Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy.

INTRODUCTION: This study aimed to evaluate the safety of an inguinal hernia repair (IHR) under local anesthesia (LA) in the elderly with a perioperative continuation of antithrombotic therapy (AT). METHODS: A total of 120 patients undergoing elective primary IHR between August 2018 and August 2019 at the West China Hospital of China were prospectively studied, among which 60 patients also had coexisting cardiovascular diseases and had a continuation of AT perioperatively (antithrombotic group); the other 60 patients were not on any prior AT (control group). The primary endpoints were intra- and postoperative hemorrhagic complications, the required interventions for complications based on the Clavien-Dindo classification, and postoperative thromboembolic complications. The secondary endpoints were nonhemorrhagic complications, intraoperative duration, and postoperative length of stay (LOS). RESULTS: None of the patients in both groups had significant intraoperative bleeding >10 mL, and there were no significant differences between the 2 groups in terms of the postoperative hemorrhagic complications: bruising (2 vs. 0%, p = 1.000), serosanguinous soakage (7 vs. 3%, p = 0.679), and no hematoma was observed. Interventions required for encountered complications based on the Clavien-Dindo classification grade I (7 vs. 5%, p = 1.000) were assessed. There were no episodes of postoperative thromboembolic complications within 60 days in both groups. There were also no significant differences between the 2 groups in terms of nonhemorrhagic complications, intraoperative duration, and postoperative LOS (p > 0.05 in all). CONCLUSIONS: The perioperative continuation of AT did not increase the risk of intra- and postoperative hemorrhagic complications following IHR in the elderly. Thus, IHR under LA seems to be safe and feasible in this setting.

Clinical, surgical characteristics and long-term outcomes of lumbar hernia.

BACKGROUND/AIM: Lumbar hernia is caused by a defect in the abdominal wall. Due to its rarity, there is no established consensus on optimal treatment for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients from our hospital. METHODS: Patients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded. RESULTS: A consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46%) and 15 females (54%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6 ± 14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39%), 15 (54%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89%) and 3 (11%) patients. General anesthesia was adopted in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5 ± 1.3 days vs. 7.1 ± 3.2 days, p = 0.001), as well as total hospitalization expenses between the two groups (2989 ± 1269 dollars vs. 1299 ± 229 dollars, p < 0.001). With a median follow-up duration of 45.9 months (range: 1-113 months), only 1 (3%) lumbar hernias recurred for the entire cohort. CONCLUSIONS: Lumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia.

Repair of a medium-sized ventral hernia with the UltraPro Hernia System.

Mesh repairs are widely accepted as a suitable option for ventral hernia repair. Among the various devices and surgical approaches used for ventral hernia repair, the UltraPro Hernia System (UHS) is considered an effective method of open repair for patients with medium ventral hernia defects between 3 and 5 cm in diameter. However, few clinical studies on this system have been reported. We describe a simple and safe UHS mesh technique for open ventral hernia repair, which was performed successfully under local anesthesia in 23 patients with medium ventral hernia defects. Minor postoperative complications included seroma (n = 3) and a superficial infection (n = 1). There was no incidence of recurrence in 12 months of follow-up. Our results show that the UHS is simple and easily reproducible for medium ventral hernia defects between 3 and 5 cm in diameter.

Application of double circular suturing technique (DCST) in repair of giant incision hernias.

BACKGROUND: Our study aims to explore the feasibility and safety of a double circular suturing technique (DCST) in the repair of giant incision hernias. METHODS: The clinical data of 221 patients (95 men and 126 women; the average age was 61.6 years) receiving DCST in the repair of giant incision hernia between January 2010 and December 2018 was analyzed retrospectively. One hundred and five primary and 16 recurrent patients underwent herniorrhaphy with anti-adhesion underlay mesh repair using DCST. RESULTS: All the 221 operations were performed successfully. The average preparation time before the operation and hospital stays were 3.7 days (range, 1-6 days) and 7.5 days (range, 2-16 days), respectively. The average diameter of the hernia ring defect observed intraoperatively was 16.4 cm (range, 12-22 cm). The average time of operation was 83.6 min (range, 43-195 min). There were 2 cases of intestinal fistula, 4 cases of wound infection, 2 cases of mesh infection, 7 cases of serum tumescence, 3 cases of pulmonary infection, and 2 cases of wound dehiscence occurred. One hundred and ninety-five patients were followed up for 6.7 years (range, 0.8-9.5 years) postoperatively. Of them, 9 patients recurred; 14 patients had chronic pain whose visual analog scale (VAS) was 2-4 cm (average 2.7 cm). CONCLUSIONS: With limited preparation time before operations, few postoperative complications, and recurrence rate, DCST in the repair of giant incision hernia is safe and possible clinically.

