Rectal Cancer Group Research Articles

The gentamicin-collagen implant and the risk of distant metastases of rectal cancer following short-course radiotherapy and curative resection: the long-term outcomes of a randomized study

PurposeA previous randomized study conducted by our group showed that application of gentamicin-collagen implant (GCI) into the pelvic cavity after total mesorectal excision (TME) reduced the incidence of distant metastases. Therefore, we decided to conduct a confirmatory study.MethodsPatients with rectal cancer were included in the study if they met the following criteria: adenocarcinoma of the rectum, preoperative short-term radiotherapy (5 × 5 Gy), and WHO performance score 0–1.ResultsOne hundred seventy-six patients were randomly assigned either to an experimental group in which GCI was applied (n = 81) or to a control group without GCI (n = 81). Median follow-up was 80 months. Cumulative incidence of distant metastases at 5 years was higher in the control group compared to the experimental group: 23.5 vs 8.6% (HR 2.4 [95% CI 1.1–5.5], P = 0.005). Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) did not differ between the experimental group and the control group: HR 0.95 [95% CI 0.55–1.70], P = 0.864; HR 0.85 [95% CI 0.50–1.45], P = 0.548, and HR 0.5 [95%CI 0.22–1.22], P = 0.093, respectively. The predefined by the protocol subgroup analysis for yp stage III disease showed better DFS in the experimental group compared to the control group; HR 0.47 [95%CI 0.23–0.97], P = 0.042).ConclusionsThe results confirmed our previous finding that GCI applied in the pelvis significantly reduced the rate of distant metastases in patients after radical rectal cancer resection.

Clinical Significance of Pelvic Peritonization in Laparoscopic Dixon Surgery.

Background:Pelvic floor peritoneum reconstruction is a key step in various standard resections for open radical rectal cancer. However, during endoscopic surgery, most surgeons do not close the pelvic floor peritoneum. This study aims to evaluate the efficacy of pelvic peritonization during laparoscopic Dixon surgery using an observational study.Methods:A total of 189 patients, who underwent laparoscopic Dixon surgery at Tianjin Union Medical Center, China, were analyzed retrospectively. All of the cases were divided into two groups according to the differences of surgical procedure. The 92 patients in Group A (observation group) underwent pelvic peritonization and the 97 patients in Group B (control group) did not undergo this procedure. Postoperative complications were observed in the two groups, compared, and analyzed using the Chi-square or Fisher's exact test.Results:The incidence of anastomotic leakage was significantly lower in Group A than in Group B (P = 0.014). A significant difference was found in the postoperative short-term (P = 0.029) and long-term (P = 0.029) ileus rates between the two groups, with Group A exhibiting a lower rate than Group B. Patients in Group A had significantly lower rates of postoperative infections than those in Group B (χ2 = 7.606, P = 0.006; χ2 = 4.464, P = 0.035). Patients in Group A had significantly lower rates of deep venous thrombosis than those in Group B (χ2 = 8.531, P = 0.003).Conclusions:Pelvic peritonization effectively reduces postoperative complications, such as anastomotic leakage, which warrants its increased use in laparoscopic surgery.

Impact of primary tumor site on the prognosis in different stage colorectal cancer patients after radical resection

