Enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer / 中华普通外科杂志

Objective To evaluate the safety and effectiveness of enhanced recovery after surgery (ERAS) in laparoscopic radical gastrectomy for gastric cancer.Methods From May 2015 to July 2017,149 patients with gastric cancer in our department were prospectively enrolled and randomly divided into the ERAS group (n =75) and control group (n =74).Results In ERAS group compared to control group,the time to first passage of flatus was (51 ± 11)vs.(62 ± 11)h,first feeding time (46 ± 12) vs.(68 ±20)h,gastric tube removal time (13 ± 12)h vs.(70 ± 16) h,pain score on the first day after surgery (3.9 ±1.3) vs.(5.2 ±0.9),C-reaction protein level (8.5 ±2.6) mg/L vs.(10.1 ±3.0)mg/L,post-op hospital stay (6.9 ± 2.9) d vs.(11.2 ± 3.5) d,were all significantly different (all P ＜ 0.05).The postoperative complication rates was 25％ vs.28％ respectively,(x2 =0.101,P =0.750).Conclusions Enhanced recovery after surgery can promote the postoperative recovery and shorten the time of hospitalization in laparoscopic-assisted radical gastrectomy for gastric cancer.

Application of fascia-orientation of pelvic autonomic nerve preservation in rectal cancer surgery / 中华胃肠外科杂志

Rectal cancer has become the second most common gastrointestinal tumor in our country. With the development of comprehensive treatment, the long-term survival rate of patients with rectal cancer has greatly increased, meanwhile, higher postoperative quality of life is required. But the genitourinary dysfunction which is mainly caused by intraoperative pelvic autonomic nerve damage haunts postoperative rectal cancer patients. Traditional pelvic autonomic nerve protection technology born in the 1980s only improves urogenital function in a part of postoperative patients. In recent years, NOME(nerve-oriented mesorectal excision) was proposed, which needed to make pelvic autonomic never exposed. However, recovery of urinary function is not ideal due to difficulty identifying pelvic autonomic nerve and unavoidable damage on pelvic autonomic nerve. In clinical practice, we found that pelvic autonomic nerve can be divided into three parts: abdominal cavity, large pelvis, small pelvis. The pelvic autonomic nerve is closely related to the surrounding fascias in each part. The fascias are not only the protection of pelvic autonomic nerve, but also can be used as a good indicator of location of pelvic autonomic nerve. The relationship of pelvic autonomic nerve with Toldt fascia, presacral fascia, the lateral rectal ligaments, and the Denonvilliers fascia is discussed in this paper. Combined with the above theory, a new technology named FOPANP (fascia-orientation of pelvic autonomic nerve preservation) is proposed. In this technique, the fascia around the rectum is used as a guidance to select the appropriate plane in the operation, and the tumor can be removed without exposing the pelvic autonomic nerve. This technology has three advantages. First, it is not necessary to search and expose the pelvic autonomic nerve, so as to avoid secondary injury to it during the operation. Secondly, the pelvic fascias are natural barriers formed between the surgical plane and the pelvic autonomic nerve retained. They can avoid the stimulation of physical and chemical factors to pelvic autonomic nerve. Thirdly, because the fascias are easier to identify, and the texture is more tough, so the technology is easier to master.

Application of delta-shaped anastomosis in totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer / 肿瘤研究与临床

Objective To investigate the feasibility and safety of delta-shaped anastomosis in totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer. Methods Clinical data of 26 patients with distal gastric cancer who received total laparoscopic distal gastrectomy with delta-shaped anastomosis from August 2013 to December 2014 were retrospectively analyzed. Results A total of 26 patients were successfully performed by laparoscopic distal gastrectomy with delta-shaped anastomosis. The operative time and delta-shaped anastomosis time was (186 ±28) min and (30 ±24) min respectively. The lengths of upper and lower segment of resection from gastric cancer were (4.9±1.2) cm and (3.5±1.5) cm respectively. Blood loss was (67±39) ml and the number of dissected lymph nodes was (27±11) for every patient. First time to ground activities, first flatus, time to fluid diet and hospital stay were respectively (1.7±0.8) d, (3.5±1.3) d, (4.2±1.6) d and (12±4 ) d. Pathological results showed upper and lower segment of resection cancers were not found. Only 1 patient had gastric small curved stump fistula and recovered after conservative treatment. There were no complications related to the anastomosis in all patients. Conclusion The delta-shaped anastomosis is safe and feasible for totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer with satisfactory short-term efficacy.

