OBJECTIVETo evaluate and compare the efficiency and safety of laparoscopic surgery (LS) and open surgery (OS) in the treatment of colorectal carcinoma.

METHODSRandomized controlled trials on laparoscopic surgery and open surgery for colorectal carcinoma from January 2000 to October 2010 were searched in the databases of EMbase, PubMed, Cochrane Library, Sciencedirect, Springer, VIP, CNKI, CBMdisc. The methodological quality was assessed according to the standard of Cochrane systematic review. For homogeneous studies, RevMan5.0 software was used for meta-analysis.

RESULTSA total of 13 RCTs involving 4603 patients were included in this study, and among those 6 were multi-center randomized controlled trials. The meta-analysis showed that: the operation time of the LS group was longer than that of the OS group (WMD = 38.91, 95%CI: 33.89 - 43.93, P < 0.001), the blood loss (WMD = -138.14, 95%CI: -195.79 - -80.50, P < 0.001) and the length of hospital stay (WMD = 2.91, 95%CI: -4.65 - -1.17, P = 0.001) of the LS group was less than those in OS group. There was no significant differences between the two groups in the number of dissected lymph nodes (WMD = -0.62, 95%CI: -1.47 - 0.23, P = 0.150). There was no significant differences between the two groups in terms of the postoperative complications (30 days) (RR = 0.78, 95%CI: 0.59 - 1.01, P = 0.06). There was no significant differences between the two groups in 3-year overall survival (RR = 1.00, 95%CI: 0.96 - 1.04, P = 0.970). There was no significant differences between the two groups in 5-year overall survival (RR = 1.03, 95%CI: 0.99 - 1.08, P = 0.140). There was no significant differences between the two groups in 5-year overall recurrence (RR = 0.89, 95%CI: 0.74 - 1.07, P = 0.200).

CONCLUSIONSLaparoscopic surgery for colorectal carcinoma is a safe and effective therapy as open surgery in the short term or long term outcomes. It could be an acceptable alternative to open surgery for colorectal carcinoma.

Colorectal Neoplasms ; surgery ; Humans ; Laparoscopy ; Randomized Controlled Trials as Topic ; Treatment Outcome

OBJECTIVETo examine the expression of tissue factor pathway inhibitor-2 (TFPI-2) in gallbladder cancer (GBC) and to investigate the anti-cancer activities of TFPI-2 against the growth of GBC.

METHODSTFPI-2 expression in gallbladder normal tissues, gallbladder polyp (GBP) tissues and GBC tissues were examined by reverse transcriptase polymerase chain reaction (RT-PCR), Western blot and immunohistochemical staining. Adenovirus carrying human TFPI-2 gene (Ad5-TFPI-2) were constructed and its anti-cancer effects were investigated in xenograft tumors. Xenograft tumors were constructed by injection of GBC-SD and SGC-996 cells into the flank of nude mice and the volume of xenograft tumors was measured every 3 days until the sacrifice of mice. The apoptosis index of xenograft tumors was examined by TUNEL assay. The status of Bax, Bcl-2 and caspase-3 was examined by Western blot assay.

RESULTSTFPI-2 expression was profoundly lower in GBC tissues (87.0%) when compared to normal tissues (23.3%) and GBP tissues (52.2%; χ(2) = 21.104, P = 0.000). Ad-TFPI-2 significantly inhibited the growth of xenograft tumors in nude mice. Ad-TFPI-2 inhibited GBC-SD cell growth through the induction of apoptosis. The means of total apoptotic cells per field were much higher in Ad5-TFPI-2 group than those in PBS and Ad5-GFP groups. Ad5-TFPI-2 elevated the expression of Bax and cleaved caspase-3, while it decreased the expression of Bcl-2.

CONCLUSIONSTFPI-2 gene and protein was down-regulated in GBC and the down-regulation of TFPI-2 may play a role in the tumorigenesis of GBC. Adenovirus-mediated TFPI-2 can inhibit GBC growth through the induction of apoptosis.

Adenoviridae ; genetics ; Aged ; Animals ; Apoptosis ; Caspase 3 ; metabolism ; Cell Line, Tumor ; Female ; Gallbladder Neoplasms ; metabolism ; pathology ; therapy ; Genetic Therapy ; Glycoproteins ; genetics ; metabolism ; Humans ; Male ; Mice ; Mice, Nude ; Middle Aged ; Neoplasm Transplantation ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; bcl-2-Associated X Protein ; metabolism

OBJECTIVETo study the mechanism underlying the inhibitory effects of peroxisome proliferator-activated receptor γ (PPARγ) agonists on transforming growth factor β1 (TGF-β(1))-induced scarring of skin.

