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Aim: To investigate the expression pattern of gamma-synuclein in colorectal cancer (CRC) tissues, and to study the effects of gamma-synuclein on CRC cell line HCT116 biological features in vitro., Methods: The expression pattern of gamma-synuclein was determined in 54 CRC tissues and 30 tumor-matched nonneoplastic adjacent tissues (NNAT) 5 cm away from the tumor via real-time quantitative reverse transcription PCR (RT-PCR) and immunohistochemistry. The relationship between gamma-synuclein protein expression and clinicopathological factors of CRC tissues was analyzed. Three small interfering RNA (siRNA) targeting gamma-synuclein mRNA plasmids were constructed and transfected into the CRC cell line HCT116. The stable cell lines were selected with G-418 for 28 d, and the biological features of these cells were examined by cell growth curve, soft agar assay, and cell migration and invasion assays in vitro., Results: The expression of gamma-synuclein mRNA and protein was much higher in CRC tissue samples than in NNAT samples (P = 0.02, P = 0.036). There was a significant correlation between the gamma-synuclein protein expression and clinical stage and lymph node involvement of CRC (P = 0.02, P = 0.033). In functional analysis we found that down-regulation of gamma-synuclein expression in HCT116 cells could inhibit the growth, colony formation rate, and migration and invasion ability of HCT116 cells., Conclusion: Increased expression of gamma-synuclein in CRC tissues and the biological effects of reduced gamma-synuclein expression on HCT116 cells suggest that gamma-synuclein may play a positive role in the progression of CRC.

Lymph node metastasis (LNM) is an important indicator for systematic therapy, which could increase the survival of colorectal cancer (CRC) patients. However, effective clinical evaluation for LNM is still absent to date. In this study, protein expression profiles of CRC tissues were compared between patients with and without LNM. Based on average expression level, 12 proteins were found to be differentially expressed in the CRC tissues with LNM, whose discrimination reliability was confirmed by PCA. With stepwise linear discriminant analysis, T-complex protein 1 ζ subunit and peptidyl-prolyl cis-trans isomerase B (PPIB) were identified as two main contributors for separating CRC tissues with positive LNM from those negative ones in both original-grouped and cross-validated-grouped cases, which was also supported in subsequent linear support vector machine analysis. In addition, the expression alterations of the two proteins were verified by Western blot and immunohistochemistry. Functional studies also confirmed the role of PPIB in migration and invasion of cancer cells. Taken together, the down-regulated T-complex protein 1 ζ subunit and up-regulated PPIB were identified as two promising indicators for the clinical evaluation of LNM in CRC patients., (Copyright © 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: There is still a debate about the utility of intraoperative cholangiography (IOC) or laparoscopic ultrasonography (LUS) for detection of occult choledocholithiasis during laparoscopic cholecystectomy (LC). The aim of this study was to assess the value of IOC combined with LUS for detection of occult common bile duct (CBD) stones at LC., Material/methods: From Dec 2002 to Aug 2006, 103 patients with moderate risk of CBD stones underwent IOC and LUS simultaneously during LC. The physician teams for the two different procedures were blinded by each other. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated by several contingency tables that cross-tabulated the results of each technique with those of the gold standard., Results: The success rate of IOC and LUS were 91.3% and 100% respectively and the time required for LUS was significantly shorter (P<0.01). The visualization of intrapancreatic part of CBD by IOC (97.3%) was significantly higher than LUS (73.8%). The sensitivities, specificities, accuracies, positive and negative predictive values, positive and negative likelihood rations identifying occult CBD stones were 75.0%, 98.7%, 92.2%, 95.5%, 91.4%, 57.7 and 0.253 by IOC, and 82.1%, 98.7%, 94.2%, 95.8%, 93.7%, 63.2 and 0.181 by IUS respectively. The McNemar test showed no significant difference between two methods. The sensitivity of IOC combined with LUS was 92.9%, which was greater than that of IOC and LUS taken separately., Conclusions: LUS is usually performed in case where IOC has failed or is contraindicated. The combination of both methods maximizes intraoperative detection of occult CBD stones and should at least be recommended as two complementary methods.

