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Purpose The molecular mechanism of perineural invasion (PNI) in stage II colorectal cancer (CRC) remains not to be defined clearly. This study aims to identify the genomic aberrations related to PNI in stage II CRC. Patients and Methods Using array-based comparative genomic hybridization (array-CGH), primary tumor tissues and paracancerous normal tissues of stage II CRC with PNI and without PNI were analyzed. We identified genomic aberrations by using Genomic Workbench and MD-SeeGH and validated the aberrations of selected genes by real-time polymerase chain reaction (PCR). Gene ontology (GO) and pathway analysis were performed to determine the most likely biological effects of these genes. Results The most frequent gains in stage II CRC were at 7q11.21-q11.22, 8p11.21, 8p12-p11.23, 8q11.1-q11.22, 13q12.13-q12.2, and 20q11.21-q11.23 and the most frequent losses were at 17p13.1-p12, 8p23.2, and 118q11.2-q23. Four high-level amplifications at 8p11.23-p11.22, 18q21.1, 19q11-q12, and 20q11.21-q13.32 and homozygous deletions at 20p12.1 were discovered in Stage II CRC. Gains at 7q11.21-q22.1, 16p11.2, 17q23.3-q25.3, 19p13.3-p12, and 20p13-p11.1, and losses at 11q11-q12.1, 11p15.5-p15.1, 18p11.21, and 18q21.1-q23 were more commonly found in patients with PNI by frequency plot comparison together with detailed genomic analysis. It is also observed that gains at 8q11.1-q24.3, 9q13-q34.3, and 13q12.3-q13.1, and losses at 8p23.3-p12, 17p13.3-p11.2, and 21q22.12 occurred more frequently in patients without PNI. Further validation showed that the expression of FLT1, FBXW7, FGFR1, SLC20A2 and SERPINI1 was significantly up-regulated in the NPNI group compared to the PNI group. GO and pathway analysis revealed some genes enriched in specific pathways. Conclusion These involved genomic changes in the PNI of stage II CRC may be useful to reveal the mechanisms underlying PNI and provide candidate biomarkers.

Reversal of loop ileostomy after colorectal surgery in obese patients can be challenging and total laparoscopic (TLAP) approach may be beneficial. This study aims to compare short-term outcomes of TLAP and open approaches in obese patients undergoing loop ileostomy reversal after laparoscopic-assisted colorectal surgery. A retrospective review was performed for consecutive patients who underwent laparoscopic-assisted colorectal surgery previously and underwent loop ileostomy reversal between January 2017 and April 2020. TLAP and open cases performed in obese patients were identified and compared for the following outcomes: baseline characteristics, operative outcomes, postoperative recovery, and postoperative complications. TLAP or open-loop ileostomy reversal was performed on 30 and 34 patients, respectively. TLAP approach was associated with a similar operation time and blood loss compared with an open approach (P 0.05). The median length of incision for stoma removal was significantly shorter in the TLAP group than in the open group (6.5 cm vs. 8.5 cm; P 0.05), and a lower incidence of incisional infection was also noted in the TLAP group (6.7% vs. 26.5%; P 0.05). The groups were comparable as regards the time to ground activities and length of hospitalization (P 0.05), but the time to first flatus was decreased (2.0 vs. 3.0 days; P 0.05). This retrospective study demonstrated that TLAP loop ileostomy reversal may have a satisfactory short-term outcome for obese patients after laparoscopic-assisted colorectal surgery, with a shorter incisional length and a lower incidence of incisional infection as well as an earlier time to first flatus.

With recent advances in laparoscopic-surgery techniques and neoadjuvant therapy options, there have been improvements in sphincter-preservation outcomes in patients with low rectal cancer [1–3]. However, several issues remain controversial, such as the incidence of anastomotic leakage, the local recurrence rate, and anal-function outcome [4–5]. Moreover, prophylactic stoma at the end of sphincter-preserving surgery is necessary to prevent anastomotic leakage, especially in patients undergoing neoadjuvant chemoradiotherapy [7]. To avoid prophylactic colostomy and decrease excessive expense, we developed a new method of overlapped end-to-end anastomosis for treating low rectal cancer—a technique referred to as ‘oversleeve anastomosis.’

BACKGROUND AND AIM Avoiding abdominal incisions is one of the unique features of natural orifice specimen extraction (NOSE) surgery. There has been no consensus on whether the avoidance of abdominal incisions can reduce the systemic inflammatory response after NOSE surgery. This study was designed to evaluate the safety and feasibility of transanal NOSE, especially the inflammatory response after transanal NOSE versus mini-laparotomy (LAP). METHODS A total of 172 colorectal cancer patients who underwent transanal NOSE were matched with 172 patients who underwent LAP for colorectal cancer. Clinical characteristics, pathological features, perioperative parameters, and indicators of the inflammatory response were collected and compared. The inflammatory response was assessed by measuring body temperature, neutrophil count, C-reactive protein levels, and procalcitonin levels. RESULTS Patients in the NOSE group had better short-term outcomes, such as lower incidence of wound infection, less postoperative pain, less need for anesthetic drugs, and faster recovery of intestinal function. Regarding the inflammatory response, the average body temperature of patients in the NOSE group was higher on postoperative day (POD) 2 than that in the LAP group. A higher median neutrophil count and C-reactive protein levels were observed in the NOSE group on POD3 and POD5 than was observed in the LAP group. CONCLUSIONS Transanal NOSE is safe and feasible for colorectal cancer, with better short-term outcomes. Although transanal NOSE produced a larger systemic inflammatory response than LAP in the early postoperative stages, this response did not appear to translate into infectious morbidity.