Objective: To analyze the effect to the prognosis of tumor site on the patients of colorectal cancer after curative resection with different stage. Methods: Clinicopathological and follow-up data of 2 097 colorectal carcinoma cases undergoing resection at Fourth Hospital of Hebei Medical University from January 2008 to March 2015 were retrospectively analyzed. There were 421 patients in left-sided colorectal cancer (LCC) group (including carcinoma in cecum, ascending colon , hepatic flexure, and transvers colon) , 386 in right-sided colorectal cancer (RCC) group (including carcinoma in splenic flexure, descending colon and sigmoid colon) and 1 290 in rectal cancer (RECC) group. Clinicopathologic features in patients with different tumor location were compared. 5-year overall survival rate were compared among the 3 groups. Patients were stratified by different stage to analyze the effect of tumor location on the prognosis. χ(2)test and Kruskal-Wallis rank-sum test were used to compare the clinicopathological features among the 3 groups, Kaplan-Meier curve and Log-rank test were used to analyze prognosis, respectively. Results: No significant differences were identified between the three groups in age, family history, N stage and intestinal obstruction. Significant difference were found in gender among LCC, RCC and RECC group (male were 62.5% vs. 54.9% vs.56.3%, χ(2)=6.040, P=0.049) . Compared with LCC group and RCC group, RECC group had more well and moderately differentiated adenocarcinoma patients (89.7% vs. 86.0% vs. 82.4%, χ(2)=10.712 and 17.385, P=0.013 and 0.001) , more stage Ⅰ patients (17.1% vs. 6.9% vs. 6.5%, χ(2)=37.459 and 37.208, P=0.000 and 0.000) , and less likely to be stage T4 (44.7% vs. 76.7% vs.78.5%, χ(2)=128.015 and 133.704, P=0.000 and 0.000), metastasis (2.6% vs. 5.7% vs. 3.6%, χ(2)=1 417.167 and 1 424.217, P=0.000 and 0.000) and intestinal obstruction (11.3% vs. 21.1% vs. 24.4%, χ(2)=25.846 and 41.141, P=0.000 and 0.000). Five-year survival rate reduced in turn in the patients with RECC, LCC and RCC(70.9%, 59.8%, 58.9%, χ(2)=11.577, P=0.009). In the subgroup of stage Ⅲ, patients with different tumor location had different overall survival (χ(2)=9.878, P=0.007). Compared to right-sided colon cancer patients, rectal ones had significantly better overall survival (χ(2)=9.271, P=0.002); but in the subgroup of stage Ⅰ, Ⅱ and stage Ⅳ, patients with different tumor location had similar overall survival (P were 0.124, 0.888, 0.263, respectively). Conclusions: Colorectal cancer patients with tumor location had different clinicopathologic features. Patients with rectal cancer had better five-year survival rate than those with left located and right located colon cancer. Tumor location had different effects on the prognosis according to the different TNM stage-subgroups.

Risk and predictors of suicide in colorectal cancer patients: a Surveillance, Epidemiology, and End Results analysis.

The risk of suicide is higher for patients with colorectal cancer (crc) than for the general population. Given known differences in morbidity and sites of recurrence, we sought to compare the predictors of suicide for patients with colon cancer and with rectal cancer. Using the U.S. Surveillance, Epidemiology, and End Results database, adult patients with confirmed adenocarcinoma of the colon or rectum during 1973-2009 were identified. Parametric and nonparametric tests were used to assess selected variables, and Cox proportional hazards regression models were used to determine predictors of suicide. The database identified 187,996 patients with rectal cancer and 443,368 with colon cancer. Compared with the rectal cancer group, the colon cancer group was older (median age: 70 years vs. 67 years; p < 0.001) and included more women (51% vs. 43%, p < 0.001). Suicide rates were similar in the colon and rectal cancer groups [611 (0.14%) vs. 337 (0.18%), p < 0.001]. On univariate analysis, rectal cancer was a predictor of suicide [hazard ratio (hr): 1.26; 95% confidence interval (ci): 1.10 to 1.43]. However, after adjusting for clinical and pathology factors, rectal cancer was not a predictor of suicide (hr: 1.05; 95% ci: 0.83 to 1.33). In the colon cancer cohort, independent predictors of suicide included older age, male sex, white race, and lack of primary resection. The aforementioned predictors, plus metastatic disease, similarly predicted suicide in the rectal cancer cohort. The suicide risk in crc patients is low (<0.2%), and no difference was found based on location of the primary tumour. Sex, age, race, distant spread of disease, and intact primary tumour were the main predictors of suicide among crc patients. Further studies and interventions are needed to target these high-risk groups.

Assessment of the relationship between neutrophil lymphocyte ratio and prognostic factors in non-metastatic colorectal cancer.

