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1.
Article in Chinese | WPRIM | ID: wpr-883244

ABSTRACT

Objective:To investigate clinical efficacy of conformal sphincter preservation operation (CSPO) versus intersphincteric resection (ISR) in the treatment of low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 183 patients with low rectal cancer who were admitted to two medical centers (117 in the Changhai Hospital of Naval Medical University and 66 in the Huashan Hospital of Fudan University) from August 2011 to April 2020 were collected. There were 110 males and 73 females, aged (57±11)years. Of 183 patients, 117 cases undergoing CSPO were allocated into CSPO group, and 66 cases undergoing ISR were allocated into ISR group, respectively. Observation indicators: (1) surgical situations of patients with low rectal cancer in the two groups; (2) postoperative complications of patients with low rectal cancer in the two groups; (3) follow-up; (4) influencing factors for prognosis of patients with low rectal cancer; (5) influencing factors for satisfaction with the anal function of patients with low rectal cancer. Follow-up was conducted using outpatient examination, questionnaire and telephone interview to determine local recurrence, distal metastasis, survival, stomal closure, satisfaction with the anal function of patients. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the rank sum test.The Kaplan-Meier method was used to draw survival curves, and life table method was used to calculate survival rates. Log-rank test was used for survival analysis. Univariate analysis was performed using the linear regression. Variables with P<0.10 in the univariate linear regression analysis were included for multivariate analysis. Multivariate analysis was performed using the COX stepwise regression model and linear regression analysis. Results:(1) Surgical situations of patients with low rectal cancer in the two groups: cases with laparoscopic surgery, operation time, volume of intraoperative blood loss, distance from tumor to distal margin, cases with postoperative chemotherapy, duration of postoperative hospital stay were 44, (165±54)minutes, (142±101)mL, (0.6±0.4)cm, 76, (6.6±2.5)days for the CSPO group, respectively, versus 55, (268±101)minutes, (91±85)mL, (1.9±0.6)cm, 9, (7.9±4.7)days for the ISR group, showing significant differences between the two groups ( χ2=35.531, t=8.995, -3.437, -3.088, χ2=44.681, t=2.267, P<0.05). (2) Postoperative complications of patients with low rectal cancer in the two groups: 19 patients in the CSPO group had complications. There were 6 cases with grade Ⅰ complications, 12 cases with grade Ⅱ complications, 1 case with grade Ⅲb complication. Fourteen patients in the ISR group had complications. There were 4 cases with grade Ⅰ complications, 7 cases with grade Ⅱ complications, 1 case with grade Ⅲa complication, 2 cases with grade Ⅲb complications. There was no significant difference in the postoperative complications between the two groups ( χ2=0.706, P>0.05). Patients with complications in the two groups were improved after symptomatic and supportive treatment. There was no perioperative death in the postoperative 30 days of the two groups. (3) Follow-up: 183 patients received follow-up. Patients of the CSPO group and ISR group were followed up for (41±27)months and (37±19)months, respectively, showing no significant difference between the two groups ( t=-1.104, P>0.05). There were 2 cases with local recurrence and 9 cases with distal metastasis of the CSPO group, respectively, versus 3 cases and 4 cases of the ISR group, showing no significant difference between the two groups ( χ2=1.277, 0.170, P>0.05). The 3-year disease-free survival rate and 3-year total survival rate were 84.0% and 99.0% for the CSPO group, versus 88.6% and 92.8% for the ISR group, showing no significant difference between the two groups ( χ2=0.218, 0.002, P>0.05). The stomal closure rate was 92.16%(94/102) and 96.97%(64/66) for 102 patients of CSPO group and 66 patients of ISR group up to postoperative 12 months,respectively, showing no significant difference between the two groups ( χ2=1.658, P>0.05). Of the 8 cases without stomal closure in the CSPO group, 2 cases refused due to advanced age, 4 cases subjectively refused, and 2 cases were irreducible due to scar caused by radiotherapy. Two cases in the ISR group had no stomal closure including 1 case of postoperative liver metastasis and 1 case of subjective refusal. There were 92 and 61 patients followed up to 12 months after stomal closure, of which 75 cases and 38 cases completed questionnaires of satisfaction with the anal function. The satisfaction score with the anal function was 6.8±2.8 and 5.4±3.0 for CSPO group and ISR group, respectively, showing a significant difference between the two groups ( t=-2.542, P<0.05). Fifty-four cases in the CSPO group and 21 cases in the ISR group had satisfaction score with the anal function >5, showing no significant difference between the two groups ( χ2=3.165, P>0.05). (4) Influencing factors for prognosis of patients with low rectal cancer: results of COX stepwise regression analysis showed that gender and pT staging were independent influencing factors for disease-free survival rate of patients with low rectal cancer ( hazard ratio=2.883, 1.963, 95% confidence interval as 1.090 to 7.622, 1.129 to 3.413, P<0.05). Gender and pT staging were independent influencing factors for total survival rate of patients with low rectal cancer ( hazard ratio=10.963,3.187, 95% confidence interval as 1.292 to 93.063, 1.240 to 8.188, P<0.05). (5) Influencing factors for satisfaction with the anal function of patients with low rectal cancer: results of univariate analysis showed that surgical method and tumor differentiation degree were related factors for satisfaction with the anal function of patients with low rectal cancer (partial regression coefficient=1.464, -1.580, 95% confidence interval as 0.323 to 2.605, -2.950 to -0.209, P<0.05). Results of multivariate analysis showed that surgical method, tumor differentiation degree and preoperative radiotherapy were independent influencing factors for satisfaction with the anal function of patients with low rectal cancer (partial regression coefficient=1.637, -1.456, -1.668, 95% confidence interval as 0.485 to 2.788, -2.796 to -0.116, -2.888 to -0.447, P<0.05). Conclusion:Compared with ISR, CSPO can safely preserve the anus in the treatment of low rectal cancer, without increasing the incidence of postoperative complications, which can also guarantee the oncological safety and improve the postoperative anal function.

