Objective:To investigate the application value of the left lobe of the liver with W-type suspension in vivo in laparoscopic gastric surgery.Methods:The clinical data and surgical videos of 68 patients who underwent laparoscopic gastric surgery from January 2021 to September 2021 were retrospectively analyzed to observe the duration of suspension and the presence of related liver accessory injury（such as liver tear，bleeding，hepatic capsular hematoma，postoperative abnormal liver function and bile leakage）.Results:Among 68 patients who underwent the laparoscopic gastric surgery，17 patients underwent laparoscopic total gastrectomy，7 patients with laparoscopic proximal gastrectomy，25 patients with laparoscopic distal gastrectomy，and 19 patients with laparoscopic partial gastrectomy. The mean age of the patients was 63.3 years（30 to 86 years）and the mean body mass index was 24.8 kg/m2（18.6~41.7 kg/m2）. All patients successfully completed the W-type left liver lobe hanging maneuver using only（3.0±1.3）minutes and no special instruments during the operation. 8 patients of parietal peritoneal puncture site bleeding were found by surgical video. The hemostasis was completed by electrical hook. No liver injuries were found in all patients.Conclusion:It is a simple，safe and effective method to use the left lobe of liver suspension in laparoscopic gastric surgery.

Objective:To explore the feasibility of wait and watch treatment for patients with high-risk pathology factors after endoscopic submucosal dissection (ESD) for early colorectal cancer.Methods:From December 2012 to June 2020, 104 patients, including 62 males and 42 females, aged from 31 to 89 years old, with the average of (59.5±10.8) years with early colorectal cancer after ESD operation were selected from the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University. According to the follow-up treatment, the patients were divided into two groups: the additional surgical resection group and the wait and watch group. The measurement data of normal distribution were shown by mean standard deviation, the comparison between groups adopted t test, and the comparison of counting data between groups adopted χ2 test. The types of pathological high-risk factors after ESD were compared between the two groups, and the overall survival (OS) and progression free survival (PFS) of the two groups were compared by Log-Rank test. Results:The median follow-up time was(40.6±15.3) months. The OS and PFS of the additional surgical resection group and the wait and watch group were 100.0% vs 98.4% and 90.7% vs 90.2%, respectively, and there was no statistically significant difference between the two groups (OS: χ2=0.875, P=0.35; PFS: χ2=0.017, P=0.80). Conclusion:The wait and watch strategy is expected to be one of the follow-up choices for some patients with high risk factors after ESD operation for early colorectal cancer.

Objective:To explore whether the protective ileostomy can reduce the incidence of anastomotic leakage after neoadjuvant treatment of rectal cancer and the relationship between protective ileostomy and anastomotic leakage.Methods:From May 2011 to August 2020, a total of 108 patients who underwent rectal cancer neoadjuvant radiotherapy and chemotherapy and then received anterior resection in Beijing Friendship Hospital, Capital Medical University were selected. Sixty-three cases were treated with protective ileostomy (Treatment group), while 45 cases were not (Control group). The chi-square test was used to compare the incidence of anastomotic leakage between the two groups. At the same time, Logistic regression was used to analyze the related factors of anastomotic leakage, and the rate of permanent stoma was calculated. SPSS19.0 software was used for statistical analysis.Results:The total incidence of postoperative anastomotic leakage in the Treatment group and Control group was 9.52% (6/63) and 6.66% (3/45) ( P=0.59). Among them, 2 cases of anastomotic leakage occurred in the Treatmentgroup, no A-grade anastomotic leakage occurred in the Control group, and there was no significant difference between the two groups (33.33% vs. 0, P=0.77). There were 4 cases of grade B anastomotic leakage occurred in the Treatment group, 2 cases in the Control group, there was no significant difference between the two groups (66.67% vs. 66.67%, P=0.45). There was no grade C anastomotic leakage in the Treatment group, and one case of grade C anastomotic leakage occurred in the Control group, there was no significant difference between the two groups (0 to 33.33%, P=0.70). Logistic regression analysis showed that whether protective stoma was implemented or not was not statistically related to the occurrence of anastomotic leakage ( P=0.26). The distance between the tumor and the anal margin ( P=0.01) affected the occurrence of anastomotic leakage. The permanent stoma rate in the Treatment group was 9/63 (16.67%). Conclusion:Protective ileostomy has no significant advantage in reducing the incidence of anastomotic leakage in patients with rectal cancer neoadjuvant radiotherapy and chemotherapy, and may lead to permanent stoma.

