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With the development of laparoscopic skills and instruments,totally laparoscopic gastrectomy for gastric cancer has become widely used in the clinic,mainly including totally laparoscopic proximal gastric reconstruction,distal gastrectomy for gastric cancer and total gastrectomy. Digestive tract reconstruction is the key procedure of totally laparoscopic gastrectomy for gastric cancer. Totally laparoscopic surgery has less trauma and better visualization than reconstruction in a small incision. At present,feasibility and safety of totally laparoscopic gastrectomy for gastric cancer have been preliminarily confirmed. However,higher level of evidence is needed for the evaluation of long-term oncologic efficacy. In the future,it is possible for patients to best benefit from totally laparoscopic surgery with minimal trauma,safe anastomosis under the principle of radical resection of gastric cancer. The digestive tract reconstruction includes Delta anastomosis (Billroth I),Billroth II anastomosis,and gastrojejunal Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy (TLDG). Billroth I with delta anastomosis has strict indications in TLDG. Gastrojejunal Roux-en-Y anastomosis is now more popular. Billroth II with Braun anastomosis and uncut Roux-en-Y anastomosis is technically easier to carry out in TLDG than Roux-en-Y. Totally laparoscopic proximal gastric reconstruction includes esophagogastric stump anastomosis,esophagogastric tubular anastomosis and interposition jejunostomy. The digestive tract reconstruction includes anastomosis using linear stapler and circular stapler in totally laparoscopic total gastrectomy (TLTG). In order to better serve the clinic,we review the progress of different endoscopic anastomotic techniques and digestive tract reconstruction.
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Humans , Anastomosis, Surgical , Methods , Gastrectomy , Methods , Laparoscopy , Stomach Neoplasms , General SurgeryABSTRACT
Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in staging of rectal cancer (RC).Methods From January 2015 to January 2017,the clinical data of 204 patients with RC and received EUS and surgery were retrospectively analyzed.Patients were divided into surgery alone group (155 cases) and preoperative neoadjuvant chemoradiation therapy (CRT) plus surgery group (49 cases).The preoperative staging by EUS and postoperative pathological staging of two groups were compared.Kappa test was performed for statistical analysis.Results Compared with postoperative pathologic diagnosis,the accuracy rate of EUS in the evaluation of invasion depth of RC in surgery alone group was 81.9％ (127/155),and the accuracy rates in the diagnosis of Tis,T1,T2,T3 and T4 were 3/4,11/13,82.1％(32/39),91.1％(41/45) and 74.1％(40/54),respectively,with a good consistency (kappa=0.751,P＜0.01).However,the accuracy rate of EUS in the invasion depth of RC in CRT plus surgery group was 34.7％ (17/49),and the accuracy rates in the diagnosis of T2,T3 and T4 were 1/13,2/7 and 14/16,respectively,with a poor consistency (kappa =0.107,P=0.850).Compared with postoperative pathologic diagnosis,the diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis in surgery alone group was 70.3％ (109/155),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 40.7％ (24/59) and 88.5％ (85/96),respectively,with a poor consistency (kappa=0.317,P＜0.01).The diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis of preoperative CRT plus surgery group was 51.0％ (25/49),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 5/11 and 52.6％ (20/38),respectively,with a poor consistency (kappa =0.014,P =0.911).Conclusions EUS can accurately evaluate the depth of tumor invasion and lymph node metastasis in preoperative staging of RC,which may be helpful for determining clinical treatment strategy.However,for patients received CRT treatment,EUS has a limited value in diagnosing and staging the tumor.
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Objective To explore the mechanical properties of the hybrid patch made of porcine acellular small intestinal submucosa (P-SIS) and polydioxanone (PDO) and its effect on repairing the abdominal wall defects of rats.Methods The PDOSIS patch and 8SIS patch were constructed by weaving and vacuum lamination and the mechanical properties were measured.In the both sides of abdomen of 36 healthy female SD rats,a partially defect (lcm × lcm) was created by surgery and repaired with a same area of PDO-SIS patch or 8SIS patch,each 12 rats were randomly sacrificed at 2,4 and 8 weeks after surgery,respectively,and tissue regeneration was evaluated.Results The bending length and tensile strength of the PDO-SIS patch were stronger than the 8SIS patch (P＜0.05) with the increase of diameter.No acute inflammation occurred at the repaired sites of the two groups,but a moderate chronic inflammation was observed 2 weeks after surgery,and the inflammatory response reduced gradually over time,no obvious chronic inflammation was found in the 8th week after surgery,with no statistical differences between the two groups (P＞0.05).Two patch materials were degraded gradually in the repaired area,and the regenerated collagen tissues were deposited continuously,but no significant differences existed between the two groups in the collagen content and collagen arrangement (P＞0.05).Conclusion The PDO-SIS patch has better mechanical properties than the 8SIS patch,and does not cause strong immune rejection when used to repair abdominal partially defect of SD rats.
