Abstract:Open retromuscular (sublay) repair and laparoscopic intraperitoneal onlay mesh (IPOM) technique are the main procedures for ventral/incisional hernia repair. All types of minimally non-intraperitoneal mesh (MINIM) repair are currently still in the exploration stages, which may have wide development prospects in the future. IPOM and MININ have different repair concepts, technical characteristics and targeted patient populations. Under strict indication control, both procedures can show their respective advantages to the greatest extent. Modern hernia surgery emphasizes “minimal invasion” and “reconstruction of abdominal wall function”. While repairing the defects of abdominal wall and restoring abdominal wall function, surgeons should minimize excessive dissection of abdominal wall. With the development of new materials, the exploration of new technologies and the upgrading of endoscopic platforms, the ventral/incisional hernia repair based on the minimally invasive concept will witness a more promising future. 

Abstract:Laparoscopic radical gastrectomy has developed for more than 20 years since its inception. With the extension of the concept of minimally invasive surgery and the continuous innovation of laparoscopic instruments, laparoscopic gastrectomy for gastric cancer has been widely carried out around the world. In our country, laparoscopic gastric surgery began relatively late, but great progress has also been made, and yet, the technical levels of laparoscopic radical gastrectomy are dissimilar, which affects the clinical efficacy seriously. Here, the authors provide an overview of how to successfully perform a laparoscopic radical gastrectomy, and propose the concept of iFIST that consists of the “strict indications”, “clear and bloodless surgical field”, “adequate peritoneal irrigation”, “intact specimens”, and “totally laparoscopic operation”.

Abstract:Background and Aims: Parastomal hernia (PSH) is a common complication after ostomy surgery, which has a high incidence rate and is difficult to repair. Therefore, some studies suggested using prophylactic mesh to strengthen abdominal wall to prevent this complication. However, the effectiveness of prophylactic mesh has been challenged by several recent studies. This study was conducted to systematically evaluate the efficacy of using prophylactic mesh in preventing PSH after ostomy surgery and its safety. 
Methods: The randomized controlled trials (RCTs) concerning using prophylactic mesh for prevention of PSH were collected by searching several national and international databases. The retrieval time was from the inception to March 2020. After literature screening, data extraction and quality assessment by two independent researchers according to the established inclusion and exclusion criteria, Meta-analysis with bias risk assessment was performed using Revaman 5.3 software.
Results: A total of 12 RCTs with a medium or high quality were included, involving 963 patients, of whom 479 cases received prophylactic mesh placement (mesh group) and 484 cases did not receive mesh placement (control group). Results of Meta-analysis showed that mesh group was superior to control group in the prevention of PSH (RR=0.44, 95% CI=0.29–0.65, P<000 1), and as for the colostomy complications, there were no statistical differences between mesh group and control group in the incidence of stoma-related infection (RR=0.92, 95% CI= 0.46–1.81, P=0.80), stoma prolapse (RR=0.29, 95% CI=0.08–1.07, P=0.06), stoma necrosis (RR=0.72, 95% CI=0.32–1.61, P=0.42) stoma stenosis (RR=2.31, 95% CI=0.79–6.81, P=0.13) and stoma requiring repair (RR=0.88, 95% CI=0.48–1.61, P=0.68). Subgroup analysis showed that the surgical type, diagnostic method, mesh position and follow-up time were all not determinants of the heterogeneity across studies (all P>0.05).
Conclusion: The existing studies indicate that using prophylactic mesh during routine ostomy surgery can effectively reduce the incidence of PSH, without increasing the stoma-related complications. However, this conclusion still needs multicenter high-quality RCTs with a large-sample size to further confirm.