OBJECTIVE:To explore whether protective ileostomy is beneficial in preventing anastomotic leakage after anterior resection of rectal cancer.METHODS:A total of 347 patients underwent anterior resection of rectal cancer in our hospital. Ninety-five patients were treated with protective ileostomy (treatment group), and 252 patients were not (control group). The incidences of anastomotic leakage and permanent stoma were compared between the two groups.RESULTS:The overall incidences of anastomotic leakage were 6.32% (6/95) and 8.73% (22/252) in the treatment group and control group, respectively. In the cohort of patients who underwent neoadjuvant radiotherapy, the incidence of anastomotic leakage was 5.88% (2/34) and 12.0% (3/25) in the treatment group and control group, respectively. Logistic regression showed that the incidence of anastomotic leakage was not statistically significant. However, diabetes and the anastomotic height significantly affected the occurrence of anastomotic leakage. The permanent stoma rate was 6.42% (6/95) and 5.95% (15/252) in the treatment group and control group, respectively.CONCLUSION:Protective ileostomy did not show a significant advantage in reducing the incidence of postoperative anastomotic leakage in patients with rectal cancer, and it may lead to a permanent stoma.

Background: Colorectal cancer (CRC) comprises a large proportion of malignant tumors, and early detection of CRC is critical for effective treatment and optimal prognosis. We aimed to discover and validate serum autoantibodies for early detection of CRC. Methods: Combined with CRC-associated autoantibodies discovered by serological proteome and multiplex analyses, 26 predefined autoantibodies were evaluated in 315 samples (130 CRCs, 75 advanced adenomas, and 110 healthy controls) by protein microarray analysis. Autoantibodies with potential detection value were verified by enzyme-linked immunosorbent assays (ELISAs). Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the accuracy of the biomarkers. Results: Four serum autoantibodies (ALDH1B1, UQCRC1, CTAG1, and CENPF) showed statistically different levels between patients with advanced neoplasm (CRC or advanced adenoma) and controls in microarray analysis, which were validated by ELISAs. Among the four biomarkers, the ALDH1B1 autoantibody showed the highest detection value with area under the curve (AUC) values of 0.70 and 0.74 to detect CRC and advanced adenoma with sensitivities of 75.68 and 62.31% and specificities of 63.06 and 73.87%, respectively. By combining the four biomarkers, the performance was improved with an AUC of 0.79 to detect CRC and advanced adenomas. Conclusion: The ALDH1B1 autoantibody has a good potential for early detection of CRC and advanced adenoma, and measuring serum autoantibodies against tumor-associated antigens may improve detection of early CRC.

BACKGROUND:The aim of this study was to determine whether circulating tumor cells (CTCs) have utility as a prognostic biomarker in stage II colorectal cancer (CRC), as well as a biomarker for the selection of patients for adjuvant chemotherapy.METHODS:CTCs were detected in peripheral blood samples obtained from 73 stage II CRC patients, using a negative enrichment and immune-fluorescence in situ hybridization (imFISH) staining method. The follow-up time ranged from 3.5 to 35.9 months, and the clinic-pathologic characteristics and recurrence free survival (RFS) were collected and analyzed.RESULTS:Seventy-three stage II CRC patients were included in this study. The positive rate of CTCs was 65.8% in all patients, 87.5% in recurrent patients and 59.6% in no recurrence patients. The mean RFS was 30.6 months for all patients, 28.7 months for CTC-positive patients and 34.0 months for CTC-negative patients (P=0.043). The mean RFS of CTC-positive and CTC-negative patients with adjuvant chemotherapy were not reached, and those without adjuvant chemotherapy were 27.7 and 33.4 months, respectively.CONCLUSIONS:The level of CTCs may be an effective prognostic factor to predict RFS in stage II CRC patients, and has potential in selecting stage II CRC patients for adjuvant chemotherapy.

