Hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation: a novel technique for right colon cancer.

BACKGROUND: It can be difficult to locate the superior mesenteric vein and dissect around middle colic vessels during laparoscopic right hemicolectomy with complete mesocolon excision due to a high rate of vascular variations in the superior mesenteric vessels. Therefore, we report a modified technique for hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation, which addresses these two problems. METHODS: Thirty-one consecutive patients with right colon cancer underwent this procedure from March 2014 to August 2015. Extracorporeally, the transverse colon and distal ileum were excised with a transumbilical hand-port incision, and the distal part of the superior mesenteric vein was identified. Intracorporeally, with the assistance of the surgeon's left hand inserted through the incision, D3-lymphadenectomy with central vascular ligation was performed, and the colon with the tumor, which had no blood supply, was removed. Patients' demographic data and intraoperative, postoperative and pathological characteristics were examined. RESULTS: The median operative time was 130.0 (range 115-180) minutes. The median blood loss was 45.0 (range 20-300) milliliters. The median length of the hand-port incision was 7.3 (range 6.0-8.2) centimeters. The median numbers of lymph nodes and central lymph nodes was 34.0 (range 18-91) and 13.0 (range 3-28), respectively. Five (16.1%) of 31 patients had positive central lymph nodes. Specimen morphometric quantitation was as follows: the median distances from the tumor and nearest bowel wall to the high tie were 10.5 (range 5.0-15.0) and 8.0 (range 6.0-12.0) centimeters, respectively; the median resected area of the mesentery was 200.0 (range 96.0-300.0) square centimeters; the median width of the chain of lymph-adipose tissue at the central lymph nodes area was 2.0 (range 0.8-8.0) centimeters; and the median length of the central lymph-adipose chain was 19.0 (range 3.0-26.0) centimeters. CONCLUSIONS: Our procedure confers technical advantages and is feasible for treatment of right colon cancer.

[The Comparison Between Extraction Methods of Exosomes From Ascites of Colorectal Cancer].

OBJECTIVE: To compare the two different methods to isolate the exosome from the ascites of colorectal cancer (CRC) patient and find the efficient one. METHODS: Exosome from the ascites of CRC patient were isolated by two different methods: density gradient exosome isolation (DG-Exo) and Exo-Quick isolation, and followed by identification with transmission electron microscopy observation and Western blot analysis. And then, Nanodrop was used for protein quantification. RESULTS: Exosome were isolated by both of the two methods. The protein concentration of the exosome isolated by the Exo-Quick isolation were higher than that of DG-Exo. CONCLUSION: Exo-Quick isolation can obtain higher purity and more complete exosome from the ascites.

Dominant change pattern of extreme precipitation and its potential causes in Shandong Province, China.

Due to global warming, global and regional extreme precipitation events occur frequently, causing severe drought and flood disasters. This has a significant impact on productivity and human life. Therefore, it is of great significance to study the characteristics of extreme precipitation and its spatiotemporal variation. In this study, we investigate the dominant variation patterns of extreme precipitation (EP), which is characterized by indices, and also analyze its potential causes in the Shandong province of China during 1961-2015 using the daily precipitation data from 123 metrological stations. The results show that there has been a dry trend in the Shandong Province in the past 55 years, that is, with the decrease in precipitation, most of the extreme precipitation index has basically showed a downward trend to varying degrees. In particular, the increase in the number of consecutive dry days (CDD) and the decrease in the number of consecutive wet days (CWD) can better explain the drought in this region. After the 1980s, the extreme precipitation index basically showed an upward trend to varying degrees, indicating that extreme precipitation events have shown an increasing trend in recent years. The spatial distribution of each extreme precipitation index generally increased from north to south. The mutation of each extreme precipitation index occurred in the 1970s and 1990s, and there was a main period of 0.9-2.2 years. In terms of influencing factors, the NINO3 area can be used as the critical sea area for the response of extreme precipitation to SSTAs in the Shandong Province. The research results are helpful to understand the temporal and spatial variations of extreme precipitation and have very important reference value for the prediction of and response to climate change and extreme events in the future.

Long-term outcome of indwelling colon observed seven years after radical resection for rectosigmoid cancer: A case report.

BACKGROUND: Indwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon. We report a rare case of purulent colonic necrosis that occurred 7 years after surgical colonic exclusion. CASE SUMMARY: A 73-year-old male had undergone extended radical resection for rectosigmoid cancer. The invaded ileocecal area and sigmoid colon were removed during the procedure, and the ileum was anastomosed side-to-side with the rectum. The excluded ascending, transverse, and descending colon were sealed at both ends and left in the abdomen. After 7 years, the patient developed persistent abdominal pain and distension. Work-up indicated intestinal obstruction. The patient underwent ultrasound-guided catheter drainage of the descending colon and a large amount of viscous liquid was drained, but the symptoms persisted; therefore, surgery was planned. Intraoperatively, extensive adhesions were found in the abdominal cavity, and the small intestine and the indwelling colon were widely dilated. The dilated colon was 56 cm long, 5 cm wide (diameter), and contained about 1500 mL of viscous liquid. The indwelling colon was surgically removed and its histopathological examination revealed colonic congestion and necrosis with hyperplasia of granulation tissue. The bacterial culture of the secretions was negative. The patient recovered after the operation. CONCLUSION: Although colonic exclusion is routinely performed, this report aimed to increase awareness regarding the possible long-term complications of indwelling colon.

