Several Critical Issues of Low Rectal Cancer Surgery / 肿瘤防治研究

Colorectal cancer is one of the top three malignant tumors in the world. With the rapid development of medical technology and the strengthening of national awareness of cancer screening, rectal cancer has been diagnosed and treated timely. At present, the application of low rectal tumor preservation operation is becoming more and more common. Anastomotic leakage and anterior resection syndrome are the most common complications of low rectal cancer. How to preserve anal and reduce the incidence of complications has always been the concern of scholars at home and abroad. In order to improve the survival time and quality of life of patients with low rectal cancer, this paper expounds five key problems: fully preoperative evaluation of anorectal function and staging, reasonable neoadjuvant therapy, safe distal margin, the selection of surgical methods and the timing of preventive stoma.

Feasibility investigation of three cavity clearance in treatment of perianal abscess / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of three-cavity clearance (TCC) in the treatment of perianal abscess.</p><p><b>METHODS</b>A retrospective study of patients with perianal abscess in our center from July 2013 to March 2015 were carried out. Clinical data of 25 patients undergoing TCC (TCC group) were analyzed. At the same time, based on matched gender, age and location of abscess, 25 patients undergoing incision and drainage (incision group) and 25 undergoing cutting seton (seton group) were enrolled. Postoperative pain visual analogue scale (VAS) score (the first defecation,1 week later), rate of fistula formation, fecal incontinence(Wexner score) and wound healing were compared among groups.</p><p><b>RESULTS</b>One week after operation, VAS score in seton group was 6.5±1.3, which was significantly higher than 1.3±0.5 in TCC group and 1.2±0.4 in incision group(P<0.01), while there were no significant differences of VAS among groups at the first defecation(P>0.05). Time of wound healing was (45.8±19.9), (49.2±23.1) and (53.5±24.1) days in TCC, incision and seton group respectively, without significant difference(P>0.05). Rate of fistula formation was 48.0% (12/25) in incision group, which was significantly higher than 12.0% (3/25) in TCC group and 12.0%(3/25) in seton group (all P<0.01). There was no patient with faecal incontinence in TCC group and incision group, while 2 patients with fecal incontinence were found in seton group.</p><p><b>CONCLUSION</b>Three-cavity clearance is feasible in treatment of perianal abscess, and can decrease the rate of fistula formation, ameliorate postoperative pain and protect anal function.</p>

Application of a novel method to collect large amount of fecal mucosa in screening colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the application of a novel device of collecting large amount of fecal mucosa for detecting the DNA methylation and screening colorectal cancer.</p><p><b>METHODS</b>Preoperative complete fecal sample and surgical specimen of 10 patients with colorectal cancer, and complete fecal sample and normal bowel mucosal samples confirmed by colonoscopy of 6 hospitalization cases at The Third Affiliated Hospital, Nanjing University of TCM from March to April 2014 were collected. A self-made bowel mucosa collector (consisting of upper, middle, lower three containers of 1 000 ml volume, with filter screen in each bottom whose pore diameter is 100, 200 and 300 mesh.) was used to collect mucosal exfoliation cells. Fecal DNA kit was applied to extract DNA of exfoliation cells and the concentration and purity of DNA were measured by UV spectrophotometer (A260/A280), meanwhile DNA methylation of fecal fluid and mucosal tissues was detected by bisulfite sequencing pCR(BSP).</p><p><b>RESULTS</b>DNA methylation sequencing showed that FBN1, SPG20, and SNCA genes presented methylation in CpG island in fecal fluid and cancer tissues from 10 colorectal cancer patients, but did not presented methylation in fecal fluid and mucosa from 6 control cases. When fecal amount was below 100 g, collection rate of fecal fluid was 60% to 80%; when fecal amount was over 100 g, collection rate of fecal fluid was unstable. When fecal amount was 50 to 100 g, DNA A260/A280 value was 1.6 to 1.8, and DNA concentration was 5.0 to 56.1 ng/L.</p><p><b>CONCLUSION</b>Collection rate of fecal fluid with this self-made fecal mucosa collector is quite stable when managing fecal amount of 50 to 100 g once, and can obtain higher purity and concentration of DNA, meeting the demand of methylation detection for screening colorectal cancer.</p>

Screening and diagnostic value of the molecular markers of DNA methylation in colorectal neoplasma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To screen the molecular markers of DNA methylation with potential diagnostic value, and to explore their methylation features in Chinese colorectal neoplasma in order to find out ones with higher diagnostic value.</p><p><b>METHODS</b>Tissue samples of colorectal cancer and normal adjacent mucosa(>10 cm distance to tumors) from 10 colorectal cancer patients undergoing operation, and tissue samples of colorectal adenoma from 10 patients undergoing endoscopic resection in our center from June to August 2013 were collected respectively. Methylation status of 8 genes, such as SNCA, MAL, INA, SPG20, FBN1, CNRIP1, TFPI2, OSMR, was detected by BSP and qMSP to screen genes with potential diagnostic valua. ROC curve was drawn to analyze its diagnostic value.</p><p><b>RESULTS</b>BSP measurement showed that the rate of DNA methylation of SNCA, SPG20 and FBN1 was 100% in colorectal cancer and adenoma, while no methylation was found in normal adjacent mucosa. The other 5 genes expressed in different extent in cancer, adenoma and normal adjacent mucosa. Among 10 cancer tissues and normal adjacent mucosa detected by qMSP method, positive SNCA methylation was found in 5 cases and 1 case respectively; positive SPG20 in 8 cases and 1 case respectively; positive FBN1 in 7 cases and 0 cases respectively, whose differences were significant (P=0.070, P=0.003 and P=0.007). The area under curve(AUC) of SNCA, SPG20, and FBN1 methylation for diagnosing colorectal cancer was 0.890, 0.730 and 0.880 respectively.</p><p><b>CONCLUSION</b>SNCA, SPG20 and FBN1 are potential genes with screening value for colorectal neoplasma.</p>

