Transperineal core-needle biopsy of a rectal subepithelial lesion guided by endorectal ultrasound after contrast-enhanced ultrasound: A case report.

BACKGROUND: Rectal subepithelial lesions (SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abnormal tissues are not easily to be obtained by regular endoscopic forceps biopsy. Traditional guidance modalities of preoperative biopsy, including endoscopic ultrasound, computed tomography, and transabdominal ultrasound, are often unsatisfactory. An updated, safe, and effective biopsy guidance method is required. We herein report a new biopsy guidance modality-endorectal ultrasound (ERUS) combined with contrast-enhanced ultrasound (CEUS). CASE SUMMARY: A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy (CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019. CONCLUSION: Transperineal CNB guided by ERUS and CEUS is a safe and effective preoperative biopsy of rectal SELs yet with some limitations.

Clinical efficacy of adjuvant chemotherapy in the treatment of pT4 stage II colorectal cancer with defective mismatch repair status: A protocol for systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analysis is to assess the efficacy of adjuvant chemotherapy in patients with stage IIB/C CRC and defective mismatch repair (dMMr) status, and to evaluate what is the determinant risk factor for adjuvant chemotherapy in those patients. METHOD: A systematic search of PubMed, EMBASE, Web of science, Cochrane Library databases will be performed. All RCTs published in electronic databases from inception to March 19, 2020, with language restricted in English will be included in this review study. Two reviewers will independently perform the Study selection, data extraction, quality assessment, and assessment of risk bias and will be supervised by third party. Outcomes consisted of overall survival, progression-free survival and sufficient information to extract hazard ratios and their 95% confidence intervals and it will be calculated to present the prognostic role of adjuvant chemotherapy in patients with stage IIB/C CRC and dMMR status using Review Manager version 5.3 when there is sufficient available data. RESULTS: The results of this systematic review and meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will summarize up-to-date evidence to assess the efficacy of adjuvant chemotherapy in patients with stage IIB/C CRC and dMMR status and provide a scientific and practical suggestions for treatment decision-making. REGISTRATION: This protocol has been registered on the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) with a registration number of INPLASY202050019.

Rare case of drain-site hernia after laparoscopic surgery and a novel strategy of prevention: A case report.

BACKGROUND: Trocar site hernia (TSH) is a rare but potentially dangerous complication of laparoscopic surgery, and the drain-site TSH is an even rarer type. Due to the difficulty to diagnose at early stages, TSH often leads to a delay in surgical intervention and eventually results in life-threatening consequences. Herein, we report an unusual case of drain-site TSH, followed by a brief literature review. Finally, we provide a novel, simple, and practical method of prevention. CASE SUMMARY: A 54-year-old female patient underwent laparoscopic subtotal hysterectomy and bilateral adnexectomy for uterine fibroids 8 d ago in another hospital. She was admitted to our hospital with a 2-d history of intermittent abdominal pain, nausea, vomiting, and abdominal enlargement with an inability to pass stool and flatus. The emergency computed tomography scan revealed the small bowel herniated through a 10 mm trocar incision, which was used as a drainage port, with diffuse bowel distension and multiple air-fluid levels with gas in the small intestines. She was diagnosed with drain-site strangulated TSH. The emergency exploratory laparotomy confirmed the diagnosis. A herniorrhaphy followed by standard intestinal resection and anastomosis were performed. The patient recovered well after the operation and was discharged on postoperative day 8 and had no postoperative complications at her 2-wk follow-up visit. CONCLUSION: TSH must be kept in mind during the differential diagnosis of post-laparoscopic obstruction, especially after the removal of the drainage tube, to avoid the serious consequences caused by delayed diagnosis. Furthermore, all abdomen layers should be carefully closed under direct vision at the trocar port site, especially where the drainage tube was placed. Our simple and practical method of prevention may be a novel strategy worthy of clinical promotion.

Silencing long non-coding RNA HOTAIR exerts anti-oncogenic effect on human acute myeloid leukemia via demethylation of HOXA5 by inhibiting Dnmt3b.

