ObjectiveTo investigate current status of anal sphincter preservation in low rectal cancer.MethodThe recent literatures on the progress of anal sphincter preservation in the low rectal cancer were reviewed.ResultsIn the past, the surgical treatment of the low rectal cancer was mainly based on the Miles. With the deepening of the anatomical understanding, the improvement of surgical concepts, and the development of minimally invasive techniques, the treatment concept of the low rectal cancer had gradually entered the era of retaining anal and anal function. At present, many surgical methods including the transanal local excision, intersphincteric resection, transanal total mesorectal excision, etc. could be applied to the anal sphincter preservation of the lower rectal cancer, but the advantages and disadvantages of each surgical procedure and the scope of application were slightly different.ConclusionsAlthough there are many surgical procedures that can be applied to patients with low rectal cancer, none of them can achieve perfection in terms of retaining anal and anal function, reducing complications and recurrence rates, and improving survival. It is believed that with continuous understanding of rectal anatomy by surgeons, emergence of various neoadjuvant chemoradiation and new devices, and more anal sphincter preservation procedures and even artificial anal surgery, treatment of low rectal cancer will also be more good care for anal and maintenance function, so that patients can obtain a higher quality and a long-term survival opportunity.
Objective To investigate the effect of postoperative recovery between trans-abdominal drainage and trans-perineum drainage in patients with rectal cancer. Methods The randomized controlled trials which were related with the comparison between trans-abdominal drainage and trans-perineum drainage of rectal cancer patients were searched from January 2006 to January 2016, and then a meta-analysis was performed by using RevMan 5.2 software, basing on the data obtained from PubMed, CBM, CNKI, WanFang, and VIP database. Results The results of meta-analysis showed that, in the aspect of postoperative drainage, there was no significant difference in the postoperative drainage duration 〔MD=–0.03, 95% CI is (–1.63, 1.57), P=0.97〕 , volume of drainage liquid 〔MD=–9.53, 95% CI is (–104.95, 85.90), P=0.84〕 , and extubation time 〔MD=0.25, 95% CI is (–0.31, 0.82), P=0.38〕 between the trans-abdominal drainage group and the trans-perineum drainage group. In terms of postoperative infection, the trans-abdominal drainage could effectively reduce the incidence rate of drainage tube incision infection 〔OR=0.32, 95% CI is (0.21, 0.48), P<0.000 01〕 . However, there was no significant difference in the abdominal incision infection 〔OR=0.84, 95% CI is (0.51, 1.36), P=0.48〕 and pelvic infection 〔OR=0.77, 95% CI is (0.52, 1.15), P=0.20〕 . In addition, compared to the trans-perineum drainage, the trans-abdominal drainage could shorten the time of pain in drainage 〔MD=–5.07, 95% CI is (–6.96, –3.17), P<0.000 01〕 . But, there was no significant difference in the duration of hospitalization 〔MD=0.82, 95% CI is (–0.39, 2.03), P=0.19〕 , incidence of anastomotic bleeding 〔OR=0.95, 95% CI is (0.58, 1.54), P=0.82〕 , and incidence of anastomotic leakage 〔OR=1.33, 95% CI is (0.93, 1.92), P=0.12〕 between the two groups. Conclusion The trans-abdominal drainage could obviously decrease the incidence of drainage tube incision infection and shorten the time of pain in drainage, so it may promote the postoperative rehabilitation of rectal cancer patients.
ObjectiveTo investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.MethodsThe clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.ResultsThere were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).ConclusionGender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.
The COSMIN-RoB checklist includes three sections with a total of 10 boxes, which is used to evaluate risk of bias of studies on content validity, internal structure, and other measurement properties. COSMIN classifies reliability, measurement error, criteria validity, hypothesis testing for construct validity, and responsiveness as other measurement properties, which primarily focus on the quality of the (sub)scale as a whole, rather than on the item level. Among the five measurement properties, reliability, measurement error and criteria validity are the most widely used in the studies. Therefore, this paper aims to interpret COSMIN-RoB checklist with examples to guide researchers to evaluate the risk of bias of the studies on reliability, measurement error and criteria validity of PROMs.
