Relationship between E-CD and Snail expressions and tumor invasion, metastasis and prognosis in colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the E-CD and Snail expressions in colorectal cancer and their relationship with colorectal cancer invasion, metastasis and prognosis.</p><p><b>METHODS</b>Immunohistochemical staining (EnVision) was used to detect the E-CD and Snail expressions in 30 normal colorectal mucosa, 30 colorectal adenoma and 142 colorectal cancer tissues.</p><p><b>RESULTS</b>E-CD in the normal colorectal mucosa was strongly positive expressed (90.0%), significantly higher than that in colorectal adenomas (63.3%) and colorectal cancer tissues (41.5%). E-CD expression was significantly related to tumor differentiation, invasion depth, vascular invasion, lymph node metastasis and Dukes' stage (P < 0.05), but not to the patients' age, gender, tumor size and tumor histological type (P > 0.05). The 1-, 3- and 5-year survival rates of the E-CD positive patients with colorectal cancer were significantly higher than that in E-CD negative patients. The positive expression rate of Snail in colorectal cancer tissues (52.1%) was significantly higher than that in normal colorectal mucosa (6.7%) and colorectal adenomas (26.7%, P < 0.05). The snail expression was significantly correlated to tumor histological type, differentiation, invasion depth, vascular invasion, lymph node metastasis and Duke's stage (P < 0.05), but not to patients' age, sex and tumor size (P > 0.05). The 1-, 3- and 5-year survival rates of Snail negative patients with colorectal cancer was significantly higher than that in patients with positive expression (P < 0.05). The expressions of E-CD and Snail in colorectal cancer tissues were inversely correlated (P < 0.05). Cox multivariate analysis showed that E-CD and Snail can be used as independent prognostic indicators (P < 0.05).</p><p><b>CONCLUSION</b>E-CD and Snail expressions in colorectal cancer are related to the tumor invasion, metastasis and prognosis. Low expression of E-CD and high expression of Snail are related to the advanced stage, and poor prognosis in colorectal cancer patients. E-CD and Snail can be used as independent prognostic indicators.</p>

Clinical study of a new intracolonic drainage to protect low rectal anastomotic leakage / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the value of using protective new intracolonic drainage in decreasing low colorectal anastomotic leakage.</p><p><b>METHODS</b>One hundred and nineteen cases of rectal cancer accepted low anterior resection were randomly assigned to study group (n=55) and control group (n=64). The study group was added with a new intracolonic drainage composed of biofragmentable anastomosis ring and condom during operation. The control group was added with protective ileostomy during operation. The results of surgery were compared between the two groups.</p><p><b>RESULTS</b>All the cases were followed up over three months and there were no perioperative death. There were no significant differences in physiopathological factors such as age, sex, body type, site of tumor, size of tumor, differentiation of tumor, site of anastomosis, condition of nutrition, concomitant disease between the two groups. In the study group, anastomotic leakage occurred in 4 cases (7.3%), the drainage devices were ablated 18.3 days after operations and there were no drainage-related complications; light anastomotic stenosis occurred in 3 cases (5.5%) three months after operations. Among the cases with leakage, no severe abdominal infection was found, the time of abdominal drainage was 4.8 days, and the amount of abdominal drainage was 12.8 ml/d in primary three days after leakage. In the control group, anastomotic leakage occurred in 7 cases (10.9%), ostomy-related complications occurred in 29 cases (45.3%), anastomotic stenosis occurred in 18 cases (28.1%) and severe anastomotic stenosis occurred in 4 cases (6.3%) after three months. Among the cases with leakage, severe infection occurred in two cases, anastomotic spoiled occurred in one case, the amount of abdominal drainage was 35.4 ml/d in primary three days after leakage, and the time of abdominal drainage was 17.1 days. There was no significant difference in the rate of anastomotic leakage between the two groups (P>0.05). But there were significant differences in the amount of abdominal drainage, the time of abdominal drainage and abdominal infection in the cases of anastomotic leakage (P<0.01). There was significant difference in anastomotic stenosis after three months between the two groups (P<0.01).</p><p><b>CONCLUSIONS</b>The intracolonic drainage is a simple, safe and effective method in protecting low colorectal anastomotic leakage, and avoiding harmful results caused by anastomotic leakage. Compared with protective ileostomy, intracolonic drainage can avoid stomy-related physical mental suffering and complications, the rate of later anastomotic stenosis is less, and the time of abdominal drainage is shorter in the cases with leakage.</p>

