Analysis of Ethical Review of Clinical Study on Defecation Function of Patients with Rectal Cancer after sphincter-preserving Surgery / 中国医学伦理学

In order to understand the status quo of ethical review of clinical research on the defecation function of patients with rectal cancer after sphincter-preserving surgery, analyze its causes and put forward corresponding suggestions, to arouse researchers’ attention to ethical review in subsequent relevant clinical studies. The ethical review of literatures related to the defecation function of patients with rectal cancer after sphincter-preserving surgery published on CNKI in recent 10 years was sorted out and summarized. The results showed that the ethical review of clinical research papers on defecation function of patients with rectal cancer after sphincter-preserving surgery was not optimistic. We should strengthen the ethical training of researchers, improve the ethical awareness of researchers, strictly implement the ethical norms of paper publication, strengthen the ethical requirements of manuscript contracts, perfect the ethical review system, and pay attention to the examination and supervision of informed consent, so as to promote the construction of ethical examination and approval norms of clinical research documents.

Evaluation of the histopathologic status of rectal adenocarcinoma and its regional lymph nodes after neoadjuvant therapy, and its relation to the duration of disease-free survival

Introduction: Colorectal cancer is one of the most common malignant tumors and has a relatively poor prognosis. Lymph node involvement is considered the most important prognostic factor. Materials and Methods: During a retrospective cohort study, 132 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2010 to 2015 in Sina hospital were reviewed. Results: Multivariable analysis was performed and shown the clinical stage was not a representative factor for disease-free survival (P = 0.187), but Dworak Tumor Regression Grading were significantly associated with higher disease-free survival (P = 0.000) in stage II and stage III. The total number of retrieved lymph nodes and involved lymph nodes in the same clinical stage were statistically associated with higher mean disease-free survival in patients (P = 0.000 in both conditions). Conclusion: In the same clinical stage, increasing the Dworak Tumor Regression Grading reduced the risk of rectal cancer recurrence. Increasing total number of retrieved lymph nodes and involved lymph nodes, 2.14 times and 3.87 times increased the risk of recurrence, respectively.

Narrative review comparing the epidemiology, characteristics, and survival in sporadic colorectal carcinoma/Lynch syndrome / Revisão narrativa na comparação da epidemiologia, características e sobrevivência no Carcinoma Colorretal esporádico/Síndrome de Lynch

Abstract Introduction: Colorectal carcinoma is the third most prevalent neoplasm in the world, and the second cause of death by cancer. The most part of these neoplasms are sporadic by somatic mutations, but around 15% are hereditary, such as Lynch syndrome or hereditary nonpolyposis colorectal cancer (HNPCC). Despite being the same tumor, it has differences between these two contexts as well as different prognosis. In Lynch syndrome cases, the survival of these individuals was greater than that observed in sporadic cases. Methods: This review focuses on the different characteristics and development of colorectal carcinoma in sporadic and Lynch syndrome cases, in order to conclude what may motivate the greater survival in the tumors associated with this syndrome. Results: Although the histopathological features drive into a worse prognosis, the colorectal carcinoma in the Lynch Syndrome presents a greater survival comparing to sporadic colorectal carcinoma. Discussion: The greater survival in the colorectal carcinoma in the HNPCC compared to the sporadic carcinomas has been linked to factors such as high microsatellite instability, diploid predominance, earlier screening for colo-rectal carcinoma, deficient DNA repair mechanism, low p53 mutation rate, and presence of lymphoid aggregates involving the neoplasm. Conclusion: Further studies should be conducted to provide new insights about survival of colorectal carcinoma in Lynch syndrome, as well as the therapeutic alternatives for this neoplasia.

