Objective:To investigate the prognosis of rectal cancer patients with wait and see strategy after near clinical complete response(near-cCR) to neoadjuvant therapy and influencing factors for tumor recurrence.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 463 patients with low advanced rectal cancer who underwent neoadjuvant therapy, including 89 cases in Shanxi Provincial People's Hospital and 374 cases in Shanxi Cancer Hospital, from January 2013 to December 2017 were collected. There were 258 males and 205 females, aged (62±7)years. Patients received efficacy evaluation at 6 weeks after neoadjuvant therapy, in which patients with near-cCR who adhered to wait and see strategy received 6 cycles of additional adjuvant chemotherapy after comprehensive reexaminations. Observation indicators: (1)situations of neoadjuvant therapy; (2) influencing factors for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy; (3) prognostic analysis. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the nonparameter rank sum test. The Kaplan-Meier method was used to draw survival curve, and the log-rank test was used for survival analysis. The binary logistic regression model was used for univariate and multivariate analyses. Results:(1)Situations of neoadjuvant therapy. There were 136 patients achieving near-cCR after neoadjuvant therapy, including 86 cases adhering to wait and see strategy and 50 cases undergoing laparoscopic radical resection of rectal cancer. Of 86 cases with wait and see strategy, 29 cases were in clinical stage Ⅱ and 57 cases were in stage Ⅲ. There were 27 cases of scar type, 16 cases of ulcer type, 20 cases of nodule type, 23 cases of inflammatory edema type based on endoscopic tumor regression. (2) Influencing factors for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy. Results of multivariate analysis showed that age was an indepen-dent protective factor for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy ( odds ratio=0.88, 95% confidence interval as 0.81-0.97, P<0.05). Compared with scar type, the ulcer type was an independent risk factor ( odds ratio=4.22, 95% confidence interval as 1.01-17.64, P<0.05). (3) Prognostic analysis. All the 136 patients achieving near-cCR were followed up for 65(range, 60-72)months. The 5-year overall survival rate was 84.9% of 86 patients with wait and see strategy, versus 76.0% of 50 patients undergoing laparoscopic radical resection of rectal cancer, showing no significant difference between them ( χ2=1.94, P>0.05). Of 86 patients with wait and see strategy, the 5-year overall survival rate was 81.5%, 75.0%, 85.0%, 95.7% for cases of scar type, ulcer type, nodule type, inflammatory edema type, showing no significant difference among them ( χ2=3.64, P>0.05). Conclusions:Compared with laparoscopic radical resec-tion of rectal cancer, wait and see strategy is safe and feasible for rectal cancer patients after near-cCR to neoadjuvant therapy. Age is an independent protective factor for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy. Compared with scar type, ulcer type is an independent risk factor.

