Xuyang Yang

Prognostic Significance of the Mucin Component in Stage III Rectal Carcinoma Patients

BACKGROUND Although mucinous adenocarcinoma has been recognized for a long time, whether it is associated with a poorer prognosis in colorectal cancer patients is still controversial. Many studies put emphasis on mucinous adenocarcinoma containing mucin component ≥50%. Only a few studies have analyzed cases with a mucin component <50%. OBJECTIVES This study aimed to analyze the prognostic value of different mucin component proportions in patients with stage III rectal cancer. MATERIALS AND METHODS Clinical, pathological and follow-up data of 136 patients with the stage III rectal cancer were collected. Every variable was analyzed by univariate analysis, then multivariate analysis and survival analysis were further performed. RESULTS Univariate analysis showed pathologic T stage, lymphovascular invasion, and histological subtype were statistically significant for DFS. Pathologic T stage was significant for OS. Histological subtype and lymphovascular invasion were independent prognostic factors in multivariate analysis for DFS, and histological subtype was the only independent prognostic factor for OS. Survival curves showed the survival time of mucinous adenocarcinoma (MUC) was shorter than non-MUC (adenocarcinomas with a mucin component <50% and without mucin component). CONCLUSIONS Histological subtype (tumor with different mucin component) was an independent prognostic factor for both DFS and OS. Patients with MUC had a worse prognosis than their non-MUC counterparts with stage III rectal carcinoma.

Hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation: a novel technique for right colon cancer.

BackgroundIt can be difficult to locate the superior mesenteric vein and dissect around middle colic vessels during laparoscopic right hemicolectomy with complete mesocolon excision due to a high rate of vascular variations in the superior mesenteric vessels. Therefore, we report a modified technique for hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation, which addresses these two problems.MethodsThirty-one consecutive patients with right colon cancer underwent this procedure from March 2014 to August 2015. Extracorporeally, the transverse colon and distal ileum were excised with a transumbilical hand-port incision, and the distal part of the superior mesenteric vein was identified. Intracorporeally, with the assistance of the surgeon’s left hand inserted through the incision, D3-lymphadenectomy with central vascular ligation was performed, and the colon with the tumor, which had no blood supply, was removed. Patients’ demographic data and intraoperative, postoperative and pathological characteristics were examined.ResultsThe median operative time was 130.0 (range 115–180) minutes. The median blood loss was 45.0 (range 20–300) milliliters. The median length of the hand-port incision was 7.3 (range 6.0–8.2) centimeters. The median numbers of lymph nodes and central lymph nodes was 34.0 (range 18–91) and 13.0 (range 3–28), respectively. Five (16.1%) of 31 patients had positive central lymph nodes. Specimen morphometric quantitation was as follows: the median distances from the tumor and nearest bowel wall to the high tie were 10.5 (range 5.0–15.0) and 8.0 (range 6.0–12.0) centimeters, respectively; the median resected area of the mesentery was 200.0 (range 96.0–300.0) square centimeters; the median width of the chain of lymph-adipose tissue at the central lymph nodes area was 2.0 (range 0.8–8.0) centimeters; and the median length of the central lymph-adipose chain was 19.0 (range 3.0–26.0) centimeters.ConclusionsOur procedure confers technical advantages and is feasible for treatment of right colon cancer.