Objective: To compare the outcomes of laparoscopic colorectal surgery in elderly (> or = 70 years) and younger(< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly., Methods: From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older(Elder Group), and 15 patients less than 70 years(Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups., Results: Elder group had a higher ASA degree(P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO(3) value and PaCO(2) value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucosa(PgCO(2)) increased significantly at the end of operation. Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, perfusion, and blood chemistry were not significantly different., Conclusions: For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.

Objective: To study the regulatory effect of galectin-9 isoforms on some molecules involved in cell adhesion/invasion, and the influence of this regulation action on the adhesion between colon carcinoma LoVo cells and human umbilical vein endothelial cells (HUVECs) in vitro., Methods: Various expression vectors of galectin-9 isoforms were transfected into LoVo cells. 24 h after transfection, the expression of integrin-beta1, E-cadherin, E-selectin, ICAM-1, CD44 and MMP-9 was detected by RT-PCR and Western blot analysis. LoVo cell-HUVEC adhesion assay was performed under conditions of galectin-9 transfection, galectin-9 transfection + galectin-9 antibody, galectin-9 transfection + E-selectin antibody and galectin-9 transfection + beta-lactose, respectively., Results: Galectin-9L down-regulates the mRNA and protein levels of E-selectin while galectin-9M and galectin-9S up-regulate the expression of E-selectin. In LoVo cell-HUVEC adhesion assay, the average fluorescence intensity of vector transfection group, galectin-9L transfection group, galectin-9M transfection group and galectin-9S transfection group was 0.90 +/- 0.20, 0.94 +/- 0.24, 1.60 +/- 0.11 and 1.45 +/- 0.13, respectively, indicating that galectin-9M and galectin-9S facilitated the adherence of LoVo cells to HUVECs (P < 0.05). E-selectin antibody, galectin-9 antibody or beta-lactose inhibited that effect., Conclusion: Galectin-9 isoforms regulate the E-selectin expression in LoVo cells differently and thus influence the adhesion between LoVo cells and HUVECs in vitro in different modes. The mechanisms through which galectin-9 isoforms participate in the metastasis process of colon cancer may not be the same.

Colorectal cancer is one of the most commonly diagnosed cancers and cause of cancer-related deaths worldwide. Studies have demonstrated that patient outcome is substantially influenced by cancer stage at the time of diagnosis. For example, patients with early stage colorectal have a significant higher 5-year survival rates compared to patients diagnosed at late stage. Thus, it is important to develop effective methods for early diagnosis as well as for precise staging of this disease process. Although traditional colonoscopy remains the most effective means to diagnose colorectal cancer, this approach generally suffers from poor patient compliance. As such, it is imperative to develop accurate and specific tests that utilize a more convenient approaches including urine examination. Urine collection is noninvasive, requires no presampling preparation, and substantially improves compliance. Recent advances in metabolomics, analytical techniques, and data analysis have tremendous potential for application in diagnostic pathology including identification of novel urinary markers in colorectal cancer.

Recent evidence suggests that gamma-synuclein is abnormally expressed in a high percentage of tumor tissues of diversified cancer types, but rarely expressed in tumor-matched non-neoplastic adjacent tissues (NNAT). The molecular mechanism of CpG island demethylation may underlie aberrant gamma-synuclein expression. To fully understand the roles of aberrant gamma-synuclein expression and demethylation in the development of colorectal cancer (CRC), we examined the expression and methylation status of gamma-synuclein in 67 CRC samples, 30 NNAT samples, and five CRC cell lines as well. By using reverse transcription-polymerase chain reaction (RT-PCR), western blot, and immunohistochemistry analyses, gamma-synuclein expression was detected in both HT-29 and HCT116 cells, and was much higher in CRC samples than in NNAT samples (P < 0.05). The demethylating agent, 5-aza-2 cent-deoxycytidine, can induce re-expression of gamma-synuclein in COLO205, LoVo, and SW480 cells. Unmethylated gamma-synuclein alleles were detected in HT-29, HCT116, and LoVo cells by nested methylation-specific PCR, and the demethylated status of gamma-synuclein was much higher in CRC samples than in NNAT samples by real-time quantitative methylation-specific PCR (P < 0.05). The results of genomic bisulfite DNA sequencing further confirmed that the aberrant gamma-synuclein expression in CRC was primarily attributed to the demethylation of CpG island. The protein expression and demethylation status of gamma-synuclein in 67 CRC samples correlated with clinical stage, lymph node involvement, and distant metastasis. These findings suggest an involvement of aberrant gamma-synuclein expression and demethylation in progression of CRC, especially in advanced stages.

