Fibroblast-derived CXCL12/SDF-1α promotes CXCL6 secretion and co-operatively enhances metastatic potential through the PI3K/Akt/mTOR pathway in colon cancer

AIM

To investigate the underlying mechanism by which CXCL12 and CXCL6 influences the metastatic potential of colon cancer and internal relation of colon cancer and stromal cells.

METHODS

Western blotting was used to detect the expression of CXCL12 and CXCL6 in colon cancer cells and stromal cells. The co-operative effects of CXCL12 and CXCL6 on proliferation and invasion of colon cancer cells and human umbilical vein endothelial cells (HUVECs) were determined by enzyme-linked immunosorbent assay, and proliferation and invasion assays. The angiogenesis of HUVECs through interaction with cancer cells and stromal cells was examined by angiogenesis assay. We eventually investigated activation of PI3K/Akt/mTOR signaling by CXCL12 involved in the metastatic process of colon cancer.

RESULTS

CXCL12 was expressed in DLD-1 cancer cells and fibroblasts. The secretion level of CXCL6 by colon cancer cells and HUVECs were significantly promoted by fibroblasts derived from CXCL12. CXCL6 and CXCL2 could significantly enhance HUVEC proliferation and migration (P < 0.01). CXCL6 and CXCL2 enhanced angiogenesis by HUVECs when cultured with fibroblast cells and colon cancer cells (P < 0.01). CXCL12 also enhanced the invasion of colon cancer cells. Stromal cell-derived CXCL12 promoted the secretion level of CXCL6 and co-operatively promoted metastasis of colon carcinoma through activation of the PI3K/Akt/mTOR pathway.

CONCLUSION

Fibroblast-derived CXCL12 enhanced the CXCL6 secretion of colon cancer cells, and both CXCL12 and CXCL6 co-operatively regulated the metastasis via the PI3K/Akt/mTOR signaling pathway. Blocking this pathway may be a potential anti-metastatic therapeutic target for patients with colon cancer.

Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis

BACKGROUND

Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC).

METHOD

Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis.

RESULTS

The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05).

CONCLUSIONS

The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.

Expression of cyclooxygenase-2 and vascular endothelial growth factor-C correlates with lymphangiogenesis and lymphatic invasion in human gastric cancer

BACKGROUND

Recent observations have suggested that overexpression of cyclooxygenase-2 (COX-2) promotes tumor lymphangiogenesis through an upregulation of vascular endothelial growth factor-C (VEGF-C) expression. It is unclear whether this mechanism also acts in gastric cancer. The aim of this study was to determine the relationship between COX-2 and VEGF-C expression in human gastric cancer, as well as to correlate with lymph node involvement, prognosis, and other clinicopathologic parameters.

METHODS

Sixty-eight primary gastric cancers were immunohistochemically examined for COX-2, VEGF-C, vascular endothelial growth factor receptor-3 (VEGFR-3, also known as Flt-4), and CD34 expressions. Assessment of Flt-4-positive vessel density (FVD) and microvessel density (MVD) was performed. Then we analyzed their relationships and correlations with clinicopathologic findings and patients' survival time.

RESULTS

The positivity rate of COX-2 and VEGF-C in the primary tumor was 67.7 and 54.4 percent, respectively. A significant correlation was found between the expression of VEGF-C and COX-2, and both were also correlated to MVD, FVD, lymphatic invasion, and TNM stage (p<0.05). COX-2 immunoreactivity was also associated with lymph node metastasis and serosa invasion. Increased MVD was significantly associated with lymph node metastasis and TNM stage. Both COX-2 and VEGF-C expression significantly correlated with poorer prognosis.

CONCLUSIONS

Our data suggest that the expression of COX-2 correlates with VEGF-C expression and both of them correlate with the presence of lymphatic invasion and prognosis in gastric cancer. COX-2-mediated VEGF-C overexpression might promote lymphatic invasion via lymphangiogenesis pathway in patients with gastric cancer.

