Comparison of laparoscopy-assisted distal gastrectomy with open gastrectomy for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, safety and short-term outcomes of laparoscopy-assisted distal gastrectomy for advanced gastric cancer.</p><p><b>METHODS</b>From January 2007 to June 2008, 135 patients with advanced gastric cancer in the lower or middle stomach were operated, of whom 66 underwent laparoscopy-assisted distal gastrectomy(LADG) with D2 dissection of lymph nodes and 69 received conventional open D2 distal gastrectomy(ODG). Clinical data were recorded and compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in age, gender, and TNM staging between LADG and ODG(all P>0.05). All the patients in the LADG group underwent gastrectomy and lymph nodes dissection successfully without conversion to open surgery and no operative deaths occurred. The operative time was significantly longer for the LADG group than for the ODG group[(266.1±55.1) min vs. (223.8±26.8) min)]. The patients in the laparoscopic surgery group had less blood loss[(131.9±88.7) ml vs.(342.3±178.7) ml], earlier recovery of bowel activity[(3.18±1.22) d vs.(4.50±1.59) d], and shorter hospitalization time[(9.20±3.39) d vs. (11.35±4.61) d]. No significant differences were found in the total number of retrieved lymph nodes(25.81±12.53 vs. 27.47±10.28). The morbidity of complications was comparable between two groups(6.1% vs. 15.94%). No mortality and recurrence were observed during a follow-up period of 1-19 months.</p><p><b>CONCLUSIONS</b>LADG with D2 lymph node dissection is a safe and feasible procedure with adequate lymphadenectomy for advanced gastric cancer.</p>

Celecoxib increased cellular ATRA sensitivity of human colon cancer cell lines through COX-2-independent mechanisms / 药学学报

Retinoid resistance has limited clinical activity of retinoids as differentiation-inducing and apoptosis-inducing drugs. The present study was designed to investigate whether celecoxib (selective COX-2 inhibitor) has effects on cellular retinoid sensitivity of human colon cancer cell lines and its possible mechanism. Cell viability was measured by MTT assay. Apoptosis was detected by Annexin-V/PI staining and flow cytometry assay. PGE2 production was measured by ELISA assay. Expression of RARbeta was assayed by Western blotting. The results showed that celecoxib enhanced the inhibitory effect of ATRA in both COX-2 high-expressing HT-29 and COX-2 low-expressing SW480 cell lines. Further study showed the ATRA and celecoxib combination induced greater apoptosis, and the addition of PGE2 did not affect the number of apoptotic cells induced by the combination. Moreover, NS398 (another selective COX-2 inhibitor) did not affect the inhibitory effects of ATRA on both cell lines. Western blotting showed that the expression of RARbeta in HT-29 cell lines increased in celecoxib group and combination group. And the addition of PGE2 did not affect the expression of RARbeta induced by celecoxib either. In conclusion, celecoxib increased expression of RARbeta and cellular ATRA sensitivity through COX-2-independent mechanisms, which may provide a potential strategy for combination therapy.

Reevaluation resection margin rectal cancer by flow cytometry and pathological examination / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the appropriate distal resection margin in rectal cancer patients.</p><p><b>METHODS</b>Thirty specimens of rectal carcinoma with total mesorectal excision(TME) were studied by flow cytometry and pathological examination. The differences of DNA ploidy status, DNA index (DI), proliferative index (PI), S-phase fraction (SPF) among rectal cancer, 3 cm and 5 cm below the tumor, normal rectum, distal mesorectum 3 cm and 5 cm below the tumor, and normal colon mesentery were analysed by flow cytometry, and were compared with the data of pathological examination.</p><p><b>RESULTS</b>Pathological examination showed that there was no tumor invasion 3 cm and 5 cm below the tumor,but the metastasis rates of distal mesorectum 3 cm and 5 cm below the tumor were 26.7% and 6.7% respectively. The DI, PI and SPF of rectal cancer by flow cytometric examination were significantly higher than those of distal rectum 3 cm and 5 cm below the tumor, and normal rectum (P<0.05). The DI, PI and SPF of distal rectum 3 cm below the tumor were also significantly higher than those of distal rectum 5 cm below the tumor, and normal rectum (P<0.05), but there were no significant differences between DI, PI and SPF of distal rectum 5 cm below the tumor and those of normal rectum (P>0.05). The rate of DNA aneuploid of tumor was significantly higher than those of normal rectum and distal rectum 5 cm below the tumor,but there was no significant difference between the rate of DNA aneuploid of tumor and that of distal rectum 3 cm below the tumor. The DI and DNA aneuploid of rectal cancer and distal mesorectum 3 cm and 5 cm below the tumor were significantly higher than those of normal mesorectum,but there were no significant differences between DI and DNA aneuploid of rectal cancer and those of distal mesorectum 3 cm and 5 cm below the tumor. The PI and SPF of rectal cancer were significantly higher than those of normal mesorectum and distal mesorectum 3 cm and 5 cm below the tumor.</p><p><b>CONCLUSIONS</b>Rectal cancer is able to invade distal rectum 3 cm below the tumor and distal mesorectum 5 cm below the tumor, and radical resection of rectal cancer should beyond that range.</p>

Comparative study on three types of digestive reconstruction after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy.</p><p><b>METHODS</b>Three types of digestive reconstruction were performed after total gastrectomy in 189 cases with gastric carcinoma. The operating time, morbidity and mortality, food intake, digestive tract symptoms, nutritional status at 1 and 3 years after surgery and 1-, 3-, 5-year cumulative survival were compared.</p><p><b>RESULTS</b>There were no significant differences among the three procedures in operative morbidity and mortality, postoperative food intake, nutritional status (Hemoglobin, total protein and labium), and incidences of diarrhea and dumping syndrome (P > 0.05). The overall 1-, 3-, 5-year survival rates were 75.3%, 38.2% and 20.5% respectively, and there were no significant differences among the three groups (P > 0.05). Orr-type and P-type esophagojejunostomy had an advantage of anti-esophageal reflux, and were obviously superior to Moynihan-type anastomosis (P< 0.01). Compared with P-type reconstruction, Orr-type reconstruction was simpler with shorter operating time, and less complications.</p><p><b>CONCLUSIONS</b>Orr-type Roux-en-Y esophagojejunostomy can be recommended as an adaptable method of digestive reconstruction after total gastrectomy for gastric cancer because of its avoiding reflux esophagitis, maintaining better nutritional status and quality of life, and simpler procedure.</p>