Cross-sectional study of low anterior resection syndrome in patients who have survived more than 5 years after sphincter-preserving surgery for rectal cancer / 中华胃肠外科杂志

Objective: In this study, we aimed to investigate the prevalence of low anterior resection syndrome (LARS) in patients who had survived for more than 5 years after sphincter-preserving surgery for rectal cancer and to analyze its relationship with postoperative time. Methods: This was a single-center, retrospective, cross-sectional study. The study cohort comprised patients who had survived for at least 5 years (60 months) after undergoing sphincter- preserving radical resection of pathologically diagnosed rectal adenocarcinoma within 15 cm of the anal verge in the Department of Gastrointestinal Surgery, Peking University People's Hospital from January 2005 to May 2016. Patients who had undergone local resection, had permanent stomas, recurrent intestinal infection, local recurrence, history of previous anorectal surgery, or long- term preoperative defecation disorders were excluded. A LARS questionnaire was administered by telephone interview, points being allocated for incontinence for flatus (0-7 points), incontinence for liquid stools (0-3 points), frequency of bowel movements (0-5 points), clustering of stools (0-11 points), and urgency (0-16 points). The patients were allocated to three groups based on these scores: no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The prevalence of LARS and major LARS in patients who had survived more than 5 years after surgery, correlation between postoperative time and LARS score, and whether postoperative time was a risk factor for major LARS and LARS symptoms were analyzed. Results: The median follow-up time of the 160 patients who completed the telephone interview was 97 (60-193) months; 81 (50.6%) of them had LARS, comprising 34 (21.3%) with minor LARS and 47 (29.4%) with major LARS. Spearman correlation analysis showed no significant correlation between LARS score and postoperative time (correlation coefficient α=-0.016, P=0.832). Multivariate analysis identified anastomotic height (RR=0.850, P=0.022) and radiotherapy (RR=5.760, P<0.001) as independent risk factors for major LARS; whereas the postoperative time was not a significant risk factor (RR=1.003, P=0.598). The postoperative time was also not associated with LARS score rank and frequency of bowel movements, clustering, or urgency (P>0.05). However, the rates of incontinence for flatus (3/31, P=0.003) and incontinence for liquid stools (8/31, P=0.005) were lower in patients who had survived more than 10 years after surgery. Conclusions: Patients with rectal cancer who have survived more than 5 years after sphincter-preserving surgery still have a high prevalence of LARS. We found no evidence of major LARS symptoms resolving over time.

Correlation between pelvic relapses of rectal cancer after radical and R0 resection: A regression model-based analysis / 中华胃肠外科杂志

Objective: To propose a new staging system for presacral recurrence of rectal cancer and explore the factors influencing radical resection of such recurrences based on this staging system. Methods: In this retrospective observational study, clinical data of 51 patients with presacral recurrence of rectal cancer who had undergone surgical treatment in the Department of Gastrointestinal Surgery, Peking University People's Hospital between January 2008 and September 2022 were collected. Inclusion criteria were as follows: (1) primary rectal cancer without distant metastasis that had been radically resected; (2) pre-sacral recurrence of rectal cancer confirmed by multi-disciplinary team assessment based on CT, MRI, positron emission tomography, physical examination, surgical exploration, and pathological examination of biopsy tissue in some cases; and (3) complete inpatient, outpatient and follow-up data. The patients were allocated to radical resection and non-radical resection groups according to postoperative pathological findings. The study included: (1) classification of pre-sacral recurrence of rectal cancer according to its anatomical characteristics as follows: Type I: no involvement of the sacrum; Type II: involvement of the low sacrum, but no other sites; Type III: involvement of the high sacrum, but no other sites; and Type IV: involvement of the sacrum and other sites. (2) Assessment of postoperative presacral recurrence, overall survival from surgery to recurrence, and duration of disease-free survival. (3) Analysis of factors affecting radical resection of pre-sacral recurrence of rectal cancer. Non-normally distributed measures are expressed as median (range). The Mann-Whitney U test was used for comparison between groups. Results: The median follow-up was 25 (2-96) months with a 100% follow-up rate. The rate of metachronic distant metastasis was significantly lower in the radical resection than in the non-radical resection group (24.1% [7/29] vs. 54.5% [12/22], χ2=8.333, P=0.026). Postoperative disease-free survival was longer in the radical resection group (32.7 months [3.0-63.0] vs. 16.1 [1.0-41.0], Z=8.907, P=0.005). Overall survival was longer in the radical resection group (39.2 [3.0-66.0] months vs. 28.1 [1.0-52.0] months, Z=1.042, P=0.354). According to univariate analysis, age, sex, distance between the tumor and anal verge, primary tumor pT stage, and primary tumor grading were not associated with achieving R0 resection of presacral recurrences of rectal cancer (all P>0.05), whereas primary tumor pN stage, anatomic staging of presacral recurrence, and procedure for managing presacral recurrence were associated with rate of R0 resection (all P<0.05). According to multifactorial analysis, the pathological stage of the primary tumor pN1-2 (OR=3.506, 95% CI: 1.089-11.291, P=0.035), type of procedure (transabdominal resection: OR=29.250, 95% CI: 2.789 - 306.811, P=0.005; combined abdominal perineal resection: OR=26.000, 95% CI: 2.219-304.702, P=0.009), and anatomical stage of presacral recurrence (Type III: OR=16.000, 95% CI: 1.542 - 166.305, P = 0.020; type IV: OR= 36.667, 95% CI: 3.261 - 412.258, P = 0.004) were all independent risk factors for achieving radical resection of anterior sacral recurrence after rectal cancer surgery. Conclusion: Stage of presacral recurrences of rectal cancer is an independent predictor of achieving R0 resection. It is possible to predict whether radical resection can be achieved on the basis of the patient's medical history.

