Colonoscopy plays an important role in detecting colorectal neoplasms in patients with gastric neoplasms

BACKGROUND Gastric cancer(GC)and colorectal cancer(CRC)are the fifth and third most common cancer worldwide,respectively.Nowadays,GC is reported to have a potential predictive value for CRC,especially for advanced CRC.AIM To evaluate the necessity of colonoscopy for gastric neoplasm(GN)patients.METHODS Four databases,including PubMed,EMBASE,the Cochrane Library,and Ovid,were used to perform the search strategy on May 2,2023.The prevalence of colorectal neoplasms(CRN)and baseline characteristics were compared between the neoplasm group and the control group.Continuous variables are expressed as the mean difference and standard deviation.Relationships of categorical variables in the two groups are expressed as odds ratios(OR)and 95%confidence intervals(95%CIs).Subgroup analysis according to different kinds of GNs was conducted for more in-depth analysis.The results of this study are represented by forest plots.Publication bias was evaluated by a funnel plot.All data analyses were performed by STATA SE 16.0 software.RESULTS A total of 3018 patients with GNs and 3905 healthy controls(age and sex matched)were enrolled for analysis.After comparing the prevalence of CRNs between the two groups,CRNs were detected significantly more frequently in GN patients than in controls(OR=1.69,95%CI=1.28 to 2.23,I^(2)=85.12%,P=0.00),especially in patients with GC(OR=1.80,95%CI=1.49 to 2.18,I^(2)=25.55%,P<0.1).Moreover,other risk factors including age(OR=1.08,95%CI=1.00 to 1.17,I^(2)=90.13%,P=0.00)and male sex(OR=2.31,95%CI=1.26 to 4.22,I^(2)=87.35%,P=0.00),were related to the prevalence of CRNs.For patients in the GN group,body mass index(BMI,OR=0.88,95%CI=0.80 to 0.98,I^(2)=0.00%,P=0.92)and smoking(OR=1.03,95%CI=1.01 to 1.05,I^(2)=0.00%,P=0.57)were protective and risk factors for CRNs,respectively.CONCLUSION Patients are recommended to undergo colonoscopy when diagnosed with GNs,especially GC patients with a low BMI and a history of smoking.

Recent advances in endoscopic management of gastric neoplasms

The development and clinical application of new diagnostic endoscopic technologies such as endoscopic ultrasonography with biopsy,magnification endoscopy,and narrow-band imaging,more recently supplemented by artificial intelligence,have enabled wider recognition and detection of various gastric neoplasms including early gastric cancer(EGC)and subepithelial tumors,such as gastrointestinal stromal tumors and neuroendocrine tumors.Over the last decade,the evolution of novel advanced therapeutic endoscopic techniques,such as endoscopic mucosal resection,endoscopic submucosal dissection,endoscopic fullthickness resection,and submucosal tunneling endoscopic resection,along with the advent of a broad array of endoscopic accessories,has provided a promising and yet less invasive strategy for treating gastric neoplasms with the advantage of a reduced need for gastric surgery.Thus,the management algorithms of various gastric tumors in a defined subset of the patient population at low risk of lymph node metastasis and amenable to endoscopic resection,may require revision considering upcoming data given the high success rate of en bloc resection by experienced endoscopists.Moreover,endoscopic surveillance protocols for precancerous gastric lesions will continue to be refined by systematic reviews and meta-analyses of further research.However,the lack of familiarity with subtle endoscopic changes associated with EGC,as well as longer procedural time,evolving resection techniques and tools,a steep learning curve of such high-risk procedures,and lack of coding are issues that do not appeal to many gastroenterologists in the field.This review summarizes recent advances in the endoscopic management of gastric neoplasms,with special emphasis on diagnostic and therapeutic methods and their future prospects.