Resumo Introdução: O carcinoma colorretal é a terceira neoplasia mais prevalente no mundo, bem como a segunda causa de morte por câncer. A maioria destas neoplasias são esporádicas, devidas a mutações somáticas, mas cerca de 15% são hereditárias como a síndrome de Lynch ou Hereditary Nonpolyposis Colorectal Cancer (HNPCC). Apesar de ser a mesma neoplasia, esta apresenta características clinico-patológicas e moleculares distintas, bem como diferentes prognósticos. Nos casos de síndrome de Lynch, a sobrevida parece ser maior quando comparada com os carcinomas esporádicos. Métodos: Realizamos uma revisão bibliográfica sobre as diferentes características e desenvolvimentos do carcinoma colorretal esporádico e no contexto da síndrome de Lynch, para concluir o que causa a maior sobrevida no caso das neoplasias associadas a esta síndrome. Resultados: Apesar das características histopatológicas apontarem para um pior prognóstico, o HNPCC apresenta uma maior sobrevida em relação ao carcinoma colorretal esporádico. Discussão: A maior sobrevivência nos carcinomas colorretais associados ao HNPCC em comparação com os carcinomas colorretais esporádicos tem sido atribuída a fatores como a elevada instabilidade microssatélite, a predominância diploide, a realização de rastreio para o carcinoma colorretal mais precoce, deficiente mecanismo de reparação de DNA, menor taxa de mutação da p53 e existência de agregados linfoides a envolver a neoplasia. Conclusão: Consideramos que deve ser encorajado o estudo mais aprofundado dos fatores que levam à maior sobrevida do carcinoma colorretal na síndrome de Lynch, bem como de alternativas terapêuticas para esta neoplasia.

Application of MRI simulation in delineation of gross tumor volume in pre-operative radiotherapy for low rectal carcinoma / 中华放射医学与防护杂志

Objective To explore the value of MRI simulation in the pre-operative radiotherapy for locally advanced low rectal carcinoma.Methods A total of 40 patients diagnosed with locally advanced low rectal carcinoma by endoscopic biopsy and radiological staging examinations were included in this study.There were 22 male and 18 female with nedian age 58 years (range 31-80).Patients underwent CT and MRI simulation scanning in the same position and fixing device.GTV under CT images and MRI inages were delineated respectively by two experienced radiologists.Primary tumor length,tumor volume and distance of distal tumor from the anal verge were calculated by treatment planning system(TPS).The two groups of data were compared.Results The distance of distal tumor to the anal verge were all no more than 5 cm on digital examination.The mean length of GTVcT was remarkably longer than that of GTVMRI [(5.21 ±1.65) cm vs.(4.46 ± 1.51) cm,t =5.059,P ＜0.05].The mean volume of GTVcTWaS significantly larger than that of GTVMRI[(55.71 ±31.57) cm3vs.(44.02 ±25.11) cm3,t=6.977,P＜ 0.05)].The mean distance of distal tumor to the anal verge was (3.72 ± 0.93) cm,significantly longer than that of lower bounds of GTVCT to the anal verge,which had a high consistency with GTVMRI.The IMRT plan was based on CT-MRI fusion images.There were no 3-4 grade adverse effects of radiotherapy.The overall pCR rate was 32.5％.Conclusions MRI simulation could define smaller GTV and more precise lower bounds than CT.With improved accuracy of target volumes contours,the application of MRI simulation may promote the efficacy of radiotherapy and result in a reduction in the incidence of toxicities.

Application of 3.0T MRI in the preoperative assessment of rectal carcinoma / 实用放射学杂志

Objective To probe the value of 3.0T MRI in the preoperative assessment of rectal carcinoma.Methods The study recruited 41 patients who were confirmed by biopsy of rectal carcinoma and underwent conventional MRI, high-resolution MRI and diffusion weighted imaging(DWI), the distance from the inferior part of tumor to transitional skin and the percentage of circumferential invasion were measured, the tumor's T staging, N staging,and the status of circumferential resection margin(CRM) and extramural vascular invasion(EMVI) were assessed.MRI findings were compared with endoscope and postoperative pathological results.Results MRI could accurately show the distance from the inferior part of tumor to transitional skin(P>0.05);The mean percentage of circumferential invasion for the tumor with T1-T2 and T3 were 61%,83% respectively (P>0.05);The total accuracy of T,N staging diagnose were 80.5%,75.6% respectively, which had a better consistent with pathological T,N staging(Kappa=0.564,0.634);The total accuracy of CRM and EMVI diagnose were 90.2%,73.2% respectively,which had a better or moderate consistent with pathological diagnose(Kappa=0.765,0.461).Conclusion 3.0T MRI has the unique application in the preoperative assessment of rectal carcinoma, which can provide more comprehensive information for clinic.

