ObjectiveTo summarizes the mechanisms of carcinogenesis of colorectal cells, the occurrence and development of cancer cells, and their interactions with the tumor niche of colorectal cancer (CRC) from the perspective of the tumor niche, exploring new ideas for the prevention, diagnosis, and treatment of CRC. MethodThe relevant literature at home and abroad in recent years on the researches of mechanism of the occurrence and development of CRC and its relation with the tumor niche of CRC was searched and reviewed. ResultsThe theory of tumor ecology indicates that the human normal body can be regarded as a relatively closed and perfect ecosystem. Each normal tissue and organ within the body represent a niche in this ecosystem, which interact, affect, and symbiotically coexist with each other, forming a dynamic ecological balance. Tumor cells, being a “new species” distinct from normal tissue cells, “invade” the ecological system of the normal body under specific conditions and interact with the surrounding microenvironment, which is defined as the tumor niche. Analysis of current literature retrieved from the perspective of the tumor niche suggested that, although genetic factors are involved in the carcinogenesis of colorectal cells, the majority of such carcinogenesis stems from the continuous stimulation of the colorectal niche. Current research primarily focuses on the conclusion that the carcinogenesis of colorectal cells is associated with factors such as chronic inflammatory response, intestinal microorganisms, oxidative stress, and pyroptosis. After carcinogenesis and the eventual formation of CRC, the growth of cancer cells and tissues first requires breaching the defense of the immune system in the colorectal niche. Immune cells in the immune system play a crucial role in the tumor niche during the occurrence and development of CRC. ConclusionsThe proposal of the tumor niche concept enables researchers, when studying the mechanisms of tumor occurrence and development, to no longer merely focus on the tumor and its microenvironment. Instead, the tumor as a part of the body’s ecosystem was studied. Components of the tumor niche, such as chronic inflammatory responses, intestinal microorganisms, oxidative stress, pyroptosis, and immune system, have a significant impact on the mechanisms of carcinogenesis of most colorectal cells, as well as the occurrence and development of cancer cells. These factors influence the progression of CRC in various aspects.
Objective To compare the differences in evaluating readiness for hospital discharge between nurses and colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) pathway. Methods A cross-sectional survey was conducted in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Patient-reported Readiness for Hospital Discharge Scale (RHDS) and nurse-reported RHDS were delivered to 130 CRC patients and 40 nurses respectively. All patients were followed ERAS pathway during perioperative periods. The differences were compared in evaluating readiness for hospital discharge between nurses and CRC patients. Results This study investigated 130 CRC patients and 40 responsible nurses. The scores of RHDS from nurses and patients were 162.86±27.95 and 149.86±33.65 respectively. When evaluating whether patients were ready to go home after discharge, the consistency between nurses’ results and patients’ results was weak（κ=0.365, P<0.001）. Items in patients’ RHDS scoring ranking from high to low were expected support, coping ability, knowledge, and personal status. Items in nurses’ RHDS scoring ranking from high to low were expected support, knowledge, coping ability, and personal status. Besides the " social support” dimension, the scores of other 3 dimensions from nurses were significantly higher than those from patients (P<0.05). Conclusion There is a gap between the assessment of RHDS from nurses and patients, nurses overestimated patients’ discharge readiness level.
Objective To establish a stable colorectal cancer model in liver specific insulin-like growth factor (IGF)-1 deficient (LID) mice and examine the potential relationship between IGF-1 level and risk of mice constitutional colorectal cancer. Methods ①Establishment of a colorectal cancer model: The LID mice, in which IGF-1 level in circulation was 25% of BALB/c mice. Induction of colorectal cancer was achieved by using the 1,1 Dimethylhydrazine (DMH) with hypodermic injection at transverse part. ②Eighty fresh samples of cancer tissues and adjacent tissues were obtained from LID mice (experimental group) and BALB/c mice (control group). The expression of IGF-1 was studied by immunohistochemical assay (SP method). Results ①Weight loss occurred in both experimental group and control group after injection. Compared with the body weight before injection on 18 weeks and 24 weeks in each group, there were significant differences after injection at the same phase in each group (P＜0.05). ②The results of IGF-1 expression in cancer tissues and adjacent tissues: IGF-1 got a diffuse distribution in cancer cell cytoplasm. The positive expressions of IGF-1 in the cancer tissues and their adjacent cancer tissues were 6/7, 2/7 and 13/16, 7/16 respectively in experimental group and control group. There were significant differences between the cancer tissues and adjacent tissues inside both groups (P＜0.05). There were no significant differences inside both of cancer tissues and adjacent tissues respectively between experimental group and control group (Pgt;0.05). Conclusion In the established colorectal cancer model by DMH, IGF-1 plays an important role in the development and progression of colorectal cancer.
