Clinical significance of intersphincteric resection related anatomy effect on surgical safety / 中华胃肠外科杂志

The anatomical studies of intersphincteric resection (ISR) have made remarkable progress in recent years. The anatomy of internal, external sphincter and hiatal ligament has been further understood. In this paper, the generation and functional mechanism of ISR related anatomy are described from the embryonic development process, and then the influence of hiatal ligament and internal sphincter on ISR surgery is analyzed respectively according to the anatomical characteristics. Finally, the correlation analysis of anatomical factors on the common problems of mucosal bleeding and instrument anastomosis in ISR is carried out. The objective of this paper is to improve the safety of ISR surgery by providing detailed anatomical explanations.

Recognition of surgical anatomy for intersphincteric resection / 中华胃肠外科杂志

Intersphincteric resection (ISR) involves the anatomy of hiatal ligament, internal and external sphincter and conjoined longitudinal muscle. The hiatal ligament is actually a branch of the longitudinal muscle of rectum, shown as an uneven ring attached to the levator ani muscle. The internal sphincter is the end of the circular muscle of rectum which begins at the level of hiatal ligament formation. The distance from the upper boundary of internal sphincter to dentate line is significantly different among individuals. Although there is adipose tissue in the space between the internal and external sphincters, no evidence of mesentery structure in the anal canal is found as in the rectum. The conjoined longitudinal muscle is the remaining branch of the longitudinal muscle, whose return passes through the external sphincter and ends at the anococcygeal ligament/coccyx after reaching the anal margin. The synergistic action of conjoined longitudinal muscle and the hiatal ligament participates in the defecation process. The individualized difference of ISR-related anatomy affects the operation, especially the anastomosis.

Expression and significance of RECK, metalloproteinase-9 and vascular endothelial growth factor-C in colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of reversion-inducing cysteine-rich protein with Kazal motifs (RECK), matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor-C (VEGF-C) in colorectal cancer.</p><p><b>METHODS</b>S-P immunohistochemistry was used to detect the expression of RECK, MMP-9 and VEGF-C in colorectal cancer specimen. Colorectal mucosal tissue at least 10 cm away from the tumor was used as control.</p><p><b>RESULTS</b>The positive expression of RECK in colorectal cancer was significantly lower than that in the controls(53.3% vs. 100%, P<0.05). Both MMP-9 and VEGF-C were over expressed compared with the controls(86.7% vs. 23.3% and 71.7% vs. 13.3% respectively, P<0.01). The expression of RECK was negatively correlated with that of MMP-9 and VEGF-C, and the expression of MMP-9 was positively correlated with that of VEGF-C. There were significant associations between the expression of these proteins and lymph node metastasis, distant metastasis, and TNM staging (all P<0.05).</p><p><b>CONCLUSIONS</b>RECK expression is low in colorectal cancer, while MMP-9 and VEGF-C expressions are high. Combined testing of these 3 markers is important in the evaluation of tumor metastasis and invasion, and is helpful in the prediction of the prognosis.</p>

Clinicopathological characteristics of advanced colorectal cancer 30 mm or smaller in diameter / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter.</p><p><b>METHODS</b>Retrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D.</p><p><b>RESULTS</b>The most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P < 0.05) , as well as between the groups with different depth of invasion (P < 0.05). Curability A resection was performed in 69 (86.2%) cases.</p><p><b>CONCLUSIONS</b>Tumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.</p>