OBJECTIVETo evaluate the therapeutic efficacy of simultaneous laparoscopic excision for the treatment of rectal carcinoma and synchronous hepatic metastasis.

METHODSTotally 38 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients in the group A were treated with laparoscopic surgery, and the other 18 patients in the group B with traditional abdominal operation to resect the rectal tumor and hepatic metastasis simultaneously. All patients received postoperative chemotherapy.

RESULTSAll the patients were treated successfully with no postoperative death in both groups. The mean operative time was 350 +/- 45 min in group A versus 342 +/- 38 min in group B (P > 0.05). The mean blood loss was 275 +/- 96 ml in group A versus 590 +/- 85 ml in group B (P < 0.01), and the average hospital stay was 12 +/- 1.5 days in group A versus 16 +/- 2.5 days in group B (P < 0.05). Only one patient in group A received blood transfusion of 200 ml during operation, while the average blood transfusion in group B was 500 +/- 100 ml (P < 0.01). The follow-up duration was from 36 to 72 months with an average duration of 45.3 months. The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the group A, versus 77.8%, 38.9% and 0% in group B, respectively (P > 0.05).

CONCLUSIONSimultaneous laparoscopic excision of rectal carcinoma and synchronous hepatic metastasis is safe, effective and minimally invasive with a similar survival achieved by traditional open abdominal operation.

Adenocarcinoma ; drug therapy ; secondary ; surgery ; Aged ; Blood Loss, Surgical ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; methods ; Length of Stay ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Male ; Middle Aged ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Survival Rate

OBJECTIVETo investigate the indication of surgical treatment for primary colorectal carcer with simultaneous hepatic metastasis.

METHODS116 colorectal cancer patients with simultaneous hepatic metastasis underwent surgery from January 1990 to December 2001. The data were analyzed using Statistical Package for the Social Sciences (Release 11.5, SPSS, Inc). The survival was estimated using Kaplan-Meier method, and the survival comparison was carried out using the log-rank test. Multivariate analysis was performed using Cox regression.

RESULTSTotally, 116 patients received surgical resection for primary colorectal tumor, 18 of them underwent liver metastasis resection simultaneously. Postoperative complication developed in 14.7% of these patients with postoperative death in two patients. The overall 5-year survival rate was 14.29%. The 5-year survival rate of those who had liver metastasis resection was 32.12%. Multivariate analysis showed that liver metastasis resection, abdominal carcinomatosis, chemotherapy and intervention treatment were the most important prognostic factors.

CONCLUSIONSurgical resection of primary colorectal cancer with simultaneous resection of liver metastasis or with combined modality therapies such as chemotherapy and intervention treatment is effective to prolong patient's survival for primary colorectal cancer patient with simultaneous hepatic metastasis.

Adenocarcinoma ; drug therapy ; secondary ; surgery ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemotherapy, Adjuvant ; Colectomy ; methods ; Colonic Neoplasms ; drug therapy ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Rectum ; surgery ; Survival Rate ; Young Adult

OBJECTIVETo study the clinical data and surgical treatment strategy of rectal neuroendocrine carcinoma (NEC).

METHODSSixteen cases of rectal NEC and 222 cases of rectal carcinomas receiving surgical treatment in Beijing Cancer Hospital from 2003 to 2007, were analyzed retrospectively.

RESULTSAmong the 16 rectal NEC patients, 4(25%) received Miles surgery, 7(43.8%) Dixon surgery, 2 combined multiple organ resection and 3 local resection. Lymph note metastases occurred in 11 cases(68.8%) and distant metastases in 7 cases (43.8%). Among the 222 rectal carcinoma patients, 43(19.4%) received Miles surgery, 152(68.5%) Dixon surgery, 12 palliative operation, 6 colostomy and 9 just received laparotomy. Lymph note metastases occurred in 125 cases (56.3%). In rectal NEC group, postoperative 1-, 2- and 3-year survival rates were 62.5%, 25.0% and 0.63% respectively, which were significantly lower than 83.1%, 61.7% and 46.1% in rectal carcinoma group(all P<0.01).

CONCLUSIONSRectal NEC is a rare disease. More vascular invasion, lymph node and distant organ metastases are found in rectal NEC than rectal carcinoma, and the prognosis of rectal NEC is worse than rectal cancer.

Adult ; Aged ; Carcinoma, Neuroendocrine ; drug therapy ; pathology ; surgery ; Chemotherapy, Adjuvant ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Retrospective Studies ; Survival Rate ; Young Adult

OBJECTIVETo analyse the clinical characteristics and potential prognostic factors of colorectal cancer patients with liver metastases.

METHODSThe clinical and pathological data of 300 colorectal cancer patients with liver metastases were retrospectively reviewed and analyzed.