Gilbert double layer graft method for groin hernias in patients with ascites: A retrospective study of 81 patients.

BACKGROUND: Patients with ascites undergoing an inguinal hernia repair have an increased rate of both morbidity and mortality compared with those without ascites, leading to controversy regarding the indications for herniorrhaphy in patients with ascites. The purpose of this retrospective study was to analyze the clinical results of a tension-free herniorrhaphy using the Gilbert approach in 81 patients with an inguinal hernia complicated by the presence of ascites. METHODS: We analyzed retrospectively the clinical data of 81 patients with ascites who underwent a tension-free hernia repair between November 2008 and November 2014 at the West China Hospital of Sichuan University. The underlay patch of the mesh device was spread to cover the entire posterior surface of the myopectineal orifice, while the onlay patch of the device was placed anterior to the transversalis fascia and fixed to the conjoint tendon and the inguinal ligament with single sutures. All patients were followed up via phone calls and outpatient examinations for 24 months until November 2016. RESULTS: The operation was completed successfully in all patients. The mean operative time was 46 ± 20 minutes (range 20-255 minutes). A drain was left in the wound in 65 cases and was removed at a median of 3 days (interquartile range 2-4) after the operation. The hospital stay after the operation was 3 ± 2 days (range 1-12 days). Postoperative complications included a seroma in 9 patients, scrotal edema in 4 patients, and no wound infections. There was no recurrence of the hernia after 24 months of follow-up in any patient. CONCLUSION: The Gilbert, double-layer, tension-free herniorrhaphy, according to the principles of the Gilbert operation, is both feasible and safe for selected patients with a symptomatic inguinal hernia who also have ascites.

Application of double circular suturing technique (DCST) in the repair of large abdominal wall defects after resection of abdominal wall tumor.

BACKGROUND: The aim of this study was to investigate the clinical effects of repairing large defects using the double circular suturing technique (DCST) after resection of abdominal wall tumor. METHODS: The clinical data of 62 patients (25 men, 37 women; average age 41.7±22.4 years) who underwent DCST between October 2010 and November 2018 for the repair of large abdominal wall defects with anti-adhesion underlay mesh after resection of abdominal wall tumor were retrospectively analyzed. The maximum diameter of abdominal wall defect after resection of abdominal wall tumor was 10.4±5.6 cm. The course of disease was 1-341 months, and the average was 32.4 months. Operative time, postoperative hospitalization time, perioperative complications, tumor recurrence in situ, incidence of postoperative chronic pain, and hernia were recorded. RESULTS: All 62 operations were completed successfully. The operative time was 73.2±31.4 minutes, and the mean postoperative hospitalization time was 9.6 days (range, 2-20 days). In total, 54 patients were followed up postoperatively for a median 6.7 years (range, 0.9-9.0 years). Partial splitting of incisions occurred in 2 patients, fat liquefaction of incisions occurred in 3 patients, and chronic pain occurred in 4 patients. No tumor in situ recurrence, hernia, or other complications were found in any cases in the follow-up. Tumor metastasis occurred in 9 patients with 6 of these patients dying of tumour progression. CONCLUSIONS: With simple operations, short procedure time, few complications, low tumor recurrence rate, and low incidence of postoperative chronic pain, application of DCST in the repair of large abdominal wall defects is effective after resection of abdominal wall tumor.

A prospective Study on Femoral Hernia Repair: Is the Inguinal Better Than The Infrainguinal Approach?

