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ABSTRACT: Our objective was to investigate the feasibility of laparoscopic inguinal hernia repair during its developmental phases in China.
The clinical data of 2,056 patients (2,473 hernias) who underwent laparoscopic inguinal hernia repair at Shanghai Minimally Invasive Surgery Center between January 2001 and December 2011 were analyzed retrospectively. The operation priority was used to divide the patients into 7 groups for analysis of the learning curve.
There were 1,005 transabdominal preperitoneal patch plastic repairs (TAPP), 1,458 total extraperitoneal repairs (TEP), and 10 intraperitoneal onlay mesh repairs performed on 874, 1,175, and 7 patients, respectively. Median follow-up period was 60 months. The operation time and postoperative hospital stay for TEP were considerably shorter than those for TAPP. The complication rate for TEP, especially seroma, was considerably lower. Transabdominal preperitoneal patch plastic repair was performed in 81.4% of the recurrent inguinal hernias. Seven patients underwent unilateral intraperitoneal onlay mesh repair and 3 others underwent unilateral intraperitoneal onlay mesh repair and TAPP on the opposite. Most of patients with grade I and II hernias underwent TEP. The learning curve has demonstrated that more obstacles occurred in the earlier phase of the laparoscopic inguinal hernia repair training, supported by findings such as fewer cases performed annually, longer operation time, and higher incidence of complications and recurrence. These findings have improved as experience is accumulated through more operations. In addition, the ratios of TEP to TAPP and mesh nonfixation to fixation also evolved throughout the course of the study.
Laparoscopic inguinal hernia repair is a feasible technique that can be popularized in China.
Journal of the American College of Surgeons 02/2013; 216(2):258-65. · 4.55 Impact Factor
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ABSTRACT: PURPOSES: To study the feasibility, safety, and short-/long-term outcomes of laparoscopy-assisted right hemicolectomy with D3 lymphadenectomy for colon cancer. METHODS: The clinical data of 177 cases that underwent laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy for colon cancer between Jun 2003 and Sep 2010 was collected; the safety of operation, status of recovery, complication, oncological outcomes, and results of short-/long-term follow-up were analyzed. RESULTS: No case died in this study; five cases (2.82 %) were converted to open surgery. Four cases (2.26 %) underwent hand-assisted laparoscopic right hemicolectomy. The average operation time was 133 ± 36 min, and the blood loss was 94 ± 34 ml. The average time for passage of flatus, liquid food eating, and hospitalization were 2.1 ± 0.7, 3.2 ± 0.5, and 10.4 ± 2.7 day, respectively. The total number of lymph nodes removed was 15.2 ± 10.1. Postoperative complications were observed in 23 of 177 patients (12.99 %). The median follow-up period was 54 months; port-site recurrence was observed in one patient; local recurrence was found in five cases (2.82 %); distant metastasis was found in 21 cases (11.86 %). The cumulative overall survival of all stages at 12, 36, 60, and 72 months was 97.18 %, 83.73 %, 70.37 %, and 68.99 %, respectively. The cancer-specific survival was 98.73 % (12 months), 87.81 % (36 months), and 80.17 % (60 months). CONCLUSIONS: Laparoscopy-assisted right hemicolectomy with D3 lymphadenectomy can be successfully performed for right colon cancer with the advantages of minimally invasive surgery. Moreover, the results implied appropriate short- and long-term outcomes.
International Journal of Colorectal Disease 11/2012; · 2.38 Impact Factor
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09/2012;
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Bo Feng,
Jing Sun,
Tian-Long Ling, Ai-Guo Lu,
Ming-Liang Wang,
Xue-Yu Chen,
Jun-Jun Ma,
Jian-Wen Li,
Lu Zang,
Ding-Pei Han,
Min-Hua Zheng
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ABSTRACT: OBJECTIVE: This study was designed to investigate the feasibility and technical strategies of laparoscopic complete mesocolic excision (CME) for right-hemi colon cancer. METHODS: The 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. RESULTS: Laparoscopic 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 15 cm 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 2.6 h and the blood loss was 80 mL. The median time for passage of flatus and hospitalization were 2 and 12 days respectively. Complications were observed in three cases. CONCLUSIONS: CME 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.
