[Anti-photoaging effects and mechanisms of active ingredients of Chinese medicine: a review].

Skin photoaging is exogenous aging caused by long-term ultraviolet radiation, which not only affects skin appearance, but also has a close relationship with the development of skin cancer. Saponins, flavonoids, polyphenols, polysaccharides, and extracts of Chinese medicine have been found to have anti-skin photoaging effects in recent studies. Various mechanisms such as anti-oxidative stress damage, inhibition of matrix metalloproteinase expression, promotion of collagen synthesis, inhibition of inflammatory response, DNA damage repair, enhancement of cell autophagy, and inhibition of melanin synthesis can improve the symptoms of skin photoaging and delay the photoaging process. With the active ingredients of Chinese medicine for anti-skin photoaging as the entry point, the study systematically discussed the research progress of the mechanisms underlying the anti-photoaging effects of active ingredients of Chinese medicine in recent years, in order to provide theoretical reference for the development of new anti-photoaging drugs and methods.

Application of clockwise modularized laparoscopic lymphadenectomy in the suprapancreatic area, a propensity score matching study and comparison with open gastrectomy.

BACKGROUND: Suprapancreatic lymphadenectomy is the essence of D2 radical gastric cancer surgery. The present study aimed to describe clockwise modularized laparoscopic lymphadenectomy in the suprapancreatic area. METHODS: The data from gastric cancer patients who underwent surgical treatment from September 2016 to December 2018 were collected. Patients were divided into clockwise modularized lymphadenectomy (CML) and traditional open gastrectomy (OG) groups according to the surgical treatment strategy. The propensity score matching method was utilized to balance the baseline characteristics between the two groups. RESULTS: Finally, 551 gastric cancer patients were included in the present study. Following propensity score matching, 106 pairs of patients in the CML group and OG group were included in the final analysis. The CML group had more total examined lymph nodes (36, IQR 28-44.74 vs. 29, IQR 29-39.5, p = 0.002) and no. 9 station nodes (2, IQR 1-5 vs. 2, IQR 1-3, p = 0.007) than the OG group. There was less intraoperative blood loss (30, IQR 20-80 ml vs. 80, IQR 50-80 ml, p < 0.001) and a longer surgical duration (262.5 min, IQR 220-303.25 min vs. 232, IQR 220-255 min, p < 0.001) in the CML group than in the OG group. The incidence of postoperative complications (19.8% vs. 16.0%, p = 0.591) and postoperative hospital stay (8, IQR 7-9 days vs. 8, IQR 7-9 days, p = 0.452) were comparable between the CML and OG groups. CONCLUSION: Laparoscopic lymphadenectomy for gastric cancer surgery is technically demanding. Clockwise modularized laparoscopic lymphadenectomy in the suprapancreatic area can attain similar effects as traditional open surgery and without an increase in postoperative adverse events.

Risk Factors and Survival Outcomes for Postoperative Pulmonary Complications in Gastric Cancer Patients.

BACKGROUND/AIMS: Facing with the high incidence rate and the poor outcomes of the postoperative pulmonary complications (PPCs), we sought to evaluate potential risk factors for developing the PPCs of gastric cancer patients. METHODOLOGY: Retrospective study was carried out to analyze consecutive gastric cancer patients who had a preoperative pulmonary function test and underwent gastrectomy in the West China Hospital (January, 2000 - December, 2009). Potential risk factors to the development of the PPCs and the survival outcomes of these patients were also analyzed. RESULTS: Totally, one hundred and twenty four patients (18.1%) were developed the PPCs after gastrectomy. For the development of the PPCs, univariate analysis identified the following risk factors is associated with the development of the PPCs: age ≥ 70 years (p < 0.001); male patients (p = 0.041); FEV1/FVC < 60 (p < 0.001); with the history of pulmonary disease (p < 0.001); hemoglobin < 90g/L (p = 0.025); serum albumin < 35g/L (p = 0.002); combined organoectomy (p = 0.036). Multivariate analysis identified FEV1/FVC < 60 (p = 0.004); with the history of pulmonary disease (p < 0.002); serum albumin < 35g/L (p = 0.004) were risk factors for the incidence of the PPCs. CONCLUSIONS: For the early detection of the PPCs, extra attention should be paid to those gastric cancer patients with FEV1/FVC < 60; history of pulmonary disease and .serum albumin < 35g/L.