METHODSFibroblasts isolated from healthy adult skin were cultured in vitro and divided into blank control group (serum-free DMEM culture), TGF-β(1) group (with stimulation of 10 ng/mL TGF-β(1) for 48 hours), troglitazone group (with the same treatment as in TGF-β(1) group after stimulation of 10 µmol/L troglitazone for 2 hours), and 15-dioxygen prostaglandin J2 (15d-PGJ2) group (with the same treatment as in TGF-β(1) group after stimulation of 10 µmol/L 15d-PGJ2 for 2 hours) according to the stimulation added into DMEM. The expression of connective tissue growth factor (CTGF) was determined with Western blot. The mRNA levels of CTGF, matrix metalloproteinase-1 (MMP-1) and platelet-derived growth factor (PDGF) were determined with real-time fluorescence RT-PCR. Data were processed with one-way analysis of variance.

RESULTSThe expression of CTGF at mRNA and protein levels in skin fibroblasts were significantly increased in TGF-β(1) group as compared with control group; while expression of CTGF at mRNA and protein levels in 15d-PGJ2 and troglitazone groups were significantly decreased as compared with that in TGF-β(1) group. The mRNA level of MMP-1 in TGF-β(1) group (0.193 ± 0.051) was obviously lower than that in blank control group (1.281 ± 0.195, F = 12.811, P < 0.01), while the mRNA levels of MMP-1 in troglitazone group (0.417 ± 0.043) and 15d-PGJ2 group (0.485 ± 0.027) were significantly increased as compared with that in TGF-β(1) group (F = 12.811, P values all below 0.01). The mRNA level of PDGF in TGF-β(1) group (1.044 ± 0.237) was obviously higher than that in control group (0.349 ± 0.057, F = 16.848, P < 0.01), while the levels in troglitazone group (0.677 ± 0.055) and 15d-PGJ2 group (0.511 ± 0.017) were significantly decreased as compared with that in TGF-β(1) group (F = 16.848, P values all below 0.01).

CONCLUSIONSThe inhibitory effect of activated PPARγ on the expression of CTGF induced by TGF-β(1) may be the main mechanism of its inhibitory effect on TGF-β(1)-induced scarring on skin, and its influence on MMP-1 and PDGF may also be one of the underlying mechanisms.

Cell Line ; Connective Tissue Growth Factor ; metabolism ; Fibroblasts ; drug effects ; metabolism ; Humans ; Matrix Metalloproteinase 1 ; metabolism ; PPAR gamma ; agonists ; Receptors, Platelet-Derived Growth Factor ; metabolism ; Signal Transduction ; Transforming Growth Factor beta1 ; metabolism

Objective To evaluate the therapeutic effects of poly(N-isopropylacrylamide)adriamycin magnetic nanoparticles(ADM-PNIPAM-Fe_3O_4)on liver VX2 tumor in rabbits via transcatheter arterial chemoembolization.Methods VX2 tumor pieces were successfully implanted into liver lobes of rabbits with liver tumors formation.All the animals were randomly divided into 4 groups of 8 each.Group A(control group)injected with 10 ml physiologic saline,Group B(ADM group)treated with free adriamycin (1 mg/kg)via arterial infusion,Group C(ADM-PNIPAM group)ADM-PNIPAM(1.5 mg/kg)was infused through arterial route,Group D(ADM-PNIPAM-Fe_3O_4+M group)ADM-PNIPAM-Fe_3O_4(2 mg/kg)was infused through arterial route;all were in individual doses,respectively;meanwhile an persistant magnet with intensity of 0.4 T was stabilized at the tumor region.Spiral CT scans were performed to measure size of liver tumors and evaluate lung metastasis at 1 day before operation and 14 days after operation.All experimental animals were sacrficed on the 15th days after operation and followed by pathologic and histologic examination of the tumor and lung specimens including changes befor and after the operation with correlative comparisons.Results There were no significant difference in volumes of tumors among 4 groups at 1 day before operation.The average tumor volume in the group A was(23.87?7.02)cm~3 at 14 days after operation;(7.70?1.53)cm3 in group B;(4.29?0.25)cm~3 in group C;(2.05?0.18)cm~3 in group D. The average tumor volumes in the group B,group C and group D were significantly smaller than that in the control group A at same time after operation and there was significant difference among the three experimental groups.According to the order of tumor sizes from small to large was as follows:group D＜group C＜group B＜group A.It showed that the average size of group D(ADM-PNIPAM-Fe_3O_4+M group) was the smallest among the 4 groups.Lung metastatic rates were 100%,66.7%,37.5% and 12.5% in group A,group B,group C and group D at 14 days after operation,respectively.Lung metastatic rates of group D was lower than that of group A,but there were no significant differences among group A,B and C.But pathological examination showed that there were lesser number of lung metastatic tumors in group B and C than that of group A .The intratumoral necrotic degrees showed as group D＞group C＞group B＞group A. Conclusions ADM-PNIPAM-Fe_3O_4 treatment for liver tumor via vascular interventional method combined with magnetic field localized in the lesion possesses significant inhibitory effect on tumor growth of liver VX2 tumor in rabbits.ADM-PNIPAM-Fe_3O_4 is thus initially confirmed as a kind of effective praeputium in interventional chemoembolization.