2.
Article in Chinese | WPRIM | ID: wpr-811682

ABSTRACT

Pneumonia caused by SARS-Cov-2 infection has been reported in Wuhan since December 2019, and spread rapidly across the country. The radical operation of colorectal cancer is confine operation. Patients with colorectal cancer should receive operation as soon as possible after elective operation is resumed in each hospital. SARS-Cov-2 virus can be transmitted by asymptomatic infectors, and it has been confirmed to be transmitted by droplets and contact. However, fecal-oral transmission and aerosol transmission have not been excluded. Based onLaparoscopic colorectal operation experiences, the author suggests that the surgery strategy for colorectal cancer patients under the COVID-19 situation. Recommending laparoscopy-assisted radical surgery for colorectal cancer patients. The aerosols need to be strictly managed during operation. NOSES and TaTME should be carried out with cautious during the epidemic period. Protective stoma should be carried out scientifically and reasonably, and the protection of operating room personnel should be strengthened.

3.
Article in Chinese | WPRIM | ID: wpr-868850

ABSTRACT

Objective:This study aims to analyze the prognosis of patients who underwent a simultaneous operations for colorectal cancer and liver metastases, and to establish a prognostic scoring system for these patients.Methods:From January 2010 to March 2019, the clinicopathological data of patients with colorectal cancer and liver metastases simultaneously operated at Shanghai Changhai Hospital were collected. The clinicopathological prognostic factors on tumor recurrence and survival outcomes on follow-up were analyzed. Single and multiple factors Cox regression analyses were used to determine the risk factors which affected the prognosis of patients. Using the risk factors of poor prognosis on Cox analysis, 1 point was given to each risk factor. Patients were then divided into different groups according to the different total scores. The median overall survival and disease-free survival of each group were analyzed.Results:Of 234 patients included in this study, there were 126 males and 108 females. The average age was (57.4±10.8) years. The median survival was 44.85 months. The 1-, 3-, and 5-year survival rates of the whole group were 87.3%, 55.2%, and 22.9%, respectively. Primary tumor in right colon, preoperative carcinoembryonic antigen ≥200 ng/ml, multiple liver metastases, and poorly differentiated adenocarcinoma/mucinous adenocarcinoma were independent risk factors of poor prognosis. After 1 point was given to each of the above 4 items, patients were then divided into the low-risk (0-1) and high-risk (2-4) groups. The median survivals of patients in the low-risk group ( n=174) and high-risk group ( n=60) were 53 months and 29 months, respectively. The corresponding median disease-free survivals were 21.34 months and 8.48 months, respectively. The differences between the 2 groups were significant ( P<0.05). Conclusion:The results of this study preliminary established a predictive scoring system for patients with simultaneous colorectal cancer and liver which can play a role in selecting treatment options for these patients.

4.
Article in Chinese | WPRIM | ID: wpr-787769

ABSTRACT

Pneumonia caused by SARS-Cov-2 infection has been reported in Wuhan since December 2019, and spread rapidly across the country. The radical operation of colorectal cancer is confine operation. Patients with colorectal cancer should receive operation as soon as possible after elective operation is resumed in each hospital. SARS-Cov-2 virus can be transmitted by asymptomatic infectors, and it has been confirmed to be transmitted by droplets and contact. However, fecal-oral transmission and aerosol transmission have not been excluded. Based onLaparoscopic colorectal operation experiences, the author suggests that the surgery strategy for colorectal cancer patients under the COVID-19 situation. Recommending laparoscopy-assisted radical surgery for colorectal cancer patients. The aerosols need to be strictly managed during operation. NOSES and TaTME should be carried out with cautious during the epidemic period. Protective stoma should be carried out scientifically and reasonably, and the protection of operating room personnel should be strengthened.

