Trimetallic coordination cage formation for nitrate encapsulation: transformation of kinetic products into thermodynamic products.

A procedure for the formation of a nitrate-encapsulating tripalladium(II) cage via self-assembly of Pd(NO3)2 with 1,3-bis(dimethyl(pyridin-4-yl)silyl)propane (L) was developed. The self-assembly reaction initially produces spiro-type macrocycles, PdL2, and finally results in transformation into a nitrate-encapsulated cage, [(NO3)@Pd3L6], in the mother liquor. The reaction of PdX2 (X- = BF4-, ClO4-, PF6-, and CF3SO3- instead of NO3-) with L gives rise to a spiro species, PdL2, as the final product, and anion exchange of the spiro products, [PdL2](X)2, with NO3- produces the tripalladium cage [(NO3)@Pd3L6].

Prognostic Impact of Carcinoembryonic Antigen Levels in Rectal Cancer Patients Who Had Received Neoadjuvant Chemoradiotherapy.

PURPOSE: Carcinoembryonic antigen (CEA) is a useful marker for rectal cancer. The aim of this study was to investigate the prognostic impact of CEA level according to neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients who underwent radical surgery. METHODS: A total of 245 patients with rectal cancer who underwent radical surgery were retrospectively evaluated. Serum CEA level was measured preoperatively and postoperatively. We compared survival outcomes based on CEA level before and after surgery according to nCRT. RESULTS: Of the 245 patients, elevation of CEA level was observed preoperatively in 79 and postoperatively in 30, respectively. Eighty-seven (35.5%) patients received nCRT, and elevated CEA level was a significant prognostic factor both before and after surgery. In patients who had not received nCRT, an elevated CEA level was a significant prognostic factor before surgery but was not significant after surgery. In a multivariate analysis for prognostic factors, elevation of preoperative CEA level was an independent prognostic factor of disease-free survival (DFS) regardless of nCRT. Postoperative CEA level was an independent prognostic factor of DFS in patients who had received nCRT but was not a factor in patients who had not received nCRT. CONCLUSION: Serum CEA level was an independent prognostic factor both preoperatively and postoperatively in rectal cancer patients who had received nCRT.

Clinical characteristics and prognosis of elderly patients with colorectal cancer: Comparison between surgical resection and supportive care.

ABSTRACT: Elderly colorectal cancer (CRC) patients tend to avoid standard treatment, especially curative surgical resection, because of concerns about surgical complications or underlying diseases. This study is intended to compare clinical characteristics and prognosis between patients who had undergone surgical resection and received supportive care, and to evaluate the usefulness of surgical treatment in elderly patients.A total of 114 patients aged ≥80 years who were diagnosed with CRC were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared.The surgical resection group had better Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists (ASA) physical status, and a lower stage than did the supportive-care group. The 3-year OS rate of the surgical group was significantly higher than that of the supportive-care group (60.7% vs 9.1%, P < .001). In extremely elderly patients (age ≥85 years), the surgical group showed a better 3-year OS rate than did the supportive-care group (73.9% vs 6.3%, P < .001), although Eastern Cooperative Oncology Group performance status and ASA physical status were not different. The post-operative mortality rate was 2.7%. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor.Surgical treatment in elderly CRC patients showed a survival benefit, even in the extremely elderly patients. Surgical resection for CRC in elderly patients can be considered to improve survival.

Prognostic value of carcinoembryonic antigen levels before and after curative surgery in colon cancer patients.

