Clinical characteristics and neurosurgical resection of brain metastases from colorectal carcinoma / 中华普通外科杂志

Objective Brain metastasis(BM) is unusual in colorectal carcinoma(CRC) patients.This study was to evaluate the characteristics and prognosis of brain metastasis of colorectal carcinoma patients.Methods Twenty-eight consecutive CRC patients underwent surgical resection for BM between January 2001 and December 2008.The clinical data were analyzed by univariate (logrank) and Cox regression test.Results The median age at BM diagnosis from CRC was 57 years(41-75 years).Median survival after neurosurgical intervention was 9.4 months.The 1-year and 5-year survival rates were 28.9%and 7.1%,respectively.Seventeen patients(61%)had concurrent systemic metastasis.All patients were symptomatic with neurologic deficits and symptoms.On multivariate analysis,gender,infratentorial location of lesions and characteristics of primary CRC had no significant impact on survival.Two factors were signitlcandy associated with better survival:single brain metastases and absence of extracranial metastases.Perioperative mortality was zero.There were no difference of survival among patients undergoing resection alone and resection combined with whole brain radiotherapy (WBRT) or stereotactic radiosurgery(SRS). Conclusions Brain metastases from colorectal cancer is an evil omen of poor prognosis of CRC patients.Sursical resection of symptomatic brain metastases from colorectal cancer is relatively safe and provides the opportunity for prolonged survival.

Management of colorectal injuries / 中国普通外科杂志

Objective To study the current management strategy for colorectal injuries. Methods The clinical data of 86 consecutively admitted patients with penetrating colorectal injuries were retrospectively reviewed. Results Most injuries were of closed type. Iatrogenic colon injury accounted for 14%. There were 61 patients (71%) associated with other abdominal organ injuries. Operations were performed in all patients. Seventy six patients were treated with primary repair or resection and anastomosis, and 10 with diverting colostomy. In recent 10 years mortality rate dwindled from 10% to 4%(2/46). Mortality was most often caused by hemorrhagic shock, associated organ injuries or severe secondary infection. Conclusions Most colorectal traumas are blunt closed type in China. Primary repair or resection and anastomosis at the time of initial exploration is most often used for colorectal injuries. Indications for diverting colostomy are severe shock, heavy intra abdominal contamination, poor condition, and rectal injury. Fecal peritonitis should be effectively prevented and treated.