Jianwen Li

Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies

ObjectiveThis study was designed to investigate the feasibility and technical strategies of laparoscopic complete mesocolic excision (CME) for right-hemi colon cancer.MethodsThe clinical and pathological findings of 64 patients with right-hemi colon cancer who underwent laparoscopic CME between March 2010 and September 2011 were collected retrospectively. Among them, 35 cases were eligible for the final analysis through various screening factors. The quality of surgery also was assessed by reviewing the recorded video obtained through the operations in terms of specimen anatomic planes and completeness of the excised mesocolon.ResultsLaparoscopic CME is focused on applying the concept of enveloped visceral and parietal planes during the operations. Laparoscopic approach proceeds with medial access where the dissection starts at ileocolic vessel before proceeds along with the superior mesenteric vessel. The access also emphasized en bloc resection of mesocolon without defections to the planes. Besides, lymph node resections at the root of ileocolic; right colic and middle colic vessels are necessary for ileocecum cancer. Cancers at the hepatic flexure requires further dissection of subpyloric lymph nodes and of greater omentum that is within 15xa0cm of the tumor and along the greater curvature. Thirty-five cases were evaluated as good plane. The median total number of central lymph nodes retrieved was 19 (range, 15–25) and central lymph node metastasis was found in 5 of all stage III cases. The median operation time was 2.6xa0h and the blood loss was 80xa0mL. The median time for passage of flatus and hospitalization were 2 and 12xa0days respectively. Complications were observed in three cases.ConclusionsCME is a novel concept for colon cancer surgery and might be a standard for the procedure. Laparoscopic CME with medial access is technically feasible and randomized trials are needed to evaluate its long-term outcomes.

Different roles of galectin-9 isoforms in modulating E-selectin expression and adhesion function in LoVo colon carcinoma cells

Galectin-9, a member of galectin family, plays multiple roles in a variety of cellular functions, including cell adhesion, aggregation, and apoptosis. Galectin-9 also has three isoforms (named galectin-9L, galectin-9M, and galectin-9S), but whether these isoforms differ in their functions remains poorly understood. In this study, we showed that transient expression of galectin-9L decreased E-selectin levels, while transient expression of galectin-9M or galectin-9S increased E-selectin levels in LoVo cells, which do not express endogenous galectin-9. We also found that over-expression of three galectin-9 isoforms led to increased attachment of LoVo cells to extracellular matrix proteins respectively, while over-expression of galectin-9M or galectin-9S increased the adhesion of LoVo cells to human umbilical vein endothelial cells inxa0vitro. In summary, these findings indicate that different isoforms of galectin-9 exhibit distinct biological functions.

Duodenal perforations after endoscopic retrograde cholangiopancreatography: experience and management.

OBJECTIVEnThe aim of this study was to summary the experiences and lessons from periduodenal perforations related to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST).nnnMETHODSnA retrospective review from 2004 to 2007 identified 9 patients (0.37%) of periduodenal perforation related to ERCP/EST. Charts were reviewed for the following parameters: clinical presentation of patients, ERCP findings, diagnostic methods, treatment (surgical or conservative procedures), complications, and outcome.nnnRESULTSnNine patients who had periampullary perforations received ERCP/EST for common bile duct stones. Cannulation was considered difficult in 7 of 9 patients, and the precut technique was used. The diagnosis was made due to subcutaneous emphysema or peritonitis, and 3 patients received emergent operations (e.g., external biliary or retroperitoneal drainage), and 1 patient had a reoperation for a retroperitoneal sealed abscess. Their median length of hospital stay was 50 days. The other 6 were treated conservatively with nasal-duodenal and nasal-biliary drainage. Their median length of hospital stay was 13 days. There was no mortality.nnnCONCLUSIONSnThe precut technical may be a risk factor of duodenal perforation. Early diagnosis of duodenal perforation is essential for an optimum outcome, and subcutaneous emphysema may be a sensitive sign. Although the management of perforation after ERCP/EST is still controversial, a selective management is proposed, based on the features of classification type. Nevertheless, duodenal and biliary drainage is essential in both surgical and conservative therapy.

Effect of endoscopic thyroidectomy via anterior chest wall approach on treatment of benign thyroid tumors.

