospital stay (WMD=-3.60, P<0.05). No differences were found with regard to anastomotic leak (OR=1.13, P>0.05), prolonged ileus (OR=0.71, P>0.05), respiratory complication (OR=0.59, P>0.05),mortality (OR=0.67, P>0.05), and reoperation (OR=0.85, P>0.05).</p><p><b>CONCLUSION</b>Laparoscopic colorectal resection is as safe as open colorectal resection, and is more favorable in terms of length of hospital stay and bowel function return in octogenarians.</p>

Curative effect analysis of radical surgery for colon cancer invading duodenum / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the clinicopathological characteristics and access the immediate- and long-term outcome of radical surgery in patients with colon cancer invading duodenum.</p><p><b>METHODS</b>A retrospective review of 19 patients with colon cancer invading duodenum underwent radical surgery between 1995 and 2010 was performed. There were 7 male and 12 female, age ranged from 36 to 73 years with an average of 56 years. The main manifestations were abdominal pain, loss of weight, change of stool frequency and so on. The tumors located at the hepatic flexure in 15 patients. All of the patients underwent radical surgery, and none of the patients had positive resection margins. One patient underwent pancreaticoduodenectomy combined with right hemicolectomy (RH). Two patients underwent pylorus preserving pancreaticoduodenectomy combined with RH. One patient underwent duodenectomy combined with RH. Four patients underwent RH. And the other 11 patients underwent lateral duodenectomy combined with RH.</p><p><b>RESULTS</b>There was no postoperative morbidity and mortality, and the 30-day mortality rate was 0. The median overall survival was 5.3 years. Overall 1 and 5 years survival rate were 94.4% and 70.4%, respectively. And 3 patients developed recurrence in 3 years.</p><p><b>CONCLUSIONS</b>The patients with colon cancer invading duodenum are lack of specific clinical manifestations. And the radical surgical procedure is safe, which could prolong the survival and improves the prognosis in these patients.</p>

Meta-analysis of safety and efficacy on paraaortic lymphadenectomy in gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of paraaortic lymphadenectomy in gastric cancer with meta-analysis.</p><p><b>METHODS</b>Randomized controlled trial comparing D(2)/D(3) and D(2)/D(3) plus paraaortic lymphadenectomy in gastric cancer were identified by two investigators after search strategy was established. Seven randomized controlled trials with 1446 cases were included in this meta-analysis. Fixed effect model or random model was separately used to evaluate the safety and efficacy of paraaortic lymphadenectomy in gastric cancer.</p><p><b>RESULTS</b>Total complication rate in the D(2)/D(3) plus paraaortic lymphadenectomy group was significantly higher than that in the D(2)/D(3) group (RR 1.34, 95% CI 1.03-1.75, P=0.03), while surgery associated complication between the two groups was almost the same. Lymphorrhea and severe diarrhea was more common in the D(2)/D(3) plus paraaortic lymphadenectomy (RR 16.23 and 9.56, 95% CI 1.99-131.98 and 1.70-53.67, respectively). Anastomotic leak, pancreatic fistula, abdominal abscess, ileus, postoperative bleeding and wound infection were similar. There were no advantages in operating time, amount of blood transfusion, in-hospital stay, reoperation, recurrence and 5-year survival favoring the paraaortic lymphadenectomy group except intra-operative blood loss and rate of blood transfusion (WMD 202.95, 95% CI 116.80-289.10; RR 1.93, 95% CI 1.20-3.10).</p><p><b>CONCLUSIONS</b>Paraaortic lymphadenectomy is associated with increased total complication without altering postoperative recurrence and survival. Strict large-scale multicenter controlled trials with long-term follow-up are required.</p>

Systematic review on safety and efficacy of lateral node dissection in rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of lateral node dissection in rectal cancer.</p><p><b>METHODS</b>Data of safety and efficacy in 27 case-controlled studies comparing lateral node dissection and non-lateral node dissection in rectal cancer were meta-analyzed using fixed effect model or random effect model.</p><p><b>RESULTS</b>The increased operating time, blood loss and urinary dysfunction were more common in lateral node dissection group. The postoperative total complications, pelvic abscess, anastomotic leak, sexual dysfunction and defecation dysfunction were similar in both groups. There was no reasonably clear evidence in favor of lateral node dissection for recurrence, local recurrence, distal metastasis and 5-year survival.</p><p><b>CONCLUSION</b>Lateral node dissection can neither reduce recurrence nor improve survival in the current study, which is not recommended to be a routine procedure in rectal cancer surgery.</p>