Neutrophil-lymphocyte ratio still has a limited clinical use due to many non-cancer factors affecting neutrophils or lymphocytes in the present time. We aimed to evaluate the association between preoperative neutrophil-lymphocyte ratio and poor prognostic factors after curative elective colorectal surgery. This clinical retrospective study was initiated with 95 patients, who had a curative surgical resection between 2003 and 2013. The patients were divided into two groups based on the preoperative neutrophil-lymphocyte ratio cut-off value above and below 3. The groups were compared for tumor localization, diameter, and staging; the histopathological perineural invasion; lymphovascular invasion; and overall survival. Univariate and multivariate Cox regression analyses were used to determine the role of neutrophil-lymphocyte ratio after stratification by several clinicopathological factors. The mean age of patients was 59.79±1.48 (range, 23-90) years, and median follow-up period was 20.77±14.85 months. There was no significant difference in perineural or lymphovascular invasion, tumor size, stage, age, sex, and tumor location between the groups [Group 1 ratio >3 (n=52) and Group 2 ratio ≤3(n=43)]. Hemoglobin (p=0.035) and albumin levels (p=0.004) were lower in the Group 1. When the stage increased, differences between the rectal cancer groups were found. Overall survival was significantly lower in the Group 1 (p=0.013). The study showed that a high neutrophil-lymphocyte ratio had an adverse effect on overall survival in colorectal cancer patients who had a curative surgery. However, we could not establish any association between neutrophil-lymphocyte ratio and the factors such lymphovascular invasion, perineural invasion, tumor size expect hemoglobin and serum albumin levels.

Real-time simulation of soft tissue deformation and electrocautery procedures in laparoscopic rectal cancer radical surgery.

Laparoscopic surgery (LS), also referred to as minimally invasive surgery, is a modern surgical technique which is widely applied. The fulcrum effect makes LS a non-intuitive motor skill with a steep learning curve. A hybrid model of tetrahedrons and a multi-layer triangular mesh are constructed to simulate the deformable behavior of the rectum and surrounding tissues in the Position-Based Dynamics (PBD) framework. A heat-conduction based electric-burn technique is employed to simulate the electrocautery procedure. The simulator has been applied for laparoscopic rectum cancer surgery training. From the experimental results, trainees can operate in real time with high degrees of stability and fidelity. A preliminary study was performed to evaluate the realism and usefulness. This prototype simulator has been tested and verified by colorectal surgeons through a pilot study. They believed both the visual and the haptic performance of the simulation are realistic and helpful to enhance laparoscopic skills.

Tissue-Associated Bacterial Alterations in Rectal Carcinoma Patients Revealed by 16S rRNA Community Profiling.

Sporadic and inflammatory forms of colorectal cancer (CRC) account for more than 80% of cases. Recent publications have shown mechanistic evidence for the involvement of gut bacteria in the development of both CRC-forms. Whereas, colon and rectal cancer have been routinely studied together as CRC, increasing evidence show these to be distinct diseases. Also, the common use of fecal samples to study microbial communities may reflect disease state but possibly not the tumor microenvironment. We performed this study to evaluate differences in bacterial communities found in tissue samples of 18 rectal-cancer subjects when compared to 18 non-cancer controls. Samples were collected during exploratory colonoscopy (non-cancer group) or during surgery for tumor excision (rectal-cancer group). High throughput 16S rRNA amplicon sequencing of the V4–V5 region was conducted on the Ion PGM platform, reads were filtered using Qiime and clustered using UPARSE. We observed significant increases in species richness and diversity in rectal cancer samples, evidenced by the total number of OTUs and the Shannon and Simpson indexes. Enterotyping analysis divided our cohort into two groups, with the majority of rectal cancer samples clustering into one enterotype, characterized by a greater abundance of Bacteroides and Dorea. At the phylum level, rectal-cancer samples had increased abundance of candidate phylum OD1 (also known as Parcubacteria) whilst non-cancer samples had increased abundance of Planctomycetes. At the genera level, rectal-cancer samples had higher abundances of Bacteroides, Phascolarctobacterium, Parabacteroides, Desulfovibrio, and Odoribacter whereas non-cancer samples had higher abundances of Pseudomonas, Escherichia, Acinetobacter, Lactobacillus, and Bacillus. Two Bacteroides fragilis OTUs were more abundant among rectal-cancer patients seen through 16S rRNA amplicon sequencing, whose presence was confirmed by immunohistochemistry and enrichment verified by digital droplet PCR. Our findings point to increased bacterial richness and diversity in rectal cancer, along with several differences in microbial community composition. Our work is the first to present evidence for a possible role of bacteria such as B. fragilis and the phylum Parcubacteria in rectal cancer, emphasizing the need to study tissue-associated bacteria and specific regions of the gastrointestinal tract in order to better understand the possible links between the microbiota and rectal cancer.