Surgical Endoscopy 06/2012; · 4.01 Impact Factor
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ABSTRACT: Polo-like kinase 1 (PLK1) is an important molecule in proliferation of many human cancers. The aim of study is to clarify the expression patterns and potential function of PLK1 in colorectal cancers.
Fifty-six colorectal cancers samples were collected and arranged onto a tissue array and the expression of PLK1 were detected by immunohistochemistry and correlated with clinico-pathological characteristics and expression of PCNA. Expression of PLK1 in 9 colorectal cancer cells lines was investigated by RT-PCR and Western blot, then SW1116 cells lines were treated with PLK1 siRNA and the efficiency was examined by Western blot. Transwell test was applied to detect the migration and invasion capability of cancer cells by counting the number of cells passing through the membranes. Cell proliferation and apoptosis were examined by Cell Counting Kit-8 (CCK-8) and Annexin-V Kit.
PLK1 was positively expressed in 73.2% (41/56) of colorectal cancers tissues, but in only 3.6% (2/56) of normal tissues, and was associated with Duke's stage (P<0.01), tumor size (P<0.01), invasion extent (P<0.05) and lymphatic metastasis (P<0.01). The expression of PLK1 was correlated with expression of PCNA (R=0.553, P<0.01). PLK1 was inhibited in SW1116 cells by treating with PLK1 siRNA oligos, which resulted in a decreased number of cells passing through the membrane as compared with control groups (P<0.01) at 24 hours after transfection. Cell proliferation was inhibited from 48 hours after transfection, while cells apoptosis was induced from 72 hours after transfection.
PLK1 could be a progression marker for colorectal cancer patients and PLK1 depletion can inhibit migration and invasion capability of colorectal cancer cells SW1116, suggesting that PLK1 might be involved in metastasis and invasion of colorectal cancer. Therapeutic strategies targeting PLK1 may be a new approach to colorectal cancer.
Medical science monitor: international medical journal of experimental and clinical research 06/2012; 18(6):BR237-46. · 1.70 Impact Factor
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ABSTRACT: Heat shock protein 70 (Hsp70), a chaperone involved in tumor progression, is overexpressed in various human tumors. However, its role in colon cancer progression is not completely understood. In the present study, two shRNA plasmid vectors against Hsp70 were constructed and stably transfected into the colon cancer cell line HT29 to determine the effect of Hsp70 on cell proliferation, cell cycle distribution and cell apoptosis in HT29 cells in vitro, and its effect on xenograft tumor growth and apoptosis in vivo. Cell proliferation was determined using MTT assay. The results revealed that Hsp70 silencing efficiently inhibited the growth of HT29 cells in culture, induced cell cycle arrest at the G1 phase, and significantly increased apoptosis. Moreover, stable clones from the Hsp70 shRNA-2 vector suppressed xenograft tumor growth and enhanced apoptosis in vivo compared with a mock and vector control group. In conclusion, specific Hsp70 shRNA silencing may inhibit colon cancer growth, indicating that Hsp70 silencing is a potential therapeutic strategy for the treatment of colon cancer.
Molecular Medicine Reports 07/2011; 4(5):805-10. · 0.42 Impact Factor
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ABSTRACT: To evaluate laparoscopic gastric resection for gastrointestinal stromal tumors (GIST).
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.
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.