Quantitative comparisons of summary receiver operating characteristics (sROC) curves among conventional serological tumor biomarkers for predicting gastric cancer in Chinese population.

The objective of this study is to quantitatively analyze the predictive strength among the conventional serological tumor biomarkers for gastric cancer in Chinese population. Thirty-three hospital-based case-control studies were searched out through Chinese databases and PubMed during 1999-2009. Gastric cancer cases and healthy volunteers or benign gastric diseases controls were detected of any of serological CA724, CA242, CEA, CA199, CA125, or CA153. Areas under the curve (AUC) and optimal Q indexes of summary receiver operating characteristics (sROC) curves were quantitatively compared. The summary positive and negative likelihood ratios (sLR + and sLR-) were pooled. Totally, 2,390 gastric cancer cases and 2,893 controls were analyzed. CA724 and CA242 both had the greatest AUCs (0.88), respectively, followed by the combination CA724 + CEA + CA199 (0.85), CA125 (0.82), CEA (0.80), and CA199 (0.76), but all of them had no statistical significance to CA153 (negative control) by Z tests, possibly due to relatively great standard errors. The results of Q index analyses were similar to those of AUCs, that CA724 and CA242 had the optimal strength. The sLR + of CA724 (16.08, 95 % confidence interval (CI) 7.86-32.86) or CA242 (11.03, 95 % CI 7.12-17.08) was strong to judge the gastric cancer status based on its positive result. The combination of CA724 + CEA + CA199 had the prior sLR- (0.33, 95 % CI 0.25-0.43) to the others. Serological CA724 or CA242 has predictive effect for screening gastric cancer and can be recommended into the screening program of population-based or symptomatic cases. However, prospective epidemiological studies are required before confirmative conclusion.

The postoperative quality of life of two anastomosis methods of gastric tube reconstruction for proximal gastrectomy.

BACKGROUND/AIMS: Compare the postoperative quality of life between the anastomosis of anterior gastric wall to the esophagus (AGE) and posterior gastric wall to the esophagus (PGE) for gastric tube reconstruction of proximal gastrectomy. METHODOLOGY: Retrospectively matched-pair study collected patients who underwent anterior and posterior gastric wall anastomosis to the esophagus after proximal gastrectomy. Surgical related parameters and postoperative 3-month, 6-month, 9-month, 12-month quality of life were according to EORTC QLQ-C30 and EORTC QLQ-STO22 questionnaires during the out-patient visit. RESULTS: Eleven pair cases included in the study and finished postoperative quality of life evaluation. General characteristics, such as age, surgical duration, blood loss, postoperative complications existed no significant difference between the two groups. The AEG reconstruction existed advantage in the pain scale (EORTC QLQ-C30 and EORTC QLQ-STO22) and reflux symptom scale (EORTC QLQ-STO22) at the 3-month postoperative evaluation. However, there was no difference between the two groups in the assessment of quality of life in the postoperative 6-month, 9-month, 12-month. CONCLUSIONS: Although there were some subtle differences between the two reconstruction methods. Both of these two reconstruction methods can as a selection of gastric tube reconstruction. Further study and other reconstruction method are expected for the proximal gastrectomy.

Safety and survival benefit of surgical management for elderly gastric cancer patients.

OBJECTIVE: To study the safety and survival outcome of surgical management for elderly gastric cancer patients. Methods: Patients proven of gastric cancer who aged ≥80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients' characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness. RESULTS: Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p=0.797). Clinical-pathological T stage and node status were comparable. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and nonsurgery, respectively (p=0.006). Incidence of postoperative complications and hospital mortality were 25.0% and 2.1%, respectively. The 2-year survival rates of M0 subgroups were 35.7% and 0% for surgery and nonesurgery, respectively (HR=3.98, p=0.022). CONCLUSIONS: The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.

Immunohistochemical HER2 expression not associated with clinicopathological characteristics of stage I-III gastric cancer patients.

