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Objective: To investigate the variants of middle colic artery (MCA) and ileocolic vein (ICV) and their influence on the deci-sion regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The pa-tient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment (MDT) discussion. Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examina-tion; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparo-scopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39. Postoperative pathological tumor stage was pT3N0. Postoperative pathological tumor type was moderately differentiated adenocarci-noma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and stan-dard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.
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Introduction of the da Vinci robotic surgical system has revolutionized the field of minimally invasive surgery. Innovative ro-botic technologies have helped surgeons overcome the technical difficulties of conventional laparoscopic surgery. At present, da Vinci robotic colorectal surgery is a safe and feasible option and has shown comparable short-term outcomes with conventional laparoscop-ic surgery. However, it has no oncological advantage despite its significantly higher cost. Promising technologies have been developed to overcome the drawbacks and obstacles of the current robotic systems. Moreover, further randomized controlled clinical trials are re-quired to assess the long-term results and potential benefits of robotic surgery over laparoscopy. This review aimed to elucidate the current developments in robotic colorectal surgery and to explore emerging surgical robotic technologies currently available or in de-velopment.
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Objective To investigate the clinical efficacy of laparoscopic fight hemicolectomy via limited medial approach.Methods The retrospective and descriptive study was conducted.The clinical data of 32 patients [15 males and 17 females,average age 62 years (range,49-70 years] with right colon cancer who were admitted to the Tianjin Medical University Cancer Hospital between July 2016 and April 2018 were collected.All the patients underwent laparoscopic right hemicolectomy via cranial-caudal-medial approach followed no-touch isolation technique.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up situations.Follow-up using outpatient examination and telephone interview to detect postoperative survival of patients and tumor metastasis or recurrence up to May 2018.Measurement data were represented as average (range).Results (1) Surgical and postoperative recovery situations:32 patients underwent successfully laparoscopic right hemicolectomy via limited medial approach,without conversion to open surgery and perioperative death.The operation time,volume of intraoperative blood loss,time to initial anal exsufflation,time for fluid diet intake and duration of postoperative hospital stay were 180 minutes (range,150-260 minutes),100 mL (range,50-350 mL),3 days (range,2-6 days),4 days (range,3-7 days) and 12 days (range,10-22 days),respectively.Of 3 with postoperative complications in the 32 patients,1 with paralytic ileus,1 with wound infection and 1 with diarrhea were improved by symptomatic treatment.(2) Postoperative pathological examination:the number of dissected lymph nodes,number of dissected central lymph nodes and length of surgical specimen were 28 (range,19-43),8 (range,6-12) and 30 cm (range,25-39 cm),respectively,with negative incision margins.Postoperative tumor pathological staging showed that stage pTl,pT2,pT3 and pT4a were detected in 2,8,19 and 3 patients,and stage pN0,pN1 and pN2 in 16,12 and 4 patients,respectively.Postoperative tumor pathological typing showed that 3,7,18 and 4 patients were respectively diagnosed with mucinous adenocarcinoma,high differentiated adenocarcinoma,moderate differentiated adenocarcinoma and low differentiated adenocarcinoma.(3) Follow-up situations:32 patients were followed-up for 1-22 months,with an average time of 11 months.During the follow-up,6 patients were complicated with distant metastasis and the others had disease-free survival.Conclusion Laparoscopic right hemicolectomy via limited medial approach is safe and feasible,with a good short-term outcome.
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Colorectal cancer (CRC) is one of the most common human malignant diseases, the cumulative result of genetic and epigenetic mutations, and its mortality rate is second only to that of lung cancer. Most patients with CRC have developed to middle to advanced stage when symptoms appear, and the treatment effects of surgery and chemotherapy are usually not satisfactory. With the emergence of targeted drugs in recent years, individualized treatment of colorectal cancer has gradually become a trend. With the development of colorectal cancer research, more and more molecular markers of colorectal cancer have been continuously discovered, and its impact on tumorigenesis, development and treatment has gradually received more attention. The application of molecular markers in the screening of colorectal cancer can help the early detection and diagnosis. Detection of molecular markers before individualized treatment can optimize the treatment plan and prompt the patient's prognosis. In this paper, the most recent findings of molecular markers with promising clinical application were summarized, in order to provide reference for the early diagnosis and treatment of colorectal cancer.
