Objective To explore the safety and efficacy of middle line approach identified with superior mesenteric vein in the right hemicolectomy combined with pancreaticoduodenectomy for colonic carcinoma involing liver and duodenun.Methods Clinical data of 13 patient's with right colonic cancer (T4b) undergoing right hemicolectomy combined with pancreaticoduodenectomy from Jan 2016 to Jul 2019 in He'nan Provincial Tumor Hospital were retrospectively analyzed.The superior mesenteric vein was used to mark the medial border of tumor resection.Vertical cutline was made to transverse mesocolon and all the way done to the root of superior mesenteric vein,the pancreas was cut in front of superior mesenteric vein,superior mesenteric artery and the affiliated lymph nodes were dissected.The stomach and pancreas were transected,the specimen was removed.Then the GI tract was reconstructed.Results Surgery was successful in all 13 patients.The operation time was (249 ± 27) min,blood loss was (442 ± 129) ml,2 cases suffered pancreatic fistula,there was no biliary fistula,and 1 case of delayed gastric emptying.There were no other major complications.The number of lymph node dissection was (20 ± 4) and hospital stay was (23.2-± 9.4) d.Conclusions It is safe and feasible to use the superior mesenteric vein-identified middle line approach in patients of right colonic cancer undergoing right hemicolectomy plus pancreaticoduodenectomy.

结肠癌完整结肠系膜切除(CME)强调沿肿瘤引流血管根部解剖,以最大限度清扫淋巴结及保证脏层筋膜光滑和完整无缺损.笔者单位将组织剪的不同操作联合左手控制技术应用于右半结肠癌手术,清扫肠系膜上血管根部、胃结肠静脉干、结肠中血管根部淋巴结.

HEADING AIMS:MicroRNA-27b (miR-27b) has been shown to play a role in the progression of many different forms of cancer, but its specific relevance in the context of non-small cell lung cancer (NSCLC) remains uncertain. As such, this study sought to explore the role of miR-27b in NSCLC and the mechanisms whereby it functions.MATERIALS AND METHODS:We quantified miR-27b and target gene expression via quantitative real-time PCR (RT-qPCR).We then used functional including proliferation assays, migration assay, flow cytometry, and western blotting to explore the mechanisms whereby miR-27b functions in vitro and in vivo. We additionally confirmed miR-27b target genes via luciferase reporter assay.KEY FINDINGS:We observed a marked decrease in miR-27b expression in NSCLC patient samples relative to paracancerous control tissues. We further found that altering miR-27b expression levels in vitro affected NSCLC tumor cell migration, proliferation, and ability to undergo epithelial-mesenchymal transition. Through the use of target prediction algorithms we identified Snail to be a miR-27b target protein that was suppressed when this miRNA was highlight expressed. Lastly, we found miR-27b expression to increase NSCLC cell sensitivity to cisplatin through its ability to target Snail.SIGNIFICANCE:Our results clearly demonstrate that miR-27b can suppress NSCLC tumor development and progression, highlighting this miR-27b/Snail1 axis as putative target for the therapeutic treatment of NSCLC.

Objective To evaluate surgical repair of vesicorectovaginal fistula using transvaginal pedicled omentum pull-through combined transanal colon pull-through.Methods A total of 11 patients with postoperative vesicorectovaginal fistulas complicating female reproductive system malignant tumors undergoing repairement from Aug 2013 to Aug 2018 were retrospectively analyzed.In order to isolate,protect the bladder and eliminate residual vaginal cavity using transvaginal pedicled omentum pull-through,combined transanal colon pull-through to repair vesicorectovaginal fistula.Results All the 11 patients in this group completed the operation successfully,and no air or stool passing from the vaginal after the operation.The fistula disappeared in five patients confirmed by cystography and enterograph.The average operation time was 115 min,the average blood loss was 260 ml.Incision fat liquefaction was found in two.Incision infection occurred in one.Urinary dysfunction in two.Anal stenosis was found in four patients which were healed by anal dilation.Conclusions Transvaginal pedicled omentum pull-through combined transanal colon pull-through can eliminate vesicorectovaginal fistula,improve life quality and avoid colostomy.

