Objective To discuss the strategies for building the framework of team culture of multi-disciplinary team (MDT) for colorectal cancer. Methods By comprehending the traditional concept of volunteer and probing into the value of traditional team culture, combining the needs of MDT for colorectal cancer, build appropriate team culture and core idea of MDT for colorectal cancer. Results Confirm that building of volunteers groups and the volunteers culture is the core of the team culture of MDT for colorectal cancer. Analyze characters of volunteers groups and the operation strategies, and find the way of maintaining the volunteers culture. Conclusion With the development of volunteers groups and increased participants, the team culture of MDT for colorectal cancer will show more sociality and extent. And it is also the important idea and direction for development in future. As team culture, organization structure and personnel structure supplements each other, adjusting and perfecting the team culture in practice continually is a long-term work for MDT.
The expression and rearrangement of bcl-2 gene in 64 cases with colorectal carcinoma were studied by immunohistochemical technique and semi-nest PCR respectively. The results showed the abnormal changes of the expression and rearrangement of bcl-2 gene had emerged in the early stage of colorectal carcinoma. The tumors with the expression of bcl-2 were associated with a higher incidence of metastasis to lymphatic node. The rearragement of bcl-2 was significantly higher in late-stage than that in early-stage. These suggest that bcl-2 gene involves in the regulation of the development of colorectal carcinoma. The state of the changes of bcl-2 gene in colorectal carcinoma may predict the therapeutic effect and prognosis of colorectal carcinoma.
The loss of heterozygosity and mutation for nm23-H1 gene in colorectal carcinomas were studied by Southern blot and RT-PCR-SSCP/silver staining sequencing. The rate of loss of heterozygosity for nm23-H1 was 29.63%. The cases of Duke’s stage D and distant metastatsis had higher frequency of the loss of heterozygosity. No mutation for nm23-H1 was found in colorectal carcinomas. These reaults indicate that the loss of heterozygosity for nm23-H1 may play a significant role in the malignant progression and distant metastasis in colorectal carcinomas.
Objective To study ultrastructure and clinical significance of gastrin secretory granule in colorectal carcinoma cells. Methods The gastrin expression in colorectal carcinoma tissue and blood of 10 cases was examined by using radioimmunity analysis and immunohistochemistry. The ultrastructure of gastrin secretory granule of 10 cases, the positive of gastrin immunohistochemistry of colorectal carcinoma were examined by using immunoelectron microscopic technique. Results The gastrin concentration of the colorectal cancer group 〔（130.75 ±21.34） pg/ml〕 was significantly higher than that of control group 〔（95.63± 12.26） pg/ml〕，Plt;0.05. In 10 specimens of colorectal cancer, 5 cases were gastrin immunohistochemistry positive (+++), 4 moderate positive (++) and 1 weak positive (+). Cells in colorectal cancer were polyshaped, with unusual nucleoli different in size, concentrating on the edge, the cytoplasm mitochondrion was plentiful with vacuolates, and more secretion granules could be seen, 400-1500 nm in diameter with a clear border of membrane. There were two types of granular appearance: type A was largest in bulk size, low electrodensity was welldistributed, granular core appeared loose; type B was smaller in bulk size, high electrodensity was welldistributed, nucleus was usually compact.protein A gold (pAg) positive granules were located partially in secreting granules. pAg positive granules in highly differentiated cancer were mainly located in secreting granules of type A. pAg positive granules in low differentiated cancer were mainly located in secreting granules of type B. A part of cancer cell membrane, and inside and outside of microvillus membrane, adhering to pAg granules in line could be seen. Conclusion The colorectal carcinoma cells may synthesize and secrete gastrin themselves, which may be the mechanism of high gastrin levels in colorectal cancer. The use of gastrin antagonist and receptor antagonist may treat the patents with colorectal carcinoma.
Until Issue 2 in 2008, the Cochrane Database of Systematic Reviews had included 23 systematic reviews concerning colorectal tumors by the colorectal cancer group. These reviews involved prevention, diagnosis, treatment, prognosis and follow-up. The preventive ability of non-steroid anti-inflammatory drugs, accuracy of chromoscopy, shortterm outcomes of laparoscopic colorectal resection and outcomes of laparoscopic total mesorectal excision were confirmed. Meanwhile, the effect of dietary fibre in prevention, mechanical preoperative preparation, and prophylactic anastomotic drainage was questioned. Because of the low quality of trials, no firm conclusions were revealed in some reviews, such as traditional Chinese medicine in chemotherapy. Through the study of Cochrane systematic reviews, medical practitioners and researchers can obtain high-quality evidence, and identify future research direction in the field of colorectal cancer.
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.
