Hepatoid adenocarcinoma of the stomach (HAS) , a rare and specific type of primary gastric adenocarcinoma, is a highly malignant neoplasm characterized by a poor prognosis and a histological component that mimicks hepatocellular carcinoma morphologically as well as immunophenotypically. In the literature, only liver and lymph nodes metastases have been identified as determinants for survival in patients with HAS.

Pancreatic cancer has a very poor prognosis, with a five-year survival less than 5%. Nowadays, to improve the treat-ment efficacy of pancreatic cancer has been a highlight for medical researchers worldwide. Increasing knowledge about the molecular pathogenesis of the disease has shown that genic mutations, such as oncogene Kras2, and anti-oncogenes Cdkn2a, and TP53, are hall-marks of pancreatic cancer. Therefore, it is vital to deeply understand the pathogenetic mechanism of pancreatic cancer and find new therapeutic strategies to cover it. In this review, we summarized the recent advances in the signaling pathways of pancreatic cancer.

Objective:To detect the expression and clinical significance of β-tubulin Ⅲ in cancer tissue of the patients with colon adenocarcinoma,and to explore its clinical significance.Methods:A total of 111 colon adenocarcinoma tissue samples were obtained.According to the location of β-tubulin Ⅲ positive cells, all patients were divided into front group (n=72) and non-front group (n=39).The positive expression rate of β-tubulin Ⅲ in the patients with colon adenocarcinoma was detected with immunohistochemistry.The correlations among the expression of β-tubulin Ⅲ and gender,age,tumor differentiation, clinical stage, lymph node metastasis, recurrence and death were analyzed.Results: The expression levels of β-tubulin Ⅲ had no significant differences between the patients with different gerder,age,lymph node metastasis,clinical stages,death and recurrence.The positive expression rates of β-tubulin in cancer tissue of the patients had significant difference between front and non-front groups (χ2=8.76, P=0.01).Lowly-to-moderately differentiated tissue was more common in front group, and highly-differentiated tissue was more common in non-front group(χ2=6.88, P=0.03).There were significant differences in the expression levels of β-tubulin Ⅲ between cancer tissues with different differentiation degrees (χ2=5.74, P=0.04).In non-front group, lymph node metastasis was closely correlated with the expression of β-tubulin Ⅲ (χ2=6.02,P=0.05).The results of immunohistochemical staining showed that the β-tubulin Ⅲ positive-expressing cells were colored brown-yellow.The number of cells with positive β-tubulin Ⅲ expression was significantly increased in highly differentiated tissue compared with low-differentiated tissue.Conclusion:The expression of β-tubulin Ⅲ is closely related to tumor differentiation in colon adenocarcinoma tissue.The highly differentiated colon adenocarcinoma tissue is more common in non-front group in which the expression of β-tubulin Ⅲ is related to lymph node metastasis.

Objective To evaluate the effects of individual extralevator abdominalperineal excision (ELAPE) for rectal neoplasms below levator hiatus on pelvic floor by finite element analysis. Methods MIMICS 10.01, GeoMagic Studio 12 and ANSYS Workbench 14.0 were used to deal with magnetic resonance data of 27 healthy nulliparous volunteers'pelvic, and then three types of finite element models were developed:intact models, ELAPE models and individual ELAPE models. The maximum stress in non levator ani tissue under the same load were measured in three types of models, and levator ani 's maximal stresses were measured in intact model and individual ELAPE and their stress distributions under the same pressure were analyzed and compared. Results The maximal stresses of non-levator ani tissue were (1.963±0.061) MPa, (5.127±0.070) MPa and (4.703±0.110) MPa for intact model, ELAPE model and individual ELAPE model respectively. The maximal stress was lower in individual ELAPE model than that in ELAPE model, but which was higher than that of intact model (P<0.01). The high-stress zone was found at the joints with surrounding structures on both sides of intact model and ELAPE model. The high-stress zone was found in front of the joints with surrounding structures on both sides in individual ELAPE model. The maximal stresses of three types of models were found in front of both sides. In intact model levator ani 's maximal stress was (0.812 ± 0.042) MPa, which was higher than that of individual ELAPE model (0.719 ± 0.027) MPa (P<0.01). The high-stress zone of intact model was found in front of the joints on both sides. The maximal stress was showed at ventral ends on both sides. For the individual ELAPE model the high-stress zone was found at the anterior part of the levator ani muscle and the surrounding structure. The maximum stress appeared at the top end of the left and right sides. Conclusion This individual ELAPE is able to decrease the stress of non-levator ani tissue, which suggests that the risk of postoperative pelvic floor hernia is relatively reduced.

Objective Summarize the experience in the surgical treatment of multiple original colon cancer in aged patients. Methods The retrospective analysis was performed in the 46 cases of multiple original colon cancer in aged patients in our hospital from August 1955 to May 2000. Results The 46 cases of multiple original colon cancer in aged patients account for 7.6% (46/608) of the total cases of colon cancer in patients in the same period. There were 26 cases of the male and 20 cases of the female. 30 cases were colon cancer with tumors from other organs. "The different time cancer" could be found 31 years later. The follow-up rate was 100%. The survival rates for 3,5,10,15,20 years were 71.1%(27/38), 63.6%(21/33), 43.3%(13/30), 28.6%(8/28) and 16.0%(4/25) respectively. In this study, we found that the survival rate of the group was higher than that of the aged patients suffering colon cancer in the same period of time. Conclusions The number of multiple original colon cancer in aged patients has been increased in the decade. The incidence was 43.5% (20/46) in the study. With the development of society, both doctors and patients have improved their knowledge about multiple original carcinomas in aged patients. The positive rate of early diagnosis was promoted to a high level, especially in the monitor and treatment of per operation. Choosing the energetic operation, we will acquire the better therapeutic efficacy for treatment of multiple original cancer in aged patients.

