Objective To explore the safety of neoadjuvant chemoradiotherapy combined with sphincter-preserving operation in treatment of locally advanced low rectal cancer. Methods The clinical data of thirty-four patients admitted into our hospital between June 2007 and June 2009 with T3 and T4 low rectal cancer treated by neoadjuvant chemoradiotherapy and sphincter-preserving operation were collected and analyzed retrospectively. Routine fraction of radiation was given with total dose of 40 Gy, five times a week, 2 Gy per fraction. Patients received oxaliplatin （150 mg/d1）, plus folinic (100 mg/d1-3) and 5FU (750 mg/d1-3) for total 1 cycles started from the 4th week of irradiation. Operation was performed 4 weeks after neoadjuvant therapy. Results After neoadjuvant therapy, all patients underwent surgical resection with average tumor size decreased by 41.2%, tumor T stage decreased in 67.6% （23/34) patients, and lymph nodenegative change rate was 58.8% (10/17). One patient had liver metastasis and one had local recurrence, but without stomal leak. And 88.2% (30/34) patients showed good function of sphincter. Conclusions Neoadjuvant chemoradiotherapy in advanced lower rectal cancer patients has shown its efficacy in down-staging, which is safe without increasing operation complications when combined with sphincterpreserving surgery.
Objective To investigate the influence of colectomy on the expressions of 5-hydroxy tryptamine (5-HT) and chromogranin A (CgA) in colon mucosa of Chinchilla rabbits. Methods Colon (7-8 cm) upon colon-rectum junction (control group) of 15 Chinchilla rabbits was cut out. After two weeks, these rabbits were executed and the samples of colon at anastomotic stoma (study group) were taken. 5-HT positive cells and CgA positive cells in two groups were detected by immunohistochemical method. Results The number of 5-HT positive cells was 10.40±2.22 in control group， and 26.27±2.35 in study group; the number of CgA positive cells was 20.60±5.34 in control group, and 51.51±6.13 in study group. There were significant differences between two groups respectively (P＜0.01). Conclusion The increase of 5-HT positive cells and CgA positive cells can be caused by colectomy.
Objective To assess the effectiveness of large-calibre (7.5#) transanal tube drainage and decompression on prevention from anastomotic leakage following anterior resection for rectal cancer. Methods Clinical data of 346 consecutive patients (M/F=1.39, age range 32-84 years, median age 58.5 years) undergone anterior resection for rectal cancer in this institute from January 2006 to December 2008 were analyzed retrospectively. Results The anastomotic leakage rate was 0 (0/185) and 5.59%(9/161) in patients with or without receiving large-calibre transanal tube drainage respectively. The anastomotic leakage rate was significantly decreased by large-calibre transanal tube drainage after anterior resection for rectal cancer (χ2=8.526, P=0.004). Eight cases of anastomotic leakage were treated conservatively and the other one required further surgical interventions. No perioperative death occurred in this series. Conclusion In this study, the large-calibre transanal tube drainage and decompression is effective in protecting rectal anastomosis and decreasing the rate of anastomotic leakage.
ObjectiveTo evaluate the efficacy, safety, and feasibility of fecal drainage technique on rectal anastomosis for preventing anastomotic leakage after operation for middle-low rectal cancer.MethodsThe retrospective analysis was used to collect the middle-low rectal cancer which completed operation in this hospital from 2014 to 2019. According to the way of preventing annstomotic leakage, the patients were divided into two groups: fecal drainage on rectal anastomosis group (Abbreviation: fecal drainage group) and end ileum prophylactic stoma group (Abbreviation: ileostomy group). The incidence of anastomotic leakage after operation and the different treatment methods following leakage were compared between the two groups.ResultsA total of 231 cases were recorded, including 84 cases in the fecal drainage group, 147 cases in the ileostomy group. There were no significant differences in the baseline data such as the gender, age, preoperative complications, operation mode, etc. between the two groups (P>0.050). There were no significant differences in the operation time, intraoperative blood loss, incision infection, postoperative intestinal obstruction, total hospitalization cost, death, anastomotic leakage (overall, each grade, treatment, and outcome) between the two groups (P>0.050). Although the length of hospital stay except the patients with anastomotic leakage in the fecal drainage group was significantly longer than that in the ileostomy group (P<0.001), there was no significant difference in the total length of hospital stay between the two groups (P>0.050), and the incidence of anastomotic stenosis in the fecal drainage group was significantly lower than that in the ileostomy group (P=0.029).ConclusionAccording to the results of this study, fecal drainage technique on rectal anastomosis is effective, safe, and feasible in preventing anastomotic leakage after operation for middle-low rectal cancer.
Objective To observe the expressions of P53 and CD34 in rectal cancer and distal mucosa and to explore the safe distal margin of radical surgery for rectal cancer at molecular pathologic level. Methods Forty-five cases of rectal cancer were marked before operation， and then the cases were detected by PET/CT. P53 and CD34 expressions in rectal tissues were detected by immunohistochemistry technique. Results P53 expression and microvessel density (MVD) in rectal cancer were significantly higher than those in distal mucosa， which in distal mucosa were decreased along the anal direction. P53 and CD34 were still found in the normal rectal tissue. P53 expression and MVD were not significantly different between in more than 1.5 cm distal rectal mucosa and in normal rectal tissue. Besides MVD was related to size of tumor in rectal cancer and distal 0.5 cm rectal mucosa tissue, P53 and CD34 in rectal cancer and distal mucosa rectal tissue were not associated with tumor diameter, stage and differentiation of rectal cancer. Conclusion From the molecular pathologic view, the resection of 2.0 cm rectal distal tissue should be safe for excision of rectal cancer.