OBJECTIVE: To investigate the value of neoadjuvant chemoradiotherapy (nCRT) combined with total pelvic exenteration (TPE) in the treatment of primary T4b rectal cancer. METHODS: A retrospective cohort study was conducted to analyze the clinicopathological data of 31 patients with primary T4b rectal cancer who underwent TPE from January 2008 to December 2015 at Peking University First Hospital. INCLUSION CRITERIA: preoperative clinical stage (cTNM) was defined as cT4b primary rectal cancer with only front wall Invasion; the lower edge of tumor was within 10 cm from the anal margin; TPE was performed; R0 resection was confirmed by pathology. Patients with recurrent rectal cancer, distant metastasis, and undergoing TPE for non-rectal tumors were excluded. Patients were divided into nCRT group and non-nCRT group according to whether receiving nCRT before surgery. The nCRT group received long course radiotherapy (total dose 50 Gy in 25 daily fractions) with concomitant chemotherapy (Capecitabine), and the surgery was performed 6-8 weeks after the neoadjuvant chemoradiation, while the non-nCRT group received surgery directly. The intraoperative, postoperative and pathological conditions and local recurrence were compared between the two groups. The survival curves were drawn by Kaplan-Meier method and the survival of two groups were compared. RESULTS: A total of 31 patients were enrolled, including 13 patients in the nCRT group and 18 patients in the non-nCRT group. The baseline data, such as age, duration of disease, preoperative basic disease, body mass index, smoking rate, and tumor distance from the anal margin, were not significantly different between the two groups (all P>0.05). In the nCRT group and non-nCRT group respectively, the ratio of anal preservation was 30.8%(4/13) and 38.9%(7/18) (P=0.468), the median intraoperative blood loss was 1 000 ml and 800 ml (P=0.644), the operation time was (531.7±137.2) minutes and (498.0±90.1) minutes (P=0.703), the median hospital stay was 18 days and 14 days (P=0.400), the morbidity of complications within 30 days after surgery was 23.1%(3/13) and 38.9%(7/18)(P=0.452), the incidence of postoperative abdominal abscess was 15.4%(2/13) and 0 (P=0.168), the proportion of secondary surgery was 7.7%(1/13) and 11.1%(2/18)(P=1.000), whose differences were not significantly different. The proportion of postoperative pathological pT4b in whole group was 58.1%(18/31), including 53.8%(7/13) in nCRT group and 61.1%(11/18) in non-nCRT group, which was not significantly different between the two groups (P=0.691). The number of harvested lymph node in nCRT group was 13.5±5.9, which was significantly less than 23.0±11.8 in non-nCRT group (P=0.013). There was no pathological complete remission (ypCR) case in nCRT group, and among 13 patients, tumor regression grade (TRG) of 2, 3, 4, and 5 was in 1 case (7.7%), 6 cases (46.2%), 5 cases(38.5%), and 1 case (7.7%), respectively. The median follow-up time was 33 (2 to 115) months, and the follow-up rate was 93.5%(29/31). One case was lost in both the nCRT group and non-nCRT group. The 3-year disease-free survival rate was 43.5% in pooled data, and was 43.6% and 43.3% in nCRT group and non-CRT group respectively without significant difference (P=0.833). The 3-year overall survival rate was 51.1% in pooled data, and was 45.7% and 54.7% in nCRT group and non-nCRT group respectively without significant difference (P=0.653).The local recurrence rate of nCRT and non-nCRT groups was 8.3%(1/12) and 5.9%(1/17) respectively, and the distant metastasis rate was 50.0%(6/12) and 41.2%(7/17) respectively, whose differences were not statistically significant as well (P=1.000 and P=0.865, respectively). CONCLUSION For primary T4b rectal cancer which can achieve R0 resection through total pelvic exenteration, neoadjuvant chemoradiotherapy has not been demonstrated any advantage in tumor regression, reducing local recurrence, or improving survival, and may increase postoperative complications.
Adenocarcinoma ; pathology ; therapy ; Antineoplastic Agents ; administration & dosage ; Chemoradiotherapy ; Combined Modality Therapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Pelvic Exenteration ; Rectal Neoplasms ; pathology ; therapy ; Retrospective Studies ; Treatment Outcome

ObjectiveTo evaluate the analgesic effect of intrarectal local anesthesia (IRLA) versus that of periprostatic nerve block anesthesia (PPNB) in initial transrectal ultrasound-guided prostate biopsy (TRUS-PB) for patients with different prostate volumes (PV).

