[Learning curve of laparoscopic-assisted surgery for rectal cancer].

OBJECTIVE: To investigate the learning curve of laparoscopic-assisted surgery for rectal cancer by comparing the effects of laparoscopic-assisted rectal surgery at different stages with a literature review. METHODS: A total of 160 surgical cases of laparoscopic-assisted rectal cancer from May 2007 to December 2009 were reviewed. Different standards were used to divided them into 11 stages (group 1:15 cases in each) and 8 stages (group 2:20 cases in each) respectively by operative sequences. The number of revealed lymph nodes, length of distal margin, operating duration, blood loss volume, the incidences of intraoperative and postoperative complications, the rate of conversion into open operation and the length of postoperative hospital stay were analyzed. With the exception of the first stage, all indices in the remainder of 10 stages and 7 stages were analyzed simultaneously. RESULTS: There was no significant differences among the 11 stages and 8 stages with the respect to the number of revealed lymph nodes, length of distal margin, blood loss volume, the incidences of intraoperative and postoperative complications, the rate of conversion into open operation and the length of postoperative hospital stay. The average operating duration in the first stage of group 1 was 201.0 min and 193.0 min in the first stage of group 2. And the operating duration in the first stage in the two groups was longer significantly than the remainder of stages in each group (P < 0.001). CONCLUSION: A surgeon may become experienced in laparoscopic-assisted rectal surgery by operating 16 - 20 patients with rectal cancer.

[Prognostic factors of resectable pulmonary metastases from colorectal cancer].

OBJECTIVE: To evaluate the prognostic factors for patients who underwent curative resection of pulmonary metastases from colorectal cancer. METHODS: The clinicopathological data of 60 patients with pulmonary metastases from colorectal carcinoma who underwent a radical pulmonary metastasectomy between February 1985 and December 2004 at the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively reviewed and analyzed. RESULTS: The overall 5-year survival rate was 43.7% after pulmonary excision and 74.0% after colorectal resection. Three factors were identified as significant by univariate log-rank test for overall survival after pulmonary resection, they were preoperative carcinoembryonic antigen, number of pulmonary metastases (solitary vs. multiple), and hilar and/or mediastinal lymph node metastases (P < 0.05). Multivariate analysis showed that number of pulmonary metastases (solitary vs. multiple) and hilar and/or mediastinal lymph node metastasis were independent prognostic factors. However, shorter disease-free interval and more number of pulmonary metastases predicted poor prognosis after primary colorectal resection. CONCLUSION: Pulmonary resection for metastases from colorectal cancer is safe and patients may get long-term survival in selected cases, especially in patients with a solitary pulmonary metastasis and without hilar and/or mediastinal lymph node metastasis.

[Prognostic factors of colorectal cancer patients with synchronous liver metastasis treated with simultaneous liver and colorectal resection].

OBJECTIVE: To analyze the prognostic factors of colorectal cancer patients with synchronous liver metastasis treated by simultaneous colorectal and liver resection. METHODS: The clinical and follow-up data of 44 colorectal cancer patients with synchronous liver metastases who underwent simultaneous colorectal and liver resection from Jan. 1993 to Jan. 2003 were analyzed retrospectively. Survival rate was estimated by Kaplan-Meier method, and was compared using log-rank test. Prognostic factors were analyzed by multivariate Cox proportional hazards model. RESULTS: The overall 1-, 3- and 5-year survival rates were 86.3%, 40.9% and 25.0%, respectively. The lymph node metastasis and vascular invasion by cancer cells from the primary tumour were found to affect prognosis significantly, while gender, age, tumor location, histopathological types, the number and distribution of liver metastases were not. Multivariate analysis revealed that the lymph node metastasis was the only independent prognostic factor. CONCLUSION: Simultaneous liver and colorectal resection can be performed and may achieve good outcome in colorectal cancer patients with synchronous liver metastases, especially in those without lymph node metastasis.

[Surgial treatment and prognosis of ovarian metastasis from colorectal cancer].

OBJECTIVE: To summarize the surgical treatment experiece and to investigate the prognosis of the patients with ovarian metastasis from colorectal cancer. METHODS: The data of 67 patients with synchronous or asynchronous ovarian metastasis from colorectal cancer surgically treated between January 1989 and December 2005 were collected and analyzed retrospectively using Statistical Package for the Social Sciences (Release 11.5, SPSS, Inc). Prognostic factors were analyzed using chi2 test. Survival analysis was estimated by the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis was carried out by Cox regression. RESULTS: The overall 1-, 3- and 5-year survival of these 67 patients was 71.0%, 18.7% and 9.2%, respectively. Univariate analysis revealed that the metastasis was confined in the ovary or pelvis only, unilateral/double ovarian metastasis, and operation mode were all statistically significant prognostic factors (P <0.05). Cox regression analysis showed that the operation mode was the most important prognostic factor (OR = 3.531, P <0.001). CONCLUSION: Surgical treatment is still the most effective mode in the treatment for the ovary metastasis from colorectal cancer.