Characteristics analysis of hospitalized patients with malignant tumors in Shanxi Cancer Hospital from 2005 to 2014 / 肿瘤研究与临床

Objective To analyze the changes of age, sex, and urban-rural characteristics of inpatients with malignant tumors in Shanxi Cancer Hospital from 2005 to 2014. Methods The data of malignant tumor patients from January 2005 to December 2014 in Shanxi Cancer Hospital were analyzed, which were stratified by age, sex and residence. SAS 9.2 statistical software was used to analyze the changes of age, sex and residence of patients with malignant tumors. Results The average age of malignant cancers was 59.16-60.99 years old for men and 50.7-52.06 years old for women from 2005 to 2014. The incidence between male and female was decreased from 0.81 in 2005 to 0.71 in 2014. The incidence ratio of urban-rural was decreased from 3.5 in 2005 and 2.13 in 2014. The disparities in urban-rural areas still existed in recent 10 years.The incidence number of women in rural areas and the average age of malignant tumors in our hospital was increased significantly respectively. Lung cancer, breast cancer, cervical cancer, esophagus cancer and stomach cancer were the major cancers. The incidence of lung cancer ranked in the first place in male tumors, and the breast cancer ranked in the first place for female tumors. Conclusions It still exists gender and urban-rural differences in patients with malignant tumors in Shanxi Cancer Hospital from 2005 to 2014, and aging tends to be more obvious. The prevention and control of lung cancer, digestive system cancer, female breast cancer are the emphasis in Shanxi Province, while the promotion of health education intervention should be undertaken. Besides, other kinds of comprehensive prevention and control measures are necessary including the screening for major cancers in key areas and the early diagnosis.

Characteristics analysis of hospitalized patients with malignant tumors in Shanxi Cancer Hospital from 2005 to 2014 / 肿瘤研究与临床

Objective To analyze the changes of age, sex, and urban-rural characteristics of inpatients with malignant tumors in Shanxi Cancer Hospital from 2005 to 2014. Methods The data of malignant tumor patients from January 2005 to December 2014 in Shanxi Cancer Hospital were analyzed, which were stratified by age, sex and residence. SAS 9.2 statistical software was used to analyze the changes of age, sex and residence of patients with malignant tumors. Results The average age of malignant cancers was 59.16-60.99 years old for men and 50.7-52.06 years old for women from 2005 to 2014. The incidence between male and female was decreased from 0.81 in 2005 to 0.71 in 2014. The incidence ratio of urban-rural was decreased from 3.5 in 2005 and 2.13 in 2014. The disparities in urban-rural areas still existed in recent 10 years.The incidence number of women in rural areas and the average age of malignant tumors in our hospital was increased significantly respectively. Lung cancer, breast cancer, cervical cancer, esophagus cancer and stomach cancer were the major cancers. The incidence of lung cancer ranked in the first place in male tumors, and the breast cancer ranked in the first place for female tumors. Conclusions It still exists gender and urban-rural differences in patients with malignant tumors in Shanxi Cancer Hospital from 2005 to 2014, and aging tends to be more obvious. The prevention and control of lung cancer, digestive system cancer, female breast cancer are the emphasis in Shanxi Province, while the promotion of health education intervention should be undertaken. Besides, other kinds of comprehensive prevention and control measures are necessary including the screening for major cancers in key areas and the early diagnosis.

The further understanding of Denonvilliers fascia based on "Fascial Surgery" / 中华胃肠外科杂志

Denonvilliers fascia is a dense structure between the rectum and the genitourinary system, and plays as a barrier. In recent years, along with in-depth study of TME, scholars have taken many discussions on Denonvilliers fascia structure and the dissection plane. On the one hand, some consensus have been made on Denonvilliers fascia structure, but still needs to further clarify its microstructure. On the other hand, scholars have generally recognized the neurovascular bundles are on Denonvilliers fascia sides. They should be protected during rectal surgery, however, the details should be clarified. Based on "Fascial Surgery" theory, this article describes Denonvilliers fascia structure and clinical application combined with previous research and our research results.