Objective To evaluate the effectiveness of endovascular deployment of metallic Z-type self- expandable stents in treating the patients with inferior vena eava(IVC)obstruction caused by hepatic malignant tumour.Methods One hundred and fifty six patients with IVC obstruction due to malignant compression were enrolled.Venography was performed via femoral vein before and after metallic Z-type self-expandable stent deployment across the stenotic segment of IVC.The diameter of stenotic segment,collateral vessels,venous pressures and the scores of patients IVC syndrome were compared before and after stent placement.Results One hundred and seventy nine stents were implanted in 156 patients successfully.The average obstructive length of IVC was(6.1?2.2)cm.The pressure gradient of stenotie segments of IVC declined from(2.1?0.5)kPa to (0.5?0.11)kPa.The diameters of stenotic segment of IVC increased from(0.33?0.11 )cm to(1.6?0.4) cm.After operations,the main clinical symptoms and physical signs relieved quickly.During 2～24 month follow-up,the pateney of IVC stents reached 86.7%.Conclusion Endovascular deployment of metallic Z-type self-expandable stent is an effective palliative treatment for patients with malignant obstruction of IVC.

Objective To research the change of the portal venous pressure after the stents implanted into portal vein in HCC.Methods Twelve HCC patients receiving portal venous stem embolization were included in this study.The portal venous pressures were recorded before varices embolized(P1),after embolized(P2)and after stents implanted(P3),respectively.Four groups were formed according to the pressures within portal vein stem(PV),portal vein branch without tumor invasion(PVB),splenic vein(SV) and superior mesenteric vein(SMV).Results In PV group,P1 was(45:17?2.25)cm H20,and P2 was (48.33?2.20)cm H_2O,P＜0.05,P3 was(39.33?2.44)em H_2O,thus P＜0.05 in comparing with P2.for PVB group,P1 was(38.08?2.97)cm H_2O,and P2 was(38.83?2.94)cm H_2O,P＞0.05,P3 was(37.41?2.37)cm H_2O,comparing with P2,P＞0.05.In SV group,P1 was(44.67?2.13)cm H_2O,and P2 was(48.17?2.20)cm H_2O,P＜0.05,P3 was(41.67?2.20)cm H_2O,comparing with P2,P＜0.05.Finally,the SMV group,P1 was(45.25?2.21 )cm H_2O,P2 was(48.42?2.19)cm H_2O,P＜0.05,P3 was(41.25?2.24)cm H_2O, in comparison with P2,P＜0.05.Conclusions In portal vein stem embolization,portal venous pressure would be higher after varices embolized,but lower after stents placement.

Objective To analyze the key factors on long-term effect for comprehensive interventional therapy of primary liver cancer.Methods The clinical data,therapeutic protocols and follow-up of 56 patients with primary liver cancer survived for more than 5 years after comprehensive interventional therapy were analyzed retrospectively.Results Before TACE,20 patients were in clinical stageⅠ,35 were in stageⅡand one was in stageⅢ,including hepatic function of grade A(36 cases),grade B(20 cases),and grade C (0 case).The tumor patterns were consisted of mononodular type(32 cases),multinodular type(24 cases),and diffuse type(0 cases).The diameter of tumor demonstrated less than 3 cm(10 cases),3-5 cm(20 cases), 5-10 cm(19 cases)and more than 10 cm(7 cases).Thirty-three cases(58.9%)were treated by only TACE for the original lesions,while 23 cases(41.1%)were treated by TACE combined other treatment including TACE combined PEt(11 cases),TACE combined RFA(4 eases),TACE combined radiotherapy(one case),and TACE combinedⅡ-staged resection(7 cases).During follow-up,24 patients with hepatic recurrence and 17 cases of distal metastasis were treated by TACE and other anti-tumor treatment.Complications after interventional therapy in 20 cases were also treated.All cases survived for more than 5 years after interventional therapy including 3 more than 10 years.Conclusions Tumor factors,liver function, standardized TACE,combination of TACE with other anti-tumor therapy,treatment of hepatic recurrence and distal metastasis and complications are the key points to improve the long-term survival rate for primary liver cancer treated by comprehensive interventional therapy.

