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Objective To investigate the teaching needs of clinical skills and scientific research skills in standardized training of surgical residents and to crient teaching remodeling. Methods A self-filling questionnaire survey was conducted in July 2018. Surgical residents of Peking Union Medical College Hospital, who are at the second and the third year of training, were gathered to sit in separate in classrooms. The filling methods and matters needing attention were explained uniformly. The trainees filled in the form of “back-to-back” by themselves. Totally 85 questionnaires were collected and 83 questionnaires were valid. This paper mainly investigates the training needs of clinical diagnosis and treatment, operation skills and scientific research skills. Results The demand of clinical skills is mostly manifested in the diagnosis and treatment of common surgical diseases and surgical teaching. The most demanded surgical teaching was “hand-holding” and acting as a assistant or master knife. The main requirements of scientific research skills are data collection, statistical methods (Meta analysis), scientific research design and project establishment, tender writing and bidding, and paper writing and publication. Conclusions The needs of surgical residents reflect their deficiencies in the diagnosis and treatment of common diseases, operation skill and research capacity. For this reason, the Surgical Teaching Group has put forward such reform schemes as “tutorial system” “animal model” “all-factor simulated surgery” “more scientific research training courses” and so on.

Aim: To evaluate the feasibility, short- and long-term outcomes, and safety of laparoscopic resection for advanced colorectal cancer (CRC) in solid organ transplant recipients. Methods: Between September 2001 and April 2016, five patients who underwent laparoscopic-assisted resection for CRC after solid organ transplantation were included in this study. Their clinical data were retrospectively analyzed with regard to patient demographics, immunosuppressive therapy, tumor characteristics, surgical outcomes, and follow-up data. Results: Four kidney and one heart transplant recipients were included. Laparoscopic-assisted low anterior resection was performed in four patients with rectal or rectosigmoid junction cancer, and sigmoidectomy was done in one with sigmoid colon cancer. One kidney transplant patient received a protective loop transverse colostomy. All resections achieved complete tumor removal with tumor-free margins and total mesorectal excision, with an average number of 14 lymph nodes harvested. Most tumors were in stage III (n = 3), one was in stage II, and one in stage IV. The mean duration of surgery, intraoperative blood loss, and postoperative hospital stay were 144 min, 105 mL, and 8.8 days, respectively. No major complications occurred and graft function stayed well. During a mean follow-up period of 62 months, two patients developed metastasis and died eventually. Conclusion: Laparoscopic resection for advanced CRC in organ transplant recipients is technically feasible and therapeutically safe, and seems to have the advantages of few postoperative complications, short recovery time, and acceptable oncological outcomes. [ABSTRACT FROM AUTHOR]

