Objective To assess the effectiveness and safety of hyperthermia combined with chemotherapy for advanced colorectal cancer. Methods Databases such as CNKI, VIP, WanFang Data, CBM, EMbase, PubMed and The Cochrane Library (Issue 3, 2012) were electronically searched from the date of their establishment to June, 2012, and the relevant literature and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on comparison of chemotherapy with hyperthermia plus chemotherapy for advanced colorectal cancer. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Results A total of 11 RCTs involving 708 patients with advanced colorectal cancer were included. The results of meta-analysis showed that: a) as for effectiveness, the chemotherapy combined with hyperthermia group was superior to the chemotherapy group in the partial improve rate (OR=1.65, 95%CI 1.39 to 1.97, Plt;0.000 01) and the total effective rate (OR=3.59, 95%CI 2.51 to 5.12, Plt;0.000 01), with significant differences; b) as for safety, the chemotherapy combined with hyperthermia group was lower than the chemotherapy group in the incidence of neurotoxicity (OR=0.50, 95%CI 0.33 to 0.75, P=0.000 8). Conclusion Compared with chemotherapy, chemotherapy combined with hyperthermia can increase partial improve rate and total effective rate and reduce the incidence of neurotoxicity. Due to the limitation of the included studies, large sample size, multicenter, high quality studies are needed to verify the above conclusion. We recommend that chemotherapy combined with hyperthermia therapy could be applied to clinic combining individual conditions of patients.
Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
【Abstract】ObjectiveTo study the distal intramural spread of rectal carcinoma, and provide evidence for modification of rectal carcinoma surgery. MethodsSixty patients with rectal carcinoma admitted to the first affiliated hospital of Chongqing university of medical science from November 2001 to October 2002 were included. The specimens were extended to its original size and shape by the fat clearing method. Mesenteric lymph nodes were dissected by using transillumination to examine metastases histologically, then a lymph nodes map was produced which including the site of the primary lesion, the vascular distribution, and the sites of dissected nodes. The specimen below the distal margin of the tumor was cut continuously with 0.5 cm interval then sectioned for histopathological examination. ResultsTumor spread to the distal intramural was observed in 11 of 60 patients (18.3%) with the range within 1.5 cm, of which less than 0.5 cm in 5 case, 5 cm to 1.0 cm in 2 cases, 1.0 cm to 1.5 cm in 4 cases. The tumor invasion was correlated with gross type, histological type and infiltrative depth, but not with sex, age, location of the tumor, size of the tumor, lymph nodes metastases and Dukes stage. Conclusion The range of distal mural excision should exceed 1.5 cm to tumor margin in radical surgery for rectal carcinoma. This rule should be emphasized for patients with poor cell differentiation and deep infiltration.
ObjectiveTo study the effects of recombinant human growth hormone (rhGH) on proliferation of human rectal cancer cell in vitro. MethodsThe experiment was divided into control group,rhGH group,Oxaliplatin (LOHP) group and rhGH+LOHP group. The double proliferation time of cells,cell inhibition rate,cell cycle, proliferation index (PI) and DNA inhibition rate of human rectal cancer line,HR8348,were studied by cell culture, MTT assay and flow cytometry on different concentration of rhGH. ResultsIn vitro the markedly accelerated effects of rhGH on multiplication of HR8348 cell line were not found: there was no statistical significance as compared rhGH group with control group or compared rhGH+LOHP group and LOHP group （Pgt;0.05）. The double proliferation time of cells was markedly lengthened, cell inhibition rate and the cells arrested in G0-G1 phase were obviously increased, meanwhile, the cells in S phase （P＜0.05） and G2-M phase and PI were markedly decreased and DNA inhibition rate was obviously risen as compared rhGH+LOHP group with control group or rhGH+LOHP group and rhGH group （P＜0.01）.ConclusionIn vitro rhGH does not accelerate the multiplication of human rectal cancer cells.
Objective To evaluate initial experience with shape memory alloy stent as an alterative to colostomy in patients with intestinal obstruction of rectal cancer. Methods Twenty-one patients with acute and chronic rectal obstructions from malignant causes underwent stent placement. After rectal stent was slenderized in ice water, it was inserted into the strictured rectum by hand or sigmoidoscope. Nitinol mesh stent were deployed in hot water. Results Eighteen patients who had underwent rectal stent placement achieved clinical decompression within 5 hours. Colostomy underwent in 3 patients due to stent failure. Eighteen patients with stent were followed-up, 14 cases died in 56-720 days and 4 other cases were still alive without intestinal obstruction in 2-15 months. Conclusion Nitinol mesh stent may be useful in the management of terminal or high-risk surgical patients for palliative purposes shuning colostomy. Palliation of stent combined with chemotherapy and immunotherapy can be performed to improve survival.