An evaluation of Mandard tumor regression grade system in patients with locally advanced rectal cancer treated with preoperative radiotherapy / 中华放射医学与防护杂志

Objective To explore the clinical and imaging factors influencing the patients' prognosis after preoperative radiotherapy for local advanced rectal cancer.Methods We retrospectively analyzed 106 locally advanced rectal cancer patients from June 2004 to September 2015 in our institution.All patients underwent preoperative radiotherapy.According to the Mandard score,patients were divided into 5 groups (TRG1-5).All patients were divided into two groups according to the TRG,which including good responder (TRG1 + 2) and poor responder (TRG3 + 4 + 5) groups.All of the tumor ADC values of post-RT were measured by Diffusion-weighted MRI technology,and the relationship between tumor ADC values of post-RT and TRG was analyzed.Results In univariate analysis,age,chemotherapy,pT,pN,differentiation degree,vascular invasion and TRG were significantly associated with overall survival (x2 =3.945-8.110,P ＜ 0.05).Multivariate analysis indicated that differentiation degree and TRG were the independent prognostic factors for OS (x2 =5.221,6.563,P ＜ 0.05).No significant difference was found between long-course and short-course radiotherapy group (P ＞ 0.05) in OS.The good responder group had a favorable survival in 5-year OS compared to the poor responder group (x2 =8.110,P ＜ 0.05).Preoperative radiotherapy,preoperative chemotherapy,pathological type,differentiation degree and gross type,vascular tumor thrombus and tumor ADC values of post-RT were significantly associated with TRG (x2 =4.189-18.139,P ＜ 0.05).The best critical point of tumor ADC values of post-RT was 1.7 x 10-3 mm2/s by using ROC curve.The accuracy of tumor ADC values of post-RT in predicting TRG1 + 2 was 70％.Conclusions The TRG can predict the efficacy of preoperative radiotherapy in patients with locally advanced rectal cancer based on the Mandard score.There was no significant difference in OS between long-course radiotherapy group and short-course radiotherapy group.The tumor ADC values of post-RT might become a potential factor to predict TRG in patients with locally advanced rectal cancer after preoperative radiotherapy.

Application of lateral lymph node dissection in the cure of rectal carcinoma / 临床外科杂志

Rectal carcinoma is one of the most common gastrointestinal malignancies in China.Surgical resection is its preferred treatment.The scope of lymph node dissection influences the postoperative recurrence and metastasis.There are many studies The significance of lateral lymph node dissection in rectal carcinoma is extensively discussed,here we make a review of lateral lymph node dissection in rectal carcinoma,which may provide assistance for the treatment of rectal carcinoma.

Correlation between the Diameter of Superior Rectal Vein and Inferior Mesenteric Vein and the Lymph Node Metastasis of Rectal Carcinoma / 中山大学学报(医学科学版)

