The 10-year outcome and prognostic factors of laparoscopic D 2 radical distal gastrectomy for locally advanced gastric cancer: a CLASS multicenter study / 中华消化外科杂志

Objective:To investigate the 10-year outcome and prognostic factors of laparo-scopic D 2 radical distal gastrectomy for locally advanced gastric cancer. Methods:The retrospec-tive cohort study was conducted. The clinicopathological data of 652 patients with locally advanced gastric cancer who were admitted to 16 hospitals from the multicenter database of laparoscopic gastric cancer surgery in the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group, including 214 cases in the First Affiliated Hospital of Army Medical University, 191 cases in Fujian Medical University Union Hospital, 52 cases in Nanfang Hospital of Southern Medical University, 49 cases in West China Hospital of Sichuan University, 43 cases in Xijing Hospital of Air Force Medical University, 25 cases in Jiangsu Province Hospital of Chinese Medicine, 14 cases in the First Medical Center of the Chinese PLA General Hospital, 12 cases in No.989 Hospital of PLA, 12 cases in the Third Affiliated Hospital of Sun Yat-Sen University, 10 cases in the First Affiliated Hospital of Nanchang University, 9 cases in the First People's Hospital of Foshan, 7 cases in Zhujiang Hospital of Southern Medical University, 7 cases in Fujian Medical University Cancer Hospital, 3 cases in Zhongshan Hospital of Fudan University, 2 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 2 cases in Peking University Cancer Hospital & Institute, from February 2004 to December 2010 were collected. There were 442 males and 210 females, aged (57±12)years. All patients underwent laparoscopic D 2 radical distal gastrectomy. Observation indicators: (1) surgical situations; (2) postoperative pathological examination; (3) postoperative recovery and complications; (4) follow-up; (5) prognostic factors analysis. Follow-up was conducted by outpatient examination and telephone interview to detect the tumor recurrence and metastasis, postoperative survival of patients up to March 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percen-tages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was analyzed using the rank sum test. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-Rank test was used for survival analysis. Univariate and multivariate analyses were analyzed using the COX hazard regression model. Results:(1) Surgical situations: among 652 patients, 617 cases underwent D 2 lymph node dissection and 35 cases underwent D 2+ lymph node dissection. There were 348 cases with Billroth Ⅱ anastomosis, 218 cases with Billroth Ⅰ anastomosis, 25 cases with Roux-en-Y anastomosis and 61 cases with other digestive tract reconstruction methods. Twelve patients had combined visceral resection. There were 569 patients with intraoperative blood transfusion and 83 cases without blood transfusion. The operation time of 652 patients was 187(155,240)minutes and volume of intraoperative blood loss was 100(50,150)mL. (2) Postoperative pathological examina-tion: the maximum diameter of tumor was (4.5±2.0)cm of 652 patients. The number of lymph node dissected of 652 patients was 26(19,35), in which the number of lymph node dissected was >15 of 570 cases and ≤15 of 82 cases. The number of metastatic lymph node was 4(1,9). The proximal tumor margin was (4.8±1.6)cm and the distal tumor margin was (4.5±1.5)cm. Among 652 patients, 255 cases were classified as Borrmann type Ⅰ-Ⅱ, 334 cases were classified as Borrmann type Ⅲ-Ⅳ, and 63 cases had missing Borrmann classification data. The degree of tumor differentiation was high or medium in 171 cases, low or undifferentiated in 430 cases, and the tumor differentiation data was missing in 51 cases. There were 123, 253 and 276 cases in pathological stage T2, T3 and T4a, respectively. There were 116, 131, 214 and 191 cases in pathological stage N0, N1, N2 and N3, respectively. There were 260 and 392 cases in pathological TNM stage Ⅱ and Ⅲ, respectively. (3) Postoperative recovery and complications: the time to postoperative first out-of-bed activities, time to postoperative first flatus, time to the initial liquid food intake, duration of postoperative hospital stay of 652 patients were 3(2,4)days, 4(3,5)days, 5(4,6)days, 10(9,13)days, respectively. Among 652 patients, 69 cases had postoperative complications. Clavien-Dindo grade Ⅰ-Ⅱ, grade Ⅲa, grade Ⅲb, and grade Ⅳa complications occurred in 60, 3, 5 and 1 cases, respectively (some patients could have multiple complications). The duodenal stump leakage was the most common surgical complication, with the incidence of 3.07%(20/652). Respiratory complication was the most common systemic complication, with the incidence of 2.91%(19/652). All the 69 patients were recovered and discharged successfully after treatment. (4) Follow-up: 652 patients were followed up for 110-193 months, with a median follow-up time of 124 months. There were 298 cases with postoperative recurrence and metastasis. Of