Technique discussion of surgical approach for Siewert type Ⅱ adenocarcinoma of esophagogastric junction under total laparoscopy or thoracoscopy / 中华消化外科杂志

Adenocarcinoma of esophagogastric junction (AEG) has attracted more attention in recent years. Surgical method of Siewert type Ⅱ AEG is especially controversial, mainly focusing on the scope of lymph node dissection, safety of surgical margin, and digestive tract reconstruction. The abdominal transhiatal approach and right thoracoabdominal Ivor-Lewis approach are the main surgical approaches of totally laparoscopic or thoracoscopic surgery for Siewert type Ⅱ AEG, which not only need close teamwork, but also require rich experience in laparoscopic surgery. The authors has started to choose these two totally minimally invasive surgical approaches, the feasibility and safety of which are proved. The key surgical details are presented in this article for reference.

Regulation Mechanism of Long Noncoding RNAs in Colon Cancer Development and Progression

Colorectal cancer (CRC) is the second most common cause of cancer-related death worldwide, and its high rates of relapse and metastasis are associated with a poor prognosis. Despite extensive research, the underlying regulatory mechanisms of CRC remain unclear. Long noncoding RNAs (lncRNAs) are a major type of noncoding RNAs that have received increasing attention in the past few years, and studies have shown that they play a role in many biological processes in CRC. Here, we summarize recent studies on lncRNAs associated with CRC and the signaling pathways and mechanisms underlying this association. We show that dysregulated lncRNAs may be new prognostic and diagnostic biomarkers or therapeutic targets for clinical application. This review contributes not only to our understanding of CRC, but also suggests novel signaling pathways associated with lncRNAs that can be targeted to block or eradicate CRC.

Prevention and treatment of hemorrhagic complications in the laparoscopic radical gastrectomy / 中华消化外科杂志

Intraoperative hemorrhage is the most common complication of laparoscopic radical gastrectomy,which is also the main cause of conversion to open surgery.With the popularization of laparoscopic surgery technology worldwide,how to complete high-quality surgery and effectively avoid intraoperative or postoperative complications is the goal pursued by all surgeons.Intraoperative hemorrhage in the laparoscopic radical gastrectomy is mainly divided into parenchymal hemorrhage,perigastric vascular injury-induced hemorrhage,lymph node hemorrhage and anastomotic bleeding.Compression,electrocoagulation,vascular clipping and vascular suture repair are the most common treatments for intraoperative hemorrhage.It is necessary to use above methods in clinical work.Proficiency in laparoscopic operation skills,familiarity with perigastric vascular anatomy and variation,and improved teamwork to reduce complications are the key to laparoscopic surgery for gastric cancer.Combined with literature reports,the authors summarize experience in laparoscopic surgery for gastric cancer,discuss the prevention and treatment of hemorrhagic complications during laparoscopic radical gastrectomy.

Diagnosis and treatment of intra-abdominal infection complicated with hypothyroidism / 中华胃肠外科杂志

Intra-abdominal infection complicated with hypothyroidism is very common. It mostly featured decreased T3, with or without decreased T4, and without elevated thyroid stimulating hormone(TSH). This particular type of hypothyroidism was called "low T3 syndrome" or "thyroid illness syndrome", and is called "non-thyroid illness syndrome" increasingly in recent years. Its pathogenesis has not been fully understood, and probably is associated with abnormality of hypothalamic-pituitary-thyroid axis, disorder of peripheral thyroid hormone metabolism, change in thyroid hormone binding protein, regulation of triiodothyronine receptors, effect of cytokines, and lack of trace element selenium. Intra-abdominal infection complicated with hypothyroidism should be differentiated from primary hypothyroidism, which may be one cause of mental depression, insufficient anabolism, and poor tissue healing. Therefore, the changes of T3 and T4 levels should be actively monitored in patients with severe or prolonged intra-abdominal infection. Whether treatment is needed for intra-abdominal infection complicated with hypothyroidism remains controversial. T3 replacement therapy may improve prognosis. When low T3 syndrome presents as a disease-mediated hypothyroidism, we recommend the use of levothyroxine(L-T4) or liothyronine (L-T3) treatment to improve the prognosis of critical patients. Enteral nutrition can improve hypothyroidism and has good efficacy for enterocutaneous fistula patients with intra-abdominal infection.

