Port-site metastasis of unsuspected gallbladder carcinoma with ossification after laparoscopic cholecystectomy: A case report.

BACKGROUND: Unsuspected gallbladder carcinoma (UGC) refers to cholecystectomy due to benign gallbladder disease, which is pathologically confirmed as gallbladder cancer during or after surgery. Port-site metastasis (PSM) of UGC following laparoscopic cholecystectomy is rare, especially after several years. CASE SUMMARY: A 55-year-old man presenting with acute cholecystitis and gallstones was treated by laparoscopic cholecystectomy in July 2008. Histological analysis revealed unexpected papillary adenocarcinoma of the gallbladder with gallstones, which indicated that the tumor had spread to the muscular space (pT1b). Radical resection of gallbladder carcinoma was performed 10 d later. In January 2018, the patient was admitted to our hospital for a mass in the upper abdominal wall after surgery for gallbladder cancer 10 years ago. Laparoscopic exploration and complete resection of the abdominal wall tumor were successfully performed. Pathological diagnosis showed metastatic or invasive, moderately differentiated adenocarcinoma in fibrous tissue with massive ossification. Immuno-histochemistry and medical history were consistent with invasion or metastasis of gallbladder carcinoma. His general condition was well at follow-up of 31 mo. No recurrence was found by ultrasound and epigastric enhanced computed tomography. CONCLUSION: PSM of gallbladder cancer is often accompanied by peritoneal metastasis, which indicates poor prognosis. Once PSM occurs after surgery, laparoscopic exploration is recommended to rule out abdominal metastasis to avoid unnecessary surgery.

Isolated metachronous splenic multiple metastases after colon cancer surgery: A case report and literature review.

BACKGROUND: Isolated splenic metastasis is a rare clinical entity. Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachronous splenic metastasis are exceedingly rare. CASE SUMMARY: We report a colon cancer patient who underwent laparoscopic radical colon resection 14 mo previously, and subsequently underwent a second local resection due to local recurrence detected by elevated serum carcinoembryonic antigen (CEA) and positron emission tomography (PET). However, multiple metastases in the spleen were found 7 mo later by elevated serum CEA and PET-magnetic resonance imaging. Then the patient underwent total laparoscopic splenectomy. Local tumor recurrence and splenic metastasis from colorectal cancer (CRC) were found by postoperative pathology. Genetic analysis of these recurrent and metastatic tissues showed KRAS exon2, APC exon16 and TP53 exon6 missense mutations, but no mutations of NRAS, KRAF, EGFR, ERBB2, MET, MLH1, MSH2 and MSH6 were detected. Chemotherapy and target therapy were administered after multiple disciplinary team (MDT) consultation, and no tumor recurrence has been observed to date. We also reviewed the literature by conducting a search of the PubMed database using the following key words: CRC, splenic metastasis, isolated, and review. We identified 34 relevant papers, which included 28 cases of metachronous metastasis and 6 cases of simultaneous metastasis. CONCLUSION: Close monitoring of serum CEA levels is crucial for the detection of isolated splenic metastases after colon surgery. In terms of overall survival and progression-free survival, MDT plays an important role in the entire process of disease management.

TPM1 is a Novel Predictive Biomarker for Gastric Cancer Diagnosis and Prognosis.