Gastric cancer (GC) is a common malignant tumor and the third most common cancer in China in terms of mortality. Stomach microorganisms play complex roles in the development of GC. The carcinogenic mechanism of Helicobacter pylori has been elucidated, and there is much evidence that other microorganisms in the gastric mucosa are also heavily involved in the disease progression of this cancer. However, their carcinogenic mechanisms have not yet been fully elucidated. The microbial compositions associated with the normal stomach, precancerous lesions, and GC are distinctly different and have a complex evolutionary mechanism. The dysregulation of gastric microbiota may play a key role in the oncogenic process from precancerous lesions to malignant gastric tumors. In this review, we explore the potential translational and clinical implications of intragastric microbes in the diagnosis, prognosis, and treatment of GC. Finally, we summarize the research dilemmas and solutions concerning intragastric microbes, emphasizing that they should be at the forefront of strategies for GC prevention and treatment., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bin Ba reports financial support was provided by Ordos Hospital of Traditional Chinese Medicine. Chen Pengfei reports financial support was provided by The Second affiliated hospital of Inner Mongolia Medical University. Chen Jing reports administrative support and writing assistance were provided by Medical Department of Ordos college of Applied Technology. Yu Lei reports financial support was provided by Traditional Chinese Medicine Hospital of Inner Mongolia Autonomous Region. Yang Fan reports financial support was provided by Inner Mongolia Autonomous Region Blood Central. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: A growing body of research indicates significant differences between left-sided colon cancers (LCC) and right-sided colon cancers (RCC). Pan-immune-inflammation value (PIV) is a systemic immune response marker that can predict the prognosis of patients with colon cancer. However, the specific distinction between PIV of LCC and RCC remains unclear., Aim: To investigate the prognostic and clinical significance of PIV in LCC and RCC patients., Methods: This multicenter retrospective cohort study included 1510 patients with colon cancer, comprising 801 with LCC and 709 with RCC. We used generalized lifting regression analysis to evaluate the relative impact of PIV on disease-free survival (DFS) in these patients. Kaplan-Meier analysis, as well as univariate and multivariate analyses, were used to examine the risk factors for DFS. The correlation between PIV and the clinical characteristics was statistically analyzed in these patients., Results: A total of 1510 patients {872 female patients (58%); median age 63 years [interquartile ranges (IQR): 54-71]; patients with LCC 801 (53%); median follow-up 44.17 months (IQR 29.67-62.32)} were identified. PIV was significantly higher in patients with RCC [median (IQR): 214.34 (121.78-386.72) vs 175.87 (111.92-286.84), P < 0.001]. After propensity score matching, no difference in PIV was observed between patients with LCC and RCC [median (IQR): 182.42 (111.88-297.65) vs 189.45 (109.44-316.02); P = 0.987]. PIV thresholds for DFS were 227.84 in LCC and 145.99 in RCC. High PIV (> 227.84) was associated with worse DFS in LCC [PIV-high: Adjusted hazard ratio (aHR) = 2.39; 95% confidence interval: 1.70-3.38; P < 0.001] but not in RCC (PIV-high: aHR = 0.72; 95% confidence interval: 0.48-1.08; P = 0.114)., Conclusion: These findings suggest that PIV may predict recurrence in patients with LCC but not RCC, underscoring the importance of tumor location when using PIV as a colon cancer biomarker., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Chemoresistance is the primary contributor to distant metastasis in the context of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer. However, the underlying mechanisms remain elusive., Aim: To detect the differential expression profiles of plasma exosomal microRNAs (miRNAs) in poor and good responders and explore the potential mechanisms of chemoresistance., Methods: In this study, the profiles of plasma exosomal miRNAs were compared in two dimensions according to treatment responses (poor/good responders) and treatment courses (pre/post-nCRT) using RNA sequencing., Results: Exosome hsa-miR-483-5p was up-regulated in good responders post-nCRT. Bioinformatics analysis revealed that the target genes of hsa-miR-483-5p were mainly enriched in tumor-specific pathways, such as the MAPK signaling pathway, EGFR tyrosine kinase inhibitor resistance, Toll-like receptor signaling pathway, VEGF signaling pathway, and mTOR signaling pathway. Further analysis indicated that MAPK3, RAX2, and RNF165 were associated with inferior recurrence-free survival in patients with rectal cancer, and the profiles of MAPK3, TSPYL5, and ZNF417 were correlated with tumor stage. In addition, the expression profiles of MAPK3, RNF165, and ZNF417 were negatively correlated with inhibitory concentration 50 values. Accordingly, an hsa-miR-483-5p/MAPK3/RNF 165/ZNF417 network was constructed., Conclusion: This study provides insights into the mechanism of chemoresistance in terms of exosomal miRNAs. However, further research is required within the framework of our established miRNA-mRNA network., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: There is currently a shortage of accurate, efficient, and precise predictive instruments for rectal neuroendocrine neoplasms (NENs)., Aim: To develop a predictive model for individuals with rectal NENs (R-NENs) using data from a large cohort., Methods: Data from patients with primary R-NENs were retrospectively collected from 17 large-scale referral medical centers in China. Random forest and Cox proportional hazard models were used to identify the risk factors for overall survival and progression-free survival, and two nomograms were constructed., Results: A total of 1408 patients with R-NENs were included. Tumor grade, T stage, tumor size, age, and a prognostic nutritional index were important risk factors for prognosis. The GATIS score was calculated based on these five indicators. For overall survival prediction, the respective C-indexes in the training set were 0.915 (95% confidence interval: 0.866-0.964) for overall survival prediction and 0.908 (95% confidence interval: 0.872-0.944) for progression-free survival prediction. According to decision curve analysis, net benefit of the GATIS score was higher than that of a single factor. The time-dependent area under the receiver operating characteristic curve showed that the predictive power of the GATIS score was higher than that of the TNM stage and pathological grade at all time periods., Conclusion: The GATIS score had a good predictive effect on the prognosis of patients with R-NENs, with efficacy superior to that of the World Health Organization grade and TNM stage., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Intestinal flora disorder (IFD) poses a significant challenge after laparoscopic colonic surgery, and no standard criteria exists for its diagnosis and treatment., Aim: To