Chuangqi Chen

Simultaneous Liver and Colorectal Resections Are Safe for Synchronous Colorectal Liver Metastases

BackgroundHepatic resection (HR) is the only option offering a potential cure for patients with synchronous colorectal cancer liver metastases (SCRLM). The optimal timing of HR for SCRLM is still controversial. This study aimed to determine whether simultaneous HR is similar to staged resection regarding the morbidity and mortality rates in patients with SCRLM.MethodsFour hundred and five consecutive patients with SCRLM were treated with either simultaneous (n = 129) or staged (n = 276) HR. The postoperative complications were analyzed retrospectively according to the documented records and hepatectomy databases at the Gastrointestinal Institute.ResultsPerioperative morbidity and mortality did not differ between simultaneous resections and staged resections for selected patients with SCRLM (morbidity, 47.3% versus 54.3%; mortality, 1.5% versus 2.0%, respectively; both p > 0.05). Simultaneous liver resections of three or more segments would not increase the rate of complications compared to staged resections (56.8% and 42.4%, respectively; p = 0.119). Meanwhile, patients with simultaneous resections experienced shorter duration of surgery and postoperative hospitalization time as well as less blood loss during surgery (all p < 0.05).ConclusionsSimultaneous resections of colorectal cancer primary lesions and hepatic metastases were safe and could serve as a primary option for selected SCRLM patients.

ERK2-Dependent Phosphorylation of CSN6 Is Critical in Colorectal Cancer Development.

Biomarkers for predicting prognosis are critical to treating colorectal cancer (CRC) patients. We found that CSN6, a subunit of COP9 signalosome, is overexpressed in CRC samples and that CSN6 overexpression is correlated with poor patient survival. Mechanistic studies revealed that CSN6 is deregulated by epidermal growth factor receptor (EGFR) signaling, in which ERK2 binds directly to CSN6 Leu163/Val165 and phosphorylates CSN6 at Ser148. Furthermore, CSN6 regulated β-Trcp and stabilized β-catenin expression by blocking the ubiquitin-proteasome pathway, thereby promoting CRC development. High CSN6 expression was positively correlated with ERK2 activation and β-catenin overexpression in CRC samples, and inhibiting CSN6 stability with cetuximab reduced colon cancer growth. Taken together, our studys findings indicate that the deregulation of β-catenin by ERK2-activated CSN6 is important for CRC development.

Ligasure versus stapled hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials.

The aim of this meta-analysis was to compare the outcomes of Ligasure hemorrhoidectomy and stapled hemorrhoidectomy for prolapsed hemorrhoids. Original studies in any language were searched from MEDLINE database, PubMed, Web of science and the Cochrane Library database, and Wangfang database. Randomized control trials that compared Ligasure hemorrhoidectomy with stapled hemorrhoidectomy were identified. Data were extracted independently for each study, and a meta-analysis was performed using fixed and random-effects models. Five trials including 397 patients met the inclusion criteria. Patients treated with Ligasure had a significantly shorter operative time compared with patients who underwent stapler techniques. The recurrence rate was higher in patients who underwent stapled hemorrhoidectomy. No statistically significant differences were observed in postoperative bleeding, urinary retention, difficult defecating, anal fissure, anal stenosis, incontinence, postoperative pain, return to normal activities, and hospital stay. Our meta-analysis shows that Ligasure is an effective instrument for hemorrhoidectomy, which results in shorter operation time and lower recurrence rate.

CXCL1 from tumor-associated lymphatic endothelial cells drives gastric cancer cell into lymphatic system via activating integrin β1/FAK/AKT signaling.

Crosstalk between lymphatic endothelial cells (LECs) and tumor cells in the tumor microenvironment plays a crucial role in tumor metastasis. Our previous study indicated chemokine (C-X-C motif) ligand 1 (CXCL1) from LECs stimulates the metastasis of gastric cancer. However, the mechanism is still unclear. Here, we successfully isolated tumor-associated LECs (T-LECs) and normal LECs (N-LECs) from clinical samples by magnetic-activated cell sorting system (MACS) and proved that CXCL1 expression was elevated in T-LECs compared with N-LECs in situ and vitro. Besides, we demonstrated that CXCL1 secreted by T-LECs promoted the migration, invasion, and adhesion of gastric cancer cells by upregulating integrin β1, MMP2, and MMP9. Furthermore, CXCL1 induced MMP2/9 expression by activating integrin β1-FAK-AKT signaling. In the animal model, CXCL1 overexpressed in LECs increased the lymph node metastasis of gastric cancer. In conclusion, CXCL1 expression in T-LECs was upregulated, and CXCL1 secreted by T-LECs promoted the lymph node metastasis of gastric cancer through integrin β1/FAK/AKT signaling, leading to MMP2 and MMP9 expression. Therefore, CXCL1 produced in T-LECs represents a potentially promising target for treating gastric cancer.

Clinical outcomes after surgical resection of colorectal cancer in 1,294 patients.

BACKGROUND/AIMS This study aimed to determine the overall survival time and clinical characteristics affecting the outcomes in patients with resectable colorectal cancer (CRC). METHODOLOGY Clinical data from CRC patients who underwent surgical resections from 1994 to 2004 was analyzed retrospectively using the documented records and gastrointestinal tumor databases at the gastrointestinal institute. Univariate and multivariate analyses were conducted to investigate the association between clinical variables and overall survival time. RESULTS A consecutive series of 1.294 CRC patients were enrolled for the final analyses. The five-year survival rates were 94.1%, 80.2%, 61.7% and 23.2% of patients with stage from I to IV CRC, respectively. One hundred and seven patients (8.3%) had disease recurrence during the follow-up with a median of 50.3 months. After radical surgical resections, patients with recurrence could still expect a five-year survival rate of 44.3%. Multivariate analysis showed that patient age >60 years, infiltrative tumor type, intestinal obstruction, poor tumor differentiation, disease recurrence and late TNM stage were associated with poor survival (all p<0.05). CONCLUSIONS The overall postoperative survival in this series of patients with CRC was mainly affected by patient age, tumor morphology, bowel obstruction, histological grade, TNM stage and disease recurrence. For those patients with recurrence, surgical resection should be recommended primarily if the tumor is resectable.

