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Objective: To compare the effectiveness of total laparoscopic versus laparoscopic-assisted distal gastrectomy and investigate the safety and replicability of total laparoscopic distal gastrectomy in older patients. Methods: This was a retrospective cohort study. The inclusion criteria were as follows: (1) age ≥65 years; (2) malignant gastric tumor diagnosed pathologically preoperatively; (3) Eastern Cooperative Oncology Group performance status score 0-1; (4) Grade I-III American Society of Anesthesiologists physical status; (5) preoperative clinical tumor stage I-III; (6) total laparoscopic or laparoscopic-assisted distal gastrectomy performed; and (7) gastrointestinal tract reconstruction using uncut Roux-en-Y or Billroth-II+Braun procedure. Patients who had received neoadjuvant therapy, undergone conversion to open surgery, or had serious comorbidities or incomplete data were excluded. The clinical data of 129 patients who met the above criteria and had undergone laparoscopic surgery for gastric cancer from January 2012 to December 2021 in the Gastrointestinal Cancer Center in the Beijing Cancer Hospital were analyzed. According to the operation method, the patients were divided into total laparoscopic group and laparoscopic-assisted group. Variables studied comprised: (1) surgical procedure and postoperative recovery; (2) postoperative pathological findings; and (3) postoperative complications. Measurement data with skewed distribution are represented as mean(quartile 1, quartile 3). Comparisons between groups were evaluated using the Mann-Whitney U test. Results: After propensity score matching in a 1:1 ratio, there were 40 patients in the total laparoscopic distal gastrectomy group and 40 in the laparoscopic-assisted distal gastrectomy group. Baseline characteristics did not differ significantly between the two groups (all P>0.05).Compared with the laparoscopic-assisted group, the total laparoscopic group had shorter main incisions (4.1±1.0 cm vs. 8.5±2.8 cm, t=9.375, P<0.001), time to fluid intake [4.0 (3.0, 4.8) days vs. 5.0 (4.0, 6.0) days, Z=2.167, P=0.030], and duration of indwelling abdominal drainage catheter [6.0 (6.0, 7.0) days vs. 7.0 (6.0, 8.0) days, Z=2.323, P=0.020]. Numerical Rating Scale scores on postoperative days 1 and 2 were higher in the total laparoscopic than the laparoscopic-assisted group [2.5 (1.0, 3.0) vs. 1.5 (1.0, 2.0), Z=1.980, P=0.048; 2.0 (1.0, 3.0) vs. 1.0 (1.0, 2.0), Z=2.334, P=0.020, respectively]. However, there were no significant differences between the groups in operation time, intraoperative blood loss, white blood cell count, hemoglobin concentration, or albumin concentration on postoperative day 1, time to ambulation, mean time to bowel movement, postoperative admission to the intensive care unit, length of postoperative hospital stay, or Numerical Rating Scale scores on postoperative day 3 (all P>0.05). There were also no significant differences between the two groups in maximum tumor diameter, pathological tumor type, total number of lymph nodes dissected, or total number of positive lymph nodes (all P>0.05). The incidence of postoperative complications was 15.0% (6/40) in the total laparoscopic group and the laparoscopic-assisted group; these differences are not significant (χ2<0.001, P>0.999). Conclusions: Compared with laparoscopic-assisted radical gastrectomy for distal gastric cancer, total laparoscopic surgery has the advantages of shorter incision, shorter time to fluid intake, and shorter duration of indwelling abdominal drainage catheter in older patients (age ≥65 years). Total laparoscopic radical gastrectomy for distal gastric cancer does not increase the risk of postoperative complications and could therefore be performed more frequently.
Subject(s)
Aged , Humans , Gastrectomy/methods , Laparoscopy/methods , Postoperative Complications , Retrospective Studies , Stomach Neoplasms/pathology , Surgical Wound , Treatment OutcomeABSTRACT
AIM:To investigate the effects of integrin-linked kinase (ILK) overexpression on survival and proliferation of cardiac c-Kit + cells,and the role of ILK-overexpressing c-Kit + cell transplantation in cardiac function in a rat myocardial infarction (MI) model.METHODS:Cardiac c-Kit + cells were isolated from the hearts of neonatal Sprague-Dawley (SD) rats and cultured to prepare the ILK-c-Kit+ cells by infected with recombinant adenoviral vector harboring human wild-type ILK cDNA.The survival and proliferation of cardiac c-Kit + cells were detected by cell counting and CCK-8 assay at 48 h after infection,respectively.The protein levels of cyclin D1 and proliferating cell nuclear antigen (PCNA) in the cardiac c-Kit+ cells were examined by Western blot.MI was induced by coronary artery ligation in 40 adult rats.After 15 min,ILK-c-Kit + cells were transplanted into the hearts by myocardial injection at 3 different sites in the infracted zone and border zone.All rats were randomly divided into 4 groups:sham group,MI plus saline injection group (MI group),MI plus null vector-infected cardiac c-Kit+ cell injection group (Ad-null-c-Kit+ cell group),and MI plus ILK-overexpressing cardiac c-Kit + cells injection group (ILK-c-Kit+ cell group),with 10 rats in each group.At 2 weeks after MI,the protein levels of c-Kit in MI hearts were investigated by immunohistochemical assay.At 4 weeks,left ventricular function was examined by hemodynamic measurement.RESULTS:The survival and proliferation of cardiac c-Kit + cells and the protein levels of cyclin D1 and PCNA were enhanced by ILK overexpression compared with Ad-null group.In MI rat model,the number of c-Kit + cells was increased by ILK-c-Kit + cell injection compared with Ad-null-c-Kit + cell group at 2 weeks after MI.Cardiac function was significantly improved in ILK-c-Kit + cell-transplanted rats.CONCLUSION:ILK overexpression improves survival and proliferation of cardiac c-Kit + cells by increasing the protein levels of cyclin D1 and PCNA.ILK-c-Kit + cell transplantation enhances the therapeutic efficiency of cardiac c-Kit + cells in the postMI hearts of rats.