The Anti-proliferative Effects of Recombinant Human Lysozyme on Human Gastric Cancer Cells

We investigated the anti-proliferative effects of recombinant human lysozyme (rHlys) on gastric cancer cell lines and normal human lung fibroblasts. Using conventional molecular cloning techniques we purified rHlys, which we incubated with cultured cells and measured the effects on cell proliferation and viability. At concentrations of 100 and 1000 μg/l, rHlys significantly inhibited the growth of human gastric cancer cell lines. In contrast, 10 and 50 μg/l of rHlys stimulated gastric cancer cell growth. None of the concentrations of rHlys affected cell viability. Only the highest concentration of rHlys (1000 μg/l) inhibited human lung fibroblast growth. Our results suggest that 100 μg/l is the optimum growth inhibiting concentration, which inhibited cancer cell growth but not normal cell growth. Our in vitro findings suggest that genetically engineered rHlys might inhibit human gastric cancer cell proliferation in vivo, so it might warrant further investigation as a potential novel anti-cancer agent.

RAPTOR promotes colorectal cancer proliferation by inducing mTORC1 and upregulating ribosome assembly factor URB1

Mammalian target of rapamycin complex 1 (mTORC1) is evolutionally conserved and frequently activated in various tumors, including colorectal cancer (CRC). It has been reported that the ribosome assembly factor Urb1 acts downstream of mTORC1/raptor signaling and contributes to digestive organ development in zebrafish. Previously, we highlighted that URB1 was overexpressed in CRC. Here, we assessed the mTORC1/regulatory associated protein with mTOR (RAPTOR)-URB1 axis in CRC tumorigenesis. We found that RAPTOR was overexpressed in CRC tissues and cell lines, was a favorable predictor in patients with CRC, and positively correlated with URB1. Silencing of RAPTOR suppressed CRC cell proliferation and migration and induced cell cycle arrest and apoptosis in vitro and inhibited xenograft growth in vivo. Moreover, ectopic overexpression of RAPTOR exerted an inverse biological phenotype. Knockdown of RAPTOR quenched mTORC1 activity and reduced the expression of URB1 and cyclinA2 (CCNA2). In contrast, overexpression of RAPTOR activated mTORC1 and upregulated URB1 and CCNA2. Furthermore, URB1 and CCNA2 expression were also impeded by rapamycin, which is a specific inhibitor of mTORC1. Thus, RAPTOR promoted CRC proliferation, migration, and cell cycle progression by inducing mTORC1 signaling and transcriptional activation of both URB1 and CCNA2. Taken together, we concluded that RAPTOR has the potential to serve as a novel biomarker and therapeutic target for CRC.

Comparison of Short-Term Outcomes Between Robotic-Assisted and Laparoscopic Surgery in Colorectal Cancer

Aim. The robotic technique has been established as an alternative approach to laparoscopy in colorectal surgery. The aim of this study was to compare short-term outcomes of robot-assisted and laparoscopic surgery in colorectal cancer. Methods. The cases of robot-assisted or laparoscopic colorectal resection were collected retrospectively between July 2015 and October 2017. We evaluated patient demographics, perioperative characteristics, and pathologic examination. A multivariable linear regression model was used to assess short-term outcomes between robot-assisted and laparoscopic surgery. Short-term outcomes included time to passage of flatus and postoperative hospital stay. Results. A total of 284 patients were included in the study. There were 104 patients in the robotic colorectal surgery (RCS) group and 180 in the laparoscopic colorectal surgery (LCS) group. The mean age was 60.5 ± 10.8 years, and 62.0% of the patients were male. We controlled for confounding factors, and then the multiple linear model regression indicated that the time to passage of flatus in the RCS group was 3.45 days shorter than the LCS group (coefficient = −3.45, 95% confidence interval [CI] = −5.19 to −1.71; P < .001). Additionally, the drainage of tube duration (coefficient = 0.59, 95% CI = 0.3 to 0.87; P < .001) and transfers to the intensive care unit (coefficient = 7.34, 95% CI = 3.17 to 11.5; P = .001) influenced the postoperative hospital stay. The total costs increased by 15501.48 CNY in the RCS group compared with the LCS group ( P = .008). Conclusions. The present study suggests that colorectal cancer robotic surgery was more beneficial to patients because of shorter postoperative recovery time of bowel function and shorter hospital stays.

