Lateral pelvic sentinel lymph node biopsy using indocyanine green fluorescence navigation: can it be a powerful supplement tool for predicting the status of lateral pelvic lymph nodes in advanced lower rectal cancer.

BACKGROUND: An innovative instrument for laparoscopy using indocyanine green (ICG) allows easy detection of sentinel lymph nodes (SLNs) in lateral pelvic lymph nodes (LPLNs). Here, we investigated the safety and efficacy of lateral pelvic SLN biopsy (SLNB) using ICG fluorescence navigation in advanced lower rectal cancer and evaluated the sensitivity and specificity of this technique to predict the status of LPLN. METHODS: From April 1, 2017 to December 1, 2020, we conducted lateral pelvic SLNB using ICG fluorescence navigation during laparoscopic total mesorectal excision and lateral pelvic lymph node dissection (LLND) in 23 patients with advanced low rectal cancer who presented with LPLN but without LPLN enlargement. Data regarding clinical characteristics, surgical and pathological outcomes, lymph node findings, and postoperative complications were collected and analyzed. RESULTS: We successfully performed the surgery using fluorescence navigation. One patient underwent bilateral LLND and 22 patients underwent unilateral LLND. The lateral pelvic SLN were clearly fluorescent before dissection in 21 patients. Lateral pelvic SLN metastasis was diagnosed in 3 patients and negative in 18 patients by frozen pathological examination. Among the 21 patients in whom lateral pelvic SLN was detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLN. CONCLUSION: This study indicated that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure for advanced lower rectal cancer with good accuracy, and no false-negative cases were found. No metastasis in SLNB seemed to reflect all negative LPLN metastases, and this technique can replace preventive LLND for advanced lower rectal cancer.

Satisfactory short-term outcomes of totally laparoscopic ileostomy reversal compared to open surgery in colorectal cancer patients.

Background: Recently, totally laparoscopic (TLAP) surgery has suggested its potential on ileostomy reversal. This study aimed to compare the short-term outcomes between TLAP and traditional open ileostomy reversal. Patients and methods: From September 2016 to September 2021, 107 eligible patients underwent TLAP (n = 48) or open (n = 59) loop ileostomy reversal were retrospectively enrolled. Surgical parameters, postoperative recovery and complications were identified and compared between TLAP technique vs. open surgery. Results: The operation time and estimated blood loss showed no obvious difference between TLAP and open group. However, TLAP reversal significantly decreased the incision length (4.5cm vs. 6cm, P < 0.001). Furthermore, patients underwent TLAP surgery showed quicker first ground activities (1 day vs. 2 days, P < 0.001), faster first flatus passage (2 days vs. 3 days, P = 0.004) and shorter postoperative stay (5 days vs. 7 days, P = 0.007). More importantly, postoperative complications were significantly reduced after TLAP reversal (3 cases vs. 10 cases, P = 0.026). Further logistic regression analyses also indicated the TLAP technique was associated with lower incidence of complications (OR=3.316, CI, 1.118-9.835; P = 0.031). Conclusions: TLAP surgery is competitive in promoting postoperative recovery as well as reducing complications compared to the traditional open ileostomy reversal.

Comparison of efficacy between natural orifice specimen extraction without abdominal incision and conventional laparoscopic surgery in the treatment of sigmoid colon cancer and upper rectal cancer.