Usefulness of artificial intelligence in gastric neoplasms

Recently,studies in many medical fields have reported that image analysis based on artificial intelligence(AI)can be used to analyze structures or features that are difficult to identify with human eyes.To diagnose early gastric cancer,related efforts such as narrow-band imaging technology are on-going.However,diagnosis is often difficult.Therefore,a diagnostic method based on AI for endoscopic imaging was developed and its effectiveness was confirmed in many studies.The gastric cancer diagnostic program based on AI showed relatively high diagnostic accuracy and could differentially diagnose non-neoplastic lesions including benign gastric ulcers and dysplasia.An AI system has also been developed that helps to predict the invasion depth of gastric cancer through endoscopic images and observe the stomach during endoscopy without blind spots.Therefore,if AI is used in the field of endoscopy,it is expected to aid in the diagnosis of gastric neoplasms and determine the application of endoscopic therapy by predicting the invasion depth.

Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms

Background:With the wide application of endoscopic submucosal dissection(ESD)for early gastric neoplasms,metachronous gastric neoplasms(MGN)have gradually become a concern.This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.Methods:A total of 814 patients were retrospectively enrolled.All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital.The risk factors for MGN were analyzed using Cox hazard proportional model.Moreover,the cumulative incidence,the correlation of initial lesions and MGN lesions,and the treatment and follow-up outcomes of MGN patients were analyzed.Results:A total of 4.5%(37/814)of patients had MGN after curative ESD.The 3-,5-,and 7-year cumulative incidences of MGN were 3.5%,5.1%,and 6.9%,respectively,and ultimately reaching a plateau of 11.3%at 99 months after ESD.There was no significant correlation between initial lesions and MGN lesions in terms of gross type(P=0.178),location(long axis:P=0.470;short axis:P=0.125),and histological type(P=0.832).Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN(hazard ratio:4.3,95%confidence interval:2.0-9.4,P<0.001).Seventy-three percent of patients with MGN were treated by endoscopic resection.During follow-up,two patients with MGN died of gastric cancer with lymph node metastasis.The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN(94.6%vs.99.6%,P=0.006).Conclusions:The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD.Thus,regular and long-term surveillance endoscopy may be helpful,especially for patients with initial multiple neoplasms.

Risk factors of major intraoperative bleeding and postoperative bleeding associated with endoscopic submucosal dissection for gastric neoplasms

Background:Endoscopic resection bleeding(ERB)classification was proposed by the authors’team to evaluate the severity of intraoperative bleeding(IB)during endoscopic submucosal dissection(ESD).This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB(MIB)and postoperative bleeding(PB)associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital.All patients were divided into the non-MIB group(including ERB-0,ERB-controlled 1[ERB-c1],and ERB-c2)and the MIB group(including ERB-c3 and ERB-uncontrolled[ERB-unc])according to the ERB classification.Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients,773(57.95%)had ERB-0,477(35.76%)had ERB-c1,77(5.77%)had ERB-c2,7(0.52%)had ERB-c3,and no patients had ERB-unc.The rate of PB in patients with IB classifications of ERB-0,ERB-c1,ERB-c2,and ERB-c3 were 2.20%(17/773),3.35%(16/477),9.09%(7/77),and 2/7,respectively.In multivariate analysis,proximal location(odds ratio[OR]:1.488;95%confidence interval[CI]:1.045-3.645;P=0.047)was the only significant risk factor of MIB.Chronic kidney disease(CKD)(OR:7.844;95%CI:1.637-37.583;P=0.010)and MIB(ERB-c3)(OR:13.932;95%CI:2.585-74.794;P=0.002)were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB.Additionally,CKD and MIB(ERB-c3)were independent risk factors of PB.More attention should be paid to these high-risk patients for MIB and PB.