Ribosome assembly factor URB1 contributes to colorectal cancer proliferation through transcriptional activation of ATF4

Ribosome assembly factor URB1 is essential for ribosome biogenesis. However, its latent role in cancer remains unclear. Analysis of The Cancer Genome Atlas database and clinical tissue microarray staining showed that URB1 expression was upregulated in colorectal cancer (CRC) and prominently related to clinicopathological characteristics. Silencing of URB1 hampered human CRC cell proliferation and growth in vitro and in vivo. Microarray screening, ingenuity pathway analysis, and JASPAR assessment indicated that activating transcription factor 4 (ATF4) and X‐box binding protein 1 (XBP1) are potential downstream targets of URB1 and could transcriptionally interact through direct binding. Silencing of URB1 significantly decreased ATF4 and cyclin A2 (CCNA2) expression in vivo and in vitro. Restoration of ATF4 effectively reversed the malignant proliferation phenotype of URB1‐silenced CRC cells. Dual‐luciferase reporter and ChIP assays indicated that XBP1 transcriptionally activated ATF4 by binding with its promoter region. X‐box binding protein 1 colocalized with ATF4 in the nuclei of RKO cells, and ATF4 mRNA expression was positively regulated by XBP1. This study shows that URB1 contributes to oncogenesis and CRC growth through XBP1‐mediated transcriptional activation of ATF4. Therefore, URB1 could be a potential therapeutic target for CRC.

Effects of AZT and RNA-protein complex (FA-2-b-β) extracted from Liang Jin mushroom on apoptosis of gastric cancer cells

AIM: To investigate the synergistic effects of 3'-azido-3'-deoxythymidine (AZT) and FA-2-b-β extracted from Ling Jin mushroom on apoptosis of gastric cancer cells MKN45 in vitro.

METHODS: MTT analysis was made to examine the inhibition rate of MKN45 cells treated with AZT (2.5, 5, 10 and 20 mg/L) and FA-2-b-β (5, 10, 20 and 40 mg/L) singly and combinatively for 24, 48 and 72 h. Apoptotic effects were evaluated by morphological methods, DNA agarose gel electrophoresis and flow cytometry, respectively. Telomerase activity was estimated by TRAP-ELISA. The mRNA expression of caspase-3 and Bcl-2 were detected by RT-PCR.

RESULTS: AZT and FA-2-b-β could significantly inhibit MKN45 cell proliferation and induce its apoptosis. MKN45 cells were inhibited in dose- and time- dependent manner. The inhibition effect of AZT combined with FA-2-b-β was obviously better than that used singly (0.469 ±0.022 vs 1.075 ± 0.055, P < 0.05, 0.325 ± 0.029 vs 0.469± 0.022 P < 0.01). AZT used singly and combination of FA-2-b-β could decrease the activity of tumor cell telomerase, and AZT has synergistic function with FA-2-b-β. A certain concentration of AZT could up-regulate the expression of caspase-3 mRNA (r = 0.9969, P < 0.01), which was positively related to apoptosis rate, and could down-regulate the expression of Bcl-2 mRNA, which was negatively related to apoptosis rate (r = 0.926, P < 0.01). Furthermore, the effect of AZT combined with FA-2-b-β was significantly higher than that used singly.

CONCLUSION: Combination of AZT and FA-2-b-β has an obviously synergetic effect in the gastric cancer cells MKN45, which has provided a new approach to the treatment of gastric cancer clinically.

A scientometric study of the top 100 most-cited publications based on Web-of-Science regarding robotic versus laparoscopic surgery

Minimally invasive surgery includes traditional laparoscopic and robot-assisted surgery. Although many studies related to robotic surgery and laparoscopic surgery have been published, when doing our search, scientometric studies that focus on related robotic surgery versus laparoscopic surgery were limited. In this study, we aimed to analyze and review the research hots and research status of robotic surgery versus laparoscopic surgery. We searched publications that involved robotic surgery versus laparoscopic surgery in the Web of Science database from 1980 to May 23, 2020. The top 100 publications were published in 2012 with the number of 17 and citations ranged from 618 to 64. Published across 34 different journals, namely European urology (n = 17) and others, the greatest contribution among 36 institutes was made by the Cleveland Clinic (n = 11). Of the top 100 publications, a total of 429 unique words were identified and the most frequently occurring keyword was laparoscopy (n = 33). The co-occurrence of keywords in the top 100 publications indicated that the study of diseases mainly focused on prostatectomy, complications, prostate cancer, retropubic prostatectomy, nephron-sparing surgery, lymph-node dissection, total mesenteric excision, sexual function, rectal cancer, and assisted distal gastrectomy. In recent years, comparative research on robot and laparoscopic surgery has decreased and most studies focus on cancer.

