Objective To explore the safety, effectiveness, operation mode and clinical value of the laparoscopic colorectal resection. Methods The clinical data and experiences of laparoscopic resection for 18 cases with colorectal neoplasm from Jun. 2007 to Mar. 2008 were studied retrospectively. Results Among 18 cases, there were 5 cases of rectal cancer, 6 cases of sigmoid colon carcinoma, 2 cases of sigmoid colonic polyp, 2 cases of descending colon carcinoma, 2 cases of ascending colon carcinoma and 1 case of ascending colonic lipoma. Fifteen cases of laparoscopic colorectal resection were performed successfully, including Dixon procedure 4 cases, Miles operation 1 case, radical resection of sigmoid colon 5 cases, palliative resection of sigmoid colon 2 cases, left hemicolectomy 2 cases and right hemicolectomy 1 case. Three cases converted to laparotomy due to adiposity or advanced status of local disease. Average intraoperative blood loss was 110 ml. The average number of lymph nodes dissected was 13.5. It took about 40 hours to restore intestinal function. The average time of hospitalization was 9 days. No one died during operation and no complications such as anastomotic leakage and postoperative hemorrhage occurred. Conclusion Laparoscopic resection for colorectal neoplasms possesses less trauma and rapid postoperative recovery. Laparoscopic colorectal surgery is safe and effective with skill and indication.
ObjectiveTo study the expression of c-Met in colorectal carcinoma cells and the effect of hepatocyte growth factor (HGF) on proliferation and invasion of colon carcinoma cells SW480. MethodsReal-time PCR and Western blot methods were respectively used to detect the expressions of c-Met mRNA and protein in the different colorectal carcinoma cells in order to screen the high c-Met expression cells. The SW480 cells were incubated with different concentrations (0, 20, 40, and 70 ng/mL) HGF. MTT assay and Transwell test were used to evaluate the effects of proliferation and invasion in the SW480 cells. Results①The c-Met was expressed in each colorectal carcinomar cells, especially highly expressed in the colon carcinoma cells SW480 in vitro.②MTT assay showed that the HGF could promote the proliferation of SW480 cells in a dose-dependent manner with some extent.③Transwell test showed that the HGF could increase the invasion of SW480 cells. ConclusionThe c-Met is highly expressed in colorectal carcinoma cells and HGF could promote proliferation and increase invasion of colorectal carcinoma cells in vitro.
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.
Since the concept of total mesorectal excision (TME) was proposed and carried out in 1982, the postoperative local recurrence rate of rectal cancer has decreased significantly and the long-term survival rate has increased, thus TME has become the gold standard for middle and low rectal cancer surgery. However, the incidence of postoperative urination and sexual dysfunctions caused by pelvic autonomic nerve injury during TME operation remains high, which needs to be investigated and solved. Over the years, through systematic studies of anatomy, histology and physiology, we have confirmed that dissection anterior to Denonvilliers’ fascia for the anterior wall of rectum, and thus partial resection of Denonvilliers’ fascia, were the leading cause of nerve injury during TME operation. On the contrary, dissection posterior to Denonvilliers’ fascia and entire preservation of Denonvilliers’ fascia are feasible and necessary. Moreover, through anatomical study, Wei’s Line, the surgical marker line of Denonvilliers’ fascia is discovered for the first time, and thus innovative TME (iTME) navigated with Wei’s Line is proposed. The multi-center clinical study has confirmed that compared with traditional TME surgery, the incidences of postoperative urination and sexual dysfunctions in iTME group decrease significantly, with comparable oncologic outcomes, suggesting that iTME surgery could be a better choice for male patients with middle and low rectal cancer at specific stages. This study systematically reviews the research process and operation standard of iTME, and summarizes the application status and future prospects of iTME.
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.
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.
【Abstract】ObjectiveTo study the specific cytotoxicity of amygdalin(a new prodrug) to LoVo cells in antibody directed enzyme prodrug therapy (ADEPT). MethodsThe specific activation of amygdalin by anti-CEA McAb-β-glucosidase conjugate and the cytotoxicity of amygdalin to LoVo cells were assessed throughTrypan blue exclusion. ResultsThe cytotoxicity of amygdalin itself to LoVo cells was low. However, when amygdalin was combinated with anti-CEA McAb-β-glucosidase conjugate, its cytotoxic effect was enhanced by nearly 40 times, and that effect was specific to to LoVo cells expressing CEA . When LoVo cells and MCF-7 cells were co-cultured in various ratios, the cytotoxic effect of amygdalin combinated with anti-CEA McAb-β-glucosidase conjugate was measured. The survival rate of cultured cells decreased while the percentage of LoVo cells increased, suggesting the cytotoxic effect to be specific to LoVo cells. ConclusionThe toxicity of amygdalin is low，and it can be activated by anti-CEA McAb-β-glucosidase conjugate effectively to kill targetd cells specifically which may be a new way for colorectal tumor therapy.
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 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.
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.