Clinical application of indocyanine green fluorescence navigation technique in laparoscopic common bile duct exploration for complex hepatolithiasis.

BACKGROUND: This study investigated the clinical application of the indocyanine green (ICG) fluorescence navigation technique in bile duct identification during laparoscopic common bile duct exploration (LCBDE) for complex hepatolithiasis. METHODS: Eighty patients with complex hepatolithiasis were admitted to our department between January 2022 and June 2023 and randomly divided into control and observation groups. The control group underwent conventional LCBDE, while the observation group underwent LCBDE guided by ICG fluorescence. RESULTS: Intraoperatively, the observation group had shorter operation and search times for the common bile duct (CBD), as well as reduced intraoperative blood loss and fewer complications, such as conversion to laparotomy and various injuries (gastroduodenal, colon, pancreatic, and vascular) than the control group, with statistical significance (P < 0.05). Postoperatively, the observation group had lower rates of postoperative bile leakage, abdominal infection, postoperative hemorrhage, and residual stone than the control group. Additionally, the observation group demonstrated significantly shorter times for resuming flatus, removal of the abdominal drainage tube, and hospitalization than the control group, with statistical significance (P < 0.05). CONCLUSION: ICG fluorescence navigation technology effectively visualizes the bile duct, improves its identification rate, shortens the operation time, prevents biliary tract injury, and reduces the occurrence of complications.

Gallbladder cancer: surgical treatment, immunotherapy, and targeted therapy.

Gallbladder cancer is a common type of biliary tract tumor. Optimal management for early stage cases typically involves radical excision as the primary treatment modality. Various surgical techniques, including laparoscopic, robotic, and navigational surgery, have demonstrated favorable clinical outcomes in radical gallbladder excision. Unfortunately, most patients are ineligible for surgical intervention because of the advanced stage of the disease upon diagnosis. Consequently, non-surgical interventions, such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy, have become the mainstay of treatment for patients in advanced stages. This review focuses on elucidating various surgical techniques as well as advancements in immunotherapy and targeted therapy in the context of recent advancements in gallbladder cancer research.

Intestinal microbiota and biliary system diseases.

Introduction: The incidence of biliary system diseases has been continuously increasing in the past decade. Biliary system diseases bring a heavy burden to humanity and society. However, the specific etiology and pathogenesis are still unknown. The biliary system, as a bridge between the liver and intestine, plays an indispensable role in maintaining the physiological metabolism of the body. Therefore, prevention and treatment of biliary diseases are crucial. It is worth noting that the microorganisms participate in the lipid metabolism of the bile duct, especially the largest proportion of intestinal bacteria. Methods: We systematically reviewed the intestinal microbiota in patients with gallstones (GS), non-calculous biliary inflammatory, and biliary tract cancer (BTC). And searched Pubmed, Embase and Web of science for research studies published up to November 2023. Results: We found that the abundance of Faecalibacterium genus is decreased in GS, primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and BTC. Veillonella, Lactobacillus, Streptococcus and Enterococcus genus were significantly increased in PSC, PBC and BTC. Interestingly, we found that the relative abundance of Clostridium was generally reduced in GS, PBC and BTC. However, Clostridium was generally increased in PSC. Discussion: The existing research mostly focuses on exploring the mechanisms of bacteria targeting a single disease. Lacking comparison of multiple diseases and changes in bacteria during the disease process. We hope to provide biomarkers forearly diagnosis of biliary system diseases and provide new directions for the mechanism of intestinal microbiota in biliary diseases.

LncRNA PCAT6 is a predictor of poor prognosis of colorectal cancer.