OBJECTIVEnThe aim of this study was to evaluate the inflammatory response and acid-base equilibrium index, as well as other clinical facts of the endoscopic thyroidectomy via the anterior chest wall approach.nnnMETHODSnThirty-nine patients who received thyroidectomy in our surgical center during September 2007 and January 2008 were included in this study. Twenty of the patients underwent an endoscopic surgery, and the remaining 19 received conventional surgery. These patients data were compared within and between treatment groups with respect to clinical facts and inflammatory evaluations. Arterial blood gas data and electrolyte data were analyzed within the endoscopic group.nnnRESULTSnEndoscopic thyroidectomy group showed shorter operative time, compared to that of the conventional thyroidectomy group, although the difference didnt reach statistical significance. No significant difference regarding postoperative hospital stay was observed between two groups. Postoperative day 1 shows much higher values of interleukin-6 and tumor necrosis factor than that measured preoperative or postoperative day 3 in both groups. C-reactive protein appeared to be significantly increased postoperatively in both groups, although no difference between the two groups was found. Although blood cortisol significantly increased in both groups postoperatively, the data of endoscopic group postoperative day 1 was lower than the same day of the conventional group. Arterial blood gas analysis showed that both PCO2 and TCO2 were statistically different between preoperation and 30 minutes after insufflation. No insufflation complication was observed.nnnCONCLUSIONnCompared with conventional thyroid surgery, endoscopic thyroidectomy via the anterior chest wall approach presented with no significant difference in respect of both clinical facts and laboratory outcomes.

Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer

Abstract This study aimed to assess the feasibility and long-term outcome of laparoscopic total mesorectal excision for middle and lower rectal cancer. Retrospective assessment was performed on 612 patients with middle and low rectal cancer in the surgery department of our hospital. Three-hundred and three patients underwent laparoscopic total mesorectal excision (LTME), and 309 patients underwent open TME (OTME). All the data regarding patient details, operative variables and the short- and long-term outcomes were collected and compared. The sphincter-preserving rates of the two groups were similar. The conversion rate in LTME was 2.31% (seven cases). Fourteen cases (6.67%) of protective diverting stoma were fashioned in the LTME group compared with 57 cases (26.64%) in the OTME group. The postoperative morbidity was the same in these two groups, while the postoperative period until bowel movement and hospital discharge was shorter in the LTME group (P < 0.01). The median follow-up period was 34 (6–81) months for the LTME group and 36 (6–81) months for the OTME group. Local recurrence rates, the five-year disease-free survival rate and the five-year overall survival rate showed no difference between the two groups. Laparoscopic surgery is feasible and safe in patients with middle and lower rectal caner and can provide favorable short-term and long-term outcomes.

Comparison of open and laparoscopic preperitoneal repair of groin hernia

AbstractBackgroundnCompared with laparoscopic groin herniorrhaphy, the open procedure used in most former studies was Lichtenstein repair. However, unlike the totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) laparoscopic techniques, Lichtenstein procedure is a premuscular but not preperitoneal repair. This retrospective study compared the outcomes between laparoscopic preperitoneal and open preperitoneal procedure—modified Kugel (MK) herniorrhaphy.MethodsGroin hernia patients older than 18xa0years who underwent open MK or laparoscopic preperitoneal herniorrhaphy in our hospitals between January 2008 and December 2010 were enrolled. Baseline characteristics, recurrence, and intraoperative, short-term, and long-term postoperative complications were recorded.ResultsAmong the 1,760 included patients (530 open and 1,230 laparoscopic), 96.08xa0% completed the follow-up (24–60xa0months). The patients in the open group were older than laparoscopic group (pxa0<xa00.001). More bilateral (91.45xa0%) and recurrent (82.12xa0%) hernia patients underwent laparoscopic procedures (pxa0<xa00.001 and pxa0=xa00.004, respectively). The overall recurrence rate was 0.71xa0%, with no significant difference between the two approaches (pxa0=xa00.227). The overall complication rate was lower for the laparoscopic than the open approach (14.47 vs. 19.25xa0%, pxa0=xa00.012), whereas the rates of life-threatening complications were similar (1.51 vs. 0.98xa0%, pxa0=xa00.332). The laparoscopic group had significantly lower incidence rates of wound infection and chronic pain (pxa0=xa00.016 and pxa0<xa00.001, respectively), shorter operative time, lower visual analogue scale scores, and faster recovery than the open group (pxa0<xa00.001).ConclusionsAs preperitoneal herniorrhaphy, both MK and laparoscopic (TEP/TAPP) procedures are safe and effective, with low incidence rates of life-threatening complications and recurrence. The laparoscopic approach is superior in terms of lower incidence rates of infection and chronic pain, shorter operative time, and faster recovery; however, careful surgical procedure selection and implementation of technical details are required.