BACKGROUND/AIMS: The aim of this study was to investigate the association of human epidermal growth factor receptor 2 (HER2) expression with clinicopathological characteristics of resectable gastric cancer patients. METHODOLOGY: A total of 394 stage I-III surgical gastric cancer patients who were detected of immunohistochemical (IHC) HER2 expression postoperatively were included in this retrospective study. Association of IHC HER2 over-expression (3+) rate with clinicopathological characteristics was tested by univariate and multivariate analyses. RESULTS: IHC HER2 over-expression rate was 5.1% (95% CI 3.1%-7.7%). By univariate analyses, none of the clinicopathological characteristics was associated with the IHC HER2 over-expression compared to negative expression (0/1+) (p>0.05), with the exception of a higher rate (12.2%) of IHC HER2 (3+) in moderate differentiation subset (p=0.02). However, the multivariate analyses didn't selected any characteristic as an independent risk factor of IHC HER2 over-expression or the combination of IHC HER2 (2/3+). CONCLUSIONS: IHC HER2 over-expression rate is relatively low among stage I-III gastric cancer patients, and might be generally not associated with clinicopathological characteristics.

Safety and Survival Benefit of Surgical Management for Elderly Gastric Cancer Patients.

BACKGROUND/AIMS: To study the safety and survival outcome of surgical management for elderly gastric cancer patients. METHODOLOGY: Patients proven of gastric cancer who aged 80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients' characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness. RESULTS: Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. Median ages were 81 years in surgery group and 83 year in non-surgery group. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p = 0.797). Clinical-pathological T stage was 6 T1, 5 T2, 14 T3 and 23 T4 cases for surgery and 7 T1, 6 T2, 3 T3, 7 T4 and 21 TX cases for non-surgery. Clinical-pathological node status was 18 N0, 7 N1, 6 N2, 7 N3 and 10 NX cases for surgery and 10 N0, 3 N1, 3 N2, 3 N3 and 25 NX cases for non-surgery. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and non-surgery, respectively (p = 0.006). Incidence of postoperative complications was 25.0% and postoperative hospital mortality was 2.1%. The 2-year survival rates were 30.8% and 8.0% for surgery and none-surgery, respectively (HR = 3.023, p = 0.001), and the 3-year survival rates were 17.6% and 0% for surgery and non-surgery, respectively (HR = 3.680, p = 0.001). In M0 subgroup, 2-year survival rate was 35.7% and 0.0% for surgery and non-surgery groups, respectively (HR = 3.98, p = 0.022). CONCLUSION: The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.

[Quality of life of patients with gastric tube anastomosis after proximal gastrectomy in adenocarcinoma of esophagogastric junction].

OBJECTIVE: To compare postoperative quality of life (QOL) of patients receiving proximal gastrectomy (PG) for adenocarcinoma of gastroesophagealjunction (AEG) throughgastric tube anastomosis and traditional esophagogastrostomy. METHODS: Between January 2010 and February 2011, 112 patients were diagnosed as AEG in our hospital. All patients underwent curative operations. Two post-PG alimentary tract reconstruction methods were adopted: gastric tube anastomosis (n = 60) and traditional direct anastomosis (n = 52). The European Organization for Research and Treatment of Cancer (EORTC) Quality of life Questionnaire Core-30 (EORTC QLQ-C30) and QLQ-STO22 were used to assess QOL of those patients before and two years after operations. RESULTS: There were no statistically significant differences between the two groups of patients in clinical and pathologic characteristics, clinical pathological characteristics and preoperative QOL (P > 0.05). Two years after operations, the patients receiving traditional direct anastomosis showed higher scores in reflux, body image, and nausea and vomiting compared with those receiving gastric tube anastomosis. No statistical differences were found between the two groups of patients in general health, physical function, role function, fatigue and pain (P > 0.05). CONCLUSION: Gastric tube reconstruction could improve the postoperative QOL of AEG patients.

Diagnostic Value of GDF10 for the Tumorigenesis and Immune Infiltration in Lung Squamous Cell Carcinoma.

