Laparoscopic versus open distal gastrectomy for advanced gastric cancer in elderly patients: a propensity-score matched analysis.

BACKGROUND: Scarce research has reported the efficacy and safety of laparoscopic distal gastrectomy in elderly patients. This retrospective study aimed to compare the outcomes of laparoscopic and open distal gastrectomy for advanced gastric cancer in elderly patients. METHODS: A total of 303 elderly patients who underwent distal gastrectomy for advanced gastric cancer from June 2017 to June 2021 were enrolled. Variables used to calculate propensity score matching included sex, age, body mass index, American Society of Anesthesiologists, history of diabetes, and history of hypertension. The statistical significance of continuous variables was tested using an independent sample t test. chi-square or Fisher's exact tests were used for categorical variables. Kaplan-Meier curve and log-rank test were used for the evaluation of 3-year overall survival and recurrence-free survival. RESULTS: After performing 1:1 propensity score matching, 248 patients were included for analysis (laparoscopic = 124, open = 124). Compared with the open group, the laparoscopic group showed significant advantages in estimated blood loss (P < 0.001), pain scale on the first postoperative day (P = 0.002), time to first flatus (P = 0.004), time to first liquid diet (P = 0.005), hospital stays (P < 0.001), and total complications (P = 0.011), but devoted much more operation time (P < 0.001). No statistical difference was observed between the two groups in 3-year recurrence-free survival (P = 0.315) or overall survival (P = 0.159). CONCLUSIONS: Our analysis demonstrated that laparoscopic surgery had the advantages of less intraoperative blood loss, fewer postoperative complications, and faster postoperative recovery in distal gastrectomy for advanced gastric, indicating that laparoscopic distal gastrectomy is safe and effective for treating elderly patients with distal gastric cancer.

Comparison of robotic­assisted versus conventional laparoscopic surgery for mid-low rectal cancer: a systematic review and meta-analysis.

PURPOSE: Scarce research has reported the comparison between robotic and laparoscopic surgery in mid-low rectal cancer. Therefore, this meta-analysis is aimed to compare the safety and efficacy of the two surgical approaches. METHODS: A comprehensive search of the databases (PubMed, EMBASE, Cochrane, and Web of Science) was performed for studies comparing robotic and laparoscopic surgery. The outcomes of interest acquired from eight articles included three aspects: intraoperative conditions, postoperative status of patients, and complications. All data (robotic = 1350 patients, laparoscopic = 1330 patients) enrolled were analyzed using Rev Man 5.4. RESULTS: Compared to the laparoscopic group, the robotic group indicated a noticeable superiority in estimated blood loss (P < 0.0001), number of lymph nodes dissected (P = 0.004), time to first flatus (P = 0.001), time to first fluid diet (P = 0.001), hospital stay (P < 0.0001), conversion (P = 0.009), and urinary retention (P = 0.0006), but devoted much more operation time (P = 0.0004). CONCLUSION: Robotic surgery was associated with superiority over laparoscopic surgery in increasing surgical safety, accelerating postoperative recovery, and reducing complications, which suggested that robotic surgery could be a safe and effective method for treating mid-low rectal cancer.

Robotic-assisted intracorporeal versus extracorporeal techniques in sigmoidectomy: a propensity score-matched analysis.

Scarce research has been performed to assess the safety and efficacy of anastomosis technique on robotic-assisted sigmoidectomy. This study was designed to evaluate the difference between intracorporeal and extracorporeal techniques during robotic-assisted sigmoidectomy. Clinical data of 193 cases who received robotic-assisted sigmoidectomy were retrospectively collected and analyzed. Only 116 cases were available for analysis (intracorporeal group = 58 and extracorporeal group = 58) after propensity score matching. Independent sample t test was conducted to evaluate the continuous variables. Moreover, the statistical significance of categorical variables was tested using Chi-square or Fisher's exact tests. Statistical analysis showed that the intracorporeal group demonstrated greater superiorities in pain scale on the first and second postoperative day (P < 0.05), time of catheter indwelling (P = 0.009), and length of hospital stay (P = 0.019). Additionally, the intracorporeal technique contributed to fewer complications including urinary retention (P = 0.027) and hernia (P = 0.037) than the extracorporeal group. Our analysis revealed that intracorporeal technique was safe and feasible due to the shorter time of catheter indwelling and length of hospital stay and fewer post-operation complications.

Comparison of intracorporeal and extracorporeal anastomosis in left hemicolectomy: updated meta-analysis of retrospective control trials.

BACKGROUND: The feasibility and effectiveness of selecting an intracorporeal or extracorporeal technique in left hemicolectomy remain poorly understood. This meta-analysis aimed to evaluate the difference between the two approaches regarding intraoperative and postoperative outcomes. METHODS: A thorough exploration of online databases (PubMed, Embase, Cochrane, and Web of Science) was executed to identify randomized controlled trials, cohort studies, and case control studies. The outcomes contained four aspects: intraoperative outcomes, postoperative complications, postoperative patient conditions, and postoperative outcomes. All of these data were analyzed using RevMan 5.4. Seven retrospective control trials (intracorporeal, 396 patients; extracorporeal, 426 patients) were evaluated. RESULTS: Compared to the extracorporeal group, the intracorporeal group demonstrated superiority in incision length (P = 0.005), overall complications (P = 0.01), time to first flatus (P < 0.001), time to first stool (P = 0.005), time to first diet (P < 0.001) and hospital stay duration (P = 0.001). CONCLUSIONS: The intracorporeal technique is associated with superiority over the extracorporeal technique in reducing postoperative complications, promoting postoperative recovery of gastrointestinal function, and reducing hospital stay duration.

