Long-term outcomes of laparoscopic versus open distal gastrectomy for patients with advanced gastric cancer in North China: a multicenter randomized controlled trial.

BACKGROUND: Laparoscopic distal gastrectomy (LDG) has become a common procedure for treating advanced gastric cancer (AGC) in China. However, there is uncertainty regarding its oncological outcomes compared to open distal gastrectomy (ODG). This study aims to compare the 3-year disease-free survival (DFS) rates among patients who underwent surgery for AGC in northern China. METHODS: A multicenter, non-inferiority, open-label, parallel, randomized clinical trial was conducted to evaluate patients with AGC who were eligible for distal gastrectomy at five tertiary hospitals in North China. In this trial, patients were randomly assigned preoperatively to receive either LDG or ODG in a 1:1 allocation ratio. The primary endpoint was postoperative morbidity and mortality within 30 days and the secondary endpoint was the 3-year DFS rate. This trial has been registered at ClinicalTrials.gov (Identifier: NCT02464215). RESULTS: A total of 446 patients were randomly allocated to LDG (n = 223) or ODG group (n = 223) between March 2014 and August 2017. After screening, a total of 214 patients underwent the open surgical approach, while 216 patients underwent laparoscopic surgery. The 3-year DFS rate was 85.9% for the LDG group and 84.72% for the ODG group, with no significant statistical difference (Hazard ratio 1.12; 95% CI 0.68-1.84, P = 0.65). Body mass index (BMI) < 25 kg/m2, advanced pathologic T4, and pathologic N2-3 category were confirmed as independent risk factors for DFS in the Cox regression. CONCLUSIONS: In comparison to ODG, LDG with D2 lymphadenectomy yielded similar outcomes in terms of 3-year DFS rates among patients diagnosed with AGC.

Sigmoido-vesical fistula secondary to sigmoid colon cancer presenting as urinary tract infection with Lactococcus lactis: A case report.

A colovesical fistula is a pathological communication between the colon and bladder. The symptoms include pneumaturia, fecaluria, and a lower urinary tract infection. The diagnosis is based on clinical symptoms, but the symptoms are not specific. Therefore, confirming the diagnosis is challenging. Urine cultures performed in patients with colovesical fistulas usually show growth of Escherichia coli or mixed growth of bowel organisms. Urinary tract infections caused by Lactococcus lactis are very rare, as it is rarely considered pathogenic in humans. We report the case of a 70-year-old woman who presented with symptoms of a recurrent urinary tract infection. Urine cultures were positive for L. lactis. Abdominopelvic computed tomography (CT) revealed focal thickening of the bladder wall and gas in the bladder. Cystoscopic examination and colonoscopy revealed sigmoid colon cancer and a sigmoido-vesical fistula. Laparoscopic surgical treatment was done. The patient recovered and was discharged 3 weeks later without chemoradiotherapy. On follow-up after 6 months, the patient was asymptomatic and stable. To our knowledge, this is the second reported case of L. lactis infection of the urinary tract and the first reported case in adults. L. lactis infection usually indicates the presence of serious underlying diseases such as malignancies, uncontrolled diabetes, and organ failure.

DcR3 induces proliferation, migration, invasion, and EMT in gastric cancer cells via the PI3K/AKT/GSK-3ß/ß-catenin signaling pathway.

BACKGROUND: Decoy receptor 3 (DcR3) has been reported to be overexpressed in a wide variety of malignancies and is correlated with tumorigenesis and progression. In gastric cancer (GC), DcR3 overexpression is associated with lymph node and distant metastasis, as well as poor prognosis. However, the functional role of DcR3 expression in GC remains elusive. PURPOSE: The aim of this study is to elucidate the direct role of DcR3 in regulating GC progression and metastasis and identify the potential mechanism. METHODS: DcR3 expression was stably knocked down in HGC27 and MKN28 cells by transfecting the cells with DcR3 shRNA using lentiviral vector system. After the knockdown of DcR3 was confirmed, cell proliferation, colony formation, cell cycle distribution, apoptosis, cell invasion and migration were assessed in vitro. In addition, Western blot analysis was performed to evaluate the expression of downstream mediators of DcR3. Comparisons between multiple groups were performed using one-way analysis of variance (ANOVA) or unpaired Student's t-test. Differences were considered significant at P<0.05. RESULTS: Our findings demonstrate that DcR3 induces proliferation, migration, invasion, and promotes epithelial-mesenchymal transition (EMT) of GC cells. In addition, DcR3 increases the expression levels of several components of the PI3K/AKT/GSK-3ß/ß-catenin signaling pathway, such as p-AKT, GSK-3ß, p-GSK-3ß and ß-catenin. Additionally, DcR3 also enhances the expression of N-cadherin and Vimentin and decreases the expression of E-cadherin. CONCLUSION: In summary, the findings of this study indicate that during GC progression, DcR3 plays a key role in cell proliferation and invasion via the PI3K/AKT/GSK-3ß/ß-catenin signaling pathway. Thus, targeting DcR3 might be a potential therapeutic approach for the treatment of GC.

