Magnetic resonance imaging-based deep learning model to predict multiple firings in double-stapled colorectal anastomosis

BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to predict preoperatively the need for multiple linear stapler cartridges during DST anastomosis.AIM To develop a deep learning model to predict multiple firings during DST anastomosis based on pelvic magnetic resonance imaging(MRI).METHODS We collected 9476 MR images from 328 mid-low rectal cancer patients undergoing LAR with DST anastomosis,which were randomly divided into a training set(n=260)and testing set(n=68).Binary logistic regression was adopted to create a clinical model using six factors.The sequence of fast spin-echo T2-weighted MRI of the entire pelvis was segmented and analyzed.Pure-image and clinical-image integrated deep learning models were constructed using the mask region-based convolutional neural network segmentation tool and three-dimensional convolutional networks.Sensitivity,specificity,accuracy,positive predictive value(PPV),and area under the receiver operating characteristic curve(AUC)was calculated for each model.RESULTS The prevalence of≥3 linear stapler cartridges was 17.7%(58/328).The prevalence of AL was statistically significantly higher in patients with≥3 cartridges compared to those with≤2 cartridges(25.0%vs 11.8%,P=0.018).Preoperative carcinoembryonic antigen level>5 ng/mL(OR=2.11,95%CI 1.08-4.12,P=0.028)and tumor size≥5 cm(OR=3.57,95%CI 1.61-7.89,P=0.002)were recognized as independent risk factors for use of≥3 linear stapler cartridges.Diagnostic performance was better with the integrated model(accuracy=94.1%,PPV=87.5%,and AUC=0.88)compared with the clinical model(accuracy=86.7%,PPV=38.9%,and AUC=0.72)and the image model(accuracy=91.2%,PPV=83.3%,and AUC=0.81).CONCLUSION MRI-based deep learning model can predict the use of≥3 linear stapler cartridges during DST anastomosis in laparoscopic LAR surgery.This model might help determine the best anastomosis strategy by avoiding DST when there is a high probability of the need for≥3 linear stapler cartridges.

Higher CO_2-insufflation pressure inhibits the expression of adhesion molecules and the invasion potential of colon cancer cells

AIM:To investigate the influence of CO2-insufflation pressure on adhesion,invasion and metastatic potential of colon cancer cells based on adhesion molecules expression.METHODS:With an in vitro artificial pneumoperitoneum model,SW1116 human colon carcinoma cells were exposed to CO2-insufflation in 5 different pressure groups:6 mmHg,9 mmHg,12 mmHg,15 mmHg and control group,respectively for 1 h.Expression of E-cadherin,ICAM-1,CD44 and E-selectin was measured at 0,12,24,48 and 72 h after CO2-insufflation using flow cytometry.The adhesion and invasion capacity of SW1116 cells before and after exposure to CO2-insufflation was detected by cell adhesion/invasion assay in vitro.Each group of cells was injected intraperitoneally into 16 BALB/C mice.The number of visible abdominal cavity tumor nodules,visceral metastases and survival of the mice were recorded in each group.RESULTS:The expression of E-cadherin,ICAM-1,CD44 and E-selectin in SW1116 cells were changed significantly following exposure to CO2 insufflation at different pressures(P<0.05).The expression of E-cadherin,CD44 and ICAM-1 decreased with increasing CO2-insufflation pressure.The adhesive/invasive cells also decreased gradually with increasing pressure as determined by the adhesion/invasion assay.In animal experiments,the number of abdominal cavity tumor nodules in the 15 mmHg group was also signif icantly lower than that in the 6 mmHg group(29.7±9.91 vs 41.7±14.90,P=0.046).However,the survival in each group was not statistically different.CONCLUSION:CO2-insufflation induced a temporary change in the adhesion and invasion capacity of cancer cells in vitro.Higher CO2-insufflation pressure inhibited adhesion,invasion and metastatic potential in vitro and in vivo,which was associated with reduced expression of adhesion molecules.

Complete mesocolic excision: Lessons from anatomy translating to better oncologic outcome

Since the introduction of complete mesocolic excision(CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total mesorectum excision for rectal cancer. Despite the fact that the exact anatomy of the organ is one of the most vital things for surgeons to conduct surgery, no team has really studied the exact structure of the mesocolon and related attachments for CME, until the mesocolonic anatomy was first formally characterized in 2012. Therefore, this article mainly focuses on the anatomy development of the mesocolon and the achievement in this field. Meanwhile, we introduce the latest progress in laparoscopic surgery for colon cancer achieved by our team.

