Background ：Anastomotic leakage (AL) limits the outcome after laparoscopic anterior resection (LAR) for middle-low rectal cancer. The study investigated the efficacy of laparoscopic anastomosis enhancing suture (LAES), preventive ileostomy and transanal drainage tube placement in reducing anastomotic leakage after LAR for middle-low rectal cancer. Methods： From April 2016 to April 2019, a prospective cohort study was performed on consecutive patients who underwent LAR for middle-low rectal cancer in Changzheng hospital. The patients were divided into group A, B, C and D in which LAES, transanal drainage tube placement, protective ileostomy, and no preventive treatment were applied, respectively. Clinical characteristics, operative variables and postoperative complication were compared between the groups. Results ：Among 320 patients, 24 (7.5%) developed AL and incidence rate of AL was 1.3%, 12.5%, 1.3% and 15.0% in the four groups, respectively. Left colic artery preservation and neoadjuvant chemotherapy were found not associated with the incidence of AL. A total of 0, 2, 2 and 5 patients had anastomotic bleeding in the four groups, respectively. No patient underwent reoperation in group A and group C, while 5.0% (4/80) of the patients had reoperation in group B and group D due to grade C AL with severe symptoms. Conclusions： Compared with preventive ileostomy, LAES was effective in preventing AL after LAR for middle-low rectal cancer and relieving the complications of AL. The transanal drainage tube placement did not reduce the risk of AL. The study was retrospectively registered with the Chinese Clinical Trial Registry on 28 th June 2016 (code: ChiCTR-IOR-17011777).

Robotic-assisted transanal total mesorectal excision (R-TaTME) has unique advantage in low rectal cancer. Single incision plus oneport (SIPOP) laparoscopic operation can synchronously cooperate with robotic-assisted transanal operation, in order to the difficulty of operation, improve the quality of operation and shorten the time of operation. A retrospective analysis was conducted on the clinical and pathological data of one patient who underwent SIPOP synchronously combined with R-TaTME + sigmoid-anal anastomosis + ileostomy at the Department of General Surgery, Army Characteristic Medical Center on September 11, 2019. This 71-year-old patient was male with body mass index of 24.08 kg/m(2) and received preoperative chemotherapy. Rectal adenocarcinoma was confirmed by colonoscopy biopsy, and distance from tumor lower edge to anal verge was 3 cm. MRI indicated T2N1 stage. The operation was completed successfully, and the transabdominal and robotic transanal surgery totaled 117 minutes, with 15 minutes for the robotic transanal preparation step. There was about 20 ml of intraoperative blood loss and no blood transfusion was performed. The patient was discharged 6 days after operation. No intraoperative or postoperative complications occurred. The postoperative TNM staging was stage I (pyT2N0cM0). No recurrence or metastasis was found at postoperative 7 month. It is a safe, effective and feasible technique for patients with low rectal cancer.

Formyl peptide receptor 1 (FPR1) belongs to G protein-coupled receptors expressed mainly in phagocytic leukocytes. The gene encoding FPR1 is highly polymorphic and related to inflammation. In this study, we investigated the single nucleotide polymorphisms (SNPs) of Fpr1 in human colorectal cancer (CRC), and analyzed the association of Fpr1 SNPs with clinicopathological parameters and some specific diagnostic markers of CRC. Although the allele and genotype frequencies of Fpr1 SNPs in CRC tissues were not significantly different from that in whole blood cells derived from healthy Chinese subjects. Significant associations were observed between genotypes of c.289C>A and distant metastasis (P=0.001), and between genotypes of c.306T>C and tumor size (P=0.016). Genotypes of c.546C>A was closer to tumor size and lymphatic invasion (P=0.012 and P=0.043, respectively). Meanwhile, genotypes of c.1037C>A was related with tumor location and differentiation (P=0.000 and P=0.005, respectively). Besides, genotypes of c.576T>C>G was related with pathological type (P=0.000). Furthermore, several Fpr1 SNP positions including c.289 (C>A) and c.576 (G>C>T) were related to the expression of P53 (P=0.004 and P=0.008, respectively), and similar results were observed between other Fpr1 SNP positions and CEA, HER2 and Ki-67 (P<0.05). Our data demonstrate that Fpr1 SNPs may play the important role in the progression and metastasis of CRC.

Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual disease (MRD) and for monitoring treatment of patients with colorectal cancers (CRC). Any technology used for this purpose, however, will face extreme performance demands. In order to build a high-performance multiplex next-generation sequencing (NGS) platform suitable for cancer MRD using ctDNA, we developed Accu-Act TM , an NGS-based assay capable of detecting low-frequency variants in plasma ctDNA with high precision. In our protocol, rolling-circle amplification is used to circularize denatured double-stranded cell-free DNA (cfDNA) and convert it into long tandem repeats, thus enabling consensus-based concatemer error correction. We demonstrated Accu-Act TM ’s sensitivity and specificity by testing it on cfDNA samples with known variant frequencies and cfDNA collected from healthy individuals (n = 100). Our results showed that the sensitivity of Accu-Act was 0.1% with an error rate of 1 in 1 million for 20ng of input cfDNA. Concordance analysis was performed using Accu-Act, a 61-gene assay, on 152 tumor/plasma pairings of preoperative samples derived from patients with CRC (stage I-IV). Depending on stage, we report 66-92% patient detection rate. Post-surgery ctDNA profiling was performed on 52 patients (stage I-IV) enrolled in our prospective MRD study. The results showed that 26% of patients had detectable postoperative ctDNA, among whom 72% had disease progression within two years. Only one out of the 41 patients without detectable postoperative ctDNA went on to relapse, and one patient died of a lung infection. Our study showed that ctDNA is a promising prognostic biomarker for CRC relapse after R0 resection (HR (95%CI) 33.00 (4.05 - 270), P TM NGS-based ctDNA assay has high accuracy and is suitable for MRD in CRC patients. Accu-Act TM should make a significant contribution in the development of personalized cancer treatment. Citation Format: Xinxing Li, Grace Zhao, Xianwen Zhang, Yanping Sun, Yi Wang, Canping Ruan, Paul Tang, Malek Faham, Shengrong Lin, Kang Ying, Zhiqian Hu. CRC MRD detection using Accu-Act TM NGS technology [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A035.

Abstract Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual disease (MRD) and for monitoring treatment of patients with colorectal cancers (CRC). Any technology used for this purpose, however, will face extreme performance demands. In order to build a high-performance multiplex next-generation sequencing (NGS) platform suitable for cancer MRD using ctDNA, we developed Accu-ActTM, an NGS-based assay capable of detecting low-frequency variants in plasma ctDNA with high precision. In our protocol, rolling-circle amplification is used to circularize denatured double-stranded cell-free DNA (cfDNA) and convert it into long tandem repeats, thus enabling consensus-based concatemer error correction. We demonstrated Accu-ActTM’s sensitivity and specificity by testing it on cfDNA samples with known variant frequencies and cfDNA collected from healthy individuals (n = 100). Our results showed that the sensitivity of Accu-Act was 0.1% with an error rate of 1 in 1 million for 20ng of input cfDNA. Concordance analysis was performed using Accu-Act, a 61-gene assay, on 152 tumor/plasma pairings of preoperative samples derived from patients with CRC (stage I-IV). Depending on stage, we report 66-92% patient detection rate. Post-surgery ctDNA profiling was performed on 52 patients (stage I-IV) enrolled in our prospective MRD study. The results showed that 26% of patients had detectable postoperative ctDNA, among whom 72% had disease progression within two years. Only one out of the 41 patients without detectable postoperative ctDNA went on to relapse, and one patient died of a lung infection. Our study showed that ctDNA is a promising prognostic biomarker for CRC relapse after R0 resection (HR (95%CI) 33.00 (4.05 - 270), P<0.001). The Accu-ActTM NGS-based ctDNA assay has high accuracy and is suitable for MRD in CRC patients. Accu-ActTM should make a significant contribution in the development of personalized cancer treatment. Citation Format: Xinxing Li, Grace Zhao, Xianwen Zhang, Yanping Sun, Yi Wang, Canping Ruan, Paul Tang, Malek Faham, Shengrong Lin, Kang Ying, Zhiqian Hu. CRC MRD detection using Accu-ActTM NGS technology [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A035.

