Abstract:The incidence of gastric cancer ranks the fourth highest malignant tumor in the world, and the associated mortality rate takes the second place. Surgical resection is still the only curative treatment option for this disease. At present, there is great controversy on the para-aortic lymph node dissection (PAND) for advanced gastric cancer. The results of JCOG 9501 trial showed that preventive PAND is not recommended, but the clinical significance of therapeutic PAND still needs further clinical investigations. In recent years, a large number of studies on PAND in advanced gastric cancer have been done by many researchers at home and abroad, and their achievements have important reference value for the selection of PAND.

Abstract:Objective: To investigate the relevant clinicopathologic factors for perineual invasion (PNI) in gastric cancer patients. Methods: The clinical and pathological data of 509 gastric cancer patients treated in the Affiliated Hospital of Jiangsu University from June 2014 to June 2017 were collected. The relations of PNI with clinicopathologic factors were analyzed. Results: Of the 509 gastric cancer patients, 250 cases were PNI positive and 259 cases were PNI negative. Univariate analysis showed that PNI in gastric cancer was significantly associated with the tumor infiltration depth, degree of tissue differentiation, lymph node metastasis and TNM stage (all P<0.001), but irrelevant to age and gender (both P>0.05). The χ2 tests for trend reported that PNI had a maximum correlation with tumor infiltration depth (r=0.623, P<0.001). The binomial Logistic regression analysis showed that tumor infiltration depth was an independent risk factor for PNI (OR=6.285, 95% CI=4.009–9.854, P<0.001). Conclusion: PNI in gastric cancer patients is associated with the degree of tissue differentiation, tumor infiltration depth, lymph node metastasis and TNM stage, in which the tumor infiltration depth is probably the most important factor.

Abstract:Objective: To investigate the surgical treatment strategies for patients with gastric mucosal lesions diagnosed as high-grade intraepithelial neoplasia (HGIN) by gastroscopic biopsy. Methods: The clinical data of 70 patients admitted in the Department of Gastrointestinal Surgery of Tongling People’s Hospital from January 2014 to September 2017 with initial diagnosis of HGIN made by gastroscopic biopsy and undergoing histopathological assessment of the whole lesion after radical resection and/or endoscopic treatment were retrospectively analyzed. Results: In the whole group of cases, the postoperative pathological examination confirmed the diagnosis of HGIN in 7 cases (10.0%), while it revealed low grade intraepithelial neoplasia or chronic inflammation in 3 cases (4.3%), diffuse large B cell lymphoma in 1 case (1.4%) and adenocarcinoma in 59 cases (84.3%). Univariate analysis showed that age (P=0.029), suspicious submucosal invasion by EUS (P<0.001), and perigastric lymph node enlargement (P=0.029) were significant risk factors for very low preoperative diagnosis. The team of the authors based on the clinical factors such as endoscopic diagnosis, imaging evaluation and serum CEA level, developed a decision tree method for surgical treatment option of gastric lesions diagnosed as HGIN by biopsy. Conclusion: Based on the development of endoscopic diagnosis and treatment technologies in recent years, the principle of individualized precise surgical treatment should be followed in patients with gastric mucosal lesions diagnosed as HGIN by biopsy, so as to avoid an over- or under-treatment.