RESULTSThe median survival time of these patients was 19.0 months. The 1-, 2- and 5-year survival rates after liver metastases were 79.0%, 29.0% and 3.0%, respectively. Univariate analysis revealed that performance status (KPS), histological grading, primary tumor, N status, lymphatic and vascular invasion, stage at diagnosis, the number, size and distribution of liver metastases and other accompanied metastases were prognostic factors. Multivariate analysis showed that KPS, lymphatic and vascular invasion, the number and size of liver metastases were independent prognostic factors of colorectal cancer with liver metastases.

CONCLUSIONPerformance status, lymphatic and vascular invasion, the number and size of liver metastases are independent prognostic factors of colorectal cancer with liver metastases.

Adenocarcinoma ; drug therapy ; pathology ; secondary ; surgery ; Adenocarcinoma, Mucinous ; drug therapy ; pathology ; secondary ; surgery ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms ; drug therapy ; pathology ; surgery ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Neoplastic Cells, Circulating ; Proportional Hazards Models ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Young Adult

OBJECTIVETo analyze the survival status and prognostic factors of patients with liver metastases from colorectal cancer.

METHODSThe survival rate and prognostic factors of 112 patients with liver metastases from colorectal cancer, who had complete follow-up data, were retrospectively assessed by Kaplan-Meier analysis and multivariate regression analysis.

RESULTSThe median survival time of the 112 patients was 18.25 months. The 1-, 2-, 3- and 5-year overall survival rates were 60.8%, 35.0%, 20.3% and 4.8%, respectively. Univariate analysis demonstrated that gender, age, primary tumor site, chemotherapy and pathological types had no significant correlation with the overall survival. But the treatment of primary tumor, time of liver metastasis, gross type of tumor, resection of liver metastases and clinical stage status were all independently related with the prognosis of patients. Multivariate regression analysis showed that resection of liver metastases, gross type of tumor and clinical stage were key factors affecting the prognosis of patients with liver metastases from colorectal cancer.

CONCLUSIONPatients with advanced stage, infiltrative gross type of colorectal cancer should be followed-up closely so that liver metastases from the cancer can be diagnosed and treated early. Resection of both the primary tumor and liver metastasis may improve survival of the patients.

Adenocarcinoma ; pathology ; secondary ; surgery ; Adenocarcinoma, Mucinous ; pathology ; secondary ; surgery ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Survival Rate ; Young Adult

OBJECTIVETo investigate the effect of enterostomy in treatment of locally advanced rectal carcinoma patients with combined chemoradiotherapy and operation.

METHODSClinical data from 51 cases of locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and operation were analyzed.

RESULTSThirty-three patients (64.9%) got staging down of their cancer after preoperative chemoradiotherapy, and 21.6% of patients (11 cases) had complete pathologic response. Thirty-seven patients received enterostomy, including extraperitoneal sigmoidostomy (29 cases), defunctioning ileostomy (8 cases) and double colostomy (3 cases with colon obstruction during preoperative therapy). One case experienced parastomal hernia and one stomal stenosis and 2 cases parastomal infection after enterostomy. No death of enterostomy occurred.

CONCLUSIONColostomy can reduce the pressure of obstructed intestinal tract and contribute much to the preoperative chemoradiotherapy, ileostomy can protect the distal stoma from leakage in sphincter saving operation. Enterostomy could be selected when needed in the favor of locally advanced rectal cancer patients.

Adult ; Aged ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Enterostomy ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; pathology ; surgery ; therapy ; Rectum ; drug effects ; radiation effects ; surgery ; Treatment Outcome

OBJECTIVETo explore the prognostic factors for rectal cancer patients with synchronous liver metastases.

METHODSData from a total of 77 cases of rectal cancer with synchronous liver metastases treated in our center from January 2002 to December 2008 were collected and reviewed. The total survival rate was analyzed by Kaplan-Meier method. Log-rank test and Cox regression model with SPSS 17.0 software were used to analyze 13 factors including clinicopathological factors and treatment choices.

RESULTSThe median survival time of the 77 cases was 12 months. The 1-, 2-, 3- and 5-year survival rates were 47.7%, 28.0%, 13.1%, and 1.5%, respectively. Univariate analysis with Kaplan-Meier method revealed that the differentiation of the primary tumor, T-stage, N status, the distribution, number and size of liver metastases, extrahepatic disease, serum CEA level at diagnosis and treatment modality were prognostic factors (P < 0.05). Multivariate analysis showed that the differentiation of the primary tumor (P = 0.007), T-stage (P = 0.027), the size of liver metastases (P = 0.003), serum CEA value at diagnosis (P = 0.000) were independent prognostic factors for rectal cancer patients with synchronous liver metastases.

CONCLUSIONThe factors affecting the prognosis for rectal cancer patients with synchronous liver metastases are the differentiation of the primary tumor, T-stage, N status, the distribution, number and size of liver metastases, extrahepatic disease, serum CEA level at diagnosis and treatment modality. The differentiation of the primary tumor, T-stage, the size of liver metastases, and serum CEA value at diagnosis are independent prognostic factors.

Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen ; blood ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; pathology ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Proportional Hazards Models ; Rectal Neoplasms ; blood ; drug therapy ; pathology ; surgery ; Retrospective Studies ; Survival Rate

OBJECTIVETo summarize and analyze the clinicopathological features and surgical management of patients with pathologic complete response (pCR) in the primary tumor after neoadjuvant chemotherapy for rectal cancer, and to explore the rational treatment of this entity.

METHODSClinical data of fifty-two patients with locally advanced mid-low rectal cancer admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Sciences from January 1994 to December 2013 were retrospectively analyzed. They were treated with neoadjuvant chemotherapy and achieved pathological complete response in the primary tumor. The preoperative clinical staging were stage II (cT3~4N0) in 10 cases and stage III (cT3~4N+) in 42 cases. After the neoadjuvant therapy, 10 cases achieved clinical complete response (cCR) (19.2%).

RESULTSRadical surgery was performed in 51 patients. Among them, five patients (9.8%) had pathological lymph node metastasis. One cCR patient underwent transanal local excision. The postoperative complication rate was 21.2%. During a median follow-up of 23.6 months, only one patient developed bone metastasis and another one had enlarged mesenteric and retroperitoneal lymph nodes detected by imaging. All the patients were alive by the last follow-up. The 2-year disease-free survival rate was 96.2% and overall survival rate was 100%.

CONCLUSIONSRadical surgery remains the standard therapy for cCR patients with rectal cancer after neoadjuvant chemotherapy. Local excision and "wait and see" should be recommended with great caution and limited to patients who cannot tolerate or refuse radical surgery with a strong demanding for sphincter saving, or applied in clinical trials.

Antineoplastic Combined Chemotherapy Protocols ; Chemotherapy, Adjuvant ; methods ; Disease-Free Survival ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Neoadjuvant Therapy ; methods ; Neoplasm Staging ; Postoperative Complications ; Rectal Neoplasms ; drug therapy ; mortality ; pathology ; surgery ; Remission Induction ; Retrospective Studies ; Survival Rate

OBJECTIVETo clarify the natural course and explore impact factors of distant metastasis in rectal cancer patients who received total mesorectal excision(TME) following neoadjuvant chemoradiotherapy (CRT).

METHODSBetween Januray 2008 and December 2013, 317 patients with locally advanced rectal cancer who underwent radical surgical resection following neoadjuvant CRT (pre- and postoperative simple fluorouracil or fluorouracil combined with oxaliplatin plus preoperative three dimensional conformal radiotherapy) at Department of Colorectal Surgery in Fujian Medical University Union Hospital were included. Univariate analysis and Cox regression were performed to evaluate the clinicopathological parameters that may be associated with distant metastasis.

RESULTSDuring a median follow-up of 39 months(range 15 - 89 months), 72 patients(22.7%) had disease recurrence, including local recurrence in 8 patients, and distant metastasis in 67 patients (among whom 3 patients had both). Distant metastasis occurred in 86.5%(58/67) patients during the first three years after surgery. The 3-year cumulative distant metastatic rate in all the patients was 22.4%. The 5-year overall survival rate in distant metastatic patient was significantly lower than that of non-distant metastatic patients following neoadjuvant CRT (36.2% vs. 81.2%, P=0.000). Univariate analysis showed that ypT stage (χ(2)=13.304, P=0.010), ypN stage(χ(2)=23.416, P=0.000), ypTNM stage (χ(2)=31.765, P=0.000) and RCRG(χ(2)=16.246, P=0.000) were associated with distant metastasis. Cox regression revealed that ypTNM stage(HR=1.959, 95% CI:1.171 ~ 3.277, P=0.010) was the only independent risk factor of distant metastasis.

CONCLUSIONSDistant metastasis is the early event during the progression in rectal cancer. ypTNM stage is the only independent risk factor of distant metastasis in locally advanced rectal cancer patients who undergo TME following neoadjuvant CRT.

Chemoradiotherapy ; Digestive System Surgical Procedures ; Fluorouracil ; therapeutic use ; Humans ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Organoplatinum Compounds ; therapeutic use ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Risk Factors ; Survival Rate

No abstract available.
Antigens, Neoplasm/metabolism ; Bone Neoplasms/diagnosis/drug therapy/secondary ; Disease Progression ; Humans ; Interferons/therapeutic use ; Liver Neoplasms/diagnosis/drug therapy/secondary ; Male ; Melanoma/*diagnosis/pathology/surgery ; Middle Aged ; Neoplasm Proteins/metabolism ; Positron-Emission Tomography ; Rectal Neoplasms/*diagnosis/pathology/surgery ; S100 Proteins/metabolism ; Tamoxifen/therapeutic use ; Tomography, X-Ray Computed