Tailgut cysts (TGCs) are rare congenital cysts that occur in the retrorectal or presacral spaces. Although most tailgut cysts have been reported as benign, there have been at least 9 cases associated with malignant change. We report herein on an unusual case of a 40-year-old woman with a carcinoembryonic antigen (CEA) -producing adenocarcinoma arising within a TGC who underwent surgical resection and local radiation therapy. Despite the complete resection, metastatic adenocarcinoma developed five months after surgery. CEA-producing adenocarcinoma from a TGC is extremely rare and only two cases, including this case, have been reported in the English medical literature. Besides CEA, the serum levels of CA 19-9 became markedly elevated in this patient. Given that the serum CEA level decreased to the normal range after complete resection of tumor and that the tumor recurrence was associated with a rebound of the CEA serum level, our case shows that serial measurements of serum CEA can be used for treatment planning and for assessing the patient's treatment response for this rare disease.
Adenocarcinoma/blood/pathology/*therapy ; Adult ; CA-19-9 Antigen/blood ; Carcinoembryonic Antigen/*blood ; Cysts/blood/pathology/*therapy ; Female ; Hamartoma/blood/pathology/*therapy ; Humans ; Rectal Neoplasms/blood/pathology/*therapy ; Sacrococcygeal Region

OBJECTIVETo evaluate the correlation between different therapies and survival of liver metastasis from colorectal cancer ( LMCC) , and to compare the clinical outcome of synchronous liver metastasis (SLM) with that of metachronous liver metastasis (MLM).

METHODSThe clinical data of 363 patients with LMCC were retrospectively reviewed with focus on the correlation between different therapy and survival.

RESULTSOf these 363 patients, 160 had SLM and 203 had MLM. Between the SLM and MLM group, there was no significant difference in age, or gender or primary cancer site (P > 0. 05 ), but significant differences were observed in condition of liver metastasis including liver lobe involved, focus number, maximum focus diameters and level of serum CEA and CA199 before therapy(P <0. 05). Ninety-one patients underwent curative hepatic resection, 22 of them in the SLM group and 69 in the MLM group. Mortality rate related to operation was 4. 5% (1/22) in SLM group and 2. 9% (2/69) in MLM group( P < 0.05). All patients were followed until 31/6/2005. The 3-year survival rate was 5. 2% with a median survival time of 10 +/- 1 months for the SLM group, and it wasl6. 4% and 17 +/- 1 months for the MLM group (P<0.01). Regarding to the treatment modalities, the 3-year survival rate was 30. 2% with a median survival time of 26 months for curative hepatic resection group, and it was 0% - 16. 7% and 10 - 17 months for non-operation groups treated by intervention, chemotherapy, radiofrequency therapy, percutaneous ethanol injection and Chinese traditional drugs (P <0. 05, P <0. 01 ).

CONCLUSIONCurative hepatic resection is still the first choice for liver metastasis from colorectal cancer improving the survival significantly. Other non-operative methods also can improve phase II resection rate. Metachronous liver metastasis has higher resection rate and better survival than the synchronous liver one.

Antineoplastic Agents, Phytogenic ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; CA-19-9 Antigen ; blood ; Carcinoembryonic Antigen ; blood ; Chemoembolization, Therapeutic ; Colonic Neoplasms ; blood ; pathology ; therapy ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; blood ; secondary ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Phytotherapy ; methods ; Rectal Neoplasms ; blood ; pathology ; therapy ; Retrospective Studies ; Survival Analysis

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 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 relationship between serum concentration of fluorouracil and therapeutic efficacy as well as adverse reactions in patients with unresectable locally advanced or measurable metastatic colorectal cancer, and to analyze its role in further improving therapeutic efficacy and reducing adverse reactions of fluorouracil-based chemotherapy.

METHODSEighty-six patients were randomly assigned into three groups according to the average plasma concentration of fluorouracil after three cycles of chemotherapy with the initial regimen of two weeks FOLFOX-4 (oxaliplatin + leucovorin + fluorouracil) or FOLFIRI (irinotecan + leucovorin + fluorouracil): group 1 (plasma concentration of fluorouracil < 25 ng/ml), group 2 (25 - 35 ng/ml) and group 3 (> 35 ng/ml). The blood samples were taken at 12 h after continuous infusion of fluorouracil in each cycle and the plasma concentration of fluorouracil was detected by high performance liquid chromatography (HPLC) (about 5 am ± 1 h). The relationship between the drug plasma concentration, therapeutic efficacy and adverse reactions in different fluorouracil plasma concentration arms was analyzed retrospectively.

