Objective To investigate the safety and feasibility of the total mesorectal excision （TME） and intersphincteric resection （ISR） for ultra-low rectal cancer and anal sphincter preservation surgery for anorectal cancer， and to evaluate the short term efficacy and postoperative anal function. Methods A retrospective analysis of clinical and follow-up data of 86 cases with TME＋ISR for ultra-low rectal cancer and anorectal cancer from January 2009 to December 2010 in West China Hospital of Sichuan University were performed. Results Eighty-six patients were successfully performed the operation， the lower edge of tumor from the anus was 1-5 cm （average 1.63cm）； tumor diameter was 2-7 cm （average 3.4cm）. The tumors were high differentiation in 4 cases， moderately differentiation in 60 cases，and poorly differentiation in 22 cases. The pTNM stages were stageⅠin 12 cases， stageⅡA in 11 cases， stage ⅡB in 15 cases， stage ⅢA in 2 cases， stage ⅢB in 23 cases， stage ⅢC in 16 cases， and stage Ⅳ in 7 cases. There were postoperative anastomotic leakage in 3 cases， perianal infection in 2 cases （1 case received reoperation with permanent colostomy because of pelvic peritoneal infection caused by perianal severe infections）. Anastomotic bleeding and anastomotic stenosis were of 2 cases respectively. Rectovaginal fistula， inflammatory ileus， urinary retention， and abdominal infection were of 1 case respectively. Eighty-six patients were followed-up for 12-24 months， the mean time was 18 months. Liver metastases was found in 1 case in 7 months after operation， 2 cases dead in the 7th month and 12th month after operation respectively. Local recurrence were found in 3 cases （3.5%） in 1 year after operation. The survival rate of 1-year was 97.7% （84/86）. The times of defecation was 1-5 times a day. The Kirwan’s score level on function of control defecation was 1-2 grade. Conclusions TME＋ISR for low rectal cancer and anorectal cancer is a viable， safe， and radical operation type for preservation of anus. The short term efficacy is satisfactory.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
Objective To build a systematic, comprehensive, high efficient and maneuverable follow-up system in multi-disciplinary team (MDT). Methods Comparing with abroad follow-up practical management, the advantages and disadvantages were analyzed by using multiple follow-up forms and the construct of staffs to guide and evaluate the postoperative patients in colorectal carcinoma at the beginning of follow up system. Results Follow-up system was made rationalized, and an effective follow-up model was built up to extend in MDT. Conclusion Following up the present situation with patients of colorectal cancer in this country, the correct direction which is based on current follow-up system would be put out. That would be the important study to improve the medical treatment in next stage.
Objective To analyze the primary status of database in multi-disciplinary team （MDT） of colorectal cancer, and to explore the tendency in construction of database in the future. Methods Described the current status of different database respectively, and analyzed the data statistically, involving the patients’ general information, essential information of duration of hospital stay, therapy and MDT from the database of patients. Results The development of different database was uncoordinated. Among the total, the database of patients was advanced, the database of reference and the database of specialists were also developing in certain. Conclusion The primary reason, which results in the lag of construction of database currently, is the long span of database and the cost of much time in data acquisition. The direction of development of database involves consummation of database gradually, refreshment of it promptly, and expanding the research of informatics related clinical medicine.
ObjectiveTo explore expression, clinical and biological significance of plasma miRNA-196a from patients with advanced gastric cancer.MethodsReal time quantitative RT-PCR (qRT-PCR) method was used to detect the miRNA-196a levels in tissues and plasma from 75 gastric cancer patients and 35 benign gastric lesions controls. Then clinic pathological correlations of plasma miRNA-196a in 75 gastric cancer patients were analyzed. Twenty-five gastric cancer patients were randomized selected from 75 patients, to compare plasma miRNA-196a levels between preoperation and postoperation. Meanwhile, the effect of miRNA-196a on the invasion ability of gastric cancer MGC-803 cell line was observed in vitro.ResultsThe levels of miRNA-196a in both plasma and tissues from 75 gastric cancer patients were significantly increased compared with 35 benign gastric lesions controls (P<0.000 1). Clinic pathological data of 75 gastric cancer patients showed that the expressions of miRNA-196a were significantly up-regulated in gastric cancer patients with serosal invasion (P<0.001), lymph node metastasis (P=0.004), distant metastasis (P<0.001) and late clinical stage (P<0.001). The expression of miRNA-196a in peripheral plasma of patients with gastric cancer was significantly down regulated after operation (P<0.000 1). In vitro, overexpression of miRNA-196a significantly increased the invasion ability of MGC-803 cells (P<0.05), whereas knockdown of endogenous miRNA-196a significantly inhibited the invasion ability of MGC-803 cells (P<0.05).ConclusionsThe expression of miRNA-196a is up-regulated not only in peripheral plasma of patients with gastric cancer, but also with the progression of gastric cancer (serosal invasion, lymph node metastasis and distant metastasis). The up-regulation of miRNA-196a expression in peripheral plasma is mainly due to the release of primary tumor tissue. miRNA-196a is expected to be a prognostic marker and a potential therapeutic target for advanced gastric cancer.
Objective To determine whether neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are important prognostic factors in patients with colorectal cancer, and to clarify relationship between NLR or PLR and TNM staging in colorectal cancer. Methods The clinical data of 304 patients with colorectal cancer who were admitted to the same medical group from January 2013 to December 2013 in the West China Hospital of Sichuan University were analyzed retrospectively. The relationship between NLR or PLR and the clinicopathologic characteristics and its effects on prognosis of patients with colorectal cancer were analyzed. Results The critical values of NLR (sensitivity=51.0%, specificity=75.4%, area under the receiver operating characteristic curve=0.66) and PLR (sensitivity=73.0%, specificity=46.4%, area under the receiver operating characteristic curve=0.60) was 2.27 and 155.92, respectively, with a 3-year cumulative survival rate as the end point. According to the critical values of NLR and PLR, there were 133 cases in a low NLR group (NLR≤2.27), 171 cases in a high NLR group (NLR>2.27), 207 cases in a low PLR group (PLR≤155.92), 97 cases in a high PLR group (PLR>155.92). ① The 3-year survival rate was 91.5% and 77.2% in the low NLR group and the high NLR group, respectively, which was 89.0% and 72.8% in the low PLR group and the high PLR group, respectively. The survival curves of NLR and PLR on prognosis prediction had significant differences (P=0.002, P=0.001). ② The results of multivariate analysis showed that the NLR was the independent risk factor for colorectal cancer (P=0.004), whereas PLR was not the independent risk factor for colorectal cancer (P=0.408). ③ The NLR and PLR were associated with the tumor TNM staging (P=0.002, P=0.000), which in the colorectal cancer with stage Ⅳ was significantly higher than those with stage Ⅰ–Ⅲ (P<0.05). ④ The NLR and PLR were associated with T stage (P=0.006, P=0.031). The NLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅰ (P=0.015) or stage Ⅱ (P=0.032). The PLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅱ (P=0.013). ⑤ The NLR was not associated with N staging (P=0.118). The PLR was associated with N staging (P=0.007), which in the colorectal cancer with N2 stage was significantly higher than that with N0 stage (P=0.008) or N1 stage (P=0.019). ⑥ The NLR and PLR in the colorectal cancer with stage M1/M2 were significantly higher than those with stage M0 (P=0.004, P=0.001). Conclusions Preliminary results of this study show that NLR is an important independent prognostic indicator for patient with colorectal cancer. While PLR is significantly increased when lymph node metastasis occurs, and platelet elevation might be related to lymph node metastasis.