Comparison of Short-term and Three-year Oncological Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Large Multicenter Cohort Study

OBJECTIVE

To compare the short-term and long-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer.

BACKGROUND

The clinical outcomes of RG over LG have not yet been effectively demonstrated.

METHODS

This retrospective cohort study included 3599 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals in China from January 2015 to June 2019. Propensity score matching was performed between patients who received RG and LG. The primary end point was 3-year disease-free survival (DFS).

RESULTS

After 1:1 propensity score matching, 1034 pairs of patients were enrolled in a balanced cohort for further analysis. The 3-year DFS in the RG and LG was 83.7% and 83.1% ( P =0.745), respectively, and the 3-year overall survival was 85.2% and 84.4%, respectively ( P =0.647). During 3 years of follow-up, 154 patients in the RG and LG groups relapsed (cumulative incidence of recurrence: 15.0% vs 15.0%, P =0.988). There was no significant difference in the recurrence sites between the 2 groups (all P >0.05). Sensitivity analysis showed that RG had comparable 3-year DFS (77.4% vs 76.7%, P =0.745) and overall survival (79.7% vs 78.4%, P =0.577) to LG in patients with advanced (pathologic T2-4a) disease, and the recurrence pattern within 3 years was also similar between the 2 groups (all P >0.05). RG had less intraoperative blood loss, lower conversion rate, and shorter hospital stays than LG (all P >0.05).

CONCLUSIONS

For resectable gastric cancer, including advanced cases, RG is a safe approach with comparable 3-year oncological outcomes to LG when performed by experienced surgeons.

Comparison of short-term efficacy analysis of medium-rectal cancer surgery with robotic natural orifice specimen extraction and robotic transabdominal specimen extraction

BACKGROUND

With the development of minimally invasive technology, the trauma caused by surgery get smaller, At the same time, the specimen extraction surgery through the natural orifice is more favored by experts domestically and abroad, robotic surgery has further promoted the development of specimen extraction surgery through the natural orifice. The aim of current study is to compare the short-term outcomes of robotic-assisted natural orifice specimen extraction (NOSES ) and transabdominal specimen extraction(TRSE ) in median rectal cancer surgery.

METHODS

From January 2020 to January 2023, 87 patients who underwent the NOSES or TRSE at the First Affiliated Hospital of Nanchang University were included in the study, 4 patients were excluded due to liver metastasis. Of these, 50 patients were in the TRSE and 33 patients in the NOSES. Short-term efficacy was compared in the two groups.

RESULTS

The NOSES group had less operation time (P < 0.001), faster recovery of gastrointestinal function (P < 0.001), shorter abdominal incisions (P < 0.001), lower pain scores(P < 0.001). lower Inflammatory indicators of the white blood cell count and C-reactive protein content at 1, 3, and 5 days after surgery (P < 0.001, P = 0.037). There were 9 complications in the NOSES group and 11 complications in the TRSE group(P = 0.583). However, there were no wound complications in the NOSES group. The number of postoperative hospital stays seems to be same in the two groups. And there was no significant difference in postoperative anus function (P = 0.591).

CONCLUSIONS

This study shows that NOSES and TRSE can achieve similar radical treatment effects, NOSES is a feasible and safe way to take specimens for rectal cancer surgery in accordance with the indication for NOSES.

Robotic natural orifice specimen extraction surgery I-type F method vs conventional robotic resection for lower rectal cancer

BACKGROUND

Robotic resection using the natural orifice specimen extraction surgery I-type F method (R-NOSES I-F) is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer. However, the current literature on this method is limited to case reports, and further investigation into its safety and feasibility is warranted.

AIM

To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.

METHODS

From September 2018 to February 2022, 206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis. Of these patients, 22 underwent R-NOSES I-F surgery (R-NOSES I-F group) and 76 underwent conventional robotic-assisted low rectal cancer resection (RLRC group). Clinicopathological data of all patients were collected and analyzed. Postoperative outcomes and prognoses were compared between the two groups. Statistical analysis was performed using SPSS software.