5.
Article in Chinese | WPRIM | ID: wpr-774424

ABSTRACT

OBJECTIVE@#To investigate the surgical efficacy and prognostic factors of T3NxM0 middle-low rectal cancer without neoadjuvant therapy.@*METHODS@#Clinical data of patients with middle-low rectal cancer undergoing TME surgery with T3NxM0 confirmed by postoperative pathology at Colorectal Surgery Department of Changhai Hospital from January 2008 to December 2010 were analyzed retrospectively.@*INCLUSION CRITERIA@#(1)no preoperative neoadjuvant chemoradiotherapy (nCRT); (2) complete preoperative evaluation, including medical history, preoperative colonoscopy or digital examination, blood tumor marker examination, and imaging examination; (3) distance between tumor lower margin and anal verge was ≤ 10 cm; (4) negative circumferential resection margin (CRM-). Finally, a total of 331 patients were included in this study. According to the number of metastatic lymph node confirmed by postoperative pathology, the patients were divided into N0 group without regional lymph node metastasis (190 cases) and N+ group with regional lymph node metastasis (141 cases). The perioperative conditions, local recurrence, distant metastasis and prognostic factors were analyzed.@*RESULTS@#Compared to N0 group in the perioperative data, N+ group had higher ratio of tumor deposit [29.8%(42/141) vs. 0, χ²=64.821, P0.05). The median follow-up period was 73.4 months. The merged 5-year local recurrence rate was 2.7%(9/331), 5-year distant metastasis rate was 23.3% (77/331), 5-year disease-free survival (DFS) rate was 73.4%, and 5-year overall survival (OS) rate was 77.2%. Multivariate analysis showed that lymph node metastasis (HR=3.120, 95%CI: 1.918 to 5.075, P<0.001), nerve invasion (HR=0.345, 95%CI: 0.156 to 0.760, P=0.008) and vascular invasion (HR=0.428, 95%CI: 0.189 to 0.972, P=0.043) were independent risk factors for DFS in patients with T3NxM0 rectal cancer after operation. Preoperative carcinoembryonic antigen level (HR=1.858, 95%CI:1.121 to 3.079, P=0.016), lymph node metastasis (HR=3.320, 95%CI: 1.985 to 5.553, P<0.001) and nerve invasion (HR=0.339, 95%CI: 0.156 to 0.738, P=0.006) were independent risk factors for OS in patients with T3NxM0 rectal cancer after operation.@*CONCLUSIONS@#Optimal local control rate of middle-low rectal cancer patients with T3NxM0 and CRM- can be achieved by standard TME surgery alone. For patients with preoperative elevated blood carcinoembryonic antigen level, regional lymph node metastasis, or neurovascular invasion confirmed by pathology after surgery, adjuvant chemoradiotherapy should be actively applied after surgery to improve prognosis.


Subject(s)
Humans , Lymph Node Excision , Lymph Nodes , Pathology , General Surgery , Lymphatic Metastasis , Mesocolon , General Surgery , Neoadjuvant Therapy , Neoplasm Staging , Proctectomy , Methods , Prognosis , Rectal Neoplasms , Pathology , General Surgery , Retrospective Studies
6.
Article in Chinese | WPRIM | ID: wpr-800457

ABSTRACT

Low anterior resection syndrome (LARS) is defined as a syndrome characterized by various abnormal defecation symptoms, including increased defecation times, urgency, frequent defecation, and fecal incontinence. LARS commonly develops after sphincter-preserving operation or reduction of protective ileostomy. The symptoms of LARS will alleviate gradually, and some patients may return to normal or basically normal. However, 60%-80% of the patients remains to suffer from LARS. Their daily life and psychosocial functionare seriously impaired. At present, the etiology of LARS is not well understood, but many factors are associated with LARS, such as tumor location, radiotherapy and surgical techniques and so on.

7.
Article in Chinese | WPRIM | ID: wpr-755880

ABSTRACT

Objective To compare the characteristics of clinical pathology between patients with early recurrence and those with late recurrence of colorectal cancer.Methods Clinicopathological data of 391 recurrence patients after surgery from Changhai Hospital were recruited between Jan 2005 and Dec 2015.The clinical and pathological characteristics of primary cancer in early recurrence group (less than 2 years after surgery) and late recurrence group (2 year or more after surgery) were compared.Results 246 patients had early recurrence (62.9%) and 145 had late recurrence (37.1%).Liver,systemic metastases and peritoneum were the main sites of distant recurrence in the early recurrence group,whereas liver,lung and systemic metastases were the most frequent sites of metastases in the late recurrence group.Patients with the increased tumor perimeter,lymph node metastasis,increased CEA and CA19-9,without postoperative adjuvant treatment and microsatellite stability are more likely to have early recurrence.5-year overall survival rate for patients with early recurrence was significantly lower than those with late recurrence.Conclusions This study showed that clinical and pathological factors are significantly associated with recurrence of colorectal cancer.Two years after surgery is an important period for the recurrence of colorectal cancer.