Background: The long non-coding RNA (lncRNA) prostate cancer-associated transcript 6 (PCAT6) has been studied in many cancers, yet its relationship with colorectal cancer (CRC) remains poorly defined. Here, we conducted an analysis of The Cancer Genome Atlas (TCGA) database to better clarify the role of PCAT6 in this cancer type. Methods: Wilcoxon rank-sum tests were utilized to assess relative levels of PCAT6 in CRC tumors and normal tissues, while logistic regression analyses were utilized to compare the relationships between PCAT6 levels and clinicopathological findings. Kaplan-Meier curves and Cox regression analyses were used to gauge correlations between PCAT6 and patient survival outcomes, while the biological roles of this lncRNA were investigated via a gene set enrichment analysis (GSEA) approach. The expression level of PCAT6 in CRC cell lines was detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results: PCAT6 levels were significantly correlated with CRC patient lymph node metastasis (N) stage [odds ratio (OR) =1.8 for N1 & N2 vs. N0], lymphatic invasion [OR =1.9 for yes vs. no), distant metastasis (M stage) (OR =2.1 for M1 vs. M0), carcinoembryonic antigen (CEA) level (OR =1.9 for >5 vs. ≤5), perineural invasion (OR =1.9 for yes vs. no), pathologic stage (OR =1.9 for stage III/IV vs. stage I/II), and neoplasm type (OR =2.1 for rectal adenocarcinoma vs. colon adenocarcinoma) (all P<0.05). CRC patients expressing higher PCAT6 levels exhibited poorer survival outcomes than those expressing low levels of this lncRNA (P=0.017), and in univariate analyses, higher PCAT6 levels were linked to worse overall survival [hazard ratio (HR) =1.540; 95% confidence interval (CI): 1.079-2.199; P=0.017], with this relationship also being preserved in a multivariate analysis (HR =6.892; 95% CI: 1.713-27.727, P=0.007). GSEA revealed high PCAT6 expression to be linked to differential DNA methylation enrichment, with high PCAT6 levels being associated with changes in base excision repair, cellular senescence, G2/M DNA damage checkpoint, chromatin-modifying enzyme, and gene silencing by RNA activity. The high expression of lncRNA PCAT6 in CRC cell lines was demonstrated by PCR experiments. Conclusions: PCAT6 represents a promising prognostic biomarker of poor CRC patient survival outcomes, with DNA methylation and RNA-mediated gene silencing being potentially promising mechanistic pathways whereby this lncRNA may shape patient outcomes.

Comprehensive analysis of EML2 as a prognostic biomarker in colon cancer.

BACKGROUND: Echinoderm microtubule-associated protein-like 2 (EML2), a gene located on 19q13.32, is overexpressed in various cancers and has been identified as a prognostic factor. However, the function and carcinogenic mechanism of EML2 in colon cancer is yet to be explored. METHODS: This study aimed to demonstrate the relationship between EML2 expression and colon cancer using The Cancer Genome Atlas (TCGA) database. The EML2 expression, including GSE33113 and GSE39923, was validated in colon cancer in the Gene Expression Omnibus (GEO) database. The Receiver Operating Characteristic (ROC) curves were used to assess the feasibility of EML2 as a distinguishing factor from the area under the curve (AUC) scores. In addition, Cox regression and logistic regression analyses were conducted to evaluate the factors linked to the prognosis of colon cancer. Moreover, the STRING tool was used to establish the EML2 binding protein network. The enrichment analysis cluster Profiler of the R package was utilized to investigate the function of EML2. The relationship between the immune infiltration and EML2 expression level in colon cancer was investigated by the R package Gene Set Variation Analysis (GSVA) and the single sample Gene Set Enrichment Analysis (ssGSEA) method in the Tumor Immune Estimation Resource (TIMER) database. RESULTS: Pan-cancer data analysis revealed that EML2 expression was higher in most cancers, including colon cancer. This outcome was in line with the findings of the GEO database. The ROC curve demonstrated that EML2 can serve as a diagnostic biomarker for colon cancer (AUC = 0.738). High EML2 expression was associated with poorer overall survival (OS; P = 0.004). Moreover, the results of the enrichment and immune infiltration analysis revealed that high EML2 expression correlated with regulation of the infiltration level of GTPase binding and some immune cell types like NK cells and NK CD56 bright cells. CONCLUSION: The findings revealed that colon cancer tissues had a higher EML2 expression than normal colon epithelial tissues. This phenomenon was significantly associated with poor prognosis and altered immune cell infiltration. Consequently, EML2 has shown the capacity to serve as a prognostic biomarker for patients diagnosed with colon cancer.

INPP4B exerts a dual role in gastric cancer progression and prognosis.

