Abstract:Any emerging technology is impossible to be perfect, at the beginning of its birth. It may be bombarded with doubts coming from all directions. If a good technology is expected to go forward, people must open their hearts to respond to the doubts raised, and meanwhile, need to constantly solve the problems. Without doubt, the life of a new technology cannot be conceived. As professor Wang Xishan once said: "Our existing knowledge and experiences as well as the inertia thinking are often the biggest enemy of innovation, and also the grounds for disagreement with others".

Abstract:Lateral pelvic lymph node dissection is still the important operation for the treatment of rectal cancer. But the experts in Europe and America hold different opinions from those in Japan on whether lateral pelvic lymph nodes should be considered as regional lymph nodes of rectal cancer and the significance of lateral pelvic lymph node dissection. Different definitions of lateral pelvic lymph nodes will lead to different staging for rectal cancer and consequently result in different treatment strategies. In different periods of time, there are evolving definitions for lateral pelvic lymph nodes proposed by the scholars in Europe and America as well as in Japan. Here, the author interprets these evolving changes based on the available data, with the emphases on evolving definitions for pelvic lateral lymph nodes of the Japanese Society for Cancer of the Colon and Rectum, because more extensive efforts have been made by Japanese scholars in this field.

Abstract:Objective: To investigate the influences of natural orifice specimen extraction surgery (NOSES) on postoperative recovery and immune function in patients with rectal cancer.    
Methods: The clinical data of 98 patients with rectal cancer treated from February 2015 to December 2016 were retrospectively analyzed. Of the patients, 49 cases underwent radical rectal cancer resection with the NOSE approach (observation group), and the other 49 cases underwent conventional laparoscopic radical rectal cancer resection (control group). The main clinical variables and the pre- and postoperative levels of stress factors and immune function parameters of the two groups of patients were analyzed. 
Results: In observation group compared with control group, the time to postoperative gas passage was significantly reduced (2.62 d vs. 3.31 d, P<0.05), while the operative time, intraoperative blood loss and number of resected lymph nodes showed no significant differences (all P>0.05). There were no significant differences in the levels of E-selectin, endothelin (ET), soluble vascular cell adhesion molecule 1 (sVCAM-1), matrix metalloproteinases 9 (MMP-9) and immunoglobulins between the two groups before operation (all P>0.05), but the postoperative levels of E-selectin, ET, sVCAM-1 and MMP-9 were significantly lower and the postoperative levels of immunoglobulins were significantly higher in observation group than those in control group (all P<0.05). the incidence of complications in observation group was lower than that in control group (8.16% vs. 18.37%), but it did not reach a statistical significance (P>0.05).
Conclusion: NOSE radical rectal cancer resection can achieve the equivalent oncologic outcomes of the traditional procedures, and it can also reduce the expressions of stress factors, exert less impact on immune function, and accelerate the recovery of the patients. 

Abstract:Objective: To systematically evaluate the efficacy and safety of robot-assisted proctectomy (RP) and laparoscopic proctectomy (LP) for rectal cancer.
Methods: The randomized controlled trials (RCTs) comparing RP and LP for rectal cancer were collected by searching several national and international databases from inception to March 28, 2018. The data were extracted and the quality was evaluated by two reviewers independently according to the inclusion and exclusion criteria. Meta-analysis was performed by using R version 3.4.2.
Results: Seven RCTs were finally included, involving 956 patients with 474 cases in RP group and 482 cases in LP group. The results of Meta-analysis showed that RP group had a longer operative time (MD=28.88, 95% CI=3.20–54.55, P=0.028), a lower conversion rate (RR=0.49, 95% CI=0.31–0.78, P=0.003), a faster recovery of postoperative bowel function (MD=–0.43, 95% CI=–0.74––0.13, P=0.006), and a shorter hospital stay (MD=–0.95, 95% CI=–1.84––0.06, P=0.037) compared with LP group; no significant differences were found in terms of perioperative mortality, incidence of complications, length of proximal and distal margins, harvested lymph nodes, time to liquid food intake between the two groups (all P>0.05). 
Conclusion: Current evidence indicates that the perioperative efficacy of RP is superior to that of LP. Regarding long-term efficacy of RP, the advantages can be not judged based on current research. To compare the long-term efficacy of RP and LP effectively, future RCTs should focus on long-term follow-up and record long-term outcomes between the two groups.

