Nowadays, thoracoscopic laparoscopic esophagectomy (TLE) has been widely used in the treatment of esophageal cancer. In recent years, robot assisted minimally invasive esophagectomy (RAMIE) has been developing vigorously. According to the research progress and practical experience in the world, RAMIE has the same safety and effectiveness as TLE. In this paper, several aspects on this novel operation were demonstrated, including the safety evaluation, lymph node dissection, prognosis of RAMIE, comparison of RAMIE and TLE, and the role of RAMIE in multidisciplinary treatment of esophageal cancer, in order to promote the rational application of RAMIE in esophagectomy.
ObjectiveTo investigate the expression of Runt-related transcription factor 1 (RUNX1) in gastric cancer and its correlation with clinicopathological features, prognosis and tumor cell invasion ability. Methods① Database analysis: the expression of RUNX1 in gastric cancer and adjacent tissues were analyzed by TCGA and GEO database. Kaplan-Meier Plotter database was used to analyze the correlation between RUNX1 expression level and overall survival (OS) of gastric cancer patients. GO analysis and KEGG pathway enrichment were used to analyze the possible functions and signaling pathways of RUNX1 in gastric cancer, and gene correlation was verified by GEPIA database. ② Clinical case validation: the cancer tissues and adjacent tissues of 62 patients with gastric cancer admitted to the Second Hospital of Lanzhou University from June 2018 to December 2019 were retrospectively collected for immunohistochemical staining, HE staining and Sirius red staining, and the relation between RUNX1 expression and clinicopathological features and prognosis of patients was explored. ③ Cell experiment: we knocked down RUNX1 by using small interfering RNA, and then analyzed the relation between RUNX1 and the invasion ability of gastric cancer cells by Transwell assay. Results① Database analysis: RUNX1 was highly expressed in gastric cancer tissues and negatively correlated with OS (P<0.001). GO analysis and KEGG pathway enrichment analysis showed that RUNX1 was not only involved in the construction of collagen in extracellular matrix (ECM), but also significantly enriched in ECM-receptor interaction pathway. The results of GEPIA gene correlation analysis showed that RUNX1 was positively correlated with gene expression involved in ECM-receptor interaction pathway (P<0.05). ② Clinical case validation: the results of immunohistochemical staining showed that RUNX1 was relatively highly expressed in gastric cancer tissues, and the high expression of RUNX1 was a risk factor affecting the postoperative OS of gastric cancer patients (RR=5.074, P=0.034); the expression of RUNX1 in gastric cancer tissues was positively correlated with red staining area of Sirius red staining (r=0.46, P<0.001). ③ Cell experiment: invasion experiments confirmed that the number of invasive AGS or HGC27 cells in si-001 group and si-002 group decreased after RUNX1 knockdown. ConclusionRUNX1 is highly expressed in gastric cancer and suggests a worse survival prognosis, and it is possible that RUNX1 promotes the development of gastric cancer by activating the ECM-receptor interaction pathway.
Objective To analyze the causes of cardiac myxoma recurrence and discuss its clinical classification. Methods We reviewed the data of two female patients, aged thirty three and forty two, with recurrent cardiac myxoma, who were admitted into our hospital separately in December 2004 and October 2005. We searched articles with “cardiac myxoma” as the key words at www.cqvip.com, and reviewed literature of big case groups having undergone surgical operations, case reports of recurrence and literature with a followup time longer than 4 years between January 1994 and December 2008. Results We reviewed a total of 1 969 cases of cardiac myxoma, in which there were 60 recurrent cases with a recurrence rate of 3.0%, and there were 15 recurrence case reports. Data analysis showed that single pedicle recurrence rate was 3.0% (3/99) and multiple pedicle recurrence rate was 35.7% (5/14); In two reports on cardiac myxoma distributed in multiple chambers, the recurrence rate was 41.7% (5/12) and 33.3% (3/9) respectively;Average interval of recurrence was 4.1 years; Repeated recurrence happened to 9 cases (12.0%) with the most repetition times of 4 in one case; Malignancy on recurrence was found in one case; Reoperation rate was 64.0% (32/50); Six cases (8.0%) were familial myxoma. Accordingly, we advocate a clinical classification of “typical” and “atypical” cardiac myxoma. The typical myxoma refers to the tumors located at left atrium with single pedicle, rooted at or around fossa ovalis, and without abnormal DNA, while the atypical myxoma are familial tumors and tumors stemming from multiple points or multiple chambers, rooted in abnormal position of the left atrium, arising from clear gene mutation, or with malignant tendency. Conclusion Myxomas with multiple pedicles, distributed in more than one chamber, and rooted in abnormal position of the left atrium have a much higher recurrence rate. Close follow-up is needed for abovementioned patients to achieve an optimal treatment results.