Proliferation of the mesenchymal stem cells in a delayed fat flap: an experimental study in rabbits / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the possibility to enhance the proliferation of adipose-derived stem cells (ASCs) in a delayed fat flap in rabbits.</p><p><b>METHODS</b>A delayed fat flap was formed in one side of inguinal region of a rabbit. 21 days after operation, the fat tissues at the delayed flaps and at the unoperated side were harvested and digested with 0.25% collagenase and sieved. The cell suspensions were centrifuged. The cells were obtained from tissue precipitate after centrifugation. The expression rates of the surface marker (CD29, CD44, CD14 and CD45) were measured by FCM and compared between the experimental and control groups.</p><p><b>RESULTS</b>Expression rates of CD29 and CD44 were higher in the delayed fat flap (74.06% and 90.74%) than in the contralateral fat tissue (62.88% and 77.54%, P < 0.05), while those of CD14 and CD45 were lower in the delayed fat flap (57.66% and 4.84%) than in the contralateral fat tissue (72.10% and 75.82%, P < 0.05 and P < 0.01).</p><p><b>CONCLUSIONS</b>Tissue hypoxic ischemia such as fat tissue in a delayed fat flap can promote proliferation of ASCs. It indicates that tissue in the delayed flap may be transplanted with better survival rate. The ischemia pretreatment of fat tissue may become a new method for fat transplantation.</p>

Safety and feasibility of laparoscopic surgery and open surgery in ulcerative colitis: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the safety and feasibility of laparoscopic surgery and open surgery in ulcerative colitis.</p><p><b>METHODS</b>A search of published studies in English and Chinese between January 1992 and May 2008 was performed. Nine hundred and twenty-three patients from 16 studies were recruited which met the inclusion criteria. Meta-analysis was performed through fixed effect model or random effect model dependent on heterogeneity.</p><p><b>RESULTS</b>Compared to open procedure, patients with ulcerative colitis undergone laparoscopic surgery were able to tolerate oral intake significantly earlier (P<0.01) with shorter hospital stay (P<0.01) and had lower total complication rate (P<0.01). But duration of laparoscopic surgery was significantly longer than that of open procedure(P=0.04). Laparoscopic procedure was no more superior to open procedure in recovery of bowel function, re-operation rate, intra-abdominal abscess, anastomotic leak, postoperative bowel obstruction, wound infection, blood loss and mortality. The conversion rate was 4.2% in this analysis.</p><p><b>CONCLUSION</b>Laparoscopic surgery for ulcerative colitis is safe and feasible with better recovery in short-term as compared to the open procedure.</p>

Increased rate change over time of a sphincter-saving procedure for lower rectal cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Total mesorectal excision (TME) has increased the rate of sphincter-preservation (SP) for more patients with low-lying rectal cancer. Here, we analyze the change of sphincter preserving rates in lower rectal cancer and their related factors.</p><p><b>METHODS</b>We reviewed retrospectively the medical records of 316 patients with lower rectal cancers, 1 to 5 cm from the anorectal line, who had surgical resections from August 1994 to November 2005. The 12-year span was divided into 2 periods: period I (August 1994-December 1998) and period II (January 1999-November 2005), based on the date (January 1999) when standard total mesorectal excision (TME) was introduced. The patients were divided into two groups based on the operation: abdominoperineal resection (APR) or SP surgery. SP rates, leakage and other clinico-pathological characteristics were compared between the two time periods and between the two different groups.</p><p><b>RESULTS</b>The SP rate increased significantly over the 12 years, from 44.9% in period I to 76.2% in period II (P = 0.000). The factors significantly influencing SP included the distance of the tumor from the anorectal line, gender, time period, circumference of intramural spread and histological differentiation (P < 0.05). Significant differences were detected between the two time periods in gender, blood transfusion volume and Dukes' stage (P < 0.05). The leakage rate was 2.7% in period I and 1.3% in period II (P > 0.05).</p><p><b>CONCLUSIONS</b>Over the 12-year period of the study the SP rate in rectal cancers 1 - 5 cm from the anorectal line has increased significantly while the blood transfusion volume has decreased due to the introduction of TME. However, TME had no effect on operating time and leakage rates.</p>

