Ai-Guo Lu

Normal and modified urinary nucleosides represent novel biomarkers for colorectal cancer diagnosis and surgery monitoring

Background: Up to now, there is still no ideal tumor marker in early diagnosis and effective monitoring, especially for surgical resection of colorectal cancer (CRC). The aim of the present study was to evaluate the application of urinary normal and modified nucleosides in diagnosis and surgery monitoring of CRC.

Clinical advantages of laparoscopic colorectal cancer surgery in the elderly.

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±108.7ml, 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.

Clinical significance of human kallikrein 10 gene expression in colorectal cancer and gastric cancer

Background and Aim:u2002 Recent evidence suggests that the human kallikrein 10 (KLK10) gene is differentially regulated in endocrine‐related tumors and has potential as diagnostic and/or prognostic marker; however, KLK10 expression has never been investigated in gastrointestinal cancers. The aims of this study were to demonstrate expression and single nucleotide polymorphisms of KLK10 in colorectal cancer (CRC) and gastric cancer (GC), and to correlate the relative KLK10 expression level with clinicopathological factors of CRC and GC.

Polo-like kinase 1 is overexpressed in colorectal cancer and participates in the migration and invasion of colorectal cancer cells.

Summary Background Polo-like kinase 1 (PLK1) is an important molecule in proliferation of many human cancers. The aim of study is to clarify the expression patterns and potential function of PLK1 in colorectal cancers. Material/Methods Fifty-six colorectal cancers samples were collected and arranged onto a tissue array and the expression of PLK1 were detected by immunohistochemistry and correlated with clinico-pathological characteristics and expression of PCNA. Expression of PLK1 in 9 colorectal cancer cells lines was investigated by RT-PCR and Western blot, then SW1116 cells lines were treated with PLK1 siRNA and the efficiency was examined by Western blot. Transwell test was applied to detect the migration and invasion capability of cancer cells by counting the number of cells passing through the membranes. Cell proliferation and apoptosis were examined by Cell Counting Kit-8 (CCK-8) and Annexin-V Kit. Results PLK1 was positively expressed in 73.2% (41/56) of colorectal cancers tissues, but in only 3.6% (2/56) of normal tissues, and was associated with Duke’s stage (P<0.01), tumor size (P<0.01), invasion extent (P<0.05) and lymphatic metastasis (P<0.01). The expression of PLK1 was correlated with expression of PCNA (R=0.553, P<0.01). PLK1 was inhibited in SW1116 cells by treating with PLK1 siRNA oligos, which resulted in a decreased number of cells passing through the membrane as compared with control groups (P<0.01) at 24 hours after transfection. Cell proliferation was inhibited from 48 hours after transfection, while cells apoptosis was induced from 72 hours after transfection. Conclusions PLK1 could be a progression marker for colorectal cancer patients and PLK1 depletion can inhibit migration and invasion capability of colorectal cancer cells SW1116, suggesting that PLK1 might be involved in metastasis and invasion of colorectal cancer. Therapeutic strategies targeting PLK1 may be a new approach to colorectal cancer.

Laparoscopic Gastric Resection Approaches for Gastrointestinal Stromal Tumors of Stomach

Purpose To evaluate laparoscopic gastric resection for gastrointestinal stromal tumors (GIST). Methods From June, 2003 to October, 2009, 56 patients with gastric GIST who underwent laparoscopic gastric resection were retrospectively reviewed, and their surgical procedure, perioperative outcomes, pathology, and follow-up outcomes were analyzed. Results All patients underwent laparoscopic gastric resection successfully, including 33 laparoscopic wedge resections, 19 laparoscopic transgastric tumor-everting resections, 3 laparoscopic-assisted distal gastrectomies, and 1 laparoscopic-assisted endoscopic resection. The operative approaches performed were mostly based on the tumor location. No conversions were observed. The mean operative duration was 90 minutes (30 to 210 min), blood loss was 55 mL (5 to 180 mL), time for passage of flatus was 2 days (1 to 11 d), and the postoperative hospital stay was 7 days (3 to 13 d). The resection margin was microscopic negative. After 21.5 months (6 to 76 mo) of follow-up, there was no operative recurrence and metastasis. Conclusions Laparoscopic gastric resection for selective cases of gastric GISTs is safe, feasible, and effective. Laparoscopic wedge resection procedure is the first choice for most GISTs located in fundus and anterior wall, laparoscopic transgastric tumor-everting resection procedure can be used in cases with the tumor located in esophagogastric junction area and in posterior wall of the stomach as well. For antral tumors, laparoscopic subtotal gastrectomy with gastrojejunostomy should be performed.

Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer

ObjectiveTo explore the feasibilities between operational approaches for laparoscopic complete mesocolic excision (CME) to right hemicolon cancer.MethodsThis prospective randomized controlled trial included patients admitted to a Shanghai minimally invasive surgical center to receive laparoscopic CME from September 2011 to January 2013 randomized into two groups: hybrid medial approach (HMA) and completely medial approach (CMA). The feasibilities and strategies of the two techniques were studied and compared. Furthermore, the operation time and vessel-related complications were designed to be the primary end points, and other operational findings, including the classification of the surgical plane and postoperative recovery, were designed to be the secondary end points for this study.ResultsAfter screening, 50 cases were allocated to the HMA group and 49 to the CMA group. Within the HMA group, there were 48 cases graded with mesocolic plane and 2 with intramesocolic plane. For the CMA group, there were 42 cases graded with mesocolic plane and seven with intramesocolic plane. The differences between the two were insignificant, as were the number of lymph nodes retrieved. The mean±standard deviation total operation time for the CMA group was 128.3xa0±xa036.4xa0min, which was significantly shorter than that for the HMA group, 142.6xa0±xa034.8xa0min. For the CMA group, the time involved in central vessel ligations and laparoscopic procedures was 58.5xa0%, 14.1 and 81.2xa0±xa023.5xa0min, respectively, which were shorter than the HMA group. The vessel-related complication rate was significantly higher in the HMA group.ConclusionsLaparoscopic CME via the total medial approach is technically feasible after the precise identification of the surgical planes and spaces for the right hemicolon. The procedure has a shorter operation time and fewer vessel-related complications.

Surgical treatment for xanthogranulomatous cholecystitis: a report of 74 cases.

Aims To be more aware of the presence of xanthogranulomatous cholecystitis (XGC) and find a better surgical measure of its treatment. Methods Data from 74 cases of XGC treated between May 1996 and May 2008 at our hospital were retrospectively analyzed and reported here. Laparoscopic and laparotomy group were compared with respect to operative time, postoperative hospital stay, postoperative complication, etc. Results In the 74 cases, 47 underwent laparoscopic surgery, the rest 27 underwent laparotomy surgery. The mean operative time of laparotomy and laparoscopic cases were 113.9 minutes and 69.4 minutes, respectively, which shows statistically significant difference between the 2 groups (P<0.01). The postoperative hospital stay of the laparotomy and laparoscopic group is 18.3 days and 8.66 days, respectively (P<0.01). The converting rate of the laparoscopic group is 10.6%. Conclusions Surgical treatment remains the most effective and feasible option for XGC.

Overexpression of CXCR2 predicts poor prognosis in patients with colorectal cancer

Colorectal cancer is a heterogeneous disease. Although many risk factors are used to predict colorectal cancer patients’ prognosis after surgical resection, new prognostic factors are still needed to be defined to promote predictive efficacy of prognosis and further guide therapies. Herein, we identified the prognostic significance of CXCR2 in colorectal cancer patients. We retrospectively analysed 134 patients with colorectal cancer who underwent minimally invasive surgery between 2010 and 2011. The overall cohort was divided into a training set (n = 78) and a validation set (n = 56). We detected CXCR2 expression using immunohistochemical staining and defined the cut-off value using X-tile program. Next, we analysed the association between CXCR2 expression and clinicopathologic features in training and validation sets. High expression of CXCR2 was associated with Dukes stage (P = 0.018), tumor invasion (P = 0.018) and liver metastasis (P = 0.047). Multivariate COX regression analyses confirmed that high CXCR2 level was an independent prognostic risk factor for both overall survival and disease free survival. Kaplan-Meier survival analysis demonstrated that patients with high expression of CXCR2 had a poor overall survival and disease free survival even in low-risk group (I + II). This indicated that CXCR2 can help to refine individual risk stratification. In addition, we established Nomograms of all significant factors to predict 3- or 5-years overall survival and disease free survival. Moreover, we found the combination of CXCR2 and its ligand CXCL5 had more significant value in predicting the prognosis than single CXCR2 factor.

Laparoscopic peritoneal dialysis catheter implantation with an intra-abdominal fixation technique: a report of 53 cases.

Objective: The purpose of this study was to evaluate the feasibility, the safety, and outcomes of renal replacement therapy with the laparoscopic technique for peritoneal dialysis (PD) catheter implantation with an intra-abdominal fixation. Methods: Medical records of 53 patients with end-stage renal disease who underwent laparoscopic PD catheter implantation with an intra-abdominal fixation in our department from December 2008 to October 2009 were reviewed retrospectively. Their surgical procedure, operative outcomes, postoperative complications, and follow-up outcomes were analyzed. Results: All patients underwent laparoscopic PD catheter implantation with an intra-abdominal fixation successfully. Neither conversion to open surgery nor major intraoperative complications were observed. The median operative time was 24.2±10.5 minutes. The operative cost was 837.3±107.0 US

A study evaluating the safety of laparoscopic radical operation for colorectal cancer

. Two patients (3.8%) had catheter obstruction peritonitis 12 and 15 months after surgery, respectively, and both of them had the catheter removed. Conclusions: Laparoscopic PD catheter implantation with an intra-abdominal fixation of the catheter tip is feasible and safe. It had a low incidence of PD catheter migration and other PD-related postoperative complications with the benefit of minimal invasiveness, a shorter operation time, and quicker postoperative recovery.