BACKGROUND: As an aggressive hematological malignancy, acute myeloid leukemia (AML) remains a dismal disease with poor prognosis. Long non-coding RNAs (lncRNAs) have been widely reported to be involved in tumorigenesis of AML. Here, we define an important role of lncRNA HOTAIR in AML in relation to HOXA5 methylation. METHODS: Firstly, the expression of HOTAIR was examined in AML samples and cells collected. Next, gain- or loss-of function experiments were conducted in AML cells to explore the effect of HOTAIR on AML. Then, relationship among HOXA5 promoter methylation, HOTAIR and Dnmt3b was measured. Expression of HOXA5 and cell proliferation/apoptosis-related genes was also detected. A last, in vivo assay was performed to assess the tumor formation in nude mice in order to explore the roles of HOTAIR and HOXA5 in cell apoptosis and proliferation. RESULTS: LncRNA HOTAIR was found to be upregulated in AML cells and tissues. With silencing of HOTAIR and overexpression of HOXA5, AML cell proliferation was decreased while the apoptosis was induced. Furthermore, HOTAIR was observed to recruit Dnmt3b and to increase HOXA5 promoter methylation. Moreover, silencing HOTAIR and upregulating HOXA5 were found to induce apoptosis and reduce proliferation of AML cells in vivo. CONCLUSION: Our findings highlight the anti-tumor ability of HOTAIR silencing in AML, suggesting that silencing HOTAIR was able to inhibit AML progression through HOXA5 promoter demethylation by decreasing Dnmt3b.

Dehydrocostus lactone inhibits in vitro gastrinoma cancer cell growth through apoptosis induction, sub-G1 cell cycle arrest, DNA damage and loss of mitochondrial membrane potential.

INTRODUCTION: The purpose of the present study was to evaluate the antiproliferative activity of dehydrocostus lactone against human BON-1 cancer cell lines and to explore the possible underlying mechanism. MATERIAL AND METHODS: MTT cell viability assay was used to determine cytotoxic effects of dehydrocostus lactone in BON-1 cells. Fluorescence and transmission electron microscopic (TEM) techniques were used to study the effect of the compound on cellular morphology and apoptosis. Flow cytometry was used to assess the effect on cell cycle phase distribution. Effects of the drug on cell apoptosis and mitochondrial membrane potential were analyzed by flow cytometry using annexin v and rhodamine-123 as fluorescent probes. RESULTS: The results of the present study indicated that dehydrocostus lactone significantly (p < 0.01) inhibited the growth of BON-1 cancer cells. These growth inhibitory effects of dehydrocostus lactone on BON-1 were found to be time and concentration-dependent. The IC50 of dehydrocostus lactone were found to be 71.9 µM and 52.3 µM at 24 and 48 h time intervals respectively. The growth inhibitory effects of dehydrocostus lactone were found to be due to loss of mitochondrial membrane potential, the induction of apoptosis and sub-G1 cell cycle arrest. CONCLUSIONS: Dehydrocostus inhibits in vitro gastrinoma cancer cell growth and therefore may prove beneficial in the management of gastrinoma cancer.

Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab: A case report.

RATIONALE: Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult. PATIENT CONCERNS: A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation. DIAGNOSIS: Intestinal BD with severe post-operative complication. INTERVENTIONS: A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy. OUTCOMES: In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation. LESSONS: This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.

Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis.

The lymph node ratio (LNR) (i.e. the number of metastatic lymph nodes divided by the number of totally resected lymph nodes) has recently emerged as an important prognostic factor in colorectal cancer (CRC). However, the tumor node metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a meta-analysis to evaluate the prognostic role of the LNR in node positive CRC. A systematic search was performed in PubMed, Embase and the Cochrane Library for relevant studies up to November 2015. As a result, a total of 75,838 node positive patients in 33 studies were included in this meta-analysis. Higher LNR was significantly associated with shorter overall survival (OS) (HR = 1.91; 95% CI 1.71-2.14; P = 0.0000) and disease free survival (DFS) (HR = 2.75; 95% CI: 2.14-3.53; P = 0.0000). Subgroup analysis showed similar results. Based on these results, LNR was an independent predictor of survival in colorectal cancer patients and should be considered as a parameter in future oncologic staging systems.

Severe Hypoglycemia Caused by Recurrent Sarcomatoid Carcinoma in the Pelvic Cavity: A Case Report.