Abstract:Objective: To compare the short-term outcomes of robotic and laparoscopic radical resection for middle and low rectal cancer. Methods: A total of 100 consecutive patients with middle and low rectal cancer (the inferior margin of the lesion locating no more than 12 cm from the anal verge) admitted in the First Affiliated Hospital of Nanchang University from October 2016 to May 2017 were enrolled. Based on the principle of sequential design, the patients were randomly assigned to robotic group and laparoscopic group with 50 cases in each group, and underwent robotic and laparoscopic middle and low rectal cancer radical surgery respectively. The main clinical variables between the two groups of patients were compared. Results: There were no differences in preoperative data between the two groups (all P>0.05). Operations were successfully performed in all patients, without any open conversion. Negative circumferential resection margins were achieved in both groups and the integrity of mesorectum was impaired in one case in laparoscopic group. In robotic group compared with laparoscopic group, the average intraoperative blood loss (67.1 mL vs. 134.6 mL), operative time (123.2 min vs. 152.6 min), time for postoperative gastrointestinal function recovery (45.7 h vs. 51.8 h), time to first postoperative food intake (52.9 h vs. 64.3 h) and time to urinary catheter removal (4.4 d vs. 4.9 d) were significantly reduced, but the average hospitalization cost (56 000 yuanvs. 42 000 yuan) and costs associated with surgery (31 000 yuanvs. 17 000 yuan) were significantly increased (all P<0.05). There were no significant differences in surgical procedures, length of the resected specimen, number of the resected lymph nodes, postoperative pathological results, length of postoperative hospital stay and non-surgery costs between the two groups (all P>0.05). Conclusion: Robotic surgery for middle and lower rectal cancer is safe and feasible, and has advantages of less trauma and fast postoperative recovery in comparison to laparoscopic surgery.

Abstract:Objective: To assess feasibility and safety of performing laparoscopic-assisted radical resection (LARR) for rectal cancer in elderly patients. Methods: The clinical data of 226 rectal cancer patients undergoing LARR in the Department of General Surgery of Anhui Provincial Hospital from January 2014 to January 2016 were retrospectively analyzed. Patients were divided according to age, into elderly group (≥70 years of age) and non-elderly group (<70 years of age). Forty-six patients in each group were selected using propensity score matching, and then, the clinical variables between the two groups were statistically analyzed. Results: The mean age was 76.3 and 59.1 years in elderly group and non-elderly group, respectively. The baseline data that included gender, preoperative concomitant disease and ASA grade showed no significant difference between the two groups (all P>0.05). The operative time, intraoperative blood loss, surgical procedures, tumor size, number of harvested lymph nodes, TNM stage, time to liquid diet and length of postoperative hospital stay, all showed no significant difference between the two groups (all P>0.05). No death occurred in either of the groups. In elderly group and non-elderly group, the differences concerning the incidence of postoperative complications (22% vs. 15%) and incidence of infection-related complications (15% vs. 7%) also showed no significant difference (both P>0.05). Conclusion: LARR for rectal cancer is safe and feasible in elderly patients and, compared with non-elderly patients, does not increase the incidence of postoperative complications.

Abstract:Objective: To investigate the influence of defunctioning ileostomy on short-term quality of life (QOL) in patients after laparoscopic low anterior resection for low rectal cancer. Methods: By retrospective case-control design, 98 patients with low rectal cancer undergoing low anterior resection in the Department of Gastrointestinal Surgery of Tangdu Hospital, Air Force Medical University from May 2015 to May 2016, who had complete clinical records were enrolled. Of the patients, 48 cases underwent defunctioning ileostomy following low anterior resection (ileostomy group) and 50 cases did not undergo defunctioning ileostomy (non-ileostomy group). The clinicopathologic data and the scores for postoperative low anterior resection syndrome and QOL between the two groups of patients were compared. Results: In ileostomy group, the number of patients receiving neoadjuvant chemoradiotherapy and patients with advanced pathological stage were higher than those in non-ileostomy group (both P<0.05). No statistical differences in incidence of anastomotic leakage, intraoperative blood loss, number of retrieved lymph nodes and length of postoperative hospital stay were noted between the two groups (all P>0.05). Despite of receiving neoadjuvant chemoradiotherapy or not, the scores for low anterior resection syndrome in ileostomy group within one year after ileostomy reduction were significantly lower than those in non-ileostomy group within one year after surgery (all P<0.05). In terms of QOL, the scores for global health, physical functioning and emotional functioning at postoperative 3 and 6 months, the scores for social functioning and role functioning at postoperative 3 months, and scores for diarrhea half a year after operation in ileostomy group were significantly superior to those in non-ileostomy group (all P<0.05). Conclusion: Defunctioning ileostomy can alleviate the severity of low anterior resection syndrome and improve postoperative short-term QOL in patients after laparoscopic low anterior resection for low rectal cancer.