[Objective] To measure the diameter of the superior rectal vein (SRV) & theinferior mesenteric vein (IMV) by CT and analyze their relationship with lymphatic metastasis of rectal carcinoma.And to discuss the feasibility of utilizing SRV to prcdict lymph node metastasis of rectal cancer.[Methods] The CT imaging and pathological data of 105 rectal carcinoma patients were analyzed retrospectively.We measured and compared the diameter of every patient's SRV & IMV by CT in the presence and absence of microvascular tumor thrombus,signet ring cell,lymph node metastasis and distant metastasis.The accuracy of predicting lymph node metastasis for rectal carcinoma by the diameter of SRV were evaluated by ROC curve.[Results] There were statistical differences in the diameters of SRV and IMV between rectal cancer group with lymph node metastasis (D =4.34 mm,D =5.00 mm) and without (D =3.56 mm,D =4.81 mm;P ＜ 0.001,P =0.023).The differences were significant in the diameter of SRV between rectal cancer group with microvascular tumor thrombus or signet ring cell and without (P =0.019,P =0.044).However,the diameter of IMV showed no statistical difference between rectal cancer group with microvascular tumor thrombus or signet ring cell and without (P =0.605,P =0.663).And there was no statistical difference in the diameter of SRV or IMV between rectal cancer patients with distant metastasis and without (P ＞ 0.05).Regarding 3.75 mm as the cut-off value for the diameter of SRV to predict lymph node metastasis for rectal cancer patients,the sensitivity was 90.9％ and the specificity was 82.0％.Regarding 4.65 mm as the cut-off value for the diameter of IMV to predict lymph node metastasis for rectal cancer patients,the sensitivity was 87.3％ and the specificity was 38％.[Conclusions] It is completely feasible to utilize the diameter of SRV measured by CT to predict lymph node metastasis of rectal carcinoma with high sensitivity,accuracy,and relatively high specificity.

Effects of Umbilical Therapy by Rheum palmatum Combined with Early Colon Irrigation on the Quality of Life in Elderly Patients with Colon Stoma / 中国药房

OBJECTIVE:To explore the effects of umbilical therapy by Rheum plamatum combined with early colonic irriga-tion on the quality of life in elderly patients with colon stoma. METHODS:80 patients underwent radical resection of abdominoperi-neal rectal carcinoma were randomly divided into control group and observation,with 40 cases in each group. Control group was given early colonic irrigation;observation group was additionally given umbilical therapy by R. plamatum. Treatment course of 2 groups lasted for one month,and both were followed up for 6 months after treatment. The quality by life in 2 groups was evaluated by using QLQ-C30,and therapy costs were calculated before and after treatment. RESULTS:Compared with before treatment, function score and total health score of 2 groups improved significantly in 1,3,6 months after treatment,while symptom score and single item score decreased significantly,with statistical significance(P<0.05). In 1,3,6 months after treatment,role func-tion,social function,cognitive function,emotional function and total health score of observation group were significantly higher than those of control group,and insomnia and pain score were significantly lower than control group,with statistical significance (P<0.05). 3 and 6 months after treatment,diarrhea and economic difficulty score of observation group were significantly lower than those of control group,with statistical significance(P<0.05). 1 months after treatment,loss of appetite score of observation group were significantly lower than those of control group,with statistical significance (P<0.05). 6 months after treatment, fa-tigue,nausea and vomiting score of observation group were significantly lower than those of control group,with statistical signifi-cance (P<0.05). 6 months after treatment,nursing cost,drug cost and total cost of observation group were significantly lower than those of control group,with statistical significance(P<0.05). CONCLUSIONS:The umbilical therapy by R. plamatum com-bined with early colonic irrigation can improve the quality of life in elderly patients with colon stoma significantly and reduce treat-ment cost.

Study of impact of operation time interval after neoadjuvant chemoradiotherapy for locally progressed rectal patients’ outcome / 中国癌症杂志

Neoadjuvant chemoradiotherapy (nCRT) is used to downstage locally advanced rectal cancer before surgery, in order to increase the chance of radical resection, reduce local recurrence, and improve overall survival. Accumulating data suggest that tumor response to nCRT is time dependent. A delay between nCRT and surgery may increase the proportion of patients that achieve a favorable response, and 4-6 weeks are considered to be a universal interval. However, delayed surgery beyond 6-8 weeks may increase the technical dififculty, and the risks of surgical complications and recurrence or metastasis. This article brielfy reviews the relevant literature to evaluate the efifciency and safety of delayed surgery.