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.

Effects of Persistent CO 2 Insufflation During Different Laparoscopic Inguinal Hernioplasty: A Prospective, Randomized, Controlled Study

OBJECTIVEnThe aims of this study were to investigate the effects of carbon-dioxide (CO(2)) insufflation on hemodynamic and respiratory function during laparoscopic inguinal hernioplasty and to evaluate the safety of transabdominal preperitoneal hernia repair (TAPP) and extraperitoneal hernia repair (TEP).nnnMATERIALS AND METHODSnForty patients with inguinal hernia were admitted for laparoscopic inguinal hernia repair in our study. The patients were randomly assigned to undergo TAPP (TAPP group, n = 20) or TEP (TEP group, n = 20). Hemodynamic and respiratory parameters, including heart rate, blood pressure, end-tidal CO(2) (EtCO(2)), and blood-gas parameters, were observed and compared between the two groups.nnnRESULTSnThere was no significant difference between the two groups in terms of sex, age, American Society of Anesthesiology degree, body-mass index, type of hernia, operation time, hospital stay, and postoperative pain score. In both groups, 5 minutes into the operation, blood pressure, EtCO(2), PaCO(2), and HCO(3)(-) increased significantly, whereas heart rate and pH decreased significantly (P < 0.05). The above tendency became significant with the operation prolonged. All parameters recovered to normal levels at the end of surgery. No significant difference was found between the TAPP and TEP groups.nnnCONCLUSIONSnBoth TAPP and TEP procedures can result in CO(2) accumulation, acidosis, increased blood pressure, and decreased heart rate. But, these effects were transient and could be well controlled by appropriate treatments during the operation. The laparoscopic TAPP and TEP techniques are safe for patients by proper perioperative management.

Aberrant expression and demethylation of γ-synuclein in colorectal cancer, correlated with progression of the disease

Recent evidence suggests that γ‐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 γ‐synuclein expression. To fully understand the roles of aberrant γ‐synuclein expression and demethylation in the development of colorectal cancer (CRC), we examined the expression and methylation status of γ‐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, γ‐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¢‐deoxycytidine, can induce re‐expression of γ‐synuclein in COLO205, LoVo, and SW480 cells. Unmethylated γ‐synuclein alleles were detected in HT‐29, HCT116, and LoVo cells by nested methylation‐specific PCR, and the demethylated status of γ‐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 γ‐synuclein expression in CRC was primarily attributed to the demethylation of CpG island. The protein expression and demethylation status of γ‐synuclein in 67 CRC samples correlated with clinical stage, lymph node involvement, and distant metastasis. These findings suggest an involvement of aberrant γ‐synuclein expression and demethylation in progression of CRC, especially in advanced stages. (Cancer Sci 2008; 99: 1924–1932)

Implementation of the trans-abdominal partial extra-peritoneal (TAPE) technique in laparoscopic lumbar hernia repair.

BackgroundThere is still not any standardized operative strategy that is well-accepted all over the world for lumbarhernia. We are here to investigate the feasibility of the trans-abdominal partial extra-peritoneal (TAPE) technique in lumbar hernia repair.MethodsThe TAPE technique was applied to 14 patients with lumbar hernia from May 2009 until January 2014. The surgical technique was described in details and follow-ups were performed for further evaluation.ResultsThe mean age of the 14 patients was 68u2009±u20098xa0years, with the average BMI 25.5u2009±u20092.1xa0kg/m2. The etiology study showed that 13 cases after surgical operations and one case after trauma. The average size of the hernia defect was 86.8u2009±u200946.4xa0cm2, while the mean size of the mesh implanted was 275u2009±u200961.2xa0cm2. The mean operative time was 59.2u2009±u20098.2xa0min. There was no intra-operative visceral injury in this serial of cases. There was no conversion case and all patients accepted the TAPE technique successfully. The VAS was 3.8u2009±u20091.9 and 2.2u2009±u20091.6 on POD1 and POD3, respectively. The mean post-operative hospital stay was 4.0u2009±u20091.3xa0days. The median follow-up time was 33xa0months. All patients returned to unrestricted movement within 2 weeks after surgery. During the follow-ups, no complication as bulge, seroma, hematoma, wound infection, abscess in surgical area and chronic pain, nor recurrence was observed.ConclusionsAccording to our experience in this series of investigations, the TAPE could be a feasible and easy-to-learn technique which can be applied to most of the lumbar hernia repairs.