Novel method for esophagojejunal anastomosis after laparoscopic total gastrectomy: semi-end-to-end anastomosis.

AIM: To test a new safe and simple technique for circular-stapled esophagojejunostomy in laparoscopic total gastrectomy (LATG). METHODS: We selected 26 patients with gastric cancer who underwent LATG and Roux-en-Y gastrointestinal reconstruction with semi-end-to-end esophagojejunal anastomosis. RESULTS: LATG with semi-end-to-end esophagojejunal anastomosis was successfully performed in all 26 patients. The average operation time was 257 ± 36 min, with an average anastomosis time of 51 ± 17 min and an average intraoperative blood loss of 88 ± 46 mL. The average postoperative hospital stay was 8 ± 3 d. There were no complications and no mortality in this series. CONCLUSION: The application of semi-end-to-end esophagojejunal anastomosis after LATG is a safe and feasible procedure, which can be easily performed and has a short operation time in terms of anastomosis.

Aberrant expression of Cx43 is associated with the peritoneal metastasis of gastric cancer and Cx43-mediated gap junction enhances gastric cancer cell diapedesis from peritoneal mesothelium.

The process of peritoneal metastasis involves the diapedesis of intra-abdominal exfoliated gastric cancer cells through the mesothelial cell monolayers; however, the related molecular mechanisms for this process are still unclear. Heterocellular gap-junctional intercellular communication (GJIC) between gastric cancer cells and mesothelial cells may play an active role during diapedesis. In this study we detected the expression of connexin 43 (Cx43) in primary gastric cancer tissues, intra-abdominal exfoliated cancer cells, and matched metastatic peritoneal tissues. We found that the expression of Cx43 in primary gastric cancer tissues was significantly decreased; the intra-abdominal exfoliated cancer cells and matched metastatic peritoneal tissues exhibited increasing expression compared with primary gastric cancer tissues. BGC-823 and SGC-7901 human gastric cancer cells were engineered to express Cx43 or Cx43T154A (a mutant protein that only couples gap junctions but provides no intercellular communication) and were co-cultured with human peritoneal mesothelial cells (HPMCs). Heterocellular GJIC and diapedesis through HPMC monolayers on matrigel-coated coverslips were investigated. We found that BGC-823 and SGC-7901 gastric cancer cells expressing Cx43 formed functional heterocellular gap junctions with HPMC monolayers within one hour. A significant increase in diapedesis was observed in engineered Cx43-expressing cells compared with Cx43T154A and control group cells, which suggested that the observed upregulation of diapedesis in Cx43-expressing cells required heterocellular GJIC. Further study revealed that the gastric cancer cells transmigrated through the intercellular space between the mesothelial cells via a paracellular route. Our results suggest that the abnormal expression of Cx43 plays an essential role in peritoneal metastasis and that Cx43-mediated heterocellular GJIC between gastric cancer cells and mesothelial cells may be an important regulatory step during metastasis. Finally, we observed that the diapedesis of exfoliated gastric cancer cells through mesothelial barriers is a viable route of paracellular migration.

[Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients].

OBJECTIVE: To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience. METHODS: Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. RESULTS: All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis. CONCLUSION: Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.

Autophagy protects against oxaliplatin-induced cell death via ER stress and ROS in Caco-2 cells.

Oxaliplatin is included in a number of effective combination regimens used as first and subsequent lines of therapy for metastatic colorectal cancer. Accumulating evidence indicates that autophagy plays a significant role in response to cancer therapy. However, the role of autophagy in oxaliplatin-induced cell death remains to be clarified. In this study, we showed that oxaliplatin induced cell death and autophagy in Caco-2 colorectal cancer cells. The suppression of autophagy using either pharmacologic inhibitors (3-methyladenine, bafilomycin A1) or RNA interference in essential autophagy genes (ATG5 or Beclin1) enhanced the cell death and reactive oxygen species (ROS) production induced by oxaliplatin in Caco-2 cells. Blocking oxaliplatin-induced ROS production by using ROS scavengers (NAC or Tiron) decreased autophagy. Furthermore, numerous dilated endoplasmic reticula (ER) were present in oxaliplatin-treated Caco-2 cells, and blocking ER stress by RNA interference against candidate of metastasis-1 (P8) and C/EBP-homologous protein (CHOP) decreased autophagy and ROS production. Taken together, these data indicate that oxaliplatin activates autophagy as a cytoprotective response via ER stress and ROS in human colorectal cancer cells.

Laparoscopy-assisted resection for gastric stump cancer and gastric stump recurrent cancer: a report of 15 cases.