analyze the clinical features and risk factors of IFD., Methods: Patients with colon cancer receiving laparoscopic surgery were included using propensity-score-matching (PSM) methods. Based on the occurrence of IFD, patients were categorized into IFD and non-IFD groups. The clinical characteristics and treatment approaches for patients with IFD were analyzed. Multivariate regression analysis was performed to identify the risk factors of IFD., Results: The IFD incidence after laparoscopic surgery was 9.0% (97 of 1073 patients). After PSM, 97 and 194 patients were identified in the IFD and non-IFD groups, respectively. The most common symptoms of IFD were diarrhea and abdominal, typically occurring on post-operative days 3 and 4. All patients were managed conservatively, including modulation of the intestinal flora (90.7%), oral/intravenous application of vancomycin (74.2%), and insertion of a gastric/ileus tube for decompression (23.7%). Multivariate regression analysis identified that pre-operative intestinal obstruction [odds ratio (OR) = 2.79, 95%CI: 1.04-7.47, P = 0.041] and post-operative antibiotics (OR = 8.57, 95%CI: 3.31-23.49, P < 0.001) were independent risk factors for IFD, whereas pre-operative parenteral nutrition (OR = 0.12, 95%CI: 0.06-0.26, P < 0.001) emerged as a protective factor., Conclusion: A stepwise approach of probiotics, vancomycin, and decompression could be an alternative treatment for IFD. Special attention is warranted post-operatively for patients with pre-operative obstruction or early use of antibiotics., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Noninfectious liver injury, including the effects of chemical material, drugs and diet, is a major cause of liver diseases worldwide. In chemical and drugs-induced liver injury, innate inflammatory responses are mediated by extracellular danger signals. The S100 protein can act as danger signals, which can promote the migration and chemotaxis of immune cells, promote the release of various inflammatory cytokines, and regulate the body's inflammatory and immune responses. However, the role of S100A6 in inflammatory response in chemical and drugs-induced sterile liver injury remains unclear. We constructed the model of sterile liver injury induced by carbon tetrachloride (CCl 4 )/Paracetamol (APAP) and performed RNA sequencing (RNA-seq) on the liver tissues after injury (days 2 and 5). We analyzed inflammatory protein secretion in the liver tissue supernatant by enzyme-linked immunosorbent assay (ELISA), determined the inflammation response by bioinformatic analysis during sterile liver injury, and assessed mononuclear/macrophage infiltration by immunohistochemistry and flow cytometry. Immunohistochemistry was used to analyze the location of S100A6. We conducted inflammatory factor expression analysis and molecular mechanistic studies in Kupffer cells (KCs) induced by S100A6 using quantitative reverse transcription-polymerase chain reaction (qRT-PCR), ELISA, and western blot in vitro experiments. We performed chemokine CCL2 expression analysis and molecular mechanism studies using the same method. We used a Transwell assay to show the infiltration of mononuclear/macrophage. We here observed that aggravated inflammatory response was shown in CCl 4 and APAP-administrated mice, as evidenced by enhanced production of inflammatory cytokines (TNF-α, IL-1β), and elevated mononuclear/macrophage infiltration and activation of immunity. The expression of S100A6 was significantly increased on day 2 after sterile liver injury, which is primarily produced by injured liver cells. Mechanistic studies established that S100A6 activates Kupffer cells (KCs) via the p-P38, p-JNK and P65 pathways to induce inflammation in vitro. Furthermore, TNF-α can stimulate liver cells via the p-P38 and p-JNK pathways to produce CCL2 and promote the infiltration of mononuclear/macrophage. In summary, we showed that S100A6 plays an important role in regulating inflammation, thus influencing sterile liver injury. Our findings provide novel evidence that S100A6 can as a danger signal that contributes to pro-inflammatory activation through p-P38 and p-JNK pathways in CCl 4 and APAP-induced sterile liver injury in mice. In addition, the inflammatory factor TNF-α induces a large amount of CCL2 production in normal liver cells surrounding the injured area through a paracrine action, which is chemotactic for blood mononuclear/macrophage infiltration., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Ethnopharmacological Relevance: Honghua Qinggan 13 Flavor Pills (HHQG), whose Mongolian name is Guri Gumu-13, is a traditional Mongolian medicine, that was stated in the "Diagnosis and Treatment of Ming Medical Code". The HHQG has been included in the Mongolian Medicine Division of the Ministry of Health Drug Standards (1998 edition). Based on our clinical expertise, HHQG demonstrated satisfactory therapeutic effects in hepatitis and liver failure. However, the pharmacological effects and potential mechanisms of HHQG have not been investigated., Aim of the Study: In this study, we combined network pharmacology, transcriptomics, and molecular biology to detect the underlying mechanism for the effect of HHQG on acute liver injury in mice., Materials and Methods: Network pharmacology was used to explore the pathways involved in the protective effect HHQG in acute liver injury. This effect was further verified by injecting carbon tetrachloride (CCl 4 ; 10 mL/kg, i.p.) to induce acute liver injury in mice. Serum markers of liver injury, morphology, histology, and monocyte/macrophage infiltration in the liver tissue were investigated. Transcriptomics further defined the HHQG targets. Transwell analysis was performed to confirm that HHQG inhibited monocyte/macrophage RAW.264.7 infiltration. qPCR and Western blot were performed to explore the mechanism of action of HHQG., Results: Network pharmacology showed that HHQG exerted anti-oxidative and anti-inflammatory effects and promoted metabolic effects against acute liver injury. Pretreatment of mice with HHQG significantly maintained their body weight and decreased serum tumor necrosis factor-alpha (TNF-α) levels induced by CCl 4 treatment in vivo. Histopathological examination further confirmed that HHQG protected the liver cells from CCl 4 -induced damage. Importantly, HHQG significantly inhibited CCl 4 -induced monocyte/macrophage infiltration. Transcriptomic analysis revealed that HHQG significantly reduced the expression of chemokines and cell adhesion molecules. We determined that HHQG significantly downregulated the expression of the key chemokine (monocyte chemokine protein-1, CCL2) at the gene and protein levels. Further research showed that HHQG inhibited chemokine production in hepatocytes by inhibiting the p-P38 and p-JNK pathways, thereby reducing monocyte/macrophage infiltration., Conclusions: These combined data showed that HHQG alleviated acute liver injury in mice, and further verified that HHQG exerted protective effects by inhibiting the production of CCL2 and reducing the infiltration of monocyte/macrophage by inhibiting the p-P38 and p-JNK pathways., (Copyright © 2022 Elsevier B.V. All rights reserved.)