Objective:To construct recombinant adenovirus vector Ad5-CCL20,and detect the expression of CCL20 after Ad5-CCL20 transfected colon cancer cells CT-26.Methods:Genes encoding CCL20 was obtained from original plasmid double-digested with EcoR I/Sal I enzymes.The CCL20 DNA segments were linked into pDC316 to recombine shuttle plasmid pDC316-CCL20.After genome sequencing,we take shuttle plasmid pDC316-CCL20 and plasmid backbone pBHGIox_E1,3Cre co-transfecting 293T cells in mediation of liposome.The constructed recombinant adenovirus vector was named Ad5-CCL20.Lastly,after Ad5-CCL20 transfected CT-26 cells in vitro,the expression of CCL20 at different time points (12h,24h,36h and48h)was detected by Western blot and Elisa.Then,Culture supernatant was added into iDC and mDC to evaluate the chemotactic activity of CCL20.Results:The recombinant adenovirus Ad5-CCL20 were successfully constructed.The expression of CCL20 was detected by Western blot and Elisa.The level of CCL20 expression was increased with prolonged incubation of the infected CT-26 cells.Chemotaxis experiments show that the chemokine CCL20 had chemotactic activity to the iDC and mDC,but more obviouly for iDC (P＜0.05).Conclusion:The construction and obtain of recombinant adenovirus vector Ad5-CCL20 provide a new method for developing tumor immunotherapy.

Marital status has been found to be a prognostic factor for survival in various cancers, but its role in gallbladder cancer (GBC) has not been fully studied. In this study, we used the Surveillance, Epidemiology, and End Results Program (SEER)-registered database to analyze the survival of GBC patients with different marital status. A total of 6,627 GBC patients were selected from SEER database from 2004 to 2013. The age, race, grade, histologic type, AJCC stage, SEER stage and marital status were identified as independent prognostic factors. Married GBC patients had a higher 5-year cancer-specific survival (CSS) than that of unmarried ones (20.1% v.s. 17.8%, P < 0.05). Subgroup analyses showed that widowed patients had 14.0% less of 5-year CSS compared to married ones of stage I (55.9% v.s. 41.9%, P < 0.05), 14.7% of stage II (15.6% v.s. 10.9%, P < 0.05), and 1.5% of stage III + IV (2.9% v.s. 1.4%, P < 0.05). In addition, single is an independent prognostic factor at stage III + IV (HR = 1.225, 95%CI 1.054–1.423, P = 0.008). These results indicated that widowed patients were at a high risk of cancer-specific mortality and marriage can be a protective prognostic factor in CSS.

Trastuzumab resistance is a common problem that impedes the effectiveness of trastuzumab in ErbB2-amplified cancers. About 70% of ErbB2-amplified breast cancers do not respond to trastuzumab (de novo resistance), and the majority of the trastuzumab-responsive cancers progress within 1 year (acquired resistance). Different mechanisms exist between de novo and acquired resistance. Innate resistance mechanisms are mainly independent of ErbB2 receptor activity, and acquired resistance involves with alterations depending on ErbB2 activity. We previously reported H2-18, an ErbB2 domain I-specific antibody, which could circumvent de novo resistance to trastuzumab. Here, we modeled the development of acquired resistance by treating human gastric cancer cell line NCI-N87 with trastuzumab to obtain the trastuzumab-resistant subline, NCIN87-TraRT. Next, we investigated the antitumor efficacy of H2-18 in NCI-N87-TraRT cell line. H2-18 exhibited a significantly greater antitumor activity in NCI-N87-TraRT tumor-bearing nude mice than pertuzumab and trastuzumab, either alone or in combination. The unique ability of H2-18 to overcome acquired resistance may be attributable to its potent programmed cell death-inducing activity, which was probably mediated by RIP1-ROS-JNK-c-Jun pathway. In conclusion, H2-18 may have the potential as an effective agent to circumvent acquired resistance to trastuzumab in ErbB2-overexpressing cancers.