RESULTS

Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1 (1.7 ± 0.7 vs 2.2 ± 0.6, P = 0.003) and shorter postoperative anal venting time (2.7 ± 0.6 vs 3.5 ± 0.7, P < 0.001) than those in the RLRC group. There were no significant differences between the two groups in terms of sex, age, body mass index, tumor size, TNM stage, operative time, intraoperative bleeding, postoperative complications, or inflammatory response (P > 0.05). Postoperative anal and urinary functions, as assessed by Wexner, low anterior resection syndrome, and International Prostate Symptom Scale scores, were similar in both groups (P > 0.05). Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups (P > 0.05).

CONCLUSION

R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer. It improves pain relief, promotes gastrointestinal function recovery, and helps avoid incision-related complications.

Comparison of robotic-assisted and laparoscopic-assisted natural orifice specimen extraction surgery in short-terms outcomes of middle rectal cancer

BACKGROUND

Surgery is becoming less invasive as technology advances. Natural orifice specimen extraction surgery (NOSES) ushered in a new era of minimally invasive techniques. At the same time, NOSES is gaining popularity in the world. With their distinct advantages, surgical robots have advanced the development of NOSES. The aim of current study was to compare the short-term outcomes between robotic-assisted NOSES and laparoscopic-assisted NOSES for the treatment of middle rectal cancer.

METHODS

Patients with middle rectal cancer who underwent robotic-assisted or laparoscopic-assisted NOSES at the First Affiliated Hospital of Nanchang University between January 2020 and June 2022 had their clinicopathological data collected retrospectively. 46 patients were enrolled in the study: 23 in the robotic group and 23 in the laparoscopic group. Short-term outcomes and postoperative anal function in the two groups were compared.

RESULTS

There was no significant difference in the clinicopathological data between the two groups. The robotic group had less intraoperative blood loss (p = 0.04), less postoperative abdominal drainage (p = 0.02), lower postoperative white blood cell counts (p = 0.024) and C-reactive protein levels (p = 0.017), and shorter catheter removal time when compared to the laparoscopic group (p = 0.003). Furthermore, there were no significant difference in mean operative time (159 ± 31 min vs 172 ± 41 min) between the robotic and laparoscopic groups (p = 0.235), but time to naked the rectum (86.4 ± 20.9 min vs. 103.8 ± 31.5 min p = 0.033) and time of digestive tract reconstruction (15.6 ± 3.88 min vs. 22.1 ± 2.81 min p < 0.01) in the robotic group were significantly shorter than laparoscopic group. The robotic group had lower postoperative Wexner scores than the laparoscopic group.

CONCLUSIONS

This research reveals that combining a robotic surgical system and NOSES results in superior outcomes, with short-term outcomes preferable to laparoscopic-assisted NOSES.

Role of minimally invasive techniques in gastrointestinal surgery: Current status and future perspectives

In recent years, the incidence of gastrointestinal cancer has remained high. Currently, surgical resection is still the most effective method for treating gastrointestinal cancer. Traditionally, radical surgery depends on open surgery. However, traditional open surgery inflicts great trauma and is associated with a slow recovery. Minimally invasive surgery, which aims to reduce postoperative complications and accelerate postoperative recovery, has been rapidly developed in the last two decades; it is increasingly used in the field of gastrointestinal surgery and widely used in early-stage gastrointestinal cancer. Nevertheless, many operations for gastrointestinal cancer treatment are still performed by open surgery. One reason for this may be the challenges of minimally invasive technology, especially when operating in narrow spaces, such as within the pelvis or near the upper edge of the pancreas. Moreover, some of the current literature has questioned oncologic outcomes after minimally invasive surgery for gastrointestinal cancer. Overall, the current evidence suggests that minimally invasive techniques are safe and feasible in gastrointestinal cancer surgery, but most of the studies published in this field are retrospective studies and case-matched studies. Large-scale randomized prospective studies are needed to further support the application of minimally invasive surgery. In this review, we summarize several common minimally invasive methods used to treat gastrointestinal cancer and discuss the advances in the minimally invasive treatment of gastrointestinal cancer in detail.