Risk factors of operation and reoperation in patients with Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the operative rate and reoperative rate of Crohn disease(CD) in China, and to assess the relative risk factors indicating surgical treatment in CD patients.</p><p><b>METHODS</b>Data of initial operation and reoperation were evaluated retrospectively in a cohort of 142 patients with CD. The influence of concomitant risk factors was assessed using multivariate analyses.</p><p><b>RESULTS</b>Of the 142 cases of CD patients, 64.8% required at least one operation and the cumulative rate of operation was 52% at 5 years after onset. The relative risk of operation was increased in male patients, older than 40 years of age at onset, and those with CD involving small bowel. Of the patients undergone operation, 33.9% relapsed and required reoperation subsequently. The cumulative reoperation rate was 21% at 3 years after first operation. Male gender, a perforating indication for initial operation, as well as colonic and ileocolonic disease, increased the relative risks of reoperation.</p><p><b>CONCLUSIONS</b>Half of patients with CD will undergo an operation at 5 years after onset, and 20% of them will relapse and require reoperation at 3 years after first operation. Men run a higher risk of operation and reoperation than women do. A perforating indication for initial operation predict a higher risk of reoperation.</p>

Experimental study of increasing effect of the fat flap tissue after delay operation on its free graft survival volume and duration / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the effects of the fat flap tissues after delay operation on free fat-graft survival rate and duration.</p><p><b>METHODS</b>The delay operation of fat flaps was performed in the inguinal region of a rabbit. Expression of VEGF was assayed using Elisa method after 12 hours of flap delay. The fat flaps were harvested and cut into pieces after 21 days. A subdermal pocket was created in each side of the dorsal midline of a rabbit, the fat pieces were grafted randomly into a pocket and the normal fat pieces into the other pocket as control. After 1, 3, 6, 9 and 12 months of implantation, the grafted fats were harvested, gross observation, weight measurement and histology were carried out. Number of the vessels stained with anti-CD34 antibody was counted out.</p><p><b>RESULTS</b>VEGF concentrations in flaps were significantly higher (P < 0.05). The density of vessels in experimental groups increased significantly compared with that in control groups at 1 and 3 months, respectively (P < 0.01), and no significant differences in the survival rate of fat tissues between experimental and control groups were observed at 1 and 3 months (P > 0.05). The fat cells from the flaps survived after 12 months of fat plantation, while those in control groups disappeared after 6 months.</p><p><b>CONCLUSIONS</b>The survival rate and duration of grafted fat could be increased implanting the fat tissues from delayed fat flap, which may provide researchers with a new method for fat graft.</p>

Endoscopic endonasal transsphenoidal approach for pituitary adenomas / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical curative effect of the endonasal transsphenoidal approach for removing pituitary adenoma (PA) under neuroendoscope-assisted.</p><p><b>METHODS</b>There were 215 patients who had undergone neuroendoscopic transsphenoidal surgery. Each patient received CT or MRI examination which showed the size and surrounding structural of tumor.</p><p><b>RESULTS</b>Among the 215 patients, 190 cases (88.4%) had total removal, 17 cases (7.9%) achieved subtotal removal and the remaining 8 cases (3.7%) with fibrous tumor was carried out partial removal. Two patients (0.9%) died after operation. Postoperative follow-up period was 1 to 10 months (the average was 3.5 months). In 182 patients, 150 cases (90.9%) got vision recovered rapidly compared with their preoperative symptoms, such as diminished acuities and visual field defects, and 15 cases (9.1%) had gotten improvements to some extend among 165 who diagnosed as pituitary macroadenoma (PMaA); There were 17 patients who diagnosed as microadenoma (PMiA) showed that the pituitary dyshormonism recovered gradually.</p><p><b>CONCLUSIONS</b>The endonasal transsphenoidal surgery under the neuroendoscope-assisted appears to be a safe, effective and micro-invasive method for PA.</p>