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Objective:To explore the effect of tumor deposit (TD) on the prognosis of patients with stage Ⅲ colon cancer after radical resection.Methods:The clinicopathological data of patients with stage Ⅲ colon cancer after radical surgery at the Department of Gastrointestinal Surgery, Peking University People's Hospital from Jan to Dec 2015 were analyzed collected. Clinicopathological characteristics such as tumor location, degree of differentiation, mismatch repair status, lymphatic and venous invasion, and preoperative CEA and CA19-9 levels were used to study the effect of TD on the postoperative survival of patients.Results:Among the 155 patients with stage Ⅲ colon cancer, 37 (23.9%) had tumor deposits. The incidence of tumor deposits was higher in patients with intravascular tumor thrombus and preoperative serum CA19-9 elevation ( χ2=9.567, P=0.002; χ2=11.561, P=0.003); Patients with tumor deposits had worse overall survival and disease-free survival than those without cancer nodules (OS: P=0.029, DFS: P=0.025). Multivariate COX analysis found that tumor deposit was an independent risk factor for postoperative overall survival and disease-free survival ( HR=1.990, 95% CI: 1.032-3.835, P=0.040; HR=2.416, 95% CI : 1.205-3.820, P=0.009). Conclusions:Tumor deposit is an independent risk factor affecting postoperative overall survival and disease-free survival in patients with stage Ⅲ colon cancer. For patients with lymph node metastasis, incorporating TD into TNM staging can more accurately predict the postoperative prognosis.
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Objective:to study the mutation of p53 gene in colorectal cancer, analyze the relationship between p53 gene mutation and numb expression pattern, and explore its clinicopathological significance in colorectal cancer.Methods:p53 gene mutation in 60 colorectal cancer tissues was analyzed by polymerase chain reaction (PCR) and DNA sequencing, and the expression of numb protein was detected by Western blot. The colon cancer cell lines HCT116 (+), HCT116 (-) and flow cytometry were used. The survival curve was drawn by Kaplan Meier method.Results:p53 gene mutation was found in 31 of 60 tissues (52%), and the mutation times of exons (E) 5, 6, 7 and 8 were 5, 6, 12 and 11 respectively. The expression level of numb in p53 mutation group was significantly lower than that in non mutation group ( P=0.009). The prognosis of patients with low expression of numb (39 cases) was worse than that of high expression of numb (21 cases) ( P=0.015). Its expression level is closely related to the degree of differentiation, lymph node metastasis and TNM stage (all P<0.05). After the two cell lines were transferred into numb, the cell cycle appeared G2-M phase arrest and proliferation was inhibited, while dapt had G1-S phase arrest. Conclusion:p53 gene mutation related to the expression of numb in colon cancer, which has significant effect on the prognosis.
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Objective:To analyze the progress and promotion effect of the national multidisciplinary team(MDT) pilot project of digestive system tumor diagnosis and treatment, for the reference in promoting the popularition of tumor MDT model.Methods:The data of MDT project evaluation forms of 231 digestive system tumor MDT pilot hospitals in 2018(July 2017 to June 2018), 2019(July 2018 to June 2019)and 2020(July 2018 to June 2019)were obtained. The MDT of digestive system tumors, the development of outpatient and inpatient MDT, the distribution of cases, and the management, charging and regional radiation of MDT in the pilot hospital were analyzed. Descriptive analysis and frequency analysis were used for all the data.Results:With pilot hospitals of missing data excluded, the number of pilot hospitals included in the analysis from 2018 to 2020 was 227, 224 and 224, respectively.The number of pilot hospitals carrying out digestive system tumor MDT increased from 174 in 2018 to 222 in 2020, the number of outpatient and inpatient MDT cases increased from 48 332 and 61 823 to 72 493 and 106 899 respectively, and the proportion of pilot hospitals implementing the MDT management system increased from 159 to 214. In 2020, the average expenses of outpatient and inpatient MDT were mainly 200-500 yuan, and 135(60.3%) pilot hospitals became the leading MDT hospitals in the region.Conclusions:The MDT pilot project of digestive system tumors in China has achieved remarkable results.For example, the number of pilot hospitals carrying out MDT keeps increasing year by year, and the pilot hospitals have played a leading role in the region. In order to accelerate the coverage of the tumor MDT model, the authors suggested that the hospitals should optimize MDT in terms of patient accessibility, optimize management mode, promote the medical insurance reimbursement, and strengthen regional influence.