Neoadjuvant chemoradiotherapy (nCRT)+ total mesorectal excision (TME) has become the standard mode of treatment for locally advanced rectal cancer(LARC). However, the sensitivity of different patients to nCRT varies greatly, some patients can get pathological complete response (pCR), and their long-term survival is significantly improved, Some patients'tumors continue to progress, therefore, accurate prediction of whether pCR can be achieved after nCRT is very important for guiding individualized treatment of patients. Current studies have shown that some accessible clinical factors, such as age, pathological types of tumors, TNM staging, circumferential extent of tumor, distance to the anal verge, CEA level, neutrophil lymphocyte ratio, can be used to predict whether pCR can be achieved.This article reviews the progress of clinical predictors of pCR in LARC after nCRT.

Background: It is urgent to develop robust prognostic biomarkers for non-metastatic colorectal cancer (CRC) patients undergoing surgery. The current study aimed to explore and compare the clinical significance of preoperative and postoperative blood tumor biomarkers including circulating tumor cells (CTCs), and develop prognostic models based on tumor biomarkers in patients with stage II-III CRC receiving surgery. Methods: A prospective study was performed to enroll 130 patients with stage II-III CRC receiving surgery between January 2015 and December 2017. Preoperative and postoperative blood tumor biomarkers including CTCs were detected and their prognostic value in predicting tumor recurrence-free survival (RFS) in stage II-III CRC were identified by Kaplan-Meier curves and Cox proportional hazard regression models. Results: CTCs counts within three postoperative days were significantly higher than preoperative CTCs (pre-CTCs). No significant association of pre-CTCs with clinical characteristics and tumor biomarkers was observed while positive postoperative CTCs (post-CTCs) were associated with female, older onset age, high TNM stage, tumor recurrence, and preoperative CEA. Kaplan-Meier curve with log-rank test and univariate Cox proportional hazard regression analysis suggested high N stage, TNM stage, positive pre-carbohydrate antigen (CA) 125, pre-CA19-9, post-CA125, post-CA19-9, post-CA72-4, post-carcinoembryonic antigen (CEA), and post-CTCs were correlated with poor RFS. In multivariate analysis, only TNM stage (adjusted HR=3.786, 95% CI=1.330-10.780; P=0.013), post-CA72-4 (adjusted HR=5.675, 95% CI=2.064-15.604; P=0.001), and post-CTCs (adjusted HR=2.739, 95% CI=1.042-7.200; P=0.041) were significantly correlated with poor RFS. We then developed prognostic models combining post-CTCs and post-CA72-4 with TNM stage or not to stratify the patients into different risk groups. These prognostic models exert a similar good performance in predicting tumor RFS in stage II-III CRC patients. Conclusions: Postoperative CTCs were prior to preoperative CTCs in predicting tumor recurrence survival in non-metastatic CRC patients undergoing surgery. We also developed CTCs-based prognostic models to predict tumor recurrence in stage II-III CRC, which might be used to identify the patients with high risk of recurrence and guide aggressive treatment to improve the clinical outcomes of those patients.

目的 探究50岁以下结直肠癌患者的临床特点,分析影响预后的因素,为临床医师提高对50岁以下结直肠癌的认识提供帮助.方法 回顾性分析2005年1月1日至2012年12月31日于首都医科大学附属北京友谊医院行手术治疗的50岁以下结直肠癌患者的临床资料,并采集其术后随访信息.Kaplan-Meier法绘制生存曲线;Log-rank检验行单因素分析,将单因素分析中有意义的因素纳入多因素COX回归分析,判断影响预后的独立因素.结果 在128例50岁以下的结直肠癌患者中,最常见的临床表现是便血、腹痛和排便习惯改变,黏液腺癌和印戒细胞癌的比例占25.8％,TNM分期Ⅲ期和Ⅳ期的比例占61.7％.多因素分析显示,根治性手术、癌结节与50岁以下结直肠癌患者的预后有关.结论 50岁以下结直肠癌患者的病理类型较差、TNM分期较晚,有癌结节的患者通常具有较差的预后,而根治性手术对提高50岁以下结直肠癌患者的预后有促进作用.

