Extended full-thickness transanal local excision to treat ultra-low rectal cancer: an initial clinical exploration.

OBJECTIVE: To investigate the feasibility of extended full-thickness transanal local excision for rectal cancers invading anorectal junction. METHODS: Four patients with small (size ≤3cm) unfixed rectal cancer, which extended into the upper anal canal, were submitted to transanal local excision with a dissection plane extended to the striated muscle layer around the upper anal canal, so that a portion of striated muscle beneath or around the tumor was excised en bloc with the anorectal wall. The defect in the anorectal wall was laid open to granulate and epithelize. RESULTS: The mean operative time was 28±6 min, with no related mortality. Postoperative pathological examination confirmed clear resection and revealed 1, T2, 2, T1, and 1 Tis carcinomas. The median follow-up was 3.2 months (range, 1.5-13.0 months). Minor soiling with flatus incontinence was common during the first postoperative month. Two patients with a follow-up longer than 3 months had perfect anal continence. No local recurrence was observed. CONCLUSION: Extended full-thickness transanal local excision for rectal tumors lying at the anorectal junction is safe and simple. Patients with partial excision of striated muscle around the upper anal canal may still enjoy good anal continence. Further studies on extended full-thickness transanal excision are worthwhile.

Cyclin D1 G870A polymorphism and colorectal cancer susceptibility: a meta-analysis of 20 populations.

PURPOSE: Studies investigating the association between genetic polymorphism of cyclin D1 (CCND1) G870A and risk of colorectal cancer (CRC) reported conflicting results. In order to derive a more precise estimation of the relationship, a meta-analysis was performed. MATERIALS AND METHODS: We performed an extensive search of relevant studies and carried out a meta-analysis, including 20 studies with 5,975 cases and 8,333 controls, to obtain a more precise estimate. RESULTS: Overall, significantly elevated colorectal cancer risk was associated with variant allele 870A when all studies were pooled (AA vs. GG: OR = 1.23, 95% CI = 1.04-1.44; GA vs. GG: OR = 1.13, 95% CI = 1.01-1.26; dominant model: OR = 1.16, 95% CI = 1.03-1.31). In the subgroup analysis by ethnicity, significantly increased risks were detected among Caucasians (AA vs. GG: OR = 1.27, 95% CI = 1.04-1.44; dominant model: OR = 1.17, 95% CI = 1.02-1.34).We also observed sporadic CRC with an increased cancer susceptibility (AA vs. GG: OR = 1.24, 95% CI = 1.04-1.48; dominant model: OR = 1.17, 95% CI = 1.04-1.33), when colorectal cancer was stratified into sporadic CRC and hereditary nonpolyposis colorectal cancer (HNPCC). However, no significant associations were found in both Asians and HNPCC patients for all genetic models. CONCLUSION: Result suggests that the cyclin D1 870A allele is a low-penetrant risk factor for developing sporadic colorectal cancer, especially among Caucasians.

The cyclin D1 G870A polymorphism and colorectal cancer susceptibility: a meta-analysis of 20 populations.

PURPOSE: Studies of the association between the cyclin D1 (CCND1) G870A genetic polymorphism and risk of colorectal cancer (CRC) have generated conflicting results. In order to derive a more precise estimation, a meta-analysis was here performed. MATERIALS AND METHODS: An extensive search of relevant studies was carried out as a meta-analysis of twenty studies with 5,975 cases and 8,333 controls. RESULTS: Overall, a significantly elevated colorectal cancer risk was associated with variant allele 870A when all studies were pooled (AA vs. GG: OR = 1.23, 95%CI = 1.04-1.44; GA vs. GG: OR = 1.13, 95% CI = 1.01-1.26; dominant model: OR = 1.16, 95%CI = 1.03-1.31). In the subgroup analysis by ethnicity, significantly increased risks were detected among Caucasians (AA vs. GG: OR = 1.27, 95%CI = 1.04-1.44; and dominant model: OR = 1.17, 95%CI = 1.02-1.34). With stratification into sporadic CRC and hereditary nonpolyposis colorectal cancer (HNPCC), the former demonstrated increased cancer susceptibility (AA vs. GG: OR = 1.24, 95%CI = 1.04-1.48; dominant model: OR = 1.17, 95%CI = 1.04-1.33). However, no significant associations were found in either Asians or HNPCC patients for any genetic model. CONCLUSION: The results suggest that the cyclin D1 870A allele is a low-penetrant risk factor for development of sporadic colorectal cancer, especially among Caucasians.

[Transsacral local wide resection for mid-lower rectal tumors].

OBJECTIVE: To evaluate the efficacy of transsacral local wide resection for mid-lower rectal tumors. METHODS: Clinical data of 133 patients undergone transsacral local wide resection for mid-lower rectal tumors between September 1994 and September 2005 were analyzed retrospectively. RESULTS: No patient died during operation. Fecal fistula occurred in 6(4.5%) patients. Negative resection margin was proved histologically in all the patients. Postoperative diagnosis was adenoma in 28 patients, hyperplastic polyp in 3 patients, carcinoid in 8 patients, gastrointestinal stromal tumor in 1 patient,adenoma with intra-mucosal carcinogenesis in 29 patients and adenocarcinoma invading into submucosa in 64 patients. Median follow-up was 76 months in 64 patients with T(1) adenocarcinoma, whose 5-year cumulative local recurrence and overall survival were 2.0% and 100% respectively. No local recurrence was observed in other patients. CONCLUSION: Transsacral local wide resection is simple and safe for mid-lower rectal tumors, which is an appropriate procedure for mid-lower rectal benign tumor and can serve as a sphincter-saving operation for selected T(1) lower rectal carcinoma.

[Diagnosis and treatment of anorectal malignant melanoma--a report of 22 cases with literature review].

BACKGROUND & OBJECTIVE: Anorectal malignant melanoma (AMM) is an aggressive malignant tumor, and its treatment still remains controversial. This study was to summarize our experience on diagnosis and treatment of AMM. METHODS: Clinicopathologic records, including clinical feature, diagnosis, operation patterns, and prognosis, of 22 patients with AMM, treated in Jiangsu Provincial Cancer Hospital from 1977 to 2003, were analyzed retrospectively with literature review. RESULTS: The 22 patients with AMM accounted for 0.04% of all the patients diagnosed as malignant tumors of large bowel simultaneously in our hospital. Of the 22 patients, 6 were men, and 16 were women, with the median age of 61 (ranged 37-72). The most common complaints of AMM patients were hematochezia (86%), anus pain or discomfort (59%), local mass (27%), and so on. The misdiagnosis rate was 86%. The definite pathologic diagnosis rate before surgery was 48%. Of the 22 patients, 6 had distant metastasis; 11 underwent abdominoperineal resection, 5 underwent wide local excision (2 underwent salvage abdominoperineal resection who suffered from local recurrence after wide local excision), 2 underwent Parkos procedure, 1 underwent Hartmannos procedure, and 3 underwent sigmoid colostomy. The 1-, 3-, and 5-year survival rates of the 22 patients were 45.4%, 18.1%, and 9.1%, respectively. The median survival time was 12 months (95% confidence interval: 6-18 months). CONCLUSIONS: AMM is a rare disease with poor prognosis. It tends to be misdiagnosed. Abdominoperineal resection may be considered as the first choice for the AMM patients without distant metastasis.