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ABSTRACT: AIM: Anorectal melanoma is a rare neoplasm with poor prognosis. The aim of this study was to investigate what clinicopathologic factors predicted lymph node metastases and to investigate their association with survival. METHODS: Patients undergoing surgery with curative intent for primary anorectal melanoma in Fudan University Shanghai Cancer Center between 1989 and 2011 were studied retrospectively. Association between clinicopathologic factors and lymph node metastases and prognosis were determined. RESULTS: Forty-three patients underwent a potentially curative resection with a median follow-up of 20 months; the 5-year overall survival rate (OS) was 29.6% with median overall survival of 28 months. Tumor diameter >3 cm was associated with mesorectal and mesenteric lymph node metastases (P=0.013). Perineural invasion (PNI)(HR 5.683; 95% CI1.978-16.328; P=0.001) was the only factor that independently predicted survival. CONCLUSION: Tumor diameter was associated with mesorectal and mesenteric lymph node metastases; therefore, wide local excision (WLE) may not be appropriate for surgery with curative intent for patients with a tumor diameter ≥ 3cm. PNI was an important prognostic factor for anorectal melanoma. This article is protected by copyright. All rights reserved.
Colorectal Disease 04/2013; · 2.93 Impact Factor
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ABSTRACT: AIMS: Based on the hypothesis that first-line chemoradiation followed by chemotherapy was superior for primary tumor and non-inferior for distant lesions compared to chemotherapy alone in synchronous unresectable distant metastases rectal adenocarcinoma, this study was designed to assess the efficacy and safety of this strategy.Materials and methods: Thirty two eligible patients received intensity modulated radiation therapy (45 Gy to the pelvis and a concomitant 10 Gy boost to the gross tumor), along with concurrent weekly capecitabine and oxaliplatin. Patients underwent radical surgery if all lesions were visually evaluated as resectable and received chemotherapy for a total of 6 months, whether pre- or post-operatively (definitive therapy group). The remaining patients received 6 months of consolidation chemotherapy followed by maintenance chemotherapy (non-definitive therapy group). RESULTS: The toxicities were acceptable, with radiation-induced dermatitis around the anal verge being the most common (18.8%). Fourteen patients underwent surgical resection of the rectal tumor, with 5 (35.7%) experiencing a pathological complete response. Nine out of 14 received definitive treatment, defined as R0 resections of all visible tumors. At a median follow-up of 12 months (range, 4--23 months), 2 cases were evaluated as local failure, and the median overall survival (OS) and progression free survival (PFS) for all 32 patients were 17.5 and 12 months, respectively. OS differed significantly in the definitive and non-definitive therapy groups (p=0.045), and PFS tended to differ (p=0.274). CONCLUSION: It was demonstrated that the strategy of first-line chemoradiation followed by chemotherapy was effective and tolerable, especially for local control. OS and PFS were superior in patients who did than did not undergo curative therapy.
Radiation Oncology 01/2013; 8(1):10. · 2.32 Impact Factor
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ABSTRACT: Aim: the aim of this study was to assess the effect of apical lymph node (APN) metastasis in predicting prognosis in curatively treated node-positive rectal cancer. We also investigated the relationship between APN metastasis and total number of metastatic lymph nodes. Method: A retrospective study was performed of 510 curatively treated patients with node-positive rectal cancer. Clincopathological variables including apical lymph node status were assessed in univariate and multivariate analysis. The prognostic significance of APN status in predicting patient outcomes and the relationship between APN status and AJCC N stage were analyzed. Results: At a median follow-up of 47 months, the 5-year local recurrence (LR) rate, disease free survival (DFS) rate and overall survival (OS) rate were 18.3%, 55.5%, and 58.8%. Five-year OS rate was 69.6% for patients with APN (-), and 40.8% with APN (+). DFS and OS for patients with undetermined APN status were between those for APN (-) and APN (+). Subgroup analysis showed the 5-year OS rate was 48.7% in stage N1 patients with APN(+), and 58.8% for stage N2 patients with APN (-) (P=0.0004). Conclusion: APN metastasis is an important prognostic factor in node-positive rectal cancer, which provides additional survival-related prognostic classification irrespective of N stage. As the APN is usually outside of the radiation field, in the era of multidisciplinary treatment its assessment should be incorporated into prognostic evaluation of rectal cancer. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Colorectal Disease 10/2012; · 2.93 Impact Factor
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ABSTRACT: Rectal carcinoid is a rare rectal tumour with a good prognosis. The aim of this study was to assess its clinicopathological characteristics and prognostic factors in a single institution.
