Robotic versus Laparoscopic Total Mesorectal Excision Surgery in Rectal Cancer: Analysis of Medium-Term Oncological Outcomes.

Background. Robotic systems can overcome some limitations of laparoscopic total mesorectal excision (L-TME), thus improving the quality of the surgery. So far, many studies have reported the technical feasibility and short-term oncological results of robotic total mesorectal excision (R-TME) in treating rectal cancer (RC); however, only a few evaluated the survival and long-term oncological outcomes. The following study compared the medium-term oncological data, 3-year overall survival (OS), and disease-free survival (DFS) of L-TME and R-TME in patients with rectal cancer. Methods. In this retrospective study, records of patients (patients with stage I-III rectal cancer) who underwent surgery (127 cases of L-TME and 148 cases of R-TME) at the Gansu Provincial Hospital between June 2016 and March 2018 were included in the analysis. Kaplan-Meier analysis evaluated the 3-year OS and DFS for all patients treated with curative intent. Results. The conversion rate was significantly higher, and the postoperative hospital stay was significantly longer in the L-TME group than in the R-TME group (all P<.05). Major complications were significantly lower in the robotic group (P<.05). The 3-year DFS rate (for all stages) was 74.8% for L-TME and 85.8% for R-TME (P = .021). For disease stage III, the 3-year DFS and OS were significantly higher in the R-TME group (P<.05). Conclusion. R-TME can achieve better oncological outcomes and is more beneficial for RC patients compared with L-TME, especially for those with stage III rectal cancers. Nevertheless, further randomized controlled trials and a longer follow-up period are needed to confirm these findings.

Comparison of laparoscopic complete mesocolic excision and traditional radical operation for colon cancer in the treatment of stage III colon cancer.

PURPOSE: To compare the clinical efficacy and safety between laparoscopic complete mesocolic excision (CME) and traditional radical operation for colon cancer in the treatment of stage III colon cancer. METHODS: A total of 196 patients with stage III colon cancer treated in out hospital from January 2014 to February 2016 were selected and divided into two groups using a random number table. One group (CME group, n=98) received laparoscopic CME, while another group (Traditional group, n=98) underwent traditional radical operation for colon cancer. The surgery-related indexes and perioperative complications were compared between the two groups, the pathological diagnosis of the patient's surgical specimens was recorded, and the survival of all patients was followed up. RESULTS: The general clinical characteristics of the patients were comparable between the two groups, and no perioperative death occurred. The operation time had no statistically significant difference between the two groups (p=0.190). There was overtly less intraoperative blood loss and shorter postoperative hospital stay in the CME group than those in the Traditional group (129.35±34.54 mL vs. 162.43±38.16 mL, p<0.001, 13.8±3.1 days vs. 15.2±3.4 days, p=0.003). There were no statistically significant differences in the indwelling time of drainage tube after operation, the time of liquid diet after operation and the recovery time of normal diet after operation between the two groups (p>0.05). The time for passage of flatus after operation was significantly shorter in the CME group than that in the Traditional group (p=0.016). The incidence rate of postoperative complications was lower in the CME group (12.2%) than that in the Traditional group (17.3%), but the difference was not statistically significant (p=0.421). The comparisons of surgical specimens revealed that there were no statistically significant differences in tumor size, stage, histopathological classification and differentiation grade between the two groups (p>0.05). The number of lymph nodes dissected and the number of positive lymph nodes detected were clearly greater in the CME group than in the Traditional group (p<0.001). At the end of the follow-up, the overall survival rate and tumor-free survival rate were notably higher in the CME group than in the Traditional group (p=0.046, p=0.038). CONCLUSION: In comparison with traditional radical operation for colon cancer, laparoscopic CME has higher yield of lymph nodes dissected, smaller intraoperative blood loss, no increase in perioperative complications, and higher overall survival and tumor-free survival of patients, demonstrating it as safe and applicable in the treatment of stage III colon cancer.

Synchronous double primary gastric and endometrial cancer: a case report and literature review.

Multiple primary malignant neoplasms (MPMN) are two or more malignancies in an individual without any relationship between the tumors. In recent years, increasing number of cases were reported. However, Synchronous double primary gastric and endometrial cancer are relatively rare to be reported. Here we present a rare case of synchronous double cancer involving the stomach and endometrium, which is resected simultaneously and received six times chemo. After reviewing lots of literatures at home and abroad, we discuss the risk factors, the diagnostic criteria, the treatment modalities and the prognosis of these rare MPMN. Although a number of risk factors have been proposed in a mass of literatures, but the mechanism of MPMN is still unclear. We didn't discover a detailed explanation for the mechanism of MPMN from our patient. Therefore, further research should focus on the etiology and mechanism of MPMN.

[S-Adenosylmethionine Inhibits Expression of Vascular Endothelial Growth Factor-C Protein and Cellular Proliferation in Gastric Cancer].