Background As one effective treatment for lateral pelvic lymph node (LPLN) metastasis (LPNM), laparoscopic LPLN dissection (LPND) is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery. With regard to improving the accuracy and completeness of LPND as well as safety, we tried an innovative method using indocyanine green (ICG) visualized with a near-infrared (NIR) camera system to guide the detection of LPLNs in patients with middle-low rectal cancer. Aim To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer. Methods A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision (TME) and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group. Clinical characteristics, operative outcomes, pathological outcomes, and postoperative complication information were compared and analysed between the two groups. Results Compared to the non-ICG group, the ICG group had significantly lower intraoperative blood loss (55.8 ± 37.5 mL vs 108.0 ± 52.7 mL, P = 0.003) and a significantly larger number of LPLNs harvested (11.5 ± 5.9 vs 7.1 ± 4.8, P = 0.017). The LPLNs of two patients in the non-IVG group were residual during LPND. In addition, no significant difference was found in terms of LPND, LPNM, operative time, conversion to laparotomy, preoperative complication, or hospital stay (P > 0.05). Conclusion ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.

Background Temporary ostomy has proved to be an effective method to reduce anastomotic leakage in low anterior resection. However, the injury of additional reversal surgery and ostomy-related complications require more evaluation regarding its necessity and feasibility. In this study, we analyzed the outcomes of temporary ostomy in low anterior resection to provide more evidence for surgeons to make clinical decisions.Methods A total of 279 consecutive patients with rectal cancer with temporary ostomy were matched 1:1 to contemporaneous 279 controls without temporary ostomy at our institution to compare the perioperative clinical situation. The matching criteria included age, body mass index (BMI), American Society of Anesthesiology (ASA) score, and tumor stage. The one-year follow-up data was collected to evaluate ostomy-related outcomes.Results The non-ostomy group had a higher proportion of chemoradiotherapy (39.4% vs 10.0%, P Conclusions Although time-consuming, temporary ostomy is a good option for high-risk patients to reduce the rates of anastomotic leakage and reoperation in low anterior resection. Considering the ostomy-related inconveniences in daily living, other related complications and rather high proportion of non-reversal, the scope of application should be more for patients with low anastomosis and neoadjuvant treatment.

Background: To evaluate the feasibility and safety of a new surgical method, complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction in right-transverse colon cancer.Methods: We retrospectively analyzed and compared the data of consecutive patients with right-transverse colon cancer who underwent complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction (n=23) and conventional complete laparoscopic extended right hemicolectomy (n=34) in our hospital between October 2017 to May 2019, respectively.Results: The overall operation time of the ileocecal junction-preserved group was significantly shorter than that of the control group (p=0.024). There was no difference in the number of harvested lymph nodes, metastatic lymph nodes and rate of metastatic lymph nodes (p＞0.05). The ileocecal junction-preserved group showed shorter time of first flatus, lower frequency of postoperative diarrhea and shorter duration of postoperative hospitalization. Furthermore, it also showed that the defecation frequency was lower in the ileocecal junction-preserved group than control group on the 1st, 3rd and 6th month (p＜0.05), and the number of patients who defecated at night or defecated four times or more a day were less in the ileocecal junction-preserved group than control group on the 1st month (p＜0.05).Conclusion: The complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction promises as a safe and feasible surgical procedure for right-transverse colon cancer, associated with earlier recovery of bowel function, shorter operation time and similar pathological outcomes when compared to the conventional laparoscopic procedure.

Background Colorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer. Methods From January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model. Results Ninety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P Conclusion In elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.