Skills of camera-assisted laparoscopic rectal cancer radical surgery

Objective To investigate the action and skills of camera-assisted laparoscopic rectal cancer radical surgery. Methods From January 2009 to May 2015, a total of 577 cases with rectal cancer underwent laparoscopic rectal cancer radical surgery, including 152 cases of abdominal perineal resection, and 425 cases of abdominal resection. The skills of camera-assisted operation were summarized. Results All the operations were successfully completed without serious complications. Conclusions Regarding for skills of camera assistant, mastering the clinical topography of rectum, understanding the operational habit of operator, understanding operating procedure and operation characteristics are the necessary condition to complete laparoscopic rectal cancer radical surgery. Key words: Laparoscopy/MT; Rectal neoplasms/SU

Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades.

The advent of total mesorectal excision (TME) together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results. However, the incidence of bladder and sexual dysfunction remains high. This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur. The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes. In this review, we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle, the lateral pelvic wall and dissection around the urogenital organs. Surgical techniques in these areas are discussed. We also discuss the results in functional outcomes of the various techniques including open, laparoscopic and robotic over the last 30 years.

Study the Possible Link Between Toxoplasmosis and Different Kinds of Cancer in Iraq

Introduction: Toxoplasma gondii is an obligate intracellular protozoan parasite which infects a wide range of warm-blooded animals and humans. Cancer remains a leading cause of death worldwide, responsible for approximately 13% of global deaths. Worldwide, the prevalence of human infection with T. gondii has been increasing. However, little is known about the epidemiology of T. gondii infection in different cancer patient groups in Iraq. Thus, the objective of the present study was to determine the prevalence of anti- T. gondii antibodies in patients with four different types of cancer (breast, rectum, thyroid, and leukemia). Methods: Blood samples were collected from 300 patients with cancer and 150 apparently healthy controls and the sera were tested for the presence of anti- T. gondii antibodies (IgG and IgM) using enzyme linked immunosorbent assay (ELISA). Results: The prevalence of anti- T. gondii IgG in cancer patients (49.0%) was significantly higher (P < 0.001) than that in controls (19.3%). The highest T. gondii IgG positivity rate was detected in breast cancer group (56.6%) followed by rectal cancer group (54.0%), thyroid cancer group (44.6%) and leukemia cancer group (36.0%). It is interesting to note that three male patients were infected with breast cancer and only one (33.3%) was seropositive with IgG. In rectum, thyroid gland, and leukemia cancer groups, the anti- T. gondii IgG seropositivity was higher in males than in female patients but the differences were significant (P < 0.05) only in rectum and leukemia groups. The highest seropositivity rates were detected in breast, rectal and leukemia cancer patients aged 51 to 60 years. Conclusions: In conclusion, Toxoplasmosis is significantly more prevalent in cancer patients than in apparently healthy volunteers and accordingly we recommend routine screening of all cancer infected patients for IgG anti- Toxoplasma gondii antibodies and treat the seropositive ones.