By combining triazenes with chalcones, we designed and synthesized 12 novel glycosides. The antiproliferative activity of all products was screened using an MTT assay against MGC803 cells and PC-3 cells. Compound [Formula: see text] displayed more potent antiproliferative activity than dacarbazine. Furthermore, we explored the preliminary structure activity relationship of all target compounds. The derivatives in this work might serve as bioactive fragments and lead compounds for developing more potent cytotoxic agents.

Aim: To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumors., Methods: We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics, tumor characteristics, operative details, postoperative outcomes, pathologic findings, and follow-ups., Results: Full-thickness excision using TEM was performed as a primary excision (n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy (n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm, and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min, and the mean blood loss was 13.5 ± 6.6 mL. No minor morbidities, transient fecal incontinence, or wound dehiscence was found. Histopathologically, all tumors showed typical histology without lymphatic or vessel infiltration, and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy, 9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. No recurrence was noted during the median of 3 years' follow-up., Conclusion: Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.

Objective: To investigate the three major problems and solutions in laparoscopic abdominoperineal resection(APR) for rectal carcinoma., Methods: A retrospective study of 60 low rectal carcinoma cases undergoing selective laparoscopic APR from September 2010 to May 2013 in our hospital was undertaken. A laparoscopic sigmoid stoma was performed through the extraperitoneal route at the left lower abdomen puncture point after lymphadenectomy and tumor excision during operation. Using the unique intracorporeal suture technique of transanal endoscopic microsurgery(TEM), the pelvic peritoneum was closed by continuous suture with TEM needle-forceps and absorbable suture. Those patients with the successful pelvic peritoneum closure received continuous irrigation of presacral space from the third postoperative day to prevent perineal incision infection., Results: Only one patient (1.7%) was converted to laparotomy. Fifty-nine patients underwent laparoscopic APR and laparoscopic sigmoid stoma was successfully performed through the extraperitoneal route without abdominal incision, and the incidence of stoma complication was only 3.4%. Out of 59 patients undergoing laparoscopic APR, the pelvic peritoneum of 56 patients(94.9%) was closed successfully. The median time of closing the pelvic peritoneum was 15 min. Fifty-seven patients with pelvic peritoneum successfully closed by laparotomy or laparoscopic approach received continuous irrigation of presacral space and the median time of presacral drainage tube placement was 7.8 days. No patient developed postoperative intestinal obstruction. The rate of perineal wound healing in grade A, B and C was 87.7%, 8.8% and 3.5%, respectively. In the 3 patients whose pelvic peritoneum failed to be closed with simple drainage of presacral space, one developed postoperative intestinal obstruction and one had a grade C perineal wound healing., Conclusions: Laparoscopic sigmoid stoma through the extraperitoneal route during laparoscopic APR for rectal carcinoma is feasible and safe. It is convenient and effective to close pelvic peritoneum by using TEM intracorporeal suture technique. It is worth discussing the role of continuous irrigation of presacral space postoperatively to prevent perineal incision infection.