Clinical and pathological information was retrospectively collected in a single institution, and patients' outcomes were determined. Multivariate analyses were performed to find independent prognostic factors attributed to overall survival.
A total of 106 patients with rectal carcinoid were included. In all, 66% of the patients underwent transanal local excision and 34% had transabdominal surgery. The 5-year survival rate was 87%. Muscularis invasion was the only independent prognostic factor for predicting 5-year survival (P = 0.00046). Tumour size was found to be significantly associated with muscular invasion (P = 0.00003). The area under the curve of tumour size in the receiver operating characteristic curve for predicting muscular invasion was 0.92.
Patients with rectal carcinoid have a good prognosis. Muscular invasion is an independent risk factor of survival.
Colorectal Disease 10/2009; 13(2):150-3. · 2.93 Impact Factor
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ABSTRACT: Anastomotic leakage is a serious complication in rectal cancer surgery. More than one third of rectal cancer patients with low anterior resection (LAR) will receive defunctional stomas during primary operation.
Six hundred thirty-nine consecutive rectal cancer patients, whose tumors were located 5 to 12 cm from the anal verge, were treated with LAR. A standardized pelvic drainage for all these patients and selective irrigation for patients with leakage were conducted, and defunctional stoma was used as a salvage modality. All the anastomoses were all extraperitonealized during primary operations.
The anastomotic leakage rate was 7.04%. Male gender and location of tumor were found to be risk factors for leakage in patients with LAR. The overall stoma rate was 1.88%. Nearly 75% of leakage could be cured by irrigation-suction without surgical intervention. Severe complications, such as peritonitis, fistula, and obstruction, were strong predictors of irrigation failure.
Extraperitonealized anastomosis and pelvic drainage obtained a very low rate of defunctional stoma for LAR. Pelvic irrigation-suction was an effective modality to resolve anastomotic leakage.
American journal of surgery 10/2009; 199(6):753-8. · 2.36 Impact Factor
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ABSTRACT: To discuss the severity grading and procedure design of concealed penis.
Between June 2004 and April 2008, 196 cases of concealed penis were surgically corrected. The age ranged from 1 year and 4 months to 44 years, with a median of 9 years. They presented with inconspicuous penis and abnormal cavernosa development. Four cases complicated by glanular hypospadias and 3 cases by penile epispadias. They were classified as mild in 49 cases, moderate in 109, and severe in 38 according to severity. Surgical procedures were selected based on varied anatomical changes in different categories.
All the patients got satisfactory appearance immediately after surgery. No voiding problem, wound infection, and skin necrosis were found. With 6 months to 48 months (mean 16 months) follow-up, most patients achieved good results and the penile appearance resembled that after circumcision. Mild penile retraction was noted in 1 moderate case and 1 severe case; and recurrence occurred in another one, the result was satisfactory after reoperation.
Various surgical procedures can be adopted for concealed penis. The key point is to design procedures according to the anatomical abnormalities.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2009; 23(7):803-6.
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ABSTRACT: The purpose of the study was to evaluate the prognostic value of metastatic lymph node ratio (LNR) in node-positive rectal cancer.
A retrospective review was performed in 318 rectal cancer patients who received curative anterior resection in a single institution. Clinicopathological variables including LNR were studied in univariate and multivariate analyses by Cox regression. LNR was further studied when stratified by quartiles. Survival analyses were performed using the Kaplan-Meier method and log-rank test.