Formyl peptide receptors (FPRs) are G protein-coupled chemoattractant receptors expressed mainly in phagocytic leukocytes. High expression of FPRs has also been detected in several cancers but the functions of FPR1 in tumor invasion and metastasis is poorly understood. In this study, we investigated the expression of FPRs in primary human colorectal cancer (CRC) and analyzed the association of FPRs expression with clinicopathological parameters. The levels of FPRs mRNA, especially those of FPR1, were significantly higher in colorectal tumors than in distant normal tissues and adjacent non-tumor tissues. FPR1 mRNA expression was also associated with tumor serosal infiltration. FPR1 protein expression was both in the colorectal epitheliums and tumor infiltrating neutrophils/macrophages. Furthermore, the functions of FPR1 in tumor invasion and tissue repair were investigated using the CRC cell lines SW480 and HT29. Higher cell surface expression of FPR1 is associated with significantly increased migration in SW480 cells compared with HT29 cells that have less FPR1 membrane expression. Finally, genetic deletion of fpr1 increased the survival rate of the resulting knockout mice compared with wild type littermates in a mouse model of colitis-associated colorectal cancer. Our data demonstrate that FPR1 may play an important role in tumor cell invasion in CRC patients.

The age-specific impact on the survival of gastric cancer patients with distant metastasis is still unclear. In this study, we identified 11, 299 gastric cancer patients with distant metastasis between 2004 and 2013 from Surveillance, Epidemiology, and End Results population-based dataset. Patients were divided into young (≤60) and elderly groups (>60). Kaplan-Meier methods and multivariable Cox regression were used for the analysis of long-term survival outcomes and risk factors. There were significant differences between the two groups in terms of race, primary site, grade, histologic type, surgery, marital status and clinical T stage (P<0.05). The 1- and 3-year cancer specific survival rates were 29.0% and 6.2% in young group and 22.8% and 4.8% in elderly group in both univariate (X2=116.430, P<0.001) and multivariate analysis (P<0.001). Young patients had significantly better 1- and 3-year cancer specific survival than elderly patients in each T stage. Age was further validated as an independent survival factor in all T stages (T1, T2, T3, T4 and TX, P<0.05). In conclusion, age was an independent prognostic factor for gastric cancer patients with distant metastasis.

e23028 Background: Circulating tumor DNA (ctDNA) holds great potential as a biomarker for cancer management. Unfortunately, with a half-life of < 2hrs, ctDNA is present in miniscule quantities and can go undetected in peripheral blood. We hypothesized that blood collected from the portal vein may yield higher quantities of ctDNA than that collected elsewhere for colorectal cancers (CRC) due to the passage of blood from gastrointestinal organs through the portal vein prior to circulation. Methods: 10mL of peripheral blood was collected from 12 CRC patients prior to or during tumor removal surgery during which an additional 10 mL of blood drawn from the portal vein. ctDNA fragment length and concentration was measured for every pair of the resulting ctDNA, along with tissue gDNA, was sequenced using Accu-Act, a NGS panel of 61 genes which have implication of cancer treatments. Concordance of ctDNA mutation profiles from both collection sites and tumor were compared. Results: ctDNA was detected in all 12 sample pairs and a comparison of ctDNA from both collection sites revealed similar fragment lengths and concentration (12.26ng/ml, and peripheral vein: 10.83ng/ml). Little difference in concordance (compared to tumor) was observe. Though the average minor allele frequency of somatic mutations from portal venous ctDNA was slightly higher than that of peripheral venous ctDNA, the difference is not substantial. A mumber of mutaions with low allele frequcy (down to 0.1%, 2 copies), were detected in both sites, and from two independent DNA extractions from each sites. Conclusions: We have demonstrated the feasibility of obtaining portal venous ctDNA and reported no substantial difference between portal venous and peripheral venous ctDNA. Even the sensitivity and reporducbility of our Nebula-Firefly are very high, this analysis is still susceptible to sampling errors associated with the low copy number of mutated ctDNA in circulation and larger studies may provide more conclusive results.