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Objective:To investigate clinicopathological characteristics and efficacy of conversion therapy in patients with metastatic gastric cancer.Methods:The clinicopathological and follow-up data of metastatic gastric cancer patients at the Department of Gastrointestinal Surgery of Peking University People's Hospital from Jan 2018 to Jun 2021 were retrospectively studied. Multivariate Logistic regression analysis was used to identify independent characteristics for pathological complete response (PCR). The influence of stage of metastatic gastric cancer and pathological response on prognosis were analyzed by Kaplan-Meier curve.Results:A total of 31 patients were enrolled, and 13 tumors located at the cardia or fundus, 8 at body, other 10 at pylorus or antrum . Baseline CT evaluation showed retroperitoneal lymph node metastasis in 10 cases, intraperitoneal metastasis in 10 cases, liver metastasis in 2 cases, adrenal and splenic metastasis in 1 case respectively, and multiple metastasis in 5 cases. After conversion therapy, 8 (26%) cases had pathological T0, 16 cases (52%) had pathological N0 and 7 cases (22%) had pathological complete response. Multivariate Logistic regression analysis showed retroperitoneal lymph node metastasis ( OR: 20.082, 95% CI: 2.141-188.315, P=0.009) was the only independent risk factor of PCR. Meanwhile, Kaplan-Meier curve showed pT0 improved disease-free survival significantly ( P=0.021). Conclusions:Metastatic gastric cancer patients with retroperitoneal lymph node metastasis alone had a tolerable conversion therapy effect. pT0 is a significant factor in improving prognosis.
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Objective:To explore CT imaging features related to disease-free survival (DFS) for gastric cancer (GC) patients with no clinical lymph node metastasis (cN0).Methods:From January 2005 to December 2018, 298 patients with GC were collected retrospectively in Peking University People′s Hospital. All the patients performed CT scanning before operation, and cT1-4N0M0 was defined by CT images. The clinical tumor stage (cT), extramural vessel invasion (EMVI), tumor morphological type, location and size were defined and recorded based on preoperative contrast-enhanced CT images. According to the pathological results, the patients were divided into pT1-2, pT3-4, pN0, and pN1-3 subgroups, with 148, 150, 135, and 163 cases, respectively. Progressive events and corresponding time were recorded during follow-up. DFS was defined as the time from radical operation to progressive events; if no progressive events occurred, DFS was defined as the time from radical operation to the last follow-up. The Kaplan-Meier curve and log-rank test were used to analyze the differences in cumulative DFS among patients with different CT imaging features, and Cox survival analysis was used to explore the independent CT imaging risk factors affecting DFS of cN0 patients. The log-rank test was used to test the effect of independent risk factors on cumulative DFS in different subgroups.Results:The follow-up time of enrolled patients was 36.0 (14.9, 59.3) months. The 3-year cumulative DFS rates of cT3-4 and cT1-2 GC patients were 61.2% and 85.6%, respectively, and the difference of DFS was statistically significant (χ 2=22.72, P<0.001). The 3-year cumulative DFS rate of EMVI-positive patients was 46.3%, which was lower than that of EMVI-negative patients (77.1%), and the difference was statistically significant (χ 2=21.34, P<0.001). There was no significant difference in 3-year cumulative DFS between different tumor locations and morphological types (χ 2=1.75, 1.73, P=0.189, 0.196). The difference in 3-year cumulative DFS between the tumor maximal diameter ≥3.4 cm and <3.4 cm groups was statistically significant (χ 2=17.58, P<0.001). On Cox survival analysis, cT (HR=5.203, P=0.001) and EMVI (HR=1.971, P=0.025) were independent risk factors for 3-year DFS in patients with cN0 GC. The results of subgroup analysis showed that the effect of EMVI on the 3-year DFS in pN0, pN1-3, pT1-2 and pT3-4 subgroups was statistically significant ( P<0.05). The effect of cT on the 3-year DFS was statistically significant in pN0, pN1-3, and pT1-2 subgroups ( P<0.05), but not in pT3-4 group (χ 2=2.58, P=0.108). Conclusion:cT and EMVI defined on preoperative CT examination are independently prognostic factors of 3-year DFS for patients with cN0 GC.
