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.
【Abstract】ObjectiveTo investigate the relationship between expression of Seprase and the clinicopathologic characteristics in colorectal cancer. MethodsThe expression of Seprase in 50 cases of colorectal cancer was detected with immunohistochemistry, Western-blotting technique and semi-quantitative immunohistochemistry, and the relationship between the expression of Seprase and the clinicopathologic characteristics (age, gender, tumor location, tumor size, gross appearance, depth of infiltration, histological classification, lymph node metastasis, venous infiltration, Dukes stage, distant metastasis) was analyzed. ResultsThe expression of Seprase was found both in tumor cells and adjacent stromal cells. The level of Seprase protein was higher in cancer tissue than that in normal tissue, and a semiquantitative assessment of the immunohistochemistry revealed a significant correlation between Seprase expression and the Dukes stage and the lymph node metastasis. ConclusionThe abundant expression of Seprase in colorectal cancer tissue is associated with the Dukes stage and the lymph node metastasis.
ObjectiveTo summarize the progress in mutant gene sequences of different types of hereditary colorectal cancer.MethodThe relevant literatures about genetic mutations in hereditary colorectal cancer at home and abroad were reviewed.ResultsHereditary colorectal cancer coule be divided into two categories according to whether it was related to the germline mutations of known oncogenes. Among the known germline mutant genes, the gene of adenomatous polyposis coli (APC), MUTYH, thymidine glycol DNA glycosylase 1 (NTHL1), polymerase (DNA) epsilon, catalytic subunit (POLE), and polymerase (DNA) delta 1, catalytic subunit (POLD1) were closely related to adenomatous polyposis syndromes, mismatch repair (MMR)-related genes were related to Lynch syndrome, serine/threonine kinase 11 (STK-11) gene was related to Peutz-Jeghers syndrome, mutant genes of SMAD4 and bone morphogenetic protein receptor type 1A (BMPR1A) were found in JPS individuals, and Cowden syndrome was caused by phosphatase and tensin homology deleted on chromosome ten (PTEN) gene mutation. For colorectal cancer patients with unknown germline mutations but significant genetic characteristics (such as hyperplastic polyposis), relevant genes had also been gradually searched out, which needed further evidence.ConclusionsColorectal cancer is a malignant tumor with genetic characteristics. Compared with sporadic colorectal cancer, the time of hereditary colorectal cancer from adenoma to cancer is shorter, and the occurrence of heterogeneous tumor is also increased, but the survival rate after active intervention is higher than the sporadic one. To study the mutant gene sequences of hereditary colorectal cancer is the improvement and development of the diseases control in modern medicine.
ObjectiveTo explain details of colorectal cancer surgery in detail as well as their tags and structures of Database from Colorectal Cancer (DACCA) in the West China Hospital.MethodThe article was described in words.ResultsThe details of colorectal cancer surgery module included procedure of anastomosis, shape of anastomosis, type of staple, enhanced suture for anastomosis, stuffing, drainage, coverage of major omentum, anti-adhesion material, reconstruction of pelvic peritoneum, contaminate, drug implants, and nano of the DACCA in the West China Hospital were defined. The data labels corresponding to each item in the database and the structured ways needed for the big data application stage in detail were explained. And the error correction notes for all classification items were described.ConclusionsThrough the detailed description of the details of colorectal cancer surgery of DACCA in West China Hospital, it provides the standard and basis for the clinical application of DACCA in the future, and provides reference for other peers who wish to build a colorectal cancer database.
ObjectiveTo evaluate effect of RAS gene mutation after liver metastasis resection on overall survival (OS) and disease-free survival (DFS) for patients with colorectal cancer combined with liver metastasis. MethodsA comprehensive and systematic literature search in the PubMed and other databases was conducted, with the final search ending on January 5, 2022. The impact of RAS gene mutation after liver metastasis resection on survival of patients with colorectal cancer combined with liver metastasis was analyzed by the Stata 12.0 software and Review Manager version 5.3 software, meanwhile which were analyzed according to subgroups, including study type (retrospective and prospective studies), region (Asian and European), and number of RAS gene mutation sites (>2 and ≤2). ResultsA total of 26 studies with 13 356 patients were included. The integrated analysis results showed that the patients with RAS mutations had statistically shorter OS [HR=1.54, 95%CI (1.43, 1.65), P<0.001] and DFS [HR=1.32, 95%CI (1.19, 1.44), P<0.001] as compared with RAS wild-type. Except the 1-year overall survival rate, the 2–5-year overall survival rate and 1–5-year disease-free survival rate of patients with RAS gene mutation were statistically lower than those of patients with RAS wild-type (P<0.05). The results of subgroup analysis showed that no matter retrospective and prospective studies, as well as studies in Asian and European countries, it was found that the OS and DFS for patients with RAS gene mutation were shorter than those of patients with wild-type (P<0.05); At the same time, subgroup analysis of the number of RAS gene mutation sites showed that OS and DFS of patients with number of mutation sites >2 were shortened as compared with ≤2 (P<0.05). ConclusionFrom the overall analysis results, the survival of patients with RAS gene mutation after liver metastasis resection is worse than that of patients with RAS wild-type for patients with colorectal cancer combined with liver metastasis.
