[Show abstract][Hide abstract] ABSTRACT: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio in gastric cancer.
We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between 1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Propensity score analysis was performed to adjust variables to control for selection bias.
Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring (hazard ratio, 1.668; 95% confidence interval: 1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage II-III disease (P = 0.019, P < 0.001), T3-T4 tumors (P < 0.001), or lymph node metastasis (P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS (P = 0.022, P = 0.030, P < 0.001, and P = 0.024, respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.
PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.
World Journal of Gastroenterology 05/2015; 21(19):5961-5971. DOI:10.3748/wjg.v21.i19.5961 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim:
To study the effect of somatostatin in patients with advanced gastric cancer who received D2 lymphadenectomy and vagina vasorum dissection.
Using a prospective, single-blind, placebo-controlled design, patients with advanced gastric cancer were randomized into a study group (n = 61) and a control group (n = 59). Patients in the study group were given somatostatin for 5-7 d starting 6 h after the operation, and patients in the control group were given normal saline. Preoperative and nonoperative complications in the perioperative period, as well as different types of postoperative drainage in the two groups were compared.
There was no significant difference between the study group and the control group for preoperative clinicopathological indicators. We found no significant difference between the two groups for the overall incidence of complications, but a lower percentage of peritoneal effusion was observed in the treatment group (1.6% vs 10.2%, P < 0.05). There were no significant differences between the two groups in the incidence of postoperative pancreatic dysfunction and chylous fistula. However, there were significant differences in the amylase concentration in drainage fluid, volume and duration of drainage, volume and duration of chylous fistula and peritoneal drainage, and volume and duration of gastric tube drainage. The study group did not show any increase in mean hospitalization cost and the cost reduced when the postoperative complications occurred.
Postoperative somatostatin reduces volume and duration of surgical drainage and related complications. Somatostatin may improve safety of gastric cancer surgery, reducing postoperative complications and promoting recovery.
World Journal of Gastroenterology 10/2014; 20(40):14927-33. DOI:10.3748/wjg.v20.i40.14927 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Constipation is a common childhood complaint. In 90% to 95% of children, constipation is functional, which means that there is no objective evidence of an underlying pathological condition. Polyethylene glycol (PEG or macrogol) solution is an osmotic laxative agent that is absorbed in only trace amounts from the gastrointestinal tract and routinely used to treat chronic constipation in adults. Here, we report the results of a meta-analysis of PEG-based laxatives compared with lactulose, milk of magnesia (magnesium hydroxide), oral liquid paraffin (mineral oil), or acacia fiber, psyllium fiber, and fructose in children.This meta-analysis was conducted in accordance with PRISMA guidelines and involved searches of MEDLINE, Cochrane, EMBASE, and Google Scholar databases up to February 10, 2014, using the keywords (Constipation OR Functional Constipation OR Fecal Impaction) AND (Children) AND (Polyethylene Glycol OR Laxative). Primary efficacy outcomes included a number of stool passages/wk and percentage of patients who reported satisfactory stool consistency. Secondary safety outcomes included diarrhea, abdominal pain, nausea or vomiting, pain or straining at defecation, bloating or flatulence, hard stool consistency, poor palatability, and rectal bleeding.We identified 231 articles, 27 of which were suitable for full-text review and 10 of which were used in the meta-analysis. Patients who were treated with PEG experienced more successful disimpaction compared with those treated with non-PEG laxatives. Treatment-related adverse events were acceptable and generally well tolerated. PEG-based laxatives are effective and safe for chronic constipation and for resolving fecal impaction in children. Children's acceptance of PEG-based laxatives appears to be better than non-PEG laxatives.Optimal dosages, routes of administration, and PEG regimens should be determined in future randomized controlled studies and meta-analyses.
