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Background: While previous studies have indicated variability in distant metastatic potential among different mismatch repair (MMR) states in colorectal cancer (CRC), their findings remain inconclusive, especially considering potential differences across various ethnic backgrounds. Furthermore, the gene regulatory networks and the underlying mechanisms responsible for these variances in metastatic potential across MMR states have yet to be elucidated. Methods: We collected 2058 consecutive primary CRC samples from the South West of China and assessed the expression of MMR proteins (MLH1, MSH2, MSH6, and PMS2) using immunohistochemistry. To explore the inconsistencies between different MMR statuses and recurrence, we performed a meta‐analysis. To delve deeper, we employed Weighted Gene Co‐expression Network Analysis (WGCNA), ClueGo, and iRegulon, pinpointing gene expression networks and key regulatory molecules linked to metastasis and recurrence in CRC. Lastly, both univariate and multivariate Cox regression analyses were applied to determine the impact of core regulatory molecules on metastasis. Results: Of the samples, 8.2% displayed deficient MMR (dMMR), with losses of MLH1 and PSM2 observed in 40.8% and 63.9%, respectively. A unique 24.3% isolated loss of PMS2 without concurrent metastasis was identified, a result that diverges from established literature. Additionally, our meta‐analysis further solidifies the reduced recurrence likelihood in dMMR CRC samples compared to proficient MMR (pMMR). Two gene expression networks tied to distant metastasis and recurrence were identified, with a majority of metastasis‐related genes located on chromosomes 8 and 18. An IRF1 positive feedback loop was discerned in the metastasis‐related network, and IRF1 was identified as a predictive marker for both recurrence‐free and distant metastasis‐free survival across multiple datasets. Conclusion: Geographical and ethnic factors might influence peculiarities in MMR protein loss. Our findings also highlight new gene expression networks and crucial regulatory molecules in CRC metastasis, enhancing our comprehension of the mechanisms driving distant metastasis. [ABSTRACT FROM AUTHOR]

Background. Several studies have been conducted to investigate the association between the presence of perineural invasion (PNI) and overall survival (OS) of gastric cancer (GC) patients who underwent curative resection, but no consensus has been reached. This study is aimed at determining the prognostic significance of PNI in gastric cancer. Study Design. The data of 2969 patients with gastric cancer and who had undergone curative gastrectomy from 2006 to 2010 in two high-volume hospitals of China and Korea were retrospectively analyzed. PNI positivity was identified when carcinoma cells were found to infiltrate into the perineurium or neural fascicles. The relationships between PNI and other clinicopathological factors were evaluated, and survival analyses were performed. Results. The presence of PNI was detected in 1055 of the 2969 patients (35.5%). Nationality, age, tumor location, size of tumor, differentiation of the tumor, pT stage, pN stage, lymphatic invasion, and vascular invasion had been associated with PNI positivity. The mean survival time of patients with and without PNI was 62.5 months and 87.3 months, respectively (P < 0.001). However, the presence of PNI was not an independent prognostic factor for gastric cancer, except for patients in stage III (P = 0.037 , hazard ratio: 1.21, 95% confidence interval: 1.01-1.44). Conclusion. PNI occurs frequently in patients with gastric cancer, and the incidence of PNI increases with the staging of the tumor. The presence of PNI can provide additional information in predicting the survival outcome for those with stage III tumors. [ABSTRACT FROM AUTHOR]

Purpose: Petersen's hernia (PH) is a serious complication after gastrectomy for gastric cancer. The aim of this study was to investigate whether closure of Petersen's defect (PD) can decrease the rates of PH and suspected Petersen's hernia (SPH). Methods: Patients who underwent gastrectomy with PD were enrolled. From January 2014 to January 2017, we performed gastrectomy without PD closure (non-closure group). From February 2017 to June 2018, we closed PDs during gastrectomy (closure group). The rates of PH and SPH were compared between the two groups. The last follow-up was updated in August 2020. Results: Among a total of 1213 patients, 12 patients (1.0%) developed PH, and 23 patients (1.9%) developed SPH. The rate of PH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 11/828, 1.3%, p = 0.042, log-rank test). The rate of SPH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 22/828, 2.7%, p = 0.008, log-rank test). Non-closure of PD was a risk factor for PH and SPH (odds ratio (OR) 7.72, 95% CI 1.84–32.35, p = 0.006). Conclusions: PD closure is recommended after gastrectomy for gastric cancer, as the rates of PH and SPH were significantly decreased. [ABSTRACT FROM AUTHOR]