Abstract:Objective: To compare the short-term efficacy and quality of life (QOL) between patients undergoing overlap esophagojejunostomy and π-shaped esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG).
Methods: The clinical data of 104 patients with gastric adenocarcinoma meeting the requirements undergoing TLTG from January 2012 to August 2017 were retrospectively collected. Of the patients, 59 cases underwent overlap esophagojejunostomy (overlap anastomosis group) and 45 cases underwent π-shaped esophagojejunostomy (π-shaped anastomosis group). The clinical data and results of QOL questionnaires before and one year after operation were compared between the two groups of patients.
Results: The preoperative data between the two groups were comparable. The average time for anastomosis in π group was significantly shorter than that in overlap group (28.9 min vs. 41.5 min, P<0.05), but the average operative time showed no significant difference between the two groups (287.6 min vs. 315.6 min, P>0.05). There were no statistically differences in terms of intraoperative blood loss, length of incision, postoperative short-term results, and postoperative one-year nutritional status and QOL between the two groups (all P>0.05).
Conclusion: Both overlap and π-shaped esophagojejunostomy after TLTG are safe and feasible. The difference in anastomotic method will not significantly affect the short-term results and QOL of the patients. In clinical practice, the two types of anastomotic methods can be selected according to the specific factors such as the conditions of the patients and the location of the tumor.

Abstract:Objective: To investigate the feasibility, safety and technical operations of robotic-assisted radical gastrectomy for gastric stump cancer using Da Vinci robotic system.   
Methods: The clinical data of 8 patients with gastric stump cancer undergoing robotic-assisted radical gastrectomy using Da Vinci robotic system from January 2017 to March 2018 were retrospectively analyzed.
Results: Robotic-assisted radical gastrectomy were successfully performed in all of the 8 patients using 
Da Vinci robotic system. The average operative time was (237.8±11.0) min, average intraoperative blood loss was (147.5±28.2) mL, and the average number of dissected lymph nodes was 32.3±7.6. The gastric tube was removed on postoperative day one in all patients. The average time to postoperative ambulation was (1.3±0.2) d, to first anal gas passage was (2.5±0.6) d, and to liquid intake was (2.7± 0.5) d, and the average length of postoperative hospital stay was (7.2±0.5) d. No death occurred during the perioperative period, and no complications such as intra-abdominal hemorrhage, abdominal infection, anastomotic leakage, anastomotic stricture, intestinal obstruction, and wound infection occurred after operation.
Conclusion: Using Da Vinci robotic system in radical gastrectomy for gastric stump cancer is safe, effective and feasible. The operation is more minimally invasive, less bleeding, less postoperative pain and less complications. 