Objective: Laparoscopic colorectal surgery is a skill-dependent procedure. The present study aims to analyze the learning curve of a properly trained surgeon, with basic laparoscopic techniques, to become skillful in performing laparoscopic colorectal operations., Methods: A series of non-selective, consecutive 189 cases of laparoscopic colorectal surgery were accomplished, from December 2009 to February 2012, by one surgeon with years of skilled technique in laparoscopic cholecystectomy, rich experience in assisting laparoscopic colorectal surgery, and experience of approximately 180 procedures of gastric and colorectal surgery annually. 170 out of 189 procedures were radical operations for colorectal neoplasma, including right colectomies in 28 cases, left colectomies in 5 cases, sigmoidectomies in 28 cases, high Dixon procedures in 45 cases, low Dixon (total mesorectal excision, TME) procedures in 41 cases and Miles procedure in 23 cases. 19 other patients underwent combined procedures for multi-primary tumors or inflammatory enteritis. All these procedures were analyzed according to time span (the earlier half and later half) in respect to length of surgery, intraoperative blood loss, number of lymph nodes retrieved, intraoperative events and postoperative complications., Results: For radical right colectomy, the D2 dissection conducted in the earlier phase (n = 8) had the similar length of surgery, more blood loss and less LN retrieval, compared with the D3 dissection conducted in recent phase (n = 20). The earlier performed high Dixon procedures (n = 22) consumed longer time than the later procedures (n = 23) consumed, but with similar blood loss and LN retrieval. Low Dixon (TME) procedures showed significant differences in length of surgery and blood loss relative to time span. Recently performed simoidectomy and Miles procedures showed a trend of shorter time consumed compared with earlier performed procedures. Conversion ratio to open surgery was 1.05%. Adverse effects occurred in 8 cases of surgeries, including intestinal injury (3/189), insufficient distal margin (2/189), intraoperative bleeding (2/189) and vaginal injury (1/76). There was no operative death. Chief complications included urinary retention 5.82%, ileus 4.76%, anastomotic leak 4.24%, perineal infection 23.08% (6/26), wound dehiscence 2.65%, gastrointestinal bleeding 1.59%, peritoneal infection 1.06%. Surgery for distal rectum tended to have more complications, such as urinary retention, anastomotic leak and perineal infection. The later performed low Dixon procedures produced insignificantly fewer anastomotic leaks than those in the earlier phase., Conclusions: For a trained surgeon with basic laparoscopic techniques, there are at least 15 - 25 cases of different procedures needed for him/her to become skilled to perform laparoscopic surgery. The learning curve should also depend on the annual number of colorectal surgeries.

Objective: To explore whether the abnormality of hMLH1 gene may be an early event of carcinogenesis in rectal carcinoma, and to evaluate the diagnostic value in differentiation between intraepithelial neoplasm and early stage of colorectal carcinoma., Methods: The expression of hMLH1 protein in 28 cases with early invasive rectal carcinoma(EIRC), 36 cases with rectal intraepithelial neoplasm(RIEN), and 30 cases with normal rectal mucosa(NRM) which were collected through surgical operations were detected by PV-9000 immunohistochemical method., Results: The positive expression rates of hMLH1 protein were 100%(30/30), 77.8%(28/36), and 39.3%(11/28) in NRM, RIEN, and EIRC respectively. The difference was statistically significant between RIEN and EIRC(P=0.002), and the difference was also statistically significant between RIEN and NRM(P=0.006). The positive expression of hMLH1 was not related to age, gender, tumor maximum diameter, dysplasia, tumor types, and distance from the anal verge in RIEV group(P>0.05). In EIRC group, hMLH1 was associated with tumor differentiation(P<0.05)., Conclusion: hMLH1 gene deletion may be an early event during carcinogenesis of rectal carcinoma, which may be useful in differentiation of intraepithelial neoplasm from early rectal carcinoma.

Objective: To investigate the safety and efficacy of prophylactic single antibiotic administration in selective open colorectal surgery., Methods: Two hundred and seventy-five patients undergoing selective open colorectal surgery in the Peking Union Medical College Hospital from October 2009 to October 2011 were retrospectively reviewed. Prophylatic single antibiotic administration was used by intravenous infusion 30-60 min before incision. No antibiotics would be given after operation if there was no surgical site infection(SSI). According to the incidence of postoperative SSI, unexplained use of antibiotics, anastomotic leakage and distant-site infection, the clinical outcome was assessed to be prophylactic success, prophylactic failure or distant-site infection, respectively., Results: There was no intraoperative or postoperative antibiotics related drug anaphylaxis in all the 275 patients. By prophylactic single antibiotic administration, there were prophylactic success in 243 patients(88.4%,243/275), prophylactic failure in 23(8.4%,23/275), distant-site infection in 9(3.3%,9/275). In the 23 patients with failed prophylaxis, there were SSI in 13(4.7%,13/275) patients, postoperative use of broad-spectrum antibiotics for unexplained fever in 2(0.7%,2/275), postoperative anastomotic leakage in 8(3.6%,8/222)., Conclusion: Prophylactic single antibiotic administration in selective open colorectal surgery is safe and effective.

