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>

Study of prophylactic intra-iliac and hepatic arterial infusion chemotherapy against pelvic recurrence and liver metastasis after radical resection for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the effects of prophylactic intra-iliac and hepatic arterial infusion chemotherapy on pelvic recurrence and liver metastasis after radical resection for rectal cancer.</p><p><b>METHODS</b>Eighty-four rectal cancer patients,undergone radical resection on Dukes stage B or C,were randomly assigned to postoperative intra-iliac and hepatic arterial infusion chemotherapy group(group I) and routine vein chemotherapy group(group II). Five-year survival and recurrence rates were compared between the two groups.</p><p><b>RESULTS</b>Among the 84 rectal cancer patients with radical resection, the 5-year liver metastasis and pelvic recurrence rates were 30.2% (13/43) and 18.6% (8/43) respectively in group II, 17.1% (7/41) and 9.8% (4/41) in group I, the difference was significant between 2 groups (chi(2)=4.31, P<0.05). The mean tumor-free survival time was 26.2 months in group I and 15.8 months in group II (t=5.05, P<0.01), the difference was significant (t=5.05, P<0.01). The five-year survival rate in group I (65.9%) was significantly higher than that in group II (56.5%) (u=8.86, P<0.01). Cox multivariate analysis showed that, compared with those in group II, the relative risks of pelvic recurrence and liver metastasis in group I decreased 20% (coefficient of relative risk: 0.7959), and the five-year mortality also decreased 20% (coefficient of relative risk: 0.8034).</p><p><b>CONCLUSION</b>Prophylactic intra-iliac and hepatic arterial infusion chemotherapy can reduce the rates of pelvic recurrence and liver metastasis after radical resection of rectal cancer.</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>