[The surgical treatment and prognosis for recurrent colon cancer].

OBJECTIVE: To investigate the surgical treatment and prognosis for recurrent colon cancer after curative resection. METHODS: The clinical data of 102 recurrent colon cancer cases from January 1997 to December 2005 were analyzed retrospectively. Obtained data were analyzed by Statistical Package for the Social Sciences (Release 11.5, SPSS, Inc). The related factors were underwent chi2 analysis,survival analysis were estimated using the Kaplan-Meier method and compared using the Log-rank test. COX regression was used in multivariate analysis. RESULTS: Univariate analysis revealed that obstruction of primary tumors, CEA level before reoperation, number of recurrence, time of recurrence, and reoperation type were significant statistically. COX regression analysis revealed that number of recurrence, reoperation type was the most important prognostic factor. CONCLUSION: The recurrent colon cancer still need active surgical treatment in order to prolong the survival time.

[Lymph node metastasis and prognosis in T1 and T2 rectal carcinoma].

OBJECTIVE: To investigate the characteristics of lymph node metastasis and prognosis of T1/T2 rectal carcinoma. METHODS: The clinical data of 241 patients with T1 or T2 rectal carcinoma were retrospectively analyzed. The factors relative to lymph node metastasis were analyzed using Chi-square test. The survival data were analyzed using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Long-rank) and multivariate (Cox model) methods. RESULTS: Of the 241 patients, 132 received Mile's operation and 109 underwent sphincter preserving operation. The over-all lymph node metastasis rate was 22.0% (53/241). The lymph node metastasis was significantly correlated with histological differentiation as revealed by Chi-square test. The over-all 5-year survival rate for the whole series group was 91.5%. Univariate analysis revealed that tumor histological type, intramural infiltration, differentiation, lymph node metastasis, radiation therapy were significant predictors of survival; however, only intramural infiltration was the most important prognostic predictor by multivariate analysis. CONCLUSION: Even though lymph node metastasis can be observed either in T1 or T2 rectal carcinoma, histological differentiation is significantly related to the lymph node metastasis. As radical resection achieve better survival than local resection, it should be suggested as the chief treatment for T1/T2 rectal carcinoma.

Outcome after simultaneous resection of gastric primary tumour and synchronous liver metastases: survival analysis of a single-center experience in China.

BACKGROUND: The optimal surgical strategy for the treatment of synchronous resectable gastric cancer liver metastases remains controversial. The aims of this study were to analyze the outcome and overall survival of patients presenting with gastric cancer and liver metastases treated by simultaneous resection. MATERIALS AND METHODS: Between January 1990 and June 2009, 35 patients diagnosed with synchronous hepatic metastases from gastric carcinoma received simultaneous resection of both primary gastric cancer and synchronous hepatic metastases. The clinicopathologic features and the surgical results of the 35 patients were retrospectively analyzed. RESULTS: The 5-year overall survival rate after surgery was 14.3%. Five patients survived for more than 5 years after surgery. No mortality has occurred within 30 days after resection, although two patients (5.7%) developed complications during the peri-operative course. Univariate analysis revealed that patients with the presence of lymphovascular invasion of the primary tumor, bilateral liver metastasis and multiple liver metastases suffered poor survival. Lymphovascular invasion by the primary lesion and multiple liver metastases were significant prognostic factors that influenced survival in the multivariate analysis (p=0.02, p=0.001, respectively). CONCLUSIONS: The presence of lymphovascular invasion of the primary tumor and multiple liver metastases are significant prognostic determinants of survival. Gastric cancer patients without lymphovascular invasion and with a solitary synchronous liver metastasis may be good candidates for hepatic resection. Simultaneous resection of both primary gastric cancer and synchronous hepatic metastases may effectively prolong survival in strictly selected patients.

Local excision carcinoma in early stage.

AIM: To assess the validity of local excision for the early stage low rectal cancer as an effective treatment alternative to radical resection. METHODS: A retrospective medical chart review was done in 47 patients with early stage low rectal carcinoma who underwent local excision from November 1980 through November 1999 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS). The patients were treated by either transanal (40 cases), trans-sacral (5 cases), or trans-vaginal (2 cases) excision of tumors and no death was related to surgery. Sixteen patients received postoperative radiotherapy. RESULTS: T1 and T2 lesion was found in 36 (76.6 %) and 11 patients (23.4 %) respectively. The overall local tumor recurrence rate was 14.9 % (7/47), with an average recurrence time of 21 months. Among these 7 recurrent patients, there were 4 T1 and 3 T2 lesions. Microscopically, the surgical incisal margin was negative in 45 (95.7 %) and positive in 2 patients (4.3 %); Both of the later had developed local recurrence. The overall 5-year survival rate was 91.7 %, in which there were 94.4 % for T1 and 83.3 % for T2 tumors. T stage, intravessel tumor thrombosis, lymphocytic infiltration and histological grade were not found to be significant by related to the local recurrence and survival (P>0.05). CONCLUSION: Local tumor excision was a safe procedure for the treatment of early stage low rectal carcinoma with minimal morbidity and mortality, which might serves as one of the primary surgical treatment methods for the disease of this kind.

