Ultrasound-Guided Continuous Thoracic Paravertebral Block Improves Patient's Quality of Recovery After Open Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial / 中国医学科学杂志(英文版)

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesize that these effects may improve the quality of recovery (QoR) after open hepatectomy. Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine (CTPVB group) or normal saline (control group). All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was statistically analyzed using Student's t-test. Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study. Compared to the control group, the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores (133.14 ± 12.97 vs. 122.62 ± 14.89, P = 0.002) on postoperative day 7. Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (P < 0.05; P = 0.002), respectively, in the CTPVB group. Conclusion Perioperative CTPVB markably promotes patient's QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.

MGST1 overexpression promotes hepatocellular carcinoma development / 基础医学与临床

Objective To investigate the expression of microsomal glutathione S-transferase 1 ( MGST1) in hepa-tocellular carcinoma ( HCC) and its significance in the development of HCC. Methods Western blot was used to measure MGST1 expression in human hepatocellular carcinoma and adjacent tissues and HCC cell lines. Further-more, shRNA targeting MGST1 was constructed and transected into MHCC97H and HCCLM3 cells to deplete MGST1 expression. MGST1 was over-expressed in SK-Hep-1 cells using pCDH lentivirus system. Cell proliferation and migration were analyzed by colony formation and Transwell migration assay, respectively. The subcutaneous xenograft model of MHCC97H cells in nude mice was established to check tumor development and mouse survival.Results MGST1 was higher in 71% (17/24) of HCC tissues compared with their adjacent liver tissues. Cell proliferation and migration were significantly decreased by MGST1 knockdown, while they were increased by MGST1 overexpression. Furthermore, mice implanted with shMGST1 MHCC97H cells exhibited retarded tumor formation and tumor progression compared with control group. Conclusions MGST1 overexpression promotes hepatocellular carcinoma development and this molecule targeted for HCC treatment.

Regulatory Effects of Long Non-coding RNA on Tumorigenesis / 中国医学科学院学报

Long non-coding RNAs(LncRNA)may play a key role in tumorigenesis by regulating gene expression and intervening transcription. Recent studies have demonstrated that a series of patterns including protein modification,chromosomal reconstruction,regulation of target gene expression,transcription intervention,epigenetic modification,and natural antisense transcript are involved in this process. This article reviews recent research advances in this aspect with an attempt to better understand the role of LncRNA in tumorigenesis.

Potential Clinical Implications of Circulating Tumor Cells / 中国医学科学院学报

The circulating tumor cells (CTCs) are derived from primary or metastatic tumor lesions and can be detected in the peripheral blood. With certain specific features, CTCs can,to certain extent, reflect the progression and invasiveness of tumors. Detection of CTCs may provide a powerful and noninvasive approach for diagnosing neoplastic disease, identifying drug sensitivity, and enabling real-time treatment monitoring and prognosis prediction. Improvements in cell isolation and molecular identification will enable a broad range of clinical applications.

Clinical experiences of surgical manipulations for hepatic masses in difficult sites / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the surgical experiences, risks, complications, and managements for hepatic masses in difficult sites.</p><p><b>METHODS</b>Totally 47 patients were divided into three groups based on the liver tumor sites: primary porta hepatis group, secondary porta hepatis group, and caudate lobe group. All patients underwent different portion of hepatectomy.</p><p><b>RESULTS</b>The surgery duration was (289.6 +/- 62.2) ml-nutes, intra-operative blood loss was (602.3 +/- 256.4) ml, and intra-operative blood transfusion was (524.0 +/- 325.9) ml. Incidence of surgical complications in each group was 61.5%, 26.9%, and 25%, respectively. Serious complications observed were biliary leakage (27.7%), bleeding (6.4%), and post-operative liver failure (2.1%). Three perioperative deaths were reported: two patients died of bleeding, and one patient died from liver failure.</p><p><b>CONCLUSIONS</b>Dissection of the liver and exposure of major blood vessels and biliary ducts are of critical importance in the surgeries for hepatic masses in difficult sites, and post-operative complications may be remarkably reduced through delicate manipulations of the small intra-hepatic vessels and biliary ducts during resection. A thorough pre-operative evaluation plays a key role in predicting the feasibility and risks of the surgery. Damage to the major blood vessels adjacent to the tumor, in addition to bleeding, may result in in-flow or outflow obstruction and cause necrosis of the corresponding hepatic lobe. Compared with damage to the primary portal area, vascular damage to the secondary porta is generally associated with higher fatality.</p>