Influence of different sphincter-preserving surgeries on postoperative defecation function / 中华胃肠外科杂志

Advances in surgical techniques and treatment concept have allowed more patients with low rectal cancer to preserve sphincter without sacrificing survival benefit. However, postoperative dysfunctions such as fecal incontinence, frequency, urgency, and clustering often occur in patients with low rectal cancer. The main surgical procedures for low rectal cancer include low anterior rectum resection (LAR), intersphincteric resection (ISR), coloanal anastomosis (Parks) and so on. The incidence of major LARS after LAR is up to 84.6%. The postoperative function of ISR is even worse than LAR. Moreover, the greater the extent of resection ISR surgery, the worse the postoperative function. There are few studies on the function of Parks procedure. Current evidence suggests that the short-term function of Parks procedure is inferior to LAR, but function can gradually recovered over time. Colorectal surgeons have attempted to improve postoperative defecation by modifying bowel reconstructions. Current evidence suggests that J pouch or end-to-side anastomosis during LAR does not reduce the incidence of defecation disorders. Pouch reconstruction during ISR cannot reduce the incidence of severe LARS either. In general, the protection of postoperative defecation function in patients with low rectal cancer still has a long way to go.

Research progress of colorectal surgery in 2021 and future prospects / 中华胃肠外科杂志

In recent years, with the wide application of immune score and liquid biopsy to guide the accurate diagnosis and precise treatment of colorectal cancer, colorectal surgery develops more rationally and scientifically. The strategy of organ function protection in colorectal surgery gradually attracts more and more attention. The continuous development of comprehensive treatments, such as targeted therapy and immunotherapy, provides more choices for colorectal cancer patients. Several significant progress in surgical strategies for benign colorectal diseases challenges the traditional concepts as well. The advances in medical science and the innovation of concepts and ideas set high new standards for the development of colorectal surgery in China. Efforts are required to improve the standardization of diagnosis and treatment of colorectal disease. There is still a long way to go to explore patient-centered new technologies, new concepts and new fields of accurate diagnosis and precise treatment in colorectal surgery.

Research progress of sexual dysfunction following rectal cancer surgery / 中华胃肠外科杂志

Sexual dysfunction with the incidence of 5%-90% is a common postoperative complication of rectal cancer and the ratio of men and women is similar. Sexual function is innervated by the abdominal-pelvic autonomic nerve. Different sexual dysfunctions can be caused by different parts and degrees of injury in autonomic nerve during operations of rectal cancer. With the development of pelvic autonomic nerves preservation in rectal cancer radical resection, postoperative sexual function can be protected. There may be many factors increasing the incidence of postoperative sexual dysfunction in rectal cancer, such as postoperative psychological factors, stoma, abdominal-perineal resection and radiotherapy. The effects of laparoscopic surgery, robotic surgery, transanal total mesorectal excision and lateral lymph node dissection on postoperative sexual function remain controversial. Based on the multidisciplinary cooperation model, attention should be paid to psychological intervention of patients and their partners. In clinical practice, for male using phosphodiesterase-5 inhibitors, vacuum erectile devices, injection of vasodilators through the penis or urethra, and for female local application of estrogen and lubricants in the vagina are effective treatment for postoperative sexual dysfunction of rectal cancer. In addition, stem cell therapy has a promising prospect for sexual dysfunction.

