Hand-assisted laparoscopic resection versus total laparoscopic gastric surgery for primary gastric gastrointestinal stromal tumors (GISTs): an analysis from a high-volume institution.

BACKGROUND: Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) is technically feasible and associated with favorable outcomes. We compared the clinical efficacy of hand-assisted laparoscopic surgery (HLS) and total laparoscopic surgery (TLS) for gastric GISTs. METHODS: We retrospectively analyzed the clinical data of 69 consecutive patients diagnosed with a gastric GIST in a tertiary referral teaching hospital from December 2016 to December 2020. Surgical outcomes were compared between two groups. RESULTS: Fifty-three patients (TLS group: n = 36; HLS group: n = 17) were included. The mean age was 56.9 and 58.1 years in the TLS and HLS groups, respectively. The maximum tumor margin was significantly shorter in the HLS group than in the TLS group (2.3 ± 0.9. vs. 3.0 ± 0.8 cm; P = 0.004). The operative time of the HLS group was significantly shorter than that of the TLS group (70.6 ± 19.1 min vs. 134.4 ± 53.7 min; P < 0.001). The HLS group had less intraoperative blood loss, a shorter time to first flatus, and a shorter time to fluid diet than the TLS group (P < 0.05). No significant difference was found between the groups in the incidence or severity of complications within 30 days after surgery. Recurrence or metastasis occurred in four cases (HLS group; n = 1; TLS group; n = 3). CONCLUSIONS: This study demonstrated that compared with TLS, HLS for gastric GISTs has the advantages of simpler operation, shorter operative time, and faster postoperative recovery.

High Expression of Peroxiredoxin 1 Is Associated with Epithelial-Mesenchymal Transition Marker and Poor Prognosis in Gastric Cancer.

BACKGROUND Recent studies show that peroxiredoxin 1 (Prdx1) contributes to the progression and poor prognosis of carcinoma through multiple mechanisms. However, there is little information on its expression and prognostic value in gastric cancer. This study investigated the expression of Prdx1 in gastric cancer, along with evaluating its clinical-pathological and prognostic importance. MATERIAL AND METHODS A total of 189 pairs of gastric cancer and paracarcinomatous tissues were assessed for Prdx1 expression and its association with clinical characteristics. The molecular mechanism was further investigated through in vitro experimentation. RESULTS The mRNA and protein levels of Prdx1 in the GC tissues were higher than in the peri-tumor tissues. We also found that high Prdx1 expression was positively correlated with the lymph node invasion and poor prognosis. It also served as an autonomous prognostic factor for patients with gastric cancer. Moreover, Prdx1 regulates the invasion and metastasis of GC cell lines through inhibiting E-Ca expression. CONCLUSIONS Prdx1 can promote epithelial-mesenchymal transition and gastric cancer progression. Therefore, it might be a therapeutic target and prognostic indicator for gastric cancer patients.

Stromal Myofibroblasts Are Associated with Poor Prognosis in Solid Cancers: A Meta-Analysis of Published Studies.

OBJECTIVE: Published studies have evaluated the impact of stromal myofibroblasts on prognosis in solid cancers. However, the results of these studies remain controversial. We therefore performed a meta-analysis to address this issue. METHODS: The PubMed, ISI Web of Science and Embase databases were searched through November 30th, 2015 by two investigators, and a total of 17 studies that contained 2606 patients were included. Stromal myofibroblasts were quantified in solid cancers using α-smooth muscle actin staining. Pooled Odds Ratio with 95% Confidence Intervals were calculated, and publication bias was analyzed. RESULTS: The results of this study suggest that in solid cancers, a high density of stromal myofibroblasts is significantly associated with poor 3- and 5-year overall survival (pooled odds ratio (95% confidence interval): 1.33 (1.10-1.60) for 3-year overall survival and 1.68 (1.22-2.32) for 5-year overall survival). In addition, a high density of stromal myofibroblasts also predicted poor 3- and 5-year disease-free survival (1.30 (1.05-1.60) for 3-year disease-free survival and 1.36 (1.01-1.83) for 5-year disease-free survival). However, stromal myofibroblasts were not associated with 3- and 5-year cancer-specific survival. No publication bias was found for all analyses. CONCLUSIONS: The results of this study suggest that a high density of stromal myofibroblasts is associated with poor survival in solid cancers. More studies were required to investigate the prognostic value of stromal myofibroblasts in different types of solid cancers.

[Study of operative procedures of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction].

OBJECTIVE: To explore the procedures and the clinical significance of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction. METHODS: Nine cases were assigned randomly to laparoscopically assisted sigmoid colpopoiesis and laparoscopic sigmoid colon colpopoiesis. The procedure of laparoscopically assisted sigmoid colpopoiesis: with the auxiliary of laparoscopy, dissected the distal portion of the sigmoid with endoscopic linear cutter, then a 4-cm incision was made in the left lower abdomen to retract and dissect the proximal portion of sigmoid. After the proximal portion of transplant-sigmoid was closed, the proximal cut end of reserved-sigmoid was placed with the anvil and made a purse-string suture, then put back sigmoid into the peritoneal cavity. A curved intraluminal stapler was inserted from the anus to the most distal cut end of reserved-sigmoid to end-end anastomose the reserved-sigmoid. Finally, an artificial canal was made between urethravesicae and rectum and the transplant-sigmoid with the blood supply was placed into the artificial canal to create an artificial vagina. The procedure of laparoscopic sigmoid colpopoiesis was performed under laparoscopy thoroughly. RESULTS: We have successfully completed the operations for 9 patients, and made 1 - 19 month following-up. The results of the artificial vaginae of all cases were satisfactory; the abdominal scar was small with remarkable cosmetic effects. Moreover, 5 cases had pleasant sexual intercourses. CONCLUSION: The procedures of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction can replace the traditional laparotomy.