【Abstract】Objective To investigate the recent studies on the biocharacters of keratin family (e.g. genetic mutations and abnormal expressions) and their relationships with the malignant tumors. Methods The literatures of recent years on the biocharacters of keratin family (e.g. genetic mutations and abnormal expressions) and their relationships with the malignant tumors were reviewed. Results Keratin family is a kind of structural proteins in cell which plays an important role in cytomechanics and regulates cell-cycle. The mutations of keratin genes (mRNA) or the overexpression of keratin proteins would interfere with the order of cell-cycle or the integrity of cytomechanics, and lead to some diseases and malignant tumors finally. Conclusion The studies on biocharaters of keratin family (e.g. genetic mutations and abnormal expressions) are helpful in the diagnosis, staging and the evaluation of prognosis of some diseases and cancers, e.g. liver cirrhosis, breast cancer, rectum carcinoma, etc.
Objective To explore the characteristics of diagnosis and treatment for the rectal cancer in the young patients （≤40 years）．Methods The domestic and abroad literatures about the research on the progress of rectal cancer in the young patients were reviewed, the clinical data of patients with rectal cancer were compared between the young patients and the other age patients, the characteristics of diagnosis and treatment for the rectal cancer in the young patients were summarized．Results The onsets of the young patients with rectal cancer were related to the diet，lifestyle, and genetic factors．Compared with the older patients, more later stage, higher percentage of poor differentiation, earlier lymph node metastasis were found in the young patients with rectal cancer．Rectal cancer of the young patients was often misdiagnosed and with a poor prognosis．Currently，surgery assisted with neoadjuvant therapy was generally acknowledged as a better method．Conclusions It has specificity in epidemiology, pathology, treatment, prognosis, and so on for rectal cancer in the young patients, but surgery needs further research．
Objective To evaluate the feasibility and clinical outcomes of laparoscopic total mesorectal excision (TME) in treating mid-low rectal cancer. Methods From March 2005 to July 2008, 74 patients with mid-low rectal cancer undergoing laparoscopic TME in Zhejiang Cancer Hospital were collected. The data of clinicopathologic parameters were analyzed. Results Laparoscopic TME was performed on 74 patients with mid-low rectal cancer. No operative death occurred in this group. No case was converted to open procedure. The mean operation time was 187 min. The mean operative blood loss was 90 ml. The mean postoperative hospital stay was 10 d. Bowel function was restored on 46 h after operation on average. The mean distance between tumor and the section edge was 3.1 cm. The average number of lymph node dissection was 19.7. The sphincter preservation rate was 97% in patients with tumor 6 cm above the anal verge. The follow-up times were 2-44 months, average 25 months. The incidence of complications was 9.5%. No tumor cell port site implantation or distant metastasis happened. One case was pelvic recurrence， no patient was dead.Conclusion Laparoscopic TME is a feasible, safe and minimally invasive technique for the patients with mid-low rectal cancer, achieving the principles of TME.
ObjectiveTo investigate the effect of pelvic autonomic nerve preservation (PANP) with total mesorectal excision (TME) on sexual and urinary function in male rectal cancer patients. MethodsClinical data of eightyfour patients with rectal cancer from January 2008 to October 2010 in our hospital were analyzed. According to different operative techniques, all the patients were divided into two groups: PANP+TME group (n=41) and TME group (n=43). The sexual dysfunction, urination disorder rate, and local recurrence rate after operation of patients between two groups were compared. ResultsErectile dysfunction rate of patients in TME+PANP group and TME group was 29.3% (12/41) and 76.7% (33/43), ejaculation disorder rate was 26.8% (11/41) and 79.1% (34/43), and urination dysfunction rate was 24.4% (10/41) and 79.1% (34/43), respectively. The rate of sexual and urinary dysfunction of patients in TME+PANP group was significantly lower than that in TME group (Plt;0.05). Local recurrence rate of patients in TME+PANP group (9.8%, 4/41) was similar to that in TME group (11.6%, 5/43)， Pgt;0.05. ConclusionPANP based on TME can reduce effectively the rate of sexual and urinary dysfunction in male rectal cancer patients, which does not increase the local recurrence rate after operation.
ObjectiveTo evaluate the safety and clinical effect of laparoscopic Miles and perineal anal recon-struction operation for patients with low rectal cancer. MethodsOne hundred and two patients underwent Mile's and perineal anal reconstruction operation for rectal cancer in this hospital from April 2006 to February 2010 were analyzed retrospectively, in which 58 patients underwent laparoscopic surgery (laparoscope group) and 44 patients underwent open surgery (laparotomy group).All these data such as the survival time, operative time, intraoperative blood loss, harvested lymph nodes, the first anal exhaust time and liquid diet recovery time after operation, postoperative hospitalization, and postoperative complications were collected and compared between the laparoscope group and laparotomy group. ResultsThe demography and clinicopathologic characteristics were similar between these two groups (P > 0.05).The operation was successfully performed in all the patients.There was no death associated with the operation.Compared with the laparotomy group, the intraoperative blood loss was less (P < 0.05), the first anal exhaust time and liquid diet recovery time after operation, postoperative hospitalization were shorter (P < 0.05), the harvested lymph node was more (P < 0.05) in the laparoscope group.There were no significant differences in the operative time, postoperative complications, and the survival curves between the two groups (P > 0.05). ConclusionsThe clinical effects of laparoscopic and open Miles and perineal anal reconstruction operation are similar for patients with low rectal cancer.But laparoscopic operation is a safe, feasible choice with quicker recover after the operation.
