Surgical anatomy and clinical variation of the left colonic artery in laparoscopic anterior rectal resection.

Objectives: This study aims to investigate the surgical anatomy and clinical variation of the left colonic artery (LCA) during laparoscopic anterior rectal resection. Methods: We conducted a retrospective analysis of 87 patients diagnosed with colorectal cancer who underwent laparoscopic anterior rectal resection with preserved LCA at the Department of Gastroenterology, Sichuan Cancer Hospital, between March 2018 and April 2022, aiming to observe the emanation location, anatomical typing, and travel trajectory of the LCA, as well as its relationship with the inferior mesenteric vein (IMV). Results: In all observed cases, we observed that the LCA emanated from the left side of the inferior mesenteric artery (IMA), and the average distance from the root of the IMA to the emanation of the LCA was approximately 3.5 ± 1.1 cm. Specifically, 35 of these cases had the LCA branching from the IMA alone (Type I, 40.2%),16 cases had the LCA cotruncating with the sigmoid artery (SA) (Type II, 18.4%), 30 cases had the LCA cotruncating with the superior rectal artery (SRA) and SA (Type III, 34.5%), and six cases had the LCA cotruncating with four or more branches of the SRA and SA (Type IV, 6.9%). No LCA agenesis cases were found in this group. In addition, we also observed the occurrence of LCA alignment. Specifically, there were 25 cases where the LCA crossed the IMV in a diagonal upward direction (Type A, 28.7%), 36 cases where the LCA crossed the IMV in an upward arched manner (Type B, 41.4%), 18 cases where the LCA crossed the IMV in a vertical outward direction (Type C, 20.7%), and eight cases where the LCA crossed the IMV in a diagonal downward manner (Type D, 9.2%). Among them, two cases developed anastomotic fistula, one case had chyle leakage 1 week after surgery, and four cases experienced urinary retention; all of the patients successfully recovered and were discharged after receiving conservative treatment. Conclusion: The anatomy and variation of the LCA can be clearly and accurately observed during laparoscopic surgery. Understanding the type and variation of the LCA helps to dissect the vessels in the IMA region during surgery, particularly in cases when the LCA is preserved, and reduce the incidence of vascular injury and its complications.

[Expressions of Spinal Macrophage Colony Stimulating Factor and Its Receptor CSF-1R in the Development ofComplicated Regional Pain Symptom I].

OBJECTIVES: To study the changes of mechanical allodynia and temperature hyperalgesia, as well as the expression of the spinal macrophage colony stimulating factor (M-CSF) and its receptor CSF-1R during the development of complicated regional pain symptom I(CRPS I). METHODS: The animal model of CRPS I was established using prolonged ischemia-reperfusion injury of rodent left hindpaw. The mechanical allodynia and temperature hyperalgesia of ipsilateral hindpaw were continuously measured for 14 d after reperfusion, and the expressions of spinal M-CSF and CSF-1R in ipsilateral spinal cord horn were measured with immunofluorescence technique on day 3, day 7 and day 14 after reperfusion. RESULTS: The thresholds of mechanical allodynia and temperature hyperalgesia of ipsilateral hindpaw were significantly decreased (P<0.05). M-CSF was secreted by the astrocytes. CSF-1R was primarily distributed on the microglia. The immunofluorescence intensities of M-CSF and CSF-1R in ipsilateral spinal cord horn were significantly increased on day 7 and day 14 after reperfusion (P<0.05). CONCLUSIONS: The ischemia-reperfusion injury simulated pain syndrome in CRPS I and increased the expressions of spinal M-CSF and CSF-1R.

Tumor Suppressor Role of miR-363-3p in Gastric Cancer.