Risk factors for local recurrence and indication for preoperative radiation therapy have not been well evaluated for patients undergoing laparoscopic rectal cancer operation. From 1998 to 2004, 497 T3 rectal cancer patients with tumor located within 12 cm from the anal verge who had undergone laparoscopic surgery without preoperative radiation therapy by eight experienced laparoscopic surgeons in four Asian countries were reviewed retrospectively for the incidence of local recurrence and related factors. The median follow-up was 29.0 months (range, 6.0 to 92.3), and 31 cases of local recurrence were observed during the follow-up period (6 anastomosis site, 6 perineum, 17 pelvic wall, and 2 unclassified). The estimated local recurrence rates at 24 and 60 months were 5.42 and 9.41%, respectively. Patient's gender, tumor location, lymph node metastasis, and tumor perforation were independent factors for local recurrence by multivariate analysis. The local recurrence rate was comparable to previous studies using conventional open surgery with preoperative chemoradiation, except for a subgroup of male patients with the tumor located within 7 cm from the anal verge. The indication for preoperative radiation therapy would be different from those who will undergo conventional open surgery, and further evaluation of the benefits of preoperative radiation therapy is required for those with low risk tumor.

Objective: To evaluate laparoscopic surgery for gastric and small intestinal stromal tumors., Methods: The clinical data of patients with laparoscopic resection of gastric and small intestinal tumors, admitted to our center from Dec. 2003 to Jul. 2006, were retrospectively analyzed. The data included the surgical procedure, operative time, blood loss, length of incision, time for passage of flatus, postoperative length of stay, operative complications, pathology and the results of follow-up., Results: All the 33 patients with gastric and small intestinal stromal tumors were treated by laparoscopic procedures successfully, including 8 laparoscopic gastric wedge resections, 8 laparoscopic transgastric tumor-everting resections, and 17 laparoscopic segmental resections of small intestine. The mean operative time was (73.1+/-27.0) min, the mean blood loss was (19.8+/-14.0) ml, the mean length of incision was (3.3+/-1.1) cm, the mean time for passage of flatus was (2.2+/-1.0) d and the postoperative length of stay was (8.1+/-2.0) d. The bleeding of intestinal anastomosis and gastric mucosa occurred on 3 patients (9.1%), who were healed with conservative therapy. No recurrence was found during 2-33 months follow-up., Conclusion: Laparoscopic surgery is an effective, safe, less invasive procedure for treatment of gastric and small intestinal stromal tumors.

Objective: To evaluate the clinical use of laparoscopy in diagnosis and surgical treatment in small intestinal tumors., Methods: Clinical data of 42 patients with small intestinal tumor undergoing laparoscopic diagnosis and surgical procedure from Sep. 2003 to Dec. 2005 were analyzed retrospectively. The operative time, blood loss,length of incision, time for passage of flatus, post-operative hospital stay and operative complications were evaluated., Results: All the patients were diagnosed and treated by laparoscopic procedure successfully, including 4 laparoscopic local resection of the tumors, 36 laparoscopy-assisted partial intestinal resections, 1 right hemicolectomy, and 1 laparoscopic exploration. The mean operative time was (73.1+/-32.9) min, the mean blood loss was (20.7+/-31.2) ml, the mean length of incision was (3.7+/-1.2) cm, the mean time for passage of flatus was (2.2+/-0.8) d, and the post-operative hospital stay was (8.0+/-3.1) d. Postoperative complications occurred in 2 patients (4.8% ) including anastomosis bleeding and adhesive intestinal obstruction in one case respectively. After follow-up from 3 to 30 months, no recurrent tumor was found except one patient with advanced intestinal carcinoma., Conclusion: Laparoscopic exploration can diagnose small intestinal tumors accurately, and laparoscopy-assisted surgical treatment is safe with less trauma and fast recovery.