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The surgical treatment principle of colorectal cancer has always been to remove the intestine with tumor locating and the adjacent mesentery. However, the optimal area of mesen-tery resection and the optimal range of lymph node dissection are still controversial. At present, there are two main theories of lymph node metastasis of colorectal cancer, including the Halsted metastasis model and the Fisher metastasis model. The Halsted metastasis model indicates that the tumor always metastasizing from the primary focus to the paraintestinal lymph nodes, then to the intermediate lymph nodes, central lymph nodes, and finally distant metastasis. The Fisher metas-tasis model, on the other hands, suggests that tumor metastasis may occurring in the early stage of tumor and may be random events. If Fisher′s model is established, lymph node dissection in traditional colorectal cancer surgery is only a step to determine the tumor stage, which is unlikely to affect the prognosis of cancer patients. The latest research data shows that lymph node metastasis and liver metastasis of colorectal cancer originating from different cell subsets of primary tumor, and the circulating tumor cells and its DNA can be detected in early stage of colorectal cancer. Therefore, the diagnosis and treatment of colorectal cancer has moved towards to the biology-based surgery. The biology-based surgery refers to the implementation of surgical treatment according to the results of tumor gene analysis or molecular immunoassay while making accurate diagnosis, so as to improve the prognosis and quality of life of patients by changing the timing, indications and methods of surgery. More and more biological and clinical research evidences are applied to guide the surgical timing and operation mode of colorectal cancer. Based on clinical practice and literature analysis, the authors believe that the biology-based surgery of colorectal cancer is still in its infancy, and with the development of gene sequencing technology and the revelation of the pathogenesis of colorectal cancer, the biology-based surgery will play a more important role in colorectal cancer.
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Objective:To investigate the clinicopathological characteristics and prognostic factors of Siewert Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospetcive cohort study was conducted. The clinicopathological data of 399 patients with AEG who were admitted to Peking University People′s Hospital from January 1998 to December 2015 were collected. There were 318 males and 81 females, aged 66(range, 19-87)years. Observation indicators: (1) clinicopathological characteristics of Siewert Ⅱ and Ⅲ AEG; (2) follow-up and survival; (3) prognostic factors analysis. Patients were followed up by telephone interview and outpatient examination to detect postoperative survival up to December 2018. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to draw survival curves and calculate survival rates. Log-rank test was used for survival analysis. Univariate and multivariate analyses were done using the COX proportional hazard model. Results:(1) Clinicopathological characteristics of Siewert Ⅱ and Ⅲ AEG. Of 399 patients, 198 cases were Siewert Ⅱ AEG and 201 cases were Siewert Ⅲ AEG. There were 130 cases undergoing transthoracic radical AEG surgery, 172 cases undergoing trans-abdominal proximal gastrectomy and 97 cases undergoing transabdominal total gastrectomy. The age, tumor diameter, cases with surgical method as transthoracic radical AEG surgery, transabdo-minal proximal gastrectomy and transabdominal total gastrectomy, the number of positive lymph nodes, cases in tumor TNM stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were (65±10)years, (5.1±2.4)cm, 102, 68, 28, 17(range, 12?22), 20, 57, 117, 4 for patients with Siewert Ⅱ AEG, versus (62±12)years, (6.3±3.2)cm, 28, 104, 69,18(range, 14?27), 16, 41, 134, 10 for patients with Siewert Ⅲ AEG, showing significant differ-ences betweeen them ( t=2.83, ?3.82, χ2=66.97, U=17 407.05, 17 532.00, P<0.05). (2) Follow-up and survival. All 399 patients were followed up for 34(range, 2?160)months. The 5-year overall survival rate was 29.3% for patients with Siewert Ⅱ AEG, versus 37.0% for patients with Siewert Ⅲ AEG, showing no significant difference betweeen them ( χ2=1.46, P>0.05). The median survival time and 5-year overall survival rate were 29.0 months [95% confidence interval ( CI) as 23.4?34.6 months] and 22.9% for patients undergoing transthoracic radical AEG surgery, 43.0 months(95% CI as 33.9?52.1 months) and 34.7% for patients undergoing transabdominal proximal gastrectomy, 54.0 months (95% CI as 37.6?70.4 months)and 44.3% for patients undergoing transabdominal total gastrectomy, showing a significant difference in the survival among the 3 groups ( χ2=13.81, P<0.05). Of the 198 Siewert Ⅱ AEG patients, the 5-year overall survival rate was 24.6% for the 96 patients undergoing transabdominal surgery, versus 35.4% for the 102 patients undergoing transthoracic surgery, showing no significant difference in the survival