Background: Due to the controversy over the prognostic significance of Borrmann type in patients with gastric cancer (GC), the present study was to investigate the clinical value of Borrmann type in advanced GC. Methods: We retrospectively evaluated 2092 patients with advanced GC and subsequently examined the clinicopathological characteristics and prognosis of patients stratified by Borrmann type. Results: Patients were divided into three groups according to Borrmann type (Borrmann types I+II, III, and IV). Patients with Borrmann types III and IV had larger size, more poorly differentiated tumor type, more advanced tumor stage, and higher chance of involving the entire stomach. The overall survival (OS) rates were significantly different among the three groups (p < 0.001). Stratification analysis revealed significant OS rates among the three groups in tumor-node-metastasis (TNM) stage III (p < 0.001) and TNM stage IV (p = 0.008). Multivariate analysis revealed that Borrmann types, adjuvant chemotherapy, curative resection, and TNM stage were all independent predictors of OS among GC patients. The subgroup analysis indicated that Borrmann type was an independent predictor of OS among GC patients who undergone curative resection and with TNM stage III cancer. However, curative resection and postoperative chemotherapy failed to prolong the survival of patients with Borrmann type IV. Conclusions: The clinicopathological characteristics and prognosis of patients with three Borrmann types of GC were different. Borrmann type can be simply used as a valuable factor to predict survival in advanced GC patients, especially in those TNM stage III undergoing curative resection. Additionally, more attention should be paid to the treatment for Borrmann type IV GC. [ABSTRACT FROM AUTHOR]

Background. The da Vinci robotic system was considered an effectively alternative treatment option for early gastric cancer patients in recent years. The aim of our study was to evaluate the safety and feasibility of robot-assisted gastrectomy in our center. Methods. This study included 33 patients who underwent robot-assisted gastrectomy (RAG) and 88 patients who underwent laparoscopic-assisted gastrectomy (LAG) between January 2016 and April 2018. Clinicopathological characteristics, surgical parameters, postoperative recovery, and the learning curves of RAG were evaluated. Results. Baseline characteristics between two groups were well balanced. The operation time of RAG was longer than that of LAG (333.1±61.4 min vs. 290.6±39.0 min, p=0.001), and the estimated blood loss was 62.4±41.2 ml in the RAG group and 77.7±32.3 ml in the LAG group (p=0.005), respectively. The mean number of examined lymph nodes in RAG was less than that in LAG (30.3±10.2 vs. 37.4±13.7, p=0.008). However, RAG had an advantage in the dissection of No. 9 lymph nodes (3.4±2.1 vs. 2.5±1.6, p=0.039). The incidence of postoperative complications was similar in both groups (p=0.735). There were no significant differences in terms of postoperative recovery between the two groups. The learning curve of RAG showed that the CUSUM value decreased from the 8th case, which suggested a rapid learning curve among experienced surgeons on LAG operations. Conclusions. RAG was safe and feasible for gastric cancer patients, with superiority in the dissection of No. 9 lymph nodes. [ABSTRACT FROM AUTHOR]

Background: The preoperative work-up has limitations on finding peritoneal dissemination (PD) in gastric cancer patients. Laparoscopic exploration (LE) can discover radiographically occult PD, obtain accurate stage and avert futile laparotomy. The aim of our study was to introduce "Four-Step Procedure" LE in West China Hospital and further evaluate its safety and feasibility.Methods: We conducted a retrospective analysis on 165 patients from July 2016 to December 2017 who underwent "Four-Step Procedure" LE in gastrointestinal surgery department of West China Hospital. All the patients were diagnosed with gastric adenocarcinoma without explicit distant metastasis through Computed Tomography and/or Gastrointestinal Ultrasonography. Peritoneal lavage cytological examination (CY) was routinely performed during LE in our research. The "Four-Step" technical process of LE was introduced comprehensively. The clinicopathologic features and the presence of PD or CY at LE were analyzed, and the stratified analysis by cT and cN stages on the proportion of P1 and/or CY1 was also reported in this study.Results: Total of 165 patients accepted LE in our study, among these patients: 27 (16.4%) patients with P1 and/or CY1: 19 (11.5%) patients were found PD (P1), 17 (10.3%) patients with positive cytological examination (CY1) and 9 (3.6%) patients with P1Cy1. The stratified analysis by cT stage indicated that there was no P1 and/or Cy1 in cT1-cT2 stages, 1 (2.7%) patient with P1 and 1 (2.7%) with Cy1 in cT3 stage, 18 (20.0%) patients with P1 and 16 (17.8%) with Cy1 in cT4 stage. After LE, there were 74 (44.8%) patients underwent laparoscopic assistant gastrectomy, 25 (15.2%) patients with open gastrectomy, 50 (30.3%) patients with neoadjuvant chemotherapy and 16 (9.7%) patients with palliative chemotherapy and/or conversion therapy.Conclusion: "Four-Step Procedure" LE is reliable and feasible for gastric cancer. From our study, LE has unique superiority on ascertaining PD and cytological examination and LE should be recommended in cT4 stage gastric cancer before resection. [ABSTRACT FROM AUTHOR]