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AIM:To investigate the effects of integrin-linked kinase (ILK) overexpression on survival and proliferation of cardiac c-Kit + cells,and the role of ILK-overexpressing c-Kit + cell transplantation in cardiac function in a rat myocardial infarction (MI) model.METHODS:Cardiac c-Kit + cells were isolated from the hearts of neonatal Sprague-Dawley (SD) rats and cultured to prepare the ILK-c-Kit+ cells by infected with recombinant adenoviral vector harboring human wild-type ILK cDNA.The survival and proliferation of cardiac c-Kit + cells were detected by cell counting and CCK-8 assay at 48 h after infection,respectively.The protein levels of cyclin D1 and proliferating cell nuclear antigen (PCNA) in the cardiac c-Kit+ cells were examined by Western blot.MI was induced by coronary artery ligation in 40 adult rats.After 15 min,ILK-c-Kit + cells were transplanted into the hearts by myocardial injection at 3 different sites in the infracted zone and border zone.All rats were randomly divided into 4 groups:sham group,MI plus saline injection group (MI group),MI plus null vector-infected cardiac c-Kit+ cell injection group (Ad-null-c-Kit+ cell group),and MI plus ILK-overexpressing cardiac c-Kit + cells injection group (ILK-c-Kit+ cell group),with 10 rats in each group.At 2 weeks after MI,the protein levels of c-Kit in MI hearts were investigated by immunohistochemical assay.At 4 weeks,left ventricular function was examined by hemodynamic measurement.RESULTS:The survival and proliferation of cardiac c-Kit + cells and the protein levels of cyclin D1 and PCNA were enhanced by ILK overexpression compared with Ad-null group.In MI rat model,the number of c-Kit + cells was increased by ILK-c-Kit + cell injection compared with Ad-null-c-Kit + cell group at 2 weeks after MI.Cardiac function was significantly improved in ILK-c-Kit + cell-transplanted rats.CONCLUSION:ILK overexpression improves survival and proliferation of cardiac c-Kit + cells by increasing the protein levels of cyclin D1 and PCNA.ILK-c-Kit + cell transplantation enhances the therapeutic efficiency of cardiac c-Kit + cells in the postMI hearts of rats.
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<p><b>OBJECTIVE</b>To explore the expression of CCAAT/enhancer binding protein beta (CEBPB) in gastric carcinoma tissues and its association with clinicopathological features and prognosis.</p><p><b>METHODS</b>CEBPB protein expression level was detected by immunohistochemistry method in resected gastric carcinomas and adjacent gastric mucosa tissues (n=81), and its association with clinicopathological features and prognosis was analyzed.</p><p><b>RESULTS</b>The immunohistochemical staining of CEBPB was predominantly in the nucleus with some cytoplasmic staining. As a result, 16% (13/81) of the gastric carcinomas were stained positively, whereas there was hardly positive expression in adjacent gastric mucosa tissues. There was a significant association between the expression of CEBPB and distant metastasis on univariate analysis (P<0.05). The median survival time in patients with positive CEBPB expression was significantly lower than those with negative CEBPB expression (19.4 months vs. 45.2 months, P=0.024). Multivariable analysis showed that CEBPB was independently associated with prognosis (HR=2.544, 95%CI:1.154-5.610, P=0.021).</p><p><b>CONCLUSION</b>Up-regulation of CEBPB suggests poor prognosis in patients with gastric cancer.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , CCAAT-Enhancer-Binding Protein-beta , Metabolism , Gastric Mucosa , Metabolism , Pathology , Prognosis , Stomach Neoplasms , Metabolism , PathologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical value of tumor markers CEA, CA19-9, CA72-4 and CA242 in the diagnosis and prognosis of patients with gastric cancer.</p><p><b>METHODS</b>One hundred and sixty gastric cancer patients who had received treatment from 2002 to 2007 at the Beijing Cancer Hospital were retrospectively analyzed. Blood samples were taken from patients upon admission to the hospital, and CEA, CA19-9, CA72-4, CA242 levels were detected. Statistical analysis was performed to identify the clinical value of these tumor markers in diagnosis and prognosis.</p><p><b>RESULTS</b>On initial diagnosis, the positive rates of CEA, CA19-9, CA72-4 and CA242 were 37.7%, 26.7%, 37.6% and 21.3%, respectively, and the positive rate of combined detection was 62.9%. CEA was more frequently positive in patients with lymph node metastasis (P=0.029); CA72-4 was more frequently positive in patients with vascular involvement and advanced stage (P=0.039, P=0.011). Multivaraite analysis showed that CA72-4 was an independent prognostic factor (P=0.012). Patients with positive CA72-4 carried a 2.147-fold increased risk of death than those with negative CA72-4. Kaplan-Meier analysis showed that patients with positive CA19-9 or positive CA72-4 had worse survival than those with negative CA19-9 or CA72-4 (P=0.006, P=0.002).</p><p><b>CONCLUSIONS</b>Tumor markers including CEA, CA19-9, CA72-4 and CA242 have clinical significance and prognostic value in patients with gastric cancer. Combined detection of four tumor markers can increase the positive rate. CA72-4 is an independent prognostic factor. CA19-9 and CA72-4 are associated with the prognosis of patients with gastric cancer.</p>