the 255 patients with the time to postoperative recurrence and metastasis ≤5 years, there were 21 cases with distant metastasis, 69 cases with peritoneal metastasis, 37 cases with local recurrence, 52 cases with multiple recurrence and metastasis, 76 cases with recurrence and metastasis at other locations. The above indicators were 5, 9, 10, 4, 15 of the 43 patients with the time to postoperative recurrence and metastasis >5 years. There was no significant difference in the type of recurrence and metastasis between them ( χ2=5.52, P>0.05). Cases in pathological TNM stage Ⅱ and Ⅲ were 62 and 193 of the patients with the time to postoperative recurrence and metastasis ≤5 years, versus 23 and 20 of the patients with the time to postoperative recurrence and metastasis >5 years, showing a significant difference in pathological TNM staging between them ( χ2=15.36, P<0.05). Cases in pathological stage T2, T3, T4a were 42, 95, 118 of the patients with the time to postoperative recurrence and metastasis ≤5 years, versus 9, 21, 13 of the patients with the time to postoperative recurrence and metastasis >5 years, showing no significant difference in pathological T staging between them ( Z=-1.80, P>0.05). Further analysis showed no significant difference in cases in pathological stage T2 or T3 ( χ2=0.52, 2.08, P>0.05) but a significant difference in cases in pathological stage T4a between them ( χ2=3.84, P<0.05). Cases in pathological stage N0, N1, N2, N3 were 19, 44, 85, 107 of the patients with the time to postoperative recurrence and metastasis ≤5 years, versus 12, 5, 18, 8 of the patients with the time to postoperative recurrence and metastasis >5 years, showing a significant difference in pathological N staging between them ( Z=-3.34, P<0.05). Further analysis showed significant differences in cases in pathological stage N0 and N3 ( χ2=16.52, 8.47, P<0.05) but no significant difference in cases in pathological stage N1 or N2 ( χ2=0.85, 1.18, P>0.05). The median overall survival time was 81 months after surgery and 10-year overall survival rate was 46.1% of 652 patients. The 10-year overall survival rates of patients in TNM stage Ⅱ and Ⅲ were 59.6% and 37.5%, respectively, showing a significant difference between them ( χ2=35.29, P<0.05). In further analysis, the 10-year overall survival rates of patients in pathological TNM stage ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 65.6%, 55.8%, 46.9%, 37.1% and 24.0%, respectively, showing a significant difference between them ( χ2=55.06, P<0.05). The 10-year overall survival rates of patients in patholo-gical stage T2, T3 and T4a were 55.2%, 46.5% and 41.5%, respectively, showing a significant difference between them ( χ2=8.39, P<0.05). The 10-year overall survival rates of patients in patholo-gical stage N0, N1, N2 and N3 were 63.7%, 56.2%, 48.5% and 26.4%, respectively, showing a signifi-cant difference between them ( χ2=54.89, P<0.05). (5) Prognostic factors analysis: results of univariate analysis showed that age, maximum diameter of tumor, degree of tumor differentiation as low or undifferentiated, pathological TNM staging, pathological T staging, pathological stage N2 or N3, post-operative chemotherapy were related factors for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparoscopic D 2 radical distal gastrectomy ( hazard ratio=1.45, 1.64, 1.37, 2.05, 1.30, 1.68, 3.08, 0.56, 95% confidence interval as 1.15-1.84, 1.32-2.03, 1.05-1.77, 1.62-2.59, 1.05-1.61, 1.17-2.42, 2.15-4.41, 0.44-0.70, P<0.05). Results of multivariate analysis showed that maximum diameter of tumor >4 cm, low-differentiated or undifferentiated tumor, pathological TNM stage Ⅲ were independent risk factors for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparoscopic D 2 radical distal gastrectomy ( hazard ratio=1.48,1.44, 1.81, 95% confidence interval as 1.19-1.84, 1.11-1.88, 1.42-2.30, P<0.05) and postoperative chemotherapy was a independent protective factor for the 10-year overall survi-val rate of locally advanced gastric cancer patients undergoing laparoscopic D 2 radical distal gastrec-tomy ( hazard ratio=0.57, 95% confidence interval as 045-0.73, P<0.05). Conclusions:Laparoscopic assisted D 2 radical distal gastrectomy for locally advanced gastric cancer has satisfactory 10-year oncologic outcomes. A high proportion of patients in pathological TNM stage Ⅲ, pathological stage T4a, pathological stage N3 have the time to postoperative recurrence and metastasis ≤5 years, whereas a high proportion of patients in pathological TNM stage Ⅱ or pathological stage N0 have the time to postoperative recurrence and metastasis >5 years. Maximum diameter of tumor >4 cm, low-differentiated or undifferentiated tumor, pathological TNM stage Ⅲ are independent risk factors for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparos-copic D 2 radical distal gastrectomy. Postoperative chemotherapy is a independent protective factor for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparos-copic D 2 radical distal gastrectomy.

