经肛门局部切除术治疗早期直肠癌的前瞻性研究

目的:探讨早期直肠癌经肛门局部切除术的临床疗效.方法:前瞻性研究,入组时间为1997年1月-2005年5月.118例早期直肠癌患者分为经肛门局部切除术组(A组,58例)及经腹前切除术组(B组,60例).分析术后直肠功能,并发症,复发,转移以及随访术后1,3,5年生存率.结果:在侵犯粘膜及粘膜下直肠癌中,局部切除组并发症发生率和控便率均低于前切组,两组有统计学意义(P<0.05).两组复发,转移及生存率比较无统计学意义.在侵犯肌层的直肠癌中,比较均无统计学意义.结论:经肛门局部切除治疗早期直肠癌(T1期)简单易行,并发症少,并有益于提高术后患者的生活质量,T2期患者应谨慎选择.选择合适的患者进行经肛门局部切除术是保证疗效的关键.     

直肠癌术后肺转移72例的临床分析

目的：探讨直肠癌根治术后肺转移的治疗效果和影响预后的因素。方法：回顾性分析1978～2008年间的直肠癌根治术后发生单纯性肺转移的72例病例资料。结果：自原发灶切除术后全组病例中位生存时间34个月,行转移灶的切除手术23例,中位生存49个月;其余49例行非手术治疗,中位生存33个月;其中转移瘤大于3个组中位生存时间28个月,转移瘤小于等于3个组中位生存时间41个月。手术患者和转移灶个数少的患者的总生存率较大,总生存率可能和是否手术、转移灶的个数有关,但尚未发现年龄、性别、原发灶病理类型、分期、转移灶大小对生存率有明显影响。结论：直肠癌肺转移灶的手术治疗是安全、有效的。手术及转移灶个数可影响患者生存率。     

Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis

Aim

The aim of this study was to compare the short-term and mid-term effects of laparoscopic intersphincteric resection with the conventional open approach for patients with low rectal cancer through a meta-analysis.

Methods

The PubMed, EMBASE, Cochrane, and Ovid databases were searched for eligible studies until March 2017. Operation time, blood loss, circumferential resection margin-positive rate, distal margin length, number of resected lymph nodes, diverting stoma rate, postoperative overall morbidity, anastomotic leakage, and hospital stay were the main short-term effect endpoints. We also examined disease-free survival, overall survival, local recurrence, and post-operational anal function as secondary outcomes to evaluate the mid-term effects of laparoscopic surgery.

Results

Five studies involving 620 patients were included in the analyses. Compared with the open approach, the laparoscopic ISR had less blood loss (weighted mean difference [WMD]?=???214.65 ml, 95% CI [??370.44, ??196.13], p?<?0.01), less postoperative overall morbidity (OR?=?0.58, 95% CI [0.40, 0.86], p?<?0.01), and shorter duration of hospital stay (WMD?=???5.87 days, 95% CI [??11.35, ??0.40], p?<?0.05); however, the operation time was significantly longer in the laparoscopic group (WMD?=?47.34 min, 95% CI [4.10, 90.58], p?<?0.05). No other significant differences were observed.

Conclusion

Laparoscopic ISR for low rectal cancer offers fewer complications and faster recovery, with similar operation quality and mid-term oncological results than the conventional approach. Although this technique is comparatively more complex than the conventional approach and requires practice, laparoscopic ISR shows great potential as a surgical option and deserves further clinical study.

     

Radioresistance-related proteins in rectal cancer

Radiation therapy (RT), combined with chemotherapy, is currently the standard adjuvant approach for UICC-stage II and III rectal cancer patients. Individual rectal tumors display wide ranges of radiosensitivity (RS). The aim of the present study was to identify proteins associated with radioresistance (RR), with the final aim of predicting tumor response. Seventeen patients were recruited between July 1998 and November 2001. All patients suffered from a locally advanced adenocarcinoma of the rectum. Tumor biopsies were taken before RT. All patients received preoperatively 50 Gray or a biologically equivalent total dose. Surgery was performed after 6 weeks, and response assessed histopathologically. Seven tumors showed complete response, seven a partial response, and in three patients only microscopic disease remained. Proteins were separated using narrow pH gradient two-dimensional polyacrylamide gel electrophoresis and silver staining. Automatic gel comparison allowed matching a mean number of 497 +/- 280 spots. Forty-four spots showing significant differential expression in RR tumors were localized on the pH 4.5-5.5 gels, 33 out of them being identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Twenty-two out of 37 spots of interest could be identified on the pH 5.5-6.7 gels. The expression of the following proteins correlates with RR: tropomodulin (p = 0.01), heat shock protein 42 (p = 0.03), beta-tubulin (p = 0.10), annexin V (p = 0.10), calsenilin (p = 0.10), or with radiosensitivity (RS): keratin type I (p = 0.03), notch 2 protein homolog (p = 0.05) and DNA repair protein RAD51L3 (p = 0.11). A further RR-related protein is so far only hypothetical: XP_030188 (NCBI Database accession number, p = 0.14). We consider the fact that several of these proteins of interest are known to be associated with RR as a valid proof of principle for this proteomics approach. These results will serve as a basis for developing an assay for testing rectal cancers for radioresistance.     

Current controversies in colon and rectal cancer

Meeting announcement

Current controversies in colon and rectal cancer     

Changes in phosphatidylserine synthesis in human rectal tumors]

We have investigated the phosphatidylserine metabolism in human adenocarcinoma. This phospholipid is involved in the regulation of several enzymic activities of plasma membranes; therefore it could be useful to state if some alteration of tumour membranes propriety depend on variation of phosphatidylserine synthesis. Our results make evident that in such human tumours the phosphatidylserine synthesis is greatly augmented.