Nonislet cell tumor hypoglycemia (NICTH) is a paraneoplastic syndrome characterized by persistent, severe hypoglycemia in different tumor types of mesochymal or epithelial origin; however, NICTH is infrequently induced by sarcomatoid carcinoma (SC). Despite some sarcomatoid and epithelioid characteristics in few cases of malignancies from epithelium, NICTH induced by recurrent SC in pelvic cavity in this report is extremely rare.We report a case in which NICTH caused by recurrence and pulmonary metastases from SC in the pelvic cavity, and the computed tomography scan revealed multiple pelvic masses and multiple large masses in the pulmonary fields. During the treatment of intestinal obstruction, the patient presented paroxysmal loss of consciousness and sweating. Her glucose even reached 1.22 mmol/L while the serum glycosylated hemoglobin was normal and previous history of diabetes or use of oral hypoglycemic agents and insulin denied.The laboratory examination showed that the low level of insulin, C-peptide, and growth hormone levels in the course of hypoglycemic episodes suggesting to the diagnosis of hypoglycemia induced by nonislet cell tumor, and the decreased levels of insulin-like growth factor (IGF)-I and IGFBP3 and the high expression of big IGF-II in the serum further confirmed the diagnosis of NICTH. Because of the widely pelvic recurrence and pulmonary metastases were unresected, the patient was discharged from the hospital after 2 weeks treatment with dexamethasone and glucose and unfortunately died 1 week later.NICTH caused by SC in the pelvic cavity is extremely rare case in clinical. The aim of this report was to present the importance to examine big IGF-II expression in patient's serum in order to reach the diagnosis of NICTH in cases of intractable cancer-associated hypoglycemia.

The prognostic factors and multiple biomarkers in young patients with colorectal cancer.

The incidence of colorectal cancer (CRC) in young patients (≤ 50 years of age) appears to be increasing. However, their clinicopathological characteristics and survival are controversial. Likewise, the biomarkers are unclear. We used the West China (2008-2013, China), Surveillance, Epidemiology, and End Results program (1973-2011, United States) and Linköping Cancer (1972-2009, Sweden) databases to analyse clinicopathological characteristics, survival and multiple biomarkers of young CRC patients. A total of 509,934 CRC patients were included from the three databases. The young CRC patients tended to have more distal location tumours, fewer tumour numbers, later stage, more mucinous carcinoma and poorer differentiation. The cancer-specific survival (CSS) of young patients was significantly better. The PRL (HR = 12.341, 95% CI = 1.615-94.276, P = 0.010), RBM3 (HR = 0.093, 95% CI = 0.012-0.712, P = 0.018), Wrap53 (HR = 1.952, 95% CI = 0.452-6.342, P = 0.031), p53 (HR = 5.549, 95% CI = 1.176-26.178, P = 0.045) and DNA status (HR = 17.602, 95% CI = 2.551-121.448, P = 0.001) were associated with CSS of the young patients. In conclusion, this study suggests that young CRC patients present advanced tumours and more malignant pathological features, while they have a better prognosis. The PRL, RBM3, Wrap53, p53 and DNA status are potential prognostic biomarkers for the young CRC patients.

Efficacy of surgery and adjuvant therapy in older patients with colorectal cancer: a STROBE-compliant article.

The present study aimed to assess the efficacy of surgery and adjuvant therapy in older patients (age≥70 years) with colorectal cancer (CRC). Older CRC patients are under-represented in available clinical trials, and therefore their outcomes after receiving surgery and adjuvant therapy are unclear. From two prospective Swedish databases, we assessed a cohort of 1021 patients who underwent curative surgery for stage I, II, or III primary CRC, with or without adjuvant chemotherapy/radiotherapy. Of the patients with colon cancer (n=467), 182 (39%) were aged <70 years, 162 (35%) aged 70 to 80 years, and 123 (26%) were aged ≥80 years. Of rectal cancer patients (n=554), 264 (48%) were aged <70 years, 234 (42%) aged 70 to 80 years, and 56 (10%) aged ≥80 years. Older patients with either colon or rectal cancer had higher comorbidity than did younger patients. Older patients with colon cancer had equivalent postoperative morbidity and 30-day mortality to younger patients. Rectal cancer patients aged ≥80 years had a higher 30-day mortality than younger patients (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.6-4.55; P=0.03). For either colon or rectal cancer, adjuvant chemotherapy compromised the 5-year overall survival (OS) of older patients with stage II disease and had no effect on those with stage III disease. Receiving adjuvant chemotherapy was a poor factor of OS for older patients with either colon (HR 1.88, 95% CI: 1.20-4.35, P=0.03) or rectal cancer (HR 1.72, 95% CI: 1.05-2.26, P=0.004). Preoperative short-course radiotherapy improved both OS and local control for older patients with stage III rectal cancer and had no effect on those with stage II disease. Radiotherapy was a favorable factor for the OS of the older patients with rectal cancer (HR 0.42, 95% CI: 0.21-3.57, P=0.01). In conclusion, Older CRC patients had equal safety of surgery as younger patients, except rectal cancer patients aged ≥80 years that had a higher mortality. Adjuvant 5FU-based chemotherapy did not benefit older CRC patient, while neoadjuvant radiotherapy improved the prognosis of older patients with stage III rectal cancer.