Cytogenetic study of 18 colorectal carcinomas confirmed the extensive heterogeneity and the complexity of the karyotypic picture in this tumor.Karyotypic analysis showed that chromosomes 7 and 3 were of the highest chromosomal gaining frequencies(72%,66%) and chromosomal losses were shown in chromosome 17(50%),chromosome5(44%) and chromosome 18(33%).The structual rearrangements frequently involved were 17p(78%),5q(61%),6q,7q,8p,12q,2p,etc.A great number of marker chromosomes and polyploid chromosomes had bad prognosis relatively.According to these results,we conclude that chromosomes 17,5,and 18 may play an important role in the evolution of colorectal cancer.
ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.
ObjectiveTo summarize the latest progress of microRNA (miRNA or miR) in colorectal cancer (CRC)-related signaling pathways in the past three years, and provide new ideas for miRNA-targeted intervention or miRNA as tumor molecular markers for early diagnosis of CRC. MethodThe literature on the roles of miRNA in the CRC-related signaling pathways was retrieved and reviewed. ResultsMiRNAs were associated with cancers in nearly all critical pathways, which regulated almost all important signaling pathways associated with CRC. At present, the signaling pathways and miRNAs related to CRC mainly included Wnt-β-catenin (miR-520e, miR-8063, miR-576-5p, miR-142-3p, miR-19a-3p, miR-381, miR-411, miR-1205), phosphatidylinositol-3-kinaset-Akt (miR-19a, miR-493-5p, miR-3064-5p, mi-196b-5p, miR-3651), mitogen-activated protein kinase (miR-1288-3p, miR-3651, miR-152-3p), transforming growth factor-β (miR-183-5p, miR-21-5p, miR-195-5p, miR-581, miR-2911, miR-128-3p, let-7a), nuclear factor kappa B (miR-155, miR-129, miR-21), Janus kinase/signal transducers and activators of transcription (miR-198, miR-452, miR-128-3p, miR-495), Notch (miR-223, miR-10b, miR-449a), Hippo (miR-30a-5p, miR-375, miR-9), and Hedgehog (miR-372, miR-373), etc. signaling pathways. ConclusionsMiRNA play a role in one or more signaling pathways at the same time, and play an important regulatory role in the occurrence and development of CRC. MiRNAs have great potential as tumor markers in the diagnosis, treatment, and prognosis of colorectal cancer.
3.2 腹腔镜左半结肠切除术3.2.1 手术要点 腹腔镜左半结肠切除术的要求往往高过腹腔镜右半结肠切除术，所以，除一套腹腔镜器械外，还应增备一套开腹手术器械，一旦腹腔镜手术中出现难以控制的出血以及必须开腹处理的特殊情况，应毫不犹豫中转开腹手术。......