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Objective To explore the feasibility and safety of laparoscopic resection for rectal stromal tumor.Methods Sixteen (10 male and 6 female) patients underwent laparascopic resection of rectal stromal tumor in our department from May 2013 to Dec.2016,and the tumor diameter of all patients was less than 5 cm.The patients with the distance of more than 5 cm from the lower margin of the tumor to the anal verge received laparoscopic anterior resection of the rectal carcinoma (Dixon),the patients with the distance of less than 5 cm and more than 3 cm received laparoscopic local resection,and the patients with the distance of less than 3 cm,whose tumor boundary with the surrounding tissue were unclear,received laparoscopic abdominal perineal resection (Miles).Results The rectal stromal tumors of 16 cases were successfully removed under laparoscope without conversion to laparotomy,and no post-operative complications such as perforation,bleeding,obstruction or anastomotic leakage occurred.Of 16 cases,12 underwent laparoscopic anterior resection of the rectal carcinoma (Dixon),3 underwent laparoscopie local resection,and 1 underwent laparoscopic perineal resection (Miles).The average operation time was (103.0±23.8) min,the average hospital stay was (7.0 ± 1.2) days,and the average volume of intra-operative bleeding was (14 ± 4.1) mL.The pathological findings were confirmed as stromal tumor with negative margin.There was no recurrence during the followup of 8 to 40 months.Two cases with the tumor transferring to the liver eventually died of liver metastasis.Conclusion Laparoscopic resection of rectal stromal tumors is safe and feasible,with less trauma,shorter hospitalization time and quicker post-operative recovery.
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Hepatocyte nuclear factor 4α is a transcription factor of the nuclear hormone receptor superfamily and plays a very important role in the differentiation and development of the digestive system as well as the polarity regulation,which is considered to be a tumor suppressor gene.It also plays a very important role in digestive tumorigenesis,invasion and metastasis of hepatic carcinoma,colon cancer and gastric cancer,which is closely associated with epithelial-to-mesenchymal transition,the regulation of cell proliferation and wnt signaling pathway.HNF4α expression and its regulation mechanism in the digestive system tumors are now the research focus.
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Objective To investigate the clinical significance of hepatocyte nuclear factor 4α(HNF4α)in rectal cancer and its relationship with prognosis.Methods Real-time PCR was designed to detect the expression of HNF4αon mRNA level and the immunohistochemistry was used to determine the expression of HNF4αon protein level in rectal cancer tissue.The relationship between HNF4αexpression and clinical characteristics was also analysed.The Kaplan-Meier method was used for univariate analysis and a Cox proportional hazards regression model was performed for multivariate analysis.Results HNF4αwas low expressed both on mRNA (t=6.092,P<0.001)and protein level (χ2 =15.230,P<0.001)in rectal cancer tissue.HNF4αexpression on protein level was related with the clinical stage (χ2 =48.311,P<0.001),depth of invasion (χ2 =23.911,P<0.001),histological differentiation (χ2 =20.787,P<0.001),lymph node metastasis (χ2 =39.064,P<0.001)and distant metastasis (χ2 =5.146,P=0.04),while age and gender were not relevant.The cumulative 3-year overall survival of patients with low HNF4αexpression (43.8%)was much worse than the patients with high HNF4αexpression (95 .5%),and the difference was statistically sig-nificant (P<0.001).Univariate analysis revealed that HNF4αexpression (χ2 =28.778,P<0.001),differ-entiation (χ2 =26.680,P<0.001 ),clinical stage (χ2 =32.702,P<0.001 ),depth of invasion (χ2 =6.226,P=0.013),lymph node invasion (χ2 =15.270,P<0.001)and distant metastasis (χ2 =21.817, P<0.001)were statistically significant worse predictors for rectal cancer,whereas age and gender were not rel-evant.The multivariate Cox proportional hazard analysis revealed that HNF4αlow expression (RR=6.084, P=0.028)was independent prognostic markers for 3-year overall survival in the patients with rectal cancer. Conclusion HNF4αwas closely related to the tumorigenesis and progression of rectal cancer,which is an independent prognostic marker for rectal cancer,and which may be an effective target for the therapy of rectal cancer.