RESULTSThe average plasma concentrations of fluorouracil of the three groups were (23.48 ± 1.95) ng/ml, (31.47 ± 2.33) ng/ml and (39.89 ± 3.87) ng/ml, respectively (P < 0.01). As for therapeutic efficacy, the median OS of the groups 2 and 3 were 18.0 and 17.5 months, significantly higher than that in the group 1 (13.0 months, P < 0.01). The PFS were 4.5, 7.5 and 8.0 months, respectively (P < 0.01). In terms of adverse reactions, the incidences of bone marrow suppression, mucositis and diarrhea in the group 3 were significantly higher than that in the first two groups (P = 0.02, P = 0.04 and P = 0.02).

CONCLUSIONSThe patients with local advanced and metastatic colorectal cancer, receiving fluorouracil-based chemotherapy, and with an average plasma concentration of fluorouracil between 25 - 35 mg/L have a better prognosis, and lower incidence of adverse reactions such as bone marrow suppression, mucositis and diarrhea.

Adenocarcinoma ; blood ; drug therapy ; pathology ; Adenocarcinoma, Mucinous ; blood ; drug therapy ; pathology ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Bone Marrow Diseases ; chemically induced ; Colonic Neoplasms ; blood ; drug therapy ; pathology ; Diarrhea ; chemically induced ; Disease-Free Survival ; Female ; Fluorouracil ; adverse effects ; blood ; pharmacokinetics ; therapeutic use ; Humans ; Leucovorin ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Mucositis ; chemically induced ; Neoplasm Staging ; Organoplatinum Compounds ; adverse effects ; therapeutic use ; Random Allocation ; Rectal Neoplasms ; blood ; drug therapy ; pathology ; Remission Induction ; Survival Rate

OBJECTIVEThe aim of this study was to evaluate the therapeutic efficacy and to determine the prognostic factors of TACE in patients with colorectal liver metastases (CRLM).

METHODSThe clinical data of 183 patients with unresectable CRLM treated with TACE from Jan. 2002 to Dec. 2008 were retrospectively reviewed. Log-rank method was used for univariate analysis and Cox proportional hazard model was used for multivariate analysis of the prognostic factors.

RESULTSThe median survival time was 22 months, and the 0.5-, 1-, 2-, 3-, 5-year survival rates were 93.9%, 81.1%, 39.8%, 18.2%, and 3.9%, respectively. Multivariate analysis showed that tumor involved more than one lobe of the liver, and elevated CEA and CA19-9 levels were independent risk factors for the overall survival (P < 0.01). Females, more times of TACE, combination with regional therapy and received phase II resection were related with a good survival (P < 0.01) in CRLM patients after TACE treatment.

CONCLUSIONSTranscatheter arterial chemoembolization is an effective therapy for unresectable colorectal liver metastases. Patients with tumor spread more than one lobe of the liver, high CEA and CA19-9 levels are independent poor prognostic factors. Females, patients received more times of TACE, combined with regional therapy and received phase II resection may have a good survival.

Adult ; Aged ; Aged, 80 and over ; Antigens, Tumor-Associated, Carbohydrate ; blood ; Carcinoembryonic Antigen ; blood ; Chemoembolization, Therapeutic ; Colonic Neoplasms ; pathology ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; blood ; secondary ; surgery ; therapy ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Organoplatinum Compounds ; administration & dosage ; Proportional Hazards Models ; Rectal Neoplasms ; pathology ; Retrospective Studies ; Survival Rate

