AbstractIntroduction: Robotic-assisted complete mesorectal excision (RATME) is increasingly being used by colorectal surgeons. Most surgeons consider RATME a safe method, and believe it can facilitate total mesorectal excision (TME) in rectal cancer, and may potentially have advantages over intersphincteric resection (ISR) and anus preservation. Therefore, this trial was designed to investigate whether RATME has technical advantages and can increase the ISR rate compared with laparoscopic-assisted TME (LATME) in patients with middle and low rectal cancer. Methods and analysis: This is a multicenter, superiority, randomized controlled trial designed to compare RATME and LATME in middle and low rectal cancer. The primary endpoint is the ISR rate. The secondary endpoints are coloanal anastomosis (CAA) rate, conversion to open surgery, conversion to transanal TME (TaTME), abdominoperineal resection (APR) rate, postoperative morbidity and mortality within 30 days, pathological outcomes,long-term survival outcomes, functional outcomes,and quality of life. In addition, certain measurements will be conducted to ensure quality and safety, including centralized photography review and semiannual assessment. Discussion: This trial will clarify if RATME improves ISR and promotes anus preservation in patients with mid- and low-rectal cancer. Furthermore, this trial will provide evidence on the optimal treatment strategies for RATME and LATME in patients with mid- and low-rectal cancer regarding improved operational safety. Trial registration: The trial has been registered on ClinicalTrials.gov website, NCT06105203.
D3 lymph node dissection could reduce the recurrent and metastatic rates of rectal cancer.How to completely dissect No.3 lymph node and protect the left colic vessels deserve further investigation.From January 2012 to March 2013,133 patients with rectal cancer received laparoscopic D3 lymph node dissection with preservation of left colic vessels in the First Affiliated Hospital of Jilin University.The recovery and postoperative complications were observed.The operation was successfully carried out with no conversion to open surgery and no intraoperative complications.The incidence of postoperative complications was 6.77％ (9/133).A total of 118 patients were followed up for 2-16 months,and the median time of follow-up was 7 months.Two patients were complicated with liver metastasis,6 with elevation of tumor markers,while no signs of tumor recurrence or metastasis were detected.The condition of other patients was normal.Laparoscopic D3 lymph node dissection with preservation of left colic vessels for the treatment of rectal cancer is feasible and safe.
Key words:
Rectal neoplasms; D3 lymph node dissection; Laparoscopy
Numerous studies have proved that microRNAs (miRNAs) play crucial roles in the tumorigenesis and progression of gastric cancer (GC). Our study was to investigate the correlation between miR-338-3p expression and clinical features as well as prognosis of GC. A total of 138 GC tissue specimens and ad jacent non-cancerous tissues were collected for further analysis, then quantitative PCR method was used to detect the relative miR-338-3p expression. Our study showed that tissue miR-338-3p level was greatly decreased in cancer tissues compared with paired normal tissues. Furthermore, loss of tissue miR-338-3p was positively associated with aggressive clinical characteristics (advanced clinical stage, poorer differentiation and lymph node invasion), shorter overall survival and recurrence free survival. Finally, tissue miR-338-3p expression was confirmed to be an independent prognostic factor for GC. Overall, our findings indicate that miR-338-3p acts as a tumor suppressor in GC and tissue miR-338-3p might serve as a novel prognostic biomarker of GC.
In this work, a novel glutathione and pH serial dual‐responsive drug delivery system has been developed, which was constructed with chitosan (CS), carbon dots (CDs) and hyaluronic acid (HA) modified the mesoporous silica nanoparticles (MSNs). The system showed excellent drug loading efficiency, controlled release and targeted delivery. In addition, the platform (MSN‐CS@HA‐CDs) exhibited fluorescence imaging property. The prepared drug delivery system appeared to be a promising cancer treatment platform.
Aim: To study the value and efficiency of CEA/CA72-4 immunohistochemistry in detecting free tumor cells from peritoneal lavage, in order to provide reliable lab information for subsequent intraperitoneal chemotherapy. Methods: A total of 112 progressive gastric cancer patients were enrolled from Oct. 2016 to Oct 2017, who were pathologically diagnosed as gastric cancer after surgery. Peritoneal lavage was respectively collected during operation. Cytology and CEA/CA72-4 immunohistochemistry of peritoneal lavage samples was performed. Overall survival and recurrence free survival was analyzed. Results: Cytology showed 16 positive cases (14.29%), CEA immunohistochemistry showed 29 positive cases (25.89%), CA72-4 immunohistochemistry showed 33 positive cases (29.46%). McNemar's test showed significant difference in positivity between cytology (CY+) and CEA/CA72-4 immunohistochemistry (IHC+). Kappa test showed consistency between immunohistochemistry of CEA and CA72-4 with cytology. Patients with CY+/IHC+ had the poorest overall survival (OS) as well as recurrence free survival (RFS), followed by those with CY+ or IHC+, while those with CY-/IHC- had higher OS and RFS. The differences of OS and RFS in IHC+ group were worse than that in IHC- group. Kaplan-Meier analysis showed that positive CEA/CA72-4 IHC revealed poorer prognosis than the negative cases. Conclusions: Due to the limitation of cytology, combination of cytology and immunohistochemistry appears to be more efficient for predicting prognosis of progressive gastric cancer.
Laparoscopic left colectomy (LLC) has been widely performed for treating patients with left hemicolon cancer. For less invasion, totally laparoscopic left colectomy intracorporeal anastomosis (TLC/IA) has been increasingly attempted and proposed. Up to now, there is no standard for intracorporeal anastomosis. Authors list various types of intracorporeal anastomosis in terms of technical details and postoperative complications. According to the literatures, side to side anastomosis with linear laparoscopic stapler is the mainstream method. Surgeons should make flexible choices based on personal technical characteristics, colon conditions and objective economic conditions of patients. An individualized anastomosis method is acceptable.
To investigate the efficacy of laparoscope complete mesocolic excision (CME) for right colon cancer.The clinical data of 49 cases of right colon cancer without metastasis and intestinal obstruction who underwent elective laparoscope CME by the same group of surgeons between October 2009 and June 2011 at the First Hospital of Jilin University were analyzed retrospectively.Among the 49 cases with CME, the median number of total lymph node retrieved was 22. The positive rate of lymph node in patients with stage III disease was 16.3%. The median operative time of all the cases was 145 min. The mean intraoperative blood loss was 75 ml. The median time to flatus passage and defecation was 3 days and 6 days respectively. The median hospital stay was 12 days. The overall postoperative complication rate was 12.2% (6/49).Laparoscope complete mesocolic excision for right colon cancer is safe and feasible.
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