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Objective:To evaluate the effects of individual extralevator abdominoperineal excision (ELAPE) of rectal neoplasms in the low posterior wall on the pelvic floor by finite element analysis. Methods:MIMICS 10.01, Geo Magic Studio 12, and ANSYS Workbench 14.0 were used to analyze the magnetic resonance data obtained from the pelvic region of 27 healthy nulliparous volunteers. Three types of finite element models (intact model, ELAPE model, and individual ELAPE model) were developed. The maximal stress on non levator ani tissues were analyzed using the three models, while the maximal stress on levator ani tissues were analyzed using the in-tact model and the individual ELAPE model. Their stress distributions under the same pressure were analyzed and compared. Results:The maximal stress on non levator ani tissues obtained using the intact model, ELAPE model, and individual ELAPE model were (1.963± 0.061), (5.127 ± 0.070), and (3.667 ± 0.126) MPa, respectively, with P<0.01. High-stress zones were obtained at the joints with pelvic walls on both sides using the three models, while the maximal stresses were obtained at the joints with pubis on both sides. The maxi-mal stress on levator ani tissues obtained using the intact model and individual ELAPE model were (0.812 ± 0.042) MPa and (1.437 ± 0.043) MPa, respectively. Thus, the individual ELAPE model yielded higher values of maximal stress compared to the intact model. Both models generated high-stress zones at the joints with tendinous arch of levator ani tissues on both sides, and maximum stresses at the joints with pubis on both sides. Conclusion:Individual ELAPE decreases the stress on non levator ani tissues. This suggests that the risk of postoperative pelvic floor hernia is relatively reduced.
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Objective:To detect the expression and clinical significance of β-tubulin Ⅲ in cancer tissue of the patients with colon adenocarcinoma,and to explore its clinical significance.Methods:A total of 111 colon adenocarcinoma tissue samples were obtained.According to the location of β-tubulin Ⅲ positive cells, all patients were divided into front group (n=72) and non-front group (n=39).The positive expression rate of β-tubulin Ⅲ in the patients with colon adenocarcinoma was detected with immunohistochemistry.The correlations among the expression of β-tubulin Ⅲ and gender,age,tumor differentiation, clinical stage, lymph node metastasis, recurrence and death were analyzed.Results: The expression levels of β-tubulin Ⅲ had no significant differences between the patients with different gerder,age,lymph node metastasis,clinical stages,death and recurrence.The positive expression rates of β-tubulin in cancer tissue of the patients had significant difference between front and non-front groups (χ2=8.76, P=0.01).Lowly-to-moderately differentiated tissue was more common in front group, and highly-differentiated tissue was more common in non-front group(χ2=6.88, P=0.03).There were significant differences in the expression levels of β-tubulin Ⅲ between cancer tissues with different differentiation degrees (χ2=5.74, P=0.04).In non-front group, lymph node metastasis was closely correlated with the expression of β-tubulin Ⅲ (χ2=6.02,P=0.05).The results of immunohistochemical staining showed that the β-tubulin Ⅲ positive-expressing cells were colored brown-yellow.The number of cells with positive β-tubulin Ⅲ expression was significantly increased in highly differentiated tissue compared with low-differentiated tissue.Conclusion:The expression of β-tubulin Ⅲ is closely related to tumor differentiation in colon adenocarcinoma tissue.The highly differentiated colon adenocarcinoma tissue is more common in non-front group in which the expression of β-tubulin Ⅲ is related to lymph node metastasis.
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Objective To evaluate the effects of individual extralevator abdominalperineal excision (ELAPE) for rectal neoplasms below levator hiatus on pelvic floor by finite element analysis. Methods MIMICS 10.01, GeoMagic Studio 12 and ANSYS Workbench 14.0 were used to deal with magnetic resonance data of 27 healthy nulliparous volunteers'pelvic, and then three types of finite element models were developed:intact models, ELAPE models and individual ELAPE models. The maximum stress in non levator ani tissue under the same load were measured in three types of models, and levator ani 's maximal stresses were measured in intact model and individual ELAPE and their stress distributions under the same pressure were analyzed and compared. Results The maximal stresses of non-levator ani tissue were (1.963±0.061) MPa, (5.127±0.070) MPa and (4.703±0.110) MPa for intact model, ELAPE model and individual ELAPE model respectively. The maximal stress was lower in individual ELAPE model than that in ELAPE model, but which was higher than that of intact model (P<0.01). The high-stress zone was found at the joints with surrounding structures on both sides of intact model and ELAPE model. The high-stress zone was found in front of the joints with surrounding structures on both sides in individual ELAPE model. The maximal stresses of three types of models were found in front of both sides. In intact model levator ani 's maximal stress was (0.812 ± 0.042) MPa, which was higher than that of individual ELAPE model (0.719 ± 0.027) MPa (P<0.01). The high-stress zone of intact model was found in front of the joints on both sides. The maximal stress was showed at ventral ends on both sides. For the individual ELAPE model the high-stress zone was found at the anterior part of the levator ani muscle and the surrounding structure. The maximum stress appeared at the top end of the left and right sides. Conclusion This individual ELAPE is able to decrease the stress of non-levator ani tissue, which suggests that the risk of postoperative pelvic floor hernia is relatively reduced.
