ObjectiveTo analyze the relationship between occupational type of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria, in which the data items analyzed included: gender, age, BMI, blood type, marriage, occupation, neoadjuvant therapy, symptomatic changes, imaging changes, and tumor regression grade (TRG), and the occupations were classified into the mental labour group, physical labour group, and the unemployed and resident groups according to the type of labour, then compared the decision-making and curative effect of neoadjuvant therapy among the 3 groups. ResultsA total of 2 415 eligible data were screened, of which 1 160 (48.0%) were the most in the manual labour group, followed by 877 (36.3%) in the unemployed and resident group, and finally 378 (15.7%) in the mental labour group. The proportion of those who did not use targeted drugs was higher in both patients ≤60 years old and >60 years old [75.6% (958/1 267) vs. 82.5% (947/1 148)], with both differences being statistically significant (P=0.004 and P=0.019), and among patients >60 years old, the different occupational types were associated with symptomatic changes and imaging changes after neoadjuvant therapy, with the highest number of both changes to partial remission [71.5% (161/225) vs. 66.7% (148/222)], both differences being statistically significant (P=0.001 and P=0.017). ConclusionThe analysis results of DACCA data reveal that the occupational type of CRC patients was associated with the choice of neoadjuvant therapy, and that different occupational types were associated with changes in curative effect before and after neoadjuvant therapy in CRC patients >60 years old, which needs to be further analysis for the reasons.
Objective To study the rule of lymphatic metastasis and to evaluate the extent of curative resection in advanced colorectal cancer. Methods One thousand and five lymph nodes from 114 consecutive patients with colorectal cancer underwent extended D3 resection were analyzed and classified as peritumor, longitudinal, and upward spread distribution. Results The metastatic rate and incidence of lymph node metastasis in peritumor, longitudinal as well as upward spread (N2 and N3) was 43.9% and 37.2%, 32.5% and 15.9% as well as 29.8% (19.3% and 10.5%) and 12.1% (16.6% and 7.8%) respectively. The distribution rate of metastatic lymph nodes was 17.5% and 23.5% in the longitudinal and upward spread respectively. In the longitudinal spread, most of lymph node metastasis was seen within 10 cm. Within 2 cm on the anal side in rectal cancer, the metastasis rate was 5.5%, and there was no metastasis in 2-4 cm. The lateral metastasis rate was 0%, 8.7% and 12.5% in the rectosigmoid (Rs), upper rectum (Ra) and lower rectum (Rb) respectively. Conclusion Advanced colorectal cancer tend to metastasize to longitudinal and upward lymph nodes. Jump metastasis is also a feature. In the lower rectal cancer within 6 cm from the anal verge or beyond pT3, there is a high risk of lateral metastasis. Extended D3 radical resection is necessary for colic cancer, but high ligation of the inferior mesenteric artery root as well as lateral lymphadenectomy and total mesenteric excision should also be performed for rectal cancer. There is no residual tumor tissue in the anastomosis when the excision distance is beyond 2 cm from the anal margin in rectal cancer.
ObjectiveTo analyze the relationship between occupation and tumor characteristics of colorectal patients served by West China Hospital of Sichuan University as a regional center in the current version of Database from Colorectal Cancer (DACCA). MethodsThe data of DACCA was updated on January 5, 2022. All data items included occupation, tumor morphology, distance of tumor from dentate line, tumor site, properties of tumor, differentiation degree, postoperative complex physiological index (CPI) stage, tumor comorbidities, tumor location, and tumor occurrence. According to the 2015 edition of the Occupational Classification of the People’s Republic of China, the occupational parameters of patients in this study were divided into three groups: Mental workers, physical workers and unemployed residents. ResultsThe DACCA database was filtered according to the conditions, obtaining 3 215 valid data. In terms of tumor complications, there were significant differences in the proportion of tumor bleeding, perforation grade, mechanical intestinal obstruction degree and pain degree among the different occupational groups (P<0.05). There were no significant difference in the ratio of edema degree and intussusception of tumor site among the different occupational groups (P>0.05). There were no significant difference in the composition ratio of tumor differentiation degree, tumor occurrence, tumor orientation and tumor morphology among the different occupational groups (P>0.05). The composition ratio of CPI staging of colorectal cancer, the distance between tumor and dentate line, the composition ratio of different tumor pathological properties, and the composition ratio of tumor located in rectum and colon were statistically significant (P<0.05). ConclusionPreoperative tumor characteristics of patients with colorectal cancer are associated with various occupations. In patients with rectal cancer, the distance from the dentate line to the physical work of the tumor is smaller, lower site, some tumor complications are more severe, and the stage is relatively later.