Abstract:Background and Aims: Inguinal hernia repair is one of the most common procedures performed in day surgery units. With the development of modern inguinal hernia surgery and anesthetic techniques, an increasing cases of inguinal hernia surgery can be done in day surgery units. However, there is no a uniform standard for the selection of procedure and anesthetic method in day surgery for inguinal hernia. Laparoscopic transabdominal preperitoneal hernia repair (TAPP), for the advantages such as minimal invasiveness, fast recovery, high patient comfort level and low recurrence rate, has become one of the main methods for clinical treatment of inguinal hernia. This study was conducted to evaluate the effectiveness and safety of day-case laparoscopic TAPP.  
Methods: The clinical data of the consecutive patients with inguinal hernia undergoing laparoscopic TAPP in Xiangya Hospital of Central South University from January 2016 to January 2021 were retrospectively analyzed, and a total of 785 patients were finally included in this study. All patients were evaluated by the surgeon and anesthesiologist before operation for decision-making on inpatient surgery or day surgery, of whom, 585 cases underwent inpatient surgery and 200 cases received day surgery. The 200 patients undergoing day-case laparoscopic TAPP were specially analyzed. 
Results: The average age of patients receiving day surgery was younger than that of patients undergoing inpatient surgery, and meanwhile, the proportions of cases with concomitant disease, recurrent hernia or bilateral hernia were less than those of patients undergoing inpatient surgery (all P<0.05). Laparoscopic TAPP was successfully performed in all patients of the two groups. The average length of total hospital stay was 0.5 d, the average postoperative length of stay was 6 h, and the average hospitalization expense (including outpatient examination cost) was 16 185 yuan for patients receiving day surgery, all of which were significantly lower than those for patients undergoing inpatient surgery (all P<0.05). Postoperative urinary retention occurred in one case in patients undergoing day surgery. The median follow-up period was 13 (2–62) months. One case (0.5%) in patients undergoing day surgery and 2 cases (0.3%) in patients undergoing inpatient surgery recurred, and the difference showed no statistical significance (P>0.05), and no long-term inguinal chronic pain, readmission and death were observed in patients of both groups during the follow-up period. 
Conclusion: Day-case laparoscopic TAPP can significantly reduce the length of hospital stay and hospitalization expenses compared with inpatient operation. It can be safely performed under the premise of reasonable selection of indications, for example, in most of young patients with less complications (American Society of Anesthesiologists grade II or below) and patients with simple inguinal hernia (such as incipient hernia, no incarceration or strangulation, and no relevant history of lower abdominal surgery). 

Abstract:Background and Aims: Umbilical hernia is one of the most common abdominal hernia, and surgical treatment is the only cure for this disease. With the development of endoscopic techniques, the application of endoscopy in hernia and abdominal wall surgery is constantly evolving. This study was conducted to evaluate the feasibility and safety of laparoscopic total extraperitoneal herniorrhaphy using a lateral approach for umbilical hernia in adults. 
Methods: From June 2019 to January 2020, 5 patients with umbilical hernia underwent laparoscopic total extraperitoneal hernia repair via lateral approach in the Department of General Surgery of Zhongshan Hospital affiliated to Xiamen University, including 3 males and 2 females, aged 30–53 years with an average age of 41.8 years at the time of consultation. The clinical data and follow-up results of the 5 patients were retrospectively analyzed.
Results: Operations were successfully completed in all the 5 patients. The average operative time was (70±5.8) min, the time to postoperative ambulation was 6–8 h, and the average length of postoperative hospital stay was (3.2±0.7) d. After operation, umbilical fluid collections occurred in 1 case, but no serious complications such as bleeding, ileus, intestinal fistula occurred. No recurrence was noted during follow-up period of 1 7 months.
Conclusion: Laparoscopic total extraperitoneal herniorrhaphy with lateral approach for adult umbilical hernia is safe and feasible. The operative difficulty of the lateral approach is relatively low and its clinical application may have broad prospects.