Surgical treatment research of gastric cancer / 国际外科学杂志

Gastric cancer is one of the most common malignant tumors, which seriously threatens people's life and health with high morbidity and mortality. Operation-centered comprehensive therapy is the most vital method for treating gastric cancer.With the development of surgical concepts, science and technology, as well as the development of a large number of high-standard clinical studies, the treatment of gastric cancer has made great progress, and the surgical method has gradually changed from open surgery to minimally invasive surgery.The research focus of early gastric cancer is to protect function and reduce trauma.Consensus has also been reached on the scope of lymph node dissection for locally advanced gastric cancer, and minimally invasive surgical methods have achieved certain results in terms of safety and effectiveness.For advanced gastric cancer with only one incurable factor, aggressive surgical treatment can also achieve good results.In recent years, high-definition laparoscopy, 3D laparoscopy, fluorescent laparoscopy, surgical robots and artificial intelligence have all promoted the development of gastric cancer diagnosis and treatment technology.This paper reviews the current surgical treatment of gastric cancer in order to better guide clinical treatment and benefit patients.

Effect of ergosterol peroxide derivatives on the proliferation ，migration and invasion of human triple negative breast cancer cell / 中国药房

OBJECT IVE To study the effects of ergosterol peroxide derivatives EP-3P on the proliferation ，migration and invasion of human tripe negative breast cancer cell MDA-MB- 231，and to provide reference for the development of breast cancer related drugs. METHODS MTT assay was adopted to detect the proliferation of MDA-MB- 231 cells after treated with 0（blank control），1.25，2.5，5，10，20，40 μmol/L EP-3P for 24，48 and 72 h. Wound healing assay and Transwell chamber method were adopted to detect the migration and invasion ability of MDA-MB- 231 cells after treated with 0（blank control ），5，10，20 EP-3P for 24 h. The apoptosis and cell cycle distribution were detected by flow cytometry. Western blot assay was used to detect the expressions of B-cell lympho ma-2（Bcl-2），Bcl-2 associated X protein （Bax），caspase-3，cleaved-caspase-3，cytochrome C （Cyt-C），matrix metalloproteinase- 2（MMP-2）and MMP- 9. RESULTS Compared with blank control group ，2.5，5，10，20，40 μmol/L EP-3P could significantly increase the inhibitory rate of cell proliferation （P＜0.05 or P＜0.01）in a dose and time- dependent manner. After 24 h treatment of EP- 3P（10，20 μmol/L），the rate of cell migration and the number of invasive cells were decreased significantly （P＜0.01），and cell was arrested at G 2/M stage （P＜0.05 or P＜0.01）；the apoptotic rate was increased significantly （P＜0.05）；the protein expressions of Bax ，Cyt-C and cleaved-caspase- 3 were upregulated significantly ， while those of Bcl- 2，caspase-3，MMP-2 and MMP- 9 were downregulated significantly （P＜0.01）. CONCLUSIONS EP-3P can inhibit the proliferation ，migration and invasion of human tripe negative breast cancer cells MDA-MB- 231 through mitochondrial mediated endogenous caspase pathway ，and induce the apoptosis of cells .