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Pancreatic cancer is a malignant with very poor prognosis.Although methods and technologies of diagnosis and treatment in connection with pancreatic cancer have made great progresses,the prognoses of patients with pancreatic cancer still have not a significant upgrade,which are closely related with the degree of malignancy of pancreatic cancer cells.Earlier studies have shown that normal pancreatic cells need to have a total of six capabilities,which are intimate connection with the degree of malignancy of pancreatic cancer cells,during the process of deterioration.A variety of immunohistochemical markers that correlate with prognosis of pancreatic cancer involve in the process of pancreatic cells obtaining these six capabilities.
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Objective A considerable percentage of gallbladder cancers are accompanied by su-perficial cancer spread adjacent to the main tumor. Therefore, cholecystectomy for early gallbladder cancer must be performed carefully to avoid leaving cancer cells at the surgical margins. Methods Thirty-six patients with gallbladder cancer invading no more than perimuscular connective tissue un-derwent surgical resection at our medical center. After operation, the resected specimens were investi-gated macroscopically and microscopically to clarify the clinicopathological features and the risk factors of superficial cancer spread. Results Seventy percent of all cases (25 cases) had superficial cancer spread. Comparison between the cases having superficial cancer spread and the cases without it re-vealed that the macroscopic morphology of the primary tumor and the depth of cancer invasion in the gallbladder wall were significantly different between the two groups. Furthermore, multivariate analy-sis indicated that 'superficial raised type' in macroscopic morphology was an independent predictive factor for having superficial cancer spread. Superficial cancer spread from the main tumor located in the neck of the gallbladder grew predominantly in the direction of the fundus. More advanced gallbladder cases were accompanied by more extensive superficial spread. Conclusion Superficial cancer spread is frequently observed adjacent to the gallbladder cancer, especially in the superficial raised type. A negative margin should be confirmed by intraoperative frozen section while performing cholecystectomy.
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To investigate the effects of Baihe Recipe, a compound traditional Chinese herbal medicine, on growth and metastasis of orthotopically transplanted gastric carcinoma and the expressions of vascular endothelial growth factor (VEGF) and p53 proteins in the tumor tissues in nude mice.
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Background and purpose:Micro-environmental hypoxia is a common phenomenon in most human solid tumors,and this investigation is done to observe the expression of HIF-1? and chemo-resistance-associated genes in human colon cancer cell line under hypoxic micro-environment in vitro,and study the influence of micro-environmental hypoxia on chemo-resistance and the possible mechanisms in human colon cancer.Methods:Human colon cancer cell line SW620 was cultured under hypoxia for 12,24,48 hr,with normoxia as control.Then the expression of HIF-1? and chemo-resistance-associated genes mdr1/P-Gp、LRP were investigated by RT-PCR and western-blot.Results:With prolongation of the hypoxic time,the mRNA expressions of HIF-1? and LRP remained at the same level,but the mRNA expressions of mdr1 showed a time-dependent increase(P
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Objective: To study retrovirus (RV)-mediated transduction of gastric carcinoma cells with the herpes simplex virus thymidine kinase (HSV-tk) gene and the subsequent treatment with ganciclovir(GCV). Methods: The TK gene was transfected into human gastric carcinoma cell line MKN28 using HSV-TK that packed with PA317 cell, the sensitivity of MKN28TK cells to GCV was examined in vitro. Results: The retroviral-mediated HSV-TK gene can be transfected to MKN28 cells. The growth rate of MKN28 cells transfected with HSV-TK gene did not change. MKN28TK cells became significantly sensitive to GCV and had bystander effect. Conclusion: Transfection of gastric carcinoma with HSV-TK has higher transfection efficiency. MKN28TK cells are significantly sensitive to GCV.
