-
Yi Xiao,
Xi-Yu Sun,
Bei-Zhan Niu,
Yi Zheng,
Guang-Bing Xiong,
Zhi-Xuan Xuan,
Guan-Nan Zhang,
Jiao-Lin Zhou,
Bin Wu, Guo-le Lin,
Hui-Zhong Qiu
[show abstract]
[hide abstract]
ABSTRACT: Laparoscopic colorectal surgery is a skill-dependent procedure. The present study aims to analyze the learning curve of a properly trained surgeon, with basic laparoscopic techniques, to become skillful in performing laparoscopic colorectal operations.
A series of non-selective, consecutive 189 cases of laparoscopic colorectal surgery were accomplished, from December 2009 to February 2012, by one surgeon with years of skilled technique in laparoscopic cholecystectomy, rich experience in assisting laparoscopic colorectal surgery, and experience of aproximately 180 procedures of gastric and colorectal surgery annually. 170 out of 189 procedures were radical operations for colorectal neoplasma, including right colectomies in 28 cases, left colectomies in 5 cases, sigmoidectomies in 28 cases, high Dixon procedures in 45 cases, low Dixon (total mesorectal excision, TME) procedures in 41 cases and Miles procedure in 23 cases. 19 other patients underwent combined procedures for multi-primary tumors or inflammatory enteritis. All these procedures were analyzed according to time span (the earlier half and later half) in respect to length of surgery, intraoperative blood loss, number of lymph nodes retrieved, intraoperative events and postoperative complications.
For radical right colectomy, the D2 dissection conducted in the earlier phase (n = 8) had the similar length of surgery, more blood loss and less LN retrieval, compared with the D3 dissection conducted in recent phase (n = 20). The earlier performed high Dixon procedures (n = 22) consumed longer time than the later procedures (n = 23) consumed, but with similar blood loss and LN retrieval. Low Dixon (TME) procedures showed significant differences in length of surgery and blood loss relative to time span. Recently performed simoidectomy and Miles procedures showed a trend of shorter time consumed compared with earlier performed procedures. Conversion ratio to open surgery was 1.05%. Adverse effects occurred in 8 cases of surgeries, including intestinal injury (3/189), insufficient distal margin (2/189), intraoperative bleeding (2/189) and vaginal injury (1/76). There was no operative death. Chief complications included urinary retention 5.82%, ileus 4.76%, anastomotic leak 4.24%, perineal infection 23.08% (6/26), wound dehiscence 2.65%, gastrointestinal bleeding 1.59%, peritoneal infection 1.06%. Surgery for distal rectum tended to have more complications, such as urinary retention, anastomotic leak and perineal infection. The later performed low Dixon procedures produced insignificantly fewer anastomotic leaks than those in the earlier phase.
For a trained surgeon with basic laparoscopic techniques, there are at least 15 - 25 cases of different procedures needed for him/her to become skilled to perform laparoscopic surgery. The learning curve should also depend on the annual number of colorectal surgeries.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2012; 50(12):1063-7.
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To explore whether the abnormality of hMLH1 gene may be an early event of carcinogenesis in rectal carcinoma, and to evaluate the diagnostic value in differentiation between intraepithelial neoplasm and early stage of colorectal carcinoma. METHODS: The expression of hMLH1 protein in 28 cases with early invasive rectal carcinoma(EIRC), 36 cases with rectal intraepithelial neoplasm(RIEN), and 30 cases with normal rectal mucosa(NRM) which were collected through surgical operations were detected by PV-9000 immunohistochemical method. RESULTS: The positive expression rates of hMLH1 protein were 100%(30/30), 77.8%(28/36), and 39.3%(11/28) in NRM, RIEN, and EIRC respectively. The difference was statistically significant between RIEN and EIRC(P=0.002), and the difference was also statistically significant between RIEN and NRM(P=0.006). The positive expression of hMLH1 was not related to age, gender, tumor maximum diameter, dysplasia, tumor types, and distance from the anal verge in RIEV group(P>0.05). In EIRC group, hMLH1 was associated with tumor differentiation(P<0.05). CONCLUSION: hMLH1 gene deletion may be an early event during carcinogenesis of rectal carcinoma, which may be useful in differentiation of intraepithelial neoplasm from early rectal carcinoma.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 11/2012; 15(11):1162-1165.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the safety and efficacy of prophylactic single antibiotic administration in selective open colorectal surgery.