BACKGROUND: Tropomyosin alpha-1 chain (TPM1) is a member of the tropomyosin family and the expression of TPM1 is found to be dysregulated in various tumors. The present study aimed to investigate the clinical performance and significance of TPM1 in gastric cancer. METHODS: First, the levels of TPM1 mRNA and protein were detected through real-time polymerase chain reaction (RT-qPCR) and immunohistochemistry (IHC) respectively. The correlation between TPM1 expression and clinicopathological variables was analyzed. Then, receiver operating characteristic (ROC) curve was applied to determine the diagnostic performance of TPM1 in gastric cancer. Finally, overall survival analysis was carried out using Kaplan-Meier method in order to determine the prognostic performance of TPM1 in gastric cancer. RESULTS: Compared with the controls, TPM1 mRNA and protein expression levels were significantly downregulated in patients with gastric cancer. Downregulation of TPM1 was associated with depth of invasion and tumor node metastasis (TNM; p = 0.0030 and 0.0175, respectively). Furthermore, TPM1 might be a novel predictive biomarker for gastric cancer with an area under curve (AUC) of 0.8327. Overall survival analysis indicated that low TPM1 expression predicted poor survival (log-rank test, p = 0.0058). CONCLUSIONS: TPM1 might be a novel predictive diagnostic and prognostic biomarker for gastric cancer (95% con-fidence interval = 0.7705 - 0.8949, p < 0.0001).

FAT2 is a novel independent prognostic factor for the poor prognosis of gastric carcinoma.

BACKGROUND: This study investigated the clinical implication of FAT2 in the progression, metastasis, and prognosis of gastric cancer. METHODS: The expression of FAT2 in 436 clinicopathologically characterized gastric cancer cases and 92 control human non-tumor mucosa were analyzed by immunohistochemistry. Consequently, survival analysis was conducted to investigate the association of FAT2 expression and the development of gastric cancers. RESULTS: FAT2 protein was found highly expressed in 90 of 92 (97.83%) control human non-tumor mucosa, while was highly expressed in 126 of 436 (28.90%) tumors samples and low in 310 of 436 (72.10%). The expression of FAT2 was associated with age, tumor size, depth of invasion, Lauren's classification, lymph node and distant metastases, regional lymph node stage, TNM stage, and prognosis. In particular, for stage I, II, and III tumors patients the 5-year survival rate was lower in those with high expression of FAT2 than those with low expression. In stage IV tumors, the expression of FAT2 was not associated with the 5-year survival rate. Lauren's classification and distant metastases, TNM stage, and expression of FAT2 were independent prognostic factors in the patients with gastric cancer, as revealed by Cox regression analysis. CONCLUSION: The expression of FAT2 in gastric cancer was significantly associated with lymph node and distant metastases, and poor prognosis. FAT2 was also associated with the collective invasion and influenced the prognosis of those patients.

Long-term prognosis of patients with distal gastric cancer underwent minimally invasive surgery combined with delta-shaped anastomosis / 中国内镜杂志

Objective To evaluate the long-term efficacy of total laparoscopic radical gastrectomy combined with delta-shaped anastomosis in treatment of distal gastric cancer. Methods The clinical data of 128 patients with distal gastric cancer who underwent laparoscopic radical gastrectomy from January 2014 to April 2016 were retrospectively reviewed. According to the different surgical methods, patients were divided into TLDG plus DA treatment group (DA group, 72 cases) and LADG plus TA treatment group (TA group, 56 cases). The operation time, intraoperative blood loss, disconnection time, postoperative exhaust time, lymph node dissection, hospitalization time and postoperative complications were recorded. Patients were followed up monthly by call, to April 2017. Results The blood loss [(55.6 ± 12.5) vs (85.6 ± 15.8) ml] and postoperative exhaust time [(2.5 ± 1.0) vs (4.5 ± 1.5) d] were significantly lower in the DA group than that in TA group (P < 0.05). There was no significant difference between the two groups in the operation time, the removal time, the number of lymph node dissection and the hospitalization time (P > 0.05). The incidence of anastomotic stenosis (0.00％ vs 7.14％), anastomotic fistula (0.00％ vs 8.93％) and anastomotic bleeding (0.00％ vs 7.14％) in DA group was significantly lower than that in TA group (P < 0.05). All the patients were followed up for 16 to 62 months in DA group. 16 patients died of tumor recurrence or metastasis, and the cumulative survival rate was 77.78％. TA group were all effective follow-up, the follow-up time of 15 to 61 months, 14 patients died of tumor recurrence or metastasis, the cumulative survival rate of 75.00％. There was no significant difference in cumulative survival rate between DA group and TA group (P > 0.05). Conclusion In the treatment of distal gastric cancer, there is a certain advantage in the effect of laparoscopic radical gastrectomy plus delta-shaped anastomosis in the treatment of distal gastric cancer over tubular anastomosis.

