Zhenyang Li

Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: A comparative study with open colectomy

The aim of the present study was to assess the short-term outcome and survival time of 166 obese patients who received laparoscopic and open colectomy for colorectal cancer (CRC) between January 2007 and December 2012. All 166 patients included in the study had a BMI >28. Laparoscopic or open colectomy procedures were performed on 64 and 102 patients, respectively. The short-term outcome and post-operative survival rates were compared. The patient characteristics were similar between the two groups. Laparoscopic colectomy correlated with an increased duration of surgery compared with open colectomy (183 vs. 167 min, respectively; P<0.05) but intraoperative blood loss was decreased (168 vs. 188 ml, respectively; P<0.05). Hospitalization costs were slightly higher following the laparoscopic procedure compared with open surgery, but this was affordable for the majority of patients (¥56,484 vs. ¥56,161, respectively; P<0.05). The incidence of wound infection (17 vs. 31%; P<0.05) and abdominal abscess rates (6 vs. 18%; P<0.05) were reduced in the laparoscopic group compared with the open group. Pathological characteristics were identified to be similar and no significant differences were identified in overall (log-rank test; P=0.85) and disease-free (log-rank test; P=0.85) survival between the two types of surgery (log-rank test; P=0.76). The current retrospective study demonstrated an improved short-term outcome in laparoscopic colectomy for CRC patients with a BMI >28 compared with patients who underwent the open procedure. Laparoscopic colectomy is technically and oncologically safe and must be popularized in obese CRC patients.

Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review)

Locally recurrent rectal cancer (LRRC) is defined as an intrapelvic recurrence following a primary rectal cancer resection, with or without distal metastasis. The treatment of LRRC remains a clinical challenge. LRRC has been regarded as an incurable disease state leading to a poor quality of life and a limited survival time. However, curative reoperations have proved beneficial for treating LRRC. A complete resection of recurrent tumors (R0 resection) allows the treatment to be curative rather than palliative, which is a milestone in medicine. In LRRC cases, the difficulty of achieving an R0 resection is associated with the post-operative prognosis and is affected by several clinical factors, including the staging of the local recurrence (LR), accompanying symptoms, patterns of tumors and combined therapy. The risk factors following primary surgery that lead to an increased rate of LR are summarized in this study, including the surgical, pathological and therapeutic factors.

Gallbladder carcinosarcoma accompanied with bile duct tumor thrombi: A case report.

Gallbladder carcinosarcoma is one of the rarest subsets of gallbladder malignancies. The first case of carcinosarcoma of the gallbladder was reported in 1907. To date, <100 cases have been reported in the English literature. The present study reports a case of gallbladder carcinosarcoma accompanied with tumor thrombi, presenting as a soft tissue mass in the common bile duct and resulting in the obstruction and inflammation of the biliary tract. Initially, the patient was diagnosed with a gallbladder tumor and choledocholithiasis. No cases of carcinosarcoma of the gallbladder accompanied with bile duct tumor thrombus formation have been reported to date. A cholecystectomy with liver segmentectomy (S4a+S5) and a lymph node dissection were performed. The presence of a tumor thrombus in the common bile duct was confirmed by analysis of a frozen section during surgery. Resection of the extrahepatic bile duct and Roux-en-Y type hepatic cholangiojejunostomy were also performed. In addition, the gallbladder carcinosarcoma was observed to produce α-fetoprotein. The patient underwent an uneventful post-operative recovery and, to date, no clinical or radiological evidence of disease recurrence or metastasis has been identified. Carcinosarcoma of the gallbladder accompanied with tumor thrombi is extremely rare. Tumor thrombi in the common bile duct may easily be misdiagnosed as choledocholithiasis. The treatment and prognosis of gallbladder carcinosarcoma is similar to that of gallbladder carcinoma.

MiR‐622 inhibited colorectal cancer occurrence and metastasis by suppressing K‐Ras

Colorectal cancer (CRC) is one of the leading causes of cancer death worldwide, with many oncogenes and anti‐oncogenes involved. MicroRNAs (miRNAs) are a class of small, noncoding RNA molecules that can adjust downstream targets. Accumulating evidence has revealed that microRNAs govern the occurrence and development of cancer. Here, we studied the role of miR‐622 in CRC and clarified the underlying mechanism. We detected that miR‐622 was down‐regulated in colorectal tumor tissues and cell lines and that miR‐622 was lower in metastatic CRC tissues compared with that in non‐metastatic specimens. Furthermore, we confirmed that miR‐622 inhibited tumor proliferation and migration in vitro. Through dual‐luciferase reporter assay, we found kirsten rat sarcoma (K‐Ras) gene was the direct target of miR‐622. More importantly, K‐Ras overexpression can rescue the inhibitory effect of miR‐622 on CRC development. All these data were validated in colon xenograft tumor model. MiR‐622‐K‐Ras signal pathway was a potentially new direction in the development of screening target and therapeutic treatments for CRC.