Objective To investigate changes in expression of the tumor stem cell marker Leucinerich repeat containing G protein-coupled receptor 5 (Lgr5) before and after neoadjuvant chemoradiotherapy and its predictive effect on neoadjuvant chemoradiotherapy.Methods A retrospective analysis was performed on the clinical data of 42 patients with locally mid-low advanced rectal cancer,who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision (TME) radical surgery.The patients were all given the test of Lgr5 level prior to and after the new adjuvant therapy.Results The univariate analysis showed that pre-chemoradiotherapy T stage (cT1-3) (P ＜ 0.05),pre-chemoradiotherapy N stage (P ＜ 0.05),pathological complete response (pCR) after neoadjuvant chemoradiotherapy (P ＜ 0.01) were associated with Lgr5 level before neoadjuvant chemoradiotherapy for locally mid-low advanced rectal cancer.In 42 patients,11 (21.4％) achieved pCR after neoadjuvant chemoradiotherapy.The relationship between Lgr5 levels and pCR were assessed.The expression of Lgr5 protein was higher in the tissues with deeper infiltration or lymph node metastasis.The expression of Lgr5 protein before and after neoadjuvant chemoradiotherapy was 73.80％ and 28.57％ respectively.Conclusion The expression of Lgr5 is significantly correlated with invasion and lymph node metastasis,and may play an important role in the occurrence and development of epithelial rectal carcinoma.The expression of Lgr5 is related to the degree of tumor pathological remission after neoadjuvant chemoradiotherapy.Overexpression of Lgr5 provides an important implication of malignancy and prognosis in the local mid-low advanced rectal cancer.

Objective To investigate the effect of interfering glutaminase 1 (GLS1) expression on the biological characteristics of human gastrointestinal neuroendocrine tumor cells.Methods The expression of GLS1 in human gastrointestinal neuroendocrine tumors was detected by Western blotting;NS-small interfering RNA (siRNA),GLS1-siRNA1,GLS1-siRNA2 and GLS1-siRNA3 were transfected into human gastrointestinal neuroendocrine tumor cell line BON-1,and no transfected any siRNA as the control group,the expression of GLS1 protein after transfected cells were detected by Western blotting;cell proliferation transfected for 12,24 and 48 h were detected by cell counting kit-8 (CCK-8) assay;cells were transfected for 24 h,cell invasion were detected by Transwell;expression of matrix metalloproteinase (MMP)-2,MMP-9,mammalian target of rapamycin (mTOR),phosphorylated mTOR (p-mTOR),human ribosomal protein S6 kinase (rps6k),phosphorylated rps6k (p-rps6k) protein was detected by Western blotting;after 10 nmol/L mTOR signaling pathway inhibitor rapamycin treated cells,cell proliferation and invasion was detected.Results The expression of GLS1 in human gastrointestinal neuroendocrine tumor tissues was significantly higher than that in the tumor adjacent tissues (P =0.000);GLS1 protein expression in GLS1-siRNA1,GLS1-siRNA2,GLS1-siRNA3 group were significantly lower than the control group,GLS1-siRNA2 is chosen as the follow-up study;cells survival in 12 h (85.31 ± 4.42) ％,24 h (76.12 ± 2.93) ％ and 48 h (69.22 ± 3.62) ％ in GLS1-siRNA group were significantly lower than the control group [(97.02 ± 2.21) ％,(96.61 ± 1.52) ％,(97.11 ± 2.32) ％;t12 h =4.104,P12 h =0.015;t24 h =10.752,P24 h =0.000;t48 h =11.235,P48 h =0.000];the number of cell invasion and MMP-2,MMP-9,p-mTOR,p-rps6k protein expression in GLS1-siRNA group were significantly lower than the control group;cell proliferation and invasion results after inhibitor adding had a the same trend with interfering with GLS1 expression.Conclusion GLS1 is highly expressed in human gastrointestinal neuroendocrine tumor.The inhibition of GLS1 expression can significantly inhibit the proliferation and invasion of BON-1 cells,and its mechanism is related to the regulation of mTOR signaling pathway.