BACKGROUND: Femoral hernia repair has various surgical methods. However, controversy still exists regarding the best method for management. This study aimed to compare the infrainguinal with the inguinal approach in the treatment of femoral hernias. MATERIALS AND METHODS: Eighty patients with primary unilateral femoral hernias were prospectively randomized to either the infrainguinal (n = 40) or inguinal approach groups (n = 40). Patient demographics, operative time, duration of hospital stay, postoperative complications, and recurrence rate were recorded. RESULTS: There were no statistically significant differences between both study groups with respect to the patients' demographics and associated comorbidities. Regarding inpatient outcomes, there were no differences between the infrainguinal and inguinal approach groups concerning the postoperative duration of stay (P = 0.248), urinary retention (P = 0.494), superficial wound infection (P = 0.494), seroma (P = 0.615), foreign body sensation (P = 0.615), and chronic pain (P = 0.359). However, total complications were encountered in 3 patients (7.5%) in the infrainguinal approach group compared to 11 patients (27.5 %) in the inguinal approach group (P = 0.037). Also, the mean operative time was significantly shorter in the infrainguinal approach group compared to that in the inguinal group (P < 0.001). Throughout the 15 mo median follow-up duration, there was no recurrence in the inguinal approach group and one (2.5%) recurrence in the infrainguinal approach group (P = 1.000). CONCLUSIONS: In patients undergoing elective primary femoral hernia repair, the infrainguinal approach has a similar clinical curative effect to that of the inguinal approach. However, the former has the advantages of simple operation, short operation time, and fewer complications.

Retrospective analysis of smaller than 3-cm umbilical hernia repair with the lightweight macroporous mesh.

There is evidence that mesh repair for primary umbilical hernias results in fewer recurrences and similar wound complication rates compared to tissue repair. Various devices and surgical approaches are used in umbilical hernia repair. The ULTRAPRO PLUG (UPP) has been adopted for inguinal hernias and femoral hernias with excellent results. However, there are few reports on the use of UPP for umbilical hernia repair. Thus, the aim of this study was to evaluate efficacy and safety in the treatment of smaller than 3-cm umbilical hernias using the UPP.The medical records of 123 patients who underwent umbilical hernia repair using the UPP between October 2011 and September 2017 were reviewed. All patients were followed-up after 1 month and later in 2018. Demographics, surgical information, and immediate postoperative and long-term complications were assessed.Out of 123 patients, there were 37 male and 86 female patients with a mean age of 50.6 years. The median duration of hernia surgery was 20.5 min (range, 12-34), and 109 (88.6%) patients underwent day surgery. The median defect diameter was 1.4 cm (range, 0.5-3). No mortality or major complications occurred during the perioperative period. Long-term follow-up data were available for 107 (87.0%) patients. The median follow-up duration was 33 months (range, 5-76 months). Early postoperative complications included 1 case of seroma, 2 cases of fat liquefaction, and 1 case of superficial surgical site infection. During follow-up, there were 2 recurrences, 1 case of chronic mesh infection, and 2 patients with chronic postoperative pain.The ULTRAPRO PLUG offers a simple and quick means of repairing smaller than 3-cm umbilical hernias with lower recurrence rates and fewer postoperative complications.

[EFFECTIVENESS OF PREPERITONEAL HERNIORRHAPHY WITH Ultrapro Plug MESH FOR UMBILICAL HERNIA REPAIR IN ADULTS].

OBJECTIVE: To explore the effectiveness of preperitoneal herniorrhaphy with Ultrapro Plug (UPP) mesh for umbilical hernia repair in adults. METHODS: Between September 2011 and June 2015, 71 patients with umbilical hernia underwent preperitoneal herniorrhaphy with UPP mesh. There were 26 males and 45 females, aged 19-92 years (mean, 54.3 years). The disease duration was 45 days to 30 years (median, 18 months). Umbilical hernia was diagnosed through physical examination, ultrasound, and other relevant auxiliary examination. According to American Society of Anesthesiologists (ASA) classification, 12 cases were rated as grade Ⅰ, 34 cases as grade Ⅱ, 21 cases as grade Ⅲ, and 4?cases as grade Ⅳ. The operation time, postoperative hospitalization time, complication, and recurrence were recorded. RESULTS: The diameter of hernia ring ranged 0.5-3.0 cm (mean, 1.8 cm). There was no vessel or intestine injury. The operation time was 12-35 minutes (mean, 22.4 minutes); postoperative hospitalization time was 12-48 hours (mean, 16.3 hours). Fat liquefaction of incision occurred in 2 cases, and primary healing of incision was obtained in the other cases. Sixty-nine patients were followed up 8-51 months (median, 28 months). Hernia recurrence and patch infection occurred in 1 case respectively during follow-up. No postoperative foreign body sensation and chronic pain occurred. CONCLUSIONS: Repairing umbilical hernia in adults with UPP mesh should be safe and reliable, because it has the advantages of short operation time, short hospital stay, less complication, and lower incidence of recurrence.

