Air Pollutants, Occupational ; analysis ; Chromatography, Gas ; methods ; Indenes ; analysis ; Workplace

Carbon Monoxide ; analysis ; Spectroscopy, Fourier Transform Infrared ; methods

OBJECTIVETo investigate the principle of management of colorectal high-grade intraepithelial neoplasia(HGIN) based on colonoscopic biopsy.

METHODSPatients diagnosed as colorectal HGIN based on colonoscopic biopsy in the Changhai Hospital from January 2002 to December 2009 were enrolled in the study. The clinical data of all the patients were collected and analyzed. According to the subsequent operation, cases were divided into local complete resection group and radical operation group. The discrepancy between the biopsy diagnosis and postoperative diagnosis was investigated.

RESULTSOf the 203 biopsy-based colorectal HGIN lesions, 156 underwent radical resection, while 47 received local complete resection. Univariate analyses indicated that tumors located in colon(P=0.02), tumors with sessile growth (P=0.00) and large tumors (P=0.00) were more likely to be treated with radical resection. Postoperative diagnosis revealed that 163 cases(80.3%) were invasive cancers, while the other 40 cases(19.7%) were HGIN lesions. Of the 156 cases resected radically, 140 cases were invasive cancers, 16 cases were diagnosed as HGIN. Of the 47 cases who underwent local complete resection, 24 cases were confirmed as HGIN but the other 23 cases were invasive cancers, in which 15 cases received subsequent radical operation.

CONCLUSIONSA large proportion of biopsy-proven colorectal HGIN lesions are invasive cancers. Therefore, local resection should be performed to confirm diagnosis. For highly suspected malignant tumors which can not be removed completely by local resection, if anus can be reserved, a radical transabdominal surgery is recommended even without biopsy-proven malignancy in order to avoid treatment delay.

Adult ; Aged ; Aged, 80 and over ; Biopsy ; Carcinoma in Situ ; diagnosis ; pathology ; surgery ; Colorectal Neoplasms ; diagnosis ; pathology ; surgery ; Endoscopy, Gastrointestinal ; Female ; Humans ; Male ; Middle Aged

BACKGROUNDNeoadjuvant chemoradiation is now considered the standard care for locally advanced rectal carcinoma (T3-4 or/and N1-2 lesions), but the accuracy of staging examinations including endorectal ultrasonography (ERUS) and MRI is far from excellent. In addition, the above staging equipment or professionals who perform the examinations may not be available in some hospitals, while preoperative colonoscopy and biopsy are usually obtainable in most hospitals. The objective of the present study was to investigate the clinical and pathological characteristics of locally advanced rectal carcinoma and identify candidates for neoadjuvant chemoradiation.

METHODSThis was a retrospective study. Patients who were treated for rectal cancer at Changhai Hospital from January 1999 to July 2008 were identified from our prospectively collected database. Statistical analysis was performed using SPSS Software System (version 15.0). The Mann-Whitney test, chi-square test and multivariate Logistic regression analysis were performed.

RESULTSA total of 1005 cases were included in this research, of which 761 cases were identified as locally advanced rectal carcinoma depending on postoperative TNM staging. The results of multivariate Logistic regression analysis indicated seven independent risk factors that could be used to predict a locally advanced rectal carcinoma independently: a high grade (including poor differentiation and undifferentiation) (OR: 3.856; 95% CI: 2.064 to 7.204; P = 0.000); large tumor size (OR: 2.455; 95% CI: 1.755 to 3.436; P = 0.000); elevated preoperative serum CEA level (OR: 1.823; 95% CI: 1.309 to 2.537; P = 0.000); non-polypoid tumor type (OR: 1.758; 95% CI: 1.273 to 2.427; P = 0.001); the absence of synchronous polyps (OR: 1.602; 95% CI: 1.103 to 2.327; P = 0.013); the absence of blood in stool (OR: 1.659; 95% CI: 1.049 to 2.624; P = 0.030); and a greater circumferential tumor extent (OR: 1.813; 95% CI: 1.055 to 3.113; P = 0.031). Based on these findings, a Logistic equation was established, the accuracy of which was 64% according to the information of the additional 50 cases.

