Objective To deeply explore the consultation model of multi-disciplinary team (MDT) for colorectal cancer (CRC) reconstruction. Methods After analyzing early consultation model of CRC-MDT, some unreasonable factors were discovered and more suitable model was found. Results With analyzing the problems of members, time and management in early consultation model, reconstructing consultative joints and links, and optimizing flow-sheet were choosed. Finally, the MDT project was set up inter-project clinical round and network consultation. Conclusion The feedback from patients after consultation model reconstruction shows good results. Total consultative system in CRC-MDT will be completely finished step by step. However, advanced researches are still needed.
Objective To explore the safety, effectiveness, operation mode and clinical value of the laparoscopic colorectal resection. Methods The clinical data and experiences of laparoscopic resection for 18 cases with colorectal neoplasm from Jun. 2007 to Mar. 2008 were studied retrospectively. Results Among 18 cases, there were 5 cases of rectal cancer, 6 cases of sigmoid colon carcinoma, 2 cases of sigmoid colonic polyp, 2 cases of descending colon carcinoma, 2 cases of ascending colon carcinoma and 1 case of ascending colonic lipoma. Fifteen cases of laparoscopic colorectal resection were performed successfully, including Dixon procedure 4 cases, Miles operation 1 case, radical resection of sigmoid colon 5 cases, palliative resection of sigmoid colon 2 cases, left hemicolectomy 2 cases and right hemicolectomy 1 case. Three cases converted to laparotomy due to adiposity or advanced status of local disease. Average intraoperative blood loss was 110 ml. The average number of lymph nodes dissected was 13.5. It took about 40 hours to restore intestinal function. The average time of hospitalization was 9 days. No one died during operation and no complications such as anastomotic leakage and postoperative hemorrhage occurred. Conclusion Laparoscopic resection for colorectal neoplasms possesses less trauma and rapid postoperative recovery. Laparoscopic colorectal surgery is safe and effective with skill and indication.
Objective To explore the clinical effects of postoperative restrict rehydration on different body mass index (BMI) of patients with colorectal cancer. Methods From January 2008 to January 2009, the patients diagnosed definitely as colorectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different BMI (underweight group, normal group, overweight group).Results The first defecation time, aerofluxus time and ambulation time of the fluid restriction group were significantly earlier than those of the tradition therapy group (Plt;0.05), and postoperative in-hospital time was also less (Plt;0.05). However, the differences of early postoperative rehabilitation among underweight group, normal group and overweight group in the tradition therapy group and fluid restriction group had no statistical significance (Pgt;0.05). The complications such as pulmonary infection, anastomotic leakage, intestinal obstruction and wound dehiscence in the fluid restriction group were significantly lower than those in the tradition therapy group (Plt;0.05). In the tradition therapy group, the incidences of anastomotic leakage and wound dehiscence in overweight group were significantly higher than those in the underweight and normal group (Plt;0.05). The rate of postoperative complications among underweight group, normal group and overweight group in the fluid restriction group had no statistical significance (Pgt;0.05). Conclusion Postoperative restrict rehydration for overweight colorectal cancer patients has a good clinical effect, which can promote the early postoperative rehabilitation.
Objective To explore the consultation model of multi-disciplinary team （MDT） for colorectal cancer (CRC). Methods Combined the characteristics of large public hospital, with recognized treatment pathway in international MDT for CRC and a comparison to the traditional consultation, to explore a consultation process model of multi-disciplinary team-working for colorectal cancer of West China Hospital (MDT-CRC-WCH) by own feature. Results Colorectal cancer MDT project team summarized the advantage of the consultation process of MDT-CRC-WCH and the drawback of the traditional consultation, descripted the purpose and characterisctics of MDT consultation by adopting creative whole-mode ideal of MDT-CRC-WCH, and descripted the present implementation of the consultation of MDT-CRC-WCH. Conclusion The consultation process of MDT has appeared distinctive features to the traditional, and it may direct the future evolving of the consultation model, however, advanced research is needed.