8.
Article in Chinese | WPRIM | ID: wpr-689678

ABSTRACT

Intersphincteric resection(ISR) is a valuable anus-preserving operation that avoids the need for permanent stoma in patients with super low rectal cancer. Recently, with the application and promotion of ISR, the rate of anus-preservation has been greatly elevated, however, some patients following ISR had poor anal function. Based on the knowledge of anal canal anatomical features for better anal function, we propose conformal sphincter-preserving operation (CSPO) for super low rectal cancer, which is a new integrated anus-preservation procedure with total mesorectal excision (TME), coloanal anastomosis, pull through resection, anal canal dissection, local resection and natural orifice transluminal endoscopic surgery technology. CSPO includes pull through conformal resection (PTCR) and transanal conformal resection (TaCR). This article focuses on the problems about TaCR for very low rectal cancer and introduces TaCR combined with our practical experience. The indications for the TaCR operation should be according to the conventional laparoscopic surgery. In addition, the TaCR operation has its special indications: the tumor location is within 2 cm of the dental line; the tumor is well differentiation (moderately to well differentiation); the diameter of the tumor is not more than 3 cm or no more than the 1/3 circle of intestinal wall; and the depth of invasion is T1-T2. Patients with a clinical complete remission after neoadjuvant radiochemotherapy can receive TaCR. The laparoscopic five hole method is used to carry out the abdominal operation with TME technique. It is unnecessary to dissection intersphincter space. The incisional line is made according to the tumor location and shape to preserve the opposite normal rectal wall, internal sphincter and dentate line as more as possible via transanal resection. After closing the rectal stump by interrupted sutures, a circular stapler or hand suture is use to perform the anastomosis as far from the dentate line as possible. Protective loop ileostomy is performed. Postoperative complications, including anastomotic leakage, abdominal infection, and anastomotic bleeding, should be remembered. If there is any signs of these complications, intervention should be done as soon as possible.


Subject(s)
Anal Canal , General Surgery , Anastomosis, Surgical , Digestive System Surgical Procedures , Humans , Laparoscopy , Rectal Neoplasms , General Surgery , Rectum
9.
Article in Chinese | WPRIM | ID: wpr-687410

ABSTRACT

Allicin is one of the main bioactive substances in garlic, with antibacterial, hypolipidemic and other pharmacological effects. In this study, apoptosis-related indicators were detected to explore the molecular mechanism of allicin on KG-1 cell proliferation inhibition. The apoptosis rate of KG-1 cells induced by allicin was detected by flow cytometry. The effect of allicin on the expressions of Bax, Bcl-2, survivin and ERK mRNA in KG-1 cells was detected by RT-qPCR. Western blot was used to detect the expressions of caspase 3, cleaved caspase 3, ERK1/2, p-ERK1/2 and survivin protein in KG-1 cells. According to the findings, compared with the control group, allicin could significantly inhibit the proliferation activity of KG-1 cells in a concentration-dependent and time-dependent manner. Flow cytometry showed that allicin could induce the apoptosis of KG-1 cells, which was mainly late apoptosis. The results of RT-qPCR showed that the expressions of Bax mRNA, Bcl-2, survivin and ERK mRNA in KG-1 cells increased after treatment with allicin. The results of Western-blot showed that after KG-1 cells were treated with allicin, the expressions of caspase 3 and its active form cleaved caspase 3 increased, the expressions of survivin, ERK1/2 and its active form p-ERK1/2 were decreased, of which p-ERK1/2 was down-regulated in a dose-dependent manner. The above results suggest that allicin inhibited the proliferation of KG-1 cells primarily by inducing late apoptosis; the execution of apoptosis involved cleaved caspase 3; the induction of apoptosis involved the protein expression, the decrease of ERK1/2andexpression of survivin and the dose-dependent decrease of p-ERK1/2; the mRNA expression involved the increase of Bax, and the down-regulation of survivin, Bcl-2 and ERK1/2.

