Radical Surgery For Colorectal Cancer Research Articles

Is the lymph node ratio superior to the Union for International Cancer Control (UICC) TNM system in prognosis of colon cancer?

BackgroundDecision making for adjuvant chemotherapy in stage III colon cancer is based on the TNM system. It is well known that prognosis worsens with higher pN classification, and several recent studies propose superiority of the lymph node ratio (ln ratio) to the TNM system. Therefore, we compared the prognosis of ln ratio to TNM system in our stage III colon cancer patients.MethodsA total of 939 patients underwent radical surgery for colorectal cancer between January 2000 and December 2009. From this pool of patients, 142 colon cancer stage III patients were identified and taken for this analysis. Using martingale residuals, this cohort could be separated into a group with a low ln ratio and one with a high ln ratio. These groups were compared to pN1 and pN2 of the TNM system.ResultsFor ln ratio, the cutoff was calculated at 0.2. There was a good prognosis of disease-free and cancer-related survival for the N-category of the TNM system as well as for the lymph node ratio. There was no statistical difference between using the N-category of the TNM system and the ln ratio.ConclusionsThere might not be a benefit in using the lymph node ratio rather than the N category of the TNM system as long as the number of subgroups is not increased. In our consideration, there is no need to change the N categorization of the TNM system to the ln ratio.

Cost-Effectiveness Analysis of Postoperative Surveillance Protocols Following Radical Surgery for Colorectal Cancer

Introduction : Up to 30–50% of patients who undergo radical surgery for colorectal cancer (CRC) develop tumor relapse. The aim of this study was to assess various surveillance protocols utilized in a tertiary referral hospital in Northern italy.Methods : Data concerning 373 consecutive patients who underwent radical surgery for CRC between 1990 and 2006 and whose data had been entered into a prospective database were considered eligible for this study. the overall costs and the percentages of recurrence following the various surveillance protocols were calculated.Results : one hundred two (27.35%) of the patients suffered a recurrence after a mean of 17.6 (95% Ci 13.9–21.1) months. the combination of physical examination, colonoscopy, thorax-abdominal computed tomography (CT) scan, and serum carcinoembryonic antigen (CEA) dosage was found to be the most cost/effective one to monitor stages i and ii colon cancer; while physical examination, rigid sigmoidoscopy, thorax-abdominal CT scan, and serum Cea dosage were found to be the most cost/effective surveillance to monitor stages iii and iV of colon cancer and rectal cancer. Conclusions : Adherence to follow-up guidelines and early detection are vital factors affecting the curability of relapsed cancer in CRC patients who undergo surgery. the first five years after surgery was found to be the most risky period for recurrence. Cost/effectiveness analysis indicate that follow-up protocols should be tailored to the risk of recurrence with the aim of identifying relapse when the disease is at an asymptomatic, presumably more curable stage.

The Follow-up After Radical Surgery of Colorectal Cancer: Is it Time for a “Tailored” Strategy?

The problem of the surveillance for colorectal cancer after radical surgery is a widely debated argument. Like for other solid tumors, the issue is divided in 2 main routes: the early diagnosis of recurrence and the early diagnosis of a second primary cancer. Genetic and molecular features have been recognized as useful tools to measure these risks, however, the instruments are still insufficient to design a personalized strategy for the patient. In an era of "tailored therapies" in oncology, even the follow-up of the surgically treated patient for colorectal cancer should enter "a tailor's shop in which several competent tailors" should be available to manage a complex problem.