METHODSA total of 253 patients undergoing initial TRUS-PB in our hospital from January 2014 to November 2017 were divided into three PV groups (<50 ml, 50－100 ml, and >100 ml), each again randomized into three subgroups (control, IRLA, and PPNB) with the random number table method. The pain during the procedure was assessed based on the Visual Analogue Scale (VAS) scores and the blind method was used by the biopsy operator, VAS valuator and data analyst.

RESULTSAmong the patients with PV <50 ml, the VAS scores in the blank control, IRLA, and PPNB subgroups were 4.39±0.87, 3.51±0.84 and 3.43±1.07, respectively, remarkably higher in the control than in the IRLA and PPNB groups (P<0.05), but with no statistically significant differences between the latter two (P>0.05). Among those with PV of 50－100 ml, the VAS scores in the three subgroups were 4.50±1.05, 4.38±1.13 and 3.38±1.44, respectively, markedly higher in the control and IRLA than in the PPNB group (P<0.05), but with no statistically significant differences between the former two groups (P>0.05). Among those with PV >100 ml, the VAS scores in the three subgroups were 5.19±1.05, 5.00±1.25 and 4.19±0.91, respectively, remarkably higher in the former two groups than in the latter (P<0.05), but with no statistically significant differences between the former two groups (P>0.05).

CONCLUSIONSEither IRLA or PPNB can be recommended for initial TRUS-PB in patients with PV <50 ml, PPNB for those with PV of 50－100 ml, and PPNB with other painkillers for those with PV >100 ml.

Administration, Rectal ; Aged ; Anesthesia, Local ; methods ; Anesthetics, Local ; administration & dosage ; Biopsy ; Humans ; Male ; Nerve Block ; methods ; Pain Measurement ; Pain, Procedural ; etiology ; prevention & control ; Prospective Studies ; Prostate ; pathology

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
Abdominal Pain ; Administration, Rectal ; Adult ; Aged, 80 and over ; Bisacodyl* ; Child ; Colitis ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility ; Humans ; Mucous Membrane ; Proctitis* ; Rectum ; Ulcer*

OBJECTIVETo explore the effect of arterial infusion with methylene blue during total mesorectal excision (TME) for better preservation of pelvic autonomic nerve on urination function and sexual function in male patients with rectal cancer.

METHODSA total of 68 male rectal cancer patients from Zhejiang Xiaoxing People's Hospital and 44 male rectal cancer patients from Guangdong Zhongshan Chenxinghai Hospital between June 2013 and June 2015 were prospectively enrolled. Patients were randomly divided into the trial group receiving arterial infusion with 8 ml of 1% methylene blue and the control group without artery infusion, with 56 cases in each group. All the patients underwent TME. Intra-operational lymph node removal and postoperative urination and sexual function (erection and ejaculation) were compared between two groups.

RESULTSThe baseline data of the two groups were not significantly different (all P>0.05). As compared to the control group, the trial group had shorter operation time [(3.28±0.63) hours vs. (4.01±0.94) hours, P<0.01], less blood loss[(92.5±36.4) ml vs. (174.1±61.4) ml, P<0.01], and more lymph nodes harvested per patient (15.8±7.6 vs. 11.9±4.3, P<0.01). One year after operation, classI(, II(, III(, IIII( of urination was observed in 33 cases (58.9%), 15 cases (26.8%), 6 cases (10.7%), 2 cases (3.6%) in the trial group, while 24 (42.9%), 15 (26.8%), 12 (21.4%), 5 (8.9%) in the control group, which indicated that trial group was superior to control group(P<0.05). ClassI(, II(, III( of erection was observed in 36 cases (64.3%), 18 cases (32.1%), 2 cases(3.6%) in the trial group, while 25(44.6%), 23(41.1%), 8(14.3%) in the control group, which indicated that trial group was superior to the control group (P<0.05). ClassI(, II(, III( of ejaculation was found in 36 cases (62.5%), 18 cases (32.1%), 3 cases (5.4%) in the trial group, while 24 (42.9%), 22 (39.3%), 10(17.9%) in the control group, which also indicated that trial group was superior to the control group(P<0.05).