10.
Article in Chinese | WPRIM | ID: wpr-851867

ABSTRACT

Objective: To investigate the effects of rosmarinic acid (RosA) on the proliferation and apoptosis of human colon cancer HCT-8 cells, and explore the related mechanisms. Methods: The proliferation of HCT-8 cells was detected by CCK-8 assay at different concentrations of RosA for different time periods. The apoptosis rates of HCT-8 cells and the expression of related proteins were investigated after the treatment of RosA at 15, 45, and 75 μmol/L for 72 h according to the CCK-8 results. The apoptosis rates of HCT-8 cells were detected by FCM. The mRNA expressions of p53, Bax, and Puma were detected by RT-qPCR. The protein levels of p53, Bax, Puma, and active Caspase-9 were detected by Western blotting. Results: RosA could inhibit the proliferation of human colon cancer cells HCT-8 in a time- and dose-dependent manner. RosA at 15 and 45 μmol/L mainly induced early apoptosis (P < 0.01), RosA at 75 μmol/L mainly induced late apoptosis (P < 0.01). RosA could up-regulate the mRNA expression of Puma in a dose-dependent manner. RosA at 45 and 75 μmol/L increased the mRNA expression of p53 and Bax (P < 0.05). RosA could up-regulate the protein levels of Puma, Bax, and active Caspase-9 in a dose-dependent manner. RosA at 75 μmol/L could significantly increase the protein expression of p53 (P < 0.05). Conclusion: RosA can significantly inhibit the proliferation of HCT-8 cells by inducing the apoptosis. The apoptosis-inducing proteins of p53, Puma, Bax, and active Caspase-9 induce the apoptosis of cells.

11.
Article in Chinese | WPRIM | ID: wpr-620800

ABSTRACT

Objective To explore the clinicopathologic factors impacting recurrence and survival in rectal cancer patients after radical resection.Methods Clinicopathologic data of 1 166 patients with rectal cancer in Changhai Hospital,were recruited between 2005 and 2010.Kaplan-Meier analysis and the logrank test were used to evaluate the effects of the pathology on patients' survival.Cox regression model was used to assess independent factors associated with clinical prognosis.Results The 1,3,5-year overall survival rates were 94.3%,81.2% and 76.5%,median survival time was 53 months.328 patients had recurrence and metastases,with a median recurrence time of 18 months.The independent prognostic factors for overall survival time were CEA,CA19-9,tumor distance to dentate line,surgical modality,radical operation,tumor invasion,tumor differentiation,lymph node metastasis and postoperative treatment.Surgical treatment,radical operation or not,tumor invasion and lymph node metastasis were statistically significant associated with tumor recurrence and metastases.Conclusions The important factors inffuencing the prognosis of rectal cancer patients were CEA,CA19-9,tumor distance to dentate line,surgical modality,radial operation,tumor in vasion,tumor differentiation,lymph node metastasis,and post operative treatment.

12.
Article in Chinese | WPRIM | ID: wpr-323539

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the intramural lateral spread distance in low rectal cancer in order to provide basis for safety lateral resection margin of pull-through conformal resection (PTCR).</p><p><b>METHODS</b>The patients with low rectal cancer who received low anterior resection or abdominal-perineal resection in Changhai Hospital from December 2015 to March 2016 were enrolled and Surgical specimens were collected. After the specimens were fixed in 10% formaldehyde for 24 hours, a piece of tissue that was 1.5 cm in length and 0.5 cm in width from the edge of tumor was cut. The tissue was obtained in the direction of 3, 5, 7 and 9 o'clock clockwise. The distance of intramural lateral spread was measured in the specimens and the risk factors were analyzed.</p><p><b>RESULTS</b>A total of 83 specimens were collected and the overall proportion of intramural lateral spread was 71.1%(59/83). The rate of lateral spread from 3 to 9 o'clock was 34.9%(29/83), 26.5%(22/83), 32.5%(27/83) and 37.3%(31/83) respectively, and the difference was not statistically significant(χ=2.444 9, P=0.485 3). The median distance of lateral spread in each direction was all 0 mm and the quartile range was 1 mm, 0.5 mm, 0.55 mm and 1 mm respectively. The 5th percentile (P5) of each direction was all 0 mm and the 95th percentile(P95) of each direction was 2.5 mm, 1.6 mm, 2.6 mm, 2.5 mm, respectively and the difference was not statistically significant either(χ=5.331 0, P=0.148 9). The rate of lateral spread of T1, T2, T3 and T4 was 0/4, 58.3%(14/24), 83.0%(44/53) and 1/2 respectively, and there was significant difference(P=0.005 0). The multivariate analysis indicated that T stage (P=0.002 2, OR=3.741, 95% CI: 1.606-8.716) was the risk factor of intramural lateral spread.</p><p><b>CONCLUSIONS</b>The intramural lateral spread does exist in low rectal cancer and T stage is the risk factor of lateral spread. The lateral resection margin should be 5 mm from the tumor edge at least when PTCR is performed.</p>