Long-term outcome of laparoscopic Nissen-Rossetti fundoplication versus Thal fundoplication in children with esophageal hiatal hernia: a retrospective report from two children's medical centers in Shanghai.

BACKGROUND: This study was undertaken to investigate the intraoperative and postoperative complications, efficacy and outcome of two laparoscopic fundoplications for the treatment of esophageal hiatal hernia in children. METHODS: To find a rational procedure, we performed a retrospective analysis of 136 children with esophageal hiatal hernia who underwent laparoscopic Nissen-Rossetti or Thal fundoplication at two children's hospitals in Shanghai over 13 years. The median follow-up time of the children was 42 months (range: 1-138 months). Their age varied from 1 month to 11 years (median: 18.6 months). RESULTS: All the children underwent laparoscopic fundoplications (72 cases of Nissen-Rossetti and 60 cases of Thal fundoplication) and 4 children converted to open surgery. The mean age of the children at the time of operation was 1.6±1.9 years, and the mean weight was 9.1±5.6 kg. Gastroesophageal reflux was significantly more severe after a Thal fundoplication (P=0.003) and slight esophageal stenosis was significant after a Nissen-Rossetti fundoplication (P=0.02). The recurrent rate of hiatal hernia was 2.8% (2/72) after Nissen-Rossetti fundoplication in contrast to 5% (3/60) after Thal fundoplication. No death occurred after surgery. CONCLUSION: There was no statistical difference of recurrence between laparoscopic Nissen-Rossetti and Thal fundoplication in the long-term outcomes. The rate of slight dysphagia was higher in the Nissen-Rossetti group. The Thal group had a significantly higher recurrence rate of gastroesophageal reflux. There still exited learning curve for this procedure. The incidence rate of complications is significantly related to the proficiency of pediatric surgeon.

The Surgical Management of H-Type Rectovestibular Fistula: A Novel Modification.

Introduction H-type rectovestibular fistulas could be rare anorectal malformations or acquired diseases secondary to perianal infection. Various surgical procedures have been described in the literature, however the problem of recurrence still remains to be solved. We describe a novel modified surgical procedure and outcome in the management of these patients. Methods From 1999 to 2014, 14 patients who had an H-type rectovestibular fistula underwent the same surgical procedure performed by the same surgical team. Rectal-vestibular pull-through inside-out and endorectal mucosal advancement flap was used, including circumferential incision of the fistula from the opening on the rectal side, pulling the fistula inside-out, ligating the fistula, and mobilizing a rectal mucosal flap to cover the internal opening. Results All the patients have been followed-up for 12 months to 15 years with no recurrences and no incontinence. Conclusion Our surgical management is a simple, safe, and probable choice for the treatment of H-type rectovestibular fistula with favorable outcomes.

MicroRNA-10b promotes migration and invasion through Hoxd10 in human gastric cancer.

BACKGROUND: This study aims to investigate the effect of miR-10b overexpression on cancer cell proliferation, migration, invasion, and Hoxd10 expression. METHODS: The effect of miR-10b on proliferation, migration, and invasion of MKN-28, BGC-823, and SGC-7901 cells and the expression of Hoxd10 protein in SGC-7901 and BGC-823 cells were detected following transfection of miR-10b inhibitor or Negative Control B. Expression of Hoxd10 protein in 436 paraffin-embedded cancer tissues was also investigated. RESULTS: miR-10b was significantly upregulated in AGS, MKN-28, BGC-823, HCG-27, SGC-7901, and MKN-45 cell lines, miR-10b inhibitor significantly inhibited proliferation and migration of MKN-45, BGC-823 and SGC-7901 cells 48 h after transfection, while Hoxd10 protein in these cells lines had increased 72 h after transfection. Hoxd10 was highly expressed in gastric cancer and correlated with size of tumor, Lauren classification, depth of invasion, lymph node and distant metastasis, Tumor-Node-Metastasis (TNM) stage, and prognosis. CONCLUSIONS: miR-10b promotes migration and invasion through Hoxd10 in human gastric cancer cell lines and may play an important role in tumorigenesis, progression, and prognosis.