Expression of CD133 in rectal cancer tissues and its relationship with neoadjuvant chemoradiotherapy

To investigate the association of CD133 expression in rectal cancer tissues with neoadjuvant chemoradiotherapy (nCRT) and tumor regression grading (TRG) after nCRT. Radical resected rectal cancer specimens and clinicopathological data of 105 patients, including 60 men and 45 women with median age of 59 years, diagnosed as locally advanced rectal cancer in Peking Union Medical College Hospital from January 2008 to December 2014 were collected retrospectively. Thirty-nine and 66 cases were histologically classified as good-moderate and poor differentiation respectively. Sixty-eight and 37 cases were clinically graded as stage I(-II( and III(-IIII( in preoperative assessment respectively. NCRT was administered in 61 cases before surgery (nCRT group). The nCRT consisted of preoperative pelvic radiotherapy using 50 Gy (2 Gy once, for 25 sessions) with FOLFOX regimen (5-fluorouracil plus oxaliplatin) for 2-3 cycles or XELOX regimen (capecitabine plus oxaliplatin) for 2 cycles. Patients underwent surgery after 6 courses of nCRT, and then received the same previous chemotherapy regimen. In nCRT group, biopsy specimens before nCRT were obtained in 45 cases. Forty-four cases received surgery alone without nCRT (surgery alone group). CD133 expression was tested by immunohistochemical Envision two-step methods. The histological TRG evaluation was performed in the nCRT group. TRG score 0-2 was defined as insensitivity to nCRT, whereas TRG score 3-4 was defined as sensitivity. CD133 expression in rectal cancer samples before and after nCRT was compared. Association of CD133 expression with TRG after nCRT was examined. No significant differences of baseline parameters were found between nCRT group and surgery alone group (all P>0.05). The positive rate of CD133 in nCRT group was 70.4%(43/61,) which was significantly higher than that in surgery alone group (47.7%, 21/44)(χ(2)=5.566, P=0.018) and that in biopsy samples before nCRT group (44.4%, 20/45)(χ(2)=7.287, P=0.007). Twenty-two cases (36.1%, 22/61) in nCRT group had TRG score of 3-4 . Among these 22 cases, 11 cases were negative CD133, and constituted 61.1% (11/18) of all CD133-low expression cases in nCRT group, whereas the other 11 cases were positive CD133, and constituted 25.6%(11/43) of all CD133-high expression cases in nCRT group (χ(2)=6.974, P=0.008). The CD133 expression up-regulates markedly in rectal cancer after nCRT and nCRT may have potential positive modulation on CD133 expression. CD133-positive cancer reveals lower response to nCRT, suggesting CD133 may be a potential target for improving efficacy of nCRT in rectal cancer.

New tumour regression grade for rectal cancer after neoadjuvant therapy and radical surgery

s / 60 (2016) e1ee19 e3 failures were within distant sites, and 53% of patients had neural pathway involvement. Initial tumour location predicted local site recurrence (p < 0.0001), regional site recurrence (p Z 0.004), and neural pathway recurrence (p Z 0.005), but not distant site recurrence (p Z 0.081). Interpretation: Most temporal lobe GBMs fail with a predictable pattern within local or regional sites unique to the initial temporal lobe site, with more than half involving classic anatomical neural pathways. Knowledge of tumour infiltration and failure can be utilised in the design of novel RT protocols. http://dx.doi.org/10.1016/j.ejca.2016.03.018 AOS06. NEW TUMOUR REGRESSION GRADE FOR RECTAL CANCER AFTER NEOADJUVANT THERAPY AND RADICAL SURGERY J. Li *, H. Liu, J. Hu, S. Liu, J. Yin , F. Du, J. Yuan, B. Lv. General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China. General Surgery Department, 2nd Affiliated Hospital of Jilin University, Changchun, China. Gastrointestinal Tumor Surgery, Hubei Cancer Hospital, Wuhan, China. Surgical Department of Gastrointestinal Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China. General Surgery Department, Xuzhou Central Hospital, Xuzhou, China. Internal Medicine-Oncology, Cancer Institute/Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences,

Long-Term Survival and Local Relapse Following Surgery Without Radiotherapy for Locally Advanced Upper Rectal Cancer: An International Multi-Institutional Study.

