Application of laparoscopy in diagnosis and treatment of massive small intestinal bleeding: report of 22 cases.

AIM: To investigate the diagnostic and therapeutic value of laparoscopy in patients with massive small intestinal bleeding. METHODS: Twenty-two patients with massive small intestinal bleeding and hemodynamic alteration underwent laparoscopic laparotomy in our unit from December 2002 to April 2005. Post pathologic sites were found, laparoscopy- or laparoscopy-assisted part small intestinal resection including pathologic intestinal site and enteroanastomosis was performed in all these patients. RESULTS: The bleeding sites were successfully detected by laparoscopy in all these 22 patients. Massive small intestinal bleeding was caused by jejunum benign stromal tumor in 8 cases, by jejunum potential malignant stromal tumor in 5 cases, by jejunum malignant stromal tumor in 1 case, by Mechel's diverticulum in 5 cases, by small intestinal vascular deformity in 2 cases, and by ectopic pancreas in 1 case. A total of 16 patients underwent laparoscopy-assisted enterectomy and enteroanastomosis of small intestine covering the diseased segment and 6 patients received enterectomy of the diseased segment under laparoscope. No surgical complications occurred and the outcome was satisfactory. CONCLUSION: Laparoscopy in diagnosis and treatment of massive small intestinal bleeding is noninvasive with less pain, short recovery time and definite therapeutic efficacy.

Racial differences in the anatomical distribution of colorectal cancer: a study of differences between American and Chinese patients.

AIM: To compare the racial differences of anatomical distribution of colorectal cancer (CRC) and determine the association of age, gender and time with anatomical distribution between patients from America (white) and China (oriental). METHODS: Data was collected from 690 consecutive patients in Cleveland Clinic Florida, U.S.A. and 870 consecutive patients in Nan Fang Hospital affiliated to the First Military Medical University, China over the past 11 years from 1990 to 2000. All patients had colorectal adenocarcinoma diagnosed by histology and underwent surgery. RESULTS: The anatomical subsite distribution of tumor, age and gender were significantly different between white and oriental patients. Lesions in the proximal colon (P<0.001) were found in 36.3 % of white vs 26.0 % of oriental patients and cancers located in the distal colon and rectum in 63.7 % of white and 74 % of oriental patients (P<0.001). There was a trend towards the redistribution from distal colon and rectum to proximal colon in white males over time, especially in older patients (>80 years). No significant change of anatomical distribution occurred in white women and Oriental patients. The mean age at diagnosis was 69.0 years in white patients and 48.3 years in Oriental patients (P<0.001). CONCLUSION: This is the first study comparing the anatomical distribution of colorectal cancers in whites and Chinese patients. White Americans have a higher risk of proximal CRC and this risk increased with time. The proportion of white males with CRC also increased with time. Chinese patients were more likely to have distal CRC and developed the disease at a significantly earlier age than white patients. These findings have enhanced our understanding of the disease process of colorectal cancer in these two races.

[Construction and application of Access database of colorectal carcinoma cases].

OBJECTIVE: To construct a database using Access software in which clinical information of colorectal cancer cases can be loaded, to facilitate relevant large-sample clinical studies. METHODS: A retrospective study was conducted in 1 374 cases of colorectal carcinoma with surgical treatment between 1975 to 1999 in Nanfang Hospital. According to the National Standards for Pathological Study of Colorectal Carcinoma, an Access2000 database consisting of 1 145 pathologically confirmed colorectal carcinoma cases was established, designated as The Specialized Access Database of Colorectal Carcinoma. RESULTS AND CONCLUSION: The database system has been successfully constructed and operates smoothly, which possesses powerful capacity for information processing of colorectal cancer cases.

[Prognosis of rectal cancer in relation to the selection of the surgical approaches].

OBJECTIVE: To investigate the prognostic significance of surgical approach selection in patients with rectal cancer. METHODS: A retrospective analysis of the relation of surgical approach selection to the prognosis was conducted in 112 cases of rectal cancer between July 2000 to June 2002. RESULTS: In this group of cases, local resection of the tumor was performed in 10 cases, Dixon operation in 75 cases and Miles operation in 27 cases. A total of 106 patients survived the operations with 10 had tumor recurrence (a recurrence rate of 8.93 %). All the 10 patients receiving local resection of the tumor survived without episodes of tumor recurrence or metastasis. After the operations, 101 patients (90.18 %) retained normal sexual function and 109 (97.32 %) were with normal urinary function. CONCLUSION: The postoperative quality of life of the patients with rectal cancer very much relies on the selection of adequate surgical procedures.