Characterization, diagnosis, and treatment of colorectal cancers (CRC) is difficult due to limited biopsy information, impracticality of repeated biopsies, and cancer biomarker fallibility. Circulating tumor DNA (ctDNA) has recently been investigated as a non-invasive way to gain representative gene mutations in tumors, in addition to monitoring disease progression and response to treatment. We analyzed ctDNA mutations and concentrations in 47 early- and late-stage CRC patients using a targetted sequencing approach using a panel that covers 50 cancer-related genes. ctDNA mutations in 37 genes were identified in 93.6% of the patients (n=47). The results showed that TP53, PIK3CA, APC, and EGFR were the most frequently mutated genes. Stage IV patients had significantly higher ctDNA concentration than Stage I patients, and increased ctDNA concentration correlated with increased tumor size. Additionally, ctDNA detection was found to be a greater predictor of disease when compared with five known commonly used tumor biomarkers. The present study supports the use of ctDNA as a liquid biopsy to gain clinical tumor information that may facilitate early diagnosis and treatment and improve CRC patient prognosis.

Objective To study the diagnosis, clinicopathological features, treatment, and prognosis of synchronous colorectal cancer (SCRC). Methods The clinical data and pathological features of the patients with SCRC admitted to Beijing Friendship Hospital, Capital Medical University from January 2008 to December 2016 were retrospectively analyzed. Results According to the inclusion criteria, 35 cases with SCRC were enrolled. Of which, Thirty-four cases were double primary carcinoma and one was triple primary carcinoma.34 cases were first diagnosed and one was second diagnosed on three months after surgery. The detection rate of barium enema examination and colonoscopy was 60.9％ and 70％, respectively while combination of colonoscopy and multiple imaging techniques increased the rate to 91.4％. Pathological analysis of the 71 tumor lesions suggested that adenocarcinoma accounted for 70.4％ (50/71) and low/middle differentiated adenocarcinoma accounted for 54.9％ (39/71). Thirty-two cases were treated with surgery, of which, 5 cases were treated with standard radical resection, 10 cases with extensive radical resection, 10 cases with regional radical resection, and 7 cases with total/subtotal colectomy. The postoperative 5 year survival rate was 59.4％ and recurrence rate was 28.1％. Conclusion SCRC was mostly double primary carcinoma with adenocarcinoma as the dominative pathological type. Combining the results of multiple imaging examinations and colonoscopy may increase the detection rate of SCRC. Choosing appropriate surgical methods according to the specific situations of SCRC may improve the therapeutic efficacy of the patients.

Colorectal carcinoma is currently the third most frequent cancer worldwide. Conventional open surgery was replaced by laparoscopic anterior resection with total mesorectal excision for the treatment of sigmoid and rectal carcinomas; however, it needed an incision to harvest the specimen, which contributed to complications. In 2013, trans-anal natural orifice specimen extraction laparoscopic anterior resection (Ta-NOSE-LAR) to treat sigmoid and rectal carcinoma was performed in our hospital for the first time. The aim of this study was to investigate the outcomes of Ta-NOSE-LAR in sigmoid and rectal carcinoma. Seventy-three patients diagnosed with sigmoid and rectal carcinoma were enrolled between September 2013 and June 2016. Thirty-five patients underwent Ta-NOSE-LAR, whereas the others underwent traditional laparoscopic anterior resection (LAR). We compared the operative data, postoperative complications, pathological evaluation results, and incision-related complications between the 2 groups. Our result showed that the operative time, specimen length, tumor size, amount of total lymph nodes, and lymph node metastasis between the 2 groups were not statistically different. Further, without abdominal scaring for harvesting the specimen, the operative blood loss (49.29 +/- 14.63 vs 69.29 +/- 13.54 mL, P<.001) and post-operation hospital stay (5.77 +/- 0.94 vs 6.76 +/- 0.75 days, P<.001) of the Ta-NOSE-LAR group were less than those of the LAR group. Besides, the follow-up data showed that 2 patients were lost to follow-up, and 1 patient had liver metastasis 2 years after surgery in the LAR group, whereas the others showed no regional recurrence, distant metastases, or critical complications. Ta-NOSE-LAR is a valuable and alternative surgical method to treat sigmoid and rectal carcinoma, with the advantages of being a scarless procedure and having a lower post-operation hospital stay duration.

