Transcecum catheterization ileostomy is safe and effective to prevent anastomotic leakage in post-laparoscopic rectal cancer surgery: a single-center retrospective study.

Background: Preventive ileostomy (PI) is conventionally performed to prevent anastomotic leakage (AL) after laparoscopic total mesorectal excision (LTME) for low rectal cancer; however, secondary surgery is required to remove the ostomy tube. We designed a new type of ostomy, transcecum catheterization ileostomy (TCI) to prevent AL. Its principle is similar to PI, but no secondary operation is needed. We evaluated the safety and efficacy of TCI in AL prevention. Methods: We analyzed the data of patients who underwent LTME with low anastomosis in Chongqing University Cancer Hospital from October 2015 to August 2021. Patients were divided into three groups according to their choice: those who underwent TCI (TCI group), those who underwent PI (PI group), and those who undergo none (C group). Intra-operation situation, postoperative efficacy and safety indicators were compared between three groups. Results: Out of the total 534 patients included, 171 underwent TCI, 156 underwent PI, and 207 underwent none. No statistically difference was noted in baseline characteristics between three groups (all P>0.05). Operation time was longer in TCI group and PI group than in C group (P<0.001). No difference was noted in intraoperative blood loss or the number of lymph nodes dissected (P=0.685 and P=0.153). Moreover, no difference was noted in the serum levels of immune cells on postoperative day 1, 3, and 7 (all P>0.05) or in the levels of serum C-reactive protein (CRP), procalcitonin (PCT), and interleukin 6 (IL-6; all P>0.05). No difference was noted in postoperative incision, pulmonary infection rates and intestinal obstruction incidence (P=0.530, P=0.971, and P=0.938). AL incidence and AL-related reoperation rates were lower in TCI or PI group (P=0.002 and P<0.001). The rate of anastomotic stricture was lower in TCI group than in the other two groups (P<0.001). Conclusions: TCI is effective to prevent AL when performed during LTME. But TCI cannot completely avoid AL. When AL occurs, TCI can reduce the degree of abdominal infection and the secondary surgical rate related AL. TCI presents an alternative option to PI, that does not require secondary operation. Therefore, TCI is safe and worthy of application.

Laparoscopic radical resection for situs inversus totalis with colonic splenic flexure carcinoma: A case report.

BACKGROUND: Situs inversus totalis (SIT) is a rare group of congenital developmental malformations in the clinical setting, with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions. Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT, and it is considered difficult even for an experienced surgeon because of the mirror positioning. We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT. CASE SUMMARY: A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma, and computed tomography showed that all the organs in the chest and abdomen were inverted. Laparoscopic hemicolectomy with complete mesocolic excision was safely performed. The operating surgeon stood on the patient's left side, which is opposite of the normal location. CONCLUSION: Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas. Laparoscopic radical resection is difficult, but it is well established and safe. The surgeon should stand in the opposite position and perform backhand operations.

Risk Analysis of Positive PD-L1 Expression and Clinicopathological Features and Survival Prognosis in Patients with Colorectal Cancer: Systematic Review and Meta-Analysis.

In order to explore the significance of PD-L1 expression in the prognosis and clinicopathological characteristics of colorectal cancer (CRC), the PubMed, Embase, Web of Science, Cochrane Library, CNKI, and multisquare databases are systematically searched for the relevant relationship between PD-L1 expression and CRC prognosis. The search time is completed until June 2021. Literature is filtered and data extracted by inclusion exclusion criteria, and Meta-analysis is performed with Stata SE12.0 software. 16 documents are included, and a total of 1997 CRC patients are included. The results show that recurrence-free survival (RFS) [OR = 2.69, 95%CI (2.07,3.48), P < 0.00001, I2 = 0%, Z = 7.50), and disease-free survival (DFS) (OR = 3.71, 95% CI (2.32,5.93), P < 0.00001, I2 = 37%, Z = 5.48) and PD-L1 expression and tumor differentiation (OR = 4.00, 95%CI (2.97,5.38), P < 0.00001, I2 = 0%, Z = 9.11) and lymphatic action metastasis (OR = 2.69,95% CI (2.07,3.48), P < 0.00001, I2 = 0%, Z = 7.50) is significantly associated.PD-L1 expression in tumor tissue suggests a poor prognosis in colorectal cancer, and the predictive significance of PD-L1 expression and PD-L1 expression in tumor cells in tumor-infiltrating immune cells may be inconsistent.

Comparison of radiofrequency ablation and surgical resection for hepatocellular carcinoma conforming to the Milan criteria: a meta-analysis.

BACKGROUND: The purpose of this study was to include all current randomized controlled trials to compare the clinical efficacy between radiofrequency ablation (RFA) and surgical resection (SR) in patients with hepatocellular carcinoma who meet the Milan criteria using meta-analysis techniques. METHODS: We conducted literature search of PubMed, Embase and Cochrane library clinical database for studies of RFA versus SR. Only randomized clinical trials were included. The odds ratios (OR) were pooled and calculated with 95% confidence intervals (CIs) for both fixed-effects and random-effects models. RESULTS: A total of 8 randomized controlled trials with 1177 patients were included in the present meta-analysis. There were no significantly difference between the patients underwent SR or RFA in terms of 1, 3 and 5 years' overall survival rate (OR 0.87, 95% CI 0.46-1.64; OR 0.84, 95% CI 0.57-1.24 and OR 1.03, 95% CI 0.61-1.73, respectively). And there were no significantly difference between the patients received SR and RFA in terms of 1 and 3 years' disease-free survival rate (OR 0.85, 95% CI 0.61-1.18 and OR 0.77, 95% CI 0.57-1.03). However, it is worth noting that RFA has advantages over SR in terms of treatment-related complications (OR 0.65, 95% CI 0.44-0.80; P < 0.05), post-operative mortality, length of stay and hospitalization costs. CONCLUSION: For patients with hepatocellular carcinoma who meet the Milan criteria, RFA exhibited similar clinical efficacy to SR.

