Contrast-enhanced computed tomography colonography (CE-CTC) is a useful guide for the laparoscopic surgeon to avoid incorrectly removing the colonic segment and the failure to diagnose of synchronous colonic and extra-colonic lesions. Lymph node dissection and vessel ligation under a laparoscopic approach can be time-consuming and can damage vessels and organs. Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers. We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates. We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.
Adult ; Aged ; Colectomy/*methods ; Colon/blood supply/pathology/radiography ; Colonography, Computed Tomographic/*methods ; Colorectal Neoplasms/pathology/*radiography/*surgery ; Contrast Media ; Female ; Humans ; Laparoscopy/*methods ; Lymph Node Excision/methods ; Male ; Middle Aged ; Neoplasm Staging/methods

OBJECTIVETo identify risk factors associated with overall survival (OS) for patients undergoing primary hepatic resection for metastatic colorectal cancer.

METHODSThe clinical and pathological data were prospectively collected from 191 consecutive patients undergoing primary hepatic resection for colorectal liver metastases from January 2000 to August 2012. The survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by Log-rank test. Parametric survival analysis was used to identify predictors of cancer-specific survival.

RESULTSThe 5-year overall survival were 38.4% and median survival time was 33 months; 5-year disease-free survival were 23.6%, and the median disease-free survival time was 10.0 months. 5-years survival rate was significantly lower in patients with synchronal metastasis than in patients with heterochronia metastasis (27.4% vs. 51.8%, χ(2) = 6.527, P < 0.05). In overall survival, univariate analysis found 7 risk factors: gender (χ(2) = 5.219), N stage of the primary tumor (χ(2) = 5.591), bilobar metastases (χ(2) = 4.269), number of metastases ≥ 2 (χ(2) = 5.051), disease-free interval ≥ 6 months (χ(2) = 6.527), carcinoembyonic antigen level ≥ 30 µg/L (χ(2) = 4.454), and extrahepatic disease (χ(2) = 5.158). On multivariate analysis, 3 risk factors were found to be independent predictors of poor survival: N stage of the primary tumor (RR = 2.198, 95%CI: 1.146-4.216), disease-free interval ≥ 6 months (RR = 1.840, 95%CI: 1.139-2.973), carcinoembyonic antigen level ≥ 30 µg/L(RR = 1.854, 95%CI: 1.056-3.255).

CONCLUSIONSResection of liver metastases provides good long-term cancer-specific survival benefit. N stage of the primary tumor, disease-free interval, carcinoembyonic antigen level are important prognostic factors for colorectal liver metastasis.

Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen ; blood ; Colorectal Neoplasms ; pathology ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Liver ; surgery ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Prognosis ; Risk Factors ; Survival Rate ; Young Adult

OBJECTIVE: To explore the technique and effect of liver hanging maneuver in anterior approach for isolated complete liver caudate lobectomy. METHODS: We recruited 17 patients with liver caudate lobe tumor (13 primary hepatocellular carcinoma, 3 cholangiocarcinoma and 1 liver metastasis from colorectal cancer). Isolated complete caudate lobectomy with liver hanging maneuver was performed in 17 patients. RESULTS: All 17 patients were successfully received the above-mentioned operation. The operative time was 166-427 (211.5 ± 20.1) min and the intraoperative blood loss was 372-1 208 (472.7 ± 83.6) mL. There was no operative death. The survival rates of follow up for 1, 3 and 5 years were 76.5%, 52.9% and 23.5%, respectively. CONCLUSION Liver hanging maneuver for isolated complete resection of the caudate lobe is an ideal approach for liver neoplasms resection.
Blood Loss, Surgical ; Carcinoma, Hepatocellular ; surgery ; Cholangiocarcinoma ; surgery ; Colorectal Neoplasms ; pathology ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; secondary ; surgery ; Survival Rate

