Hui Wang

Sun Yat-Sen University, Shengcheng, Guangdong, China

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Publications (6)9.26 Total impact

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    ABSTRACT: Magnetic resonance imaging and endoluminal ultrasound play an important role in the restaging of locally advanced rectal cancer after preoperative chemoradiotherapy, yet their diagnostic accuracy is still controversial. Meta-analysis was performed to estimate the diagnostic performance of MRI and endoluminal ultrasound. Electronic databases from 1996 to March 2012 were searched. Either MRI or endoluminal ultrasound was used to restage rectal cancer after chemoradiotherapy or radiation. T category, lymph node, and circumferential resection involvement were measured. The sensitivity estimate for rectal cancer diagnosis (T0) by endoluminal ultrasound (37.0%; 95% CI, 24.0%-52.1%) was higher (p = 0.04) than the sensitivity estimate for MRI (15.3%; 95% CI, 6.5%-32.0%). For T3-4 category, sensitivity estimates of MRI and endoluminal ultrasound were comparable, 82.1% and 87.6%, whereas specificity estimates were poor (53.5% and 66.4%). For lymph node involvement, there was no significant difference between the sensitivity estimates for MRI (61.8%) and endoluminal ultrasound (49.8%). Specificity estimates for MRI and endoluminal ultrasound were 72.0% and 78.7%. For circumferential resection margin involvement, MRI sensitivity and specificity were 85.4% and 80.0%. To identify the heterogeneity, metaregression was performed on covariates. However, few of the covariates were identified to be statistically significant because of the lack of adequate original data. Accurate restaging of locally advanced rectal cancer by MRI and endoluminal ultrasound is still a challenge. Identifying T0 rectal cancer by imaging is not reliable. Before performing surgery, restaging is important, but some of the T0-2 patients are likely overestimated as T3-4. Both modalities for lymph node involvement are not very good. Magnetic resonance imaging may be a good method to reassess circumferential resection margin.
    Diseases of the Colon & Rectum 03/2014; 57(3):388-95. DOI:10.1097/DCR.0000000000000022 · 3.20 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess the value of neoadjuvant therapy for resectable rectal cancer and the impact on postoperative complications. METHODS: Literature search was performed in PubMed, Ovid, Web of Science, Springer-Link and Elsevier ScienceDirect for randomized controlled trials published before May 2010 that compared neoadjuvant therapy with surgery alone or postoperative adjuvant therapy. The computer search was supplemented with hand search of reference lists for available primary studies. Inclusion criteria and quality assessment were performed. RESULTS: Eleven studies including 7407 patients were enrolled for analysis. Neoadjuvant therapy group had significant advantages in local recurrence (OR=0.43, 95%CI:0.37-0.50, P<0.01), distant recurrence (OR=0.85, 95%CI:0.76-0.95, P<0.01), 5-year overall survival (RR=1.15, 95%CI:1.04-1.28, P<0.01), and sphincter-saving surgery (RR=1.48, 95%CI:1.17-1.87, P<0.01). There were no significant difference in postoperative mortality rate(OR=1.20, 95%CI:0.68-2.13, P=0.53) and anastomotic complications (OR=1.04, 95%CI:0.73-1.48, P=0.84). CONCLUSION: Neoadjuvant therapy improves local control, distant recurrence and long-term survival without increasing postoperative complications.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 11/2012; 15(11):1150-1155.
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    ABSTRACT: To evaluate the safety and efficacy of self-expending metallic stents (SEMS) as bridge to surgery versus emergency surgery for left-sided malignant colorectal obstruction. A comprehensive literature search of CENTRAL, PubMed, EMBASE, Medline, Ovid LWW, CMB, CNKI and Wanfang Databases were performed for all randomized controlled trials or retrospective studies comparing self-expending metallic stents as bridge to surgery(SABS group) with emergency surgery (ES group). A meta-analysis was carried out by RevMan5.1 software on the outcomes concerning safety and efficacy of the two groups. Fourteen studies matched the criteria including 1083 patients. Five were randomized controlled trials and nine were retrospective analysis. Compared with the ES group, the SABS group had a lower short-term mortality(RR=0.52, 95% CI:0.30-0.93, P<0.05), lower overall complications(RR=0.46, 95% CI:0.31-0.70, P<0.05), higher resection rate(RR=1.90, 95%CI:1.33-2.70, P<0.01), shorter operative time(MD=-59.77, 95%CI:-87.51--32.04, P<0.01), and shorter interval to first flatus(MD=-10.78, 95%CI:-16.67--4.90, P<0.01). There were no statistically significant differences between the two groups in permanent stomy and hospital stay. The safety and efficacy of self-expending metallic stents as bridge to surgery for left-sided malignant colorectal obstruction is superior to emergency surgery.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2012; 15(7):697-701.
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    ABSTRACT: To compare oncologic adequacy of resection and long-term oncologic outcomes between laparoscopic-assisted surgery (LS) and open surgery (OS) in the treatment of rectal cancer. Literature searches of electronic databases (PubMed, Embase, Web of Science,and Cochrane Library) and manual searches up to June 30, 2010 were performed to identify RCTs comparing values of oncologic adequacy of resection, recurrence and survival following LS and OS. Fixed and random effects models were used. Six RCTs enrolling 1033 participants (LS group:577 cases, OS group:456 cases)were included in the meta-analysis. Number of lymph node harvested was similar(WMD=-0.38, 95%CI:-1.35-0.58, P=0.43). LS had a slightly higher circumference resection margin(CRM) positive rate with no statistical significance[7.94% vs. 5.37%; risk ratio(RR)=1.13; 95%CI:0.69-1.85, P=0.63]. There was no significant difference between the two groups in local recurrence (RR=0.55; 95%CI:0.22-1.40, P=0.21). The 3-year overall survival [Hazard ratio(HR)=0.76; 95%CI:0.54-1.07, P=0.11] and 3-year disease-free survival(HR=1.16; 95%CI:0.61-2.20, P=0.64) were not significantly different between the two groups. Compared with open surgery, laparoscopic surgery of rectal carcinoma offers similar oncological clearance and long-term oncological outcomes.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 08/2011; 14(8):606-10.
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    ABSTRACT: Whether laparoscopic-assisted surgery (LS) can achieve the same oncologic outcomes compared with open surgery (OS) for rectal cancer remains controversial. The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare oncologic adequacy of resection and long-term oncologic outcomes of LS with OS in the treatment of rectal cancer. Literature searches of electronic databases (Pubmed, Embase, Web of Science, and Cochrane Library) and manual searches were performed to identify RCTs comparing values of oncologic adequacy of resection, recurrence, and survival following LS and OS. Six RCTs enrolling 1,033 participants were included in the meta-analysis. LS was associated with similar number of lymph nodes harvested and a similar distal tumor-free margin. LS was associated with a slightly high circumferential resection margin (CRM) positive rate with no significant difference (7.94% vs. 5.37%; risk ratio [RR], 1.13; P = 0.63). There was no significant difference between the two groups in local recurrence (RR, 0.55; P = 0.21). The 3-year overall survival advantage for LS over OS was not statistically significantly different (hazard ratio [HR], 0.76; P = 0.11). The 3-year disease-free survival was not significantly different between the two groups (HR, 1.16; P = 0.64). The meta-analysis suggests that there are no differences between laparoscopic-assisted and open surgery in terms of number of lymph nodes harvested, involvement of CRM, local recurrence, 3-year overall survival, and disease-free survival for rectal cancer. However, more high-quality studies are needed for further analysis due to the small number of included studies.
    International Journal of Colorectal Disease 12/2010; 26(4):415-21. DOI:10.1007/s00384-010-1091-6 · 2.42 Impact Factor
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    ABSTRACT: Liver-specific gene therapy is advantageous to minimize the possible adverse effects caused by non-target gene expression. The CMV promoter of the enhanced green fluorescent protein (EGFP) expressing plasmid pCMV-EGFP was replaced with the liver-specific promoter apolipoprotein A-I (ApoAI) generating pApoAI-EGFP plasmid. In vitro expression experiments performed in various cell lines including HepG2, SMMC-7721, MCF7, ACC-2 and Lo2 indicated that pCMV-EGFP treatment caused gene expression in all the cell lines, whereas pApoAI-EGFP treatment only induced EGFP expression in cells of liver origin including the liver cancer cells HepG2 and SMMC-7721 and the normal liver cells Lo2. Either pCMV-EGFP or pApoAI-EGFP was formulated as pegylated immuno-lipopolyplexes (PILP), a novel and efficient gene delivery system. Following intravenous administration of the PILP in H22 tumor-bearing mice, there was significant EGFP expression in liver, tumor, spleen, brain and lung in the pCMV-EGFP treated mice, whereas in the pApoAI-EGFP treated mice there was only gene expression in liver and tumor and the non-liver organ gene expression was eliminated. This study suggests that the use of the PILP technology and liver-specific promoter enables efficient and liver-specific expression of an exogenous gene.
    International Journal of Pharmaceutics 10/2010; 398(1-2):161-4. DOI:10.1016/j.ijpharm.2010.07.023 · 3.65 Impact Factor