Preliminary clinical observation of neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer / 中华放射肿瘤学杂志

Objective:To evaluate the efficacy of preoperative neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer.Methods:Clinical data of 46 patients with low rectal tumors located within 6 cm from the edge of anal admitted to our hospital between February 2014 and December 2018 were retrospectively analyzed. SIB-IMRT technique was adopted for preoperative radiotherapy. Rectal tumors and positive lymph nodes were irradiated with a dose of 58.75 Gy in 25 fractions (2.35 Gy/fraction), and pelvic lymphatic drainage area was given with 50 Gy in 25 fractions (2.0 Gy/fraction). Oral administration of capecitabine was delivered for concurrent chemotherapy. Radical surgery for rectal cancer was performed at 6 to 12 weeks after the end of chemoradiotherapy. The overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), local recurrence-free survival (LRFS) and metastasis-free survival (MFS) were calculated by using Kaplan- Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox’s regression model. Results:After a median follow-up of 47 months, local recurrence occurred in 3 patients and distant metastasis in 6 patients. The ypCR rate was 26%(12/46), the sphincter-preservation rate was 74%(34/46), the R 0 resection rate was 100%(44/44), the overall tumor response TN down staging rate was 87%(40/46), and the postoperative complication rate was 13%(6/46). The 3-year OS, DFS, and PFS were 93%, 91% and 87%, respectively. In univariate analysis, ypN staging was an important factor affecting OS, DFS, PFS, LRFS and MFS (all P<0.05). In multivariate analysis, ypN staging was significantly correlated with DFS, PFS, LRFS and MFS (all P<0.05). Conclusions:Preoperative SIB-IMRT 58.75 Gy in 25 fractions combined with capecitabine chemotherapy is a safe and efficacious treatment for patients with low and locally advanced rectal cancer, which improves the ypCR rate and quality of life, and yields tolerable adverse reactions. Nevertheless, the long-term survival benefits remain to be validated.

Practice of TBL teaching in functional experiment teaching based on clinical practice ability / 中华医学教育探索杂志

To explore the application effect of team-based learning (TBL) model in functional experiment teaching. A clinical case related to the animal experiment was selected and distributed to students through Internet before class. Individual tests for students were conducted in class to assess their understanding for the case. Then group tests were carried out, which were completed by in-group discussion. Finally, the clinical case was analyzed within group. The teaching process possesses several characteristics and advantages in helping students retrieve literature, cultivate their spirit of cooperation, their ability of clinical practice and so on, but it also has some shortcomings and deficiencies. Therefore, this paper summarizes the advantages and disadvantages of TBL teaching in functional experiment teaching based on existing experience so as to promote a broader application of TBL in our medical education.

Clinical efficacy of preoperative SIB-IMRT for 26 cases of locally-advanced low rectal cancer / 中华放射肿瘤学杂志

Objective To evaluate the feasibility and clinical efficacy of preoperative simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with neoadjuvant chemotherapy of capecitabine in patients with locally-advanced low rectal cancer.Methods Between 2015 and 2016,26 patients admitted to 301 Hospital who were diagnosed with locally-advanced low rectal cancer,which was located within 5 cm from the anal verge,were enrolled in this investigation.Dose fractionation pattern was delivered:58.75 Gy in 25 fractions (2.35 Gy/fraction) for rectal cancer and lymph node metastasis and 50 Gy in 25 fractions for the pelvic lymphatic drainage area and simultaneously combined with capecitabine chemotherapy (825 mg/m2,bid d 1-5 weekly).One cycle of capecitabine (1 250 mg/m2,twice daily,d 1-14)was given at one week after the completion of chemoradiotherapy (CRT).Total mesorectal excision (TME)was performed at 6 to 8 weeks after the completion of CRT.The primary endpoints included pathological complete response rate (ypCR) and sphincter-preserving rate.The secondary endpoints included acute toxicity,tumor downstaging rate and postoperative complications.Results Twenty-six patients successfully completed neoadjuvant CRT,25 of them underwent surgical resection and one patient failed to receive surgery due to pxrianal edema.Postoperative ypCR rate was 32％ (8/25),the sphincter-preserving rate was 60％ (15/25),the tumor downstaging rate was 92％ (23/25) and the R0 resection rate was 100％.During the period of CRT,grade 1 and 2 adverse events occurred in 24 patients,grade 3 radiation dermatitis was noted in 2 cases.No ≥ grade 4 acute adverse event was observed.Postoperative complications included ureteral injury in one case and intestinal obstruction in one patient.Conclusions Preoperative SIB-IMRT combined with neoadjuvant chemotherapy of capecitabine is a feasible and safe treatment for patients with locallyadvanced low rectal cancer,which yields expected ypCR rate,R0 resection rate and sphincter-preserving rate.Nevertheless,the long-term clinical benefits remain to be elucidated.Clinical Trial Registry Chinese Clinical Trial Registry,registration number:ChiCTR-ONC-12002387.