Background: The new 8th TNM system attributes AEG Siewert type II to esophageal classification system. However, the gastric and esophageal classification system which was more suitable for type II remains in disputation. This study aimed to illuminate the 8th TNM-EC or TNM-GC system which was more rational for type II, especially for patients underwent transhiatal approaches. Methods: We collected the database of patients with AEG who underwent radical surgical resection from two high-volume institutions in China: West China Hospital (N = 773) and Xi Jing Hospital of Fourth Military University (N = 637). The cases were randomly matched into 705 training cohort and 705 validation cohort. All the cases were reclassified by the 8th edition of TNM-EC and TNM-GC. The distribution of patients in each stage, the hazard ratio of each stage, and the separation of the survival were compared. Multivariate analysis was performed using the Cox proportional hazard model. Comparisons between the different staging systems for the prognostic prediction were performed with the rcorrp.cens package in Hmisc in R (version 3.4.4. http://www.R-project.org/). The validity of these two systems was evaluated by Akaike information criterion (AIC) and concordance index (C-index). Results: By univariate analysis, the HRs from stage IA/IB to stage IV/IVB were monotonously increased according to TNM-GC scheme in both cohorts (training 2.63, 3.91, 5.02, 8.64, 15.51 and 29.64; validation 1.54, 3.55, 4.91, 7.14, 11.67, 18.71 and 48.32) whereas only a fluctuating increased tendency was found when staged by TNM-EC. After the multivariate analysis, TNM-GC (P < 0.001), TNM-EC (P = 0.001) in training cohort and TNM-GC (P < 0.001) TNM-EC (P < 0.001) in the validation cohort were both independent prognostic factors. The C-index value for the TNM-GC scheme was larger than that of TNM-EC system in both training (0.721 vs. 0.690, P < 0.001) and validation (0.721 vs. 0.696, P < 0.001) cohorts. After stratification analysis for Siewert type II, the C-index for TNM-GC scheme was still larger than that of TNM-EC in both training (0.724 vs. 0.694, P = 0.005) and validation (0.723 vs. 0.699, P < 0.001) cohorts. Conclusions: The 8th TNM-GC scheme is superior to TNM-EC in predicting the prognosis of AEG especially for type II among patients underwent transhiatal approaches. [ABSTRACT FROM AUTHOR]

Background: Obesity has become an epidemic in developing countries including China. The use of bariatric surgery to treat obesity has grown in popularity worldwide, but it is still a new concept in China. This study aims to investigate the trends in bariatric surgery in China. Methods: An electronic search of the MEDLINE, EMBASE, and Chinese National Knowledge Infrastructure was conducted to select studies for this survey. Results: A total of 7779 bariatric procedures were reported from 2001 to 2015, most of which (89.2 %) were performed in the most recent 5 years. Further, 70.9 % of all procedures were performed to treat obesity and related comorbidities, defined as metabolic surgery. The data showed 89.4 % of all operations were performed laparoscopically. The absolute number of bariatric surgeries increased 148.7 times in the last 5 years compared to the 2001-2005 period. The percentage of laparoscopic Roux-en-Y gastric bypasses performed increased from 0 to 62.2 %, and the percentage of laparoscopic sleeve gastrectomies from 0 to 12.7 %. The percentage of laparoscopic adjustable gastric bands increased dramatically from 0 to 73.3 % in the 2006-2010 period, but it dropped quickly to 12.9 % in the 2011-2015 period. Most operations (66.7 %) were conducted in the East area, which is the most developed economic region in China. There was limited surgical innovation or original research reported in China. Conclusions: Bariatric surgery is still at an early stage in China, but is now experiencing an explosive growth. A national registry system needs to be established to record and provide precise data. [ABSTRACT FROM AUTHOR]