Medicine 10/2014; 93(16):e65. DOI:10.1097/MD.0000000000000065 · 5.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reactive nodular fibrous pseudotumor (RNFP), which presents abdominal clinical manifestations and malignant radiographic results, usually requires radical resection as the treatment. However, RNFP has been recently described as an extremely rare benign post-inflammatory lesion of a reactive nature, which typically arises from the sub-serosal layer of the digestive tract or within the surrounding mesentery in association with local injury or inflammation. In addition, a postoperative diagnosis is necessary to differentiate it from the other reactive processes of the abdomen. Furthermore, RNFP shows a good prognosis without signs of recurrence or metastasis. A 16-year-old girl presented with a 3-mo history of epigastric discomfort, and auxiliary examinations suggested a malignant tumor originating from the stomach; postoperative pathology confirmed RNFP, and after a 2-year follow-up period, the patient did not display any signs of recurrence. This case highlights the importance of preoperative pathology for surgeons who may encounter similar cases.
[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] ABSTRACT: To explore the risk factors and prognostic impact of duodenohepatic ligamentous lymph node (No.12 LN) metastasis in cases with curable advanced distal gastric cancer.
The data of 379 cases with advanced distal gastric cancer undergoing radical resection were screened from the Database of Gastric Cancer Center of Sun Yat-sen University from January 1997 to December 2010. According to No.12 LN metastasis, they were divided into negative (n = 339) and positive (n = 40) groups. Their clinicopathological parameters and surgical regimens were compared. And the risk factors and prognostic impact of No.12 LN metastasis were analyzed.
No significant inter-group difference existed in gender, age, infiltration depth or differentiation degree (all P > 0.05). In negative and positive groups, the percent of tumor size ≥ 5 cm was 30.1% (102/339) vs 55.0% (22/40), lymph node metastasis N3 stage 8.3% (28/339) vs 42.5% (17/40), other lymph nodes except for No.12 metastasis 70.2% (238/339) vs 92.5% (37/40), distal metastasis M1 10.9% (37/339) vs 32.5% (13/40), TNM stage IV 18.6% (63/339) vs 65.0% (26/40), infiltration Borrmann type 74.3% (252/339) vs 92.5% (37/40), non-adenocarcinoma 15.9% (54/339) vs 35.0% (14/40) and positive serum-carcinoembryonic antigen (S-CEA) 12.7% (43/339) vs 32.5% (13/40). There were all with significant difference (all P < 0.01). Logistic regression analysis showed tumor size ≥ 5 cm, lymph node (except for No.12) metastasis, distal metastasis and positive S-CEA were independent risk factors of No.12 LN metastasis (OR = 2.144, 3.581, 2.597, 2.552; P = 0.035, 0.042, 0.019, 0.022 respectively). Cox regression analysis showed lymph nodes (except for No.12) and No.12 metastasis, distal metastasis and Borrmann type were independent prognostic factors for all cases. In negative and positive groups, median survival time was 63.0 versus 12.0 months with significant difference (P = 0.000).
For cases with curable advanced distal gastric cancer, No.12 LN metastasis was an independent prognostic factor. No.12 LN should be dissected thoroughly in cases with tumor size ≥ 5 cm, lymph nodes (except No.12) metastasis, distal metastasis and positive S-CEA.
Zhonghua yi xue za zhi 12/2013; 93(48):3847-51. DOI:10.3760/cma.j.issn.0376-2491.2013.48.010
[Show abstract][Hide abstract] ABSTRACT: To elucidate the mechanism of Hedgehog pathway in the metastasis of gastric cancer and examine particularly the effect on epithelial-mesenchymal transition (EMT).
Using pharmacological and siRNA knockdown approach, the Hedgehog pathway was inhibited. The cellular morphology, protein level, invasion and metastatic abilities were measured by microscope, Western blot, Transwell invasion assay and Transwell migration assay.
Under the inhibition of Hedgehog pathway, the invasive and migration abilities of gastric cancer decreased. The transforming growth factor (TGF) -β could induce spindle-like-shaped morphological changes with a down-regulation of epithelial characteristic (decreased E-cadherin protein level) and an up-regulation of mesenchymal characteristics (increased Vimentim protein level). There were concurrent increases of invasive and migration potentials by 3 and 4 folds respectively.However, under the continuous stimulation of TGF-β, the inhibition of Hedgehog pathway could reverse the EMT changes, lower the expression of vimentim and reduce the invasion and metastatic abilities by 3 and 2 folds respectively.