Controversy remains regarding whether preoperative chemoradiation protocol should be applied uniformly to all rectal cancer patients regardless of tumor height. This pooled analysis was designed to evaluate whether preoperative chemoradiation can be safely omitted in higher rectal cancer.An international consortium of 7 institutions was established. A review of the database that was collected from January 2004 to May 2008 identified a series of 2102 patients with stage II/III rectal or sigmoid cancer (control arm) without concurrent chemoradiation. Data regarding patient demographics, recurrence pattern, and oncological outcomes were analyzed. The primary end point was the 5-year local recurrence rate.The local relapse rate of the sigmoid colon cancer (SC) and upper rectal cancer (UR) cohorts was significantly lower than that of the mid/low rectal cancer group (M-LR), with 5-year estimates of 2.5% for the SC group, 3.5% for the UR group, and 11.1% for the M-LR group, respectively. A multivariate analysis showed that tumor depth, nodal metastasis, venous invasion, and lower tumor level were strongly associated with local recurrence. The cumulative incidence rate of local failure was 90.6%, 92.5%, and 94.4% for tumors located within 5, 7, and 9 cm from the anal verge, respectively.Routine use of preoperative chemoradiation for stage II/III rectal tumors located more than 8 to 9 cm above the anal verge would be excessive. The integration of a more individualized approach focused on systemic control is warranted to improve survival in patients with upper rectal cancer.

Anatomical basis and clinical research of pelvic autonomic nerve preservation with laparoscopic radical resection for rectal cancer.

The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation (PANP) was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP) from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients (18.37%) presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients (21.82%) in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed (P>0.05). It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction.

Correlation between lysyl oxidase gene polymorphism and the risk of colorectal cancer

Objective To investigate the correlation between lysyl oxidase (LOX) gene G473A polymorphism and the susceptibility of colorectal cancer. Methods From October 2012 to July 2014, in Tangshan area, peripheral blood samples of 335 patients with colorectal cancer and 335 healthy subjects (control group) were collected. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis and gene sequencing were used to detect LOX gene G473A polymorphism genotypes. Multivariate Logistic regression analysis was performed to analyze the correlation between different genotypes and the risk of colorectal cancer. Results The GG, GA and AA genotype of colon cancer group accounted for 48.5%(63/130), 41.5%(54/130) and 10.0%(13/130), respectively. And those of the control group were 63.1%(164/260), 33.5%(87/260) and 3.5%(9/260). Compared with subjects carrying GG allele, the risk of colon cancer increased in the subjects carrying GA and AA allele (OR=1.62, 95%CI 1.03-2.54, P=0.035; OR=3.80, 95%CI 1.54-9.36, P=0.004). The GG and AA genotype of rectal cancer group accounted for 52.2% (107/205) and 10.7% (22/205), and those of the control group were 61.7% (190/308) and 3.6% (11/308). Compared with subjects carrying GG allele, the risk of rectal cancer increased in the subjects carrying AA allele (OR=3.38, 95%CI 1.57-7.29, P=0.002). The GG, GA and AA genotype of colorectal cancer group accounted for 50.8% (170/335), 38.8% (130/335) and 10.4% (35/335), and those of the control group were 62.4% (209/335), 34.0% (114/335) and 3.6% (12/335). Compared with subjects carrying GG allele, the risk of colorectal cancer increased in the subjects carrying GA and AA allele (OR=1.41, 95%CI 1.02-1.95, P=0.037; OR=3.58, 95%CI 1.80-7.12, P<0.01). Conclusion In Tangshan area, LOX gene 473G/A polymorphism is correlated with the risk of colorectal cancer, and which indicate it plays an important role in the pathogenesis of colorectal cancer. Key words: Lysyl oxidase; Colonic neoplasms; Rectal neoplasms; Gene polymorphism

Evidence-based treatment of patients with rectal cancer.