Panel discussion on the fundamentals of laparoscopic surgery program / 中华消化外科杂志

Laparoscopic surgery develops fast in China in recent years,and it is widely applied in different fields in the digestive surgery and satisfactory results are achieved.However,uniformed training,technique standard and quality control standard are missing in the education of laparoscopic surgery in China.Fundamentals of laparoscopic surgery (FLS) program is developed by the Society of American Gastrointestinal and Endoscopic Surgeons in 2004.It is composed of congenital assessment and manual skills assessment.Twelve surgeons from China have taken FLS examination in April of 2014,and they introduced the content,features of FLS examination,some thoughts and inspirations on the training of laparoscopic surgery in China in this article.

Clinical features and therapy of fournier's gangrene / 中华消化外科杂志

Objective To investigate the clinical features and therapy of fournier's gangrene.Methods The clinical data of 12 patients with fournier's gangrene who were treated at the Third Affiliated Hospital of Nanjing University of Chinese Medicine from January 2010 to February 2012 were retrospectively analyzed.Eleven patients had perianal abscess and 1 patient had perianal foreign body,most of the patients were presented with perianal pain,fever (＞ 38.5 ℃) and tachycardia.The mean interval between the onset of symptoms and admission to the hospital was 8 days (range,3-20 dyas).Seven patients were complicated with diabetes.Only 2 patients were administered hypoglycemic agents,but the effects were poor.Six patients were complicated with hypertension.One patient had the history of resection of sigmoid colon cancer 2 months before operation.Debridement and drainage were applied to all the patients after examination.Antimicrobial therapy applied to all the patients according to the results of drug sensitivity test.The incisions were washed by hydrogen peroxide solution postoperatively.Redebridement was applied if the disease was progressed.All patients were followed up via out-patient examination and phone call till June 2012.Results Results of clinical features:Perianal tissues necrotized,with the color of black.The scrotum or labia majora of 8 patients were invaded by the necrotic tissues.Results of laboratory test:the white blood cell count was (3.8-27.6) × 109/L,the white blood cell count of 6 patients was above 10 × 109/L,3 was above 20 × 109/L.The ratio of neutrophil granulocytes was 0.61-0.93.Four patients received single debridement,5 received redebridement,and 3 patients received debridement for more than 2 times.Two patients had sapremia and infectious shock,and they received treatment for 3 days and 4 days at the intensive care unit.Results of bacterial culture:6 patients were infected by the escherichia coli,4 by klebsiella pnenmoniae,and 1 by pseudomonas aeruginosa.The mean duration of hospital stay was (25± 14)days (range,1-49 days).All patients were followed up for 4-29 months,1 patient was discharged at postoperative day 2,and the prognosis of the 11 patients was good,no mortality was observed.Conclusions The clinical features of fournier's gangrene include severe pain and rapid spread of infections caused by necrosis of perianal subcutaneous tissues.Diabetes might be the risk factor of fournier's gangrene.Early diagnosis and prompt and aggressive surgical debridement are critical for improving survival.

Tea polyphenol inhibits colorectal cancer with microsatellite instability by regulating the expressions of HES1, JAG1, MT2A and MAFA / 中西医结合学报

Objective: To investigate the mechanism of tea polyphenol in inhibiting microsatellite instability (MSI) of colorectal cancer. Methods: Using LoVo cells and SW480 cells treated with aqueous solution of tea polyphenol, cell proliferation was detected by methyl thiazolyl tetrazolium (MTT) method, changes in microsatellite sequences were detected by genescan method and changes in gene expression of LoVo cells were detected by illumina expression arrays and quantitative real-time polymerase chain reaction (PCR). Results: The proliferation inhibition rates of LoVo and SW480 cells treated with tea polyphenol increased with the increasing of drug concentration and showed an increasing tendency with time. The proliferation inhibition rate of LoVo cells with tea polyphenol was higher than that of SW480 cells, and there was a significant difference in the proliferation inhibition rates at 24 h, 72 h and one week. The microsatellite sequence of LoVo cells treated with tea polyphenol remained stable. The gene expression arrays and quantitative real-time PCR suggested that tea polyphenol inhibited the gene expressions of MT2A, MAFA, HES1 and JAG1 nearly two-fold over controls. It was also found that tea polyphenol inhibited the BAX and p38 genes with a more than two-fold difference but did not significantly inhibit the nuclear factor-κB pathway. Conclusion: Tea polyphenol significantly inhibited the proliferation of MSI colorectal cancer cells and stably maintained the microsatellite state in MSI colorectal cancer. Tea polyphenol inhibited the gene expressions of HES1, JAG1, MT2A and MAFA, up-regulated the gene expression of BAX and down-regulated that of P38. Further research is required to investigate how these pathways are interrelated.

Anticancer effects of tea polyphenols on colorectal cancer with microsatellite instability in nude mice / 中西医结合学报

To study the anticancer effects of tea polyphenols on colorectal cancer with microsatellite instability (MSI) in nude mice and to explore its mechanism.

Analysis the features of extracolonic cancer in hereditary nonpolyposis colorectal cancer spectam / 临床外科杂志

Objective Analysis the features of extracolonic cancer of HNPCC.Method 32 families with HNPCC were registered and followed up.Results Among 12 families with typical HNPCC,8 cases in 6 families and 1 case of nontypical HNPCC families developed extracolonic cancer. Endometrial and gastric cancers are the most common cancers.Conclusions The extracolonic cancers are the important part in the cancer spectum of HNPCC. Among Chinese families, endometrial and gastric cancers are more common.