[Effects of the zhikuofang on the inflammation and cytostatics of the airway model of bronchiectasis].

OBJECTIVE: To explore the effects of Zhikuofang, a TCM prescription, and Ofloxacin on the inflammation and cytostatics of the airway model of bronchiectasis. METHOD: The airway model of bronchiectasis (AMB) was set up and infused with Ps. Aeruginosa. A comparison between the effects of Zhikuofang and Of loxacin on the AMB was made. RESULT: Zhikuofang is better than Ofloxacin in following aspects: lowering the density of inflammation cells in blood, decreasing the volume of tracheal secretion and inhibiting the cytostatics (IL-8 and TNF-alpha) of the trachea tissue, but Ofloxacin is more effective in diminishing the amount of bacteria in trachea flushing liquor. There was no marked difference between them in their histopathy effects on the trachea. CONCLUSION: Zhikuofang probably plays antiphlogistic and bacteriostatic effects by inhibiting the IL-8 and TNF-alpha, resisting secretion, decreasing the inflammation cells and resisting inflammation of trachea.

Optimization of reference genes for normalization of the quantitative polymerase chain reaction in tissue samples of gastric cancer.

For an exact comparison of mRNA transcription in different samples or tissues with real time quantitative reverse transcription-polymerase chain reaction (qRT-PCR), it is crucial to select a suitable internal reference gene. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and beta-actin (ACTB) have been frequently considered as house-keeping genes to normalize for changes in specific gene expression. However, it has been reported that these genes are unsuitable references in some cases, because their transcription is significantly variable under particular experimental conditions and among tissues. The present study was aimed to investigate which reference genes are most suitable for the study of gastric cancer tissues using qRT-PCR. 50 pairs of gastric cancer and corresponding peritumoral tissues were obtained from patients with gastric cancer. Absolute qRT-PCR was employed to detect the expression of GAPDH, ACTB, RPII and 18sRNA in the gastric cancer samples. Comparing gastric cancer with corresponding peritumoral tissues, GAPDH, ACTB and RPII were obviously up-regulated 6.49, 5.0 and 3.68 fold, respectively. Yet 18sRNA had no obvious expression change in gastric cancer tissues and the corresponding peritumoral tissues. The expression of GAPDH, ß-actin, RPII and 18sRNA showed no obvious changes in normal gastric epithelial cells compared with gastric cancer cell lines. The carcinoembryonic antigen (CEA), a widely used clinical tumor marker, was used as a validation gene. Only when 18sRNA was used as the normalizing gene was CEA obviously elevated in gastric cancer tissues compared with peritumoral tissues. Our data show that 18sRNA is stably expressed in gastric cancer samples and corresponding peritumoral tissues. These observations confirm that there is no universal reference gene and underline the importance of specific optimization of potential reference genes for any experimental condition.

Intra-operative perforation: a risk factor for prognosis of low rectal cancer after abdominoperineal resection.

This study was designed to explore the influence of intra-operative perforation on prognosis of low rectal cancer after APR and to investigate the risk factors of perforation. Perforation is not scarce during the procedure of abdominoperineal resection (APR). There is no consensus on perforation rate and related risk factor for APR. Data of 925 patients who received APR for low rectal cancer between January 2000 and August 2008 were reviewed. The intra-operative perforation rate was 7.4 % (68/925). The recurrence rate was 28.6 % in patients with intra-operative perforation compared with 6.8 % in patients with no perforation (P < 0.001); 5-year survival rate in patients with perforation was 41.4 and 66.3 % in patients with no perforation. Univariate analysis showed that intra-operative perforation affected recurrence rate and survival significantly (P < 0.001, P < 0.001); multivariate analysis revealed that intra-operative perforation was an independent prognostic factors for recurrence (RR: 3.087, P < 0.001), while not for survival (RR: 1.331, P = 0.051). Patients aged more than 70 years, T3 tumor and treated by general surgeon had higher perforation rate (P = 0.001, P = 0.004, P = 0.008). Intra-operative perforation affected the prognosis of low rectal cancer after APR significantly. Elderly patient aged more than 70 years, T3 tumor and general surgeon who performed operation were three risk factors of increased perforation rate.

Clinicopathologic characteristics and prognostic factors of 63 gastric cancer patients with metachronous ovarian metastasis.