Emerging roles of the ribonucleotide reductase M2 in colorectal cancer and ultraviolet-induced DNA damage repair

AIM:To investigate the roles of the ribonucleotide reductase M2 (RRM2) subunit in colorectal cancer (CRC) and ultraviolet (UV)-induced DNA damage repair. METHODS:Immunohistochemical staining of tissue microarray was performed to detect the expression of RRM2. Seven CRC cell lines were cultured and three human colon cancer cell lines, i.e., HCT116, SW480 and SW620, were used. Reverse transcription polymerase chain reaction and Western blotting were performed to determine the mRNA and protein expression levels of RRM2, respectively. Cell proliferation assay, cell cycle analysis were performed. Cell apoptosis was evaluated by double staining with fluorescein isothiocyanate-conjugated Annexin Ⅴ and propidium iodide (PI) usingAnnexin Ⅴ/PI apoptosis kit. The motility and invasion of CRC cells were assessed by the Transwell chamber assay. Cells were irradiated with a 254 nm UV-C lamp to detect the UV sensitivity after RRM2 depletion. RESULTS:Immunohistochemical staining revealed elevated RRM2 levels in CRC tissues. RRM2 overexpression was positively correlated with invasion depth (P < 0.05), poorly differentiated type (P = 0.0051), and tumor node metastasis stage (P = 0.0015). The expression of RRM2 in HCT116 cells was downregulated after transfection, and HCT116 cell proliferation was obviously suppressed compared to control groups (P < 0.05). In the invasion test, the number of cells that passed through the chambers in the RRM2-siRNA group was 81 ± 3, which was lower than that in the negative control (289 ± 7) and blank control groups (301 ± 7.2). These differences were statistically significant (P < 0.01). Our data suggest that RRM2 overexpression may be associated with CRC progression. RRM2 silencing by siRNA may inhibit the hyperplasia and invasiveness of CRC cells, suggesting that RRM2 may play an important role in the infiltration and metastasis of CRC, which is a potential therapeutic strategy in CRC. In addition, RRM2 depletion increased UV sensitivity. CONCLUSION:These findings suggest that RRM2 may be a facilitating factor in colorectal tumorigenesis and UV-induced DNA damage repair.

Expression of γ-synuclein in colorectal cancer tissues and its role on colorectal cancer cell line HCT116

AIM: To investigate the expression pattern of γ-synuclein in colorectal cancer (CRC) tissues, and to study the effects of γ-synuclein on CRC cell line HCT116 biological features in vitro.METHODS: The expression pattern of γ-synuclein was determined in 54 CRC tissues and 30 tumor-matched nonneoplastic adjacent tissues (NNAT) 5 cm away from the tumor via real-time quantitative reverse transcription PCR (RT-PCR) and immunohistochemistry. The relationship between γ-synuclein protein expression and clinicopathological factors of CRC tissues was analyzed. Three small interfering RNA (siRNA) targeting γ-synuclein mRNA plasmids were constructed and transfected into the CRC cell line HCT116. The stable cell lines were selected with G-418 for 28 d, and the biological features of these cells were examined by cell growth curve, soft agar assay, and cell migration and invasion assays in vitro. RESULTS: The expression of γ-synuclein mRNA and protein was much higher in CRC tissue samples than in NNAT samples (P = 0.02, P = 0.036). There was a significant correlation between the γ-synuclein protein expression and clinical stage and lymph node involvement of CRC (P = 0.02, P = 0.033). In functional analysis we found that down-regulation of γ-synuclein expression in HCT116 cells could inhibit the growth, colony formation rate, and migration and invasion ability of HCT116 cells.CONCLUSION: Increased expression of γ-synuclein in CRC tissues and the biological effects of reduced γ-synuclein expression on HCT116 cells suggest that γ-synuclein may play a positive role in the progression of CRC.