[Efficacy comparison between robot-assisted and laparoscopic surgery for mid-low rectal cancer: a prospective randomized controlled trial]

Objective: To compare the short- and long-term outcomes of robot-assisted and laparoscopic radical resection for mid-low rectal cancer. Methods: A prospective randomized controlled trial was conducted. A total of 130 patients with mid-low rectal cancer (inclusion criteria: age > 18 or ≤80 years old; pathological diagnosis of rectal adenocarcinoma by colonoscopy; distance from tumor to the anal verge ≤12 cm; no distant metastasis; cT1-3N0-1 or ycT1-3 after neoadjuvant radiotherapy and chemotherapy; suitable for laparoscopic and robotic surgery) at the Department of Colorectal Surgery of the First Affiliated Hospital of Nanchang University from October 2016 to September 2018 were prospectively enrolled. According to computer-generated random number method, patients were randomly divided into the robot group (n=66) and laparoscopy group (n=64), and underwent robot-assisted surgery or laparoscopic surgery respectively. Clinicopathological data of all the patients were collected and analyzed. The demographic parameters, short- and long-term outcomes were compared between two groups. Results: One patient in robot group whose postoperative sample was diagnosed as rectal adenoma by pathology was excluded. There were no statistically significant differences in age, sex, BMI, ASA classification, distance from tumor to the anal verge, serum CEA level, CA199 level between two groups (all P>0.05). Operations were successfully performed in all the patients without conversion to open operation. Robotic surgery was found to be associated with less intraoperative blood loss than laparoscopic surgery [(73.4±49.7) ml vs. (119.1±65.7) ml, t=-4.461, P<0.001], while there were no statistically significant differences in surgical procedures, operation time, time to first flatus, time to first liquid intake, time to removal of catheter or postoperative hospital stay between two groups (all P>0.05). Besides, there was no significant difference in the morbidity of postoperative complication between two groups [10.8% (7/65) vs. 12.5 (8/64), χ(2)=4.342, P=0.720]. The median number of harvested lymph node in the robot group and the laparoscopy group was 15.7±6.2 and 13.8±6.1 (t=1.724, P=0.087). There were no significant differences between two groups in tumor sample length, distance between proximal and distal resection margin, integrity grade of TME specimen, number of positive lymph nodes, postoperative pathological stage and tumor differentiation (all P>0.05). The distal resection margin of samples in two groups was all negative. One case in the robot group was found to have positive circumferential resection margin. The median follow up was 24 (9 to 31) months. In the robot group and the laparoscopy group, the 2-year overall survival rate was 95.4% and 90.6% respectively; the 2-year disease-free survival rate was 90.8% and 85.9% respectively, whose differences were not significant (both P>0.05). Conclusion: Robot-assisted radical resection for mid-low rectal cancer can achieve similar short-term and long-term outcomes of laparoscopic resection, while robot-assisted surgery can decrease blood loss during operation, leading to more precise practice in minimally invasive surgery.

[Key points and skills of assistant in robotic radical gastrectomy for gastric cancer]

An excellent assistant for robotic radical gastrectomy can play an important role in the operation, especially in a initial team. In robotic gastric cancer surgery, an excellent assistant should actively participate in the operation process, choose the appropriate trocar position according to patient's body habitus. Moreover, he should master various surgical instruments skillfully and switch instruments fluently to assist the surgeon to expose key parts during operation, and provide effective help in the operative details, so that the whole operation process can run more smoothly and the operation efficiency and quality will be greatly improved. The growth of the assistants needs constant practice and summary of experience. Meanwhile, the encouragement of the chief surgeon also plays a positive role in promoting the development of the assistants.

Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Reports in the field of robotic surgery for gastric cancer are increasing. However, studies only on patients with advanced gastric cancer (AGC) are lacking. This retrospective study was to compare the short-term outcomes of robotic-assisted distal gastrectomy (RADG) and laparoscopic-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for AGC. From December 2014 to November 2019, 683 consecutive patients with AGC underwent mini-invasive assisted distal gastrectomy. Propensity-score matching (PSM) analysis was conducted to reduce patient selection bias. Short-term outcomes were compared between the two groups. The clinical features were well matched in the PSM cohort. Compared with the LADG group, the RADG group was associated with less operative blood loss, a lower rate of postoperative blood transfusion, less volume of abdominal drainage, less time to remove abdominal drainage tube, retrieved more lymph node, and lower rates of surgical complications and pancreatic fistula (P <0.05). However, the time to recovery bowel function, the length of postoperative stay, the rates of other subgroups of complications and unplanned readmission were similar between the two groups (P > 0.05). This study suggests that RADG is a safe and feasible technique with better short-term outcomes than LADG for AGC.

Robotic- vs laparoscopic-assisted proctectomy for locally advanced rectal cancer based on propensity score matching: Short-term outcomes at a colorectal center in China

BACKGROUND

Reports in the field of robotic surgery for rectal cancer are increasing year by year. However, most of these studies enroll patients at a relatively early stage and have small sample sizes. In fact, studies only on patients with locally advanced rectal cancer (LARC) and with relatively large sample sizes are lacking.

AIM

To investigate whether the short-term outcomes differed between robotic-assisted proctectomy (RAP) and laparoscopic-assisted proctectomy (LAP) for LARC.

METHODS

The clinicopathological data of patients with LARC who underwent robotic- or laparoscopic-assisted radical surgery between January 2015 and October 2019 were collected retrospectively. To reduce patient selection bias, we used the clinical baseline characteristics of the two groups of patients as covariates for propensity-score matching (PSM) analysis. Short-term outcomes were compared between the two groups.

RESULTS

The clinical features were well matched in the PSM cohort. Compared with the LAP group, the RAP group had less intraoperative blood loss, lower volume of pelvic cavity drainage, less time to remove the pelvic drainage tube and urinary catheter, longer distal resection margin and lower rates of conversion (P < 0.05). However, the time to recover bowel function, the harvested lymph nodes, the postoperative length of hospital stay, and the rate of unplanned readmission within 30 days postoperatively showed no difference between the two groups (P > 0.05). The rates of total complications and all individual complications were similar between the RAP and LAP groups (P > 0.05).

CONCLUSION

This retrospective study indicated that RAP is a safe and feasible method for LARC with better short-term outcomes than LAP, but we have to admit that the clinically significant of part of indicators are relatively small in the practical situation.

An NIF-doped ZIF-8 hybrid membrane for continuous antimicrobial treatment

Sodium alginate (ALG) composites with ZIF-8 and niflumic acid (NIF) were prepared by a one-pot method at room temperature and characterized by FTIR, SEM and XRD studies. In the composite, ZIF-8 was used as a highly connected node in a supercrosslinked polymer network. In addition, the material exhibits good antibacterial activity against Staphylococcus aureus and Escherichia coli in vitro. Compared to the original ALG membrane and ZIF-8, the ZIF–NIF–ALG membrane has the following advantages: stronger antibacterial properties; slow release of Zn(ii); high drug loading; and longer sustained release time. This research introduces new concepts for the design and manufacture of various antimicrobial membranes and broadens the range of applications of MOFs.

A ZIF-8 hybrid film has shows continuous medical effects, with including antibacterial and anti-inflammatory effects.