Research progress of single-incision laparoscopic radical gastrectomy / 中华胃肠外科杂志

Gastric cancer is one of the most common malignant diseases in the world, which has a high incidence in our country and threatens people's health seriously. Laparoscopic radical gastrectomy is one of the main methods of surgical treatment for gastric cancer, whose clinical application has a history of near 30 years. With the in-depth understanding of minimally invasive surgery and the improvement of patients' cosmetic demand, single-incision laparoscopic surgery has emerged. Since the first report of single-incision laparoscopic radical gastrectomy in 2010, its safety has been preliminarily confirmed. While this result still needs to be further verified by more prospective randomized controlled studies. Compared with traditional laparoscopic radical gastrectomy, single-incision laparoscopic radical gastrectomy has the advantages of less trauma, less postoperative pain and faster postoperative recovery. So it has been favored by surgeons. However, the steeper learning curve and difficult operation of single-incision laparoscopic radical gastrectomy limit its promotion in clinical applications. At present, there are still controversies and confusions in the single-incision laparoscopic radical gastrectomy. This article elucidates the advances and existing problems of single-incision laparoscopic radical gastrectomy.

Research progress of different bowel reconstructions for postoperative functional protection during low anterior resections of rectal cancer / 中华胃肠外科杂志

Straight coloanal anastomosis (SCA), colonic J-pouch anastomosis (CJP), transverse coloplasty pouch anastomosis (TCP), and side-to-end anastomosis (SEA) are the most commonly used procedures of bowel reconstructions in the low anterior resections (LAR) of rectal cancer. Different bowel reconstruction procedures greatly affect postoperative bowel function, urinary function and sexual function. SCA is the most traditional procedure. CJP has been studied extensively and well-developed reconstruction method; however, recent studies have shown that CJP has the highest morbidity of complications, so the clinical application of CJP is limited. SEA is not inferior to CJP and SCA in the short-term and long-term defecation function, urination function, and sexual function, with reliable operational safety, so it is expected to become an alternative to SCA and CJP. The research on TCP is lacking, but there are some related clinical trials currently underway, and the results are worth expecting. The improvement and innovation of bowel reconstructions provide a bright prospect for better functional prognosis in patients with rectal cancer.

Investigation on the status quo of diagnosis and treatment related to the protection of defecation function in sphincter-preserving resections for rectal cancer: a cross-sectional study of Chinese colorectal surgeons / 中华胃肠外科杂志

Objective: To understand the current status of diagnosis and treatment regarding the protection of defecation function in Chinese surgeons performing sphincter-preserving resections (SPR) for rectal cancer in order to discover the problems existing in the function protection during SPR and provide support and reference for the standardized clinical management of rectal cancer. Methods: A cross-sectional survey was performed. Colorectal surgeons who obtained the medical qualifications and volunteered to participate in this study were included, and respondents with incomplete information were excluded. From October 18 to 22, 2020, randomized sampling was conducted among Chinese colorectal surgeons from Chinese Association of Colorectal Surgeons, Chinese Colorectal Cancer Committee, Chinese Sexology Association Anal functional Surgery Committee and National Health Commission Capacity Building and Continuing Education Committee. The questionnaire included basic information of the respondents, assessment of defecation function before SPR, intraoperative details, postoperative follow-up, evaluation and intervention of patients with low anterior resection syndrome (LARS). Observation indicator: results of the questionnaire survey. Result: A total of 231 questionnaires were collected, and 230 were effective, with an effective rate of 99.6%. Among these participants, 217 (94.3%) were males; 107 (46.5%) had medical doctor degrees; 129 (56.1%) were national commission members in colorectal surgery; 137 (59.6%) performed more than 50 SPR operations per year; 211 (91.7%) assessed defection function by auxiliary examinations before SPR. Rigid sigmoidoscopy (n=116, 55.0%) and anorectal manometer (n=81, 38.4%) were the most commonly used method. Among the 230 respondents, 64.8% (n=149) of surgeons used 2D laparoscopy for SPR surgery most commonly, and 51.3% (n=118) of surgeons performed direct colorectal anastomosis for reconstruction, and 98.3% (n=226) used staplers during anastomosis. All the surgeons indicated that they would follow up patients after SPR, and outpatient clinic was the most common method (84.4%, 184/230). When LARS occurred, 50.0% (115/230) of surgeons chose defecation function scale and 78.7% (181/230) actively provided guidance and intervention for patients. Conclusions: Chinese colorectal surgeons still have shortcomings in the protection of defecation function during SPR for rectal cancer. They do not make enough preoperative functional evaluation and postoperative functional recovery estimate for patients. The knowledge and use of defecation function scales and interventions on LARS are expected to be standardized.