Sicheng Zhou,* Xuewei Wang,* Chuanduo Zhao, Wei Pei, Haitao Zhou, Qian Liu, Jianwei Liang, Zhixiang Zhou, Xishan WangDepartment of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People’s Republic of China*These authors contributed equally to this workBackground: Transanal natural orifice specimen extraction (NOSE) in colorectal surgery has been introduced as a less invasive surgery. However, its long-term survival effects remain controversial. The aim of this study was to compare the short-term and long-term survival outcomes of transanal NOSE with those of the conventional laparoscopic approach with mini-laparotomy (LAP) for anastomosis construction and specimen extraction in sigmoid colon cancer or rectal cancer.Methods: From January 2007 to January 2018, a retrospective study was conducted at the China National Cancer Center. In total, 52 consecutive patients who underwent laparoscopic anterior resection with NOSE were matched with an additional 52 patients who underwent conventional LAP for colorectal cancer.Results: Patients in the NOSE group experienced shorter time to passage of flatus (2.8±0.8 vs 3.2±0.9 days; p=0.042), less pain (4.2±1.4 vs 5.4±1.7; p=0.003) and less analgesia required (7.7% vs 25.0%; p=0.032). After a median follow-up of 68.5 (range, 8–83) months, the two groups had similar 5-year overall survival rates (92.3% vs 94.2%; p=0.985) and disease-free survival rates (84.6% vs 86.5%; p=0.802).Conclusion: Transanal NOSE for total laparoscopic anterior resection is safe and feasible with more advantages, including lower pain, lower tissue trauma and faster recovery of intestinal function. Moreover, with proper protection of the surgical route, transanal NOSE has the same long-term outcomes as conventional laparoscopic surgery.Keywords: natural orifice specimen extraction, transanal specimen extraction, total laparoscopic resection, sigmoid colon cancer, rectal cancer, surgical outcomes &nbsp

NUT (nuclear protein in testis) midline carcinoma is a rare malignant tumor arising in midline structures, such as head, neck and mediastinum. In the 2015 WHO classification of lung tumours, it was categorized in "Epithelial tumors". However, because of limited clinical data, its biological features have not been fully recognized. We report a case of NUT midline carcinoma presented as a primary lung tumor. Pneumonectomy was performed without any neoadjuvant therapy and it turned out to be a gross total resection. Even so, the prognosis is poor with a disease-free survival of 2 months and an overall survival of 6 months.

Multiple synchronous lung cancers (MSLCs) present a clinical dilemma as to whether individual tumours represent intrapulmonary metastases or independent tumours. In this study we analyse genomic profiles of 15 lung adenocarcinomas and one regional lymph node metastasis from 6 patients with MSLC. All 15 lung tumours demonstrate distinct genomic profiles, suggesting all are independent primary tumours, which are consistent with comprehensive histopathological assessment in 5 of the 6 patients. Lung tumours of the same individuals are no more similar to each other than are lung adenocarcinomas of different patients from TCGA cohort matched for tumour size and smoking status. Several known cancer-associated genes have different mutations in different tumours from the same patients. These findings suggest that in the context of identical constitutional genetic background and environmental exposure, different lung cancers in the same individual may have distinct genomic profiles and can be driven by distinct molecular events., Some patients present with multiple lung tumours but it is unclear whether these are metastases or individual lesions. Here, the authors use genomics techniques to demonstrate in six patients that multiple tumours have individual genetic profiles and represent separate tumours.

To evaluate the distribution, diagnosis, indication and modus operandi of surgical treatment and prognostic factors for patients with lung metastatic tumors.The clinical features were collected for 329 surgical patients with lung metastatic tumors during March 1998 and December 2013. Survival analysis was also performed by Log-rank test and Cox-regression analysis.The origins were epithelial tissue tumors (n = 278), sarcomas (n = 32), germ cell tumors (n = 3), malignant melanoma (n = 3) and miscellaneous tumors (n = 13). Their 1, 3 and 5-year survival rates were 85.1％, 50.9％ and 37.1％ respectively with a median survival time of 38 months. Log-rank survival analysis showed that resection extent (P = 0.004), lymph node dissection (P = 0.017) and radical operation (P0.01) were significantly associated with patient survival. And multi-variable Cox-regression analysis showed that lymph node dissection and radical operation were two independent prognostic factors.For lung metastatic tumor patients with well-controlled primary malignancy and non-metastasis of other organs, radical resection should be performed with minimal resection extent. And routine systematic lymph node dissection is not recommended. The necessity of lymph node dissection should be determined by radiological evaluations and surgical explorations.

To explore the clinical characteristics of multiple primary lung cancer (MPLC) and provide potential clues to the early diagnosis and treatment selection of MPLC patients.The clinical data of 21 patients with MPLC confirmed by postoperative histopathology were analyzed retrospectively.All the 21 patients received surgery (pulmonary lobectomy or pulmonary wedge resection), and 49 intrapulmonary tumors were resected. The histopathological examination demonstrated that all the 21 cases were MPLC. Among the 21 patients, 10 had bilateral lesions in lung and 11 had unilateral lesions; 17 suffered synchronous and 4 suffered metachronous tumors; 14 had double two primary tumors, 6 had three primary tumors and 1 had four primary tumors. In these patients, 2 had various histological subtypes among their multiple lesions and 19 had same histological subtypes among their multiple tumors; 14 cases with stage I disease, stage II 2 cases, stage III 5 cases.For the patients who were detected as MPLC by diagnostic imaging examination, more positive therapeutic decision, such as surgery, could be suggested. The molecular markers should be developed for assisting diagnosis of MPLC.