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Objective To investigate the incidence rate,timing and risk factors of metachronous pulmonary metastasis after curative resection in patients with rectal cancer.Methods A total of 198 patients with rectal cancer undergoing curative resection in gastroenterology surgery department of Beijing Hospital from 2007 to 2012 were enrolled in this retrospective study.The metachronous metastasis and recurrence were observed.Clinicopathologic factors which might be associated with postoperative pulmonary metastasis were analyzed by the univariate and multivariate analysis.Results The 5-year disease-free survival was 76.8％ in a total of 198 patients cohort.The most frequent metastatic sites were the lung(incidence of 11.6 ％)followed by liver(7.6 ％).Median interval from rectal surgery to diagnosis of pulmonary metastasis was much longer than that of hepatic metastasis(19 vs.11 months,P =0.002).Tumor location,current tumor-node-metastasis (TNM)stage,and a positive circumferential resection margin(CRM)were identified as the independent risk factors for pulmonary metastasis.The most common metachronous metastasis site for rectal cancer after curative surgery was the lung in elderly patients.Conclusions The lung is the most common metachronous metastatic site after curative surgery of rectal cancer in elderly patients.For patients with unfavorable risk profiles,a more intensive surveillance program is needed for the early detection of metachronous metastasis and recurrence.
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Objective To assess the application of preoperative prognostic nutritional index (PNI) in evaluation the surgical risk and long-term prognosis for elderly patients with gastric cancer.Methods The clinical data of 205 patients aged ≥ 75 years with gastric cancer undergoing radical resection from January 2004 to December 2016 were analyzed retrospectively.The PNI value was calculated by serum albumin (g/L) +5 x lymphocyte count (x 109/L).The receiver operating characteristic (ROC) curve and Youden's index was used to determine the value of PNI in surgical risk and prognosis of patients.Patients were divided into low PNI group and high PNI group based on the cut-off value,the clinicopathological characteristics,postoperative complications and long-term survival were compared between two groups.Results The average PNI value of 205 patients was 47.3 ± 5.5.When 44.9 was set as the cut-off value with the maximal Youden's index,the sensitivity and specificity of PNI were 0.86 and 0.47,respectively.There were statistically significant differences between the two groups of patients in age(t =-2.16,P =0.032),BMI (t =4.88,P =0.000),Charlson comorbidity score (x2 =7.77,P =0.005),gastric resection range (x2 =8.63,P =0.003),postoperative complications (x2 =9.46,P =0.002).The incidence of complications in the high PNI group was 24.8％ (33/133),which was lower than that in the low PNI group (45.8％,33/72;x2 =9.46,P =0.002).Multivariate logistic analysis showed that age (P =0.032),Charlson coplications scal (CCS) (P =0.042) and PNI ＜ 44.9 (P =0.027) were independent risk factors for postoperative complications;PNI ＜ 44.9 (P =0.001),gastrectomy (P =0.011),lymph node dissection (P =0.000),tumor differentiation (P =0.001) and TNM stage (P =0.000) were independent prognostic factors for elderly patients with gastric cancer.Conclusions Prognostic nutritional index is a valuable clinical marker in evaluation of surgical risk and prognosis for elderly patients with gastric cancer.
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Objective To evaluate if mucinous subtype has a relevant impact on disease-free survival (DFS) of patients with rectal carcinoma.Methods The clinicopathological data of patients with rectal adenocarcinomas (ring cell carcinoma were excluded)undergoing radical surgery at Beijing Cancer Hospital from Jan 2010 to Jan 2012 were retrospectively studied,survival analysis was done to detect potential prognostic predictors.Results 353 patients with stage Ⅰ-Ⅲ rectal cancer were included in this study,of whom 28 (7.9％) had mucinous histology.The 3-year DFS for patients with a mucinous adenocarcinoma was 50.0％ and 83.4％ for patients with nonmucinous adenocarcinoma (P ＜ 0.001).Mucinous adenocarcinoma was associated with advanced pathologic T (T3/4,100％ vs 52.3％,P ＜0.001) and N stage (N1/2,64.3％ vs.32.6％,P =0.001).More patients were diagnosed under 40 years in mucinous adenocarcinoma group (21.4％ vs.5.5％,P =0.005).Conclusions Patients with mucinous adenocarcinoma more often present at a younger age,mucinous adenocarcinomas are associated with more advanced tumor stages,and should be regarded as a dismal prognostic factor for the survival of patients with rectal cancer.
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Because of the improvement of surgical technique and the widely use of multimodality therapy, more patients with rectal cancer undergo sphincter-preserving surgery. However, it has been reported that up to 90% of such patients will suffer from bowel dysfunction, ranging from increased bowel frequency to faecal incontinence or evacuatory dysfunction. This wide spectrum of symptoms after resection of the rectum has been termed anterior resection syndrome (ARS). This disordered bowel function has a substantial negative effect on quality of life, however, the causal mechanisms have not been clarified. The present review discusses the clinical manifestation, underlying mechanisms, as well as prevention and treatment strategies.
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Humans , Combined Modality Therapy , Digestive System Surgical Procedures , Fecal Incontinence , Organ Sparing Treatments , Postoperative Complications , Therapeutics , Quality of Life , Rectal Neoplasms , General Surgery , RectumABSTRACT
<p><b>OBJECTIVE</b>To analyze the complications of ileostomy closure and related risk factors.</p><p><b>METHODS</b>Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital from September 2006 to March 2013 were included in this study. Clinical features of these patients were reviewed, the complications rate was calculated, and univariate and multivariate analyses with regard to the risk factors of surgical site infection(SSI) were also conducted.</p><p><b>RESULTS</b>A total of 245 consecutive patients were enrolled in the study. Thirty-nine complications were observed in thirty-three patients, the overall complication rate was 13.5%. Complication after primary closure of defunctioning ileostomy included surgical site infection (n=21, 8.6%), ileus (n=8, 3.3%), preoperatively undiagnosed anastomotic leakage or rectovaginal fistula (n=5, 2.0%), pulmonary infection (n=2, 0.8%), and anal sphincter dysfunction (n=2, 0.8%). No patient died in the perioperative period, and 5 patients (2.0%) underwent reoperation for ileus (n=3), anastomotic leakage (n=1) and rectovaginal fistula (n=1). Multivariate analysis showed that postoperative complications [OR=10.576, 95%CI:2.898-38.597, P=0.000] and total operation time>90 min[OR=4.862, 95% CI:1.758-13.451, P=0.002] were independent risk factors of SSI, and the presence of subcutaneous vacuum drainage [OR=0.063, 95%CI:0.007-0.540, P=0.012] was protective factor of SSI.</p><p><b>CONCLUSIONS</b>Surgical site infection is the most common complication after primary closure of defunctioning ileostomy. Subcutaneous vacuum drainage is effective for reducing SSI in patients undergoing primary closure of ileostomy, and it is especially recommended for patients with operation time>90 min.</p>