PART ?:Anatomical Observation Of Colorectal Mesenteric Vessels Based On CTA And Three-dimensional Reconstruction Technology PART ?:Clinical Study Of 3D CTA In The Laparoscopic Surgery For Rectal Cancer With Preservation Of The Left Colic Artery PART ?:B

PART ?:Anatomical observation of colorectal mesenteric vessels based on CTA and three-dimensional reconstruction technologyObjective To investigate the anatomy,classification,variation and postoperative blood flow reconstruction passway of colorectal mesenteric vessels based on CTA and three-dimensional reconstruction technology.Methods A retrospective study was carried out.177patients with CRC underwent surgery in the Cancer Hospital from January 2019 to June 2020 were enrolled,whose contrast-enhanced CT scan data and clinical data were intact.Vascular three-dimensional reconstruction and systematic anatomical observation of colorectal mesenteric vessels was performed.Results A total of 177 patients with colorectal cancer eligible for enrollment were included in the study,of which 39 cases had paired preoperative and postoperative image information.There were 125 males and 52 females,mean age was 61.47±10.57 years old,mean height was 169.46±7.09cm,mean weight was 70.98±11.38Kg,mean body mass index was(24.63±3.13)kg/m2.ICA,MCA,SA and SRA are fixed arteries.And RCA,AMCA and LCA might be lacking.The overall distribution of the SMA is divided into four types(87 cases for type I,17 cases for type ?,54 cases for type ?,19 case for type?).The occurrence probability of the ICA was 100%,and ICV running on the ventral and dorsal sides of ICA were 73 cases and 104 cases respectively.36 cases of RCA appeared and 141 cases were absent.The occurrence probability of the MCA and AMCA were 100%and 41.24%respectively.The blood supply of the splenic flexure is from MCA,AMCA and LCA.The blood supply of the splenic flexure is divided into three types(104 cases for type ?,64 cases for type ? and 9 cases for type ?).The inferior mesenteric artery is divided into four types(103 cases for type I,41 cases for type ?,24 cases for type ? and9 cases for type ?).The average distance from the inferior mesenteric artery to the bifurcation of the aorta was 4.48±0.87 cm.At the level of the root of the inferior mesenteric artery,the running relationship between the left colon artery and the inferior mesenteric vein is divided into three types(71 cases for type ?,76 cases for type ? and 21 cases for type ?).The average horizontal distance from LCA to the inferior mesenteric artery was 3.22±1.64cm.The blood pathway after rectal cancer surgery without LCA preservation is divided into five types(9 cases for type ?,3 cases for type ?,2 cases for type ?,2 case for type ?,and 2 case for type V).The blood pathway after rectal cancer surgery with LCA preservation is divided into two types(9 cases for type ? and 12 cases for type ?).Conclusions 1.ICA,MCA,SA and SRA are fixed arteries and RCA,AMCA and LCA might be lacking;2.The overall distribution of the superior mesenteric artery is divided into four types,the inferior mesenteric arteries are divided into four types and the blood supply of the splenic flexure is divided into three types;3.The blood flow pathway after surgery without and with LCA preservation is divided into five and two types,respectively;4.Preoperative CTA and vascular three-dimensional reconstruction technology can better clarify the anatomy and variation of colorectal vessels,and provide a reference for colorectal surgery.PART ?:Clinical study of 3D CTA in the laparoscopic surgery for rectal Cancer with preservation of the left colic arteryObjective:To investigate the clinical application of vascular three-dimensional reconstruction in laparoscopic rectal cancer surgery with preservation of left colic artery(LCA).Methods:A retrospective cohort study was carried out.Clinical data of 146 patients undergoing laparoscopic rectal cancer surgery with preservation of the LCA in the Cancer Hospital Chinese Academy of Medical Sciences from January 2019 to August 2019 were retrospectively analyzed.All the patients were treated with laparoscopic rectal cancer surgery with preservation of the LCA and had complete operative and postoperative data.Based on the vascular reconstruction or not,72 patients received vascular three-dimensional reconstruction(reconstruction group)and 74 patients did not receive reconstruction(non-reconstruction group).Patient