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To evaluate the effect of oral nutritional supplementation (ONS) on the postdischarge nutritional status and quality of life (QoL) of gastrointestinal cancer patients after surgery.A multi-center study was conducted on gastrointestinal cancer patients who received surgical treatment from 2013-2015. All patients were screened using the Nutrition Risk Screening 2002 (NRS 2002) to assess nutritional risk. Patients with nutritional risk were randomized into two groups: patients in the study group (n=55) were given dietary guidance and ONS, control group (n=59) received only dietary guidance. Anthropometric measurements, nutrition-related laboratory tests, and gastrointestinal function scores were also collected and analyzed using Student's t test and analysis of variance (ANOVA). In addition, the EQ-5D was used to evaluate patients' QoL.Compared with baseline measurements, the body weight of patients in the study group increased by 1.35±0.53 kg and 1.35±0.73 kg at 60 and 90 days, which were significantly higher than those in the control group (-1.01±0.54 kg, and -1.60±0.81 kg at 60 and 90 days). The results from ANOVA showed that only weight and BMI differed significantly between the study and control groups and also between different measurement times (p0.01). No differences were found for the other indicators or QoL between the study groups.ONS may improve the weight and BMI of surgically treated gastrointestinal cancer patients postdischarge. However, these effects had little impact on patients' QoL.

A high proportion of patients with stable angina remains symptomatic despite multiple treatment options. Di'ao Xinxuekang (XXK) capsule and Compound Danshen (CDS) tablet have been approved for treating angina pectoris for more than 20 years in China. We compare the anti-anginal effectiveness of XXK capsule and CDS tablet in patients with symptomatic chronic stable angina. A randomized, multicenter, double-blind, parallel-group, superiority trial was conducted in 4 study sites. 733 patients with symptomatic chronic stable angina were included in the full analysis set. The primary outcomes were the proportion of patients who were angina-free and the proportion of patients with normal electrocardiogram (ECG) recordings during 20 weeks treatment. Compared with CDS, XXK significantly increased the proportion of angina-free patients, but no significant difference was noted in the proportion of patients with normal ECG recordings. Weekly angina frequency and nitroglycerin use were significantly reduced with XXK versus CDS at week 20. Moreover, XXK also improved the quality of life of angina patients as measured by the SAQ score and Xueyu Zheng (a type of TCM syndrome) score. We demonstrate that XXK capsule is more effective for attenuating anginal symptoms and improving quality of life in patients with symptomatic chronic stable angina, compared with CDS tablet.

Aim: To take a deeper insight into the relationship between the root of the inferior mesenteric artery (IMA) and the autonomic nerve plexuses around it by cadaveric anatomy and explore anatomical evidence of autonomic nerve preservation in high ligation of the IMA in laparoscopic surgery for colorectal cancer. Methods: Anatomical dissection was performed on 11 formalin-fixed cadavers and 12 fresh cadavers. Anatomical evidence-based autonomic nerve preservation in high ligation of the IMA was performed in 22 laparoscopic curative resections of colorectal cancer. Results: As the upward continuation of the presacral nerves, the bilateral trunks of SHP had close but different relationships with the root of the IMA. The right trunk of SHP ran relatively far away from the root of IMA. When the apical lymph nodes were dissected close to the root of the IMA along the fascia space in front of the anterior renal fascia, the right trunk of SHP could be kept in suit under the anterior renal fascia. The left descending branches to SHP constituted a natural and constant anatomical landmark of the relationship between the root of IMA and the left autonomic nerves. Proximal to this, the left autonomic nerves surrounded the root of the IMA. Distally, the left trunk of the SHP departed from the root of IMA under the anterior renal fascia. When high ligation of the IMA was performed distal to it, the left trunk of SHP could be preserved. The distance between the left descending branches to SHP and the origin of IMA varied widely from 1.3 cm to 2.3 cm. Conclusions: The divergences of the bilateral autonomic nerve preservation around the root of the IMA may contribute to provide anatomical evidence for more precise evaluation of the optimal position of high ligation of the IMA in the future.