Clinical value of improved lateral lymph node dissection for stageⅢ lower rectal cancer / 中国癌症杂志

Background and purpose:The extent of lymph node dissection for the stageⅢ lower rectal cancer is still a subject of debate. Some Japanese researchers recommend improved lateral lymph node dissection for stageⅢ lower rectal cancers while American scholars claim that total mesorectal excision is sufficient. This study aimed to explore the clinical significance of improved lateral lymph node dissection for stageⅢ lower rectal cancer in patients treated with radical resection.Methods:Sixty-six patients with stageⅢ lower rectal cancer were enrolled. Among these patients, 31 had been treated with radical resection combined with improved lateral lymph node dissection, whereas the others received radical resection without improved lateral lymph node dissection.Results:In the group of improved lateral lymph node dissection, five patients had positive lateral node including four poorly differentiated adenocarcinoma and one mucinous cell carcinoma. Compared with the group without improved lateral lymph node dissection, the group of improved lateral lymph node dissection showed significant difference in sexual disturbance, dysuresia and operation duration (P0.05). Furthermore, patients had lower rate of pelvis recurrence and better 5-year rate of survival for the group of improved lateral lymph node dissection (P<0.05).Conclusion:Radical resection with improved lateral lymph node dissection may decrease the pelvis recurrence rate and increase survival rate in patients with stageⅢ lower rectal carcinoma.

Effect of dexmedetomidine combined with seven isoflurane for elderly patients with rectal cancer radical operation on recovery quality / 中国基层医药

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality.Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method, while each groupincluded 30 cases:the control group( group N) and the dexmedetomidine group( group D) .Before the induction of anesthesia,group D vein was injected with micro pump ( more than 10 min) of dexmedetomidine 1μg/kg ( which was formulated with physiological saline as 4μg/mL) ,and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately (T3),extubation after 5min(T4),30min(T5)the time of HR,BP,SpO2,BIS;propofol and remifentanil dosage,opera-tive time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score, pain score,patient satisfaction and adverse reactions were recorded.Results In T3 period,the changes of HR (82 ± 14)times/min,SBP (130 ±8)mmHg,DBP (85 ±13)mmHg in group N were more obvious than (70 ±12)timse/min, SBP (121 ±7)mmHg,DBP (79 ±9)mmHg in group D,the difference between the two groups had statistical signifi-cance(t=6.28,4.63,2.08,all P0.05).In group N,postoper-ative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2 =4.32,6.67,5.45,all P<0.05).At the same time,the satisfaction score of patient in group D (3.0 ±0.3)point,which was significant higher than (2.7 ±0.5)points in group N (t=1.88,P<0.05).Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative re-covery quality of elderly patients with rectal cancer radical surgery.

Applied value of multilayer dynamic CT Scan in the diagnosis and staging of rectal carcinoma / 中国医学装备

Objective:To evaluate the value of multilayer dynamic CT scan in the preoperative diagnosis and staging of rectal carcinoma.Methods: CT findings of a retrospective analysis of 38 cases with pathologically confirmed cancer, study characteristics of partial image, Adjacent tissue invasion and distant organ metastasis, And compared with postoperative pathology.Results:Intraluminal mass 15 cases, Intraluminal mass associated with of bowel wall thickening 12 cases, The a tumor breakthrough serosa layer and surrounding tissue invasion 7 cases; Tumor invasion of adjacent organs or with distant metastasis 4 cases; consistent rate compared with pathological was 81.5%(31/38).Conclusion: Multilayer enhanced CT scan is well consistent rate in the diagnosis and staging of rectal cancer compared with pathologic staging, Preoperative contrast enhanced CT scanning have guiding significance for clinical choice of surgical approach, With higher value of clinical application.