Measurement properties studies of patient-reported outcome measures (PROMs) aims to validate the measurement properties of PROMs. In the process of designing and statistical analysis of these measurement properties studies, bias will occur if there are any defects, which will affect the quality of PROMs. Therefore, the COSMIN (consensus-based standards for the selection of health measurement instruments) team has developed the COSMIN risk of bias (COSMIN-RoB) checklist to evaluate risk of bias of studies on measurement properties of PROMs. The checklist can be used to develop systematic reviews of PROMs measurement properties, and for PROMs developers, it can also be used to guide the research design in the measurement tool development process for reducing bias. At present, similar assessment tools are lacking in China. Therefore, this article aims to introduce the primary contents of COSMIN-RoB checklist and to interpret how to evaluate risk of bias of the internal structure studies of PROMs with examples.
Objective To clarify the role of gastrokine 1 in the process of formation and development of gastric cancer. Methods The expressions of gastrokine 1 in gastric cancer and paracancerous tissues of 52 patients with gastriccancer were detected by real-time fluorescence quantitative polymerase chain reaction （RT-PCR） and immunohistochemistry. Meanwhile the relationship of the expression level of gastrokine 1 with clinicopathologic characteristics were analyzed. Results The expression levels of gastrokine 1 gene and protein in the gastric cancer tissues were significantly lower than those in the paracancerous tissues （P＜0.01）. No significant relationship was found between expression of gastrokine 1 gene and clinicopathologic features including tumor location， depth of invasion， differentiation， lymph node metastasis， tumor stage， gender， age， and preoperative peripheral blood CEA and CA19-9 levels （P＞0.05，respectively）. What’s more， the expression level of gastrokine 1 gene in gastric cancer tissues of Helicobacter pylori （HP）-positive patients was lower than that in the negative ones （P＜0.05）. Conclusions Gastrokine 1 may play a significant role as an anti-oncogene in the process of the formation and development of gastric cancer. Its effect may become weak due to HP infection in gastric cancer patients.
Objective To explore the tumorigenicity and expressions of dishevelled 3 (DVL3) in HCT116 cells and HCT116 spherical cells. Methods Human colorectal tumor HCT116 cells were cultured in the serum-free culture medium for HCT116 spherical cells. Through the subcutaneous tumor experiment in nude mice and clone formation assay, we observed the tumor growth and colony formation ability of the two kinds of cells in vivo and in vitro. The Western blotting experiment was utilized to detect the expressions of DVL3 in these two kinds of cells. Results ① Colonyformation: the mean value of colony formation rate in the HCT116 cells group was 3.78%, and the mean value of fcolony formation rate in the HCT116 spherical cells group was 28.67%, which was higher in the HCT116 spherical cells group (t=21.16, P<0.05). ② Tumorigenicity in nude mice: 11 nude mice with tumor formation were observed in the HCT116 cells group, and the tumor formation rate was 55.0%; 18 nude mice with tumor formation were observed in the HCT116 spherical cells group, and the tumor formation rate was 90.0%, the tumor formation rate of the HCT116 spherical cells group was higher (P=0.039). The tumor volume of the HCT116 cells group was (92±31) mm3, and the tumor volume of HCT116 spherical cells group was (298±85) mm3, the tumor volume of the HCT116 spherical cells group was larger (t=9.27, P<0.05). ③ The expression of DVL3: the expression level of DVL3 in HCT116 cells was 0.12±0.05, and expression level of DVL3 in HCT116 spherical cells was 0.35±0.10, the expression level of DVL3 in HCT116 spherical cells was higher (t=4.31, P<0.05). Conclusions The HCT116 spherical cells have stronger colonization and tumorigenicity than the HCT116 cells. It has been speculatd that the high expression of DVL3 may be closely related with the stronger tumorigenicity.