Objective To evaluate the curative effect of trans-anal surgery vs.conventional laparoscopic surgery in treating sigmoid and high-rectum tumor.Methods From Jan 2014 to Mar 2017,100 patients in Beijing Friendship Hospital participated in this clinical study.45 patients underwent transanal surgery and 55 patients underwent conventional laparoscopic surgery.Results No significant difference was found between trans-anal surgery group and the traditional laparoscopic group in terms of operation time,blood loss,the use of analgesic drugs and the radical evaluation of tumor.While the postoperative pain scores in trans-anal surgery group (2.0 ± 1.0 vs.2.6 ± 1.0,t =2.9,P =0.005) were lower than those in the conventional group.The follow-up data showed one case of local tumor recurrence and one case of multiple peritoneal metastasis in the trans-anal surgery group,compared to two cases of liver metastasis and one case dying of pneumonia in the conventional laparoscopic group.The remaining cases were of no local recurrence,nor distant metastases or any critical complications.Conclusions Trans-anal surgery in the treatment of sigmoid and high-rectum tumor is safe,reliable and having the same clinical efficacy with conventional laparoscopic surgery.

OBJECTIVE:To assess the incidence and independent risk factors for clinical anastomotic leakage (AL) in patients undergoing anterior resection(AR) or low anterior resection, (LAR) for rectal cancer.METHODS:This was a retrospective case-control study of 550 patients with rectal cancer who underwent AR or LAR from April 2007 to March 2017 in Beijing Friendship Hospital, Capital Medical University. The relationship between the incidence of AL and clinicopathological manifestations was analyzed by Chi-squared test and Fisher exact test, and the independent risk factors of AL were analyzed using logistic regression analysis. AL is defined as a defect (including necrosis or abscess formation) of the intestinal wall at the anastomotic site, leading to a communication between the intra- and extra-luminal compartments. AL can be divided into three grades. Grade A anastomotic leakage results in no change in the management of patients, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy.RESULTS:AL was noted in 32(5.8%) of 550 patients with rectal cancer who underwent AR or LAR, including 15(46.9%), 4(12.5%), and 13 patients (40.6%) with Grades A, B, and C, respectively. Five patients(0.9%, 5/550) died peri-operatively. AL- and non-AL-related deaths occurred in 3 (9.4%, 3/32, all cases were Grade C) and 2 patients(0.4%, 2/518), respectively, with the two mortality rates being significant difference(P=0.002). Chi-squared test or Fisher exact test showed that the incidence of AL was associated with neoadjuvant chemoradiotherapy (P=0.011), intraoperative bleeding(≥100 ml)(χ2=11.980, P=0.001), and tension-reducing suture of anastomosis(P=0.015). The results of logistic regression analysis showed that the independent risk factors of AL were neoadjuvant chemoradiotherapy(OR=2.402, 95%CI: 1.004-5.749, P=0.049), intraoperative bleeding(≥100 ml)(OR=2.971, 95%CI: 1.269-6.957, P=0.012) and tension-reducing suture of anastomosis(OR=2.304, 95%CI: 1.008-5.263, P=0.048).CONCLUSION:The incidence of AL in patients undergoing AR for rectal cancer is 5.8%. The high-risk factors for AL are neoadjuvant chemoradiotherapy, intraoperative bleeding (≥100 ml), and tension-reducing suture of anastomosis. Patients with these three risk factors have a high risk of AL rate, and a defunctioning stoma should be performed.