Cirugía transanal a través de puerto único (TAMIS). Revisión frente otras técnicas de excisión endoscópica de lesiones rectales / Transanal surgery through single port (TAMIS). Revision front of the techniques of endoscopic excision of rectal lesions

Introducción: los programas de screening y la mejora en las técnicas diagnósticas han aumentado el porcentaje de tumores rectales que se pueden tratar en estadios iniciales. La morbimortalidad asociada a la cirugía radical de la neoplasia rectal, así como la tendencia a una cirugía menos agresiva, ha hecho que se desarrollen las técnicas de abordaje transanal, aplicando las últimas tecnologías disponibles. Material y métodos: se realizó una revisión de la literatura, considerando las diferentes técnicas de excisión endoscópica. Resultados: la cirugía endoscópica transanal, en todas sus variantes, ha demostrado ser un abordaje seguro para el tratamiento de adenomas y tumores rectales en estadios iniciales (pT1N0). Conclusión: son necesarios más estudios que permitan demostrar la seguridad de ampliar esta técnica para el tratamiento de lesiones avanzadas, asociada a quimio-radioterapia neoadyuvante.

Background: screening programs and improvement of diagnostic techniques have increased the percentage of rectal tumors that can be treated in an early stage. Radical surgery of the rectum is associated with high morbimortality, and the general tendency towards a less aggressive surgery has led to the development of transanal techniques, adjusting the latest technologies available. Methods: a review of the literature, including the different types of endoscopic surgery available. Results: transanal endoscopic microsurgery, in all its variants, has proven to be a safe and effective method for treating rectal adenomas and early stage cancer (pT1N0). Conclusion: further studies are required to prove the safeness of these techniques on more advanced lesions, in association with neoadjuvant chemoradiation therapy.

The clinical significance of CK-19 mRNA expression in the axillary drainage fluid of rectal cancer patients with real-time RT-PCR detection / 中国综合临床

Objective To detect CK-19 mRNA expression by quantitative real-time RT-PCR in axillary drainage fluid of rectal cancer and investigate its clinical significance.Methods Axillary drainage fluids were collected from 59 patients with rectal cancer and 15 patients with benign abdominal lesion from Sep.2010 to Dec.2010.Level of CK-19 mRNA in axillary drainage fluid was detected using specific primers by real-time RTPCR.The data were statistically analyzed to investigate the relationships between CK-19 mRNA level and tumor invasion,lymph node status,tumor stage and tumor differentiation level.Results The positive rate of CK-19 mRNA expression in patients with rectal cancer was 67.8％,which was significantly higher than that in patients with benign abdominal lesion.The expression of CK-19 mRNA was significantly correlated with the depth of tumor invasion,lymphnode status,tumor stage and histopathological differentiation( P ＜ 0.05 or P ＜ 0.01 ).Ck129 mRNA expression was associated with the pathological level,the higher of the lymph node translation level,the higher expression in the axillary drainage fluid after rectal cancer surgery (r =0.674,P =0.021 ).The lower of the lymph node differentiation level,the higher expression in the axillary drainage fluid after rectal cancer surgery (r =-0.741,P =0.014).Conclusion Quantitative detection of CK-19 mRNA in axillary drainage fluid of rectal cancer by RT-PCR could enhance the diagnostic sensibility of colorectal cancer micrometastases.RT-PCR assay is suitable for predicting peritoneal micrometastasis of rectal cancer,which is a reference for postoperative treatment and prognosis prediction.

The synchronous primary carcinomas of the rectum and prostate.

The diagnosis of synchronous prostatic and rectal carcinomas is uncommon. To make a correct diagnosis, biopsies of both sites are mandatory. Pathological slides should be compared and immunohistochemical staining should be taken into consideration. In this paper, an unexpected case of synchronous rectal and prostatic carcinomas arising in an 84-year-old male with hematemesis and pelvic pain is reported. These two tumoral components have a distinctive histological appearance. Immunohistochemical evaluation confirmed the diagnosis of these synchronous tumors. This case emphasizes that rectal and prostatic carcinomas can arise simultaneously. In this situation, providing clinicopathological correlation and deciding the necessity of intraoperative consultation in proper time are extremely important.