PURPOSE: CEA is a useful tumor marker for colon cancer. The aim of this study was to investigate the prognostic value of changes in CEA levels before and after surgery in colon cancer patients who underwent radical surgery. METHODS: A total of 601 colon cancer patients who underwent radical surgery from January 2007 to December 2017 at a single institution were evaluated. Patients were categorized according to preoperative and postoperative CEA levels. We adjusted patient characteristics using propensity score matched analysis between groups and compared survival outcomes according to changes in CEA levels before and after surgery. RESULTS: According to the preoperative and postoperative CEA levels, patients were classified into 3 groups: group 1, ≤5 and ≤5 ng/mL, respectively (n = 407); group 2, >5 and ≤5 ng/mL, respectively (n = 127); and group 3 (>5 and >5 ng/mL, respectively (n = 67). Postoperative CEA elevation was associated with adverse clinical features. Before and after matching, the patients in group 3 showed significantly lower disease-free survival and overall survival rates compared to the patients in group 1 and group 2. In multivariate analysis, changes in CEA levels were an independent prognostic factor of overall survival (P = 0.041). CONCLUSION: The changes in CEA levels before and after surgery can be a useful prognostic factor for disease-free survival and overall survival in colon cancer patients.

Short-term Outcomes of Single-port Versus Multiport Laparoscopic Surgery for Colon Cancer: The SIMPLE Multicenter Randomized Clinical Trial.

OBJECTIVE: To compare short-term perioperative outcomes of single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for colon cancer. SUMMARY BACKGROUND DATA: Although many studies reported short- and long-term outcomes of SPLS for colon cancer compared with MPLS, few have reported results of randomized controlled trials. METHODS: This was a multicenter, prospective, randomized controlled trial with a noninferiority design. It was conducted between August 2011 and June 2017 at 7 sites in Korea. A total of 388 adults (aged 19-85 yrs) with clinical stage I, II, or III adenocarcinoma of the ascending or sigmoid colon were enrolled and randomized. The primary endpoint was 30-day postoperative complication rates. Secondary endpoints were the number of harvested lymph nodes, length of the resection margin, postoperative pain, and time to functional recovery (bowel movement and diet). Patients were followed for 30 days after surgery. RESULTS: Among 388 patients, 359 (92.5%) completed the study (SPLS, n = 179; MPLS, n = 180). The 30-day postoperative complication rate was 10.6% in the SPLS group and 13.9% in the MPLS group (95% confidence interval, -10.05 to 3.05 percentage points; P < 0.0001). Total incision length was shorter in the SPLS group than in the MPLS group (4.6 cm vs 7.2 cm, P < 0.001), whereas the length of the specimen extraction site did not differ (4.4 cm vs 4.6 cm, P = 0.249). There were no significant differences between groups for all secondary endpoints and all other outcomes. CONCLUSIONS: Even though there was no obvious benefit to SPLS over MPLS when performing colectomy for cancer, our data suggest that SPLS is noninferior to MPLS and can be considered an option in selected patients, when performed by experienced surgeons.Trial registration: ClinicalTrials.gov Identifier: NCT01480128.

Quality of life and patient satisfaction after single- and multiport laparoscopic surgery in colon cancer: a multicentre randomised controlled trial (SIMPLE Trial).

BACKGROUND: The clinical benefits of single-port laparoscopic surgery (SPLS) in patients with colon cancer patients are unclear because only a few studies have reported on the quality of life (QoL) of such patients. This study aimed to compare the QoL and patient satisfaction between SPLS and multiport laparoscopic surgery (MPLS) in colon cancer. METHODS: The multicentre randomised controlled SIngle-port versus MultiPort Laparoscopic surgEry (SIMPLE) trial included patients with colon cancer who underwent radical surgery at seven hospitals in South Korea. We performed a pre-planned secondary analysis of the QoL data of 359 patients from that trial. The QoL was surveyed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 preoperatively and at 1, 3, 6, and 12 months postoperatively. Patient satisfaction was measured with a 5-point questionnaire at these postoperative time points. RESULTS: Overall, 145 and 147 patients were included in the SPLS and MPLS groups, respectively. Most QoL domains were similar between the groups. In the subgroup analysis of patients without adjuvant chemotherapy, patients in the SPLS group presented with significantly better global health status (p = 0.017), fatigue (p = 0.047), and pain (p = 0.005) scores and tended to have improved physical (p = 0.055), emotional (p = 0.064), and social (p = 0.081) functioning, with marginal significance at 1 month postoperatively, compared to those in the MPLS group. Patient satisfaction regarding surgery (p = 0.002) and appearance of the abdominal scar (p = 0.002) was significantly higher with SPLS than with MPLS at 12 months postoperatively. CONCLUSION: Patients who underwent SPLS without adjuvant chemotherapy had better global health status, fatigue status, and pain at 1 month postoperatively; however, these improvements were minimal and temporary. In the near future, the effect of SPLS on postoperative QoL should be confirmed through a randomised controlled trial targeting the QoL in colon cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01480128.