CONCLUSIONSSome independent risk factors related with locally advanced rectal carcinoma were identified, based on which it is possible to establish a Logistic equation as a tool to predict candidates of neoadjuvant chemoradiation. Further research about optimization of the equation is warranted.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; methods ; Endosonography ; Female ; Humans ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Rectal Neoplasms ; diagnosis ; pathology ; Retrospective Studies

OBJECTIVETo investigate factors associated with lymph node metastasis and prognosis in patients with T1-2 colorectal cancer.

METHODSPatients with pT1-2 colorectal cancer between January 1999 to January 2005 were included. Chi-square test and multivariable logistic analysis were performed to evaluate risk factors associated with lymph node metastasis. Survival outcomes were analyzed using Kaplan-Meier and Cox regression model.

RESULTSTumor location and depth of invasion were independent risk factors for lymph node metastasis(P<0.01 and P<0.05). Gender, age, tumor gross pattern, tumor differentiation, carcinoembryonic antigen level, and tumor diameter were not associated with lymph node metastasis. Lymph node metastasis and distant metastasis on postoperative follow-up were independent risk factors for survival(P<0.05 and P<0.01).

CONCLUSIONFactors associated with lymph node metastasis in pT1-2 colorectal cancer do not affect the survival. However, lymph node metastasis and distant metastasis are predictive for survival.

Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Colorectal Neoplasms ; diagnosis ; pathology ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; diagnosis ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the reasonable proposal of prophylactic antibiotics use in selective colorectal operation.

METHODSOne hundred and sixty-five patients underwent colorectal surgery were randomized to Treatment 1 (55 cases), Treatment 2 (50 cases) and Control (60 cases) group. The Treatment 1 group was given oral MgSO4 solution at the night before operation, and Cefradine 2.0 g (I.V.) during the induction of anesthesia, continued with tow times of intravenous Cefradine 2.0 g and 0.5% Metronidazole 100 ml at an interval of 12 hours in 24 hours after the operation. The Treatment 2 group was given the same treatment as Treatment 1, but the antibiotics would not be withdrawn until 3-5 d after operation. On the basis of the treatment of Treatment 2 group, the Control group was given oral antibiotics 2-3 days before operation. Postoperative complications including surgical site infection, stoma leakage, dysbacteriosis, and WBC, body temperature, days of hospitalization and antibiotic expenses in the three groups were observed and compared.

RESULTSThere was no significant differences in surgical site infection, stoma leakage, WBC counting and its change, body temperature and hospital stay among the three groups (P > 0.05). The incidence rate of dysbacteriosis in Control group was significantly higher than that in Treatment 1 group (P < 0.05). The antibiotic expenses in the Treatment 1 group was significantly lower than those of the other two groups (P < 0.05).

CONCLUSIONSProphylactic antibiotic use during the induction of anesthesia and 24 hours after operation was reasonable in selective colorectal operation, it can prevent the surgical site infection effectively with good social-economic effects and fewer side effects.

Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; adverse effects ; Antibiotic Prophylaxis ; adverse effects ; methods ; Colorectal Surgery ; Female ; Humans ; Male ; Middle Aged ; Surgical Wound Infection ; prevention & control

OBJECTIVETo introduce the experiences of pull-through transection and double stapling anastomosis for early lower rectal cancer.

METHODSFrom May 2001 to March 2008, 25 patients with early stage lower rectal cancer were operated by using pull-through transection and double stapling anastomosis. The average distance between the dentate line and lower margin of the tumor is (3.2 +/- 0.5) cm (2.0 - 4.5 cm). The average tumor diameter is (2.8 +/- 0.8) cm (2.0 - 3.5 cm).

