[This corrects the article DOI: 10.3892/ol.2022.13273.].

Abstract Background To explore the application value of free omental wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD). Methods The clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analysed. In total, 86 cases were divided into Group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases were divided into Group B (control group). The incidences of postoperative pancreatic fistula and other complications were compared between the two groups, and univariate and multivariate logistic regression analyses were used to determine the potential risk factors for postoperative pancreatic fistula. Risk factors associated with postoperative overall survival were identified using Cox regression. Results The incidences of grade B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in Group A were lower than those in Group B, and the differences were statistically significant (P < 0.05). Group A had an earlier drainage tube extubation time, earlier return to normal diet time and shorter postoperative hospital stay than the control group (P < 0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) inflammatory factors 1, 3 and 7 days after surgery also showed significant. Univariate and multivariate logistic regression analyses showed that a body mass index (BMI) ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P < 0.05). Cox regression analysis showed that age ≥ 65 years old, body mass index ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap isolation and modified pancreaticojejunostomy, and malignant postoperative pathology were independent risk factors associated with postoperative overall survival (P < 0.05). Conclusions Wrapping and isolating the modified pancreaticojejunostomy with free greater omentum can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and favourably affect prognosis.

A previous bioinformatics study suggested that circular RNA 0001666 (circ_0001666) and its target microRNA (miR)-1229 were associated with colorectal cancer (CRC) pathogenesis. However, the role of this interaction in the regulation of CRC cell malignancy remains unclear. Thus, the aim of the present study was to examine the interaction between circ_0001666 and miR-1229, and its effects on CRC cell malignancy. circ_0001666 overexpression or knockdown plasmids were transfected into the HT-29 and HCT-116 cell lines. In addition, in rescue experiments, circ_000166 or miR-1229 overexpression plasmids were transfected into the HT-29 cell line, either alone or in combination. Following transfection, cell proliferation, apoptosis, invasion and the number of CD133+ cells were analyzed. The protein expression level of proteins in the Wnt/β-catenin pathway was also examined. In both HT-29 and HCT-116 cell lines, circ_0001666 overexpression increased apoptosis, whilst inhibiting cell proliferation and invasion, and reducing the frequency of CD133+ cells. By contrast, circ_0001666 knockdown reduced apoptosis, but increased cell proliferation and the number of CD133+ cells. However, cell invasion remained unaffected. In addition, circ_0001666 expression levels negatively regulated those of miR-1229, whereas miR-1229 expression did not affect circ_0001666, in both the HT-29 and HCT-116 cell lines. Furthermore, a luciferase reporter assay confirmed that miR-1229 directly bound to circ_0001666. In the HT-29 cell line, miR-1229 overexpression activated the Wnt/β-catenin pathway, and promoted cell proliferation, invasion and stemness, while suppressing cell apoptosis. In addition, miR-1229 overexpression reversed the effects of circ_0001666 overexpression. In conclusion, circ_0001666 suppresses CRC cell proliferation, invasion and stemness by inhibiting the Wnt/β-catenin signaling pathway by targeting miR-1229, and may represent a potential target for CRC treatment.

The aim of the this retrospective study was to investigate the clinicopathological features of gastric cancer (GC) in young patients and the potential impact of age on the prognosis of patients undergoing radical gastrectomy for GC. From November 2010 to November 2016, 317 young (≤45 years) and 1344 older patients (>45 years) who underwent radical gastrectomy for stage I-III GC were enrolled. The association between age and prognosis was estimated by univariate and multivariate analyses after propensity score matching (PSM). Compared with older patients, the proportion of females, poorly differentiated tumors, good nutritional status, and who received neo-adjuvant and/or adjuvant chemotherapy was significant higher in younger patients, but were less likely to suffer from comorbidities or post-operative complications (all P < 0.05). PSM analysis created 310 pairs of patients. After matching, the long-term survival in younger patients was significantly longer than in older patients at stage I, but similar at stages II and III. However, a young age was not identified as a significant prognostic factor. In conclusion, the prognosis of young GC patients is comparable with and even better than that in older patients after radical gastrectomy when matched for baseline characteristics. Early detection could improve the prognosis of young GC patients.