【Abstract】ObjectiveTo review recent studies on Muir-Torre syndrome (MTS) and to improve the knowledge about MTS.MethodsThe literatures in recent years on clinic and gene research of MTS were reviewed.ResultsMTS was is a rare autosomal-dominant disorder characterized by the predisposition to both sebaceous tumors (or multiple keratoacanthomas) and internal malignancies. Gastrointestinal cancers were the most common kind of internal malignancies in MTS patients(61%)，followed by genitourinary cancers(22%). In most cases(56%)，sebaceous tumors appeared after the emergence of internal maliganancy. Both hereditary nonpolyposis colorectal cancer(HNPCC) and MTS were caused by germline mutations in the DNA mismatch repair genes. MTS patients exhibit significantly more mutations in the hMSH2 than in the hMLH1. In these cases , both internal and skin tumors showed the characteristic of high microsatellite instability(MSI).ConclusionThe presence of sebaceous tumors(or multiple keratoacanthomas) necessitates the search for internal malignancies. It is mandatory that patients with MTS, as patients with HNPCC, should be regularly followed up to search new malignancies. Evaluation and monitoring of the family members of patients are also necessary. The patients and their families should be counseled for genetic test. Sequencing the hMSH2 gene should be the prior selection of further examinations when clinical manifestations, history and laboratory tests suggest MTS.
ObjectiveTo investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.MethodsThe clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.ResultsThere were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).ConclusionGender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.
Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.
Objective To explore the factors associated with clinic follow-up of old patients with colorectal cancer and provide more evidence to improve the efficiency and quality of clinic follow-up after sugery. Methods The data of 253 patients who were underwent sugery because of old colorectal cancer in our hospital from January 2009 to May 2010 were reviewed. Data about the rate and times of clinic follow-up within 6 months after operation were collected via Hospital Information Systerm,??then the follow-up rate was calculated,??and to analyse the possible factors associated with follow-up times and rate. Results The total follow-up rate was 84.2%（213/253）,??and the total times of follow-up was between 0 to 24 times per one,??（4.08±0.03）times on average. On the times of follow-up,??patients inside the city was higher than that outside,??patients with medical or postoperative complications were higher than those without,??and patients with a stoma was lower than that without,??and the differences were statistically significant （P＜0.05）.While on the follow-up rate,??patients underwent a radical sugery or with a stoma were lower than those not or without,??and the differences were statistically significant （P＜0.05）. Conclusions The clinic follow-up of old colorectal cancer patients is not satisfactory,??and the possible factors associated with follow-up times or rate are the distance between residence and hospital,?have medical complications or not,??have postoperative complications or not,??radical sugery or not,??and with a stoma or without.
ObjectiveTo explore the influence of patients who accepted chemotherapy of Folfox4 scheme before operation for the expression of miR-196 and HoxB8 in colorectal cancer, and illustrating the differences between the miR-196 and HoxB8 expressions in colorectal cancer tissues and sensitivity to chemotherapy with Folfox4 scheme and its corre-lation and significance. MethodsFluorescence quantitative PCR (RT-PCR) and immunohistochemistry were used to determine the expressions of miR-196 and HoxB8 in 50 specimens of neoadjuvant chemotherapy group (chemotherapy sensitive group and chemotherapy insensitive group) and 30 specimens which received the surgery directly (no-chemo-therapy group), and analyzing the relationship and discrepancy between miR-196 and HoxB8 in these groups. ResultsThe RT-PCR examination showed that the relative expression levels of miR-196 and HoxB8 in the neoadjuvant chemo-therapy group were lower than the no-chemotherapy group (0.646 8±0.683 9 vs.1.000 0±0.000 0, P < 0.01;0.607 6±0.418 9 vs.1.000 0±0.000 0, P < 0.01).Expression of miR-196 in the chemotherapy sensitive group was higher than the chemotherapy insensitive group (0.948 9±0.691 0 vs.0.344 7±0.536 1, P < 0.01), however, the expression of HoxB8 mRNA in the chemotherapy sensitive group was lower than the chemotherapy insensitive group (0.489 9±0.371 5 vs.0.725 3±0.437 5, P < 0.05).Expression positive rate of HoxB8 protein in chemotherapy sensitive group was lower than the chemotherapy insensitive group (Z=-2.396, P=0.017).The expressions of miR-196 and HoxB8 in the neoadjuvant chemotherapy group had negative relationship (r=-0.595, P < 0.01), which was also exist in the no-chemo-therapy group (r=-0.435, P < 0.01). ConclusionsThe neoadjuvant chemotherapy with Folfox4 scheme before oper-ation can reduce the expression levels of miR-196 and HoxB8 in colorectal cancer tisssues.The different expression levels of miR-196 and HoxB8 could influence the sensitivity of neoadjuvant chemotherapy with Folfox4 scheme in colorectal cancer.The high level expression of miR-196 could restrain the expression of HoxB8, and then increase the sensitivity of chemotherapy with Folfox4 scheme in colorectal cancer.