RESULTSThe average distance between the lower margin of the tumor and transection line is (1.5 +/- 0.4) cm (1.1 - 2.2 cm). All the resection margins were negative. Eighteen cases of the anastomosis were above the dentate line, 0.3 - 2.1 cm [(1.7 +/- 0.2) cm] and the other 7 were below, 0.1 - 0.5 cm (average 0.3 cm). Anastomotic leakage occurred in 1 case, and cured with conservative treatment. Local recurrence occurred in 1 case (4.0%), liver metastasis in 3 (12.0%) and lung metastasis in 2(8.0%), respectively. Mild fecal incontinence occurred in 7 cases.

CONCLUSIONCompared with trans-abdominal transection of distal rectum in low anterior resection of rectal cancer, pull-through transection and anastomosis provides more precise control of the cutting line and simpler resection.

Adult ; Anal Canal ; surgery ; Anastomosis, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery ; Retrospective Studies ; Surgical Stapling ; methods

OBJECTIVETo evaluate the value of positron emission tomography (PET) in diagnosing liver metastases from colorectal cancer.

METHODSEighteen patients suspected with liver metastases after resection of colorectal cancer and three patients suspected with other diseases were diagnosed by PET and CT before operation. The result of both diagnostic approaches was compared with the result of exploratory operation.

RESULTSSeventeen of 18 patients were confirmed as liver metastases after resection of colorectal cancer, in whom 14 patients had other synchronous metastases outside liver metastasis including lung metastasis (n= 2), abdominal wall metastasis (n= 2 ), bone metastasis (n= 1), peritoneal cavity lymph nodes metastasis (n= 6), mediastinal lymph nodes (n= 2), virchow lymph node metastasis (n= 1). One patient with negative PET diagnosis was still alive with cancer- free after 1 year followed- up. Three patients suspected with other diseases were also diagnosed as liver metastases from colorectal cancer by PET.

CONCLUSIONPET has higher sensitivity in diagnosing liver metastases or other synchronous metastases after resection of colorectal cancer, which suggests that PET can guide the determination of second operative surgery for liver metastases after resection of colorectal cancer.

Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; pathology ; Female ; Humans ; Liver Neoplasms ; diagnostic imaging ; secondary ; Lymphatic Metastasis ; diagnostic imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, X-Ray Computed

OBJECTIVETo compare the accuracy of preoperative assessment in differentiation and grading of rectal adenocarcinoma.

METHODSOne hundred consecutive patients diagnosed as invasive rectal cancer by colonoscopy biopsy and undergone operation in the Changhai Hospital from March 2006 to May 2008 were studied retrospectively. Patient characteristics, examination records, operative and pathologic reports were reviewed. The slides of preoperative biopsy and postoperative pathologic specimen were reviewed to identify the differentiation by a single pathologist. The results of preoperative biopsy were compared to those of postoperative specimen which was considered as final diagnosis. The accuracy of preoperative assessment of differentiation was calculated. Patients were then divided into two groups based on the preoperative differentiation:the low-grade tumor including well and moderately differentiated tumors, and the high-grade tumor consisting of poorly differentiated and undifferentiated tumors. The accuracy of grading was also calculated.

RESULTSThe accuracy of preoperative assessment of differentiation was 72%, with 20% overgrading and 8% undergrading, while the accuracy of preoperative grading was 91%, with 4% overgrading and 5% undergrading. The accuracy of grading was significantly higher than that of specific differentiation(P<0.01).

CONCLUSIONThe grading of preoperative biopsy has high accuracy rate and should be considered in clinical practice.

Adenocarcinoma ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies

For locally advanced rectal cancer after neoadjuvant radiation, it is difficult to make a choice between close observation, local resection, and radical resection. The decision should be made after carefully weighing postoperative complications, anal function, local recurrence and long-term survival. There is a high consistency of the radiosensitivity between primary tumor and mesenteric lymph node, which may be used to guide the treatment decisions. If the primary tumor shrinks significantly after neoadjuvant radiation, local resection is recommended, and the next treatment plan should be made based on the pathological examination of resected specimen. Transabdominal radical resection is recommended for unfavorable tumors. Distal resection margin should be at least 1 cm, and marking the inferior margin of tumor is also recommended before neoadjuvant radiation since it would shrink significantly after radiation.
Humans ; Neoadjuvant Therapy ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; radiotherapy ; surgery