Clinicopathological characteristics and prognosis of 232 patients with poorly differentiated gastric neuroendocrine neoplasms

BACKGROUND Poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)include gastric neuroendocrine carcinoma(NEC)and mixed adenoneuroendocrine carcinoma,which are highly malignant and rare tumors,and their incidence has increased over the past few decades.However,the clinicopathological features and outcomes of patients with PDGNENs have not been completely elucidated.AIM To investigate the clinicopathological characteristics and prognostic factors of patients with PDGNENs.METHODS The data from seven centers in China from March 2007 to November 2019 were analyzed retrospectively.RESULTS Among the 232 patients with PDGNENs,191(82.3%)were male,with an average age of 62.83±9.11 years.One hundred and thirteen(49.34%)of 229 patients had a stage III disease and 86(37.55%)had stage IV disease.Three(1.58%)of 190 patients had no clinical symptoms,while 187(98.42%)patients presented clinical symptoms.The tumors were mainly(89.17%)solitary and located in the upper third of the stomach(cardia and fundus of stomach:115/215,53.49%).Most lesions were ulcers(157/232,67.67%),with an average diameter of 4.66±2.77 cm.In terms of tumor invasion,the majority of tumors invaded the serosa(116/198,58.58%).The median survival time of the 232 patients was 13.50 mo(7,31 mo),and the overall 1-year,3-year,and 5-year survival rates were 49%,19%,and 5%,respectively.According to univariate analysis,tumor number,tumor diameter,gastric invasion status,American Joint Committee on Cancer(AJCC)stage,and distant metastasis status were prognostic factors for patients with PDGNENs.Multivariate analysis showed that tumor number,tumor diameter,AJCC stage,and distant metastasis status were independent prognostic factors for patients with PDGNENs.CONCLUSION The overall prognosis of patients with PDGNENs is poor.The outcomes of patients with a tumor diameter>5 cm,multiple tumors,and stage IV tumors are worse than those of other patients.

Gastric neuroendocrine neoplasms: A review

Gastric neuroendocrine neoplasms(g-NENs)or neuroendocrine tumors are generally slow-growing tumors with increasing incidence.They arise from enterochromaffin like cells and are divided into four types according to clinical characteristic features.Type 1 and 2 are gastrin dependent,whereas type 3 and 4 are sporadic.The reason for hypergastrinemia is atrophic gastritis in type 1,and gastrin releasing tumor(gastrinoma)in type 2 g-NEN.The diagnosis of g-NENs needs histopathological investigation taken by upper gastrointestinal endoscopy.g-NENs are positively stained with chomogranin A and synaptophysin.Grading is made with mitotic index and ki-67 proliferation index on histopathological analysis.It is crucial to discriminate between types of g-NENs,because the management,treatment and prognosis differ significantly between subtypes.Treatment options for g-NENs include endoscopic resection,surgical resection with or without antrectomy,medical treatment with somatostatin analogues,netazepide or chemotherapy regimens.Follow-up without excision is another option in appropriate cases.The prognosis of type 1 and 2 g-NENs are good,whereas the prognosis of type 3 and 4 g-NENs are close to the prognosis of gastric adenocancer.

Nomogram based on tumor-associated neutrophil-tolymphocyte ratio to predict survival of patients with gastric neuroendocrine neoplasms

AIM To assess the predictive value of the tumor-associated neutrophil-to-lymphocyte ratio in terms of the clinical outcomes of patients with gastric neuroendocrine neoplasms after radical surgery.METHODS Data were retrospectively collected from 142 patients who were diagnosed with gastric neuroendocrine neoplasms and who underwent radical gastrectomy at our department from March 2006 to March 2015. These data were retrospectively analyzed, and a receiver operating characteristic curve analysis was used to identify the optimal value of the tumorassociated neutrophil-to-lymphocyte ratio. Univariate and multivariate survival analyses were used to identify prognostic factors. A nomogram was then applied to predict clinical outcomes after surgery.RESULTS The tumor-associated neutrophil-to-lymphocyte ratio was significantly associated with tumor recurrence, especially with liver metastasis and lymph node metastasis(P < 0.05 for both), but not with clinical characteristics(P > 0.05 for all). A multivariate Cox regression analysis identified the tumor-associatedneutrophil-to-lymphocyte ratio as an independent prognostic factor for recurrence-free survival and overall survival(P < 0.05 for both). The concordance index of the nomograms, which included the tumorassociated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio, was 0.788(0.759) for recurrence-free survival(overall survival) and was higher than the concordance index of the traditional TNM staging system [0.672(0.663)].CONCLUSION The tumor-associated neutrophil-to-lymphocyte ratio is an independent prognostic factor in patients with gastric neuroendocrine neoplasms. Nomograms that include the tumor-associated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio have a superior ability to predict clinical outcomes of postoperative patients.