between them ( χ2=3.10, P>0.05). Of the 201 Siewert Ⅲ AEG patients, the 5-year overall survival rate was 40.0% for the 173 patients undergoing transabdominal surgery, versus 16.1% for the 28 patients undergoing transthoracic surgery, showing a significant difference between them ( χ2=11.32, P<0.05). (3) Prognostic factors analysis. Results of univariate analysis showed that surgical method, pathological N staging, patholgical M staging were related factors for prognosis of Siewert Ⅱ and Ⅲ AEG ( hazard ratio=0.68, 1.25, 2.18, 95% CI as 0.54?0.86, 1.15?1.36, 1.28?3.73, P<0.05). Results of multivariate analysis showed that transthoracic approach, pathological stage N2?N3 and pathological stage M1 were independent risk factors for prognosis of Siewert Ⅱ and Ⅲ AEG ( hazard ratio=0.64, 1.25, 2.18, 95% CI as 0.51?0.80, 1.16?1.35, 1.28?3.70, P<0.05). Conclusions:Compared with Siewert Ⅲ AEG, Siewert Ⅱ AEG has a smaller tumor diameter, less positive lymph nodes, poorer prognosis. Transthoracic approach is preffered for the Siewert Ⅱ AEG. Transthoracic approach, pathological stage N2?N3 and pathological stage M1 are independent risk factors for prognosis of Siewert Ⅱ and Ⅲ AEG.
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Objective:To observe the clinical characteristics of esophageal reflux after total gastrectomy (ERATG), and to explore the mechanism of occurrence.Methods:Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study. The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results:After total gastrectomy patients were with different degrees of ERATG as heartburn, appetite loss, chest tightness and belching. The overall nature of ERATG is mainly weak acid, with a pH between 4 and 7. ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis. Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71) vs.(5.68±0.37), t=2.866, P<0.05]. Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76) vs.(4.50±9.14), t=0.011, P<0.05; liquid-air(19.50±12.99) vs.(2.00±2.61), t=0.004, P<0.05]. Conclusion:ERATG is mainly a upward reflux of weakly acidic gas, with typical symptoms of heartburn, appetite loss, chest tightness and belching. Patients with typical symptoms usually have lower pH in the upright position.
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Objective:To observe the expression patterns of miR-195 and DLL4 in colorectal cancer, and to explore the relationship between miR-195 and DLL4 and clinicopathological parameters and prognosis of patients with colorectal cancer.Methods:The relative expression of miR-195 in 56 colorectal cancer tissues was detected by real-time fluorescent quantitative PCR the expression of DLL4 protein and tumor microvessel density (MVD) were detected by bloting and immunohistochemistry. Colon cancer cell line SW480 was treated with miR-195. The expression of DLL4, Jagged1, (the intracellular domain of notch, NICD), CyclinD1, Hes1, Bcl-2 and NF-kB were detected by bloting.Results:The expression level of DLL4 protein in colorectal cancer tissues was significantly higher than that in normal intestinal mucosa (30/56 vs.16/56, t=5.323, P=0.018). The expression level of miR-195 was significantly lower than that in normal intestinal mucosa (36/56 vs.20/56, t=2.371, P=0.008). The expression of DLL4 was negatively correlated with the expression of miR-195 ( r=- 0.881, P=0.015) , which was closely related to the differentiation degree, lymph node metastasis and TNM stage . The prognosis of patients with high expression of DLL4 was significantly worse than that with low expression of DLL4 ( P=0.013). The prognosis of patients with low expression of miR-195 was worse than that with high expression of miR-195 ( P=0.009) . Conclusion:The antagonistic expression of miR-195 and Notch might be closely related to the occurrence and development of colorectal cancer, which can be used as a new reference index for prognosis of colorectal cancer.
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Objective:To explore the expression of vasohibin-1 (VASH1) and vascular endothelial growth factor A (VEGF-A) and clinical significance of VASH1 in gastric carcinoma.Methods:The expression of VASH1 and VEGF-A were detected by immunohistochemistry in formalin-fixed and paraffin-embedded sections in 56 pairs of gastric cancer and corresponding paraneoplastic tissue specimens. The correlation between the expression of VASH1, VEGF-A, clinicopathological parameters and prognosis were analyzed.Results:VASH1 and VEGF-A expression was significantly higher in gastric cancer tissues than normal paraneoplastic tissues. VASH1 and VEGF-A protein were expressed in 79% and 82% of gastric cancer tissues, respectively. A positive correlation was found between Vasohibin-1 and VEGF-A expression in gastric cancer tissues. VASH1 expression has significant positive correlation with TNM stage, tumor stromal invasion, tumor gross types and distant metastasis. Patients with high VASH1 expression had significantly worse overall survival (OS) and progression-free survival (PFS) than those with low VASH1 expression.Conclusion:VASH1 might be a clinically relevant predictor of patients in gastric cancer.