Abstract:Objective: To investigate the influence of primary tumor resection on prognosis of patients with stage IVB colorectal cancer. Methods: A total of 6 934 patients diagnosed as stage IVB colorectal cancer between 2010 and 2013 were collected from the SEER database. Of the patients, 2 824 cases underwent primary tumor resection combined with systemic chemotherapy (surgery-chemotherapy group) and 4 110 cases underwent systemic chemotherapy alone (chemotherapy group). The difference in survival rate between the two groups of patients was compared after the clinicopathologic characteristics of the two groups of patients were balanced by propensity score matching (PSM). Results: Before PSM, the survival rate in surgery-chemotherapy group was significantly better than that in chemotherapy group (HR=1.540, 95% CI=1.423–1.667, P<0.001), but there were significant imbalances in clinicopathologic characteristics (age, gender, primary tumor site, degree of histological differentiation, T stage, N stage, metastases and CEA level) between the two groups of patients (all P<0.001). After 1:1 matching of PSM, 3 826 patients were selected with 1 913 cases in either group; the differences in clinicopathologic characteristics between the two groups of patients were markedly minimized, in which, the distributions of age, gender, primary tumor site, N stage, metastases and CEA level of the two groups were well balanced (all P>0.05); the survival rate in surgery-chemotherapy group was significantly better than that in chemotherapy group (HR=1.603, 95% CI= 1.439–1.787, P<0.001). Conclusion: Surgical resection of the primary tumor can improve the prognosis of colorectal cancer patients with unresectable metastatic lesions. So, the treatment strategy of primary tumor resection combined with systemic chemotherapy is recommended for patients with stage IVB colorectal cancer and surgical tolerance.

Abstract:Objective: To investigate the expression of the long non-coding RNA (lncRNA) CCAT2 in gastric cancer cells and its actions. Methods: The expressions of CCAT2 in different gastric cancer cell lines (AGS, Hs746T and BSG823) and normal gastric mucosal GES-1 cells were detected by qRT-PCR. The gastric cancer AGS cells were transfected with CCAT2 siRNA (si-CCAT2 group) or scrambled siRNA sequences (negative control group) respectively, and then their proliferative abilities were measured by CCK-8 assay, using untransfected AGS cells as blank control. In si-CCAT2 group and negative control group, the apoptosis, the migration and invasion abilities and the expressions of apoptosis-associated proteins were determined by flow cytometry, scratch assay, Transwell assay and Western blot analysis, respectively. Results: The relative expression levels of CCAT2 in all studied gastric cancer cell lines were significantly higher than that in the normal gastric mucosal GES-1 cells (all P<0.05). At 72 and 96 h after transfection, the proliferative ability in si-CCAT2 group was significantly lower than that in negative control group or blank control group (all P<0.05), while, no significant difference in proliferative ability was noted between negative control group and blank control group at each predefined time point (all P>0.05). In si-CCAT2 group compared with negative control group, the apoptosis rate was increased, and the wound healing rate and the number of invading cells were decreased significantly (all P<0.05); the protein expressions of P53, caspase-8 and Bax were up-regulated, while the protein expression of Bcl-2 was down-regulated significantly (all P<0.05). Conclusion: CCAT2 expression is increased in gastric cancer cells. Knockdown of its expression can inhibit the proliferation and abilities of migration and invasion of the gastric cancer cells, and the mechanism may be related to its regulating the expressions of apoptosis-associated proteins.