[Investigation of diagnostic method and treatment on acute appendicitis with acute intestinal obstruction as presenting manifestation].

OBJECTIVE: Prevention of the misdiagnosis of acute appendicitis when it first manifested as acute intestinal obstruction, and to search proper way of diagnosis and treatment for such event to provide the reference. METHODS: Clinical data of 33 acute appendicitis cases presented with acute intestinal obstruction in Beijing Tong Ren Hospital during January 2000 and December 2015 were analyzed retrospectively. RESULTS: All 33 patients were admitted to the Emergency Department with symptoms of various degrees abdominal pain and abdominal distension. There was no passage of gas and feces. The mean time of onset was (62.2±25.0) hours. The imaging examination showedthat all patients had complete bowel obstruction. Twenty one patients(63.6%) had peritonitis, three of whom developed with septic shock. Abdominal CT was performed in 17 patients preoperatively, which showed retention of gas and fluid in the small intestine in all the patients and 13 were suggestive of acute appendicitis. All of these patients received surgical treatment, 12 patients underwent laparoscopic exploration, and the remaining 21 patients received exploratory laparotomy during which acute appendicitis was confirmed to be the cause of intestinal obstruction, of whom 14(42.4%) was identified as mechanical intestinal obstruction. Nine patients underwent appendectomy and lysis of adhesion, five appendectomy and partial excision of the greateromentum. Nineteenpatients(57.6%) were identified as paralytic ileus and underwent appendectomy only. Twelve patients required respiratory and circulatory support and were admitted to ICU postoperatively. The mean duration time in ICU was(8.8±5.2) days. Postoperative pathology showedgangrene accompanied with perforation in the appendix. All patients were discharged without any complication. The length of hospital stay was (15.4±4.6) days. All patients were followed up for 3 ~ 12 months. One patient with chronic obstructive pulmonary disease developed repeated pulmonary infection and died of respiratory failure at 185 days postoperatively. The remaining patients were followed up and there were no patients developed intra-abdominalsepsis, intestinal obstruction, surgery-related complications, or death. CONCLUSION: Patients with acute appendicitis presenting with acute intestinal obstruction are mostly in severe condition. Clinical diagnosis for this patients is difficult and surgery should be performed as soon as possible.

[Role of the small intestinal decompression tube and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction].

OBJECTIVE: To evaluate the role of the small intestinal decompression tube (SIDT) and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction (EPISBO). METHODS: Twelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastric tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy. RESULTS: In 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction. CONCLUSION: For severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.

[Clinical application of magnifying colonoscopy in diagnosis and treatment of colorectal benign neoplastic lesions].

OBJECTIVE: To evaluate the clinical value of magnifying endoscopy in diagnosis and treatment of colorectal benign neoplastic lesions. METHODS: Seventy-eight colorectal lesions in 61 patients were examined with magnifying colonoscopy after indigo carmine dyeingìand pit pattern diagnosis was made for every lesion according to Kudos classification to differentiate neoplastic lesions from non-neoplastic lesions. The lesions were resected by endoscopic polypectomy and mucosectomy or surgical treatment. The diagnoses made by magnifying colonoscopy were compared with pathologic results. RESULTS: The diagnostic sensitivity of magnifying endoscopy for neoplastic lesions was 98.4% and specificity was 85.7%. The overall accuracy for adenoma and early colorectal cancer was 96.2%. 89.7% of adenomatous lesions were treated by endoscopic resection. CONCLUSION: The magnifying colonoscopy can provide instantaneous and accurate diagnosis of neoplastic lesions in colon and rectum,as well as minimally invasive treatment.

[Effects on micro-vessel density after pre-operative intra-arterial infusion chemotherapy in colorectal cancer].

OBJECTIVE: To evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal cancer. METHODS: Twenty-eight patients with colorectal cancer, treated by surgery from February to October 2000, were divided into two groups randomly. There were 12 patients in group A (pre-operative intra-arterial infusion chemotherapy) and 16 in group B (control). Arterial contrast technique was used in group A, then mitromycin 10 mg, 5-Fu 1,000 mg, epirubicin 60 mg were given through Weidner's way. RESULTS: Micro-vessel density in the center, surface of the tumor and adjacent tissue around the tumor were 40.46 +/- 7.06, 52.27 +/- 18.40, 49.92 +/- 8.15 in group A, and 46.09 +/- 12.21, 73.44 +/- 22.06, 51.94 +/- 12.64 in group B. Micro-vessel density on the surface in group A was significantly lower than that of group B (P < 0.05), with no significance between the center and the adjacent tissue. CONCLUSION: Pre-operative intra-arterial infusion chemotherapy is able to reduce micro-vessel density on the surface of colorectal tumor.

[Colonoscopy in preoperative staging and treatment of colorectal cancer].

OBJECTIVES: To investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment. METHODS: 28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made. RESULTS: Endoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89% (25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow-up for 12 - 40 months. CONCLUSION: Correct preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.