Wei-Guo Hu

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:  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.

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.

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.

Cancer-Associated-Fibroblast Induces Epithelial-Mesenchymal Transitionof Gastric Cancer Cells via Activating Thy-1

Cancer-associated fibroblasts (CAFs) are the key stromal cells in solid tumor microenvironment and are crucial for facilitating tumor metastasis. However, the detailed mechanism of how CAFs induce metastasis in human gastric cancer remains to be elucidated. In this study, using the CAFs isolated from human gastric tumor tissues, we have demonstrated that co-culturing of the CAFs with gastric cancer cells could activate the epithelial-mesenchymal transition (EMT) program, leading to enhanced cancer cell migration and invasion. In the CAF cells, Thy-1 expression was significantly increased, compared to the normal fibroblasts. Mechanistic studies revealed that depletion of Thy- 1 by siRNA in CAF cells attenuated the CAFs-induced EMT and aggressiveness in gastric cancer cells. Taken together, our studies indicate a significant role of Thy-1 in CAFs-induced gastric cancer progression. Targeting Thy-1 could be a potential therapeutic strategy for gastric cancer treatment.

Laparoscopic Treatment for Small Intestinal Bleeding: A Report of 77 Cases

BACKGROUND Morbidity of small intestinal disease is rare and the associated lesion is hard to be detected due to lack of specific manifestations and effective diagnostic approaches. Hematochezia and melena are the most common symptoms in small intestinal diseases. Hence, small intestinal disease is an important differential diagnosis when hematochezia or melena occurs, especially when gastric and colonic diseases are excluded. As the small intestinal lesion is hard to be located preoperatively, laparotomy used to be performed without a preoperative location. This might lead to related postoperative complications. With the development of laparoscopic technique, laparoscopic operations are more frequently applied to surgical disease, despite their benign or malignant nature. Generally, almost all kinds of small intestinal disease can be treated with laparoscopic surgery. METHODS Clinical data of 77 patients with small intestinal bleeding undergoing laparoscopic or laparoscopy-assisted operations from April 2003 to December 2008 were included, and their clinical information were analyzed retrospectively. RESULTS No intraoperative complication or conversion was observed in all cases. The mean operative time, mean estimated blood loss, and mean size of incision were 78.3 +/- 30.5 minutes, 17.5 +/- 9.8 mL, and 3.3 +/- 1.9 cm, respectively. Postoperative complications occurred in 4 patients, including 2 cases of adhesive ileus, 1 case of gastric retention, and 1 case of anastomotic bleeding. All of them were cured by nonoperative management. The mean flatus time was 2 days after operation and the mean postoperative hospital stay was 7 days. There was 1 case of gastrointestinal stromal tumor with local recurrence and hepatic metastasis. Four patients died from metastasis of malignant tumors during the follow-up from 2 to 70 months after operations. No trocar site or wound recurrences were noted. CONCLUSIONS Laparoscopic treatment in small intestinal bleeding is feasible, safe, and minimally invasive. It may be widely used in the future for its good therapeutic outcomes and improved diagnostic chance in small intestinal bleeding diseases.