Rectal cancer is a worldwide disease whose incidence has increased significantly. Evidence-based medicine is a category of medicine that optimizes decision making by using evidence from well-designed and conducted research. Evidence-based medicine can be used to formulate a reasonable treatment plan for newly diagnosed rectal cancer patients. The current review focuses on the application of evidence-based treatment on patients with rectal cancer. The relationship between perioperative blood transfusion and recurrence of rectal cancer after surgery, the selection between minimally invasive laparoscopic surgery and traditional laparotomy, choice of chemotherapy for patients with rectal cancer prior to surgery, selection between stapled and hand-sewn methods for colorectal anastomosis during rectal cancer resection, and selection between temporary ileostomy and colostomy during the surgery were addressed. Laparoscopy is considered to have more advantages but is time-consuming and has high medical costs. In addition, laparoscopic rectal cancer radical resection is preferred to open surgery. In radical resection surgery, use of a stapling device for anastomosis can reduce postoperative anastomotic fistula, although patients should be informed of possible anastomotic stenosis.

Effect of dexmedetomidine combined with seven isoflurane for elderly patients with rectal cancer radical operation on recovery quality

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality. Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method,while each groupincluded 30 cases:the control group(group N)and the dexmedetomidine group(group D).Before the induction of anesthesia,group D vein was injected with micro pump(more than 10 min) of dexmedetomidine 1μg/kg (which was formulated with physiological saline as 4μg/mL),and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately(T3),extubation after 5min(T4),30min(T5)the time of HR,BP,Sp O2,BIS;propofol and remifentanil dosage,operative time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score,pain score,patient satisfaction and adverse reactions were recorded. Results In T3 period,the changes of HR (82±14)times/min,SBP(130±8)mm Hg,DBP(85±13)mm Hg in group N were more obvious than(70±12) timse/min,SBP(121±7)mm Hg,DBP(79±9)mm Hg in group D,the difference between the two groups had statistical significance(t= 6.28,4.63,2.08,all P 0.05).In group N,postoperative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2= 4.32,6.67,5.45,all P< 0.05).At the same time,the satisfaction score of patient in group D(3.0±0.3) point,which was significant higher than(2.7±0.5)points in group N(t= 1.88,P<0.05). Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative recovery quality of elderly patients with rectal cancer radical surgery. Key words: Rectal Carcinoma; Dexmedetomidine; Seven halothane; Aged

The relationship between dyslipidemia and colorectal cancer

Objective To explore the relationship between dyslipidemia and colorectal cancer. Methods The levels of total cholesterol(TC),triglyceride(TG), 1ow density lipoprotein- cholesterol(LDL- C)and high density lipoprotein- cholesterol(HDL- C)of 182 patients with colorectal cancer and 86 controls were tested. The serum lipids levels between the colorectal cancer group and control group, colorectal cancer with different location,different gender were compared. Results The level of TCin the colorectal cancer group[(5.51±0.76)mmol/L]was significantly higher than that of the control group[(4.84 ±0.53)mmol/L](t= 2.41,P 0.05).TClevel in the male colorectal cancer group[(5.96±0.87)mmol/L]was significantly higher than that of the female colorectal cancer group[(5.26±0.74)mmol/L](t= 2.10,P<0.05). The level of TC in the distal colon and rectal cancer group was(6.07± 0.78)mmol/L,which was significantly higher than(5.14±0.56)mmol/L of the proximal colon cancer group(t= 3.24,P<0.05);The level of HDL- C in the distal colon and rectal cancer group was(0.75±0.26)mmol/L,which was significantly lower than(1.07±0.19)mmol/L of the proximal colon cancer group(t=- 3.20,P< 0.05). Conclusion TC was positively correlated with colorectal cancer,and HDL-C was negatively correlated with colorectal cancer. Key words: Colorectal cancer; Total cholesterol; Triglyceride; Low density lipoprotein-cholesterol; High density lipoprotein-cholesterol

Comparison of long-term oncologic outcomes of stage III colorectal cancer following laparoscopic versus open surgery.