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Objective:To summarize the core research topics of the literature on differentiated thyroid cancer (DTC) , and to analyze the citation status to form the knowledge domain of citation science.Methods:Web of Science was used to search the literature on DTC, which was limited to April 04, 2021. The published records on DTC were identified. VOSviewer 1.6.11 and CiteSpace 5.5.R2 software were used to cluster and visualize the knowledge domain of citation.Results:A total of 8, 629 records on DTC were obtained, including 87, 973 citations, which showed that the publication volume increased year by year. Moreover, the trend of the annual records became more significant after the year of 2005. Meanwhile, it was reported that clinical staging and surgical management, as well as clinical researches on targeted therapy drugs, were treated as the currently hot research topics. The data showed that 115 records were cited more than 100 times, and 14 cited more than 300 times. And two records had been cited more than 1,000 times. Furthermore, the publication year of top15 were from 1988 to 2016, which also illustrated that the development of DTC researches were relatively slow before 2006. And the annual publication volume of DTC increased significantly with the publication of four highly cited records in 2006, even three with which have 1,000 citations. And the results revealed that the Consensus and Clinical Guidelines on DTC issued by ATA, as well as targeted therapy and radioactive 131I therapy on DTC had been highly cited. However, the newer highly cited documents on surgical treatment of DTC were still lacking. Conclusions:The current hot topics on DTC are focused on clinical staging, surgical management and targeted therapy. And a high-quality clinical guidelines and consensus and RCTs of targeted drugs on DTC have a significant impact on its development. Moreover, the further researches need to pay more attention to persistent/recurrent and metastatic DTC.
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Objective:To evaluate the efficacy and safety of primary tumor resection for asymptomatic metastatic colorectal cancer with unresectable metastases.Methods:A literature search was conducted in PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure and WanFang databases to identify studies comparing primary tumor resection and systemic treatment for asymptomatic metastatic colorectal cancer with unresectable metastases until March 31, 2021 (inchuding RCTs and non-RCTs) . The search strategy was: (((colorectal cancer) OR (colorectal neoplasms) OR (colon cancer) OR (colon neoplasms) OR (rectal cancer) OR (rectal neoplasms)) AND ((metastatic) OR (stage Ⅳ)) AND (asymptomatic) AND (primary tumor resection)). Review manager (RevMan) (Version 5.3.0, Cochrane Collaboration, Oxford, UK) was used to perform the statistical analysis.Results:A total of 14 original studies (RCT: 1; cohort study: 13) were included in this analysis with a total of 2123 patients (primary tumor resection: 1162 cases, systemic treatment: 961 cases). The results of this Meta-analysis showed that PTR group had a significantly improved overall survival in 1-year overall survival ( HR=0.80, 95% CI: 0.67~0.95, P=0.01), 2-year overall survival ( HR=0.81, 95% CI: 0.71~0.93, P=0.002), 3-year overall survival ( HR=0.82, 95% CI: 0.72~0.92, P=0.001), 4-year overall survival ( HR=0.86, 95% CI: 0.75~0.98, P=0.02) and 5-year overall survival ( HR=0.85, 95% CI: 0.74~0.97, P=0.02). The median survival time of PTR group was 4.35 months longer than that of systemic treatment group ( MD=4.35, 95% CI: 0.99~7.72, P=0.015). Conclusions:The current evidence suggests that primary tumor resection may be a potentially safe and feasible treatment strategy for asymptomatic metastatic colorectal cancer with unresectable metastases. Large sample size prospective randomized controlled trials are needed to validate our findings in the future.