With median follow-up of 41 months, the 5-year disease-free survival (DFS) rate, overall survival (OS) rate, and local recurrence (LR) rate were 56.82%, 59.8%, and 11%, respectively. Multivariate analysis revealed that LNR as a continuous variable was the most significant prognostic factor for DFS, OS, and LR. On quartiles, LNR was stratified into three groups: <0.14, 0.14-0.49, and 0.5-1. The 5-year DFS rate was 72.57%, 58.54%, and 34.75% (P = 0.0001) and the 5-year OS rate was 72.19%, 61.92%, and 38.47% (P = 0.002) in the three groups, respectively. Five-year LR rate was significantly higher with LNR between 0.14 and 1 (3.6% in LNR<0.14 versus 15.6% in LNR 0.14-1, P = 0.019).
LNR is an important prognostic factor for node-positive rectal cancers. With a cutoff of 0.14 and 0.5, node-positive rectal cancer patients could be categorized into three subsets with significant different outcomes.
Annals of Surgical Oncology 09/2008; 15(11):3118-23. · 4.17 Impact Factor
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ABSTRACT: To investigate the effect of ventral urethroplasty for postoperative anastomotic stricture in patients with hypospadias.
From August 2000 to December 2005, 20 patients with anastomotic stricture after hypospadias repair were treated with ventral urethroplasty. The age ranged from 2 to 27 years with an average of 6.4 years. All patients showed dysuria after operation. Main clinical manifestation included dysuria and acraturesis. Interruption of urinary stream occurred in 17 cases; of them, 3 cases had urinary stasis and 4 cases had frequent micturition, urgent micturition and pain in urination. Urethrography and cystourethrography showed 0. 5-1. 0 cm stricture with proximal dilation of urethra in 16 cases and obvious diverticularization in 9 cases. Urine routine examination showed that white blood cell was ++ to ++++ in 16 cases and pus cell was +/+ to ++ in 13 cases.
Twenty cases were followed up 2 months to 4 years (mean 2.3 years). All the cases achieved good results in urination with normosthenuria and normal force of urinary stream. No recurrent stricture, urethrocutaneous fistula, or penile curvature occurred. The cosmesis was satisfactory, and the results of urine routine examination was normal.
Ventral urethroplasty for postoperative anastomotic stricture in patients with hypospadias is a simple and effective procedure.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2007; 21(7):726-8.
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ABSTRACT: To investigate the anatomical features of congenital chordee without hypospadias in children and to discuss the diagnosis and treatment.
From August 1984 to December 2004, 94 children with chordee without hypospadias treated in the West China Hospital of Sichuan University were classified and analyzed for anatomical alterations. Their ages ranged from 18 months to 13 years (mean 6. 9 years). Ninety-four patients were divided into four groups. With intraoperation artificial erection, the patients with penis straightened after degloving were classified as type I patients (skin-tethering), those with penis straightened after fibrotic tissue in Buck's fascia released as type II patients (dysgenetic fascia), those with normal urethra and orthoplasty failed after degloving and removing fibrotic tissue as type III patients (corporal disproportion), and those with dysgenetic urethra tethering the corpora cavernosa as type lV patients (short urethra).
In type I (n = 31, 32.9%) patients, the ventral skin and dartos fascia were contracted while Buck's fascia and the urethra was normal, in some (7 cases) scrotal skin extended to the ventral portion of penis (webbed penis). In type II (n = 45, 47.9%), contracture of Buck's fascia was evident and the thickening fibrotic tissue constituted the chief obstacle to orthoplasty, though in some skin was shortened. In type III (n = 6), the dorsal and ventral sides of the corpora cavernosa were disproportionated, and the morphologically normal urethra tightly adhered to the ventral aspect of corpora cavernosa. In some cases ventral skin and fascia were contracted, but orthoplasty could not be achieved through releasing these layers. In type IV (n = 12, 12.8%), the distal urethra was paper-thin and lacking corpus spongiosum, or dense fibrotic bands were found to be deep to the urethra. The urethra tethered the corpora cavernosa and formed a bow-to-string relation. The overlying skin and fascia were contracted in varying degrees while none had significance in straightening the penis. After operation, the length of penis increased to 6.9 cm from 5.2 cm on average and the chordee was corrected to 1.6 degrees from 42.6 degrees before operation on average. The patients were followed up 1 months to 15 years. The results were satisfactory. Chordee remained in 2 cases, fistula and urethral stricture occurred in 2 cases respectively, fistula in association with urethral stricture and diverticulum in 1 case; the operation was given again and the results was satisfactory.