Objective To study the expression of p53 and vascular endothelial growth factor (VEGF) and its correlation with hematogenous metastasis in colorectal cancer. MethodsAvidinbiotin complex method was used to study the expression of p53 and VEGF in 79 cases of colorectal cancer.ResultsThe positive rates of p53 and VEGF were 48.1% and 58.2% respectively in 79 cases of colorectal cancer. p53 and VEGF expression were identical in 49 (62.0%) cases. There was significant association between p53 or VEGF expression and venous invasion or hematogenous metastasis (P＜0.05). The incidence of hematogenous metastasis in the p53（＋）/VEGF（＋） subgroup was 66.7% and was significantly higher than that in the p53（－）/VEGF（－） or p53（＋）/VEGF（－） subgroup （P＜0.01）. Neither synchronous nor metachronous hematogenous metastasis were found in the p53（－）/VEGF（－） subgroup.Conclusion The combination of p53 and VEGF expression is an important predictor for hematogenous metastasis in patients with colorectal cancer.
Objective To study the relationship between blood metastasis of colorectal cancer and cancer metastasis related factors.MethodsCK20 mRNA in peripheral blood was investigated by reverse transcription polymerase chain reaction (RTPCR) and proteins of CD44v6 and p53 in cancer tissues were examined by immunohistochemical in 50 cases of colorectal neoplasm. ResultsThe results showed that the positive rates of peripheral blood micrometastasis of colorectal cancer were 68%. It escalated along with the rising of the Dukes stage, the rates in Dukes C and D stage were significantly higher than that in Dukes A and B stage. The positive rates of CD44v6,p53 expression in colorectal cancer were 74% and 62% respectively. The positive rates of CD44v6 and p53 in Dukes A and B stage were significantly lower than those in Dukes C and D stage,in peripheral blood and colorectal cancer micrometastasispositive group were significantly higher than that in the micrometastasisnegative group. CK20 mRNA was significantly correlated with expressions of CD44v6 and p53 in cancer tissues. Conclusion The detection of CK20 mRNA in blood before operation and after operation examination of CD44v6 and p53 in cancer tissues are helpful for prediction of blood metastasis of colorectal neoplasm and postoperative treatment.
To investigate the pathological characteristics, diagnosis and treatment of rectal carcinoid tumors, 26 cases, which had been diagnosed and treated in our hospital from 1987 to 1997, were retrospectively analysed. The rectoscopic examination were taken in all 26 patients and final diagnosis were made by pathological examination, among them, 19 cases were treated with local resection or expensively local resection, 7 cases with radical operation because the diameter of tumor was beyond 2 cm. These patiests were followed up 1-10 years with 5 patients died. The authors consider that rectoscopic examination and biopsy are important method to diagnose rectal carcinoid tumors preoperatively, in addition, for suspicious case, argentation and immunohistochemistry staining should be further made besides routine HE staining. The operative treatment is the best therapy to this kind of disease, the choice of operative mode must be made according to the size, infiltration of the tumor, the condition of infiltrated lymph node and hepatic metastasis.
Objective To evaluate the feasibility, safety, radicality, and short-term and mid-term clinical outcomes of laparoscopic total mesorectal excision （TME） in comparison with open procedure for the middle-lower rectal cancer. Methods From October 2005 to October 2008， 52 patients with middle-lower rectal cancer received laparoscopic TME （Dixon’operation） without preventive stoma， while 46 patients underwent conventional open TME （Dixon’operation） without preventive stoma. The operative procedures, clinicopathological data， and short-term and mid-term outcomes were collected and compared between the two groups. Results The other patients were successful in both groups in addition to 2 （3.8%） patients were converted to open procedure in laparoscopic TME group. There was no perioperative death in both groups. The intraoperative blood loss, the time for bowel movement retrieval （first flatus）， and the incision healing in laparoscopic TME group were better than that in open TME group （P＜0.05）. No significant differences were observed between two groups in anastomotic leakage and pulmonary infection （P＞0.05）. Comparison of specimen, no significant differences were observed between two groups in negative distal margin and circumferential resection margin, number of lymph nodes resected, distance of distal resection margin to the tumor （P＞0.05）. No significant differences were observed between two groups in cancer-related death, local recurrence, distant metastasis, and 3-year survival rate （P＞0.05）. Conclusions Laparoscopic TME for middle-low rectal cancer is a safe, feasible, and minimally invasive technique, and can achieve satisfactory oncological outcome, which provides similar short-term and mid-term outcome compared with the traditional open procedure.
ObjectiveTo evaluate the possible role of the expression of insulin-like growth factor-1 receptor (IGF-1R) in determining rectal cancer radiosensitivity. MethodsThe paired preradiation biopsy specimens and postoperative specimens were obtained from 87 patients with rectal cancer in the department of digestive tumor surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2009 to December 2010. The IGF-1R expression was examined by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR). The tumor radiosensitivity was defined according to Rectal Cancer Regression Grade, then the relation between the IGF-1R expression and tumor radiosensitivity was evaluated. ResultsCompared with the preradiation biopsy specimens, IGF-1R expression significantly increased in the paired postoperative specimens of the residual cancer cells (Plt;0.001). The IHC result demonstrated IGF-1R overexpression was significantly associated with a poor response to radiotherapy (rs=0.401, Plt;0.001); RT-PCR detection of IGF-1R expression on preradiation biopsy specimens also showed that IGF-1R mRNA negative patients had a higher radiation sensitivity (rs=0.497, Plt;0.001). ConclusionDetection of IGF-1R expression may predict radiosensitivity of preoperative irradiation for rectal cancer.