Esophageal cancer is one kind of the common gastrointestinal cancers, which is a serious threat to health and life of human beings.Esophagectomy with systematic lymphadenectomy is still the most effective treatment method for early and resectable esophageal cancer.However, due to the complex paraesophageal anatomy, there are some great difficulties need to be overcome in traditional open surgery and minimally invasive esophagectomy(MIE), such as the exposure and separation of esophagus together with tumor, lymph node dissection, etc.Da Vinci Surgical System (Intuitive Surgical, USA) with the advantages like 3-dimensional view, accuracy and stability, has been used to perform robot-assisted minimally invasive esophagectomy (RAMIE) in many countries including China.Frequently-used procedures of RAMIE include McKeown procedure, Ivor-Lewis procedure and transhiatal esophagectomy (THE).This review makes an introduction to the methods and applications of these 3 procedures, and the research status of RAMIE.

For early-stage lung cancer,the treatment is given priority to surgery.As a new approach of minimally invasive surgery,three-dimensional and high definition view,and better dexterity robotic platform and tremor filtering system are the main advantages of da vinci robot compared to video-assisted thoracic surgery.In recent years,the technique of robot surgery has become more and more mature and has already been used in the treatment for lung cancer.However,its safety and postoperative outcomes should be evaluated in detailed.As a consequence,the comparison of robotic,video-assisted thoracic surgery and thoracotomy surgery for lung cancer has become a hot spot in recent clinical research.

Purpose: To study the expression of MMP-2 in lymph node-negative breast carcinoma and its relation to other factors and its clinical value. Methods: Paraffin-embedded specimens from 270 patients with lymph node-negative breast carcinoma were studied. MMP-2 were investigated by immunohistochemical staining. Results: Positive staining for MMP-2 were observed in some breast carcinoma cells. Positive staining of MMP-2 was significantly related to higher tumor grade and larger tumor size but not ER, PR and other factors. It was also significantly associated with patients relapse free survival but not overall survival. Conclusions: MMP-2 is an unfavorable prognostic factor in lymph node-negative breast carcinoma patients and it is an important prognostic factor.

Angiogensis plays an important role in tumor growth and metastasis,and anti-angiogenic therapy is a promising treatment of cancer. We review the proceedings on angiogensis and breast cancer ,and the progress in the field of anti-angiogenic therapy for breast cancer.

Objective:To observe the up-regulation of nuclear Clusterin (nCLU)gene on the biological behaviors of human non-small cell lung cancer cell line A549 .Methods:Sense eukaryotic expression vector of nCLU was constructed by cloning the cDNA of nCLU into pIREShyg3 vector. A549 cells were transfected with pIRES-nCLU and pIREShyg3 vectors by lipofectAMINE~(TM) 2000 mediation, respectively. Stable transfected cells were selected by hygromycin B screening. CCK-8 assay was performed to evaluate the effect of nCLU over-expression on cell proliferation in vitro. The expression level of nGLU protein was examined by Western blotting. Cell cycle distribution was detected by FCM with PI staining. The alteration of migration and metastasis potential of A549 cells before and after nCLU gene transfection were assayed by cell chemotactic migration and invasion test. Results:The proliferation speed of the transfected A549 cell clones stably over-expressing nCLU was slowed down. FCM analyses revealed that the percentage of cells in G_0/G_1 phase dramatically increased from (33.54±2.10)% to (63.31±4.30)%. The cell chemotactic migration and invasion potentials were markedly reduced after nCLU gene transfection (P<0.05). Conclusion:Up-regulation of nCLU can greatly inhibited the proliferation and decreased the migration and invasion capabilities of A549 cells.

Background and purpose: Primary study showed that clusterin was associated with tumorigenicity. The goal of the study is to investigate the role of secretory clusterin in non-small cell lung cancer cell A549/H460. Methods: The lung cancer cell A549/H460 was treated with purified secretory clusterin, the Boyden Chamber migration assay was used to detected the migration of the lung cancer cell;the CCK8 assay was used to detected the growth of the cells;microRNA expression spectrum in H460 treated with secretory clusterin was analyzed, after that, we used the real-time florescence quantification detected the expression of microRNA in H460, and the biological function of microRNA molecular mechanisms of secretory clusterin was analyzed. Results: Secretory clusterin promoted the migration in A549/H460 (P<0.000 1);Secretory clusterin inhibited the growth in H460/A549 (P<0.000 1);MicroRNA-302b-3p, microRNA-23a-5p and microRNA-101-5p was overexpressed in H460 when treated with secretory clusterin. Conclusion:Secretory clusterin could promote the migration and inhibit the growth of lung cancer cell;It could change the microRNA expression spectrum as well. Our studies revealed that secretory clusterin could be used as a tool for further study, and it is a potential target in the treatment of lung cancer.