The inhibition of Hedgehog pathway can decrease the TGF-β-inducing EMT.It suggests that Hedgehog pathway may play a critical role in the metastasis of gastric cancer.
[Show abstract][Hide abstract] ABSTRACT: To explore the impact of clinicopathological features and extent of lymph node dissection on the prognosis in early gastric cancer (EGC) patients.
A total of 142 EGC cases screened from database of gastric cancer of Sun Yat-sen University, from Aug. 1994 to Jan. 2010, were included in this study. According to the lymph node metastasis status, they were divided into lymph node negative (n = 116) and lymph node positive (n = 26) groups. The clinicopathological features of the two groups and the impact of extent of lymph node dissection on the prognosis were analyzed.
There were no significant differences in age, gender, tumor size and location, Borrmann typing, WHO TNM staging, histological typing, and CEA value between the two groups (P > 0.05). The TNM stages in the lymph node positive group were higher than that in the lymph node negative group (P < 0.001). Between the cases who underwent D1 (n = 21) and D2 (n = 121) dissection, there were no significant differences in postoperative hospital days, blood transfusion volume, and operation time (P > 0.05). The median numbers of LN dissected in D1 and D2 cases were 4 (0 to 16) and 20 (12 to 30), with a significant difference (P = 0.000), but the number of positive LN without significant difference (P = 0.502). The postoperative complication rates were 9.5% in the D1 and 3.3% in the D2 dissection groups, without a significant difference (P = 0.128). The median survival time of the lymph node negative and positive groups was 156 vs. 96 months (P = 0.010). In cases who received D2 and D1 lymph node dissection, the median survival time (MST) was 156 vs. 96 months (P = 0.0022). In the lymph node positive group, D2 dissection prolonged survival time significantly than D1 dissection (96 vs. 27months) (P = 0.001). Cox regression analysis showed that the extent of lymph node dissection and LN metastasis were independent prognostic factors for EGC patients.
It is not able to accurately assess the LN metastasis status preoperatively according to the routine clinicopathological features. For the patients with unknown LN metastasis status, D2 dissection should be the first choice. Comparing with D1 dissection, the morbidity of D2 dissection are not increased, but survival time is prolonged.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 07/2013; 35(7):509-513.
[Show abstract][Hide abstract] ABSTRACT: Histopathological results are critical for the diagnosis and surgical decision regarding gastric cancer. However, opposite opinions from radiology and pathology can sometimes affect clinical decisions. The two cases reported in this article were both highly suspected as gastric cancer by clinical manifestations and radiologic findings, although both showed negative results in the first biopsy examination. One was confirmed as gastric cancer by the time of the 6(th) biopsy, while the other was still negative even after 8 biopsies. With a definite pathologic result and the agreement of the patient for the latter case, both of them finally received surgery. Postoperative pathological examination revealed findings that were the same as Borrmann type IV gastric cancer. We believed that duplicate biopsies under radiologic guidance were necessary for highly suspected gastric cancer cases in the absence of a definite pathology result, and patients should be under close follow-up. We propose that, if gastric cancer is highly suspected when typical radiology changes of widely diffuse gastric parietal lesions suffice to exclude lymphoma and other similar situations, and even in absence of a positive biopsy result, a diagnostic laparotomy under laparoscopy and even radical gastrectomy may be reasonably performed by an experienced gastric cancer center with the agreement of the patient after being decided by a multidisciplinary discussion team.
World Journal of Gastroenterology 06/2013; 19(24):3904-10. DOI:10.3748/wjg.v19.i24.3904 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To screen and collect the familial gastric cancer (FGC) kindreds for exploring its clinicopathological characteristics and prognosis.
