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Objective: To compare the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) 18 to 75 years old; (2) gastric cancer proved by preoperative gastroscopy, CT and pathological results and tumor was suitable for D2 radical distal gastrectomy; (3) postoperative pathological diagnosis stage was T1-4aN0-3M0 (according to the AJCC-7th TNM tumor stage), and the margin was negative; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, and American Association of Anesthesiologists (ASA) grade 1 to 3; (5) no mental illness; (6) able to answer questionnaires independently; (7) patients agreed to undergo laparoscopic distal gastrectomy and signed an informed consent. Exclusion criteria: (1) patients with severe chronic diseases and American Association of Anesthesiologists (ASA) grade >3; (2) patients with other malignant tumors; (3) patients suffered from serious mental diseases; (4) patients received neoadjuvant chemotherapy or immunotherapy. According to the above criteria, clinical data of 200 patients who underwent laparoscopic distal gastrectomy at the Department of General Surgery of the First Affiliated Hospital of Army Medical University from January 2016 to December 2019 were collected. Of the 200 patients, 108 underwent uncut Roux-en-Y anastomosis and 92 underwent Billroth II with Braun anastomosis. The general data, intraoperative and postoperative conditions, complications, and endoscopic evaluation 1 year after the surgery were compared. Besides, the quality of life of two groups was also compared using the Chinese version of the European Organization For Research and Treatment of Cancer (EORTC) quality of life questionnaire-Core 30 (QLQ-C30) and quality of life questionnaire-stomach 22 (QLQ-STO22). Results: There were no significant differences in baseline data between the two groups (all P>0.05). All the 200 patients successfully underwent laparoscopic distal gastrectomy without intraoperative complications, conversion to open surgery or perioperative death. There were no significant differences between two groups in operative time, intraoperative blood loss, postoperative complications, time to flatus, time to removal of gastric tube, time to liquid diet, time to removal of drainage tube or length of postoperative hospital stay (all P>0.05). Endoscopic evaluation was conducted 1 year after surgery. Compared to Billroth II with Braun group, the uncut Roux-en-Y group had a significantly lower incidences of gastric stasis [19.8% (17/86) vs. 37.0% (27/73), χ(2)=11.199, P=0.024], gastritis [11.6% (10/86) vs. 34.2% (25/73), χ(2)=20.892, P<0.001] and bile reflux [1.2% (1/86) vs. 28.8% (21/73), χ(2)=25.237, P<0.001], and the differences were statistically significant. The EORTC questionnaire was performed 1 year after surgery, there were no significant differences in the scores of QLQ-C30 scale between the two groups (all P>0.05), while the scores of QLQ-STO22 showed that, compared to the Billroth II with Braun group, the uncut Roux-en-Y group had a lower pain score (median: 8.3 vs. 16.7, Z=-2.342, P=0.019) and reflux score (median: 0 vs 5.6, Z=-2.284, P=0.022), and the differences were statistically significant (all P<0.05), indicating milder symptoms. Conclusion: The uncut Roux-en-Y anastomosis is safe and reliable in laparoscopic distal gastrectomy, which can reduce the incidences of gastric stasis, gastritis and bile reflux, and improve the quality of life of patients after surgery.
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Adolescente , Adulto , Anciano , Humanos , Persona de Mediana Edad , Adulto Joven , Anastomosis en-Y de Roux/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Gastrectomía/métodos , Gastroenterostomía/efectos adversos , Laparoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Estudios Retrospectivos , Neoplasias Gástricas/patología , Resultado del TratamientoRESUMEN
BACKGROUND: This study aims to assess the learning curve of robotic distal gastrectomy (RDG) and robotic total gastrectomy (RTG) for gastric cancer. METHODS: Data on consecutive patients who underwent robotic gastrectomy for gastric cancer by five surgeons between March 2010 and August 2019 at two high-volume institutions were collected. The learning curve was determined based on the analyses of operation time and postoperative complications within 30 days. Cumulative sum analysis (CUSUM) and risk-adjusted-CUSUM (RA-CUSUM) were applied to identify the turning points (TPs). RESULTS: A total of 899 consecutive patients were included. The mean number of patients needed to overcome the learning curve for operation time of RDG and RTG were 22 and 20, respectively. The number of patients needed to overcome the learning curve for postoperative complications after RDG and RTG were 23 and 18, respectively. The surgical outcomes in the post-TP group were better than in the pre-TP group and improved as surgeons' experience increased. Also, increased case numbers in RDG promoted the RTG learning process. CONCLUSION: The present study demonstrated a substantial influence of surgical cumulative volume on improved surgical outcomes in robotic gastrectomy. Increased experience in RDG may help surgeons to achieve proficiency faster in RTG.