Application of technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection on liver imaging in mouse models with different hepatic injuries / 中国医学科学院学报

<p><b>OBJECTIVE</b>To identify the uptake and biological distribution of technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection (99mTc-GSA) in three mouse models with different degrees of hepatic injuries.</p><p><b>METHODS</b>Three mouse models including hepatic fibrosis, hepatic cholestasis, and liver cancer were established. Hepatic fibrosis model was established by intraperitoneal injection of carbon tetrachloride, 0.4 ml 10%, every 48 hours for 48 days. Hepatic cholestasis model was set up by ligature of the common bile duct for 72 hours, and liver cancer model by implantation of H22 tumor cells underneath liver capsule for 10 days. On measurement, each mouse in different models and normal controls was injected with 0.1 ml (0.37 MBq)99mTc-GSA (2 microg) into vena caudalis, and 5 minutes later sacrificed by decapitation. Important organs and tissues including liver, heart, lungs, kidney, spleen, stomach, blood, bones, muscles, and intestines were taken and their different radio countings were measured. The hepatic injuries were evaluated with serum and pathological examinations.</p><p><b>RESULTS</b>99mTc-GSA was concentrated in the liver in all three models and the control mice ( >40% ID x g(-1)). Compared with the control mice (90.05 +/- 10.55)% ID x g(-1), the density of 99mTc-GSA was significantly lower in the models with hepatic injuries (P < 0.001). The liver function test indicated that the injury in hepatic fibrosis model was less serious than those in the other two models. However, the concentration of 99mTc-GSA in hepatic fibrosis model [(72.20 +/- 2.13)% ID x g(-1)] was significantly higher than those in the models with cholestasis [(56.72 +/- 5.92)% ID x g(-1)] and liver cancer [(42.80 +/- 6.05)% ID x g(-1)] (P < 0.001).</p><p><b>CONCLUSIONS</b>99mTc-GSA may well concentrate in liver and its concentration degree is adversely correlated with hepatic injuries. Therefore 99mTc-GSA may be clinically used as liver imaging agent. When combined with three-dimensional scanning technique, it may facilitate constructing a new three-dimensional imaging method to demonstrate the function of designed liver segments.</p>

Preoperative evaluation of liver function using 99mTc-diethyl iminodiacetic acid based on single photon emission computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To establish a three-dimentional liver function evaluation system using 99mTc-diethyl iminodiacetic acid (99mTc-EHIDA) scintigraphy based on single photon emission computed tomography (SPECT).</p><p><b>METHODS</b>Totally 16 patients with liver lesions were divided into cirrhosis group and non-cirrhosis group. SPECT was performed 2 days before operation and 5 days after operation. Serum liver functions were examined on the same day of scintigraphy. SPECT images of areas of interest of heart and liver were aquired. Time of the peak of EHIDA density in liver (Tpeak), five-minutes heart liver index (HLI5), blood clearance index (HH15), receptor index (LHL15), and the predictive values were calculated.</p><p><b>RESULTS</b>Tpeak was not significantly different between two groups, while HLI5, HH15, and LHL15 were significantly different (P = 0.033, P = 0.001, and P = 0.005). HLI, and LHL15 were significantly correlated with preoperative total protein and prealbumin levels (P = 0.003, P = 0.015, P = 0.022, P = 0.038) and post-operative prealbumin (P = 0.037, P = 0.042). The predictive values of HLI5 and LHL15 correlated well with postoperative HLI5 and LHL15 (r = 0.675, P = 0.016; r = 0.629, P = 0.028).</p><p><b>CONCLUSION</b>The three-dimentional liver function evaluation system using 99mTc-EHIDA based on liver SPECT may facilitate the further studies of risks of liver surgery.</p>