Clinical efficacy of the superior pancreatic region approach guided by pancreatic capsule in laparoscopic radical gastrectomy of 438 patients / 中华消化外科杂志

Objective To investigate the clinical efficacy of the superior pancreatic region approach guided by pancreatic capsule in laparoscopic radical gastrectomy of 438 patients.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 438 patients who underwent laparoscopic radical gastrectomy of gastric cancer in the Second Hospital of Jilin University between April 2013 and April 2017were collected.Patients were confirmed with stage T2 and above by postoperative pathological examination and then underwent adjuvant chemotherapy of XELOX regimen.Observation indicators:(1) surgical situation;(2)postoperative recovery situation;(3) postoperative pathological examination;(4) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy,postoperative long-term complications and tumor metastasis or recurrence up to May 2017.Measurement data with normal distribution were represented as x±s.Results (1) Surgical situation:all the 438patients underwent laparoscopic radical gastrectomy of gastric cancer through the superior pancreatic region approach guided by pancreatic capsule,including 295 undergoing distal gastrectomy and 143 undergoing total gastrectomy.There were no conversion to open surgery.Operation time and volume of intraoperative blood loss were respectively (178 ±32) minutes and (39± 11)mL.There were no intraoperative complications and death in perioperative period.(2) Postoperative recovery situation:time to anal exsufflation,time for fluid diet intake and duration of hospital stay were (32±6) hours,(26±3) hours and (8.7±2.3) days,respectively.Volume of amylase drainage was (157±35) U/L at postoperative day 1,(68±25) U/L at postoperative day 2 and (43±17) U/L at postoperative day 3,respectively.No pancreatic fistula occurred postoperatively.(3) Postoperative pathological examination:results of postoperative pathological examination showed that 218,209 and 11 patients were detected in T2,T3 and T4a staging,respectively.Numbers of lymph node dissected and lymph node metastases were respectively 27.0± 6.0 and 4.2-± 2.9.Pathological typing:high-or moderate-differentiated adenocarcinoma,lowdifferentiated adenocarcinoma and undifferentiated carcinoma or signet-ring cell carcinoma were detected in 67,279 and 92 patients,respectively.(4) Follow-up situation:of 438 patients,415 were followed up for 1-48months,with a median time of 33 months of 438 patients,293 received postoperative adjuvant chemotherapy of XELOX regimen,122 received unknown adjuvant chemotherapy or refused chemotherapy.During the follow-up,there was no oecurrence of tumor-related complications,13 patients had tumor metastases or recurrence and 5patients died of tumor recurrence or metastases.Conclusion The superior pancreatic region approach guided by pancreatic capsule is safe and feasible in laparoscopic radical gastrectomy.

Clinical experience of combined laparoscopic-endoscopic Heller myotomy and modified Dor fundoplication for cardiochalasia / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication for cardiochalasia patients.</p><p><b>METHODS</b>Clinical data of 11 cardiochalasia patients who underwent combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication by the same medical team from January 2015 to December 2016 at The Second Hospital of Jilin University were retrospectively analyzed. The procedure was as follows: an incision was made in the anterior wall of esophagus and dissection of esophageal muscular layer was performed, then the bulged esophageal mucosa was covered by the fundus after 180 degrees fold to the right (fundoplication), finally the gastric fundus was joined to the right diaphragmatic foot by 3 to 5 knotted suture. The efficacy was judged by the Eckardt scoring standard: the postoperative Eckardt score ≤3 points indicated effectiveness, otherwise the treatment was invalid.</p><p><b>RESULTS</b>Combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication was completed successfully in all the 11 patients without any subsequent laparotomy and death. The mean operative time was 85 (78 to 137) min, blood loss was 15 (5 to 35) ml, and no upper digestive tract perforation occurred. The mean postoperative hospital stay was 7.0(6 to 9) d. After the operation, the pressure of lower esophageal sphincter decreased significantly compared to that before operation [(5.31±6.23) mmHg vs. (35.72±17.13) mmHg, P<0.05], and the Eckardt score decreased significantly as well (0.53±0.56 vs. 6.17±1.17, P<0.05). During the follow-up of 2 to 23 months, there was no postoperative mortality. One case experienced mild gastroesophageal reflux 6 months after operation, and another patient had recurrent dysphagia 17 months after operation, who both were improved after receiving proton pump inhibitors or gastric dynamic drugs, and balloon dilation.</p><p><b>CONCLUSION</b>Combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication is an effective and safe surgical procedure for cardiochalasia with minimal invasion and fast recovery.</p>