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Xiong B.,First Affiliated Hospital | Ma L.,Chongqing Huaxi Hospital | Zhang C.,First Affiliated Hospital
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2012

Background: Laparoscopic total mesorectal excision (LTME) for rectal cancer remains controversial. The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare LTME and open total mesorectal excision (OTME) as the primary treatment for patients with middle and low rectal cancer with regard to short-term outcomes. Materials and Methods: Literature searches of electronic databases (PubMed, Embase, and the Cochrane Library) and manual searches up to October 30, 2011 were performed. Prospective randomized clinical trials were eligible if they included patients with middle and low rectal cancer treated by LTME versus OTME. Fixed and random effects models were used. Review Manager version 5.1 software was used for pooled estimates. Results: Four RCTs enrolling 624 participants (LTME group, 308 cases; OTME group, 316 cases) were included in the meta-analysis. LTME for rectal cancer was associated with a significantly longer operative time but significantly less intraoperative blood loss and earlier time to pass first flatus. We found no significant differences in the number of lymph nodes, overall morbidity, and perioperative mortality rates between the two groups. Time to resume liquid diet, time to resume normal diet, and length of hospital stay, although not significantly different between the two groups, did suggest a positive trend toward LTME. Conclusions: It may be concluded that LTME is a safe and effective alternative to OTME and is justifiable under the setting of clinical trials. Additional RCTs that compare LTME and OTME and investigate the long-term oncological outcomes of LTME are required to determine the advantages of LTME over OTME. © Copyright 2012, Mary Ann Liebert, Inc. 2012. Source


Xiong B.,Chongqing Medical University | Ma L.,Chongqing Huaxi Hospital | Hu X.,Chongqing Medical University | Zhang C.,Chongqing Medical University | Cheng Y.,Chongqing Medical University
International Journal of Oncology | Year: 2014

Side population (SP) cells may play a crucial role in tumorigenesis and the recurrence of cancer. Many types of cell lines and tissues have demonstrated the presence of SP cells, including colon cancer cell lines. This study aimed to identify cancer stem cells (CSCs) in the SP of the colon cancer cell line SW480. SP cells were isolated by fluores cence-activated cell sorting (FACS), followed by serum-free medium (SFM) culture. The self-renewal, differentiated progeny, clone formation, proliferation, invasion ability, cell cycle, chemosensitivity and tumorigenic properties in SP and non-SP (NSP) cells were investigated through in vitro culture and in vivo serial transplantation. The expression profiles of ATP-binding cassette (ABC) protein transporters and stem cell?related genes were examined by RT-PCR and western blot analysis. The human colon cancer cell lines SW480, Lovo and HCT116 contain 1.1±0.10, 0.93±0.11 and 1.33±0.05% SP cells, respectively. Flow cytometry analysis revealed that SP cells could differentiate into SP and NSP cells. SP cells had a higher proliferation potency and CFE than NSP cells. Compared to NSP cells, SP cells were also more resistant to CDDP and 5-FU, and were more invasive and displayed increased tumorigenic ability. Moreover, SP cells showed higher mRNA and protein expression of ABCG2, MDR1, OCT-4, NANOG, SOX-2, CD44 and CD133. SP cells isolated from human colon cancer cell lines harbor CSC properties that may be related to the invasive potential and therapeutic resistance of colon cancer. Source


Xiong B.,Chongqing Medical University | Ma L.,Chongqing Huaxi Hospital | Zhang C.,Chongqing Medical University
Surgical Oncology | Year: 2012