Early recurrence after the resection of hepatocellular carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the precise time of the recurrence after resection of hepatocellular carcinoma (HCC) and to further explore the risk factors associated with postoperative recurrence.</p><p><b>METHODS</b>Totally 94 patients who had undergone resection of HCC were divided into three groups based on the time of recurrence, which was indicated by the digital subtraction angiography (DSA) examination: recurrence between 1 to 6 months, recurrence between 7 to 12 months, and tumor-free after 12 months. Patients with intra-hepatic recurrence were treated with transcatheter arterial chemoembolization and confirmed by CT scans after embolization, contrast-enhanced ultrasound, or magnetic resonance imaging.</p><p><b>RESULTS</b>The recurrence rates of 6 months and 1 year were 30.9% and 36.2%, respectively. No statistically significant difference between 6-month and 1-year recurrence rates was observed. Nine (26.5%) patients with recurrence and five (8.3%) patients free of tumor had previously presented as multifocal HCC, which showed a statistical significance (P = 0.032). The diagnostic accuracy of DSA was 87.2%, which was eventually confirmed by the other investigations.</p><p><b>CONCLUSIONS</b>Most recurrences occure within the first six months postoperatively and multifocal carcinogenesis is one of the risk factors associated with early recurrence after liver resection for advanced HCC. DSA is an important surveillance for early detection of intra-hepatic recurrence after surgery; meanwhile, it also provides information for early management to control the disease progression and for future active therapies.</p>

Autophagy in fibrotic and postoperative remnant liver in rat / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the characteristics of autophagy in fibrotic and postoperative remnant liver.</p><p><b>METHODS</b>Male Wistar rats were randomly divided into three groups: control group; fibrosis group, which received the solution of CCl4 in oil twice a week for 5 weeks; and hepatectomy group, which underwent 70% hepatectomy. Liver tissues and plasma were harvested 18 hours after the surgery. The rats' general conditions and plasma liver function were observed. Histopathological characteristics and regeneration were observed with microscope and transmission electron microscope. Qualitative analysis of autophagosome was made base on the data from transmission electron microscope.</p><p><b>RESULTS</b>Compared with the control group, plasma total protein and albumin level significantly decreased in the fibrosis group (P < 0.01). Proliferating cell nuclear antigen (PCNA) index was 85%-95% in the fibrosis group. Plasma alanine aminotransferase and aspartate aminotransferase levels significantly increased in the hepatectomy group compared with the control group (P < 0.01), while the autophagical index significantly decreased in both the fibrosis group and hepatectomy group compared with the control group (-95%, P < 0.01; -19%, P < 0.05, respectively). PCNA index was 20%-30% in the hepatectomy group.</p><p><b>CONCLUSIONS</b>Autophagy is weakened after fibrosis and hepatectomy, although it differs between these two processes. Proper regulation of autophagy may help facilitate the recovery of the residual liver function after hepatectomy.</p>

Expression of melanoma antigen-1, 3 genes in human intrahepatic cholangiocarcinoma and its clinical significance / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the possibility of using melanoma antigen (MAGE)-1 and MAGE-3 gene encoding proteins as an index of potential target for immunotherapy in intrahepatic cholangiocarcinoma (IHCC) patients.</p><p><b>METHODS</b>The expressions of MAGE-1 and MAGE-3 genes in tumor tissues and tumor adjacent non-IHCC liver tissues were examined by RT-PCR method. The relationship between positive expression rates of MAGE-1 and MAGE-3 genes and clinical data including sex, age, tumor diameters, tumor envelope, tumor nodules number, and hepatitis B virus surface antigen were determined.</p><p><b>RESULTS</b>The positive expression rates of MAGE-1 (35%) and MAGE-3 genes (45%) were significantly higher in the tumor tissues than in tumor adjacent tissues (0) (P<0.01). The positive expression rates of MAGE-1 and MAGE-3 genes had no relationship with the clinical data (P >0.05), except the morphology of tumor (P <0.05).</p><p><b>CONCLUSION</b>The high expression rates of MAGE-1 and MAGE-3 genes in IHCC suggests the MAGE-1 and MAGE-3 gene may be a target for immunotherapy in IHCC patients.</p>