Objective: To compare the systemic and local inflammatory response after laparoscopic and conventional surgery for colorectal carcinoma., Methods: From April 2004 to August 2004, 51 colorectal cancer patients undergoing laparoscopic (n=25) and conventional open (n=26) colorectal resection were enrolled in the study. The general clinical data,and inflammatory response were compared between the two groups., Results: There were no significant differences in age, sex, pre-operative levels of haemoglobin and albumin, Dukes stage and surgical procedure between the two groups (P > 0.05). Laparoscopic surgery had more advantages over conventional open surgery such as incision, operating time, recovery time of bowel function, and hospitalization. On postoperative day (POD) 1, WBC count [(7.30+/- 2.62)x10(9)/L], and the serum levels of IL-10 [(19.46+/- 3.31)pg/ml] and C-reactive protein (CRP) [(2.76+/- 2.17)mg/dl] were significantly lower in laparoscopic group than those in conventional group (P< 0.05), but there were no differences on POD 4 between the two groups (P > 0.05). There were no significant differences in the volume of peritoneal drainage fluid, and levels of IL-10, TNF and CRP in it on POD 1 between the two groups, but the volume of peritoneal drainage fluid decreased significantly from POD 2, and the level of IL-10 in it was significantly lower on POD 4 in laparoscopic group than that in conventional group., Conclusions: In early stage after operation,intra- peritoneal inflammatory response caused by laparoscopic surgery is similar to that by conventional open surgery, but systemic inflammatory response is slighter than that by conventional open surgery for colorectal carcinoma.

Background and Aims: Elderly patients have a high incidence of colorectal cancer, which may be associated with increased morbidity and mortality due to complex comorbidity and diminished cardiopulmonary reserves. The aims of this study were to compare the outcomes of laparoscopic colorectal cancer surgery with those observed in traditional open surgery in patients aged over 70 years., Methods: Between January 2003 and October 2004, 51 patients aged over 70 years with colorectal cancer, who underwent laparoscopic surgery (LAP group), were evaluated and compared with 102 controls (also over 70 years old) treated by traditional open surgery (OPEN group) in the same period. All patients were evaluated with respect to the American Society of Anesthesiologists (ASA) classification, surgery-related complications, and postoperative recovery., Results: No surgery-related death was observed in the LAP group, whereas two deaths occurred in the OPEN group for severe post-operative pulmonary infection and anastomotic leak, respectively. No pneumoperitoneum-related complications were observed in the LAP group; 2 (3.9%) patients required conversion to open surgery, because of the unexpectedly bulky tumor and severe adhesions in the abdominal cavity. With the increase in patients' age, increased ASA classification was observed. No significant differences were observed in gender, Dukes' staging or types of procedures between LAP and OPEN groups. The overall morbidity in the LAP group was significantly less than that of the OPEN group [17.6% (9/51) vs 37.3% (38/102), p=0.013]. Mean blood loss, time to flatus passage, and time to semi-liquid diet in the LAP group were significantly shorter than those of the OPEN group (90.7+/-49.9 vs 150.3+/-108.7 ml, 2.4+/-1.2 vs 3.5+/-2.9 d, 5.0+/-1.8 vs 5.9+/-1.2 d, respectively, p<0.05). No significant differences were observed in terms of mean operation time or hospital stay between LAP and OPEN groups., Conclusion: Laparoscopic colorectal cancer surgery in elderly patients with colon cancer has clinically significant advantages over traditional open surgery, and appears to be the ideal surgical choice for the elderly.