The prognostic significance of peroxisome proliferator-activated receptor ß expression in the vascular endothelial cells of colorectal cancer.

OBJECTIVE: Currently, little is known regarding the role of peroxisome proliferator-activated receptor-ß (PPAR ß) in the vascular endothelial cells (VECs) of colorectal cancers (CRCs). The aim of this study was to investigate the relationship of PPAR ß expression in the VECs of CRCs in terms of the prognosis and clinicopathological features of CRC patients. DESIGN: The expression and localization of PPAR ß in the primary cancers and the matched normal mucosal samples of 141 Swedish CRC patients were analyzed in terms of its correlation with clinicopathological features and the expression of angiogenesis-related genes. This study also included 92 Chinese CRC patients. RESULTS: PPAR ß was predominantly localized in the cytoplasm and was significantly downregulated in the VECs of CRC compared to that of the normal mucosa. The low expression levels of PPAR ß in the VECs of CRC were statistically correlated with enhanced differentiation, early staging and favorable overall survival and were associated with the increased expression of VEGF and D2-40. The patients exhibiting elevated expression of PPAR ß in CRC cells but reduced expression in VECs exhibited more favorable survival compared with the other patients, whereas the patients with reduced expression of PPAR ß in CRC cells but increased expression in VECs exhibited less favorable prognosis. CONCLUSIONS: PPAR ß might play a tumor suppressor role in CRC cells in contrast to a tumor promoter role in the VECs of CRCs.

Can K-ras gene mutation be utilized as prognostic biomarker for colorectal cancer patients receiving chemotherapy? A meta-analysis and systematic review.

INTRODUCTION: K-ras gene mutations were common in colorectal patients, but their relationship with prognosis was unclear. OBJECTIVE: Verify prognostic differences between patient with and without mutant K-ras genes by reviewing the published evidence. METHOD: Systematic reviews and data bases were searched for cohort/case-control studies of prognosis of colorectal cancer patients with detected K-ras mutations versus those without mutant K-ras genes, both of whom received chemotherapy. Number of patients, regimens of chemotherapy, and short-term or long-term survival rate (disease-free or overall) were extracted. Quality of studies was also evaluated. PRINCIPAL FINDINGS: 7 studies of comparisons with a control group were identified. No association between K-ras gene status with neither short-term disease free-survival (OR=1.01, 95% CI, 0.73-1.38, P=0.97) nor overall survival (OR=1.06, 95% CI, 0.82-1.36, P=0.66) in CRC patients who received chemotherapy was indicated. Comparison of long-term survival between two groups also indicated no significant difference after heterogeneity was eliminated (OR=1.09, 95% CI, 0.85-1.40, P=0.49). CONCLUSIONS: K-ras gene mutations may not be a prognostic index for colorectal cancer patients who received chemotherapy.

Downregulation of microRNA-124 is an independent prognostic factor in patients with colorectal cancer.

PURPOSE: Recently, microRNA-124 (miR-124) has been demonstrated as a potential tumor suppressor in several types of cancers. However, the role of miR-124 in colorectal cancer remains unclear. This study was aimed at investigating the clinicopathological significance of miR-124 expression in colorectal cancer. METHODS: Quantitative real-time PCR was used to analyze miR-124 expression in 96 colorectal cancers and individual-matched normal mucosa samples. The expression of miR-124 was assessed for associations with clinicopathological characteristics using chi-square test. The survival curves were calculated by the Kaplan-Meier method. The influence of each variable on survival was examined by the Cox multivariate regression analysis. RESULTS: The miR-124 expression was significantly downregulated in colorectal cancer compared to normal mucosa (P = 0.001). In colorectal cancer, miR-124 decreased expression correlated significantly with the grade of differentiation (P = 0.021). Univariate survival analysis showed that the downregulated miR-124 was significantly correlated with worse prognosis, both in terms of overall survival (P = 0.017) and disease-free survival (DFS) (P = 0.014). Further, the downregulated miR-124 was demonstrated as a prognostic factor for overall survival (hazard ratio, HR = 4.634; 95 % confidence interval, CI, 1.731-12.404; P = 0.002) and DFS (HR = 4.533, 95 % CI 1.733-11.856, P = 0.002), independently of gender, age, location, maximum tumor size, depth of invasion, differentiation, and TNM stage. CONCLUSIONS: MiR-124 may play a certain role in the development of colorectal cancer. The downregulation expression of miR-124 is an independent prognostic factor in patients with colorectal cancer.