Laparoscopic-Assisted Transhiatal Esophagogastrectomy Without Thoracic or Cervical Access: A Series of One Hundred Three Consecutive Cases.

AIM: To evaluate short-term and long-term outcomes of laparoscopic-assisted transhiatal esophagogastrectomy (LTEG) for treatment of adenocarcinoma of the esophagogastric junction (AEG). METHODS: Patients with AEG who underwent laparoscopic or open surgery at our department from October 2008 to December 2012 were enrolled in this retrospective study. Patients' demographics, perioperative outcomes, and survival data were collected. RESULTS: A total of 136 patients with AEG were enrolled (103 patients underwent laparoscopic surgery and 33 patients underwent open surgery). Patient characteristics were comparable between two groups in terms of age, gender, tumor-node-metastasis stage, tumor size, preoperative complications, and type of surgery. The median operative time was longer in laparoscopic group (240 versus 210 minutes, P = .048). However, the estimated blood loss was less, and the rate of pleural rupture was lower in laparoscopic group (20 versus 70 mL, P < .001 and 18.4% versus 36.4%, P = .033, respectively). The rate of patients with pleural rupture requiring prolonged use of mechanical ventilation longer than 12 hours (6/31, 19.4%) was higher than that of patients without pleural rupture (6/105, 5.7%) (P = .019). The incidence of reflux symptoms at postoperative month six was similar in two groups (18.4% in laparoscopic group versus 24.2% in open group, P = .468), as well as the use of proton pump inhibitors (12.6% versus 15.2%, P = .709). Furthermore, the number of lymph nodes harvested (22 versus 25), 2-year cumulative overall survival rates (80.4% versus 57.5%), and the median survival times (51.52 months versus 24.24 months) were similar between two groups (P > .05). CONCLUSION: LTEG is a safe, feasible, and oncologically effective procedure for AEG when performed by an experienced surgeon. Laparoscopic surgery is associated with a lower risk of pleural rupture, but pleural rupture in laparoscopic surgery may cause an adverse effect on the recovery of pulmonary function presumably due to tension pneumothorax.

Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma: A Single-Institution Experience.

To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI. This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups. Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%). Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI.

Prognostic significance of the mucin component in stage III rectal carcinoma patients.

BACKGROUND: Although mucinous adenocarcinoma has been recognized for a long time, whether it is associated with a poorer prognosis in colorectal cancer patients is still controversial. Many studies put emphasis on mucinous adenocarcinoma containing mucin component ≥50%. Only a few studies have analyzed cases with a mucin component <50%. OBJECTIVES: This study aimed to analyze the prognostic value of different mucin component proportions in patients with stage III rectal cancer. MATERIALS AND METHODS: Clinical, pathological and follow-up data of 136 patients with the stage III rectal cancer were collected. Every variable was analyzed by univariate analysis, then multivariate analysis and survival analysis were further performed. RESULTS: Univariate analysis showed pathologic T stage, lymphovascular invasion, and histological subtype were statistically significant for DFS. Pathologic T stage was significant for OS. Histological subtype and lymphovascular invasion were independent prognostic factors in multivariate analysis for DFS, and histological subtype was the only independent prognostic factor for OS. Survival curves showed the survival time of mucinous adenocarcinoma (MUC) was shorter than non-MUC (adenocarcinomas with a mucin component <50% and without mucin component). CONCLUSIONS: Histological subtype (tumor with different mucin component) was an independent prognostic factor for both DFS and OS. Patients with MUC had a worse prognosis than their non-MUC counterparts with stage III rectal carcinoma.

Prognostic analysis of schistosomal rectal cancer.

BACKGROUND: Schistosomiasis is an infectious disease that affects more than 230 million people worldwide, according to conservative estimates. Some studies published from China and Japan reported that schistosomiasis is a risk factor for colorectal cancer in Asia where the infective species is S. japonicum. However, there have been only few reports of prognosis of patients with schistosomal rectal cancer SRC. OBJECTIVES: This study aimed to analyze differences in prognosis between SRC and non-schistosomal rectal cancer(NSRC) with current treatments. MATERIALS AND METHODS: A retrospective review of 30 patients with schistosomal rectal cancer who underwent laparoscopic total mesorectal excision operation (TME) was performed. For each patient with schistosomal rectal cancer, a control group who underwent laparoscopic TME with non-schistosomal rectal cancer was matched for age, gender and tumor stage, resulting in 60 cases and controls. RESULTS: Univariate analysis showed pathologic N stage (P=0.006) and pathologic TNM stage (P=0.047) statistically significantly correlated with disease-free survival (DFS). Pathologic N stage (P=0.014), pathologic TNM stage (P=0.002), and with/without schistosomiasis (P=0.026) were statistically significantly correlated with overall survival (OS). Schistosomiasis was the only independent prognostic factor for DFS and OS in multivariate analysis. CONCLUSIONS: The prognosis of patients with schistosomal rectal cancer is poorer than with non-schistosomal rectal cancer.