目的:探讨重组腺病毒Ad5-CCL20联合热疗对结肠癌CT-26细胞小鼠移植瘤的抑制作用.方法:将Ad5-CCL20转染CT-26细胞,采用ELSA法和趋化实验分别检测CT-26细胞中CCL20的表达及其对DC的趋化作用.Western blot-ting检测热激结肠癌CT-26细胞中HSP70、GP96的表达.用热激后细胞蛋白(Heat组)对DC进行诱导,并设对照组(Control组)和阴性对照组(Unheat组),流式细胞术检测DC的表型.建立CT-26细胞移植瘤模型,设Ad5-CCL20/Heat、Heat、Ad5-CCIL20、Ad5-GFP和Control组,观察各组荷瘤小鼠肿瘤生长和生存时间;采用ELISAPOT法和LDH法分别检测脾组织T淋巴细胞分泌IFN-y的能力和对CT-26细胞的CTL杀伤活性,免疫组化法检测肿瘤组织DC浸润情况.结果:Ad5-CCL20转染CT-26细胞后可高表达CCL20,且对iDC、mDC都具有趋化活性,对iDC更为明显(P＜0.05).CT-26细胞热激后可高表达诱导型HSPT0和GP96.与Control、Unheat组相比,Heat组细胞蛋白诱导后DC的CD80、CD86、CCR6和MHC-Ⅱ的表达率明显升高(均P＜0.01).与Control、Ad5-GFP、Ad5-CCL20组和Heat组相比,联合治疗组荷瘤小鼠的肿瘤抑制最为明显(均P＜0.01),生存时间明显延长(均P ＜0.05).联合治疗后的荷瘤小鼠脾组织T淋巴细胞的CTL活性要明显高于另外四组(均P＜0.05),其瘤组织中CD11c+ DC的阳性率也明显增高(均P＜0.05).结论:重组腺病毒Ad5-CCL20联合热疗可召募并促进DC成熟和抗原提呈,明显抑制肿瘤生长,并延长荷瘤小鼠的生存期,提示其对结肠癌有潜在的治疗作用.

Background. Plasminogen activator inhibitor-I (PAI-1) is reported to be expressed in many cancer cell types and regarded as one of the most informative biochemical markers for poor prognosis. However, no previous study has evaluated whether PAI-1 could serve as a target in antitumor and antimetastasis therapies of colorectal cancer (CRC).Methods. The plasma level of PAI-1 in CRC patients was detected and its correlation with the clinicopathologic features was evaluated. PAI-1 protein expression was assessed by Western blot assay and immunohistochemistry: The biologic consequences of PAI-1 silencing in colon cancer cell lines and CRC bearing nude mice were also investigated.Results. Plasma PAI-1 level was higher in CRC patients with liver metastasis and correlated with liver metastasis, tumor size, differentiation, serosa infiltration, Duke's stage, and lymphatic metastasis. PAI-1 protein expression in the CRC tissue of patients with liver metastasis was significantly greater than that in those without liver metastasis. In addition, the abilities of proliferation, invasion, and migration of CRC cells transfected with lentivirus expressing PAI-1 small interfering RNA were reduced significantly. Nude mice inoculated with PAI-1 knockdown cells also had fewer metastatic nodules in the liver and smaller tumor volumes.Conclusion. Plasma PAI-1 level was increased in CRC patients with liver metastasis, and PAI-1 silencing may significantly compromise the malignant behaviors of CRC cells in vitro and in vivo. These findings may provide evidence for PAI-1 targeted therapy of CRC.