[Short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction]

Objective: To explore the short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction. Methods: A cohort study was carried out. The clinical data of consecutive patients with high rectal cancer who underwent robotic radical resection at the Department of General Surgery of The First Affiliated Hospital of Nanchang University from June 2017 to January 2018 were retrospectively analyzed. Inclusion criteria: (1) preoperative diagnosis of rectal cancer, and distance from tumor to anal margin≥10 cm undercolonoscopy; (2) T1-3 assessed by preoperative imaging examination, and no distant metastasis; (3) female, age≥50 years old, body mass index ≤ 30 kg/m(2); (4) without radiotherapy and chemotherapy before surgery; (5) implementation of robotic radical surgery for high rectal cancer. Fourteen female patients undergoing transvaginal removal of specimen without abdominal incision were included in the no incision group with age of (62.2±9.3) years old and distance from tumor to anal verge of (12.5±0.9) cm. As the match of 1:2, 28 simultaneous patients of high rectal cancer undergoing traditional robotic surgery (surgery interval <8 months) were enrolled to the control group, with age of (60.6±12.8) years old and distance from tumor to anal verge of (11.3±3.8) cm. Short-term efficacy and safty were compared between two groups. Follow-up ended in September 2018. Results: There was no significant difference in baseline data between the two groups (all P>0.05). Compared with the control group, the no incision group had longer operation time [(149.6±15.6) minutes vs. (130.9±12.9) minutes, t=-4.135, P<0.001], shorter time to postoperative flatus [(40.9 ±2.6) hours vs. (51.9±2.9) hours, t=12.049, P<0.001], lower pain score on the operation day and the first day after surgery (using Changhaipainstick) [(3.1±0.4) points vs. (4.6±0.7) points, t=7.458, P<0.001; (2.5±0.3) points vs. (3.3±0.5) points, t=6.142, P<0.001], shorter time to ground activity [(15.6±2.0) hours vs. (24.3±2.5) hours, t=11.102, P=0.030], and shorter postoperative hospital stay [(6.1±0.8) days vs. (7.2±1.3) days, t=2.806, P=0.008], whose differences were statistically significant. There were no significant differences in intraoperative blood loss, proportion of postoperative analgesia patients, and complication within 30 days after surgery (all P>0.05). In the no incision group and the control group,the tumor size was (3.1±0.4) cm and (3.6±0.9) cm, the proximal margin distance was (9.1±1.5) cm and (9.8±1.5) cm, the distal margin distance was (4.3±0.4) cm and (4.5±0.4) cm, the number of harvested lymph node was 15.8±2.4 and 15.2 ± 2.5, and the number of positive lymph node was 0.6±1.3 and 1.1±2.4, respectively, whose differences were not statistically significant (all P>0.05). The mean followed-up period was 10 months (7-14 months) in the no incision group, and 14 months (10-18 months) in the control group. No local recurrence and distant metastasis were found in both groups. Conclusion: Robotic radical resection for high rectal cancer with transvaginal specimen extraction is safe and feasible with advantages of rapid postoperative recovery, less postoperative pain and short hospital stay.

Robotic-assisted versus conventional laparoscopic-assisted total gastrectomy with D2 lymphadenectomy for advanced gastric cancer: short-term outcomes at a mono-institution

BACKGROUND

Robotic-assisted surgery, a developed technology, is becoming more and more accepted by surgeons. However, the comparison between robotic-assisted total gastrectomy (RATG) and conventional laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC) is seldom reported, or usually the sample sizes reported are small. The current research was designed to compare the short-term outcomes of RATG and LATG with D2 lymphadenectomy for AGC in a mono-institution from China.

METHODS

A total of 205 patients from June 2015 to October 2018 were included in this study. Among them, 106 patients underwent LATG, and 99 patients underwent RATG. The patients' clinicopathological characteristics, surgical performance and short-term outcomes were retrospectively analyzed.