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Objective To evaluate the impact of laparoscopic cholecystectomy(LC) on the prognosis of unsuspectedgallbladder cancer(GC).Methods A retrospective clinicopathologic study was performed on 21 patients with unsuapective GC,but diagnosed gallbladder cancer postoperatively by pathology.Of which,11patients underwent LC and 10 patients underwent open cholecystectomy(OC),The correlation was evaluatedbetween cumulative survival rates and the following 5 prognostic factors:histopathological grade,pathologic stage,occurrence of bile spillage,type of cholecystectomy(LC or OC),and additional surgical treatments.Results Eight patients(73%) after LC and 7 patients(70%) after OC had cancer recurrence,and the difference was of no statistical significance(P=0.86).There were no recurrences of cancer in the abdominal wall after either LC or OC.Survival rate was statistically correlated to tumor stage(P=0.006),and to the occurrence of bile spillage(P=0.003).Survival rate did not differ according to whether the operation was carried out using LC or OC(P=0.74).Conclusions LC does not worsen the prognosis of unsuspected gallbladder cancer.
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Objective To investigate the diagnostic and treatment methods of appendiceal mucoceles and peritoneal pseudomyxoma. Methods Thirteen cases of appendiceal mucoceles were enrolled in this study. Six cases underwent appendectomy, two cases ileocecal resection, two cases right colectomy, and two cases appendectomy in emergency followed by right colectomy because their postoperative pathological diagnosis was appendiceal muco-cystadenocarcinoma. Ruptured appendiceal mucocele and peritoneal pseudomyxoma were found during operation in one case, then right colectomy was performed, ascites was removed and abdominal cavity was washed with normal saline and 5-Fu solution. Systemic chemotherapy was given to this patient after operation. Results Operation was successful in all the patients. Except one case not followed up, the other patients remained free of disease after operation. Conclusion Appendiceal mucoceles is uncommon. The patients should be suspected suffering from this disease when chief complaints are right lower abdominal pain and mass. B-type ultrasonography and other necessary digestive image examinations are economical and inexpensive diagnostic method of appendiceal mucoceles. It is necessary to explore the whole abdominal cavity carefully when this disease is suspected during operation.
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Objective To investigate the cause and management of postsplenectomy fever in portal hypertensive patients . Methods The clinical data of 295 portal hypertension patients undergoing splenectomy from 1990 to 2003 were reviewed. Among these,80 patients suffered from a continuous fever higher than 38.5℃ for more than 2 weeks postoperatively. Results Except for two patients with unknown cause, 78 of 295 patients with continuous fever were caused by complications such as splenoportal thrombosis(35 cases), infection of hematocele or hydrops in splenic recess(20 cases), left subphrenic infection(7 cases), pneumonia and hydrothorax or empyema(5 cases), 3 cases each of postoperative abscess of tail of pancreas,winary tract infection and inteclion of surgical incision, 1 case of leakage of esophageal anastomosis and intraabdominal infection in 1 case. The lasting fever was related to the grade of liver function(P0.05). Conclusions Splenoportal thrombosis, and hematocele, hydrops or infection in the splenic recess were the main causes of persistent fever after splenectomy. Prevention and treatment of infection and amelioration of hepatic function will help to reduce the rate of postoperative continuous fever.
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To evaluate the efficacy and safety of an oxaliplatin, fluorouracil (5 FU), and folinic acid (FA) combination in treatment of patients with metastatic or advanced gastric cancer,we used oxaliplatin 130 mg/m 2 (2 hour intravenous infusion,1 d)and FA 200 mg/m 2 (2 hour intravenous infusion,1 to 5 d) followed by 5 FU 500 mg/m 2 (4 hour continuous infusion,1 to 5 d) every 3 weeks. Efficacy of treatment was evaluated after 3 cycles and the responders were confirmed 4 weeks later. In 26 case evaluated, patial release was achieved in 11 cases, stablized in 9 cases, progressed in 6 cases. The overall response rate was 42.3%. The main adverse effects were gastrointestinal tract toxicity, neurosensory toxicity and bone marrow suppression. This trail suggested that the short term curative effect of this regimen was similar to those of others and showed good efficacy and an acceptable safety profile. It is a new option for the treatment of metastatic and advanced gastric cancer.
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The effects of thy rotropin-releasing hormone (TRH) on survival time, hemodynamics, acid-base balance and subcellular structure of liver cells in canine severe hemorrhagic shock were studied. The results showed that: (1) TRH significantly elevated and maintained mean arterial pressure (MAP) of dogs during shock (MAP was 13.99 ? 0.62 kPa at 4 h after treatment vs 5.09? 105 kPa in control); (2) TRH significantly prolonged the survival time of dogs (alive/total = 4/5 vs 1/5); (3) TRH effectively maintained acid-base balance; and (4) TRH maintained the integrity of subcellular structure of the liver cells. These results suggest that TRH may reverse severe hemorrhagic shock.