Programmed death-ligand 1 expression in the tumour stroma of colorectal liver oligometastases and its association with prognosis after liver resection.

BACKGROUND: The clinical value of programmed death-ligand 1 (PD-L1) expression in colorectal liver oligometastases (CLOs) remains undefined. This study aimed to detect PD-L1 in the microenvironment of CLOs and determine its association with patient prognosis. METHODS: We collected 126 liver-resection specimens from CLO patients who underwent curative liver resection between June 1999 and December 2016. Immunohistochemistry (IHC) was performed to assess PD-L1 expression in paraffin-embedded specimens. Overall survival (OS) and recurrence-free survival (RFS) were analysed using the Kaplan-Meier method and log-rank test. RESULTS: PD-L1 was mainly expressed in the stroma of liver oligometastases. Patients with high PD-L1 expression had a higher proportion of clinical-risk scores (CRSs) of 2-4 (67.7% vs 40.4%; P = 0.004). With a median 58-month follow-up, patients with high PD-L1 expression had a significantly lower 3-year OS rate (65.5% vs 92.7%; P = 0.001) and 3-year RFS rate (34.7% vs 83.8%; P < 0.001) than patients with low PD-L1 expression. Multivariate Cox analysis demonstrated that high PD-L1 expression (hazard ratio [HR] = 3.581; 95% confidence interval [CI] 2.301-9.972; P = 0.015), CRS 2-4 (HR = 6.960; 95% CI 1.135-42.689; P = 0.036) and increased preoperative CA19-9 (HR = 2.843; 95% CI 1.229-6.576; P = 0.015) were independent risk factors for OS. High PD-L1 expression (HR = 4.815; 95% CI 2.139-10.837; P < 0.001) and lymph-node metastasis (HR = 2.115; 95% CI 1.041-4.297; P = 0.038) were independent risk factors for RFS. CONCLUSION: This study found that PD-L1 was commonly expressed in the tumour stroma of CLOs and high PD-L1 expression was associated with poor prognosis.

Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study.

PURPOSE: Patients with mid-to low-rectal cancer can have various dysfunctions of defecation after sphincter-saving resection. Defecation dysfunction can manifest as incontinence, urgency, or frequent bowel movements, and is called low anterior resection syndrome (LARS). This study aimed to examine LARS score and objective anorectal function indices in Chinese patients receiving sphincter-saving surgery for mid-to low-rectal cancer. METHOD: This was a single-center cross-sectional study of patients undergoing sphincter-saving resection for low- or mid-rectal cancer and had restoration of trans-anal defecation for at least 1 month seen between January 2019 and June 2020. Patients completed a questionnaire regarding clinical characteristics, and Low Anterior Resection Syndrome (LARS) score and high-resolution anorectal manometry (HR-ARM) were used to assess defecation function. Multivariable analysis was used to identify variables significantly associated with defecation dysfunction. RESULTS: 146 patients completed and returned the questionnaires. 25 healthy adults also participated as control group for the anorectal manometry. Approximately 76% of patients developed LARS after surgery, of which 35.6% had major LARS. In these patients, anorectal manometry indices including initial rectal sensory capacity and rectal fecal sensory capacity, were significantly lower than normal. Logistic regression analysis showed that preoperative chemo-radiotherapy and the tumor inferior margins being close to the dentate line, especially 2-5 cm, were independent risk factors for defecation dysfunction after surgery. CONCLUSIONS: Defecation dysfunction is a frequent occurrence after sphincter-saving resection for mid- and low-rectal cancer. Preoperative chemo-radiotherapy and a shorter tumor inferior margins distance to the dentate line are independent factors for defecation dysfunction.

A randomized trial of negative pressure wound therapy technology combined with intermittent instillation in the treatment of neck anastomotic leakage after esophageal cancer surgery.

BACKGROUND: This study aimed to examine the effects of applying the negative pressure wound therapy (NPWT) combined with intermittent instillation (NPWTi) in patients with cervical anastomotic leakage (AL) after esophageal cancer surgery. METHODS: From July 2019 to June 2021, 64 patients undergoing AL after esophageal cancer surgery were selected from our Hospital's Thoracic Department, and randomly allocated to the conventional nursing group (20 patients), the hospital central NPWTi group (23 patients), and the portable NPWTi group (21 patients). The hospital central NPWTi group was treated with central negative pressure combined with intermittent instillation, and the portable NPWTi group was treated with portable negative pressure combined with intermittent instillation. Indicators of fistula healing, healing days, treatment costs, comfort, and nursing satisfaction were examined in each group. RESULTS: The fistula healing rate, healing days, nursing satisfaction, and comfort level of the hospital central NPWTi group and the portable NPWTi group were better than those of the conventional nursing group (P<0.05). There was no difference in the fistula healing rates and healing days between the hospital central NPWTi group, and the portable NPWTi group (P>0.05). The treatment costs of the hospital central NPWTi group were lower than those of the portable NPWTi group (P<0.05). CONCLUSIONS: Negative pressure treatment technology combined with the intermittent instillation of the neck anastomotic fistula improved the fistula microenvironment, strengthened the sterilization effect, drained the leachate effectively, shortened the fistula healing time, improved the fistula cure rate, and increased patients' satisfaction with nursing. In relation to the negative pressure source, there was no difference in the therapeutic effects of hospital central NPWTi compared to the portable negative pressure meter, but the hospital central NPWTi treatment costs were lower and patients' acceptance of NPWT instillation was higher. Thus, central NPWT instillation treatment is worthy of promotion. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100052240.