Compound amino acid solution (CAAS) is a large class of solution of amino acids' mixture and was widely used in China. Its extensive nutritional treatment was accompanied by a substantial incidence of adverse reactions, especially life-threatening anaphylaxis. However, the adverse reactions were reported in isolated case reports only, and the reasons behind this needed further investigation. The Chinese language papers were searched from China National Knowledge Infrastructure and Wanfang database published in China from 1985 to 2010. The search terms 'anaphylactic', 'anaphylaxis', 'allergic', 'allergy', 'shock', and 'adverse reaction' combined with the term 'amino acid' were used. Totally 71 episodes of anaphylactic shock and seven deaths in 38 articles were analyzed. Chest distress and cool extremities were the most common clinical manifestations. Almost all patients suffered from significant hypotension. The vast majority of patients were not found to be allergic to certain substances. CAAS was inappropriately administrated in more than one-third of patients. The life-threatening anaphylaxis was prominently prevalent in pregnant women, the elderly and patients with hypersensitivity such as asthma, and patients without medicinal indication. Innovation of processing technique and establishment of more strict supervision system are an urgent need for CAAS to control its production quality and thus improve its safety in China. [ABSTRACT FROM AUTHOR]

Objective: The systemic spread of colorectal cancer (CRC) is dominated by the portal system and exhibits diverse patterns of metastasis without systematical genomic investigation. Here, we evaluated the genomic evolution of CRC with multiorgan metastases using multiregion sequencing., Design: Whole-exome sequencing was performed on multiple regions (n=74) of matched primary tumour, adjacent non-cancerous mucosa, liver metastasis and lung metastasis from six patients with CRC. Phylogenetic reconstruction and evolutionary analyses were used to investigate the metastatic seeding pattern and clonal origin. Recurrent driver gene mutations were analysed across patients and validated in two independent cohorts. Metastatic assays were performed to examine the effect of the novel driver gene on the malignant behaviour of CRC cells., Results: Based on the migration patterns and clonal origins, three models were revealed (sequential, branch-off and diaspora), which not only supported the anatomic assumption that CRC cells spread to lung after clonally expanding in the liver, but also illustrated the direct seeding of extrahepatic metastases from primary tumours independently. Unlike other cancer types, polyphyletic seeding occurs in CRC, which may result in late metastases with intermetastatic driver gene heterogeneity. In cases with rapid dissemination, we found recurrent trunk loss-of-function mutations in ZFP36L2 , which is enriched in metastatic CRC and associated with poor overall survival. CRISPR/Cas9-mediated knockout of ZFP36L2 enhances the metastatic potential of CRC cells., Conclusion: Our results provide genomic evidence for metastatic evolution and indicate that biopsy/sequencing of metastases may be considered for patients with CRC with multiorgan or late postoperative metastasis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aimed to investigate the effectiveness of postoperative chemotherapy in pT1bN0 and pT2N0 gastric cancer patients with high risk factors., Materials and Methods: Clinicopathological data of gastric cancer patients, who had undergone gastrectomy in high volume centers in Korea and China and were finally diagnosed with pT1bN0 and pT2N0 between 2006 and 2010, were analyzed retrospectively. Survival analyses stratified by risk factors and multivariable analyses were performed., Results: A total of 1509 patients were enrolled, with 41 (2.7%) patients receiving adjuvant chemotherapy after gastrectomy and 1468 (97.3%) patients undergoing surgery alone. The adjuvant chemotherapy group showed higher percentages of tumor with maximal diameter >3 cm (51.2% vs. 25.8%), poor differentiation (68.3% vs. 49.8%), and less harvested lymph nodes (17.1% vs. 5.2%) compared to the surgery alone group. The overall survival rates were 95.1% in the adjuvant chemotherapy group and 93.3% in the surgery alone group, without significant difference. In multivariable analysis, age was found to be an independent prognostic factor. However, there were no difference in the overall survival between patients with risk factors and those without risk factors, even in terms of age. Meanwhile, patients with more than two risk factors who received chemotherapy showed better survival trend, especially for pT2N0 patients, compared to the surgery alone group, although no significant differences were observed., Conclusion: In pT1bN0 and pT2N0 patients, age was found to be an independent prognostic factor. However, adjuvant chemotherapy seemed to be unnecessary, while postoperative chemotherapy might offer survival benefits to pT2N0 patients with more than two risk factors., Competing Interests: Dr. Woo Jin Hyung is a consultant for Ethicon and Verb Surgical, and has grants from Medtronic & GC Pharma and stocks in Hutom. Doctors Kun Yang, Mo-Xi Chen, Yoon Young Choi, Zong-Guang Zhou, Jian-Kun Hu, and Sung Hoon Noh have no conflicts of interest or financial ties to disclose., (© Copyright: Yonsei University College of Medicine 2021.)

Studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) anastomosis are still lacking and inconsistent. The aim of this trial was to compare the quality of life (QoL) of B-I with R-Y reconstruction after curative distal gastrectomy for gastric cancer. A total of 140 patients were randomly assigned to the B-I group (N = 70) and R-Y group (N = 70) with the comparable baseline characteristics. The overall postoperative morbidity rates were 18.6% and 25.7% in the B-I group and R-Y group without significant difference. More estimated blood loss and longer surgical duration were found in the R-Y group. At the postoperative 1 year time point, the B-I group had a higher score in pain, but lower score in global health. However, the R-Y anastomosis was associated with lower incidence of reflux symptoms at postoperative 6 months (P = 0.002) and postoperative 9 months (P = 0.007). The multivariable analyses of variance did not show any interactions between the time trend and grouping. For the results of endoscopic examination, the degree and extent of remnant gastritis were milder significantly in the R-Y group. The stronger anti-reflux capability of R-Y anastomosis contributes to the higher QoL by reducing the reflux related gastritis and pain symptoms, and promotes a better global health.

China has high incidence of gastric cancer (GC). However, the treatment outcomes of China were unsatisfactory compared to those of Korea. We performed this study to compare tumour characteristics, treatment parameters, and survival outcomes of GC patients between Korea and China based on the databases of two high-volume hospitals, with the aim of identifying indicators of GC prognosis. Data of patients undergoing gastrectomy for GC from 2006 to 2010 were analysed retrospectively. Subgroup survival analyses, stratified by clinicopathologic factors and multivariable analyses, were performed. The interactive roles of chemotherapy and D2 lymphadenectomy for overall survival were also investigated. Among 1365 Chinese and 4981 Korean patients, the proportion of early cancer detection in Chinese patients was much lower relative to that of Korean patients. There were no significant differences between countries in terms of surgical morbidity and mortality. The overall 5-year survival rates were 54.3% and 81.4%; when stratified by clinicopathologic factors, the survival were generally statistically higher in Korean patients. Gender, age, T stage, N stage, extent of lymphadenectomy, radicality of surgery, resection type, and chemotherapy were independently associated with survival in patients without metastasis. Survival rates for stage II and III GC differed significantly between the two countries, but this difference was eliminated among patients who underwent D2 lymphadenectomy or received chemotherapy. These treatments were given to patients with advanced-stage diagnoses (approximately 20% and 80% of patients, respectively). Treatment type was selected as independent prognostic factors in stage I-III and D2/D2+, with chemotherapy resulting in the best prognosis. Many differences in GC tumour characteristics exist between two countries. Early cancer detection and standardized treatment in Korea contribute to superior survival rates. Promotion of an early screening program, training and dissemination of standard D2 lymphadenectomy, and appropriate applications of chemotherapy would improve survival outcomes., Competing Interests: No potential conflicts of interest were disclosed.

Background: The aim of this study is to evaluate the safety and efficacy of bursectomy of D2 gastrectomy in terms of postoperative complications and short-term survival outcomes., Methods: From January 2012 to December 2013, data of 406 gastric cancer patients with advanced tumor stages and who underwent D2 radical gastrectomy and were grouped according to whether bursectomy was performed or not in West China Hospital, Sichuan University, were analyzed., Results: Finally, 159 patients were in bursectomy group and 247 patients in non-bursectomy group. Surgical duration was 260.1 ± 43.4 min in the bursectomy group, compared to 227.9 ± 48.6 min in the non-bursectomy group (p < 0.001). The intraoperative blood loss was comparable between the bursectomy group and the non-bursectomy group (198.9 ± 63.5 vs. 201.1 ± 53.7 ml, p = 0.729). Postoperative morbidity rate showed no significant difference between the two groups, which were 23.3 % in the bursectomy group and 17.8 % in the non-bursectomy group, p = 0.179. The overall survival outcomes of patients were compared between the two groups of all patients (p = 0.055): patients who underwent distal gastrectomy (p = 0.129) and total gastrectomy (p = 0.016) and pT2-3 stage patients (p = 0.117) and pT4a stage patients (p = 0.128). The multivariate survival analysis identified that bursectomy or not, pT stage and pN stage were independent prognostic risk factors for the overall survival., Conclusions: The bursectomy might increase the surgical duration when the D2 gastrectomy was done. Experienced surgeons can perform it safely. However, for the survival benefits of bursectomy, long-term, large sample sized, and high-quality randomized controlled trials are expected.

