Abstract: Forkhead box protein M1 (FOXM1) is an oncogene regulating tumor growth and metastasis. Exosome was suggested to mediate cell communication by delivering active molecules in cancers. However, the existence of FOXM1 in circulating exosomes and the role of exosome FOXM1 in gastric cancer (GC) were not clear. This study aims to investigate the potential role of FOXM1 related long noncoding RNA (FRLnc1) in exosomes in GC. Results The prepared CD63 immunomagnetic beads (CD63-IMB) had the characteristics of good dispersity and high magnetic response. The isolated exosomes were presented with elliptical membranous particles under a transmission electron microscope (TEM), with the particle size of 89.78 ± 4.8 nm. Western blot (WB) results showed that the exosomes were rich in CD9 and CD81. The Dil-labeled exosomes were distributed around cytoplasm and nucleus of cells by imaging flow cytometry (IFC) analysis. The results of quantitative real-time PCR (qRT-PCR) revealed that the FRLnc1 expressions were up-regulated in GC cells, tumor tissues, and serum of GC patients. An obviously up-regulated FRLnc1 expression was found in serum exosomes of GC patients. Up-regulation of FRLnc1 expression was closely correlated to lymph node metastasis (LNM) and TNM stage with the combination of relevant clinicopathological parameter analysis. The in vitro functional analyses demonstrated that FRLnc1 knockdown by RNA interference suppressed cell proliferation and migration in HGC-27 cells, whereas FRLnc1 overexpression promoted cell proliferation and migration in MKN45 cells. After exosome treatment, the FRLnc1 expression was significantly increased in MKN45 cells, and the MKN45 cells showed increased ability of proliferation and migration. Conclusion GC cells-derived exosomes played roles in promoting the growth and metastasis of GC by transporting FRLnc1, suggesting that FRLnc1 in the exosomes may be a potential biomarker for the diagnosis and treatment of GC. The delivery of FRLnc1 by the exosomes may provide a new way for the treatment of GC. Trial registration 2020-KYSB-094. Registered 23 March 2020—Retrospectively registered Graphic abstract

Abstract: Objective. This study was to quantitatively synthesize data in randomized controlled trials (RCTs) of laparoscopic resection comparing natural orifice specimen extraction (NOSE) versus conventional laparoscopy (CL) in colorectal cancer. Methods. We identified eligible RCTs by searching seven electronic databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, CQVIP, Wanfang, and Sinomed). Mean differences (MDs) between groups with 95% confidence intervals (CIs) were used for continuous outcomes. Event rate ratios (RRs) were also calculated with their 95% CIs. Results. 1,569 citations were identified from electronic database as of June 2020, and finally, 21 RCTs involving 2,112 patients met the study eligibility criteria and were included. Compared to the CL group, NOSE had longer operation time (MD: 8.14 min, 95% CI: 3.02 to 13.25, and p 〈 0.01 ), less estimated blood loss (-10.64 ml, 95% CI: -14.92 to -6.36, and p 〈 0.01 ), less hospital stay after surgery (-2.21 days, 95% CI: -3.36 to -1.06, and p 〈 0.01 ), shorter time of gas passage after surgery (-0.58 days, 95% CI: -0.82 to -0.34, and p 〈 0.01 ), better pain score (-1.06, 95% CI: -3.74 to -0.37, and p 〈 0.01 ), and improved cosmetic scores (1.93, 95% CI: 0.77 to 3.10, p 〈 0.01 ). Rate ratios of total complications, infection, and incision infection all favored NOSE surgery, with RRs (95% CIs) of 0.81 (0.71 to 0.93), 0.34 (0.21 to 0.54), and 0.24 (0.12 to 0.51), respectively. Conclusion. This report appeared the first comprehensive meta-analysis of RCTs to synthesize data of laparoscopic resection with NOSE versus conventional laparoscopy. NOSE surgery seemed favorable with shorter hospital stay, less pain score, a shorter time to recover along with better cosmetic scores, and less postoperative complications.

Abstract: Colorectal cancer is a common malignant tumor worldwide. In China, the ratio of rectal cancer to colon cancer in terms of incidence is close to 1: 1. Low rectal cancer accounts for more than half of all cases of rectal cancer. In recent years, the proportion of rectal cancer has trended downward, however the incidence of rectal cancer in younger adults is increasing. The CACA Guidelines for Holistic Integrative Management of Rectal Cancer were edited to help improve the diagnosis and comprehensive treatment in China. Methods This guideline has been prepared by consensuses reached by the CACA Committee of Colorectal Cancer Society, based on a careful review of the latest evidence including China’s studies, and referred to domestic and international relative guidelines, also considered China’s specific national conditions and clinical practice. Results The CACA Guidelines for Holistic Integrative Management of Rectal Cancer include the epidemiology of rectal cancer, prevention and screening, diagnosis, treatment of nonmetastatic and metastatic rectal cancer, follow-up, and whole-course rehabilitation management. Conclusion Committee of Colorectal Cancer Society, Chinese Anti-Cancer Association, standardizes the diagnosis and treatment of rectal cancer in China through the formulation of the CACA Guidelines.