RESULTS

The clinicopathological characteristics showed no difference between the LATG group and the RATG group. However, compared with the LATG group, the operation time was longer (P = 0.000), and the operative blood loss (P = 0.000) and the volume of abdominal drainage was less (P = 0.000) in the RATG group. Moreover, the RATG took less time to remove abdominal drainage tube than LATG (P = 0.000). The plasma levels of CRP at 72 h post-operation was lower (P = 0.000), and the number of retrieved lymph nodes was more (P = 0.000) in the RATG group. Nevertheless, the postoperative length of stay (P = 0.890), the time to first flatus (P = 0.448), the postoperative complication (P = 0.915) and the visual analogue pain score at 24 h post-operation (P = 0.457) were comparable between the two groups.

CONCLUSIONS

RATG with D2 lymphadenectomy shows safety and feasibility for AGC and could be served as an alternative treatment for AGC in the future.

Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection: A case report and literature review

RATIONALE

Synchronous double malignancies, including carcinoma of the ampulla of Vater and rectal carcinoma, are generally uncommon occurrences in the gastrointestinal tract.

PATIENT CONCERNS

The present study report a case of a 37-year-old man who was incidentally found to suffer from carcinoma of the ampulla of Vater and rectal carcinoma.

DIAGNOSES

The duodenoscopy was performed and revealed an ulcerated and bulky ampulla of Vater, the biopsy from which revealed a moderate-differentiated adenocarcinoma, A local hospital colonoscopy confirmed a tumor located in rectal 7 cm from the anal margin and biopsy-confirmed poorly differentiated adenocarcinoma.

INTERVENTIONS

About such patient treatment, both open and laparoscopic surgery are restricted because of operation complexity, large injury, and poor cosmetic effect. surgery performed using Da Vinci robotic surgical system (DVSS).

OUTCOMES

No evidence of recurrence or relapses was found in the first year after surgery.

LESSONS

Although sporadic double malignancies are uncommon, they should be considered when evaluating cancer patients. Complex surgery performed by robotic surgery may became surgeon's preferred treatment modality.

A novel mutation in PRPF31, causative of autosomal dominant retinitis pigmentosa, using the BGISEQ-500 sequencer

AIM

To study the genes responsible for retinitis pigmentosa.

METHODS

A total of 15 Chinese families with retinitis pigmentosa, containing 94 sporadically afflicted cases, were recruited. The targeted sequences were captured using the Target_Eye_365_V3 chip and sequenced using the BGISEQ-500 sequencer, according to the manufacturer's instructions. Data were aligned to UCSC Genome Browser build hg19, using the Burroughs Wheeler Aligner MEM algorithm. Local realignment was performed with the Genome Analysis Toolkit (GATK v.3.3.0) IndelRealigner, and variants were called with the Genome Analysis Toolkit Haplotypecaller, without any use of imputation. Variants were filtered against a panel derived from 1000 Genomes Project, 1000G_ASN, ESP6500, ExAC and dbSNP138. In all members of Family ONE and Family TWO with available DNA samples, the genetic variant was validated using Sanger sequencing.

RESULTS

A novel, pathogenic variant of retinitis pigmentosa, c.357_358delAA (p.Ser119SerfsX5) was identified in PRPF31 in 2 of 15 autosomal-dominant retinitis pigmentosa (ADRP) families, as well as in one, sporadic case. Sanger sequencing was performed upon probands, as well as upon other family members. This novel, pathogenic genotype co-segregated with retinitis pigmentosa phenotype in these two families.

CONCLUSION

ADRP is a subtype of retinitis pigmentosa, defined by its genotype, which accounts for 20%-40% of the retinitis pigmentosa patients. Our study thus expands the spectrum of PRPF31 mutations known to occur in ADRP, and provides further demonstration of the applicability of the BGISEQ500 sequencer for genomics research.

Comparison of short-term outcomes between robotic-assisted and laparoscopic surgery for rectal cancer

AIM: To compare the short-term outcomes of robotic-assisted and laparoscopic radical resection for rectal cancer.