Octreotide for advanced hepatocellular carcinoma: a meta-analysis of randomized controlled trials

PURPOSE

To evaluate the effectiveness of octreotide in advanced hepatocellular carcinoma participants on the basis of randomized controlled trials.

METHODS

We searched the Cochrane Center Register of Controlled Trials in The Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database, China Journal Full-text Database, Chinese Scientific Journals Database up to June 2008 in any language. Randomized controlled trials of octreotide for advanced hepatocellular carcinoma were selected and evaluated by two investigators. Any disagreement was solved by discussion. Analyses were performed using Review Manager 4.2.

RESULTS

Six randomized controlled trials totaling 352 participants were included. The median survival time was reported in four randomized controlled trials. The results between the octreotide group and the control group (the placebo or best supportive care group) were as follows: 13.0 versus 4.0 months, 1.93 versus 1.97 months, 4.7 versus 5.3 months, and 7.0 versus 2.5 months. Three randomized controlled trials reported 6-month survival rates and 12-month survival rates and meta-analysis results in these two outcomes [(RR 1.35, 95% CI 0.92-1.97); (RR 1.35, 95% CI 0.66-11.16) respectively] were not found to be statistically significant by random-effects model. When we analyzed 6-month survival rates by fixed-effect model (RR 1.30, 95% CI 1.02-1.66), meta-analysis result reached statistical significance.

CONCLUSIONS

As for the limitations of the included trials, the result may not demonstrate a significant superiority of octreotide administration in participants with advanced hepatocellular carcinoma from the available evidence.

Clinical significance of telomerase activity in peritoneal lavage fluid from patients with gastric cancer and its relationship with cellular proliferation

AIM: To evaluate the efficacy of telomerase activity assay and peritoneal lavage cytology (PLC) examination in peritoneal lavage fluid for the prediction of peritoneal metastasis in gastric cancer patients, and to explore the relationship between telomerase activity and proliferating cell nuclear antigen expression.

METHODS: Telomeric repeated amplification protocol (TRAP)-enzyme-linked immunosorbent assay (ELISA) was performed to measure the telomerase activity in 60 patients with gastric cancer and 50 with peptic ulcer. PLC analysis of the 60 patients with gastric cancer was used for comparison. The proliferating cell nuclear antigen (PCNA) in gastric carcinoma was immunohistochemically examined.

RESULTS: The telomerase activity and PLC positive rate in peritoneal lavage fluid from patients with gastric cancer was 41.7% (25/60), and 25.0% (15/60), respectively. The positive rate of telomerase activity was significantly higher than that of PLC in the group of pT₄ (15/16 vs 9/16, P < 0.05), P_1-3 (13/13 vs 9/13, P < 0.05) and diffuse type (22/42 vs 13/42, P < 0.05). The patients with positive telomerase activity, peritoneal metastasis, and serosal invasion had significantly higher levels of average PCNA proliferation index (PI), (55.00 ± 6.59 vs 27.43 ± 7.72, 57.26 ± 10.18 vs 29.15 ± 8.31, and 49.82 ± 6.74 vs 24.65 ± 7.33, respectively, P < 0.05).

CONCLUSION: The TRAP assay for telomerase activity is a useful adjunct for cytologic method in the diagnosis of peritoneal micrometastasis and well related to higher proliferating activity of gastric cancer. The results of this study also suggest a promising future therapeutic strategy for treating peritoneal dissemination based on telomerase inhibition.

Therapeutic challenge for immunotherapy targeting cold colorectal cancer: A narrative review

Cold colorectal tumors are not likely to trigger a robust immune response and tend to suppress the immune response. There may be three reasons. First, the complex tumor microenvironment of cold colorectal cancer (CRC) leads to tolerance and clearance of immunotherapy. Second, the modification and concealment of tumor-specific targets in cold CRC cause immune escape and immune response interruption. Finally, the difference in number and function of immune cell subsets in patients with cold CRC makes them respond poorly to immunotherapy. Therefore, we can only overcome the challenges in immunotherapy of cold CRC through in-depth research and understanding the changes and mechanisms in the above three aspects of cold CRC.