OBJECTIVE: Lung squamous cell carcinoma (LUSC) is associated with a low survival rate. Evidence suggests that bone morphogenetic proteins (BMPs) and their receptors (BMPRs) play crucial roles in tumorigenesis and progression. However, a comprehensive analysis of their role in LUSC is lacking. Our study aimed to explore the relationship between BMPs/BMPRs expression levels and the tumorigenesis and prognosis of LUSC. METHODS: The "R/Limma" package was utilized to analyze the differential expression characteristics of BMPs/BMPRs in LUSC, using data from TCGA, GTEx, and GEO databases. Concurrently, the "survminer" packages were employed to investigate their prognostic value and correlation with clinical features in LUSC. The core gene associated with LUSC progression was further explored through weighted gene correlation network analysis (WGCNA). LASSO analysis was conducted to construct a prognostic risk model for LUSC. Clinical specimens were examined by immunohistochemical analysis to confirm the diagnostic value in LUSC. Furthermore, based on the tumor immune estimation resource database and tumor-immune system interaction database, the role of the core gene in the tumor microenvironment of LUSC was explored. RESULTS: GDF10 had a significant correlation only with the pathological T stage of LUSC, and the protein expression level of GDF10 decreased with the tumorigenesis of LUSC. A prognostic risk model was constructed with GDF10 as the core gene and 5 hub genes (HRASLS, HIST1H2BH, FLRT3, CHEK2, and ALPL) for LUSC. GDF10 showed a significant positive correlation with immune cell infiltration and immune checkpoint expression. CONCLUSION: GDF10 might serve as a diagnostic biomarker reflecting the tumorigenesis of LUSC and regulating the tumor immune microenvironment to guide more effective treatment for LUSC.

The feasibility and safety of early removal of nasogastric tube after total gastrectomy for gastric cancer.

BACKGROUND/AIMS: To evaluate the feasibility and safety of early removal of nasogastric tube after total gastrectomy for gastric cancer. METHODOLOGY: Data of 142 gastric cancer patients who underwent total gastrectomy from January 2011 to March 2012 were retrospectively collected and analyzed. Early removal ER group n=57 of nasogastric tube was defined as removal within postoperative 48 h, and conventional placement CP group n=85 of nasogastric tube was defined as removal till flatus and less than 300 cc gastric juice drainage. Outcome measures included postoperative temperature, hospital stay length, days to passage of flatus, days to semi-liquid diet, postoperative complications and mortality. RESULTS: No statistically significant difference was found between the ER group and the CP group in postoperative highest temperature p=0,456 the incidence of temperature over 38.5C p=0,772 postoperative hospital stay length p=0,102 and time to flatus p=0,163 There was no death or reoperation in patients of both groups. There were no significant differences in postoperative complications between the two groups 22,8% vs 30,6%, p=0,309 There was no anastomotic leakage, hemorrhage or stenosis. There was a trend of decreased risk of postoperative pneumonia in the ER group 10,5% vs 21,2% despite no significance p=0,097 CONCLUSIONS: The early removal of nasogastric tube within postoperative 48 h after total gastrectomy is feasible and safe in common practice and might also have a potential benefit in preventing postoperative pneumonia.

[Clinical analysis of efficacy and prognosis of intermediate risk gastric stromal tumor patients].

OBJECTIVE: To explore the clinical efficacy and prognosis of the patients with intermediate risk gastric stromal tumor (GST). METHODS: The data of intermediate risk GST patients confirmed by pathology and immunohistochemistry at Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, between January 2007 and July 2011 were collected and retrospectively analyzed. And univariate and multivariate analyses were performed to assess the efficacy of imatinib mesylate (IM) according to recurrence-free survival (RFS). RESULTS: A total of 46 intermediate risk GST patients were enrolled with a median follow-up period of 31 (9-64) months. Among them, 20 patients received IM treatment and 1 had hepatic metastasis at 16 months after withdrawal. In contrast, 5 of 26 patients refusing IM treatment recurred or had a distant metastasis. The 1-, 2-, 3-year recurrence-free survival in IM treatment group and no IM treatment group were: 20/20 vs 25/26, 14/14 vs 17/20 and 6/7 vs 10/14, respectively. Cox proportion hazards regression: hazard ratio(HR) = 0.265, 95%CI: 0.025-2.761, P = 0.267. Among 6 patients with recurrence and(or) metastasis, 5 had mitotic count > 5/50 HPF. Cox proportion hazards regression (HR = 0.059, 95%CI: 0.004 - 0.976, P = 0.048) showed that IM can improve the progression free survival of mitotic count > 5/50 HPF group versus mitotic count < 5/50 HPF. The most common IM-related side effects were edema, nausea, abdominal discomfort, leukemia, etc. Most of them were Grade 1-2. CONCLUSIONS: Intermediate risk GST has a low rate of recurrence or metastasis. And 1-year IM treatment may improve the prognosis of the patients with mitotic counts > 5/50 HPF. Furthermore, IM treatment is safe in intermediate risk GST patients.

[Clinical research of the sentinel lymph node in patients with early gastric cancer].