Previous studies have shown that S100P contributes to the development of a number of tumors. However, its prognostic significance in colorectal cancer (CRC) has not been demonstrated. This study aimed to confirm the expression of S100P in colorectal cancer as well as the epigenetic mechanism underlying its gene expression, and to demonstrate whether S100P could be used to predict prognosis as a biomarker. We tested the expression of S100P in 96 CRCs and their paired tissue controls, as well as 13 colon cancer cell lines by RT-PCR and western blotting. Expression of the S100P protein and mRNA was significantly higher in cancerous regions compared to that in paired non-cancerous tissues (P=4.59 x 10(-17), 0.005 respectively). The expression was significantly correlated with the hypomethylation of the S100P promoter (P=4.92 x 10(-5)), which was detected by bisulphite sequencing PCR (BSP) and quantitative methylation-specific real-time PCR (QMSP). In stages I to III, the patients with positive expression of S100P protein showed poorer overall survival compared to those with S100P negative expression, P=0.031. We also measured the preoperative serum S100P levels by ELISA. The patients with normal serum levels of S100P showed favorable prognosis compared with patients with elevated S100P levels (P=0.008). These data suggest that S100P protein may be a potential novel prognostic biomarker in CRC patients.

Objective: To summarize clinical experience in the treatment of low rectal cancer with anterior perineal plane for ultra-low anterior resection of the rectum(APPEAR)., Methods: Clinical and follow-up data of 26 patients with low rectal cancer undergoing the APPEAR operation in Department of General Surgery at Peking Union Medical College from September 2009 to August 2011 were retrospectively analyzed., Results: The 26 cases consisted of 19 male and 7 female patients with an average age of (63.4 ± 9.5) years. The average tumor distance from the anal verge was (4.6 ± 0.7) cm according to preoperative examinations. Fourteen patients received neoadjuvant radiochemotherapy before the operation. All the 26 patients had successful sphincter-preserving operations. The average operative time was (170 ± 21) min and the average intra-operative blood loss (140 ± 69) ml. Complications included one case of intraoperative injury to the rectal wall and 4 cases of postoperative perineal wound infection. Postoperative pathological examination showed well to moderately differentiated adenocarcinomas(n=10), moderately differentiated adenocarcinomas with partial mucinous adenocarcinomas (n=7), poorly differentiated adenocarcinoma(n=1), villous adenoma with high-grade intraepithelial neoplasia (n=1), and rectal villous adenoma(n=1). In 6 cases no residual tumor cells were detected in the surgical specimens. All the patients were followed-up for an average period of(11.4 ± 5.6) months. No impaired urinary function or tumor recurrence was observed during the follow-up. Eighteen patients had the transverse colon stoma closure six months after the operation. The average Wexner continence score was 5.5 after colostomy reversal surgery. The anorectal manometry tests showed that maximum squeeze pressure of the anal sphincter was(224.0 ± 59.3) mm Hg. The maximum resting pressure was (42.5 ± 11.8) mm Hg, and the maximum tolerable volume of the rectum was (120.0 ± 27.4) ml. Anorectal reflexes were present in all these patients., Conclusion: The APPEAR technique can be applied in the sphincter-preserving operations for low rectal cancer patients with satisfactory anal function.

Objective: To evaluate the impact of neoadjuvant chemoradiation on perineal wound healing following abdominoperineal resection(APR) for lower rectal cancer., Methods: Data of 93 patients who underwent APR for low rectal cancer between January 2005 and January 2009 in Peking Union Medical College Hospital were reviewed, including patients who received neoadjuvant chemoradiation (n=29) and those undergoing surgery alone(n=64). Perineal wound healing was the primary outcome measurement. Condition of wound healing was classified as good, moderate, and poor and was compared between the two groups., Results: Twenty nine patients in the neoadjuvant group received preoperative regional radiation(50 Gy, 25 fractions/5 weeks) with synchronous FOLFOX4 chemotherapy(fluorouracil and oxaliplatin). In the neoadjuvant group, wound healing after APR was good in 18 patients(62.1%), moderate in 6(20.7%), and poor in 5(17.2%). In patients who had surgery alone, wound healing after APR was good in 41 patients(64.1%), moderate in 15(23.4%), and poor in 8(12.5%). There was no significant difference in the incidence of wound infection(poor wound healing)between the two groups(P=0.773)., Conclusion: Neoadjuvant chemoradiation therapy is not associated with increased perineal wound infection following abdominoperineal resection for low rectal cancer.