PURPOSE: To compare the short-term efficacy between natural orifice specimen extraction (NOSE) without abdominal incision and conventional laparoscopic surgery in the treatment of sigmoid colon cancer and upper rectal cancer. METHODS: A total of 86 patients scheduled to undergo laparoscope-assisted radical surgery of sigmoid cancer or upper rectal cancer from January 2015 to September 2017 (T1-3 stages in preoperative imaging evaluation, no distant metastasis, and body mass index <28 kg/m2) were selected and randomly divided into the NOSE group (no abdominal incision, n=43) and conventional laparoscopy group (LA group, n=43). The operation time, amount of intraoperative bleeding, postoperative exhaust time, postoperative diet time, postoperative hospitalization duration, postoperative pain score and perioperative complications were compared between the two groups. The pathological conditions of surgical specimens were recorded. The postoperative recurrence rate of tumor and survival rate of patients were also recorded and compared. RESULTS: The general clinical features were comparable between the two groups, and there were no perioperative deaths. The operation time in NOSE group was slightly longer than that in LA group, without statistically significant difference (p=0.130). In NOSE group, the amount of intraoperative bleeding was significantly smaller than in LA group [(59.31±14.64) mL vs. (75.41±18.16) mL, p<0.001], the postoperative visual analogue scale (VAS) score was significantly lower than that in LA group [(4.2±1.6) points vs. (5.9±1.4) points, p<0.001], and the postoperative exhaust time and regular diet time were significantly shorter than those in LA group [(2.1±1.0) d vs. (2.6±1.2) d, p=0.039, (3.8±1.1) d vs. (4.4±1.4) d, p=0.030]. The cosmetic result in NOSE group was better than that in LA group [(8.0±1.5) vs. (6.4±1.1), p<0.001]. Moreover, the comparison results of surgical specimens showed that there were no statistically significant differences in the intestine resection length, proximal and distal resection margins, tumor size, number of lymph nodes dissected and TNM stage of tumor between the two groups (p>0.05). The postoperative tumor recurrence rate had no significant difference between the two groups (p=0.359), and the Log-rank test revealed that the disease-free survival (DFS) rate had no statistically significant difference between the two groups (p=0.280). CONCLUSIONS: NOSE without abdominal incision has a comparable short-term clinical efficacy to conventional laparoscopic surgery in the treatment of sigmoid cancer and upper rectal cancer, but it significantly reduces the amount of intraoperative bleeding and lowers the pain of patients, with rapid postoperative recovery and high safety, so it is worthy of clinical popularization.

Comparing short-time outcomes of three-dimensional and two-dimensional totally laparoscopic surgery for colon cancer using overlapped delta-shaped anastomosis.

PURPOSE: Overlapped delta-shaped anastomosis is a newly developed intracorporeal procedure in totally laparoscopic surgery for colon cancer. We explored the safety and efficacy of three-dimensional (3D) totally laparoscopic surgery for colon cancer using overlapped anastomosis and compared its short-term outcomes with those of two-dimensional (2D) surgery. MATERIALS AND METHODS: From January 2016 to March 2018, 97 colon cancer patients were grouped into the 3D group (43 patients) and the 2D group (54 patients); they underwent totally laparoscopic surgery for colon cancer using overlapped anastomosis by 3D and 2D laparoscopy, respectively. Data regarding the clinical characteristics, surgical and pathological outcomes, postoperative recovery and complications were collected and compared. RESULTS: These two groups were well balanced in terms of age, gender, body mass index, American Society of Anesthesiologists scores, previous abdominal operation history and preoperative chemotherapy (P>0.05). The overall operation time, intraoperative blood loss and removal method of the specimen were similar between groups (P>0.05), but the anastomosis time was significantly shorter in the 3D group than that in the 2D group (P=0.004). There were no differences in terms of pathological outcomes, postoperative recovery and the postoperative complication rates between the groups (P>0.05). Moreover, no mobility related to the anastomosis, such as anastomotic bleeding, stenosis or leakage, occurred in any patient. CONCLUSION: 3D totally laparoscopic surgery for colon cancer using overlapped delta-shaped anastomosis is safe and effective, with satisfactory short-term outcomes. In addition, it is less time-consuming than 2D surgery regarding the overlapped anastomosis procedure.

Intra-corporeal delta-shaped anastomosis in laparoscopic right hemicolectomy for right colon cancer: a safe and effective technique.

BACKGROUND AND OBJECTIVE: Intra-corporeal delta-shaped anastomosis (IDA) is an important development in laparoscopic digestive-tract reconstruction. We applied it in laparoscopic right hemicolectomy for right colon cancer and compared the short-term outcomes between the patients treated with IDA and conventional extracorporeal anastomosis (EA). METHODS: Between 1 January 2016 and 1 October 2017, 36 and 50 patients who underwent IDA and EA, respectively, were included. Data on clinicopathological characteristics, surgical outcomes, post-operative recovery and complications were collected and compared between the two groups. RESULTS: Surgical outcomes and clinicopathological characteristics were similar between the two groups except the length of incision, which was significantly shorter in the IDA group than in the EA group (4.6 ± 0.6 vs 5.6 ± 0.7 cm, P < 0.001). The time to ground activities, fluid diet intake and post-operative hospitalization did not differ between the groups; however, the time to first flatus was significantly shorter in the IDA group than in the EA group (2.8 ± 0.5 vs 3.2 ± 0.8 days, P = 0.004). The post-operative visual analogue scale for pain was lower in the IDA group than in the EA group on post-operative Day 1 (4.0 ± 0.7 vs 4.5 ± 1.0, P = 0.002) and post-operative Day 3 (2.7 ± 0.6 vs 3.4 ± 0.6, P < 0.001). The surgical complication rates were 8.3 and 16.0% in the IDA and EA groups (P = 0.470), respectively. No complications such as anastomotic bleeding, stenosis and leakage occurred in any patient. CONCLUSIONS: IDA is safe and feasible and shows more satisfactory short-term outcomes than EA.