Rectal cancer is one of the common cancers which poses a threat to the health of mankind. In recent years. Multi-modality treatment strategies for locally advanced rectal cancer improve the treatment efficiency. Accurate prediction of the treatment response after the neoadjuvant chemoradiotherapy (CRT) can guide more suitable treatment strategy. MERCURY study proved the prognostic value of post-CRT standard morphologic MRI(T2-weighted) assessment of tumor regression grade(TRG), and MRI assessment of circumferential resection margin can guide the definitive surgery. Compared with standard morphologic MRI (T2-weighted), functional MRI, including diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI, has shown more promising results for the prediction of therapeutic response in rectal cancer. The addition of diffusion-weighted images to T2-weighted images improves the accuracy of restaging examinations for determination of complete pathologic responders. DCE can reflect the tumor micro-vascular environment, and the change of perfusion in response to treatment. These images have the potential to improve the accuracy of therapeutic response in rectal cancer.
Chemoradiotherapy ; statistics & numerical data ; Contrast Media ; Diffusion Magnetic Resonance Imaging ; statistics & numerical data ; Humans ; Magnetic Resonance Imaging ; methods ; statistics & numerical data ; Margins of Excision ; Neoadjuvant Therapy ; statistics & numerical data ; Neoplasm Staging ; instrumentation ; methods ; statistics & numerical data ; Prognosis ; Rectal Neoplasms ; blood supply ; diagnostic imaging ; pathology

OBJECTIVETo summarize the perioperative and postoperative complications follow laparoscopic intersphincteric resection (LapISR) in the treatment of low rectal cancer and their management.

METHODSAn observational study was conducted in 73 consecutive patients who underwent LapISR for low rectal cancer between June 2011 and February 2016 in our hospital. The clinicopathological parameters, perioperative and postoperative complications, and clinical outcomes were collected from a prospectively maintained database. Perioperative and postoperative complications were defined as any complication occurring within or more than 3 months after the primary operation, respectively.

RESULTSForty-nine(67.1%) cases were male and 24(32.9%) were female with a median age of 61(25 to 79) years. The median distance from distal tumor margin to anal verge was 4.0(1.0 to 5.5) cm. The median operative time was 195 (120 to 360) min, median intra operative blood loss was 100 (20 to 300) ml, median number of harvested lymph nodes was 14(3 to 31) per case. All the patients underwent preventive terminal ileum loop stoma. No conversion or hospital mortality was presented. The R0 resection rate was 98.6% with totally negative distal resection margin. A total of 34 complication episodes were recorded in 21(28.8%) patients during perioperative period, and among which 20.6%(7/34) was grade III(-IIII( according to Dindo system. Anastomosis-associated morbidity (16.4%,12/73) was the most common after LapISR, including mucosa ischemia in 9 cases(12.3%), stricture in 7 cases (9.6%, 4 cases secondary to mucosa necrosis receiving anal dilation), grade A fistula in 3 cases (4.1%) receiving conservative treatment and necrosis in 1 case (1.4%) receiving permanent stoma. After a median follow up of 21(3 to 60) months, postoperative complications were recorded in 12 patients (16.4%) with 16 episodes, including anastomotic stenosis (8.2%), rectum segmental stricture (5.5%), ileus (2.7%), partial anastomotic dehiscence (1.4%), anastomotic fistula (1.4%), rectovaginal fistula (1.4%) and mucosal prolapse (1.4%). These patients received corresponding treatments, such as endoscopic transanal resection, anal dilation, enema, purgative, permanent stoma, etc. according to the lesions. Six patients (8.2%) required re-operation intervention due to postoperative complications.

CONCLUSIONAnastomosis-associated morbidity is the most common after LapISR in the treatment of low rectal cancer in perioperative and postoperative periods, which must be strictly managed with suitable methods.

Adult ; Aged ; Anal Canal ; surgery ; Anastomosis, Surgical ; adverse effects ; Blood Loss, Surgical ; statistics & numerical data ; Colectomy ; adverse effects ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Surgical Procedures ; adverse effects ; Female ; Humans ; Ileostomy ; adverse effects ; Intestinal Mucosa ; pathology ; Ischemia ; etiology ; Laparoscopy ; adverse effects ; Lymph Node Excision ; statistics & numerical data ; Male ; Margins of Excision ; Middle Aged ; Necrosis ; etiology ; Operative Time ; Postoperative Complications ; etiology ; therapy ; Rectal Neoplasms ; complications ; surgery ; Rectovaginal Fistula ; etiology ; therapy ; Surgical Stomas ; Treatment Outcome