RESUMEN

Neoadjuvant therapy has become a standard treatment for patients with locally advanced rectal cancer to achieve better prognostic outcomes. The response to treatment has been shown to correlate closely with the prognosis. However, current evaluation systems only provide coarse assessment on limited information, due to the lack of accurate and reproducible approach for quantitation of different types of responses. In this study, a novel stain-free, slide-free multimodal multiphoton microscopy imaging technique was applied to image rectal cancer tissues after neoadjuvant therapies with high resolution and contrast. Qualitative and quantitative evaluation of tumor, stromal, and inflammatory responses were demonstrated which are consistent with current tumor regression grading system using American Joint Committee on Cancer criteria, showing the great potential of such approach to build a more informative grading system for accurate and standardizable assessment of neoadjuvant therapy in rectal cancer.

Asunto(s)

Terapia Neoadyuvante , Neoplasias del Recto , Colorantes , Humanos , Microscopía , Estadificación de Neoplasias , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Recto , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Gastrointestinal stromal tumor (GIST) is the most common gastrointestinal soft tissue tumor. Clinical diagnosis mainly relies on enhanced CT, endoscopy and endoscopic ultrasound (EUS), but the misdiagnosis rate is still high without fine needle aspiration biopsy. We aim to develop a novel diagnostic model by analyzing the preoperative data of the patients. METHODS: We used the data of patients who were initially diagnosed as gastric GIST and underwent partial gastrectomy. The patients were randomly divided into training dataset and test dataset at a ratio of 3 to 1. After pre-experimental screening, max depth = 2, eta = 0.1, gamma = 0.5, and nrounds = 200 were defined as the best parameters, and in this way we developed the initial extreme gradient-boosting (XGBoost) model. Based on the importance of the features in the initial model, we improved the model by excluding the hematological features. In this way we obtained the final XGBoost model and underwent validation using the test dataset. RESULTS: In the initial XGBoost model, we found that the hematological indicators (including inflammation and nutritional indicators) examined before the surgery had little effect on the outcome, so we subsequently excluded the hematological indicators. Similarly, we also screened the features from enhanced CT and ultrasound gastroscopy, and finally determined the 6 most important predictors for GIST diagnosis, including the ratio of long and short diameter under CT, the CT value of the tumor, the enhancement of the tumor in arterial period and venous period, existence of liquid area and calcific area inside the tumor under EUS. Round or round-like tumors with a CT value of around 30 (25-37) and delayed enhancement, as well as liquid but not calcific area inside the tumor best indicate the diagnosis of GIST. CONCLUSIONS: We developed a model to further differential diagnose GIST from other tumors in initially clinical diagnosed gastric GIST patients by analyzing the results of clinical examinations that most patients should have completed before surgical resection.

Asunto(s)

Tumores del Estroma Gastrointestinal , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/cirugía , Humanos

RESUMEN

Hemophagocytic lymphohistiocytosis (HLH) comprises a group of severe immune function disorders that can lead to immune-mediated organ damage. There are two subtypes of HLH: primary and secondary. Secondary HLH is associated with infectious, oncologic, chemotherapeutic, and other underlying causes, and studies on HLH triggered by tumors have mainly focused on hematological malignancies. Secondary HLH in patients with solid tumors is rare. Here, we present two cases of gastric cancer complicated with HLH. The patient 1 was diagnosed as gastric cancer at stage I and got intractable fever after a distal subtotal gastrectomy without any evidence of infections or other complications. The patient 2 suffered from unresectable gastric adenocarcinoma and got fever, hemorrhagic rashes, and petechiae in mouth after six cycles of neoadjuvant chemotherapy. After detailed and comprehensive examinations, HLH was diagnosed in the two patients according to 2004 HLH diagnostic criteria, and the patients received treatment including immunosuppressive agents immediately. After therapy, the two patients showed partial remission, but both eventually died due to HLH relapse or progression of the primary tumor. The treatment regimen for HLH is intricate, and only a few relevant studies have focused on the treatment of cancer patients with HLH. The high mortality associated with this disease calls for more attention and additional research to improve the prognosis for these patients.

