Objective:To investigate the short term efficacy of laparoscopic assisted transanal total mesorectal excision (taTME) for low rectal cancer.Methods:The prospective study was conducted. The clinicopathological data of 80 patients who underwent laparoscopic assisted taTME for low rectal cancer in 8 medical centers，including 27 cases in the First Affiliated Hospital of Jilin University，16 cases in the Daping Hospital of Army Medical University，15 cases in the Beijing Friendship Hospital of Capital Medical University，10 cases in the Peking University Cancer Hospital，7 cases in the Peking Union Medical College Hospital of Chinese Academy of Medical Sciences，2 cases in the Peking University People′s Hospital，2 cases in the Liaoning Cancer Hospital Institute，1 case in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine，from August 2017 to September 2018 were collected. Observation indicators：(1) clinical data of enrolled patients；(2) surgical situations；(3) postoperative histopathological examination；(4)postoperative complications and hospitalization. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and (or) percentages. Results:(1) Clinical data of enrolled patients：a total of 80 patients were selected for eligibility. There were 59 males and 21 females，aged from 53 to 79 years，with a median age of 61 years. (2）Surgical situations：all 80 patients underwent surgery successfully，including 73 cases undergoing low anterior resection，4 cases undergoing Hartmann operation，1 case undergoing intersphincteric and abdominoperineal resection，1 case undergoing other operations and 1 case missing operation information. Nineteen of the 80 patients underwent transabdominal and transanal operations simultaneously. The operation time of 80 patients was 255 minutes (range，211?305 minutes). Of 80 patients，77 cases had the volume of intraoperative blood loss ≤500 mL，3 cases had the volume of intraoperative blood loss >500 mL，44 cases underwent instrumental anastomosis，24 cases underwent manual anastomosis，12 cases were missing anastomosis information，66 cases had specimens been taken out through anus，2 cases had specimens been taken out through Pfannens-tiel incision，10 cases had specimens been taken out through other ways，2 cases were missing the information of specimens removal ways，57 cases underwent preventive stoma，32 cases under-went anal canal indwelling，30 cases underwent free of splenic flexure and 2 cases were converted to open surgery. (3) Postoperative histopathological examination：of 80 patients，68 cases had the integrity of mesorectal specimens with complete，5 cases had the integrity of mesorectal specimens with near complete，1 case had the integrity of mesorectal specimens with not complete，6 cases were missing the information of integrity of mesorectal specimens，1 case had rectal perforation，1 case had positive circumferential margin and 1 case had positive distal margin. The number of lymph node dissected and diameter of tumor were 12(range，9?16) and 3.0 cm(range，1.9?4.0 cm) of 80 patients. Four of 80 patients achieved pathological complete remission. Cases with tumor stage as T0 stage，Tis stage，T1 stage，T2 stage，T3 stage or T4 stage of the pT staging，cases with tumor stage as N0 stage，N1 stage or N2 stage of the pN staging，cases with tumor stage as M0 stage or M1 stage of the pM staging were 4，2，11，24，35，4，55，21，4，75，5 of 80 patients. (4) Postopera-tive complications and hospitalization：8 of 80 patients underwent anastomotic leakage，including 2 cases with grade A anastomotic leakage，4 cases with grade B anastomotic leakage and 2 cases with grade C anastomotic leakage.Seven of 80 patients underwent intestinal obstruction. The 2 cases with grade A anastomotic leakage were improved after symptomatic drug treatment，the 4 cases with grade B anastomotic leakage were improved after treatment with antibiotics or catheter drainage and the 2 cases with grade C anastomotic leakage were improved after operation. The duration of hospital stay of 80 patients was 14 days(range，11?21 days). No patient died during hospitalization.Conclusion:Laparoscopic assisted taTME for low rectal cancer is safe and feasible，which has a good short term efficacy.