Carcinoma, Hepatocellular ; complications ; drug therapy ; pathology ; Chemoembolization, Therapeutic ; methods ; Female ; Humans ; Liver Neoplasms ; complications ; drug therapy ; pathology ; Male ; Neoplastic Cells, Circulating ; Portal Vein ; pathology ; Stents ; Venous Thrombosis ; complications ; pathology

OBJECTIVETo evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice (MOJ).

METHODSThirty-nine patients with diagnosis of MOJ, whose serum total bilirubin (TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization (TACE). During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m(2) was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up.

RESULTSMedian total serum bilirubin in 39 patients was 72.7 micromol/L (range: 52.1 - 91.4 micromol/L) before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed: grade I in 41.0% of patients, grade II in 35.9% and grade III - IV in 15.4%. Grade III - IV nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients (48.7%) with a medium jaundice recurrence time of 9.0 months (range: 2 - 20 months).

CONCLUSIONEpirubicin-lipiodol emulsion at a dose of 30 mg/m(2) is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 micromol/L after biliary drainage.

Adult ; Aged ; Antibiotics, Antineoplastic ; administration & dosage ; Bile Duct Neoplasms ; complications ; Bilirubin ; blood ; Carcinoma, Hepatocellular ; complications ; Chemoembolization, Therapeutic ; Epirubicin ; administration & dosage ; Female ; Follow-Up Studies ; Humans ; Iodized Oil ; administration & dosage ; Jaundice, Obstructive ; etiology ; therapy ; Liver Neoplasms ; complications ; Male ; Middle Aged ; Recurrence ; Survival Rate

OBJECTIVETo study the features of blood supply and results of transarterial infusion and embolization in spinal metastases.

METHODSForty-one patients with spinal metastasis received transarterial infusion and embolization between March 2001 and June 2008. The inclusion criteria were: The metastatic lesion caused back pain; The metastatic lesion involved vertebra at or below T3 level. There were 29 males and 12 females with a mean age of 56.0 (33 - 71) years. Epirubicin was used as the chemotherapeutic agent. Lipoid Ultra-Fluid, Contour SE or gelfoam particles were used as embolitic material.

RESULTSThe technical success of therapy was achieved in 52 vertebrae (100%) including 14 thoracic, 35 lumbar and 3 sacral vertebrae. 105 arteries were used for infusion and embolization (16 intercostal arteries, 78 lumbar arteries, 4 iliolumbar arteries, 4 branches of iliac arteries, and 3 median sacral arteries). Lipoid Ultra-Fluid (2 - 8 ml) was used in 15, Contour SE (300 approximately 500 microm, 20 - 100 mg) in 20, and gelfoam particles in 33 arteries. Three days after treatment, complete pain relief (CR) was achieved in 17 patients, partial pain relief (PR) in 20, and moderate pain relief (MR) in 4, with an effective rate of 90.2%. Two weeks after treatment, CR was achieved in 17 patients, PR in 21, and MR in 3, with an effective rate of 92.7%. No adverse nervous system effect occurred. 16 patients developed swelling and pain of normal tissues which were alleviated after symptomatic treatment.

CONCLUSIONTransarterial infusion and embolization is an effective therapy in relieving pain resulting from spinal metastases.

Adult ; Aged ; Antibiotics, Antineoplastic ; administration & dosage ; Back Pain ; etiology ; therapy ; Breast Neoplasms ; pathology ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Embolization, Therapeutic ; methods ; Epirubicin ; administration & dosage ; Female ; Gelatin Sponge, Absorbable ; therapeutic use ; Humans ; Iodized Oil ; therapeutic use ; Liver Neoplasms ; pathology ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Remission Induction ; Spinal Neoplasms ; blood supply ; secondary ; therapy