Risk factors for postoperative delirium after colorectal surgery: a systematic review and meta-analysis.

PURPOSE: Postoperative delirium is common after any type of surgery and can lead to serious outcomes; thus, its prevention is important. Early assessment can help identify patients at higher risk of postoperative delirium. However, the risk factors for postoperative delirium in patients who underwent colorectal surgery are unclear. This meta-analysis aimed to identify the risk factors for postoperative delirium after colorectal cancer surgery. METHODS: We selected all articles related to postoperative delirium after colorectal surgery published up to March 2019. Studies using any method for diagnosing delirium were eligible. Ovid-Embase, Ovid-Medline, and the Cochrane library were searched. Two reviewers independently conducted quality assessment and data collection. The risk factors identified in the studies were recorded, and a meta-analysis was conducted. RESULTS: Of the 1216 studies initially screened, 1197 were reviewed by two independent reviewers. Finally, 14 articles were identified to be relevant for this review. In total, 11 of the 14 studies reported the risk factors for postoperative delirium. The incidence of postoperative delirium ranged from 8% to 54%. A total of 19 risk factors were identified, and we classified them into two categories as patient-related and treatment-related risk factors. CONCLUSION: Postoperative delirium is highly common in those undergoing colorectal surgery including cancer, with advanced old age, history of preoperative delirium and preoperative serum albumin level which are risk factors for POD. Larger multi-institutional randomized studies to address this issue are warranted in the future.

Delta neutrophil index as a prognostic marker in emergent abdominal surgery.

BACKGROUND: Delta neutrophil index (DNI) is the fraction of circulating immature granulocytes provided by a routine, complete blood cell analyzer. It is known to be a useful prognostic marker of sepsis. The aim of this study was to evaluate the role of DNI in the diagnosis and prognosis of patients who had undergone emergent surgery for an acute abdomen. METHODS: A total of 694 patients who had visited the emergency room for acute abdominal pain and undergone emergent abdominal surgery from May 2015 to September 2016 were retrospectively reviewed. Clinical characteristics, laboratory findings on the day of hospital visit, hospital stay, postoperative complications, and 30-day mortality were investigated. RESULTS: In the analysis of patients who had undergone an operation for acute peritonitis, the DNI was a good predictor for predicting 30-day mortality rate (area under the curve [AUC]: 0.826). It was not inferior to other laboratory values, including activated partial thromboplastin time (AUC: 0.729), C-reactive protein (AUC: 0.727), albumin (AUC: 0.834), prothrombin time (AUC: 0.816), and creatinine (AUC: 0.837) known to be associated with sepsis. Patients with high DNI displayed higher incidence of bacteremia and sepsis, longer hospital stay, higher postoperative complication rate, and higher 30-day mortality rate than patients with low DNI. Among patients diagnosed with acute appendicitis, the DNI was a useful marker for differentiating appendiceal perforation. CONCLUSION: The DNI was a practical and useful marker for predicting the prognosis of patients who needed emergent abdominal surgery.

HER2 as a limited predictor of the therapeutic response to neoadjuvant therapy in locally advanced rectal cancer.