Abstract:Objective: To investigate the expressions of YAP1, E-cadherin and N-cadherin in gastric cancer tissue and their significance. Methods: The expressions of YAP1, N-cadherin and E-cadherin proteins in tissue microarray containing 135 samples of gastric cancer tissue and adjacent tissue were determined by immunohistochemical staining. The relations of YAP1 expression with E-cadherin and N-cadherin expressions as well as with clinicopathologic characteristics and prognosis of the patients were analyzed. Results: In gastric cancer tissue compared with adjacent non-tumor tissue, the YAP1 expression was increased and E-cadherin expression was decreased significantly (both P<0.05), but the N-cadherin showed no significant difference (P>0.05). There was a negative correlation between YAP1 expression and E-cadherin expression (r=–0.273, P=0.032), and a positively correlation between YAP1 expression and N-cadherin (r=0.304, P=0.019) in gastric cancer tissue. The expression of YAP1 in gastric cancer was correlated with lymphatic metastasis and vascular invasion (P<0.05), and the overall survival rate in patients with YAP1 positive expression was significantly lower than that in those with YAP1 negative expression (χ2=4.354, P=0.037). Conclusion: The expressions of YPA1 and E-cadherin are significantly changed in gastric cancer tissue, and high YAP1 expression is closely related to the unfavorable clinicopathologic features and poor prognosis in the gastric cancer patients.

Abstract:Objective: To investigate the expression of the long noncoding RNA TUG1 and UCA1 in colon cancer tissue and their clinical significance. Methods: The frozen specimens of cancer tissues along with their adjacent tissues from 185 colon cancer patients undergoing surgical resection from January 2010 to June 2014 were collected. The expressions of TUG1 and UCA1 were determined by in situ hybridization and qRT-PCR respectively, and the relations of their expressions with the clinicopathologic features and prognosis of the patients were analyzed. Results: Both positive expression rates and relative expression levels of UCA1 and TUG1 in colon cancer tissue were significantly higher than those in the adjacent non-tumor tissue (all P<0.05). The expressions of UCA1 and TUG1 were significantly related to the clinicopathologic factors that included tumor size, lymph node metastasis, degree of differentiation and TNM stage (all P<0.05). Survival analysis showed that the overall survival rate in patients with high UCA1 expression or high TUG1 expression was significantly lower than that in patients with low UCA1 expression or low TUG1 expression (χ2=5.491, P=0.019; χ2=4.345, P=0.037). Both UCA1 and TUG1 expressions were independent risk factors for prognosis of the colon cancer patients (both P<0.05). Conclusion: The expressions of UCA1 and TUG1 are up-regulated in colon cancer tissue, and their high expressions are closely associated with the progression of colon cancer and poor prognosis of the patients.

Abstract:Objective: To explore the diagnostic markers as well as the potential therapeutic targets and drugs for colorectal cancer (CRC) through bioinformatics approach. Methods: The microarray data of GSE74602 was downloaded from the public data platform Gene Expression Omnibus (GEO) of the National Center for Biotechnology Information (NCBI), which contained 30 CRC tissue samples and 30 normal colorectal tissue samples. The differential expressed genes between CRC tissue and normal colorectal tissue were identified by Limma package of R language. Then, the differential expressed genes were subjected to Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis using DAVID online tool. At the same time, Protein-protein interaction networks of the differential expressed genes were generated by using the STRING server and visualized by Cytoscape software. Subnetwork module analyses were performed through the MCODE plugin to screen out the core genes for CRC carcinogenesis. Finally, the small molecule compounds potentially against CRC were searched from the Connectivity Map (cMap) database. Results: A total of 231 differential expressed genes were picked up, among which 122 were up-regulated and 109 were down-regulated. The GO analysis showed that the up-regulated genes were enriched for biological processes that mainly included cell cycle and cell division, while the down-regulated genes were enriched for biological processes such as immune response, intracellular signaling cascade and defense response. KEGG pathway analysis showed the up-regulated genes were mainly involved in the signaling pathways associated with the intracellular nitrogen and mineral metabolism and secretion (such as bile and pancreatic juice), while the down-regulated genes were mainly involved in the signaling pathways associated with drug metabolism, cell cycle and p53. Some genes playing critical roles in regulating the occurrence of CRC were identified, such as KIF20A, CENPF, NCAPG, PYY, and IQGAP3. Several small molecule drugs potentially against CRC were screened out after the differentially expressed genes in the protein-protein interaction networks were submitted to the cMap database, such as viomycin, harmalol and ikarugamycin. Conclusion: The identified pivotal genes may probably be used as the new biomarkers for diagnosis of CRC or therapeutic targets of CRC. Moreover, the screened small molecule compounds may potentially be developed into novel drugs for the treatment of CRC.