Background: Minimal access techniques have gained wide acceptance in surgical practice, but the role of laparoscopic pancreaticoduodenectomy is still controversial. Laparoscopic pancreaticoduodenectomy has seldom been described. In this report, we assessed the feasibility and safety of laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma of the common bile duct., Case Report: According to imaging findings, a 71-year-old Chinese man was diagnosed with malignancy of the common bile duct, and successfully underwent laparoscopic pancreaticoduodenectomy in our center. The operation's safety, postoperative recovery, complications, oncological clearance, and short-term follow-up results of the patient are evaluated. No severe intraoperative or postoperative complications were observed. The operation time was 390 minutes, and the blood loss was about 50 ml; the flatus, time to resume early activity and hospital stay were 3, 4, and 30 days respectively. The patient remained well at a follow-up of 6 months., Conclusions: Laparoscopic pancreaticoduodenectomy can be performed feasibly and safely by surgeons with advanced laparoscopic skills, and could be considered for the treatment of common bile duct tumors.

Objective: To demonstrate expression and single nucleotide polymorphisms (SNP) of human kallikrein 10 (KLK 10) in colorectal cancer (CRC) and to correlate the KLK 10 expression level with clinicopathological factors of CRC., Methods: KLK 10 expression in 63 cases of tumoral and nontumoral colorectal tissues at the mRNA and protein levels were evaluated by quantitative real-time RT-PCR (qRT) and Western blot methods. KLK 10 protein was localized by immunohistochemistry. The KLK 10 genomic DNA from 16 cases of paired normal and cancerous colorectal tissues was PCR-amplified and examined for SNP by direct sequencing., Results: The KLK 10 mRNA expression was detected by qRT in 61 of 63 (97%) CRC specimens. The KLK 10 expression was much higher in tumor tissue than in the corresponding normal mucosal tissue at the mRNA and protein levels. The KLK 10 mRNA expression level significantly correlated with the lymphatic invasion (P < 0.05) and clinical stage of CRC (P < 0.05). No mutations or polymorphisms were detected in exon 1, 2 and 5 of KLK 10 gene in CRC. A SNP in codon 50 of exon 3, GCC (alanine) to TCC (serine) was identified. The genetic changes of exon 4 were located at codon 106 [GGC (glycine) to GGA (glycine)], codon 112 [ACG (threonine) to ACC (threonine)], codon 141 [CTA (leucine) to CTG (leucine)], and codon 149 [CCG (proline) to CTG (leucine)]. All these SNP were identical in tumor as well as the corresponding normal tissue DNA from the same individuals., Conclusions: The KLK 10 expression is up-regulated in CRC and higher expression of KLK 10 closely correlate with advanced disease stage, which predicts a poorer prognosis, however, further follow-up study is needed.

Objective: To investigate the feasibility of the laparoscopic salvage surgery for locally recurrent rectal cancer., Methods: Seven cases with recurrent rectal carcinoma treated by laparoscopic salvage surgery from February 2004 to July 2005 were retrospectively analyzed. Among them, four were males and 3 females, and the median age was 60 years (range 37-74). Three cases of recurrence were after conventional anterior resection, 2 after laparoscopic-assist anterior resection, 1 after laparoscopic-assist Parks' procedure, and 1 with pars sacral fistula after per-sacral-local resection for three times. Image examination (CT scanning) was taken preoperatively to evaluate the locally recurrence and exclude the distant metastases. The laparoscopic-assist procedure with or without a hand-assist technique was used in this study., Results: Six cases with the recurrent lesion of central type were treated by salvage surgical procedure as follows: 3 laparoscopic-assist anterior resection, 1 laparoscopic-assist abdominoperineal resection, 1 laparoscopic-assist posterior exenteration, and 1 laparoscopic-assist proctocolectomy with a terminal ileum stoma. All of them were R0 resection confirmed by postoperative pathological examination. The other one with the lesion of combination type was treated with the procedure of laparoscopic-assist sigmoid colostomy. A hand-assist technique was used in 2 cases. The mean operation time, bleeding and hospital day was (211 +/- 13) min, (200 +/- 91) ml, and (15 +/- 10) d, respectively. No conversion and complication occurred., Conclusion: Laparoscopic salvage surgery for locally recurrent rectal cancer is safe and feasible when taken by experienced laparoscopic colorectal surgeon to the cases with the recurrent lesion of central type.