Patients with chordee without hypospadias may be divided into four types depending on which layer of the ventral penis constitutes the chief contribution to chordee. A systematic approach with repeated artificial erection tests is needed in determining the classification and surgical correction.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 04/2006; 20(3):217-9.
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ABSTRACT: To present the experience of hypospadias repair using the tubularized incised plate urethroplasty (Snodgrass procedure).
From May 2001 to November 2004, 82 patients with hypospadias underwent the Snodgrass procedure and the clinical data were analysed retrospectively. The mean age was 5 years (1.5 to 16 years). These cases were divided into: the earlier stage group (34 cases) and the later stage group (48 cases); the proximal group (19 cases) and the distal and middle group (63 cases); the primary operational group (49 cases) and the preoperational group (33 cases).
Fistulas occurred in 12 patients (14.6%), complete glans dehiscence in 1 case. Fistula were as follows: 11 cases in the earlier stage group (32.4%) and 1 case in the later stage group (2.1%); 2 cases in the proximal group (10.5%) and 10 cases in the group of distal and middle group (15.9%); 8 cases in the primary operational group (16.1%) and 4 cases in the preoperational group (12.1%). There was statistically significant difference in the incidence of fistula between the earlier stage group and the later stage group (P < 0.01). There was no statistically significant difference between the proximal group and the distal and middle group, between the primary operational group and the preoperational group (P > 0.05). All patients were followed up more than one month. The neo-meatus was in normal position. The results of penile cosmetic and urethral function were satisfactory. Of these cases, 15 were followed up 1.5-6.0 months. The average flow rate was 7.8 ml/s (6.8-10.5 ml/s). The mean of maximum flow rate was 10. 5 ml/s (8.8-14.5 ml/s).
Excellent neourethral functional and superior cosmetic results with low rate of complication can be gained by using tubularized incised plate urethroplasty for the cases of hypospadias without chordee or with mild chordee. But the preputial flap procedure should be chosen in condition that the hypospadias was association with obvious chordee.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 04/2006; 20(3):226-8.
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ABSTRACT: Ureteral triplication is a rare congenital anomaly of the urinary tract. Since the first description of ureteral triplication by Wrany in 1870, only about 100 cases have been reported in the literature. Pediatric cases are very few. Here, 2 cases of ureteral triplication were reported. Diagnosis was established preoperatively in 1 case and intraoperatively in 1. To the authors knowledge, this is the first report of ureteral triplication in China.
Journal of Pediatric Surgery 02/2004; 39(1):E38-9. · 1.45 Impact Factor
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ABSTRACT: We reviewed the clinicopathological features and surgical management of 16 cases of single ureteral ectopia with congenital renal dysplasia.
Excretory urography, retrograde ureterography, computerized tomography, diuretic B-mode ultrasound (B-US) and color Doppler imaging (CDI) were performed in 16 females. Explorative operations were performed in all 16 patients and renal dysplasia was further confirmed by pathological examination.
The 16 female patients were 1.5 to 12 years old. The main clinical signs were urinary incontinence accompanied by regular voiding since birth. Vaginal ectopic ureters were observed in 6 patients and vestibular ureters in 10. Excretory urography did not show dysplastic kidney except some indirect signs of renal dysplasia. Computerized tomography clearly revealed renal dysplasia in 4 of 9 cases performed without contrast medium. Dysplastic kidneys were precisely located and diagnosed by diuretic B-US in 6 of 8 cases, and by CDI in 7 of 7 cases. Nephrectomy was performed in all 16 patients with satisfactory results.
Single ureteral ectopia with congenital renal dysplasia is exceedingly rare. B-US, especially CDI, is the recommended procedure for preoperative localization and diagnosis. Nephrectomy of dysplastic kidney is the treatment of choice.
The Journal of Urology 09/2003; 170(2 Pt 1):558-9. · 3.75 Impact Factor
