ObjectiveBased on recently update Database from Colorectal Cancer (DACCA), we aimed to analyze the characteristics of in-hospital process management from reginal medical center’s colorectal cancer patients.MethodsWe used Version January 29th, 2019 of DACAA being the analyzing source. The items were included date of first out-patient meeting, admitted date, operative date, discharged date, waiting-time, preoperative staying days, postoperative staying days, hospital staying days, and manage protocol, whose characteristics would be analyzed.ResultsWe left 8 913 lines to be analyzed by filtering DACCA. Useful data lines of first out-patient meeting had 3 915, admitted date had 8 144, operative date had 8 049, and discharged date had 7 958. The average of waiting-time were (9.41±0.43) days, and based on timeline trend for line prediction analyzing, which showed R2=0.101 257, P<0.001. The average of preoperative staying days were (5.41±0.04) days, and based on timeline trend for line prediction analyzing, which showed R2=0.023 671, P<0.001. The average of postoperative staying days were (8.99±0.07) days, and based on timeline trend for line prediction analyzing, which showed R2=0.086 177, P<0.001. The average of hospital staying days were (14.43±0.08) days, and based one timeline trend of line prediction analyzing, which showed R2=0.098 44, P<0.001. Analyzable ERAS data were 2 368 lines in DACCA. Total EARS data in 2 368 lines, there were 108 lines (5%) completed and 2 260 lines (95%) incomplete. Pre/post ERAS data in 2 260 lines, there were 150 lines (7%) completed and 2 110 lines (93%) incomplete. Post ERAS data in 2 110 lines, there were 170 lines (8%) completed and 1 940 lines (92%) incomplete.ConclusionsIn recent 20 years, the regional medical center served in-hospital colorectal cancer patients with decreased preoperative staying days, postoperative staying days, and in-hospital staying days from DACCA analyzing, which could prove the service ability had been in improved. Utilization rate of EARS was increased, and also being the main in-hospital process management.
ObjectiveTo analyze whether neoadjuvant chemoradiotherapy can impact patients’ anal function and quality of life after rectal cancer surgery.MethodThe domestic and international publications on the studies how the neoadjuvant chemoradiotherapy impacted patients’ anal function and quality of life were collected and reviewed.ResultsThe neoadjuvant chemoradiotherapy negatively impacted the patients’ anal function and quality of life, but which would be improved over time. The impact had no obvious difference between the long-course chemoradiotherapy and short-couse radiotherapy on the patients’ anal function and quality of life. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy might impact less on the anal function, but which still needed to evaluate the lower anterior resection syndrome (LARS) score. In present, it lacked evidence of a higher rate of anastomotic leakage caused by the neoadjuvant chemoradiotherapy, which might lead to the bowel dysfunction.ConclusionsNeoadjuvant chemoradiotherapy negatively impacts patients’ anal function and quality of life. Further studies are needed to figure out the best choice between long-course neoadjuvant chemoradiotherapy and short-couse radiotherapy. In long term, impact of neoadjuvant therapy can be improved over time and be accepted by patients. Some intervention treatments including medicine and operations are needed if major LARS occurs.
ObjectiveBased on the current version of Database from Colorectal Cancer (DACCA), we aimed to analyze the preoperative specialized examination and evaluation of colorectal cancer.MethodsThe DACCA version selected for this data analysis was updated on July 25, 2019. The data items included: combined preoperative stage, integrating degree of combined preoperative stage, preoperative diagnostic intensity, accuracy of colonoscopy, tumorous type by biopsy, tumor differentiation by biopsy, completion of chest CT, CT stage, accuracy of CT stage, outcome of transrectal ultrasound, outcome of liver ultrasound, MRI stage, accuracy of MRI stage, outcome of PET-CT, outcome of bone scanning, diagnostic way at first visit, misdiagnosis and mistreatment. Characteristic analysis was performed on each selected data item.ResultsA total of 4 484 admitted data were filtered from the DACCA database. The effective data of accuracy of preoperative CT examination, evaluation of preoperative CT staging, preoperative MRI accuracy, preoperative MRI evaluation stage, the accuracy of preoperative transrectal ultrasound, preoperative liver ultrasound accuracy, the accuracy of preoperative bone scan, preoperative PET-CT accuracy, completion of colonoscopy, preoperative colonoscopy biopsy pathology type, strength of diagnosis, integrating degree of total preoperative staging, preoperative staging and pathological staging, factors of the first diagnosis, misdiagnosis and mistreatment were 3 877 (86.5%), 3 166 (70.6%), 3 480 (77.6%), 286 (6.4%), 3 607 (80.4%), 2 736 (61.0%), 3 570 (79.6%), 3 490 (77.8%), 3 847 (85.8%), 3 636 (81.1%), 3 981 (88.8%), 2 346 (52.3%), 2 209 (49.3%), 3 466 (77.3%), and 3 411 (76.1%), respectively. Among the preoperative CT stages, phase Ⅳ had the highest accuracy (86.6%), phase Ⅰ had the highest rate of underestimation (30.4%), and phase Ⅲ had the highest rate of overestimation (21.8%). Preoperative CT accuracy, excluding errors caused by too few data rows, was 66.8%–83.7% in other years. Among the preoperative MRI stages, stage Ⅳ showed the highest accuracy (89.1%), stage Ⅰ showed the highest rate of underestimation (33.3%), and stage Ⅲ showed the highest rate of overestimation (13.3%). Preoperative MRI evaluation