OBJECTIVE: This study was designed to investigate the technical methods and clinical therapeutic effects of laparoscopy-assisted resection of gastric stump cancer (GSC). METHODS: Laparoscopy-assisted resection was performed on 15 patients with GSC. The approach, method, difficult points, and techniques of the operation were analyzed, and its clinical therapeutic effect was evaluated. RESULTS: With the help of laparoscopy, D2 radical resection of gastric stump was performed on 12 patients, and palliative gastric stump resection was performed on two patients. There was one case of conversion from laparoscopic surgery to open surgery. Roux-en-Y gastric bypass was performed in all cases to reconstruct the alimentary tract. The mean operative time for laparoscopy-assisted resection was 205 ± 25 min. The mean intraoperative blood loss volume was 110 ± 40 ml. The mean number of lymph nodes removed was 18 ± 5. A gastric tube was not placed in the patients after surgery. The mean time for the recovery of intestinal function was 2.5 ± 1 days, the mean duration of postoperative liquid diet was 2.5 ± 1 days, and the mean time for the recovery of ambulatory activity was 3 ± 0.5 days. There was one case of postoperative infection of the incision site. The follow-up time was 6-40 months, with 1 case of death due to liver metastasis, 1 case of death due to peritoneal metastasis, 1 case of death due to complications from lupus erythematosus, and survival for the remaining 12 cases. CONCLUSIONS: Laparoscopy-assisted resection of GSC is technically feasible; determination of the short- and long-term efficacies will require a larger and comparative sample study.

[A modified method of laparoscopic side-to-side esophagojejunal anastomosis after laparoscopic total gastrectomy: a report of 12 cases].

OBJECTIVE: To explore the method of alimentary reconstruction after laparoscopic total gastrectomy. METHODS: The clinical data of 12 patients undergone laparoscopic total gastrectomy and side- to- side esophagojejunal anastomosis from Feb. 2006 to Oct. 2006 were analyzed retrospectively. RESULTS: Laparoscopic side- to- side esophagojejunal anastomosis was successfully performed in 12 patients. The mean operation time was (247.0+/- 13.1) min and the anastomosis time was (43.5+/- 10.4) min. Bleeding volume during operation was (107.5+/- 44.9)ml. The distance between anastomosis and proximal margin of tumor was (3.4+/- 1.2)cm. There was no postoperative death, fistula or anastomotic stenosis occurred after short- term follow- up. CONCLUSION: The modified laparoscopic side- to- side esophagojejunal anastomosis is a safe, less challenging and more economic method of alimentary reconstruction after laparoscopic total gastrectomy.

[Laparoscopic-assisted radical gastrectomy: a report of 105 cases].

OBJECTIVE: To investigate the feasibility and safety of laparoscopic-assisted radical gastrectomy for gastric cancer. METHODS: One hundred and five patients with gastric cancer received laparoscopic-assisted radical gastrectomy, radical total gastrectomy were performed in 7 cases, proximal gastrectomy in 27 cases, proximal gastrectomy combined with splenectomy in 3 cases and distal gastrectomy in 68 cases. RESULTS: One hundred and five cases had laparoscopic-assisted radical gastrectomy successfully. The mean operation time was 381 +/- 91 (300 - 435) min for total gastrectomy, 279 +/- 73 (212 - 390) min for proximal gastrectomy, 312 +/- 64 (265 - 405) min for proximal gastrectomy combined with splenectomy, 281 +/- 69 (230 - 360) min for distal gastrectomy, respectively. The mean blood loss was 260 +/- 202 (20 - 900) ml in total gastrectomy, 200 +/- 153 (20 - 400) ml in proximal gastrectomy, 333 +/- 116 (200 - 400) ml in proximal gastrectomy combined with splenectomy, 140 +/- 82 (20 - 450) ml in distal gastrectomy, respectively. The mean number of harvested lymph nodes was 34.2 +/- 20.5 (8 - 83). The mean time for gastrointestinal function recovery was 3.5 +/- 1.4 (2 - 5) days, 3.0 +/- 1.6 (2 - 6) days for patients' taking normal activity, 4.9 +/- 1.7 (3 - 7) days for taking liquid food. The short-term efficiency was obvious. CONCLUSIONS: Laparoscopic-assisted radical gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.

[Laparoscopy-assisted radical gastrectomy: a report of 71 cases].

OBJECTIVE: To investigate the feasibility and safety of laparoscopy-assisted radical gastrectomy for gastric cancer. METHODS: Seventy-one patients with gastric cancer received laparoscopy-assisted radical gastrectomy for gastric cancer. Among them radical total gastrectomy was performed in 8 cases, proximal partial gastrectomy in 16 cases, proximal partial gastrectomy combined with splenectomy in 3 cases, and distal partial gastrectomy in 44 cases. RESULTS: Sixty-nine cases had laparoscopic-assisted surgery performed successfully, but 2 cases were converted to open surgery. The mean operation time was (343 +/- 52) min for total gastrectomy, (268 +/- 62) min for proximal gastrectomy, (312 +/- 64) min for proximal gastrectomy combined with splenectomy, and (283 +/- 44) min for distal gastrectomy respectively. The mean volume of blood loss was (267 +/- 220) ml in total gastrectomy, (150 +/- 103) ml in proximal gastrectomy, (333 +/- 116) ml in proximal gastrectomy combined with splenectomy, (139+/- 84) ml in distal gastrectomy respectively. The mean numbers of harvested lymph nodes were (34.3 +/- 11.8). The mean time was (4.1 +/- 1.1) d for gastrointestinal function recovery, (3.5 +/- 1.0) d for patient's taking general activity, (5.0 +/- 1.2) d for taking liquid food. The short-term efficiency was obvious. CONCLUSION: Laparoscopy-assisted radical gastrectomy is a feasible, safe and minimally invasive treatment and can achieve the same outcomes as the open operation.