RESUMEN

OBJECTIVE: The aim of the study was to evaluate the oncological outcomes of complete mesocolic excision (CME) in colon cancer patients. SUMMARY BACKGROUND DATA: CME is considered a standard procedure for colon cancer patients. However, previous evidence regarding the effect of CME on prognosis has fundamental limitations that prevent it from being fully accepted. METHODS: Patients who underwent radical resection for colon cancer were enrolled between November 2012 and March 2016. According to the principles of CME, patients were stratified into 2 groups based on intraoperative surgical fields and specimen photographs. The primary outcome was local recurrence-free survival (LRFS). The clinicopathological data and follow-up information were collected and recorded. The final follow-up date was April 2016. The trial was registered in ClinicalTrials.gov (identifier: NCT01724775). RESULTS: There were 220 patients in the CME group and 110 patients in the noncomplete mesocolic excision (NCME) group. Baseline characteristics were well balanced. Compared with NCME, CME was associated with a greater number of total lymph nodes (24 vs 20, P = 0.002). Postoperative complications did not differ between the 2 groups. CME had a positive effect on LRFS compared with NCME (100.0% vs 90.2%, log-rank P < 0.001). Mesocolic dissection (100.0% vs 87.9%, log-rank P < 0.001) and nontumor deposits (97.2% vs 91.6%, log-rank P < 0.022) were also associated with improved LRFS. CONCLUSIONS: Our findings demonstrate that, compared with NCME, CME improves 3-year LRFS without increasing surgical risks.

Asunto(s)

Colectomía/métodos , Neoplasias del Colon/cirugía , Mesocolon/cirugía , Adulto , Anciano , Neoplasias del Colon/mortalidad , Método Doble Ciego , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Fotograbar , Complicaciones Posoperatorias , Estudios Prospectivos , Tasa de Supervivencia

RESUMEN

The genome-wide sequencing information of PJS is still lacking. Our result demonstrates that c.862+2T>C variant on STK11 as an important foundation of molecular mechanism in this familial PJS. Variants in KDR and MLL3 may play important roles in the initiation and development of this familial PJS polyps.

RESUMEN

BACKGROUND: Transanal total mesorectal excision (taTME) is a novel sphincter-preserving procedure for low rectal cancer. This "bottom to up" approach is unfamiliar to colorectal surgeons and the crucial anatomical landmarks also remain unclear. METHODS: Two hundred and five cases of pelvic magnetic resonance imaging (MRI) from 2015 to 2016 were reviewed. Curvature of posterior mesorectal fascia, distal mesorectal angle, length of posterior mesorectal fascia, main structures around the mesorectum were measured and analyzed. The landmarks identified on MRI were verified in taTME procedures of five rectal cancer patients. RESULTS: The most of acute angles of posterior mesorectal fascia located at the joint of anococcygeal ligament-coccyx. Degree of distal mesorectal angle was independently correlated with gender and degree of angle of anococcygeal ligament-coccyx. Candidate landmarks evaluated by MRI with verification during taTME procedures included: anterior: seminal vesicle for male while cervix for female. And peritoneal reflection was a substitute landmark when cervix was hardly confirmed in operation; posterior: the joint of anococcygeal ligament-coccyx. The area between the joint of anococcygeal ligament-coccyx and S3S4 was a "transitional zone", the level of S3S4 could be the as the terminal landmark of transanal posterior dissection during taTME. CONCLUSIONS: Preoperative MRI geometrical measurement of mesorectum might play an important role in evaluating the difficulty of taTME procedure before operation, as well as standardizing landmarks during taTME procedure.

Asunto(s)

Canal Anal/diagnóstico por imagen , Canal Anal/cirugía , Endoscopía Gastrointestinal/métodos , Imagen por Resonancia Magnética , Neoplasias del Recto/cirugía , Recto/diagnóstico por imagen , Recto/cirugía , Canal Anal/anatomía & histología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Recto/anatomía & histología , Estudios Retrospectivos