Background: Robotic gastrectomy (RG) for gastric cancer remains controversial. The main aim of this meta-analysis was to compare the safety and efficacy of robotic gastrectomy (RG) and conventional laparoscopic gastrectomy (LG) for gastric cancer. Methods: Literature searches of electronic databases (PubMed, Embase, Cochrane Library Ovid, and Web of Science databases) and manual searches up to December 30, 2011 were performed. Comparative clinical trials were eligible if they reported perioperative outcomes for RG and LG for gastric cancer. Fixed and random effects models were used. The RevMan 5.1 was used for pooled estimates. Results: Three NRCTs enrolling 918 patients (268 in the RG group and 650 in the LG group) were included in the meta-analysis. RG for gastric cancer was associated with a significantly longer operative time (WMD: 68.77, 95% CI: 35.09-102.45; P < 0.0001), but significantly less intraoperative blood loss (WMD: -41.88, 95% CI: -71.62 to -12.14; P = 0.006). We found no significant differences in the number of lymph nodes (WMD: -0.71, 95% CI: -6.78 to 5.36; P = 0.82), overall morbidity (WMD: 0.74, 95% CI: 0.47 to 1.16; P = 0.19), perioperative mortality rates (WMD: 1.80, 95% CI: 0.30 to 10.89; P = 0.52) and length of hospital stay (WMD: 0.42, 95% CI: -1.87 to 0.79; P = 0.42) between the two groups. Conclusions: It may be concluded that RG is a safe and effective alternative to LG and is justifiable under the setting of clinical trials. Additional RCTs that compare RG and LG and investigate the long-term oncological outcomes are required to determine potential advantages or disadvantages of RG. © 2012 Elsevier Ltd. All rights reserved. Source


Xiong B.,Chongqing Medical University | Ma L.,Chongqing Huaxi Hospital | Zhang C.,Chongqing Medical University | Cheng Y.,Chongqing Medical University
Journal of Surgical Research | Year: 2014

Background Robotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME. Materials and methods Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated. Results Eight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME. Conclusions RTME for RC is safe and feasible, and the short- and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC. © 2014 Elsevier Inc. All rights reserved. Source


Xiong B.,Chongqing Medical University | Ma L.,Chongqing Huaxi Hospital | Cheng Y.,Chongqing Medical University | Zhang C.,Chongqing Medical University
European Journal of Surgical Oncology | Year: 2014

Abstract Aims To assess the efficacy and safety of neoadjuvant chemotherapy (NAC) for advanced gastric cancer (AGC). Methods By searching electronic databases (PubMed, Embase, Cochrane Library) and ASCO proceedings from 1990 to 2012, all randomized controlled trials (RCTs) which compared the effect of NAC-combined surgery versus surgery alone in AGC were included. All calculations and statistical tests were performed using RevMan 5.0 software. Results 12 RCTs with a total of 1820 patients were included. All patients had locally advanced but resectable gastric cancer and received NAC. NAC can slightly improve the survival rate (OR = 1.32, 95% confidence interval (CI): 1.07-1.64, P = 0.01), with little or no significant benefits in subgroup analyses between either different population or regimens. NAC can significantly improve the 3-year progression-free survival (PFS) (OR: 1.85, 95% CI: 1.39-2.46, p < 0.0001), tumor down-staging rate (OR: 1.71, 95% CI: 1.26, 2.33, p = 0.0006) and R0 resection rate (OR: 1.38, 95% CI: 1.08-1.78, P = 0.01) of patients with AGC. There was no difference between the two arms, in terms of relapse rates (OR: 1.03, 95% CI: 0.60-1.78, p = 0.92), operative complications (OR: 1.20, 95% CI: 0.90-1.58, p = 0.21), perioperative mortality (OR: 1.14, 95% CI: 0.64-2.05, p = 0.65) and grade 3/4 adverse effects: gastrointestinal problem (OR: 0.57, 95% CI: 0.25-1.30, p = 0.18), leukopenia (OR: 0.88, 95% CI: 0.41-1.91, p = 0.75), thrombocytopenia (OR: 1.27, 95% CI: 0.27-5.93, p = 0.76). Conclusion NAC is effective and safe. However, further prospective multi-national and multi-center RCTs are still needed in order to investigate the long-term oncological and functional outcomes to define the clinical benefits of NAC and the most effective strategies for AGC. © 2014 Elsevier Ltd. All rights reserved. Source

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