Short-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Cohort Study

The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus ( P < 0.001), the time to the first postoperative oral fluid intake ( P < 0.001), and the length of hospital stay ( P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy ( P = 0.038) and postoperative urinary retention ( P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group ( P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.

Liposome-mediated induction of apoptosis of human hepatoma cells by c-myc antisense phosphorothioate oligodeoxynucleotide and 5-fluorouracil

BACKGROUND

The aim of this study was to investigate the effect of a c-myc antisense oligodeoxynucleotide and 5-fluorouracil on the expression of c-myc, invasion and proliferation of HEPG-2 liver cancer cells.

MATERIALS AND METHODS

HEPG-2 cells were treated with lipiosome-mediated c-myc ADSON and 5-fluorouracil. The proliferation inhibition rate and invasion were measured by MTT and invasion assay, respectively. Cell apoptosis was detected by flow cytometry and expression of c-myc by RT-PCR and immunohistochemistry.

RESULTS

The proliferation inhibition rate was significantly higher in the antisense oligodeoxynucleotide added-5-fluorouracil group than single antisense oligodeoxynucleotide or 5-fluorouracil group (p<0.05). G0/G1 cells in the antisense oligodeoxynucleotide group and S cells in the 5-fluorouracil groups were significantly increased than that in the control group, respectively (P<0.01). The amplification strips of PCR products in 5-FU, ASODN and combination groups were significantly weaker than that in the control group (P<0.01). The percentage of c-myc-protein- positive cells were significantly lower in antisense oligodeoxynucleotide, 5-fluorouracil and combination groups than that in the control group (P<0.01).

CONCLUSIONS

A liposome-mediated c-myc antisense oligodeoxynucleotide and 5-fluorouracil can inhibit the proliferation and invasion of liver cancer cells by reducing the expression of c-myc. A c-myc antisense oligodeoxynucleotide can increase the sensitivity of liver cancer cells to 5-fluorouracil and decrease the dosage of the agent necessary for efficacy, providing an experimental basis for the clinical therapy of liver cancer.

Clinical significance of expression of chemokine factor receptor 7 in gastric cancer: A meta-analysis

AIM

To investigate the expression of chemokine factor receptor 7 (CXCR7) in gastric cancer and evaluate its clinical significance.

METHODS

PubMed, EMBASE, Web of Science, CNKI, CBM, VIP, and Wanfang were searched for case-control studies on the significance of expression of CXCR7 in gastric cancer. Meta-analysis was conducted using RevManv.5.3 software to yield odds ratio (OR) and 95% confidence interval (95%CI).

RESULTS

A total of four case-control studies involving 320 gastric cancer tissues and 105 normal gastric tissues were included. The results of meta-analyses showed that the positive rate of CXCR7 expression was higher in gastric cancer tissues than in normal gastric tissues (OR = 46.35, 95%CI: 19.99-107.43), and CXCR7 expression in gastric cancer tissues was significantly associated with deep invasion (OR = 0.17, 95%CI: 0.05-0.58), lymph node metastasis (OR = 0.23, 95%CI: 0.12-0.44), and advanced clinical stage (OR = 0.29, 95%CI: 0.16-0.54). However, no significant correlation was found between CXCR7 expression and the degree of differentiation in gastric cancer.

CONCLUSION

The expression of CXCR7 in gastric cancer is higher than that in normal tissue. CXCR7 expression is associated with depth of invasion, lymph node metastasis and clinical stage, indicating that CXCR7 may play a role in gastric cancer metastasis.

Impact of 3 kinds of digestive tract reconstruction on carbohydrate and lipid metabolism in non-obese type 2 diabetes mellitus patients

AIM: To evaluate the effect of three digestive tract reconstruction procedures on carbohydrate and lipid metabolism in non-obese patients with type 2 diabetes mellitus (T2DM).