Abstract:Background and Aims: The clinical application of addition of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of gastric cancer is becoming increasingly popular. However, there is still no unified standard for HIPEC in the treatment of gastric cancer, and its safety and efficacy are still unclear. Therefore, the purpose of this study was to investigate the safety and short-term efficacy of radical operation plus intraoperative HIPEC with raltitrexed for locally advanced gastric cancer. 
Methods: By querying the cloud database of gastric cancer of the Department of Oncological Surgery, Anqing Hospital Affiliated to Anhui Medical University, the clinical data of 155 patients with locally advanced gastric cancer who underwent D2 radical gastrectomy from December 2017 to December 2019 were analyzed retrospectively. Of the patients, 52 cases underwent operation plus HIPEC (observation group) and 103 cases underwent operation alone (control group). The postoperative data, postoperative complications and hematological adverse events were compared between the two groups by using the propensity score matching (PSM) to balance the covariates. 
Results: Before the PSM matching, there were significant differences in tumor location and pathological TNM stages between observation group and control group (both P<0.05), and the baseline data of the patients in the two groups were unbalanced. After 1:1 PSM, 100 patients (50 patients in observation group and 50 patients in control group) were matched successfully. There was no significant difference in clinical and pathological staging between observation group and control group (all P>0.05), and the baseline data were well balanced. The operative time before and after matching in observation group were longer than those in control group (both P<0.001). On the first day after operation, the levels of aspartate aminotransferase (AST) and albumin (ALB) in observation group were significantly lower than those in control group before matching (both P<0.05), but there were no significant differences in all laboratory indexes between the two groups on the first day after operation after matching (all P>0.05). There were no significant differences in intraoperative blood loss, time to postoperative first flatus, length of postoperative hospital stay and postoperative pain score in the first three days between the two groups before and after matching (all P>0.05). There were no significant differences in perioperative mortality, unplanned reoperation rate, incidence of postoperative complications, Clavien-Dindo classification of postoperative complications and incidence of hematological adverse events between the two groups (all P>0.05).  
Conclusion: Immediate HIPEC with raltitrexed during radical operation for locally advanced gastric cancer prolongs the time of surgical anesthesia, but it does not affect the postoperative recovery and increase the incidence of postoperative complications. It is safe and reliable, and the long-term effect needs further study, which may bring survival benefits to the patients.

Abstract:Background and Aims: C-X-C motif chemokine ligand 14 (CXCL14) is a chemokine that induces migration of tumor cells, and closely related to the occurrence and development of various malignant tumors. This study was conducted to investigate the expression of CXCL14 in colorectal cancer cells and its influence on angiogenesis.
Methods: The expressions of CXCL14 mRNA and protein in different colorectal cancer cell lines (HT-29, WiDr, CaCo-2 and Colo-320) were detected by RT-PCR and Western blot analysis respectively, and the effects of CXCL14 siRNA transfection on these cells were also observed. The effects of different concentrations of CXCL14 alone or with simultaneous addition of CXCL14 antibodies on proliferation, migration and angiogenesis abilities of human umbilical vein endothelial cells (HUVECs) were measured by WST-1 assay, Transwell migration assay and angiogenesis assay, respectively. The differences in angiogenesis ability of HUVECs after co-culture with different colorectal cancer cell lines were also observed.
Results: The CXCL14 mRNA and protein were expressed in colorectal cancer cell lines with high hepatic metastasis potential (HT-29 and WiDr), but were absent in colorectal cancer cell lines with low hepatic metastasis potential (CaCo-2 and Colo-320). After CXCL14 siRNA transfection, the CXCL14 protein expressions in HT-29 and WiDr cells were remarkably decreased, and were remained unchanged in CaCo-2 and Colo-320 cells. After CXCL14 treatment, the proliferation, migration and angiogenesis abilities of HUVECs were all significantly enhanced with a concentration dependent manner (all P<0.05), but these effects were all abolished by simultaneous addition of CXCL14 antibodies (all P<0.05). The number of vessel formation of HUVECs after co-culture with CaCo-2 cells that didnot express CXCL14 was significantly lower than that of HUVECs after co-culture with HT-29 cells that express CXCL14 (P<0.05), but showed no significant difference with that of HUVECs after co-culture with HT-29 cells transfected with CXCL14 siRNA (P>0.05).
Conclusion: CXCL14 is expressed in colorectal cancer cells with high liver metastasis potential. It may increase the angiogenesis through enhancing the proliferation and migration abilities of vascular endothelial cells, and thereby promote the metastasis of colorectal cancer to the liver.

