Objective To discuss the influence of the progress and result in rectal cancer operation through application of neo-adjuvant chemotherapy in multi-disciplinary team (MDT). Methods The patients treated in MDT model and non-MDT model between June to September 2007 were respectively analyzed, and the index about pathologic change, histologic transform and operative result between the two groups were compared.Results In the index of pathologic change, the incidence of abdominal adherence (13.5%, 7/52), ascites (7.7%, 4/52) and latent malignant intestinal obstruction (5.8%, 3/52) in MDT model group were obviously less than non-MDT model group (P=0.000). In the index of histologic transform, texture of mesentery in MDT model group was more fragile than non-MDT model group (P=0.000). The incidence of edema of pelvic tissues in MDT model group were more than non-MDT model group (P=0.000). However, the differences between the incidence of edema of pelvic peritoneum and adherence of mesorectum in two groups were insignificant (Pgt;0.05). In the index of operative results, the operative duration and intra-operative bleeding in MDT model group were less than non-MDT model group (P=0.000). And the protection of pelvic autonomic nerve in MDT model group was better than non-MDT model group (P=0.000). Meanwhile, accuracy rate in prediction of radical resection with anus-preserving in both groups were in high level (92.3% vs 76.2%). Conclusion Neo-adjuvant chemotherapy has certain influence in rectal cancer operation, but the successful operations are performed by standard and correct procedures. Therefore, optimizing combined therapy in MDT model and constructing preoperative evaluation system with neo-adjuvant chemotherapy, would be the next important focus.
Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.
目的 觀察替吉奧膠囊聯合奧沙利鉑治療晚期結直腸癌的近期療效和毒性反應。 方法 2011年5月－12月，將30例晚期結直腸癌患者根據體表面積來確定初始劑量，體表面積＜1.25 m2者，替吉奧膠囊40 mg/次，2次/d；體表面積1.25～1.50 m2者，替吉奧膠囊50 mg/次，2次/d；體表面積＞1.50 m2者，替吉奧膠囊60 mg/次，2次/d。早飯后和晚飯后分別口服1次，第1～4天服用奧沙利鉑注射液 130 mg/ m2，靜脈滴注，第1、21天重復，此為1個月周期。連用2周期后，按美國國立癌癥研究所擬定的藥物不良反應的分級評價標準3.0版本評價不良反應，按實體瘤治療療效評價標準評價療效。 結果 30例患者中，完全緩解1例（3.3%），部分緩解7例（23.3%），穩定12例（40%），進展10例（33.3%），疾病控制率為66.6%。不良反應主要是血液學毒性、胃腸道反應、皮膚色素沉著及外周神經毒性；1例Ⅳ度骨髓抑制，3例3度貧血，2例3度腹瀉，2例3度皮膚色素沉著，2例3度惡心、嘔吐，其余且均在Ⅰ～Ⅱ度骨髓抑制。 結論 替吉奧膠囊聯合奧沙利鉑方案治療晚期結直腸癌可獲得較高的疾病控制率，不良反應可控。