Inositol polyphosphate 4-phosphatase type II (INPP4B) negatively regulates PI3K-Akt signalling and plays diverse roles in different types of cancer, but its role in gastric cancer (GC) is still unknown. Our study aimed to investigate the function and clinical relevance of INPP4B in GC. INPP4B expression was detected in GC tissues and nontumour tissues. The effect of INPP4B on the phenotypic changes of AGS and BGC-823 cells was investigated in vitro. The activation of serum and glucocorticoid-regulated kinase 3 (SGK3) and AKT were used to evaluate the specific mechanistic function of INPP4B in GC cells. The messenger RNA (mRNA) and protein expression levels of INPP4B were decreased in GC tissues compared with nontumour tissues. INPP4B expression was associated with tumour-node-metastasis (TNM) stage and histopathological differentiation. In addition, high INPP4B expression in GC patients with large tumour size/low-undifferentiated/TNM's III-IV stage was correlated with a poor prognosis but it was correlated with a better prognosis in patients with small tumour size/high-moderate differentiated/TNM's I-II stage patients. In addition, INPP4B knockdown inhibited proliferation, clonal formation and migration and promoted cell apoptosis in vitro, while INPP4B overexpression led to the opposite effects. Mechanistically, we found that INPP4B overexpression enhanced the phosphorylation of SGK3 (p-SGK3) in AGS cells, whereas INPP4B knockdown enhanced the p-Akt level in BGC823 cells. These findings suggested that the expression of INPP4B in GC is lower than that in normal tissues. Based on stratification survival analysis and in vitro cell experiments, INPP4B may play dual roles as an oncogene and tumour suppressor gene in different tissue grades and clinical stages.

MiR-3614-5p Is a Potential Novel Biomarker for Colorectal Cancer.

MiR-3614-5p has been found in a variety of cancers including colorectal cancer. However, the association of miR-3614-5p with colorectal cancer is still unclear. Based on the Cancer Genome Atlas (TCGA) database, the relationship between miR-3614-5p and colorectal cancer can be proved. Wilcoxon rank-sum test was used to compare the miR-3614-5p expression in colorectal cancer tissues and under normal conditions, respectively. The logistic regression method was further employed to analyze the relationship between miR-3614-5p and clinicopathological characteristics. Also, the correlation between miR-3614-5p and survival rate was evaluated by Kaplan-Meier and Cox regression analysis. Besides, gene set enrichment analysis (GSEA) was used to investigate the biological functions of miR-3614-5p. The decrease of miR-3614-5p expression of colorectal cancer was significantly correlated with N stage (OR) = 0.7 for N1&N2 vs. N0), M stage (OR = 0.5 for M1 vs. M0), pathologic stage (OR = 0.7 for Stage III & Stage IV vs. Stage I & Stage II), neoplasm type (OR = 0.5 for rectum adenocarcinoma vs. colon adenocarcinoma), and lymphatic invasion (OR = 0.6 for YES vs. NO) (all p-values < 0.05). Kaplan-Meier survival analysis showed that colorectal cancer with low miR-3614-5p has a poorer prognosis than that of high miR-3614-5p (p = 0.005). According to univariate analysis, low miR-3614-5p was associated with poor overall survival (OS) [hazard ratio (HR) = 0.599; 95% confidence interval (CI): 0.418-0.857; p = 0.005]. In multivariate analysis, miR-3614-5p was closely related to OS (HR = 0.630; 95% CI: 0.405-0.978, p = 0.021). GSEA showed that the high expression phenotype of miR-3614-5p differentially enriches the P53 pathway. Meanwhile, the high expression phenotype of miR-3614-5p enhanced NK T cell activation, negative T cell selection, response to interleukin 2, and response to tumor cells. MiR-3614-5p is a possible prognostic marker of low survival rate for patients with colorectal cancer. Moreover, the P53 pathway and P38MAPK pathway may be the key pathways regulated by miR-3614-5p in colorectal cancer.

Expression and functional characterization of INPP4B in gallbladder cancer patients and gallbladder cancer cells.

BACKGROUND: Inositol polyphosphate 4-phosphatase type II (INPP4B) is a negative regulator of the PI3K-Akt signalling pathway and plays a contradictory role in different types of cancers. However, the its biological role played by INPP4B in human gallbladder cancer (GBC) has not been elucidated. In this study, we investigated the expression, clinical significance and biological function of INPP4B in GBC patients and cell lines. METHODS: The INPP4B protein expression levels in gallbladder cancer tissues and normal gallbladder tissues were detected by immunohistochemistry, and the clinical significance of INPP4B was analysed. Knockdown and overexpression of INPP4B in GBC-SD and SGC-996 cells followed by cell proliferation, clonogenic, apoptosis detection, scratch wound-healing and transwell assays were used to identify INPP4B function in vitro. RESULTS: INPP4B was up-regulated in human GBC tissues compared with normal gallbladder tissues and was related to histopathological differentiation (p = 0.026). Here, we observed that INPP4B was highly expressed in high-moderately differentiated tumours compared with low-undifferentiated tumours (p = 0.022). Additionally, we found that INPP4B expression was not associated with overall survival of GBC patients (p = 0.071) and was not an independent prognostic factor. Furthermore, when we stratified the relationship between INPP4B expression and the prognosis of GBC based on histopathological differentiation, we found that INPP4B played a contradictory role in GBC progression depending on the degree of differentiation. In addition, INPP4B knockdown inhibited the proliferation, colony formation, migration and invasion in GBC cells, while INPP4B overexpression had the opposite effects in vitro, which indicates its role as an oncoprotein. CONCLUSIONS: These findings suggested that INPP4B may play a dual role in the prognosis of GBC depending on the degree of differentiation and that INPP4B might act as an oncogene in gallbladder cancer cells.