Abstract:Background and Aims: Lymph node metastasis is a key factor affecting the prognosis of patients with colorectal cancer (CRC). Voltage gated sodium ion channels (Nav) are highly expressed in a variety of tumors and closely related to tumor metastasis. Therefore, this study was conducted to investigate the expressions of different Nav subtypes in CRC tissue, and relationship between the Nav expressions and lymph node metastasis as well as invasiveness of CRC. 
Methods: The surgical specimens of tumor tissue and adjacent tissues from 100 patients with first-onset of CRC were collected. After identification by HE staining, the expressions of different Nav subtypes in the two types of tissues were detected by qRT-PCR. The associations of different Nav subtypes with lymph node metastasis, vascular infiltration as well as neural invasion in CRC patients were analyzed. The difference in the expressions of relevant Navs in non-metastatic lymph nodes and metastatic lymph nodes was detected by immunohistochemical staining.
Results: A number of Nav subtypes were highly expressed in CRC tissue, especially the Nav1.1, Nav1.5, Nav1.6 and Nav1.8. Among these Nav subtypes, the expressions of Nav1.1 and Nav1.6 were significantly increased in tumor tissues from patients with positive lymph nodes, and the expression of Nav1.6 was significantly increased in tumor tissues from patients with vascular infiltration (all P<0.05). The results of correlation analysis showed that the expressions of Nav1.1 and Nav1.6 were positively correlated with lymph node metastasis (r=0.272, P=0.006; r=0.234, P=0.019), the expression of Nav1.6 was positively correlated with vascular infiltration (r=0.341, P=0.001) and the expression of Nav1.6 was positively correlated with neural invasion (r=0.330, P=0.001). The results of immunohistochemical staining showed that Nav1.6 was highly expressed in positive lymph nodes, while low expression of Nav1.1 was found in both positive and negative lymph nodes.
Conclusion: Various Nav subtypes are abnormally expressed in CRC tissue, among them, Nav1.1 and Nav1.6 are possibly the potential markers for lymph node metastasis in CRC, and Nav1.6 may be closely related to the invasiveness of CRC cells.

Abstract:Background and Aims: Tumor immune cell infiltration plays a key role in the progression and prognosis of gastric cancer (GC). However, the regulatory genes of immune cell infiltration that affect the prognosis of GC are still unclear at present. This study was conducted to identified the immune genes associated with the prognosis of GC by co-expression network analysis and deconvolution analysis.  
Methods: GC mRNA expression data were downloaded from TCGA database and the proportions of immune cells in each sample were determined using the CIBERSORT deconvolution algorithm. A co-expression network was also constructed, and then, the immune-related prognostic genes were identified by combining the Kaplan-Meier method.
Results: Of the 22 types of immune cells included in the analysis, 11 were significantly higher in tumor tissue than those in normal tissue (all P<0.05). Survival analysis for the above 11 types of immune cells showed that infiltration of T cells CD4 memory resting and T cells regulatory was significantly correlated with survival rate in GC patients (all P<0.05). Based on the above results, the co-expression network analysis revealed that the genes in the turquoise module were most significantly correlated with the above two types of cells, and then, 3 prognostic genes associated with memory CD4 T cells (CGB5, LINC00106, LINC00392) and one associated with regulated T cells (UPK1B) were identified (all P<0.05). 
Conclusion: The 4 prognostic genes identified in this study may play important roles in the progression and prognosis of GC, and these genes may serve as potential targets for immunotherapy of GC by influencing the tumor immune process.