To evaluate the risk factors of postoperative complications following D2 radical resection for advanced gastric cancer.From June 2004 to May 2011, 483 patients with local advanced gastric cancer who underwent radical gastrectomy with D2 lymph node dissection were enrolled in the study, including 132 patients of LAG (27.3%) and 351 patients of open procedure (72.7%). Clinicopathological data and postoperative complications were reviewed retrospectively. Postoperative complications were classified into overall and severe complications according to Clavien-Dindo Classification. Multivariate logistic model was used to identify risk factors of postoperative complications.The overall incidence of postoperative overall and severe complications and mortality were 12.4% (60/483), 2.5% (12/483) and 0.2% (1/483), respectively. Univariate analysis showed that no significant differences were found in overall and severe complications between the two surgical approaches (13.6% vs. 12.0%, P=0.620; 3.0% vs. 2.3%, P=0.743). Furthermore, multivariate analysis showed that age ≥60 years, preoperative comorbidity and intraoperative blood loss300 ml were independent risk factors associated with overall postoperative complications. Remarkably, intraoperative blood loss300 ml was also an independent risk factor for severe postoperative complications.LAG with D2 lymph node dissection for local advanced gastric cancer is technically feasible and safe. However, the elderly, preoperative comorbidity and increased intraoperative blood loss are associated with elevated risk of complications. Decreased intraoperative bleeding may reduce the potential postoperative complications.

To evaluate the short-term outcomes and 5-year recurrence, overall survival, and disease-free survival of laparoscopic assisted surgery for colon cancer.The clinical and pathologic data were compared between the patients who underwent colectomy during March 2003 to July 2008 and assigned in laparoscopic group (n = 92) and open group (n = 285) according the surgical approach. The 5-year overall survival, disease-free survival, and recurrence rate were analyzed for all patients who were followed-up for more than 36 months in either of the groups.The laparoscopic colectomy was associated with manifested less blood loss (50(50) ml) (Z = -8.292, P0.01), early return of bowel function (the evacuation time was (3.0 ± 1.0) days, and the meal time after operation was (4.0 ± 1.3) days) (t = -6.475 and -4.871, P0.01), and longer length (cm) of distal resection margin ((10 ± 4) cm vs. (9 ± 4) cm, t = 3.527, P = 0.000). The 5-year overall survival of the laparoscopic group and the open group were 63.6% and 61.8% respectively. The 5-year disease-free survival of the I-III stage patients in the laparoscopic group and the open group were 69.5% and 65.5% respectively, and the local recurrence were 8.7% and 13.6% (all P0.05).The laparoscopic colectomy for colon cancer is safe in short-term clinical results and non-inferior to the open colectomy in long-term oncological outcomes.

To explore the association between the score of preoperative Nutritional Risk Screening 2002 (NRS 2002) and anastomotic leakage following anterior resection for the rectal cancer.Clinical data of 641 patients with rectal cancer undergoing anterior resection in Nanfang Hospital, Southern Medical University between January 2003 and July 2012 were analyzed retrospectively. Preoperative nutritional status was evaluated using NRS 2002. Association of clinicopathologic characteristics with postoperative anastomotic leakage was examined using univariate χ(2) and Logistic regression model.Among the 641 patients, postoperative anastomotic leakage occurred in 26 (4.1%) cases. The proportion of anastomotic leakage in patients with the NRS 2002 score ≥3 was significantly higher than that in patients with the score3 (6.9% vs. 2.1%, P=0.002). After the adjustment of factors as age, distance of anastomosis above the anal margin, and pathological staging, NRS 2002 score ≥3 was identified as an independent risk factor for anastomotic leakage following anterior resection for rectal cancer (OR=3.198, 95%CI:1.324-7.722, P=0.010).The use of the NRS 2002 for preoperative evaluation on patient's nutritional status may help to predict the occurrence of anastomotic leakage following anterior resection for rectal cancer, which may be involved in the indication of protecting ileostomy in clinical practice.

To investigate the safety and feasibility of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach.Between October 2005 and January 2012, 21 consecutive patients underwent laparoscopic-assisted total proctocolectomy by medial-to-lateral approach in Department of General Surgery in Nanfang Hospital. The clinical data and follow-up results were reviewed.Twenty cases underwent laparoscopic resection successfully, and 1 case (4.8%) was converted to open surgery because of serious peritoneal cavity adhesion. The mean operative time was (237.1±64.2) min and intraoperative blood loss was (90.0±77.7) ml. The mean time to first flatus was (2.7±0.8) days. The mean postoperative hospital stay was (11.8±5.7) days. Three patients (14.3%) experienced postoperative complications, including anastomotic leakage (n=1), lymphatic leakage (n=1), and anastomotic stricture (n=1). The median follow-up was 22 months (4-60 months). There were two deaths including one patient died of progressive disease 5 months after surgery and the other died of multiple organ failure.The advantages of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach include simplified surgical procedure, clearly revealed surgical plane, and shortened operative time. This procedure is safe and feasible in the experienced department of laparoscopic colorectal surgery.