Increased expression of RBMS3 predicts a favorable prognosis in human gallbladder carcinoma.

Multiple regions in the short arm of chromosome 3 are frequently deleted in a variety of solid tumors including gallbladder carcinoma (GBC). RNA binding motif, single­stranded interacting protein 3 (RBMS3), a tumor suppressor gene (TSG), is located in this region. However, the role of RBMS3 in GBC remains unclear. Reverse transcription­quantitative polymerase chain reaction (RT­qPCR) and western blotting were performed to evaluate the mRNA and protein expression levels of RBMS3 in 41 fresh frozen GBC tissues and paired normal tissues. An immunohistochemical assay was performed on a tissue microarray (TMA, consisting of 125 cases GBC and 47 normal controls). Microvessel density (MVD) counts were determined using CD34 immunohistochemical staining. Moreover, univariate and multivariate analyses were performed to determine the correlations between RBMS3 expression, MVD and patient prognosis. Cellular functions including proliferation, clonogenicity and apoptosis, were assessed to further identify in vitro roles of RBMS3. It was revealed that both mRNA and protein expression levels of RBMS3 were significantly lower in GBC tissues than in normal controls. Multivariate Cox regression analyses demonstrated cytoplasmic RBMS3 expression as an independent prognostic factor correlated with GBC angiogenesis, histopathological differentiation and TNM stage. Kaplan­Meier curves revealed that patients with lower cytoplasmic RBMS3 levels had a significantly worse OS than patients with higher cytoplasmic RBMS3 expression. Additionally, ectopic expression of RBMS3 markedly suppressed GBC cell proliferation and clonogenicity and promoted apoptosis in vitro. These findings indicated the potential of cytoplasmic RBMS3 as a tumor prognostic biomarker and a promising therapeutic target for GBC.

Effects of NIX-mediated mitophagy on ox-LDL-induced macrophage pyroptosis in atherosclerosis.

Pyroptosis is a form of cell death that is uniquely dependent on caspase-1. Pyroptosis involved in oxidized low-density lipoprotein (ox-LDL)-induced human macrophage death through the promotion of caspase-1 activation is important for the formation of unstable plaques in atherosclerosis. The mitochondrial outer membrane protein NIX directly interacts with microtubule-associated protein 1 light chain 3 (LC3). Although we previously showed that NIX-mediated mitochondrial autophagy is involved in the clearance of damaged mitochondria, how NIX contributes to ox-LDL-induced macrophage pyroptosis remains unknown. Here, immunoperoxidase staining Nix expression decreased in human atherosclerosis. When we silenced NIX expression in murine macrophage cell, active caspase-1, and mature interleukin-1ß expression levels were increased and LC3 was reduced. In addition, LDH release and acridine orange and ethidium bromide staining indicated that damage to macrophage cell membranes induced by ox-LDL was substantially worse. Moreover, intracellular reactive oxygen species and NLRP3 inflammasome levels increased. Taken together, these results demonstrated that NIX inhibits ox-LDL-induced macrophage pyroptosis via autophagy in atherosclerosis.

Randomized trial of umbilical incisional hernia in high-risk patients: extraction of gallbladder through subxiphoid port vs. umbilical port after laparoscopic cholecystectomy.