Prevention of anastomotic leakage after robotic surgery for rectal cancer / 中华胃肠外科杂志

With popularity of robotic surgery system, robotic rectal cancer surgery is increasing. Precautionary measures of different perioperative periods should be taken to reduce the risk for anastomotic leakage. First, the general condition of patients should be acquainted and improved, and the risk for anastomotic leakage should be evaluated preoperatively. Preoperative neoadjuvant chemoradiotherapy may not increase the risk for anastomotic leakage after rectal surgery. The impact of routine bowel preparation to prevent anastomotic leakage needs to be verified further. Second, surgical techniques are crucial to prevent anastomotic leakage. Surgical procedures and resected intestines should be carefully selected. Careful surgery, adequate mobilization of the proximal colon, anastomosis with direct view will be required. Tension-free anastomosis and sufficient blood supply are necessary. We selected low ligation of the inferior mesenteric artery and preservation of the left colic artery in our routine practice to guarantee sufficient blood supply of the anastomosis site. Using the robotic Da Vinci system, indocyanine green (ICG) florescence can identify the collateral vessels in the inferior mesenteric artery zone. For patients with high risk for anastomotic leakage, pelvic drains, defunctioning stoma, and rectal tube may be useful to prevent anastomotic leakage. Early diagnosis and treatment are crucial for patients with anastomotic leakage.

Present situation and prospect of Da Vinci robotic surgical system in radical resection of colorectal cancer / 中华消化外科杂志

Radical resection is the main procedure to cure colorectal cancer.In recent years,with the development of minimally invasive technique,clinical application of Da Vinci robotic surgical system in radical resection of colorectal cancer was increasing rapidly.However,there still remains controversy about whether Da Vinci robotic surgery is superior to conventional laparoscopic surgery.In this review,authors will summarize results of clinical researches on Da Vinci robotic surgery application in colorectal cancer,investigate its advantages,disadvantages and future research direction.

Application of multidisciplinary treatment in patients with liver metastasis of colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the application of multidisciplinary treatment (MDT) in patients with liver metastasis of colorectal cancer(CLM).</p><p><b>METHODS</b>Clinical data of 118 patients with liver metastasis of colorectal cancer, including 32 patients with MDT (MDT group) and 86 patients without MDT (control group), from February 2014 to April 2015 in PLA General Hospital were analyzed retrospectively. Compliance of preoperative examination and adjuvant therapy, and efficacy-associated indexes were compared between the two groups.</p><p><b>RESULTS</b>(1) As compared to control group, statistically significant increase in imaging examination ratio was found in MDT group: chest CT [87.5%(28/32) vs. 40.7%(35/86), P=0.0000], abdominal MRI [84.4%(27/32) vs.61.6%(53/86), P=0.019], pelvic MRI [63.7%(7/11) vs. 24.3%(8/33), P=0.017]. The preoperative assessment of TNM staging was also higher in MDT group [100%(32/32) vs. 20.9%(18/86), P=0.0000], while there was no significant difference in accuracy rate of TNM staging between the two groups [81.3%(26/32) vs. 66.7%(12/18), P=0.2465]. (2) Rates of preoperative chemotherapy and chemotherapy completion were also higher in MDT group than those in control group [90.6%(29/32) vs. 62.8%(54/86), P=0.0033; 82.8% (24/29) vs. 57.4% (31/54), P=0.000], but conversion rate of unresectable CLM showed no significant difference [24.0% (6/25) vs. 14.3% (7/49), P=0.299 ]. (3) Rate of one-stage resection or ablation was higher in MDT group compared to control group [76.9%(10/13) vs. 36.0%(9/25), P=0.038], and resection rate of metastasis nidus was also higher in MDT group [77.0%(20/26) vs. 44.9%(13/29), P=0.015]. No significant differences were observed in rates of R0 resection, positive surgical margin, lymph node clearance, ablation of metastasis nidus, pathological complete response, postoperative chemotherapy or postoperative complications (all P>0.05).</p><p><b>CONCLUSION</b>MDT has the advantages on standardization of preoperative examination and perioperative chemotherapy, and can improve the rate of one-stage resection or ablation, as well as resection of metastasis nidus.</p>