Clinical practice of multidisciplinary team diagnosis and treatment of colorectal cancer / 中华消化外科杂志

Multidisciplinary team(MDT)diagnosis and treatment of colorectal cancer has been adopted by plenty of hospitals as a kind of effective comprehensive therapy.Compared with the traditional diagnosis and treatment methods,MDT diagnosis and treatment achieve standardization of diagnosis and treatment and technical promotion through specialization of the team to ensure better treatment and prognosis of patients.However,MDT diagnosis and treatment of colorectal cancer is not perfect,which can be limited by two aspects of hospitals and patients and can realize maximum utility with knowledge of its characteristics.This article will try to explore the distribution and usage of the resource in MDT diagnosis and treatment of colorectal cancer,the advantages over the traditional cure methods and the limits.

Application value of cruciform anastomosis in the laparoscopic radical resection of colon cancer / 中华消化外科杂志

Objective To evaluate the safety and feasibility of cruciform anastomosis in the laparoscopic radical resection of colon cancer.Methods The retrospective descriptive study was adopted.The clinicopathologic data of 9 patients with colon cancer who were admitted to the Shanxi Provincial Caner Hospital between December 2011 to October 2013 were collected.After the laparoscopic free colon and dissection of lymph nodes,the proximal and distal ends of the colon tumor were cut off using an ENDO-GIA,cutting one small incision on the both side of stump,and ENDO-GIA was put into the incision to staple the mesentery of colonic wall,finally,the beak-like common incision was closed by ENDO-GIA and digestive tract construction was conducted.Observation indices:(1)operative indices:operation time,time of cruciform colon anastomosis,volume of intraoperative blood loss,conversion to open surgery.(2)Tumor indices:number of lymph nodes dissected,distance to resection margin,R resection.(3)Surgical complications:anastomotic stoma incompetence,anastomotic leakage,anastomotic stenosis,twisting of bowel,wound liquefaction infection.(4)Postoperative recovery time:time for initial out-of-bed activity,time to anal exsufflation,time for fluid diet intake,duration of postoperative hospital stay.(5)Follow-up situations:follow-up using outpatient examination was conducted up to April 2014.Karnofsky performance status(KPS)score was used to evaluate the health conditions and tumor recurrence of anastomotic stoma and colonic cavity stenosis were detected by fibercoloscope.Measurement data with normal distribution were presented as x±s.Results(1)Operative indices:9 patients received successful total laparoscopic resection of colon cancer+D3 lymph node dissection+cruciform anastomosis,without conversion to open surgery.Operation time,time of cruciform colon anastomosis and volume of intraoperative blood loss were respectively(140±50)minutes,(43±26)minutes and(62±56)mL.(2)Tumor indices:the number of lymph nodes dissected was 17±6 percase.The distance to resection margin was more than 8 cm,and pathological findings showed no residual cancer.(3)Surgical complications:9 patients had no postoperative complications.(4)Postoperative recovery time:time for initial out-of-bed activity,time to anal exsufflation,time for fluid diet intake and duration of hospital stay were respectively(1.8±0.9)days,(2.4±1.2)days,(3.6±1.7)days and(9.6±2.5)days.All the patients were discharged from hospital at postoperative day 12,without the occurrence of readmission within postoperative day 30.(5)Follow-up situations:all the patients were followed up by outpatient examination at postoperative month 6,with KPS score≥90 and without the occurrence of tumor recurrence of anastomotic stoma and colonic cavity stenosis.Conclusion Cruciform anastomosis in the laparoscopic radical resection of colon cancer is safe and feasible.

Application of nomogram in the risk assessment of postoperative recurrence of gastrointestinal stromal tumor / 中华消化外科杂志

Gastrointestinal stromal tumor (GIST) is originated from the gastrointestinal mesenchymal stem cells,composed of undifferentiated or pluripotent spindle and epithelioid cells,often occurs in the whole range of the gastrointestinal tract and occasionally in the omentum,mesenterium and other areas which are outside of digestive tract.The treatment is difficult due to broad-spectrum biological behaviour of GIST,while surgery may be the only potential method for curing GIST with a risk of recurrence.Currently,there is still not an evaluative standard in the choice of surgery or imatinib therapy as well as the risk of recurrence.The F/NIH consensus,Armed Forces Institute of Pathology (AFIP) standard,modified standard of National Institutes of Health(NIH) and consensus of mathematical model which have been widely used cannot accurately evaluate risk probability of recurrence,so the current researches have focused on the postoperative risk assessment for GIST.In recent years,the nomogram model has been applied to predict the risk of GIST recurrence by some scholars,with the better outcomes.

