Surgical Strategies And Significance Of HIP2 Expression For Abdominal Wall Invasion Of Gastrointestinal Cancer

ObjectiveThe abdominal wall invasion of gastrointestinal cancer(AWI-GI)could cause many complications,resulting in poor survival and quality of life.The surgical treatment rate of AWI-GI is low.How to repair the complex abdominal wall defect caused by tumor resection is a difficult problem.This study was designed to summarize the surgical strategy for AWI-GI and repair and reconstruction techniques for complex abdominal wall defect after tumor resection.The expression and its significance of Huntington interacting protein 2(HIP2)in the AWI-GI were also analyzed,and the cellular function and molecular mechanism were further studied.MethodsA retrospective study was conducted on the surgical treatment of AWI-GI patients with complex abdominal wall defect after tumor resection in our hospital.To summarize the surgical strategies of surgical purpose,abdominal wall defect classification and abdominal wall reconstruction.The expression levels of HIP2 in AWI-GI and gastrointestinal cancer(GIC)without abdominal wall invasion were detected by immunohistochemical staining and their relationship was analyzed by SPSS software.Then,the stable HIP2 knockdown GIC cells were constructed to investigate the influence of HIP2 expression on the subcutaneous implantation of GIC in nude mice.Furthermore,the cellular functions and the molecularmechanisms of HIP2 in GIC cells were studied.Results(1)Twenty-six cases of AWI-GI were treated with extensive tumor resection or palliative resection,aimed to eradicate the tumor or remove the tumor complications respectively,which both caused the complex abdominal wall defect.The classifications of abdominal wall defect after tumor resection were accurately assessed.All immediate reconstructions of the abdominal wall were performed successfully after tumor resection,among which,the reinforcement repair technique(21 cases)and the double patches bridging repair technique(5 cases)were adopted.The operative time,hospitalization time and postoperative complications of patients with type II abdominal wall defect were significantly less than those of patients with type III abdominal wall defect.The postoperative survival time of patients with extensive tumor resection was significantly longer than that of patients with palliative resection.(2)All 26 patients with AWI-GI tumor lesions were strongly positive for HIP2 staining,while only 37 patients with GIC were strongly positive for HIP2 staining in 60 patients of the control group by immunohistochemical staining.There is a significant statistical difference between the two groups.The stable HIP2 knockdown GIC cell lines were designed and constructed by shRNA interference.The tumor formation rate of subcutaneous implantation of GIC cells decreased significantly in HIP2 knockdown cells in vivo.(3)The GIC cells were blocked in G2/M phase and the proliferation ability of the cells was significantly decreased after HIP2 expression was inhibited in vitro.The cell death were significantly increased in HIP2 knockdown GIC cells using of proteasome inhibitor MG132 to induce cytotoxic stress,as well as the expression of ubiquitin.ConclusionAppropriate surgical treatment could be a good choice to prolong survival time and improve the quality of life for patients with AWI-GI.The complex abdominal wall defect in patients with AWI-GI after tumor resection could be one-stage functional reconstructed by different repair techniques.HIP2 was highly expressed in the tumor lesions of AWI-GI patients.HIP2 expression knockdown could induce G2/M block in GIC cells,inhibit cell proliferation,and induce cell death by increasing proteasome stress.