Objective To explore the clinical application value of carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients with sigmoid colon cancer who were admitted to the Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from December 2015 to June 2016 were collected.Among 40 patients undergoing radical resection of sigmoid colon cancer,20 using nanometer carbon lymph node staining combined with artery approach and 20 using the traditional lymph node sorting were respectively allocated into the observation group and control group.Observation indicators:(1) detection of the lymph node and pathological examination;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect adjuvant chemotherapy,tumor recurrence or metastasis and surgery-related complications up to June,2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with the t test.Comparisons of count data were analyzed using the chi-square test.The comparisons of ordinal data were analyzed using the nonparametric test.Results (1) Detection of the lymph node and pathological examination:40 patients underwent successful radical resection of sigmoid colon cancer.The lymph node sorting time,total and average numbers of lymph node sorting,total and average numbers of lymph node with diameter ＜ 5 mm,cases with lymph node number ＜ 12 and numbers of the first,second and third stations lymph nodes were respectively (13.1±2.4) minutes,522,28.0±7.0,152,8.6±2.5,0,13.7±3.6,9.5±2.5,4.7±1.2 in the observation group and (18.4±3.5) minutes,239,13.0±3.0,64,3.9± 1.7,6,6.1 ± 1.6,6.6± 2.2,2.5± 1.0 in the control group,with statistically significant differences between groups (t =14.562,24.872,19.256,x2 =4.902,t =14.368,10.026,8.210,P＜0.05).The total number of positive lymph node,positive rate of lymph node,metastasis rate of patients,total and average numbers of positive lymph node with diameter ＜ 5 mm and numbers of the first,second and third stations positive lymph nodes were respectively 82,0.22％±0.13％,17/20,51,3.9± 1.9,4.2± 1.8,1.9±0.6,2.3± 1.2 in the observation group and 43,0.48％±0.18％,7/20,38,2.7±1.5,2.1±0.6,2.6±0.7,1.4±0.5 in the control group,showing no statistically significant difference in the positive rate of lymph node and number of the third station positive lymph nodes between groups (t =1.462,1.759,P＞0.05).There were statistically significant differences in the metastasis rate of patients,average number of positive lymph nodes with diameter ＜ 5 mm and numbers of the first and second stations positive lymph nodes between groups (x2 =10.417,t =7.264,4.682,3.410,P＜0.05).(2) Follow-up situations:40 patients were followed up for 12-18 months,with a median time of 16 months.Eighteen and 10 patients in the observation group and control group received postoperative adjuvant chemotherapy,showing a statistically significant difference between groups (x2=5.833,P＜ 0.05).Tumor recurrence or metastasis was respectively detected in 0 and 2 patients (1 with local recurrence and 1 with liver metastasis) in the observation group and control group,with no statistically significant difference between groups (x2=2.105,P＞ 0.05).During the follow-up,there was no surgery-related complication.Conclusion The carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer can increase the sorting rate and number of lymph node,and improve the accuracy of postoperative pathological staging.

OBJECTIVE:To establish a scoring system to predict the risk of anastomotic leakage in patients with rectal cancer older than 60 years. METHODS:The study included 995 patients (≥60 years) with rectal cancer locating 3-12 cm from the anal verge who underwent anterior resection or intersphincteric resection at the Department of General Surgery, Henan Cancer Hospital from January 2012 to December 2016. Potential risk factors for leakage were subjected to univariate analysis. Multivariate logistic regression analysis was used to identify the independent risk factors for anastomotic leakage. The scoring system was developed based on regression coefficient for each significant risk factor. One point was allocated to the risk factor with a regression coefficient β<1, and two points were allocated to the risk factor with β>1. The proposed scoring system was tested by the area under curve (AUC) of the receiver operating characteristic curve (ROC). RESULTS:Surgery was successfully performed in all 995 patients. The incidence of anastomotic fistula was 4.6%(46/995). Among these 46 patients, 31 recovered after conventional treatment, and 13 patients underwent transverse colostomy,and 2 died of multiple organ failure. Independent risk factors included age (β=0.643, OR=1.902, 95%CI: 1.020-3.614, P=0.048), body mass index(BMI) (β=1.218, OR=3.379, 95%CI: 1.607-7.105, P=0.001), albumin levels (β=0.986, OR=2.681, 95%CI: 1.432-5.021, P=0.002), and level of anastomosis from the anal verge (β=1.395, OR=4.034, 95%CI: 2.086-7.801, P=0.000). The scoring system was created base on coefficient β of the independent risk factors (age≥70 years for 1, BMI≥25 kg/m2 for 2, albumin levels <35 g/L for 1, level of anastomosis from anal verge <4.0 cm for 2). All the scores were added up, and all patients were divided into the high-risk group(4-6 points, n=71) and intermediate-low-risk group(0-3 points, n=924) based on the scoring system. The incidence of anastomotic leakage in the two groups was 23.9%(17/71) and 3.1%(29/924), respectively (χ2=60.092, P=0.000). The AUC of age, BMI, albumin levels, and level of anastomosis from the anal verge were 0.598, 0.591, 0.622, and 0.635 respectively. The AUC of the scoring system was 0.656, which was higher than above parameters with a sensitivety of 0.37 and specificity of 0.94. CONCLUSIONS:The scoring system is effective and accurate for identifying a subgroup at high risk for postoperative anastomotic leakage in rectal cancer patients over 60 years old.