【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 systematically evaluate the correlation of amplification of human epidermal growth factor receptor 2 (HER2) with the clinicopathological characteristics and prognosis of colorectal cancer patients.MethodsPubMed, EMbase, Cochrane Library, Chinese Biomedical Literature Database (CBM), Wanfang, and other databases were searched, and cohort studies focused on the relationship between HER2 amplification and clinicopathological characteristics and prognosis of colorectal cancer patients were included. The retrieval time limit was from October 2020, and RevMan 5.4 software was used for meta-analysis.ResultsA total of 9 studies (11 cohorts) were included for meta-analysis of 7 209 patients with colorectal cancer. Results of the meta-analysis showed that HER2 amplification was not associated with overall survival [HR=1.10, 95%CI (0.98, 1.24), P=0.11]. HER2 amplification was not correlated with gender [OR=0.98, 95%C1 (0.74, 1.31), P=0.90] and tumor differentiation [OR=0.80, 95%C1 (0.49, 1.32), P=0.39], but correlated with the tumor location [OR=1.85, 95%C1 (1.01, 3.37), P=0.04], RAS wild-type gene [OR=6.36, 95%C1 (3.41, 11.87), P<0.000 01], TNM stage [OR=0.45, 95%C1 (0.32, 0.64), P<0.000 01], lymph node metastasis [OR=1.54, 95%C1 (1.12, 2.13), P=0.008], and the depth of tumor invasion [OR=0.17, 95%C1 (0.05, 0.55), P=0.003].ConclusionCurrent evidence shows that HER2 amplification is not associated with OS in patients with colorectal cancer, but associated with tumor infiltration, lymph node metastasis, TNM stage, tumor site, and RAS genotype.
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.
目的 探讨新辅助化学疗法（化疗）对结直肠癌手术患者炎症因子水平的影响。 方法 回顾2008年1月－2009年12月诊断为结直肠癌的487例患者的临床资料，剔除不符合研究条件者后，共390例，以是否接受过新辅助化疗分为术前化疗组（化疗组）156例与对照组234例进行研究。分别比较两组在入院时、术前、术后的炎症因子水平。 结果 入院时两组外周血白细胞、C反应蛋白（CRP）、纤维蛋白原、血清淀粉样蛋白水平差异均无统计学意义（P＞0.05）；术后化疗组CRP水平[（64.09 ± 60.24）mg/L]低于对照组[（87.80 ± 61.54）mg/L]，差异有统计学意义（P＜0.05）；其余炎症因子组间差异无统计学意义（P＞0.05）。 结论 新辅助化疗不会刺激机体产生免疫反应，且有一定的安全性。
Objective To investigate the features of extracolonic carcinoma spectrum in Northeast Chinese with hereditary nonpolyposis colorectal cancer. Methods The extracolonic carcinoma spectrum’s characteristics of 85 families registered in strict conformity with the HNPCC Amsterdam criteriaⅡwere analyzed retrospectively. Results In the 85 HNPCC families， the tumorous patients were 509 cases，the primary tumors were 589 cases， among the total consisted of 219 cases of colon cancer， 91 cases of rectal cancer，and 279 cases of extracolonic cancer， the most common extracolonic carcinoma was lung cancer. Conclusions Extracolonic carcinoma is an important part of cancer spectrum in HNPCC family， and the common extracolonic carcinoma in Northeast of Chinese are lung cancer， gastric cancer， endometrial cancer， liver cancer， and esophagus carcinoma.
Objective To explore the expressions of Galectin-3, Fascin-1, and β-catenin protein in colorectal adenocarcinoma and the relations to clinicopathologic characteristics. Methods The expressions of Galectin-3, Fascin-1, and β-catenin protein were detected in 60 cases of colorectal adenocarcinoma, 30 cases of adenoma, and 30 cases of normal mucosa by microwave-EliVisionTM immunohistochemistry method, and analyzed the expressions of them and the relations to clinicopathologic characteristics. Results The expression rate of Galectin-3, Fascin-1, and β-catenin protein in CRC was 68.3% （41/60）, 53.3% （32/60）, and 81.7% （49/60） respectively, which was 46.7% （14/30）, 30.0% （9/30）, and 43.3% （13/30） respectively in adenoma, and 20.0% （6/30）, 3.3% （1/30）, and 13.3% （4/30） respectively in normal mucosa, the differences had statistical significance （P＜0.05）. The expressions of Galectin-3, Fascin-1, and β-catenin protein had statistically significant correlation with the TNM stage, invasive degree, and lymph node metastasis of colorectal adenocarcinoma （P＜0.05, P＜0.01）. The expressions of Galectin-3 and β-catenin protein had statistically significant correlation with the different differentiation degree of colorectal adenocarcinoma （P＜0.05）, but the expression of Fascin-1 protein was not related to differentiation degree of colorectal adenocarcinoma （P＞0.05）.The expressions of Galectin-3, Fascin-1, and β-catenin protein had not statistically significant correlation with the patient’s age and gender, and tumour size （P＞0.05）.There were positive correlations between the Galectin-3 and Fascin-1 or β-catenin （r=0.728，P＜0.01；r=0.696，P＜0.01）, and there was positive correlation between β-catenin and Fascin-1 （r=0.507，P＜0.01）. Conclusions The high expressions of Galectin-3, Fascin-1, and β-catenin protein in colorectal adenocarcinoma tissues are some extent correlated to the high invasive ability and lymph node metastasis, which could be used for the indexes to predict the invasion and metastasis in colorectal carcinoma potentially.