To compare the effectiveness and safety of in-vivo dissection procedure of No. 10 lymph nodes with those of ex-vivo dissection procedure for gastric cancer patients with total gastrectomy.Patients were divided into in-vivo group and ex-vivo group according to whether the dissection of No. 10 lymph nodes were performed after the mobilization of the pancreas and spleen, and migration out from peritoneal cavity. Clinicopathologic characteristics, overall survival, morbidity, and mortality were compared between the 2 groups.There were 148 patients in in-vivo group, while 30 in ex-vivo group. The baselines between the 2 groups were almost comparable. The metastatic ratio of No. 10 lymph nodes were 6.1% and 10.0% (P = 0.435) and the metastatic degree were 7.9% and 13.6% (P = 0.158) for in-vivo group and ex-vivo group, respectively. There was no difference in morbidity or mortality between the 2 groups. The number of total harvested lymph nodes and No. 10 lymph nodes increased significantly in ex-vivo group at the cost of prolonged operation time. The estimated overall survival rates for patients in in-vivo group and ex-vivo group were (3-year: 52.0% vs 61.8%) and (5-year: 45.3% vs 49.5%), respectively, without statistical significance. Further multivariable analysis had showed that the procedure of No. 10 lymphadenectomy was not a significant independent prognostic factor.Both in-vivo and ex-vivo dissection of No. 10 lymph nodes could be performed safely. It seems that ex-vivo dissection of No. 10 lymph nodes can result in a higher effective dissection at the cost of the operation time, but the overall survival rates were not statistically significant between the 2 groups, which should be confirmed further in a well-designed randomized controlled trial.

The objective of this study is to quantitatively analyze the predictive strength among the conventional serological tumor biomarkers for gastric cancer in Chinese population. Thirty-three hospital-based case-control studies were searched out through Chinese databases and PubMed during 1999-2009. Gastric cancer cases and healthy volunteers or benign gastric diseases controls were detected of any of serological CA724, CA242, CEA, CA199, CA125, or CA153. Areas under the curve (AUC) and optimal Q indexes of summary receiver operating characteristics (sROC) curves were quantitatively compared. The summary positive and negative likelihood ratios (sLR + and sLR-) were pooled. Totally, 2,390 gastric cancer cases and 2,893 controls were analyzed. CA724 and CA242 both had the greatest AUCs (0.88), respectively, followed by the combination CA724 + CEA + CA199 (0.85), CA125 (0.82), CEA (0.80), and CA199 (0.76), but all of them had no statistical significance to CA153 (negative control) by Z tests, possibly due to relatively great standard errors. The results of Q index analyses were similar to those of AUCs, that CA724 and CA242 had the optimal strength. The sLR + of CA724 (16.08, 95 % confidence interval (CI) 7.86-32.86) or CA242 (11.03, 95 % CI 7.12-17.08) was strong to judge the gastric cancer status based on its positive result. The combination of CA724 + CEA + CA199 had the prior sLR- (0.33, 95 % CI 0.25-0.43) to the others. Serological CA724 or CA242 has predictive effect for screening gastric cancer and can be recommended into the screening program of population-based or symptomatic cases. However, prospective epidemiological studies are required before confirmative conclusion.