METHODS: Clinical data for 39 patients who underwent BillrothⅠanastomosis (10 cases), Billroth Ⅱ anastomosis (13 cases) or Roux-en-Y anastomosis (13 cases) in the Department of General Surgery, Gansu Provincial People's Hospital from July 2008 to May 2011 were reviewed. Clinical outcome were assessed and compared between the three groups.

RESULTS: All patients recovered without major complications. Compared to preoperative levels, postoperative levels of FPG, GHbAlc, TG, TC and LDL-c decreased by 2.6 mmol/L ± 0.7 mmol/L, (2.1 ± 0.7)%, 1.5 mmol/L ± 0.5 mmol/L, 0.8 mmol/L ± 0.3 mmol/L, and 1.0 mmol/L ± 0.4 mmol/L, respectively, while postoperative levels of HDL-c, Fins and FC-p increased by 0.3 mmol/L ± 0.07 mmol/L, 6.1 mU/L ± 3.2 mU/L and 0.28 nmol/L ± 0.06 nmol/L. Postoperative levels of FPG, GHbAlc, TG and LDL-c in patients undergoing Roux-en-Y anastomosis were much lower than those in other two groups (all P < 0.05). Without any drug treatment and special diet, BillrothⅠanastomosis, Billroth Ⅱ anastomosis and Roux-en-Y anastomosis improved glycolipid abnormality in 40%, 69.2% and 81.3% of patients, respectively.

CONCLUSION: All three digestive tract reconstruction procedures could improve carbohydrate and lipid metabolism in non-obese T2DM patients.

Evaluation of intra- and post-operative outcomes to compare robot-assisted surgery and conventional laparoscopy for gynecologic oncology

OBJECTIVE

To compare robot-assisted surgery and conventional laparoscopy for gynecologic oncology regarding intra- and post-operative outcomes.

METHODS

A retrospective study was performed on consecutive patients with gynecologic oncology from February 2014 to October 2017 at Gansu Provincial Hospital, China. Multivariable linear and logistic regression models were performed to explore the difference between two surgeries in the surgical outcomes after adjusting for potential confounders.

RESULTS

276 women were included in this study: 153 robot-assisted surgeries and 123 conventional laparoscopies. The multivariable linear regression model showed that robot-assisted surgery was longer operative time [coefficient (coef), 33.76; 95% CI, 12.47, 55.05; P = 0.002) ], higher lymph node yield (coef, 10.41; 95% CI, 7.47, 13.35; P < 0.001), shorter time to early post-operative feeding (coef, -1.09; 95% CI, -1.33, -0.84; P < 0.001) and less post-operative drainage volume (coef, -368.77; 95% CI, -542.46, -195.09; P < 0.001) than conventional laparoscopy. However, no difference was observed between the two surgeries regarding the estimated blood loss (P > 0.05). The multivariable logistic regression model showed that post-operative complications were similar between robot-assisted surgery and conventional laparoscopy (P > 0.05).

CONCLUSION

Robot-assisted surgery was superior to conventional laparoscopy regarding intra- and post-operative outcomes for gynecologic oncology.

Linaclotide improves quality of life in patients with irritable bowel syndrome with constipation: A Meta-analysis

AIM: To perform a meta-analysis to determine the efficacy and the safety of linaclotide, compared with placebo, for patients with irritable bowel syndrome with constipation (IBS-C).

METHODS: CNKI, CBM, Wanfang, VIP, PubMed, EMBASE, clinical trials.gov and the Cochrane library were searched for randomized, placebo controlled trials examining the effect of linaclotide in adults with IBS-C. Dichotomous results were pooled by using the RevMan v.5.2 software to yield relative risks (RRs) and 95% confidence intervals (CIs).

RESULTS: The search identified three randomized controlled trials of linaclotide in patients with IBS-C published in four papers. Meta-analysis suggested that linaclotide significantly improved abdominal pain (RR = 1.58, 95%CI: 1.02-2.46), complete spontaneous bowel movements (CSBMs) (RR = 3.19, 95%CI: 2.40-4.25) and quality of life (RR = 1.38, 95%CI: 1.09-1.74). Linaclotide also improved stool form and reduced the severity of abdominal pain, bloating and overall symptoms in patients with IBS-C. Diarrhoea was the most frequent adverse event (AE) in the group of linaclotide.