A cross-sectional study was performed among 3640 patients with gastric cancer at 5 hospitals in Guangdong province between 2000 and 2007 and FGC kindreds were diagnosed according to the Amsterdam criteria. Their pedigree features and cancer incidence were analyzed. Clinical characteristics and prognosis were compared between FGC and sporadic gastric cancer (SGC) patients. Survival curves and overall five-year survival rates were established according to the Kaplan-Meier and Log-rank methods. Hazard ratios for death were calculated by Cox regression analysis.
A total of 112 FGC kindreds (3.1%) were diagnosed among 3640 gastric cancer patients. In these 112 FGC families, 182 malignant tumors were diagnosed in the first- and second-degree relatives. Gastric cancer (n = 154, 84.6%), esophageal cancer (n = 8, 4.4%) and lung cancer (n = 6, 3.3%) were most common tumors. Tumor types in male proband families did not differ from those in female counterparts (P = 0.644). Most tumors occurred in the first-degree relatives and the ratio of male-to-female was 106:44. The mean age of FGC patients at 54 years was 10 years younger than that of SGC patients. No differences existed in tumor size, tumor location, Borrmann type, pT or pN between the FGC and SGC patients. The overall 5-year survival was 56.0% for FGC patients and 48.8% for SGC patients. Univariable (P = 0.287) and multivariable (HR = 1.101, P = 0.807) analyses demonstrated that FGC was not a significant prognostic factor.
Gastric cancer is the most common cancer in FGC families. The first-degree male relatives are at a high risk of developing gastric cancer. Not particular clinical characteristics but pedigree examination facilitates the diagnosis of FGC.
Zhonghua yi xue za zhi 04/2013; 93(16):1214-8. DOI:10.3760/cma.j.issn.0376-2491.2013.16.003
[Show abstract][Hide abstract] ABSTRACT: To summarize the clinicopathological characteristics and analyze the prognostic factors of young patients with gastric cancer.
A total of 99 patients with the age less than or equal to 40 were admitted in The First Affiliated Hospital of Sun Yat-sen University from August 2001 to December 2009. Their clinicopathological and follow-up data were compared with middle-aged and elderly patients with the age more than 40.
There were statistically significant differences in gender, tumor location, Borrmann type, histological type, differentiated histology, depth of invasion, peritoneal metastasis between young patients and elder ones. The 5-year survival rates of young and elder patients were 49.1% and 44.4% respectively, and the difference was not statistically significant(P>0.05). Univariate and multivariate analyses showed that TNM stage(P=0.014) and surgical methods(P=0.012) were independent predictive factors of survival for young patients. For the young patients, the 5-year survival rate was 56.7% after curative resection, 11.1% after palliative resection. Those who underwent palliative surgery or biopsy alone died within 1 year after surgery. The difference between difference surgical procedures in survival were statistically significant(P<0.05).
As compared to elder patients, young patients with gastric cancer have special clinicopathological features. However, no significant difference of survival rate is found between the young and the elder patients. TNM stage and surgical methods are independent prognostic factors of young patients with gastric cancer. Radical resection appears to confer the only chance of prolonged survival.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 02/2013; 16(2):160-2.
[Show abstract][Hide abstract] ABSTRACT: Pancreaticogastrostomy (PG) has been proposed as an alternative to pancreaticojejunostomy (PJ), assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.
Articles of prospective controlled trials published until the end of December 2010 comparing PJ and PG after PD were searched by means of MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and Chinese Biomedical Database. After quality assessment of all included prospective controlled trials, meta-analysis was performed with Review Manager 5.0 for statistic analysis.
Overall, six articles of prospective controlled trials were included. Of the 866 patients analyzed, 440 received PG and 426 were treated by PJ. Meta-analysis of six prospective controlled trials (including RCT and non-randomized prospective trial) revealed significant difference between PJ and PG regarding postoperative complication rates (OR, 0.53; 95%CI, 0.30 - 0.95; P = 0.03), pancreatic fistula (OR, 0.47; 95%CI, 0.22 - 0.97; P = 0.04), and intra-abdominal fluid collection (OR, 0.42; 95%CI, 0.25 - 0.72; P = 0.001). The difference in mortality was of no significance. Meta-analysis of four randomized controlled trials (RCT) revealed significant difference between PJ and PG regarding intra-abdominal fluid collection (OR, 0.46; 95% CI, 0.26 - 0.79; P = 0.005). The differences in pancreatic fistula, postoperative complications, delayed gastric emptying, and mortality were of no significance.