CONCLUSIONSIn the treatment of male rectal cancer patients, TME combined with arterial infusion with methylene blue can facilitate the distinction of operation scope, which is beneficial to reduce damages to the pelvic nerve, leading to the protection of urinary function and sexual function. In addition, this procedure can result in shorter operation time, less operational blood loss and more lymph nodes harvested.

Digestive System Surgical Procedures ; Humans ; Infusions, Intra-Arterial ; Lymph Node Excision ; Male ; Methylene Blue ; administration & dosage ; Postoperative Period ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Urination

PURPOSE: Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. MATERIALS AND METHODS: Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. RESULTS: Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. CONCLUSION: Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out.
Adult ; Aged ; Anus Diseases/economics/*therapy ; Colonic Diseases/economics/*therapy ; Efficiency, Organizational ; Female ; Hospital Charges/*statistics & numerical data ; Hospitals, General/organization & administration ; Hospitals, Special/organization & administration ; Humans ; Inpatients/*statistics & numerical data ; Length of Stay/economics/*statistics & numerical data ; Male ; Middle Aged ; Outcome Assessment (Health Care)/economics/methods/*statistics & numerical data ; Rectal Diseases/economics/*therapy ; Republic of Korea

OBJECTIVETo improve the diagnosis and treatment of penile metastasis from rectal carcinoma.

METHODSWe reported a case of penile metastasis secondary to rectal adenocarcinoma, reviewed the relevant literature, and discussed the common origins, clinical features, pathogenic mechanisms, diagnosis and treatment of this disease.

RESULTSThe patient was a 54-year-old male, with metastatic penile tumors secondary to rectal adenocarcinoma, with serious adhesion to the surrounding tissue and metastasis to the liver. As treatment, we performed colostomy to relieve voiding difficulty, followed by combination chemotherapy with oxaliplatin, 5-fluorouracil, and levofolinate. The patient died 10 months later as a result of systemic failure.

CONCLUSIONPenile metastatic malignancy has a poor prognosis. Early diagnosis and combined and individualized therapies may improve the quality of life, relieve pain and prolong the life of the patient.

Adenocarcinoma ; secondary ; therapy ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Combined Modality Therapy ; methods ; Fluorouracil ; administration & dosage ; Humans ; Liver Neoplasms ; secondary ; therapy ; Male ; Middle Aged ; Organoplatinum Compounds ; administration & dosage ; Penile Neoplasms ; secondary ; therapy ; Quality of Life ; Rectal Neoplasms ; pathology

OBJECTIVETo investigate the feasibility of Xelox(capecitabine plus oxaliplatin) in the volumetric modulated arc therapy(VMAT)-based preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer(LARC).

METHODSClinical data of 141 LARC patients in our hospital from April 2011 to April 2013 treated by preoperative CRT based on VMAT with concurrent Xelox followed by surgery were analyzed retrospectively. There were 95 men and 46 women, and the median age was 56 years old. Clinical staging was stage II( in 33 cases(18 cases with II(a, 11 cases with II(b, 4 cases with II(c) and stage III( in 108 cases(1 case with III(a, 52 cases with III(b, 55 cases with III(c). The target doses were 50 Gy for PTV1 in 25 fractions and 46 Gy for PTV2 in 23 fractions.

RESULTSAll the patients completed the planned radiotherapy, and only 2 cases were interrupted with acute grade 3 diarrhea. The overall incidence of grade 3 hematologic and non-hematologic adverse events during CRT was 9.9% and 16.3% respectively without grade 4 toxicity. Operation was performed after a median interval of 54 days(34-86 days) following CRT. The R0 resection rate was 100%, sphincter preservation rate for low rectal cancer was 45.8%(33/72), postoperative complication morbidity was 17.0%(24/141), pCR rate was 32.6%(46/141), and rates of pathological down-staging for the primary tumor, lymph node and clinical stage were 87.2%, 88% and 90.1%, respectively.