Although the prognostic value of nodal metastases in differentiated thyroid cancer remains controversial, it is of interest to evaluate and understand the different characteristics of predictive outcomes. A multicenter retrospective study was conducted in 215 untreated patients with differentiated thyroid cancer from July 1997 to July 2015 in 4 medical centers of Guangdong Province. A total of 107 patients with nodal metastases (group A) were compared to 108 patients without metastases (group B). The 5-year disease-free survival (DFS), overall survival (OS), and postoperative complications in both groups were calculated. Variables predictive of DFS and OS were evaluated in group A. The group A had lower 5-year DFS (69.16%, 11 months) and shorter median time of recurrence than those in group B (87.96%, 8.5 months, respectively, P 45 years and have higher pTNM stage or follicular histology tend to have poor prognosis. Selective lymph node dissection with appropriate postoperative treatment and frequent follow-up should be accorded to these vulnerable groups of patients.

To explore regional anatomy of fasciae and spaces related to laparoscopic right hemicolectomy (LRC).Seven cadavers and 49 patients undergoing LRC for cancer were observed. Computed tomography (CT) images of patients and healthy individuals were reviewed.Between ascending mesocolon and prerenal fascia (PRF), there was a right retrocolic space (RRCS), which communicated in all directions. Anterior, posterior, medial, lateral, cranial, and caudal boundaries of the RRCS were ascending mesocolon, PRF, superior mesenteric vein, peritoneal reflexion at right paracolic sulcus, inferior margin of transverse part of duodenum, and inferior margin of the mesentery root, respectively. Between transverse mesocolon and pancreas and duodenum, there was a transverse retrocolic space (TRCS), which was bounded cranially by root of transverse mesocolon. On CT images of healthy individuals, PRF was noted as slender line of middle density, continuing to transverse fascia, and the retrocolic spaces were unidentifiable. For patients with right colon cancer, PRF and right retrocolic space might be easier to be identified.The RRCS and the TRCS are natural surgical spaces. The PRF is natural surgical plane in LRC for cancer.

To analyze the vascular anatomy and complications of the right colon under laparoscope.Videotapes of 55 laparoscopic extended right hemicolectomy with D3 lymphadenectomy were reviewed and the anatomic relationship and bleeding vessels were determined.The superior mesenteric vein, superior mesenteric artery, ileocolic artery, and middle colic artery were present in all the patients. The right colic artery was present in 45.5%(25/55) of the patients. The incidence of the gastrocolic venous trunk was 74.5%. The overall incidence of intraoperative bleeding was 43.6%. Vessels in the pre-pancreatic region including the right gastroepiploic artery, the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding than the middle colic vein and artery (16.4% vs. 14.5%). Intraoperative bleeding significantly prolonged the overall operative time and lymphadenectomy time.The vascular anatomy of the right colon is intricate and variable and laparoscopic extended right hemicolectomy with D3 lymphadenectomy is associated with a high risk of hemorrhage. Understanding the vessels anatomic relationship of the right colon is valuable to decrease vascular complication.

To explore the regional anatomy of the rectum including the perirectal fasciae and spaces.Twenty-one cadavers (15 males and 6 females) were embalmed and their vessels were visualized by injection with color dye. From the cadavers, 30 hemipelvis and 6 three-quarter pelvis were harvested. The perirectal fasciae and spaces and the pelvic autonomic nerves were dissected and examined.Three tissue layers were dissected from the inside to the periphery including the proper rectal fascia enveloping the mesorectum, the presacral fascia, and the piriformis fascia fused with the sacral periosteum. The mesorectum comprised 2 parts with the classical posterolateral fat covered by the proper rectal fascia posteriorly and the anterior fat covered by the posterior layer of Denonvilliers fascia anteriorly. Extending anteriorly to the anterior layer of Denonvilliers fascia, the presacral fascia bisected the space between the mesorectum and the piriformis fascia into the retrorectal space and the presacral space. The retrorectal space extended cranially to the left retrocolic space, anterior to the space between the 2 layers of Denonvilliers fascia(prerectal space).From the inside to the periphery, the proper rectal fascia, the presacral fascia, and the muscular fascia are distributed in an annular pattern around the mesorectum. The presacral fascia divides the perirectal space into 2 annular parts, the central retrorectal space and the peripheral presacral space. The retrorectal space is the ideal surgical plane for total mesorectal excision.