RESUMEN

OBJECTIVE: The objective of this study was to compare the prognoses of patients with low- and high-risk rectal cancer detected by MRI who were treated without neoadjuvant chemoradiotherapy (NCRT) and to determine independent risk factors. MATERIALS AND METHODS: This retrospective study included 185 patients with pathologically proven rectal adenocarcinoma who were treated without NCRT. Cancer was defined as high risk if one or more of the following factors were present: extramural depth of tumor invasion greater than 5 mm or stage T4a or T4b for tumor in the mid or high rectum; involvement of intersphincteric space, levators, or adjacent organs for tumor in the low rectum; extramural venous invasion (EMVI); or circumferential resection margin (CRM) involvement. Patients without any of those risk factors were placed in the low-risk group. The Kaplan-Meier method and Cox proportional hazards regression model were used to compare the survival outcomes between the two groups and to investigate the univariate and multivariate influences of the risk factors. RESULTS: Cancer was deemed to be low risk in 65 (35.1%) patients and high risk in 120 (64.9%) patients. The two patient groups had statistically significant differences in 3-year actuarial overall survival (OS; 100% vs 88.3%, p = 0.0044), disease-free survival (DFS; 92.3% vs 60.0%, p < 0.0001), and local recurrence (LR; 1.5% vs 10.0%, p = 0.0297). CRM involvement was identified as an independent risk factor for OS (hazard ratio [HR], 4.78; 95% CI, 1.24-18.45), DFS (HR, 2.44; 95% CI, 1.24-4.81), and LR (HR, 3.92; 95% CI, 1.07-14.41). Moreover, EMVI was identified as an independent risk factor for DFS (HR, 2.46; 95% CI, 1.28-4.74). CONCLUSION: The LR and long-term survival of patients in the low-risk group were more favorable than those of patients in the high-risk group. EMVI and CRM status were independent risk factors.

Asunto(s)

Imagen por Resonancia Magnética/métodos , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Neoplasias del Recto/patología , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia

RESUMEN

Growing evidence indicates a potential role for miR­490­3p in tumorigenesis. However, its function in colorectal carcinoma (CRC) remains undefined. In this study, miR­490­3p was markedly downregulated in fifty colorectal cancer tissue samples compared with the corresponding adjacent non­cancerous specimens, by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The expression levels of miR­490­3p were closely associated with tumor differentiation and distant metastasis. In addition, both Kaplan-Meier and multivariate analyses indicated CRC patients with elevated miR­490­3p amounts had prolonged overall survival. Overexpression of miR­490­3p markedly reduced proliferation, colony formation and invasion in CRC cells by enhancing apoptosis and promoting G2/M phase arrest. Furthermore, ectopic expression of miR­490­3p resulted in decreased expression of RAB14, which was directly targeted by miR­490­3p, as shown by the dual-luciferase reporter gene assay. Finally, in a nude mouse model, miR­490­3p overexpression significantly suppressed the growth of CRC cells. The above results indicated that miR­490­3p might constitute a prognostic indicator and a novel molecular target for miRNA-based CRC therapy.

Asunto(s)

Biomarcadores de Tumor/metabolismo , Neoplasias Colorrectales/genética , Regulación Neoplásica de la Expresión Génica , MicroARNs/metabolismo , Proteínas de Unión al GTP rab/genética , Animales , Apoptosis/genética , Biomarcadores de Tumor/genética , Carcinogénesis/genética , Movimiento Celular/genética , Proliferación Celular/genética , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Regulación hacia Abajo , Transición Epitelial-Mesenquimal/genética , Femenino , Puntos de Control de la Fase G2 del Ciclo Celular/genética , Células HCT116 , Humanos , Estimación de Kaplan-Meier , Masculino , Ratones , Ratones Desnudos , MicroARNs/genética , Persona de Mediana Edad , Pronóstico , ARN Interferente Pequeño/metabolismo , Ensayos Antitumor por Modelo de Xenoinjerto , Proteínas de Unión al GTP rab/metabolismo

RESUMEN

OBJECTIVE: To explore the predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases and its significance for the timing of exploratory laparotomy. METHODS: This retrospective study enrolled 63 patients diagnosed as acute mesenteric vascular occlusive diseases at Peking University People's Hospital between July 1995 and June 2015. Univariate analysis and multivariate logistic regression analysis were used to identify predictive factors for intestinal necrosis. RESULTS: Of 63 patients, 39 were male and 24 were female, with a mean age of (58.8±12.7)(31 to 82) years. The overall rate of intestinal necrosis was 46.0%(29/63). Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (χ2=5.908, P=0.015). In univariate analysis, the predictive factors of intestinal necrosis were systemic inflammatory reactive syndrome (SIRS) (χ2=18.535, P=0.000), shock (χ2=7.775, P=0.007), peritoneal irritation sign (χ2=11.533, P=0.001), changes of intestinal wall and blood signals on ultrasound or CT scans (χ2=14.344, P=0.000), international normalized ratio(INR) (prothrombin time) ≥1.2 (χ2=4.498, P=0.034), D-dimer ≥1 000 g/L(χ2=6.680, P=0.010), low-density lipoprotein ≥270 U/L (χ2=6.513, P=0.011), serum albumin <35 g/L (χ2=3.914, P=0.048), blood urea nitrogen ≥6.2 mmol/L (χ2=11.377, P=0.000), pH values <7.35 (χ2=15.887, P=0.000), blood lactate ≥2 mmol/L(χ2=17.134, P=0.000), base excess <-1.0 mmol/L (χ2=6.674, P=0.010). According to multivariate logistic regression analysis, SIRS(OR=28.945, 95%CI:2.294 to 365.199, P=0.009), pH values <7.35(OR=13.174, 95%CI:1.157 to 150.027, P=0.038), changes of intestinal wall and blood signals on ultrasound or CT scans(OR=4.857, 95%CI:1.110 to 21.253, P=0.036) were independent predictive factors of intestinal necrosis in patients with acute mesenteric vascular occlusive diseases. CONCLUSIONS: Intestinal necrosis in acute mesenteric vascular occlusive diseases prompts a poor prognosis. When patients with acute mesenteric vascular occlusive diseases are found to have acidosis, SIRS and changes of intestinal wall and blood signals on ultrasound or CT scans, surgeons should be alert to the occurrence of intestinal necrosis and should perform laparotomy promptly in order to take suitable management.

Asunto(s)

Enfermedades Intestinales/patología , Mesenterio/patología , Necrosis , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Obstrucción Intestinal/complicaciones , Intestinos , Isquemia/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X

RESUMEN

OBJECTIVE: To evaluate the factors affecting perineal incision complications after abdominperineal excision(APE) for rectal cancer. METHODS: This was a retrospective study of 167 patients with rectal cancer undergoing APE at Peking University People's Hospital between October 1998 and December 2013. Chi-square test and multivariate Logistic regression analysis were used to identify risk factors. RESULTS: The overall rate of perineal incision complication was 24.6%(41/167) including 7 cases of incision infection, 10 cases of incision fat liquefaction, 21 cases of poor wound healing, 2 cases of incision fistula, 1 case of incision dehiscence. In univariate analysis, the risk factors associated with perineal incision complication were operating time≥280 minutes(P=0.005), blood loss≥350 ml(P=0.017) and the protective factors associated with perineal incision complication were the procedure of APE (P=0.048), intraperitoneal chemotherapy with 5-FU sustained release (P=0.014), lymph node metastasis (P=0.006), while gender, age, BMI, ASA score, other complications, distance from distal tumor to anal verge, preoperative radiochemotherapy, postoperative stay in ICU, total drainage volume 3 days before operation, tumor differentiation, and postoperative TNM staging were not associated with perineal incision complication(all P>0.05). Multivariate logistic regression analysis identified two independent risk factors: operating time≥280 minutes(OR=5.217, 95% CI:1.250 - 6.234, P=0.000), intraperitoneal chemotherapy with 5-FU sustained release(OR=3.284, 95% CI:1.156 - 9.334, P=0.026). CONCLUSIONS: Operating time≥280 minutes and intraperitoneal chemotherapy with 5-FU sustained release are independent risk factors for perineal incision complications after APE for rectal cancer. For patients receiving APE procedure, intraperitoneal chemotherapy with 5-FU sustained release should be used with caution, and the operative time should be reduced when possible.