Long-term results of femoral hernia repair with ULTRAPRO Plug.

BACKGROUND: The infrainguinal plug technique for femoral hernia (FH) has gained popularity for its feasibility, simplicity, and encouraging rate of success, but materials and structures of traditional mesh plugs may cause postoperative discomfort, plug migration, and even recurrence. The new hernia repair device ULTRAPRO Plug (UPP) may avoid those problems. MATERIALS AND METHODS: In 121 of patients, a total of 125 elective FH repairs with UPP were performed between March 2009 and March 2013. Demographics, surgical information, and outcome were assessed. RESULTS: Out of 121 patients, 105 were female. The mean age was 57.6 y. FHs occurred more often on the right (72) than the left (45), and in 4 patients the hernias were bilateral. Mean duration of a hernia surgery was 14.7 min, and 91% patients were discharged within 24 h. Mean time to complete return to daily activities was 7.4 d. No mortality or major complications occurred during the perioperative period. Median follow-up was 26 mo, and the total follow-up rate was 91%. No recurrence or chronic mesh infection was noted. Postoperative chronic pain in two patients, sensory loss in one patient, and foreign body sensation in three patients were found in the follow-up. CONCLUSIONS: Repair of FHs with UPP through an infrainguinal approach is a simple and effective procedure without major postoperative events.

Low concentrations of lidocaine for inguinal hernia repair under local infiltration anaesthesia.

OBJECTIVE: A randomized, double-blind, prospective, controlled study to determine the lowest concentration of lidocaine that provides satisfactory anaesthesia and analgesia for inguinal hernia repair. METHODS: Patients with inguinal hernia undergoing tension-free mesh repair under local infiltration anaesthesia were randomized to receive 0.25% (Group A), 0.33% (Group B) or 0.5% (Group C) lidocaine. Total dose and volume of lidocaine consumed and intraoperative visual analogue scale (VAS) pain scores were recorded for each patient. Each patient's degree of satisfaction and the incidence of anaesthesia- and procedure-related complications were recorded and assessed. RESULTS: A total of 120 patients were randomized. There were no between-group differences in median VAS scores, degree of satisfaction, volume of lidocaine consumed or incidence of complications. Patients in group A consumed significantly lower doses of lidocaine than those in both other groups. CONCLUSIONS: The mean dose of lidocaine consumed in group A was significantly lower but exerted similar efficacy to that in the other groups, and may lead to a lower risk of local anaesthetic toxicity.

[Effectiveness of tension-free herniorrhaphy with UPP mesh through a femoris approach for femoral hernia repair].

OBJECTIVE: To explore the effectiveness of tension-free herniorrhaphy with Ultrapro Plug (UPP) mesh through a femoris approach for femoral hernia repair. METHODS: Between March 2009 and January 2013, 123 patients (126 sides) underwent tension-free herniorrhaphy with UPP mesh through a femoris approach. There were 17 males and 106 females, aged 32-95 years (mean, 63.3 years). The locations were the left side in 48 cases, the right side in 72 cases, and both sides in 3 cases. The disease duration was 1 month to 26 years (median, 25 months). Of 123 cases, 35 cases (36 sides) were reducible and 88 cases (90 sides) were irreducible. According to American Society of Anesthesiologists (ASA) classification, 20 cases were rated as grade I, 42 cases as grade II, 56 cases as grade III, and 5 cases as grade IV. The operation time, postoperative hospitalization time, complication, recurrence, and chronic pain were recorded. RESULTS: The operation time was 7-28 minutes (mean, 14.5 minutes); postoperative hospitalization time was 2-96 hours (mean, 19.4 hours) (112 patients discharged from hospital within 24 hours). Wound dehiscence occurred in 1 case and fat liquefaction in 2 cases. A total of 119 patients (122 sides) were followed up 4-50 months (median, 18 months); no recurrence was noted. Two cases (2 sides) suffered from chronic pain after operation, whose visual analogue scale (VAS) was 20 mm and 30 mm, respectively. CONCLUSION: Tension-free herniorrhaphy with UPP mesh through a femoris approach should be recommended because it has the advantages of simple operation, short operation time, less complication, and lower incidence of chronic pain.