Management of gastric mucosa-associated lymphoid tissue lymphoma in patients with extra copies of the MALT1 gene

AIM To identify the clinical features of gastric mucosaassociated lymphoid tissue(MALT) lymphoma with extra copies of MALT1.METHODS This is a multi-centered,retrospective study. We reviewed 146 patients with MALT lymphoma in the stomach who underwent fluorescence in situ hybridization analysis for t(11;18) translocation. Patients were subdivided into patients without t(11;18) translocation or extra copies of MALT1(Group A,n = 88),patients with t(11;18) translocation(Group B,n = 27),and patients with extra copies of MALT1(Group C,n = 31). The clinical background,treatment,and outcomes of each group were investigated.RESULTS Groups A and C showed slight female predominance,whereas Group B showed slight male predominance. Mean ages and clinical stages at lymphoma diagnosis were not different between groups. Complete response was obtained in 61 patients in Group A(69.3%),22 in Group B(81.5%),and 21 in Group C(67.7%). Helicobacter pylori(H. pylori) eradication alone resulted in complete remission in 44 patients in Group A and 13 in Group C. In Group B,14 patients underwent radiotherapy alone,which resulted in lymphoma disappearance. Although the difference was not statistically significant,event-free survival in Group C tended to be inferior to that in Group A(P = 0.10).CONCLUSION Patients with t(11;18) translocation should be treated differently from others. Patients with extra copies of MALT1 could be initially treated with H. pylori eradication,similar to patients without t(11;18) translocation or extra copies of MALT1.

Relationship between clinicopathological features and mucin phenotypes of advanced gastric adenocarcinoma

AIM: To investigate a relationship between the clinicopathological features and mucin phenotypes in advanced gastric adenocarcinoma (AGA). METHODS: Immunohistochemical staining was performed to determine the mucin phenotypes in 38 patients with differentiated adenocarcinomas (DACs), 9 with signet-ring cell carcinomas (SIGs), and 48 with other diffuse-type adenocarcinomas (non-SIGs) of AGA. The mucin phenotypes were classified into 4 types: gastric (G), gastrointestinal (GI), intestinal, and unclassified. RESULTS: The G-related mucin phenotypes were highly expressed in all the histological subtypes of AGA. The expression of the GI phenotype in SIG patients was lower than that in DAC patients (P = 0.02), and this phenotype was observed in 56% of the non-SIG patients in the intramucosal layer. Among non-SIG cases, the expression of the GI phenotype was significantly higherin patients with extended adenocarcinomas and those with positive rates of lymph node metastasis. There was no difference between the expressions of the G and other GI phenotypes factors. Among DAC and non-SIG patients, there were no differences between the survival rates of the corresponding patient groups. CONCLUSION: The GI phenotype might possess more invasive characteristics than the G phenotype in nonSIG. Neither of the phenotypes indicated a poor prognosis of DAC and non-SIG.

SOME PROBLEMS IN THE SURGICAL TREATMENT OF GASTRIC CANCER

Radical resections were performed in 177 cases of gastric cancer ( early cancer 31 cases and advanced cancer 146 cases). R1+ operation was performed in 10 cases and R2 or R3 was in 167. All patients were followed up to the end of the study with the 5-year survival rate of 57. 6%. In the patients with normal serosa, cancer was often located in the mucosa. In such situation, R1 or R1+ operation was advisiable. In the patients of reactive serosal types, the extent of operation should not be reduced. The serosa were often penetrated by cancer cells in diffusely infiltrated cancer, with a poor prognosis. If measures were not taken to destroy free cancer cells, the 5-year survival rate was very low inspite of radical operations. The number of lymph nodes metastasis was closely related to the biological behavior of primary cancer. Prognosis was good after R2 or R3 operation when the cancer was still within the gastric wall, Borrmann type 1,2,3 massive or nest growth patterns, and the number of lymph node metastasis was below 5 and within first station (n1) .If the number of lymph nodes metastasis was above 10, metastasis to the second (n2) or third station (n3), the cancer infiltrated to the serosa, Borrmann type 4, diffused growth pattern theprognosis was poor even R2 or R3 operations were performed.