Objective:To investigate the prognosis of rectal cancer patients with wait and see strategy after near clinical complete response(near-cCR) to neoadjuvant therapy and influencing factors for tumor recurrence.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 463 patients with low advanced rectal cancer who underwent neoadjuvant therapy, including 89 cases in Shanxi Provincial People's Hospital and 374 cases in Shanxi Cancer Hospital, from January 2013 to December 2017 were collected. There were 258 males and 205 females, aged (62±7)years. Patients received efficacy evaluation at 6 weeks after neoadjuvant therapy, in which patients with near-cCR who adhered to wait and see strategy received 6 cycles of additional adjuvant chemotherapy after comprehensive reexaminations. Observation indicators: (1)situations of neoadjuvant therapy; (2) influencing factors for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy; (3) prognostic analysis. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the nonparameter rank sum test. The Kaplan-Meier method was used to draw survival curve, and the log-rank test was used for survival analysis. The binary logistic regression model was used for univariate and multivariate analyses. Results:(1)Situations of neoadjuvant therapy. There were 136 patients achieving near-cCR after neoadjuvant therapy, including 86 cases adhering to wait and see strategy and 50 cases undergoing laparoscopic radical resection of rectal cancer. Of 86 cases with wait and see strategy, 29 cases were in clinical stage Ⅱ and 57 cases were in stage Ⅲ. There were 27 cases of scar type, 16 cases of ulcer type, 20 cases of nodule type, 23 cases of inflammatory edema type based on endoscopic tumor regression. (2) Influencing factors for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy. Results of multivariate analysis showed that age was an indepen-dent protective factor for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy ( odds ratio=0.88, 95% confidence interval as 0.81-0.97, P<0.05). Compared with scar type, the ulcer type was an independent risk factor ( odds ratio=4.22, 95% confidence interval as 1.01-17.64, P<0.05). (3) Prognostic analysis. All the 136 patients achieving near-cCR were followed up for 65(range, 60-72)months. The 5-year overall survival rate was 84.9% of 86 patients with wait and see strategy, versus 76.0% of 50 patients undergoing laparoscopic radical resection of rectal cancer, showing no significant difference between them ( χ2=1.94, P>0.05). Of 86 patients with wait and see strategy, the 5-year overall survival rate was 81.5%, 75.0%, 85.0%, 95.7% for cases of scar type, ulcer type, nodule type, inflammatory edema type, showing no significant difference among them ( χ2=3.64, P>0.05). Conclusions:Compared with laparoscopic radical resec-tion of rectal cancer, wait and see strategy is safe and feasible for rectal cancer patients after near-cCR to neoadjuvant therapy. Age is an independent protective factor for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy. Compared with scar type, ulcer type is an independent risk factor.

Objective To explore the application value of circulating tumor cell (CTC) counting in the diagnosis of patients with colorectal cancer.Methods From July to October in 2015,a total of 61 patients firstly diagnosed with colorectal cancer,at stagc] to Ⅳ were enrolled.At the same period,20 individuals (healthy volunteers or patients with benign colorectal diseases) were selected as controls.Peripheral blood (7.5 mL) was taken before therapy.Peripheral blood CTC were counted by immunomagnetic beads enrichment combined with fluorescent staining method in two hours.The positive detection rate of CTC for colorectal cancer,especially early colorectal cancer was analyzed.And the priority of combination it with carcino-embryonic antigen (CEA) was also investigated.Chi-square test,t test and rank-sum test were used for statistical analysis.Results Two patients could not be pathological staged,due to the lack of whole body imaging evaluation.There were 30 patients with colorectal cancer at early stage (stage Ⅰ to Ⅱ) and 29 patients at advanced stage (stage Ⅲ to Ⅳ).The difference in CEA level between patients at early stage and advanced stage ((3.3±1.1) μg/L vs (20.4±3.3) μg/L) was statistically significant (t=-2.74,P=0.008).The median cell number of CTC of colorectal cancer group and control group was 1 (interquartile range=4) and 0,respectively,and the difference was statistically significant (Z=2.721,P=0.007).Taken 0/7.5 mL and 5 μg/L as the cut-off value of CTC and CEA,the detection rates of CTC for colorectal cancer and early colorectal cancer were 65.6％ (40/61) and 63.3％ (19/30),respectively;the detection rates of CEA for colorectal cancer and early colorectal cancer were 29.5 ％ (18/61) and 13.3％ (4/30).When CTC combined with CEA,the detection rates for colorectal cancer and early colorectal cancer were 73.8％ (45/61) and 66.7％ (20/30),respectively.Conclusions CTC has certain detection value in colorectal cancer especially early colorectal cancer.If it combined with CEA,the detection rate is much higher.