Advances in drug delivery system for platinum agents based combination therapy

Platinum-based anticancer agents are widely used as first-line drugs in cancer chemotherapy for various solid tumors. However, great side effects and occurrence of resistance remain as the major drawbacks for almost all the platinum drugs developed. To conquer these problems, new strategies should be adopted for platinum drug based chemotherapy. Modern nanotechnology has been widely employed in the delivery of various therapeutics and diagnostic. It provides the possibility of targeted delivery of a certain anticancer drug to the tumor site, which could minimize toxicity and optimize the drug efficacy. Here, in this review, we focused on the recent progress in polymer based drug delivery systems for platinum-based combination therapy.

Safety and feasibility of laparoscopic surgery for colorectal and gastric cancer under the Chinese multi-site practice policy:admittance standards of competence are needed

Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gastric cancer(LSGC)under the Chinese MSP policy.Methods:We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital(n=573)and his MSP institutions(n=508)between January 2017 and December 2020.Baseline demographics,intraoperative outcomes,post-operative recovery,and pathological results were compared between the original hospital and MSP institutions,as well as between MSP institutions with and without specific competence(surgical skill,operative instrument,perioperative multi-discipline team).Results:In our study,690 patients underwent LSCRC and 391 patients underwent LSGC.The prevalence of post-operative complications was comparable for LSCRC(11.5%vs 11.1%,P=0.89)or LSGC(15.2%vs 12.6%,P=0.46)between the original hospital and MSP institutions.However,patients in MSP institutions without qualified surgical assistant(s)and adequate instruments experienced longer operative time and greater intraoperative blood loss.The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC(11.5%vs 21.2%,P<0.01)and LSGC(9.8%vs 20.5%,P<0.01).Conclusion:For an experienced gastrointestinal surgeon,performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible,but relies on the precondition that the MSP institutions are equipped with qualified surgical skills,adequate operative instruments,and complete perioperative management.

Laparoscopic lysis of duodenum for superior mesenteric artery syndrome： how and why we do it？

Superior mesenteric artery syndrome （SMAS） is a rare etiology of duodenal obstruction resulting from the compression of the third part of the duodenum between the superior mesenteric artery and the aorta. The typical clinical presentation of SMAS is persistent postprandial abdominal distention, vomiting and weight loss.

Chinese guideline for the application of rectal cancer staging recognition systems based on artificial intelligence platforms (2021 edition)

Development and Application of Artificial Intelligence Recognition Systems in Rectal Cancer Staging Whether for surgical treatment or for neoadjuvant chemoradiotherapy,imaging evaluation has become an important basis to perform the treatment plans.[1]The reading of imaging results requires a large number of experienced radiologists to complete,but shortages and uneven distributions of personnel cause delays and biases in imaging results.Therefore,independent research and development of automatic recognition systems of rectal cancer staging based on artificial intelligence(AI)platforms aim to partially replace practitioners’work and achieve rapid and accurate identification of rectal cancer staging.

Multiple Polypoid Colonic Metastases from Primary Gastric Signet Ring Cell Carcinoma

To the Editor： Gastric carcinoma is a common gastrointestinal （GI） malignancy while signet ring cell carcinoma （SRCC） is a well-known poorly differentiated histological type that has a strong tendency for metastasis. The dissemination of gastric carcinoma mainly presents in three patterns. The most common approach for metastasis is through the regional lymph node. Hematogenous spread is also very common and mostly occurs in the liver, lungs, bones, and adrenal gland. In addition, direct adjacent invasion, peritoneal seeding, and Krukenberg tumor are less seen but are also very important in clinic with poor prognosis. In this report, we present a case of rare colonic metastases in the form of multiple polyps from primary gastric SRCC.

Chinese guidelines for the application of colon cancer staging recognition systems based on artificial intelligence platforms (2021)

The incidence and mortality of colon cancer in China are increasing each year.At present,treatment selection for colon cancer patients mainly depends on imaging results,which require a large number of radiologists to interpret.In China,there is a shortage and uneven distribution of experienced radiologists,which leads to delays and bias in the evaluation of imaging data.Based on these considerations,the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association in collaboration with experts at Beihang University has independently developed an artificial intelligence(AI)-based recognition system for the preoperative determination of colon cancer stage to partially replace the work of and relieve the pressure on radiologists.These guidelines aim to standardize the use of AI-based recognition systems in the preoperative staging of colon cancer and guide their clinical application.