ObjectiveTo investigate effect of carbon nanoparticles on number of lymph nodes harvested in radical operation of rectal cancer after neoadjuvant chemoradiotherapy. MethodsOne hundred and five patients diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy in Cancer Hospital, Chinese Academy of Medical Sciences from March 1, 2014 to October 31, 2015 were included. Thirtysix patients were injected with carbon nanoparticles by colonoscopy before surgery and were classified as study group, and the rest patients were classified as control group. According to the same principle of surgery and procedure of pathological specimen handling, the effect of carbon nanoparticles on lymph node harvested in resected specimens was analyzed. ResultsThe total lymph nodes harvested were 764 in the study group and 1 242 in the control group. Among them, the metastatic lymph nodes were 19 in the study group, 58 in the control group. Although the average lymph nodes harvested in each patient had no significant difference between the study group and the control group (21.22±7.13 versus 18.00±9.84, t=1.739, P=0.085), the proportion of patients with 12 or more than 12 lymph nodes harvested in the study group was significantly higher than that in the control group [88.9% (32/36) versus 71.0% (49/69), χ2=4.287, P=0.038]. The ratio of patients with metastatic lymph nodes [27.8% (10/36) versus 33.3% (23/69), χ2=0.339, P=0.561] and the average metastatic lymph nodes harvested in each patient (1.90±1.29 versus 2.52±2.33, t=0.788, P=0.437) all had no significant differences between the study group and the control group. ConclusionThe injection of carbon nanoparticles by colonoscopy before surgery could increase detection rate of 12 or more than 12 lymph nodes in resected specimens of patients who were diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy.
The standard treatment for locally advanced rectal cancer is neoadjuvant chemoradiotherapy combined with surgery, but patients after the same treatment regimen show a large difference in outcomes. For patients with good response to neoadjuvant therapy, the waiting & observation scheme can be selected to avoid surgery and other complications. Therefore, accurate assessment of the response of patients with locally advanced rectal cancer after neoadjuvant therapy can better develop personalized treatment strategies. Current studies have found that blood sample detection, endoscopy, imaging examination and artificial intelligence have their own advantages and disadvantages in evaluating the response of neoadjuvant therapy. Therefore, this article reviews the application of different clinical tools in evaluating and predicting the response of neoadjuvant therapy for locally advanced rectal cancer, and looks forward to the future development direction.
Objective To investigate K-ras gene exon 2 codon 12 and 13 mutations， and analyze the clinical significance in the Uyghur and Han patients with rectal cancer. Methods A total of 144 surgical specimens taken from patients with rectal cancer who were treated in this hospital from January 2010 to December 2011 were used in this study. DNA was picked up from the tumor tissues and amplificated by PCR then direct sequencing.Results The K-ras gene muta-tion rate was 22.22% （32/144）， which was 26.09% （12/46） and 20.41% （20/98） in the Uyghur and Han patients， respec-tively， the difference was not statically significant （P＞0.05）. The K-ras gene mutation was related to the depth of invasion（T1＋T2：25.0%， T3＋T4：75.0%， P=0.01）， which was not related to the nation， gender， location of tumor， differen-tiation degree， or lymph node metastasis （P＞0.05）. Conclusions K-ras gene mutation is a common event in the Uyghur and Han patients with rectal cancer， but the K-ras gene mutation rate is not significant difference between the Uyghur nationality and Han nationality， which is only related to depth of invasion.
Objective To investigate the situation and prospect of local recurrence of rectal cancer by using CT and MRI. Method Relevant references about the imaging diagnosis of local recurrence of rectal cancer， which were published domestic and abroad in recent years， were collected and reviewed. Results In the diagnosis of local recurrence of rectal cancer， the sensitivity of CT was higher than that of MRI， while the specificity and accuracy were not. Perfusion CT， dynamic contrast-enhanced MRI， and diffusion weighted imaging were valuable in diagnosing local recurrence of rectal cancer， as new diagnostic techniques. Conclusion Both CT and MRI are important and valuable methods in diagnosing for local recurrence of rectal cancer.
Objective To observe the histopathological changes of tumor tissue after intraoperative regional chemotherapy of rectal cancer. Methods After the treatment of intraoperative regional chemotherapy with 5-FU (15 mg/kg)， the histopathological changes of tumor tissue were detected. Results Slight changes with cancer cells in all the cases accepted intraoperative regional chemotherapy were found under light microscope such as karyopyknosis, nuclear swelling, coagulation and necrosis of cytoplasm, hydropsia of intercellular substance, invasion of inflammatory cells, and 9/15 cases with slight inflammation of vessels were observed; While those changes were found in individual cells of the cases without regional chemotherapy. The more enlarged intercellular space of cancer cell was observed under electron microscope in the case with regional chemotherapy. Conclusion The intraoperative regional chemotherapy of rectal tumor can change the histopathological appearance of tumor tissue, that is significant in preventing cancer cells diffusing during operation and relapsing after operation.