Efficacy analysis of transanal local excision in low rectal cancer:report of 40 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the indication and efficacy of transanal local excision for low rectal cancer.</p><p><b>METHODS</b>A total of 40 consecutive patients undergoing transanal local excision of low rectal cancer were analyzed retrospectively.</p><p><b>RESULTS</b>The mean operative time was 50 (30-85) minutes. The mean intraoperative blood loss was 40 (10-100) ml. The mean hospital stay was 5 (2-10) days. The local recurrence rate was 20.0% (8/40). The 5-year survival rate was 90.0%. Local recurrence rate was 17.9% (5/28 cases) for T1, and 25.0% (3/12) for T2 lesions. However, the difference between the two groups was not statistically significant (P=0.61). Local recurrence rate was significantly lower for moderate differentiated than that for well-differentiated cancer [12.9% (4/31) vs. 44.4% (4/9), P=0.037]. Tumor diameter less than 3 cm was associated with a significantly lower local recurrence rate as compared to the counterparts (10.7% vs. 41.7%, P=0.03). No significant correlations were found between local recurrence and other variables including tumor location (P=0.93), tumor classification (P=0.53), and method of surgical excision (P=0.41).</p><p><b>CONCLUSIONS</b>Indications for transanal local excision of low rectal cancer include T1 and T2 tumors with well differentiation and the diameter less than 3 cm. Clinical outcome may be favorable if patients are carefully selected for transanal local excision.</p>

Clinical efficacy comparison between laparoscopy and open radical resection for 191 advanced colorectal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, the radicalness and efficacy of laparoscopy for advanced colorectal cancer.</p><p><b>METHODS</b>From June 2006 to December 2007, laparoscopic surgery and open radical resection were performed in 191 cases of colorectal cancer. The curative effect and clinical data were collected and analyzed.</p><p><b>RESULTS</b>The patients were randomized to two groups, 98 patients underwent laparoscopic surgery and 93 open operation. Five cases(5.1%) were converted to open surgery in laparoscopic surgery group. The average intraoperative blood loss of open surgery group was(279.5+/-189.4) ml, while that of laparoscopic surgery group was(87.2+/-27.1) ml, the difference between the two groups was statistically significant(P=0.011). Within postoperative 48 hours, the intestinal function and early mobile physical activity were restored in 37.8% (37/98) and 30.6% (30/98) patients of laparoscopic surgery group, while in 6.5%(6/93, P=0.000) and 3.2% (3/93, P=0.000) patients of open surgery group, the differences between two groups were statistically significant. The average hospital stay of laparoscopic surgery group was (8.9+/-5.9) d, whereas open surgery group(12.1+/-7.6) d, the difference was statistically significant(P=0.036). No significant differences were found between the two groups in gender, age, tumor location, resection range of surgery, TNM staging, post-operative complication and lymph node harvest(P>0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic surgery is feasible for the patients with advanced colorectal cancer. The radicalness of laparoscopic surgery is similar to that of open surgery, and laparoscopic surgery can provide less intraoperative blood loss, better intestinal function restoration, early mobile physical activity and shorter hospital stay.</p>

Clinic study of lateral lymph node metastasis in advanced lower rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the risk factors of lateral lymph node metastasis in advanced lower rectal cancer and its correlation with local recurrence and prognosis.</p><p><b>METHODS</b>Data from 96 consecutive patients with advanced lower rectal cancer underwent curative surgery with lateral dissection were retrospectively analyzed. The correlations of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and prognosis were investigated.</p><p><b>RESULTS</b>Lateral lymph node metastasis was observed in 14.6 (14/96) of the cases. In 40 patients with tumor diameter > or = 5 cm, 10 (25.0%) patients were found with lateral lymph node metastasis; while in the other 56 patients, only 4 (7.1%) cases were found with lateral lymph node metastasis (P < 0.05). Lateral lymph node metastasis was more frequent in patients whose tumor infiltrated full range of the intestinal wall (70%) than patients with 3/4, 2/4 and 1/4 intestinal wall was infiltrated (12.0%, 6.7% and 6.3%, respectively) (P < 0.05). Lateral lymph node metastasis rate of poorly differentiated carcinomas was significantly higher than those of moderate and well-differentiated ones (30% vs. 9.1% and 4.5%, P < 0.05). Local recurrence occurred in 18.8% (18 of 96 cases) of patients. Local recurrence in patients with positive lateral lymph node metastasis was 64.3%, while 11.0% in those without lateral lymph node metastasis (P < 0.05). Kaplan-Meier survival analysis showed significant improvements in median survival for patients with negative lateral lymph node metastasis over patients with lateral lymph node metastasis (80.9 +/- 2.1 vs. 38 +/- 6.7 months, log-rank P < 0.05).</p><p><b>CONCLUSIONS</b>Tumor diameter, degree of tumor infiltration and histological differentiation are significant risk factors of lateral lymph node metastasis in advanced lower rectal cancer. Lateral lymph node metastasis is an important predictor of local recurrence and prognosis of patients.</p>