Background The biological behavior of early recurrence is more invasive and the prognosis is worse in gastric cancer (GC). The risk of early recurrence (ER) for GC in stage II/III has not been reported of which the majority of GC patients are in China. Therefore, it is necessary to analyze the ER of gastric cancer in stage II/III. Methods The medical records of 1511 consecutive stage II/III GC patients who received resections were retrospectively reviewed. They were randomly classified into either a development or validation group at a ratio of 7:3. The nomogram was constructed based on prognostic factors using logistic regression analysis and was validated by bootstrap resampling and validation dataset, respectively. Concordance index (C-index) values and calibration curves were used to evaluate the predictive accuracy and discriminatory capability. Results Three hundred eleven patients experienced ER, accounting for 20.58% of the GC patients investigated. Multivariate logistic regression analysis identified tumors located at upper, middle third, or mixed, a positive lymph node ratio ≥ 0.335, pTNM stage III, lymphocyte count < 1.5 × 10 9 /L, postoperative infection complications and adjuvant chemotherapy < 6 cycles were all independent predictors for ER after curative resection of stage II/III GC. The C-index value obtained for the model was 0.780 (95% CI, 0.747–0.813), and the calibration curves of validation group yielded a C-index value of 0.739 (95% CI, 0.684–0.794), suggesting the practicability of the model. Conclusions The nomogram which was developed for predicting ER of stage II/III GC after surgery had good accuracy and was verified through both internal and external validation. The nomogram established can assist clinicians in determining the optimal therapy strategies in counseling, adjuvant treatments, and subsequent follow-up planning.

目的 探讨NCTD在结肠癌CME术后患者中的应用及对其免疫功能和预后的影响评估.方法 选取60例行结肠癌根治术治疗的患者,根据术后治疗方案的不同,分为研究组及对照组两组(各30例),其中研究组(采用CME手术+术后化疗+ NCTD)和对照组(采用CME手术+术后化疗),比较2组患者的临床疗效.结果 两组患者的半年局部复发及生存率比较均无差异(P＞0.05);化疗前两组患者免疫相关指标比较无差异(P＞0.05),而化疗2个周期后研究组患者的免疫相关指标均较对照组改善明显(P＜0.05);化疗2个周期后,两组患者的化疗不良反应总发生率比较无显著差异(P＞0.05);化疗前两组患者的生活质量相关指标比较均无差异(P＞0.05),而化疗2周期后研究组患者的生活质量较对照组提高明显(P＜0.05).结论 结肠癌根治术后患者辅助化疗联合口服NCTD安全有效,同时短期内可提高患者的免疫功能及生活质量,值得临床推广应用.

To investigate whether smoking adversely affects the short-term outcomes and the potential effects of cigarette dose and preoperative smoking cessation, in patients who underwent gastric cancer (GC) surgery. Two thousand, four hundred sixty-nine consecutive patients who underwent radical gastrectomy from November 2010 to July 2018 were included in the present study. Smokers (current or former smokers) were divided into 3 groups in accordance with the duration of smoking cessation preoperatively (≤ 2, 2 to 4, or ≥ 4 weeks) and the cigarette dose (≤ 20, 20 to 40, and ≥ 40 pack-years). The primary endpoint was postoperative complications (surgical site infection, pulmonary problems, bleeding, and others). A total of 1056 patients (42.8%) were smokers. Compared with non-smokers, smokers had significantly higher overall postoperative complications (11.3% vs 7.5%, P = 0.001), and in particular pulmonary problems. Smokers also had more major complications, needing intensive care unit care, and longer postoperative hospital stays. Multivariate analysis confirmed that smoking (odds ratio = 1.506, 95% confidence interval 1.131–2.004, P = 0.005) was an independent risk factor for postoperative complications. Further subgroup analysis identified that there was a positive relationship between the incidence of complications and cigarette dose, and > 20 pack-years was demonstrated to have increased significantly the risk of complications. Smokers who stopped smoking ≥ 4 weeks before surgery had lower pulmonary problems than those with a shorter period of smoking cessation. Preoperative smoking cessation should be encouraged to reduce postoperative complications in GC patients, especially for heavy smokers.