OBJECTIVE: To assess the value of carbon nanoparticles which mapping sentinel lymph node (SLN) and predict the status of lymph node metastasis status in the early gastric cancer (EGC), and to explore the SLN distribution. METHODS: Forty five patients with EGC, who underwent surgical treatment, were enrolled. At the completion of exploratory laparotomy, 1 mL solution of carbon nanoparticles was injected subserosally in the gastric wall 4-6 sites around the primary tumor during surgery in all patients. The first stained lymph nodes were defined as the SLN. Postoperative SLN and dissection of the lymph node was sent for histopathological examination. RESULTS: Carbon nanoparticles were applied in 45 EGC patients for mapping SLN and 43 cases (95.6%) were observed with positive stain. 53 pieces of SLN were detected, average (1.23 +/- 0.53) pieces for one person. 11 of the 43 patients (25.6%) developed lymph node metastasis, through the SLN histopathological examination, 3 cases (7.0%) were false negative, the accuracy and sensitivity of the prediction of regional lymph node metastasis status was 93.0% and 72.7%, respectively. The false negative and negative predictive value was 27.3% and 91.4%. There were significant differences between the mucosal cancer group and submucous cancer group in the diameter of tumor (P = 0.042) and the rate of lymph node metastasis (P = 0.001). There were no significant differences between the two groups in the accuracy and sensitivity (P > 0.05). In 36 cases of gastric cancer patients, 23 SLN positive cases (63.9%) were detected in third group. CONCLUSIONS: The dyeing rate, accuracy and sensitivity of carbon nanoparticles mapping SLN for EGC were high. Carbon nanoparticles mapping SLN can more accurately predict perigastric lymph node metastasis status in patients with EGC.

[Prognostic analysis of 349 cases with gastrointestinal stromal tumor].

OBJECTIVE: To investigate the prognostic factors of gastrointestinal stromal tumor (GIST). METHODS: Clinical data of 349 cases of GIST patients in our hospital between January 2006 and September 2011 were analyzed retrospectively and the prognostic factors were evaluated. RESULTS: 335 patients underwent R0 resection and 14 with palliative resection. With a follow-up of 288 (82.5%) patients (median: 33 months, range 3-72 months), 61 patients with progressed were observed and 33 of them died. Unconditional logistic regression analysis showed that tumor location (P = 0.003, OR = 1.412, 95% CI: 1.125-1.772), risk classification (P = 0.011, OR = 2.930, 95% CI: 1.278-6.716) and use of imatinib treatment (P = 0.009, OR =0.291, 95 CI: 0.115-0.734) were independent factors for post-operative recurrence or metastasis. Survival analysis of 128 patients between January 2006 and December 2008, Cox regression analysis demonstrated diameter (P = 0.034, OR = 2.328, 95% CI: 1.065-5.089), risk classification (P = 0.015, OR = 3.031, 95% CI: 1.236-7.428) and use of imatinib treatment (P = 0.011, OR = 0.259, 95% CI: 0.091-0.734) were independent prognosis factors. CONCLUSIONS: No specific clinical manifestation was observed for GIST. Tumor location, diameter, risk classification and imatinib treatment could influence on prognosis. Radical resection combined with imatinib treatment could improve the prognosis.

Citrus peel extract protects against diesel exhaust particle-induced chronic obstructive pulmonary disease-like lung lesions and oxidative stress.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and characterized by emphysema, small airway remodeling and mucus hypersecretion. Citrus peels have been widely used as food spices and in traditional Chinese medicine for chronic lung disease. Given that citrus peels are known for containing antioxidants and anti-inflammatory compounds, we hypothesize that citrus peel intake can suppress oxidative stress and inflammatory response to air pollution exposure, thereby alleviating COPD-like pathologies. This study aimed to investigate the efficacy of citrus peel extract, namely Guang Chenpi (GC), in preventing the development of COPD induced by diesel exhaust particles (DEPs) and its potential mechanism. DEP-induced COPD-like lung pathologies, inflammatory responses and oxidative stress with or without GC treatment were examined in vivo and in vitro. Our in vivo study showed that GC was effective in decreasing inflammatory cell counts and inflammatory mediator (IL-17A and TNF-α) concentrations in bronchoalveolar lavage fluid (BALF). Pretreatment with GC extract also significantly decreased oxidative stress in the serum and lung tissue of DEP-induced COPD rats. Furthermore, GC pretreatment effectively reduced goblet cell hyperplasia (PAS positive cells) and fibrosis of the small airways, decreased macrophage infiltration as well as carbon loading in the peripheral lungs, and facilitated the resolution of emphysema and small airway remodeling in DEP-induced COPD rats. An in vitro free radical scavenging assay revealed robust antioxidant potential of GC in scavenging DPPH free radicals. Moreover, GC demonstrated potent capacities in reducing ROS production and enhancing SOD activity in BEAS-2B cells stimulated by DEPs. GC treatment significantly attenuated the increased level of IL-8 and MUC5AC from DEP-treated BEAS-2B cells. Mechanistically, GC treatment upregulated the protein level of Nrf-2 and could function via MAPK/NF-κB signaling pathways by suppressing the phosphorylation of p38, JNK and p65. Citrus peel extract is effective in decreasing oxidative stress and inflammatory responses of the peripheral lungs to DEP exposure. These protective effects further contributed to the resolution of COPD-like pathologies.