BACKGROUND Gastric cancer (GC) is the most common cancer in the world. Despite the advancement of the treatment of GC, the 5-year overall survival rate is still very low. MicroRNAs (miRNAs) play important roles in the pathogenesis of GC. A recent study suggested that miR-363-3p plays a role in the development of GC. However, the function of miR-363-3p in GC is not fully understood. MATERIAL AND METHODS The network of NOTCH1 and the involved molecules was constructed by use of Cytoscape software. MiR-363-3p levels in GC tissues and cells were tested by qRT-PCR. Cells were miR-363-3p mimics or anti-miR-363-3p transfected by Lipofectamine. Bioinformatics algorithms from TargetScanHuman were used to predict the target genes of miR-363-3p. The NOTCH1 protein level was tested by Western blot. The interaction between miR-363-3p and NOTCH1 was confirmed by dual luciferase assays. RESULTS MiR-363-3p showed low levels in GC tissues and cells. Enforced expression of miR-363-3p inhibited cell growth and migration of GC cells and vice versa. NOTCH1 is the targeted gene of miR-363-3p. CONCLUSIONS MiR-363-3p plays a tumor suppressor role in GC.

[Experience of ultralow anterior excision for rectal cancer: 508 cases analysis].

OBJECTIVE: To investigate the operative techniques and postoperative effects of ultralow anterior excision for rectal cancer. METHODS: From October 1996 to October 2006, 508 cases with rectal carcinoma at or below the peritoneal reflection with potential to preserve the anal function were divided into two groups. Of the patients, 365 cases underwent ultralow anterior excision and instrumental anastomosis, and 143 cases underwent manual colon-anal anastomosis (Parks operation). RESULTS: In the group with anterior excision, the operations were all completed in the abdominal cavity, and avulsion of distal occlusive end occurred in 3 cases (0.9%), unsuccessful anastomosis happened in 2 cases (0.6%), unsatisfactory anastomosis with incomplete anastomosis circle turned out in 18 cases (5.6%). In the Parks operation group, the anastomosis was carried out manually at the anus and in abdominal cavity. Postoperative defecation function (times, soiling underwear, feeling of urgent defecation) in the group anterior excision was clearly better than that in the group of Parks operation (P < 0.05); difficulty of defecation (sense of residual stool, prolonging of defecation, cathartic usage) was also better in the group with anterior excision (P < 0.05). The anastomosis leakage rate was 3.5% in anterior excision group, compared to 5.6% in Parks operation group (P > 0.05). Anastomotic stenosis occurred in 77 cases (22.5%) in anterior excision group, and 40 cases (27.9%) in Parks operation group (P > 0.05). The local recurrence rate and 5-year survival rate were 11.8% and 68.8% in anterior excision group, and 10.1% and 66.8% in Parks operation group, respectively (P > 0.05). CONCLUSIONS: Although there is no significant differences in local recurrence and 5-year survival rate between the two groups, the function and difficulty of defecation with instrumental anastomosis demonstrates clear advantages over Parks operation.

[Expression of phosphatase of regeneration liver-3 in human colorectal carcinoma and its prognosis value].

OBJECTIVE: To investigate the expression of phosphatase of regeneration liver-3(PRL-3) protein and its relationship with tumor invasion and metastasis in human colorectal carcinoma,and elucidate prognostic value. METHODS: Immunohistochemistry method was applied to detect the PRL-3 expression in the primary tumor specimens and paired paratumor normal tissues from 46 colorectal carcinoma patients, the adenoma tissues from 6 patients with colorectal adenoma, all the metastatic lymph nodes from 29 cases and the metastatic liver lesions from 6 cases. The relationship between PRL-3 expression and clinicopathologic parameters was analyzed and a survival curve was achieved according to Kaplan-Meier method. RESULTS: No or weak PRL-3 protein expression was detected in normal colorectal mucosa and colorectal adenoma. In colorectal carcinoma tissues, PRL-3 expression was confirmed in 26 of 46 cases (56.5%) of primary colorectal carcinomas (with lymph node metastasis 63.0%, without lymph node metastasis 37.0%, P=0.001), 26 of 29 (89.7%) lymph node metastases, and 5 of 6 liver metastases. The expression of PRL-3 was assembled in the cytoplasm of carcinoma cells and more intensively on the cell membrane.Analysis of the relationship between PRL-3 expression and the clinicopathologic features showed that PRL-3 expression was closely associated with tumor stage (P=0.019), lymph node metastasis (P=0.026), but no relationship with age, sex, tumor size, degree of differentiation was founded (P<0.05). The mean follow-up time was 41.4 months and results showed that patients with positive expression of PRL-3 had a significantly poorer prognosis than those with negative PRL-3 expression group(P=0.032). CONCLUSIONS: PRL-3 protein plays a novel role in tumor progression and metastasis of colorectal carcinoma. PRL-3 can be expected to be a potential predictive biomarker for identifying the prognosis in colorectal carcinoma patients.