Matrix metalloproteinase-2 expression and its correlation with mesorectal metastasis in middle and lower rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the expression of matrix metalloproteinase-2 (MMP-2) and to evaluate its correlation with mesorectal metastasis in middle and lower rectal cancer.</p><p><b>METHODS</b>The resected primary tumors from 56 patients with middle and lower rectal cancer who received total mesorectal excision were studied from Dec. 2001 to Jul. 2003.</p><p><b>RESULTS</b>The MMP-2 expression was positive in 42 (75%) cases. The positive rate of MMP-2 expression was 88.9% in T3 tumors and 69.6 % in T2 tumors respectively, while only 33.3% in T1 tumors (P=0.013). MMP-2 was positive in 91.2% (31/34) infiltrative rectal carcinomas while 40.0% (6/15) expansive rectal carcinomas (P=0.001). Mesorectal metastasis was detected in 36 (64.3%) of 56 cases. The expression of MMP-2 was positive in 31 (86.1%) of the 36 patients with mesorectal metastasis, while in 11(55%) of the 20 patients without mesorectal metastasis (P=0.01).</p><p><b>CONCLUSIONS</b>The expression of MMP-2 in middle and lower rectal cancer is significantly associated with depth of tumor invasion and Ming classifications. The high expression of MMP-2 may play an important role in the development of mesorectal metastasis in middle and lower rectal cancer.</p>

Value of lymph node micrometastasis detected by RT-PCR assay in determining the stage of gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To detect micrometastasis in regional lymph nodes using RT- PCR assay and evaluate the significance of the new assessment of nodal status in determining pN staging in gastric carcinoma.</p><p><b>METHODS</b>In addition to HE,RT- PCR assay for cytokeratin-20 gene marker was used to detect micrometastasis in 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy from Dec. 2003 to Apr. 2004.</p><p><b>RESULTS</b>The detection rate of HE staining was 27.1% (233/850), the detection rate of RT-PCR assay was 36.5% (310/850) (Pa< 0.01). Lymph node micrometastasis was further detected in 77 nodes from 14 patients. The detection rate of RT- PCR assay from the routine negative lymph nodes was 12.5% (77/617). Seven of those patients were up- staged (from IB stage to II stage, from IB stage to III A stage, from I stage to III A stage, from III A stage to III B stage, from III A stage to IV stage in one patient respectively, and from III B stage to IV stage in 2 patients).</p><p><b>CONCLUSION</b>RT- PCR assay can increase the detection rate of lymph node metastasis and have a significant impact on the staging system of gastric carcinoma.</p>

Mesorectal metastasis of middle and lower rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To detect mesorectal metastasis of middle and lower rectal cancer and to evaluate its relationship with clinicopathologic characteristics.</p><p><b>METHODS</b>Cancer specimens resected from 56 patients with middle and lower rectal cancer who received total mesorectal excision were examined by routine pathologic observation. The relationship between mesorectal metastasis and clinicopathologic characteristics of middle and lower rectal cancer was also investigated.</p><p><b>RESULTS</b>Mesorectal metastasis was detected in 36 (64.3%) of 56 cancer specimens. In 18 cancer specimens with tumor diameter > or = 5 cm, 15 (83.3%) were detected mesorectal metastasis, while in 38 cancer specimens with tumor diameter < 5 cm only 21 (55.3%) were detected mesorectal metastasis (P = 0.041). Mesorectal metastasis was more frequent in T(3) cancer specimens (81.5%) and T(2) cancer specimens (56.6%), compared with T(1) cancer specimens (1/6) (P = 0.007). 85.7% poorly differentiated cancer specimens were detected mesorectal metastasis, while moderate and well-differentiated cancer specimens were only 63.2% and 1/5 respectively (P = 0.028). Mesorectal metastasis was more frequent in stage III cancer specimens (100%), compared with stage II and I cancer specimens (27.3% and 1/5 respectively, P = 0.000). No significant correlations were found between mesorectal metastasis and other variables such as age, gender and Ming classification (P > 0.05).</p><p><b>CONCLUSION</b>Mesorectal metastasis of middle and lower rectal cancer has significant correlation with tumor diameter, tumor invasion, tumor differentiation and TNM stage. Total mesorectal excision or > or = 5 cm mesorectal distal to the rectal tumor should be followed in the management of middle and lower rectal cancer.</p>