The aim of this retrospective study was to develop and validate a nomogram for predicting the risk of post-operative pulmonary infection (POI) in gastric cancer (GC) patients following radical gastrectomy. 2469 GC patients who underwent radical gastrectomy were enrolled, and randomly divided into the development and validation groups. The nomogram was constructed based on prognostic factors using logistic regression analysis, and was internally and crossly validated by bootstrap resampling and the validation dataset, respectively. Concordance index (C-index) value and calibration curve were used for estimating the predictive accuracy and discriminatory capability. Sixty-five (2.63%) patients developed POI within 30 days following surgery, with higher rates of requiring intensive care and longer post-operative hospital stays. The nomogram showed that open operation, chronic obstructive pulmonary disease (COPD), intra-operative blood transfusion, tumor located at upper and/or middle third and longer operation time (≥4 h) in a descending order were significant contributors to POI risk. The C-index value for the model was 0.756 (95% CI: 0.675−0.837), and calibration curves showed good agreement between nomogram predictions and actual observations. In conclusion, a nomogram based on these factors could accurately and simply provide a picture tool to predict the incidence of POI in GC patients undergoing radical gastrectomy.

Whether peri-operative blood transfusions (BTF) negatively impact long-term survival after gastrectomy for gastric cancer (GC) remains controversial. The aim of this retrospective study was to investigate independent predictive factors of BTF and the potential impact of BTF on overall survival (OS) and disease-free survival (DFS) in patients who underwent radical gastrectomy for stage II/III GC.

The aim of this retrospective study was to investigate the incidence of, causes and risk factors for readmission to hospital ≤30 days after discharge of patients who underwent radical gastrectomy for gastric cancer. A total of 2,023 patients underwent radical gastrectomy operations from November 2010 to July 2017 in our hospital. Of these, 60 patients (3.0%) were readmitted within 30 days after their original discharge. The median time span between the index discharge and readmission was 14 days and the median time for readmission was 8 days. The main reasons for readmission were intestinal obstruction (n = 10, 16.7%), intra-abdominal fluid collection (n = 9, 15.0%), abdominal pain (n = 7, 11.7%), nutritional difficulty (n = 4, 6.7%) and anastomotic leakage (n = 4, 6.7%). Five patients (8.3%) required intensive care and 4 patients (6.7%) died from sudden cardiac arrest, gastrointestinal bleeding, sepsis or multiple organ dysfunctions. Multivariate analysis revealed that post-operative complications (Odds Ratio = 5.116, 95% confidence interval: 2.885–9.073, P < 0.001) was the only independent risk factor for readmission. Thus, appropriate strategies on discharge and close follow-ups for these high-risk patients should be drawn up in order to enhance significantly their quality of care.

The aim of this retrospective study was to investigate the prognostic significance of pre-treatment immunological and nutritional statuses in patients with locally advanced gastric cancer (GC), and to use the risk factors to develop a predictive score. A total of 731 patients who underwent gastrectomy for stage II/III GC from November 2010 to December 2015 were recruited into this retrospective study. On the basis of univariate and further multivariate Cox regression analyses, decreased pretreatment lymphocyte count (<1·5×109/litre) and prealbumin concentrations (<180 mg/l) were identified to be independently associated with poorer overall survival (OS) and disease-free survival (DFS). Low albumin concentrations (<33 g/l) were identified as an independent risk factor only for OS, but not for DFS. Thereafter, patients who had a decreased prealbumin concentration and lymphocyte count were given a combination of serum prealbumin concentration and lymphocyte count (Co-PaL) score of 2. Patients with only one or neither of these concentrations were given a Co-PaL score of 1 or 0, respectively. Both the OS and the DFS time were inversely related to the Co-PaL scores, and the differences among the three groups were all significant. In contrast, the prognosis did not differ significantly between patients with good nutrition and those with mild to moderate malnutrition according to the prognostic nutritional index. This study indicated that the simple scoring system could accurately predict the prognosis of patients who underwent gastrectomy for stage II/III GC. The score might be helpful in terms of clinical preoperative decision-making.