Human epidermal growth factor 2 (HER2) is a candidate therapeutic and prognostic marker for rectal cancer treated with neoadjuvant chemoradiotherapy. The specific frequency and prognostic role of HER2 protein expression and HER2 gene amplification in those rectal cancers has not been fully investigated. Pretreatment biopsied and surgically resected formalin-fixed paraffin-embedded tissues from 74 patients were retrospectively evaluated for HER2 protein expression and HER2 gene copy number using immunohistochemistry (IHC) and silver in situ hybridization (SISH), respectively. The tumor response to chemoradiation was evaluated with TNM staging and tumor regression grading (TRG) systems. Good response to chemoradiation therapy (TRG3), poor response (22 TRG1 and 19 TRG2), and TNM downstaging achieved in 33 (44.6%), 41 (55.4%), and 42 (56.8%) patients, respectively. The frequency of HER2 positivity is 17.6%, all of which were low-level HER2 gene amplification with 2.2 of median gene copy number ratio, detected in IHC0 (3/39), IHC1+ (2/18), IHC2+ (5/14) and IHC3+ (2/3). There was no association of HER2 positivity with clinicopathological parameters or survival. However, older age (≥61 years) and HER2 positivity were the independent predictive factors for non-down staging, while poorly differentiation and the papillary pattern were predictors for poor response. In multivariate analysis, good response proved as an only independent favorable prognostic factor affecting survivals. In conclusion, HER2 positivity may be predictive for a high-risk therapeutic resistance in rectal cancers. The discrepancy between IHC and gene amplification may result from the low-level amplification, which may explain lack of prognostic impact of HER2 positivity.

Feasibility and Safety of Single-Incision Laparoscopic Appendectomy by a Surgical Resident under Supervision of a Staff Surgeon.

Purpose: This study was aimed at reporting our experience with single-incision laparoscopic appendectomies (SILA) performed by a surgical resident, and to evaluate the safety and feasibility of the procedure, together with a comparison of the outcomes of the same procedure performed by a staff surgeon. Methods: We conducted a retrospective case series analysis of 60 consecutive patients who underwent SILA. Two surgeons, an attending staff surgeon and a second-year surgical resident, performed the SILA procedures. SILA procedures performed by the resident were intraoperatively guided and supervised by the staff surgeon. Results: A total of 60 case-matched patients with acute appendicitis underwent a SILA performed by either the resident or attending staff. There was no difference in patient demographics between the two groups of patients. The mean operation time was longer in the resident group than in the staff group (43.2±6.0 minutes vs. 32.9±10.5 minutes, p<0.001). There was no significant difference in the operative data between the two groups. No conversion to an open procedure occurred in either group. Postoperative pain, time to onset of oral intake, and number of days of postoperative hospital stay were similar in both groups. Conclusion: SILA procedures performed by a resident are safe and feasible despite longer operation times. Perioperative supervision and guidance by an attending staff surgeon may facilitate surgical outcomes.

Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis.

PURPOSE: Few studies have compared robotic and laparoscopic intersphincteric resection (ISR) in rectal cancer. Therefore, we performed a meta-analysis of recently published studies to compare perioperative outcomes of ISR for the treatment of low rectal cancer. METHODS: We performed a systematic literature search of the Ovid-Medline, Ovid-EMBASE, and Cochrane Central Register of Controlled Trials databases for studies comparing robotic and laparoscopic ISR in patients with low rectal cancer. Demographic and clinical data were extracted from articles that met the inclusion and exclusion criteria. Perioperative outcomes of interest included the rate of diverting stoma, open conversion rate, operation time, estimated blood loss, length of hospital stay, time to first flatus, and time to initiate the postoperative diet. Oncological outcomes included the number of retrieved lymph nodes, distal resection margin, proximal resection margin, circumferential resection margin, 3-year overall survival, 3-year disease-free survival, and local recurrence. Postoperative complications included overall complications, a Dindo-Clavien classification ≥ III, and anastomotic leakage. All outcomes were compared between the two groups. RESULTS: We included 5 retrospective cohort studies with a total of 510 patients undergoing 273 (53.5%) robotic ISR procedures and 237 (46.5%) laparoscopic ISR procedures. The robotic ISR group lower conversion rate, lower blood loss, and longer operation times than the laparoscopic group. We also noted that fewer lymph nodes were harvested in the robotic ISR group; however, this difference was not statistically significant. Other outcomes were similar between the two groups. CONCLUSIONS: Robotic and laparoscopic ISR showed comparable perioperative outcomes, functional outcomes, and 3-year oncologic outcomes; however, robotic ISR was associated with a lower conversion rate and less blood loss despite longer operation times compared to laparoscopic ISR. These findings suggest that robotic ISR maybe a safe and effective technique for treating low rectal cancer in selected patients. The potential oncologic and functional benefits of robotic ISR should be evaluated in larger randomized controlled trials.