Aim: Fourteen urinary nucleosides, primary degradation products of tRNA, were evaluated to know the potential as biological markers for patients with colorectal cancer., Methods: The concentrations of 14 kinds of urinary nucleosides from 52 patients with colorectal cancer, 10 patients with intestinal villous adenoma and 60 healthy adults were determined by column switching high performance liquid chromatography method., Results: The mean levels of 12 kinds of urinary nucleosides (except uridine and guanosine) in the patients with colorectal cancer were significantly higher than those in patients with intestinal villous adenoma or the healthy adults. Using the levels of 14 kinds of urinary nucleosides as the data vectors for principal component analysis, 71% (37/52) patients with colorectal cancer were correctly classified from healthy adults, in which the identification rate was much higher than that of CEA method (29%). Only 10% (1/10) of patients with intestinal villous adenoma were indistinguishable from patients with colorectal cancer. The levels of m1G, Pseu and m1A were positively related with tumor size and Duke's stages of colorectal cancer. When monitoring the changes in urinary nucleoside concentrations of patients with colorectal cancer associated with surgery, it was found that the overall correlations with clinical assessment were 84% (27/32) and 91% (10/11) in response group and progressive group, respectively., Conclusion: These findings indicate that urinary nucleosides determined by column switching high performance liquid chromatography method may be useful as biological markers for colorectal cancer.

Objective: To evaluate the value of urinary normal and modified nucleosides in diagnosis and surgical monitoring of colorectal cancer (CRC)., Methods: Between October 2002 and July 2003, 52 consecutive patients with pathological confirmed CRC were included in this study. Spontaneous urine samples were collected 1 d before and 8 d after surgery and 14 kinds of urinary nucleosides in the samples were determined by reversed-phase high-performance liquid chromatography (RP-HPLC) method. Another 62 healthy volunteers were also enrolled as controls. The routine clinical tumor markers, including serum CEA, CA199, CA125 and AFP levels of CRC patients were evaluated by electrochemical-luminescence immunoassay simultaneously., Results: The mean levels of pseudouridine (Pseu), adenosine (A), cytidine (C), 1-methyladenosine (m1A), 1-methylinosine (m1I), 3-methyluridine + 5-methyluridine (mU), 2,2-methylguanosine (m22G), inosine (I), 1-methylguanosine (m1G), N4-acetylcytidine (ac4C), N6-methyladenosine (m6A) among 14 kinds of determined urinary nucleosides in CRC group were much higher than those of controls (P < 0.05). Based on principal component analysis, 76.9% of CRC patients were correctly identified, which was much higher than that of CEA (38.5%), CA199 (40.4%), CA125 (15.4%), and AFP (17.3%) (P < 0.01). ROC curve analysis of m1G, and Pseu showed good sensitivity-specificity profiles to CRC. Two classification equations, Y(normal) = -3.009 + 0.0272 x Pseu + 4.918 x m1G and Y(CRC) = -8.057 + 0.0667 x Pseu + 8.258 x m1G, were established by Bayes stepwise discriminate analysis for predicting carcinogenesis of CRC. The elevated levels of Pseu, C, U (uridine), m1A, m1I, m1G, ac4C, A, m22G dramatically decreased after curative resection of 40 cases of CRC. And our data also showed that the preoperative levels of Pseu, m1G, m1A and m22G were positively related with tumor size and the preoperative levels of m1A, m22G and ac4C were positively related with Duke's staging of CRC (P < 0.05)., Conclusions: Normal and modified urinary nucleosides may become additional tumor markers which are feasible in the clinical setting and will prove helpful in the diagnosis, management and follow-up of CRC, and Pseu and m1G may be more promising for clinical application.

