Objective To prospectively evaluate the health-related quality of life (HRQOL) outcomes in patients undergoing laparoscopic total mesorectal excision (LTME) with anal sphincter preservation (ASP) for low rectal cancers. Methods From June 2001 to March 2004, 125 patients undergoing LTME and 103 patients undergoing OTME were included in this study. The international standard questionnaires (QLQ-C30 and QLQ-CR38) were used to evaluate the conditions of patients at 3 periods after surgery respetively: 3-6 months, 12-18 months, gt;24 months. Results In contrast to OTME patients, the LTME ones showed significantly better physical function during 3-6 months after surgery, less micturition problems within 12-18 months, less male sexual problems and better sexual function during 12-18 months after surgery, with better sexual enjoyment after postoperative 24 months. Both groups showed significant improvement in most subscales from the first to the second assessment, and improvement in sexual enjoyment from the second to the third assessment. The sexual function, micturition problems and male sexual problems in LTME group significantly improved from the first to the second assessment, whereas the sexual function in OTME group improved from the second to the third assessment.Conclusion Patients undergoing LTME for low rectal cancers have bette postoperative HRQOL than patients undergoing OTME, with better physical function, micturition function, overall sexual and male sexual functions in short term, and better sexual enjoyment in the long term. The HRQOL of both LTME and OTME patients may be expected to improve over time, particularly in the first postoperative year.
Objective To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.
Objective To introduce the surgical technique and results of total mesorectal excision (TME) for rectal cancer. Methods Reviews.Results As a result of TME, local recurrence rates have declined from 20%-30% to 3%-8%, 5-year survival rate have risen to 75%, and the rates of sphincter preservation have risen too.Conclusion Total mesorectal excision reduces the local recurrence rates and raise the survival figures after excision of rectal cancer. Patients have a high quality of life.
Objective To investigate the correlation among lymph node metastasis and clinical features, postoperative survival rate in rectal cancer. Methods Seventy-nine patients who had accepted total mesorectal excision (TME) were collected, and the correlation among their clinical features (including gender, age, tumor size, gross type, depth of infiltration, histology type, differentiated degree and the level of blood serum CEA), lymph node metastasis, and postoperative survival rate were analyzed. Results There was significant correlation between six factors (namely the tumor size, gross type, depth of infiltration, histology type, differentiated degree and the level of blood serum CEA) and lymph node metastasis in single factor analysis. However， multivariate analysis showed that only gross type of tumor and depth of tumor infiltration were related to lymph node metastasis. The postoperative survival time of 43 non-metastasis cases was remarkably longer than that of 33 cases with lymph node metastasis (χ2=18.806， P=0.000), and it was longer in 22 cases with ＜4 lymph nodes metastasis than that of 11 cases with ≥4 lymph nodes metastasis (χ2=4.659， P=0.031). Conclusion In rectal cancer patients the clinical features can reflect the condition of lymph node metastasis in a certain extent, and it can help doctors to evaluate the lymph node metastasis and prognosis.
Objective To investigate the expressions of tumor necrosis factor related apoptosis inducing ligand （TRAIL） and its receptors (DR4, DcR1) in human rectal cancer tissues and normal rectal tissues. MethodsThe expressions of TRAIL and its receptors (DR4, DcR1) in 31 cases of human rectal cancer tissues and 20 cases of normal rectal tissues were detected by immunohistochemical staining. ResultsThe positive expression rates of TRAIL, DR4 and DcR1 （32.26%， 29.03%， 0） were lower than those of normal rectal tissues （55.00%， 70.00%， 65.00%）, the difference was statistically significant(P=0.015， P=0.000， P=0.000). There were no relation between the expressions of TRAIL, DR4 and DcR1 and clinicopathologic characteristics (Pgt;0.05). ConclusionThe expressions of TRAIL and its receptors (DR4, DcR1) in human rectal cancer tissues were lower than those of normal rectal tissues, which may suggest that the apoptotic effect induced by the interaction between TRAIL and its receptors has attenuated in human rectal cancer.
Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.
Objective To evaluate the adoption of carbon nano-particle in the pathologic examination of lymph node for lower rectal cancer. Methods Sixty consecutive patients with rectal cancers located at or below the peritoneal reflection were randomly allocated to the routine method group or the group using carbon nano-particle. Resultsof pathologic examination were compared. Results Altogether, 1 070 lymph nodes were examined from the 2 study groups. The average examined number of the carbon nano-particle group was (20.2±4.9)/case, which was significantly higher than the other group 〔(15.4±6.8)/case〕, P=0.003. More tiny lymph nodes were examined in the nano-particle group (P=0.029) and more metastases were proved from the lymph nodes dyed by nano-particle (P=0.000). The majority of examined lymph nodes were located along the superior rectal vessel and its branches. ConclusionAdoption of nano-particle in pathologic examination of rectal cancer surgery can increase the examined number of lymph nodes, while detect small nodes harboring cancer, thus ensuring the correctness of pathologic report. The distribution of mesorectal lymph nodes underlines the execution of TME principle in dissection.