Abstract:Background and Aims: Colorectal cancer (CRC) is an aggressive disease with late diagnosis and poor prognosis. There is growing evidence suggesting a prominent correlation between immune signature and CRC. This study was aimed to establish an immune-related gene pairs (IRGP) signature for predicting the outcomes of CRC patients. 
Methods: The gene expression profiles and clinical information of CRC patients were extracted from TCGA and GEO databases, and were then divided into a training dataset (TCGA-COAD) and a validation dataset (GSE39582). Immune-related genes (IRGs) were downloaded from the ImmPort database for screening of the IRGs in the training dataset and the validation dataset. Paired comparison of the expression values of IRGs in each sample was performed, and the final immune-related gene pairs (IRGP) signature [immune-related gene pair index (IRGPI)] was constructed by Lasso-Cox proportional hazard model with an iteration number of 1 000. Then, the ROC curve of the IRGP signature was applied to split CRC patients into high and low-risk groups, followed by analysis of the survival states of the two groups of patients using Kaplan-Meier curves and Log-rank test. Simultaneously, the predictive ability of the signature was evaluated using univariate and multivariate Cox proportional hazards regression models. Subsequently, the infiltration conditions of immune cells in CRC patients were identified on the tumor samples using CIBERSORT through deconvolution algorithms. Finally, functional annotation and analyses of the model were performed to further understand its biological functions.
Results: Twenty IRGPI containing 28 IRGs were successfully constructed (CXCL14|BST2, RBP1|STC2, RBP7|PTGS2, RBP7|ARG2, RBP7|IL7, APOD|IL17RB, GNAI1|GRP, CCL4|INHBB, CCL28|INHBB, ABCC4|GRP, ARG2|GRP, CCR7|INHBB, CD86|IL7, OLR1|IL7, C5AR1|NR3C2, INHBB|PDGFC, STC2|HNF4G, IL10RA|TNFRSF11A, RORC|PRKCQ, TNFRSF11A|LCK), which were significantly associated with the prognosis of CRC patients. In the training dataset, the overall survival of CRC patients in high-risk group was shorter than that of CRC patients in the low-risk group (P=1.295×10–11, HR=6.51, 95% CI=3.79–11.21), and the similar result was obtained in the validation dataset (P=0.000 1, HR=1.82, 95% CI=1.36–2.44). Univariate and multivariate Cox analysis verified IRGPI as an independent prognostic factor for CRC (training dataset: HR=3.270, 95% CI=2.555–4.186, P<0.001 and HR=3.008, 95% CI=2.295–3.941, P<0.001; validation dataset: HR=1.278, 95% CI=1.10–1.474, P<0.001 and HR=1.189, 95% CI=1.024–1.380, P=0.023). According to the analysis of tumor-infiltrating immune cells, the regulatory T cells (P=0.007) and macrophages (P=0.024) in high-risk group were significantly higher than those in low-risk group, while the resting dendritic cells (P=0.006), resting memory CD4+T cells (P=0.006), and resting macrophages (P=1.784×10e–05) were significantly increased in low-risk group. The results of functional annotation indicated that IRGs correlate with certain biological processes, which included the leukocyte migration, cell chemotaxis, cytokine-cytokine-receptor interaction, etc. Further, the related pathways with significant differences between high and low-risk groups included the keratinocyte differentiation, keratinization, epidermal cell differentiation, and skin development, etc.
Conclusion: A IRGP signature for evaluating the prognosis of CRC patients is successfully constructed, which may provide novel insights into the diagnosis and treatment of CRC.

Abstract:Colorectal cancer (CRC) is a common digestive tract tumor for which surgical resection is mainstay of treatment, or in combination with chemotherapy and radiotherapy. At present, the treatment mode has evolved from the traditional "group-based" diagnosis and treatment to the precise "individualized" therapy. Precision medicine is to find the cause of the disease and the therapeutic targets through genome detection, and finally forms a diagnosis and treatment system involving the screening of cancer-related molecular markers, accurate diagnosis and classification, and precise treatment with the help of cancer genome sequencing and information analysis. Whole exome sequencing (WES) is a new gene sequencing technique, which has been widely applied in the fields of complex human diseases and various malignant tumors. Some progress has also been achieved in its application in studies concerning the pathogenesis, treatment, metastasis risk assessment and prognosis estimation of CRC.