Multicenter, randomized single-port versus multiport laparoscopic surgery (SIMPLE) trial in colon cancer: an interim analysis.

BACKGROUND: Single-port laparoscopic surgery (SPLS) was recently introduced as an innovative minimally invasive surgery method. Retrospective studies have revealed the safety and feasibility of SPLS for colon cancer treatment. However, no prospective randomized trials have been performed. The multicenter, randomized SIMPLE (single-port versus multiport laparoscopic surgery) trial aimed to investigate short-term perioperative outcomes of SPLS for colon cancer treatment, compared with multiport laparoscopic surgery (MPLS). METHODS: Between August 2011 and April 2014, a total of 194 patients with colon cancer were recruited from seven hospitals in Korea. Patients were randomly allocated into the SPLS group (n = 99) or MPLS group (n = 95). The primary endpoint was postoperative complications. Operative, postoperative, and pathologic outcomes were analyzed after 50% of the patient study population had been recruited. RESULTS: The patients' demographic characteristics, operative times, estimated blood volume losses, numbers of harvested lymph nodes, and lengths of both resection margins were not significantly different between groups. In the SPLS group, the rates of conversion to MPLS and open surgery were 12.9 and 2.2%, respectively. Postoperative complications occurred in 10.8% of the SPLS, and 12.5% of the MPLS patients (p = 0.714). Times to functional recovery, pain scores, and amounts of analgesia were similar between groups. CONCLUSION: The results of this interim analysis suggested that SPLS is technically safe and appropriate when used for radical resection of colon cancer. (ClinicalTrials.gov Identifier: NCT01480128).

Intracorporeal Traction of the Rectum with a Beaded Plastic Urinary Drainage Bag Hanger: Comparison with Conventional Laparoscopic Rectal Cancer Surgery.

BACKGROUND: Laparoscopic rectal cancer surgery with proper total mesorectal excision is a challenge for colorectal surgeons during trouble shooting. We used a beaded plastic urinary drainage bag hanger to encircle the rectum and clamp laparoscopic rectal transaction in this study. METHODS: Sixty-three patients with rectal cancer underwent laparoscopic radical rectal resection with curative intent between February 2015 and December 2015. Plastic beaded form urinary Foley catheter bag hanger was inserted intracorporeally via right lower 12-mm trocar, encircling the rectal tube distal to the rectal lesion followed by fastening. Thirty patients in the rectal resection group (28 laparoscopic, 2 robotic-assisted) using the commercial beaded plastic hanger for Foley catheter drainage were compared to 33 patients who underwent conventional laparoscopic rectal resection. RESULTS: Low anterior resection was performed for both groups. The Foley bag hanger group had less operation time (162.6 min vs. 187.3 min, p = 0.006) and fewer numbers of stapler cartilage (1.6 vs. 2.1, p = 0.001). CONCLUSIONS: Intracorporeal ligation of the rectum with a beaded plastic Foley catheter bag hanger could be used as a valuable method for rectal handling and transaction in laparoscopic rectal cancer surgery.

Single port laparoscopic repair of sigmoid colon perforation during colonoscopy.