Study of standardized training in shorten the learning curve of zero-based assistant of laparoscopic gastrointestinal surgery / 中华医学科研管理杂志

Objective Using the scientific thinking mode,applied the standardized training in zero-based assistant of laparoscopic gastrointestinal surgery,observe and explore the effect of shorten learning curve.Methods Took 40 students studied in our hospital from February 2013 to December 2014 as object of our study,who were randomly divided into Group Ⅰ and Group Ⅱ.Group Ⅰ was given standardized training,group Ⅱ was given regular training.After total 200 cases of laparoscopic assisted colectomy,5cases each doctor,we analyzed the two teams outcome of surgery cooperation.Results Compared with the control group,doctors from observation group were better in the surgery cooperation and the examination.Conclusions Standardized training is very meaningful for the zero-based assistant of laparoscopic gastrointestinal surgery.

Current status and novel approach of robotic surgery for rectal cancer / 中华胃肠外科杂志

With the development of minimally invasive surgery, laparoscopic technique is now widely used in rectal surgery because of its advantages in terms of pain control, recovery of bowel function, length of hospital stay, short- and long-term outcomes. Total mesorectal excision(TME) is recommended as the standard procedure for rectal cancer. Laparoscopic TME, however, can be challenging due to its two-dimensional vision, restricted instrument movements, and a prolonged learning curve. Robotic surgery overcomes these intrinsic limitations by superior three-dimensional magnified optics, stable retraction platform, and 7 degrees of freedom of instrument movements, and offers an easier operation and shorter learning curve. This review summarizes the advantages as well as the current status of robotic rectal surgery, and explores the novel approach and new techniques with the related literature and the author's own experience.

Predictive value of lymph node ratio for postoperative distant metastasis of stage III colorectal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the predictive value of metastatic lymph node ratio for postoperative distant metastasis in patients with colorectal cancer.</p><p><b>METHODS</b>The clinicopathological data were collected from 180 patients with colorectal cancer who underwent surgical resection in General Hospital of PLA between from January, 2007 to January, 2012. The patients were divided into 2 groups according to the presence of distant organ metastasis and the clinicopathological factors were analyzed with Chi-square test and logistic regression.</p><p><b>RESULTS</b>Of the 118 surgical patients enrolled, 118 were free of distant metastasis and 62 had distant metastasis involving the liver (39 cases), lungs (12 cases), and multiple organs (11 cases). The gross types, differentiation, ELN and LNR of the tumors differed significantly between the two groups. Logistic regression analysis showed that LNR was an independent factor correlating to distant metastasis of colorectal cancer.</p><p><b>CONCLUSION</b>LNR is independently correlated with distant organ metastasis of colorectal cancer and serves as an important predicative factor for estimating the prognosis of colorectal cancer.</p>

Preoperative platelet-lymphocyte ratio is an independent prognostic factor for resectable colorectal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the impact of preoperative platelet-lymphocyte ratio (PLR) on the prognosis in patients with operable colorectal cancer.</p><p><b>METHODS</b>The clinical data of 140 patients with operable colorectal cancer were analyzed retrospectively. According to preoperative PLR, the patients were divided into low PLR group (PLR<250) and high PLR group (PLR≥250). The overall 5-year survival rates and the clinicopathological factors in the two groups were analyzed using univariate analysis and COX regression model.</p><p><b>RESULTS</b>The patients with a high PLR had a significantly lower overall 5-year survival rate than those with a low PLR (71.4% vs 51.5%, P=0.045). Univariate analyses identified tumor location, the depth of tumor invasion, lymph nodes metastasis, TMN stage, and PLR as significant risk factors for reduced overall 5-year survival. In COX regression model, a high PLR was identified as an independent risk factor for poorer prognosis in patients with resectable colorectal cancer (RR: 2.213; 95%CI: 1.007-4.863, P=0.0048).</p><p><b>CONCLUSION</b>Preoperative PLR can be a clinically significant factor for assessment of prognosis of resectable colorectal cancer.</p>