Objective To investigate the significance of serum carcinoembryonic antigen (CEA) in locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy.Methods A retrospective analysis was performed on the clinical data of 84 patients with rectal cancer,who underwent neoadjuvant chemoradiotherapy followed by radical surgery.The patients were all given the test of CEA level prior to and after the new adjuvant therapy.The relationship between CEA levels and pathological complate response (pCR) were assessed.Results In 84 patients,18 (21.4％) achieved pCR after neoadjuvant chemoradiotherapy.The univariate analysis showed that circumferential extent of the tumor (≤ 1/2 cycle) (P =0.008),pre-chemoradiotherapy serum carcinoembryonie antigen (CEA) level (≤5 μg/L) (P =0.001),pre-chemoradiotherapy T stage (cT1-3) (P =0.001),pre-chemoradiotherapy N stage (P =0.049),distance between tumor and the anal verge (≤5 cm) (P =0.023) were associated with pCR or non-pCR after neoadjuvant chemoradiotherapy for rectal cancer.After neo-adjuvant therapy,more patients achieved pCR was observed in patients that CEA decreased ≥50％.Conclusion Patients with low CEA level are more likely to achieve pCR and patients with CEA decreased significantly are more likely to achieve greater pCR after neoadjuvant chemoradiotherapy for rectal cancer.

Objective To investigate the relationship between the sensitivity of neoadjuvant chemoradiotherapy and the expression of cyclooxygenase-2 (COX-2) in locally advanced rectal cancer.Methods Clinicopathologic data of 42 patients with local mid-low advanced rectal cancer receiving preoperational concomitant chemoradiotherapy were retrospectively analyzed.Immunohistochemical assay was performed in pre-chemoradiotherapy specimens to determine the expression of COX-2 protein.Postoperative pathological tissue sections were reassessed for evaluation of tumor regression grade [0-4,complete pathological response (pCR) =4] after radiochemotherapy.The relationship of expression COX-2 with pCR was analyzed by chisquare test.Results Patients with low expression of COX-2 had significantly higher incidence of pCR than those with high expression of COX-2 (63.6％ vs.36.3％).The expression of COX-2 was negatively correlated with pCR (r =-0.762,P =0.019).Patients with high expression of COX-2 had significantly higher expression of VEGF than those with low expression of COX-2 (64.0％ vs.36.0％).The expression of COX-2 was positively correlated with VEGF (r =0.531,P =0.028).The univariate analysis showed that age,gender,distance between tumor and the anal verge,circumferential extent of the tumor,clinical stage and T-staging were not clearly associated with the expression of COX-2 in rectal cancer.Conclusion The expression of COX-2 is associated with efficiency of neoadjuvant chemoradiation of rectal cancer.