[p53 expression and cancer cell invasion in the distal bowel wall of patients with rectal carcinoma].

OBJECTIVE: To determine an adequate distal bowel length to be excised for safe surgical removal of rectal carcinoma. METHODS: p53 expression and patterns of cancer cell invasion into the bowel wall distal to the tumors were studied in 68 surgically removed rectal carcinoma specimens with immunohistochemical and routine pathological methods respectively. RESULTS: In 52.9% (36/68) of the cases, cancer cell infiltration in the bowel was found microscopically, among which 32 (88.9%) had the infiltration confined within 2 cm from the primary tumors, with the rest cases within 3 cm. The scope of the distal infiltration of the cancer cells was correlated to the gross morphology, histological type and Dukes' stages of the primary tumors. Of the 16 cases (23.5%) positive for p53 expression in the distal bowel mucosa, 13 had p53 expression profile detected within 2 cm, all within 3 cm. The expression of p53 in the distal bowel mucosa was not correlated with the clinical and pathological features of the primary rectal carcinoma. CONCLUSION: Excision till the compromised bowel 3 cm distal to the tumor may ensure safe removal of rectal cancer.

Effect of parenteral nutrition with L-arginine supplementation on postoperative immune function in patients with colorectal cancer.

OBJECTIVE: To study the effects of parenteral nutrition (PN) supplemented with L-arginine on the immune function of patients with colorectal cancer after operation. METHODS: Forty randomly chosen patients with colorectal cancer were enrolled in this study, who received either standard PN or PN supplemented with 20 g/d L-arginine for 7 d after surgical removal of the tumors. Tests of the immune function (CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+), interleukin-2R, natural killer cells, C3, C4, CH50, IgA, IgM, IgG) were performed preoperatively and at different time periods postoperatively. RESULTS: Data analysis with ANOVA demonstrated immune suppression in the patients before operation, and the condition was improved (as evidenced by increased CD4(+),CD4(+)/CD8(+), natural killer cells and interleukin-2R levels) in L-arginine group as compared with the results in the control group at days 4 and 7 (P<0.05). CONCLUSION: Arginine can improve the immune function in patients with colorectal cancer after operation and enhance PN effect.

[Clinical application of perioperative continuous hyperthermic peritoneal perfusion chemotherapy for gastric cancer].

OBJECTIVE: To evaluate the clinical effect of intraoperative and early postoperative continuous hyperthermic pertioneal perfusion chemotherapy (CHPPC) for gastric cancer. METHODS: Eight-five patients with gastric cancer were randomized into therapeutic group with perioperative CHPPC combined with intravenous chemotherapy (n=44) and control group with intravenous chemotherapy only (n=41). The postoperative complications, adverse effects, local recurrence rates, distant metastasis rates, and 1- and 3-year survival rates were compared between two groups. RESULTS: No significant differences were found in the postoperative complications and adverse effects between the two groups. The recurrence rate and distant metastasis rates in the therapeutic group were significantly lower than those in the control group (20.45% vs 43.90%, and 15.90% vs 39.02%, P<0.05). The 1- and 3-year survival rates in the therapeutic group were significantly higher than those in the control group (90.90% vs 78.05%, and 59.09% vs 34.15%, P<0.05). CONCLUSION: Perioperative CHPPC for gastric cancer is safe and feasible, and can reduce the recurrence rate, distant metastasis rate and improve the survival for gastric cancer patient after operation.

[Total mesorectal excision versus conventional radical surgery for rectal cancer: a meta analysis].