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 laparoscopy, endoscopy & percutaneous techniques 04/2011; 21(2):101-5. · 1.23 Impact Factor
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Min-Hua Zheng,
Bo Feng,
Chun-Yun Hu, Ai-Guo Lu,
Ming-Liang Wang,
Jian-Wen Li,
Wei-Guo Hu,
Lu Zang,
Zhi-Hai Mao,
Tao-Tao Dong,
Feng Dong,
Wei Cai,
Jun-Jun Ma,
Ya-Ping Zong,
Michael Ka Wah Li
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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 cancer and can provide favorable short-term and long-term outcomes.
Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 12/2010; 19(6):329-39. · 1.33 Impact Factor
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You Li,
Lu Zang,
Wei-guo Hu,
Ming-liang Wang, Ai-guo Lu,
Jian-wen Li,
Jun-jun Ma,
Bo Feng,
Yu Jiang,
Yun-lin Wu,
Zheng-gang Zhu,
Min-hua Zheng
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ABSTRACT: To evaluate laparoscopic radical gastrectomy for early gastric cancer.
A total of 204 patients with early gastric cancer undergoing laparoscopic-assisted radical gastrectomy or open radical gastrectomy between October 2004 and December 2009 were retrospectively reviewed and analyzed. Patients were divided into laparoscopic group(LAP, n=78) and open group (OPEN, n=126). Operative time, blood loss, time to passage of flatus, postoperative hospital stay, complications and pathologic findings were compared between the two groups.
Compared to the OPEN group, operative time in the LAP group was significantly shorter[(202.9±45.6) min vs.(219.8±45.2) min, P<0.05], blood loss was less[(144.5±146.5) ml vs. (245.0±146.4) ml, P<0.05], time to passage of flatus was shorter[(3.1±1.1) d vs.(4.5±1.6) d, P<0.05], postoperative hospital stay was shorter[(10.8±1.2) d vs. (12.4±3.8) d, P<0.05]. However, the two groups were comparable with regard to postoperative complication rate(10.3% vs. 12.7%, P>0.05), proximal resection margin[(4.0±1.9) cm vs. (4.2±1.7) cm, P>0.05], distal resection margin [(3.6±1.7) cm vs. (3.5±1.8) cm, P>0.05], number of harvested lymph node(13.1±6.5 vs. 14.5±8.2, P>0.05). The median follow up was 22(2-64) months. There were no tumor recurrences or metastases in the LAP group. In the OPEN group, only 1 patient died from peritoneal metastasis. Total hospital costs between the two groups were similar(P>0.05).
Laparoscopic radical gastrectomy is a safe, feasible, effective, and less invasive surgery for early gastric cancer.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 12/2010; 13(12):899-902.
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Bo Feng,
Qian-Lin Zhu,
Yi Xia, Ai-Guo Lu,
Ming-Liang Wang,
Jian-Wen Li,
Wei-Guo Hu,
Lu Zang,
Zhi-Hai Mao,
Feng Dong,
Jun-Jun Ma,
Min-Hua Zheng
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ABSTRACT: Few studies evaluate the cost-effectiveness issues of laparoscopic anterior resection (LAR) for rectal cancer. This study evaluates direct and indirect costs of LAR and its long-term survival rate in rectal cancer patients.
This prospective nonrandomized controlled trial included 2 endpoints (direct and indirect costs, and disease-free survival). From January 2003 to May 2005, rectal cancer patients admitted to our center were assigned to 2 groups: 87 patients underwent LAR (LAP), while 86 cases received open anterior resection (OPEN). The direct costs were prospectively evaluated. Main indirect cost is productivity loss. The data of direct costs, indirect costs, and the total costs were collected for the minimal cost analysis.
Disease-free survival at 65 months in the LAP group and the OPEN group was 78.2% and 74.7%; there was no significant difference between the groups. Median direct costs were not significantly different between the LAP and the OPEN groups. Indirect costs of the LAP group were significantly lower than those of the OPEN group, while total costs were not significantly different. Cost percentage for operations, medications, and hospitalization were 75.90%, 11.28%, and 2.18% in the LAP group; while in the operation group, they were 54.50%, 29.09%, and 3.35%.
