RESUMEN
Objective:To explore the feasibility of wait and watch treatment for patients with high-risk pathology factors after endoscopic submucosal dissection (ESD) for early colorectal cancer.Methods:From December 2012 to June 2020, 104 patients, including 62 males and 42 females, aged from 31 to 89 years old, with the average of (59.5±10.8) years with early colorectal cancer after ESD operation were selected from the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University. According to the follow-up treatment, the patients were divided into two groups: the additional surgical resection group and the wait and watch group. The measurement data of normal distribution were shown by mean standard deviation, the comparison between groups adopted t test, and the comparison of counting data between groups adopted χ2 test. The types of pathological high-risk factors after ESD were compared between the two groups, and the overall survival (OS) and progression free survival (PFS) of the two groups were compared by Log-Rank test. Results:The median follow-up time was(40.6±15.3) months. The OS and PFS of the additional surgical resection group and the wait and watch group were 100.0% vs 98.4% and 90.7% vs 90.2%, respectively, and there was no statistically significant difference between the two groups (OS: χ2=0.875, P=0.35; PFS: χ2=0.017, P=0.80). Conclusion:The wait and watch strategy is expected to be one of the follow-up choices for some patients with high risk factors after ESD operation for early colorectal cancer.
RESUMEN
Objective:To explore whether the protective ileostomy can reduce the incidence of anastomotic leakage after neoadjuvant treatment of rectal cancer and the relationship between protective ileostomy and anastomotic leakage.Methods:From May 2011 to August 2020, a total of 108 patients who underwent rectal cancer neoadjuvant radiotherapy and chemotherapy and then received anterior resection in Beijing Friendship Hospital, Capital Medical University were selected. Sixty-three cases were treated with protective ileostomy (Treatment group), while 45 cases were not (Control group). The chi-square test was used to compare the incidence of anastomotic leakage between the two groups. At the same time, Logistic regression was used to analyze the related factors of anastomotic leakage, and the rate of permanent stoma was calculated. SPSS19.0 software was used for statistical analysis.Results:The total incidence of postoperative anastomotic leakage in the Treatment group and Control group was 9.52% (6/63) and 6.66% (3/45) ( P=0.59). Among them, 2 cases of anastomotic leakage occurred in the Treatmentgroup, no A-grade anastomotic leakage occurred in the Control group, and there was no significant difference between the two groups (33.33% vs. 0, P=0.77). There were 4 cases of grade B anastomotic leakage occurred in the Treatment group, 2 cases in the Control group, there was no significant difference between the two groups (66.67% vs. 66.67%, P=0.45). There was no grade C anastomotic leakage in the Treatment group, and one case of grade C anastomotic leakage occurred in the Control group, there was no significant difference between the two groups (0 to 33.33%, P=0.70). Logistic regression analysis showed that whether protective stoma was implemented or not was not statistically related to the occurrence of anastomotic leakage ( P=0.26). The distance between the tumor and the anal margin ( P=0.01) affected the occurrence of anastomotic leakage. The permanent stoma rate in the Treatment group was 9/63 (16.67%). Conclusion:Protective ileostomy has no significant advantage in reducing the incidence of anastomotic leakage in patients with rectal cancer neoadjuvant radiotherapy and chemotherapy, and may lead to permanent stoma.
RESUMEN
Neoadjuvant chemoradiotherapy (nCRT)+ total mesorectal excision (TME) has become the standard mode of treatment for locally advanced rectal cancer(LARC). However, the sensitivity of different patients to nCRT varies greatly, some patients can get pathological complete response (pCR), and their long-term survival is significantly improved, Some patients'tumors continue to progress, therefore, accurate prediction of whether pCR can be achieved after nCRT is very important for guiding individualized treatment of patients. Current studies have shown that some accessible clinical factors, such as age, pathological types of tumors, TNM staging, circumferential extent of tumor, distance to the anal verge, CEA level, neutrophil lymphocyte ratio, can be used to predict whether pCR can be achieved.This article reviews the progress of clinical predictors of pCR in LARC after nCRT.