Abstract:Objective: To investigate the expression, clinical significance and biological function of miR-105-5p in gastric cancer (GC), as well as its potential action mechanism.
Methods: The expressions of miR-105-5p in GC and tumor adjacent tissues as well as in different GC cell lines (MGC 803, MKN 1, SGC 7901, BGC 823 and AGS) and normal gastric mucosal cell line (GES-1) were determined by real-time PCR. The relations of miR-105-5p expression with the clinicopathologic features and prognosis of GC patients were analyzed. The effects of miR-105-5p on migration, invasion and proliferation of GC cells were examined by Transwell migration and invasion assay and MTT assay, respectively. The potential target gene for miR-105-5p was predicted by using Bioinformatics tools, and then, the correlation between miR-105-5p and its target gene was verified by Luciferase reporter assay and Western blot, respectively. 
Results: The expression of miR-105-5p in GC tissues was significantly higher than that in tumor adjacent tissue, and in each studied GC cell line was significantly higher than that in normal gastric mucosal cell line (all P<0.05). The expression of miR-105-5p was significantly associated with tumor size (P=0.020) and distant metastasis (P=0.004); the overall survival rate in GC patients with low miR-105-5p expression was significantly higher than that in GC patients with high miR-105-5p expression (P=0.001 8). The BGC-823 cells with a relatively low miR-105-5p expression and the MKN 1 cells with a relatively high miR-105-5p expression were transfected with miR-105-5p mimics and miR-105-5p inhibitors respectively, and the results after transfection showed that the migration, invasion and proliferative abilities in BGC-823 cells were significantly increased, while were significantly decreased in MKN 1 cells (all P<0.05). Bioinformatics analysis suggested that DIRAS family GTPase 3 (DIRAS3) was possibly be the target of miR-105-5p; luciferase reporter assay indicated that the luciferase activity of DIRAS3-3’-UTR was negatively regulated by miR-105-5p; Western blot demonstrated that the DIRAS3 expression was significantly down-regulated in BGC-823 after transfection with miR-105-5p mimics, and was significantly up-regulated in MKN 1 cells after transfection with miR-105-5p inhibitors (both P<0.05).
Conclusion: The expression of miR-105-5p is elevated in GC, promotes migration, which can enhance the migration, invasion and proliferative abilities of GC cells probably through targeting DIRAS3, and thereby promote the occurrence and development of GC.

Abstract:Objective: To investigate the predictive indicators and therapeutic targets of gastric cancer using bioinformatics approach and analyze the relations of them with prognosis.
Methods: Three microarray datasets (GSE13911, GSE33651, GSE79973) were downloaded from Gene Expression Omnibus (GEO) database. The differentially expressed genes between gastric cancer samples and normal tissue samples were screened using GEO2R tools. The functional and pathway annotations of the differentially expressed genes were performed by Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses, Meanwhile, the protein-protein interaction network (PPI) was constructed using STRING and Cytoscape to pick up the hub genes, and the relations of the hub genes with prognosis were analyzed using the Kaplan-Meier plotter database. 
Results: A total of 135 differentially expressed genes were screened, of which 68 were up-regulated and 67 were down-regulated. GO analysis showed that the differentially expressed genes were mainly enriched in biological processes such as signal transduction, calcium ion binding and extracellular exosomes. KEGG analysis revealed that the major enriched pathways of the differentially expressed genes included PI3K/Akt signaling pathways, ECM receptor interactions and focal adhesions. PPI analysis showed that COL1A1, COL1A2, COL4A1, FN1, THBS1, CD44, COL2A1, COL4A2, CXCL8, COL5A1 were the hub genes. Survival analysis showed that except the up-regulation of THBS1, the abnormal expressions of other hub genes were significantly associated with the overall survival of the gastric cancer patients. 
Conclusion: The abnormal expressions of the screened hub genes may be involved in the development and progression of gastric cancer, and could be closely related to the prognosis of gastric cancer patients. These genes may serve as potential predictors and therapeutic targets for further research of gastric cancer. 

Abstract:Objective: To investigate the expression of COL12A1 in gastric cancer and its biological function.  
Methods: The COL12A1 expression in gastric cancer and its relations with pathological stage and prognosis of gastric cancer were analyzed by using Oncomine and GEPIA online databases. The gene and protein expressions of CLL12A1 in 58 specimens of gastric cancer and tumor adjacent tissue were determined by qPCR and immunohistochemical staining. In gastric cancer SGC7901 cells after CLL12A1 knockdown through siRNA interference technique, the changes in biological behaviors were observed through CCK-8 assay, plate clone formation assay, and Transwell chamber assay, respectively.
Results: Oncomine- and GEPIA-based online analysis indicated that COL12A1 was significantly upregulated in gastric cancer (both P<0.05); COL12A1 expression was irrelevant to the pathological stage of gastric cancer (P>0.05), but the overall survival rate in gastric cancer patients with high COL12A1 expression was significantly decreased (P<0.05). the results of qPCR and immunohistochemical staining showed that both gene and protein expressions of COL12A1 were significantly higher than those in the tumor adjacent tissue (both P<0.05). In gastric cancer SGC7901 cells after CLL12A1 knockdown, the growth, proliferative and invasion abilities were all significantly inhibited (all P<0.05).
Conclusion: COL12A1 is upregulated in gastric cancer, and high COL12A1 expression may probably promote growth, proliferative and invasion abilities of gastric cancer cells, and also related to poor prognosis of the patients.