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Pancreatic cancer has a very poor prognosis, with a five-year survival less than 5%. Nowadays, to improve the treat-ment efficacy of pancreatic cancer has been a highlight for medical researchers worldwide. Increasing knowledge about the molecular pathogenesis of the disease has shown that genic mutations, such as oncogene Kras2, and anti-oncogenes Cdkn2a, and TP53, are hall-marks of pancreatic cancer. Therefore, it is vital to deeply understand the pathogenetic mechanism of pancreatic cancer and find new therapeutic strategies to cover it. In this review, we summarized the recent advances in the signaling pathways of pancreatic cancer.
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Hepatoid adenocarcinoma of the stomach (HAS) , a rare and specific type of primary gastric adenocarcinoma, is a highly malignant neoplasm characterized by a poor prognosis and a histological component that mimicks hepatocellular carcinoma morphologically as well as immunophenotypically. In the literature, only liver and lymph nodes metastases have been identified as determinants for survival in patients with HAS.
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<p><b>OBJECTIVE</b>To seek the optimum treatment for patients with primary gastric non-Hodgkin's lymphoma and factors associated with prognosis.</p><p><b>METHODS</b>A retrospective study was conducted on 157 primary gastric non-Hodgkin's lymphoma patients who had received operation for 45 years.</p><p><b>RESULTS</b>The X-ray diagnosis rate was 39.4% before operation. The diagnosis rate by gastroscopy was 52.7%. Among the 157 patients, 32 belonged to stage I(E), 40 stage II(E), 29 stage III(E), and 56 stage IV(E). All of the patients were received chemotherapy or radiation. The 3-, 5-, 10-, 15-year survival rates were 51.1% (69/135), 42.3% (55/130), 20.7% (23/111), and 13.5% (14/104).</p><p><b>CONCLUSIONS</b>The 3-, 5-year survival rates in stage I(E) and stage II(E) were 2 to 5 times higher than those in stage III(E) and IV(E) (P < 0.01). The 3-, 5-year survival rates of primary gastric non-Hodgkin's lymphoma were 60.2% (65/108) and 50.0% (52/104) respectively. The prognosis was better than the 5-year survival rate of gastric cancer patients with D(2) lymphodenectomy (33.3%). Early diagnosis and treatment are effective to prevent complications, enhance quality of patient's life, and prolong the survival.</p>
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Humans , Lymphoma, Non-Hodgkin , Neoplasm Staging , Prognosis , Retrospective Studies , Survival RateABSTRACT
Objective Summarize the experience in the surgical treatment of multiple original colon cancer in aged patients. Methods The retrospective analysis was performed in the 46 cases of multiple original colon cancer in aged patients in our hospital from August 1955 to May 2000. Results The 46 cases of multiple original colon cancer in aged patients account for 7.6% (46/608) of the total cases of colon cancer in patients in the same period. There were 26 cases of the male and 20 cases of the female. 30 cases were colon cancer with tumors from other organs. "The different time cancer" could be found 31 years later. The follow-up rate was 100%. The survival rates for 3,5,10,15,20 years were 71.1%(27/38), 63.6%(21/33), 43.3%(13/30), 28.6%(8/28) and 16.0%(4/25) respectively. In this study, we found that the survival rate of the group was higher than that of the aged patients suffering colon cancer in the same period of time. Conclusions The number of multiple original colon cancer in aged patients has been increased in the decade. The incidence was 43.5% (20/46) in the study. With the development of society, both doctors and patients have improved their knowledge about multiple original carcinomas in aged patients. The positive rate of early diagnosis was promoted to a high level, especially in the monitor and treatment of per operation. Choosing the energetic operation, we will acquire the better therapeutic efficacy for treatment of multiple original cancer in aged patients.