CONCLUSIONSXelox is feasible and well tolerated in the treatment of VMAT-based preoperative CRT for patients with LARC, with excellent rates of pCR and pathological down-staging.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Capecitabine ; Chemoradiotherapy ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Feasibility Studies ; Female ; Fluorouracil ; administration & dosage ; analogs & derivatives ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Organoplatinum Compounds ; administration & dosage ; Radiotherapy, Intensity-Modulated ; Rectal Neoplasms ; pathology ; therapy ; Treatment Outcome

Irinotecan suppository was prepared using the moulding method with a homogeneous blend. A sensitive and specific fluorescence method was developed and validated for the determination of irinotecan in plasma using HPLC. The pharmacokinetics of intravenous administered and rectal administered in rabbits was investigated. Following a single intravenous dose of irinotecan (50 mg/kg), the plasma irinotecan concentration demonstrated a bi-exponential decay, with a rapid decline over 15 min. C(max), t(1/2), AUC(0-30h) and AUC(0-infinity) were 16.1 +/- 2.7 g/ml, 7.6 +/- 1.2 h, 71.3 +/- 8.8 microg.h/ml and 82.3 +/- 9.5 microg.h/ml, respectively. Following rectal administration of 100 mg/kg irinotecan, the plasma irinotecan concentration reached a peak of 5.3 +/- 2.5 microg/ml at 4 h. The AUC(0-30h) and AUC(0-infinity) were 32.2 +/- 6.2 microg.h/ml and 41.6 +/- 7.2 microg.h/ml, respectively. It representing ~50.6% of the absolute bioavailability.
Administration, Rectal* ; Biological Availability ; Chromatography, High Pressure Liquid ; Fluorescence ; Pharmacokinetics ; Plasma ; Rabbits

Irinotecan suppository was prepared using the moulding method with a homogeneous blend. A sensitive and specific fluorescence method was developed and validated for the determination of irinotecan in plasma using HPLC. The pharmacokinetics of intravenous administered and rectal administered in rabbits was investigated. Following a single intravenous dose of irinotecan (50 mg/kg), the plasma irinotecan concentration demonstrated a bi-exponential decay, with a rapid decline over 15 min. C(max), t(1/2), AUC(0-30h) and AUC(0-infinity) were 16.1 +/- 2.7 g/ml, 7.6 +/- 1.2 h, 71.3 +/- 8.8 microg.h/ml and 82.3 +/- 9.5 microg.h/ml, respectively. Following rectal administration of 100 mg/kg irinotecan, the plasma irinotecan concentration reached a peak of 5.3 +/- 2.5 microg/ml at 4 h. The AUC(0-30h) and AUC(0-infinity) were 32.2 +/- 6.2 microg.h/ml and 41.6 +/- 7.2 microg.h/ml, respectively. It representing ~50.6% of the absolute bioavailability.
Administration, Rectal* ; Biological Availability ; Chromatography, High Pressure Liquid ; Fluorescence ; Pharmacokinetics ; Plasma ; Rabbits

Acute pancreatitis remains the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP), with reported incidence rates that have changed little over several decades. Patient- and procedure-related risk factors for post-ERCP pancreatitis (PEP) are well-defined. Effective measures to prevent PEP have been identified, including improvements in cannulation techniques and pancreatic stenting, as well as pharmacological intervention. Pharmacotherapy has been widely studied in the prevention of PEP, but the effect in averting PEP has been inconclusive. Although pharmacological prophylaxis is appealing, attempts to find an ideal drug are incomplete. Most available data on the efficacy of pharmacological agents for PEP prophylaxis have been obtained from patients at average risk for PEP. However, recently, a randomized prospective controlled trial of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent PEP in high-risk patients was published. The results revealed that rectal indomethacin reduced the incidence of PEP significantly. Thus, rectal administration of diclofenac or indomethacin immediately before or after ERCP is used routinely to prevent PEP. However, additional studies with NSAIDs using large numbers of subjects are necessary to confirm the prophylactic effect of these drugs and to establish whether they act synergistically with other prophylactic interventions, including pancreatic stenting.
Acute Disease ; Administration, Rectal ; Animals ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Humans ; Pancreatitis/etiology/*prevention & control ; Treatment Outcome