Neoadjuvant therapy of imatinib in gastrointestinal stromal tumors and the timing of surgery / 中华胃肠外科杂志

Imatinib is the key medication for adjuvant therapy in gastrointestinal stromal tumors(GIST) and the first line therapy for patients with metastatic or recurrent GIST. Preoperative treatment with imatinib may improve R0 resection rate and provide the chance of metastasectomy for cytoreduction as well as prolonging patient's survival. We investigate the significance of neoadjuvant therapy of imatinib and the timing of surgery by reviewing clinical trials and consensus in recent years.

Anatomic characteristics of the Denonvilliers fascias and its application in rectal surgery / 中华消化外科杂志

Denonvilliers fascia locating between the front of the rectum and urogenital organs is an important barrier separating the urogenital organs and the rectum.It has great significance in the clinical treatment of rectal tumors and genitourinary system tumors.However,controversial on the embryological origins and anatomic characteristics of the Denonvilliers fascias still exist.In this article,the embryonic origin,anatomical structure,adjacent structures and clinical applications of the Denonvilliers fascias were introduced.

Analysis of postoperative complications and their related factors after laparoscopic-assisted radical surgery in rectal cancer / 肿瘤研究与临床

Objective To investigate the factors associated with postoperative complications after laparoscopic-assisted radical surgery in rectal cancer.Methods The clinical data of 310 patients with rectal cancer performed by laparoscopic-assisted radical resection from November 2010 to August 2013 were analyzed retrospectively.The differences between patients with and without postoperative complications were compared.All the data were analyzed by the t test,chi-square test or Logistic regression analysis.Results Among the 310 patients,postoperative complication occurred in 80 patients.On univariate analysis,postoperative complication was associate with gender,age,body mass index,preoperative comorbidity,diameter and location of tumor,TNM staging,operative time and surgeon experience (all P ＜ 0.05).Logistic regression analysis revealed that gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience were independent risk factors for postoperative complications (all P ＜ 0.05).Follow-up was available in 260 patients,with a median follow-up of 18 months (3-30 months).Differences in survival rates between patients with and without postoperative complications were no statistical significance (x2 =1.201,P =0.273).Conclusions Gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience are independent risk factors for postoperative complications in laparoscopic-assisted radical surgery for rectal cancer.The short and medium-term survival time between patients with and without postoperative complications are similar.

The combination of transrectal ultrasonography and serum CEA in preoperative staging of rectal carcinoma / 肿瘤研究与临床

Objective To evaluate the diagnostic accuracy of the combination of endorectal ultrasonography and serum CEA in preoperative diagnosis of rectal wall invasion (T staging) and nodal involvement (N staging) of rectal carcinoma.Methods We retrospectively analyzed clinical records of 310 patients with rectal carcinoma who underwent endorectal ultrasonography and serum CEA evaluation in Shanxi Province Tumor hospital from January 2007 to January 2010.The positive standard of CEA is more than 5 μg/L.The endorectal ultrasonography staging with postoperative pathological staging,and calculated the overall accuracy of T staging and N staging based on TRUS alone or on TRUS combined with serum CEA level were compared.Results The difference in serum CEA level was statistically significant from T1 to T4 (P ＜ 0.05).The accuracy rate of preoperative T staging of rectal carcinoma by TRUS alone was 71％ (219/310) and was 82 ％ (254/310) with TRUS combined with serum CEA level,showing significant statistical difference (x2 =10.92,P ＜ 0.01).The accuracy rate of preoperative N staging of rectal carcinoma was 69 ％ (211/308)with TRUS alone and was 77 ％ (238/308) with TRUS combined with serum CEA level,the difference of which was statistically significant (x2 =5.00,P ＜ 0.05).Conclusion Serum CEA level increases with an increasing pathological stage of rectal cancer.The combination of TRUS and serum CEA improves the accuracy of preoperative staging of rectal cancer.