Distribution and patterns of lymph nodes metastases and micrometastases in the mesorectum of rectal cancer.

BACKGROUND AND OBJECTIVES: Facts buried in the mesorectum remain to be unveiled. This study investigated the number, size, and detailed distribution of lymph nodes metastases and micrometastases within the mesorectum of rectal cancer. METHODS: Thirty-one patients who underwent total mesorectal excision (TME) were treated with lymph node revealing solution to retrieve lymph nodes, which were submitted to hematoxylin and eosin (HE) examination and immunohistochemical (IHC) staining. RESULTS: The mean number of mesorectal nodes per case was 17.7. The mean size of metastatic, micrometastatic, and isolated tumor cells (ITC) harbored nodes was 5.2 mm, 4.5 mm, and 3.3 mm, respectively. Most of the metastatic (92.1%), micrometastatic and ITC-involved nodes (69.2%) were located along the superior rectal artery (SRA). Posterior-wall located tumor might spread along both sides of the mesorectum simultaneously (P = 0.34), while lateral-wall located tumor spread preferably to ipsolateral side versus contralateral side (P = 0.012). CONCLUSION: Most of the metastases and micrometastases positive lymph nodes were smaller than 5 mm and distributed along the SRA. The patterns of lymph nodes spread were related to the circumferential situation of tumor in the rectal wall. Surgical excision of the rectal cancer should completely remove the whole mesorectum, especially to avoid any damage of the mesorectum on tumor side.

Effect of ambient conditions on simultaneous growth and bioaccumulation of mercuric ion by genetically engineered E. coli JM109.

Genetically engineered E. coli JM109, namely M1, which expressed both Hg(2+) transport system and metallothionein, was tested for its capability of simultaneous growth and bioaccumulation of Hg(2+) under low nutritional circumstances. The influential factors of ambient conditions, e.g. initial concentrations of mercuric ion, ionic strength, the presence of metal chelators and other coexisting metal ions were investigated. Hg(2+) bioaccumulation behavior of M1 proved to be well coupled with its growth. NaCl was essential to the growth of M1. Of all tested NaCl concentrations, 0.04 mol/L was optimal. The presence of 0.1 mol/L CaCl(2) or MgCl(2) could promote the growth of M1 and keep the Hg(2+) removal ratio high, but the growth of M1 was inhibited seriously as the concentration of CaCl(2) or MgCl(2) reached 0.3 mol/L. Chelator EDTA had a significant influence on M1 growth and Hg(2+) bioaccumulation, while the effect of citration was little. The presence of other coexisting metal ions inhibited the growth of M1. The influential order was as follows: Cd(2+)>Zn(2+)> or =Cu(2+)>Pb(2+)>Ni(2+). However, only Cd(2+) and Cu(2+) posed obviously adverse effects on Hg(2+) bioaccumulation during the SG&B process.

[Study with large slice technique and tissue microarray on lymph node involvement and micro-metastasis of rectal cancer].

OBJECTIVE: To study lymph node involvement and micro-metastasis of rectal cancer with large slice technique and tissue microarray. METHODS: Large slice technique, combined with tissue microarray,was used in pathologic study of 31 patients after total mesorectal excision (TME) for rectal cancer. RESULTS: Nine hundred and ninety- two lymph nodes were harvested and 148 were positive. More than 40% of positive lymph nodes were located in the outer layer of the mesorectum and in the same side of the mesorectum as the primary tumor was. Circumferential margin involvement was observed in 12 cases and correlated with the numbers of metastatic lymph nodes (Beta =1.166, P=0.041). Micrometastasis was found in 9 cases with negative pathological lymph nodes, but not correlated with tumor differentiation and stage (P> 0.05). CONCLUSION: Large slice technique combined with tissue microarray facilitates the detection of lymph node involvement and micrometastasis. There is a predominance of lymph node metastasis in the outer layer and the same side of the mesorectum. Micrometastasis can be discovered in different stages of rectal cancer.