Two hundred and seventy-five patients undergoing selective open colorectal surgery in the Peking Union Medical College Hospital from October 2009 to October 2011 were retrospectively reviewed. Prophylatic single antibiotic administration was used by intravenous infusion 30-60 min before incision. No antibiotics would be given after operation if there was no surgical site infection(SSI). According to the incidence of postoperative SSI, unexplained use of antibiotics, anastomotic leakage and distant-site infection, the clinical outcome was assessed to be prophylactic success, prophylactic failure or distant-site infection, respectively.
There was no intraoperative or postoperative antibiotics related drug anaphylaxis in all the 275 patients. By prophylactic single antibiotic administration, there were prophylactic success in 243 patients(88.4%,243/275), prophylactic failure in 23(8.4%,23/275), distant-site infection in 9(3.3%,9/275). In the 23 patients with failed prophylaxis, there were SSI in 13(4.7%,13/275) patients, postoperative use of broad-spectrum antibiotics for unexplained fever in 2(0.7%,2/275), postoperative anastomotic leakage in 8(3.6%,8/222).
Prophylactic single antibiotic administration in selective open colorectal surgery is safe and effective.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 10/2012; 15(10):1040-3.
-
[show abstract]
[hide abstract]
ABSTRACT: Previous studies have shown that S100P contributes to the development of a number of tumors. However, its prognostic significance in colorectal cancer (CRC) has not been demonstrated. This study aimed to confirm the expression of S100P in colorectal cancer as well as the epigenetic mechanism underlying its gene expression, and to demonstrate whether S100P could be used to predict prognosis as a biomarker. We tested the expression of S100P in 96 CRCs and their paired tissue controls, as well as 13 colon cancer cell lines by RT-PCR and western blotting. Expression of the S100P protein and mRNA was significantly higher in cancerous regions compared to that in paired non-cancerous tissues (P=4.59 x 10(-17), 0.005 respectively). The expression was significantly correlated with the hypomethylation of the S100P promoter (P=4.92 x 10(-5)), which was detected by bisulphite sequencing PCR (BSP) and quantitative methylation-specific real-time PCR (QMSP). In stages I to III, the patients with positive expression of S100P protein showed poorer overall survival compared to those with S100P negative expression, P=0.031. We also measured the preoperative serum S100P levels by ELISA. The patients with normal serum levels of S100P showed favorable prognosis compared with patients with elevated S100P levels (P=0.008). These data suggest that S100P protein may be a potential novel prognostic biomarker in CRC patients.
Oncology Reports 04/2012; 28(1):303-10. · 1.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To summarize clinical experience in the treatment of low rectal cancer with anterior perineal plane for ultra-low anterior resection of the rectum(APPEAR).
Clinical and follow-up data of 26 patients with low rectal cancer undergoing the APPEAR operation in Department of General Surgery at Peking Union Medical College from September 2009 to August 2011 were retrospectively analyzed.
The 26 cases consisted of 19 male and 7 female patients with an average age of (63.4 ± 9.5) years. The average tumor distance from the anal verge was (4.6 ± 0.7) cm according to preoperative examinations. Fourteen patients received neoadjuvant radiochemotherapy before the operation. All the 26 patients had successful sphincter-preserving operations. The average operative time was (170 ± 21) min and the average intra-operative blood loss (140 ± 69) ml. Complications included one case of intraoperative injury to the rectal wall and 4 cases of postoperative perineal wound infection. Postoperative pathological examination showed well to moderately differentiated adenocarcinomas(n=10), moderately differentiated adenocarcinomas with partial mucinous adenocarcinomas (n=7), poorly differentiated adenocarcinoma(n=1), villous adenoma with high-grade intraepithelial neoplasia (n=1), and rectal villous adenoma(n=1). In 6 cases no residual tumor cells were detected in the surgical specimens. All the patients were followed-up for an average period of(11.4 ± 5.6) months. No impaired urinary function or tumor recurrence was observed during the follow-up. Eighteen patients had the transverse colon stoma closure six months after the operation. The average Wexner continence score was 5.5 after colostomy reversal surgery. The anorectal manometry tests showed that maximum squeeze pressure of the anal sphincter was(224.0 ± 59.3) mm Hg. The maximum resting pressure was (42.5 ± 11.8) mm Hg, and the maximum tolerable volume of the rectum was (120.0 ± 27.4) ml. Anorectal reflexes were present in all these patients.