Asunto(s)

Abdomen/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Perineo/cirugía , Complicaciones Posoperatorias/epidemiología , Neoplasias del Recto/cirugía , Humanos , Estadificación de Neoplasias , Tempo Operativo , Recto , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología

RESUMEN

OBJECTIVE: To compare clinical efficacy between abdominoperineal resection (APR) procedure and anterior resection(AR) procedure in patients with rectal cancer. METHODS: Clinicopathological data of 309 cases with rectal cancer undergoing resection in Peking University People's Hospital from January 1998 to December 2012 were retrospectively analyzed. Short-term outcomes, local recurrence, overall survival (OS) and progression-free survival (PFS) were investigated between two groups. RESULTS: As compared to the AR group, the operative time was longer [(268.5 ± 66.7) min vs. (247.4 ± 64.2) min, P=0.005], blood loss[(668.5 ± 680.1) ml vs.(441.8 ± 478.6) ml, P=0.001] and drainage volume were more[(66.9 ± 54.7) ml vs. (49.0 ± 45.9) ml, P=0.002] in the APR group. There was no significant difference of local recurrence between the two groups, while the 5-year local recurrence rate of T3-T4 patients undergoing APR procedure (24.9%) was higher than that of AR group (13.9%)(P=0.038), especially in the patients with tumors located at 4-6 cm away from the anus verge. There were no significant differences of OS (P=0.273) and PFS (P=0.589) between two groups, while both 5-year OS and PFS of T3-T4 patients with BMI ≥ 24 undergoing APR procedure (43.1% and 42.8%) were significantly worse than those of patients undergoing AR procedure (87.9% and 76.9%, P=0.022 and P=0.041). CONCLUSIONS: The overall prognosis of patients after APR and AR is comparable. Tumor located at 4-6 cm away from the anus verge, T3-T4 stage, obese may play an important role in the worse prognosis of the patients undergoing APR procedure.

Asunto(s)

Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias del Recto , Abdomen , Supervivencia sin Enfermedad , Humanos , Recto , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To compare the safety and efficacy between extralevator abdominoperineal excision(ELAPE) and traditional abdominoperineal excision(APE) in patients with low rectal cancer. METHODS: From January 2011 to December 2013, 61 patients undergoing abdominoperineal excision for low rectal cancer at the Department of Gastrointestinal Surgery, Peking University People's Hospital were enrolled. The safety and efficacy of two procedure groups, ELAPE group (33 patients) and traditional APE group (28 patients) were reviewed retrospectively. RESULTS: Less intraoperative blood loss [(201 ± 147) ml vs. (343 ± 308) ml, P=0.022], shorter exhaust time [(3.8 ± 1.5) d vs. (4.6 ± 1.6) d, P=0.039] and lower perineal wound complication rate (9.1% vs. 25.0%, P=0.042) were observed in the ELAPE group as compared to the traditional APE group. However, longer operation time [(292 ± 46) min vs. (256 ± 28) min, P=0.008] and perineal drainage removal time [(11.1 ± 4.8) d vs. (7.1 ± 2.7) d, P<0.01] were noted in the ELAPE group than those in the traditional APE group. Number of lymph node retrieved and positive lymph node retrieved was not significantly different between two groups. The ELAPE group had lower rate of IOP (intraoperative perforation) (6.1% vs. 17.9%, P=0.055), but no significant difference was found. There were no significant differences in bowel movement, diet restoring time, average perineal drainage, postoperative hospitalization time and removing perineal stitches time between the two groups (all P>0.05). CONCLUSION: ELAPE possesses less intraoperative blood loss and lower perineal wound complication rate than traditional APE. ELAPE is associated with better safety and efficacy than traditional APE.

Asunto(s)

Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo , Humanos , Tempo Operativo , Estudios Retrospectivos

RESUMEN

Multifocal liposarcoma with different histological types is rare, especially that originating from the mesentery. We herein report a case of primary myxoid liposarcoma from the sigmoid mesocolon that was accompanied with well-differentiated liposarcomas in the pelvis. The location, the fat signal and the relationship with adjacent organs of the liposarcomas were well shown in the axial, coronal and sagittal dimensions of MRI, giving a comprehensive and specific image before surgery. To alleviate the patient's symptoms and mental stress, a laparotomy was performed. The tumors were all completely excised with macroscopic free margins. The final histopathological report showed that the tumor in the sigmoid mesocolon was a pure myxoid liposarcoma, while the pelvic tumors were spindle cell liposarcomas, a special type of well-differentiated liposarcoma. According to the AJCC staging system, they were all stage IIB. No further adjuvant therapy was performed. Close follow-up after the surgery has been performed, and the patient has remained healthy without any evidence of recurrence or metastasis for 17 months after the surgery.

Asunto(s)

Liposarcoma Mixoide/cirugía , Liposarcoma/cirugía , Neoplasias Primarias Múltiples/cirugía , Neoplasias Pélvicas/cirugía , Neoplasias del Colon Sigmoide/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , Liposarcoma/diagnóstico , Liposarcoma/patología , Liposarcoma Mixoide/diagnóstico , Liposarcoma Mixoide/patología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/patología , Neoplasias Pélvicas/diagnóstico , Neoplasias Pélvicas/patología , Neoplasias del Colon Sigmoide/diagnóstico , Neoplasias del Colon Sigmoide/patología , Resultado del Tratamiento

RESUMEN

The study aim was to explore the anatomy, histopathology, and molecular biological function of the fascias posterior to the interperitoneal colon and its mesocolon to provide information for improving complete mesocolic excision. To accomplish this aim, we performed intraoperative observations in 60 interperitoneal colon-cancer patients accepted for complete mesocolic excision and conducted local anatomy observations for five embalmed cadavers. An additional two embalmed child cadaver specimens were studied with large slices and paraffin sections. Ten of the 60 patients were examined with a lymph node tracer technique in vivo, while fresh specimens from these patients were assessed by histopathological examination and transwell cell migration assays in vitro. The anatomical and histopathological findings showed that the fascias posterior to the interperitoneal colon and its associated mesocolon were composed of two independent layers: the visceral and parietal fascias. These two fascias were primarily composed of collagen fibers, with the parietal fascia containing a small amount of muscle fiber. The in vivo test showed that the visceral fascia surrounded the colon and its associated mesocolon, including vessels and lymphatics, and that it had no lymphatic flow through it into the rear tissues. Moreover, the in vitro assays showed the visceral fascia was able to block tumor cell migration. Although many surgical scholars have known of the existence of fascia tissue posterior to the intraperitoneal colon, the detailed structure has been ignored and been unclear. As shown by our findings, the visceral and parietal fascias are truly formed structures that have not been previously reported. A thorough understanding of fascial structures and the function of the visceral fascia barrier in blocking tumor cells will facilitate surgeons when performing high-quality complete mesocolic excision procedures.

Asunto(s)

Colon/anatomía & histología , Neoplasias del Colon/patología , Fascia/anatomía & histología , Mesocolon/anatomía & histología , Peritoneo/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Cadáver , Preescolar , Neoplasias del Colon/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

OBJECTIVE: To investigate the short-term efficacy of complete mesocolic excision (CME). METHODS: Clinical data of 62 cases of colon cancer (I-III phase) with radical resection including CME surgery group of 31 cases and traditional surgery group of 31 cases from January 2011 to October 2011 in Peking University People's Hospital were retrospective analyzed. RESULTS: The number of removed lymph node in CME and traditional resection group was 22.5±1.8 and 17.6±1.3 respectively (P<0.05) and the positive rate of lymph node in mesentery root was 9.7% (3/31) in CME surgery group. Operative blood loss was (123.5±17.6) ml and (143.5±15.3) ml in CME and traditional resection group without significant difference (P>0.05). Except for more abdominal drainage volume of 3 days post-operation in CME group (P<0.05), the postoperative recovery indicators of postoperative drainage tube removed time, exhaust time, eating time, and the socioeconomic effects indicators of postoperative hospitalization, hospitalization costs were not significantly different between two groups (all P>0.05). Postoperative intestinal obstruction occurred in 3 cases and 4 cases, lymph fistula in 2 cases and 0 case, wound dehiscence in 1 case and 1 case in CME group and traditional resection group respectively. Postoperative complication rate was not significantly different (19.4% vs. 16.1%, P>0.05). CONCLUSION: Compared with traditional radical surgery, CME sweeps lymph nodes more thoroughly, including lymph nodes of mesocolic roots, and does not affect postoperative recovery and increase the risk of postoperative complications.

Asunto(s)

Neoplasias del Colon/cirugía , Mesocolon/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To explore the short-term outcomes and safety of complete mesocolic excision (CME) in elderly patients with colon cancer. METHODS: The clinical pathological factors of 71 patients with colon cancer undergoing CME procedure by the same group of surgeons were analyzed retrospectively from November 2009 to February 2012. The elderly group(≥70 years) and the non-elderly group(<70 years) were compared regarding short-term outcomes and safety. RESULTS: Similar extent of resection could be achieved in the elderly and non-elderly groups in terms of area of mesentery[(13 049±4332) vs. (13 163±4725) mm2, P=0.916], distance between the tumor and the high ligation site[(95±22) vs. (98±20) mm, P=0.516], distance between normal bowel and high ligation site [(130±25) vs. (128±25) mm, P=0.731], the length of colon [(262±60) vs. (245±49) mm, P=0.212], and lymph nodes retrieved(22.0±6.4 vs. 24.8±9.9, P=0.168). The mean operative time, intraoperative blood loss, postoperative complications, time to first flatus, time to first bowel movement, drainage removal time, diet resumption, drainage volume in three days after surgery, and hospital deaths showed no statistical significances(all P>0.05), while hospital stay and expenses of the elderly group were significantly increased(both P<0.01). CONCLUSION: Elderly patients undergoing elective CME operation can achieve similar operative extent and lymph nodes harvest, and the surgical risk is not increased.

Asunto(s)

Neoplasias del Colon/cirugía , Mesocolon/cirugía , Anciano , Colectomía , Procedimientos Quirúrgicos Electivos , Humanos , Ligadura , Ganglios Linfáticos , Mesenterio , Tempo Operativo , Complicaciones Posoperatorias , Estudios Retrospectivos

RESUMEN

BACKGROUND: The advantage or disadvantage of laparoscopic appendectomy for acute appendicitis remains unclear. PATIENTS AND METHODS: Data were collected prospectively from 129 consecutive patients with appendicitis between June 2008 and December 2009. The clinical outcomes of acute appendicitis after laparoscopic and open operation were compared. Furthermore, the outcomes of laparoscopic procedure for acute and chronic appendicitis were compared. RESULTS: The length of hospitalization and incidence of intra-abdominal abscess were significantly decreased in patients with laparoscopic group after operation as compared to open operation. The mean operation time, the time of first anal exsufflation, and oral intake after operation were longer for acute appendicitis patients than for chronic appendicitis in laparoscopic group. The incidence of postoperative intestinal obstruction in patients with acute appendicitis was higher after laparoscopic surgery than after open procedure. CONCLUSIONS: Laparoscopic appendectomy for acute appendicitis is feasible and safe. However, laparoscopic appendectomy for acute appendicitis might cause more postoperative complications including intra-abdominal abscess and small intestinal obstruction compared to laparoscopic appendectomy for chronic appendicitis. These complications could potentially be avoided by improving techniques in operation.

Asunto(s)

Apendicectomía/métodos , Apendicitis/cirugía , Laparoscopía/métodos , Enfermedad Aguda , Apendicectomía/efectos adversos , Enfermedad Crónica , Femenino , Humanos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Análisis de Regresión

RESUMEN

OBJECTIVE: To compare the short-term efficacy and safety between complete mesocolic excision (CME) and traditional radical resection in colon cancer. METHODS: Between January 2008 and August 2011, 92 patients undergoing elective open surgery for colon were included in the study. CME was performed in 54 patients in the period from November 2009 to August 2011. The other 38 patients underwent traditional radical resection from January 2008 to October 2009. Short-term outcomes were compared between the patients of two different time periods. RESULTS: Lymph nodes retrieved in the CME group (22.2 ± 8.0) were significant more than that in the control group (18.6 ± 4.7)(P<0.05). In patients with stage III cancer, CME group was associated with higher lymph node counts (23.8 ± 7.6 vs. 16.7 ± 3.6, P<0.01), however, there were no significant differences for those with stage I and stage II cancer (P>0.05). The number of positive lymph nodes and metastatic lymph node ratio (LNR) for stage III patients in two groups were not significantly different (P>0.05). There were no differences in operation time, time to first bowel movement, hospital stay, and postoperative complications between the two groups (P>0.05). However, intraoperative blood loss in the CME group was significantly reduced (median, 100 vs. 115 ml, P<0.05). CONCLUSIONS: CME can achieve en-bloc resection of the tumor and mesocolon, and have optimal lymph nodes harvest. Despite wider resection extent with CME technique, the surgical risk and postoperative complications are not increased and the short-term efficacy is good.