Objective To investigate the diagnosis and treatment of anorectal malignant melanoma,in order to regulate surgical methods and explore multi-modality treatment.Methods Clinical pathological features,diagnosis and treatment procedures of 38 patients with anorectal melanoma were reviewed,and their correlation with prognosis were analyzed.Results In 38 patients,10 of them were male and 28 were female,with the mean age of 58.7 years old (ranged 28-75 years old).28 patients underwent abdominoperineal resection,10 patients underwent wide local excision.The 1-,3-,and 5-year disease-free survival rates were 64.9 ％,18.5 ％ and 5.7 ％,respectively.The 1-,3-,and 5-year overall survival rates were 85.8 ％,24.1％ and 6.4 ％,respectively.Tumor thickness (≥ 1.51 rm) and tumor diameter (≥3 cm) were associated with lymph metastases (x2 =13.093,4.449,P =0.011,0.020),tumor thickness was also associated with distant metastases (x2 =11.965,P =0.018).According to the Kaplan-Meier method,comprehensive treatment after surgery had significant effects on disease-free survival (x2 =7.441,P =0.006).Tumor thickness,lymph metastases,and clinical staging had significant effects on overall survival (x2 =16.741,16.474,16.775,P =0.002,0.000,0.000).Cox proportional hazards model indicated that comprehensive treatment after surgery was the independent prognostic risk factors of disease-free survival (95 ％ CI 1.420-17.621,P =0.012).Tumor thickness and lymph metastases were the independent prognostic risk factors of overall survival (95 ％ CI 0.250-0.949,1.033-2.573,P =0.035,0.036).Conclusion Early detection,reasonable surgical procedure,generalized systemic focus on immunotherapy treatment are the key to improve quality of life and prolong the survival time of anorectal malignant melanoma patients.

Objective To investigate the cause,therapeutic strategy,methods of treatment and clinical results for the rectovaginal fistulas(RVF)after rectal cancer operations.Methods The clinical data of 14 female patients with RVF after rectal cancer operations were examined retrospectively.According to therapeutic strategy,all patients were divided into two groups,A group and B group,which were seperately performed traditional treatment,and progynova in combination with non-operative treatment.Results Among 10 patients in A group,8 patients were performed feacal diversion stoma,and 7 patients with RVF cured naturally,then performued colostomy reversal and restoration of bowel continuity,the other 2 cases were performed non-operative treatment for refusing feacal diversion stoma.Among 4 patients in B group,3 cases with RVF healed naturally during 1.5 to 2 months,one case secondary to rectal anastomosis was performed feacal diversion stoma for rectovaginal fistula without signs of healing.Conclusion RVF is a rare but serious complication after resection of rectal carcinoma,which is taken by the treatment strategy of progynova in combination with non-operative treatment,not only can promote the natural healing of RVF obviously,but also can shorten the healing time greatly.Feacal diversion stoma can be used while the treatment is failure.

Objective To investigate the diagnosis,the treatment methods and the prognosis of rectal cancer patients after renal transplantation.Methods Four patients with rectal cancer were found in 1035 renal transplantation recipients.Three of four patients were treated with anterior resection (AR) or abdomenoperineal resection (APR) with total mesorectal excision (TME).The two patients accepted regular adjuvant chemotherapy for six months period after surgery,but one patient rejected to accept any chemotherapy after surgery.Otherwise,one patient was only treated with chemotherapy and best support therapy for diagnosed as rectal cancer with multiple liver metastases.Results Two patients were fine to be followed up,8 months and 21 months after rectal resection respectively.Two other patients eventually died of metastasized cancer 5 months and 31 months respectively after therapy had been initiated.Conclusion Transplantation patients should receive standard oncology treatment,including operation and adjuvant treatment,so long as their general condition and organ graft functions allow to do so,although a higher degree of morbidity might be encountered,and periodical colorectal screening should be performed before and after renal transplantation.