Prognostic Analysis of Schistosomal Rectal Cancer

BACKGROUND Schistosomiasis is an infectious disease that affects more than 230 million people worldwide, according to conservative estimates. Some studies published from China and Japan reported that schistosomiasis is a risk factor for colorectal cancer in Asia where the infective species is S. japonicum. However, there have been only few reports of prognosis of patients with schistosomal rectal cancer SRC. OBJECTIVES This study aimed to analyze differences in prognosis between SRC and non-schistosomal rectal cancer(NSRC) with current treatments. MATERIALS AND METHODS A retrospective review of 30 patients with schistosomal rectal cancer who underwent laparoscopic total mesorectal excision operation (TME) was performed. For each patient with schistosomal rectal cancer, a control group who underwent laparoscopic TME with non-schistosomal rectal cancer was matched for age, gender and tumor stage, resulting in 60 cases and controls. RESULTS Univariate analysis showed pathologic N stage (P=0.006) and pathologic TNM stage (P=0.047) statistically significantly correlated with disease-free survival (DFS). Pathologic N stage (P=0.014), pathologic TNM stage (P=0.002), and with/without schistosomiasis (P=0.026) were statistically significantly correlated with overall survival (OS). Schistosomiasis was the only independent prognostic factor for DFS and OS in multivariate analysis. CONCLUSIONS The prognosis of patients with schistosomal rectal cancer is poorer than with non-schistosomal rectal cancer.

Do inflammatory markers predict prognosis in patients with synchronous colorectal cancer

Abstract Systematic inflammatory response markers are considered as the most informative prognostic factors in many types of cancer. However, in synchronous colorectal cancer (synCRC), the prognostic value of inflammatory markers, including prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), had rarely been evaluated. Thus, this present study reviewed our consecutive patients with synCRC to investigate the prognostic value of those factors. The primary endpoint was overall survival (OS), and disease-free survival (DFS) was considered as the secondary endpoint. Receiver-operating characteristic curve analysis was conducted to determine optimal cutoff levels for the 5 markers. Kaplan–Meier survival curves and Cox proportional hazards models were applied to assess the relationship between OS, DFS, and inflammatory markers. In total, 114 patients with pathologically confirmed synCRC at initial diagnosis were identified among 5742 patients who underwent surgery for colorectal cancer from October 2009 to May 2013. In the multivariate analysis, elevated postoperative NLR (≥10.50) was confirmed as an independent prognostic factor for 3-year OS (P = .001; hazard ratio [HR] 4.123, 95% confidence interval [CI] 1.750–9.567) and DFS (P = .001; HR 3.342, 95% CI 1.619–6.898). In addition, for 3-year OS, both tumor grade and pN stage were confirmed as independent prognostic factors. And pN stage was confirmed as an independent prognostic factor for 3-year DFS. In conclusion, this study identified elevated postoperative NLR is associated with a poor prognosis in patients with synCRC underwent surgery resection, and the NLR provides improved accuracy for predicting clinical outcomes to stratify patients into different risk categories.

A Rare Cause of Recurrent Hematochezia

DIS 5.4.0 DTD YGAST60193 proof 28 January 2016 1:23 pm ce Gas 68 69 70 71 72 73 74 75 76 77 78 79 80 81 Question: A 15-yearold female presented with recurrent pallor, fatigue, and hematochezia. The patient had no history of nonsteroidal antiinflammatory drug use, or peptic ulcer, and no family history of gastrointestinal (GI) bleeding. Notably, she denied any discom82 83 84 85 86 87 88 89 90 91 fort with massive characteristic venous malformations of the skin since infancy. These lesions, which increased in size and number over time, were deep blue, soft, rubbery, and easily compressible. Physical examination showed bluish nodules of various sizes occurred on the lower limbs, back, and buttocks (Figure A, white arrows). Laboratory examinations exhibited a hemoglobin level of 40 g/L, a reduced red blood cell count characterized by small cells, and low pigment. Bone marrow aspiration revealed depleted iron stores and normocellular marrow. No clinically important signs were observed on computed tomography scan. Endoscopy revealed multiple bluish mucosal polypoid lesions ranging between 8 and 20 mm in stomach, jejunum, ileum, and colon (Figure B). Based on these findings, what is the most likely diagnosis? What is the next step in management for this patient? Look on page 000 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. 92 93 94 95 96 97 98 Conflicts of interest The authors disclose no conflicts.

Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: A meta-analysis

With neoadjuvant therapy increasingly used in advanced rectal cancer, the lymph node ratio (LNR) has been strongly considered to indicate cancer‐specific survival in recent years, and a comprehensive evaluation of a large number of studies is deficient. The objective of our study is to pool enough eligible studies to assess the relationship between LNR and prognosis of advanced rectal cancer after neoadjuvant therapy.

The Role of CXCL12 Axis in Lung Metastasis of Colorectal Cancer

This study aimed to explore the mechanism of lung metastases of colorectal cancer. The expression of CXCR4, CXCR7, and CXCL12 in colorectal cancer and lung metastases was analyzed by the immunohistochemical (IHC) method. Further, the study aimed at getting new insights into the role of CXCL12 in lung metastasis. A total of 41 patients who underwent surgical resections for both colorectal cancer and lung metastasis were retrospectively selected for this study. Also, 41 patients who underwent lung resection for benign lung disease were selected as the control group. In the in vivo experiment, the mice were injected with exosomes isolated from CT26. The mice with and without injection were sacrificed 3 weeks later. The lung tissue was analyzed by the IHC method and quantitative real-time PCR. The expression of CXCR7 and CXCL12 was significantly higher in lung metastases than in paired primary lesions. The expression of CXCL12 was significantly higher in the noncancerous lung tissue of patients with CRC than in patients with benign lung disease. Also, the expression of CXCL12 in the lung was higher in mice with exosome education. The results inferred that the expression of CXCR7 and CXCL12 was significantly higher in lung metastases than in primary tumors. Their combination could promote colorectal cancer lung metastasis. The expression of CXCL12 was elevated before metastasis. And this effect was induced by exosomes.

A novel hand-assisted laparoscopic versus conventional laparoscopic right hemicolectomy for right colon cancer: study protocol for a randomized controlled trial

BackgroundAlthough conventional laparoscopic and hand-assisted laparoscopic surgery for colorectal cancer is widely used today, there remain many technical challenges especially for right colon cancer in obese patients. Herein, we develop a novel hand-assisted laparoscopic surgery (HALS) with complete mesocolic excision (CME), D3 lymphadenectomy, and a total “no-touch” isolation technique (HALS-CME) in right hemicolectomy to overcome these issues. According to previous clinic practice, this novel procedure is not only feasible and safe but has several technical merits. However, the feasibility, short-term minimally invasive virtues, long-term oncological superiority, and potential total “no-touch” isolation technique benefits of HALS-CME should be confirmed by a prospective randomized controlled trial.Methods/designThis is a single-center, open-label, noninferiority, randomized controlled trial. Eligible participants will be randomly assigned to the HALS-CME group or to the laparoscopic surgery with CME, D3 lymphadenectomy, and total “no-touch” isolation technique (LAP-CME) group, or to conventional laparoscopic surgery with CME and D3 lymphadenectomy (cLAP) group at a 1:1:1 ratio using a centralized randomization list. Primary endpoints include safety, efficacy, and being oncologically clear, and 3-year disease-free, progression-free, and overall survival. Second endpoints include operative outcomes (operation time, blood loss, and incision length), pathologic evaluation (grading the plane of surgery, length of proximal and distal resection margins, distance between the tumor and the central arterial high tie, distance between the nearest bowel wall and the same high tie, area of mesentery resected, width of the chain of lymph-adipose tissue, length of the central lymph-adipose chain, number of harvested lymph nodes), and postoperative outcomes (pain intensity, postoperative inflammatory and immune responses, postoperative recovery).DiscussionThis trial will provide valuable clinical evidence for the feasibility, safety, and potential total “no-touch” isolation technique benefits of HALS-CME for right hemicolectomy. The hypothesis is that HALS-CME is feasible for the radical D3 resection of right colon cancer and offers short-term safety and long-term oncological superiority compared with conventional laparoscopic surgery.Trial registrationClinicalTrials.gov, NCT02625272. Registered on 8 December 2015.

Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma: A Single-Institution Experience.

AbstractTo identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI.This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups.Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%).Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI.