Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.
Objective Surgical treatment for rectal cancer has been developed for centuries. After anesthetic technics are applied， classic operation procedures for rectal cancer resection are still cited repeatedly. There are few articles regarding to the development history of surgical treatment for rectal cancer， and we summarize it chronologically. Methods We searched articles in the past 20 years， dated back to the original journal and explored the development of the operation type. Results We summarized more than 100 articles and listed more than 40 articles here. According to the articles retrieved， the surgery for rectal cancer could be dated back to 1739， spanning for more than 270 years. In the premier one hundred years， the resection area was limited and the effect of the treatment was not good. And in the recent one hundred years， the development of surgery conceptions was huge and the related knowledge and skills had been rapidly develop. The operation type for rectal cancer was gradually getting mature. Conclusions Surgery treatment for rectal cancer has been through a development of more than two hundred years， with new concepts and technics continuously fused in. Thus the meaning of surgery treatment for rectal cancer has been renewed. Introduction of total mesorectum excision， conception of 2 cm distal resective margin， development of stapling devices， preoperative chemoradiation and appplication of laparoscopic surgery have fasciliated function-preserving operations with minimal invasion， rapid recovery and high survival rate. Appearance of new drugs and improvement of local excision， preoperative chemoradiation， as well as new agents for chemotherapy and target therapy have promoted surgical resection for rectal cancer to a multidisciplinary model.
【Abstract】Objective To analyze the clinical features of multiple primary colorectal carcinoma(MPCC). Methods Data in 21 patients with MPCC during the past 10 years in our hospital were analyzed retrospectively. Results The incidence of synchronous and metachronous carcinoma was 1.1% and 1.2% respectively. The sites and pathologic stages of tumors showed no significant difference compared with single colorectal carcinoma. 47.6% of the cases accompanied with colorectal adenoma. 77.8% of the MPCC could be found during operation. Patients with carcinoma involved rectum had relatively poor survival. Conclusion The full-course colonoscopy, careful intraoperative exploration and regular postoperative colonoscopic follow-up are essential in improving the diagnosis and prognosis of patients with MPCC.
The technique of laparoscopic radical right hemicolectomy is becoming mature, but there are still controversies on some key steps, including the extent of lymph node dissection, the scope of bowel resection, the choice of surgical access and anastomosis. The new function-preserving surgery and natural-orifice transluminal endoscopic surgery (NOTES) have further enhanced the minimally invasive nature of surgery. The author’s have reviewed the latest domestic and international literature, combined with the experience of the author’s center, and elaborated on the current focus issues of laparoscopic radical surgery for right-sided colon cancer.
ObjectiveTo understand the incidence of fecal incontinence after sphincter-preserving operation for middle and low rectal cancer, the factors influencing fecal incontinence, the relationship of fecal incontinence to anorectal manometry, and treatment. MethodThe literatures about fecal incontinence after sphincter-preserving operation for middle and low rectal cancer were reviewed. ResultsThe incidence of fecal incontinence after sphincter-preserving operation for middle and low rectal cancer was about 35.3%. Wexner fecal incontinence score was the most popular scale in assessing the severity of fecal incontinence, which had high validity and utility. When Wexner score≥9, the fecal incontinence-related quality of life was seriously damaged. Closer the anastomosis to the anal margin, the fecal incontinence was more likely to happen and much severer if it appeared. Surgeon could improve the anorectal function through some kinds of surgeries, like ultralow anterior resection with levator-sphincter reinforcement when the tumor site was rather low. The effect of chemoradiotherapy on fecal incontinence was uncertain now. Age itself was a risk factor for fecal incontinence, for elderly patients underwent sphincter-preserving operation needed to be careful. The relationship of fecal incontinence to anorectal function was not completely clear. The anal sphincter nerve function was a predicting factor whether neurogenic fecal incontinence was going to happen or not. Even though the retrograde colonic irrigation, sacral nerve stimulation, and biofeedback therapy had been proved to alleviate the symptoms and improve the quality of life after sphincter-preserving operation, much more prospective and controlled studies were needed to validate their efficacy and explore other new solutions. ConclusionsWe still need to come up with the objective criterion to assess fecal incontinence. Much more prospective studies are needed to analyze the influencing factors and to find effective prevention and treatment.