Objective: To compare the outcomes of right hemicolectomy performed either by the hand-assisted laparoscopic(HALS) or conventional laparoscopic surgery(LAS)., Methods: Ninety-five patients undergoing HALS(n=47) from March 2002 to November 2006 or by LAS (n=48) from January 2007 to December 2009 were retrospectively studied. All the operations were performed by the same surgical team. Patient safety, postoperative recovery, complications, oncologic outcomes, medical expenses, and the follow-up results were compared between the two groups., Results: No severe complications or perioperative deaths were oberved. There were significant differences between the two groups in terms of intraoperative bleeding, operative time, and length of incision(all P<0.05). However, the conversion rate, intraoperative injuries, time to first bowel movement, postoperative bed-rest time, hospital stay, time to first oral intake, and the number of patients requiring postoperative analgesia were comparable between the two groups(P>0.05). Length of surgical specimen was (25.6±9.9) cm in the HALS group and was (26.8±7.9) cm in the LAS group, the diffenence was not statistically significant(P<0.05). The mean number of lymph nodes retrieved in HALS group was 18.2±12.1, which was significantly lower than that in LAS group(24.1±9.3, P<0.05). The medical expense of the LAS group was (28 049.8±7576.1) RMB, which was significantly higher than that of the HALS group(21 132.7±5323.4) RMB(P<0.05). A follow-up rate of 93.7% was achieved in the HALS group with 3 patients lost to follow-up. The follow-up duration ranged from 45.4 to 101.9 months with a median of 66.7 months. In LAS group, the follow-up rate was 96% with 2 patients lost to follow-up and the follow-up duration ranged from 12.4 to 45.7 months with a median of 21.6 months. There was no significant difference in 3-year disease-free survival(91.3% vs. 87.9%, P>0.05) between the two groups., Conclusion: HALS and LAS can achieve similar minimal invasiveness efficacy and oncologic outcomes for right hemicolectomy.

Objective: To report a case of APPEAR performed using a laparoscopic-assisted approach., Methods: A laparoscopic-assisted APPEAR was performed with end-to-end anastomosis on October 12, 2010 for a patient with low rectal cancer who received neoadjuvant chemoradiation. After total mesorectal excision was completed laparoscopically, a crescent-shape incision was then made in the middle perineum. The distal part of the rectum was dissected with electrocautery. An double-stapling end-to-end anastomosis was performed after transaction of the rectum., Results: Total operative time was 195 minutes. The perineal approach cost 30 minutes. The estimated blood loss was 50 ml. First stoma output with flatus was on postoperative day 3, and the patient resumed liquid diet. The patient was discharged on postoperative day 7. There were no complications including pelvic sepsis, perineal infection, or anastomotic leak., Conclusion: The APPEAR procedure can be performed safely with the abdominal approach completed laparoscopically.

Objective: To compare the effects of presacral irrigation and simple drainage on the perineal wound healing in patients after abdominoperineal resection (APR)., Methods: From October 2004 to August 2009, patients with rectal cancer, ulcerative colitis or rectal gastrointestinal stromal tumor, who underwent APR or proctocolectomy, were randomized into two arms: simple drainage group (n = 37) and continuous irrigation (n = 37). Patients randomized to arm B received simple drainage only to presacral space; while those patients in arm A received continuous irrigation in addition to simple drainage. Perineal wound healing was taken as endpoint of this study. Major complication was defined as wound dehiscence or wound infection that the perineal wound should be reopened for drainage. Minor complication was defined as delayed healing wound with seroma or hematoma., Results: A total of 74 patients were enrolled in present study, with 37 patients in each arm, and there were 12 cases and 10 cases who received preoperative radiation therapy, respectively. In the arm A, 2 patients developed major complications, 3 patients incurred with minor complications and 32 patients got primary healing of the perineal wounds. In arm B, 8 patients suffered major complications, 3 patients incurred with minor complications and 26 patients got primary healing of the perineal wounds. The incidence of major complication was significantly lower in arm A (5.4% vs.21.6%, P = 0.042). Patients received preoperative radiation therapy had significantly higher rate of minor complications than patients underwent surgery only (18.2% vs. 3.9%, P = 0.039)., Conclusions: Simple drainage with continuous irrigation of the presacral space, in patients with abdominoperineal resection or proctocolectomy, could significantly lower the incidence of major complication and improve wound healing for perineal wound when compared with simple drainage only. Preoperative radiation therapy tends to increase the incidence of minor complications.