Galectin­1 binds GRP78 to promote the proliferation and metastasis of gastric cancer.

The present study aimed to investigate the potential molecular mechanisms by which galectin­1 (Gal­1) and glucose­regulated protein 78 (GRP78) influence the development of malignant gastric cancer (GC). Immunohistochemistry and western blotting were used to map the expression and location of the Gal­1 gene in the 80 paraffin­embedded GC samples, 16 fresh samples and surrounding tissues. Gal­1 was overexpressed and knocked down using lentiviral vectors in the human GC cell lines HGC­27 and AGS. Through the use of the Cell Counting Kit­8 assay, clone formation assay, wound healing assay, invasion assay and tumor xenograft, the possible biological roles of Gal­1 were further evaluated. The downstream interacting proteins were predicted by the BioGRID database, and GRP78 was chosen for further investigation. Immunofluorescence labeling and Co­IP were used to confirm the connection. The statistical tests utilized were the two­tailed paired Student's t­test, χ2 test, Kaplan­Meier and Cox regression analysis, and Spearman's rank correlation coefficients. In GC, Gal­1 is extensively expressed and has the potential to interact with GRP78. Poor prognosis is linked to high levels of GRP78 and Gal­1 expression in patients with GC. According to the functional study, Gal­1 knockdown prevented cells from thriving and pushed Gal­1 expression, which aided in the proliferation, migration and invasion of GC. Gal­1 overexpression additionally aided the development of subcutaneous xenograft tumors. The mechanistic investigation proved that GRP78 and Gal­1 interacted, accelerating the course of GC. Gal­1 silencing had an inhibitory effect on the proliferation of HGC­27 cells that was removed by ectopic GRP78 expression, whereas the stimulating effects of Gal­1 overexpression in AGS cells were inhibited by GRP78 knockdown. In conclusion, Gal­1 interacts with GRP78 to facilitate the advancement of GC. The Gal­1/GRP78 axis is supported by the functional data of the present study as a possible GC treatment target.

Low Tumor Infiltrating Mast Cell Density Reveals Prognostic Benefit in Cervical Carcinoma.

Objectives: Research on the role of mast cells (MCs) in cervical tumor immunity is more limited. Therefore, our study aimed to evaluate the prognostic value of MCs and their correlation with the immune microenvironment of cervical carcinoma (CC). Methods: The Cancer Genome Atlas (TCGA) data was utilized to obtain the degree of immune infiltration of MCs in CC. Meanwhile, this study retrospectively collected patient clinical characteristic data and tissue specimens to further verify the relevant conclusions. Mast cell density (MCD) was measured by the CIBERSORT algorithm in TCGA data and immunohistochemical staining of tryptase in CC tissues. Finally, differentially expressed genes (DEGs) of TCGA data were performed using "limma" packages and key gene modules were identified using the MCODE application in Cytoscape. Results: The results showed MCs were diffusely distributed in CC tissues. Moreover, we found that low tumor-infiltrating MCD was beneficial for overall survival (OS) in the TCGA cohort. Consistent conclusions were also obtained in a clinical cohort. In addition, a total of 305 DEGs were analyzed between the high tumor-infiltrating MCD and low tumor-infiltrating MCD group. Seven key modules, a total of 34 genes, were screened through the MCODE plug-in, which was mainly related to inflammatory response and immune response and closely correlated with cytokines including CSF2, CCL20, IL1A, IL1B, and CXCL8. Conclusion: In short, high tumor-infiltration MCs in CC tissue was associated with worse OS in patients. Furthermore, MCs were closely related to cytokines in the tumor microenvironment, suggesting that they collectively played a role in the immune response of the tumor. Therefore, MCD may be a potential prognostic indicator and immunotherapy target of CC.

eIF4E­related miR­320a and miR­340­5p inhibit endometrial carcinoma cell metastatic capability by preventing TGF­ß1­induced epithelial­mesenchymal transition.

Endometrial cancer (EC) is a common form of cancer in women. Metastasis is the main cause of EC treatment failure. Eukaryotic translation initiation factor 4E (eIF4E) is an oncogene that is overexpressed in a variety of malignancies and their distant metastases. The present study analyzed microarray data from the Oncomine database and revealed that high eIF4E expression was associated with poor prognosis and high pathological grade of EC. The expression of eIF4E was higher in EC tissues compared with in adjacent normal tissues. In addition, microRNA (miR)­320a and miR­340­5p expression levels were downregulated in EC tissues compared with those in adjacent normal tissues, which suggested that these microRNAs may serve as EC tumor suppressor genes. miR­320a and miR­340­5p could bind to the 3'­UTR of eIF4E mRNA, thus downregulating the expression of eIF4E and phosphorylated (p)­eIF4E in EC cells. Overexpression of miR­320a or miR­340­5p effectively suppressed HEC­1A cell migration and invasion. The downregulation of eIF4E and p­eIF4E following miR­320a or miR­340­5p transfection reduced the invasiveness and metastatic capability of EC cells in a manner associated with decreased expression of matrix metallopeptidase (MMP)­3 and MMP­9. In addition, one of the effects of transforming growth factor ß1 (TGF­ß1), which is to induce the phosphorylation of eIF4E, was suppressed by miR­320a and miR­340­5p overexpression. These two microRNAs also attenuated the features of TGF­ß1­induced epithelial­mesenchymal transition (EMT). In conclusion, the results of the present study demonstrated that eIF4E was upregulated in EC, whereas miR­320a and miR­340­5p were downregulated in EC compared with adjacent normal tissues. In vitro, miR­320a and miR­340­5p inhibited the migratory capability of EC cells by downregulating MMP­3 and MMP­9 and prevented TGF­ß1­induced EMT through p­eIF4E.