MicroRNA-21 controls hTERT via PTEN in human colorectal cancer cell proliferation.

Colorectal cancer is a major health problem worldwide. The aim of this study was to determine a role of microRNA-21 (miRNA-21) in colorectal cancer (CRC) and to elucidate miRNA-21 regulation of hTERT by phosphatase and tensin homologue (PTEN). Protein and mRNA samples were extracted with 30 CRC samples and one CRC cell lines. The expression of miRNA-21, hTERT, PTEN in CRC tissues and CRC cell lines was measured by real-time fluorescent quantitative PCR, Western blotting. Cell viability was detected by MTT and cell cycle assay. In this study, we show that the expression of miRNA-21 was overexpressed in CRC tissue and CRC cell lines compared with the control group. The effects of miRNA-21 were then assessed in MTT assays through in vitro transfection with a miRNA-21 mimic or inhibitor. PTEN has been identified as a target gene of miRNA-21 in CRC cell lines. Moreover, Western blot and qRT-PCR analyses revealed that miRNA-21 increased the expression of human telomerase reverse transcriptase (hTERT) via the PTEN/ERK1/2. In addition, Western blot analyses confirmed that an inverse correlation between PTEN and hTERT levels of high miRNA-21 RNA-expressing CRC tissues and cell lines. Finally, these data indicate that miRNA-21 regulates hTERT expression via the PTEN/ERK1/2 signaling pathway, therefore controlling CRC cell line growth. MiRNA-21 may serve as a novel therapeutic target in CRC.

New perspectives on ß-catenin control of cell fate and proliferation in colon cancer.

Colorectal cancer is a major health problem worldwide. Aberrant activation of the Wingless-type mouse mammary tumor virus integration site family(Wnt)/ß-catenin signaling pathway is the most common and initial alteration in sporadic colorectal tumors. Numerous experimental studies have indicated that ß-catenin is a key regulator of colorectal cancer. Indeed, ß-catenin activity was shown to designate colon cancer stem cells (CSC) and is, therefore, an attractive target for new therapeutic agents. Thus, it is necessary to further understand its biology and search for effective therapy. Here we review the current literature regarding the functions of ß-catenin control of intestinal cell fate and proliferation. Further, we provide a brief commentary on our current understanding of the role that ß-catenin plays in colorectal tumor. These results show that ß-catenin may serve as a good diagnosis biomarker of early-stage tumor development and a novel potential therapeutic target for colon cancer.

Sphincter-preserving surgery after preoperative radiochemotherapy for T3 low rectal cancers.

The aim of this study was to evaluate the feasibility and the effectiveness of preoperative radiochemotherapy followed by total mesorectal excision (TME) and sphincter-preserving procedures for T3 low rectal cancer. Patients with rectal cancer and T3 tumors located within 1-6 cm of the dentate line received preoperative radiochemotherapy. Concurrent 5-fluorouracil-based radiochemotherapy was used. Radical resection with TME and sphincter-preserving procedures were performed during the six to eight weeks following radiotherapy. Survival was analyzed using the Kaplan-Meier method. The anal function was evaluated using the Wexner score. The clinical response rate was 83.5%, overall downstaging of T classification was 75.3% and pathological complete response was 15.3%. The anastomotic fistula rate was 4.7%. A median follow-up of 30 months showed the local recurrence rate to be 4.7% and the distant metastasis rate to be 5.9%. The three-year overall survival rate was 87%. The degree of anal incontinence as measured using the Wexner score decreased over time, and the anal sphincter function in the majority of patients gradually improved. Preoperative radiochemotherapy was found to improve tumor downstaging, reduces local recurrence, increase the sphincter preservation rate, and is therefore of benefit to patients with T3 low rectal cancer.