RESUMEN
Objective@#To assess the incidence and independent risk factors for clinical anastomotic leakage (AL) in patients undergoing anterior resection (AR) or low anterior resection, (LAR) for rectal cancer.@*Methods@#This was a retrospective case-control study of 550 patients with rectal cancer who underwent AR or LAR from April 2007 to March 2017 in Beijing Friendship Hospital, Capital Medical University. The relationship between the incidence of AL and clinicopathological manifestations was analyzed by Chi-squared test and Fisher exact test, and the independent risk factors of AL were analyzed using logistic regression analysis. AL is defined as a defect (including necrosis or abscess formation) of the intestinal wall at the anastomotic site, leading to a communication between the intra- and extra-luminal compartments. AL can be divided into three grades. Grade A anastomotic leakage results in no change in the management of patients, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy.@*Results@#AL was noted in 32 (5.8%) of 550 patients with rectal cancer who underwent AR or LAR, including 15 (46.9%) , 4 (12.5%) , and 13 patients (40.6%) with Grades A, B, and C, respectively. Five patients (0.9%, 5/550) died peri-operatively. AL- and non-AL-related deaths occurred in 3 (9.4%, 3/32, all cases were Grade C) and 2 patients (0.4%, 2/518) , respectively, with the two mortality rates being significant difference (P = 0.002) . Chi-squared test or Fisher exact test showed that the incidence of AL was associated with neoadjuvant chemoradiotherapy (P = 0.011) , intraoperative bleeding (≥100 ml) (χ2 = 11.980, P = 0.001) , and tension-reducing suture of anastomosis (P = 0.015) . The results of logistic regression analysis showed that the independent risk factors of AL were neoadjuvant chemoradiotherapy (OR = 2.402, 95%CI: 1.004 - 5.749, P = 0.049) , intraoperative bleeding (≥100 ml) (OR = 2.971, 95%CI: 1.269 - 6.957, P = 0.012) and tension-reducing suture of anastomosis (OR = 2.304, 95%CI: 1.008 - 5.263, P = 0.048) .@*Conclusion@#The incidence of AL in patients undergoing AR for rectal cancer is 5.8%. The high-risk factors for AL are neoadjuvant chemoradiotherapy, intraoperative bleeding (≥100 ml) , and tension-reducing suture of anastomosis. Patients with these three risk factors have a high risk of AL rate, and a defunctioning stoma should be performed.
RESUMEN
Objective To explore the clinicopathological features and prognosis of the obstructive colorectal cancer (CRC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 667 CRC patients who were admitted to the Beijing Friendship Hospital Affiliated to Capital Medical University between January 2013 and December 2015 were collected.The diagnosis and treatment of CRC patients were based on colon cancer and rectal cancer clinical practice guidelines in oncology(Version 2013) of the National Comprehensive Cancer Network (NCCN) and the 7th edition of the American Joint Committee on Cancer (AJCC) cancer staging manual and the future of TNM.CRC and clinical staging were confirmed by colonoscopy,biopsy pathology and CT or MRI examination.Patients selected laparoscopic surgery or open surgery according to their conditions,and then selectively underwent postoperative adjuvant therapy based on the results of pathological examination.Observation indicators:(1) diagnosis and treatment;(2) clinicopathological features;(3) prognosis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall and tumor-free survivals up to April,2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Count data were described as case and percentage,comparisons between groups were evaluated with the chi-square test.Ordinal data were analyzed using the nonparametric test.Results (1) Diagnosis and treatment:tumor locations of 677 patients:tumors located in the right hemicolon,left hemicolon and rectum were respectively detected in 213,312 and 142 patients.Preoperative clinical staging:3,47,300,298 and 19 patients were respectively detected in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ.Ninety-nine patients were complicated with intestinal obstruction,with an obstructive rate of 14.84％ (99/667),and 568 patients didn't have intestinal obstruction.Treatments of 667 patients:① Preoperative adjuvant treatment:17 non-obstructive CRC patients underwent preoperative adjuvant treatments and 650 didn't undergo preoperative adjuvant treatment.