ABSTRACT
The number of minimally invasive surgery (MIS) for adenocarcinoma of esophagogastric junction (AEG) has been increasing year by year. The key technical points such as surgical approach, lymph node dissection and GI tract reconstruction have gradually reached their maturity. With the emergence of proofs of evidence-based neoadjuvant therapy, neoadjuvant chemotherapy or neoadjuvant radiochemotherapy for advanced AEG is also gradually accepted by most surgeons and oncologists. European scholars have previously started researches on MIS after neoadjuvant therapy for esophageal cancer and AEG. Domestic scholars also raise practical suggestions on the application of neoadjuvant therapy for AEG via the cooperation between gastrointestinal and thoracic surgeons, demonstrating the trend in standardization and individualization. But there is still no consent to the indication of MIS after neoadjuvant therapy. Furthermore, there is also a lack of the standardization of technical points for MIS, GI tract reconstruction, short- and long-term outcomes. Such associated problems have been the hot controversy and exploration in recent years. This article describes current progress of neoadjuvant therapy for AEG, current status of MIS after the neoadjuvant therapy in Europe, America, East Asia, including China, and related researches plus future prospects, hoping for better clinical outcomes.
Subject(s)
Humans , Adenocarcinoma/surgery , Esophageal Neoplasms/surgery , Esophagogastric Junction/surgery , Minimally Invasive Surgical Procedures , Neoadjuvant Therapy , Stomach Neoplasms/surgeryABSTRACT
Standardized surgical residency training is an important part of graduate medical education, a necessary path towards becoming a surgeon with the capability to deal with common clinical surgical problems in an independent, correct and evidence-based manner. It is also the fundamental policy for homogeneous clinician training, medical human resources construction and improvement of health care quality. Since its nationwide implementation at the end of 2013, there have been great achievements while problems and confusions were also exposed. Surgical residency training is now facing new challenges and opportunities. With the rapid development of minimally invasive surgery, young surgeons have been actively promoted to learning laparoscopic technique; however,traditional surgical basic skills as well as the essence of handson apprenticeship shall not be neglected. In the meantime, the Internet, and the series of revolutions and breakthroughs it brings, need to be utilized in residency training and construction of a system for standardized training management,which can be a creative model for future medical education.
ABSTRACT
With the better diagnosis of early gastric cancer,increasing diversity and complexity of its treatment has united a multidisciplinary team led by physicians and surgeons. Japanese Gastric Cancer Treatment Guidelines are compiled and reviewed by a committee composed of physicians, surgeons and pathologists, which are based on the epidemiological trend of gastric cancer in Japan over the past two decades and clinical evidence from Japanese domestic studies and other promi-nent international clinical trials. Updated every three to six years, the guidelines now have five versions. They are one of the authoritative documents for the diagnosis and treatment for gastric cancer in the world. As far as the treatment strategies for early gastric cancer are concerned, they include the changes of endoscopic resection, the evolution of minimally invasive surgery, the widespread application of laparoscopic surgery and the promotion of the concept of functional preservation.The evolutionary trends are perfect reflections of a philosophical shift of Japanese physicians towards precision medicine:from radical resection to functional preservation, and from long-term survival only to better quality of life.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the role of Notch1 in the proliferation, migration and invasion of gastric cancer cells.</p><p><b>METHODS</b>Notch1 expression was detected by RT-PCR and Western blot in four gastric cancer cell lines(SGC-7901, BGC-823, MKN-45 and MKN-28). The RNAi segments targeting Notch1 were designed and transfected into cell lines with the highest level of Notch1. The transcription and translation level of Notch1 expression was detected by real-time PCR and Western blot. The proliferation of transfected cells were determined by CCK8 test. Meanwhile, the migration and invasive ability of transfected tumor cells were detected by Transwell test.</p><p><b>RESULTS</b>Gastric cell line BGC-823 was selected with the highest expression of Notch1 at both mRNA level and protein level. The expression of Notch1 was significantly reduced after the transfection. The CCK8 test showed the growth rate was significantly reduced in RNAi group after two days(F=4.644, P=0.046). In migration test, the number of cells crossing through chambers in RNAi group(30.1±3.1) was significantly lower than that in the negative control group(44.5±3.2) and in the mock group(46.1±2.6)(P<0.05). In invasion test, the number of cells crossing through chambers in RNAi group(22.9±4.5) was also significantly lower than that in the negative control group (37.3±4.2) and in the mock group (37.8±3.7)(P<0.05).</p><p><b>CONCLUSION</b>Down-regulation of Notch1 inhibits the proliferation and reduces the ability of migration and invasion in gastric cell line BGC-823, suggesting that Notch1 may play an important role in the gastric carcinogenesis and metastasis.</p>