【Abstract】ObjectiveTo investigate the expression of Tob mRNA in human colorectal cancer tissues, and their corresponding paracancerous normal tissues which was 10 cm above the tumor and pathologically proved and to explore the role of Tob mRNA in the pathogenesis of colorectal cancer. MethodsQuantitative real time RTPCR was used to detect the expression of Tob mRNA in 31 colorectal cancers. ResultsCompared with paracancerous tissue, the expression of Tob mRNA in colorectal cancer tissues was significantly increased. Moreover, the expression levels of Tob in Dukes A, B, C, D were 1.146±0.067, 1.120±0.073, 1.052±0.020 and 1.047±0.010 respectively. Analyzed by oneway ANOVA, there were significant differences in expression of Tob in different Dukes stage. ConclusionThe upregulation expression of Tob mRNA may be closely associated with tumorigenesis of colorectal carcinoma.
Objective To study the effect of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery. Methods A total of 96 patients with colorectal cancer after laparoscopic surgery in our hospital from December 2019 to December 2021 were selected and randomly divided into the control group (used the formula prediction method to guide enteral nutrition support, n=48) and the observation group (used indirect calorimetry to guide enteral nutrition support, n=48). The target resting energy expenditure (REE) value and nutritional support energy intake were compared between the two groups. The cellular immune indexes (CD3+, CD4+, CD8+, CD4+/CD8+) and oxidative stress indexes [serum superoxide dismutase (SOD), malondialdehyde (MDA), the changes of glutathione peroxidase (GSH-Px)], and the changes of REE at different time points (1 day before operation and 1, 2 and 3 days after operation) of the two groups were compared. The incidence of complications in the two groups were observed. Results The target REE value of the observation group was lower than that of the control group (P＜0.05), and there was no significant difference in the enteral energy intake and parenteral energy intake compared with the control group (P＞0.05). After treatment, CD3+, CD4+ and CD4+/CD8+ in the two groups were lower than those before treatment (P<0.05), and CD8+ was higher than before treatment (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ in the observation group after treatment were higher than those in the control group (P<0.05) , while the level of CD8+ in the observation group was lower than that in the control group (P<0.05). After treatment, the levels of SOD and GSH-Px in the two groups were lower than those before treatment (P<0.05), and the levels of MDA were higher than those before treatment (P<0.05). The levels of GSH-Px and SOD in the observation group were higher than those in the control group (P<0.05), while the level of MDA in the observation group was lower than that in the control group (P<0.05). There was no significant difference in the REE value between the two groups at 1 day before operation (P>0.05); compared with the 1 day before operation, the REE values of the two groups at 1, 2, and 3 days after operation were significantly increased, and there was a statistically significant difference between the two groups at each time point (P<0.05), but the REE value at 3 days after operation was significantly lower than that at 1 and 2 days after operation (P<0.05). The REE values in the observation group were lower than those in the control group at 1, 2 and 3 days after operation (P<0.05). The incidence of complications in the observation group was 6.25%, which was lower than 20.83% in the control group (P<0.05). Conclusion Enteral nutrition support guided by indirect calorimetry in colorectal cancer patients after laparoscopic surgery can help reduce postoperative energy consumption, improve cellular immune function and oxidative stress response, and reduce the risk of postoperative complications, which is worthy of promotion.