Abstract:Objective: To investigate the expression of Wnt7a protein in gastric cancer tissue, and its association with clinicopathologic features and prognosis of the patients. 
Methods: The surgical specimens of 135 gastric cancer patients were collected. The Wnt7a protein expressions in gastric cancer tissues and tumor adjacent tissues were determined by Western blot and immunohistochemical staining, respectively. The relationship between Wnt7a protein expression and clinicopathologic characteristics as well as the disease-free survival rate and overall survival rate of the patients were analyzed.
Results: The expression level of Wnt7a protein in gastric cancer tissue was higher than that in tumor adjacent tissue, and the high expression rate of Wnt7a protein in gastric cancer tissue was also significantly higher than that in tumor adjacent tissue (χ2=30.5, P=0.000). The Wnt7a protein expression was not associated with sex, age, HP infection, degree of differentiation and Lauren typing (all P>0.05), but was significantly associated with TNM stage, distant metastasis and lymph node metastasis (all P<0.05). The 1- and 5-years disease-free survival rate of overall survival rate in gastric cancer patients with high Wnt7a expression were significantly lower than those in Wnt7a gastric cancer patients with low Wnt7a expression (all P<0.01). High Wnt7a expression (P=0.01) and distant metastasis (P=0.02) were independent risk factors for disease-free survival rate of gastric cancer patients, while high Wnt7a expression (P=0.02) along with TNM stage (P=0.03) and distant metastasis (P<0.01) were independent risk factors for overall survival rate of gastric cancer patients. 
Conclusion: Wnt7a protein is highly expressed in gastric cancer tissue, and high Wnt7a protein expression is significantly associated with malignant pathological features of the patients. Wnt7a protein expression can be used as a predictor for postoperative survival of gastric cancer patients.  

Abstract:Objective: To investigate the cardioprotective effect of Rhodiola Crenulate in patients with gastric cancer and concomitant coronary heart disease during perioperative period.
Methods: Sixty-nine consecutive patients with gastric cancer and concomitant coronary heart disease from January 2017 to June 2018 scheduled to undergo gastrectomy were enrolled. The patients were randomly allocated to study group and control group. Thirty-four cases in study group were given 10 mL Rhodiola Crenulate injection by intravenous infusion from preoperative day 1 to postoperative day 3, and 35 cases in control group were given placebo (0.9% saline) administered in the same fashion. The blood samples of the patients were drawn before operation as well as immediately and 24 h after operation to examine the levels of creatine kinase-MB (CK-MB), troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP). The postoperative recovery and the incidence of main adverse cardiac events during hospitalization were observed. 
Results: The baseline data showed no significant differences between the two groups of patients (all P>0.05). The levels of cTnI, CK-MB, NT-proBNP and hs-CRP in both groups were continually increased after operation, but the increasing amplitudes of them were milder in study group than those in control group, in which, the level of CK-MB in study group was significantly lower than that in control group immediately after operation, and the levels of all above parameters in study group were significantly lower than those in control group 24 h after operation (all P<0.05). The times to first flatus and defecation as well as the length of hospital stay in study group were shorter than those in control group (all P<0.05). The incidence of each adverse cardiac event showed no significant difference between the two groups (all P<0.05). 
Conclusion: Rhodiola Crenulate has cardioprotective effect for patients with gastric cancer and concomitant coronary heart disease during perioperative period, and can also promote the postoperative recovery of these patients.