Establishment of a nude mouse model of orthotopic engineered gastric tumor and its in vivo fluorescence imaging / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish a nude mouse model of orthotopic engineered gastric tumor for in vivo fluorescence imaging studies.</p><p><b>METHODS</b>An engineered gastric tumor was constructed in vitro using collagen as the scaffold and the human gastric cancer cell line BGC823-EGFP cells expressing enhanced green fluorescence protein (EGFP) as the seed cells. The engineered tumor was then implanted into the stomach of nude mice, and the tumor growth was observed with in vivo fluorescence imaging. The nude mice were sacrificed 6 weeks after the transplantation to assess the tumor growth and metastasis, and the tumor histology was evaluated.</p><p><b>RESULTS</b>The tumor cells in the engineered tumor model grew well in three-dimensional culture. The success rate of orthotopic gastric tumor implantation was 100% (10/10) in nude mice with metastasis in the abdominal organs. The isolated tumor mass, weighing 1.719∓0.349 g, showed a histological characteristic of poorly differentiated adenocarcinoma. In vivo fluorescence imaging detected EGFP-expressing tumors in the abdominal cavity of the nude mice, but not accurately.</p><p><b>CONCLUSION</b>The nude mouse model bearing orthotopic engineered gastric tumor provides a simple animal model for the study of gastric cancer, but a stronger fluorescence than green fluorescence is more desirable for more effective observation in in vivo fluorescence imaging.</p>

Effects of laparoscopic radical resection of mid-low rectal cancer on sexual and urinary functions of male patients / 中华消化外科杂志

Objective To evaluate the effects of laparoscopic radical resection of mid-low rectal cancer on sexual and urinary functions of male patients. Methods The clinical data of 150 patients with mid-low rectal cancer who were admitted to the PLA General Hospital from May 2006 to March 2009 were retrospectively analyzed. Sixty-eight patients were allocated to laparoscopic group and 82 to open group. The incidences of erectile and ejaculatory dysfunction and the short- and long-term urinary dysfunction of patients in the 2 groups were compared seperately at 6 and 12 months after the operation. All data were analyzed using the chi-square test. Results The incidences of erectile and ejaculation dysfunction at 6 months after operation, incidence of ejaculation dysfunction at 12 months after operation, and long-term urinary dysfunction were 15% (10/68), 16% (11/68), 10% (7/68) and 0 in the laparoscopic group, and 22% (18/82), 23% (19/82), 21% (17/82) and 2% (2/82) in the open group, respectively, no significant difference between the two groups was found (x2 = 1. 285, 1. 137, 3. 013, 1.681, P>0. 05). The incidences of erectile dysfunction at 12 months after operation and short-term urinary dysfunction were 7% (5/68) and 4% (3/68) in the laparoscopic group, and 17% (14/82) and 20% (16/82) in the open group, respectively, a significant difference between the two groups was observed (x = 4. 565, 5.930, P <0.05). Conclusion Laparoscopic radical resection of mid-low rectal cancer can reduce the injury of pelvic autonomic nerve and improve the life quality of patients.

Application of Da Vinci surgical system in the treatment of low rectal cancer / 中华消化外科杂志

The first few cases of colonic surgery using Da Vinci surgical system were reported in 2002;since then,Da Vinci surgical system has gradually been used in several centers for rectal cancer and with favorable outcomes.Laparoscopy has opened a new era in modern surgery,however,the inherent limitations of traditional laparoscopic surgery may cause certain difficulties during manipulation,especially in the demanding field of colonic laparoscopic surgery,which prolonged the learning curve.The advantages of Da Vinci surgical system include stable camera platform,three-dimensional imaging,excellent ergonomics,tremor elimination,ambidextrous capability,motion scaling,and instruments with multiple degrees of freedom.Low rectal region was regarded as the"forbidden zone"for laparoscopy,so we applied the Da Vinci surgical system in low anterior resection for rectal cancer.Because of mulyiquadrant operations in low anterior resection of rectal cancer,moving the robotic cart twice during the operation is necessary,which increased the operation time.In order to solve the problem,many surgeons use conventional laparoscopy for vessel ligation and flexure mobilization,and adopt the Da Vinci surgical system only in the lower quadrant of the abdomen.We present a technique that allows for the complete isolation of the mesorectum from the same position of the robotic cart,during the process,the enhanced dexterity and precise dissection offered by the Da Vinci surgical system were fully utilized.