Value of microalbuminuria in fluid balance after abdominal surgery

To evaluate the relationship among the microalbuminuria, surgical stress and postoperative fluid balance after abdominal surgery. A total of 191 patients undergoing an elective abdominal operation were studied. According to the extent of operative trauma, all patients were divided into 4 groups. GroupI: laparoscopic cholecystectomy (n=64); Group II: laparotomy of cholecyst and biliary tract (n=36); Group III: radical surgery of colorectal cancer (n=43); Group IV: distal subtotal gastrectomy (D2) or total gastectomy (D3) or pancreaticoduodenectomy (n=48). The operative severities were predicated by surgical stress score (SSS). Urine albumin-creatinine ratio (ACR) was measured at both pre- and post-operation. The levels of ACR were compared by ANOVA among these 4 groups. The correlation of ACR and SSS was analyzed. In Groups III and IV, body weight was measured by weight-bed simultaneously. The correlation of variation of ACR at 0 and 6 hours post-operation (ΔACR) and the volume of positive fluid balance in the first 24 hour post-operation were studied. We also compared the varied durations of ACR levels returning to normal or the pre-operative level and body weight reaching peak values. The levels of ACR increased in all groups. The level of ACR was the highest in Group IV and the lowest in Group I, significantly different from the levels of group II and III. There was a significant positive correlation between the increase in ACR and the severity of surgical trauma as measured by SSS. A positive correlation was observed between the volume of positive fluid balance in the first 24 hour post-operation and ΔACR at 0 and 6 hours post-operation. The varied duration of ACR levels returning normal or the pre-operative level was earlier than that of reaching the peak values. ACR has a positive correlation with the extent of surgical stress and volume of positive fluid balance. The fact that the ACR comes earlier than the change of body weight indicates that the change of ACR is a more sensitive and simpler parameter than body weight to predict the onset of negative fluid balance.

Effects of preoperative oral glucose on perioperative insulin resistance and plasma proteins of intestinal surgery

To investigate the effects of oral intake of glucose solution before surgery on the pH at the lower esophagus, perioperative blood glucose level, and plasmic protein in patients undergoing radical resection for colorectal cancer. Between January 2008 and December 2008, 60 patients undergoing radical surgery for colorectal cancer were enrolled and randomized into three groups using the table of random digits. Four patients were withdrawn from the study. Patients in group A (n=19) were given 800 ml of 12.5% glucose solution for oral intake the night before surgery, and 200 ml two hours before surgery. Patients in group B (n=19) were given distilled water instead of glucose. Patients in group C (n=18) were asked to fast for 8-12 hours before operation. Combined general and epidural anesthesia was used. pH at the lower esophagus was monitored during intubation and extubation. Albumin, transferrin, prealbumin, insulin, and fasting blood glucose were measured before surgery and at postoperative day 1, 3, and 7. pH at the lower esophagus was 8.05±0.43 in group A, 7.98±0.41 in group B, and 7.94±0.41 in group C. There were no perioperative acid regurgitations (P>0.05). Serum insulin in group A at postoperative day 1 was (16.32±16.11) μU/L, which was significantly lower than that in group B (30.65±41.74) μU/L and group C (34.01±52.91) μU/L. Log HOMA-IR in group A at postoperative day 1 was significantly lower than that in group B and group C (0.49±0.35 vs. 0.59±0.56 and 0.60±0.63, P<0.05). Transferrin in group C at postoperative day 3 and 7 was significantly lower than that in the other two groups, as was albumin at postoperative day 3 (P<0.05). Oral liquid intake 2 hours before surgery is not associated with increased risk of regurgitation or aspiration during intubation and extubation, and may glucose solution intake reduce insulin resistance and protein degradation after colorectal surgery.

The correlation between the number of lymph nodes identified and treatment outcomes in colorectal cancer patients: Single-institution experience.

e14096 Background: Colorectal cancer is the third leading cause of cancer-related death in the Western world. International guidelines recommend evaluating at least 12 locoregional lymph nodes (LNs) on curative surgery to obtain optimal staging information and satisfactory long-term outcomes. In the United States, adequate number of LN identified is achieved in 37% of cases. This study aimed to evaluate the impact of LN status on survival rates in colorectal cancer patients in a single institution setting. Methods: We analyzed data on all patients undergoing radical surgery for colorectal cancer in the Bon Secours Hospital Cork in Ireland between years 2000 and 2006. Numbers of LN identified and number of LN infiltrated were recorded. The lymph node ratio (LNR) was calculated using following formula: LNR = LN infiltrated/LN identified. Overall survival (OS) was used as a primary endpoint. Multivariate analyses were performed on all patients and on following LNR groups: LNR < 0.05, 0.05-0.19, 0.2-0.39, and 0.4-1.0. Covariates included were age, sex, tumor grade, tumor location, lymphovascular and perineural invasion. Results: In total 265 patients were included in this study. The median age was 66 years (range 34 to 89). One hundred and thirty-three patients (50.2%) had 11 or less LNs examined, and 132 patients (49.8%) had 12 or more LNs examined. Mean OS was 73 months for all patients. Patients in the Dukes C2 category (> 3 LN infiltrated and/or tumour infiltrating adjacent structure) who had 12 or more LNs identified had a better OS compared to those who had 11 or less LNs investigated (hazard ratio 0.677 [95%CI 0.45-1.01]). Patients in all Dukes categoreis who had a lower LNR had a significantly better OS than those with a higher LNR (p < 0.0001). Conclusions: Nearly 50% of patients with colorectal cancer undergoing radical surgery had 12 or more lymph nodes investigated. A higher number of LN identified was associated with better survival in the Dukes C2 category. A higher number of LN infiltrated was associated with shorter survival. No significant financial relationships to disclose.