To evaluate the accuracy of sentinel lymph node mapping(SLM) in patients with rectal cancer by single-photon emission computed tomography (SPECT-CT) lymphoscintigraphy and carbon nanoparticles suspension injection.Twelve patients with clinical T(1-2)N(0)M(0) rectal cancer were selected and locally injected with technetium-(99m)sulfur-colloid and carbon nanoparticles suspension by endoscope one day before surgery, followed by SPECT-CT scanning 1, 3 and 5 hours later. Radioactive isotope(RI) uptake of each sentinel node(SN) basin with location preoperatively determined by SPECT-CT was postoperatively calculated using gamma probe. Nodes with the highest RI uptake, the number of which was also pre-determined by SPECT-CT, was defined as SNs. Immunohistochemical cytokeratin staining was performed for all the SNs and non-SNs.The rate of sentinel node detection was 91.7%(11/12) with at least one SN(1-3) per patient. Ten cases showed metastasis-negative in SNs as well as all the resected regional nodes by immunohistochemical cytokeratin staining. Only one patient had positive nodes in both SN and non-SNs. The accuracy of SLM was 100%.SPECT-CT lymphoscintigraphy and carbon nanoparticles suspension injection can effectively detect the anatomic location and number of sentinel nodes, and improve the accuracy of SLM for rectal cancer.

To investigate the expression of microRNA-221 (miR-221) and CDKN1C/P57 in colorectal carcinoma (CRC) and adjacent non-cancerous tissues. The effect of miR-221-specific inhibitor on cell proliferation and apoptosis in CRC cells was also assessed.The expression of miR-221 was detected by real-time RT-PCR. CDKN1C/P57 mRNA and corresponding protein expression pattern were detected by semi-quantitative RT-PCR and Western-blot. The specific 2'-methoxy-modified RNA oligonucleotide of miR-221(miRNA inhibitor,anti-miR-221) was designed, synthesized and transfected into Caco2 cell by liposome. Finally, the status of CRC cell proliferation and apoptosis were detected by MTT assay and flow cytometry.The expression of miR-221 was significantly up-regulated in CRC tissues as compared to the adjacent non-cancerous tissues(2.041±1.401 vs. 0.806±0.341, P0.01). There was no significant difference in CDKN1C/P57 mRNA expression between CRC and non-cancerous tissues, whereas CDKN1C/P57 protein markedly decreased in CRC (3.019±1.708 vs. 0.972±0.316, P0.01). miR-221-specific inhibitor significantly enhanced CDKN1C/P57 protein expression, inhibited proliferation of CRC cells and induced apoptosis of CRC cells(P0.01).miR-221 inhibits CDKN1C/P57 expression by post-transcriptional gene silencing to promote CRC development and progression. miR-221-specific inhibitor potentially inhibits the growth of CRC cells. Therefore, it may be a new target for the biologic therapy for CRC.

To investigate risk factors associated with peritoneal metastasis in colorectal cancer.Clinicopathological data of 873 patients with colorectal cancer treated at the Nanfang Hospital of Southern Medical University from January 2003 to December 2008 were retrospectively analyzed. The associations between peritoneal metastasis and clinicopathological factors were evaluated by univariate analysis including independent-samples t test and χ(2) test, and multivariable logistic regression analysis.Univariate analysis showed that age(P=0.032), tumor size(P=0.001), tumor differentiation(P=0.008), depth of bowel wall invasion(P=0.000), lymph node metastasis(P=0.000), serum carcinoembryonic antigen (CEA) level(P=0.003), and serum carbohydrate antigen 19-9(CA19-9) level(P=0.009) were associated with peritoneal metastasis. On multivariable logistic regression analysis, depth of bowel wall invasion, lymph node metastasis, serum CEA level and CA19-9 level remained as significant risk factors(all P0.05).Depth of bowel wall invasion, lymph node metastasis, serum CEA level, and CA19-9 level are risk factors for peritoneal metastasis in colorectal cancer.