Drug resistance mechanism and new therapy strategy progression in targeted treatment of gastrointestinal stromal tumors / 中华胃肠外科杂志

Gastrointestinal stromal tumors(GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Most of these stromal tumors are characterized by mutations in the KTT or platelet-derived growth factor receptor α (PDGFRA) genes, resulting in the constitutive activation of tyrosine kinase signaling. Tyrosine kinase inhibitors(TKI), such as imatinib and sunitinib, provide the standard first-line and second-line therapy for patients with metastatic or unresectable GIST. Imatinib resistance has been a challenging problem in clinical practice and raised great concern. This review introduces the underlying mechanisms of imatinib resistance and advances of treatment strategies. Reasonable individual treatment with the guidance of molecular biology is promising to improve the efficacy and the quality of life for GIST patients.

Anatomical basis and main points of pelvic autonomic nerve preserving in proctectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate the course of pelvic autonomic nerves and its relationship with pelvic fascia in order to identify the safe plane to reduce the damage of pelvic autonomic nerves in total mesorectum I excision(TME).</p><p><b>METHODS</b>The course and distribution of pelvic autonomic nerves were observed and their relationship with pelvic interfascial space was examined through the anatomy of 12 adult pelvic specimens.</p><p><b>RESULTS</b>The entire course of hypogastric nerves ran within the anterior sacral fascia and the inferior hypogastric plexus ran within parietal fascia. Inferior hypogastric plexus crossed the fusion line of Denonvilliers fascia and parietal fascia in the 10 o'clock and 2 o'clock directions of the rectum, and joined urogenital vessel bundle finally. Laterigrade traffic nerves could be found in Denonvilliers fascia.</p><p><b>CONCLUSION</b>The safe plane should be chosen between rectal proper fascia and anterior sacral fascia near rectal proper fascia in posterior dissection and lateral dissection of rectum. More attention should be paid to protect the neurovascular bundle in the 10 o'clock and 2 o'clock directions of rectum and traffic nerve within Denonvilliers fascia in anterior dissection.</p>

Treatment strategy of rectovaginal fistula after rectal cancer operation / 肿瘤研究与临床

Objective To investigate the cause,therapeutic strategy,methods of treatment and clinical results for the rectovaginal fistulas(RVF)after rectal cancer operations.Methods The clinical data of 14 female patients with RVF after rectal cancer operations were examined retrospectively.According to therapeutic strategy,all patients were divided into two groups,A group and B group,which were seperately performed traditional treatment,and progynova in combination with non-operative treatment.Results Among 10 patients in A group,8 patients were performed feacal diversion stoma,and 7 patients with RVF cured naturally,then performued colostomy reversal and restoration of bowel continuity,the other 2 cases were performed non-operative treatment for refusing feacal diversion stoma.Among 4 patients in B group,3 cases with RVF healed naturally during 1.5 to 2 months,one case secondary to rectal anastomosis was performed feacal diversion stoma for rectovaginal fistula without signs of healing.Conclusion RVF is a rare but serious complication after resection of rectal carcinoma,which is taken by the treatment strategy of progynova in combination with non-operative treatment,not only can promote the natural healing of RVF obviously,but also can shorten the healing time greatly.Feacal diversion stoma can be used while the treatment is failure.

A Meta-analysis of capecitalbine or 5-Fu combined with oxaliplatin therapy for metastatic colorectal cancer / 肿瘤研究与临床