Subject(s)
Digestive System Surgical Procedures , Methods , Humans , Margins of Excision , Multivariate Analysis , Neoplasm Invasiveness , Pathology , Neoplasm Staging , Rectal Neoplasms , Pathology , General Surgery , Rectum , General Surgery , Risk Factors
13.
Article in Chinese | WPRIM | ID: wpr-353792

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the risk factors associated with lymph node metastasis of T1 and T2 rectal cancer.</p><p><b>METHODS</b>Clinicopathological data of 576 patients with stage T1 to T2 rectal cancer without serosal invasion confirmed by pathology undergoing curative resection in Changhai Hospital from January 1999 to December 2013 were analyzed retrospectively. The relationship of clinicopathological factors of overall patients and stage T1 patients with lymph node metastasis was analyzed by univariate or multivariate analysis.</p><p><b>RESULTS</b>The lymph node metastasis rate of stage T2 rectal cancer was significantly higher than that of stage T1[22.9% (108/463) vs. 9.7%(11/113), P=0.002], and the difference of stage T2a and T2b was not significant[22.0%(38/173) vs. 23.4% (68/290), P=0.733]. Multivariate analysis showed that poor differentiation(HR=1.54, 95% CI:1.12 to 2.13), abnormal carbohydrate antigen (CA) 199 level (HR=2.05, 95% CI:1.16 to 3.62), ulcerative mass (HR=1.58, 95% CI:1.05 to 2.39) and invasion of muscle (of inner ring muscle HR=3.55, 95% CI:1.79 to 7.02; of outer longitudinal muscle, HR=2.35, 95% CI:1.21 to 4.60) were independent risk factors of lymph node metastasis in patients with stage T1-T2 rectal cancer(all P<0.05). Meanwhile poor differentiation(HR=4.43, 95% CI:1.51 to 13.03), abnormal carcinoembryonic antigen(CEA) level (HR=4.66, 95% CI:1.18 to 20.11) and ulcerative mass (HR=6.23, 95% CI:1.51 to 25.66) were risk factors of lymph node metastasis in patients with stage T1 rectal cancer.</p><p><b>CONCLUSION</b>Poor differentiation, preoperative high CA199, ulcerated tumor, invasion of inner ring muscle or outer longitudinal muscle are risk factors of lymph node metastasis in patients with stage T1-T2 rectal cancer, while the invasion depth of muscularis propria is not risk factor. Besides, poor differentiation, abnormal CEA level, ulcerated tumor are risk factors of lymph node metastasis in stage T1 rectal cancer patients, which can be used as reference for local excision in patients with stage T1 rectal cancer.</p>

14.
Article in Chinese | WPRIM | ID: wpr-260315

ABSTRACT

A new clinical teaching mode of standardized treatment in colorectal cancer for fellows in training is reported here with good results. This one-year program included medical ethics education, humanistic management, pre job training, clinical thinking mode, surgery teaching, and computerized teaching. This new clinical teaching mode with distinct features is effective and introduced in this article.


Subject(s)
Colorectal Neoplasms , Education, Medical, Graduate , Humans
15.
Article in Chinese | WPRIM | ID: wpr-314782

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of colonoscopy-guided placement of self-expandable metallic stent without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction.</p><p><b>METHODS</b>Clinical data of 42 patients (24 males and 18 females with a mean age of 64.3 years) undergoing colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between January 2010 and June 2012 were reviewed retrospectively.</p><p><b>RESULTS</b>The obstruction was located in the rectum (n=19), sigmoid (n=9), descending colon (n=8), splenic flexure (n=1), hepatic flexure (n=3), and ascending colon (n=2). Technical success was achieved in all the 42 patients (100%). The mean time of operation was (11.8±10.4) min (range 1.1-51.0 min). No serious procedure-related complication occurred. Minor bleeding occurred in 3 cases (7.1%). One patient died on the second day after surgery because of heart failure.</p><p><b>CONCLUSIONS</b>Colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe with shorter operative time.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Colonoscopy , Colorectal Neoplasms , Female , Humans , Intestinal Obstruction , Therapeutics , Male , Middle Aged , Retrospective Studies , Stents
16.
Article in Chinese | WPRIM | ID: wpr-312315

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the emergency therapeutic strategy for sigmoid vovulus in the elderly.</p><p><b>METHODS</b>Clinical data of 14 elderly patients with sigmoid vovulus were analyzed retrospectively.</p><p><b>RESULTS</b>The mean age was(79.1±7.2) years(range, 70-93), and 11 patients (78.6%) were male. Emergency decompression and restoration with colonoscopy was performed in all the patients with a success rate of 100%. No patient required emergent surgery. Four patients(28.6%) recurred and they were managed well by repeat colonoscopic restoration.</p><p><b>CONCLUSION</b>Emergency colonoscopic restoration is the first treatment of choice for sigmoid vovulus in the elderly because it is safe and effective, and can be performed repeatedly.</p>