INTRODUCTION: Trocar site incisional hernia (TSIH) is one of the most common complications of laparoscopic surgery. Using the umbilical port as a common hole for removing the gallbladder in laparoscopic cholecystectomy is more likely to lead to TSIH than other ports. Thus, extracting the gallbladder through other ports may reduce the incidence of TSIH. AIM: To ascertain whether extraction of the gallbladder through the subxiphoid port is more beneficial for reducing umbilical incisional hernia than the umbilical port. MATERIAL AND METHODS: From April 2014 to March 2017, a randomized clinical trial was conducted among patients with high risk of incisional hernia and accepted for three-port laparoscopic cholecystectomy (TLC) in our department. 182 patients with indications of cholecystectomy were allocated randomly to group A (subxiphoid port) and group B (umbilical port). Data collection was carried out on operative time, postoperative pain, hospital stay, wound infection and TSIH in the early postoperative course, and at 1, 10, and 24 months after surgery. RESULTS: The incidence of TSIH in group A was lower than that in group B (4.9% vs. 14.6%; odds ratio = 8.02; 95% CI: 2.15-47.6; p < 0.001). The mean operative time of group A was significantly shorter than that of group B (35 ±15.16 min vs. 42 ±14.58 min, p < 0.01). There was no significant difference in wound infection rate between group A and group B (p = 0.068). The data of hospital stay (p = 0.428) and postoperative pain (p = 0.349) of all analyzed patients were similar in the two groups. CONCLUSIONS: Extraction of the gallbladder through the subxiphoid port can reduce umbilical incisional hernia in high-risk patients effectively.

The role of TRPP2 in agonist-induced gallbladder smooth muscle contraction.

TRPP2 channel protein belongs to the superfamily of transient receptor potential (TRP) channels and is widely expressed in various tissues, including smooth muscle in digestive gut. Accumulating evidence has demonstrated that TRPP2 can mediate Ca(2+) release from Ca(2+) stores. However, the functional role of TRPP2 in gallbladder smooth muscle contraction still remains unclear. In this study, we used Ca(2+) imaging and tension measurements to test agonist-induced intracellular Ca(2+) concentration increase and smooth muscle contraction of guinea pig gallbladder, respectively. When TRPP2 protein was knocked down in gallbladder muscle strips from guinea pig, carbachol (CCh)-evoked Ca(2+) release and extracellular Ca(2+) influx were reduced significantly, and gallbladder contractions induced by endothelin 1 and cholecystokinin were suppressed markedly as well. CCh-induced gallbladder contraction was markedly suppressed by pretreatment with U73122, which inhibits phospholipase C to terminate inositol 1,4,5-trisphosphate receptor (IP3) production, and 2-aminoethoxydiphenyl borate (2APB), which inhibits IP3 recepor (IP3R) to abolish IP3R-mediated Ca(2+) release. To confirm the role of Ca(2+) release in CCh-induced gallbladder contraction, we used thapsigargin (TG)-to deplete Ca(2+) stores via inhibiting sarco/endoplasmic reticulum Ca(2+)-ATPase and eliminate the role of store-operated Ca(2+) entry on the CCh-induced gallbladder contraction. Preincubation with 2 µmol L(-1) TG significantly decreased the CCh-induced gallbladder contraction. In addition, pretreatments with U73122, 2APB or TG abolished the difference of the CCh-induced gallbladder contraction between TRPP2 knockdown and control groups. We conclude that TRPP2 mediates Ca(2+) release from intracellular Ca(2+) stores, and has an essential role in agonist-induced gallbladder muscle contraction.

MEK1 expression and its relationship with clinical pathological features in hepatocellular carcinoma.

BACKGROUND: MEK1 is overexpressed in various human carcinomas, but the role of MEK1 is not well unknown in hepatocellular carcinoma (HCC). In the present study, we aimed to explore MEK1 expression of in HCC tissues, and to evaluate its relationship with clinical pathological features. METHODS: Expressions of MEK1 were detected by western blot assay, real-time quantitative PCR and immunohistochemical (IHC) staining in 30 HCC tissues and their adjacent normal tissues. Pearson Chi-square test was used to analyze the relationship between MEK1 expression and clinical pathological features. The survival curve was drawn by Kaplan-Meier method, and survival was analyzed by Lon-rank test. RESULTS: The expression of MEK1 mRNA in HCC tissues was significantly higher than that in adjacent normal tissues and so was the expression of MEK1 protein. In the 30 specimens, 70% was with Tumor/Normal ratio > 2, 10% with Tumor/Normal ratio < 1 and 20% with 1 < Tumor/Normal ratio < 2. The mean survival time in high MEK1 expression group was significantly lower than that in low MEK1 expression group (Log-rank value = 11.946, P < 0.01). CONCLUSION: MEK1 expressions in HCC tissues were significantly higher than that in adjacent normal tissues, which indicated that MEK1 was involved in the genesis and development of HCC. Moreover, it was closely related to the postoperative survival time of patients with HCC.

MicroRNA-29a inhibits cell migration and invasion via targeting Roundabout homolog 1 in gastric cancer cells.

