Clinical efficacy of radical rectal cancer surgery combined with irradiation in treatment of rectal cancer and its effect on angiogenesis and survival rate / 中华放射肿瘤学杂志

Objective To evaluate the clinical efficacy of radical surgery combined with irradiation in the treatment of rectal cancer and its effect on the angiogenesis and survival rate.Methods A total of 200 colorectal cancer patients admitted to Zhengzhou Central Hospital from March,2014 to March,2015 were recruited and divided into the observation group (n=105) and control group (n=95) by using random number table method.In the control group,radical surgery was performed,and radical surgery combined with irradiation was conducted in the observation group.The clinical efficacy,the serum levels of vascular endothelial growth factor-C (VEGF-C) and prostaglandin E2(PGE2) were statistically compared between the control and observation groups.The changes of the microvascular morphology and microvessel density (MVD) in the rectal cancer tissues were observed and recorded.The 3-year survival rate was calculated during postoperative follow-up.Results After corresponding treatment,the clinical overall response rate was 86.67％ in the observation group,and 70.53％ in the control group (P＞0.05).The 2-year survival rate did not significantly differ between two groups (P＞0.05).The 3-year survival rate in the observation group was significantly higher than that in the control group (P＜0.05).After treatment,the serum levels of VEGF-C and PGE2 were significantly improved in two groups (both P＜0.05).In the observation group,the serum levels of VEGF-C and PGE2 were significantly lower compared with those in the control group (both P＜0.05).The microvessel morphology in the cancer tissues remarkably differed between two groups.The microvessel diameter did not significantly differ,whereas the lumen diameter in the observation group was significantly smaller than that in the control group.The MVD in the observation group was 12.25±3.35,significantly lower than 28.14± 17.26 in the control group (P＜0.05).Conclusion Radical surgery combined with irradiation is an efficacious treatment of rectal cancer,which can effectively improve the serum levels of VEGF-C and PGE2,decrease the MVD,reduce the lumen diameter in the cancer tissues,lower the angiogenesis in rectal cancer and enhance the survival rate,which deserves widespread application in clinical practice.

Risk factors for anastomotic leakage after rectal cancer surgery / 中华胃肠外科杂志

Anastomotic leakage is one of the common complications after rectal cancer surgery. Advances in the field of rectal surgery, such as introduction of total mesorectal excision, double-stapling reconstruction techniques, and minimally invasive surgery have improved oncologic outcomes and resulted in more favorable functional results, with a greater proportion of patients undergoing sphincter-preserving surgeries. Despite technical improvements, the incidence of anastomotic leakage has not decreased significantly. The incidence of anastomotic leakage is related to many factors, including patient-related factors, such as male sex, obesity, low score of nutrition risk screening, and Ⅲ-Ⅴ grade of ASA grading; disease-related factors, such as lower tumor location, tumor diameter > 3 cm, preoperative chemoradiotherapy and comorbidity; surgery-related factors, such as open or laparoscopic surgery, blood supply of anastomosis, tension of anastomosis, preventive stoma, duration of surgery, intraoperative blood loss, intraoperative events, and contamination, as well as selection and use of anastomotic device. Fully understanding the risk factors of anastomotic leakage are very important for reducing the occurrence of anastomotic leakage. For patients with risk factors, appropriate preventive measures should be implemented timely to reduce the risk of anastomotic leakage.

Long-term efficacy of preoperative chemoradiotherapy combined with total mesorectal excision for locally advanced rectal cancer: an analysis of 241 patients / 中华放射肿瘤学杂志