New minimally invasive technique for repairing femoral hernias: 3-D patch device through a femoris approach.

BACKGROUND: Femoral hernias are less common than inguinal hernias. The use of preformed mesh to repair femoral hernias without tension has become increasingly common. We sought to investigate the safety and feasibility of repairing femoral hernias with a Prolene 3-dimentional (3-D) patch using a femoris approach. METHODS: We identified all consecutive patients with femoral hernias treated at our centre with a Prolene 3-D patch using a femoris approach in our institution over a 5-year period (2004-2009). We assessed duration of surgery, length of stay in hospital, recurrence, postoperative pain and complications. RESULTS: We repaired 73 hernias with this technique during the study period. The mean duration of surgery was 13.1 minutes, most patients were discharged in less than 24 hours, no recurrence was noted, and only minor complications occurred. CONCLUSION: This technique has not only the same advantage of other tension-free repairs, but also the advantages of convenience and shorter duration of surgery.

[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.

[Lateral pelvic metastasis and micrometastasis in low rectal cancer].

OBJECTIVE: To study lateral pelvic metastasis and micrometastasis of low rectal cancer and elucidate their prognostic value. METHODS: Whole-mount slice and tissue microarray of dissected lateral pelvic specimen from 67 cases of low rectal cancer were examined, and the included cases were followed up. RESULTS: Twelve specimens were diagnosed as lateral metastasis, while another 10 were proved to bear micrometastasis. Most of the involved metastatic lymph nodes (82.9%) were smaller than 5 mm in diameter. Internal iliac, obturator regions and middle rectal root were more likely to be involved by tumors. Patients with lateral metastasis suffered more recurrence and poorer survival. CONCLUSIONS: Lateral pelvic metastasis could be observed in low rectal cancer and its incidence differed among lateral pelvic regions. Patients with lateral spread predisposed poor prognosis, thus underlies the value of pre/postoperative adjuvant therapy.

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.

[Evaluation of clinical necessity of gastrointestinal decompression after excision and anastomosis of lower digestive tract].

OBJECTIVE: To evaluate the clinical necessity of postoperative gastrointestinal decompression after operation on lower digestive tract. METHODS: Three hundred and sixty-eight patients who required excision and anastomosis of lower digestive tract were randomly divided into two groups, with or without receiving gastrointestinal decompression after operation. Clinical therapeutic efficacy and complications were compared between two groups. RESULTS: The volume of gastrointestinal suction ranged from 10 ml to 520 ml each day after operation, and was less on the first day than those on the second and the third day after operation in decompression group. There was no significant difference in the average girth between two groups before and after operation. The average girths were shorter before operation than those after operation in two groups (P< 0.001). There was no significant difference in postoperative defecation and urination time between two groups (P > 0.05). The complication rate was significantly higher in decompression group than that in non-decompression group (28% vs. 8.2%, P< 0.001). The incidence of pharyngolaryngitis was up to 23.1% in decompression group. There was no difference in hospital stay between the two groups after operation. CONCLUSION: The recovery of patients who receive excision and anastomosis of lower digestive tract will benefit from non-gastrointestinal decompression.

[Expression of phosphatase of regenerating liver-3 mRNA and its clinical implications in human colorectal carcinoma].