Subject(s)
Aged , Aged, 80 and over , Colon, Sigmoid , General Surgery , Colonoscopy , Decompression, Surgical , Emergencies , Female , Humans , Intestinal Volvulus , General Surgery , Male , Recurrence , Retrospective Studies
17.
Article in Chinese | WPRIM | ID: wpr-321275

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of surgical treatment for recurrent colorectal carcinoma in the elderly.</p><p><b>METHODS</b>The clinical and follow up data of 24 elderly patients with recurrent colorectal carcinoma who were treated between January 2000 and June 2009 at the Changhai hospital of the Second Military Medical University were analyzed retrospectively.</p><p><b>RESULTS</b>Among the 24 patients there were 14 men and 10 women. The mean age of the patients was 76.9 ± 5.3 years. The local recurrence was found in 15 patients. In 9 patients, both distant metastases and local recurrence were found. A total of 24 patients received operation, including radical resection in 15 patients and palliative resection in 8 patients. One patient had laparotomy only because of diffuse metastases in the abdomen and involvement of the duodenum and common bile duct.The patient received stent placement in the common bile duct and chemotherapy after the surgery. Postoperative complication occurred in 7(29.2%) patients, which included ileus(n=1), pulmonary infection(n=1), urinary infection(n=1), wound infection(n=2), wound dehiscence(n=1), and wound fat liquefaction(n=1). There were no perioperative deaths. The median survival time was 6 months in the entire cohort. The median survival time was 33 months in patients undergoing radical resection, and the 1-, 3-, and 5-year survival rate was 71.4%, 28.6%, and 14.3%. The median survival time was 3 months in patients who underwent palliative resection, and the 1-year survival rate was 0. The difference between the two groups was statistically significant(P<0.01).</p><p><b>CONCLUSION</b>Outcomes are acceptable after radical resection for elderly patients with recurrent colorectal cancer if careful preoperative evaluation and perioperative management are performed.</p>


Subject(s)
Aged , Aged, 80 and over , Colorectal Neoplasms , Pathology , General Surgery , Female , Humans , Male , Neoplasm Recurrence, Local , General Surgery , Prognosis , Retrospective Studies , Survival Rate
18.
Article in Chinese | WPRIM | ID: wpr-321224

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the limiting effect of pelvic diameters on the technical difficulty of total mesorectal excision(TME) for rectal cancer by computed tomography pelvimetry.</p><p><b>METHODS</b>From January 2009 to January 2011, 69 patients with rectal cancer underwent TME in the Department of Proctology at the Changhai Hospital in Shanghai. There were 55 males and 14 females. Using three dimensional reconstruction software, pelvic dimensions of rectal cancer patients were measured based on pelvic MDCT thin-slice computed tomography. All the patients were measured for 15 pelvic parameters, including the length of pelvic inlet, the length of pubic symphysis, the interspinous distance, the distance from sacral promontory to tip of coccyx, etc. All the procedures were open surgery, including anterior resection(n=19), low anterior resection and ileostomy(n=29) and abdominal perineal resection(n=21). Duration of the operation and blood loss at surgery were recorded as evaluation indicators of the technical difficulty of total mesorectal excision. By univariate analysis significant pelvic parameters were selected. Multiple regression analysis was used to investigate the relationship between pelvic parameters and blood loss or duration of operation.</p><p><b>RESULTS</b>The mean operative time was(139.9±32.4) min and the mean intraoperative blood loss was (228.8±150.6) ml. Multivariate analysis showed that the interspinous distance, the length of pelvic inlet, the distance from sacral promontory to the tip of coccyx were the main factors affecting the operation time, and that the length of pubic symphysis and the distance from sacral promontory to the tip of coccyx were the main factors affecting the amount of blood loss (all P<0.05). Among the 3 procedures, the multivariate analysis for low anterior resection appeared to be most valuable, in which operative time was associated with the distance from sacral promontory to the tip of coccyx and the interspinous distance (adjusted coefficient of determination of the regression equation, Rc(2)=0.460, P=0.003). Factors associated with intraoperative blood loss were the length of pelvic inlet, the distance from sacral promontory to the tip of coccyx, and the sacrum-pubis angle(Rc(2)=0.358, P=0.022). Comprehensive analysis of the measurement parameters showed that the ratio between the length of pelvic inlet and the distance from sacral promontory to the tip of coccyx was associated with the operative time and blood loss. This ratio was significantly higher in female patients than that in males. In females with a ratio greater than 1, the operative time was significantly shorter(P=0.050), and the intraoperative blood loss was significantly less in males with a ratio greater than 0.9(P=0.021).</p><p><b>CONCLUSIONS</b>Operative time and intraoperative blood loss for total mesorectal excision are more favorable in patients with a wide and shadow pelvis. Surgical difficulty is increased in deep and narrow pelvis or those with major sacrum curvature. The difficulty of total mesorectal excision procedure can be predicted by measuring the length of pelvic inlet and the distance from sacral promontory to the tip of coccyx.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Digestive System Surgical Procedures , Methods , Female , Humans , Imaging, Three-Dimensional , Male , Mesentery , Diagnostic Imaging , General Surgery , Middle Aged , Pelvis , Diagnostic Imaging , Rectal Neoplasms , Diagnostic Imaging , General Surgery , Tomography, Spiral Computed , Methods
19.
Article in Chinese | WPRIM | ID: wpr-237169