Allogeneic blood transfusions (BTF) are sometimes inevitable during radical gastrectomy with lymphadenectomy for advanced gastric cancer. The aim of this retrospective study was to investigate the association between BTF and post-operative infections, focusing on the impact of timing, amount of transfusion and the role of leukocyte depletion.

The aim of this retrospective study was to analyze the morbidity, mortality, and survival rates of extended multiorgan resection (EMR) for locally advanced gastric cancer patients compared to gastrectomy alone and a palliative operation. 893 locally advanced gastric cancer patients without distant metastasis had surgery including gastrectomy alone (GA group, n = 798), EMR resection (EMR group, n = 75), and palliative operation (palliative gastrectomy or gastrojejunostomy (PO group, n = 20)). Postoperative mortality and complication rates in the EMR group were significantly higher than in the GA group (2.7% vs 0.4%, P = 0.010 and 25.3% vs 8.1%, P < 0.001, respectively), but similar in the PO group. The median survival time of the EMR group was significantly longer than in the PO group (27 months vs 11 months, P = 0.020), but significantly worse (P = 0.020) than in the GA group (44 months). Incompleteness of resection (R1) and linitis plastica were independent prognostic factors for survival in the EMR group. Three different gastric cancer surgeries led to different postoperative mortality and complication rates. EMR had a better survival rate compared with PO while GA had the longest survival time with the lowest mortality and complication rates.

OBJECTIVE:The objective of the present study was to explore the major risk factors of surgical complications using the Clavien-Dindo classification.METHODS:The case-control design was used. A total of 1049 patients who underwent radical gastrectomy in Hunan Cancer Hospital between October 2010 and August 2014 were retrospectively analyzed, including 122 patients (11.6%) with complications and 927 patients (88.4%) with no complications. Risk factors were evaluated.RESULTS:Following radical gastrectomy, 122 patients (11.6%) experienced a total of 151 complications. The incidence of Stages II, IIIa, IIIb, IVa, IVb and V complications was 9.6% (n = 101), 2.5% (n = 26), 1.0% (n = 11), 0.8% (n = 8), 0% (n = 0), and 0.5% (n = 5), respectively. The incidence of severe complications (Stage ≥ IIIa) was 4.8% (n = 50). Multivariate analysis showed that combined resection (Odds Ratio [OR] = 3.36, 95% confidence interval [CI]: 1.71~6.60, P < 0.01), perioperative blood transfusion (OR = 2.13, 95% CI: 1.38-3.29, P < 0.01), and BMI ≥ 25 kg/m(2) (OR = 1.98, 95% CI: 1.16-3.40, P = 0.01) were independent risk factors of complications.CONCLUSIONS:Combined resection, perioperative blood transfusion, and BMI ≥ 25 kg/m(2) are positively correlated with complications.

目的 探讨胃癌根治术后淋巴漏发生的原因及防治.方法 回顾性分析2010年11月至2014年1月间在我院行胃癌根治术胃癌患者535例的临床资料.结果 D2+淋巴清扫术后淋巴漏发生率为5.74％ (12/209),明显高于D2淋巴清扫术后淋巴漏的发生率2.14％ (7/326).胃癌术后病理越晚术后淋巴漏发生率越高.术后淋巴漏经非手术治疗可痊愈.结论 胃癌根治术后淋巴漏的发生与淋巴清扫范围和胃癌术后病理分期密切相关,非手术治疗是术后淋巴漏的主要和有效的治疗方法.

目的：探讨中下段直肠癌患者行全系膜切除术并保留盆腔自主神经对术后性功能、排尿功能和局部复发率的影响。方法回顾性分析2010年11月~2012年11月我院39例行保留盆腔自主神经(PANP)全直肠系膜术的6男性直肠癌患者的随访资料,取同期52例行传统非保留自主盆腔神经全直肠系膜切除术的男性直肠癌患者作为对照,比较两组术后性功能、排尿功能和局部复发率。结果性功能障碍保留自主盆腔神经组为20.51%(8/39),非保留自主盆腔神经为48.08%(25/52),两组比较差异具有统计学意义(P<0.05)。排尿功能障碍保留自主盆腔神经组为5.13%(2/39),非保留自主盆腔神经为11.54%(6/52),两组比较差异具有统计学意义(P<0.05)。术后复发率保留自主盆腔神经组为5.13%(2/39),非保留自主盆腔神经为5.77%(3/52),P>0.05,差异无统计学意义。结论全直肠系膜切除术中保留盆腔自主神经,可减少患者术后性功能及排尿功能障碍的发生率,且不增加术后局部复发率,提高术后生活质量。