Rule of lymph node metastasis in colorectal cancer and its affecting factors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the rule of lymph node metastasis in colorectal cancer and its affecting factors, and to provide clues for clinical diagnosis and treatment of colorectal cancer patients.</p><p><b>METHODS</b>The clinical data of 1166 cases of colorectal cancer receiving surgical resection were analyzed retrospectively.The relationships between clinicopathologic variables and lymph node metastases were evaluated by crosstabs and logistic regression in SPSS 10.0 for windows.</p><p><b>RESULTS</b>The rate of lymph node metastasis in colorectal cancer was 49.7%. After entering crosstabs estimation, gender and tumor site were not significantly correlated with lymph node metastasis in colorectal cancer(chi2=1.46, r=0.035, P>0.05 and chi2=3.86, r=0.012, P>0.05). Age, tumor size, the massive type of the tumor, the differentiating degree of the tumor, histology type and the depth of tumor invasion were proved to be independent factors influencing the lymph node metastasis in colorectal cancer (chi2 =13.1, r=0.064, P<0.05 and chi2=77.161, r=0.245, P<0.01 and chi2=144.831, r=0.341, P<0.01 and chi2=128.310, r=0.318, P<0.01 and chi2=120.418, r=0.319, P<0.01 and chi2=227.287, r=0.434, P<0.01). After entering logistic regression estimation, the correlativity of risk factor of lymph node metastasis in colorectal cancer: the depth of tumor invasion > the massive type of the tumor>the differentiating degree of the tumor > tumor size. Preoperative blood serum CEA level was significantly correlated with lymph node metastasis (chi2=509.599, r=0.661, P<0.01).</p><p><b>CONCLUSION</b>The depth of tumor invasion is the most risk factor of lymph node metastasis in colorectal cancer. Preoperative high level of blood serum CEA indicates the occurrence of lymph node metastasis.</p>

Surgical treatment for local recurrence of rectal carcinoma after operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of reoperation for local recurrence of rectal carcinoma.</p><p><b>METHODS</b>The data of 62 cases with post-operative local recurrence of rectal carcinoma were analyzed retrospectively.</p><p><b>RESULTS</b>All the 62 patients received reoperation. Thirty two of those patients were treated with radical resection (16 patients combined multiple organ resection), 6 palliative resection, 11 colostomy, and 13 laparatomy only. The 1-, 3- and 5-year survival rates in the patients accepted radical resection were 90.6%, 59.4% and 18.8% respectively. But in patients undergone palliative resection and combined therapy, survival time was 6-24 months with median survival time of 16 months. The patients, accepted laparatomy and intra-abdominal chemotherapy, all died within 2-14 months postoperatively. For patients with postoperative recurrence time >5 years, <2 years and 2-5 years, the reoperation resection rates were 100%(11/11), 62.9%(22/35), and 31.3%(5/16) respectively, and there were significant differences among 3 groups (P<0.01). The rate of reoperation resection of pure local recurrence was 80.0%(32/40). The rate of reoperation resection of local recurrence, associated with near organ invasion, was 27.3%(6/22). The difference was significant(P<0.01). The reoperation resection rate of first operation with Dixon or Miles was 61.9%(26/42) and 30.0%(6/20), and the difference was significant as well(P<0.05).</p><p><b>CONCLUSIONS</b>The recurrence of rectal carcinoma still needs positive operation in order to prolong the survival time and improve the quality of life of the patient. First operative procedure, post-operative recurrence time and recurrence type are important factors of reoperative resection.</p>