Objective To explore the risk factors of ulcerative colitis-associated colorectal cancer (UC-CRC). Methods The retrospective case-control study was conducted. The clinicopathological data of 536 patients with ulcerative colitis (UC) who were admitted to the Henan Tumor Hospital from March 2004 to June 2015 were collected. Observation indicators: (1) follow-up results: cases with follow-up, follow-up time, cases of UC-CRC, age of onset, pathological type of UC-CRC; (2) risk factors analysis affecting occurrence of UC-CRC: gender, age of onset, course of disease, severity of disease, disease classification, extent of lesion, smoking history, family history of colorectal cancer, anemia, hypoproteinemia, body weight loss, extraintestinal manifestations, colonic polyps, backwash ileitis, atypical hyperplasia, anxiety or depression, treatment method and regular endoscopy reexamination. Follow-up using outpatient examination and telephone interview was performed to detect prognosis of patients up to April 2017. Patients underwent colonoscopy once every 6 months within 3 years after diagnosis and once every 1 year after 3 years. Measurement data with skewed distribution were described as M (range). The univariate analysis was done using the chi-square test and Fisher exact probability. The multivariate analysis was done using the Logistic regression model. Results (1) Follow-up results: of 536 patients, 450 were followed up for 26.0-120.0 months, with a median time of 76.4 months. During the follow-up, 16 patients were complicated with UC-CRC, including 9 males and 7 females. Age of onset of colorectal cancer was 14-78 years, with an average age of onset of 44 years. Pathological type: high-differentiated right colon adenocarcinoma was detected in 5 patients, high-and moderate-differentiated left colon adenocarcinoma in 3 patients, left colon signet-ring cell carcinoma in 2 patients, moderate-differentiated rectal tubular adenocarcinoma in 3 patients, high-differentiated rectal papillary adenocarcinoma in 2 patients and malignant lymphoma in 1 patient. (2) Risk factors analysis affecting occurrence of UC-CRC: the results of univariate analysis showed that course of disease, extent of lesion, colonic polyps and atypical hyperplasia were risk factors affecting occurrence of UC-CRC (χ2=14.848, 18.885, 10.554, P 10 years, lesion involving the whole colon, colonic polyps and atypical hyperplasia were independent risk factors affecting occurrence of UC-CRC (OR=12.893, 17.847, 7.326, 19.742, 95% confidence interval: 1.726-74.337, 1.445-89.793, 1.263-43.128, 3.625-96.524, P<0.05). Conclusion The course of disease >10 years, lesion involving the whole colon, atypical hyperplasia and colonic polyps are independent risk factors affecting occurrence of UC-CRC. Key words: Ulcerative colitis; Inflammatory bowel disease; Canceration; Risk factors

OBJECTIVE To explore the technical advantages of nano carbon development combined with artery approach in lymph node sorting of rectal cancer. METHODS From December 2015 to June 2016, 70 patients with of rectal cancer in General Surgery Department of Henan Cancer Hospital were randomly divided into nano carbon development combined with artery approach group(artery approach group) and conventional group. Specimen of artery approach group was placed on the sorting table. Anatomy was performed from the root of inferior mesenteric artery to left colonic artery, sigmoid artery and superior rectal artery. Along the arterial vessel shape, the black-stained lymph nodes and non-stained lymph nodes (perhaps pink, pale yellow, white or pale brown) were examined carefully using visual and haptic combination method for identification of lymph node. From the root of inferior mesenteric artery, central lymph nodes were sorted. Along the vessel shape, vascular lymph nodes were sorted. Intestinal lymph nodes around the rectum were examined as well. Then, specimen was reversed on the sorting table and underwent sorting as above after the examination of obverse. The conventional group received routine method. The total number, the average harvested number, the number of positive lymph nodes and the number of patients with lymph nodes less than 12 were compared between two groups. RESULTS Among 70 cases, 37 were male and 33 were female with the median age of 57(32-88) years old. Dixon resection was performed in 46 cases, and Miles resection in 24 cases. Total sorting lymph node was 1 105, including 641 of artery approach group and 464 of control group with significant difference (t=20.717, P=0.000). Lymph node sorting time of artery approach group was (12.6±3.9) minutes, which was shorter than (18.2±4.1) minutes of control group (t=12.464, P=0.000). In artery approach group, number of lymph node with diameter less than 5 mm was 142, sorting rate was 22.2%(142/641), of which 29 were positive(20.4%). In conventional group, 37 lymph nodes with diameter less than 5 mm were found, and sorting rate was 8.0%(37/464), of which 6 were positive(16.2%). Number of the first station of lymph node sorting in artery approach group and conventional group was 282(44%) and 169(36.4%); number of the second station lymph node sorting was 230(35.9%) and 180(38.8%); number of the third station lymph node sorting was 129(20.1%) and 115(24.8%). CONCLUSION The method of nano carbon development combined with artery approach in lymph node sorting of rectal cancer has some advantages, such as simple operation, more harvested lymph nodes, and more accurate pathological staging.