OBJECTIVE: To explore inhibitory effects of S-adenosylmethionine on vascular endothelial growth factor-C (VEGF-C) protein and cellular proliferation in gastric cancer by regulating methylation status of VEGF-C promoter. METHODS: MTT analyses and nude mice model were employed to examine the effects of S- adenosylmethionine on inhibiting gastric cancer growth in vitro and in vivo. The protein expression of VEGF-C in gastric cancer cells was assessed by Western blot. The methylation status of VEGF-C promoter was assessed by bisulfite genomic DNA sequencing analysis. RESULTS: VEGF-C promoter was hypomethylated in MGC803 and SGC7901. The treatment of S-adenosylmethionine resulted in a heavy hypermethylation of VEGF-C promoter, which consequently down regulated protein level of VEGF-C. S-adenosylmethionine effectively inhibited the growth of gastric cancer cells in vitro and in vivo (P<0. 05). CONCLUSION: S-adenosylmethionine can effectively reverse DNA hypomethylation on VEGF-C promoter which down-regulates VEGF-C protein expression and inhibit gastric cancer growth.

Alterations in vitamin D signaling pathway in gastric cancer progression: a study of vitamin D receptor expression in human normal, premalignant, and malignant gastric tissue.

Amount of studies in cells and animal models have proved vitamin D has multifarious antitumor effects. However, epidemiological studies showed inconsistent result on gastric cancer. The antitumor role is mainly mediated by the vitamin D receptor (VDR). Our hypothesis is that VDR may be abnormally (poorly) expressed in gastric cancer tissue. Present study is aimed at discovering and analyzing VDR expression in a series of human gastric tissues, including normal, premalignant, and malignant gastric tissue, and correlated VDR to the clinicopathological parameters of gastric cancer patients. VDR expression was detected by immunohistochemistry. The χ(2) test was used to analyze the VDR expression as well as the relationship between VDR and the clinicopathological factors of gastric cancer patients. Compared with normal (82.61%) and premalignant tissues (73.64%), VDR was lower expressed in cancer tissues (57.61%), with a statistically significant difference (P = 0.001). Among cancer tissues, VDR was higher expressed in well and moderate differentiated tissues contrasted with tissues with poor differentiation, and higher expressed in small tumors (< 5 cm) compared with large tumors (≥ 5 cm), with a statistically significant difference respectively (P = 0.016, P = 0.009). A decline linear trend appeared when analyzing the statistical difference of VDR expression among normal, premalignant, and malignant gastric tissues. VDR expression has been on the decline from the premalignant stage, finally low expressed in gastric cancer tissues, especial in poorly differentiated tissues. VDR could be a potential prognostic factor for patients with gastric cancer.

Expression of MACC1 and c-Met in human gastric cancer and its clinical significance.

BACKGROUND: Recent studies have suggested that the metastasis-associated colon cancer1 (MACC1) gene can promote tumor proliferation, invasion and metastasis through an upregulation of c-Met expression. However, its role in gastric cancer is controversial. Our study investigated expression of MACC1 and c-Met in gastric cancer, as well as correlated this with clinicopathological parameters. METHODS: Expressions of MACC1 and c-Met protein in a sample of 98 gastric carcinoma and adjacent nontumorous tissues were detected by immunohistochemistry. Their relationships and correlations with clinicopathological features were analyzed. RESULTS: The positive rates of MACC1 and c-Met protein in primary tumors were 61.22% and 59.18%, respectively. A significant correlation was found between expression of MACC1 and c-Met (P<0.05). Expression of the MACC1 protein in gastric cancer tissue was correlated with lymph node metastasis (χ2 = 10.555,P = 0.001), peritoneal metastasis (χ2 = 5.694, P = 0.017), and hepatic metastasis (χ2 = 4.540,P = 0.033), but not with age, gender, tumor size, location, clinical stage or the distant metastases (P>0.05). CONCLUSION: The positive rate of MACC1 protein expression was related to the protein expression of c-Met. Both had a correlation with the presence of peritoneal metastasis, lymph node metastasis and hepatic metastasis, all of which contribute to a poor prognosis for gastric cancer patients.

RNAi-mediated gene silencing of vascular endothelial growth factor-C inhibits tumor lymphangiogenesis and growth of gastric cancer in vivo in mice.

Overexpression of vascular endothelial growth factor-C (VEGF-C) has been implicated as a critical molecular signal in tumor development by promoting intratumoral lymphangiogenesis. The aim of this study was to explore whether small hairpin RNA (shRNA) targeting VEGF-C could inhibit gastric cancer lymphangiogenesis and tumor growth. Plasmid-mediated expression of VEGF-C-shRNA was employed to silence VEGF-C gene expression in human SGC-7901 cell lines. The inhibition of the target gene expression was quantified by real-time quantitative polymerase chain reaction, Western blotting, and enzyme-linked immunosorbent assay. In vitro, the cell viability was determined by MTT assay, flow cytometry analysis, and migration assay. After VEGF-C knockdown was confirmed, the stable cells were inoculated into nude mice. Tumor growth, lymph vessel density (LVD), and microvascular density were compared for mice administered either VEGF-C-shRNA or control. VEGF-C-shRNA causes effective and specific downregulation of VEGF-C expression (P<0.05). The migration activity of SGC-7901 cells was attenuated in vitro (P<0.05). Tumor growth rate and LVD was suppressed in vivo (P<0.05). VEGF-C-shRNA effectively suppressed gastric cancer cell migration in vivo, retards tumorigenicity, and lymphangiogenesis in nude mice.