Meta-analysis of six prospective controlled trials (including randomized controlled trials (RCT) and non-randomized prospective trial) revealed significant difference between PJ and PG regarding overall postoperative complications, pancreatic fistula, and intra-abdominal fluid collection. Meta-analysis of four RCT revealed significant difference between PJ and PG with regard to intra-abdominal fluid collection. The results suggest that PG may be as safe as PJ.
Chinese medical journal 11/2012; 125(21):3891-7. DOI:10.3760/cma.j.issn.0366-6999.2012.21.027 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the effects of fast track surgery on postoperative insulin sensitivity on the basis of clinical benefits in patients undergoing elective open colorectal resection.
During May 2008 to December 2008, Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters, stress markers and insulin sensitivity were evaluated in both groups.
The 62 patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. The speed of recovery of postoperative insulin sensitivity on 7 days postoperative in the fast-track group (97% ± 9%) was significantly faster than the conventional care group (88.5% ± 9.0%, t = 2.552, P = 0.016). The hospitalization days in the fast-track group was 6 days (M(50)), and it was significantly shorter than the conventional care group ((11.7 ± 3.8) days, Z = 4.360, P = 0.000). The time of recovery of bowel function were faster in the fast-track group (time to pass flatus was 2 days (M(50))) than the conventional care group (4 days, Z = 3.976, P = 0.000). The Infectious complication rate in the fast-track group (2/32) is lower than the other group (8/30, P = 0.040).
Fast track surgery accelerates recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a lower rate of postoperative infectious complications and a shorter length of postoperative hospital stay.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2012; 50(10):870-4.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the impact of different gastrectomy and reconstruction method on prognosis and quality of life in proximal gastric cancer.
The 265 cases of proximal gastric cancer received radical resection, according to gastrectomy or reconstruction method, were divided into proximal gastrectomy/gastroesophagostomy group (PG) (n = 63) and total gastrectomy/esophagojejunostomy group (TG) (n = 202). The clinical pathologic features, prognosis, postoperative quality of life in 2 groups were compared.
There had no significant differences in age, gender, CEA value between two groups (all P > 0.05). In PG and TG group, tumor size (cm), ratio of organic invasion, lymph nodes metastasis, distal metastasis, TNM IV stage, Borrmann typing, poor or undifferentiated carcinoma was 2.9 ± 1.9 vs. 4.8 ± 2.8, 9.5% vs. 32.2%, 64.7% vs. 70.6%, 0 vs. 8.4%, 6.9% vs. 31.8%, 44.4% vs. 69.2%, 31.7% vs. 53.7%, respectively, all with significant difference (t = -6.260, χ(2) = 29.473, 14.559, 5.665, 32.483, 12.588, 10.954, all P < 0.05). In PG and TG group, the ratio of D3 and D3(+) resection, multi-visceral resection, complications was 0 vs. 13.8%, 9.5% vs. 38.6%, 7.9% vs. 1.5% respectively, showed increasing range of resection and decreasing complications significantly in TG group (all P < 0.05). The median survival time (months) was 62.5 vs. 78.9 in TG and PG group respectively, without significant difference (P > 0.05). In 2 groups, the evaluation index of post-operative quality of life without significant differences (P > 0.05).
For proximal gastric cancer, although the cases received TG with worse clinicopathological features, which prognosis was similar to that received PG. The postoperative quality of life without significant difference between the cases received gastroesophagostomy and esophagojejunostomy.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2012; 50(10):875-8.
[Show abstract][Hide abstract] ABSTRACT: To compare Borrmann type IV gastric cancer with other types of cancer and explore their clinicopathological features and prognostic factors.