ObjectiveTo study the significance of lateral lymph nodes sweeping in lower rectal cancer. MethodsRoutine pathological methods were used to detect the regularity of lateral lymph nodes metastasis and the survival rate of the patient. All the data was analysed by χ2 test. Results①Lateral lymph nodes metastasis was observed in 12.5% rectal cancer below the peritoneum,and it was the main lymph metastatic way. ②Low differented adenocarcinoma and mucous adenocarcinoma had more lateral lymph nodes metastasis than other types. Lateral lymph nodes metastasis was also related with invaded degree of invasion. ③The survival rate of the case with lateral lymph node metastasis was 42.2%.ConclusionLateral lymph nodes should be swept in advanced rectal cancer to prevent remains of lymph nodes remained and increase the survival rate.
Objective To explore anesthetic quality of epidural anesthesia with general anesthesia applied for surgery of rectal cancer. Methods One hundred and seventy-eight patients who were diagnosed as rectal cancer and received operation in the Central Hospital of Bazhong City from June 2010 to June 2012 were included retrospectively. These patients were divided into two groups according to the type of anesthesia， and the patients who received general anesthesia only were defined as group A， the patients who received epidural anesthesia with general anesthesia were defined as group B. The anesthetic quality and anesthetic adverse reaction were observed in two groups. Results The differences of baseline characteristics in two groups were not significant （P＞0.05）. The difference of anesthetic quality in two groups was not significant （P＞0.05）. In terms of anesthetic adverse reaction， the incidence rate of hypertension， hypotension，tachycardia， or postoperative nausea and vomiting of the group B was significantly lower than those of the group A （P＜0.05）. The incidence rate of bradycardia， premature ventricular contractions， or time of gastrointestinal function recovery had no significant differences （P＞0.05）. There was no nerve dysfunction of lower limb in two groups. Conclusion Epidural anesthesia with general anesthesia applied for surgery of rectal cancer as compared with general anesthesia only not only has the same anesthetic quality， but also has obvious advantages in decreasing anesthetic adverse reaction.
Objective To investigate prognostic factors of surgery treatment for pulmonary metastasis from rectal cancer. Methods From September 1973 to September 2007,43 patients, 12 women and 31 men with mean age of 58 years (ranged 36-77 years) were diagnosed and performed 45 curative resections of pulmonary metastases from rectal cancer in this hospital.Followup informations were collected including：the clinical parameters include age, sex, pTNM/UICC stage,the number, maximum diameter of lung metastases，the preoperative serum carcinoembryonic antigen(CEA) levels, the interval between resection of primary tumor and diagnosis of lung metastasis (disease-free interval (DFI)，the presence of hilar/mediastinal tumorinfiltrated lymph nodes，intraoperative blood loss and postoperative chemotherapy schemes. After lung metastasectomy，probability of survival was calculated according to the method of KaplanMeier.All factors that may have affected the survival were entered into Cox’s proportional hazards regression model to identify significant variables associated with survival. Results Fourty-three patients were selected fully follow-up cases, with mean period ranged from 1-103 months (median 54 months). There was 1 early postoperative mortality from cardiac complications (2.3%). The probability of survival at 1, 3, and 5 years was 91.3％，56.4% and 32.2%, respectively，Median overall survival was 42.6 months. The DFI was found to be 28.6 months（ranged 0-114 months）. Hilar or mediastinal tumorinvolvedlymph nodes were found in 9 patients. Fiveyear survival was 42.6% for patients with CEA＜5ng／ml and 18.0% for those with CEA≥5ng／ml (P=0.009).Fiveyear survival rate was 53.3% for patients with DFI≥3 years, 32.3% for those with1 year＜DFI＜3 years and 15.1% for those with DFI ≤1 year (P=0.036). In the multivariate analysis,the overall survival was significantly correlated with the preoperative serum CEA level and DFI (P=0.013,0.016),respectively. Conclusion Patients with pulmonary metastases from colorectal carcinoma will benefit from pulmonary metastasectomy. Patients with preoperative serum CEA ＜5ng／ml and DFI ≥3 years have an significantly long-term survival.