Objective To investigate the effect of cholecystolithiasis with cholecystitis and cholecystectomy on intestinal flora in patients with colorectal cancer. Methods A total of 168 patients with colorectal cancer who admitted to the Department of Anorectal Surgery in Gansu Provincial Hospital from June 2020 to March 2021 were selected, and 29 patients with colorectal cancer who met the criteria were selected as the research objects, including 10 colorectal cancer patients with gallstones and cholecystitis (cholecystolithiasis with cholecystitis+colorectal cancer group), 10 colorectal cancer patients after cholecystectomy (cholecystectomy+colorectal cancer group), and 9 colorectal cancer patients with normal gallbladder (normal gallbladder+colorectal cancer group). Clinical data of the patients in three groups were collected and compared. The fresh fecal samples of the patients included in the study were collected, and the 16S rDNA high-throughput sequencing method was used to determine and analyze the composition and distribution of the intestinal flora in the obtained samples. Results The interleukin-6 level in the cholecystolithiasis with cholecystitis+colorectal cancer group was statistically higher than that in the normal gallbladder+colorectal cancer group and the cholecystectomy+colorectal cancer group (P<0.05). At the phylum level of the fecal flora in three groups patients: ① In the samples of three groups, the relative abundances of Bacteroidetes, Firmicutes, Proteobacteria, Fusobacteria and Verrucomicrobia phylums were all high, accounting for almost more than 95% of the total intestinal bacteria. ② The relative abundance of Fusobacteria phylum in the cholecystolithiasis with cholecystitis+colorectal cancer group was statistically higher than that in the normal gallbladder+colorectal cancer group (P<0.05). ③ The relative abundance of Verrucomicrobia phylum in the normal gallbladder+colorectal cancer group was statistically higher than that in the cholecystolithiasis with cholecystitis+colorectal cancer group and the cholecystectomy+colorectal cancer group (P<0.05). ④ The relative abundance of Synergistetes phylum in the cholecystectomy+colorectal cancer group was statistically higher than that in the cholecystolithiasis with cholecystitis+colorectal cancer group and the normal gallbladder+colorectal cancer group (P<0.05). At the genus level: ① The relative abundances of Bacteroidetes and Roseburia genus were lower in the gallstone with cholecystitis+colorectal cancer group than those in the cholecystectomy+colorectal cancer group and the normal gallbladder+colorectal cancer group (P<0.05). ② The relative abundance of Shigella genus in the cholecystectomy+colorectal cancer group was higher than that in the cholecystolithiasis with cholecystitis+colorectal cancer group (P<0.05). ③ The relative abundance of the Lachnospira genus in the cholecystolithiasis with cholecystitis+colorectal cancer group was lower than that in the normal gallbladder+colorectal cancer group (P<0.05). ④ The relative abundances of Prevotella and Fusobacteria genus were higher in the cholecystolithiasis with cholecystitis+colorectal cancer group than that in the cholecystectomy+colorectal cancer group and the normal gallbladder+colorectal cancer group (P<0.05). ⑤ The relative abundances of Clostridium and Akkermansia genus were lower in the cholecystolithiasis with cholecystitis+colorectal cancer group and the cholecystectomy+colorectal cancer group than that in the normal gallbladder+colorectal cancer group (P<0.05). ⑥ The relative abundance of Enterococcus genus was higher in the normal gallbladder+colorectal cancer group than that in the cholecystectomy+colorectal cancer group (P<0.05).Conclusions ① Long-term occurrence of cholecystolithiasis with cholecystitis can cause obvious decrease in the abundances of Bacteroides, Roseburia, Lachnospira, etc. ② Cholecystectomy can cause changes in the relative abundances of Clostridium, Enterococcus, Verrucomicrobia, Synergistetes, etc. ③ The relative abundance of Fusobacterium is obviously increased in colorectal cancer patients with gallstones and cholecystitis, then promotes the release of inflammatory cytokines and causes intestinal inflammation, which is conducive to the growth of opportunistic pathogens, thus may affect the occurrence and development of colorectal cancer.