Abstract: In recent years, natural orifice specimen extraction surgery (NOSES) has gained widespread attention as an alternative approach. Although the safety and feasibility of NOSES have been well documented, many questions remain open for discussion. The aim of this guideline is to provide more evidence for the promotion of NOSES. Methods This guideline has been prepared by the CACA Committee of Colorectal Cancer Society and the International NOSES Alliance, based on the latest evidence. Results The guideline on NOSES for colorectal cancer include the definition, classification, technology requirement, indications, technical difficulties and clinical research. Conclusion The guideline provides a full introduction of the theoretical and technical aspects of NOSES for colorectal cancer which will beneficial to development of NOSES.

Abstract: The effect of anterograde lavage in patients with rectal cancer who underwent anterior resection and plan to receive stoma closure is unclear. OBJECTIVE: This study aimed to investigate the effect of anterograde lavage on postoperative bowel function recovery in patients who underwent temporary loop ileostomy and stoma closure. DESIGN: This was a hospital-based retrospective cohort study. SETTINGS: This study was conducted at a tertiary referral center. PATIENTS: All consecutive patients who underwent anterior resection for rectal cancer and were planning to receive stoma closure from March through December 2019 were included. INTERVENTIONS: The enrolled patients were divided into 2 groups according to whether they received anterograde lavage before stoma closure. MAIN OUTCOME MEASURES: Short-term functional outcomes, including time to first passing of flatus, first defecation time, and recovery time to first meal, were compared between the groups. Secondary outcomes included length of hospital stay, total cost of hospitalization, and postoperative complications. RESULTS: A total of 222 eligible participants were included in the analysis, including 114 in the lavage group and 108 in the nonlavage group. No statistically significant differences were found in age, sex ratio, or distance between the anastomotic line and dentate line. In the lavage group, patients’ time to first passing of flatus (38 vs 42 h; p = 0.006), first defecation time (42 vs 48 h; p 〈 0.001), recovery time to first meal (48 vs 55.5 h; p 〈 0.001), and length of hospital stay (5 vs 7 d; p 〈 0.001) were significantly shorter than those in the nonlavage group, and the total cost of hospitalization was significantly lower than that of the nonlavage group (25,000 vs 28,000 RMB; p 〈 0.001). No significant difference was found in the incidence of postoperative complications between the 2 groups ( p = 0.067). LIMITATIONS: This study is limited by its relatively small sample size and retrospective design with single-center participants. CONCLUSIONS: Anterograde lavage before stoma closure is safe and noninvasive. For patients receiving anterior resection and planning to have stoma closure, this procedure can potentially help recover bowel function more rapidly. See Video Abstract at http://links.lww.com/DCR/C51. EFECTO DEL LAVADO ANTERÓGRADO MEDIANTE ILEOSTOMA TEMPORAL EN ASA SOBRE LA RECUPERACIÓN DE LA FUNCIÓN INTESTINAL EN PACIENTES QUE RECIBEN CIERRE DE ESTOMA: UN ESTUDIO DE COHORTE RETROSPECTIVO ANTECEDENTES: No está claro el efecto del lavado anterógrado en pacientes con cáncer de recto con resección anterior que planean recibir el cierre del estoma. OBJETIVO: Investigar el efecto del lavado anterógrado en la recuperación de la función intestinal posoperatoria en pacientes que se sometieron a ileostomía en asa temporal y cierre de estoma. DISEÑO: Estudio de cohorte retrospectivo basado en el hospital. AJUSTES: Centro de referencia terciario. PACIENTES: Todos los pacientes que se sometieron a una resección anterior por cáncer de recto y que planeaban recibir el cierre del estoma desde marzo hasta diciembre de 2019. INTERVENCIONES: Los pacientes inscritos se dividieron en dos grupos según si recibieron lavado anterógrado antes del cierre del estoma. PRINCIPALES MEDIDAS DE RESULTADO: Los resultados funcionales a corto plazo, incluido el tiempo de la primera evacuación de flatos, tiempo de la primera defecación y tiempo de recuperación hasta la primera comida, se compararon entre los grupos. Resultados secundarios incluyeron duración de la estancia hospitalaria, costo total de la hospitalización y complicaciones posoperatorias. RESULTADOS: Se incluyeron en el análisis un total de 222 participantes elegibles, incluidos 114 en el grupo de lavado y 108 en el grupo de no lavado. No hubo diferencias estadísticamente significativas en la edad, la proporción de sexos o la distancia entre la línea de anastomosis y la línea dentada. En el grupo de lavado, el tiempo de la primera evacuación de flatos de los pacientes (38 vs 42 h; p = 0,006), el tiempo de la primera defecación (42 vs 48 h; p 〈 0,001), el tiempo de recuperación hasta la primera comida (48 vs 55,5 h; p 〈 0,001) y la duración de la estancia hospitalaria (5 vs 7 días; p 〈 0,001) fueron significativamente más cortos que los del grupo de no lavado, y el costo total de la hospitalización fue significativamente menor que el del grupo de no lavado (25000 vs 28000 RMB; p 〈 0,001). No hubo diferencia significativa en la incidencia de complicaciones postoperatorias entre los dos grupos ( p = 0,067). LIMITACIONES: Este estudio está limitado por su tamaño de muestra relativamente pequeño y su diseño retrospectivo con participantes de un solo centro. CONCLUSIONES: El lavado anterógrado antes del cierre del estoma es seguro y no invasivo. Para los pacientes que se someten a una resección anterior y planean cerrar el estoma, este procedimiento puede ayudar potencialmente a recuperar la función intestinal más rápidamente. Consulte Video Resumen en http://links.lww.com/DCR/C51. (Traducción—Dr. Francisco M. Abarca-Rendon )