Fever of unknown origin as a presentation of colonic inflammatory myofibroblastic tumor in a 36‑year‑old female: A case report

Inflammatory myofibroblastic tumor is a rare type of lesion that mimics malignancy and has various clinical manifestations. The current study presents a 36-year-old female with a colonic mass, which closely resembled a stromal tumor during imaging. The patient experienced intermittent fever and slight abdominal pain for one month. The fever remained at ≤38.5°C until the day of surgery. The patient underwent a right hemicolectomy and the preoperative fever disappeared and did not recur until the patient was discharged.

Expression of C4.4A is a Potential Independent Prognostic Factor for Patients with Gastric Cancer

C4.4A, a metastasis-associated gene, encodes a glycolipid-anchored membrane protein which is overexpressed in several human malignancies. However, there are few data available on C4.4A expression and its relationship with progression in gastric cancer. Our study was designed to explore the expression of C4.4A in gastric cancer and to correlate it with clinical outcome. C4.4A expression was studied by quantitative real-time RT-PCR and immunohistochemistry for assessment of correlations with clinicopathological factors. C4.4A mRNA expression was significantly up-regulated in gastric cancer as compared with noncancerous tissue (p<0.05)., being observed in 107 (88.4%) of the 121 gastric cancer cases by immunohistochemistry. We found that the expression of C4.4A mRNA was correlated with size of the tumor, depth of invasion, lymph node metastasis, distant metastasis and TNM stage. Moreover, patients with overexpression of C4.4A has a significantly worse survival (p<0.05). Further multivariable analysis indicated that the expression of C4.4A was an independent prognostic indicator for gastric cancer (p<0.05). In conclusion, overexpression of C4.4A correlates with metastatic potential of gastric cancer and C4.4A could be a novel independent prognostic marker for predicting outcome.

Mesenteric lymphatic hygroma in adults: A case report with a review of the literature.

Mesenteric lymphatic hygroma is a benign tumor of lymphatic origin that is rarely observed in adult patients. Congenital and developed non-specific symptoms, including abdominal distension, pain and ileus, develop at an early age in patients. This type of disease is usually reported by pediatric doctors, as referred to in the literature. The current study presents the case of a 23-year-old male in whom a polycystic mass in the mesentery was identified by computed tomography. The size of the tumor was measured to be 30×20×15 cm during surgery. The mass was excised completely with preservation of the intestine, duodenum, pancreas and other neighboring organs. Histopathological examination confirmed the diagnosis of lymphatic hygroma. The post-operative recovery was uneventful, with the exception of chylous leakage for one week, which was relieved spontaneously. In addition, the present study presents a review of the previous literature concerning mesenteric lymphatic hygroma.

Application of cryoablation to treat peritoneal carcinomatosis from gastric cancer in a rabbit model

OBJECTIVES Peritoneal carcinomatosis is one of the causes of death in patients with advanced gastric cancer. We assumed that cryoablation could be applied as adjuvant therapy to control peritoneal carcinomatosis from gastric cancer. METHODS We investigated the feasibility of cryoablation technique in rabbit model using a novel cryoablation balloon probe. The cryozones were harvested 7 days after cryoablation for histological evaluation. The levels of cytokines in the peripheral blood of rabbits were also detected. RESULTS The results demonstrated that cryoablation could be applied in a rabbit model of peritoneal carcinomatosis from gastric cancer. Seven days after cryoablation, necrotic tumor cells could be seen the cryozones. Higher level of IFN-γ was observed. The level of IL-10 was decreased after treatment. CONCLUSIONS The findings provided the experimental basis for the future application of cryoablation in patients.

Identification of a mature cystic teratoma mimicking a presacral tumor by transsacral surgery in a young female: A case report

The current case report presents an account of a unique surgical procedure performed to remove an extremely rare occurrence of a transsacral abdominal mass from a 24-year-old female. The patient presented with subtle sacrococcygeal pain for two months and a presacral abdominal mass derived from the right ovary. The mass was misdiagnosed as a presacral tumor based on the results of magnetic resonance imaging (MRI) performed prior to the surgery. The patient also exhibited the symptoms commonly caused by a presacral mass, however, during the surgery, the mass was not initially located under the sacrum. An ultrasound examination and an analysis of an intraoperative frozen section indicated that the mass was a mature cystic teratoma (MCT) of the ovary, located in the peritoneal cavity between the rectum and uterus. The mass was successfully resected and removed from the affected ovary through the abdominal cavity via the sacral region. A pathological examination of the tumor section confirmed a diagnosis of a MCT of the ovary.