Aberrant Methylation of T-cadherin Can Be a Diagnostic Biomarker for Colorectal Cancer.

BACKGROUND/AIM: T-cadherin is a tumor suppressor gene, its predictive value in colorectal cancer (CRC) still remains controversial. In this study, we aimed to evaluate the association between T-cadherin promoter methylation and CRC by performing a meta-analysis. MATERIALS AND METHODS: The relevant literature was searched using the PubMed, Cochrane Library, Web of Science and Google Scholar databases for articles published until December 2016. The effect sizes were estimated by measuring an odds ratio (OR) with a 95% confidence interval (CI). Sensitivity analysis was performed to examine the heterogeneity and funnel plots were constructed to evaluate publication bias. RESULTS: Nine studies, including 488 samples were included in this meta-analysis. The pooled OR of T-cadherin promoter methylation in cancer tissues was 16.73 (95%CI=6.24-44.87), 19.48 (95%CI=5.64-67.31) and 2.23 (95%CI=1.05-4.75) compared to normal tissues, adjacent tissues and premalignant tissues, respectively. The relationship between T-cadherin promoter methylation and clinicopathological features were also analyzed. However, a significant association was not observed between T-cadherin promoter methylation status and gender, tumor stage, and lymph node status (p>0.05). CONCLUSION: The methylation status of T-cadherin promoter was strongly associated with CRC risk. However, T-cadherin promoter methylation may have a limited prognostic value for CRC patients.

Robotic Verse Laparoscopic Gastrectomy for Gastric Cancer: A Pooled Analysis of 11 Individual Studies.

OBJECTIVE: Robotic surgery is a new technique with the benefits of a 3-dimensional view, the ability to use multidegree-of-freedom forceps, the elimination of physiological tremors, and a stable camera view. The aim of this study was to evaluate the feasibility and short-term outcomes of robotic surgery for gastric cancer, compared with conventional laparoscopic surgery. METHODS: A literature search was performed for comparative studies reporting perioperative outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG). The methodological quality of the selected studies was assessed. The data were analyzed using Stata (Version 13.0) software. RESULTS: Eleven studies of 3503 patients totally were included for meta-analysis. Compared with LG, RG indicated potentially favorable outcomes in terms of blood loss [weighted mean difference (WMD)=-36.50; 95% confidence interval (CI), -61.39 to -11.61], and time to oral intake (WMD=-0.28; 95% CI, -0.46 to -0.09). But RG suggested longer operative time (WMD=53.48; 95% CI, 38.84-68.12). There were no differences in terms of postoperative flatus, length of hospital stay, postoperative complications, and lymph nodes harvested (P>0.05). CONCLUSIONS: RG for the treatment of gastric cancer is a feasible and safe procedure in the hand of experienced laparoscopic surgeons. But the long-term outcomes between the 2 techniques need to be further examined.

A Pooled Analysis of Robotic Versus Laparoscopic Surgery for Colon Cancer.

OBJECTIVE: An increasing number of studies have been reported since the "Da Vinci" Robotic System was used in gastrointestinal disease. Thus, we conducted this meta-analysis to evaluate the safety and efficacy of robotic colectomy (RC) compared with laparoscopic colectomy (LC) in the treatment of colon cancer. METHOD: A systematic search of Medline, Embase databases, and the Cochrane Library was performed to identify studies that compared RC and LC and were published up to February 2015. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, the fixed or the random-effect model was used for the meta-analysis. Outcomes of interest included the operating time, blood loss, the length of hospital stay, conversion rates to open, postoperative complications, and related outcomes were evaluated. RESULTS: Fourteen studies were included in the meta-analysis. These studies involved a total of 125,989 patients: 4924 of them underwent RC and 121,055 underwent LC. The meta-analysis showed that the RC group had a longer operating time (P<0.01), lower blood loss (P<0.01), lower intraoperative conversion to open rate (P<0.01), shorter hospital stay (P<0.01), lower postoperative complication rate (P<0.01), and significantly faster bowel function recovery (P<0.01). There were no differences in the number of lymph nodes harvested (P>0.05). CONCLUSIONS: Our data suggest that RC may be a safe, feasible, and minimally invasive alternative to its LC counterpart when performed by experienced surgeons in selected patients. However, the long-term outcomes between the 2 techniques need to be further examined.

Long-term outcome after surgical resection for cholangiocarcinoma and prognostic index value.

OBJECTIVE: To investigate the prognostic factors of patients with cholangiocarcinoma and establish a prognostic model to evaluate the prognosis. METHODS: 169 cases of cholangiocarcinoma were analyzed retrospectively. Clinicopathological factors were evaluated using univariate and multivariate analysis. Prognostic index (PI) was calculated based on the results of multivariate analysis. Patients with different PI were divided into 3 groups in order to compare the survival rate of each group and draw the survival curves. Individual expected survival rate was calculated based on the prognostic Cox model and PI. The PI equation was built that included all significant variables and coefficients as follow formula: PI = (ß1 × lymph node metastasis) + (ß2 × CEA level) - (ß3 × surgical margin). RESULTS: Univariate analysis showed that CEA, lymph node metastasis, surgical margin, AJCC staging, tumor differentiation and adjuvant chemotherapy were prognostic impacts. The difference was statistically significant (p < 0.05). Cox multivariate analysis showed that CEA, lymph node metastasis and surgical margin are three separate prognostic factors. According to different PI, patients were divided into high-risk group, middle-risk group and low-risk group and three groups were statistically significant difference in survival rate (P < 0.05). CONCLUSION: Racical resection is the key to improve the long-term survival rate of cholangiocarcinoma. By using prognostic Cox model and the PI, the prognosis of patients could be estimated and individualized clinical treatment could be conducted.

Treatment and multivariate analysis of colorectal cancer with liver metastasis.

BACKGROUND/AIMS: The aim of this study was to identify the influencing factors related to outcome of patients of colorectal cancer with liver metastasis. METHODOLOGY: From January 1999 to January 2009, 293 cases of colorectal cancer with liver metastasis undergoing surgery were analysised retrospectively. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate analysis. Results: The 1-, 3- and 5-year survival rates of patients after resection were 58.3%, 26.4%, and 11.3%, respectively. Univariate analysis showed that preoperative CEA level, degree of primary tumor differentiation, resection margin, number of liver metastases, resection of liver metastases were prognostic impacts. The difference was statistically significant (p<0.05). Cox multivariate analysis showed that preoperative CEA level, number of liver metastases, and resection of liver metastases are three separate prognostic factors. CONCLUSIONS: Racical resection is the key to improve the long-term survival rate of colorectal cancer with liver metastasis. Important predictive factors related to poor survival are preoperative CEA level and number of liver metastases.