Colonic perforation during colonoscopy is a rare but lethal complication. Recently, it is usually managed with laparoscopic approach. Here we present our experience of single incision laparoscopic repair for sigmoid colon perforation during colonoscopy. A 57-year-old male patient presented with an acute sigmoid colon perforation event during diagnostic colonoscopy. Emergency operation was performed with transumbilical single incision laparoscopic exploration. The perforated site of sigmoid colon was primarily repaired with the curved endoscopic linear stapler. The patient was discharged after 5 days uneventfully. Single port laparoscopic repair is a safe and feasible method for the management of acute colonoscopic perforation during diagnostic colonoscopy.

Laparoscopic surgery for colorectal cancer in patients over 80 years of age: the morbidity outcomes.

PURPOSE: The aim of this study was to compare the outcomes between patients under 60 years of age and older patients over 80 years of age who underwent laparoscopic colorectal surgery with colorectal cancer. METHODS: A retrospective analysis of 519 colorectal patients who underwent laparoscopic colorectal surgery for colorectal adenocarcinoma between January 2007 and December 2012 was collected and categorized into 2 groups of patients, those under 60 years of age (n = 404) and those over 80 years of age (n = 115). RESULTS: The group of patients over 80 years of age had a significantly higher ASA physical status classification (P < 0.001), more preoperative comorbidities (P < 0.001), had a tendency towards more tumors in a colonic location (P = 0.034), and more advanced American Joint Committee on Cancer TNM stage (P = 0.001). A higher proportion of right hemicolectomy and abdominoperineal resection was performed and more transfusions were required in the group of patients over 80 years of age (P = 0.002 and P = 0.001, respectively). There were no significant differences in operative time, conversion rate, resection margins, and numbers of harvested lymph nodes, hospital stay, and morbidity between the 2 groups. No postoperative mortality was found in the present study. The 3-year DFS for over 80 years age group and under 60 years age group were 73.5% and 73.9%, respectively (P = 0.770). CONCLUSION: Laparoscopic colorectal surgery was effective and safe for elderly patients over 80 years of age and resulted in postoperative outcomes similar to those in younger patients. The postoperative morbidity after laparoscopic colorectal cancer surgery was not increased in over 80 years of age.

Learning curve for single-port laparoscopic colon cancer resection: a multicenter observational study.

BACKGROUND: The aim of this study was to investigate the learning curves (LCs) of single-port laparoscopic surgery (SPLS) for colon cancer using multidimensional statistical analyses. Although SPLS yields better cosmetic results and comparable short-term outcomes compared to conventional laparoscopic surgery, its technical difficulties make surgeons hesitant to try SPLS. Moreover, the LCs of SPLS for colon cancer are not well delineated. METHODS: Data were collected from patients who underwent SPLS for colon cancer in seven Korean institutions between May 2009 and May 2015. The LCs were analyzed using the moving average method and the cumulative sum control chart (CUSUM) for operation time and surgical failure. Surgical failure was defined as the any conversion, postoperative complications, or less than 12 harvested lymph nodes from surgical specimens. RESULTS: A total of 356 patients were included in this study. Six and three surgeons performed 282 anterior resections (ARs) and 74 right colectomies (RCs), respectively. On the basis of the moving average method and CUSUM for operation time and surgical failure, the LCs for AR were 18, 16, 35, 13, 36, and 13 cases for surgeons A-F, respectively. However, the LCs for RC were 6 and 15 cases for surgeons D and E, respectively, and were ambiguous for one surgeon. CONCLUSIONS: For surgeons experienced in conventional laparoscopic colorectal surgery, the LCs of SPLS for colon cancer ranged from 6 to 36 cases, which is shorter than the LCs reported for conventional laparoscopic surgery.

PHLDA3 overexpression in hepatocytes by endoplasmic reticulum stress via IRE1-Xbp1s pathway expedites liver injury.