目的 探讨结肠脾曲重建技术用于预防胃癌联合脾脏切除术后近期并发症的效果。 方法 将2013年2月至2016年2月河南省肿瘤医院普外科收治的52例胃癌行联合脾脏切除的患者，根据术中是否采用结肠脾曲重建技术分为两组：采用结肠脾曲重建技术30例（观察组），不采用结肠脾曲重建技术22例（对照组）。观察两组患者的治疗效果，采用χ2检验比较其术后并发症的发生情况。 结果 术后发生粘连性肠梗阻：观察组2例，均经鼻肠管减压、生长抑素和肠外营养支持治疗痊愈；对照组7例，4例保守治疗后痊愈，3例经二次手术后痊愈。观察组与对照组术后胰瘘和粘连性肠梗阻的发生率比较，差异有统计学意义（2/30比9/22，χ2=6.988，P=0.008；2/30比7/22，χ2=3.990，P=0.046），而腹腔感染和肺炎发生情况比较，差异无统计学意义（1/30比4/22，P=0.187；3/30比9/22，χ2=0.577，P=0.209）。 结论 结肠脾曲重建技术能有效降低全胃联合脾脏切除术后粘连性肠梗阻和胰瘘的发生率，并能减轻粘连性肠梗阻的严重程度。

Objective To explore the surgical approach of retroperitoneal giant tumors not crossing the midline.Methods We retrospectively analyzed the clinical data of 60 cases of resected giant retroperitoneal tumors (diameter ＞ 10 cm) totally located one-sided of the obdominal cavity from September 2010 to May 2016 in Henan Cancer Hospital.Results Fifty-nine patients underwent successful resection of the tumor,the average operation time was (110 ± 13) min,with an average bleeding volume of (635 ± 22) ml.One patient died of postoperative intra abdominal bleeding.32 cases died during the follow-up for tumor recurrence.The median survival time was 63 months,and the survival rates of the patients at 1,3,and 5 years were 96％,80％,and 54％.Conclusion For large retroperitoneal tumors within one side of the midline,appropriate surgical approach and surgical strategy can reduce the operation time and improve the operation safety.

Objective To investigate the application value of the curved cutter stapler device combined with trans-orally inserted anvil (OrVil) in the radical resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 206 patients with Siewert type Ⅱ AEG who were admitted to the Henan Tumor Hospital between March 2011 and March 2016 were collected.All the 206 patients underwent radical resection and 3-step clock wise total gastrectomy + D2 lymph node dissection.Observation indicators:(1) surgery and postoperative recovery situations:surgical approach,overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,postoperative complications and duration of postoperative hospital stay;(2) postoperative pathological examination and chemotherapy;(3) follow-up and survival situations.Follow-up using telephone interview and outpatient examination was performed to detect tumor-free survival of patients up to April 2016.Measurement data with normal distribution were represented as x±s.The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgery and postoperative recovery situations:all the 206 patients received successful operations,including 85 with abdominal operation,50 with abdominal incision through the diaphragmatic muscle into thoracic surgery and 71 with thoracic-abdominal surgery.Overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation and duration of hospital stay were (113.7± 15.4)minutes,(3.5± 1.2)minutes,(10.4±2.9)minutes,(128±25) mL,32± 6,(2.4 ± 0.9) days and (12.3 ± 1.9) days,respectively.Of 206 patients,15 with postoperative complications were cured by conservative treatment,including 6 with implicit anastomotic fistula,3 with dominant anastomotic fistula,2 with pancreatic leakage,2 with intestinal obstruction,1 with anastomotic stenosis and 1 with thoracic and abdominal infection.There was no reoperation due to perioperative complications.(2) Postoperative pathological examination and chemotherapy:postoperative pathological results showed that distance from resection margin of the esophagus to tumor was (5.2±0.4) cm,without cancer cells in the resection margin.Among 206 patients,171 received postoperative chemotherapy by S1 single agent combined with oxaliplatin for 6-8 cycles or oral S1 single agent for 1 year.(3) Follow-up and survival situations:206 patients were followed up for (2.7± 0.3)years,with a tumor-free 3-year survival rate of 58％.During the follow-up,there was no recurrent anastomotic tumor.Conclusion The curved cutter stapler device combined with OrVil in the radical resection of Siewert type Ⅱ AEG can simplify the difficulty of esophagojejunal anastomosis and guarantee the safe resection margin of the lower esophagus.

Objective To evaluate the result of early repair for urinary fistula caused by iatrogenic injury to ureter,bladder and urethra during resection of rectal cancer.Methods We retrospectively analyzed 26 cases of urinary fistula after resection of rectal cancer patients encountered in Department of General Surgery,Henan Tumor Hospital from October 2005 to May 2016.Urinary fistula was divided into four types according to the site of fistula.Results Surgery was performed ever after the diagnosis of the fistula was identified.In type Ⅰ fistula (6 cases of posterior urethral fistula) the treatment was stent placement and packing of the greater omentum.2 cases of bladder top fistula (type Ⅱ),were treated by fistula repair and cystostomy.Type Ⅲ involved 12 cases (bladder triangle fistula).The treatment was ureter stenting replantation,and cystostomy Type Ⅳ:ureteral fistula in 6 cases,the treatment was end-to-end anastomosis and stenting.After surgery 24 cases were cured and 2 cases (all of type Ⅲ fistula) ended up with permanent bilateral ureterocutaneostomy.Conclusion It is safe and effective to make early remedy repair for ureter,bladder and urethral fistula iatrogenically during rectal cancer resection.