To assess the differences in peritoneal microstructure injury between laparoscopic and open radical resection for colorectal cancer.A total of 50 patients with colorectal cancer were consecutively assigned into laparoscopic group (LO, n=27) and conventional laparotomy group (CO, n=23). Prospectively comparative analyses of operative time, intraoperative blood loss, number of lymph node harvest, positive rate of lymph nodes, length of specimen and resection margin involvement were performed. Optical microscope and scanning electron microscope were used to detect postoperative peritoneal injury between patients who received laparoscopic surgery or open surgery.Compared with the CO group, operative time [(150.6+/-39.5) min vs (183.0+/-39.2) min, P0.05] and intraoperative blood loss [(80.0+/-75.2) ml vs (234.5+/-235.3) ml, P0.01] were significantly less in the LO group. No significant differences were found between two groups in length specimen, number of lymph nodes harvest, positive rate of lymph nodes, and all resection margins were negative (P0.05). Optical microscope indicated less serosal injury in the LO group as compared to the CO group with regard to serosal integrity, continuity of covering adipocyte and mesothelial cell, and the aggregation level of erythrocytes and inflammatory cells (P0.01). Scanning electronic microscopy showed more severe injury to colorectal serosa, mesothelium and basement membrane in the CO group as compared to the LO group.With equal degree of radical resection, laparoscopic technique for colorectal cancer causes less peritoneal structural injury as compared with open surgery.

To evaluate the feasibility, safety, radicality and short-term outcome of laparoscopic total mesorectal excision(TME) in comparison with open procedure for the middle-lower rectal cancer.From November 2005 to October 2008, 93 patients with middle-lower rectal cancer received laparoscopic total mesorectal excision (LTME group), while 105 patients underwent conventional open TME (OTME group). The operative procedures, clinicopathological data and short-term outcome were collected and compared between the 2 groups.(1) Comparison of surgical procedures. The demographic data of LTME and OTME groups were comparable (P0.05). Four (4.3%) patients were converted to open procedure in LTME group. The anal sphincter preserved procedure accounted for 82.8% in LTME group and 81.9% in OTME group. The difference was not significant (P0.05). (2) Comparison of perioperative surgical data. The mean operating time was (164.6+/-35.6) min in LTME group, significantly longer than that in OTME group (141.9+/-29.4) min (P0.001). The operative blood losses were (51.4+/-20.2) ml and (180.0+/-64.7) ml in LTME and OTME group respectively, the difference was significant (P0.001). The analgesia requirement, time for bowel movement retrieval, time to liquid food intake, time to resuming early activity and hospital stay in LTME group were significant lower or shorter than those in OTME group (P0.001). There was no operative death in both groups. (3) Comparison of operative complications. The overall morbidity rate was 11.8% in LTME group, and 12.4% in OTME group, the difference was not significant (P0.05). The major complications were equivalent between two groups. (4) Comparison of specimen. No significant differences were observed between two groups in terms of specimen length, lymph node harvest and negative distal margin. (5) Follow-up results. The mean follow-up time was 19 months. The recurrent rate and overall survival rate were 4.4% and 97.8% in LTME group, with no significant difference compared to those in OTME group (7.3% and 97.9%, P0.05).Laparoscopic TME for middle-low rectal cancer is safe and feasible, and can potentially offer all the benefits of a minimally invasive approach and achieve satisfactory oncological outcome,which may lead to a better future of the TME technique.

To observe the effect of laparoscopy-assisted and open distal gastrectomies on the perioperative levels of C-reactive protein (CRP) and visceral proteins in patients with gastric cancer.T Fifty-three patients with gastric cancer were randomized into two groups to receive laparoscopic surgery (n=26) or open surgery (n=27). The CRP levels were measured preoperatively and at 1, 2, 3 and 7 days after the operation. The levels of the visceral proteins including albumin (ALB), prealbumin (PRE), transferrin (TRF) and retinal-binding protein (RbP) were assayed before and at 3 and 7 days after the operation.Compared with the preoperative levels, the CRP levels in both groups were significantly increased on days 1, 2, and 3 after the operation (P0.05), with the highest level occurred on day 2 postoperatively. The postoperative CRP levels were significantly lower in the laparoscopic group than in the open surgery group (P0.01). The levels of ALB, PRE, TRF, and RbP were significantly decreased after operation in both groups (P0.01) without significant differences between the two groups (P0.05).Compared with open surgeries, laparoscopy-assisted distal gastrectomy for gastric cancer causes minimal surgical trauma and mild inflammatory responses to allow the recovery of the levels of the visceral proteins.