Objective To investigate the safety and clinical outcome of laparoscopic resection of rectal cancer. Methods The clinical data of 347 patients with rectal cancer who were admitted to the Shanxi Tumor Hospital from May 2004 to July 2008 were prospectively analyzed. Of all the patients, 343 met the inclusion criteria,and they were randomly allocated to laparoscope group (n = 169) and open group (n= 174). The diameter of the tumors, number of lymph node dissected, length of rectum resected, morbidity, the mean operation time, number of patients receiving blood transfusion, time to out-of-bed activity, first flatus, bowel movement and liquid diet were observed. All data were analyzed using the t test and chi-square test. The survival rate was calculated using the Kaplan-Meier method. Results The diameter of the tumors, number of lymph node dissected, length of rectum resected and number of patients receiving blood transfusion in the laparoscope group were (4.3 ± 1.3 ) cm, 7 ± 5,(19.1±2.2)cm and 4, and they were (4.2±1.3)cm, 7 ±5, (19.0±2.3)cm and 8 in the open group,respectively, with no significant difference between the two groups ( t = 0. 629, - 0. 726, 0. 562, x2 = 1. 264,P ＞0.05). The mean operation time in the laparoscope group was 19 minutes longer than that in the open group (t = 7. 904, P ＜ 0.05 ). The time to out-of-bed activity, first flatus, bowel movement and liquid diet in the laparoscope group were 0.6, 0.3, 0.3 and 0.6 days earlier than those in open group( t = - 6. 392, - 3.581, - 3. 802,- 3. 493, P ＜ 0.05 ). There were no significant differences in postoperative infection, anastomotic leakage, intestinal obstruction and deep vein thrombosis between the two groups ( x2 = 0. 236, 0. 354, 0. 000, 0. 000, P ＞0.05). A total of 167 patients in the laparoscope group and 172 patients in the open group had been followed upuntil 1 may, 2010. The 1-, 2-year survival rates were 94.0% and 82.6% in the laparoscope group and 95.3% and 91.2% in the open group. There was no significant difference in the 2-year survival between the two groups (x2 =0.541, P ＞0.05). The survival time of the patients in the laparoscope group and open group were 55.9 and 57.9 months, respectively. Conclusions Laparoscopic surgery is safe and feasible for patients with rectal cancer, with quick recovery after the operation.

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.

Objective To study the safety of enteral nutrition in preoperative bowel preparation for patients with colorectal carcinoma. Methods 68 patients with colorectal carcinoma were randomized into 2 groups.34 patients in the study group were applied with a kind of enteral nutrition in preoperative bowel preparation.34 patients in the control group were applied with the traditional liquid diet. Results In the study group, the change of the total sum of lymphocytes, hemoglobin, the serum total protein, albumin,prealbumin, transferrin and immune parameters CD3+, CD4+, CD8+ and CD4+/CD8+ after operation had no significant difference compared with that before preoperative bowel preparation (P >0.05). But in the control group, the total sum of lymphocytes, hemoglobin and immune parameters CD+3, CD+4, CD+8 after operation had no significant difference compared with that before preoperative bowel preparation, the serum total protein [(65.35±3.02) g/L],albumin [(32.5±1.98) g/L], prealbumin [(221.02±22.45) mg/L], transferrin [(2.12±0.2) g/L] and CD+4/CD+8 (1.14±1.98) were significantly lower after operation than that before preoperative bowel preparation [(69.43±3.21) g/L, (35.43±2.45) g/L, (236.54±18.45) mg/L, (2.31±0.03) g/L, 1.53±2.45] (P ＜0.05). Conclusion Enteral nutrition could be applied to the preoperation bowel preparation and replace the traditional liquid diet. As a simple way, it can make the colon clear, improve the nutrition and immunity status of the patients.

High incidence of liver metastases from colorectal cancer was found. To the patients with liver metastases from colorectal cancer, regardless of whether the liver metastases could be resected or not, hepatectomy after neoadjuvant chemotherapy was recommended. The combination of cetuximab and chemotherapy based on irinotecan and oxaliplatin as the second-line and first-line for the liver metastases from colorectal cancer could get higher response and longer survival, and more patients got the chance of hepatectomy. However, cetuximab was only good for the colorectal cancer patients with wild-type k-ras.