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With certain advantages of superior surgical fields and better chances for anus reservation, transanal total mesorectal excision (TaTME) is a novel surgical approach for low rectal cancer. Guidelines recommend multidisciplinary team (MDT) work as a clinical routine for standardized treatment of rectal cancer. Indication of TaTME depends on multidisciplinary discussion including preoperative staging, prediction of recurrence risks. Standardized preoperative evaluation by MDT and decisions after MDT discussion are the guarantee for the stan-dardized implementation and reasonable promotion of TaTME. Meanwhile, as a procedure for improving local efficacy of rectal cancer, TaTME could save a part of patients with low rectal cancer the trouble of neoadjuvant chemoradiotherapy based on accurate staging by radiologists. That might upgrade status of colorectal surgeons in the MDT and contribute to optimize both curative effects and health economics.
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Objective:To explore the clinical characteristics, diagnosis and treatment of Petersen hernia after gastrectomy.Methods:The clinical data of 6 patients with Petersen hernia developed after gastrectomy in Shizuoka Cancer Center from Jan 2014 to Dec 2019 were retrospectively analyzed.Results:All 6 patients were males, with a median age of 76 years. The operative procedures for preceding gastrectomies were robotic-assisted total gastrectomy in 2 patients, laparoscopic distal gastrectomy in 2 patients, and laparoscopic proximal gastrectomy in 2 patients. Petersen′s defect was closed in all patients at previous gastrectomy. The time of onset was 1 month to 55 months after surgery. The main manifestations are acute pain in upper abdomen with nausea and vomiting. In all the cases, abdominal CT showed obstruction caused dilatation of the small intestine. The whirl sign was present in 3 patients. All the patients underwent reoperation with reduction and repair of the hernia. All the patients did not show obvious bowel necrosis. Their postoperative courses were uneventful, and all the patients were discharged. During the follow-up period, none of the patients developed complications related to the Petersen hernia.Conclusions:Petersen hernia is a rare complication of gastrectomy. It is important to conduct abdominal CT scanning as early as possible from the clinical history and physical findings, and to determine the surgical indication.
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Objective:To investigate the role of indocyanine green(ICG) fluorescence imaging in laparoscopic anterior resection for rectal cancer.Methods:A retrospective analysis was performed on 7 patients who had undergone laparoscopic anterior resection with the use of ICG fluorescence imaging at Peking University People′s Hospital between Oct 2018 and Mar 2019. The clinicopathological variables, surgical factors, short-term outcome and complications were analyzed.Results:The median operation time was 185 min. The median estimated blood loss was 50 ml. The median time from ICG injection to anastomotic perfusion was 45 s. One patient received extended proximal resection of bowel due to poor perfusion as suggested by ICG imaging. The median time to soft diet was 4 days, and the median hospital stay was 8 days. The median number of lymph nodes harvested was 16. There were no major complications in all these patients. No adverse events related to ICG were recorded.Conclusions:ICG fluorescence imaging was safe and effective in detecting insufficient blood supply around newly established bowel anastomsis, hence potentially reducing the anastomotic leakage rate.
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Objective:To determine the diagnostic value of tumor markers in peritoneal lavage fluid from colorectal cancer patients for tumor peritoneal metastasis.Methods:A total of 227 colorectal cancer patients who undergoing surgical treatment were included. 300 ml of peritoneal lavage fluid was irrigated immediately upon laparotomy for traditional cytology (PLC) testing, 134 patients were tested for tumor marker of peritoneal lavage fluid (pTM). Univariate analysis was performed to determine the risk factors for peritoneal metastasis; pTM ROC curve was used to determine the best cutoff value; paired chi-square test was used to compare the difference between PLC and pTM detection.Results:The positive rate of PLC was 12.3% (28/227). Age>65, stage T3 + , lymph node metastasis, mucinous adenocarcinoma and increased serum CA125, CA19-9 are related to peritoneal metastasis; The best cutoff value of pTM for peritoneal metastasis : pCEA 17.095 ng/dl, sensitivity 58.3%, specificity 93.9%; pCA19-9 4.515 U/ml, sensitivity 83.3%, specificity 80.0%; pCA125 303.2 U/ml, sensitivity 58.3%, specificity 95.7%; pCA-724 3.01 U/ml, sensitivity 66.7%, specificity 95.7%; The best cutoff value of pTM for peritoneal micrometastasis: pCA19-9 3.43 U/ml, sensitivity 100%, specificity 72.2%. The positive rate of pCA19-9 was 29.85%, which was higher than that of PLC (χ 2=2.00, P<0.05). Conclusion:Peritoneal metastasis of colorectal cancer is related to tumor T stage, lymph node metastasis, tumor pathological type, and increased serum CA125 and CA19-9; pTM has diagnostic value for peritoneal metastasis of colorectal cancer.