The APPEAR technique can be applied in the sphincter-preserving operations for low rectal cancer patients with satisfactory anal function.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 01/2012; 15(1):47-50.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the impact of neoadjuvant chemoradiation on perineal wound healing following abdominoperineal resection(APR) for lower rectal cancer.
Data of 93 patients who underwent APR for low rectal cancer between January 2005 and January 2009 in Peking Union Medical College Hospital were reviewed, including patients who received neoadjuvant chemoradiation (n=29) and those undergoing surgery alone(n=64). Perineal wound healing was the primary outcome measurement. Condition of wound healing was classified as good, moderate, and poor and was compared between the two groups.
Twenty nine patients in the neoadjuvant group received preoperative regional radiation(50 Gy, 25 fractions/5 weeks) with synchronous FOLFOX4 chemotherapy(fluouracil and oxalipatin). In the neoadjuvant group, wound healing after APR was good in 18 patients(62.1%), moderate in 6(20.7%), and poor in 5(17.2%). In patients who had surgery alone, wound healing after APR was good in 41 patients(64.1%), moderate in 15(23.4%), and poor in 8(12.5%). There was no significant difference in the incidence of wound infection(poor wound healing)between the two groups(P=0.773).
Neoadjuvant chemoradiation therapy is not associated with increased perineal wound infection following abdominoperineal resection for low rectal cancer.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 10/2011; 14(10):775-7.
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the outcomes of right hemicolectomy performed either by the hand-assisted laparoscopic(HALS) or conventional laparoscopic surgery(LAS).
Ninety-five patients undergoing HALS(n=47) from March 2002 to November 2006 or by LAS (n=48) from January 2007 to December 2009 were retrospectively studied. All the operations were performed by the same surgical team. Patient safety, postoperative recovery, complications, oncologic outcomes, medical expenses, and the follow-up results were compared between the two groups.
No severe complications or perioperative deaths were oberved. There were significant differences between the two groups in terms of intraoperative bleeding, operative time, and length of incision(all P<0.05). However, the conversion rate, intraoperative injuries, time to first bowel movement, postoperative bed-rest time, hospital stay, time to first oral intake, and the number of patients requiring postoperative analgesia were comparable between the two groups(P>0.05). Length of surgical specimen was (25.6±9.9) cm in the HALS group and was (26.8±7.9) cm in the LAS group, the diffenence was not statistically significant(P<0.05). The mean number of lymph nodes retrieved in HALS group was 18.2±12.1, which was significantly lower than that in LAS group(24.1±9.3, P<0.05). The medical expense of the LAS group was (28 049.8±7576.1) RMB, which was significantly higher than that of the HALS group(21 132.7±5323.4) RMB(P<0.05). A follow-up rate of 93.7% was achieved in the HALS group with 3 patients lost to follow-up. The follow-up duration ranged from 45.4 to 101.9 months with a median of 66.7 months. In LAS group, the follow-up rate was 96% with 2 patients lost to follow-up and the follow-up duration ranged from 12.4 to 45.7 months with a median of 21.6 months. There was no significant difference in 3-year disease-free survival(91.3% vs. 87.9%, P>0.05) between the two groups.
HALS and LAS can achieve similar minimal invasiveness efficacy and oncologic outcomes for right hemicolectomy.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2011; 14(7):545-8.
-
[show abstract]
[hide abstract]
ABSTRACT: The study aimed to identify the factors predictive for extreme unresponsiveness to neoadjuvant therapy for rectal cancer.
Ninety-six patients with rectal cancer received neoadjuvant therapy (41 were treated with radiotherapy and 55 with chemoradiotherapy) before surgery. Tumour response, downstaging, pathological complete response (pCR) and disease-free survival were evaluated.