Total economic budget for a patient receiving LAR was not significantly increased compared with the conservative method owing to its technical predominance, oncologic safety, as well as frequent bed turnover.
Medical science monitor: international medical journal of experimental and clinical research 11/2010; 16(12):PH97-102. · 1.70 Impact Factor
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ABSTRACT: To investigate the effect of oncolytic adenovirus SG600-IL24 and replication-incompetent adenovirus Ad.IL-24 on hepatocellular carcinoma (HCC) cell lines and normal liver cell line.
HCC cell lines (HepG2, Hep3B and MHCC97L) and normal liver cell line (L02) with a different p53 status were infected with SG600-IL24 and Ad.IL-24, respectively. Melanoma differentiation-associated (MDA)-7/interleukin (IL)-24 mRNA and protein expressions in infected cells were detected by reverse transcription-polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA), and Western blotting, respectively. Apoptosis of HCC cells and normal liver cells was detected by cytometric assay with Hoechst33258 staining. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to investigate proliferation of HCC cells and normal liver cells, and cell cycle was assayed by flow cytometry.
RT-PCR, ELISA and Western blotting showed that the exogenous MDA-7/IL-24 gene was highly expressed in cells infected with SG600-IL24. MTT indicated that SG600-IL24 could suppress the growth of HepG2, Hep3B, MHCC97L, with an inhibition rate of 75% ± 2.5%, 85% ± 2.0%, 72% ± 1.8%, respectively (P < 0.01), promote the apoptosis of HepG2, Hep3B, MHCC97L, with an apoptosis rate of 56.59% ± 4.0%, 78.36% ± 3.5%, 43.39% ± 2.5%, respectively (P < 0.01), and block the HCC cell lines in the G2/M phase with a blocking rate of 35.4% ± 4.2%, 47.3% ± 6.2%, 42% ± 5.0%, respectively (P < 0.01) but not the normal liver cell line in a p53-independent manner.
SG600-IL24 can selectively suppress the proliferation and apoptosis of HCC cell lines in vitro but not normal liver cell line L02 in a p53-independent manner. Compared with Ad.IL-24, SG600-IL24 can significantly enhance the antitumor activity in HCC cell lines.
World Journal of Gastroenterology 10/2010; 16(37):4677-84. · 2.47 Impact Factor
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ABSTRACT: Pak1 has been reported to be overexpressed in colorectal cancer, but the role of Pak1 in colorectal cancer remains unclear. In this study, Pak1 expression and activity were associated with aggressive behavior of colorectal cancer. Overexpression of Pak1 increased colorectal cancer cell motility and invasion, whereas down-regulation of Pak1 expression or activity reduced colorectal cancer cell migration and invasion. In addition, activated Pak1 inhibited stress fiber and focal adhesion complex formation in colorectal cancer cells and led to formation of motile phenotypes. Importantly, activated Pak1 elicited phosphorylation of FAK at Ser-910 via an ERK-dependent pathway in colorectal cancer cell lines and clinical samples. In conclusion, our results suggest that activated Pak1 regulates colorectal cancer metastasis requiring an ERK-dependent phosphorylation of FAK at Ser-910.
International Journal of Oncology 10/2010; 37(4):951-62. · 2.40 Impact Factor
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ABSTRACT: To analyze the clinical manifestations and risk factors of complications in laparoscopic low anterior resection (LAR) for rectal cancer patients.
A series of 132 consecutive patients who received laparoscopic LAR for rectal cancer in our center were included. The etiology, diagnosis, treatment and prevention of rectal cancer were studied among the patients with surgery-related complications using both univariate and multivariate regression analysis.