② Surgical treatment:389 and 278 patients underwent respectively open and laparoscopic surgeries,and 588 received radical resection and 79 received non-radical resection.(2) Clinicopathological features:of 99 obstructive CRC patients,tumors located in the right hemicolon,left hemicolon and rectum were respectively detected in 26,61 and 12 patients.Eighteen and 81 patients underwent respectively laparoscopic and open surgeries,including 21 with low-differentiated tumors,61 with moderate-differentiated tumors and 17 with high-differentiated tumors;71 patients received radical resection,with a number of lymph node dissected of 12±9,and 37,20 and 14 were respectively detected in stage N0,N1 and N2.Of 568 non-obstructive CRC patients,tumors located in the right hemicolon,left hemicolon and rectum were respectively detected in 187,251 and 130 patients.Two hundred and sixty and 308 patients underwent respectively laparoscopic and open surgeries,including 38 with low-differentiated tumors,420 with moderate-differentiated tumors and 110 with high-differentiated tumors;517 patients received radical resection,with a number of lymph node dissected of 15±8,and 338,155 and 24 were respectively detected in stage N0,N1 and N2.There were statistically significant differences in above indicators between obstructive CRC and non-obstructive CRC patients(x2=11.234,46.505,30.088,Z=-2.782,t=2.942,Z=-2.892,P＜0.05).(3) Prognosis:of 667 patients,584 were followed up for 18-52 months,with a median time of 36 months,including 88 with obstructive CRC (1,5,23,28 and 31patients were respectively in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ) and 469 with non-obstructive CRC (5,62,212,116 and 101 patients were respectively in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ).During the follow-up,56 obstructive CRC patients survived,including 1 in stage 0,4 in stage Ⅰ,15 in stage Ⅱ,17 in stage Ⅲ and 19 in stage Ⅳ,with an overall survival rate of 63.64％ (56/88),and overall survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 1/1,4/5,65.22％(15/23),60.71％(17/28) and 61.29％ (19/31);38 had tumor-free survival,including 1 in stage 0,4 in stage Ⅰ,15 in stage Ⅱ,13 in stage Ⅲ and 5 in stage Ⅳ,with a tumor-free survival rate of 43.18％(38/88),and tumor-free survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 1/1,4/5,65.22％ (15/23),46.43％ (13/28),16.13％ (5/31).Four hundred and forty-three non-obstructive CRC patients survived,including 5 in stage 0,58 in stage Ⅰ,181 in stage Ⅱ,106 in stage Ⅲ and 93 in stage Ⅳ,with an overall survival rate of 89.31％(443/496),and overall survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 5/5,93.55％ (58/62),85.38％ (181/212),91.38％ (106/116) and 92.08％ (93/101);384patients had tumor-free survival,including 5 in stage 0,52 in stage Ⅰ,166 in stage Ⅱ,94 in stage Ⅲ and 67 in stage Ⅳ,with a tumor-free survival rate of 77.42％ (384/496),and tumor-free survival rates in stage 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 5/5,83.87％ (52/62),78.30％ (166/212),81.03％ (94/116) and 66.34％ (67/101).There were statistically significant differences in overall survival rate and tumor-free survival rate between obstructive CRC and non-obstructive CRC patients (x2 =39.626,43.707,P＜ 0.05).The subgroup analysis:there were statistically significant differences in stage Ⅱ,Ⅲ and Ⅳ overall survival rates between obstructive CRC and non-obstructive CRC patients (x2 =6.092,17.027,11.268,P＜0.05) and in stage Ⅲ and Ⅳ tumor-free survival rates (x2 =14.148,24.116,P＜ 0.05).Conclusion The obstructive CRC commonly locates in the left hemicolon,with complex clinicopathological features and low-differentiated tumors,meanwhile,there are lower radical rate and poor prognosis.