Correlation between serum CA724 and gastric cancer: multiple analyses based on Chinese population.

Serum tumor biomarker carbohydrate antigen 724 (CA724) is noticeable for gastric cancer. Correlation between CA724 and gastric cancer was investigated based on Chinese population. Chinese Biomedical Database, Chinese Journal Full-text Database and PubMed were searched. Gastric cancer patients were proven by biopsy, and control included health volunteers or benign gastric diseases. Participants received at least one test of CA724, CA125, CA153, CA199, CA242 or CEA. Meta-analysis, summary ROC (SROC) and post hoc analysis were performed by RevMan 5.0 and SPSS 11.5. Totally, 33 eligible studies were analyzed. Meta-analysis showed CA724 had the highest odds ratio 32.86 compared to control, orderly followed by CA242, CA199, CEA, CA125 and CA153. Accumulated accuracy rate of CA724 was 77 %, superior to others. In SROC analysis, specificity of all studies was above 0.70, but sensitivity of few studies was above 0.70; CA724 was selected as the preferable single test, followed by CA242, CA199, CEA, CA125 and CA153. If threshold of both specificity and sensitivity up to 0.70, CA153 was unacceptable; if up to 0.80, only CA724 and CA242 were considerable. In CA724-combined patterns, CA724+CEA+CA199 combination performed best by increasing sensitivity to 0.74 without impairing specificity, while CA724 + CA199 pattern was not a proper combination. CA724 was the most correlative serum tumor biomarker for gastric cancer in Chinese population. Sensitivity of serum CA724 is limited, but CA724+CEA+CA199 combination is considerable to improve sensitivity without impairing specificity.

Gastric tube reconstruction reduces postoperative gastroesophageal reflux in adenocarcinoma of esophagogastric junction.

BACKGROUND: The anastomosis of gastric remnant to esophagus after proximal gastrectomy is the traditional surgical treatment procedure for patients with types II and III adenocarcinoma of esophagogastric junction. However, the postoperative complications such as gastroesophageal reflux are frequent. AIMS: To assess the outcome of the intraperitoneal anastomosis of the reconstructed gastric tube to esophagus after proximal gastrectomy for types II and III adenocarcinoma of esophagogastric junction. METHODS: Seventy-six consecutive patients with preoperative diagnosis of type II or type III adenocarcinoma of esophagogastric junction were recruited. Forty-one patients had the traditional anastomosis of gastric remnant to esophagus and 35 patients underwent an anastomosis of esophagus to a gastric tube that was constructed from the gastric remnant after proximal gastrectomy. RESULTS: Twenty-three (56.1%) versus 12 (28.6%) patients (p = 0.016) complained various discomforts and/or were diagnosed with complications in the traditional group and gastric tube group, respectively, although there were no significant differences between the two groups in demographic data and pathological characteristics. Fourteen (34.1%) versus five (14.3%) patients (p = 0.046) complained of heartburn or acid regurgitation and nine (22.0%) versus two (5.7%) patients (p = 0.045) were confirmed reflux esophagitis in the traditional group and the gastric tube group, respectively. CONCLUSIONS: The intraperitoneal anastomosis of the reconstructed gastric tube to esophagus demonstrates less complaints of gastroesophageal reflux and reflux esophagitis than the traditional anastomosis of gastric remnant to esophagus in the surgical treatment of types II and III adenocarcinoma of esophagogastric junction in 1-year follow-up.