Pros and cons of perioperative therapy in the protection of organ function in rectal cancer / 中华胃肠外科杂志

The goal of rectal cancer treatment should be to better protect organ function and improve patients' quality of life on the basis of ensuring radical resection. The current evidence has proved the superiority of perioperative chemoradiotherapy in reducing local recurrence and improving long-term survival. From the perspective of organ function protection, however, perioperative chemoradiotherapy has both disadvantages and advantages. Despite the great help in improving long-term outcomes, adverse reactions of chemoradiotherapy can aggravate defecation, urination and sexual dysfunction. Also, for patients with significant or complete remission, if the treatment strategy of local resection or close follow-up is selected, organ function can be preserved to the greatest extent. The key to the choice of treatment is to evaluate preoperatively whether pathological complete response is achieved. It should be kept in mind that preserving organ itself is not the same as protecting organ function. For patients who need perioperative chemoradiation, the optimal treatment methods should be chosen based on the patient's condition. Surgeons should fully evaluate organ function before operation, select the appropriate treatment strategy, pay special attention to the protection of important organs and nerves during surgeries, and carry out close postoperative follow-up and organ function rehabilitation as soon as possible, so as to reduce the incidence of dysfunction and the impact on the quality of life.

Safety and efficacy of adjuvant chemotherapy with oxaliplatin and S-1 for patients with locally advanced gastric cancer after D2 lymph nodes dissection / 中华胃肠外科杂志

Objective: To investigate the safety and efficacy of oxaliplatin combined with S-1 (SOX) as adjuvant chemotherapy after D2 radical gastrectomy for locally advanced gastric cancer. Methods: A descriptive case series study was applied. Case inclusion criteria: (1) locally advanced gastric cancer confirmed by endoscopic biopsy or surgical specimen pathology as gastric adenocarcinoma; (2) receiving D2 radical gastric resection followed by SOX regimen adjuvant chemotherapy. Case exclusion criteria: (1) postoperative pathological TNM stage I or IV; (2) acute complications and emergency surgeries; (3) receiving neoadjuvant therapy; (4) concurrent malignancies and complications compromising patients' treatment or survival; (5) without receiving adjuvant SOX chemotherapy. A total of 94 patients with stage II-III gastric cancer who underwent D2 radical gastrectomy and postoperative adjuvant SOX chemotherapy at department of Gastrointestinal Surgery, Peking University People's Hospital from January 2014 to December 2019 were retrospectively enrolled. Chemotherapy-related adverse events, overall survival (OS) and progression-free survival (PFS) were analyzed. Kaplan-Meier survival analysis was performed and log rank test was used to analyze the difference between groups. P<0.2 or clinically significant indicators in univariate analysis were included in Cox regression model for multivariate survival analysis. Results: Among these 94 patients, there were 65 males and 29 females with an average age of (58.2±12.1) years; 33 patients with hypertension, diabetes mellitus, or cardiovascular and cerebrovascular diseases, 11 patients with family history of gastrointestinal tumors; 59 patients with tumors locating in the antrum or pylorus, 16 patients in the gastric body, 19 patients in the gastric fundus or cardia; 29 patients underwent total gastrectomy, 5 patients underwent proximal subtotal gastrectomy, and 60 patients underwent distal subtotal gastrectomy. In this study, 73 patients (77.7%) completed at least 5 cycles of adjuvant SOX regimen chemotherapy. Grade 3-4 adverse reactions included thrombocytopenia (23.4%, 22/94), nausea and vomiting (18.1%, 17/94) and peripheral neurotoxicity (6.4%, 6/94). Eighty-nine patients (94.7%) completed follow-up with a median follow-up time of 32 months. The 3-year and 5-year OS rates were 89.8% and 83.7%, respectively, and the 3-year and 5-year PFS rates were 81.4% and 78.1%, respectively. Taking 5 chemotherapy cycles as the cut-off point, the 3-year OS rate and 3-year PFS rate were 72.2% and 53.9% in the adjuvant chemotherapy < 5 cycles group, and 93.7% and 87.1% in the adjuvant chemotherapy ≥5 cycles group, respectively; the differences were statistically significant (P=0.029, P=0.006). Univariate analysis showed that the adjuvant chemotherapy < 5 cycles group was associated with worse 3-year OS (P=0.029). Multivariate analysis showed that insufficient chemotherapy cycle (HR=9.419, 95% CI: 2.330-38.007, P=0.002) was an independent risk factor for 3-year OS. Meanwhile, univariate analysis showed that the adjuvant chemotherapy <5 cycles (P=0.006), preoperative CEA > 4.70 μg/L (P=0.035) and adjacent organ resection (P=0.024) were associated with worse 3-year PFS. Multivariate analysis showed that adjuvant chemotherapy <5 cycles (HR=10.493, 95% CI: 2.466-44.655, P=0.001) and adjacent organ resection (HR=127.518, 95% CI: 8.885-1 830.136, P<0.001) were independent risk factors for 3-year PFS. Conclusions: Oxaliplatin combined with S-1 as an adjuvant chemotherapy regimen for locally advanced gastric cancer has high efficacy and low incidence of adverse reactions. At least 5 cycles of SOX regimen adjuvant chemotherapy can significantly improve prognosis of patients with stage II-III gastric cancer.