Tumour response, downstaging and pCR occurred in 70 (72.9%), 47 (49.0%) and 14 (14.6%) patients, respectively. Univariate analyses showed that a large tumour size, T4 stage, elevated serum tumour markers, poor differentiation, radiotherapy alone and mucinous tumour were indicators of poor tumour response and/or downstaging. On multivariate analysis, chemoradiotherapy was found to be predictive for tumour response and downstaging, whereas mucinous type and T4 stage negatively affected tumour response. No variable was found to be associated with pCR, but poor differentiation and T4 stage together predicted extreme unresponsiveness with a high specificity and a high positive predictive value. Very poor disease-free survival was also observed in patients simultaneously carrying these phenotypes.
Neoadjuvant chemoradiotherapy is superior to radiotherapy alone in producing a response of rectal cancer. Unresponsiveness was most likely to occur in patients with poor differentiation and T4 disease.
Colorectal Disease 02/2011; 13(12):1353-60. · 2.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the effects of presacral irrigation and simple drainage on the perineal wound healing in patients after abdominoperineal resection (APR).
From October 2004 to August 2009, patients with rectal cancer, ulcerative colitis or rectal gastrointestinal stromal tumor, who underwent APR or proctocolectomy, were randomized into two arms: simple drainage group (n = 37) and continuous irrigation (n = 37). Patients randomized to arm B received simple drainage only to presacral space; while those patients in arm A received continuous irrigation in addition to simple drainage. Perineal wound healing was taken as endpoint of this study. Major complication was defined as wound dehiscence or wound infection that the perineal wound should be reopened for drainage. Minor complication was defined as delayed healing wound with seroma or hematoma.
A total of 74 patients were enrolled in present study, with 37 patients in each arm, and there were 12 cases and 10 cases who received preoperative radiation therapy, respectively. In the arm A, 2 patients developed major complications, 3 patients incurred with minor complications and 32 patients got primary healing of the perineal wounds. In arm B, 8 patients suffered major complications, 3 patients incurred with minor complications and 26 patients got primary healing of the perineal wounds. The incidence of major complication was significantly lower in arm A (5.4% vs.21.6%, P = 0.042). Patients received preoperative radiation therapy had significantly higher rate of minor complications than patients underwent surgery only (18.2% vs. 3.9%, P = 0.039).
Simple drainage with continuous irrigation of the presacral space, in patients with abdominoperineal resection or proctocolectomy, could significantly lower the incidence of major complication and improve wound healing for perineal wound when compared with simple drainage only. Preoperative radiation therapy tends to increase the incidence of minor complications.
Zhonghua wai ke za zhi [Chinese journal of surgery] 07/2010; 48(14):1088-91.
-
[show abstract]
[hide abstract]
ABSTRACT: To identify the clinical pathologic factors predicting tumor response of preoperative neoadjuvant therapy in patients with rectal cancer.
Seventy-nine patients with rectal cancer underwent neoadjuvant therapy before surgery from July 2000 to July 2009 were included in this study. Clinical pathologic factors were retrospectively analyzed to check the predicting effect of tumor response to the neoadjuvant therapy.Pathologic complete response (pCR) and T down-staging were the study endpoints.
Of the 79 patients, 10 cases (12.7%) got pCR after the neoadjuvant treatment. T down-staging was achieved in 41 patients (51.9%). The colonoscopy showed that the tumor occupied < or = 1/3 proportion of the bowel lumen in 22 patients, and 7 of them got pCR after the neoadjuvant therapy. Chi-square analysis showed that the proportion of tumor occupied in the bowel lumen was relevant to pCR rate (P < 0.05). Serum carcino-embryonic antigen (CEA) level was examined in 74 patients. Twenty-seven cases of the 46 patients with a serum CEA level < 5 microg/L got a T down-staging. Twenty-three cases of the 38 patients with a normal range of both serum CEA/CA19-9 levels got a T down-staging. Chi-square analysis showed normal range of both serum CEA/CA19-9 levels indicated better T down-staging.
It's defined some possible predictive factors for effects of neoadjuvant therapy in patients with rectal cancer. Particularly, patients with less tumor occupation of the bowel lumen and a serum CEA level < 5 microg/L seem to be more likely to get better clinical results.
Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2010; 48(5):348-52.
-
[show abstract]
[hide abstract]
ABSTRACT: To study the impact of neoadjuvant therapy on lymph nodes retrieval in locally advanced mid-low rectal carcinoma.