We retrospectively reviewed the medical records of 893 consecutive advanced gastric cancer patients. They were divided into 2 groups: Borrmann type IV (n = 139) and other macroscopic Borrmann types of cancer (n = 754). Their clinicopathologic characteristics and overall survival data were analyzed.
Borrmann type IV gastric cancer was found to be associated with more advanced and unfavorable clinicopathological features. The incidence of preoperative biopsy-negative rate of Borrmann type IV gastric cancer was much higher (15.9%) than other Borrmann types of gastric cancer. The 5-year survival rate of Borrmann type IV cancer patients was 9.9% and it was significantly lower than that of other types. Moreover, the 5-year survival rate was higher in the patients with curative resection (18.7%) (P < 0.05). Stratified analysis revealed that when the tumor TNM stages were of II, III, the survival data of Borrmann type IV cancer were worse than others. Multivariate analyses revealed distant metastasis and curability were independent prognostic factors for Borrmann type IV gastric cancer.
Borrmann type IV carcinoma has poor clinicopathological features and survival rate compared with other types. An early detection and curative resection may improve the prognosis for the patients with Borrmann type IV cancer.
[Show abstract][Hide abstract] ABSTRACT: This study was conducted to investigate whether and how macrophages recruited to tumor microenvironments (tumor-associated macrophages, TAMs) were involved in angiogenesis and lymphangiogenesis of gastric cancer (GC).
TAMs, microvessel density (MVD), and lymphatic vessel density (LVD) in 115 cases of GC tissue were assessed by immunohistochemistry (IHC) staining of CD68, CD34, and D2-40, respectively. Preoperative blood samples from 43 patients were obtained to detect serum levels of vascular endothelial growth factor (VEGF) and VEGF-C. A co-culture system was also developed to study effects and underlying mechanisms of THP-1 macrophages on SGC7901 GC cells.
TAMs numbers were closely related to serosa invasion, lymph node metastasis and tumor, nodes, and metastases stage and a positive correlation existed between the TAMs count and MVD and LVD. Additionally, TAMs were associated with preoperative serum levels of VEGF and VEGF-C, the expression of VEGF and VEGF-C protein in macrophages was up-regulated in the co-culture system, and inhibition of the NF-κB pathway in macrophages induced a significant reduction in the expression of VEGF and VEGF-C in both macrophages and GC cells (all P<0.05).
TAMs may promote angiogenesis and lymphangiogenesis of GC, possibly by enhancing VEGF and VEGF-C expression.
[Show abstract][Hide abstract] ABSTRACT: Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.
Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively.
Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.
Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.
Chinese medical journal 09/2012; 125(18):3261-5. DOI:10.3760/cma.j.issn.0366-6999.2012.18.012 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to clarify the relationship of hepatocyte growth factor (HGF), c-Met, and E-cadherin with clinicopathological parameters and prognosis in gastric carcinoma (GC).
114 specimens were collected from GC patients and expression of HGF, c-Met, and E-cadherin in tissue microarray was evaluated by immunohistochemical staining. Correlation between immunostainings and clinicopathological parameters, follow-up data of patients, was analyzed statistically.
Abnormal E-cadherin expression was found in 60.5% (69/114) and associated with tumor depth (P = 0.003), lymph node metastasis (P = 0.001) and advanced clinical stage (P = 0.001). High-expression of HGF and c-Met were found in 64.0% (73/114) and 82.4% (94/114), respectively. High c-Met expression was significantly associated with advanced clinical stage (P = 0.001) and lymph node metastasis (P = 0.011) of GC. In univariate survival analysis, high-expression of HGF and c-Met, and abnormal E-cadherin were significantly associated with poor prognosis of GC patients. However, only abnormal E-cadherin expression (P = 0.001) and tumor depth (P = 0.010) emerged as strong independent prognostic factors for overall survival of GC patients.
We found significant correlation among HGF/c-Met, E-cadherin expression and worse prognosis of patients with GC. Abnormal E-cadherin expression may serve as an independent predictive factor for prognosis of GC patients.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the rationality of different radical operative modalities for proximal gastric cancer.