Prdx2 Upregulation Promotes the Growth and Survival of Gastric Cancer Cells.

Peroxiredoxins (Prdxs) play important roles in cell proliferation, differentiation, and the mediation of intracellular signalling pathways. Prdx2 is an important member of the peroxiredoxin family and is upregulated in many cancers. Until now, the biological functions of Prdx2 in gastric cancer have not been completely understood, and the underlying mechanisms remain elusive. The aim of this study was to identify the role of Prdx2 on the growth of gastric cancer cells and the underlying mechanisms. We demonstrated that Prdx2 was highly expressed in gastric cancer tissues and cell lines and that the over-expression of Prdx2 correlated with the progression of gastric cancer. Further, Prdx2 was silenced with a specific, lentiviral vector-mediated shRNA, and this suppressed the proliferation of gastric cancer cells and promoted the apoptosis of gastric cancer cells. Finally, the knockdown of Prdx2 contributed to the attenuated gastric cancer growth in BALB/c nude mice. In conclusion, these findings demonstrate that Prdx2 may participate in the carcinogenesis and development of gastric cancer.

Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and/or multiple common bile duct stones: a systematic review and meta-analysis.

AIM: To compare endoscopic papillary large balloon dilation (EPLBD) alone with EPLBD following endoscopic sphincterotomy (EST) in patients with large and/or multiple common bile duct stones. METHODS: We conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library database to identify relevant available articles until July 19, 2018. Complete common bile duct stone (CBDS) removal rate, frequency of mechanical lithotripsy (ML) usage, total procedure time and intra- and postoperative adverse events were analyzed. We used RevMan 5.3 to perform the pooled analyses. RESULTS: Seven RCTs matched the selection criteria. A total of 369 patients underwent EPLBD alone, and 367 patients underwent EPLBD following EST. Our meta-analysis revealed that there were no significant differences in terms of initial success rate (OR =0.69, 95% CI=0.44-1.09, P=0.11), frequency of ML usage (OR =1.18, 95% CI=0.68-2.05, P=0.55), rate of post-endoscopy pancreatitis (PEP) (OR =0.88, 95% CI=0.43-1.78, P=0.72), total procedure time (MD =1.52, 95% CI=-0.13-3.17, P=0.07), or other intra- and postoperative adverse events between the groups for patients with large and/or multiple CBDSs. CONCLUSIONS: EPLBD alone was comparable to EPLBD with prior EST in patients with large and/or multiple CBDSs. Further studies are required to confirm the mechanisms of PEP in patients who accept EPLBD during endoscopic retrograde cholangiopancreatography (ERCP).

The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials.

BACKGROUND: Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB). METHODS: A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers. RESULTS: Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], -3.86 minutes, 95% CI -5.45 to -2.27 minutes; I = 85%) and motor (MD, -5.21 minutes; 95% CI -7.48 to -2.94 minutes; I = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87-269.52 minutes; I = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48-230.91 minutes; I = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84-377.24 minutes; I = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI -0.02 to 0.05, I = 45%; P = .45) and hypotension (RD, 0.01, 95% CI -0.01 to 0.03, I = 0%; P = .57) between 2 groups. CONCLUSION: Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.

Comparison of Metal and Plastic Stents for Preoperative Biliary Drainage in Resectable and Borderline Resectable Periampullary Cancer: A Meta-Analysis and System Review.

AIM: The aim of this study was to compare the plastic stents with metal stents for preoperative biliary drainage (PBD) in terms of the rate of endoscopic reintervention and PBD-related pre- and postoperative complications in patients with resectable and borderline resectable periampullary cancer. METHODS: We conducted a comprehensive search of the PubMed, EMBASE, and the Cochrane Library database to identify relevant available articles from their inception to September 2017. The odds ratio (OR) with 95% confidence interval (CI) was calculated to compare the incidence of endoscopic reintervention and stent-related complications between the plastic and metal stents groups. Also, we used RevMan 5.3 to perform the pooled analyses. RESULTS: Four trials (three randomized controlled trials [RCT] and one prospective clinical trial) with 392 patients were included. One hundred seventy-four patients received metal stents for PBD, and 218 patients received plastic stents. The metal stents group had a significant lower rate of endoscopic reintervention (OR = 0.30, 95% CI = 0.13-0.73, P = .008) and preoperative cholangitis (OR = 3.60, 95% CI = 1.62-7.98, P = .002) compared with the plastic stents group. But there was a significantly higher rate of PBD-related pancreatitis (OR = 3.60, 95% CI = 1.62-7.98, P = .002) in the metal stents group. CONCLUSIONS: The present meta-analysis revealed that metal stents have significantly lower rate of reintervention and cholangitis than plastic stents. But plastic stents have an obvious superiority over metal stents in terms of the incidence of preoperative pancreatitis. More RCTs are required to support this conclusion and provide more detailed information about the complications and treatment. Meanwhile, a uniform standard for the PBD is required in patients with malignant distal biliary obstruction.