Objective:To investigate the incidence and influencing factors of anastomotic leakage after anterior resection (AR) for rectal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 1 243 patients with rectal cancer who were admitted to 3 medical centers between August 2008 and July 2017 were collected, including 512 in the Beijing Friendship Hospital of Capital Medical University, 480 in the Cancer Hospital of Chinese Academy of Medical Sciences, 251 in the Peking University People′s Hospital. There were 734 males and 509 females, aged from 25 to 89 years, with an average age of 65 years. All patients underwent AR for rectal cancer. Observation indicators: (1) surgical situations and incidence of postoperative anastomotic leakage; (2) influencing factors for postoperative anastomotic leakage. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using the Logistic regression model based on factors with P<0.10 in the univariate analysis. Results:(1) Surgical situations and incidence of postoperative anastomotic leakage: all the 1 243 patients with rectal cancer underwent successfully AR including 219 undergoing defunctioning stoma and 1 024 undergoing non-defunctioning stoma, of which 70 patients had postoperative anastomotic leakage, with a total incidence rate of 5.632%(70/1 243). The incidence rates of grade A anastomotic leakage, grade B anastomotic leakage, and grade C anastomotic leakage were 27.1%(19/70), 21.4%(15/70), 51.4%(36/70), respectively. (2) Influencing factors for postoperative anastomotic leakage: results of univariate analysis showed that gender, surgical procedure, volume of intra-operative blood loss, and pathological metastasis staging were related factors for anastomotic leakage after AR ( χ2=8.518, 6.548, 10.834, 4.501, P<0.05). Results of multivariate analysis based on factors with P<0.10 in the univariate analysis showed that male and volume of intraoperative blood loss≥100 mL were independent risk factors for anastomotic leakage after AR [ odds ratio ( OR)=2.250, 1.949, 95% confidence interval ( CI): 1.281-3.952, 1.142-3.324, P<0.05)]; defunctioning stoma was an independent protective factor for anastomotic leakage after AR ( OR=0.449, 95% CI: 0.201-1.001, P<0.05). Subgroup analysis on effects of defunctioning stoma versus non-defunctioning stoma on grade of anastomotic leakage showed that percentage of grade C anastomotic leakage for defunctioning stoma group was 14.3%(1/7), versus 55.6%(35/63) for non-defunctioning stoma group, with a significant difference between the two groups ( χ2=9.570, P<0.05). Conclusions:Male and volume of intraoperative blood loss≥100 mL are independent risk factors for anastomotic leakage after AR. Defunctioning stoma is an independent protective factor for anastomotic leakage after AR. For male patients and patients with large volume of intraoperative blood loss, defunctioning stoma is recommended to reduce the incidence of postoperative anastomotic leakage.

Objective To investigate the mechanism of lnc-AC079612.1-1∶1 in the metastasis of colorectal cancer by regulating miR-1915 expression and provide a theoretical basis for new therapeutic targets of colon cancer.Methods Continuously harvested 3 pairs of primary tumor and hepatic metastases of patients with synchronous colon cancer with liver metastasis.LncRNA + mRNA Human Gene Expression Microarray V4.0 and 4 × 180K Expression Microarray were used to detect the Expression profile of LncRNA in primary colon cancer and matched liver metastases.The detection of expression profile chip was used to find some lncRNAs that may be closely associated with colon cancer liver metastasis,and through the literature retrieval,the author preliminarily analyzed the co-expression encoding genes of lncRNAs,in order to find lncRNAs that may play key roles in the process of colon cancer liver metastasis.The effect of lnc-AC079612.1.1-1∶1 on the proliferation capacity of colon cancer cell lines was detected in SW480 cell lines and SW620 cell lines of colon cancer through CCK-8 experiment.Effects of lnc-AC079612.1.1-1∶1 on the migration and invasion of colon cancer cells were examined by Transwell cell invasion assay.Through TargetScan,Miranda,LNCipedia and other web tools,miRNAs that may bind to lncRNA and o-6-methylguanine-DNA methyl transferase (MGMT) were predicted.Double luciferase reporter gene assay was used to detect the interaction between miR-1915 andlnc-AC079612.1.1-1 ∶ 1.SPSS 22.0 statistical software was used to analyze the data.The measurement data were expressed as ((x) ± s).T test was compared between the two groups,and multiple groups were compared with F test.Results The expression of lnc-AC079612.1-1 ∶ 1 was 3.94 times higher in the liver metastases than in the primary tumor,and expression of MGMT was 3.74 times higher in the liver metastases than in the primary tumor.The results showed that there was a significant co-expression relationship between the lncRNA and o-6-methylguanine DNA transferase (MGMT) gene,and the co-expression correlation coefficient was 0.994 (P ＜ 0.001).The over expression of lnc-ac079612.1.1-1∶1 could significantly enhance the proliferation capacity of SW480 and SW620 cell lines of colon cancer through the CCK-8 experiment.The over expression of lnc-ac079612.1.1-1:1 could promote the invasion and metastasis of SW480 and SW620 cell lines of colon cancer through Transwell cell invasion experiment.MirR-1915-3p was the only miRNA that predicted to be combined with lnc-ac079612.1-1∶1 and MGMT through TargetScan,Miranda,LNCipedia and other web tools.Lnc-ac079612.1.1-1∶1 was found to bind to miR-1915 by double luciferase assay.Conclusion Lnc-ac079612.1.1-1∶ 1 may participate in the liver metastasis process of colon cancer by regulating MGMT,and may play a role in the liver metastasis of colon cancer through the action of mir-1915 on MGMT.