Objective To retrospectively analyze the long-term efficacy of and prognostic factors after preoperative chemoradiotherapy combined with total mesorectal excision (TME) in the treatment of 241 patients with locally advanced rectal cancer.Methods A total of 241 patients who were consecutively admitted to our hospital and diagnosed with locally advanced mid-low rectal adenocarcinoma by pelvic magnetic resonance imaging or computed tomography from January 2006 to November 2014 were enrolled as subjects.All patients received preoperative radiotherapy with doses ranging between 42.0 and 50.4 Gy (median dose =50 Gy) and concurrent chemotherapy with capecitabine ±oxaliplatin.Patients received TME (R0 excision) at 4-15 weeks (median time =7 weeks) after chemoradiotherapy.Adjuvant postoperative chemotherapy was given depending on the recovery and preference of each patient.Disease-free survival (DFS),locoregional recurrence (LRR),overall survival (OS),and distant metastasis (DM) rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test.The Cox model was used for multivariate analysis.Results In all the patients,the median follow-up time was 42 months;the 3-year LRR,DFS,OS,and DM rates were 3.8％,76.2％,85.9％,and 20.6％,respectively.The subgroup analysis showed that ypT0-2,ypN-,pCR,and TRG4 were associated with improved DFS (ypT0-2 vs.yp T3-4:86.0％ vs.69.3％,P =0.002;ypN-vs ypN +:88.1％ vs.56.9％,P=0.000;pCR vs.non-pCR:100％ vs.72.4％,P=0.001;TRG4 vs.TR G2-3 vs.TR G0-1:94.9％ vs.73.6％ vs.66.3％,P=0.011).The multivariate analysis revealed that the postoperative ypN status was an independent prognostic factor for DFS (P=0.000).Conclusions For patients with locally advanced mid-low rectal adenocarcinoma,preoperative chemoradiotherapy combined with radical surgery achieves satisfactory outcomes in local control.The major reason for treatment failure lies in distant metastasis.The ypN status after chemoradiotherapy is an independent prognostic factor for DFS.

Efficacy of preoperative concurrent chemoradiotherapy in treatment of locally advanced middle-low rectal cancer / 中华放射肿瘤学杂志

Objective To evaluate the efficacy and tolerance of preoperative concurrent chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer.Methods From June 2007 to June 2013,51 untreated patients with histopathologically proven rectal cancer (T3/T4 or N (+))were included in this study.Three-dimensional radiotherapy was delivered to the whole pelvic cavity at 45.0-50.4 Gy/25-28 fractions.Two cycles of chemotherapy with FOLFOX4 or XELOX were given concurrently at weeks 1 and 4 of radiotherapy.Surgery was performed at 4-8 weeks after chemoradiotherapy.Adjuvant chemotherapy with FOLFOX4 or XELOX was given within one month after surgery.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for univariate analysis;the Cox regression model was used for multivariate prognostic analysis.Results Fortynine patients completed the preoperative chemoradiotherapy and surgery.The median follow-up was 2.9 years.The overall sphincter preservation rate was 65％;the overall downstaging rate was 59％.Ten (20.4％) of all patients achieved a pathologic complete response (pCR).Grade ≥3 toxicities occurred in 25％ of all patients,and the overall postoperative complication rate was 31％.The 3-and 5-year sample sizes were 24,12,respectively.The 3-and 5-year overall survival rates were 81％ and 69％,respectively;the 3-and 5-year disease-free survival (DFS) rates were 76％ and 60％,respectively;the 3-and 5-year local recurrence-free survival (LRFS) rates were 78％ and 70％,respectively;the distant metastasis-free survival rates were 82％ and 74％,respectively.The multivariate analysis showed that tumor downstaging was an independent prognostic factor for 5-year DFS and LRFS.Conclusions For locally advanced middle-low rectal cancer,preoperative radiotherapy with concurrent FOLFOX4/XELOX chemotherapy can increase pathologic downstaging rate,pCR rate,and sphincter preservation rate.Patients with tumor downstaging may have a better survival advantage.