To investigate the effect of laparoscopic-assisted resection of rectal carcinoma on perioperative levels of C-reactive protein (CRP), immunoglobulins(Ig) and complements.Fifty-four patients with rectal carcinoma were divided into laparoscopic group (n=26) and open operation group(n=28) according to the patients' will. C-reactive protein (CRP), IgG, IgA, IgM, C(3), C(4) and CH(50) of peripheral blood were assayed preoperatively and on the 1st, 2nd, 3rd and 7th day postoperatively.Compared with the preoperative period, the CRP levels in both groups were significantly increased on the 1st, 2nd, and 3rd day(P0.01) and peaked on the 2nd day postoperatively. The postoperative CRP levels were significantly lower in the laparoscopic group than those in the open operation group(P0.01). After operation, the immunoglobulin levels were significantly decreased in both groups(P0.01), and there were no significant differences in IgG and IgM. The levels of C(3), C(4) and CH(50) were significantly decreased after operation in both groups(P0.05) and returned to the preoperative levels during postoperative 48-72 hours in laparoscopic group.Laparoscopic-assisted resection of rectal carcinoma results in less wound, lower levels of stress response, and less effect on immune function compared to open surgery, which recovers the immune function of patients more rapidly after operation.

To evaluate the safety and feasibility of laparoscopic surgery following neoadjuvant chemoradiotherapy (CRT) for mid-low rectal cancer.A retrospective analysis was conducted among 24 patients with mid-low rectal cancer who received laparoscopic total mesorectal excision (TME) after neoadjuvant CRT. Another 24 patients with mid-low rectal cancer were randomly selected form those undergoing primary laparoscopic TME to serve as the control group. The clinical data and surgical data of the two groups of patients were collected and analyzed comparatively.TME after CRT resulted in significantly lower lymph node yield compared with the control group (7.08-/+6.5 vs 12.5-/+4.1, P0.05). The two groups were comparable in the operative time, intraoperative blood loss, intestinal function recovery, positive surgical margins, rate of conversion to open surgery, and occurrence of intra- and postoperative complications.Laparoscopic surgery of mid-low rectal cancer after neoadjuvant CRT can be safe and feasible and produce surgical effects comparable to exclusive laparoscopic surgery.

To explore living anatomy of pancreas and peripancreatic spaces,as well as their implications on laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer.Living observation was carried out in 132 patients diagnosed as distal gastric cancer and undergoing laparoscopic gastrectomy with D(2) lymphadenectomy.Spaces between greater omentum and transverse mesocolon continued to pre-pancreatic and retro-pancreatic spaces at inferior margin of pancreas. The pre-pancreatic and retro-pancreatic spaces continued each other at inferior and superior margin of pancreas and extended in all directions. Left gastroepiploic vessels were located in pre-pancreatic spaces at superior margin of pancreatic tail. In retro-pancreatic space at inferior margin of pancreatic neck, superior mesenteric veins were located. In retro-pancreatic spaces or in gastric mesenteries inferior to gastric antrum, right gastroepiploic vessels were located. In spaces between gastric antrum and pancreatic heads, gastroduodenal arteries were located and traced to locate common hepatic arteries. In retro-pancreatic spaces at superior margin of pancreatic body, common hepatic arteries, left gastric arteries,celiac arteries and splenic arteries were located. Hepatopancreatic folds and gastropancreatic folds were landmarks respective to locate common hepatic arteries and left gastric arteries. The aforementioned vessels and spaces in their vagina vasorum continued each other and united as a whole.Laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer is carried out in macroscopic surgical planes of pre-pancreatic space and retro-pancreatic space, as well as their extensions in all directions, and in microscopic surgical planes of spaces in vagina vasorum of perigastric vessels which continue each other, under the guidance of central landmarks of pancreas and concrete landmarks of vessel trunks and their furcations.