Objective To investigate the surgical techniques and effectiveness for reconstruction of severe full-thickness chest wall defects. Methods Between January 2006 and December 2010, 14 patients with full-thickness chest wall defects were treated, including 12 cases caused by giant chest wall mal ignant tumor excision, 1 case by thermocompression injury, and 1 case by radiation necrosis. There were 8 males and 6 females with an average age of 42 years (range，23-65 years). The size of chest wall defects ranged from 8 cm × 5 cm to 26 cm × 14 cm. All patients compl icated by rib defect (1-5 ribs), and 3 cases by sternum defect. Thoracic skeleton reconstruction was performed with Vicryl mesh or polytetrafluroethylene mesh in 10 patients. Other 4 patients did not undergo thoracic skeleton reconstruction. The bilobed skin flaps, pectoral is major myocutaneous flap, latissimus dorsi myocutaneous flap, and rectus abdominis myocutaneous flap were util ized for repairing soft tissue defects. The size of the dissected flaps ranged from 10 cm × 7 cm to 25 cm × 13 cm. The donor sites were sutured directly or were repaired by free skin graft. Results Poor heal ing of incision occurred in 2 cases, which was cured after debridement, myocutaneous flap transfer, and skin graft. The other wounds healed by first intention. All patients were followed up 6-36 months (mean, 8 months). No tumor recurrence during follow-up, except 1 patient with osteosarcoma who died of l iver matastasis at 6 months after operation. Transient sl ight paradoxical respiration occurred in 1 patient who did not undergo thoracic skeleton reconstruction at 5 days after operation. Integrity of chest wall in other patients was restored without paradoxical respiration and dyspnea. Conclusion Depending on the cause, the size, and the location of defect, single or combination flaps could be used to repair soft tissue defect, and thoracic skeleton reconstruction should be performed when defect is severe by means of syntheticmaterials.
ObjectiveTo give an annual data report of surgical treatment of esophageal cancer in Shanghai Chest Hospital to provide reference for treatment and research on esophageal cancer.MethodsThe clinical data of 414 patients with esophageal cancer who underwent endoscopy (9 patients) and esophagectomy (405 patients) in Shanghai Chest Hospital in 2015 were reviewed, including 334 males and 80 females. Their tumor biological characteristics and short-term and long-term treatment results were analyzed.ResultsPatients in this group were predominantly aged 60 to 69 years (46.9%), and the tumor was mainly located in the middle thorax (50.7%). About 79.9% of the patients received trans-right thoracic esophagectomy, 44.4% received minimally invasive surgery; 388 (93.7%) patients accepted upfront esophagectomy without induction therapy, and 179 (43.2%) patients received postoperative adjuvant therapy. The R0 resection rate was 90.6%, and the 30- and 90-day mortality rates were 1.4% and 2.4%, respectively. The 4-year overall survival rate of the R0 resection patients was 65.7%.ConclusionSatisfactory long-term survival results can be obtained for thoracic esophageal cancer if R0 resection can be achieved by trans-right thoracic esophagectomy and extended lymphadenectomy combined with appropriate postoperative adjuvant treatment.