The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective, randomized clinical study

Although colonoscopy plays an important role in postoperative surveillance of patients with colorectal cancer, the optimum protocol for colonoscopic surveillance has not been established. Our purpose was to compare the efficacy of 2 different colonoscopic surveillance strategies in terms of both survival and recurrence resectability. Prospective, randomized, controlled trial. A teaching hospital in Sun Yat-sen University. Three hundred twenty-six consecutive patients undergoing radical surgery for colorectal cancer. In the intensive colonoscopic surveillance group (ICS group, n = 165), colonoscopy was performed at 3-month intervals for 1 year, at 6-month intervals for the next 2 years, and once a year thereafter. In the routine colonoscopic surveillance group (RCS group, n = 161), colonoscopy was performed at 6 months, 30 months, and 60 months postoperatively. The 5-year survival rate was 77% in the ICS group and 73% in the RCS group (P > .05). Postoperative colorectal cancer was detected in 13 patients (8.1%) in the ICS group and in 18 patients (11.4%) in the RCS group. In the ICS group, there were more asymptomatic postoperative colorectal cancers (P = .04), more patients had reoperation with curative intent (P = .048), and the probability of survival after postoperative colorectal cancer was higher (P = .03). Lack of detailed characterization of metachronous colorectal adenomas in these patients. Although the patients in the ICS group had more curative operations for postoperative colorectal cancer and survived significantly longer, ICS itself did not improve overall survival.

Preoperative interleukin‐6 production by mononuclear blood cells predicts survival after radical surgery for colorectal carcinoma

Colorectal cancer is one of the most common forms of cancer in the Western world. Staging based on histopathology is currently the most accurate predictor of outcome after surgery. Colorectal cancer is curable if treated at an early stage (stage I-III). However, for tumors in stages II and III there is a great need for tests giving more accurate prognostic information defining the patient population in need of closer follow-up and/or adjuvant therapy. Furthermore, tests that provide prognostic information preoperatively could provide a guide both for preoperative oncologic treatment and the surgical procedure. Peripheral blood mononuclear cells (PBMCs) were isolated preoperatively, within a week before primary surgery, from 39 patients undergoing surgery for colorectal cancer. The PBMCs were cultured in vitro for 24 hours in the presence of autologous serum and lipopolysaccharide (LPS). Interleukin-6 (IL-6) production was measured with enzyme-linked immunosorbent assay (ELISA). Staging based on histopathology was performed in all patients. Patients were followed for at least 54 months. A production of >5000 pg/mL of IL-6 identified colorectal cancer patients with a poor prognosis. Eight out of 13 patients with >5000 pg/mL IL-6 died from cancer within the follow-up period, whereas no cancer-related deaths were recorded among 21 patients with 5000 pg/mL IL-6 or less. A multivariate Cox regression analysis, stratified for T- and N-stage, identified IL-6 production as an independent prognostic factor. IL-6 production in vitro by PBMC can predict survival after radical surgery for colorectal cancer.