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Gastrectomía/métodos , Laparoscopía/métodos , Curva de Aprendizaje , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias Gástricas/cirugía , Humanos , Tempo Operativo , Estudios RetrospectivosRESUMEN
BACKGROUND: Robotic distal gastrectomy (RDG) has been increasingly used for the treatment of gastric cancer in recent year. However, whether RDG could reduce the morbidity when compared to laparoscopic distal gastrectomy (LDG) remains controversial. This study aimed to compare the morbidity and short-term surgical outcomes of RDG and LDG for gastric cancer and identify the related risk factors. METHODS: Between March 2010 and August 2019, consecutive patients undergoing RDG or LDG (519 and 957 patients, respectively) at our institution were included in this study. Postoperative complications were stratified according to the Clavien-Dindo (C-D) classification. We performed one-to-one propensity score matching (PSM) analysis, and evaluated postoperative morbidity and short-term surgical outcomes in PSM 1032 patients undergoing RDG or LDG. RESULTS: After PSM, the two groups were well-balanced. The mean blood loss of the RDG group was about 27 mL less than that of the LDG group (112.1 vs 139.0 mL, P < 0.001). The RDG group had more retrieved lymph nodes than that in the LDG group (32.7 v 30.2, P < 0.001). The RDG group showed a similar overall (9.9% vs 10.7%, P = 0.682), severe (2.7% vs 3.7%, P = 0.376), local (5.6% vs 5.2%, P = 0.783), and systemic complication rates (5.4% vs 6.0%, P = 0.688). There were no significant differences in mortality between the two groups (RDG 0% vs LDG 0.2%, P = 1.000). Subgroup analyses showed no significant differences in most stratified parameters. Age > 65 years and ASA III were identified as two major risk factors for complications. CONCLUSION: RDG could be a safe and feasible in treating gastric cancer compared to LDG. However, we did not observe significant reduction in postoperative complications of RDG compared with LDG, although the use of robotic system is assumed to provide a technically superior operative environment.
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Laparoscopía , Procedimientos Quirúrgicos Robotizados , Neoplasias Gástricas , Estudios de Cohortes , Gastrectomía/efectos adversos , Humanos , Recién Nacido , Morbilidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
Objective: To determine the effect of peritoneum reconstruction on postoperative complications after laparoscopic low anterior resection (LAR) for rectal cancer. Methods: Retrospective cohort study and propensity score matching were conducted. Case inclusion criteria: (1) pathologically confirmed rectal adenocarcinoma; (2) 18 to 80 years; (3) patients with middle to low rectal cancer undergoing laparoscopic LAR; (4) patients staging cT1-4aN0-2M0 or ycT1-4aN0-2M0 after neoadjuvant therapy; (5) the distance of 4-10 cm from tumor low margin to anal verge. Exclusion criteria: (1) abdominal surgery history (except appendicitis, cholecystitis, ectopic pregnancy); (2) anastomosis above the peritoneal reflection; (3) tumor distant metastasis or clinical staging of T4b during surgery; (4) conversion to open surgery; (5) severe incapacitating disease (American Society of Anesthesiologists classification IV or V, ASA). A total of 666 patients with middle to low rectal cancer undergoing laparoscopic LAR in The First Affiliated Hospital of Army Medical University from January 2017 to June 2020 were enrolled. There were 473 males and 193 females with the median age of 59 (18-80) years. Laparoscopic LAR with peritoneum reconstruction was performed in 188 cases (PR group), and laparoscopic LAR without peritoneum reconstruction was performed in 478 cases (NPR group). After 1:1 propensity score matching according to 1:1 based on age, gender, body mass index, TNM staging, ASA classification, intraoperative blood loss, distance from tumor low margin to anal edge, 153 cases were included in each group. Postoperative complications were classified according to Clavien-Dindo classification. Anastomotic leakage was defined and graded according to the International Study Group of Rectal Cancer (ISGRC) criteria. Results: After propensity score matching, there were no significant differences in baseline demographic characteristics between the 2 groups (all P>0.05), indicating that these two groups were comparable. (1) Operative conditions: All the patients in both groups completed operation successfully. Compared with the NPR group, the PR group had longer operation time [(181.3±60.3) minutes vs. (168.9±51.5) minutes, t=2.185, P=0.029], shorter postoperative median hospital stay [8 (7, 10) days vs. 9 (7, 11) days, Z=-2.282, P=0.022], and the differences were statistically significant (P<0.05). (2) Postoperative complications: The overall morbidity of postoperative complication in PR group and NPR group was 20.3% (31/153) and 24.2% (37/153) respectively, and the incidence of anastomotic leakage was 9.8% (15/153) and 11.1%(17/153) respectively, whose differences were not statistically significant (both P>0.05). Compared with NPR group, PR group had lower morbidity of grade III to IV complications [3.9% (6/153) vs. 11.1% (17/153), χ(2)=5.688, P=0.017] and lower secondary operation rate [1.3% (2/153) vs. 5.9% (9/153), χ(2)=4.621, P=0.032], the differences were statistically significant (both P<0.05). Though PR group had lower incidence of grade C anastomoic leakage [1.3% (2/153) vs. 3.9% (6/153), χ(2)=2.054, P=0.152], but the differences were not statistically significant. (3) Postoperative inflammation: The difference of the procalcitonin level of both PR and NPR groups at postoperative 1-d, 3-d, and 5-d was statistically significant (F=5.222, P=0.010) in time-dependent manner, while the difference was not significant in the interaction effect (P>0.05). No statistically significant differences in the C-reactive protein level between two groups at postoperative 1-d, 3-d, and 5-d were found (all P>0.05). Conclusion: Peritoneum reconstruction in laparoscopic LAR can decrease the morbidity of postoperative complication of grade III to IV and the reoperation rate, and plays an important role in controlling the inflammatory reaction, which has great clinical value.
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Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Fuga Anastomótica , Laparoscopía , Peritoneo , Neoplasias del Recto/cirugía , Estudios RetrospectivosRESUMEN
OBJECTIVE: To compare the short-term outcomes of gastric cancer patients treated with robotic gastrectomy (RG) or laparoscopic gastrectomy (LG). INTRODUCTION: Robotic gastrectomy (RG) has been used for gastric cancer since 2002. This meta-analysis evaluates the safety and efficacy of robotic gastrectomy (RG) and conventional laparoscopic gastrectomy (LG) for gastric cancer. MATERIAL AND METHODS: Pubmed, Embase and The Cochrane Library were searched, and manual searches were performed up to March 31, 2013. Five non-randomized control trials that reported RG and LG for gastric cancer were included. Outcomes evaluated were operation time, number of retrieved LN, blood loss, the length of the resection margin, complications, length of postoperative hospital stay. RESULTS: Of 1796 patients in five studies, 551 were allocated to RG and 1245 to LG. Operation time was significantly shorter in the latter group (weighted mean difference 42.9; 95 % confidence interval 20.87 to 64.92 min; p < 0.05). Blood loss weighted mean difference was -16.07 (95 % confidence interval -32.78 to 0.64 mL; p < 0.05) and postoperative stay weighted mean difference was -1.98 (95 % confidence interval -3.66 to -0.3 days; p < 0.05); both were less in the RG group. LN, length of the resection margin, and postoperative complications were similar in both groups. CONCLUSION: It may be concluded that RG is a safe and comfortable alternative to LG and is justifiable in the light of clinical trials.
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Gastrectomía/métodos , Laparoscopía/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Neoplasias Gástricas/cirugía , Pérdida de Sangre Quirúrgica , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Tempo Operativo , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados/efectos adversosRESUMEN
<p><b>OBJECTIVE</b>To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience.</p><p><b>METHODS</b>Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology.</p><p><b>RESULTS</b>All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis.</p><p><b>CONCLUSION</b>Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.</p>
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Humanos , Procedimientos Quirúrgicos del Sistema Digestivo , Recurrencia Local de Neoplasia , Neoplasias del Recto , Cirugía General , Recto , RobóticaRESUMEN
<p><b>OBJECTIVE</b>To evaluate the effect of different CO2 pneumoperitoneum on IL-1β and IL-6 in abdominal cavity.</p><p><b>METHODS</b>Fifty-six female SD rats were randomly divided into seven groups. One group was served as control and the others received CO2 pneumoperitoneum. Pneumoperitoneum was established at 0.67 kPa and 1.0 L/min gas flow for 1, 2 or 3 h with CO2 (group C1 h, C2 h, and C3 h, respectively). CO2 pneumoperitoneum was further established at 1.07 kPa and 1.0 L/min gas flow for 1 h (group C8p), at 0.67 kPa and 2.0 L/min gas flow for 1 h(group C2f), and at 0.67 kPa and 3.0 L/min gas flow for 1 h (group C3f). After the procedures, peritoneal fluid was collected to analyze the IL-1β and IL-6 level by ELISA method.</p><p><b>RESULTS</b>CO2 pneumoperitoneum caused peritoneal inflammatory reaction. With the increasing of duration and gas flow in CO2 pneumoperitoneum, the concentrations of IL-1β and IL-6 in group C2 h, C3 h and C3f were higher than those in group C1 h (P<0.05). On the other hand, the concentrations of IL-1β and IL-6 in peritoneal fluid did not change significantly when pressure was increased (P>0.05).</p><p><b>CONCLUSIONS</b>The inflammatory reaction in abdominal cavity after CO2 pneumoperitoneum may be attributed to duration and gas flow instead of the pressure within the standard pneumoperitoneum working pressures. Surgeons should reduce surgical duration and adopt low-velocity gas flow within normal working pressures in clinical practice.</p>
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Animales , Femenino , Ratas , Cavidad Abdominal , Dióxido de Carbono , Interleucina-1beta , Metabolismo , Interleucina-6 , Metabolismo , Neumoperitoneo Artificial , Métodos , Ratas Sprague-DawleyRESUMEN
<p><b>OBJECTIVE</b>To study the effect of different CO2 pneumoperitoneum pressures on the expression of adhesion molecules of human gastric cancer cell line MNK-45.</p><p><b>METHODS</b>MKN-45 cells in the experimental groups were exposed to simulated CO2 environment maintained at different pressures (1.2, 1.6, 2.0 kPa) for 4 hours. Control groups were exposed to room air. At the 0, 24, 48, 72, 96 hours after treatment, CD44v6, ICAM-1 and E-cadherin were detected by flow cytometry method.</p><p><b>RESULTS</b>CD44v6 and ICAM-1 expressions showed pattern of firstly elevating, then descending to normal under the pressures of 1.2 kPa and 1.6 kPa. The expressions were different from control group significantly at 24 and 48 hours (P<0.01), while the 72 hours expression showed no difference compared with the controls (P>0.05). E-cadherin expression decreased significantly right after treatment compared to the control (P<0.01), but recovered to the level of control at 48 hours (P>0.05). In the 2.0 kPa group the expression changes of CD44v6, ICAM-1 and E-cadherin were more remarkable. CD44v6 and ICAM-1 expressions were increased significantly compared to control right after treatment (P<0.05). E-cadherin expression was significantly decreased even at 48 hours compared to the controls (P<0.01).</p><p><b>CONCLUSION</b>In vitro CO2 pneumoperitoneum pressures have transient influence on the adhesion molecules expression of gastric cancer cell MKN-45, then those expressions can recover in a short-time.</p>
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Humanos , Cadherinas , Metabolismo , Dióxido de Carbono , Moléculas de Adhesión Celular , Metabolismo , Línea Celular Tumoral , Receptores de Hialuranos , Metabolismo , Molécula 1 de Adhesión Intercelular , Metabolismo , Neumoperitoneo Artificial , Presión , Neoplasias Gástricas , MetabolismoRESUMEN
<p><b>OBJECTIVE</b>To investigate the feasibility and safety of da Vinci robotic-assisted radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>Forty-one patients with gastric cancer from Southwest Hospital between March 2010 and December 2011 underwent da Vinci robotic-assisted radical gastrectomy including total gastrectomy(n=12) and distal gastrectomy (n=29).</p><p><b>RESULTS</b>Conversion was required in two patients. One was converted to open surgery, and the other to conventional laparoscopic surgery. The remaining thirty-nine patients underwent da Vinci robotic-assisted radical gastrectomy successfully. The mean operative time was (285±61) min for total gastrectomy, and (225±39) min for distal gastrectomy. The mean blood loss was (180±157) ml in total gastrectomy, and (150±127) ml in distal gastrectomy. The mean number of harvested lymph nodes was 34.2±18.5. The mean time for gastrointestinal function recovery was (3.1±1.2) days. The time to ambulation was (2.7±1.5) days. The time to oral liquid intake was (3.7±1.5) days. Two patients had complication including wound infection and pneumonia. After follow up ranging from 1 to 21 months (median 11 months), 4 patients died from peritoneal metastasis, 1 survived with tumor, and the remaining 36 patients survived without disease.</p><p><b>CONCLUSIONS</b>da Vinci robotic-assisted radical gastrectomy is a feasible and safe surgical procedure with clear operation field, precise dissection, minimal trauma and fast recovery.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios de Seguimiento , Gastrectomía , Métodos , Estudios Retrospectivos , Robótica , Neoplasias Gástricas , Cirugía GeneralRESUMEN
<p><b>OBJECTIVE</b>To study the effect of hypoxia-inducible factor-1α (HIF-1α) on human gastric cancer cells apoptosis in simulated CO2 pneumoperitoneum environment.</p><p><b>METHODS</b>Applied closed box to simulated CO2 pneumoperitoneum environment under the pressure of 0, 5, 10 and 15 mm Hg (1 mm Hg = 0.133 kPa). Compared HIF-1α mRNA and protein expression of MKN-45 cells before and after silencing HIF-1α by RT-PCR and Western blot. Study the changes of bcl-2/bax expression in MKN-45 cells before and after silencing HIF-1α by immunohistochemistry. The apoptosis ratio of MKN-45 was measured by using Annexin V-FITC/PI double labelled staining.</p><p><b>RESULTS</b>In 15 mm Hg group, HIF-1α mRNA and protein expression of MKN-45 cells (1.48 ± 0.22, 1.34 ± 0.09) and HIF-1α protein expression in 10 mm Hg group (1.25 ± 0.10) were significantly higher than those in control group (0.55 ± 0.17, 0.83 ± 0.04) (P < 0.05). But there was no significant differences among 0, 5, 10 mm Hg group and control group in HIF-1α mRNA (P > 0.05); and no obvious difference was found among 0, 5 mm Hg group and the control group in HIF-1α protein expression (P > 0.05). In 15 mm Hg CO2 pressure, bcl-2/bax expression (0.78 ± 0.05) was obviously lower than that in the control group (1.43 ± 0.15) (P < 0.05) and the apoptosis ratio (11.70 ± 0.12) was significantly higher than the control group (0.22 ± 0.07) (P < 0.01) before silencing HIF-1α. But once HIF-1α was silenced, HIF-1α mRNA (0.52 ± 0.11), HIF-1α protein expression (0.92 ± 0.02), bcl-2/bax ratio (1.57 ± 0.04) and apoptosis ratio (0.45 ± 0.11) in MKN-45 were not significantly different between 15 mm Hg group and the control group (P > 0.05).</p><p><b>CONCLUSIONS</b>The apoptosis ratios of MKN-45 under 0, 5, 10 mm Hg CO2 pneumoperitoneum are comparable with that in the control group before the silencing of HIF-1α. The apoptosis ratio of MKN-45 is increased under 15 mm Hg CO2 pneumoperitoneum environment and HIF-1α may be one of the important factor to improve the apoptosis of human gastric cancer cell.</p>
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Humanos , Apoptosis , Dióxido de Carbono , Fisiología , Línea Celular Tumoral , Vectores Genéticos , Subunidad alfa del Factor 1 Inducible por Hipoxia , Genética , Metabolismo , Neumoperitoneo Artificial , Interferencia de ARN , Neoplasias Gástricas , Metabolismo , PatologíaRESUMEN
<p><b>OBJECTIVE</b>To examine the association of connexin 43 (Cx43) in the intraperitoneal free gastric cancer cells and clinicopathological characteristics.</p><p><b>METHODS</b>Immunohistochemistry and immunofluorescence staining were used to detect connexin 43 in 75 paraffin-embedded gastric cancer tissues, matched paracancerous tissue, and intraperitoneal free gastric cancer cells.</p><p><b>RESULTS</b>The positive rates of Cx43 expression were 33.3% (25/75) in gastric cancer tissue specimens and 100% (75/75) in matched paracancerous tissue (P<0.01). The positive detection rate of free cancer cells in peritoneal lavage was 38.6% (29/75) and the positive rate of Cx43 in peritoneal free gastric cancer cells was 72.4% (21/29), which was significantly higher than that in gastric cancer tissue specimens (P<0.01). Significant association was observed of Cx43 expression of free gastric cancer cells with tumor infiltration and histological type (P<0.05).</p><p><b>CONCLUSION</b>Cx43 gene may be involved in the mechanism of peritoneal metastasis of gastric cancer.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Estudios de Casos y Controles , Conexina 43 , Metabolismo , Metástasis de la Neoplasia , Estadificación de Neoplasias , Neoplasias Peritoneales , Metabolismo , Neoplasias Gástricas , Metabolismo , PatologíaRESUMEN
<p><b>OBJECTIVE</b>To determine the expression of Na+/H+ exchanger 1(NHE1) in human gastric carcinoma tissue and to investigate the association between NHE1 expression and clinicopathological characteristics.</p><p><b>METHODS</b>The expressions of NHE1 mRNA and protein were detected in both gastric carcinoma tissue (n=60) and adjacent gastric mucosa tissue (n=30) by reverse transcription polymerase chain reaction (RT-PCR) and Western blot. The association between the expression and the clinicopathological characteristics was analyzed.</p><p><b>RESULTS</b>The relative expression levels of NHE1 mRNA and protein in gastric carcinoma tissue were 0.786+/-0.291 and 1.442+/-0.175, which were significantly higher than those in adjacent gastric mucosa tissue (0.369+/-0.052 and 0.348+/-0.029) (P<0.01). The expression of NHE1 mRNA was positively correlated with NHE1 protein in the gastric carcinoma tissue (r=0.264, P<0.05). The expressions of NHE1 mRNA and protein were associated with the depth of invasion, lymph node metastasis, and TNM staging (P<0.05). However, no statistical difference was found in age, gender, and tumor differentiation (P>0.05).</p><p><b>CONCLUSION</b>The expression levels of NHE1 mRNA and protein are significantly up-regulated in gastric carcinoma tissue, which may be involved in the development of gastric carcinoma.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma , Metabolismo , Patología , Proteínas de Transporte de Catión , Metabolismo , Pronóstico , ARN Mensajero , Metabolismo , Intercambiador 1 de Sodio-Hidrógeno , Intercambiadores de Sodio-Hidrógeno , Metabolismo , Estómago , Metabolismo , Patología , Neoplasias Gástricas , Metabolismo , PatologíaRESUMEN
<p><b>OBJECTIVE</b>To investigate the changes of the expression of intercellular adhesion molecule-1 (ICAM-1) and integrin beta(1) in peritoneal mesothelial cells during laparoscopy-assisted radical gastrectomy(LARG) and to explore the possible effects of LARG on the peritoneal metastasis.</p><p><b>METHODS</b>From April to August 2008, LARG was performed for 26 patients with gastric cancer (laparoscopy group), while 20 cases underwent open radical gastrectomy(open group). Peritoneum of right upper belly was collected at 3 operation time points(the beginning, 2 hours, 4 hours). The expressions of ICAM-1 and integrin beta(1) in peritoneal mesothelial cells at 3 time points were detected by immunohistochemistry.</p><p><b>RESULTS</b>With the operation prolonging, the expression of ICAM-1 and integrin beta(1) was increased gradually in both LARG and open groups. The expression of integrin beta(1) in two groups was obviously increased at 4-hour time point as compared to the beginning(P<0.05). Besides, there were no significant differences of these two adhesion molecules among the three operation time points between two groups(P>0.05).</p><p><b>CONCLUSIONS</b>Compared with open surgery, LARG is not associated with a greater effect on the expression of ICAM-1 and integrin beta(1) in peritoneal mesothelial cells, and may not promote peritoneal metastasis of gastric cancer through increasing the expression of adhesion molecule in peritoneal mesothelial cells.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Células Epiteliales , Metabolismo , Gastrectomía , Métodos , Integrina beta1 , Metabolismo , Molécula 1 de Adhesión Intercelular , Metabolismo , Laparoscopía , Peritoneo , Biología Celular , Neoplasias Gástricas , Metabolismo , Patología , Cirugía GeneralRESUMEN
<p><b>OBJECTIVE</b>To evaluate male sexual function in a series of rectal cancer patients randomized to laparoscopic(LS) or open surgery(OS).</p><p><b>METHODS</b>Between June 2006 and October 2007, a total of 119 patients with rectal cancer were randomly assigned to laparoscopic(n=60) or open (n=59) resection group. All the patients were treated by D(3) lymphadenectomy combined with pelvic autonomic nerve preservation(PANP) technique. Sexual function was assessed by International Index of Erectile Function(IIEF) before surgery and on 3, 6 and 12 months after operation.</p><p><b>RESULTS</b>Sexual dysfunction rate of LS and OS at 3rd month after operation were 23.3% and 32.3% respectively, and 18.3% vs 27.1% after 6 months, and 11.6% vs 16.9% after 12 months. There were no significant difference between LS and OS in sexual dysfunction rate after surgery.</p><p><b>CONCLUSIONS</b>Laparoscopic D(3) lymphadenectomy combined with PANP is not associated with higher sexual dysfunction rate, and the sexual function after laparoscopic surgery is satisfactory.</p>
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Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Vías Autónomas , Cirugía General , Estudios de Seguimiento , Laparoscopía , Métodos , Escisión del Ganglio Linfático , Estadificación de Neoplasias , Pelvis , Neoplasias del Recto , Cirugía General , Disfunciones Sexuales FisiológicasRESUMEN
<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of laparoscopic radical gastrectomy on gastric cancer through comparison of peritoneal free gastric cancer cells detecting rates between laparoscopic and open radical gastrectomy.</p><p><b>METHODS</b>Sixty-three patients received laparoscopic gastrectomy and 61 patients received open gastrectomy between April 2006 and June 2008 were included in this study. The peritoneal lavage fluid in those patients before and after the operation was collected. The cancer cell cytology and carcinoembryonic antigen (CEA) mRNA were detected with those samples. The relationship between peritoneal free gastric cancer cells and the area of cancer-invaded serosa was also observed.</p><p><b>RESULTS</b>The positive rate of cytology in laparoscopic surgery was 25.4% in the peritoneal fluid after the operation, while it was 29.5% in the open surgery, there was no significant difference between the two groups (P > 0.05). The positive rate of CEA mRNA in the peritoneal fluid after the operation in the laparoscopic group was 41.3%, and was 40.3% in the open group (P > 0.05). The area of cancer-invaded serosa in patients with positive cytology before and after the operation in the laparoscopic group was (16.2 +/- 2.2) cm(2), and it was (17.6 +/- 3.0) cm(2) in their counterparts in the open surgery group, while it was (5.3 +/- 0.8) cm(2) in patients with negative cytology before and after the operation. The area of cancer-invaded serosa was positively correlated with the positive rate of cytology(R(2) = 0.874, P = 0.000).</p><p><b>CONCLUSIONS</b>Laparoscopic radical gastrectomy is not associated with a greater risk for peritoneal dissemination of cancer cells than the open technique.</p>
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Líquido Ascítico , Metabolismo , Patología , Antígeno Carcinoembrionario , Genética , Metabolismo , Estudios de Factibilidad , Gastrectomía , Métodos , Laparoscopía , Invasividad Neoplásica , Siembra Neoplásica , Lavado Peritoneal , ARN Mensajero , Genética , Neoplasias Gástricas , Metabolismo , Patología , Cirugía GeneralRESUMEN
<p><b>OBJECTIVE</b>To investigate the influence of CO(2) and He insufflation administered at different pressures on the migration and cytoskeleton of cultured human gastric cancer cells.</p><p><b>METHODS</b>The cultured gastric cancer cells MKN-45 were exposed to a CO(2) or He environment maintained at different pressures (12, 15 mm Hg). After 0, 2, 4, 6, 8 hours exposure to CO(2) or He environment, pH of the MKN-45 cells culture media was measured with blood gas analysis. The cell migration was detected with Transwell technology. The cell cytoskeleton was observed with laser confocal microscope.</p><p><b>RESULTS</b>The media pH was acid after exposure to CO(2) environment, while it was basic in the He group. The number of cells passing millipore in 12 mm Hg CO(2) or He insufflation pressure were not significantly different with control group (P>0.05), however in 15 mm Hg pressure CO(2) group, it was significantly decreased as compared to control group (P<0.01). The microfilament and microtubule in gastric cancer cell were ambiguous in 15 mm Hg pressure CO(2) group.</p><p><b>CONCLUSIONS</b>There are no obvious effects on the migration and cytoskeleton of MKN-45 cells under 12 mm Hg CO(2) insufflation pressure. The migration and cytoskeleton of MKN-45 cells can be inhibited in 15 mm Hg CO(2) pneumoperitoneum environment.</p>
Asunto(s)
Humanos , Dióxido de Carbono , Línea Celular Tumoral , Movimiento Celular , Supervivencia Celular , Citoesqueleto , Neumoperitoneo Artificial , Presión , Neoplasias GástricasRESUMEN
<p><b>OBJECTIVE</b>To investigate the effects of T lymphoma invasion and metastasis inducing factor 1 antisense oligodeoxynucleotides (Tiam 1 ASODN) transfection on the morphology and invasive migration potential of gastric cancer cells.</p><p><b>METHODS</b>The higher invasive and migratory subgroup (M(H)) were separated from human gastric cancer cell line MKN-45 (M(0)) by laminin adhesion method in vitro. Tiam 1 ASODN was transfected into M(H) cells with liposome, and the expression of Tiam 1 mRNA and protein was determined by RT-PCR and flowcytometry respectively. The changes in morphology, the invasive and migratory potential between Tima 1 ASODN transfected M(H) cells and no transfected M(H) cells were observed by HE stain, cytoskeletal protein stain, scanning electronic microscope (SEM) and Boyden chamber test.</p><p><b>RESULTS</b>Compared with the control, the expression of Tiam 1 mRNA and protein in M(H) cells was significantly decreased after transfected with 0.43 micromol/L ASODN(P< 0.01). The invasive and migratory potential of M(H) cells in vitro was also much more decreased than that of no transfected cells (P< 0.05 or P< 0.01). At the same time, transfected M(H) cells had less membrane surface projections, fewer or shorter pseudopodia, less irregular cytoskeletal network and less spotted-like actin bodys than no transfected M(H) cells did.</p><p><b>CONCLUSION</b>Tiam 1 ASODN transfection can effectively suppress the expression of Tiam 1 in gastric cancer cells and impair its invasive and migratory potential in vitro, which may be fulfilled through modulating the reconstruction of cytoskeleton and decreasing the deforming and migratory potential of gastric cancer cells.</p>
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Animales , Humanos , Ratones , Línea Celular Tumoral , Citometría de Flujo , Factores de Intercambio de Guanina Nucleótido , Genética , Ratones Endogámicos BALB C , Invasividad Neoplásica , Oligonucleótidos Antisentido , Genética , ARN Mensajero , Genética , Neoplasias Gástricas , Genética , Patología , Proteína 1 de Invasión e Inducción de Metástasis del Linfoma-T , TransfecciónRESUMEN
<p><b>OBJECTIVE</b>To investigate the influence of CD4+ CD25+ regulatory T cells(Treg cells) on mouse gastric cancer.</p><p><b>METHODS</b>Treg cell in mouse spleen bearing gastric tumor was tested in different time points. Magic cell sorting(MACS) method was used to purify mouse Treg cells and the Treg cells were injected into mouse bearing gastric tumor with different dosage. After 3 weeks, the tumor size and tumor cell apoptosis rate were measured.</p><p><b>RESULTS</b>Treg existed in normal mouse spleen with a rate of (3.86+/-0.07)%. In tumor model this percentage increased gradually and was (4.12+/-0.13)% after 3 weeks, which was significantly higher than that in control. When Treg cell applied in mouse reached 2.0 x 10(5), the tumor size enlarged significantly(P=0.013) and tumor cell apoptosis rate decreased significantly (P=0.012).</p><p><b>CONCLUSIONS</b>Treg cell is associated with gastric cancer progress in mouse tumor model. Treg cell can promote gastric cancer growth and decrease tumor apoptosis. The anti- Treg GITR can improve anti- tumor effects.</p>
Asunto(s)
Animales , Femenino , Masculino , Ratones , Apoptosis , Citometría de Flujo , Ratones Endogámicos , Bazo , Biología Celular , Neoplasias Gástricas , Alergia e Inmunología , Patología , Linfocitos T Reguladores , Alergia e InmunologíaRESUMEN
<p><b>OBJECTIVE</b>To explore the method of alimentary reconstruction after laparoscopic total gastrectomy.</p><p><b>METHODS</b>The clinical data of 12 patients undergone laparoscopic total gastrectomy and side- to- side esophagojejunal anastomosis from Feb. 2006 to Oct. 2006 were analyzed retrospectively.</p><p><b>RESULTS</b>Laparoscopic side- to- side esophagojejunal anastomosis was successfully performed in 12 patients. The mean operation time was (247.0+/- 13.1) min and the anastomosis time was (43.5+/- 10.4) min. Bleeding volume during operation was (107.5+/- 44.9)ml. The distance between anastomosis and proximal margin of tumor was (3.4+/- 1.2)cm. There was no postoperative death, fistula or anastomotic stenosis occurred after short- term follow- up.</p><p><b>CONCLUSION</b>The modified laparoscopic side- to- side esophagojejunal anastomosis is a safe, less challenging and more economic method of alimentary reconstruction after laparoscopic total gastrectomy.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anastomosis Quirúrgica , Métodos , Esófago , Cirugía General , Gastrectomía , Métodos , Yeyuno , Cirugía General , Laparoscopía , Procedimientos de Cirugía Plástica , Métodos , Estudios Retrospectivos , Neoplasias Gástricas , Cirugía GeneralRESUMEN
<p><b>OBJECTIVE</b>To investigate the treatment efficacy of laparoscopic resection of gastric stromal tumors.</p><p><b>METHODS</b>The clinical data of 30 patients with laparoscopic resection of gastric stromal tumors from Apr. 2004 to Apr. 2006 were retrospectively analyzed.</p><p><b>RESULTS</b>The preoperative diagnosis of gastric stromal tumors mainly relied on gastroscope, ultrasound gastroscope, barium meal and abdominal CT scan. Tumor size ranged from 2 to 10 cm. Surgical procedures included laparoscopic wedge resection for 22 patients, laparoscopic distal gastrectomies for 6 patients, and laparoscopic proximal gastrectomies for 2 patients. All operations were successful, with an average operation time of 120+/-35 min and a blood loss of 5-200 ml. Postoperative length of stay was 4-10 days. No recurrence had occurred during 3-24 months follow-up.</p><p><b>CONCLUSION</b>Laparoscopic resection of gastric stromal tumors is a safe and reliable procedure, with quick postoperative recovery and minimal invasion.</p>