Abstract:Objective: To investigate the early diagnosis and surgical treatment of cancer of the duodenal papilla. Methods: The clinical data of 80 patients with cancer of the duodenal papilla treated in Xiangya Hospital of Central South University from March 2010 to March 2017 were retrospectively analyzed. Of the patients, 16 cases underwent local resection and 64 underwent pancreatoduodenectomy (PD). Results: The main initial clinical manifestations included pruritus and jaundice in 60 cases (75.0%), abdominal pain and discomfort in 40 cases (50.0%), chills and fever in 4 cases (5.0%), inappetence and emaciation in 3 cases (3.75%), and mass at the duodenal papilla found by examinations in 2 cases (2.5%). The positive rates of preoperative ultrasound, CT, MRI, gastroscope/duodenal endoscope and ERCP were 82.26%, 89.66%, 91.3%, 93.75%, 94.29%, respectively. Among the patients undergoing local resection, 13 cases were adenocarcinoma of the duodenal papilla, one case was neuroendocrine carcinoma of the duodenal papilla and 2 cases were local canceration of duodenal papilla adenoma; among those undergoing PD, 61 cases were adenocarcinoma of the duodenal papilla, 2 cases were neuroendocrine carcinoma of the duodenal papilla and one case was local canceration of duodenal papilla adenoma. In patients undergoing local resection compared with those undergoing PD, the average intraoperative blood loss, hospitalization cost and incidence of postoperative complications were significantly reduced (all P<0.05), but the average length of hospital stay showed no significant difference (P>0.05), and postoperative 1-, 3- and 5-year survival rates also showed no significant difference (all P>0.05). Conclusion: For cancer of the duodenal papilla, duodenoscopy and ERCP are relatively reliable diagnostic methods, and PD should be the first choice of treatment options. For some special cases, local resection can be used as a safe and effective surgical method based upon the premise of strict adherence to indications and ensuring the negative margins during operation.

Abstract:Objective: To systematically evaluate the impacts of using enhanced recovery after surgery (ERAS) protocols on perioperative inflammatory response and immune function in patients with colorectal cancer undergoing elective surgery. Methods: The randomized controlled trials concerning using ERAS pathways in the setting of surgery for colorectal cancer were searched from several national and international online databases. The retrieval time was from inception of the database to April 2018. Quality assessment and data extraction of the selected studies were performed according to the Cochrane systematic review methods. Meta-analysis was performed by using RevMan 5.3 software. Results: Twenty-six studies were finally included, involving a total of 2 420 patients, with 1 185 cases in ERAS group and 1 235 cases in control group. The results of descriptive analysis showed that the postoperative levels of inflammatory factors were decreased and the time for postoperative recovery was shortened significantly in ERAS group compared with control group (all P<0.05). The results of pooled analysis showed that the percentage of CD4+T cells (WMD=0.85, 95% CI=0.21–1.49; WMD=2.85, 95% CI=1.76–3.94; WMD=1.52, 95% CI=0.42–2.62) and IgG levels (WMD=0.54, 95% CI=0.11–0.97; WMD=1.26, 95% CI=0.79–1.74; WMD=0.63, 95% CI=0.27–0.99) at postoperative day (POD) 1, 3 and 7, the percentage of CD3+ T cells (WMD=1.46, 95% CI=0.62–2.30; WMD=2.78, 95% CI=1.82–3.73) and IgA levels (WMD=0.14, 95% CI=0.07–0.22; WMD=0.29, 95% CI=0.22–0.36) at POD 1 and 3, and IgM levels (WMD=0.11, 95% CI=0.06–0.16) at POD 3 in ERAS group were significantly higher than those in control group (P<0.05); the incidence of wound infection (OR=0.52, 95% CI=0.31–0.85), pulmonary infection (OR=0.40, 95% CI=0.21–0.73), urinary tract infection (OR=0.15, 95% CI=0.04–0.54), postoperative intestinal obstruction (OR=0.34, 95% CI=0.13–0.87) and the overall complications (OR=0.40, 95% CI=0.28–0.56) in the ERAS group were significantly lower than those in control group (all P<0.05). Conclusion: ERAS protocols can be safely used in colorectal cancer patients undergoing elective surgery, which can inhibit the release of inflammatory mediators and help to maintain the stability of immune function during perioperative period, and thereby reduce the complications and promote early postoperative recovery.