B lymphocytes are not the only source of Igs,instead,various non-B cell types,including the normal epithelial cells and cancer cells,also own the ability to produce different types of Igs.The non-B cell derived Igs possess their own characteristics.For instance,they are highly conserved in V (D)J rearrangement patterns;each Ig has its own rearrangement pattern of the variable region of IgH.The non-B Igs are closely related with tumors.They are highly expressed in different tumors,including clear cell renal cell carcinoma,lung cancer,breast cancer,and they act as a tumor promoter through different mechanisms.As to the digestive system tumors,several digestive organs or their corresponding tumors could produce Igs,such as stomach,liver,pancreas,small intestine and colon.The Igs derived from these organs may participate in the innate immune responses,as well as the tumorigenesis processes.A more detailed study on the non-B cell derived Igs may provide new therapeutic targets for malignant tumors,including tumors from digestive system.

Objective To introduce and analyze the status of tumor multidisciplinary team (MDT) model application in primary hospitals.Methods MDT discussion decision-making and implementation of Nanpi People's Hospital from June 2013 to July 2015 were retrospectively analyzed.Results A total of 251 cases were recruited into the MDT discussion.Among them,233 primarily diagnosed cases reached MDT decision-making and 159 cases took the decision,118 cases achieved the purpose (74.2％),41 cases failed (25.8％).Yet in 74 cases not following the decision,11 cases achieved the desired purpose (14.9％),while 63 cases didn't meet the desired purpose (85.1％),the difference was statistically significant (x2 =71.97,P ＜ 0.01).Ultrasound interventional biopsy,enhanced CT scan,CT guided puncture,intraoperative frozen section examination in malignant tumor patients had significantly increased after MDT applied,the difference was statistically significant (all P ＜ 0.05).The annual new rural cooperative medical system referral rate in malignant tumor patients dropped sharply (x2 =19.86,P ＜ 0.01) Conclusions Doctors and cancer patients can benefit from MDT diagnosis and treatment model,which is worth generalization.

Objective To investigate the association between extramural vascular invasion (EMVI) detected by multi-detectors computed tomography (MDCT) with contrast enhanced (ceMDCT) and clinicopathologic characteristics in patients with colon cancer.Methods Between February 2009 and December 2013,patients with histologically proven primary colon cancer and undergoing curative resection were included in this retrospective study.According to American Joint Committee on Cancer TNM staging system,patients of stage Ⅱ and Ⅲ were included in this study.EMVI status detected by MDCT (ctEMVI) was defined according to the EMVI scores.Chi-square test was used to analyze the association between clinicopathologic characteristics and ctEMVI.Results 165 stage Ⅱ and stage Ⅲ patients were included in this study as confirmed by pathology based on AJCC.Positive ctEMVI was demonstrated in 51 patients (34.5％,51/165).There were significant association between positive ctEMVI and age ＜ 65 years (x2 =4.810,P =0.031),ceMDCT defined tumor stage (x2 =17.911,P =0.000),ceMDCT defined metastatic lymph node (x2 =5.436,P =0.022),tumor size≥5 cm (x2 =3.799,P =0.036) and pathological T stage (x2 =13.346,P =0.001).Conclusions EMVI,detected by ceMDCT,is significantly associated with age,tumor size and T staging in colon cancer.

Objective To compare the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) for the treatment of type 2 diabetes mellitus (T2DM) patients in various obesity degree.Methods A total of 36 T2DM patients undergoing LRYGB were enrolled in this study in our hospital from June 2012 to June 2014.The patients were divided into BMI ≥ 32.5 kg/m2 group (n =13) and 27.5 kg/m2 ≤ BMI ＜ 32.5 kg/m2 group (n =23) based on BMI.Results In group 1,following the degression of BMI from (37.7±3.6) kg/m2 to (29.1 ±3.5) kg/m2 at 12 months after surgery,fasting blood glucose of group 1 decreased from (7.8 ± 1.6)mmol/L to (5.2 ±1.0)mmol/L (t =5.796,P =0.000),and HbA1c decreased from 7.3％ ±0.7％ to 6.1％ ± 1.0％ (t =5.589,P =0.000);and following the degression of BMI from(30.0 ± 1.6) kg/m2 to (25.8 ± 3.2) kg/m2,fasting blood glucose of group 2 decreased from (8.9 ± 1.7) mmol/L to (6.1 ± 1.5) mmol/L (t =6.577,P =0.000),and HbA 1 c decreased from 7.8 ％ ± 1.8％ to 6.4％ ± 1.0％ (t =4.257,P =0.000).Though Homa-IR of two groups was significantly improved after surgery (t =6.415,4.135;P =0.000,0.000),there was no difference to Homa-β (t =1.007,-0.155;P =0.334,0.878).Complete remission ratio of BMI ≥ 32.5 kg/m2 group was not significantly different with 27.5 kg/m2 ≤ BMI ＜ 32.5 kg/m2 group.Conclusion LRYGB is effective for the treatment of type 2 diabetes patients despite preoperative various obesity degree.

