ABSTRACT
BACKGROUND/AIM: Neoadjuvant chemotherapy without radiation (NAC) shows favorable outcomes for locally advanced rectal cancer (LARC), however, the optimal regimen has not been determined yet. This study aimed to compare the efficacy and safety of oxaliplatin, irinotecan, folinic acid, and 5-fluorouracil (mFOLFOXIRI) with capecitabine/S-1 and oxaliplatin (XELOX/SOX) in rectal cancer patients. PATIENTS AND METHODS: We retrospectively examined patients with LARC who received mFOLFOXIRI or XELOX/SOX as NAC. RESULTS: Between January 2015 and July 2019, 49 patients received mFOLFOXIRI and 37 patients received XELOX/SOX. The pathological response rates (over two-thirds affected tumor area) were 36.7% and 40.5% in the mFOLFOXIRI and XELOX/SOX groups, respectively. Grade 3/4 neutropenia was experienced by 45.0% of the patients in the mFOLFOXIRI group and 8.0% in the XEOX/SOX group. CONCLUSION: Although pathological responses were comparable between two groups, mFOLFOXIRI tended to be more toxic compared to XELOX/SOX as NAC for LARC.
Subject(s)
Neoadjuvant Therapy , Rectal Neoplasms , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Capecitabine , Chemotherapy, Adjuvant , Fluorouracil/adverse effects , Humans , Neoadjuvant Therapy/adverse effects , Oxaloacetates , Rectal Neoplasms/drug therapy , Retrospective StudiesABSTRACT
BACKGROUND: In gastric cancer, various methods of gastric resection and reconstruction have been devised according to the location of the primary tumor and the depth of invasion. The functional outcomes of patients treated by laparoscopy-assisted or totally laparoscopic distal gastrectomy were compared with respect to the approach, size of the remnant stomach, and type of reconstruction. METHODS: Patients who required distal gastrectomy to treat early-stage cancer between May 2000 and December 2008 were treated by one of the four following procedures: Billroth Type I (B-1) reconstruction for 1/2 remnant stomach (1/2B1ML) or B-1 for 1/3 remnant stomach (1/3B1ML), through a mini-laparotomy following laparoscopy-assisted surgery; intra-corporeal B-1 for 1/2 remnant stomach (1/2 B1IC); or intra-corporeal Roux-en-Y for 1/3 remnant stomach (1/3RYIC). The primary outcome measure was digestive function, assessed by body weight, food intake, and degree of abdominal symptoms. The secondary outcome was morbidity. RESULTS: The 1/2B1ML (n = 27) and 1/2B1IC (n = 56) groups were significantly superior to the 1/3 resection groups in terms of the preservation of body weight. The 1/3B1ML (n = 29) and 1/3RYIC (n = 64) groups were associated with significantly decreased food intake compared with the 1/2B1ML group. Endoscopy revealed a greater incidence of esophagitis and gastritis among the 1/3B1ML patients compared with the 1/3RYIC patients. There were no operative deaths, and no differences in morbidity between the groups. CONCLUSION: Patients with early-stage cancer actually benefit from 1/2 gastrectomy rather than the typical 2/3 gastrectomy. B-1 reconstruction is appropriate for patients with large gastric remnants, and intra-corporeal reconstruction in experienced hands is associated with no apparent disadvantages, while offering a favorable cosmetic result.
Subject(s)
Anastomosis, Roux-en-Y , Gastrectomy , Gastric Stump/surgery , Gastroenterostomy , Laparoscopy , Plastic Surgery Procedures , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Adenocarcinoma/secondary , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Gastric Stump/pathology , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Neoplasm, Residual/pathology , Neoplasm, Residual/surgery , Retrospective Studies , Survival RateABSTRACT
PURPOSE: Laparoscopic colorectal surgery, while minimally invasive, is a complicated technique. Therefore, prior to this surgery, it is important to determine the anatomical information of colorectal cancer. MATERIALS AND METHODS: Fifty-eight cases of patients with a confirmed diagnosis of colon cancer [caecal (n = 4), ascending colon (n = 6), transverse colon (n = 7), descending colon (n = 2), sigmoid colon (n = 22), and rectal (n = 17) cancer] were evaluated using multislice CT before laparoscopic surgery. CT examination was performed in an air-filled colorectum by colon fiberscopy. Contrast-enhanced images on multislice CT were obtained at arterial and venous phases. All images were reviewed on a workstation, and three-dimensional (3D) images of vessels, colorectum, cancer, and swollen lymph nodes were reconstructed by volume rendering and fused (integrated 3D imaging). We evaluated the usefulness of integrated 3D imaging with multislice CT for laparoscopic colorectal surgery. RESULTS: Integrated 3D imaging demonstrated clearly the distribution of arteries feeding the colorectal cancer and the anatomical location of colorectal cancer and arterial and venous systems. Moreover, measurement of the distance between the aortic bifurcation and the origin of the inferior mesenteric artery and that between the base of the inferior mesenteric artery and the origin of the left colic artery on integrated 3D imaging contributed to safe, prompt ligation of the vessels and excision of lymph nodes. CONCLUSION: Integrated 3D imaging with multislice CT was useful for simulation of laparoscopic colorectal surgery.