OBJECTIVE: To investigate the expression of phosphatase of regenerating liver-3 (PRL- 3) mRNA and evaluate its relationship with tumor invasion and metastasis in human colorectal carcinoma. METHODS: The expression level of PRL-3 mRNA was examined semi-quantitatively in surgically resected tumor specimens, paired paratumor normal tissues from 46 CRC patients, metastatic lymph nodes and liver metastases from 18 cases with metastasis,adenoma tissues from 6 patients with colorectal adenoma (CRA). In addition,the mutation of PRL-3 gene was examined by PCR-SSCP. RESULTS: The PRL-3 mRNA level was increased in primary CRC tissues as compared with paired paratumor normal tissues (1.6+/- 0.7 vs. 0.4+/- 0.1, P< 0.01), while no significant difference of its expression was found between CRA tissues and their adjacent normal mucosae (P> 0.05). However,the PRL-3 mRNA levels of liver metastases (2.1+/- 0.8) in 12 cases and metastatic lymph nodes (3.3+/- 1.0) in 6 cases were significantly higher compared with the matched primary lesions, normal tissues and negative-lymph nodes (P< 0.01). There was significant relation of the expression of PRL-3 mRNA with the clinicopathological features including Dukes stage, invasion depth and metastasis (P< 0.05), but no relation with sex,tumor size,degree of differentiation was found (P> 0.05). Abnormal electrolysis band was found in 1 of 6 cases with liver metastasis by PCR-SSCP analysis. CONCLUSION: PRL-3 gene plays an important role in tumor invasion and metastasis and may associated with carcinogenesis and development of CRC. There might exist some unknown mechanisms of overexpression and mutation of PRL-3 gene in CRC.

Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin.

AIM: Local recurrence after curative surgical resection for rectal cancer remains a major problem. Several studies have shown that incomplete removal of cancer deposits in the distal mesorectum contributes a great share to this dismal result. Clinicopathologic examination of distal mesorectum in lower rectal cancer was performed in the present study to assess the incidence and extent of distal mesorectal spread and to determine an optimal distal resection margin in sphincter-saving procedure. METHODS: We prospectively examined sepecimens from 45 patients with lower rectal cancer who underwent curative surgery. Large-mount sections were performed to microscopically observe the distal mesorectal spread and to measure the extent of distal spread. Tissue shrinkage ratio was also considered. Patients with involvement in the distal mesorectum were compared with those without involvement with regard to clinicopathologic features. RESULTS: Mesorectal cancer spread was observed in 21 patients (46.7%), 8 of them (17.8%) had distal mesorectal spread. Overall, distal intramural and/or mesorectal spreads were observed in 10 patients (22.2%) and the maximum extent of distal spread in situ was 12 mm and 36 mm respectively. Eight patients with distal mesorectal spread showed a significantly higher rate of lymph node metastasis compared with the other 37 patients without distal mesorectal spread (P = 0.043). CONCLUSION: Distal mesorectal spread invariably occurs in advanced rectal cancer and has a significant relationship with lymph node metastasis. Distal resection margin of 1.5 cm for the rectal wall and 4 cm for the distal mesorectum is proper to those patients who are arranged to receive operation with a curative sphincter-saving procedure for lower rectal cancer.

Gastrointestinal decompression after excision and anastomosis of lower digestive tract.

AIM: To discuss the clinical significance of postoperative gastrointestinal decompression in operation on lower digestive tract. METHODS: Three hundred and sixty-eight patients with excision and anastomosis of lower digestive tract were divided into two groups, i.e. the group with postoperative gastrointestinal decompression and the group without postoperative gastrointestinal decompression. Clinical therapeutic outcome and incidence of complication were compared between two groups. Furthermore, an investigation on application of gastrointestinal decompression was carried out among 200 general surgeons. RESULTS: The volume of gastric juice in decompression group was about 200 mL every day after operation. Both groups had a lower girth before operation than every day after operation. No difference in length of the first passage of gas by anus and defecation after operation was found between two groups. The overall incidence of complications was obviously higher in decompression group than in non-decompression group (28% vs 8.2%, P<0.001). The incidence of pharyngolaryngitis was up to 23.1%. There was also no difference between two groups regarding the length of hospitalization after operation. The majority (97.5%) of general surgeons held that gastrointestinal decompression should be placed till passage of gas by anus, and only 2.5% of surgeons thought that gastrointestinal decompression should be placed for 2-3 d before passage of gas by anus. Nobody (0%) deemed it unnecessary for placing gastrointestinal compression after operation. CONCLUSION: Application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce gastrointestinal tract pressure and has no obvious effect on preventing postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial to the recovery of patients without undergoing gastrointestinal decompression.