Quality of life following laparoscopic-assisted distal gastrectomy for gastric cancer.

BACKGROUND/AIMS: This study investigated quality of life (QoL) of patients 6 months after surgery for early or advanced gastric cancer. METHODOLOGY: Between June, 2006 and December, 2009, 39 patients undergoing laparoscopic assisted distal gastrectomy (LADG) and 35 patients undergoing open distal gastrectomy (ODG) were enrolled. All the patients completed a validated questionnaire (EORTC QLQ-C30) and site specific module (QLQ-STO22) after surgery. Clinicopathological characteristics were compared and the patients' QoL were emphasized. RESULTS: There were no significant differences between the two groups in age, comorbidities, curative degree, tumor stage, etc. In terms of QLQ-C30 items, significantly better role, cognitive, emotional and social functioning in the LADG group were identified as well as a significant lower incidence rate of constipation. Physical functioning, dyspnea, pain, fatigue, insomnia, diarrhea, financial difficulties and global health status, were not significantly different between the two groups. With respect to QLQ-STO22 items, LADG associated with lower incidence of reflux symptoms and better body image. However, there were no significant differences on symptoms of dysphagia, pain, eating restrictions, dry mouth, change of taste, anxiety and hair loss. QoL stratified by Billroth II reconstruction procedure gave similar results except for role functioning and body image, LADG had higher score compared with ODG. CONCLUSIONS: Long-term follow-up results suggest that LADG might help improve the QoL in patients with gastric cancer. Well-designed large scale randomized controlled trials are needed.

Spread and development of laparoscopic surgery for gastric tumors in mainland China: initial experiences.

BACKGROUND/AIMS: To introduce the initial experience of the laparoscopic surgery for gastric tumors in mainland China. METHODOLOGY: A key Chinese full-text database was comprehensively searched for eligible reports on laparoscopic gastric surgery from 1991 to 2009. Outcomes of laparoscopic gastrectomy for gastric cancer were extracted for pooling estimate. RESULTS: In the period 2003-2008, the amount of relevant journal papers sharply increased (p<0.001). Analysis included 67 reports (no randomized controlled trial, 4 case control studies and the remnant of case series or case reports); 74.6% of the reports were from institutions in the Eastern China region. Finally 542 patients of gastric cancer were analyzed. Early gastric cancer (TNM stage Ia/Ib) was only 30.0%. D2/D2+ lymphadenectomy was performed in 69.0% patients. The combined overall complication and mortality rates were 10.9% and 0.4%, respectively. The incidence of conversion to open surgery and reoperation were 4.1% and 1.1%, respectively. The long-term outcome of 5-year survival rate was unavailable. CONCLUSIONS: Laparoscopic gastric surgery has spread rapidly and developed in mainland China during recent several years. The initial experiences from mainland China showed that postoperative complication and mortality rates of laparoscopic gastrectomy for gastric cancer were acceptable and comparable to Japanese and Korean trials.

Total vs. proximal gastrectomy for proximal gastric cancer: a systematic review and meta-analysis.

BACKGROUND/AIMS: To compare effectiveness between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer. METHODOLOGY: PubMed, Embase, Cochrane library and Chinese CNKI databases were searched to select eligible studies comparing TG to PG for proximal gastric cancer. Outcome measures included overall survival, recurrence, mortality and morbidity rates, as well as nutritional states. Meta-analyses were performed by RevMan 5.0. RESULTS: One randomized controlled trial and 7 retrospective studies involving 1077 patients were included. Meta-analysis showed no significant difference of 5-year overall survival rate (OR=0.89, p=0.53). However, TG achieved a lower recurrence rate (Peto OR=0.53, p=0.004). PG experienced higher morbidity risk (OR=0.11, p<0.00001), concerning higher risks of reflux esophagitis (OR=0.04, p<0.00001) and anastomotic stenosis (OR=0.14, p<0.00001) in a short period. TG performed longer operation time (p=0.002) and more blood loss (p<0.00001). Operative mortality and nutritional states were comparable without significant differences. CONCLUSIONS: Based on current retrospective evidences, TG and PG had similar overall survival outcome for proximal gastric cancer, but TG showed lower recurrence rate. PG with gastroesophagostomy had higher incidence of reflux esophagitis and anastomotic stenosis. TG can be recommendation for proximal gastric cancer, although more high-quality trials are still expected.