OBJECTIVETo compare clinical efficacy between abdominoperineal resection (APR) procedure and anterior resection(AR) procedure in patients with rectal cancer.

METHODSClinicopathological data of 309 cases with rectal cancer undergoing resection in Peking University People's Hospital from January 1998 to December 2012 were retrospectively analyzed. Short-term outcomes, local recurrence, overall survival (OS) and progression-free survival (PFS) were investigated between two groups.

RESULTSAs compared to the AR group, the operative time was longer [(268.5 ± 66.7) min vs. (247.4 ± 64.2) min, P=0.005], blood loss[(668.5 ± 680.1) ml vs.(441.8 ± 478.6) ml, P=0.001] and drainage volume were more[(66.9 ± 54.7) ml vs. (49.0 ± 45.9) ml, P=0.002] in the APR group. There was no significant difference of local recurrence between the two groups, while the 5-year local recurrence rate of T3-T4 patients undergoing APR procedure (24.9%) was higher than that of AR group (13.9%)(P=0.038), especially in the patients with tumors located at 4-6 cm away from the anus verge. There were no significant differences of OS (P=0.273) and PFS (P=0.589) between two groups, while both 5-year OS and PFS of T3-T4 patients with BMI ≥ 24 undergoing APR procedure (43.1% and 42.8%) were significantly worse than those of patients undergoing AR procedure (87.9% and 76.9%, P=0.022 and P=0.041).

CONCLUSIONSThe overall prognosis of patients after APR and AR is comparable. Tumor located at 4-6 cm away from the anus verge, T3-T4 stage, obese may play an important role in the worse prognosis of the patients undergoing APR procedure.

Objective To compare clinical efficacy between abdominoperineal resection (APR) procedure and anterior resection (AR) procedure in patients with rectal cancer. Methods Clinicopathological data of 309 cases with rectal cancer undergoing resection in Peking University People′s Hospital from January 1998 to December 2012 were retrospectively analyzed. Short-term outcomes, local recurrence, overall survival (OS) and progression-free survival (PFS) were investigated between two groups. Results As compared to the AR group, the operative time was longer [(268.5± 66.7) min vs. (247.4±64.2) min, P=0.005], blood loss[(668.5±680.1) ml vs.(441.8±478.6) ml, P=0.001] and drainage volume were more [(66.9±54.7) ml vs. (49.0±45.9) ml, P=0.002] in the APR group. There was no significant difference of local recurrence between the two groups, while the 5-year local recurrence rate of T3~T4 patients undergoing APR procedure (24.9%) was higher than that of AR group (13.9%)(P=0.038), especially in the patients with tumors located at 4-6 cm away from the anus verge. There were no significant differences of OS (P=0.273) and PFS (P=0.589) between two groups, while both 5-year OS and PFS of T3-T4 patients with BMI≥24 undergoing APR procedure (43.1% and 42.8%) were significantly worse than those of patients undergoing AR procedure (87.9% and 76.9%, P=0.022 and P=0.041). Conclusions The overall prognosis of patients after APR and AR iscomparable. Tumor located at 4-6 cm away from the anus verge, T3-T4 stage, obese may play an important role in the worse prognosis of the patients undergoing APR procedure.

Objective To compare clinical efficacy between abdominoperineal resection (APR) procedure and anterior resection (AR) procedure in patients with rectal cancer. Methods Clinicopathological data of 309 cases with rectal cancer undergoing resection in Peking University People′s Hospital from January 1998 to December 2012 were retrospectively analyzed. Short-term outcomes, local recurrence, overall survival (OS) and progression-free survival (PFS) were investigated between two groups. Results As compared to the AR group, the operative time was longer [(268.5± 66.7) min vs. (247.4±64.2) min, P=0.005], blood loss[(668.5±680.1) ml vs.(441.8±478.6) ml, P=0.001] and drainage volume were more [(66.9±54.7) ml vs. (49.0±45.9) ml, P=0.002] in the APR group. There was no significant difference of local recurrence between the two groups, while the 5-year local recurrence rate of T3~T4 patients undergoing APR procedure (24.9%) was higher than that of AR group (13.9%)(P=0.038), especially in the patients with tumors located at 4-6 cm away from the anus verge. There were no significant differences of OS (P=0.273) and PFS (P=0.589) between two groups, while both 5-year OS and PFS of T3-T4 patients with BMI≥24 undergoing APR procedure (43.1% and 42.8%) were significantly worse than those of patients undergoing AR procedure (87.9% and 76.9%, P=0.022 and P=0.041). Conclusions The overall prognosis of patients after APR and AR iscomparable. Tumor located at 4-6 cm away from the anus verge, T3-T4 stage, obese may play an important role in the worse prognosis of the patients undergoing APR procedure.