Prognoses and treatment strategies for synchronous peritoneal dissemination of colorectal carcinoma.

PURPOSE: We devised a simple dichotomous classification system and showed sufficient reproducibility to indicate treatment strategies for peritoneal metastasis of colorectal cancer. METHODS: We included 67 patients with peritoneal metastasis of colorectal cancer and classified them according to the largest lesion size, number of lesions and number of regional peritoneal metastases. The oncological data were recorded and compared. RESULTS: According to the univariate analyses, the prognoses were significantly better in patients with ≤3 disseminated lesions than in those with ≥4, and in patients with disseminated lesions in only one region than in those with ≥2 lesions. A multivariate analysis showed that primary tumor resection and the presence of peritoneal metastases in only one region were favorable factors for the patient survival. Patients with disseminated lesions in only one region (localized group) and those with nonlocalized lesions had three-year survival rates of 45.6 and 12.2 %, respectively. Finally, primary tumor resection improved the prognoses in both the localized and nonlocalized groups. CONCLUSIONS: Colorectal cancer patients were categorized into localized and nonlocalized groups according to the number of regions with peritoneal metastasis, and significant prognostic associations were demonstrated. Subsequent analyses of the oncological data suggested that primary tumor resection contributes to an improved prognosis in all patients with synchronous peritoneal metastases.

Effects of robotic rectal surgery on sexual and urinary functions in male patients.

PURPOSES: This study prospectively assessed the sexual and urinary functions, as well as factors influencing these functions, in patients who underwent open or robotic surgery for rectal cancer. METHODS: Forty-five consecutive male patients who underwent rectal resection for rectal cancer were prospectively enrolled in this study. Their sexual and urinary functions were assessed through self-administered questionnaires comprising the International Index of Erectile Function (IIEF; sexual function) and the International Prostate Symptom Score (IPSS; urinary function) before and at 3, 6, and 12 months after surgery. RESULTS: Fifteen patients who underwent robotic surgery and 22 who underwent open surgery were finally analyzed in this study. The total IIEF score and the individual score items did not change at 3, 6 or, 12 months after open or robotic surgery compared with the preoperative values. However, a univariate analysis revealed that age affected the urinary function 12 months after surgery, while both univariate and multivariate analyses revealed that postoperative complications affected the sexual function 12 months after surgery. CONCLUSIONS: In this non-randomized comparison, the postoperative sexual and urinary functions were comparable between patients who underwent open rectal surgery and those who underwent robotic rectal surgery. Postoperative complications were a risk factor for sexual dysfunction, while age was a risk factor for urinary dysfunction.

[Clinical Significance of Lateral Lymph Node Dissection for Stage â £ Low Rectal Cancer].

We reviewed the clinical records of 81 patients with stage Ⅳ low rectal carcinoma (LRC) (25 Cur B surgeries and 56 Cur C surgeries) to evaluate the effectiveness of lateral lymph node dissection (LLND) by comparing the treatment outcomes with those of patients with stage Ⅲ LRC. Mesenteric lymph node metastasis was a risk factor for local recurrence in a multivariate analysis. There were no significant differences in the frequency of lateral node metastasis, local recurrence rate, or prognosis between Cur B and stage Ⅲ LRC patients. We suggest that LLND effectively improves prognosis as well as local control in Cur B patients. In Cur C patients, prognosis was poor regardless of lateral node metastasis. However, in patients with lateral node metastasis, there were no significant differences in between the Cur C (25.0%), Cur B, and stage Ⅲ groups, suggesting that LLND improves local control in Cur C patients with lateral node metastasis. Although the local recurrence rate was high (71.4%) in Cur C patients without lateral node metastasis, fewer lateral lymph nodes were harvested in these patients than in those with lateral node metastasis. Our results indicate that further examination of the local control effects of LLND in Cur C patients is necessary.

[Four cases of anal squamous cell carcinoma treated by chemoradiotherapy].

We reviewed clinical records of 4 cases with squamous cell carcinoma in anus to evaluate the clinical effectiveness of the chemoradiotherapy. The radiation therapy consisted of 40 Gy was delivered to pelvis and bilateral inguinal lesion, and perianal booster dose of 20 Gy, in fractions of 2.0 Gy per day, was given five days a week. On the first day of radiation therapy, 750 mg/m2 of 5-FU in the form of a continuous 24-hour infusion for 5 days was given. On the first day of chemotherapy, 10 mg/m2 of MMC was also given as a single bolus infusion. 5-FU and MMC were administered 4 times every 4 weeks. Three patients had T2 tumor, and one patient had T1 tumor. One patient had metastases in para-aortic and Virchow lymph node. No patients had hematogenous metastases. Grade 1 or 2 adverse effects occurred in 3 patients during chemoradiotherapy, but the completion of chemoradiotherapy was achieved in all of the 4 patients. All patients had complete response in the anal lesion after chemoradiotherapy. No patients had any sign of recurrence in anal lesion. Chemoradiotherapy was expected to be a safe and effective treatment to improve prognosis for anal squamous carcinoma.

[HAI chemotherapy for liver metastases of colorectal cancer].

We evaluated the effect of hepatic arterial infusion(HAI)chemotherapy for liver metastases from colorectal cancer. A total of 65 patients received HAI chemotherapy. The chemotherapy regimen consisted of weekly 5-FU (1, 500 mg/body) or 5-FU (400 mg/mm2) and l-LV (200mg/mm2). The survival and response rates were assessed according to RECIST. Median survival time with HAI chemotherapy was 13. 5 months, 5-year survival rate 8% and response rates 55%. There was no evidence of myelosuppression, and HAI could be continued for a long time even for poor PS patients. There were no differences in survival time between synchronous, metachronous and postoperative metachronous liver metastases. In the patients who underwent curative hepatectomy after HAI chemotherapy, the 5-year survival rate was 21%, which was better than in patients with HAI chemotherapy alone. HAI chemotherapy could thus be an option for unresectable liver metastases, which could be well tolerated.

[Our experiences of preoperative chemoradiotherapy for rectal cancer with invasion to adjacent organs].

We reviewed clinical records of 10 cases with preoperative chemoradiotherapy to evaluate the clinical effectiveness of the chemoradiotherapy for T4 rectal cancer. The preoperative radiation therapy consisted of 40-50 Gy delivered in fractions of 1.8-2.0 Gy per day for five days per week. A treatment of 5-fluorouracil (500 mg/body) per day intravenously, or oral UFT-E (300 mg/m2) with l-leucovorin (75 mg/body) per day, or oral S-1 (80 mg/m2) per day for five days per week, was given during radiotherapy. Grade 1 or 2 adverse effects occurred in 3 patients during chemoradiotherapy, but a completion of chemoradiotherpy was achieved in all of the 10 patients. Invasive findings to the adjacent organs identified by CT and MRI disappeared in 6 cases with complete or partial response 1 month after chemoradiotherapy. Although the adjacent organs were also removed during surgery in 7 patients, curative surgery was performed in 7 patients. There was no histological invasion to the adjacent organs in 4 patients, and one patient had a histological complete disappearance of tumor. Although complications after surgery were found in all of the patients, they were improved by conservative treatment. Two of 7 patients with curative surgery had recurrence, but the rest of them survived without recurrence. Preoperative chemoradiotherapy was expected to be a safe and effective treatment to improve the resection rate and prognosis for T4 rectal cancer.