ObjectiveTo evaluate the expression of miR-338-5p in colorectal cancer tissues and study its role in colon cancer cell proliferation, apoptosis, and cell cycle. MethodsThe expression of miR-338-5p was detected by real-time PCR in the colorectal cancer tissues and corresponding adjacent to cancer tissue samples. The miR-338-5p-mimics was transfected into the colon cancer cell lines HCT116 and SW620 to investigate its role in cell proliferation, apoptosis, and cell cycle. The cell proliferation and apoptosis were measured by CCK-8 and flow cytometry, respectively. The cell cycle was also analyzed by flow cytometry. Results①miR-338-5p expression was significantly downregulated in the colorectal cancer tissues as compared with corresponding adjacent to cancer tissue samples(P < 0.01). 2 Compared with the transfected negative control cells, the proliferation ability of colon cancer cell HCT116 or SW620 was significantly decreased(P < 0.01), cell apoptosis was significantly increased[HCT116 cell:(11.43±0.67)% versus(7.98±0.36)%, P < 0.01;SW620 cell:(10.5±0.2)% versus(7.93±0.5)%, P < 0.01), and cell G1 was arrested[HCT116 cell:(80.41±1.34)% versus (64.87±1.83)%, P < 0.01;SW620 cell:(68.76±0.41)% versus(54.89±0.78)%, P < 0.01) after transfecting miR-338-5p-mimics cells. ConclusionmiR-338-5p may act as an anti-oncogene in colorectal cancer through regulation of cell proliferation, apoptosis, and cell cycle.
ObjectivePulmonary infection is commonly seen in patients with rheumatic autoimmune disease (RAD).Sometimes bronchoscopy is used to obtain microorganisms.In order to improve diagnostic yield, the factors affecting diagnostic yield of bronchoscopy in obtaining microorganisms in RAD patients with pulmonary abnormality were analyzed retrospectively. MethodsA retrospective study was performed in RAD patients with lung infiltrates who received bronchoscopy for obtaining microorganisms at the Department of Rheumatology,Peking Union Medical College Hospital from January 2009 to June 2013.Patients characteristics,clinical symptoms,medication history,laboratory parameters,radiographic findings and locations where microorganisms were obtained were recorded. Results87 patients received 91 bronchoscopic exams,including 72 bronchoalveolar lavages,21 bronchial aspirates,and 72 bronchial brushes.The total diagnostic yield was 52.7%.The diagnostic yield was 71.4% with bronchoalveolar lavage,38.9% with bronchial aspirate,and 18.1% with bronchial brush.Diagnostic yield was significantly higher in the patients with clinical symptoms of fever,cough or expectoration compared with the patients without either symptoms (60.0%% vs.34.6%,P=0.028).The patients with CT finding of nodular,massive or consolidation had a higher diagnostic yield compared with those with CT findings of reticular,linear or ground glass opacity (61.8% vs.26.1%,P=0.003).Diagnostic yield was not affected by location of bronchoalveolar lavage (P=0.691). ConclusionRAD patients with fever,cough or sputum,and CT findings of nodular,massive or consolidation would get a higher diagnostic yield by bronchoscopy.
ObjectiveTo investigate the expression of catechol O-methyltransferase (COMT) mRNA and its protein in colorectal adenoma tissues and corresponding adjacent tissues, colorectal cancer tissues and corresponding adjacent tissues. MethodsExpressions of COMT mRNA and its protein were evaluated by real-time PCR and immunohistochemistry method in colorectal adenoma tissues and corresponding adjacent tissues, colorectal cancer tissues and corresponding adjacent tissues. Meanwhile, the relationship between the expression of COMT and clinic-pathological features of colorectal adenoma and colorectal cancer were analyzed. Results①The expression of COMT mRNA in colorectal adenoma tissue/colorectal cancer tissue group was higher than that of corresponding adjacent tissue group (0.109 0 vs. 0.000 5, t=3.02, P=0.01; 0.041 8 vs. 0.013 5, t=2.71, P=0.02).②The rate of high-expression of COMT in colorectal adenoma tissue/colorectal cancer tissue group was higher than that of corresponding adjacent tissue group [72.34% (34/47) vs. 25.53% (12/47), χ2=28.72, P < 0.01; 66.67% (28/42) vs. 28.57% (12/42), χ2=4.97, P < 0.05].③High-expression of COMT was not related to age, gender, location of tumor, and pathological type in colorectal adenoma patients (P > 0.05). High-expression of COMT was not related to age, gender, location of tumor, and differentiation degree (P > 0.05), but was related to TNM staging, T staging, and N staging in colorectal cancer patients (P < 0.05), the patients of TNMⅠ+Ⅱstaging, T1+T2 staging, and N0 staging had higher rate of high-expression of COMT. ConclusionCompared with corresponding adjacent tissues, COMT expresses highly in colorectal adenoma tissues and colorectal cancer tissues, so it may play a partial role in the emergence and development of colorectal cancer.