No conversion to open surgery was observed and 5 cases converted to hand-assisted laparoscopic operation. The overall morbidity rate was 20.5%. Complications occurred during the operation in 7 patients (5.3%), within 30 postoperative days in 24 patients (18.2%), and within 3 mo in 2 patients (1.5%). The most significant complications were anastomotic leakage (9.1%) and anastomotic hemorrhage (5.3%). Size and location of tumor, pathological staging and preoperative nutrition were significant factors associated with LAR complications, while gender, age and pathological type showed no relevance. Binary logistics regression showed that the size and location of tumor, and pathological staging were independent factors of laparoscopic LAR. All the complications were treated during their onset of clinical manifestations by interventional or conservative therapy.
Anastomotic leakage is a major complication in laparoscopic LAR. The complications may be associated with tumor size and site, and pathological stage. Interventional therapies are of value in the management of laparoscopic LAR complications.
World Journal of Gastroenterology 09/2010; 16(36):4605-10. · 2.47 Impact Factor
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Qing Ye,
Bo Feng,
Yuan-fei Peng,
Qu Cai,
Xue-hua Chen,
Bei-qin Yu,
Jun-jun Ma, Ai-guo Lu,
Jian-wen Li,
Ming-liang Wang,
Bing-ya Liu,
Min-hua Zheng
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ABSTRACT: To explore the relationship between gamma-synuclein gene expression and CpG island demethylation in colorectal cancer(CRC), and the relationship between the demethylation and clinicopathological factors of CRC.
The expression of gamma-synuclein mRNA was examined in 30 pairs of tumor tissues and tumor-matched non-neoplastic adjacent tissues(NNAT) by RT-PCR. CRC cell lines including COLO205, LoVo, and SW480 were used and treated with a demethylating agent, 5-aza-2'-deoxycytidine(5-aza-C). Before and after the treatment, the expression of gamma-synuclein mRNA in the cells was determined by RT-PCR, and bisulfite sequencing PCR was also used to analyze methylation status of CpG island. The methylation status of gamma-synuclein was then examined in 67 CRC samples and 30 NNAT samples by nested methylation-specific PCR (NMSP) and real time methylation-specific PCR(real-time MSP). The relationship between the demethylation of gamma-synuclein in CRC and clinicopathological factors was analyzed.
The mean gamma-synuclein mRNA expression was 0.66+/-0.34 in CRC samples, which was much higher than 0.45+/-0.26 in NNAT samples(P=0.011). 5-aza-C could induce expression and demethylation of gamma-synuclein in COLO205, LoVo and SW480 cells. gamma-Synuclein gene was demethylated in 80.0%(24/30) of the CRC samples and 50.0%(15/30) of the NNAT samples. The demethylated status of gamma-synuclein was much higher in CRC samples than that in NNAT samples(P=0.030), and was significantly correlated with clinical stage, lymph node involvement, and distant metastasis of CRC(P<0.05).
The upregulation of gamma-synuclein expression in CRC is primarily attributed to the demethylation of CpG island, which may be used as a marker for prognosis.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 06/2010; 13(6):440-4.
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ABSTRACT: To investigate the impact of previous abdominal operations on the outcome of laparoscopic colorectal cancer surgery and to evaluate the feasibility and safety of laparoscopic reoperation in treatment for colorectal cancer.
According to the statistical standards, 653 consecutive patients treated from March 2002 and March 2009 were enrolled in this study. The patients were divided into three groups: upper abdominal surgery group (n = 48), middle-lower abdominal surgery group (n = 110) and non-previous abdominal surgery group (n = 495). Demographic, pathoanatomical and surgical data were compared among the three groups.
