Outcome of surgical management of the bladder in advanced colorectal cancer.

BACKGROUND: To evaluate morbidity, mortality, and long-term survival in patients undergoing partial or total cystectomy during en bloc resection for locally advanced colorectal cancer. METHODS: This study retrospectively evaluated the outcome of combined bladder resection for colorectal cancer in our department. RESULTS: Patients (n=33) with colorectal tumors adherent to the bladder were followed. Overall morbidity was 11/33 (33.3%). Histological staging demonstrated inflammatory adhesion in 54.5% (18/33) and invasion in 45.6% (15/33). Morbidity was significantly higher in those that had undergone total cystectomy than in those that had undergone partial cystectomy (4/5 vs 7/28, P=0.033). The local recurrence has no difference the between total cystectomy group and the partial cystectomy group (1/5 vs 8/28, P=1.000). Overall 5-year survival rate was 39.4% (13/33). Mean survival time was 46.6875 month. There was no difference in 5-year survival between patients with inflammatory adhesion vs those with tumorous infiltration between colorectal tumor and bladder (P=0.7389). CONCLUSION: Survival after surgery for colorectal cancer is not influenced by the need to excise part or all of the urinary bladder in case it is contiguous to a colorectal tumor. Experienced surgeons in urology and colon and rectal surgery should be left to decide on the surgical options to be employed.

[Clinical, endoscopic and pathological features of primary colorectal non-Hodgkin lymphoma: 24 cases report].

OBJECTIVE: To investigate the clinical, endoscopic and pathological features in primary colorectal non-Hodgkin lymphoma. METHODS: Twenty-four cases of primary colorectal non-Hodgkin lymphoma were studied retrospectively. RESULTS: The main clinical symptoms were abdominal pain, abdominal mass, loss of weight, fever, bloody stools and altered bowel habits. There were 6 cases (25.0%) involving two or more lesion sites, including three cases showing continuous skip-distribution from sigmoid colon to ascending colon, one case showing the homologous manifestation from rectum to cecum, one case involving ascending colon and rectum, and the last one involving sigmoid colon and rectum. There were 18 cases involving single lesion site and the caecum was the most frequently affected site (44.4%, 8 cases). The major endoscopic phenotypes were ulcer (39.1%), bossing (43.5%) and infiltrating (17.4%). The major pathology types were diffuse large B-cell lymphoma (11/24, 45.8%), intestinal T-cell lymphoma (8/24, 33.3%), and mucosa-associated lymphoid tissue lymphoma (MALT) (3/24, 12.5%). 2 of 24 cases (8.3%) were not decided. Twenty-one patients were treated surgically, containing fifteen radical excisions, one local excision, four palliative excisions and one exploratory laparotomy. Sixteen postoperative patients accepted CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or COP (cyclophosphamide, vincristine, prednisone) chemotherapy, and three patients abandoned treatment. Twenty-one patients were followed up and the 5-year survival rate was 37.7%. CONCLUSION: The clinical features of primary colorectal non-Hodgkin's lymphoma have no specificity. Ulcer and bossing are the two major morphologic manifestations of endoscopic. Diffuse large B-cell lymphoma and intestinal T-cell lymphoma are the main pathological types. Comprehensive treatment of surgery and chemotherapy are effective methods for primary colorectal non-Hodgkin lymphoma.

[Influence and significance of preoperative intraarterial infusion chemotherapy combined with radiotherapy on survivin, p53 and Bax expression in low rectal carcinoma].

BACKGROUND & OBJECTIVE: Recently, neoadjuvant therapy has attracted more attention, but the influence of preoperative intraarterial infusion chemotherapy (PRAC) combined with radiotherapy on Survivin expression in rectal carcinoma is unclear. This study was to investigate the effect of PRAC or radiotherapy on Survivin, P53, and Bax expression in low rectal cancer. METHODS: A total of 60 patients with low rectal carcinoma were randomized into 3 groups: 19 received PRAC combined with preoperative radiotherapy (radiochemotherapy group), 15 received preoperative radiotherapy alone (radiotherapy group), and 26 received operation alone (control group). PRAC was performed using Seldinger technique. Preoperative radiotherapy was performed with a total dose of 20 Gy in 5 days, and superadded 30 Gy after operation. Control group received postoperative radiotherapy with a total dose of 50 Gy. The expression of Survivin, P53, and Bax was examined by immunohistochemistry. RESULTS: After neoadjuvant therapy, there was no significant difference in the positive rates of Survivin, P53, and Bax among the 3 groups. In radiochemotherapy group, the positive rate of Survivin was reduced from 63.16% before neoadjuvant therapy to 26.32% after operation (P<0.05), and the overexpression rate of P53 was reduced from 57.89% to 26.32% (P<0.05). In radiotherapy group, the overexpression rate of Survivin was reduced from 53.33% to 13.33% (P<0.05), but there was no significant change in the positive rate of P53. The positive rate of Bax was slightly increased after operation in above 2 groups. In these 2 groups, the median survival time was significantly longer in the patients with reduced Survivin expression than in those with increased Survivin expression (50.05 months vs. 42.61 months, P<0.01). Survivin expression was not obviously related to Bax and P53 expression (P>0.05). CONCLUSION: Neoadjuvant therapy could decrease the levels of P53 and Survivin expression, might enhance the level of Bax expression, and consequently accelerate cancer cell apoptosis and achieve a better short-term curative effect on low rectal cancer.