Gastric cancer is one of the leading causes of cancer-related deaths worldwide. We report our experience with surgery-related parameters and survival outcomes at a single Chinese center. This study analyzed patients following gastric resection between 2000 and 2010, and overall survival was the primary end point. In this study, 1,936 patients who underwent gastrectomy were collected from 2000 to 2010. Curative gastrectomy (R0 resection) was performed in 86.6 % of patients. D1/D1+ lymphadenectomy was frequently performed from 2000 to 2005, and the proportion of D2/D2+ lymphadenectomy increased after 2006. The number of harvested lymph nodes was 10.1 ± 6.0 in 2000 and increased to 28.0 ± 10.5 in 2010. Serosa-invasive lesions (pT4) accounted for 67.9 % of all cases. The 1-year overall survival (OS), 2-year OS, and 3-year OS rates were 89, 74, and 63 %, respectively. Multivariate analysis identified R status, tumor location, macroscopic type, and tumor stage (pT stage and pN stage) as the independent risk factors for overall survival. The prognosis of gastric cancer patients in China remains dismal. To improve the survival outcomes, further efforts toward early detection and multi-disciplinary treatment are needed.

Background/aims: Primary pancreatic leiomyoarcoma (PLMS) is a rare disease; its clinical characters and prognosis are poorly demonstrated. This study aimed to investigate the tumor's clinical characters and to reveal the true outcome., Methodology: A retrospective review of both Chinese and worldwide PLMS patients were performed. Data was collected and analyzed and overall survival was described by Kaplan-Meier curve., Results: In total, there were 9 cases identified in China and 55 cases identified in the worldwide literature. Incidence rate was general equal in gender and had an increased trend with age(mean +SD: 55+14 years). Abdominal pain, mass and weight loss were the most common presentations, mean tumor size was 10cm (SD 7.2cm) and most of them presented as a solid mass. Forty six cases accepted operation, 33 of which obtained a radical resection. Median overall survival time was 27 months.The patients who accepted radical resection had an obviously improved prognosis over non-resectable patients., Conclusions: PLMS commonly occurred in the mid-age people and there was lack of specific non-invasive methods for precise preoperative diagnosis.PLMS has a much better prognosis compared with pancreatic ductal adenocarcinoma. Radical resection is the only hope for improving the outcome of this malignancy.

Serum tumor biomarker carbohydrate antigen 724 (CA724) is noticeable for gastric cancer. Correlation between CA724 and gastric cancer was investigated based on Chinese population. Chinese Biomedical Database, Chinese Journal Full-text Database and PubMed were searched. Gastric cancer patients were proven by biopsy, and control included health volunteers or benign gastric diseases. Participants received at least one test of CA724, CA125, CA153, CA199, CA242 or CEA. Meta-analysis, summary ROC (SROC) and post hoc analysis were performed by RevMan 5.0 and SPSS 11.5. Totally, 33 eligible studies were analyzed. Meta-analysis showed CA724 had the highest odds ratio 32.86 compared to control, orderly followed by CA242, CA199, CEA, CA125 and CA153. Accumulated accuracy rate of CA724 was 77 %, superior to others. In SROC analysis, specificity of all studies was above 0.70, but sensitivity of few studies was above 0.70; CA724 was selected as the preferable single test, followed by CA242, CA199, CEA, CA125 and CA153. If threshold of both specificity and sensitivity up to 0.70, CA153 was unacceptable; if up to 0.80, only CA724 and CA242 were considerable. In CA724-combined patterns, CA724+CEA+CA199 combination performed best by increasing sensitivity to 0.74 without impairing specificity, while CA724 + CA199 pattern was not a proper combination. CA724 was the most correlative serum tumor biomarker for gastric cancer in Chinese population. Sensitivity of serum CA724 is limited, but CA724+CEA+CA199 combination is considerable to improve sensitivity without impairing specificity.

Background/aims: To evaluate short-term versus long-term single prophylactic antibiotic for elective gastric tumor surgery., Methodology: Patients in a single surgical team undergoing elective gastric tumor surgery were enrolled from November 2009 to December 2010. The included patients were aged from 18 to 70 years without conditions as severe comorbidity, preoperative infectious diseases, antibiotic administration 48 h before surgery, exploratory laparotomy only or combined colorectal resection, neoadjuvant chemotherapy, or steroid administration before surgery. The overall and infection-related postoperative complications and also economic outcomes were analyzed. The software SPSS 17.0 and TreeAge Pro 2007 were used for statistics., Results: Patients (n=158 (45 vs. 113)) were enrolled in short-term and long-term groups. No death cases occurred. Overall postoperative complication rates were 8.9% and 8.0%, respectively (p=1.000). The rates of infection related complications were 8.9% and 4.4%, respectively (p=0.231). No surgical site infection (SSI) occurred in the short-term group, whereas SSI was 1.8% in the long-term group. Total hospitalization cost (THC) of short-term branch was 36,557RMB per patients and preferable against 39,523RMB of long-term branch. Incremental cost-effectiveness analysis showed there was a 10 times interval between the extra healthcare expenditure of benefit and harm., Conclusions: Short-term administration did not increase the risk of postoperative complications and was more cost-effective.