[Multi-disciplinary hybrid therapy for tracheoesophageal fistula in children: analysis of 4 cases].

OBJECTIVE: To explore an innovative technique that is aided by multi-disciplinary hybrid approach in identification and treatment of tracheoesophageal fistula (TEF) in children intraoperatively. METHOD: From April 2008 to October 2011, 4 patients with isolated TEF were presented with 2 H-type fistulas and 2 recurrent TEF. For all the four cases, with the cooperation of the gastroenterologists, respiratory physician and surgeon, methylene blue was first injected into the trachea for detecting the dye in the esophagus by the gastroscopy. Bronchoscopy was performed where the fistula tract was shown by the methylene blue and a guide wire was passed through the fistula. The patients underwent rigid gastroscopy and the guide wire was identified and brought out through the mouth by biopsy pliers. This created a wire loop through the fistula. X-ray was then used to identify the level of the fistula. According to the level of the fistula it was determined whether surgical incision and approach should be used. The fistula was then repaired successfully by surgery. RESULT: In the 4 patients, with the aid of gastroscopy and bronchoscopy, identification of the fistula intraoperatively was then facilitated by traction on the loop. The fistula was identified and repaired. There were no fistula recurrences. CONCLUSION: Multi-disciplinary hybrid therapy for tracheoesophageal fistula in children is beneficial for the precise localization of the fistula. This new technique is an effective and definitive method in identification and treatment of TEF in children.

Modified silo technique-An easy and effective method to improve the survival rate of neonates with gastroschisis in Shanghai.

OBJECTIVES: To introduce the clinical practice and experience of using a modified silo technique to treat neonates with severe gastroschisis in three referral medical centers in Shanghai, China. STUDY DESIGN: Seventeen neonates with severe gastroschisis, whose viscera could not be reduced primarily, were admitted to three referral hospitals in Shanghai in the period of April 2004-July 2008. We placed a spring-loaded silo bag to hold the viscera as a bedside procedure and without anesthesia. Five to eight days later, after the bowel had been reduced to the abdominal cavity, we explored the intestines and closed the abdominal wall defect secondarily. Three of the cases had been diagnosed prenatally. Immediately after these 3 infants had been born and while still in the delivery room, the pediatric surgeons placed the silo bag. RESULTS: In 16 of the 17 cases, we performed a secondary surgery to explore the abdominal cavity and to close the defective abdominal wall 5-8 days after the silo bag had been inserted. When closing the abdominal wall, omphaloplasty was performed in 12 cases and transverse skin closure was done in 4 cases. All 16 cases recovered well. The follow-up periods ranged from 1 to 51 months, during which 15 babies developed well. One baby, however, incurred an intestinal obstruction 1 month after discharge and died, because his parents failed to send him to the hospital immediately. Due to an improper placement of the silo bag, one patient's bowel became incarcerated, ischemic and necrotic locally, causing the death of the patient. CONCLUSIONS: Placing a spring-loaded silo bag as a bedside procedure without anesthesia on newborns with severe gastroschisis whose viscera cannot be reduced primarily has increased the survival rate (94.1%, 16/17, 2004-2008) of infants with severe gastroschisis in comparison to our previous experience (60.9%, 14/23, 1996-2003, p=0.026, Chi-square test) in Shanghai, China. This modified procedure deviates from the classic silo procedure, which is carried out under anesthesia..