To evaluate the clinical effect of intraoperative and early postoperative continuous hyperthermic pertioneal perfusion chemotherapy (CHPPC) for gastric cancer.Eight-five patients with gastric cancer were randomized into therapeutic group with perioperative CHPPC combined with intravenous chemotherapy (n=44) and control group with intravenous chemotherapy only (n=41). The postoperative complications, adverse effects, local recurrence rates, distant metastasis rates, and 1- and 3-year survival rates were compared between two groups.No significant differences were found in the postoperative complications and adverse effects between the two groups. The recurrence rate and distant metastasis rates in the therapeutic group were significantly lower than those in the control group (20.45% vs 43.90%, and 15.90% vs 39.02%, P0.05). The 1- and 3-year survival rates in the therapeutic group were significantly higher than those in the control group (90.90% vs 78.05%, and 59.09% vs 34.15%, P0.05).Perioperative CHPPC for gastric cancer is safe and feasible, and can reduce the recurrence rate, distant metastasis rate and improve the survival for gastric cancer patient after operation.

To evaluate the frequency of microsatellite instability (MSI) and absence of hMLH1/hMSH2 expression in young patients with colorectal cancer, and investigate their role in screening hereditary nonpolyposis colorectal cancer (HNPCC).Seventy-three young patients (below 40 years old) with colorectal cancer were examined for DNA mismatch repair deficiency by microsatellite testing and immunohistochemical detection of hMLH1/hMSH2 gene products.The frequency of MSI and absence rate of hMLH1/hMSH2 expression are 56.16% and 49.32% in these patients, respectively, which increased significantly with younger age for cancer diagnosis.Defects in the DNA mismatch repair system are frequent in Chinese young patients with colorectal cancer. Microsatellite analysis and immunohistochemical detection are useful for efficient identification of HNPCC in these young patients.

AIM: To investigate the causes of small intestinal bleeding as well as its diagnosis and therapeutic approaches. METHODS: A retrospective analysis was conducted according to the clinical records of 76 patients with small intestinal bleeding admitted to our hospital in the past 5 years. RESULTS: In these patients, tumor was the most frequent cause of small intestinal bleeding (37/76), followed by Meckel’s diverticulum (21/76), angiopathy (15/76) and ectopic pancreas (3/76). Of the 76 patients, 21 were diagnosed by digital subtraction angiography, 13 by barium and air double contrast X-ray examination of the small intestine, 11 by 99mTc-sestamibi scintigraphy of the abdominal cavity, 6 by enteroscopy of the small intestine, 21 by laparoscopic laparotomy, and 4 by exploratory laparotomy. Although all the patients received surgical treatment, most of them (68/76) received part enterectomy covering the diseased segment and enteroanastomosis. The follow-up time ranged from 1 year to 5 years. No case had recurrent alimentary tract bleeding or other complications. CONCLUSION: Tumor is the major cause of small intestinal bleeding followed by Meckel’s diverticulum and angiopathy. The main approaches to definite diagnosis of small intestinal bleeding include digital subtraction angiography, 99mTc-sestamibi scintigraphy of the abdominal cavity, barium and air double contrast X-ray examination of the small intestine, laparoscopic laparotomy or exploratory laparotomy. Part enterectomy covering the diseased segment and enteroanastomosis are the most effective treatment modalities for small intestinal bleeding.

To investigate the diagnostic and therapeutic value of laparoscopy in patients with massive small intestinal bleeding.Twenty-two patients with massive small intestinal bleeding and hemodynamic alteration underwent laparoscopic laparotomy in our unit from December 2002 to April 2005. Post pathologic sites were found, laparoscopy- or laparoscopy-assisted part small intestinal resection including pathologic intestinal site and enteroanastomosis was performed in all these patients.The bleeding sites were successfully detected by laparoscopy in all these 22 patients. Massive small intestinal bleeding was caused by jejunum benign stromal tumor in 8 cases, by jejunum potential malignant stromal tumor in 5 cases, by jejunum malignant stromal tumor in 1 case, by Mechel's diverticulum in 5 cases, by small intestinal vascular deformity in 2 cases, and by ectopic pancreas in 1 case. A total of 16 patients underwent laparoscopy-assisted enterectomy and enteroanastomosis of small intestine covering the diseased segment and 6 patients received enterectomy of the diseased segment under laparoscope. No surgical complications occurred and the outcome was satisfactory.Laparoscopy in diagnosis and treatment of massive small intestinal bleeding is noninvasive with less pain, short recovery time and definite therapeutic efficacy.