Background/aims: To introduce the initial experience of the laparoscopic surgery for gastric tumors in mainland China., Methodology: A key Chinese full-text database was comprehensively searched for eligible reports on laparoscopic gastric surgery from 1991 to 2009. Outcomes of laparoscopic gastrectomy for gastric cancer were extracted for pooling estimate., Results: In the period 2003-2008, the amount of relevant journal papers sharply increased (p<0.001). Analysis included 67 reports (no randomized controlled trial, 4 case control studies and the remnant of case series or case reports); 74.6% of the reports were from institutions in the Eastern China region. Finally 542 patients of gastric cancer were analyzed. Early gastric cancer (TNM stage Ia/Ib) was only 30.0%. D2/D2+ lymphadenectomy was performed in 69.0% patients. The combined overall complication and mortality rates were 10.9% and 0.4%, respectively. The incidence of conversion to open surgery and reoperation were 4.1% and 1.1%, respectively. The long-term outcome of 5-year survival rate was unavailable., Conclusions: Laparoscopic gastric surgery has spread rapidly and developed in mainland China during recent several years. The initial experiences from mainland China showed that postoperative complication and mortality rates of laparoscopic gastrectomy for gastric cancer were acceptable and comparable to Japanese and Korean trials.

Objectives: To detect the frequency of Toll-like receptor (TLR) 4896A>G (Asp299Gly) polymorphism in acute pancreatitis (AP) patients and to determine the relationship between polymorphism and pancreatic necrotic infection., Methods: The allele frequency of TLR4 Asp299Gly was surveyed by mispairing polymerase chain reaction-restriction fragment length polymorphism analysis technique in AP patients with pancreatic necrosis and healthy volunteers, respectively., Results: All individuals with TLR4 Asp299Gly polymorphism were heterozygotes. Compared with healthy volunteers (5.6%), TLR4 896G allele frequencies was significantly higher in AP patients with pancreatic infection (20%), the incidence of gram-negative infection was significantly higher in AP patients with TLR4 Asp299Gly polymorphism (15 [44%]/34) than that in AP patients without TLR4 polymorphism (15 [18%]/81)., Conclusions: Toll-like receptor 4 Asp299Gly polymorphism is associated with the infection of pancreatic necrosis in AP. Patients who carried TLR4 896A>G mutation is susceptible to pancreatic gram-negative bacteria infection.

Objectives: Tumors with high-frequency microsatellite instability (MSI-H) have unique biological behavior and the predictive role of microsatellite instability (MSI) status on survival of colorectal cancer is still debated. The prognostic significance of MSI status in sporadic stage II and III rectal cancer patients needs to be more precisely defined. So we investigated the relationship between MSI status and clinicopathological features and prognosis in these patients., Methods: DNAs from fresh-frozen paired samples of tumors and corresponding normal tissue from 128 stage II and III rectal cancer patients were analyzed for MSI by PCR amplification using markers recommended by a National Cancer Institute workshop on MSI. To assess prognostic significance, Cox proportional hazards modeling was used., Results: Twelve (9.3%) tumors in our study were MSI-H, 28 (21.9%) were low-frequency MSI (MSI-L) and 88 (68.8%) were microsatellite stable (MSS). Most of the MSI-H tumors compared with MSI-L and MSS tumors were found in female patients (p = 0.031), had mucinous histology (p = 0.023), high grade of differentiation (p = 0.002) and high level of preoperative serum carcinoembryonic antigen (p = 0.005). Rectal cancer patients with MSI-H did not show a better clinical outcome than those with MSI-L/MSS, neither in all cases (p = 0.986) nor in stage II and stage III disease analyzed separately (p = 0.705 and p = 0.664, respectively)., Conclusions: Data provided here demonstrated there was high incidence of MSI-H and MSI was not a prognostic factor in sporadic stage II and III rectal cancers from the Chinese Han population included in this study. Tumor stage is more suitable than MSI status for prediction of individual survival in sporadic stage II and III rectal cancer patients., (Copyright 2007 S. Karger AG, Basel.)