Mesorectal spread and micrometastasis of rectal cancer studied with large slice technique and tissue microarray.

BACKGROUND AND OBJECTIVES: Mesorectal tissue seems to be an ideal substrate for the spreading of tumors. The aim was to study the distribution of mesorectal neoplastic foci, examine occurrence of circumferential margin involvement and investigate micrometastasis of the lymph nodes. METHODS: A large slice technique, combined with tissue microarray, was used in the pathologic study of 31 specimens operated on following the principles of total mesorectal excision (TME). RESULTS: Three hundred and forty-nine mesorectal neoplastic foci were examined from 18 specimens. Almost one third of them were in the outer layer of mesorectum. Concerning position of primary tumor, ipsolateral neoplastic foci were significantly more than contralateral neoplstic foci. Twelve specimens were diagnosed to have circumferential margin involved. Nine hundred and ninety-two lymph nodes were harvested with 148 involved by tumor. No significant difference in occurrence of micrometastasis was observed among tumors of different stage. CONCLUSION: Combination of large slice and tissue microarray provided a more detailed method in studying the spread of rectal cancer. Complete excision of the mesorectum with fascia propria circumferentially intact is essential since there is an outer scattering and lateral discrepancy for neoplastic foci distribution. Circumferential margin involvement and micrometastasis observed suggested adoption of preoperative and/or postoperative radiochemotherapy.

Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum.

BACKGROUND AND AIMS: Local recurrence after rectal cancer surgery is conceived to result from microscopically incomplete resection. We aimed to investigate the patterns of mesorectal neoplastic foci, and examined the involvement and micrometastasis of lymph nodes. METHODS: Observation of large tissue slice and analysis of tissue microarray were integrated in the pathological study of 31 total mesorectal excision (TME) specimens. RESULTS: Altogether, 349 mesorectal neoplastic foci were examined from 18 specimens. Almost 33% of them were in the outer layer of mesorectum. Concerning position of primary tumor, ipsilateral neoplastic foci were significantly more than contralateral neoplastic foci. Distal mesorectal spread was found in four patients with the distance ranging from 1 to 3.5 cm. Four specimens were diagnosed to have circumferential margin involved. Nine hundred seventy-two lymph nodes were harvested with 128 involved by tumor. No significant difference in occurrence of micrometastasis was observed among tumors of different stage. CONCLUSIONS: Combination of large tissue slice and tissue microarray provided a more detailed method in studying the metastasis of rectal cancer. Complete excision of the mesorectum with fascia propria circumferentially intact is essential. Circumferential margin involvement and micrometastasis suggested that tumor spread may go beyond the scope of a single TME procedure.

Nodal spread and micrometastasis within mesorectum.

AIM: To study the distribution of positive lymph nodes within mesorectum and to investigate the possible micrometastasis in negative lymph nodes. METHODS: Large slice technique combined with tissue microarray was used in the pathologic study of 31 specimens. RESULTS: A total of 992 lymph nodes were harvested and cancer metastasis was found in 148 lymph nodes. Some positive lymph nodes were located in the outer layer of mesorectum and more at the same site of mesorectum as the primary tumor. Circumferential margin lymph node metastasis was observed in nine cases. No significant difference in occurrence of micrometastasis was observed in different stage tumors. CONCLUSION: Positive lymph nodes are distributed in mesorectum and micrometastasis can be found in negative lymph nodes.

[Mesorectal spread and circumferential margin involvement of rectal cancer studied on large slice].