Data collected from 120 patients with locally advanced mid-low rectal cancer (T2-4 and/or N1-2M0) treated from January 2005 to June 2008 was investigated. The patients were divided into two groups: the study group (n=54) was treated with neoadjuvant therapy (preoperative radiation with a total dosage of 50 Gy and synchronous 5-Fu-based chemotherapy) followed by radical tumor resection 4-6 weeks after;the control group (n=66) underwent primary surgery without neoadjuvant therapy. The clinical stage was evaluated before and after neoadjuvant therapy. The total lymph nodes yields, as well as the tumor-positive lymph nodes of each resected specimen was compared between the two groups statistically.
Clinical downstage was achieved in 30 cases (56%) in study group after neoadjuvant therapy. The number of total lymph nodes and positive lymph nodes harvested from each resected specimen in the control group were 14+/-7 and 2.2+/-3.7, meanwhile those were 9+/-6 and 0.7+/-2.4 in study group, which were all significantly lower than those in control group (P<0.01).
Preoperative radiotherapy combined with chemotherapy can downstage the tumor and reduce the retrieval rate of total lymph nodes and positive lymph nodes in locally advanced rectal cancer. It is necessary to retrieve as many lymph nodes as possible for it has some prognostic significance for the patients.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2009; 47(23):1779-83.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms.
Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases.
The mean diameter of the rectal lesions was (1.6 +/- 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 +/- 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall: 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right wall. Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7 +/- 32.1) min (range, 30-180 min). The mean operative blood loss was (9.8 +/- 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 +/- 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8. 4 months (range, 3-26 months), no tumor recurrence or metastasis was observed.
Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.
Zhonghua wai ke za zhi [Chinese journal of surgery] 07/2009; 47(13):981-3.
-
Guan-Ning Cong,
Ming-Wei Qin,
Hui You,
Xiao-Zhen Li,
Yi Xiao,
Hui-Zhong Qiu,
Bin Wu, Guo-Le Lin,
Chun-Ling Meng,
Wei Meng,
Bo Jiang,
Dong Liu,
Jin Xu,
Yang Jin
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the clinical value of diffusion weighted imaging (DWI) combined with conventional sequences of magnetic resonance imaging (T1 and T2-weighted imaging) for the diagnosis of rectal cancer.
DWI and conventional sequences were performed in 29 patients with endoscopically diagnosed rectal cancer and 15 patients without rectal cancer. Two doctors who were blind to the history of the patients interpreted the imaging findings. The sensitivity and specificity of conventional sequences with and without DWI were analyzed using receiver operating characteristic curve (ROC).
The areas under ROC were 0.915 and 0.930 for conventional sequences alone, and 0.990 and 0.994 for conventional sequences with DWI, respectively, indicating that although both of them were optimal methods for the diagnosis of rectal cancer, the accuracy of conventional sequences with DWI was significantly superior to that of conventional sequence alone (P < 0.05). The Kappa value was 0.850 for conventional sequences alone and 0.858 for DWI with conventional sequences.
DWI was necessary for the diagnosis of rectal cancer when performing conventional sequences.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 04/2009; 31(2):200-5.
-
[show abstract]
[hide abstract]
ABSTRACT: The posterior trans-sphincteric approach to treat different lesions of the rectum has been known since the last century. Although there are many advantages to this procedure, it has never been widely accepted because many surgeons fear its potential postoperative complications. The purpose of this study is to reevaluate the role of this conventional approach to surgery of the rectum from the authors' 16 years experience.
Data were collected retrospectively from clinical records of 102 patients with mid- to low-lying rectal neoplastic disease treated by a single surgeon using a posterior trans-sphincteric approach to the rectum at Peking Union Medical College Hospital, China, between August 1990 and August 2006. The Williams incontinence scale of every patient was assessed preoperatively and postoperatively and the results were analyzed.