Efficiency of Electronic List-Based Multidisciplinary Team Meetings in Management of Gastrointestinal Malignancy: A Single-Center Experience in Southern China

Background The multidisciplinary team (MDT) discussion has earned increasing popularity for the delivery of cancer care. However, MDT meeting (MDTM) is time and resource intensive, and some efforts to optimize discussion processes are required. This study aims to investigate the efficiency of electronic list-based MDTM in treatment of gastrointestinal (GI) malignancy.

Pancreatic head cancer involving variant common hepatic artery with situs inversus totalis

A 56‐year‐old male patient was admitted to our hospital presenting with a 3‐month history of epigastric pain, jaundice and weight loss of 5 kg. Abdominal magnetic resonance imaging and computed tomography (CT) scan revealed situs inversus totalis (SIT), a mass in the pancreatic head and obstructed common bile duct and dilated pancreatic duct. The patients electrocardiogram and chest X‐ray showed dextrocardia. Laboratory examination showed that serum alpha fetoprotein, carcinoembryonic antigen, CA‐125 and CA19‐9 were within normal limits. According to the above symptoms and examinations, the patient was diagnosed as pancreatic head carcinoma with SIT. Because of severe jaundice, percutaneous transhepatic cholangial drainage (PTCD) was carried out and about 500 mL of yellow liquid can be drained daily. Three‐dimensional (3D) angiography with multidetector‐row computed tomography (MD‐CT) showed multiple anomalies: the common hepatic artery (CHA) originating from the superior mesenteric artery; splenic artery originating from the abdominal aorta; a lack of celiac trunk originating from the abdominal aorta; and the pancreatic head neoplasm invading part of variant CHA. Due to anatomical variations with SIT and obstructive jaundice, an endoscopic retrograde cholangiopancreatography (ERCP) was attempted but it was unsuccessful in cannulating the inverted ampulla of Vater. Abdominal laparotomy confirmed SIT with a complete mirror‐ image transposition of the abdominal viscera. Dilated common biliary duct (1.2 cm in diameter), a pancreatic head mass (3.5 cm in size) with swollen lymph nodes around the hepatoduodenal ligament and pancreatic were discovered. The exploration again confirmed the multiple vascular variants (Fig. 1). The hepatic artery was in the middle of the portal vein (right) and the common biliary duct (left). After laparotomy, a pancreaticoduodenectomy (PD), partial resection of the CHA and transplant artery revascularization, was performed with an end‐to‐side pancreaticojejunotomy, an end‐ to‐side choledochojenunostomy and a side‐to‐side gastrojejunostomy with a modified Childs procedure. A 2‐cm proximal jejunum artery was removed to revascularize to the resected part of CHA (Fig. 2). Post‐operative 3‐ and 6‐day colour Doppler ultrasound of abdominal blood vessels revealed that CHA was in peak blood flow with an about 19.8–34.5 cm/s velocity without occlusion or stenosis. Pathology showed chronic cholecystitis, moderately and poorly differentiated pancreatic head ductal adenocarcinoma and lymph node metastasis rate of 1/42 within T3N1M0 stage (the 7th Edition of American Joint Committee on Cancer Stage III). The patient was discharged without operative complications 10 days after surgery. One‐year post‐operative assessment revealed the return of normal liver function. Abdominal 3D angiography and MD‐CT showed normal transplanted and revascularized CHA and without tumour recurrence and metastasis. SIT is a congenital malformation of the visceral organs where the anatomical structure of the thoracic and abdominal viscera is either reversed or presenting in a complete mirror‐image transposition. The incidence is believed to occur in the range of 1/8000 to 1/25 000 of the general population. Although the aetiology of SIT remains unknown, it is thought to result from chromosomal abnormalities that can also result in an underlying condition known as primary ciliary dyskinesia (PCD), a dysfunction of the cilia that can occur during the early embryological development stage.

Sclerosing angiomatoid nodular transformation of the spleen in a patient with Maffucci syndrome: a case report and review of literature

BackgroundMaffucci syndrome is a congenital, non-hereditary mesodermal dysplasia characterized by multiple enchondromas and hemangiomas. The presence of visceral vascular lesions in this syndrome is exceedingly rare.Case presentationWe report a 26-year-old female who was diagnosed with Maffucci syndrome along with sclerosing angiomatoid nodular transformation (SANT) of the spleen. The patient underwent a laparoscopic splenectomy. Immunostaining of the excised specimen revealed 3 distinct types of vessels in the angiomatoid nodules: CD34−/CD8−/CD31+ small veins, CD34−/CD8+/CD31+ sinusoids, and CD34+/CD8−/CD31+ capillaries, leading to the diagnosis of SANT of the spleen.ConclusionsThis case reports the first patient in the literature exhibiting the features of Maffucci syndrome along with SANT of the spleen. The spleen is probably a predilection site of visceral vascular lesions in this syndrome with a proportion of 4 out of 14. An abdominal Computed Tomography (CT) scan is recommended for any cases of abdominal discomfort. Surgical excision is usually sufficient because of the relatively benign behavior of SANT, however, a more aggressive follow-up is proposed due to the high risk of malignant transformation of enchondromas and development of other neoplasms associated with this syndrome. Further studies are required to reveal its genetic basis for comprehensive prognosis evaluation and therapeutic guidance.