There was no significant differences in demographic, pathoanatomical data and post-operative complications among the three groups. Compared with the other two groups, middle-lower abdominal surgery subgroup had a higher intra-operative conversion rate due to intra-abdominal adhesion (4.2%, 11.8% and 3.8% in upper abdominal surgery group, middle-lower abdominal surgery group and non-previous abdominal surgery group, respectively). And no significant differences was found in operating time [(132 ± 36), (141 ± 42), (132 ± 36) min], intra-operation blood loss [(58 ± 50), (81 ± 99), (57 ± 57) ml], blood transfusion rate (6.3%, 10.9%, 7.9%), low sphincter-preserving surgery rate (47.1%, 44.7%, 55.2%), time of first flatus passage [(2.5 ± 1.4), (2.9 +/- 1.7), (2.5 ± 2.1) d], fasting time [(5 ± 4), (5 ± 4), (4 ± 3) d], hospital stay [(17 ± 9), (15 ± 8), (16 ± 10) d] between the three groups.
The history of previous abdominal operations should not be regarded as a contraindication for laparoscopic colorectal cancer reoperation. The laparoscopic reoperation for colorectal cancer is safe and feasible.
Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2010; 48(9):675-80.
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ABSTRACT: The synucleins (alpha-, beta- and gamma-synuclein) are a small, soluble, highly conserved group of neuronal proteins that attracted considerable attention due to their involvement in both neurodegenerative diseases and cancer. In this study, we examined the synuclein exprsssion in colorectal cancer (CRC) tissues, tumor-matched non-neoplastic adjacent tissues (NNAT), and CRC cell lines, and then investigated clinical significance of synucleins. By using semi-quantitative RT-PCR, synuclein mRNA expression was detected in eight CRC cell lines. It was much higher in CRC samples than in NNAT samples (P<0.05). The results of western blotting showed that the levels of synucleins protein expression in CRC cells approximately corresponded to the levels of synuclein mRNA expression. Immunohistochemical staining revealed that gamma-synuclein protein expression was up-regulated in CRC samples compared to NNAT samples (P=0.022), and was significantly correlated with clinical stage and lymph node involvement of CRC (P<0.05). Although, there was no significant difference in either alpha- or beta-synuclein protein expression between tumor and normal samples (P>0.05), often more than one form of synuclein was expressed in a tumor sample. More ratios of later stage and lymph node-positive tumors expressed a least one type of synuclein protein, and more ratios showed positive for either alpha or gamma-synuclein expression, as well as positive either for beta or gamma-synuclein in more ratios of lymph node-positive tumors. These results show that alpha-, beta- and gamma-synuclein are expressed in a high percentage of CRC. gamma-synuclein protein is valuable for evaluation of progression of CRC, and it is more sensitive to predict advanced stage and lymph node invasion by detection of gamma-synuclein protein combined with either alpha- or beta-synuclein protein or both than by detection of gamma-synuclein only.
Oncology Reports 02/2010; 23(2):429-36. · 1.84 Impact Factor
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ABSTRACT: Lymph node metastasis (LNM) is an important indicator for systematic therapy, which could increase the survival of colorectal cancer (CRC) patients. However, effective clinical evaluation for LNM is still absent to date. In this study, protein expression profiles of CRC tissues were compared between patients with and without LNM. Based on average expression level, 12 proteins were found to be differentially expressed in the CRC tissues with LNM, whose discrimination reliability was confirmed by PCA. With stepwise linear discriminant analysis, T-complex protein 1 ζ subunit and peptidyl-prolyl cis-trans isomerase B (PPIB) were identified as two main contributors for separating CRC tissues with positive LNM from those negative ones in both original-grouped and cross-validated-grouped cases, which was also supported in subsequent linear support vector machine analysis. In addition, the expression alterations of the two proteins were verified by Western blot and immunohistochemistry. Functional studies also confirmed the role of PPIB in migration and invasion of cancer cells. Taken together, the down-regulated T-complex protein 1 ζ subunit and up-regulated PPIB were identified as two promising indicators for the clinical evaluation of LNM in CRC patients.
PROTEOMICS - CLINICAL APPLICATIONS 10/2009; 3(10):1225-35. · 1.81 Impact Factor
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ABSTRACT: There is still a debate about the utility of intraoperative cholangiography (IOC) or laparoscopic ultrasonography (LUS) for detection of occult choledocholithiasis during laparoscopic cholecystectomy (LC). The aim of this study was to assess the value of IOC combined with LUS for detection of occult common bile duct (CBD) stones at LC.