Background: The use of somatostatin analogues (SAs) following pancreaticoduodenectomy (PD) is controversial. Method: Literature databases were searched systematically for relevant articles. A meta-analysis of all randomized controlled trials (RCTs) evaluating prophylactic SAs in PD was performed. Results: Fifteen RCTs involving 1,352 patients were included. There was a towards reduced incidences of pancreatic fistulas (p = 0.26), clinically significant pancreatic fistulas (p = 0.08), and bleeding (p = 0.05) in prophylactic SAs group. In subgroup analyses, prophylactic somatostatin significantly reduced the incidence of pancreatic fistulas (p = 0.02), with a nonsignificant trend toward reduced incidence of clinically significantly pancreatic fistulas (p = 0.06). Pasireotide significantly reduced the incidence of clinically significantly pancreatic fistulas (p = 0.03). Octreotide had no influence on the incidence of pancreatic fistulas. Conclusion:The current best evidence suggests prophylactic treatment with somatostatin or pasireotide has a potential role in reducing the incidence of pancreatic fistulas, while octreotide had no influence on the incidence of pancreatic fistulas. High-quality RCTs assessing the role of somatostatin and pasireotide are required for further verification. (C) 2015 S. Karger AG, Basel

Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy. We introduce here a simple, secure and universal technique for pancreaticojejunostomy with a two-layer continuous running suture. We also report on the preliminary results for grades of pancreatic fistulas among patients who underwent this new technique. 51 consecutive cases were successfully performed using this new technique during pancreaticoduodenectomy. The overall morbidity was 29.4%. Only 3 (5.9%) grade B pancreatic fistulas were observed postoperatively, and were successfully treated with conservative management. The time taken to create the pancreatic anastomosis was less than 15 minutes in all cases. In conclusion, this novel pancreatic anastomosis technique is easy and quick to perform, universally applicable, and appears to be a secure technique that reduces pancreatic fistula rates after pancreaticoduodenectomy.

Objective: To study the relationship between epithelial-mesenchymal transition (EMT) phenotype of circulating tumor cells (CTCs) and liver metastasis of pancreatic cancer.Methods: The patients who were found without liver metastasis by preoperative imaging examination but confirmed with pancreatic cancer by postoperative pathological diagnosis were recruited in this study from January 2010 to December 2013 in Department of General Surgery, Changzheng Hospital, Second Military Medical University. All patients were followed up for 1 year after surgical operation, then divided into liver metastasis group and non-liver metastasis group according to whether the patient had liver metastasis or not during the follow-up. In each group, 50 patients were randomly selected. The peripheral blood samples from all patients were collected before surgery, and at the same time, the peripheral blood samples from 10 healthy volunteers were collected as the control. Then the CTCs were enriched and isolated from peripheral blood samples using immunomagnetic method, and identified by immunofluorescence method with carbamoyl-phosphate synthetase 1 (CPS1) antibody. The expressions of EMT markers Snail and Vimentin in blood samples were detected by immunofluorescence method. The relationships between these EMT markers and liver metastasis of pancreatic cancer were analyzed by univariate and multivariate analyses.Results: CPS1, Snail and Vimentin were not expressed in blood samples from 10 healthy volunteers. In peripheral blood samples from 50 pancreatic cancer patients with liver metastasis, the positive expression rates of Snail and Vimentin were 82% (41) and 72% (36), respectively; while in non-liver metastasis group, the positive expression rates of Snail and Vimentin were 20% (10) and 12% (6), respectively. The positive expression rates of Snail and Vimentin in liver metastasis group were higher than those in non-liver metastasis group (χ2 = 38.455, P 37 kU/L, tumor diameter ≥ 4 cm, pancreatic head tumors, vascular invasion, and positive expressions of Snail and Vimentin were correlated with liver metastasis of pancreatic cancer (all P 37 kU/L (β = 3.411, P < 0.01) and positive expressions of Snail (β = 2.882, P < 0.01) and Vimentin (β = 3.361, P < 0.01) were independent risk factors for liver metastasis of pancreatic cancer.Conclusion: CTCs-EMT phenotype markers Snail and Vimentin in peripheral blood may be closely related to liver metastasis of pancreatic cancer. DOI:10.3781/j.issn.1000-7431.2015.33.221