Consensuses and controversies on one-stage resection and anastomosis surgery in patients with acute obstructive colorectal cancer / 中国实用外科杂志

Acute intestinal obstruction is one of the common causes of emergency surgery in patients with colorectal cancer,which is usually with poor prognosis. Surgery is the most important way to relieve obstruction and save the lives. One-stage resection and anastomosis can completely remove the tumor, restore the continuity of the intestine, avoid complications of staged surgery and reduce disease burden,and is supposed to be the most ideal surgery. However,due to certain intraoperative technical difficulties and the risk of anastomotic leakage,it is still controversial whether the one-stage resection and anastomosis surgery can be preferred during emergency exploration.

Emphasize on the postoperative anal function of middle and low rectal cancer patients / 中国实用外科杂志

Organ function preservation emphasizes the application of various therapeutic techniques to avoid or reduce the influence of tumor treatment process on the normal function of cancer organs and adjacent organs under thepremise of ensuring the best prognosis of oncology. Modern surgical treatment of middle and low rectal cancer does requireanal organ function preservation, but the current rectal cancer guidelines lack guidance on how to protect organ function. Inthe author's opinion,modern colorectal surgeons should recognize that anal function is an important factor affecting the quality of life after rectal cancer surgery. Functional considerations should be raised to the same level as techniqueas to whether the patient should preserve the anus. Correct evaluation of postoperative defecation function of patients isthe basis of selecting anal preservation indications.Preoperative evaluation of risk factors for anal dysfunction are helpful to predict postoperative functional status. The rational use of multidisciplinary strategies is recommended to reduce surgical trauma and improve anastomosis techniques to achieve functional preservation in middle and low rectal cancer.

Detection of preoperative chemoradiotherapy sensitivity molecular characteristics of rectal cancer by transcriptome second generation sequencing / 北京大学学报(医学版)