From Dec 2002 to Aug 2006, 103 patients with moderate risk of CBD stones underwent IOC and LUS simultaneously during LC. The physician teams for the two different procedures were blinded by each other. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated by several contingency tables that cross-tabulated the results of each technique with those of the gold standard.
The success rate of IOC and LUS were 91.3% and 100% respectively and the time required for LUS was significantly shorter (P<0.01). The visualization of intrapancreatic part of CBD by IOC (97.3%) was significantly higher than LUS (73.8%). The sensitivities, specificities, accuracies, positive and negative predictive values, positive and negative likelihood rations identifying occult CBD stones were 75.0%, 98.7%, 92.2%, 95.5%, 91.4%, 57.7 and 0.253 by IOC, and 82.1%, 98.7%, 94.2%, 95.8%, 93.7%, 63.2 and 0.181 by IUS respectively. The McNemar test showed no significant difference between two methods. The sensitivity of IOC combined with LUS was 92.9%, which was greater than that of IOC and LUS taken separately.
LUS is usually performed in case where IOC has failed or is contraindicated. The combination of both methods maximizes intraoperative detection of occult CBD stones and should at least be recommended as two complementary methods.
Medical science monitor: international medical journal of experimental and clinical research 09/2009; 15(9):MT126-30. · 1.70 Impact Factor
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ABSTRACT: To investigate the influence of CO(2)-insufflation pressure on adhesion, invasion and metastatic potential of colon cancer cells based on adhesion molecules expression.
With an in vitro artificial pneumoperitoneum model, SW1116 human colon carcinoma cells were exposed to CO(2)-insufflation in 5 different pressure groups: 6 mmHg, 9 mmHg, 12 mmHg, 15 mmHg and control group, respectively for 1 h. Expression of E-cadherin, ICAM-1, CD44 and E-selectin was measured at 0, 12, 24, 48 and 72 h after CO(2)-insufflation using flow cytometry. The adhesion and invasion capacity of SW1116 cells before and after exposure to CO(2)-insufflation was detected by cell adhesion/invasion assay in vitro. Each group of cells was injected intraperitoneally into 16 BALB/C mice. The number of visible abdominal cavity tumor nodules, visceral metastases and survival of the mice were recorded in each group.
The expression of E-cadherin, ICAM-1, CD44 and E-selectin in SW1116 cells were changed significantly following exposure to CO(2) insufflation at different pressures (P < 0.05). The expression of E-cadherin, CD44 and ICAM-1 decreased with increasing CO(2)-insufflation pressure. The adhesive/invasive cells also decreased gradually with increasing pressure as determined by the adhesion/invasion assay. In animal experiments, the number of abdominal cavity tumor nodules in the 15 mmHg group was also significantly lower than that in the 6 mmHg group (29.7 +/- 9.91 vs 41.7 +/- 14.90, P = 0.046). However, the survival in each group was not statistically different.
CO(2)-insufflation induced a temporary change in the adhesion and invasion capacity of cancer cells in vitro. Higher CO(2)-insufflation pressure inhibited adhesion, invasion and metastatic potential in vitro and in vivo, which was associated with reduced expression of adhesion molecules.
World Journal of Gastroenterology 07/2009; 15(22):2714-22. · 2.47 Impact Factor
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ABSTRACT: To compare the outcomes of laparoscopic colorectal surgery in elderly (> or = 70 years) and younger(< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly.
From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older(Elder Group), and 15 patients less than 70 years(Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups.
Elder group had a higher ASA degree(P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO(3) value and PaCO(2) value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucosa(PgCO(2)) increased significantly at the end of operation. Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, perfusion, and blood chemistry were not significantly different.
For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2009; 12(3):244-8.
