Mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction for early central breast cancer.

OBJECTIVE: This study aims to evaluate efficacy and safety of mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction for early central breast cancer. MATERIALS AND METHODS: The medical records of patients, who underwent mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction during the period of March 2011 and November 2016, were collected from Fuxing Hospital. Data on clinicopathologic characteristics, operative time, the number of resected sentinel lymph nodes, and complications were analyzed. RESULTS: The procedures were performed in 11 patients with central breast cancer. Among these patients, 10 patients were diagnosed with infiltrating ductal carcinoma, while the remaining patient had Paget's disease with infiltrating ductal carcinoma. The mean operation time was 148.2 minutes with minimal bleeding, and the median number of sentinel lymph nodes dissected from each operation was 4.6. The volume range of implants was 180-245 cc. There were no recurrences and upper limb swelling during the follow-up period. Merely two cases had sporadic axillary pain due to the mastoscopic lymph node dissection performed for the positive sentinel lymph nodes. All patients were satisfied with the reconstructive appearance. CONCLUSION: The present study shows that mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction is a feasible procedure for early central breast cancer. KEY WORDS: Breast cancer, Fat suction, Reconstructive surgery, Sentinel lymph node, Skin sparing mastectomy.

Cooperatively transcriptional and epigenetic regulation of sonic hedgehog overexpression drives malignant potential of breast cancer.

Sonic hedgehog (Shh), a ligand of Hedgehog signaling pathway, is considered an important oncogene and an exciting potential therapeutic target in several cancers. Comprehensive understanding of the regulation mechanism of Shh in cancer cells is necessary to find an effective approach to selectively block its tumorigenic function. We and others previously demonstrated that nuclear factor-kappa B (NF-κB) activation and promoter hypomethylation contributed to the overexpression of Shh. However, the relationship between transcriptional and epigenetic regulation of Shh, and their roles in the malignant phenotype of cancer cells are still not clearly elucidated. In the present study, our data showed that the level of Shh was higher in breast cancer tissues with positive NF-κB nuclear staining and promoter hypomethylation. In addition, survival analysis revealed that Shh overexpression, but not hypomethylation and NF-κB nuclear staining, was a poor prognosis indicator for breast cancers. Moreover, in vitro data demonstrated that both NF-κB activation and hypomethylation in promoter region were positively associated with the overexpression of Shh. Mechanistically, the hypomethylation in Shh promoter could facilitate NF-κB binding to its site, and subsequently cooperate to induce transcription of Shh. Furthermore, the biological function data indicated that overexpressed Shh enhanced the self-renewal capacity and migration ability of breast cancer cells, which could be augmented by promoter demethylation and NF-κB activation. Overall, our findings reveal multiple and cooperative mechanisms of Shh upregulation in cancer cells, and the roles of Shh in tumor malignant behavior, thus suggesting a new strategy for therapeutic interventions to reduce Shh in tumors and improve patients' prognosis.

[Operative experiences on transumbilical single incision laparoscopic cholecystectomy].

OBJECTIVE: To study the feasibility and safety of transumbilical single incision laparoscopic cholecystectomy. METHODS: Eighty-two cases with gallbladder diseases were underwent with transumbilical single incision laparoscopic cholecystectomy. Some difficulties and countermeasure in operations were analyzed. RESULTS: Nine in all patients were converted because of the surrounding inflammation of gallbladder, difficult to dissect in Calot's triangulation and variation of gallbladder artery. Of them, 6 cases converted to two-hole laparoscopic cholecystectomy and 3 cases to open operation. Other 73 cases were successfully operated with transumbilical single incision laparoscopic cholecystectomy. The success rate was 89.0%. The average operative duration was 48.4 min. The average operative blood loss was 20.8 ml. Patients returned to liquid food on the first day after operation. Hospital duration was 3 ~ 6 d. During 13.7 months of follow-up, there was no bile duct injury, large bleeding, incision infection, bile fistula and umbilical hernia. The incision healed well. The scar in umbilicus was concealing and difficult to be observed. CONCLUSIONS: Transumbilical single incision laparoscopic cholecystectomy is safe and feasible. The difficulties in technique are easy to be broken through.

[Clinical study of laparoscopic rectal surgery without abdominal scar].

OBJECTIVE: To assess the feasibility and safety of laparoscopic rectal surgery without abdominal scar. METHODS: A total of 23 patients of rectal cancer were operated by laparoscopy with the assistance of PPH (procedure for prolapse and hemorrhoids) anal expander and TEM (transanal endoscopic microsurgery) outer-shell according to the principle of TME (total mesorectal excision). RESULTS: All operations were successfully accomplished laparoscopically. There was no conversion into an open procedure. The average operative duration was 129 (105 - 211) minutes. The intra-operative blood loss volume was 152 (85 - 420) ml. No immediate or delayed injury of urinary duct and other intra-operative severe complications, such as massive hemorrhage of presacral venous plexus, occurred. There was no pelvic infection or anastomotic stoma fistula during the post-operative period. The average follow-up period was 13.4 months. Neither anastomotic stoma recurrence nor Trocar implantation occurred. CONCLUSION: The laparoscopic technique of hybrid NOTES (Natural Orifice Transluminal Endoscopic Surgery), plus PPH/TEM is both feasible and convenient for selective rectal cancer surgery. There is no need for extra abdominal incision. It is recommended for laparoscopic rectal surgery.

[The anatomical characteristics and its applied significance of laparoscopic rectal surgery].

OBJECTIVE: To realize the anatomical characteristics of laparoscopic rectum surgery and its clinical significance. METHODS: 117 cases with benign and malignant diseases of rectum were operated by laparoscopic methods. The anatomy closely related with operation was analyzed. RESULTS: The median operative time were 144 min. 4 cases were converted to open operations, so the converted rate was 1.7%. The blood loss in operation was rather little with an average of 126 ml. No instant or delayed injury of ureters, large bleeding in front of sacrum and other operation-related severe complications happened intra- and after operation. Dissecting only in one case disrupted the anterior-left wall of rectum. CONCLUSION: Laparoscopic rectal surgery is clinically feasible. Mastering the anatomical characteristics of laparoscopic rectum surgery can make us reduce the operative mistakes and complications.

[Standardized skill of mastoscopic axillary lymph node dissection].

OBJECTIVE: To investigate the standardized skill of mastoscopic axillary lymph node dissection (MALND). METHODS: The clinical results and operation experiences of 473 mastoscopic lymph node dissections performed were analyzed. RESULT: The operation time was 22 - 156 minutes with the average of 42. The operative bleeding was minimal. No case was converted to conventionally open operation because of the uncontrolled bleeding. Fourteen (4 - 38) lymph nodes were removed. There was no intra- or post-operative complication. CONCLUSION: The special view of mastoscopic lymph node dissection makes operative dissection clear. The suitable procedure and standardization of the operative method can stride over the learning curve, so as to quicken the operation and avoid the operative complication.