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Objective:To investigate the expression of CD157 and its significance in colorectal cancer.Methods:The expression of CD157 was detected in 50 cases of colorectal cancer tissues and corresponding adjacent normal colorectal tissues by immunohistochemistry. The correlation between the expression of CD157 and clinicopathological parameters and prognosis was analyzed statistically.Results:Higher expression of CD157 protein was observed in colorectal cancer than that in normal colorectal tissues (72% vs. 20%, χ 2=25.09, P<0.01). Moreover, High expression of CD157 was correlated with the tumor size (χ 2=7.368, P=0.007), TNM stage (χ 2=9.223, P=0.002), the depth of tumor infiltration (χ 2=4.158, P=0.041), distant metastasis (χ 2=5.521, P=0.019), vascular invasion (χ 2=6.307, P=0.012) and microsatellite instability (χ 2=4.778, P=0.029), but not with gender, age, histology type, location, differentiation grade, lymph node metastasis, nerve infiltration or Kras mutation (all P>0.05 respectively). Patients with low expression of CD157 had longer survival (45±4 )months than those with high expression (30±3)months (χ 2=5.234, P=0.022). Conclusions:High expression of CD157 in colorectal cancer tissue is related to poor survival of postoperative patients.
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With certain advantages of superior surgical fields and better chances for anus reservation,transanal total mesorectal excision (TaTME) is a novel surgical approach for low rectal cancer.Guidelines recommend muhidisciplinary team (MDT) work as a clinical routine for standardized treatment of rectal cancer.Indication of TaTME depends on multidisciplinary discussion including preoperative staging,prediction of recurrence risks.Standardized preoperative evaluation by MDT and decisions after MDT discussion are the guarantee for the startdardized implementation and reasonable promotion of TaTME.Meanwhile,as a procedure for improving local efficacy of rectal cancer,TaTME could save a part of patients with low rectal cancer the trouble of neoadjuvant chemoradiotherapy based on accurate staging by radiologists.That might upgrade status of colorectal.surgeons in the MDT and contribute to optimize both curative effects and health economics.
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Objective To investigate the influence of mismatch repair status on clinicopathological characteristics and prognosis in patients with colon cancer.Methods Patients who underwent radical excision for colon cancer between Nov 2012 and Mar 2016 at Peking University People's Hospital were enrolled.Clinicopathological data and prognosis were collected.Multivariate analysis were used to identify independent characteristics of MMR-deficient colon cancer.The influence of MMR-deficient on prognosis of colon cancer were analyzed through Kaplan-Meier curve.Results The overall rate of MMR-deficient in colon cancer was 17.1％ (51/299).Multivariate logistic regression analysis showed that low differentiation (OR =3.555,95％ CI:1.685-7.640,P ＜ 0.001),right-sided colon cancer (OR =5.645,95％ CI:2.483-14.715,P ＜ 0.001) and UICC Stage Ⅰ-Ⅱ (OR =4.099,95％ CI:1.863-9.840,P ＜0.001) were associated with MMR-deficient colon cancer.Conclusion Low differentiation,right-sided colon cancer and UICC Stage Ⅰ-Ⅱ were more common in MMR-deficient colon cancer.
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Thanks to endoscopic assistance and the pressure effect of pelvic pneumoperitoneum, transanal total mesorectal excision (taTME) can better expose the surgical field of distal mesorectal space, and may have a prospect for the preservation of pelvic nerves and organ function. The transanal minimally invasive surgery (TAMIS) platform may decrease the injury of internal anal sphincter and protect anal function. Current data show that taTME procedure has similar results on postoperative anal function, urinary function and sexual function compared to transabdominal TME procedure. The early impaired anal function after taTME may be related to the transanal approach itself, implement of single port and the learning curve, but the anal function can improve with time. Regarding the protection of urinary and sexual function, the beginners should be familiar with the course of pelvic nerves, the anatomical landmarks and the technical points during the dissection upward, and try to avoid the injury of the pelvic plex trunk and pelvic splanchnic nerves. TaTME is different from natural orifice transluminal endoscopic surgery (NOTES), while the latter focuses on the minimally invasive principle, the former focuses on the oncological safety and nerve protection. We should combine the advantages of transanal and transabdominal approaches to achieve the final goal of surgical quality improvement and organ function preservation.