A meta-analysis of short-term outcomes of laparoscopic and open total mesorectal excision for rectal cancer in China / 中国医师杂志

Objective To investigate the clinical short-term outcomes after laparoscopic total mesorectal excision (TME)for rectal cancer in China.Methods A systematic literature searching was performed to identify all randomized controlled trial(RCT) studies or well-designed retrospective studies on laparoscopic surgery(LS) and open surgery(OS) for rectal cancer published from January 2003 to October 2010 in China.Two reviewers independently screened and extracted the data.The reports which matched the inclusion criteria were analyzed with Revman 5.2.Results A total of 17 RCT studies and 3 retrospective studies (2246 patients)was included in this study.The basic features of 2 groups were balance.Compared to group OR,the incidence of complications such as postoperative wound infection (RR =0.30,95 ％ CI:0.17 ～0.54,P ＜ 0.01),pulmonary infection (RR =0.47,95％ CI:0.25 ～0.91,P ＜0.05),and ileus (RR =0.41,95％ CI:0.19 ～0.88,P ＜0.05)were significantly lower in group LS.No difference was observed in the incidence of peritoneal abscess(RR =0.78,95％ CI:0.38 ～ 1.60,P ＞0.05),anastomotic leakage(RR =0.66,95％ CI:0.38 ～ 1.16,P ＞0.05),and uroschesis(RR =0.57,95％ CI:0.26 ～ 1.25,P ＞0.05).Furthermore,parameters of postoperative recovery were compared between groups,LS group manifested early recovery.Conclusions Laparoscopic total mesorectal excision for rectal cancer,with minimal invasion,benefits the postoperative recovery and reduces incidence of complications.LS radical resection of rectal cancer is technically feasible,safe,and prospectively favorable.

The effect of local excision and adjuvant radiotherapy for patients with stage Ⅰ rectal cancer / 中华放射肿瘤学杂志

ObjectiveTo evaluate the long-term survival and treatment failure patterns for patients with stage Ⅰ adenocarcinoma in the lower rectum after local excision with or without adjuvant radiotherapy.MethodsFrom Jan.2000 to Dec.2008,Seventy-seven patients with rectal cancer received local excision.Among them,41 received adjuvant radiotherapy.Fifty-four patients were pathologically proven as T1,the other 23 as T2.Patients were classified into low-and high-risk groups according to tumor grade,the length of tumor,surgical margin,circumference ratio of tumor/rectum and T stage.Survival rates and prognostic factors were estimated by Kaplan-Meier method,and comparisons were made by the Logrank test.Results Fourty patients were followed up more than 5 years.The 5-year locoregional recurrence-free survival (LRFS)and overall survival (OS)rates were 83％and 82％for the whole group.There were no significant differences in 5-year LRFS and OS rates in low-risk patients between local excision alone and local excision followed by adjuvant radiotherapy ( 86％ ∶ 83％,x2 =0.29,P =0.588 and 100％ ∶ 100％,x2 =1.50,P =0.221 ).In high-risk patients,the 5-year LRFS were similar (80％ ∶ 82％,x2 =0.27,P =0.600),but the OS were significantly different (92％∶ 66％,x2 =4.64,P =0.031 ) between local excision alone and local excision followed by adjuvant radiotherapy.By univariate analysis,large tumor size,positive margin,poor differentiation,tumor located less than 5 cm from anal verge and pT2 stage were poor prognostic factors for OS.The overall relapse rate for the whole group was 29％,and 70％ of them were locoregional relapse.The 5-year OS for patients treated with radical salvage surgery after local relapse was 69％.Conclusions For stage Ⅰ lower-sited rectal cancer,low-risk patients can achieve good result after local excision alone.The role of adjuvant radiotherapy in high-risk patients needs further evaluation.Local relapse is the main cause of failure,and salvage surgery after local relapse can provide long-term survival.

Outcome of locally advanced rectal cancer patients treated with radical surgery followed by concurrent capecitabine and radiotherapy / 中华放射肿瘤学杂志