Diagnosis and treatment of pancreatic metastasis from renal cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Pancreatic metastasis from renal cell carcinoma (RCC) is a rare event and has not been reported in our country. We report a series of 3 patients with metastatic RCC to the pancreas after radical nephrectomy at our institution. The published reports in the literature were reviewed, and the diagnosis, treatment as well as prognosis of this rare event were discussed.</p><p><b>METHODS</b>The data of 3 RCC patients with metastasis to the pancreas were reviewed retrospectively, including radical nephrectomy, metastatic interval, the second and third surgical removal. Survival of the three patients was analyzed and the reports in the literature were compared as well.</p><p><b>RESULTS</b>The average interval from radical nephrectectomy to the comfirmed pancreatic metastasis was 6.6 years (range, 1.2 to 12 years). The pathological stage revealed T2N0M0 (n = 2) or T3N0M0 (n = 1), with right-sided tumor in 2 patients and left side in 1. One patient was asymptomatic, while the other two cases were symptomatic at presentation, including upper abdominal pain, weight loss, slight xanthochromia of the skin and titillation, clay stool (n = 1); irregular fever, weight loss and jaundice (n = 1). All pancreatic metastases were hypervascular on arterial stage of CT imaging. One patient had only a solitary pancreatic metastasis (n = 1), the another showed two metastatic lesions (n = 1), the third one had multiple lesions (n = 1). Surgical removal was accomplished in 2 patients: including pylorus-preserving pancreaticoduodenectomy in one, and pylorus-preserving pancreaticoduodenectomy together with partial tail resection in another one. The third one only received interventional therapy due to widespread extrapancreatic metastasis, and died of disseminated disease 11 months after the therapy. One of the above two surgically treated patients underwent the second removal due to local recurrence 2.5 years after the first removal of pancreatic metastasis. These two patients were still alive after follow-up of 8.6 years and 16.1 years, respectively.</p><p><b>CONCLUSION</b>Renal cell carcinoma is an unpredictable tumor that may demonstrate very delayed metastasis even from early-stage of the disease. The pancreas is a rare site of metastasis from renal cell carcinoma. We advocate careful long-term follow-up of patients with a history of RCC. Aggressive surgical management of pancreatic metastatic lesions may provide a chance of long-term survival.</p>

Three-dimensional assessment of the remnant hepatic function following surgery using single photon emission computed tomography in an animal model / 中华外科杂志

<p><b>OBJECTIVE</b>The predictive value of postoperative hepatic function evaluated by liver functional imaging combined with single photon emission computed tomography (SPECT) technique was appraised in the present study.</p><p><b>METHODS</b>Twenty New Zealand white rabbits were divided randomly into two groups, including the Hepatic Fibrosis with Carcinoma Group (FC-Group, n = 10) and the Control Group (C-Group, n = 10). All the rabbits underwent the resection of outer-right lobe of the liver. The whole hepatic function indexes, such as HCI(5), HLI(5) and Ex(15), and the hepatic function remnant indexes, including HCI(5P), HLI(5P) and Ex(15P), were calculated by 99mTc-EHIDA liver imaging.</p><p><b>RESULTS</b>Ex(15) of FC-Group was lower than that of C-Group (P < 0.05). HCI(5) and HLI(5) of FC-Group had the trends to increase compared with the C-Group. Ex(15) was positively correlated with ALB, and negatively correlated with TBil and GGT (P < 0.05). HCI(5) had a positive correlation with CHE (P < 0.05), while HLI(5) had a negative correlation with A/G (P < 0.05). HLI(5P) had the negative correlation with postoperative A/G (P < 0.05), and Ex(15P) had the negative correlation with postoperative TBil and GGT (P < 0.05).</p><p><b>CONCLUSIONS</b>This study has established a method of 3-D liver function evaluation system on an animal model. Among the indexes, Ex(15) can exactly represent the whole liver function while Ex(15P) and HLI(5P) can predict the liver function after the liver resection. The results may help the future clinical use of this technique to evaluate the risk of operation.</p>