Urogenital dysfunctions are well-recognized problems after rectal cancer surgery and are often due to autonomic nerve damage. Although following holy planes during total mesorectal excision (TME) reduces the possibility of damage to the autonomic nerve fibers, these could still be affected in some critical areas.1 , 2 To improve the quality of surgery and prevent nerve damage, accurate intraoperative anatomical orientation of autonomic nerve is essential.3 Thanks to advancement of the high-definition laparoscopic technology, even the finest nerve fibers deep in the pelvic cavity can be identified through illumination and magnification.4 We aim to present a surgical technique of using the autonomic nerves as landmarks to guide laparoscopic TME for distal rectal cancer, with the purpose of preventing autonomic nerve damage to the largest extent.

Background: The use of somatostatin analogues (SAs) following pancreaticoduodenectomy (PD) is controversial. Method: Literature databases were searched systematically for relevant articles. A meta-analysis of all randomized controlled trials (RCTs) evaluating prophylactic SAs in PD was performed. Results: Fifteen RCTs involving 1,352 patients were included. There was a towards reduced incidences of pancreatic fistulas (p = 0.26), clinically significant pancreatic fistulas (p = 0.08), and bleeding (p = 0.05) in prophylactic SAs group. In subgroup analyses, prophylactic somatostatin significantly reduced the incidence of pancreatic fistulas (p = 0.02), with a nonsignificant trend toward reduced incidence of clinically significantly pancreatic fistulas (p = 0.06). Pasireotide significantly reduced the incidence of clinically significantly pancreatic fistulas (p = 0.03). Octreotide had no influence on the incidence of pancreatic fistulas. Conclusion: The current best evidence suggests prophylactic treatment with somatostatin or pasireotide has a potential role in reducing the incidence of pancreatic fistulas, while octreotide had no influence on the incidence of pancreatic fistulas. High-quality RCTs assessing the role of somatostatin and pasireotide are required for further verification.

目的：探讨分析胃肠外科临床实践教学对转化医学理念结合病例讨论模式实践可行性。方法：选取2010-2013年我院普通外科实习医师共60名，拆信封法随机将其分成实验组（30名）和对照组（30名），给予实验组学生采取转化医学理念结合病例讨论临床实践教学模式，给予对照组传统教学法。观察对比两组学生考试成绩和分析相关问卷调查指标。结果：实验组学生平均成绩为82.252分，对照组学生平均成绩为73.151分，实验组学生平均成绩高于对照组，两组差异对比具有明显统计学意义（P＜0.05）。实验组30名学生中，有26名学生认为能增加探索临床问题的兴趣，占86.66%，有24名学生认为能提升从临床实践中提炼科研思路的能力，占80%。有25名学生认为能促进独立思考和自主学习，占83%，有22名学生认为能增加学习的深度和广度，占73%。与对照班学生17/30，56.67%、13/30，43.3%、15/30，50%，12/30，占40%调查比例相比，两组差异对比具有明显统计学意义（P＜0.05）。结论：转化医学理念结合病历讨论教学模式克服了传统教学模式的不足，适合当前临床实践教学所需，同时也适应现代医学教学的要求，教学效果明显，值得在胃肠外科临床教学中应用和推广。