[Expression of P33ING1, P53 and their relationship with apoptosis in anal canal carcinoma].

OBJECTIVE: To explore the expressions of P33ING1, P53 and their relationships with apoptosis in anal canal carcinoma (ACC). METHODS: The expressions of P33ING1, P53 proteins were measured by immunohistochemistry method (SP method), and apoptosis was detected in 42 cases with ACC, 36 cases with anal canal adenoma (ACA) or anal canal papilloma (ACP), and 40 cases with paraanal inflammatory mass(PAIM). RESULTS: The positive expression rates of P33ING1 and P53 proteins were 40.5% (17/42), 97.2% (35/36) and 97.5% (39/40), 50.0% (21/42), 22.2% (8/36) and 27.5% (11/40) respectively, and the average apoptosis indexes(AI) were (10.27+/- 1.23) per thousand, (42.75+/- 0.98) per thousand and (42.67+/- 1.04) per thousand respectively in ACC, ACA or ACP and PAIM. There were significant differences in the positive expression rates of P33ING1, P53 and apoptosis index between ACC and the other two groups respectively (P< 0.05). Among 21 cases of ACC with positive expression of P53 protein,there were 18 cases with P33ING1 negative expression. CONCLUSIONS: P33ING1 expression decrease in ACC, which may play an important role in the carcinogenesis and progression of ACC. P33ING1 and P53 may have an synergistic effect of suppressing cell growth and accelerating cell apoptosis.

Genetic alterations and expression of inhibitor of growth 1 in human sporadic colorectal cancer.

AIM: To explore the effect and significance of inhibitor of growth 1 (ING1) gene in carcinogenesis and progression of human sporadic colorectal cancer. METHODS: mRNA expression, mutation, and loss of heterozygosity (LOH) of ING1 gene in 35 specimens of sporadic colorectal cancer tissues and the matched normal mucous membrane tissues were detected by semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR), PCR-single strain conformation polymorphism (PCR-SSCP) and PCR-simple sequence length polymorphism (PCR-SSLP) using microsatellite markers, respectively. RESULTS: The average ratios of light intensities of p33(ING1b) and p47(ING1a) mRNA expression in the cancerous tissues were significantly lower than those in normal tissues. The difference between the two mRNA splices was not significant in the matched tissues. In addition, the ratios of light intensities of p33(ING1b) and p47(ING1a) mRNA expression in the cancerous tissues of Dukes' stages C and D were significantly lower than those in cancerous tissues of Dukes' stages A and B. However, no mutation of ING1 gene was detected in all 35 cases; only 4 cases of LOH (11.4%) were found. CONCLUSION: p33(ING1b) and p47(ING1a) mRNA expressions are closely related with the carcinogenesis and progression of human sporadic colorectal cancer. No mutation of ING1 gene is found, and there are only few LOH in sporadic colorectal cancers. These might not be the main reasons for the down regulation of ING1 expression. Its low expression may happen in transcription or post-transcription.

[Clinical analysis of anorectal malignant melanoma].

OBJECTIVE: To summarize the clinicopathological characteristics of primary anorectal malignant melanoma (AMM). METHODS: Clinical data of nine patients with AMM were reviewed retrospectively from January 1999 to March 2005. RESULTS: Anorectal malignant melanoma had a female predominance. The average age was 56 years old and average course of disease was 5.8 months. The onset of symptom was hematochezia, then anus prolapses. 94.7% of patients had AMM within 5 cm from anus margin; the average tumor size was (3.3+/- 2.1) cm. The polyp and ulcer were most common types. More than a half (54.5%) of the tumor was movable, 19.1% smooth surfaced, 6.6% soft textured. Synchronous metastasis was found in 14.0% of the patients, the first common metastasis was found in liver, the secondary was superficial inguinal lymph node metastasis. Half of the patients were misdiagnosed,and over 50% of patients were misdiagnosed as benign disease. Mile's operation was performed in most of patients (63%), while anal resection was performed in 30% of the patients. CONCLUSIONS: Anorectal malignant melanoma is often misdiagnosed,surgical procedure is the first choice for patients with AMM.