CONCLUSION: Our study suggests that linaclotide significantly improves bowel function, reduces abdominal pain and improves quality of life in patients with IBS-C.

Stilamin for intestinal obstruction: A systematic review of efficacy

AIM: To assess the efficacy of Stilamin for intestinal obstruction.

METHODS: Cochrane Library, PubMed, Embase, SCI, CNKI, CBM, VIP and WANFANG databases were searched to identify randomized controlled trials and quasi-randomized controlled trials of Stilamin combined with conventional therapy versus conventional therapy for intestinal obstruction. The data were analyzed using the RevMan 5.1 software.

RESULTS: Thirteen studies(852 patients) were enrolled. The results of meta-analysis showed that there is a significant difference between the group of Stilamin combined with conventional therapy and the group of conventional therapy in: (1) time to relief of abdominal pain: MD = -2.96, 95% CI: (-4.08, -1.84); (2) time to relief of abdominal distention: MD = -2.98, 95% CI: (-4.33, -1.63); (3) time required for restoration of anus exhaust: MD = -4.69, 95% CI: (-5.24, -4.13); (4) rate of remission of abdominal pain and abdominal distention: according to the treatment cycle of different subgroups, there is a statistical significance among different subgroups for 48 h after treatment and at the end of treatment: RR = 1.23, 95% CI: (1.08, 1.42); RR = 1.51, 95% CI: (1.29, 1.76); (5) rate of restoration of anus exhaust: according to the treatment cycle of different subgroups, there is a statistical significance for 48 h post-treatment and at the end of the treatment: RR = 1.20, 95% CI: (1.04, 1.37), RR = 1.71, 95% CI: (1.35, 2.17); (6) mean hospitalization stay: MD = -5.09, 95% CI: (-5.95, -4.22); (7) rate of conversion to operation: RR = 0.33, 95% CI: (0.21, 0.52); and (8) amount of gastrointestinal decompression: according to the treatment cycle of different subgroups, there is a statistical significance for 48 h, 72 h post-treatment and at the end of the treatment: MD = -305.43, 95% CI: (-359.84, -251.03); MD = -345.80, 95% CI: (-406.63, -284.97); MD = -507.14, 95% CI: (-549.19, -465.09).

CONCLUSION: Current evidence suggests that Stilamin combined with conventional therapy is superior to the conventional therapy for intestinal obstruction. However, large-scale, high-quality, double-blinded RCTs are required to confirm the efficacy.

Robotic versus Laparoscopic Gastrectomy for Gastric Carcinoma: a Meta-Analysis of Efficacy and Safety

PURPOSE

To systematically review efficacyand safety of robotic gastrectomy (RG) compared with conventional laparoscopic gastrectomy (LG) for gastric carcinoma.

MATERIALS AND METHODS

A systematic literature search was carried out using PubMed, Cochrane Library, CBM, CNKI, WanFang, VIP and other sources like relevant references to obtain comparative studies assessing the effectiveness and safety between RG and LG published between 2013 and 2016. Then the literature was screened and the data were extracted by 2 independent reviewers. The quality of the literature was assessed, and the data analyzed using Stata/SE 14 software. Fixed effects or random effects models wereapplied according to heterogeneity.

RESULTS

A total of 12 non-randomized observational clinical studies involving 3,580 patients were included, of which 1,096 had undergone RG and 2,484 had received LG. The results of the meta-analysis showed in terms of effectiveness, RG was associated with less blood loss, less time to first flatus and greater number of harvested lymph nodes, but there were no significant differences in proximal and distal resection margins, compared with LG. In terms of efficiency, RG was associated with shorter hospital stay, but longer operative time. In terms of safety, there were no statistically significant differences in complications, mortality and conversions between RG and LG.

CONCLUSIONS

RG can achieve comparable or better short-term and radical effects than LG, with respect to effectiveness, efficiency and safety in treatment of gastric carcinoma. Future studies involving RG should focus on decreasing operative time and reducing cost. Moreover, there is a need for randomized controlled trials comparing the two techniques with long-term follow-up.

Short-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Cohort Study

The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients' records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus (P < 0.001), the time to the first postoperative oral fluid intake (P < 0.001), and the length of hospital stay (P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy (P = 0.038) and postoperative urinary retention (P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group (P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.