Objective To explore the related factors of postoperative pulmonary infection (PPI) in patients undergoing laparoscopic colorectal cancer surgery, and analyze the perioperative management strategy of pulmonary infection combined with the concept of enhanced recovery after surgery (ERAS). Methods Total of 687 patients who underwent laparoscopic colorectal cancer surgery in the colorectal cancer professional treatment group of Gastrointestinal Surgery Center of West China Hospital of Sichuan University from January 2017 to May 2019 were retrospectively included. According to the occurrence of PPI, all the included cases were divided into infection group (n=97) and non-infection group (n=590). The related factors and prevention strategies of PPI were analyzed. Results The rate of PPI among patients underwent laparoscopic resection in our study was 14.1% (97/687). Compared with the non-infection group, the proportions of patients with preoperative complications other than cardiopulmonary, receiving preoperative neoadjuvant radiotherapy and/or chemotherapy, preoperative Eastern Cooperative Oncology Group (ECOG) score 1–2, preoperative Nutrition Risk Screening 2002 (NRS2002) score 1–3, tumor located in the left colon and rectum, combined organ resection, operative time >3 h and postoperative TNM stage Ⅱ patients in the infection group were higher (P<0.05). However, the proportions of patients who used intraoperative lung protective ventilation strategy and incision infiltration anesthesia in the infection group were lower than those in the non-infection group (P<0.05). In the infection group, the proportions of patients who received regular sputum excretion, atomization therapy, balloon blowing/breathing training, stomatology nursing after operation and postoperative analgesia were all significantly lower than those of the non-infection group (P<0.05), whereas the proportions of patients receiving antibiotics and intravenous nutrition after operation were significantly higher than those in the non-infection group (P<0.05). Logistic regression analysis showed that low preoperative NRS2002 score, intraoperative protective ventilation strategy, postoperative respiratory training, and postoperative regular sputum excretion were the protective factors of PPI, while preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor located in the left colon and rectum, late TNM staging and postoperative antibiotics were risk factors for pulmonary infection.Conclusions Preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor location in the left colon and rectum, late TNM staging and postoperative antibiotics are risk factors for pulmonary infection in patients with laparoscopic colorectal cancer. Preoperative good nutritional status, intraoperative protective ventilation strategy, postoperative respiratory training and regular sputum excretion may reduce the incidence of PPI to a certain extent.
ObjectiveTo understand the related factors and prevention and treatment of anastomotic leakage after colorectal cancer operation.MethodThe literatures on the studies of colorectal anastomotic leakage in recent years were reviewed and analyzed.ResultsThe occurrence of postoperative anastomotic leakage of colorectal cancer was usually related to many factors, besides the patients’ nutritional status, body mass index, gender, smoking and drinking history, preoperative radiotherapy and chemotherapy, etc., as well as the distance between the anastomotic stoma and the anal margin and the ligation of the left colonic artery. The monitors of albumin, prealbumin, C-reactive protein, procalcitonin and other indicators might be better for early prediction of anastomotic leakage. The use of oral antibiotics while mechanical bowel preparation, intraoperative ICG fluorescence angiography, single-layer intestinal anastomosis, reducing the number of staplers, preserving the left colon artery, placing drainage tube through anus, and minimally invasive colorectal cancer resection might have some advantages in reducing the incidence of postoperative anastomotic leakage.ConclusionsAs a surgeon, risk factors associated with anastomotic leakage should be fully understood. It is of great significance to use related markers to identify early anastomotic leakage and timely intervene, and use of more accurate surgical procedures to reduce occurrence of anastomotic leakage.
ObjectiveTo summarize the current common clinical laparoscopic gastrointestinal tumor surgical localization methods, and to provide reference for clinicians to choose reasonable localization methods. MethodThe domestic and foreign literatures related to laparoscopic gastrointestinal tumor surgical localization methods were searched and reviewed. ResultsThe common localization methods for laparoscopic gastrointestinal tumor surgery were imaging localization, preoperative endoscopic localization, intraoperative endoscopic localization and intraoperative fluorescence localization, among which abdominal enhanced CT and endoscopic-related localization methods were the most commonly used localization methods in clinical practice at present. ConclusionA variety of methods are available for surgeons to choose from, and the precise localization of tumors is better facilitated by combining multiple methods.