METHODS: The clinical data for 120 rectal cancer patients treated from December 2014 to January 2016 at the First Affiliated Hospital of Nanchang University were analyzed retrospectively, of whom 63 underwent robotic surgery (robotic group) and 57 underwent laparoscopic surgery (laparoscopic group). Operative details, postoperative recovery and postoperative complications were compared between the two groups.

RESULTS: Operative time was significantly longer in the robotic group than in the laparoscopic group (161.1 min ± 41.4 min vs 135.5 min ± 39.1 min, P = 0.001). Intra-oprerative blood loss in the robotic group was significantly less than that in the laparoscopic group (104.8 mL ± 70.8 mL vs 140.3 mL ± 81.4 mL, P = 0.013). The anal sphincter preservation rate was significantly higher in the robotic group than in the laparoscopic group [65.0% (13/20) vs 25.0% (4/16), P = 0.017]. The time to first postoperative exhaust, time to resume liquid food and time to remove the urinary catheter were significantly shorter in the robotic group than in the laparoscopic group (P < 0.05). The cost was significantly higher in the robotic group than in the laparoscopic group (27.0 thousand yuan ± 11.0 thousand yuan vs 43.0 thousand yuan ± 13.0 thousand yuan, P = 0.000). No conversion occurred in the two groups. There was no significant difference between the two groups in terms of length of specimens, length of distal margin, number of resected lymph nodes, postoperative hospital stay and incidence of postoperative complications (P > 0.05).

CONCLUSION: The robotic rectal cancer surgery can achieve a similar radical therapeutic effect to laparoscopic surgery. Moreover, it has the advantages of less trauma, less intraoperative bleeding, faster recovery, and higher anus preserving rate.

Clinical significance of flotillin-1 overexpression in human gastric cancer

AIM: To investigate the expression of flotillin-1 (FLOT1) protein in gastric cancer and analyze their correlation with pathological characteristics and prognosis.

METHODS: We detected the FLOT1 expression in fresh gastric cancer samples and matched adjacent noncancerous tissue samples by real-time florescence quantitative PCR (qRT-PCR) (n = 16) and Western blot analysis (n = 16). Additionally, immunohistochemistry was performed to examine FLOT1 protein expression in paraffin-embedded gastric carcinoma tissues and matched normal specimens from 187 gastric cancer patients. Statistical analyses were applied to evaluate the associations of FLOT1 expression with clinical parameters and prognosis.

RESULTS: FLOT1 mRNA and protein levels were evidently up-regulated in gastric cancer tissues compared with adjacent non-cancerous tissue samples (13/16; 12/16). FLOT1 expression in gastric cancer tissues was significantly higher than that in corresponding adjacent normal tissues (92.35% vs 26.67%, P < 0.05). Expression of FLOT1 in tumor tissue was not significantly associated with gender, age, tumor size, differentiation status or tumor location. However, elevated FLOT1 expression was strongly correlated with depth of invasion (P = 0.000), lymph node metastasis (P = 0.000), distant metastasis (P = 0.000), and AJCC stage (P = 0.016). Elevated FLOT1 cases had a poor prognosis.

CONCLUSION: FLOT1 expression is significantly correlated with depth of invasion and distant metastasis. FLOT1 may be used as an early diagnostic marker and therapeutic target for gastric carcinoma.