Outcomes of Total and Subtotal Laparoscopic Gastrectomy with D2 Lymphadenectomy in Advanced Gastric Cancer in a Brazilian Hospital

Background: Although laparoscopic gastrectomy is becoming more popular as a curative therapy for gastric cancer, there are concerns about its oncological adequacy. We have compared the outcomes of laparoscopic total gastrectomy (LTG) and laparoscopic subtotal gastrectomy (LSG), both with modified D2 lymphadenectomies for the treatment of advanced gastric cancers. Aim: To compare the outcomes of laparoscopic (total and subtotal) gastrectomy with modified D2 lymphadenectomy for the treatment of gastric cancer, contributing to the literature regarding the overall survival of these patients and postoperative complications. Methods: From 1993 to 2014, 239 patients were operated on laparoscopic gastrectomy at our department. The routinely laparoscopic gastrectomy was performed in all patients with gastric cancer including those presenting with obstruction and bleeding. Data could be collected, on a retrospective way, from 2006 to 2014, from the medical records of 103 patients who underwent LSG (n = 72) or LTG (n = 31). We excluded patients with metastatic disease and those who could not have a complete tumor resection. Results: Most patients were in advanced stages of cancer. Adenocarcinoma was the most common find, with 43% of cases in stage IIA and 31% in stage IIIB. Intracorporeal Roux-en-Y or Billroth II anastomoses were employed. Postoperative complications, for LSG and LTG, were 18% and 35.4%;mortality rate, during hospital stay, was 4.9% and 7.7%;three-year survival rate, 53.1% and 59.3%;and five-year survival rate, 46.9% and 40.7%. Mean hospital stay was 7.08 days, being significantly lower in LSG group (p < 0.05). Hospital acquired pneumonia was the most prevalent clinical complication, while deaths arising from surgical complications were caused mainly by gastro-jejunal or esophago-jejunal anastomosis leaks. Conclusions: Both LSG and LTG with modified D2 lymphadenectomy are feasible alternatives to open surgery and survival rates were comparable. The increased risk of complications observed in LTG did not influence the overall mortality rate. We hope that these findings should contribute to improve the acceptance of laparoscopic gastrectomy as a safe procedure for gastric cancer treatment.

Health-related quality of life after gastric cancer treatment in Brazil:Narrative review and reflections

In Brazil,gastric cancer is the third most common type of cancer among men and fifth among women,with an estimated 13360 new cases among men and 7870 among women each year during the 2020-2022 period.This study presents reflections and attempts to add knowledge to the theme of quality of life(QoL)in patients with gastric adenocarcinoma and describes some of its characteristics in three regions of Brazil,with an evaluation of the disease’s impacts in various dimensions of life,as reported by the patients themselves.We performed a narrative review of the literature and a data analysis of studies on QoL in Brazilian patients treated for gastric adenocarcinoma from three different cities in three geographic regions:Brasília(the midwest),Jaú(the southeast),and Macapá(the north).

ADYNAMIC STUDY OF THE CYTOTOXICEFFECTS OF HYPERTHERMIA COMBINED WITH CIS－DIAMINE DICHLOROLPLATINUM（DDP） ON HUMAN GASTRIC CANC

Cytotoxic effects of hyperthermia combined with DDP on MKN28 and MKN45 cells were studied by MTT assay according to a nested design. The results showed:hyperthermia alone above 43℃ for 30 mins was cytotoxic;hyperthermia at temperature lower than 43℃ for 30 mins could increase sensitivity of cancer cells to DDP. The cytotoxic effect of simultaneous use of hyperthermia and DDP was more marked than that of sequential use of the 2 treatments. Hyperthermia combined with DDP could inhibit growth of human gastric adenocarcinoma cells regardless of their degree of differentiation.