Aim: This study aimed to assess the safety and feasibility of laparoscopic curative resection for colorectal cancer through the clinical practice and basic research., Material and Methods: From September 2001 to September 2002, 47 patients with colorectal cancer were treated using laparoscopic approach, compared with 113 patients underwent traditional operation. The length of intestinal segment excised, size of tumour, clearance of lymph nodes, local recurrence and distant metastasis rate during the period of follow-up in both groups were compared. The other part of the study involved the detection of exfoliated tumour cells in the peritoneal washing before and after surgery; flushing of the instruments was performed in both groups and the results compared. For the laparoscopic cases, the filtrated liquid of CO(2) pneumoperitoneum was also checked for tumour cells., Results: No significant differences existed in tumour size, operative site and manner between the two groups. The exfoliated tumour cell was not detected in the CO(2) filtrated liquid. Between both groups there was no difference in the incidence of exfoliated tumour cells in peritoneal washing before and after surgery as well as in the fluid used for flushing the instruments. The total number of lymph nodes harvested was 13.71±9.57 for the laparoscopic group and 12.10±9.74 for the traditional procedure. Similar length of colon was excised in both groups; this was (19.38±7.47) cm in the laparoscopic and (18.60±8.40) cm in the traditional groups. The distal margins of resection for rectal cancer were (4.19±2.52) cm and (4.16±2.00) cm respectively. The local recurrence rate was 2.13% (1/47) and 1.77% (2/113) with the distant metastasis rate 6.38% (3/47) and 6.19% (7/113) respectively. Both the statistics were comparable between the laparoscopic and traditional surgery for the colorectal cancer., Conclusion: Laparoscopic curative resection for colorectal cancer can be performed safely and effectively. In the treatment of colorectal malignancy, laparoscopic resection can achieve similar radicalilty as compared to the traditional laparotomy.

Aim: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma., Methods: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery-related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival., Results: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resume early activity in the LRH group were significantly shorter than those in the ORH group (2.24+/-0.56 vs 3.25+/-1.29 d, 13.94+/-6.5 vs 18.25+/-5.96 d, 3.94+/-1.64 vs 5.45+/-1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%)., Conclusion: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure.

Objective: To investigate the causes of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy., Methods: 617 patients who had received laparoscopic cholecystectomy from September, 2000 to March, 2001 at this hospital were reviewed retrospectively. Ninety-one of these patients were selected randomly for prospective observation. Color Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy and to examine the anatomic relationship between the gallbladder bed and the branches of the middle hepatic vein in 91 patients preoperatively., Results: A large branch of the middle hepatic vein extended closely behind the gallbladder bed in all 91 patients. The mean distance between the closest point (C point) of this branch to the gallbladder bed was 5.0+/-4.6 mm. The branch of the middle hepatic vein was completely adherent to the gallbladder bed in 14 (15.38%) of the 91 patients. The distance between this branch and the gallbladder bed was within 1 mm in 10 (10.99%) of the 91 patients. The inside diameter at C point of this branch was 3.2+/-1.1 mm. The C point was found on the left side of the longitudinal axis of the gallbladder in 31 (34.66%) of the 91 patients, on the right side in 39 patients (42.86%), just on the axis in 21 patients (23.08%). The venous blood flow rate at the C point was 9.9+/-3.3 cm/s., Conclusions: A large branch of the middle hepatic vein passes behind the gallbladder. The inside diameter of this branch is relatively larger. The bleeding of this branch during operation can only be stopped by transfixion. The closest point of this vein to the gallbladder is mostly situated on the right side of the longitudinal axis of the gallbladder. Patients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasound.