A meta-analysis: laparoscopic versus open liver resection for large hepatocellular carcinoma.

BACKGROUND: The indication of laparoscopic liver resection (LLR) for treating large hepatocellular carcinoma (HCC) is controversial. In this study, we compared the short-term and long-term outcomes of LLR and open liver resection (OLR) for large HCC. MATERIAL AND METHODS: We searched eligible articles about LLR versus OLR for large HCC in PubMed, Cochrane Library, and EMBASE and performed a meta-analysis. RESULTS: Eight publications involving 1,338 patients were included. Among them, 495 underwent LLR and 843 underwent OLR. The operation time was longer in the LLR group (MD: 22.23, 95% CI: 4.14-40.33, p = 0.02). but the postoperative hospital stay time was significantly shorter (MD : -4.88, CI: -5.55 to -4.23, p < 0.00001), and the incidence of total postoperative complications and major complications were significantly fewer (OR: 0.49, 95% CI:0.37-0.66, p < 0.00001; OR: 0.54, 95% CI:0.36 - 0.82, p = 0.003, respectively). Patients in the laparoscopic group had no significant difference in intraoperative blood loss, intraoperative transfusion rate, resection margin size, R0 resection rate, three-year overall survival (OS) and three-year disease-free survival (DFS). CONCLUSION: LLR for large HCC is safe and feasible. This surgical strategy will not affect the long-term outcomes of patients.

Clinical efficacy of laparoscopic modified Parks operation on the ultra-low rectal cancer. / è ¹è ”é•œä¸‹æ”¹è‰¯Parksæœ¯æ²»ç–—è¶ ä½Žä½ç›´è‚ ç™Œçš„ä¸´åºŠç–—æ•ˆ.

OBJECTIVES: To investigate the clinical efficacy of laparoscopic modified Parks operation on the patients with ultra-low rectal cancer. METHODS: According to the preoperative stage and intraoperative anastomotic position, 98 patients with ultra-low rectal cancer above T2 stage underwent laparoscopic Dixon operation, modified Parks operation and Miles operation, respectively. All patients were divided into 3 groups: a Dixon operation group (n=39), a modified Parks operation group (n=43) and a Miles operation group (n=16). The clinical data and postoperative follow-up results were collected, compared, and analyzed to evaluate the clinical efficacy of laparoscopic modified Parks operation. RESULTS: The patients were more obese, the distance between tumor and anal margin was closer, and the operation time was longer in the modified Parks operation group than those in the Dixon operation group (all P<0.05). However, the results of bleeding volume, the number of lymph nodes and the postoperative complications in the modified park operation group were similar than those in the Dixon operation group (all P>0.05). In addition, the exhaust and defecation time and the hospitalization time were shorter, and the total cost of hospitalization was lower in the modified Parks operation group than those in the Dixon operation group (all P<0.05). Although the anal function in the modified Parks operation group was poor in the early postoperative period, it reached the same level as that in the Dixon operation group from 6 months after the treatments with the regular anal function exercise (P>0.05). There were no significant differences in tumor size, body shape, distance between tumor and anal margin, operation time, bleeding volume, number of lymph nodes detected, postoperative exhaust and defecation time between the Miles operation group and the modified Parks operation group, but the hospitalization time was shorter, the incidence of complications and the total cost of hospitalization were lower in the modified Parks operation group (all P<0.05). CONCLUSIONS: Laparoscopic modified Parks operation is a safe, economical and effective anus preservation operation, which can not only save the anus for some patients who had to perform Miles operation, but also recover better and faster after operation. Although the early anal function of patients performed with the modified operation is poor, it can gradually recover to the same level as the patients performed with the Dixon operation.

Anal function and quality of life analysis after laparoscopic modified Parks for ultra-low rectal cancer patients.

BACKGROUND: To assess postoperative anal function and quality of life of ultra-low rectal cancer patients treated by laparoscopic modified Parks surgery. METHODS: From February 2017 to March 2019, 114 patients with ultra-low rectal cancer above T2 were treated respectively with ultra-low anterior resection (Dixon), modified coloanal anastomosis (modified Parks), and Miles according to the preoperative stage and anastomotic position. The postoperative anal function and Fecal Incontinence Quality of Life Scale (FIQL) of each patient were collected and synthetically analyzed. RESULTS: Compared with the Dixon group, the postoperative anal function and FIQL in the Parks group were poor at the early stage. However, from 6 to 12 months after surgery, the scores of anal function and FIQL in the Parks group were similar to those in the Dixon group (P > 0.05). Compared with the Miles group, the FIQL of the two groups were similar in the early postoperative stage. However, with the passage of time, from 3 to 9 months after surgery, the four domains of FIQL in the Parks group were higher than those in the Miles group successively (P < 0.05). CONCLUSIONS: Laparoscopic modified Parks is a safe, effective, and economical anus-preserving surgery. Although its early anal function and FIQL were poor, it could gradually recover to the similar level as Dixon. Moreover, it can save the anus and obtain a better postoperative quality of life for some patients who previously could only undergo Miles.

[Laparoscopy combined with total intersphincteric resection for extremely low rectal cancer].

OBJECTIVE: To investigate the feasibility and therapeutic effect of laparoscopy combined with total intersphincteric resection (Total-ISR) for extremely low rectal cancer.
 Methods: We performed laparoscopy combined with Total-ISR in 45 patients with extremely low rectal cancer (1.0 cm≤the lower edge of tumor to the anal edge≤3.0 cm) from January 2014 to December 2016. The operation time, blood loss, resection margin and overall incidence of postoperative complications were observed. The rate of local recurrence and distant metastasis after surgery during the median following-up time of 20.5 months were observed. Anal function at 3, 6, and 12 months after operation were compared.
 Results: The operation for 45 cases were successful without perioperative death. The operation time was (220±33) min and blood loss was (110±31) mL. The surgical margins were all negative. The incidence of postoperative complication was 6.7% (3/45) and no one suffered anastomotic leakage. After a median follow-up of 20.5 (6-30) months, 2 cases developed local recurrence and 1 case developed distant metastasis. According to Kirwan grade, the grade II was 24.4% (11/45), grade III was 57.8% (26/45) in 3 months after operation, and the grade II increased to 51.1% (23/45), the grade III decreased to 35.5% (16/45) after 6 months. Seven out of 40 patients in 12 months after operation reached the grade I, and 25 patients reached the grade II. There were significant differences between 3 months and 6 months, 6 months and 12 months after operation (P<0.05) in the anal function situation.
 Conclusion: It is feasible, for appropriate patients, to perform laparoscopic combined with total-ISR, especially for the patients with extremely low rectal cancer that were in early stage without invasion to the extemal sphincter. The procedure has the advantages of radical sphincter-saving, minimal invasion and economy.

The clinical significance of circulating GPC1 positive exosomes and its regulative miRNAs in colon cancer patients.

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Recent study found an increased level of glypican-1 positive (GPC1+) plasma exosomes in patients with stage II CRC, but decreased levels of plasma miR-96-5p and miR-149. This study further investigated the clinical significance of plasma GPC1+ exosomes and plasma miR-96-5p and miR-149 levels in stage III CRC patients. To study the effect of these microRNAs on GPC1+ plasma exosomes, we isolated and purified exosomes and overexpressed human GPC1 and the microRNAs miR-96-5p and miR-149 by adenovirus vectors. Overexpression of GPC1 activated epithelial-mesenchymal transition (EMT) which then increased invasion and migration in HT29 and HCT-116 colon cancer cells. In contrast, silencing GPC1 expression and overexpressing miR-96-5p and miR-149 significantly inactivated EMT and decreased invasion and migration of HT29 and HCT-116 cells. miR-96-5p and miR-149 inhibitors significantly increased invasion and migration of HT29 and HCT-116 cells. Our results indicate that high levels of circulating GPC1 positive exosomes before and after surgery as well as low circulating miR-96-5p and miR-149 before surgery indicated a severe clinical status and poor prognosis in stage III colon cancer patients. We conclude that GPC1 can be a biomarker for relapse of stage III CRC and may be involved in EMT activation, invasion, and migration of colorectal cancer cells.

GPC1 exosome and its regulatory miRNAs are specific markers for the detection and target therapy of colorectal cancer.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. However, a biomarker for a sensitive and simple diagnostic test and highly effective target therapy of CRC is still clinically unavailable. This study is to investigate the evidence and significance of plasma GPC1 positive exosomes as a biomarker of CRC. Results showed that GPC1+ exosomes were successfully isolated from tissues and plasma. The percentage of GPC1+ exosomes and the GPC1 protein expression in exosomes from tumour tissues and plasma of CRC patients before surgical treatment was significantly elevated compared to that in the peritumoural tissues and the plasma of healthy controls. miR-96-5p and miR-149 expression in tumour tissues and plasma of CRC patients as well as in the GPC1+ exosomes from CRC patients were significantly decreased compared to that in the peritumoural tissues and the plasma of healthy controls. Two months after surgical treatment, levels of all tested markers significantly normalized. Overexpression of miR-96-5p and miR-149 significantly decreased GPC1 expression in HT-29 and HCT-116 cells, xenograft tumours, plasma in mice bearing HT-29 and HCT-116 tumours, and the secretion of GPC1+ exosomes from the HT-29 and HCT-116 cells and xenograft tumours. Overexpression of miR-96-5p and miR-149 significantly decreased cell viability and increased cell apoptosis in HT-29 and HCT-116 cells, and inhibited the growth of xenograft HT-29 and HCT-116 tumours. In conclusion, the increased plasma GPC1+ exosomes and reduced plasma miR-96-5p and miR-149 expression are specific markers for the diagnosis of CRC and targets for the therapy of CRC.