Mesohepatectomy is considered a feasible option for patients with centrally located hepatocellular carcinoma (HCC). However, mesohepatectomy is a technically demanding and less frequently used procedure. In this study, we summarized the surgical experience and evaluated the clinical outcomes of mesohepatectomy in 24 patients with centrally located HCC. Of these patients, 9 were treated with hepatectomy of Couinaud's segments IV, V and VIII with concurrent cholecystectomy; 8 underwent resection of segments IVb, V and VIII, including 7 patients who also received a cholecystectomy; 4 underwent hepatectomy of segments IVa, V and VIII; and 3 patients were treated with hepatectomy of segments I, IV, V and VIII, with concurrent cholecystectomy. The Pringle maneuver was used on 17 patients during hepatectomy. Total hepatic vascular exclusion (HVE) was performed on 3 patients and HVE was not used on 4 patients. The average mesohepatectomy operative time was 238 min and the average intraoperative blood loss was 480 ml (200-2,200 ml). There was no intraoperative mortality and the postoperative morbidity rate was 25% (6/24). The 1- and 3-year overall survival rates were 76 and 46%, respectively. Therefore, mesohepatectomy is a safe and effective surgical procedure for the treatment of centrally located HCC and HVE during mesohepatectomy for centrally located HCC is crucial to the success of the operation and postoperative patient recovery.

OBJECTIVE:To explore the major risk factors for pulmonary infection after radical gastrectomy in patients with gastric cancer. METHODS:From November 2010 to February 2014, a total of 765 patients undergoing radical gastrectomy at our hospital were divided into 2 groups based upon the presence of postoperative pulmonary infection (n = 32, 4.2%) or not (n = 733, 95.8%). Their clinicopathological data were retrospectively analyzed by Logistic regressive analysis with a case-control study model. RESULTS:Comparing with the control group, the patients had longer surgical duration (245.7 ± 66.7 vs 210.9 ± 47.2 min, P < 0.01), higher rates of requiring intensive care (12.50% vs 2.86%, P = 0.02) and longer post-operative hospital stays (21.9 ± 24.9 vs 14.2 ± 4.2 days, P < 0.01) in the postoperative pulmonary infection group.Univariate Logistic regressive analysis found that age ≥ 60 years, smoking ≥ 400 year by cigarette, diabetes mellitus, chronic obstructive pulmonary disease, proximal or total gastrectomy, combined organ resection, surgical duration ≥ 240 min, intra-operative blood loss ≥ 300 ml, peri-operative transfusion, transfusion ≥ 3 unit packed red blood cell, post-operative transfusion and post-operative complications other than pulmonary infections were associated with postoperative pulmonary infection (all P < 0.05).Further multivariate analysis identified 4 independent risk factors for pulmonary infection after radical gastrectomy, including diabetes mellitus (OR = 4.77, 95%CI:1.18-19.23), post-operative complications other than pulmonary infections (OR = 3.15, 95%CI:1.25-7.90), intra-operative blood loss ≥ 300 ml (OR = 2.63, 95%CI:1.17-5.90) and post-operative nasogastric tube ≥ 5 days (OR = 2.30, 95%CI:1.02-5.21). CONCLUSION:Correcting the modifiable risk factors may reduce the incidence of pulmonary infection and shorten the length of hospital stays and costs after radical gastrectomy in patients with gastric cancer.