demographics,operative data,postoperative complications,pathological data and postoperative recovery data were compared between the two groups.Results:A total of 146 patients with rectal cancer eligible for enrollment were included in the study,of which 72 were in the reconstruction group and 74 were in the non-reconstruction group.In the reconstruction group,there were 47 males and 25 females,mean age was(59.75±6.2)years old,mean body mass index was(24.1±2.2)kg/m2.In the non-reconstruction group,there were 51 males and 23 females,mean age was(58.77±6.1)years old,mean BMI was(23.6±2.7)kg/m2.No statistically significant difference in the baseline data between the two groups.In terms of vascular type of IMA,there were 35 cases for type ?,25 cases for type ?,11cases for type ? and 1 case for type ? in the reconstruction group and 37 cases for type ?,24 cases for type ?,12 cases for type ? and 1 case for type ? in the non-reconstruction group.There was no statistically significant difference in the vascular type between the two groups(P>0.05).The operation time was 162.2±10.8 min in the reconstruction group and 197.9±19.1 min in the non-reconstruction group.Compared with the non-reconstruction group,the operation time was shortened in the reconstruction group.Intraoperative blood loss was 30.4±20.0ml in the reconstruction group and 61.2±26.4ml in the non-reconstruction group.The blood loss in the reconstruction group was less(P<0.05).There were no statistically significant differences between the reconstruction group and non-reconstruction group,with regard to anastomotic leakage(1 case,1.4%vs 1 case,1.4%,P=0.984),anastomotic bleeding(2 cases,2.8%vs 3 cases,4.1%,P=0.672),postoperative hospitalization(6.8±0.7d vs 7.0±0.7d,P=0.141)and postoperative pathological outcomes(P>0.05).Conclusions:1.Preoperative 3D CTA can judge the type,variation and course of IMA and its branch vessels;2.Preoperative 3D CTA can shorten the operation time,reduce intraoperative blood loss and improve the success rate of LCA preservation;3.Preoperative 3D CTA is recommended for laparoscopic rectal cancer surgery with LCA preservation,which can provide reference for the operation.PART ?:Bioinformatics analysis of the differential expression and prognostic value of APOC1 in liver metastasis of colorectal cancerObjective:To investigate the HDEGs and prognostic marker for liver metastases of colorectal cancer(CRC).Methods:We utilized public datasets from three GEO to identify HDEGs between liver metastases of CRC and tumour samples and that of CRC and normal samples.These significantly HDEGs of the three GEO databases take the interaction.And these genes were screened through an online tool to explore the prognostic value.Then,we utilized the online tool TIMER and R package to explore the functions of these genes in immunity and performed GSEA to investigate their potential functions in CRC.Results:Based on the selection criteria of the GEO data,we selected three eligible CRC datasets for exploration(GSE14297,GSE41258 and GSE49355).Venn diagrams were used to identify significantly HDEGs common to the 6 groups and got 47 HDEGs.The HDEGs were visualized using STRING and Cytoscape software.Based on the TCGA database,APOC1 showed significantly different expressions between N2 and N0,and N2 and N1.And there was also a significant difference in expression between T2 and T4;and between T2 and T3.PCR illustrated that the APOC1 mRNA was strongly upregulated in colorectal cancer tissues(P=0.014).PrognoScan and GEPIA2 revealed the prognostic value of APOC1 for OS and DFS in CRC(P<0.05).TIMER showed that APOC1 has a close relationship with immune infiltration(P<0.05).The analysis of the relationship between APOC1 expression and common immune checkpoint gene expression showed that APOC1 expression is related related with TNFSF14 and VTCN1 in both colon cancer and rectal cancer.Conclusion:1.Compared with normal colorectal tissues and primary tumors,APOC1 is highly expressed in liver metastases;2.The expression of APOC1 is associated with OS and DFS of colorectal cancer;3.The expression of APOC1 has a close relationship with immune cell and infiltration tumor immune microenvironment;4.The expression of APOC1 in colorectal cancer is correlated with the expression of immune checkpoint genes TNFSF14 and VTCN1;5.APOC1 is might be a biomarker that is associated with prognosis of liver metastases of colorectal cancer.