A total of 366 cases of proximal gastric cancer undergoing radical dissection were screened from data base. According to the operative modalities, they were divided into proximal gastrectomy group (PG) (n = 77) and total gastrectomy group (TG) (n = 289). Through the comparisons of clinical pathologic features, surgical profiles, postoperative complications, postoperative quality-of-life and prognosis in two groups, the rationality of different operative modalities was evaluated.
No significant differences existed in age, gender or carcinombryonic antigen (CEA) value between two groups (all P > 0.05). The rates of tumor diameter ≥ 5 cm, organic infiltration, lymph nodes metastasis, distal organs metastasis, infiltrative type, poorly differentiated tumor in PG and TG groups were 15.6% (12/77) vs 49.8% (144/289), 16.9% (13/77) vs 37.7% (109/289), 67.5% (52/77) vs 79.9% (231/289), 3.9% (3/77) vs 11.4% (33/289), 45.5% (35/77) vs 68.9% (199/289), 32.5% (25/77) vs 57.8% (167/289) respectively (all P < 0.05). Operative duration, volume of blood transfusion, number of dissected lymph nodes and positive lymph nodes, rate of combined organic resection and complications in groups of PG and TG were (256 ± 83) vs (298 ± 86)min, 0 vs 400 ml, 15 ± 12 vs 26 ± 15, 0 vs 3, 15.6% (12/77) vs 43.2% (125/289), 14.3% (11/77) vs 7.6% (22/289) respectively (all P < 0.05). In two groups, the evaluating indices of posteroperative quality-of-life showed no significant differences (P > 0.05). In two groups, the median survival time of the cases with tumor diameter < 5 cm, no-organic infiltration, no-peri-tumor lymph nodes metastasis, no-distal organic metastasis had no significant difference (all P > 0.05). However, in groups of PG and TG, the median survival time of the cases with tumor diameter ≥ 5 cm, organic infiltration, peri-tumor lymph nodes metastasis and distal organic metastasis was 15.0 months vs 29.0 months, 15.0 months vs 30.0 months, 34.0 months vs 45.0 months, 4.0 months vs 18.0 months respectively(all P < 0.05).
As compared with radical proximal gastrectomy, radical total gastrectomy improves significantly the prognosis of patients of proximal gastric cancer with organic infiltration, peri-tumor lymph nodes metastasis, distal organic metastasis and tumor diameter ≥ 5 cm.
[Show abstract][Hide abstract] ABSTRACT: To compare the nutritional status between pancreaticojejuno-stomy(PJ) and pancreaticogastrostomy(PG) following pancreaticoduodenectomy.
A retrospective clinical analysis was performed on 37 patients undergoing pancreaticoduodenectomy(PD) for duodenal carcinoma and pancreatic non-epithelial tumor with PG(n=19) and PJ(n=18) in the First Hospital of Sun Yat-sen University from April 2006 to December 2010. All the patients had a needle catheter jejunostomy inserted at the conclusion of laparotomy. Postoperative early enteral nutrition and parenteral nutrition was performed for all the patients. Nutritional status of two groups was compared in body mass index (BMI), serum nutritional parameters such as albumin, transferrin and prealbumin before surgery and on 1, 3, and 6 months postoperatively.
There were no significant differences between PG and PJ groups in operative time, blood loss, pancreatic fistula, perioperative death, or postoperative length of hospital stay. One month after surgery, there were no significant differences in BMI [(17.1±7.0) vs. (19.0±4.8) kg/m(2), P>0.05], albumin [(30.1±0.5) vs. (32.1±1.3) g/L, P>0.05], transferrin [(1.89±0.57) vs. (2.01±0.61) g/L, P>0.05] and prealbumin[(0.18±0.05) vs. (0.18±0.09) g/L, P>0.05]. These parameters were decreased at 1 month after surgery, and gradually recovered to baseline or higher than the preoperative levels at 6 months after surgery. However, the differences were still not statistically significant between two groups.
The influence of PJ and PG on the postoperative nutritional status are comparable.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2012; 15(5):457-9.