OBJECTIVE:To explore the application of three-stitch preventive transverse colostomy in anterior resection of low rectal cancer. METHOD:From May 2015 to March 2016, 70 consecutive low rectal cancer patients undergoing anterior resection and preventive transverse colostomy in our department were recruited in this prospective study. According to the random number table method, 70 patients were divided into three-stitch transverse colostomy group(observation group, n=35) and traditional transverse colostomy group(control group, n=35). Procedure of three-stitch preventive transverse colostomy was as follows: firstly, at the upper 1/3 incision 0.5-1.0 cm distance from the skin, 7# silk was used to suture from outside to inside, then the needle belt line went through the transverse edge of the mesangial avascular zone. At the lower 1/3 incision 0.5-1.0 cm distance from the skin, 7# silk was used to suture from inside to outside, then silk went through the transverse edge of the mesangial avascular zone again and was ligatured. Finally, in the upper and lower ends of the stoma, 7# silk was used to suture and fix transverse seromuscular layer and the skin. The operation time and morbidity of postoperative complications associated with colostomy were compared between two groups. RESULTS:There were no significant differences in baseline data between the two groups(all P>0.05). The operative time of observation group was shorter than that of control group [(3.2±1.3) min vs. (15.5±3.4) min, P<0.05]. Incidences of colostomy skin-mucous separation, dermatitis, stoma rebound were significantly lower in observation group [5.7%(2/35) vs. 34.3%(12/35), P=0.007; 8.6%(3/35) vs. 31.4%(11/35), P=0.036; 0 vs. 17.1%(6/35), P=0.025, respectively], while incidences of parastomal hernia and stoma prolapse in two groups were similar (both P>0.05). CONCLUSION:Compared with traditional transverse colostomy method, the three-stitch preventive transverse colostomy has more operating advantages and can reduce postoperative complications associated with colostomy.

Objective To evaluate a novel lymph node (LN) sorting method on surgical resected sample guided by nanometer carbon staining and principle following the supplying artery tributory in rightsided colon carcinoma.Methods From May 2015 to June 2016,51 patients were randomly divided into two groups adopting traditional LN sorting method and that of a combination of nanometer carbon and artery guided.The final LN status were compared between the 2 groups.Results The total LN number and the positive LN in novel method group were higher than control group (437 vs.349,70 vs.54).The dissection time used,the number of harvested positive LN that was ＜ 5 mm were significantly different [(13.1 ± 3.2) minvs.(17.8 ±3.8)min,t=4.75,P=0.000;1.0±l.0vs.0.2 ±0.6,t=3.51,P=0.000].The number of patients with harvested LN less than 12,the rate of positive lymph nodes,the rate of metastasis were not significantly different (all P ＞ 0.05) between the two groups.Conclusions Use of nanometer carbon development combined with artery approach facilitates LN sorting,yielding more positive LNs,and increating the accuracy of pathological staging in right-sided colon cancer.