Abstract:Gastric cancer is one of the most malignant tumors in the world. In recent years, a number of studies have proved that noncoding RNAs play an important part in many biological processes in gastric cancer such as initiation, proliferation and metastasis. The regulatory network of nocoding RNAs consisting of the micro-RNAs (miRNAs), circular RNAs (circRNAs) and long noncoding RNAs (lncRNAs) are involved in the processes of regulating a variety of gene expressions. At present, the diagnosis of gastric cancer mainly depends on endoscopy, the simple and effective screening measures are still lacking, and the treatment modalities for advanced gastric cancer are also limited. Fortunately, the appearance of noncoding RNAs offers a new perspective for diagnosis and treatment of gastric cancer. The miRNAs can bind to the mRNAs to induce their degradation, and thereby regulate the expressions their target mRNAs at post-transcriptional level. The lncRNAs and circRNAs are able to antagonize the functions of miRNAs by competitively harboring miRNAs, and thereby indirectly regulate the gene expressions. Tumorigenesis can be regarded as the joint outcome of the abnormal features of tumor cells, the formation of tumor microenvironment and the influences of external environmental factors. The noncoding RNAs are closely related to the proliferation, apoptosis, invasion and metastasis of gastric cancer cells. Furthermore, the noncoding RNAs are associated with the autophagy and have great influence on stemness and drug resistance of gastric cancer cells. Tumor microenvironment is generally consisted of the components such as the tumor peripheral vasculature, mesenchymal cells, immune cells, signaling molecules and extracellular matrix. On the one hand, the noncoding RNAs are involved in the process of the formation of tumor microenvironment such as angiogenesis and immunosuppression induced by gastric cancer cells. On the other hand, the noncoding RNAs can function as exosomes to participate the action of microenvironment on gastric cancer cells, so as to affect the biological processes that include the proliferation, metastasis, drug resistance of gastric cancer cells. External environmental factors have great significance for inducing tumorigenesis of gastric cancer. Helicobacter pylori (HP) infection is one of the important causes for the occurrence of gastric cancer, and the noncoding RNAs considerably contribute to the oncogenic properties of the HP. In addition, oxidative stress and EB virus infection can also lead to tumorigenesis of gastric cancer, which are as well associated with the noncoding RNAs. The noncoding RNAs have potential to serve as diagnostic biomarker or therapeutic targets for gastric cancer owing to their essential roles in gastric cancer. The pattern of gene expression modulation shown by majority of current reports is post-transcriptional gene regulation by miRNAs serving as the central event with the lncRNAs or circRNAs as upstream regulators. Both lncRNAs and circRNAs competitively combine with the mRNAs but their reciprocal relationship is still unidentified. The actions of circRNAs in tumor are roughly recognized in recent years and their specific roles in gastric cancer remain to be further explored. Full understanding of the roles of noncoding RNAs in gastric cancer will not only help gain insights into the mechanism of tumorigenesis but may provide novel avenues for diagnosis and treatment gastric cancer. In the future, the noncoding RNAs may probably be used for description of different characteristics of gastric cancer after specification and subdivision, and become the “tumor identity cards” just as genes, which also has great significance for the development of precision medicine or personalized medicine.

Abstract:S100A14 is one of the multifunctional S100 protein family members, which is involved in a wide range of biological functions, such as cell proliferation, differentiation and apoptosis, invasion and metastasis. Its expression presents cell and tissue specificity in a variety of tumors, and its expression level is related to the prognosis of patients. In digestive system tumors, S100A14 exerts its function mainly through binding to the target protein, but the action mechanism has not been fully elucidated. Here, the authors review the molecular structure and function of S100A14, and its expression and action mechanism in the digestive system tumors.