Asunto(s)

Neoplasias del Colon/cirugía , Mesocolon/cirugía , Colectomía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To evaluate the learning curve of complete mesocolic excision(CME) for colon cancer. METHODS: Clinical data of 75 cases in whom CME was performed by a group of surgeons in the Department of Gastrointestinal Surgery, Peking University People's Hospital from November 2009 to June 2011 were reviewed. The patients were divided into three groups(groups A, B, C, 25 cases in each group) by operative chronologic sequence. RESULTS: There were no significant differences in age, sex, preoperative staging, cancer location, operation history of abdomen, ASA among the three groups(P>0.05). The operative time in group A was (205.4 ± 53.2) min and decreased to (180.4 ± 29.7) min in group B and (169.8 ± 41.3) min in group C (P<0.05). The postoperative hospital stay decreased from (17.8 ± 10.9) d in group A to(12.9 ± 4.1) d in group B and(11.0 ± 3.5) d in group C(P<0.05). The postoperative complication rate decreased from 32%(8/25) in group A and 36%(9/25) to 8%(2/25) in group C. The specimen quality was superior in group C compared to group A (WEST grade C above were 20 and 11 respectively, P<0.05). There were no significant differences in intraoperative bleeding, time to first flatus, postoperative fasting time, number of retrieved lymph nodes among the three groups(P>0.05). CONCLUSION: From the learning curve of CME, surgeons can learn CME skill after performing 25 cases.

Asunto(s)

Colectomía/métodos , Neoplasias del Colon/cirugía , Curva de Aprendizaje , Mesocolon/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/educación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven

RESUMEN

BACKGROUND: Although metabolic syndrome (MS) has received a lot of attention in recent years, the correlation between MS and colorectal carcinoma is still not very clear. This study aims at exploring the relationship between MS and colorectal carcinoma. METHODS: Data was collected from 507 cases of colorectal carcinoma and 507 cases of healthy patients between January 2002 and March 2007 to establish the database. The patients with colorectal cancer were divided into two groups based on the presence of MS. Multivariate analysis of these data for the overall survival and recurrence was performed with the Cox proportional hazard model. Variables examined by multivariate analysis were sex , age, location, histotype, differentiation, tumour, node, metastasis (TNM) stage, the number of lymph nodes detected, etc. RESULTS: The existence of MS in the colorectal carcinoma group was clearly more than that in the control group. The existence of two to four types of abnormal metabolic diseases was significantly more in the colorectal cancer group than in the control group. MS is one of the important elements that can independently influence the survival (odds ratio (OR) = 1.501, 95% confidence interval (CI) = 1.057-2.131) and have the highest risk with worse survival compared with other parameters. CONCLUSION: There is a close relationship between MS and colorectal carcinoma, and MS is a significantly independent element that influences the survival of the colorectal carcinoma. Decreasing the incidence of MS maybe play a role in improving therapeutic efficacy and prognosis of the cancer.

Asunto(s)

Neoplasias del Colon/complicaciones , Síndrome Metabólico/complicaciones , Neoplasias del Recto/complicaciones , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios de Cohortes , Neoplasias del Colon/metabolismo , Neoplasias del Colon/patología , Femenino , Humanos , Incidencia , Masculino , Síndrome Metabólico/mortalidad , Síndrome Metabólico/patología , Persona de Mediana Edad , Neoplasias del Recto/metabolismo , Neoplasias del Recto/patología , Factores de Riesgo , Análisis de Supervivencia , Adulto Joven