Identification of novel compound heterozygous RECQL4 mutations and prenatal diagnosis of Baller-Gerold syndrome: a case report

Birth defects are structural and/or functional malformations present at birth that cause physical or mental disability and are important public health problems. Our study was aimed at genetic analysis and prenatal diagnosis of congenital anomalies to understand the cause of certain birth defects. Karyotypes and array-comparative genomic hybridization (aCGH) were performed on a pregnant woman, surrounding amniotic fluid, and her husband. A short-stature panel genetic test was conducted in accordance with the phenotype of the fetus. Following examination, it was determined that the karyotype and aCGH results were normal. The RECQL4 gene in the fetus showed compound heterozygous mutations, and each parent was found to be a carrier of one of the mutations. The two heterozygous mutations (c.2059-1G>C and c.2141_2142delAG) were detected in the RECQL4 (NM_004260) gene in the fetus; therefore, the fetus was predicted to have Baller-Gerold syndrome. These two mutations have not previously been reported. In addition, these results identified a 25% risk of the parents having a sec-ond conceptus with this congenital disease. Therefore, prenatal genetic diagnosis was highly recommended for future pregnancies.

alpha-Crystallin downregulates the expression of TNF-alpha and iNOS by activated rat retinal microglia in vitro and in vivo

PURPOSE

Inhibition of microglial activation has become an important strategy to attenuate neurotoxic damage to the central nervous system. We evaluated the effects of alpha-crystallin on the production of cytokines in lipopolysaccharides (LPS) and optic nerve injury-activated retinal microglia.

METHODS

Microglia were collected from retinas of newborn rats, cultured and treated with LPS in vitro. Microglia were also activated by an optic nerve crush in vivo. Pretreatments with and without alpha-crystallin were performed in cultured cells, and by intravitreal injection in adult rats. Expression of tumor necrosis factor-alpha (TNF-alpha), nitric oxide (NO) and inducible NOS synthase (iNOS) were measured by RT-PCR, ELISA, Western blot and the nitrate reductase method.

RESULTS

Activated microglia significantly upregulated TNF-alpha and iNOS mRNA expression and protein production in vitro. An optic nerve crush also increased expression of retinal iNOS and TNF-alpha protein. Treatment with alpha-crystallin in vitro and in vivo downregulated their expression.

CONCLUSION

The protective effect of alpha-crystallin may be due to its effect on microglia via a downregulation in the expression and release of 2 key immune regulatory and inflammatory molecules: TNF-alpha and iNOS.

Effects of bee venom peptidergic components on rat pain-related behaviors and inflammation

To identify the active components of honeybee venom in production of inflammation and pain-related behaviors, five major peptidergic subfractions were separated, purified and identified from the whole honeybee venom. Among them, four active peptidergic components were characterized as apamin, mast-cell degranulating peptide (MCDP), phospholipase A(2) (PLA(2))-related peptide and melittin, respectively. All five subfractions were effective in production of local inflammatory responses (paw edema) in rats although the efficacies were different. Among the five identified subfractions, only MCDP, PLA(2)-related peptide and melittin were able to produce ongoing pain-related behaviors shown as paw flinches, while only apamin and melittin were potent to produce both thermal and mechanical hypersensitivity. As shown in our previous report, melittin was the most potent polypeptide in production of local inflammation as well as ongoing pain and hypersensitivity. To further explore the peripheral mechanisms underlying melittin-induced nociception and hypersensitivity, a single dose of capsazepine, a blocker of thermal nociceptor transient receptor potential vanilloid receptor 1, was treated s.c. prior to or after melittin administration. The results showed that both pre- and post-treatment of capsazepine could significantly prevent and suppress the melittin-induced ongoing nociceptive responses and thermal hypersensitivity, but were without influencing mechanical hypersensitivity. The present results suggest that the naturally occurring peptidergic substances of the whole honeybee venom have various pharmacological potencies to produce local inflammation, nociception and pain hypersensitivity in mammals, and among the five identified reverse-phase high pressure liquid chromatography subfractions (four polypeptides), melittin, a polypeptide occupying over 50% of the whole honeybee venom, plays a central role in production of local inflammation, nociception and hyperalgesia or allodynia following the experimental honeybee's sting. Peripheral transient receptor potential vanilloid receptor 1 is likely to be involved in melittin-produced ongoing pain and heat hyperalgesia, but not mechanical hyperalgesia, in rats.