Subject(s)
Colorectal Neoplasms , Peritoneal Neoplasms , Peritoneum/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Disease-Free Survival , Female , Humans , Incidence , Laparotomy , Male , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Peritoneal Neoplasms/epidemiology , Peritoneal Neoplasms/secondary , Peritoneal Neoplasms/surgery , Prognosis , Survival Rate , Turkey/epidemiologyABSTRACT
BACKGROUND: Accurate staging of colorectal cancer is important for predicting prognosis and guiding treatment. This study uses meta-analysis to investigate if the pre- or post-resection detection of intraperitoneal free cancer cells can predict recurrence in patients undergoing curative colorectal cancer surgery. METHODS: A literature search was performed on all studies between January 1990 and July 2007 comparing the detection of intraperitoneal free cancer cells either pre- or post-resection with prognosis in colorectal cancer. The following prognostic outcomes were meta-analyzed: overall recurrence rate and local recurrence rate. A random-effect model was used and heterogeneity was assessed. RESULTS: Nine studies reporting on a total of 1182 subjects matched the selection criteria. Free cancer cells were detected prior to tumor resection in 125/822 (15.2%) of patients and following resection in 64/533 (12%) of patients. Preresection, the absence of tumor cells was associated with a lower overall recurrence (25.2%) compared to the presence of tumor cells [46.4%, odds ratio (OR) = 0.41, confidence interval (CI) 0.19-0.88]; as well as a significantly lower local recurrence (12.2% versus 21.1%, OR = 0.42, CI 0.21-0.82). Postresection, the absence of tumor cells also resulted in significantly lower overall recurrence (17.3%) when compared to the presence of tumor cells (52.6%, OR = 0.07, CI 0.03-0.18). CONCLUSIONS: The detection of intraperitoneal free cancer cells is associated with higher recurrence and poorer prognosis. Use of these techniques can identify patients at higher recurrence risk. This could be particularly valuable in stage II disease to identify patients who may benefit from adjuvant chemotherapy.
Subject(s)
Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/surgery , Neoplasm Recurrence, Local/diagnosis , Ascitic Fluid/pathology , Biomarkers, Tumor/metabolism , Colorectal Neoplasms/metabolism , Female , Humans , Intraoperative Care , Male , Neoplasm Staging , Peritoneal Lavage , Prognosis , Risk Factors , Survival RateABSTRACT
BACKGROUND: The aim of this study is to describe a single institution's experience in the use of transanal endoscopic microsurgery for rectal tumors. METHODS: Between 1996 and 2005, transanal endoscopic microsurgery was performed in 76 patients. The histologic diagnosis was adenoma in 48 and adenocarcinoma in 28 patients. RESULTS: Clear resection margins were achieved in 71 of 74 patients (95.9%). Overall morbidity was 18.9% because 14 patients developed minor (10 patients) or major complications (4 patients). During the follow-up, benign tumor recurrence was detected in 3 patients (6.3%). The recurrence rates among patients with T1, T2, and T3 malignant tumors were 7.1%, 42.8%, and 66.6%, respectively. COMMENTS: Transanal endoscopic microsurgery is a safe and feasible technique with low incomplete excision rates and may be the preferred method in patients with benign rectal tumors. Its role in the management of malignant tumors should be limited to selected patients with T1 lesions.