Abstract:Objective: To investigate clinical efficacy of using T-shaped incision of the hernia sac for separation of the giant hernia sac during transabdominal preperitoneal (TAPP) inguinal hernia repair. Methods: One-hundred and fifty eligible patients with giant oblique inguinal hernia scheduled to undergo TAPP during January 2013 to January 2016 in the Sixth Affiliated Hospital of Sun Yat-sen University were enrolled. Using a computer-generated random number table, the patients were randomly assigned to control group (76 cases) and study group (74 cases). Patients in control group underwent conventional separation of the hernia sac, and those in study group underwent T-shaped hernia sac incision and two directional dissection. The main clinical variables between the two groups were compared. Results: There were no significant differences in age, body index mass, time of onset, and size of the hernia defect between the two groups (all P>0.05). In study group compared with control group, the average time for hernia sac separation (8.3 min vs. 11.2 min), average intraoperative blood loss (2.1 mL vs. 4.3 mL), and average operative time (47.2 min vs. 51.3 min) were all significantly reduced (all P<0.05). No postoperative recurrence or mesh infection occurred in either group. The incidence of postoperative seroma in study group was significantly lower than that in control group (2.6% vs. 8.1%, P=0.029). The scores of visual analogue scale, length of hospital stay and hospitalization costs showed no significant difference between the two groups (all P>0.05). Conclusion: Using T-shaped incision of the hernia sac during TAPP separation of the giant hernia sac can effectively shorten the separation and operative time, and reduce the intraoperative blood loss, with no increase of incidence of postoperative complications.

Abstract:Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. The mechanism for most GIST is considered to be the gain-of-function mutations of the c-Kit gene and Kit protein expression which cause the sustained activation of its down-stream signaling pathways and thereby the continuous proliferation of the tumor cells. As a tyrosine kinase inhibitor, application of imatinib has allowed the targeted therapy to become an important therapeutic option besides surgical treatment for GIST, and significantly influenced the treatment mode of GIST. Foxp3+Treg cells are important regulatory T population, and they negatively control the anti-tumor immune responses through suppressing the anti-tumor cells such as CTL and NK cells. Studies have revealed that imatinib inhibits GIST through not only targeted mechanism but also immunological mechanisms by suppressing the Foxp3+Treg cells and enhancing the anti-tumor immune responses. Here, the authors present research progress of the effects of imatinib on the peripheral blood Foxp3+Treg cells and their subpopulations in patients with GIST.

Abstract:Colorectal cancer is one of the most common malignant tumors, with morbidity and mortality ranking on the top five among all cancers. In recent years, an increasing number of reports indicate that the incidence of colorectal cancer is on the rise in younger population, with more advanced stage and worse prognosis. However, the understandings on the definition, risk factors, clinical features, treatment methods and prognosis of the young-onset colorectal cancer are still limited. Here, the authors address the above aspects with review of the latest research at home and abroad to provide a reference for clinical practice.

Abstract:The incidence of diabetes is rising with years, and its high morbidity and disability rates have seriously threatened human health. As one of the important components of human microecosystem, intestinal microecological system helps the human body to transform and absorb nutrients and has close reciprocities with many tissues and organs, so it is an important guarantee for human health. In recent years, the intestinal microecological structure and characteristics of populations with different diseases have been analyzed by using techniques of macrogenomics and bioinformatics, which revealed that there is a close and complex relationship between human health and the intestinal microecological profile. There is also a strong relationship between intestinal microecological profile and the occurrence and development of diabetes mellitus. Here, the authors mainly address the complex link of intestinal microecological environments to diabetes mellitus and the research progress.