Risk Evaluation of Colorectal Cancer Patients with Neo-Adjuvant Chemotherapy Combined with Operation in Multi-Disciplinary Team_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaodong , CAO Lin , L Donghao , QIU Meng , LI Li.

1.Department of Anal-Colorectal Surgery,West China Hospital, Sichuan University, Chengdu 610041, China2.Department of Oncology;;
West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: LI Li, E-mail: drlili116@126.com;

Corresponding author：

Keywords：

Neo-adjuvant chemotherapy; Risk evaluation; Multi-disciplinary team; Colorectal neoplasmas

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the risk of management decision combined neo-adjuvant chemotherapy with operation for colorectal cancer by means of the colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CCM).
Methods 　One hundred and eighty-one eligible patients (102 male, 79 female, mean age 58.78 years), which were pathologically proved colorectal cancer in our ward from July to November 2007, involved 62 colonic and 119 rectal cancer. The enrollment were assigned into multi-disciplinary team (MDT) group (n=65) or non-MDT group (n=116), according to whether the MDT was adopted, and the operative risk was analyzed by ACPGBI-CCM.
Results 　The baseline characteristics of MDT and non-MDT group were coherent. The watershed of lower risk group (LRG) and higher risk group (HRG) was set as predictive mortality=2.07%. The time involving extraction of gastric, urethral and drainage tube, feeding, out-of-bed activity after operation in MDT group, whatever in LRG or HRG, were statistically earlier than those in non-MDT group (P＜0.05). The resectable rate in LRG was statistically higher than that in HRG (P＜0.05), and the proportion of Dukes staging was significantly different (P＜0.05) between two groups; Moreover, predictive mortality in HRG was statistically higher than that in LRG (P＜0.05), while actually there was no death in both groups.
Conclusion 　Dukes staging which is included as an indispensable option by ACPGBI-CCM is responsible for the lower predictive mortality in LRG.Hence, the value of ACPGBI-CCM used to asses the morbidity of complications within 30 days postoperatively would be warranted by further research. The postoperative risk evaluation can serve as a novel routine to comprehensively analyze the short-term safe in the MDT.

Citation： WANG Xiaodong,CAO Lin,L Donghao,QIU Meng,LI Li.. Risk Evaluation of Colorectal Cancer Patients with Neo-Adjuvant Chemotherapy Combined with Operation in Multi-Disciplinary Team. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(9): 692-696. doi: Copy

1.	汪晓东, 曾天芳, 曹霖, 等. 多学科协作诊治模式下新辅助化疗干预结直肠癌手术方案的临床研究 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(6)∶451.
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7.	汪晓东, 冯硕, 游小林, 等. 结直肠肿瘤多学科协作诊治模式下的随访体系建设 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(6)∶709.
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9.	Chao MW, Tjandra JJ, Gibbs P, et al. How safe is adjuvant chemotherapy and radiotherapy for rectal cancer? [Ｊ]. Asian J Surg, 2004; 27(2)∶147.
10.	Glynne-Jones R, Sebag-Montefiore D. Role of neoadjuvant che-motherapy in rectal cancer: interpretation of the EXPERT study [Ｊ]. J Clin Oncol, 2006; 24(28)∶4664.
11.	Buie WD, MacLean AR, Attard JA, et al. Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(10)∶1868.
12.	Wichmann MW, Meyer G, Adam M, et al. Detrimental immunologic effects of preoperative chemoradiotherapy in advanced rectal cancer [Ｊ]. Dis Colon Rectum, 2003; 46(7)∶875.
13.	Metcalfe, Nrwood MG, Miller AS, et al. Unreasonable expections in emergency colorectal cancer surgery [Ｊ]. Colorect Dis, 2005; 7(3)∶275.
14.	Ferjani AM, Griffin D, Stallard N, et al. A newly devised scoring system for prediction of mortality in patients with colorectal cancer: a prospective study [Ｊ]. Lancet Oncol, 2007; 8(4)∶317.

1. 　汪晓东, 曾天芳, 曹霖, 等. 多学科协作诊治模式下新辅助化疗干预结直肠癌手术方案的临床研究 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(6)∶451.
2. 　Glynne-Jones R, Harrison M. Locally advanced rectal cancer: what is the evidence for induction chemoradiation? [Ｊ]. Oncologyist, 2007; 12(11)∶1309.
3. 　Al-Homoud S, Purkayastha S, Aziz O, et al. Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models [Ｊ]. Surg Oncol, 2004; 13(2-3)∶83.
4. 　Bromage SJ, Cunliffe WJ. Validation of the CR-POSSUM risk-adjusted scoring system for major colorectal cancer surgery in a single center [Ｊ]. Dis Colon Rectum, 2007; 50(2)∶192.
5. 　吕东昊, 汪晓东, 阳川华, 等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(6)∶713.
6. 　Isbister WH, Al-Sanea N. POSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [Ｊ]. ANZ J Surg, 2002; 72(6)∶421.
7. 　汪晓东, 冯硕, 游小林, 等. 结直肠肿瘤多学科协作诊治模式下的随访体系建设 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(6)∶709.
8. 　Tekkis PP, Poloniecki JD, Thompson MR, et al. Operative mortality in colorectal cancer: prospective national study[Ｊ]. BMJ, 2003; 327(7425)∶1196.
9. 　Chao MW, Tjandra JJ, Gibbs P, et al. How safe is adjuvant chemotherapy and radiotherapy for rectal cancer? [Ｊ]. Asian J Surg, 2004; 27(2)∶147.
10. 　Glynne-Jones R, Sebag-Montefiore D. Role of neoadjuvant che-motherapy in rectal cancer: interpretation of the EXPERT study [Ｊ]. J Clin Oncol, 2006; 24(28)∶4664.
11. 　Buie WD, MacLean AR, Attard JA, et al. Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(10)∶1868.
12. 　Wichmann MW, Meyer G, Adam M, et al. Detrimental immunologic effects of preoperative chemoradiotherapy in advanced rectal cancer [Ｊ]. Dis Colon Rectum, 2003; 46(7)∶875.
13. 　Metcalfe, Nrwood MG, Miller AS, et al. Unreasonable expections in emergency colorectal cancer surgery [Ｊ]. Colorect Dis, 2005; 7(3)∶275.
14. 　Ferjani AM, Griffin D, Stallard N, et al. A newly devised scoring system for prediction of mortality in patients with colorectal cancer: a prospective study [Ｊ]. Lancet Oncol, 2007; 8(4)∶317.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk Evaluation of Colorectal Cancer Patients with Neo-Adjuvant Chemotherapy Combined with Operation in Multi-Disciplinary Team

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