Objective To investigate the role of heat shock protein 70 (HSP70) in liver flbrosis in infants with biliary atresia (BA) and its impact on prognosis. Methods Fourty-six (46) cases of infants with BA undergoing elective Kasai surgery were selected. In the same period, 30 cases of children with choledochal cyst and 17 cases of children with portal vein cavernous transformation were selected. The expressions of HSP70 in liver tissues were detected using immunohistochemical staining. The liver flbrosis in children with BA was detected using Sirius red-saturated picric acid staining. The expressions of HSP70 proteins in different flbrotic liver tissues were detected by using double staining. All postoperative BA infants were followed up and ended at June 30, 2016.Results The proportion of high expression of HSP 70 proteins in BA infants were signiflcantly higher than that in children with choledochal cyst and vein cavernous transformation (P<0.05). Rank correlation analysis showed that the expressions of HSP70 in liver tissues were positively correlated with the degree of liver flbrosis (r=0.861,P<0.05). 15 patients died among 46 cases of BA infants. The survival rate in BA children with mild liver flbrosis was 82.4%, which was signiflcantly higher than 58.6% in the severe group (P<0.05). The survival rate in HSP70 protein low expression group was 85.0%, while in HSP70 protein high expression group was 53.8%. Kaplan-meier survival analysis showed that the median survival time in the HSP70 protein low expression group was (34.0±2.6) months, while in the HSP70 protein high expression group was (18.3±2.2) months, the difference was statistically signiflcant (χx2=4.765,P=0.029).Conclusions The expressions of HSP70 proteins in liver tissues in infants with BA were high and were positively correlated with the degree of hepatic flbrosis. It suggested the possible involvement of HSP70 in the process of liver fibrosis. The upregulated expressions of HSP70 often indicated poor prognosis in children. It could be used as determining biomarker for prognosis.

Objective To evaluate the safety,efficiency of retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors,and summarize the surgical experience.Methods From Jan 2015 to Jan 2016,5 patients with completely endophytic tumors,who underwent retroperitoneal laparoscopic partial nephrectomy were recruited.one patient underwent 3D printing kidney model,and another 4 patients underwent 3Dimensional CT and locating four projection positions of the tumor on the surface,in order to guide the tumor resection in laparoscopic partial nephrectomy.Perioperative,operative,and postoperative,as well as oncological outcomes were analyzed.Results In all 5patients,preoperative four points location in 3D model or 3Dimensional CT for completely endophytic tumors is feasible and accurate in term of locating the tumor.The mean operative time was(129.0 ± 19.5) min,mean warm ischaemia time was (19.6 ± 5.4) min and mean estimated blood loss was(100 ± 83) ml.Pathological examination showed cell renal cell carcinoma.All the patients had a negative surgical margin,and no tumor recurrence or metastasis during 6-18months of follow up.Conclusions In experienced institutes,retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors is a feasible and safe procedure in terms of accurate locations,low complication rates,reasonable functional and oncologic outcomes after an intermediate-term follow-up

Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery.

Objective To improve the non?surgical N staging system for esophageal carcinoma ( EC) . Methods A retrospective analysis was performed in 501 patients newly diagnosed with esophageal squamous cell carcinoma who received radiotherapy in our hospital from 2009 to 2013. The impacts of the supraclavicular lymph nodes and mediastinal lymph nodes on the overall survival ( OS) rate were analyzed. The original non?surgical N staging system was improved and the proposed N staging system was evaluated. The OS rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The univariate and multivariate analyses were performed using the log?rank test and Cox regression model, respectively. Results The 3?and 5?year sample sizes were 404 and 205, respectively. In all patients, the 1?, 3?, and 5?year OS rates were 64?9%, 26?5%, and 18?3%, respectively;the 1?, 3?, and 5?year distant metastasis?free ( DMF) rates were 86?2%, 68?9%, and 67?3%, respectively;the 1?, 3?, and 5?year local control rates were 72?7%, 53?1%, and 43?6%, respectively. The univariate analysis showed that the incidence, 3?year OS rate, and 3?year DMF rate of supraclavicular lymph node metastases in patients with cervical and upper?thoracic EC were significantly higher than those in patients with middle?thoracic and lower?thoracic EC ( 25?7% vs. 14?2%, P=0?034;24?2% vs. 11?5%, P=0?016;84?8% vs. 69?2%, P=0?007) . The multivariate analysis also showed that the number of metastatic lymph nodes was an independent prognostic factor for the OS and DMF rates in patients ( P= 0?000;P= 0?007 ) . Conclusions It is reasonable to classify upper?thoracic EC with supraclavicular lymph node metastasis into stage N1 diseases. The proposed N staging system with the factor of the number of metastatic lymph nodes is more scientific and objective than the original N staging system.