ObjectivesTo develop an orthotopic xenografts model that can dynamically observe the growth of rectal cancer and lymphatic metastasis, and to preliminarily explore the feasibility of monitoring the growth and metastasis of rectal cancer by in vivo imaging system.MethodsAn orthotopic xenografts model was developed in nude mouse by rectal submucosal injection of red fluorescent protein-labeled human colorectal adenocarcinoma cell line HCT 116. Then, the fluorescence signal from cancer cells was collected at different time points by means of in vivo imaging system, and the growth and metastasis of cancer cells in the rectum of nude mice was observed in real time. Finally, the model was evaluated by pathology.ResultsFifty visualized nude mouse models of orthotopic implantation and lymphatic metastasis were successfully constructed. At 2-7 weeks after implantation, the fluorescent protein of tumor were observed in all nude mouse with in vivo imaging system. After the orthotopic implantation, the volume of the transplanted tumor grew with the extension of time, and the integrated density expanded gradually. The number of caudal mesenteric lymph node metastases, para-aortic lymph node metastases, liver metastases and lung metastases increased time-dependent. The results of histological study was consistent with depending on lymph nodes to express fluorescent proteins to determine metastasis.ConclusionsIt is reliable and feasible to visualize the orthotopic implantation and lymphatic metastasis model of nude mice. The in vivo imaging system is simple and effective for real-time, non-invasive and dynamic observation of the growth of orthotopic xenografts and lymphatic metastasis in nude mice.
ObjectiveTo describe the constructive process of neoadjuvant therapy for colorectal cancer part in the West China Colorectal Cancer Database (DACCA).MethodWe used the form of text description.ResultsThe specific concept of neoadjuvant therapy for colorectal cancer including neoadjuvant treatment therapies, compliance of patients with neoadjuvant therapy, neoadjuvant therapy intensity scheme, the CEA value of patients during neoadjuvant therapy, changes of symptoms, changes of primary tumor size in colorectal cancer, and TRG grading of the DACCA in the West China Hospital were defined. Then the neoadjuvant therapies were detailed for their definition, label, structure, error correction, and update.ConclusionThrough detailed description and specification of neoadjuvant therapy for colorectal cancer in DACCA in West China Hospital, it can provide a reference for the standardized treatment of colorectal cancer and also provide experiences for the peers who wish to build a colorectal cancer database.
ObjectiveTo systematically evaluate the correlation of amplification of human epidermal growth factor receptor 2 (HER2) with the clinicopathological characteristics and prognosis of colorectal cancer patients.MethodsPubMed, EMbase, Cochrane Library, Chinese Biomedical Literature Database (CBM), Wanfang, and other databases were searched, and cohort studies focused on the relationship between HER2 amplification and clinicopathological characteristics and prognosis of colorectal cancer patients were included. The retrieval time limit was from October 2020, and RevMan 5.4 software was used for meta-analysis.ResultsA total of 9 studies (11 cohorts) were included for meta-analysis of 7 209 patients with colorectal cancer. Results of the meta-analysis showed that HER2 amplification was not associated with overall survival [HR=1.10, 95%CI (0.98, 1.24), P=0.11]. HER2 amplification was not correlated with gender [OR=0.98, 95%C1 (0.74, 1.31), P=0.90] and tumor differentiation [OR=0.80, 95%C1 (0.49, 1.32), P=0.39], but correlated with the tumor location [OR=1.85, 95%C1 (1.01, 3.37), P=0.04], RAS wild-type gene [OR=6.36, 95%C1 (3.41, 11.87), P<0.000 01], TNM stage [OR=0.45, 95%C1 (0.32, 0.64), P<0.000 01], lymph node metastasis [OR=1.54, 95%C1 (1.12, 2.13), P=0.008], and the depth of tumor invasion [OR=0.17, 95%C1 (0.05, 0.55), P=0.003].ConclusionCurrent evidence shows that HER2 amplification is not associated with OS in patients with colorectal cancer, but associated with tumor infiltration, lymph node metastasis, TNM stage, tumor site, and RAS genotype.
Objective To investigate the feasibility of laparoscopic-assisted transanal everted pull-through resection and anastomosis in the treatment for ultra-low rectal cancer （the inferior margin of the tumor from the anal margin of less than 5cm）. Methods From December 2006 to December 2009，46 patients with ultra-low rectal cancer had been undergone laparoscopic-assisted transanal everted pull-through resection and anastomosis. The intraoperative condition，postoperative complications，and the result of follow-up were analyzed retrospectively. Results The operation was successfully performed on all the patients. The intraoperative blood loss was （202±56） ml （100-290m1）. The time of recovery of gastrointestinal function was （60±16） h （36-82 h）. No anastomotic bleeding or stomal leak was observed. All the patients were followed-up for （31±5） months （21-45months），15 patients developed mild to moderate anastomotic stricture，1 local recurrence， and 2 liver metastasis. All the patients had no anal incontinence 10months after stoma closure operation， the defecation of all the patients became normal （4.5±1.2） months（2-10months） later. Conclusions Laparoscopic-assisted transanal everted pull-through resection and anastomosis for ultra-low rectal cancer is safe and feasible， and the effect is satisfactory.