PurposeThe oncologic outcomes after performing laparoscopic surgery (LS) compared to open surgery (OS) are still under debate and a concern when treating patients with colon cancer. The aim of this study was to compare the long-term oncologic outcomes of LS and OS as treatment for stage III colorectal cancer patients.MethodsFrom January 2001 to December 2007, 230 patients with stage III colorectal cancer who had undergone LS or OS in this single center were assessed. Data were analyzed according to intention-to-treat. The primary endpoints were disease-free survival and overall survival.ResultsA total of 230 patients were entered into the study (114 patients had colon cancer-33 underwent LS and 81 underwent OS; 116 patients had rectal cancer-44 underwent LS and 72 underwent OS). The median follow-up periods for the colon and rectal cancer groups were 54 and 53 months, respectively. The overall conversion rate was 12.1% (n = 4) for colon cancer, and 4.5% (n = 2) for rectal cancer. Disease-free 5-year survival of colon cancer was 84.3% and 90% in LS group (LG) and OS group (OG), respectively, and that of rectal cancer was 83% and 74.6%, respectively (P > 0.05). Overall 5-year survival for colon cancer was 72.2% and 71.3% for LG and OG, respectively, and that for rectal cancer was 67.6% and 59.2%, respectively (P > 0.05).ConclusionThe long-term analyses for oncologic aspects of our study may confirm the safety of LS compared to OS in stage III colorectal cancer patients.

A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer

Genito-urinary disorders (GUD) for radical rectal cancer surgery range from 10 to 30%. In this study, primary endpoint is to prospectively assess their incidence in patients undergoing Laparoscopic Total Mesorectal Excision (LTME) without neoadjuvant chemo-radiation (NCR). Secondary endpoint is to detect the potential lesion site evaluating video-recordings of surgery. A study of 35 consecutive patients treated by LTME for extra-peritoneal rectal cancer not subjected to NCR, M:F = 23:12, median age 70, was evaluated preoperatively by Uroflowmetry and US postvoid residual urine measurement (PVR), International Prostatic Symptoms Score (IPSS), and International Consultation on Incontinence Modular Questionnaire (ICIQ) at 1 and 9 months post-operatively. Evaluation of sexual function was carried out by International Index of Erectile Function (IIEF) in males. Data were analyzed performing Fisher and paired samples t tests. Surgical videos of patients affected by GUD were reviewed to identify lesion sites. Urinary function:IPSS average score: baseline 6.03 ± 5.51, 8.93 ± 6.42 (p = .005) at 1 month, and 7.26 ± 5.55 (p = .041) at 9 months. ICIQ baseline 2.67 ± 5.42, 4.27 ± 6.19 (p = NS) at 1 month, and 3.63 ± 5.23 (p = NS) at 9 months. Maximum urine flow rate baseline 15.95 ± 4.78 ml/s, 14.23 ± 5.27 after 1 month (p = .041), and 15.22 ± 4.01 after 9 months (p = NS). Mean urine flow rate baseline 9.15 ± 2.96 ml/s, 7.99 ± 4.12 ml/s at 1 month (p = .044), and 8.54 ± 4.19 ml/s at 9 months (p = NS). PVR baseline 59.62 ± 54.49, 64.59 ± 58.71 (p = NS) at 1 month, and 68.82 ± 77.72 (p = NS) at 9 months. Sexual function: IIEF baseline 19.38 ± 6.25, 14.06 ± 8.65 at 1 month (p = .011), and 15.4 ± 8.41 at 9 months, (p = NS). Video review of patients with disorders showed potential damage at the site of ligation of IMA (high hypogastric plexus) in 1 case, lateral and posterior mesorectum dissection (hypogastric nerves) in 2 cases, anterior dissection of the Denonvilliers fascia from seminal vesicles in 2 cases. GUD at 1 month from LTME for rectal cancer are significant but improve at 9 months. Surgical video review of patients with GUD provides an important tool for detection of lesion sites.