Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients.

BACKGROUND: Curative resection of hilar cholangiocarcinoma (HC) is typically carried out using open surgery. In the present study, we examined the safety (postoperative complication) and effectiveness (resection margin status and patient survival) of minimally invasive surgery (MIS) for HC. METHODS: This retrospective analysis included 158 patients receiving MIS for HC at 10 participating centers between December 2013 and November 2019. Patient demographics, surgical outcomes, and oncological outcomes were retrospectively analyzed. RESULTS: Clinical information obtained from 10 different clinical centers did not show any evident cohort-bias clustering. One hundred and twenty-six (79.7%) patients underwent LRHC, 12 (7.6%) patients underwent RARHC, conversion to an open procedure occurred in 20 (12.7%) patients. The operation time and estimated blood loss were 410.8 ± 128.9 min and 477.8 ± 706.3 mL, respectively. The surgical radicality of the 158 patients was R0, 129 (81.6%); R1, 20 (18.4%) and R2, 9 (5.7%). Grades I-II complications was occurred in 68 (43.0%) patients. Severe morbidity (grade III-V) occurred in 14 (8.7%) patients. The median overall survival in whole cohort was 25.4 months. The overall survival rate was 67.6% at year 1, 28.8% at year 3, and 19.2% at year 5. Comparing the first half of MISHC performed by each center with the following cases, the operation time and postoperative hospital stay does not decrease with the increasing cases. On literature review, MISHC is non-inferior to open surgery at least in perioperative period. CONCLUSIONS: In this Chinese MIS for HC multicenter study, the largest to date, long-term overall survival rates after MIS appear comparable to those reported in current open series. Further randomized controlled trials are necessary to assess the global impact of MISHC.

The expression and significance of CD44v17 in cervical cancer and cervical intraepithelial neoplasia / 重庆医学

Objective To analyse the expression and significance of CD44 variant (CD44v17) in the process of cervical intraepithelial neoplasia (CIN) to cervical cancer,and to explore the relationship of CD44v17 with CIN and cervical cancer.Methods The expressions of CD44v17,matrix metalloproteinase 9 (MMP9) and Ki67 in normal cervical tissue,CIN Ⅰ,Ⅱ,Ⅲ and cervical carcinoma tissues were detected by real-time quantitative RCR.The expressions of CD44v17,MMP9 and Ki67 in human cervical cancer cell lines HeLa and SiHa after transfecting with CD44v17 siRNA were detected,as well.The tumor-bearing nude mice were treated with lentivirus particles of CD44v17,and the influence of CD44v17 siRNA on tumorigenicity in nude mice was analysed.Results The expression level of CD44v17 increased gradually from CIN Ⅰ,Ⅱ,Ⅲ to cervical carcinoma tissues.Compared with normal cervical tissue,the expression levels of CD44v1 7,MMP9 and Ki67 were significantly increased in CIN Ⅱ,Ⅲ and cervical carcinoma tissues (P＜0.05),while no significant difference was found between normal cervical tissue and CIN Ⅰ tissue (P＞0.05).The expression levels of MMP9 and Ki67 in human cervical cancer cell lines HeLa and SiHa were decreased significantly after transfecting with CD44v17 siRNA (P＜0.01).The tumor volume and weight were decreased by treatment with CD44v17 siRNA transfection (P＜0.01),and the tumorigenicity in nude mice was decreased.Conclusion CD44v17 may promote the development of CIN to cervical cancer.It is expected to be an indicator in predicting malignant potential of CIN.

The expression and significance of TNF-α,IL-6, HMGB1 in the cervix uteri after the prior cervical conization / 重庆医学

Objective To investigate the dynamic changes and its significance of inflammatory factors in cervical secretions and prior cervical tissues after cervical conical resection.Methods Women who received prior cervical conization during December 2013 and December 2015 in this hospital were selected,then the cervical tissue and secretion were collected regular interval after the conization.The expression of tumor necrosis factor-α(TNF),interleukin 6 (IL-6) and high mobility group protein 1 (HMGB1) were quantitative detected and analyzed.The expression and infiltration of inflammatory cell were detected by HE and immunohistochemical staining.Results The expression of TNF-α,IL-6 and HMGB1 in cervical tissues and secretions increased gradually after priorcervical conization,which reached the peak at 1 to 2 weeks after priorcervical conization,and then gradually decreased,the differences were statistically significant when compared with the preoperative control group (P＜0.05).The inflammatory cell infiltration and the inflammatory response were most severe at 1st week after the conization.The expression of TNF-α,IL 6 and HMGB1 was at 1st week after the conization were significantly higher than that of the 4thweek group.Conclusion The cervical inflammatory were most severe after the prior cervical conization about 1-2weeks,and the hysterectomy should be avoided at this stage.

Expression and significance of ABCG2 and ALDH1 in malignant transformation of ovarian endometriosis / 重庆医学

Objective To investigate the expression and significance of ABCG2 and ALDH1 in malignant transformation of ovarian endometriosis.Methods The protein expressions of ABCG2 and ALDH1 were detected with immunohistochemistry in 38 cases of malignant transformation of ovarian endometriosis(EMs malignant transformation group),35 cases of endometriosis(EMs group)and 30 cases of normal endometrium(control group).Results The positive rates of ABCG2 and ALDH1 expressions in EMs malignant transformation group were significantly higher than those in EMs group and control group(P0.05).There was no correlation between the expression of ABCG2 and ALDH1 in malignant transformation of ovarian endometriosis(P>0.05).Conclusion The expressions of ABCG2 and ALDH1 might be involved in malignant transformation of ovarian endometriosis.

Serum CA125 and ALDH1 levels for diagnosis and postoperative follow-up of endometriosis / 西安交通大学学报(医学版)

ABSTRACT:Objective To investigate CA125 and ALDH1 levels in diagnosis and postoperative follow‐up of endometriosis (EMs) .Methods Serum CA125 and ALDH1 levels were tested by enzyme‐linked immunosorbent assay (ELISA) in 105 patients with EMs and 100 healthy subjects who came to our hospital between January 2011 and June 2013 .Results The preoperative serum CA125 and ALDH1 levels of EMs patients were significantly higher than those in the control group ( P0 .05) .Taking CA125≥35 U/mL and ALDH1≥2 .0 pg/mL as the boundary values ,the specificity , sensitivity ,positive predictive value and negative predictive value of serum CA 125 combined with ALDH1 for diagnosis of EMs were 87 .1% ,91 .6% ,84 .6% and 89 .3% ,respectively .One month after operation ,serum CA125 and ALDH1 levels of EMs patients were decreased significantly (P0 .05) .Relapse occurred in 1 patient 1 year after treatment and in 6 patients 2 years after treatment ;all these patients had a higher serum ALDH1 level than the control group ,but only 2 of them had a higher serum CA125 level .Conclusion The combined detection of serum CA125 and ALDH1 has a higher sensitivity in diagnosis of EMs .Serum ALDH1 level increases in stages Ⅰ and Ⅱ and recurrent patients and can become a better serum marker for early diagnosis and detection of the recurrence of EMs in patients .