OBJECTIVE@#To detect the preoperative chemoradiotherapy sensitivity molecular characteristics of rectal cancer by transcriptome second generation sequencing.@*METHODS@#The clinicopathological data of 30 patients with locally advanced rectal cancer were collected prospectively, including 9 indicators (general conditions, imaging data before radiotherapy and chemotherapy, pathological data of biopsy before radiotherapy and chemotherapy, and tumor differentiation degree, etc.), in order to analyze the correlation between them and tumor regression grading (TRG) after radiotherapy and chemotherapy for rectal cancer. At the same time, frozen specimens of colonoscopy biopsy before neoadjuvant therapy were collected from these 30 patients, and transcriptome second-generation sequencing was performed for bioinformatics analysis to screen out the genes that might drive the radio chemotherapy sensitivity of rectal cancer.@*RESULTS@#Among the 30 patients with rectal cancer, 9 had complete pathological remission, 12 had partial remission, and 9 had poor remission. The degree of pathological TRG remission after radiotherapy and chemotherapy for rectal cancer was negatively correlated with the preoperative MRI T stage (P=0.046), and positively correlated with preoperative MRI rectal cancer extravascular invasion (EMVI) (P=0.003). Transcriptome second-generation sequencing of the obtained 217 transcripts (P<0.05) for signal pathway enrichment analysis, and multiple cell signal transduction pathways related to antigen presentation could be found. The high expression of HSPA1A, HSPA1B and EXOSC2 was positively correlated with postoperative pathological remission (P<0.05). The high expression of DNMBP, WASH8P, FAM57A, and SGSM2 was positively correlated with postoperative pathological remission (P<0.05).@*CONCLUSION@#Preoperative NMR detection of extra-tumoral vascular invasion (EMVI-positive) in patients with rectal cancer was significantly better than that of EMVI-negative patients after chemoradiotherapy. Patients with high expressions of HSPA1A, HSPA1B and EXOSC2 had poor postoperative pathological remission, while patients with high expressions of genes, such as DMNMB, WASH8P, FAM57A, and SGSM2 had good postoperative pathological remission. Based on the molecular characteristics of rectal cancer radiotherapy and chemotherapy, attempts to block or enhance the molecular pathways associated with chemosensitivity of rectal cancer, are to be made to further explore new candidate therapeutic targets that can increase the sensitivity of radiotherapy and chemotherapy for rectal cancer.

Identifying a Safe Range of Stimulation Current for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve: Results from a Canine Model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has been widely applied during thyroid surgery. However, the safe range of stimulation intensity for IONM remains undetermined.</p><p><b>METHODS</b>Total thyroidectomies were performed on twenty dogs, and their RLNs were stimulated with a current of 5-20 mA (step-wise in 5 mA increments) for 1 min. The evoked electromyography (EMG) of vocal muscles before and after supramaximal stimulation were recorded and compared. Acute microstructural morphological changes in the RLNs were observed immediately postoperatively under an electron microscope.</p><p><b>RESULTS</b>The average stimulating threshold for RLNs stimulated with 15 mA and 20 mA showed no significant changes compared to the unstimulated RLNs (15 mA group: 0.320 ± 0.123 mA vs. 0.315 ± 0.097 mA, P = 0.847; 20 mA group: 0.305 ± 0.101 mA vs. 0.300 ± 0.103 mA, P = 0.758). Similar outcomes were shown in average evoked EMG amplitude (15 mA group: 1,026 ± 268 μV vs. 1,021 ± 273 μV, P = 0.834; 20 mA group: 1,162 ± 275 μV vs. 1,200 ± 258 μV, P = 0.148). However, obvious acute microstructural morphological changes were observed in the nerves that were stimulated with 20 mA.</p><p><b>CONCLUSIONS</b>A stimulation intensity less than 15 mA might be safe for IONM of the RLN.</p>

Significant Differences in the Clinicopathological Characteristics and Survival of Gastric Cancer Patients from Two Cancer Centers in China and Korea

PURPOSE: To compare the clinicopathological data and long-term survival of gastric cancer patients in China and Korea. MATERIALS AND METHODS: Patients who had undergone gastrectomy for gastric cancer between 1998 and 2009 in 2 high-volume institutions in both China (n=1,637) and Korea (n=2,231) were retrospectively evaluated. Clinicopathological variables, overall survival (OS), progression-free survival (PFS), and surgery-related complications were assessed for all patients and compared between the 2 institutions. RESULTS: Chinese patients included in the study were significantly older and had a significantly lower body mass index (BMI) than the Korean patients. Esophagogastric junction tumors were more frequent in Chinese patients. However, the number of patients with stage I gastric cancer, the number of harvested lymph nodes, and the number of total gastrectomies were significantly higher in the Korean population. Korean patients also presented with fewer undifferentiated tumors than Chinese patients. Furthermore, Korean patients had prolonged OS and PFS for stage III cancers only. BMI, tumor-node-metastasis (TNM) stage, tumor invasion, number of positive lymph nodes, and distant metastases were all independent factors affecting OS and PFS. CONCLUSIONS: Although China and Korea are neighboring Asian countries, the clinicopathological characteristics of Chinese patients are significantly different from those of Korean patients. Korean gastric cancer patients had longer OS and PFS than Chinese patients. Influencing factors included TNM stage, tumor invasion, and lymph node metastasis.