Objective To explore the clinicopathological features and prognosis of the obstructive colorectal cancer (CRC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 667 CRC patients who were admitted to the Beijing Friendship Hospital Affiliated to Capital Medical University between January 2013 and December 2015 were collected.The diagnosis and treatment of CRC patients were based on colon cancer and rectal cancer clinical practice guidelines in oncology(Version 2013) of the National Comprehensive Cancer Network (NCCN) and the 7th edition of the American Joint Committee on Cancer (AJCC) cancer staging manual and the future of TNM.CRC and clinical staging were confirmed by colonoscopy,biopsy pathology and CT or MRI examination.Patients selected laparoscopic surgery or open surgery according to their conditions,and then selectively underwent postoperative adjuvant therapy based on the results of pathological examination.Observation indicators:(1) diagnosis and treatment;(2) clinicopathological features;(3) prognosis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall and tumor-free survivals up to April,2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Count data were described as case and percentage,comparisons between groups were evaluated with the chi-square test.Ordinal data were analyzed using the nonparametric test.Results (1) Diagnosis and treatment:tumor locations of 677 patients:tumors located in the right hemicolon,left hemicolon and rectum were respectively detected in 213,312 and 142 patients.Preoperative clinical staging:3,47,300,298 and 19 patients were respectively detected in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ.Ninety-nine patients were complicated with intestinal obstruction,with an obstructive rate of 14.84％ (99/667),and 568 patients didn't have intestinal obstruction.Treatments of 667 patients:① Preoperative adjuvant treatment:17 non-obstructive CRC patients underwent preoperative adjuvant treatments and 650 didn't undergo preoperative adjuvant treatment.② Surgical treatment:389 and 278 patients underwent respectively open and laparoscopic surgeries,and 588 received radical resection and 79 received non-radical resection.(2) Clinicopathological features:of 99 obstructive CRC patients,tumors located in the right hemicolon,left hemicolon and rectum were respectively detected in 26,61 and 12 patients.Eighteen and 81 patients underwent respectively laparoscopic and open surgeries,including 21 with low-differentiated tumors,61 with moderate-differentiated tumors and 17 with high-differentiated tumors;71 patients received radical resection,with a number of lymph node dissected of 12±9,and 37,20 and 14 were respectively detected in stage N0,N1 and N2.Of 568 non-obstructive CRC patients,tumors located in the right hemicolon,left hemicolon and rectum were respectively detected in 187,251 and 130 patients.Two hundred and sixty and 308 patients underwent respectively laparoscopic and open surgeries,including 38 with low-differentiated tumors,420 with moderate-differentiated tumors and 110 with high-differentiated tumors;517 patients received radical resection,with a number of lymph node dissected of 15±8,and 338,155 and 24 were respectively detected in stage N0,N1 and N2.There were statistically significant differences in above indicators between obstructive CRC and non-obstructive CRC patients(x2=11.234,46.505,30.088,Z=-2.782,t=2.942,Z=-2.892,P＜0.05).(3) Prognosis:of 667 patients,584 were followed up for 18-52 months,with a median time of 36 months,including 88 with obstructive CRC (1,5,23,28 and 31patients were respectively in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ) and 469 with non-obstructive CRC (5,62,212,116 and 101 patients were respectively in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ).During the follow-up,56 obstructive CRC patients survived,including 1 in stage 0,4 in stage Ⅰ,15 in stage Ⅱ,17 in stage Ⅲ and 19 in stage Ⅳ,with an overall survival rate of 63.64％ (56/88),and overall survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 1/1,4/5,65.22％(15/23),60.71％(17/28) and 61.29％ (19/31);38 had tumor-free survival,including 1 in stage 0,4 in stage Ⅰ,15 in stage Ⅱ,13 in stage Ⅲ and 5 in stage Ⅳ,with a tumor-free survival rate of 43.18％(38/88),and tumor-free survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 1/1,4/5,65.22％ (15/23),46.43％ (13/28),16.13％ (5/31).Four hundred and forty-three non-obstructive CRC patients survived,including 5 in stage 0,58 in stage Ⅰ,181 in stage Ⅱ,106 in stage Ⅲ and 93 in stage Ⅳ,with an overall survival rate of 89.31％(443/496),and overall survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 5/5,93.55％ (58/62),85.38％ (181/212),91.38％ (106/116) and 92.08％ (93/101);384patients had tumor-free survival,including 5 in stage 0,52 in stage Ⅰ,166 in stage Ⅱ,94 in stage Ⅲ and 67 in stage Ⅳ,with a tumor-free survival rate of 77.42％ (384/496),and tumor-free survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 5/5,83.87％ (52/62),78.30％ (166/212),81.03％ (94/116) and 66.34％ (67/101).There were statistically significant differences in overall survival rate and tumor-free survival rate between obstructive CRC and non-obstructive CRC patients (x2 =39.626,43.707,P＜ 0.05).The subgroup analysis:there were statistically significant differences in stage Ⅱ,Ⅲ and Ⅳ overall survival rates between obstructive CRC and non-obstructive CRC patients (x2 =6.092,17.027,11.268,P＜0.05) and in stage Ⅲ and Ⅳ tumor-free survival rates (x2 =14.148,24.116,P＜ 0.05).Conclusion The obstructive CRC commonly locates in the left hemicolon,with complex clinicopathological features and low-differentiated tumors,meanwhile,there are lower radical rate and poor prognosis.