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate association between DNA methylation of MAL, CDKN2A, and MGMT in stool and development of colorectal cancer, and to evaluate the screening value of these biomarkers in colorectal cancer and pre-malignant lesions.</p><p><b>METHODS</b>Morning stool specimens were collected from 69 patients with colorectal cancer, 24 with colon adenoma, 19 with hyperplastic polyps, and 26 healthy controls. DNA was extracted and treated with bisulfite. Methylation-specific PCR(MSP) was performed for methylation analysis of MAL, CDKN2A and MGMT in DNA samples. Associations between clinicopathological features and gene methylation were analyzed. The sensitivity of diagnosis by combining three methylation markers was compared with fecal occult blood test(FOBT).</p><p><b>RESULTS</b>The methylation frequencies of MAL, CDKN2A and MGMT were 78.3%, 52.5% and 55.1% in colorectal cancer, 58.3%, 41.7% and 37.5% in colon adenomas, 26.3%, 15.8% and 10.5% in hyperplastic polyps, and 3.8%, 0 and 3.8% in healthy controls, respectively. Significant differences in three genes were found between colorectal cancer and hyperplastic polyp, colorectal cancer and healthy control, colon adenoma and hyperplastic polyp, colon adenoma and healthy control(all P<0.05). The diagnostic sensitivity by combining three methylation markers was 92.8% in colorectal cancer, 70.8% in colon adenomas, significantly higher than FOBT examination (29.0% in colorectal cancer and 25.0% in colon adenomas, all P<0.05). No significant associations existed between three genes methylation of the three genes and clinical characteristic including sex, age, tumor location, lymph node metastases and TNM stage (all P>0.05).</p><p><b>CONCLUSION</b>DNA methylations levels of MAL, CDKN2A, and MGMT in stools are significantly higher in colorectal cancer and colon adenoma, which may serve as an noninvasive approach for the screening of colorectal cancer and pre-malignant lesions.</p>


Subject(s)
Adult , Aged , Colorectal Neoplasms , Diagnosis , Genetics , Cyclin-Dependent Kinase Inhibitor p16 , Genetics , DNA Methylation , Early Detection of Cancer , Feces , Chemistry , Female , Humans , Male , Mass Screening , Middle Aged , O(6)-Methylguanine-DNA Methyltransferase , Genetics , Precancerous Conditions , Diagnosis , Genetics , Promoter Regions, Genetic , Genetics
20.
Article in Chinese | WPRIM | ID: wpr-259317

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the integrity of the resected mesentery specimen after total mesorectal excision (TME) for low rectal cancer using methylene blue perfusion via the superior rectal artery.</p><p><b>METHODS</b>Twenty patients with low rectal cancer were randomly divided into the methylene blue group (n=10) and the control group (n=10). All the patients received TME and macroscopic examination of the mesorectal surface was performed to evaluate the quality of the surgical specimen. The methylene blue was injected into the specimen postoperatively via superior rectal artery.</p><p><b>RESULTS</b>The mesorectal surface of all the specimens was intact on macroscopic examination. However, after methylene blue perfusion, 2 specimens were found to be incomplete. The number of lymph nodes in the methylene blue group were significantly larger (17.3+/-2.4 vs 12.4+/-5.4, P=0.016).</p><p><b>CONCLUSIONS</b>Integrity evaluation of TME specimen is necessary. Methylene blue perfusion is a convenient and effective method to identify subtle incompleteness of specimen and can improve the detection of lymph node.</p>


Subject(s)
Adult , Aged , Digestive System Surgical Procedures , Female , Humans , Infusions, Intra-Arterial , Male , Mesenteric Artery, Inferior , Mesentery , Pathology , General Surgery , Methylene Blue , Middle Aged , Postoperative Period , Prognosis , Rectal Neoplasms , General Surgery , Rectum
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