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An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion.118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed.There were no significant differences in preoperative data among all groups (P 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P 0.05). The incidence of esophageal anastomotic stenosis in Uncut-D group was significantly lower than that in EG group (P 0.05); In Uncut-D group, the incidence of reflux esophagitis, postoperative nutrition index(PNI), weight recovery and Visick classification were significantly better than those in EG group (P 0.05), furthermore, the incidence of delayed gastric emptying,PNI and weight recovery were better than those in JI group (P 0.05).The Uncut-D procedure gave full play to jejunal continuity and the advantages of pouch, and played a valuable role in gastric and cardiac replacement, which significantly reduced long-term complications, improved postoperative nutritional status of patients and long-term quality of life.

BackgroundPatients with extremely high-risk abdominal trauma and full-thickness necrosis and defects of the partial abdominal wall are clinically rare, and the treatments for these patients are very difficult and complex . In this study, we will explore the key factors for successful treatment of these patients . MethodsThree patients with extremely high-risk abdominal trauma and partial full-thickness abdominal wall defects were involved in this retrospective study, and one representative case was emphatically reviewed. According to the theory of damage control surgery,the consultation and coordinated treatment of multidisciplinary team(MDT) were involved firstly, then, stepped multiple operations,such as partial perforated small bowel resection, full-thickness abdominal wall defects repair, vacuum sealing drainage (VSD), and wounds skin grafts, were performed, meanwhile, systemic life resuscitation was strengthened. ResultsTwo patients were cured and discharged after 3 and 9 operations respectively. One patient suffered 2 operations and eventually died of lung infection and respiratory failure. ConclusionThe determination and responsibility of surgeons, rational use of damage control theory and multidisciplinary cooperation should be the keys for successful treatment.

Objective To compare the surgical effects and long-term efficacy of hand-assisted laparoscopic surgery (HALS) and open surgery (OS) in radical gastrectomy for advanced distal gastric cancer. Methods One hundred twenty-four patients who were admitted to the Department of Gastrointestinal Surgery of the West War Zone General Hospital from May 2008 to April 2012 were randomly divided into a HALS group (n = 62) and an OS group (n = 62). After surgery, 113 patients were followed up for 5 and 8 years, and 11 patients were lost to follow-up. The 5- and 8-year overall survival and disease-free survival rates of the two groups were compared and analyzed. Results The 5- and 8-year overall survival rates were 31.90% and 18.40% in the HALS group and 32.50% and 18.60% in the OS group, respectively. The 5- and 8-year disease-free survival rates were 21.50% and 13.00% in the HALS group and 21.90% and 13.10% in the OS group, respectively. No significant differences were found. Conclusion Hand-assisted laparoscopic radical gastrectomy for advanced distal gastric cancer has the advantages of less severe trauma, less intraoperative blood loss, more rapid postoperative recovery, and equivalent long-term efficacy compared with OS.

Gastric cancer (GC) was one of the most common types of the digestive system. COL8A1 was reported to be associated with cancer progression. The present study showed COL8A1 was overexpressed and correlated to shorter overall survival (OS) time across human cancer types. Specially, our results showed COL8A1 was up-regulated in advanced stage GC compared to low stage GC samples. Higher expression of COL8A1 was significantly correlated to shorter OS time in patients with GC. Bioinformatics analysis revealed COL8A1 was involved in regulating cell proliferation and metastasis. Experimental validations of COL8A1 showed that silencing of COL8A1 could significantly suppressed cell proliferation, migration and invasion in GC. These results provided a potential target for the clinical prognosis and treatment of gastric cancer.

Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical procedure that has achieved satisfactory results for obese patients in our surgical center. To fully elucidate the advantages of this procedure, in this study, comprehensive and in-depth comparative analyses were performed to assess clinical data from obese gastric cancer patients who underwent HALG, laparoscopic-assisted D2 radical gastrectomy (LAG), and open D2 radical gastrectomy (OG) in our surgical center during a specific time period. For the 3 groups, incision length was 1.25 cm longer for the HALG group than for the LAG group but was significantly shorter for the HALG group than for the OG group (P =0.00). The rate of conversion to laparotomy , the pneumoperitoneum time and the number of recovered lymph nodes were significantly better for the HALG group than for the LAG group (P 0.05) but were significantly better for the HALG group than for the OG group (P

AIM: To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy (HALG) for the treatment of gastric cancer. METHODS: The HALG surgical procedure consists of three stages: surgery under direct vision via the port for hand assistance, hand-assisted laparoscopic surgery, and gastrointestinal tract reconstruction. According to the order of the date of surgery, patients were divided into 6 groups (A-F) with 20 cases in each group. All surgeries were performed by the same group of surgeons. We performed a comprehensive and in-depth retrospective comparative analysis of the clinical data of all patients, with the clinical data including general patient information and intraoperative and postoperative observation indicators. RESULTS: There were no differences in the basic information among the patient groups (P > 0.05). The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups, with the difference being statistically significant (P = 0.01). There were no differences in total operative time between the groups (P = 0.30). Postoperative intestinal function recovery time in group A was longer than that of other groups (P = 0.02). Lengths of hospital stay and surgical quality indicators (such as intraoperative blood loss, numbers of detected lymph nodes, intraoperative side injury, postoperative complications, reoperation rate, and readmission rate 30 d after surgery) were not significantly different among the groups. CONCLUSION: HALG is a surgical procedure that can be easily mastered, with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.