Objective To study the relationships between expressions of somatostatin receptor subtypes（SSTR1-SSTR5） and angiogenesis in colorectal cancer. Methods The expressions of SSTR1-SSTR5, VEGF, and CD34 in the paraffin sections of colorectal cancer tissues from 127 cases were detected by the standard streptavidin-peroxidase (SP) technique. CD34 was used as a marker to account microvessel density (MVD) in colorectal cancer tissues. The relationships between the expressions of SSTR1-SSTR5 and VEGF expression, or MVD were analyzed. Results The positive expression rate of SSTR1, SSTR2, SSTR3, SSTR4, and SSTR5 was 64.6% （82/127）, 36.2% （46/127）, 18.9% （24/127）, 18.9% （24/127）, and 38.6% （49/127） in colorectal cancer tissues, meanwhile, the positive expression rate of VEGF was 63.8% （81/127） and MVD was (34.67±16.62)/HP in colorectal cancer tissues. The positive expression rate of VEGF (47.8%， 22/46) and MVD 〔(29.00±15.32)/HP〕 in colorectal cancer tissues with SSTR2 positive expression were significantly lower than those in colorectal cancer tissues with SSTR2 negative expression 〔72.8%， 59/81； (37.90±16.56)/HP〕, Plt;0.05. There were no relationships between SSTR1, SSTR3, SSTR4, and SSTR5 expression and VEGF expression or MVD （Pgt;0.05）. Conclusion The positive expression of SSTR2 is related with angiogenesis in colorectal cancer tissues.
Objective To analyze the relationship between age and tumor characteristics of colorectal patients served by West China Hospital of Sichuan University as a regional center in the current version of Database from Colorectal Cancer (DACCA). Methods The data of DACCA was updated on January 5, 2022. All data items included age, precancerous lesions, family history of cancer, tumor site, distance of tumor from dentate line, tumor morphology, location, pathological properties of tumor, differentiation, and preoperative TNM stage. The patients were divided into three groups according to the age segment proposed by the United Nations World Health Organization (WHO): 35 years old and below (including infant, infant, child, teenager and youth, young group), 35 to 59 years old (middle-aged group), and 60 years old and above (elderly group). Results After scanning, 7 856 data rows were analyzed. ① There was significant difference in the composition ratio of precancerous lesions with or without among different age groups (χ2=6.219, P=0.045), and the constituent ratio of various precancerous lesions in different age groups was also statistically significant (χ2=51.698, P<0.001). ② There was significant difference in the composition ratio of family history of cancer with or without among different age groups (χ2=50.212, P<0.001), and there was significant difference in the composition ratio of different tumor history among different age groups (χ2=9.880, P=0.027), and there was significant difference in the constituent ratio of various tumor history among relatives in different age groups (χ2=16.138, P=0.003). ③ There were significant differences in the number of primary cancers among different age groups (χ2=12.973, P=0.036). In all patients with single primary rectal cancer, the constituent ratio of different rectal tumor sites among different age groups was statistically significant (χ2=43.817, P<0.001), and in all patients with single primary colon cancer, there was significant difference in the composition ratio of different colon tumor sites between different age groups (χ2=86.704, P<0.001). ④ The distance of tumor from dentate line was statistically significant in different age groups (H=28.589, P<0.001). ⑤ There was no significant difference in the composition ratio of tumor location among different age groups (χ2=14.795, P=0.140). ⑥ There was significant difference in the composition ratio of pathological properties of tumor among different age groups (χ2=121.387, P<0.001). ⑦ The proportion of tumor morphology was significantly different among different age groups (χ2=89.719, P<0.001). ⑧ There were significant differences in differentiation degree of tumor among different age groups (H=43.544, P<0.001). ⑨ There was statistically significant difference in preoperative TNM stage of colorectal cancer among different age groups (H=7.547, P=0.023). Conclusions Preoperative tumor characteristics of colorectal cancer patients are associated with age at diagnosis. Most young colorectal cancer patients do not have precancerous lesions, and once precancerous lesions are present, familial adenomatous polyposis is more common. Younger patients with colorectal cancer also have a higher percentage of relatives with a family history of cancer with colorectal cancer. From the perspective of tumor location, the proportion of single primary cancer in young colorectal cancer is higher than that in middle-aged and elderly patients. Younger patients with rectal cancer have a lower distance of tumor from dentate line, a higher proportion of low differentiated malignant tumors, and a relatively later neoplasm staging.