Pre-operative interleukin-6 production by mononuclear blood cells predicts survival after radical surgery for colorectal carcinoma (49.31)

Abstract Colorectal cancer (CRC) is one of the most common forms of cancer in the Western world with an estimated yearly incidence rate of 77 per 100 000 in North America. Besides histopathological staging, there is a great need for tests giving more accurate prognostic information defining the patient population in need of closer follow-up and/or adjuvant therapy. Elevated serum levels of IL-6 have been found in patients with CRC. The source of the serum IL-6 is still unclear. Peripheral blood mononuclear cells (PBMC) were isolated preoperatively (within a week before surgery) from 34 patients undergoing radical surgery for colorectal cancer. The PBMCs were cultured for 24 hours in the presence of autologous serum and LPS. IL-6 production was measured with ELISA. Staging based on histopathology was performed in all patients. A production of &amp;gt;5000 pg/ml of IL-6 identified CRC patients with a poor prognosis. Eight out of thirteen patients with &amp;gt;5000 pg/ml IL-6 died from cancer within the follow-up period (at least 54 months) whereas no cancer related deaths were recorded among twenty-one patient with 5000 pg/ml IL-6 or less. IL-6 production was identified as an independent prognostic factor. These data support the hypothesis that the adaptive immune system is of importance for tumour progression and that immunological parameters can serve as useful as prognostic and predictive tools in cancer management.

Surveillance after radical surgery for colorectal cancer

Abstract Follow-up of patients with colorectal cancer after radical surgery has become a traditional component of their care but remains controversial. This follow-up is often resource intense, but the evidence to date for its effectiveness has been lacking. Randomized controlled trials have been conducted to test the effectiveness of follow-up in improving patient outcomes, and a Cochrane systematic review of these trials is in progress. Additional clinical trials of follow-up in colorectal cancer patients are underway, and their results may be included in future updates of the systematic review. Copyright © 2002 by W.B. Saunders Company

Surveillance after radical surgery for colorectal cancer

Surveillance after radical surgery for colorectal cancer

Effectiveness of postoperative surveillance after radical surgery for colorectal cancer (CRC). Preliminary analysis of a multicenter, randomized controlled trial

Effectiveness of postoperative surveillance after radical surgery for colorectal cancer (CRC). Preliminary analysis of a multicenter, randomized controlled trial

Effectiveness of postoperative surveillance after radical surgery for colorectal cancer (CRC). Preliminary analysis of a multicenter, randomized controlled trial

Effectiveness of postoperative surveillance after radical surgery for colorectal cancer (CRC). Preliminary analysis of a multicenter, randomized controlled trial

Postoperative septic complications and neoplastic progression in colorectal cancer

Abstract Background Proinflammatory cytokines, mainly interleukin (IL) 6, may induce suppressive effects on antitumour immunity. IL-6 inhibits T lymphocyte proliferation and maturation of dendritic cells. In the postoperative period, an increase in IL-6 serum level due to surgical trauma is a normal finding. Very high levels of IL-6 are detected only in patients with septic complications. In consideration of the suppressive effects of IL-6 on antitumour immunity, septic complications may promote a worsening of the late prognosis of patients undergoing radical treatment for cancer. To detect a possible negative effect on cancer progression due to sepsis after colorectal surgery, this study was carried out in patients who underwent radical surgery (Dukes' B and C stages). Cancer-related late recurrence and mortality rates were compared in patients with and without postoperative septic complications. Methods Patients who underwent operation for colorectal cancer between January 1987 and December 1998 were studied. Patients treated by emergency surgery, patients aged over 80 years, those with a previous or second neoplasm and patients treated with steroid therapy or other immunomodulatory drugs were excluded. Major surgical postoperative septic complications were considered: wall and intra-abdominal abscess and anastomotic leakage. Five-year survival (Kaplan–Meier curve) and recurrence rates were recorded. Results Some 210 patients were studied; 137 patients with a mean age of 65 (range 22–80) years and median follow-up of more than 5 years (range 12–144 months) had Dukes' B disease (77 men and 60 women). Of these 137 patients, 28 (20 per cent) had septic complications. Thirteen of 28 patients with sepsis had progression of cancer disease compared with 26 of 109 without sepsis (P &amp;lt; 0·03). In patients with sepsis the 5-year mortality rate was 32 per cent (nine of 28), worse than that in patients without sepsis (19 per cent; 21 of 109). Seventy-three patients (41 men and 32 women), of mean age 64 (range 38–80) years, with median follow-up greater than 5 years (range 13–120 months), had Dukes' C lesions. Of these 73 patients, 16 (22 per cent) had septic complications. Thirteen of 16 patients with sepsis had progression of cancer disease compared with 33 of 57 without sepsis. In those with sepsis the 5-year mortality rate was 75 per cent (12 of 16), significantly worse than that in patients without sepsis (40 per cent; 23 of 57) (P &amp;lt; 0·02). Conclusion The immunological response against cancer is generally impaired after major surgery owing to lymphocytopenia and lack of dendritic cells. It is known that IL-6 promotes suppression of antitumour-specific (dendritic cells and CD8 cytotoxic cells) and aspecific (IL-2 activation of lymphokine-activated killer cells) systems. The increase in IL-6 levels after surgery is relevant in patients with septic complications and this phenomenon may negatively influence the immunological control of malignant spread. As hypothesized, septic complications after radical surgery for colorectal cancer were followed by an increased recurrence rate in patients with both Dukes' B and C tumours. This finding supports a significant role for the immune system in the control of malignant progression of disease. The postoperative course represents a vulnerable period since septic complications and secondary immunosuppression negatively influence a cancer-related prognosis.