Identification and expression of non-coding RNAs NC28 and NC119 in human tumors / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore and identify the non-coding RNAs related to tumors.</p><p><b>METHODS</b>We used RT-PCR and Northern blot to analyze non-coding RNAs in tumor tissues and cell lines.</p><p><b>RESULTS</b>Two predicted non-coding RNAs were confirmed to be expressed in cancer tissues and cell lines by RT-PCR and DNA sequencing. We detected the expression of two non-coding RNA transcripts by Northern blot. The length of NC28 was about 1800 nt, and that of NC119 was about 1200nt.</p><p><b>CONCLUSIONS</b>NC28 and NC119 have a tumor-associated expression pattern. The non-coding RNAs may play a role in the development of tumors.</p>

Approaches of preoperative assessment of liver function in cirrhotic patient: current status and future prospects / 中国医学科学院学报

Risks persists during liver resection in the patients with cirrhosis. Routine examinations usually are unable to predict the morbidity and mortality following surgery. Evaluation approaches of liver function, including aminotransferase, bilirubin, albumin, prothrombin time, Child-Pugh classification, and indocyanine green (ICG) test, currently remain the most important method to determine the prognosis of liver resection, especially in cirrhotic patients. However, all these approaches have their weakness. Some new methods, including non-invasive ICG test, liver function evaluation by hepatic imaging, and remnant hepatic function test, are awaiting further investigation. This article reviews the current status and future prospect in the assessment of liver functions.

Diagnosis and treatment of primitive neuroectodermal tumors of pancreas / 中国医学科学院学报

<p><b>OBJECTIVE</b>To improve the diagnosis and treatment of primitive neuroectodermal tumors (PNET) of the pancreas.</p><p><b>METHODS</b>One patient with PNET of the pancreas was reported in this article. The corresponding literatures on the diagnosis and treatment was reviewed.</p><p><b>RESULTS</b>The patient was diagnosed as pancreatic PNET by her clinical, microscopic, and immunohistochemical features as well as cytogenetic analysis after the resection of the tumor located in the uncinate process in PUMC Hospital. Radiochemotherapy was given after the operation for 8 months and no recurrence was observed. Since PNET of pancreas have no specific clinical symptoms and most patients have jaundice and/or abdominal pain, the diagnosis depended on the immunohistochemical features of positive P30/32(MIC2) and at least two of the neural markers. The cytogenetic analysis showed translocation mainly harbored the characteristic t (11; 22) (q24; q12). Since pancreatic PNET were highly aggressive, early chemotherapy, close follow-up, and immediate surgical interventions were required as early as possible.</p><p><b>CONCLUSION</b>PNET can occur in pancreas, and diagnosis and treatment should be made as early as possible to improve the outcome.</p>

One-day bowel preparation with sodium phosphate prior to colorectal surgery: a prospective, randomized, controlled clinical trial / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the feasibility and safety of one-day bowel preparation for colorectal surgery.</p><p><b>METHODS</b>Forty patients undergone colorectal surgery were divided randomly into the Control group and the Experimental group and received 3-day magnesium sulfate and 1-day sodium phosphate bowel preparations before the operation, respectively. The levels of hemoglobin, hematocrit, serum electrolytes, and anaerobe counts in the stool prior and post bowel preparation were examined. The general status, surgical complications, and structure of intestinal mucosa in the patients were observed after the operation.</p><p><b>RESULTS</b>There was no significant difference in the anastomoses healing, infectious complications, serum tests and intestinal mucosa structures between the two groups. Less diarrhea occurred prior and post the surgery in the experimental group, and they felt better with the bowel preparation. The anaerobe counts in stool were higher after the bowel preparation than before in both groups.</p><p><b>CONCLUSIONS</b>One-day bowel preparation with sodium phosphate is a safe and reliable method for colorectal surgery. The shortening of preparation time can reduce the degrees of uncomfortable feeling and disruptions of intestinal micro-ecology and barrier.</p>

The first case of primary epithelial-myoepithelial carcinoma in the liver / 中华外科杂志