Surveillance of bacterial distribution and drug resistance in inpatients with surgical infections: a single center study / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the bacterial distribution and drug resistance in patients with surgical infections, and provide the basis for the standardization treatment of the surgical infection.</p><p><b>METHODS</b>Retrospectively analyzed from January 2008 to December 2011 surgical infection in our samples bacteria identification and drug sensitivity test results.</p><p><b>RESULTS</b>A total of 3829 nonduplicate isolates from 3257 samples, Gram-negative bacteria accounted for 62.4% (the main microbes were P.aeruginosa, K. pneumonia and E.coli etc) and Gram-positive bacteria accounted for 37.6% (the main microbes were Enterococcus, Staphylococcus and coagulase negative Staphylococcus). Incidence of Staphylococcus aureus and Enterococcus faecalis were on an obvious increase. For the performance of the high level of sensitive to Imipenem, Amikacin, Piperacillin and Tazobactam by E. coli and K. pneumonia. The Pseudomonas aeruginosa and Acinetobacter baumannii to cephalosporins, Carbapenems and Fluoroqinolones were higher resistant with Multidrug resistance. No vancomycin and teicoplanin resistant Enterococcus faecium were found. The prevalence of ESBL E.coli was 45.6%-61.5% and ESBL K.pneumoniae isolates were fluctuated. The methicillin-resistant S.aureus (MRSA) isolates were relatively high (21.1%-55.8%), and methicillin-resistant Staphylococcus epidermidis was higher than the other Gram-positive cocci. Vancomycin for Staphylococcus performance was highly sensitive.</p><p><b>CONCLUSIONS</b>The main composition of surgical clinical infection pathogens are Gram-negative bacillus, and the emergency of resistance of bacteria to antibacterial drugs is a common phenomenon. The resistant rate shows ascendant trend; Drug resistance is significantly higher in Pseudomonas aeruginosa and Acinetobacter baumannii. Antimicrobial resistance is a serious and challenging issue.</p>

Short-term efficacy comparison of complete mesocolic excision and traditional colon cancer resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the short-term efficacy of complete mesocolic excision (CME).</p><p><b>METHODS</b>Clinical data of 62 cases of colon cancer (I-III phase) with radical resection including CME surgery group of 31 cases and traditional surgery group of 31 cases from January 2011 to October 2011 in Peking University People's Hospital were retrospective analyzed.</p><p><b>RESULTS</b>The number of removed lymph node in CME and traditional resection group was 22.5±1.8 and 17.6±1.3 respectively (P<0.05) and the positive rate of lymph node in mesentery root was 9.7% (3/31) in CME surgery group. Operative blood loss was (123.5±17.6) ml and (143.5±15.3) ml in CME and traditional resection group without significant difference (P>0.05). Except for more abdominal drainage volume of 3 days post-operation in CME group (P<0.05), the postoperative recovery indicators of postoperative drainage tube removed time, exhaust time, eating time, and the socioeconomic effects indicators of postoperative hospitalization, hospitalization costs were not significantly different between two groups (all P>0.05). Postoperative intestinal obstruction occurred in 3 cases and 4 cases, lymph fistula in 2 cases and 0 case, wound dehiscence in 1 case and 1 case in CME group and traditional resection group respectively. Postoperative complication rate was not significantly different (19.4% vs. 16.1%, P>0.05).</p><p><b>CONCLUSION</b>Compared with traditional radical surgery, CME sweeps lymph nodes more thoroughly, including lymph nodes of mesocolic roots, and does not affect postoperative recovery and increase the risk of postoperative complications.</p>