OBJECTIVE: To compare treatment outcomes of total mesorectal excision (TME) with those of conventional radical surgery (CRS) for rectal cancer. METHODS: Literature reviews were performed with key words, such as rectal cancer, total mesorectal excision, TME on all studies reported on TME versus CRS for rectal cancer between January 1986 to May 2006. According to the same screening criteria, 17 clinical studies were included in our systematic reviews. Two of our co-authors drew the details of trial design, characteristics of participants, results and so on from the studies included. Data analyses were performed by using RevMan 4.2. RESULTS: Sample volume in this Meta analysis was 5267 rectal cancer cases. Quality and quantity analyses were performed within all included studies, prospective studies (prospective nonrandomized studies and multicenter prospective nonrandomized studies) and retrospective studies. The results showed that postoperative survival rate was significantly increased [OR 1.81 (95%CI 1.55-2.11, P<0.00001), OR 1.79 (95%CI 1.49-2.15, P<0.00001) and OR 1.84 (95%CI 1.39-2.45, P<0.00001)] and local recurrence rate was significantly reduced [OR 0.35 (95%CI 0.29-0.43, P<0.00001), OR 0.41 (95%CI 0.32-0.53, P<0.00001) and OR 0.29 (95%CI 0.22-0.39, P<0.00001)] after TME was used. The results of all study analyses agreed with those from prospective studies analyses, in which postoperative mortality was significantly reduced [OR 0.51 (95%CI 0.32-0.87, P=0.007) and OR 0.56 (95%CI 0.33-0.94, P=0.04)] after TME treatment, meanwhile the results of retrospective study analyses indicated that there was no significant difference between TME group and CRS group in postoperative mortality [OR 0.39 (95%CI 0.14-1.10, P=0.07)]. TME was a risk factor for postoperative anastomotic leak according to the results of all included studies and prospective study analyses, but no difference between TME group and CRS group had been found [OR 1.24 (95%CI 0.84-1.83, P=0.29) OR 1.98 (95%CI 0.85-4.61, P=0.11)]. CONCLUSIONS: TME is still the standard operative technique for rectal cancer. As compared with CRS, TME results in lower postoperative local recurrence rate and higher survival rate.

[Photosensitizer nanoparticles photodynamic therapy on LOVO human colon cancer xenografts in athymic mice].

OBJECTIVE: To evaluate the inhibitory of profrin II nanoparticles photodynamic therapy on Lovo human colon cancer xenografts in athymic mice. METHODS: Profrin II nanoparticles were obtained from hypersound emulsification method. LOVO human colon cancer xenograft were established in athymic mice. Athymic mice were divided into four groups:normal control group, profrin II nanoparticles control group, profrin II PDT group and profrin II nanoparticles PDT group. The animals bearing xenografts were treated 30 mg/kg body weight profrin II nanoparticles and 3 h later were irradiated with 9 J/cm(2) light from a diode laser. After Profrin II nanoparticles PDT, the anti-tumor effect was assessed by measuring tumor volume over a 3-4 weeks period, the morphologic changes were observed by microscopy and microscopy via the histological examination. RESULTS: Compared with the control groups, profrin II nanoparticles control group, profrin II PDT group and profrin II nanoparticles-PDT treated tumors had regressed significantly in earlier period with the inhibiting rate being 87.9% (P<0.05), 87.5% (P<0.05) and 56.0% respectively (P<0.05). In the later period post-PDT, tumors growth resumed with a slower rate. Profrin II nanoparticles-PDT prolonged the survival time in the treated group with (38.0+/-6.0) days (P<0.05). Extensive damage to tumor tissue was found in the earlier period (7d) post-PDT, whereas in the later period (21d) post-PDT, islands of vital-looking tumor cells were observed around the damaged tissue. CONCLUSION: Profrin II nanoparticles-PDT results in inhibition Lovo colon carcinoma growth in post-PDT earlier period in vivo, and can prolong the survival time of nude mice bearing xenografts significantly, whereas profrin II-PDT could not inhibit the growth of colon tumor completely.

Diagnosis and treatment of small intestinal bleeding: retrospective analysis of 76 cases.

AIM: To investigate the causes of small intestinal bleeding as well as its diagnosis and therapeutic approaches. METHODS: A retrospective analysis was conducted according to the clinical records of 76 patients with small intestinal bleeding admitted to our hospital in the past 5 years. RESULTS: In these patients, tumor was the most frequent cause of small intestinal bleeding (37/76), followed by Mecke's diverticulum (21/76), angiopathy (15/76) and ectopic pancreas (3/76). Of the 76 patients, 21 were diagnosed by digital subtraction angiography, 13 by barium and air double contrast X-ray examination of the small intestine, 11 by 99mTc-sestamibi scintigraphy of the abdominal cavity, 6 by enteroscopy of the small intestine, 21 by laparoscopic laparotomy, and 4 by exploratory laparotomy. Although all the patients received surgical treatment, most of them (68/76) received part enterectomy covering the diseased segment and enteroanastomosis. The follow-up time ranged from 1 year to 5 years. No case had recurrent alimentary tract bleeding or other complications. CONCLUSION: Tumor is the major cause of small intestinal bleeding followed by Meckel's diverticulum and angiopathy. The main approaches to definite diagnosis of small intestinal bleeding include digital subtraction angiography, 99mTc-sestamibi scintigraphy of the abdominal cavity, barium and air double contrast X-ray examination of the small intestine, laparoscopic laparotomy or exploratory laparotomy. Part enterectomy covering the diseased segment and enteroanastomosis are the most effective treatment modalities for small intestinal bleeding.