结直肠癌是最常见的恶性肿瘤之一,其发病率和病死率均居恶性肿瘤前五位.近年来,越来越多的报道指出结直肠癌发病呈现年轻化趋势,且这部分患者的分期更晚、预后更差,然而目前对年轻结人直肠癌的定义、危险因素、临床特点、治疗方式及预后认识仍不足.现笔者结合国内外最新研究就上述几个方面作一综述,以供临床参考.

Background. Recent literature has stressed the prominent role of antibodies in graft loss. This study was designed to assess a growing perception that T cell-mediated rejection (TCMR) is no longer clinically relevant. Methods. Five hundred forty-five renal allograft recipients over a 3-year period were screened for biopsies with: (a) TCMR including borderline change (BL), (b) negative complement protein C4 degradation fragment, and (c) absence of donor-specific antibody at time of transplant, within 30 days of the biopsy, and up to 4 measurements at later time points. Results. These stringent requirements identified 28 "pure" cases of late TCMR/BL. Low-grade glomerulitis, peritubular capillaritis, or chronic transplant glomerulopathy were found in 9/28 (32%) biopsies. Serum creatinine showed complete short-term remission in 7/10 (70%) BL and 9/18 (50%) TCMR patients 1 month postbiopsy. Yet, both treated and untreated patients demonstrated further decline in graft function as assessed by serum creatinine and estimated glomerular filtration rate. Conclusions. Late TCMR seen in 7.9% of biopsies can contribute to significant deterioration of graft function in patients in whom the dominant contribution of antibody-mediated injury has been reasonably excluded. Our data also reinforce existing literature showing that microvascular lesions do not have absolute specificity for a diagnosis of antibody-mediated rejection.