Colorectal cancer (CRC) is one of the most common human malignant diseases, the cumulative result of genetic and epigenetic mutations, and its mortality rate is second only to that of lung cancer. Most patients with CRC have developed to middle to advanced stage when symptoms appear, and the treatment effects of surgery and chemotherapy are usually not satisfactory. With the emergence of targeted drugs in recent years, individualized treatment of colorectal cancer has gradually become a trend. With the development of colorectal cancer research, more and more molecular markers of colorectal cancer have been continuously discovered, and its impact on tumorigenesis, development and treatment has gradually received more attention. The application of molecular markers in the screening of colorectal cancer can help the early detection and diagnosis. Detection of molecular markers before individualized treatment can optimize the treatment plan and prompt the patient's prognosis. In this paper, the most recent findings of molecular markers with promising clinical application were summarized, in order to provide reference for the early diagnosis and treatment of colorectal cancer.

OBJECTIVETo seek the optimum treatment for patients with primary gastric non-Hodgkin's lymphoma and factors associated with prognosis.

METHODSA retrospective study was conducted on 157 primary gastric non-Hodgkin's lymphoma patients who had received operation for 45 years.

RESULTSThe X-ray diagnosis rate was 39.4% before operation. The diagnosis rate by gastroscopy was 52.7%. Among the 157 patients, 32 belonged to stage I(E), 40 stage II(E), 29 stage III(E), and 56 stage IV(E). All of the patients were received chemotherapy or radiation. The 3-, 5-, 10-, 15-year survival rates were 51.1% (69/135), 42.3% (55/130), 20.7% (23/111), and 13.5% (14/104).

CONCLUSIONSThe 3-, 5-year survival rates in stage I(E) and stage II(E) were 2 to 5 times higher than those in stage III(E) and IV(E) (P < 0.01). The 3-, 5-year survival rates of primary gastric non-Hodgkin's lymphoma were 60.2% (65/108) and 50.0% (52/104) respectively. The prognosis was better than the 5-year survival rate of gastric cancer patients with D(2) lymphodenectomy (33.3%). Early diagnosis and treatment are effective to prevent complications, enhance quality of patient's life, and prolong the survival.

Introduction of the da Vinci robotic surgical system has revolutionized the field of minimally invasive surgery. Innovative ro-botic technologies have helped surgeons overcome the technical difficulties of conventional laparoscopic surgery. At present, da Vinci robotic colorectal surgery is a safe and feasible option and has shown comparable short-term outcomes with conventional laparoscop-ic surgery. However, it has no oncological advantage despite its significantly higher cost. Promising technologies have been developed to overcome the drawbacks and obstacles of the current robotic systems. Moreover, further randomized controlled clinical trials are re-quired to assess the long-term results and potential benefits of robotic surgery over laparoscopy. This review aimed to elucidate the current developments in robotic colorectal surgery and to explore emerging surgical robotic technologies currently available or in de-velopment.

Objective: To analyze clinical features and prognosis of hepatocellular carcinoma (cHCC) patients after liver resection, so as to clarify the prognostic risk factors. Methods: We retrospectively reviewed the data of patients who underwent mesohepatectomy for cHCC at Tianjin Medical University Cancer Hospital and Chinese Academy of Medical Sciences Cancer Hospital between October 2006 and December 2014. The patients were assigned into three subgroups according to disease-free survival (DFS): high risk (DFS≤1 year), middle risk (1 year3 years). Clinicopathological characteristics were compared and prognostic factors were evaluated using univariate and multivariate analyses. Results: In total, 173 patients were reviewed. The median overall survival (OS) in the high-risk group was 13.5 months compared with 24.0 months in the middle-risk group and 45.5 months in the low-risk group. Univariate analysis showed that liver capsule invasion (P=0.022), tumors adjacent to major vascular vessels (<1 cm) (P<0.01), HCC size>50 mm (P=0.012), presence of microvascular invasion (P<0.001), tumor invasive growth (P<0.001), and preoperative transarterial chemoembolization (TACE; P=0.028) were significant risk factors for recurrence. The main risk factors for OS were male gender (P=0.013), alpha-fetoprotein >200 ng/mL (P=0.005), tumor size >50 mm (P=0.013), adjacent to major vascular vessels (P<0.001), high Edmondson-Steiner differentiation grade (P=0.003), preoperative TACE (P=0.010), and tumor invasive growth (P=0.001). Cox multivariate analysis demonstrated that tumors adjacent (<1 cm) to major vascular trunks and tumor invasive growth were inde-pendent prognostic factors for both DFS and OS. In total, 40.5% patients in the high-risk group had both risk factors; this percentage was 13.4% in the middle-risk group and 3.1% in the low-risk group (P=0.001). A prognostic model including the above 9 factors were created based on Logistic regression to predict the percentage of patients belonging to the high-risk group. The results showed that the prediction accuracy continued to increase with the number of more factors added. When all the 9 factors were included, the pre-dictive percentage was 82.1%. Conclusions: cHCC patients in the high-risk group had more risk factors than those in the middle-and low-risk groups. A prognostic model containing these factors may provide accurate prediction of survival or risk stratification, and cHCC patients with these risk factors should be candidates for aggressive following-up and adjuvant therapy.

Objective: To investigate the variants of middle colic artery (MCA) and ileocolic vein (ICV) and their influence on the deci-sion regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The pa-tient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment (MDT) discussion. Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examina-tion; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparo-scopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39. Postoperative pathological tumor stage was pT3N0. Postoperative pathological tumor type was moderately differentiated adenocarci-noma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and stan-dard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.