OBJECTIVE: To provide the mode of cancer distribution in the mesorectum and circumferential resection margin. METHODS: Large slice technique was used in the pathologic study of 62 specimens operated on following the principles of total mesorectal excision (TME). RESULTS: More than 40% of all the observed neoplastic foci were located in the outer layer of the mesorectum in Stage III patients. Further analysis of the foci's localities with respect to the primary tumor's locality showed that ipsolateral neoplastic foci (44.44%) were significantly more than the contralateral neoplastic foci (13.33%) in the mesorectum (P<0.05). Extramural distal spread was found in 8 cases with the maximum extent of 3.5 cm. No significant difference in occurrence of circumferential margin involvement (CMI) was observed among tumors of different location, but tumors of poorer differentiation were noted to have a higher risk of CMI. CONCLUSION: Large slice technique offers a whole image of rectum, mesorectum, together with the position of neoplastic foci. There are outer preponderance and lateral discrepancy of neoplastic foci distribution in the mesorectum. A distal clearance margin of 4 cm would be mandatory. We advocate the adoption of TME as the baisc surgical principles in treating patients with rectal cancer and in avoiding surgery-related circumferential margin involvement.

Tumor micrometastases in mesorectal lymph nodes and their clinical significance in patients with rectal caner.

AIM: To investigate the number, size, and status of lymph nodes within the mesorectum and to explore the prognostic significance of lymph node micrometastases in patients with rectal cancer. METHODS: Thirty-one patients with rectal cancer undergone total mesorectal excision between October 2001 and October 2002 were included. Mesorectal nodes retrieved from the resected specimens were detected with a combination of haematoxylin and eosin (HE) staining and immunohistochemistry (IHC). The relations between lymph node metastases, micrometastases and postoperative recurrence were analyzed. RESULTS: A total of 548 lymph nodes were harvested, with 17.7+/-8.2 nodes per case. The average number of metastatic nodes in HE-positive patients and micrometastatic nodes in IHC-positive patients was 5.2+/-5.1 per case and 2.2+/-1.3 per case, respectively. The mean size of all nodes and metastatic nodes was 4.1+/-1.8 mm and 5.2+/-1.7 mm in diameter, respectively. The mean size of micrometastatic nodes was 3.9+/-1.4 mm in diameter. The size of the majority of mesorectal nodes (66.8%), metastatic nodes (52.6%), and micrometastatic nodes (79.5%) was less than 5 mm in diameter. During a median follow-up period of 24.6+/-4.7 mo, 5 patients (16.7%) had recurrence, of them 2 died and 3 survived. Another case died of tumor unrelated cause and was excluded. All 5 recurrent cases had 3 or more nodes involved, and one of them developed only lymph node micrometastases. The mean number of both metastatic and micrometastatic nodes per case differed significantly between the recurrent and non-recurrent groups (P<0.01 and P = 0.01, respectively). CONCLUSION: The majority of lymph nodes, metastatic, and micrometastatic lymph nodes within the mesorectum are smaller than 5 mm in diameter. The nodal status and the number of lymph nodes involved with tumor metastases and micrometastases are related to the rapid postoperative recurrence.

Laparoscopic management of severe acute pancreatitis.

INTRODUCTION: Severe acute pancreatitis (SAP) remains a serious disease state difficult to manage. Laparoscopic surgery represents a relatively new solution to this problem. This study was aimed to investigate the feasibility of laparoscopic treatment of SAP and the selection of laparoscopic procedures in various stages of SAP according to different pathologic alterations. METHODS: Thirteen patients, 9 men and 4 women with an average age of 46 years old, were diagnosed with SAP. Laparoscopic necrosectomy followed by external drainage were performed on 7 patients with massive fluid collections and/or infected necrosis in acute reaction phase of SAP. For 2 cases in subacute phase characterized by fresh-formed adhesions and encapsulation, laparoscopic intracavitary debridement experienced difficulty. For the other 4 patients in late phase with well-defined pancreatic or peripancreatic pseudocyst/abscess, ultrasound-guided, directly visualized laparoscopic intracavitary debridement, and external drainage were carried out with ease and efficiency. RESULTS: Laparoscopic procedures were accomplished successfully on 12 patients (92.3%), except for 1 conversion (7.7%) to open laparotomy owing to poor exposure and hard maneuvers in subacute phase. There was no mortality in this group. Patients were witnessed to have accelerated recovery following laparoscopic surgery. CONCLUSION: Laparoscopic technique offers new hope for the treatment of SAP. It is recommended as a feasible, effective, and less traumatic therapeutic means on condition that the strategy of individualization is followed.