Forty men and 62 women with a median age of 55.5 years (range = 21-87 years) underwent this approach. Their preoperative anal continence was assessed as grade 1 in 98 and grade 2 in 4. Indications for surgery were rectal villous adenoma in 36, early rectal carcinoma in 43, advanced rectal carcinoma in 10, and rectal submucosal neoplastic disease in 13. The median operating time, blood loss, and postoperative hospital stay were 75 min (range = 40-180 min), 60 ml (range = 0-300 ml), and 8 days (range = 7-60 days), respectively. All 102 rectal neoplastic diseases achieved complete excision (partial rectectomy in 96, segmental rectectomy in 6), and the resection margins were all clear. Three patients (2.9%) developed postoperative wound infection, and 4 patients (3.9%) developed fecal fistula. Thirty-three patients (32.4%) developed postoperative initial incontinence to flatus (n = 26) or liquid stool (n = 7) within 1 week. Three months after the operation, 94 patients (92.2%) achieved grade 1 continence and only 8 patients (7.8%) had occasional episodes of flatus incontinence. No patient developed postoperative anal stricture. There was no operation-related mortality. Three patients (2.9%) developed local tumor recurrence during median follow-up of 76.8 months (range = 10-192 months).
The posterior trans-sphincteric approach is suitable for mid- to low-lying rectal lesions amenable to treatment using local therapy.
World Journal of Surgery 07/2008; 32(8):1776-82. · 2.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To summarize the clinical features and surgical methods for colorectal cavernous hemangioma in China.
Data of 4 cases in Peking Union Medical College Hospital and 54 cases with colorectal cavernous hemangioma from 1979 to 2006 reported in Chinese literatures were analyzed retrospectively, including clinic manifestations and surgery treatment.
The incidence of male to female was 1.0:1.0, and 43.1% of the patients had their first onset of recurrent rectal bleeding in early childhood. Colonoscopy, rectal CT scan and MRI were the accurate methods for the diagnosis (100%). 91.4% of the patients had diffuse infiltrative lesions and 8.6% of the patients had localized lesions. 82.8% of the patients underwent surgical treatment while 3.5% of the patient did not received treatment.
Colonoscopy is the first choice for the diagnosis of colorectal cavernous hemangioma. Local resection should be performed for the localized cavernous hemangioma. Sigmoid colon and rectum resection with coloanal anastomosis is suitable for the diffuse and infiltrative colorectal cavernous hemangioma.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2008; 11(4):312-6.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the efficacy of neoadjuvant radiotherapy alone versus chemoradiotherapy in patients with mid-low locally advanced rectal cancer.
Data of 69 patients with advanced (stage T(3) or T(4)) rectal cancer, undergone neoadjuvant therapy in our hospital from October 1997 to October 2007, were analyzed retrospectively. Forty patients received preoperative radiotherapy (50 Gy in 25 fractions over 5 weeks) alone (RT group), and 29 patients received preoperative radiotherapy concomitant with 5-FU/leucovorin -based preoperative chemoradiotherapy (CRT group). Radical surgery was performed 4-6 weeks after radiation therapy by the rule of TME.
All the patients underwent operations, including 26 abdominoperineal resections, 27 anterior resections, 10 Parks operations and 6 Hartmann's procedures. The sphincter preservation rate was 47.5%(19/40) in RT group, and 62.1%(18/29) in CRT group(P>0.05). In pathological findings, tumor and nodal downstaging were observed in 12 patients of RT group (30.0%), and 17 of CRT group (58.6%)(P<0.05). In RT group, 3 patients (7.5%) showed pathological complete regression (pCR), and the overall response rate (CR plus PR) was 60%(24/40). In CRT group, 4(13.8%) showed pCR and the overall response rate was 79.3%(23/29). There was significant difference of the overall response rate between two groups. Three-year disease-free survival for all patients was 77.3%.
For patients with locally advanced rectal cancer, neoadjuvant chemoradiotherapy provides higher sphincter preservation rate, overall response rate and better down-staging as compared to radiotherapy alone.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 03/2008; 11(2):124-7.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the clinical value of transanal endoscopic microsurgery (TEM) for rectal intraepithelial neoplasia (IN) and early rectal carcinoma.
Fifteen patients with rectal tumor were selected to undergo local excision by TEM. The pre-operative diagnosis by biopsy and endoanal ultrasonography (EUS): rectal low-grade IN in 8 cases, high-grade IN in 4 and early rectal carcinoma in 3. The average distance of tumors from the anal verge was 7.2(4-15) cm. The average tumor size was 1.8(1-4) cm. The average proportion of the circumference of bowel lumen involved was 20%(10%-40%).