Influence of Follow-up on Health-Related Quality of Life after Radical Surgery for Colorectal Cancer

Background: The possible benefit for patients of follow-up examinations after curative surgery for colorectal cancer is at present not proven. The purpose of this study was to evaluate the influence of follow-up examinations on health-related quality of life and to assess the attitude of the patients to check-ups. Methods: A total of 350 patients who had had curative surgery for colorectal cancer and who had been subsequently randomized to either frequent follow-up or virtually no follow-up completed the Nottingham Health Profile and a second questionnaire assessing their attitude to the follow-up visits. Results: The patients who were receiving more frequent follow-up had greater confidence in the check-ups, but the improvement in the health-related quality of life was only marginally better than that of those receiving few follow-up visits. Conclusion: The relatively small benefit for health-related quality of life does not justify expensive frequent routine examinations after surgery for colorectal cancer. The Nottingham Health Profile proved to be a reliable instrument within this patient group.

Value of postoperative surveillance after radical surgery for colorectal cancer: results of a cohort study.

Early detection of recurrence after curative resection for primary colorectal cancer should improve patients' prognosis. However, the usefulness of postoperative surveillance programs has not been clarified yet. The present cohort study was aimed at assessing the effectiveness of systematic follow-up in patients with colorectal cancer who were operated on for cure, regarding both rate of tumor recurrence amenable to curative-intent surgery and rate of survival. One hundred ninety-nine colorectal cancer patients who underwent radical primary surgery were followed according a well-defined postoperative surveillance program, which consisted of laboratory studies (including serum carcinoembryonic antigen assay) every three months, physical examination and abdominal ultrasound or computed tomography every six months, and chest radiograph and total colonoscopy once per year. Cohorts were defined according to patients' compliance with the proposed follow-up program. A multivariate regression model was constructed to predict survival. One hundred forty patients were considered to be compliant with the surveillance program, whereas the remaining 59 patients occasionally attended follow-up investigations or did not comply at all. Although there were no differences in the overall recurrence rate (38 vs. 41 percent; P = 0.52), curative-intent reoperation was possible in 18 patients (34 percent) of those with tumor recurrence in the compliant cohort but in only 3 patients (12 percent) in the noncompliant cohort (P = 0.05). Similarly, the probability of survival was higher in the compliant cohort, both regarding overall (63 vs. 37 percent at 5 years; P < 0.001) and cancer-related (69 vs. 49 percent at 5 years; P < 0.02) rates. Cox regression analysis disclosed that only a more advanced TNM stage (odds ratio, 8.17; 95 percent confidence interval, 1.13-59.29) and noncompliance with the postoperative surveillance program (odds ratio, 2.32; 95 percent confidence interval, 1.50-3.60) had an independent negative impact on survival. Systematic postoperative surveillance in patients with colorectal cancer who were operated on for cure increases both the rate of tumor recurrence amenable to curative-intent surgery and rate of survival.