Abstract:Objective: To construct a nomogram-based model for predicting the postoperative survival of patients with linitis plastica of the stomach, and verify its accuracy. 
Methods: The clinical and pathological data of 203 patients with gastric linitis plastica who underwent R0 resection in the Department of Gastric Surgery of Fujian Medical University Union Hospital from December 2008 to September 2014 were collected. The independent prognostic factors were determined by Cox regression analysis, and then the nomogram predictive model was constructed by using R software. Further, the accuracy of the model in predicting the prognosis of patients with gastric linitis plastica was analyzed.
Results: In the whole group of patients, 152 cases were males and 51 cases were females, with an average age of 60.3 (21–89) years; 25 cases (12.3%) had stage II disease and 178 cases (87.7%) had stage III disease; the median follow-up time was 38 (2–111) months; the 3- and 5-year overall survival rates were 31.2% and 18.7% respectively. Results of multivariate analysis showed that BMI (P=0.006), tumor differentiation (P=0.042), T stage (P=0.032), N stage (P=0.032) and ASA score (P=0.016) were independent prognostic factors. Based on these independent risk factors, a nomogram model was established. The risk stratification analysis of the patients according to their scores from the nomogram showed that there was a significant statistical difference among high-risk group (>16), intermediate-risk group (>8–16) and low-risk group (≤8) (P<0.001). The values of χ2 for linear trend, likelihood ratio, and Akaike information criterion of the nomogram were all superior to those of the 7th edition AJCC staging system (68.99 vs. 58.58, 70.18 vs. 58.36, 1 473.38 vs. 1 485.04).
Conclusion: The established nomogram can effectively predict the postoperative survival of the patients with gastric linitis plastica, and its accuracy is better than that of the 7th edition AJCC staging system. However, but the results still need to be further verified by large sample size and multicenter studies.

Abstract:Objective: To analyze clinicopathologic features and prognosis of primary gastrointestinal stromal tumor (GIST).
Methods: The clinicopathologic and follow-up data of 314 patients with primary GIST treated in Xiangya Hospital of Central South University from January 2012 to August 2018 were retrospectively analyzed.
Results: Of the 314 GIST patients, 169 cases (53.8%) were males and 145 cases were (46.2%) females, with a median age of 55 (24-86) years and a median tumor diameter of 6 (1-34) cm; the primary site located in the stomach in 165 cases (52.6%), duodenum in 15 cases (4.8%), jejunum or ileum in 115 cases (36.6%), colorectum in 6 cases (1.9%), and other sites in 13 cases (4.1%). According to the modified NIH classification, the diseases of the patients were classified as very low risk in 11 cases (3.5%), low risk in 109 cases (34.7%), moderate risk in 80 cases (25.5%), and high risk in 114 cases (36.3%). All the 314 patients underwent surgical treatments, of whom, 305 cases (97.1%) achieved R0 resection, 4 cases (1.3%) received R1 resection, and 5 cases (1.6%) had R2 resection. Followed -up was obtained in 268 patients (85.4%) for a median time of 37 (2–69) months. Of the 194 patients with moderate or high risk disease, 67 cases (34.5%) received imatinib-based adjuvant therapy after operation, with a median time of 26 (7–56) months. In the whole group of patients, the 1-, 3- and 5-year relapse-free survival rates were 97.0%, 92.6% and 81.7%, and the 1-, 3- and 5-year overall survival rates were 99.4%, 95.2% and 88.2%, respectively. In patients with very low risk, low risk, moderate risk and high risk disease, the 5-year relapse-free survival rates were 100.0%, 93.3%, 79.1% and 64.4%, and the 5-year overall survival rates were 100.0%, 94.1%, 91.7% and 74.9%, respectively. Among the 194 patients with moderate or high risk disease, the 5-year relapse-free survival rates in the 67 cases with postoperative imatinib adjuvant therapy and the 127 cases without postoperative imatinib adjuvant therapy were 73.8% and 65.2%, and the 5-year overall survival rates were 87.5% and 71.6%, respectively.
Conclusion: Primary GIST is mostly found in the stomach and small intestine. Complete resection and imatinib-based adjuvant therapy based on risk classifications can lead to better prognosis. However, individualized treatment should be tailor to specific patients with high risk GIST, and close and regular follow-up is still needed in addition to the standard adjuvant therapy.