Clinical and microbiological features of community-acquired and nosocomial bloodstream infections in the surgical department of a tertiary-care hospital in Beijing / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bloodstream infections (BSIs) remain a major cause of morbidity and mortality in patients undergoing surgery. This study aimed at elucidating the clinical characteristics of community-acquired BSIs (CABs) and nosocomial BSIs (nBSIs) in patients admitted to the surgical wards of a teaching hospital in Beijing, China.</p><p><b>METHODS</b>This cross-sectional study compared 191 episodes of BSIs in 4074 patients admitted to the surgical wards between January 2008 and December 2011. Cases of BSIs were classified as CABs or nBSIs, and the characteristics, relevant treatments, and outcomes of CABs and nBSIs were compared.</p><p><b>RESULTS</b>Of the 191 BSIs, 52 (27.2%) and 139 (72.8%) were CABs and nBSIs, respectively. Escherichia coli, coagulasenegative staphylococci, and Klebsiella spp, were the most frequently isolated microorganisms. There were significant differences between CABs and nBSIs with respect to the use of hormonal drugs, ventilation, acute physiology and chronic health evaluation (APACHE) II and American Society of Anesthesiologists scores, and prevalence of cancer (P < 0.05). Empirical antibacterial therapy did not decrease the crude mortality, but multivariate analysis showed that high APACHE II was independently associated with a risk of mortality (odds ratio = 0.97, 95% confidence interval: 0.93-1.02 for APACHE II).</p><p><b>CONCLUSIONS</b>We found significant differences in the clinical characteristics of surgical patients with CABs and nBSIs. The outcome of patients seems to be related to high APACHE II scores.</p>

Animal experimental study of biodegradable magnesium alloy stapler for gastrointestinal anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the safety and feasibility of biodegradable magnesium alloy stapler based on the result of animal experimental study for gastrointestinal anastomosis.</p><p><b>METHODS</b>Sixteen beagle dogs were equally and randomly divided into experimental (magnesium alloy) group and control (titanium alloy) group. A gastrojejunal and a colonic anastomosis were performed in each beagle dog. The anastomosis time, postoperative complications, body weight, blasting pressure of anastomosis and serum glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, creatinine, blood urea nitrogen, and serum magnesium were compared between the two groups. The healing of anastomosis and degradation of magnesium alloy were observed. The histopathological features of heart, liver, spleen and kidney were examined in the two groups.</p><p><b>RESULTS</b>There were no significant differences in anastomosis time, body weight, postoperative complications, anastomotic bursting pressure between the two groups. The anastomosis was healed well, and no dramatic inflammatory cell infiltration was observed. Magnesium alloy could be degraded completely in the animal body within 90 days. There were no significant differences in serum glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, creatinine, blood urea nitrogen and serum magnesium between the two groups. Histopathological examination showed that the degradation of magnesium alloy did not harm the important organs (liver, kidney, heart, brain and spleen).</p><p><b>CONCLUSIONS</b>Magnesium alloy stapler is safe and feasible for gastrointestinal anastomosis in beagle dogs. The degradation of magnesium alloy does not harm the healing of anastomosis and other important organs. Magnesium alloy stapler may be a candidate of biodegradable and safe material of stapler for gastrointestinal anastomosis in human.</p>

Expression of transgelin-2 and clinical significance in colorectal cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the relationship between the expression of transgelin-2 and the clinicopathological factors of colorectal carcinoma and evaluate the value of transgelin-2 in prognostic assessment of the colorectal cancer patients.</p><p><b>METHODS</b>Using tissue microarray and immunohistochemical methods, we examined transgelin-2 of 120 colorectal cancer patients received surgical treatment from September 2002 to April 2004, including 74 male and 46 female, age from 26 to 89 years. Analyzed the relationship between transgelin-2 and both the clinicopathological features and prognosis of the colorectal cancer by using χ² test and Kaplan-Meier survival analysis. Cox proportion hazard regression analysis was used to study the independent prognostic factors.</p><p><b>RESULTS</b>The positive rate of transgelin-2 expression was 69.2% in colorectal carcinoma. The transgelin-2 expression correlated with differentiation degree (χ² = 5.420), lymph nodes metastasis (χ² = 45.577), distant metastasis (χ² = 12.009), and TNM staging (χ² = 47.577). The survival time was (39 ± 5) months in patients with positive expression of the transgelin-2, while (59 ± 3) months in patients with negative expression. The patient's survival time was statistically correlated with the transgelin-2 expression (P = 0.003). Distant metastasis (RR = 8.318, 95%CI: 4.119 - 16.790), lymph nodes metastasis (RR = 2.794, 95%CI: 1.246 - 6.263) and transgelin-2 expression (RR = 1.834, 95%CI: 1.118- 2.973) were independent prognostic factors in patients with colorectal cancer (P < 0.05).</p><p><b>CONCLUSIONS</b>The expression of transgelin-2 is correlated with clinicopathological features and prognosis in colorectal cancer, may be the potential marker of metastasis and the prognosis of colorectal cancer patients.</p>