The nodal stage of colorectal cancer is based on the number of positive nodes. It is inevitably affected by the number of removed lymph nodes, but lymph node ratio can be unaffected. We investigated the value of lymph node ratio in stage III colorectal cancer in this study. The clinicopathologic factors and follow-up data of 145 cases of stage III colorectal cancer between January 1998 and December 2008 were analyzed retrospectively. The Pearson and Spearman correlation analyses were used to determine the correlation coefficient, the Kaplan-Meier method was used to analyze survival, and the Cox proportional hazard regression model was used for multivariate analysis in forward stepwise regression. We found that lymph node ratio was not correlated with the number of removed lymph nodes (r = -0.154, P = 0.065), but it was positively correlated with the number of positive lymph nodes (r = 0.739, P < 0.001) and N stage (r = 0.695, P < 0.001). Kaplan-Meier survival analysis revealed that tumor configuration, intestinal obstruction, serum carcinoembryonic antigen (CEA) concentration, T stage, N stage, and lymph node ratio were associated with disease-free survival of patients with stage III colorectal cancer (P < 0.05). Multivariate analysis showed that serum CEA concentration, T stage, and lymph node ratio were prognostic factors for disease-free survival (P < 0.05), whereas N stage failed to achieve significance (P = 0.664). We confirmed that lymph node ratio was a prognostic factor in stage III colorectal cancer and had a better prognostic value than did N stage.
Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen ; blood ; Chemotherapy, Adjuvant ; Colectomy ; Colorectal Neoplasms ; blood ; drug therapy ; pathology ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Rectum ; surgery ; Retrospective Studies ; Young Adult

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoembryonic Antigen ; blood ; Catheter Ablation ; methods ; Colorectal Neoplasms ; pathology ; Combined Modality Therapy ; Fluorouracil ; therapeutic use ; Humans ; Leucovorin ; therapeutic use ; Liver Neoplasms ; blood ; drug therapy ; secondary ; surgery ; Neoplasm Recurrence, Local ; Organoplatinum Compounds ; therapeutic use

OBJECTIVETo investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter.

METHODSRetrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D.

RESULTSThe most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P < 0.05) , as well as between the groups with different depth of invasion (P < 0.05). Curability A resection was performed in 69 (86.2%) cases.

CONCLUSIONSTumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.

Aged ; Aged, 80 and over ; Carcinoembryonic Antigen ; blood ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Humans ; Japan ; Laparotomy ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies

OBJECTIVESTo detect the serum proteomic patterns by using SELDI-TOF-MS (surface enhanced laser desorption/ ionization-time of flight-mass spectrometry) technology and CM10 ProteinChip in colorectal cancer (CRC) patients, and to evaluate the significance of the proteomic patterns in the tumour staging of colorectal cancer.

METHODSSELDI-TOF-MS and CM10 ProteinChip were used to detect the serum proteomic patterns of 76 patients with colorectal cancer, among them, 10 Stage I, 19 Stage II, 16 Stage III and 31 Stage IV samples. Different stage models were developed and validated by support vector machines, discriminant analysis and time-sequence analysis.

RESULTSThe Model I formed by 6 protein peaks (m/z: 2759.58, 2964.66, 2048.01, 4795.90, 4139.77 and 37761.60) could be used to distinguish local CRC patients (Stage I and Stage II) from regional CRC patients (Stage III) with an accuracy of 86.67% (39/45). The Model II formed by 3 protein peaks (m/z: 6885.30, 2058.32 and 8567.75) could be used to distinguish locoregional CRC patients (Stage I, Stage II and Stage III) from systematic CRC patients (Stage IV) with an accuracy of 75.00% (57/76). The Model III could distinguish Stage I from Stage II with an accuracy of 86.21% (25/29). The Model IV could distinguish Stage I from Stage III with accuracy of 84.62% (22/26). The Model V could distinguish Stage II from Stage III with accuracy of 85.71% (30/35). The Model VI could distinguish Stage II from Stage IV with accuracy of 80.00% (40/50). The Model VII could distinguish Stage III from Stage IV with accuracy of 78.72% (37/47). Different stage groups could be distinguished by the two-dimensional scattered spots figure obviously.