To evaluate the effect of pirarubicin (THP) in combination with hyperthermia on gastric cancer tissues in vitro and explore the underlying mechanisms.In vitro three-dimensional culture models were established with tissue biopsies from 36 patients with pathologically confirmed gastric cancer. The tumor cell viability was measured by MTS-PMS assay, and HE staining was used to study the histomorphological changes of the tissues following chemotherapy and hyperthermia.Synergistic tumor cell-killing effects of cisplatin, THP, and mitomycin with hyperthermia was observed in the tumor tissues (P=0.000), and THP exhibited stronger cytotoxic effects than the other drugs. Histomorphological study suggested strong killing effects of THP on the tumor tissues, which displayed disrupted tissue structure, cellular degradation and necrosis, karyopyknosis and karyolysis, with cytoplasm loss. The anti-tumor effects of THP were associated with clinical staging and pathological grading of the tumors (P=0.000), but not with the patients' gender, age, tumor size and preoperative CEA levels (P0.05).Pirarubicin shows good synergistic effects with hyperthermia, and the cytotoxicity of pirarubicin against gastric cancer tissue is enhanced considerably by mild hyperthermia. THP can be a potential therapeutic drug for intraperitoneal chemohyperthermia.

To evaluate the surgical outcomes of laparoscopic resection for rectal cancer and to investigate how surgeons without previous training of laparoscopic cholecystectomy(LC) can quickly learn laparoscopic resection for rectal cancer.Clinical data of 105 cases of laparoscopic rectal resection performed by a group of surgeons without previous training of LC were reviewed. The cases were divided equally into 3 groups (groups A, B and C) according to the sequence of the operations. The operating time, blood loss, lymph node harvest, length of specimen, conversion rate to open surgery, intra- and postoperative complications and hospital stay were compared between the 3 groups.There were no significant differences between the 3 groups with respect to age, gender, Dukes'stage or surgical approach (P0.05). The operating time in group A was 196.1+/-30.3 min, significantly longer than that in group B (164.8+/-22.7 min) and group C (158.7+/-20.9 min) (P0.001), but the operating time did not vary significantly between groups B and C (P0.05). The blood loss was significantly greater in group A than in groups B and C (72.4+/-21.5, 48.2+/-16.3, and 46.6+/-15.4 ml, respectively, P0.001), but showed no significant difference between the latter two groups (P0.05). The rate of conversion to open surgery decreased from 11.4% in group A to 2.9% in group B and group C, but the difference was not statistically significant (P0.05). The rate of intraoperative complications declined from 17.1% in group A to 5.7% in group B and group C, showing no significant difference either. The lymph node harvest, length of specimen, and postoperative complications showed no significant variation between the 3 groups (P0.05), but group C had significantly shorter mean hospital stay in comparison with groups A and B (P0.001). The 35 patients in group A received the operation within a time period of 17 months (2.1 cases per month), and operations in groups B and C were done in 7 months (5 cases per month).The learning curve of laparoscopic rectal resections is approximately 35 cases, and the surgeons without previous experience of laparoscopic cholecystectomy can learn the surgical skills after performing 35 laparoscopic resections for rectal cancer at the monthly frequency of 2.1 cases.

To explore the effect of the tri-cuff vascular anastomosis for simplifying the surgical procedure and improving the success rate.Sixty recipient Wistar rats were randomized into experimental group and the control group, the former was subjected to the tri-cuff vascular anastomosis for heterotopic small bowel transplantation while the latter had vascular anastomosis using classical methods. The effects of the two methods for anastomosis were compared.The tri-cuff vascular anastomosis was superior to the classical methods in view of the total operation time, arterial anastomosis time, and hot-ischemia time of the small bowel graft.Compared with the classical methods, the tri-cuff vascular anastomosis is safer and time-saving.

To determine an adequate distal bowel length to be excised for safe surgical removal of rectal carcinoma.p53 expression and patterns of cancer cell invasion into the bowel wall distal to the tumors were studied in 68 surgically removed rectal carcinoma specimens with immunohistochemical and routine pathological methods respectively.In 52.9% (36/68) of the cases, cancer cell infiltration in the bowel was found microscopically, among which 32 (88.9%) had the infiltration confined within 2 cm from the primary tumors, with the rest cases within 3 cm. The scope of the distal infiltration of the cancer cells was correlated to the gross morphology, histological type and Dukes' stages of the primary tumors. Of the 16 cases (23.5%) positive for p53 expression in the distal bowel mucosa, 13 had p53 expression profile detected within 2 cm, all within 3 cm. The expression of p53 in the distal bowel mucosa was not correlated with the clinical and pathological features of the primary rectal carcinoma.Excision till the compromised bowel 3 cm distal to the tumor may ensure safe removal of rectal cancer.