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review.

BACKGROUND: Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients. OBJECTIVES: A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients. METHODS: A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers. RESULTS: Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization. CONCLUSIONS: The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.

Occult tumor metastasis and the prognostic value of sentinel lymph nodes in rectal cancer.

The aim of the present study to evaluate the application of sentinel lymph node (SLN) pathology in rectal cancer using ex vivo mapping and to investigate the incidence and prognostic value of occult SLN metastasis in routine node-negative specimens. Specimens (n=117) of rectal cancer were examined using a combination of routine pathology and ex vivo SLN mapping. The inspected SLNs were further treated with immunohistochemical staining for occult cancer foci. The log-rank test was used to assess survival. SLNs were examined in 112 of the included specimens with a total number of 212, resulting in an identification rate of 95.7% (112/117). The status of SLNs accurately reflected N stage in 93.8% (105/112) of cases and the sensitivity was 75.6% (31/41) in detecting nodal metastasis. The accuracy of SLN pathology decreased in cancers of more advanced TNM stages (P=0.001). In 74 cases with routine node-negative (N0) disease, SLN micrometastasis (MIC) and isolated tumor cells (ITC) were examined in 9 and 4 cases, while the remaining 61 were regarded as negative (NEG). The log-rank test revealed poorer disease-free and overall survival of the MIC group compared with the NEG group. However, the findings from the ITC group were not significant compared with those from the MIC and NEG groups. In conclusion, ex vivo SLN pathology is practical and accurate in rectal cancer; however, its utility is limited in cases of advanced disease. Immunohistochemically detected SLN micrometastasis in node-negative cases is therefore a predictor of poorer outcome, and may therefore be listed as a marker for adjuvant therapy.

Duodenal intussusception due to a giant neuroendocrine carcinoma in a patient with Peutz-Jeghers syndrome: case report and systematic review.

Duodenal intussusception is a rare entity. To date, only a few cases have been reported in the literature. In this report, a case of duodenal intussusception due to an unusual tumor was presented and the clinical features of this entity were discussed. A 42-year-old man with Peutz-Jeghers syndrome presented with epigastric pain, vomiting, and severe anemia. Computed tomography scan revealed synchronous duodenojejunal and jejunojejunal intussusceptions. An emergency laparotomy revealed a polypoid mass originating from the lateral wall of the descending duodenum with intussusception of the distal duodenum. Histological examination demonstrated a poorly differentiated neuroendocrine carcinoma with muscularis infiltration, vascular invasion, and a Ki-67 index of 20%. A comprehensive literature search revealed 44 English reports that provided adequate descriptions of an additional 47 such cases. Clinical presentation was usually chronic and nonspecific. Diagnostic modalities included ultrasonography, upper gastrointestinal series, computed tomography, and endoscopy. Five patients were due to a non-neoplastic lesion; however, the other 43 patients were secondary to a tumor, benign in 35 cases and malignant in eight cases. Only one patient was treated by endoscopic polypectomy, whereas the remaining underwent open surgeries. Duodenal intussusception is a challenging condition due to its rarity and nonspecific presentation. It should be considered in the differential diagnosis of gastric outlet obstruction, upper gastrointestinal bleeding, pancreatitis, and obstructive jaundice.

[Differential expression of colon cancer microRNA in microarry study].

OBJECTIVE: To investigate the miRNA expression difference between colon cancer and normal colonic mucosa. METHODS: Twelve (12) pairs of colorectal cancer tissue and normal colonic mucosa were collected, total RNA was extracted and purified. After fluorescent tags being added, hybridization was carried out on miRNA microarray chip (Affymetrix company). SAM analysis was performed to find out the significant expression difference, then the difference was verified by RT-PCR, finally target gene analysis software was utilized to predict the miRNA function. RESULTS: The up-regulated miRNAs in colon cancer included has-miR-182, has-miR-17, hasmiR-106a, has-miR-93, has-miR-200c, has-miR-92a, has-let-7a, has-miR-20a (FDR value < 5%), while the downregulated miRNAs were has-miR-l195, has-miR-143, has-miR-145 (FDR value < 5%). CONCLUSION: There is significant difference of miRNA expression between colon caner and normal colonic mucosa.