Survival analysis based on human epidermal growth factor 2 status in stage Ⅱ-Ⅲ gastric cancer

AIM To investigate human epidermal growth factor 2(HER2) overexpression and validate its prognostic effect in stage Ⅱ-Ⅲ gastric cancer.METHODS We reviewed the data of patients who were diagnosed with gastric cancer between March 2008 and October 2013 at the Yonsei University Medical Center. Among these patients, 384 patients who met the inclusion criteria were analyzed retrospectively. RESULTS Thirty-two(8.3%) of the 384 stage Ⅱ-Ⅲ gastric cancer patients exhibited HER2 overexpression. The median follow-up duration was 26.0 mo. HER2-negative patients had superior recurrence-free survival(RFS) compared to HER2-positive patients(HR = 0.52, 95%CI: 0.30-0.89; P = 0.015). The median overall survival(OS) was significantly prolonged in the HER2-negative group compared with the HER2-positive group(55.0 mo vs 38.0 mo, HR = 0.43, 95%CI: 0.21-0.88, P = 0.021). OS was also prolonged in HER2-negative patients who received adjuvant chemotherapy compared to HER2-positive patients(55.0 vs 38.0mo, HR = 0.42, 95%CI: 0.18-1.00, P = 0.051). In patients who did not receive adjuvant chemotherapy,the median RFS was prolonged in the HER2-negative group compared to the HER2-positive group(not reached vs 12.0 mo, HR = 0.17, 95%CI: 0.06-0.49, P= 0.001). In a multivariate analysis, HER2 status(HR= 0.421, 95%CI: 0.206-0.861, P = 0.018) and Eastern Cooperative Oncology Group performance status(HR = 2.002, 95%CI: 1.530-2.618, P < 0.001) were independent predictors of OS.CONCLUSION Our findings showed that HER2-positive patients had inferior OS and RFS. Stage Ⅱ-Ⅲ HER2-positive patients might be potential candidates for targeted therapies involving trastuzumab.

How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

BACKGROUND Intraoperative methylene blue testing(IMBT),air leak testing,or endoscopy is used to assess the anastomotic integrity of esophagojejunostomy during open total gastrectomy for gastric cancer.Totally laparoscopic radical gastrectomy has been widely used to treat gastric cancer in the last few decades.However,reports on testing anastomotic integrity in totally laparoscopic radical gastrectomy are limited.AIM To explore the effects of IMBT on the incidence of postoperative anastomotic leaks(PALs)and identify the risk factors for PALs in totally laparoscopic radical gastrectomy.METHODS From January 2017 to December 2019,patients who underwent totally laparoscopic radical gastrectomy at the Shaanxi Provincial People's Hospital were retrospectively analyzed.According to whether or not they experienced an IMBT,the patients were divided into an IMBT group and a control group.If the IMBT was positive,an intraoperative suture was required to reinforce the anastomosis.The difference in the incidence of PALs was compared,and the risk factors were investigated.RESULTS This study consisted of 513 patients,211 in the IMBT group and 302 in the control group.Positive IMBT was shown in seven patients(3.3%)in the IMBT group,and no PAL occurred in these patients after suture reinforcement.Multivariate analysis showed that risk factors for predicting positive IMBT were body mass index(BMI)>25 kg/m2(hazard ratio[HR]=8.357,P=0.009),operation time>4 h(HR=55.881,P=0.002),and insufficient surgical experience(HR=15.286,P=0.010).Moreover,15 patients(2.9%)developed PALs in 513 patients,and the rates of PALs were significantly lower in the IMBT group than in the control group[2 of 211 patients(0.9%)vs 13 of 302 patients(4.3%),P=0.0026].Further analysis demonstrated that preoperative complications(HR=13.128,P=0.017),totally laparoscopic total gastrectomy(HR=9.075,P=0.043),and neoadjuvant chemotherapy(HR=7.150,P=0.008)were independent risk factors for PALs.CONCLUSION IMBT is an effective method to evaluate the integrity of anastomosis during totally laparoscopic radical gastrectomy,thus preventing technical defect-related anastomotic leaks.Preoperative complications,totally laparoscopic total gastrectomy,and neoadjuvant chemotherapy are independent risk factors for PALs.