Objective To evaluate the toxicities and long-term survival of a pilot study of radical surgery followed by concurrent capecitabine and radiotherapy for stage Ⅱ/Ⅲ rectal cancer patients.Methods From March 1,2005 to December 31,2007,131 pathologically proved stage Ⅱ and Ⅲ rectal cancer patients received radical surgery followed by chemoradiotherapy and adjuvant chemotherapy.Capecitabine was delivered daily in twice,for 2 weeks followed by a 2nd cycle after a rest of 7 days during radiotherapy,with the dosage of 1600 mg/m2/d.Three-dimensional conformal radiotherapy was encouraged to the dose of 50 Gy in 25 fractions,and Oxaliplatin/5-fluorouracil or leucovorin based adjuvant chemotherapy was recommended.Results Grade 3 +4 toxicities during concurrent chemoradiotherapy were observed in 28.2％ of patients.The follow-up rate was 93.9％.The 3-year overall survival (OS),locoregional-free survival and distant metastasis-free survival rates were 85.1％,96.7％ and 79.5％,respectively.Among the 31 patients with relapse,5 had loco-regional recurrence and 28 had distant metastasis.Univariate analysis indicated that patients with low and moderate-low differentiated adenocarcinoma,no adjuvant chemotherapy,stage ⅢC disease or positive lymph node ratio (LNR) more than 30％ had lower OS ( x2 =15.49,15.85,8.80 and 9.76,P ＝ 0.000,0.000,0.011 and 0.002 ).Patients with N2 disease had more loco-regional recurrence.Patients with stage ⅢC,without adjuvant chemotherapy,or LNR more than 30％ were at higher risk of distant metastasis ( x2 =6.51,11.57 and 9.70,P =0.034,0.001 and 0.002 ).However,patients who didn ' t receive adjuvant chemotherapy were likely to have low differentiated adenocarcinoma and T4 stage disease ( x2 =7.20,6.48,P =0.027,0.039).Conclusions After radical surgery and concurrent eapecitabine and radiotherapy for stage Ⅱ/Ⅲ rectal cancer patients,loco-regional recurrence rate is pretty low.Distant metastasis is the main treatment failure.

Efficacy of Stump Irrigation in Removing Tumor Cells During Low Anterior Resection Using the Double Stapling Technique

BACKGROUND: In low rectal cancer, creating a permanent stoma can be avoided by applying a low anterior resection using the double stapling technique. However, the problem of local recurrence is still a major pattern of tumor recurrence in rectal cancer. We aimed to verify the clinicopathologic variables related to exfoliation of tumor cells and searched for an efficient method to remove the tumor cells from the rectal stump during a low anterior resection. METHODS: Forty-four patients who underwent a low anterior resection using the double stapling technique were enrolled prospectively. For patient, we irrigated each rectal stump twice with 500 cc of normal saline through the anus. Two specimens from each irrigation were obtained and examined for any malignant tumor cells. Cases in which no tumor cells were found from the two specimens were defined as Group I, cases in which tumor cells were found in only the first specimen were defined as Group II, and cases in which tumor cells were found in both the first and the second specimens were defined as Group III. Clinicopathologic variables were analyzed with regard to the presence of exfoliated tumor cells in irrigated saline. RESULTS: There were sixteen (36%), fourteen (32%), and fourteen cases (32%) in Groups I, II, and III, respectively, according to the examination results. Age classification (P=0.05) and metastatic lymph nodes (P=0.013) were associated with the presence of tumor cells in irrigated saline (I vs. II, II). CONCLUSIONS: Stump irrigation during a low anterior resection using the double stapling technique is recommended as an easy and simple method to remove exfoliated tumor cells from anastomosis sites, although further study is necessary to elucidate the association between exfoliated tumor cells and local recurrence.

Down stage and long term results of preoperative chemoradiotherapy for locally advanced lower rectal cancer: a cooperative clinical trial of 6 institutions / 中华放射肿瘤学杂志

Objective To investigate the down stage effect and long-term results of preoperative chemoradiotherapy for locally advanced lower rectal adenocarcinoma. Methods From Jan. 1989 to Jul 1999, 103 patients suffering from lower rectal carcinoma were treated. Criteria entry: 1. Distance between anal verge and centre of tumor 4-8?cm(median 6.2?cm), 2. Uncertainty in decision of preservation of anus before admission, 3. Lesion belonged to locally advanced type, 4. definitive pathology, clinical stage and presence of objective observation of tumor extent, 5. Performance status proposed by Eastern Cooperative Oncology Group 0-2, 6. Age0.05), 25.5% and 48.5% (P