Abstract:Objective: To compare the application efficacy of self-gripping mesh and sutured mesh in Lichtenstein inguinal hernia repair.    
Methods: The randomized controlled trials (RCTs) comparing using self-gripping mesh and sutured mesh in Lichtenstein tension-free mesh repair from January 2010 to January 2019 were searched in the national and international databases. After literature screening according to the inclusion and exclusion criteria, the risks of bias of included studies were assessed by the Cochrane collaboration tool, and the pooled effect size was analyzed by using of Review Manager Version 5.3 software.
Results: Fourteen RCTs were finally included involving 3 904 patients, with 1 930 cases in self-gripping mesh group and 1 974 cases in sutured mesh group. The results of Meta-analysis showed that the operative time was significantly shortened (MD=–5.31, 95% CI=–8.11––2.51, P=0.000 2) and the wound infection rate was significantly decreased (RR=0.46, 95% CI=0.26–0.81, P=0.007) , but the hernia recurrence rate was significantly increased (RR=1.67, 95% CI=1.12–2.48, P=0.01) in self-gripping mesh group compared with sutured mesh group; there was no statistical differences in incidence of postoperative chronic groin pain, foreign body sensation, hematoma and seroma between the two groups (all P>0.05).
Conclusion: Compared with the traditional sutured mesh in Lichtenstein tension-free repair, self-gripping mesh has the advantages of shortening operative time and reducing incidence of incision infection, but it may lead to an increased hernia recurrence in short-term postoperative period (within one year after operation). However, this conclusion still needs to be validated by large sample size and high-quality studies.

Abstract:Colorectal cancer (CRC) is the third most common malignant tumor in the world. Despite many advances in understanding the pathogenesis, pathology, prevention and treatment of CRC, there is still a high mortality rate. The mortality rate is closely related to CRC liver metastasis. Therefore, studying the mechanism of liver metastasis and controlling disease progression are important measures to improve the survival time of these patients. In recent years, mouse models of CRC liver metastasis have been widely used in metastasis research. Here, the authors address the current mouse models and their characteristics, and analyze their advantages and disadvantages. It is expected to provide references for investigators in selecting the mouse CRC liver metastasis model, and clues for the study of the mechanism of CRC liver metastasis.

Abstract:Anastomotic fistula is one of the most severe complications after digestive tract surgery. At present, endoscopic treatment for anastomotic fistula is developing gradually, and it has many advantages such as safety, minimally invasiveness, low cost of treatment compared with traditional surgery. The treatment methods include endoscopic jejunal nutrition tube placement, metal clip closure, stent placement, tissue sealants, suturing, vacuum-assisted closure therapy. The relevant characteristics of them include: jejunal nutrition tube can effectively improve the nutritional status of the patients; through-the-scope clip combined with nylon rope trap has advantages in the treatment of anastomotic fistula with diameter less than 1.0 cm; over-the-scope clip is suitable for anastomotic fistula with large defect and high tension; endoscopic stent can cover the fistula orifice entirely and control the leakage early, and it has a higher benefit for patients at risk of stenosis of the lumen, but stent displacement, removal difficulties and other circumstances are possibly occur; tissue sealant combined with endoscopic clip or stent can improve the success rate of leak occlusion; endoscopic suturing is safe and effective in preventing stent displacement; endoscopic vacuum-assisted closure therapy can sufficiently drain the inflammatory environment around the leakage, and has better applicability for anastomotic leak patients with secondary mediastinitis or intrathoracic inflammation. Endoscopic minimally invasive treatment of anastomotic fistula can avoid repeated operation and be the preferred treatment option for some patients.

Abstract:Periostin (POSTN) is a cell adhesion protein. Under physiological conditions, it plays an important role in the formation of bone and teeth, can promote development of the heart valves and participate in the pathophysiological processes of various heart diseases. In recent years, POSTN has been found to be highly expressed in a variety of malignancies and is often associated with recurrence and metastasis as well as poor prognosis. As an extracellular matrix protein, its role and mechanism in the development of tumors has attracted increasingly attention in many researches. Here, the authors address the research progress of POSTN in tumors.