RESUMEN
Objective To evaluate the curative effect of trans-anal surgery vs.conventional laparoscopic surgery in treating sigmoid and high-rectum tumor.Methods From Jan 2014 to Mar 2017,100 patients in Beijing Friendship Hospital participated in this clinical study.45 patients underwent transanal surgery and 55 patients underwent conventional laparoscopic surgery.Results No significant difference was found between trans-anal surgery group and the traditional laparoscopic group in terms of operation time,blood loss,the use of analgesic drugs and the radical evaluation of tumor.While the postoperative pain scores in trans-anal surgery group (2.0 ± 1.0 vs.2.6 ± 1.0,t =2.9,P =0.005) were lower than those in the conventional group.The follow-up data showed one case of local tumor recurrence and one case of multiple peritoneal metastasis in the trans-anal surgery group,compared to two cases of liver metastasis and one case dying of pneumonia in the conventional laparoscopic group.The remaining cases were of no local recurrence,nor distant metastases or any critical complications.Conclusions Trans-anal surgery in the treatment of sigmoid and high-rectum tumor is safe,reliable and having the same clinical efficacy with conventional laparoscopic surgery.
RESUMEN
<p><b>OBJECTIVE</b>To verify the clinical safety of complete mesocolic excision (CME) and manufacture pathological large slices.</p><p><b>METHODS</b>A prospective analysis clinical data of 85 right colon cancer in patients by the same group of surgeons at the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from January 2012 to December 2013 which were divided into two groups: CME group (n=39) and traditional radical operation group (n=46) by surgical approach. CME group and control group were compared the differences of clinic and pathologic variables, precise tissues morphometry, lymph nodes harvest, mesocolic area and so on. By comparison to operation time, blood loss, postoperative complications, flatus restoring time, drainage removal time and length of stay, the security of CME was analyzed. Statistical methods included independent sample t-test, Wilcoxon rank sum test and χ(2) test. In order to manufacture pathological large slices, the CME operation specimens were fixed. The large slices were stained by routine HE staining to detection of circumferential resection margin.</p><p><b>RESULTS</b>Mean number of total lymph nodes was increased obviously in CME group (26.8±1.9 vs. 23.2±3.4, t=4.261, P=0.000). Mean number of lymph nodes of stage Ⅰ, Ⅱ were different between two groups (25.8±3.6 vs. 18.2±4.5, 26.8±7.7 vs. 24.9±6.2, t=8.776, 2.802, P=0.000). The positive lymph nodes of CME group was higher than control group (4(7) vs. 1.5(2), P=0.032), above all with statistically significant difference. Comparing CME group with the control group, there were the larger area of mesentery ((15 555±1 263) mm(2) vs. (12 493±1 002) mm(2,) t=12.456, P=0.000), the greater distance between the tumor and the high vascular tie ((116±22) mm vs. (82±11) mm, t=9.295, P=0.000), the greater distance between the normal bowel and the high vascular tie ((92±17) mm vs. (74±10) mm, t=8.132, P=0.000) of CME, with statistically significant difference. There were no statistically significant differences from operation safety when CME group was compared with the control group. The pathological large slices of colon cancer were prepared successfully and dyed evenly than those large slices were used to observe whether the lymph tube and lymph node metastasis inside the mesocolon. Existence of direct tumor invasion could be confirmed by investigating the large slices. Cancer embolus in intravascular and micro infiltration in mesocolon also could be found.</p><p><b>CONCLUSIONS</b>CME operation can get the standard excision according the mesocolic area and integrity, as well as to harvest the maximum number of lymph node. The clinical application of CME is safe and does not increase the risk of operation. Circumferential resection margins can be detected by pathological large slices.</p>