<p><b>OBJECTIVE</b>To report the first case of primary epithelial-myoepithelial carcinoma (EMC) in the liver.</p><p><b>METHODS</b>The clinical manifestations, imaging characteristics, and histopathological changes of EMC in this case were described. The patient was a thirty-seven-year old female. A 10 cm lesion was detected in the right liver upon a routine examination. Following that, the CT scan, magnetic resonance imaging (MRI), repeated puncture biopsies, and serum alpha-fetoprotein (AFP) detection were done with no specificity and significance found.</p><p><b>RESULTS</b>Right hemi-hepatectomy was performed. The special double catheterization cannula was found in the histopathological examination, and the final diagnosis of EMC was proven by immuno-histochemical staining.</p><p><b>CONCLUSIONS</b>Primary EMC is difficult to be finally diagnosed prior to the surgery. The diagnosis can be confirmed using pathological examination and immuno-histochemical staining of the specimen.</p>

Influence on the cytokines expression on hepatic tissue by inhibition the signal pathway of inflammatory mediators following extensive hepatectomy in rats / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of AG490, a cytokine signaling inhibitor, on cytokine signaling pathway with phosphorylation levels of Janus kinase 2 (Jak2) and singal transducers and activators of transcription 3 (Stat3), and liver pro-/anti-inflammatory cytokine expressions.</p><p><b>METHODS</b>Rats were divided into two groups after surgery: control group, without treatment; AG490 group, with AG490 (1 mg.kg(-1).12 h(-1)) administration intraperitoneally, immediately and through 36 hs after the operation. Western blotting was used to detect the levels of phosphorylated Jak2 and Stat3. Semi-quantitative RT-PCR was employed to examine Interleukin-6 (IL-6) and Interleukin-10 (IL-10) expression.</p><p><b>RESULTS</b>At 8 h and 12 h post-operatively, the phosphorylation levels of Jak2 and Stat3 were significantly inhibited in the AG490 group when compared with the control group. The DNA levels of IL-6 in the liver of the AG490 group rat at the same time points were also decreased, whereas IL-10 levels markedly increased. These changes made the ratio of IL-6/IL-10 dropped significantly.</p><p><b>CONCLUSIONS</b>AG490 ameliorates the overwhelming inflammatory response via a mechanism of blocking cytokine signaling transduction and consequently suppresses the ratio of pro-/anti-inflammatory cytokine expression, which exerts potential clinical implications of use of anti-inflammatory agents in hepatic surgery.</p>

Mechanisms of increased survival rate by administration of AG490 in rats following extensive liver resection / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the mechanism by which AG490 improves the survival rate of rats following extensive liver resection.</p><p><b>METHODS</b>Thirty-eight rats were randomly divided into two groups after surgery: control group (n=10), without treatment; (2) AG490 group (n=28), with AG490 (1 mg x kg(-1) x 12 h(-1)) administrated intraperitoneally immediately and 36 hours after the operation. The survival rate was observed and the serum liver functions were measured.</p><p><b>RESULTS</b>The survival rates of control group and AG490 group were 0% and 25%. AG490 group had significantly better blood glucose and aminotransferase levels (P < 0.05) than control group; serum bilirubin levels significantly decreased 48 hours after the operation. Serum protein levels in both two groups had slow decrease but without statistical significance (P > 0.05).</p><p><b>CONCLUSIONS</b>AG490 can significantly increase the survival rate of rats following extensive liver resection. Such a benefit mainly results from the protection towards residual liver function rather than from the promotion of liver regeneration.</p>

Bowel preparation before colorectal surgery: from intestinal mucosal barrier / 中国医学科学院学报

The routine bowel preparation before colorectal surgery usually includes mechanical and medicine preparations, with the original purpose of reducing complications such as anastomosis leakage, wound, and abdominal infections. Many domestic hospitals are still employing the methods of three-day bowel preparation, while in the West, the way of this preparation has dramatically changed. In last decade, one-day preparation has been widely accepted internationally, with two major medications of sodium phosphate and polyethylene glycol frequently used in the clinic. It has also been indicated that excessive mechanical and medicinal bowel preparations exert harmful effects on the combined intestinal barrier, and may result in various complications. A few reports have suggested to omit the mechanical bowel preparation before surgery, which is still under controversy, however, well-designed clinical trials are needed to readjust and regulate the duration and intensity of bowel preparation before colorectal surgery in China.