accuracy gradually increased from 2016 to 2019. The accuracy of transrectal ultrasound, liver ultrasound, bone scan, and PET-CT were 287 (76.7%), 145 (99.3%), 301 (98.7%), and 15 (93.8%), respectively. The most pathological type under colonoscopy was adenocarcinoma, accounting for 82.2%. The lowest was stromal tumor and lymphoma, each below 0.1%. The diagnostic efficiency were 3 445 (86.5%) with grade A, 316 (7.9%) with grade B, and 220 (5.5%) with grade C. In the preoperative total staging, 109 data rows (4.9%) were appeared as stage Ⅰ, 615 (27.5%) as stage Ⅱ, 1 263 (56.6%) as stage Ⅲ, and 245 (11.0%) as stage Ⅳ. The preoperative total staging integrating degree in stage Ⅳ was the highest (98.7%), while the underestimate rate in stage Ⅱ was the highest (28.3%), and the overestimate rate in stage Ⅲ was the highest (20.6%). From 2008 to 2019, the integrating degree between preoperative comprehensive staging and final pathology staging ranged from 70.8% to 87.7%. Among the factors of the first diagnosis, digital examination was found the frequently (64.0%), followed by symptoms such as bleeding and obstruction (28.2%). Considering family history, the proportion of patients with colorectal cancer was the least (less than 0.1%). There were 442 cases (13.0%) of misdiagnosis and mistreatment behaviors, among which 207 cases (46.8%) were misdiagnosed as hemorrhoids.ConclusionsTo significantly improve the long-term survival rate of colorectal cancer patients requires preoperative imaging diagnosis efficiency and multi-factor evaluation staging to break through the limitation of development, so as to optimize the choice of treatment plan, increasing the prevalence of early screening for colorectal cancer, and reducing the rate of misdiagnosis and mistreatment at the first visit of colorectal cancer.
ObjectiveTo summarize the significance of nucleosome and its omics in the occurrence, development, screening, treatment, and prognosis of colorectal cancer.MethodThis article reviewed and analyzed the literatures about significance of nucleosome in diagnosis and treatment of colorectal cancer in recent years.ResultsThe changes of circulating nucleosome and its omics in patients with colorectal cancer were more significant than those in normal persons, and these changes were closely related to the occurrence and development of colorectal cancer, as well as early screening, evaluation of therapeutic effect, and prognosis. The present study found this association only and failed to elucidate its specific mechanism.ConclusionsNucleosome and its omics may have clinical value in the screening, treatment, and prognosis evaluation of colorectal cancer. Compared with other serum markers, nucleosome has some advantages in the early screening of colorectal cancer.
ObjectiveTo elaborate the contents and concrete concepts of preoperative specialized examination and evaluation of colorectal cancer of the Database from Colorectal Cancer (DACCA) in the West China Hospital. MethodThe article was described in the words.ResultsThe components, stage, accuracy, preoperative comprehensive evaluation, clinical factors of initial diagnosis, misdiagnosis and mistreatment of colorectal cancer in the DACCA were defined and elaborated in the detail. The data label corresponding to each item in the database and the required structured way in the application stage of large data were also described in detail, and the corrective precautions for all classified items were described.ConclusionsThrough the detailed description of the preoperative specialized examination and evaluation of colorectal cancer of DACCA in West China Hospital, it might provide the standard and basis for the clinical application of database in the future, and provide reference for other peers who wish to build a colorectal cancer database.
ObjectiveTo investigate whether neoadjuvant chemotherapy alone may affect recent anal function in patients with rectal cancer.MethodsThe structured data from the December 3, 2018 version of Database from Colorectal Cancer (DACCA) of West China Hospital were extracted . The follow-up investigation was performed within 2 weeks from December 3, 2018 to December 16, 2018 by the telephone. The postoperative anal function of patients with rectal cancer was evaluated by the lower anterior resection symptom (LARS) score questionnaire.ResultsA total of 209 patients with rectal cancer treated by the total mesolectal excision in the Department of Gastrointestinal Surgery of West China Hospital were included. One hundred and thirty-six patients of them were only treated with TME, while the other 73 patients were treated by the TME and neoadjuvant chemotherapy. As for the baseline data of the 2 groups, there was no difference in the age, body mass index, gender, surgical procedure, differentiation degree or anastomotic position (P>0.050), while the pathological staging (P=0.022) and postoperative recovery time (P<0.001) had the significant differences between these 2 groups. The postoperative 1-year LARS score was not associated with the gender, age, body mass index, pathological stage, physical comorbidity, neoadjuvant chemotherapy or time of postoperative recovery (P>0.050), but which was associated with the heart disease (P=0.019) or position of anastomosis (P=0.005). Moreover, the multivariate analysis showed that the higher anastomosis position was a protective factor for the LARS after 1 year (OR=0.706, P=0.003).ConclusionsThere is no significant difference in postoperative anal function between patients with rectal cancer treated with neoadjuvant chemotherapy or not . It suggests that neoadjuvant chemotherapy has no more additional adverse effects on postoperative anal function in patients either.