Deregulation of Roundabout homolog 1 (Robo1) has been demonstrated to be associated with several types of human cancer, including gastric cancer. However, the detailed role of Robo1 and its regulatory mechanism in gastric cancer remain largely unclear. In the current study, it was demonstrated that the expression of microRNA (miR)­29a was frequently reduced in gastric cancer tissues, compared with their matched normal adjacent tissues. Similar results were additionally observed in AGS and SGC­7901 human gastric cancer cells. Overexpression of miR­29a led to reduced migration and invasion of AGS cells. To explore the targets of miR­29a in gastric cancer, bioinformatics analysis was conducted and Robo1 was identified as a putative target of miR­29a. Further western blotting and luciferase activity assay data confirmed that miR­29a was able to negatively regulate the protein expression of Robo1, through directly binding to the 3'­untranslated region of Robo1 mRNA in gastric cancer cells. In addition, it was demonstrated that Robo1 was frequently upregulated in gastric cancer tissues compared with their matched adjacent normal tissues, and a significant inverse correlation was identified between miR­29a and Robo1 expression. In addition, knockdown of Robo1 by small interfering RNA markedly inhibited the migratory and invasive capabilities of AGS cells, which the results obtained with overexpression of miR­29a. In conclusion, to the best of our knowledge the current study suggested for the first time, that miR­29a inhibits migration and invasion in part via direct inhibition of Robo1 in gastric cancer cells. Therefore, Robo1 and miR­29a may serve as diagnostic or therapeutic targets for gastric cancer.

Do patients with pN0 gastric cancer benefit from prophylactic extended lymphadenectomy?

PURPOSE: To investigate the impact of prophylactic extended lymphadenectomy on survival for patients with node-negative (pN0) advanced gastric cancer according to the extent of lymph node dissection. METHODS: This study retrospectively investigated the clinicopathological characteristics and prognostic outcomes of 458 patients who had pN0 advanced gastric cancer between 1995 and 2001. Postoperative survival was compared in patients who underwent different extents of prophylactic lymphadenectomy. RESULTS: The overall 5-year and 10-year survival rates were 62.01% (284/458) and 40.83% (187/458), respectively. The survival rates differed significantly in patients who underwent a different extent of prophylactic lymphadenectomy (≤D1+ versus D2 versus D3 versus ≥D3) (X(2) = 8.59, P = 0.035). Survival in patients who received less than D1+ dissection, however, were not significantly better than patients who received D2 dissection (X(2) = 0.907, P = 0.341). Survival in patients who received D2 dissection was significantly better than survival in patients who received D3 dissection (X(2) = 5.685, P = 0.017). No differences in postoperative survival rates were observed between patients who received D3 dissection and those received more than D3 dissection (X(2) = 2.468, P = 0.116). Patients who were older than 60 years and receive more than D2 dissection experienced significantly worse postoperative survival than those who received less than D2 dissection (X(2) = 14.885, P = 0.001). The extent of prophylactic lymphadenectomy did not significantly affect local tumor recurrence in patients with node-negative advanced gastric cancer (X(2) = 0.458, P = 0.928). CONCLUSIONS: D2 prophylactic lymphadenectomy is appropriate for pN0 patients who were less than 60 years old, and less than D2 dissection was suitable for the older cases.

Early laparoscopic cholecystectomy for acute gallbladder disease in Chinese elderly.

BACKGROUND/AIMS: Evidence now strongly supports that early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute gallbladder disease. However, the optimal time for managing acute gallbladder disease in elderly people is still controversial. The purpose of this study was to evaluate the outcome of ELC in patients aged 65 years old and older. METHODOLOGY: We performed a retrospective case study review of patients undergoing ELC in a single institution between January 2005 and December 2008. RESULTS: A total of 4048 patients were analyzed: 737 patients were older than 65 years old and 3311 younger. In total, 18% of the elderly patients and 3% of the younger patients had American Society of Anesthesiologists (ASA) score III and IV, respectively (p < 0.001). Co-morbidity rates were significantly higher in the elderly group (61.5% vs. 20.7%, p < 0.001). There was no difference in operative time, intraoperative complications, hospital stay and mortality between the two groups, except that the rate of conversion to open cholecystectomy (OC) and postoperative complications were significantly higher in elderly patients. CONCLUSION: Even though elderly patients are more likely to present with several co-morbidities in advanced stages, ELC for elderly patients with acute gallbladder disease is safe and effective, and should be regarded as the standard of care.