Objective: To identify the clinical pathologic factors predicting tumor response of preoperative neoadjuvant therapy in patients with rectal cancer., Methods: Seventy-nine patients with rectal cancer underwent neoadjuvant therapy before surgery from July 2000 to July 2009 were included in this study. Clinical pathologic factors were retrospectively analyzed to check the predicting effect of tumor response to the neoadjuvant therapy.Pathologic complete response (pCR) and T down-staging were the study endpoints., Results: Of the 79 patients, 10 cases (12.7%) got pCR after the neoadjuvant treatment. T down-staging was achieved in 41 patients (51.9%). The colonoscopy showed that the tumor occupied < or = 1/3 proportion of the bowel lumen in 22 patients, and 7 of them got pCR after the neoadjuvant therapy. Chi-square analysis showed that the proportion of tumor occupied in the bowel lumen was relevant to pCR rate (P < 0.05). Serum carcino-embryonic antigen (CEA) level was examined in 74 patients. Twenty-seven cases of the 46 patients with a serum CEA level < 5 microg/L got a T down-staging. Twenty-three cases of the 38 patients with a normal range of both serum CEA/CA19-9 levels got a T down-staging. Chi-square analysis showed normal range of both serum CEA/CA19-9 levels indicated better T down-staging., Conclusions: It's defined some possible predictive factors for effects of neoadjuvant therapy in patients with rectal cancer. Particularly, patients with less tumor occupation of the bowel lumen and a serum CEA level < 5 microg/L seem to be more likely to get better clinical results.

Objective: To study the impact of neoadjuvant therapy on lymph nodes retrieval in locally advanced mid-low rectal carcinoma., Methods: Data collected from 120 patients with locally advanced mid-low rectal cancer (T2-4 and/or N1-2M0) treated from January 2005 to June 2008 was investigated. The patients were divided into two groups: the study group (n=54) was treated with neoadjuvant therapy (preoperative radiation with a total dosage of 50 Gy and synchronous 5-Fu-based chemotherapy) followed by radical tumor resection 4-6 weeks after;the control group (n=66) underwent primary surgery without neoadjuvant therapy. The clinical stage was evaluated before and after neoadjuvant therapy. The total lymph nodes yields, as well as the tumor-positive lymph nodes of each resected specimen was compared between the two groups statistically., Results: Clinical downstage was achieved in 30 cases (56%) in study group after neoadjuvant therapy. The number of total lymph nodes and positive lymph nodes harvested from each resected specimen in the control group were 14+/-7 and 2.2+/-3.7, meanwhile those were 9+/-6 and 0.7+/-2.4 in study group, which were all significantly lower than those in control group (P<0.01)., Conclusions: Preoperative radiotherapy combined with chemotherapy can downstage the tumor and reduce the retrieval rate of total lymph nodes and positive lymph nodes in locally advanced rectal cancer. It is necessary to retrieve as many lymph nodes as possible for it has some prognostic significance for the patients.

Objective: To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms., Methods: Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases., Results: The mean diameter of the rectal lesions was (1.6 +/- 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 +/- 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall: 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right wall. Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7 +/- 32.1) min (range, 30-180 min). The mean operative blood loss was (9.8 +/- 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 +/- 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8. 4 months (range, 3-26 months), no tumor recurrence or metastasis was observed., Conclusion: Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.

Objective: To evaluate the clinical value of diffusion weighted imaging (DWI) combined with conventional sequences of magnetic resonance imaging (T1 and T2-weighted imaging) for the diagnosis of rectal cancer., Methods: DWI and conventional sequences were performed in 29 patients with endoscopically diagnosed rectal cancer and 15 patients without rectal cancer. Two doctors who were blind to the history of the patients interpreted the imaging findings. The sensitivity and specificity of conventional sequences with and without DWI were analyzed using receiver operating characteristic curve (ROC)., Results: The areas under ROC were 0.915 and 0.930 for conventional sequences alone, and 0.990 and 0.994 for conventional sequences with DWI, respectively, indicating that although both of them were optimal methods for the diagnosis of rectal cancer, the accuracy of conventional sequences with DWI was significantly superior to that of conventional sequence alone (P < 0.05). The Kappa value was 0.850 for conventional sequences alone and 0.858 for DWI with conventional sequences., Conclusion: DWI was necessary for the diagnosis of rectal cancer when performing conventional sequences.

Objective: To summarize the clinical features and surgical methods for colorectal cavernous hemangioma in China., Methods: Data of 4 cases in Peking Union Medical College Hospital and 54 cases with colorectal cavernous hemangioma from 1979 to 2006 reported in Chinese literatures were analyzed retrospectively, including clinic manifestations and surgery treatment., Results: The incidence of male to female was 1.0:1.0, and 43.1% of the patients had their first onset of recurrent rectal bleeding in early childhood. Colonoscopy, rectal CT scan and MRI were the accurate methods for the diagnosis (100%). 91.4% of the patients had diffuse infiltrative lesions and 8.6% of the patients had localized lesions. 82.8% of the patients underwent surgical treatment while 3.5% of the patient did not received treatment., Conclusions: Colonoscopy is the first choice for the diagnosis of colorectal cavernous hemangioma. Local resection should be performed for the localized cavernous hemangioma. Sigmoid colon and rectum resection with coloanal anastomosis is suitable for the diffuse and infiltrative colorectal cavernous hemangioma.