ObjectivesTo compare clinical outcomes and safety of 5-Fu or capecitabine combined with oxaliplatin therapy for metastatic colorectal cancer. MethodsLiterature search were performed by key words,such as metastatic colorectal cancer,capecitabine,oxaliplatin,5-Fu on all randomized controlled trails reported on 5-Fu or capecitabine combined with oxaliplatin therapy for metastatic colorectal cancer before Jun.2011.Two authors drew the details of trail design,characteristics of patients,outcomes and so on from the studies included. Data analysis was performed by RevMan 4.2. ResultsAccording to the same screening criteria,6 clinical studies were included in this Meta-analysis. Sample volume in this Meta-analysis was 2189 colorectal cancer cases.The baseline characteristics of 5-Fu group were similar to those of capecitabine group.The short-term outcome such as response rate,RR was 0.92 [95 ％CI(0.82,1.02),P=0.12], and the long-term outcome such as median overall survival, median progression-free survival and the WMD was -0.19 [95 ％CI(-0.73,0.35),P=0.49],-1.91 [95 ％CI(-2.53,0.16),P=0.08],respectively,two groups weresimilar. In the comparison of Ⅲ-Ⅳ grade toxicity between the two groups, the incidences of neutropenic in 5-Fu group were higher than those in capecitabine group,and the RR was 0.24 [95 ％CI(0.11,0.55), P=0.0007]. However, the incidence of wand-foot symptoms in 5-Fu group was lower than those in capecitabine group, the RR was 2.83 [95％CI (1.66,4.82), P=0.0001]. ConclusionBoth 5-Fu and capecitabine were similarly effective in the therapy of metastatic colorectal cancer. And the Ⅲ-Ⅳ grade toxicity such as neutropenic was easier to happen in 5-Fu group,while the incidence of hand-foot symptoms was on the other hand.

Literatures analysis of clinical significance of lymph node metastasis in gastrointestinal stromal tumor / 肿瘤研究与临床

ObjectiveTo explore the clinical significance of lymph node metastasis in gastrointestinal stromal tumor (GIST).Methods A literature search to identify studies relating to GIST cases reported between January 1998 and December 2010 was conducted.The associations between lymph node metastasis and GIST clinicopathological features, gene expression, GIST stage, and GIST prognosis were evaluated.Results 6063 literatures were screened and only 16 GIST patients (median age of 49.25 years,10females) with lymph node metastasis were enrolled in this study.Among them,12 tumors were located in the stomach, 3 in the small intestine, and 1 in the esophagus.Morphologically, 13 specimens were mainly characterized by spindle cells.Gene analysis was examined in 7 cases.Conclusions Lymph node metastasis in GIST might more frequently found in the stomach, tumor stage of high grade, and cellular morphology of spindle-shaped.Gene mutation may have a relationship with lymph node metastasis.However, its clinical significance remains unclear.

Analysis of follow-up results and its impact factors in patients with breast cancer / 肿瘤研究与临床

Objective To assess follow-up work status for the patients with breast cancer and analyze the impact factor of the follow-up rate.Methods 331 female patients with complete clinical data in diagnosis and treatment with breast cancer from December 2006 to November 2008 in Shanxi Cancer Hospital were follow-up investigated by telephone.With Logistic regression method,the analysis was preformed on the impact related factors of follow-up effect.Results Telephone follow-up rate was 82.8 ％ (274/331).There was significant difference on the long-term residence between follow-up group and missing group (Fisher exact probability method,P =0.045),the results of regression analysis showed that follow-up results were influenced by the patient's occupation (β=-0.279,s-x =0.116,Wald =5.806,P =0.016,OR =0.757,95 ％ CI 0.603-0.949).Conclusion The telephone investigation for breast cancer patients is an important way for postoperative follow-up.The occupation of patient might influence the investigate results.

Diagnosis, treatment and prognosis of rectal cancer after renal transplantation / 肿瘤研究与临床

Objective To investigate the diagnosis,the treatment methods and the prognosis of rectal cancer patients after renal transplantation.Methods Four patients with rectal cancer were found in 1035 renal transplantation recipients.Three of four patients were treated with anterior resection (AR) or abdomenoperineal resection (APR) with total mesorectal excision (TME).The two patients accepted regular adjuvant chemotherapy for six months period after surgery,but one patient rejected to accept any chemotherapy after surgery.Otherwise,one patient was only treated with chemotherapy and best support therapy for diagnosed as rectal cancer with multiple liver metastases.Results Two patients were fine to be followed up,8 months and 21 months after rectal resection respectively.Two other patients eventually died of metastasized cancer 5 months and 31 months respectively after therapy had been initiated.Conclusion Transplantation patients should receive standard oncology treatment,including operation and adjuvant treatment,so long as their general condition and organ graft functions allow to do so,although a higher degree of morbidity might be encountered,and periodical colorectal screening should be performed before and after renal transplantation.