【摘要】 目的 探讨Survivin表达在结直肠癌发生，转移中的作用及临床意义。 方法 2003年1月－2004年12月间采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结法测定58例结直肠癌、12例结直肠腺瘤和9例正常结肠组织中Survivin的表达水平，研究其与结直肠癌患者临床病理特征及预后的关系。 结果 Survivin蛋白在正常结直肠黏膜中不表达，而在结直肠腺瘤及结直肠癌组织中的表达均高于正常大肠黏膜，差异有统计学意义（Plt;0.05）。不同年龄、性别、浆膜浸润、淋巴结转移、远处转移、分化程度、Dukes分期等之间Survivin的表达差异均无统计学意义（Pgt;0.05）。Kaplan-Meier生存分析提示:Survivin表达阳性患者的5年生存率为51.2%，阴性者为90.9%，两组比较差异有统计学意义（Plt;0.05）。 结论 Survivin的异常表达参与了结直肠癌发生、发展的病理生理过程，对结直肠癌患者的治疗方式的选择、疗效和预后的评估方面具有重要的参考价值。【Abstract】 Objective To determine the expression of Survivin in the onset and metastasis of colorectal adenocarcinoma, and its clinical significance. Methods From January 2003 to December 2004, immunohistochemical staining, streptavidin-perosidase method, was used to detect the Survivin expression in 58 cases of colorectal carcinoma, 12 cases of colorectal adenoma, and 9 cases of normal tissues. Correlation between the expression of Survivin and clinicopathological factors in colorectal cancer was analyzed. Results Survivin was not expressed in normal colorectal tissues. The expression of Survivin in colorectal carcinoma and adenoma was significantly higher than that in norma1 colorectal tissues (Plt;0.05). There was no correlation of Survivin expression with such clinicopathologic factors as age, gender, serosa infiltration, lymph node metastasis, distal metastasis, differentiation level and Dukes stage (Pgt;0.05). The Kaplan-Meier survival analysis demonstrated that patients with Survivin-positive tumors had significantly poorer survival rate (51.2%) than those with Survivin-negative tumors (90.9%) (Plt;0.05). Conclusion Abnormal expression of Survivin plays an important role in carcinogenesis and progress of colorectal carcinoma and can be regarded as a good index for the choice of surgery, and assessment of clinical outcomes and prognosis for colorectal cancer patients.
Objective To analyze the impact of body mass index (BMI) on surgical difficulty and surgical reaction of patients with colorectal cancer served by West China Hospital, based on the current version of Database from Colorectal Cancer (DACCA). MethodsThe data of DACCA were updated on September 22, 2021. All data items included BMI, operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, intestinal quality in surgical area, surgery reaction, and perioperative complications of colorectal cancer module including temperature, flatus, pain, and mental status. The patients were divided into lean (BMI <18.5 kg/m2), normal (BMI 18.5–23.9 kg/m2), overweight (BMI 24.0–27.9 kg/m2), and obesity (BMI ≥28.0 kg/m2) by Chinese four classification method. ResultsAfter scanning, 6 311 data rows were analyzed. ① The effect of BMI on surgical difficulty: BMI was weakly positively correlated with operative duration (rs=0.096, P<0.001). The overweight and obesity patients were more likely to have anatomical abnormalities (rs=0.385, P<0.001 ), pelvic stenosis (rs=0.386, P<0.001), abdominal obesity (rs=0.567, P<0.001), and adhesion in surgical area (rs=0.043, P=0.004). There was difference in tissue or organ hypertrophy among patients with different BMI (χ2=39.988, P<0.001). It was also found that the lean patients were prone to develop ‘very heavy adhesions’ when adhesions occurred in surgical area, and to ‘mesangial contracture, short, fixed’ of abnormal mesenteric status, while the obesity patients were prone to ‘mesangial thickening’ of abnormal mesenteric status. There was no difference in intestinal quality among patients with different BMI (P>0.05). ② The effect of BMI on surgical reaction: BMI was weakly positively correlated with the overall assessment of surgical reaction (rs=0.049, P=0.001), and obesity patients were more likely to have severe surgical reaction. BMI was weakly negatively correlated with pain (rs=–0.058, P<0.001）and the lean patients were more likely to have pain that needed drug control. However, there were no differences in temperature, flatus, and mental status among patients with different BMI (P>0.05). ConclusionsHigh BMI of patients will affect several indicators including operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, resulting in increased difficulty of surgery. Although high BMI might affect overall response state after surgery, it will not affect temperature, flatus, and mental status, reflecting a relatively weak impact on surgical reaction.