Comparison of Intracorporeal and Extracorporeal Esophagojejunostomy after Laparoscopic Total Gastrectomy for Gastric Cancer： A Meta-Analysis Based on Short-Term

Background： Laparoscopic total gastrectomy （LTG） is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy （IEJ） following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG. Methods： Studies published from January 1994 to January 2017 comparing the outcomes ofl EJ and extracorporeal esophagojejunostomy （EEJ） following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge lntemet （CNKI）. Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference （WMD） and odds ratio （OR） with a 95% confidence interval （CI） were calculated using the Review Manager 5.3. Results： Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss （WMD： -13.52 ml; 95% CI： -24.82-2.22; P = 0.02）, earlier time to first oral intake （WMD： -0.49 day; 95% CI： -0.83-0.14; P 〈 0.01 ）, and shorter length of hospitalization （WMD： -0.62 day; 95% CI： - 1.08-0.16; P 〈 0.01 ）. There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections （all P 〉 0.05）. Conclusions： Compared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.

Integrase interactor 1 regulates proliferation, apoptosis and invasion in gastric cancer cells

Background Integrase interactor 1 （INI1）,which encodes a component of the ATP-dependent chromatin remodeling hSWI-SNF complex,has been identified as a tumor suppressor in many tumors.Nonetheless,the role of INI1 in gastric tumor progression is not known exactly.The aim of this research was to investigate the effect of INI1 in the carcinogenesis and progression of gastric cancer.Methods Gastric tumor tissues with different differentiation levels from clinical gastric carcinoma samples and adjacent control normal tissues were taken. Expression levels of INI1 were detected by quantitative reverse transcriptation-polymerase chain reaction （RT-PCR） and Western blotting.Gastric cancer cell line SGC7901 was transfected with INI1 eukaryotic expressing vector INI1-GFP.Cell proliferation activities were assessed by MTT; cell count and cell cycle were detected by flow cytometry （FCM）; cell apoptosis were measured by TUNEL and FCM; cell migration and invasiveness were evaluated by wound healing and transwell assays.Expression levels of INI1 and proliferation-related genes including p16,p21,cyclin D1 and cyclin A,apoptosis genes p53,B-cell non-Hodgkin lymphoma-2 （Bc/-2）,Bcl-2-associated x protein （Bax） and caspase-3,and invasion-related genes including intercellular adhesion molecule 1 （ICAM1）,matrix metalloproteinase 2 （MMP2）,MMP9 and tissue inhibitor of matrix metalloproteinase 1 （T/MP1）,were detected by quantitative RT-PCR and Western blotting.Results INI1 expression levels were lower in gastric carcinoma compared with adjacent control normal tissues.Overexpression of INI1 in SGC7901 cells inhibited its proliferation and invasiveness,but increased anoikis and Go/G1 cell number.INI1-GFP transfection upregulated expression of INI1 and proliferation related genes p16 and p21,apoptosis genes p53 and Bax,and invasion-related genes TIMP1; cyclin D1,cyclin A,Bcl2,ICAM1,MMP2 and MMP9 were downregulated,and there was no significant change in caspase 3 levels.Conclusion INI1 plays a key role in gastric carcinogenesis by affecting proliferation,apoptosis and invasion.

Multielements of medical caring in gastric cancer

With recent advances in both knowledge and available technology,therapeutic strategies for gastric cancer have become diversified.1 Surgical instruments and devices have improved,and chemotherapeutic drugs and targeted agents have become more advanced as we gain a more comprehensive understanding of gastric cancer biology.The epidemiology of gastric cancer has also been changing due to mass screening programs and improved survival rates.2 However,these collective achievements have not reached the point of making patients satisfied.The relationship between doctors and patients is a very sensitive and hot topic in Chinese medical fields.It is like complex hair knots that can not easily be smoothed without suffering and pain.Keywords：gastric neoplasm; multidisciplinary treatment