Mesorectal and lateral node metastasis and micrometastasis in lower rectal cancer.

BACKGROUND/AIMS: To study lymph node metastasis and micrometastasis within the mesorectum and lateral pelvic area in lower rectal cancer. METHODOLOGY: Specimens of 96 patients, who underwent total mesorectal excision (TME) and lateral lymph node dissection (LLND), were included. RESULTS: An average of 19.4 mesorectal lymph nodes were examined. Horizontally, more than 30 percent of involved lymph nodes were located in the outer layer of the mesorectum. Longitudinally, metastasized lymph nodes were harvested from the distal, paratumoral and proximal mesorectum of 6, 42 and 29 specimens, respectively. Fourteen specimens were observed to have circumferential resection margin involvement, while another 3 had micrometastasis. The average amount of harvested lateral pelvic lymph nodes was 12.1. Most (1052/1159) of the lateral nodes were defined as negative. Fourteen and 11 specimens were examined to contain lateral node metastasis and micrometastasis, respectively. Among regions of the lateral pelvic area, middle rectal root (44%), internal iliac (28%) and obturator (20%) were more likely to be involved by cancer spread. CONCLUSIONS: Complete excision of the mesorectum is essential for local clearance of lower rectal cancer. Mesorectal margin involvement and lateral metastasis underlined the limitation of single surgical procedure, thus suggesting the significance of neoadjuvant therapy.

Selective laparoscopic lateral dissection of regional micrometastasis in rectal carcinoma--ten years single center experience.

Although total mesorectal excision (TME) has been generally accepted as a principle of rectal cancer surgery, the corresponding laparoscopic approach still needs evaluation in depth, especially the controversial dissection of lateral pelvic areas. At our center, 982 patients with rectal cancers received laparoscopic or laparoscopic-assisted surgery during the past ten years. Short-term results showed an anastomic leakage rate of 4.2% (29/683) in patients with anal sphincter preservation and an average hospitalization of 8.8 days. Sixty-two cases (6.3%) suffered postoperative urinary dysfunction while well-controlled defecation was observed in 87.6% cases that underwent colo-rectal/colo-anal anastomosis. According to our experience, the laparoscope amplifies the local view within the narrow pelvis, thus facilitating the identification of surgical plane and adjacent structures. The radial, proximal and distal distribution of mesorectal micrometastases underline the importance of total mesorectal excision and the sharp dissection between parietal and visceral pelvic fascia is essential for better clearance and nerve protection. Lateral metastasis was more common in lower located cancers while laparoscopic lateral dissection is practical and safe when performed by trained surgeons. Lateral dissection is advised when preoperative imaging or intraoperative exploration suggest the existence of lateral metastasis.

The Ile646Val (2073A>G) polymorphism in the kinase-binding domain of A-kinase anchoring protein 10 and the risk of colorectal cancer.

OBJECTIVE: The purpose of this study is to investigate whether the Ile646Val (2073A>G) polymorphism in the kinase-binding domain of A-kinase anchoring protein 10 (AKAP10) is related to the risk of colorectal cancer (CRC), clinicopathological variables and the environmental factors for the development of CRC. METHODS: Applying TaqMan allelic discrimination, we investigated AKAP10 Ile646Val (2073A>G) polymorphism in 288 Chinese CRC patients and 281 healthy controls. RESULTS: Logistic regression analysis revealed a significant association of AKAP10 Ile646Val (2073A>G) polymorphism with increased CRC risk (adjusted OR = 1.44, 95% CI 1.01-2.07, p = 0.02). Stratification analysis showed that the increased risk associated with the variant genotypes (GG+AG) was more evident in male subjects (adjusted OR = 1.48, 95% CI 0.94-2.34, p = 0.03). Compared with the AA genotype, the adjusted OR for the variant genotypes was 1.81 (95% CI 1.08-3.05, p = 0.01) among young subjects (age <57 years). Among individuals who did not smoke or who smoked lightly, there was a significantly increased risk with the variant genotypes (adjusted OR = 1.66, 95% CI 1.08-2.56, p = 0.02). We did not observe a relationship between the AKAP10 polymorphism and other clinicopathological and environmental factors. CONCLUSIONS: Our data suggested that the AKAP10 2073A>G variation is associated with an increased risk of CRC in the Chinese population.