Influence of gender differences on nuclear factor-kappa B activation in livers in septic rats / 中华急诊医学杂志

Objective To investigate the influence of gender differences on NF-kB activation in livers in septic rats. Methods Total 20 female and 20 male Wistar rats were randomly divided into four groups.Tissue samples of the livers were collected to measure NF-kB activation by EMSA.The level of plasma ALT,TNF-?and estrogen were measured also. Results NF-kB activation in normal male and female rats has no significant difference (P＞0.05).After stimulated by LPS,the level of NF-kB activation and ALT,TNF-?in plasma were markedly upregulated,and the index of female group lower than that in male group (P＜0.01).The level of NF-kB activation in livers and ALT,TNF-?in plasma both in male and female have significantly negative correlation with the level of estrogen in plasma (P＜0.05 ).Conclusion There are significantly gender differences on NF-kB activation in livers in septic rats.Estrogen may decrease the injury of livers in septic rats.

Laparoscopic repair of abdominal wall incisional hernia:A report of 41 cases / 中国微创外科杂志

Objective To investigate effects of laparoscopic repair of abdominal wall incisional hernia using polypropylene and expanded polytetrafluoroethylene(e-PTFE) composite mesh. Methods Forty-one patients with abdominal wall incisional hernia(4~25 cm in length and 3~18 cm in width) were treated in this hospital from October 2004 to August 2005. The patients received laparoscopic mesh herniorrhaphy after complete dissection of adhesion using an ultrasonic scalpel.A polypropylene and(e-PTFE) composite mesh(Bard Composite Mesh) was used and fixed using the Ethicon Endopath Multifeed Stapler(EMS).Results The laparoscopic mesh herniorrhaphy was successfully completed in all the 41 patients without conversions to open surgery.The operative time was 60~182 min(mean,85 min).Postoperatively,the patients felt slight pain and began to take food on the second day.The time to first passing flatus was 25~41 hours(mean,32 hours).The postoperative hospital stay was 5~7 days(mean,6 days).No recurrence occurred during a follow-up period of 6~16 months(mean,9 months) in the 41 patients. Conclusions The laparoscopic incisional hernia repair using the Bard Composite Mesh is a safe and effective method.

Influence of Genders on Activity of Nuclear Factor-Kappa B in Lungs in Endotoxemic Rats / 中国普外基础与临床杂志

0.05). Yet, the activity of NF-?B (female: 12.10?2.89; male: 19.53? 2.12) and the level of TNF-? female: (4.10?0.72) ng/ml; male: (6.37?1.29) ng/ml were significantly increased after injection of lipopolysaccharide (P

Laparoscopic resection of gastric stromal tumors:a report of 32 cases / 中国普通外科杂志

Objective To investigate the clinical value of laparoscopic resection of gastric stromal tumors.Methods Thirty-two cases received this new type of operation.The tumors ranged in size from 1.5 to 5.5cm with a mean diameter of 2.6 cm.The operative methods included the full laparoscopic resection of(gastric) tumor and the hand-assisted laparoscopic resection of gastric tumor.Results All cases were(successfully) resected and no complications were observed.The mean operative time was 75min.The mean(intraoperative) blood loss was 50ml.Postoperative pain was slight.Postoperative flatus and feces were passed at a mean of 34 hours,and average postoperational hospital stay was 7.5days.Postoperative pathologic(examination) confirmed that 25 cases were benign GIST and 7 cases were of low-grade malignancy.No(recurrences) were observed at follow up of 8 to 30 months.Conclusions Laparoscopic resection of gastric(stromal) tumor is a technically simple,safe and effective procedure that could be widely used.