All the 15 rectal tumors were achieved complete excision (submucosal excision in 5, full-thickness excision in 10), and all the resection margins were clear. The average operating time was 57 (40-90) min. The average blood loss was 35 (10-60) ml. The average post-operative stay was 4.5 (2-9) d. The post-operative pathological diagnosis: rectal low-grade IN in 5 cases, high-grade IN in 6, early submucous invasive carcinoma (pT(1)) in 2, advanced carcinoma (pT(2)) in 2. The diagnostic accuracy of EUS in assessing invasive depth of rectal tumor was 86.7% (13/15). The average follow-up period of 15 patients was 6 (2-10) months. There was no local recurrence occurred.
TEM is an ideal minimally invasive procedure for the treatment of rectal IN and early rectal carcinoma, with excellent exposure and accurate excision, providing a high-quality tumor specimen for pathological staging. Pre-operative EUS is very important in selecting patients suitable for resection by TEM.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 02/2008; 11(1):39-43.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the role of transsphincteric surgery in local excision of mid and lower rectal tumors.
The clinical data of 97 patients with mid and lower rectal tumors underwent transsphincteric surgery from March 1990 to March 2007 were retrospectively analyzed.
Ninety-one patients underwent partial proctectomy, and six underwent segmental proctectomy. Postoperative complications included wound infection in 5 (5.2%), fecal fistula in 4 (4.2%). Pathological examination showed rectal villous adenoma in 35 cases, rectal cancer in 50, rectal carcinoid and others in 12. The pathological stages of rectal cancers included Tis stage in 17 cases, T1 in 21, T2 in 7, T3 in 2, T4 in 3. The mean follow-up was 6.4 years (range, 2 months - 16 years). Three patients developed postoperative local recurrence (6.2%). The three- and five-year survival rate was 93.7% and 87.5%, respectively. There was no operation-related mortality, and no patient developed fecal incontinence.
The transsphincteric surgery brings minor invasion, low operative risk and increased chance of sphincter preservation, which is suitable for treatment of mid and lower rectal tumors.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2007; 45(17):1167-9.
-
[show abstract]
[hide abstract]
ABSTRACT: To compare local resection of early rectal tumours by transanal endoscopic microsurgery (TEM) and the conventional posterior trans-sphincteric approach (Mason's operation).
The study group comprised 31 consecutive patients with early rectal tumours (18 villous adenomas, 13 adenocarcinomas) who underwent TEM in Kwong Wah Hospital, Hong Kong. The control group consisted of 51 patients with early rectal tumours (27 villous adenomas, 24 adenocarcinomas) who underwent Mason's operation in Peking Union Medical College Hospital, Beijing. Outcome measures included morbidity and mortality, operation time, recurrence rate and postoperative pathological staging.
Age, sex and pathological staging were similar in the two groups. The tumour size, operation time and blood loss were similar. The median distance from the anal verge was significantly higher in the TEM group (TEM/Mason = 8.0/6.4 cm, p = 0.042). The postoperative resumption of food intake (TEM/Mason = 1/5 days, p = 0.002) and the median hospital stay (TEM/Mason = 4/10 days, p = 0.005) were significantly shorter in the TEM group. Analgesic intake was significantly less in the TEM group (TEM/Mason = 0/100 mg, p = 0.0003). There was no operation-related mortality and the resection margins were clear in both groups. Two patients (3.9%) in the Mason's group developed postoperative wound infection, and two patients (3.9%) developed faecal fistulae. There was one secondary haemorrhage in the TEM group that required injection sclerotherapy. On median follow-up of 23 months, there was no tumour recurrence in the TEM group, whereas two patients (3.9%) in the Mason's group experienced recurrence during a median follow-up of 30 months.
TEM is as effective as the conventional posterior trans-sphincteric approach (Mason's operation) for local curative resection of early rectal tumours. TEM is less invasive, with shorter hospital stay and fewer complications than conventional Mason's operation.
Asian Journal of Surgery 11/2006; 29(4):227-32. · 0.57 Impact Factor
-
Zhonghua zhong liu za zhi [Chinese journal of oncology] 09/2006; 28(8):635-6.