BACKGROUND/AIMS:More and more reports have shown that the dysregulation of miRNAs can contribute to the progression and metastasis of human cancers. Many studies have shown that the down-regulation of the miR-495 level occurs in a variety of cancers, including colorectal cancer (CRC). However, the precise molecular mechanisms of miR-495 in CRC have not been well clarified. In the current study, we investigated the biological functions and molecular mechanisms of miR-495 in CRC cell lines.METHODS:qRT-PCR was used to determine the level of miR-495 in CRC cell lines and tissues. A miR-495 mimic and inhibitor were transfected into CRC cells, and the effects of miR-495 on the invasion and EMT were explored by qRT-PCR as well as transwell and Western blot assays. Meanwhile, luciferase assays were performed to validate Annexin A3 as a miR-495 target in CRC cells.RESULTS:In our study, we found that miR-495 is down-regulated in CRC tissues and cell lines. Moreover, the low level of miR-495 was associated with increased expression of Annexin A3 in CRC tissues and cell lines. The invasion and EMT of CRC cells were suppressed by the overexpression of miR-495. However, the down-regulation of miR-495 promoted the invasion and EMT of CRC cells. Bioinformatics analysis predicted that Annexin A3 was a potential target gene of miR-495. Next, the luciferase reporter assay confirmed that miR-495 could directly target Annexin A3. Consistent with the effect of miR-495, the down-regulation of Annexin A3 by siRNA inhibited the invasion and EMT of CRC cells through the up-regulation of p53. The introduction of Annexin A3 in CRC cells partially blocked the effects of the miR-495 mimic.CONCLUSION:The introduction of miR-495 directly targeted Annexin A3 to inhibit the invasion and EMT of CRC cells by up-regulating p53, and the down-regulation of Annexin A3 was essential for inhibiting the invasion and EMT of CRC cells by overexpressing miR-495. Overall, the re-activation of the miR-495/Annexin A3/ p53 axis may represent a new strategy for overcoming metastasis of CRC.

Objective: To compare the surgical and pathological outcomes of complete mesocolic excision (CME) with conventional surgery in colon cancers. Methods: 125 patients with right colon cancer received surgical treatment were enrolled in the retrospective study, of whom, 59 underwent CME surgery (CME group) and 66 underwent conventional radical surgery (control group). Surgical specimens of the CME group were then prepared as pathological large format with the complete mesocolon. Hematoxylin-eosin staining and subsequent pathological analyses were conducted. Results: The number of dissected lymph node was larger in the CME group than that in the control group (29.7 +/- 6.1 vs. 19.3 +/- 5.3, P < 0.05). Similar results were observed in subgroups of stage I, II, and III colon cancers (25.2 +/- 5.7 vs. 13.2 +/- 5.6, 31.3 +/- 7.7 vs. 19.6 +/- 6.2, 30.3 +/- 8.4 vs. 25.2 +/- 7.2, respectively; P < 0.05). And also, larger mesocolon area, longer distance from vascular high ligation point to intestinal wall, and longer distance from vascular high ligation point to tumor center were observed in CME group (P < 0.05). The pathological large format could be used to identify mesenteric lymphatic metastasis (59.32%) and observe the dynamics of continuous and skip metastases of colon cancer along with the lymphatic vessels in a single slice. Conclusions: CME is appropriate in colon cancer surgery and it reveals the status of lymph node metastasis more precisely. The pathological large format is potential for illustrating the biological behavior of colon cancer. This technique is worth considering as a quality control standard for colon cancer surgery.

BACKGROUND The Ki67 index is a biomarker of proliferation, while the circulating tumor cell (CTC) count acts as a metastasis-related biomarker. In this study, we analyzed the potential value of CTC count and Ki67 index in diagnosis of colorectal cancer (CRC). MATERIALS AND METHODS A total of 105 patients with CRC undergoing surgery were included in the study. Isolation and identification of CTCs were performed by negative enrichment and immuno-fluorescence in situ hybridization, respectively. Expression of Ki67 was assessed by immunohistochemistry. RESULTS Patients with CTC count ≥2 were defined as CTC-positive. Ki67 index ≥50% was regarded as highly proliferative. Overall, 71 cases were CTC-positive, while 82 cases displayed a high Ki67 index. CTC count and Ki67 index had no correlation with tumor size, tumor site, age, gender and TNM stages of the patients. CTC count was correlated with tumor size (p=0.018) and Ki67 index with level of differentiation (p<0.001). However, there was no relationship between CTC count and Ki67 index (p=0.198). CONCLUSION Our results suggest that CTCs can act as a potent metastasis-related biomarker for the diagnosis of CRC, independently of the Ki67 index.