Subcutaneous Metastases from Rectal Carcinoma: A Case Report

Subcutaneous metastasis of rectal adenocarcinoma is an infrequent event as it occurs in less than 4% of all patients with rectal malignancy. When present, it signifies an advanced disease and carries poor prognosis. We hereby, present the case of a 51-year-old woman with subcutaneous lesion that turned out to be rectal adenocarcinoma metastases. She was then managed as an advanced case.

MSCT is unsuitable for preoperative staging estimation of rectal carcinoma independently / 中国综合临床

Objective To evaluate the validity and reliability of multi-slice spiral CT (MSCT) in preoperative TNM staging judgment of rectal carcinoma. Methods Three hundred and one patients with rectal carcinoma were diagnosed and treated consecutively in Colorectal and Anal Surgery Department of Shanxi Province Tumor Hospital from January 2009 to December 2009. The clinical data of these patients were analyzed retrospectively. The diagnosis results were compared between the preoperative MSCT staging and the postoperative pathological staging,the ROC curve and the diagnostic concordance test were analyzed by software Medcalc 11.2. Results The sensitivity, specificity, Kappa value, area under the curve of TNM staging were 64.7% ,96. 8% ,0. 667,0. 808 for T2 staging tumors; 93.8% ,75.0% ,0.709,0.844 for T3 staging tumors;87. 8% ,98. 1% ,0. 859,0. 929 for T4 staging tumors; 72. 0% ,91.2% ,0. 619,0. 816 for N staging tumors;92. 7%, 99. 7%, 0. 925,0. 963 for M staging tumors respectively. Conclusion The diagnostic value of independent use of MSCT in estimating the infiltration degree and lymph node metastasis of rectal cancer is very poor and cannot be used in preoperative staging judgment.

Expression and significance of COX-2 protein and BCL-2 protein in distal transitional mucosa adjacent to rectal carcinoma / 中国现代普通外科进展

Objective:To detect the expressions of COX-2 protein and BCL-2 protein in transitional mucosa adjacent to rectal carcinoma,and determine whether the transitional mucosa was the cancer precursor event.Methods:Mucin histochemical method was employed to detect the distal mucosa 2 cm away from rectal tumor and the transitional mucosa was found in 54 cases of rectal carcinoma.Immunohistochemical method was used to investigate the expressions of BCL-2 and COX-2 protein in the specimen of rectal carcinoma mass,transitional mucosa and non-transitional mucosa,and 20 cases of normal rectal mucosa,and the points of the expressions of COX-2 protein and BCL-2 protein were counted.Results:35.19%(19/54)of distal mucosa were characterized as the transitional mucosa.The expressions of COX-2 and BCL-2 protein were detected in carcinoma mass and distal mucosa.Significant difference was observed in carcinoma mass and transitional mucosa(p<0.01).But there were no significant differences between the expressions of those in transitional mucosa and non-transitional mucosa(p>0.05),as well as transitional mucosa and normal mucosa(p>0.05).Conclusion:The performance of transitional mucosa was not the cancer precursor event,but the non-specificity reaction of carcinoma or inflammation.

Carcinoma espinocelular de reto: relato de caso / Squamous cell carcinoma of the rectum: a case report

O Carcinoma Espinocelular de Reto é entidade extremamente rara e seu comportamento biológico permanece desconhecido. O tratamento pode variar entre radio e quimioterapia isoladamente ou complementar ao tratamento cirúrgico. Relatamos caso de carcinoma espinocelular de reto superior, tratado com radio e quimioterapia, com regressão total da lesão.

Squamous cell carcinoma of the rectum is a extremely rare neoplasm and its biological behavior remains unknown. Treatment varies from surgery with and without adjuvant therapy to chemotherapy and radiotherapy alone. We present a patient with squamous cell carcinoma of the superior rectum who underwent chemo and radiotherapy exclusively, with total regression of the tumor.