Objective To investigate the difference of effect between laparoscopic and open surgery in patients with traumatic rupture of spleen. Methods The literatures on comparison of laparoscopic and open surgery in patients with traumatic rupture of spleen were retrieved in PubMed, Web of Science, CNKI, Wanfang, and VIP databases from Jan. 2007 to Jan. 2017, and then Stata 12.0 software was applied to present meta-analysis. Results ① The condition during operation: compared with the OS group, operative time of the LS group was shorter [SMD=–0.71, 95% CI was (–1.12, –0.30), P=0.001] and intraoperative blood loss of the LS group was less [SMD=–1.53, 95% CI was (–2.28, –0.78), P<0.001]. ② The postoperative condition: compared with the OS group, the postoperative anal exhaust time [SMD=–2.47, 95% CI was (–3.24, –1.70), P<0.001], postoperative ambulation time [SMD=–2.97, 95% CI was (–4.32, –1.62), P<0.001], and hospital stay [SMD=–1.68, 95% CI was (–2.15, –1.21), P<0.001] of the LS group were all shorter. ③ The overall incidence of complications and the incidence of complications: on the one hand, compared with the OS group, patients in the LS group had a lower overall incidence of postoperative complications [OR=0.29, 95% CI was (0.19, 0.43), P<0.001]. On the other hand, compared with the OS group, patients in the LS group had lower incidences of infection [OR=0.27, 95% CI was (0.13, 0.55), P<0.001], ascites [OR=0.36, 95% CI was (0.13, 1.00), P=0.049], bleeding [OR=0.29, 95% CI was (0.10, 0.90), P=0.032], ileus [OR=0.34, 95% CI was (0.13, 0.90), P=0.030], incision fat liquefaction [OR=0.27, 95% CI was (0.08, 0.94), P=0.040], and incision rupture [OR=0.17, 95% CI was (0.03, 0.96), P=0.045]. However, there was no statistical difference on splenectomy fever [OR=0.41, 95% CI was (0.13, 1.27), P=0.123], pancreatic fistula [OR=0.40, 95% CI was (0.06, 2.63), P=0.343], liver function lesion [OR=0.36, 95% CI was (0.10, 1.34), P=0.127], and thrombosis [OR=0.33, 95% CI was (0.09, 1.22), P=0.097] between the 2 groups. Conclusions Laparoscopic surgery can not only significantly reduce the incidence of multiple complications of traumatic rupture of spleen, but also can speed up the recovery rate of postoperative recovery. Therefore, it is safe and beneficial in treatment of patients with traumatic rupture of spleen.
Objective To compare efficacy of laparoscopic surgery and open surgery in treatment of rectal cancer after neoadjuvant chemoradiotherapy. Methods The relevant literatures were retrieved from databases including CNKI, CBM, Wanfang, VIP, PubMed, Cochrane Library, and Embase from 2007 to 2017, all the relevant randomized controlled trial (RCT) or non-randomized controlled trial (NRCT) of laparoscopic surgery versus open surgery in patients with rectal cancer were collected according to the inclusion and exclusion criterial. Two reviewers independently screened the literatures, extracted the data, and assessed the bias risk of the included studies. Then, the meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs and 9 NRCTs involving 2 036 patients with rectal cancer were included, of these, including 1 021 cases of laparoscopic surgery and 1 015 cases of open surgery. The results of the meta-analysis showed that the operation time was increased ［WMD=14.21, 95% CI (1.92, 26.51)］, the intraoperative blood loss ［WMD=–38.96, 95% CI (–60.29, –7.63)］, first postoperative exhaust time ［WMD=–0.86, 95% CI (–1.14, –0.57)］, first postoperative intake food time ［WMD=–0.89, 95% CI (–1.15, –0.62)］, and postoperative hospitalization time ［WMD=–2.38, 95% CI (–3.44, –1.32)］ were reduced in the laparoscopic surgery as compared with the open surgery; the rate of the sphincter-saving was increased ［OR=2.35, 95% CI (1.67, 3.30)］, the rates of the local recurrence ［OR=0.25, 95% CI (0.13, 0.47)］, postoperative overall complications ［OR=0.34, 95% CI (0.26, 0.43)］, infection of incision ［OR=0.39, 95% CI (0.25, 0.62)］, intestinal obstruction ［OR=0.30, 95% CI (0.17, 0.53)］, lung infection ［OR=0.32, 95% CI (0.18, 0.57)］, and anastomotic fistula ［OR=0.40, 95% CI (0.22, 0.73)］ were decreased in the laparoscopic surgery as compared with the open surgery; the intraoperative lymph node resection ［WMD=–0.99, 95% CI (–2.11, 0.12)］, the rates of the 3-year disease-free survival ［OR=0.91, 95% CI (0.54, 1.54)］, pelvic infection ［OR=0.64, 95% CI (0.17, 2.45)］, anastomotic bleeding ［OR=0.54, 95% CI (0.22, 1.34)］, urinary retention ［OR=0.71, 95% CI (0.34, 1.48)］, and urinary tract infection ［OR=1.22, 95% CI (0.45, 3.30)］ had no significant differences between these two surgeries. Conclusion Laparoscopy surgery is still safer, more effective, and more reliable than conventional open surgery after neoadjuvant chemoradiotherapy in rectal cancer, but it needs more clinical RCTs to further provide accurate and reliable results.