OBJECTIVE:To explore the association of perioperative homologous blood transfusion (packed red blood cell, PRBC) and postoperative complications after radical gastrectomy in patients with gastric cancer. METHODS:From October 2010 to July 2013, a total of 636 patients undergoing radical gastrectomy at Department of Gastric, Duodenal & Pancreatic Surgery at Hunan Provincial Tumor Hospital were divided into 2 groups according to perioperative blood transfusion (n = 170, 26.73%) or not (n = 466, 73.27%). Their clinicopathological data, such as age, gender, co-morbidities, surgical duration, intraoperative blood loss volume and pathological stage were retrospectively analyzed by case-control study model. And the transfusion group was further divided into subgroup by transfusion volume (total PRBC<3.0, 3.0-7.5 or >7.5 U) and timing (pre-, intra- or post-operative) to examine the association of transfusion volume and timing with postoperative complications by Logistic regression. RESULTS:Thirty-two patients suffered from complications in the transfusion group (18.82%). And it was significantly more common than that in the control group (10.09% (47/466) , P < 0.01). Moreover, the complication rate (33.33% (12/36) ) was obviously higher in the large transfusion volume group (PRBC>7.5 U) than with those in the moderate (15.53% (16/103), P = 0.02) and low groups (12.90% (4/31) , P = 0.04). Infection was more common along with the total amount of transfused blood (6.45% (2/31), 10.68% (11/103) and 19.44% (7/36) in the low, moderate and large transfusion group respectively). Yet the differences were insignificant (P = 0.22). There was no significant difference of complication rates among the pre-, intra- and post-operative transfusion group classified by transfusion time (P = 0.39). And the postoperative infection rates were also insignificantly different (P = 0.88). Further Logistic analysis revealed that perioperative transfusion (OR = 2.71, 95% CI: 1.40-5.27, P < 0.01) was an independent risk factor for postoperative complications after radical gastrectomy. CONCLUSIONS:Perioperative blood transfusion is significantly associated with postoperative complications after radical gastrectomy in patients with gastric cancer. And a positive correlation exists between infection and the amount of transfused blood. But there was no association between transfusion time and complications. Thus decreasing perioperative transfusion may reduce the incidence of postoperative complications and shorten the length of hospital stays.

OBJECTIVE:To explore the major risk factors for intra-abdominal infections after radical gastrectomy in patients with gastric cancer. METHODS:From October 2010 to January 2013, a total of 479 patients undergoing radical gastrectomy at Department of Gastric, Duodenal & Pancreatic Surgery, Hunan Provincial Tumor Hospital were divided into 2 groups according to an onset of postoperative intra-abdominal infections (n = 32, 6.68%) or not (n = 447, 93.32%). Their clinicopathological data, such as age, gender, co-morbidities, surgical duration, operative blood loss and pathological stage were retrospectively analyzed by Logistic regressive analysis with a case-control study model. RESULTS:As compared with the control group, the patients had a greater age ((59 ± 10) vs (53 ± 11) years, P < 0.01), lower lymphocyte count ((1.4 ± 0.7) ×10(9)/L vs (1.7 ± 0.6) ×10(9)/L, P = 0.02), lower hemoglobin level ( (108 ± 28) vs (117 ± 24) g/L, P = 0.04), lower albumin level ((34 ± 6) vs (37 ± 5) g/L, P < 0.01) and longer surgical duration ((244 ± 43) vs (216 ± 45) min, P < 0.01) in the postoperative intra-abdominal infection group. Univariate Logistic regressive analysis found that a history of abdominal surgery, body mass index (BMI) >25 kg/m(2), co-morbidities, diabetes mellitus, complications due to gastric cancer, lymphocyte count <1.5×10(9)/L, hemoglobin <100 g/L, albumin <30 g/L, ascites, perioperative transfusion, total mastectomy, combined organ resection and surgical duration >240 min were associated with the occurrence of postoperative intra-abdominal infections (all P < 0.05). Further multivariate analysis identified 4 independent risk factors for intra-abdominal infections after radical gastrectomy, including combined multiorgan resection (OR = 3.64, 95%CI: 1.39-9.55), BMI>25 kg/m(2) (OR = 3.04, 95%CI: 1.17-7.92), diabetes mellitus (OR = 3.41, 95%CI: 1.05-11.09) and perioperative transfusion (OR = 2.24, 95%CI: 1.02-5.13). CONCLUSION:A correction of modifiable risk factors may reduce the incidence of intra-abdominal infections after radical gastrectomy, shorten the length of hospital stays and improve outcomes in patients with gastric cancer.