ObjectiveTo compare oncologic and short-term outcomes between the robotic and laparoscopic total mesorectal excision for rectal cancer. Methods This is a retrospective cohort study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent robotic-assisted total mesorectal excision (R-TME group) and one hundred and sixteen with the same histopathological stage of the tumor underwent an laparoscopic total mesorectal excision (L-TME group). Both operations were performed by the same surgeon. Results The time to the first passage of flatus ［(3.28±1.64) d vs. (6.01±2.77) d, P<0.001］, the time to the first postoperative oral fluid intake ［(4.46±1.62) d vs. (6.28±2.74) d, P<0.001） and the length of hospital stay ［（11.20±5.80）d vs. (14.72±6.90) d, P=0.023］ of the R-TME group was about 3 days faster than the L-TME group. The incidence of postoperative urinary retention (2.50% vs 7.76%, P=0.016) was significantly lower in the R-TME group than the L-TME group. However, the intraoperative blood loss of the R-TME group was more than the L-TME group ［(175.06±110.77) mL vs. (123.91±99.61) mL, P=0.031, ）. The operative time, number of lymph nodes harvested and distal margin were similar intergroup（P>0.05）. The total cost was higher in the R-TME than in the L-TME group ［(85 623.91±13 310.50) CNY vs. (67 356.79±17 107.68) CNY, P=0.084), however, this difference was statistically insignificant. ConclusionsCompared with the L-TME, the R-TME has the same oncologic outcomes and rapid postoperative short-term recovery. However, the long-term outcome of the R-TME remains to be further observed.
ObjectiveTo analyze the relevant risk factors affecting postoperative relapse-free survival (RFS) in the primary gastrointestinal stromal tumors (GIST) and develop a Nomogram predictive model of postoperative RFS for the GIST patients. MethodsThe patients diagnosed with GIST by postoperative pathology from January 2011 to December 2020 at the First Hospital of Lanzhou University and Gansu Provincial People’s Hospital were collected, and then were randomly divided into a training set and a validation set at a ratio of 7∶3 using R software function. The univariate and multivariate Cox regression analysis were used to identify the risk factors affecting the RFS for the GIST patients after surgery, and then based on this, the Nomogram predictive model was constructed to predict the probability of RFS at 3- and 5-year after surgery for the patients with GIST. The effectiveness of the Nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), consistency index (C-index), and calibration curve, and the clinical utility of the Nomogram and the modified National Institutes of Health (M-NIH) classification standard was evaluated using the decision curve analysis (DCA). ResultsA total of 454 patients were included, including 317 in the training set and 137 in the validation set. The results of multivariate Cox regression analysis showed that the tumor location, tumor size, differentiation degree, American Joint Committee onCancer TNM stage, mitotic rate, CD34 expression, treatment method, number of lymph node detection, and targeted drug treatment time were the influencing factors of postoperative RFS for the GIST patients (P<0.05). The Nomogram predictive model was constructed based on the influencing factors. The C-index of the Nomogram in the training set and validation set were 0.731 [95%CI (0.679, 0.783)] and 0.685 [95%CI (0.647, 0.722)], respectively. The AUC (95%CI) of distinguishing the RFS at 3- and 5-year after surgery were 0.764 (0.681, 0.846) and 0.724 (0.661, 0.787) in the training set and 0.749 (0.625, 0.872) and 0.739 (0.647, 0.832) in the validation set, respectively. The calibration curve results showed that a good consistency of the 3-year and 5-year recurrence free survival rates between the predicted results and the actual results in the training set, while which was slightly poor in the validation set. There was a higher net benefit for the 3-year recurrence free survival rate after GIST surgery when the threshold probability range was 0.19 to 0.57. When the threshold probability range was 0.44 to 0.83, there was a higher net benefit for the 5-year recurrence free survival rate after GIST surgery. And within the threshold probability ranges, the net benefit of the Nomogram was better than the M-NIH classification system at the corresponding threshold probability. ConclusionsThe results of this study suggest that the patients with GIST located in the other sites (mainly including the esophagus, duodenum, and retroperitoneum), with tumor size greater than 5 cm, poor or undifferentiated differentiation, mitotic rate lower than 5/50 HPF, negative CD34 expression, ablation treatment, number of lymph nodes detected more than 4, and targeted drug treatment time less than 3 months need to closely pay attentions to the postoperative recurrence. The discrimination and clinical applicability of the Nomogram predictive model are good.
ObjectiveTo evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.MethodsA literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.ResultsA total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].ConclusionsRobotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.
ObjectiveTo summarize the application status and related progress of robot-assisted technology in general surgery.MethodThe related researches about robot-assisted technology in general surgery in recent year were searched and reviewed.ResultsRobot-assisted techniques had similar safety and effectiveness to endoscopic surgery in general surgery. In addition, in rectal cancer, thyroid and pancreatic surgery, due to the narrow operation space, the advantages of robot-assisted surgery was more obvious.ConclusionsThe application of robot-assisted techniques in general surgery is safe and effective. With the decrease of the cost of robotic surgery, which has wide application value in general surgery.