CONCLUSIONThis method showed great success in preoperatively determining the colorectal cancer stage of patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; blood ; Colorectal Neoplasms ; blood ; diagnosis ; pathology ; surgery ; Female ; Gene Expression Profiling ; methods ; Humans ; Male ; Middle Aged ; Neoplasm Proteins ; blood ; Neoplasm Staging ; Preoperative Care ; methods ; Protein Array Analysis ; methods ; Reproducibility of Results ; Sensitivity and Specificity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; methods

Serum carcinoembryonic antigen (s-CEA) is used to detect recurrence and predict prognosis in colorectal cancer. However, the cutoff values of s-CEA for prognosis have not been determined. We therefore tried to determine the preoperative s-CEA levels predictive of survivals in colorectal cancer patients. We retrospectively analyzed the medical records of 989 patients who underwent curative resection for colorectal cancer between July 1990 and December 1997, with a mean followup of 46 months (range, 3-129 months). When patients were divided into four subgroups with the cutoff values of s-CEA at 3,6, and 17 ng/mL, their 5-yr diseasefree survival rates were 85.3% (<3.0 ng/mL), 70.0% (3-6 ng/mL), 64.2% (6-17 ng/mL), and 55.2% (>17 ng/mL) (p<0.001). Multivariate analysis showed that factors predictive of survival included age (p=0.028), tumor stage (p<0.001), cell differentiation (p=0.016), and gross type (p=0.007), location (p=0.003) and preoperative s-CEA (p<0.001). Using the above-described cutoff levels, a significant difference in survival was observed only in patients with stage III tumors (p=0.007) when analyses were performed by stage. We can suggest the new cutoff values of s-CEA used in the present study.
Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen/*blood ; Colorectal Neoplasms/blood/*pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Predictive Value of Tests ; Preoperative Care ; Prognosis ; Survival Analysis

OBJECTIVETo investigate the minimal invasiveness of laparoscopic operation for colorectal carcinoma.

METHODSForty cases with pathologically proven colorectal carcinoma were divided into laparoscopic group (n=20) and open surgical group (n=20). Perioperative alterations of peripheral blood IL-6, IL-8, TNF-alpha, CRP, sICAM-1 and WBC CD11b were compared between the two groups. TNF-alpha, IL- 6, IL- 8 and sICAM-1 were determined by ELISA, CRP by scattered radiation turbidity comparison and WBC CD11b by flow cytometry with monoclonal antibody PS- CD11b, M2Ab.

RESULTSThe postoperative cytokine levels of TNF-alpha, IL-6 and IL-8 in open surgery group were significantly higher than those in laparoscopic group (P< 0.05). Dynamic level of sICAM-1 at 6 and 24 hours after operation in open surgery group were significantly higher than those in laparoscopic group. Peripheral WBC CD11b decreased to the lowest level at 6 hours after operation in open surgery group,significantly lower than that in laparoscopic group (P< 0.05).

CONCLUSIONLaparoscopic surgery for colorectal carcinoma exerts less effects on patients than traditional open surgery, and can maintain patients defense function,therefore it is less invasive.

Aged ; C-Reactive Protein ; metabolism ; Colorectal Neoplasms ; blood ; pathology ; surgery ; Female ; Humans ; Intercellular Adhesion Molecule-1 ; blood ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Laparoscopy ; Male ; Middle Aged ; Postoperative Period ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo investigate the alternation and significance of CD4(+)CD45RA(+) T cells and CD4(+)CD45RO(+) T cells in peripheral blood of colorectal cancer patients.

METHODSThe expression of CD4(+) T cells, CD4(+)CD45RA(+) T cells and CD4(+)CD45RO(+) T cells in peripheral blood of 60 colorectal cancer patients were detected with flow cytometry pre-operatively and 1, 3 months post-operatively, compared with those of 10 healthy persons.

RESULTSCD4(+) T cells expression of colorectal cancer patients was the same as the healthy persons. The proportion of CD4(+)CD45RO(+) T cells of colorectal cancer patients was higher, which descended post-operatively, especially in Dukes A and B patients, while CD4(+)CD45RA(+) T cells showed the opposite findings.

CONCLUSIONCD4(+)CD45RA(+) T cells and CD4(+)CD45RO(+) T cells, playing an important immune effect in colorectal cancer patients, is closely related to stage and prognosis.

Adult ; Aged ; CD4-Positive T-Lymphocytes ; immunology ; Colorectal Neoplasms ; immunology ; pathology ; surgery ; Female ; Humans ; Leukocyte Common Antigens ; blood ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Period ; Prognosis