OBJECTIVE: Endoplasmic reticulum (ER) stress is involved in liver injury, but molecular determinants are largely unknown. This study investigated the role of pleckstrin homology-like domain, family A, member-3 (PHLDA3), in hepatocyte death caused by ER stress and the regulatory basis. DESIGN: Hepatic PHLDA3 expression was assessed in HCV patients with hepatitis and in several animal models with ER stress. Immunoblottings, PCR, reporter gene, chromatin immunoprecipitation (ChIP) and mutation analyses were done to explore gene regulation. The functional effect of PHLDA3 on liver injury was validated using lentiviral delivery of shRNA. RESULTS: PHLDA3 was overexpressed in relation to hepatocyte injury in patients with acute liver failure or liver cirrhosis or in toxicant-treated mice. In HCV patients with liver injury, PHLDA3 was upregulated in parallel with the induction of ER stress marker. Treatment of mice with tunicamycin (Tm) (an ER stress inducer) increased PHLDA3 expression in the liver. X box-binding protein-1 (Xbp1) was newly identified as a transcription factor responsible for PHLDA3 expression. Inositol-requiring enzyme 1 (IRE1) (an upstream regulator of Xbp1) was required for PHLDA3 induction by Tm, whereas other pathways (c-Jun N-terminal kinase (JNK), protein kinase RNA-like endoplasmic reticulum kinase (PERK) and activating transcription factor 6 (ATF6)) were not. PHLDA3 overexpression correlated with the severity of hepatocyte injury in animal or cell model of ER stress. In p53-deficient cells, ER stress inducers transactivated PHLDA3 with a decrease in cell viability. ER stress-induced hepatocyte death depended on serine/threonine protein kinase B (Akt) inhibition by PHLDA3. Lentiviral delivery of PHLDA3 shRNA to mice abrogated p-Akt inhibition in the liver by Tm, attenuating hepatocyte injury. CONCLUSIONS: ER stress in hepatocytes induces PHLDA3 via IRE1-Xbp1s pathway, which facilitates liver injury by inhibiting Akt.

Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy.

PURPOSE: The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer. METHODS: Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012. RESULTS: In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes). CONCLUSION: SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.

Single-port laparoscopic colorectal cancer surgery in Korea: retrospective analysis of the multicenter, pooled database.

INTRODUCTION: Single-port laparoscopic surgery (SPLS), one of the advanced techniques of laparoscopic surgery, is performed through a single multichannel port. Regarding colorectal surgery, several colorectal procedures, including right colectomy, sigmoidectomy, and total proctocelectomy with ileal pouch anal anastomosis, have been performed successfully. The aim of this study was to elucidate the feasibility and safety of SPLS for the treatment of the patient with colorectal cancer in Korea. SUBJECTS AND METHODS: Data were collected retrospectively from six hospitals through a Web-based case reporting form, which requested baseline characteristics of the patient, intraoperative findings, postoperative course, pathologic results of the tumor, and postoperative surveillance. RESULTS: From May 2009 to June 2012, 257 patients were included in this study. Anterior resection was performed in 117 patients, low anterior resection in 66 patients, and right colectomy in 53 patients. The primary entry incision site was umbilicus in all patients except for 2 cases; in these, stoma sites were used for the entry of the single port. The total mean incision length was 3.8±2.3 cm. Among 257 initially SPLS-attempted patients, 45 (17.5%) patients needed additional ports (one additional port in 44 patients), and 2 patients (0.78%) had to be converted to open laparotomy. Intraoperative complications were noted in 5 patients, including anastomotic failures in 3 patients and bleeding in 1 patient. Postoperative complications were noted in 34 patients (13.2%). Anastomotic leak developed in 11 patients, urinary retention in 5 patients, and wound complications in 4 patients. Re-admission was needed in 15 patients (5.8%). CONCLUSIONS: SPLS could be performed safely and appropriately in selected colorectal cancer cases by experts in laparoscopic colorectal surgery in Korea. Prospective randomized trials to demonstrate the benefit and effectiveness of SPLS in colorectal cancer surgery with long-term oncologic results are needed.