739 - The value of postoperative surveillance after radical surgery for colorectal cancer

PURPOSE: Early detection of recurrence after curative resection for primary colorectal cancer should improve patients' prognosis. However, the usefulness of postoperative surveillance programs has not been clarified yet. The present cohort study was aimed at assessing the effectiveness of systematic follow-up in patients with colorectal cancer who were operated on for cure, regarding both rate of tumor recurrence amenable to curative-intent surgery and rate of survival. METHODS: One hundred ninety-nine colorectal cancer patients who underwent radical primary surgery were followed according a well-defined postoperative surveillance program, which consisted of laboratory studies (including serum carcinoembryonic antigen assay) every three months, physical examination and abdominal ultrasound or computed tomography every six months, and chest radiograph and total colonoscopy once per year. Cohorts were defined according to patients' compliance with the proposed follow-up program. A multivariate regression model was constructed to predict survival. RESULTS: One hundred forty patients were considered to be compliant with the surveillance program, whereas the remaining 59 patients occasionally attended follow-up investigations or did not comply at all. Although there were no differences in the overall recurrence rate (38vs. 41 percent;P=0.52), curative-intent reoperation was possible in 18 patients (34 percent) of those with tumor recurrence in the compliant cohort but in only 3 patients (12 percent) in the noncompliant cohort (P=0.05). Similarly, the probability of survival was higher in the compliant cohort, both regarding overall (63vs. 37 percent at 5 years;P<0.001) and cancer-related (69vs. 49 percent at 5 years;P<0.02) rates. Cox regression analysis disclosed that only a more advanced TNM stage (odds ratio, 8.17; 95 percent confidence interval, 1.13–59.29) and noncompliance with the postoperative surveillance program (odds ratio, 2.32; 95 percent confidence interval, 1.50–3.60) had an independent negative impact on survival. CONCLUSION: Systematic postoperative surveillance in patients with colorectal cancer who were operated on for cure increases both the rate of tumor recurrence amenable to curative-intent surgery and rate of survival.

A prospective randomized study of follow-up after radical surgery for colorectal cancer

The possible benefit for patients from follow-up examinations after curative surgery for colorectal cancer is unproven. The purpose of this study was to determine whether survival is improved by frequent follow-up examinations. A total of 597 patients less than 76 years old treated with radical surgery for colorectal cancer were included in the study from 1983 to 1994. Patients were randomized to frequent follow-up (group 1) or virtually no follow-up (group 2) with examinations at 5 and 10 years. Group 1 comprised 290 patients, group 2 contained 307. Recurrence was equally frequent (26 per cent), but the time of diagnosis was 9 months earlier in group 1; also, more recurrences were asymptomatic in group 1 and more patients had new surgery with curative intent (P = 0.02). However, no improvement in overall survival or in cancer-related survival resulted. Patients subjected to intensive follow-up have recurrence diagnosed earlier, and have more operations for recurrence, but the survival results suggest that any major improvement by intensive follow-up is unlikely.

A prospective randomized study of follow-up after radical surgery for colorectal cancer

A prospective randomized study of follow-up after radical surgery for colorectal cancer

Accumulation of p53 in relation to long-term prognosis in colorectal carcinoma

To evaluate the prognostic value of p53 in colorectal cancer. A retrospective study to investigate the correlation between p53 in tumour tissue and the course of patients' disease. One hundred and two patients who underwent radical surgery for colorectal cancer and were followed up for a minimum of 5 years, or until death, were included in this study. The p53 expression in tumour tissue was studied by immunohistochemistry using CM1 polyclonal rabbit antibody and formalin-fixed, paraffin-embedded material. p53 accumulation was detected in 46% (47/102) of the tumours. There was no significant difference in long-term survival between the patients with p53 positive and negative tumours (P=0.86). Five-year survival rates were 55% for p53 positive tumours compared with 56% for patients with p53 negative tumours. However, patients with p53 overexpressing tumours showed a higher local recurrence rate than those having carcinomas with undetectable levels of p53, 23% versus 9% respectively; the 2-year actuarial rates of 26% and 9% were statistically different (P=0.015). The results suggest that in colorectal carcinoma accumulation of p53 is not associated with a difference in long-term prognosis. However, this phenomenon might be useful in the identification of patients with a high risk of local recurrence.