Objective To investigate the expression of forkhead/winged helix transcripition factor 3 (Foxp3) in colorectal cancer and the effect of Foxp3 short hairpin RNA (shRNA) on apoptosis of colorectal cancer cells.Methods Western blotting was used to detect the expression level of Foxp3 in colorectal cancer tissues and corresponding paracancerous tissues.The expression of Foxp3 in human colorectal cancer cells HCT116,SW480,RKO and human intestinal mucosal cell line CCC-HIE-2 was detected by Western blotting.Transfected Foxp3 shRNA1,Foxp3 shRNA2 and shRNA control to human colorectal cancer cells,which were named as Foxp3 shRNA1group,Foxp3 shRNA2 group,shRNA control group.At the same time,the non transfection group was established and transfection reagent was added into the non transfection group.After culturing 48 h,the expression level of Foxp3 in the cells was detected by Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR),and the higher interference efficiency of shRNA was screened.Flow cytometry was used to detect the apoptosis of cells.Results The expression levels of Foxp3 in the adjacent tissues and colon cancer tissues were: 0.24±0.05,0.78±0.08,and the difference was statistically significant (P=0.000,t=63.254).The expression level of Foxp3 in human colorectal cancer cells HCT116,SW480,RKO was higher than that of CCC-HIE-2,and the expression level of Foxp3 was from low to high: RKO,HCT116,SW480.Later selection SW480 continue to study.The expression level of Foxp3 protein in the transfected group,shRNA control group,Foxp3 shRNA1 group and Foxp3 shRNA2 group were: 0.92±0.05,0.93±0.07,0.21±0.04,0.34±0.06.The expression level of mRNA was as follows: 1.00±0.07,1.01±0.08,0.53±0.06,0.79±0.08.Subsequent Foxp3 shRNA2 interference Foxp3 expression.The apoptosis rates of the non transfection group,shRNA control group and Foxp3 shRNA2 group were as follows: (13.21±3.12)%,(12.98±3.54)%,(42.01±6.72)%.The expression level of B cell lymphoma/lewkmia-2 (bcl-2) in Foxp3 group shRNA2 was 0.86±0.05,0.85±0.06,0.26±0.05.The expression level of cleaved cysteinyl aspartate specific proteinase 3 (Cleaved Caspase-3) was: 0.38±0.09,0.39±0.08,0.88±0.06.The expression level of p-signal transducers and activators of transcription 3 (STAT3) was as follows: 0.40±0.06,0.39±0.04,0.22±0.05.Conclusion Foxp3 was up-regulated in colorectal cancer tissues and cells.Interference of Foxp3 expression could promote apoptosis of human colorectal cancer cells.The mechanism may be related to STAT3 signaling pathway.

OBJECTIVETo study the expression of myeloid-derived suppressor cells (MDSC) in peripheral blood of patients with rectal carcinoma and to preliminarily explore its clinical significance.METHODSBlood samples from 76 rectal carcinoma patients who underwent surgery in Department of General Surgery, The Affiliated Cancer Hospital, Zhengzhou University between June and October 2013 were collected before operation, postoperative day 10 and 2 years after operation respectively. Flow cytometry was used to detect MDSC percentage in peripheral blood of 76 rectal carcinoma patients and 40 healthy people. The change of MDSC percentage in peripheral blood of rectal carcinoma patients after treatment was investigated. Furthermore, the relationship of peripheral blood MDSC percentage with clinicopathological characteristics was examined.RESULTSPreoperative MDSC percentage in peripheral blood of 76 rectal carcinoma patients [(3.52±0.68)%] was higher than that of 40 healthy people[(0.92±0.21)%], with significant difference (t=3.026, P=0.005). Preoperative MDSC percentage in peripheral blood of rectal carcinoma patients was significantly related with histological classification (t=2.453, P=0.018), depth of tumor invasion (t=2.051, P=0.035), lymph node metastasis (t=2.328, P=0.022), TNM stage (t=2.529, P=0.016). Univariate analysis showed that TNM stage, histological classification, lymph node metastasis, preoperative MDSC percentage in peripheral blood were the prognostic factors in rectal carcinoma. Multivariate analysis showed that TNM stage (HR=2.535, 95%CI: 0.851 to 4.160, P=0.038) and preoperative MDSC percentage in peripheral blood (HR=3.651, 95%CI: 0.877 to 14.263, P=0.031) were independent prognostic factors of rectal carcinoma. MDSC percentage in peripheral blood of rectal carcinoma patients decreased significantly on the postoperative 10-day [(2.41±0.46)%] compared to that before operation [(3.52±0.68)%], whose difference was statistically significant (t=1.778, P=0.043). During follow-up, tumor recurrence or metastasis was found in 23 patients. MDSC percentage in peripheral blood of rectal carcinoma patients with recurrence or metastasis [(4.37±1.23)%] was higher than that of rectal carcinoma patients without recurrence or metastasis [(2.36±0.35)%] two years after operation, with statistically significant difference (t=1.982, P=0.039).CONCLUSIONSMDSC percentage in peripheral blood of rectal carcinoma patients is significantly elevated compared to that of healthy people. Increased MDSC percentage indicates poor prognosis and tumor progression in rectal carcinoma patients. Measurement of peripheral blood MDSC percentage may have a potential clinical value in prognosis prediction of rectal carcinoma.