OBJECTIVE: This study aims to explore the clinicopathologic characteristics and prognostic factors of gastric cancer patients with metachronous ovarian metastasis. METHODS: Clinicopathologic data were collected from 63 post-operative gastric cancer patients with metachronous ovarian metastasis. The patients were admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Science and Peking Union Medical College between January 1999 and December 2011. A log-rank test was conducted for survival analysis. Possible prognostic factors that affect survival were examined by univariate analysis. A Cox regression model was used for multivariate analysis. RESULTS: The incidence of ovarian metastasis was 3.4% with a mean age of 45 years. Up to 65.1% of the patients were pre-menopausal. The mean interval between ovarian metastasis and primary cancer was 16 months. Lowly differentiated carcinoma ranked first in the primary gastric cancers. The majority of lesions occurred in the serous membrane (87.3%). The metastatic sites included N2-3 lymph nodes (68.3%), bilateral ovaries (85.7%), and peritoneal membrane (73%). Total resection of metastatic sites was performed (31.7%). The overall median survival was 13.6 months, whereas the overall 1-, 2-, and 3-year survival rates were 52.5%, 22.0%, and 9.8%, respectively. The 5-year survival rate was zero. Univariate analysis showed that the patient prognosis was correlated with metastatic peritoneal seeding, vascular tumor embolus, range of lesion excision, and mode of comprehensive treatment with adjuvant chemotherapy (P<0.05). Multivariate analysis indicated that metastatic peritoneal seeding was an independent prognostic factor for gastric cancer patients with ovarian metastasis (P<0.01). CONCLUSION: Effective control of peritoneal seeding-induced metastasis is important for improving the prognosis of gastric cancer patients with ovarian metastasis.

[Association between the number of retrieved lymph nodes in stage II( colorectal cancer radical resection and its prognosis].

OBJECTIVE: To investigate the association between the number of retrieved lymph nodes and the prognosis of stage II colorectal cancer. METHODS: Clinical data of 380 patients with stage II colorectal cancer were analyzed retrospectively. SPSS 13.0 was used for data processing. Survival rate was calculated by Kaplan-Meier method, and risk factors related to prognosis of stage II colorectal cancer were analyzed by Logistic regression analysis. Recurrence rate and survival rate were assessed with Chi-squared test. RESULTS: The average number of lymph nodes retrieved from 56 patients who developed recurrence or metastasis in 5 year after surgery was 9.5, and 16.3 from patients who had no recurrence or no metastasis(P<0.01). The number retrieved from 97 patients who died in 5 years after surgery was 11.1, and 16.7 from survivors. Patients were divided into 2 groups:>or=12 group and <12 group. The 5-year survival rate was 83.9% in >or= 12 group and 62.0% in < 12 group, respectively(P<0.01), the recurrence rate was 6.4% in >or=12 group and 25.7% in < 12 group (P<0.01). The univariable analysis showed that the number of retrieved lymph nodes was significantly associated with the survival and recurrence in patients with stage II colorectal cancer (P<0.05). CONCLUSIONS: The number of retrieved lymph nodes is associated with the prognosis of stage II colorectal cancer. Patients with more retrieved lymph nodes have a higher survival rate.

Wide local excision could be considered as the initial treatment of primary anorectal malignant melanoma.

BACKGROUND: Anorectal malignant melanoma was a rare disease with extremely poor prognosis. The aim of this study was to explore the clinical characteristic, diagnosis and treatment strategies of anorectal malignant melanoma. METHODS: The data of 57 patients with anorectal malignant melanoma was collected and retrospectively analyzed. RESULTS: Rectal bleeding and anal mass were found to be common symptoms of anorectal malignant melanoma. The preoperative diagnosis rate of anorectal malignant melanoma was 48.6%. The overall 3-year and 5-year survival rate was 38.0% and 21.3% respectively. The 3-year survival rates of stage I and II patients were 63.0% and 16.7% respectively (P = 0.000), and the 5-year survival rates were 33.3% and 11.1% (P = 0.001), which both had significant statistic differences. The 3-year survival rate of patients undergone abdmoninoperineal resection and patients undergone wide local excision were 36.7% and 53.0% respectively (P = 0.280), while the 5-year survival rate were 24.1% and 23.1% (P = 0.642), which both had no significant statistic differences. CONCLUSIONS: This study identified no survival advantage to abdominoperineal resection in treatment of anorectal malignant melanoma, and we propose that wide local excision could be considered as the initial treatment of choice.

[Analysis of factors related to recurrence after local excision for low rectal cancer].

OBJECTIVE: To discuss the factors predicting recurrence after local excision for low rectal cancer. METHOD: Medical records and follow-up histories of 97 patients undergone local excision of adenocarcinoma of the rectum between April, 1975 and April, 2005 in Cancer Hospital of the Chinese Academy of Medical Sciences were reviewed retrospectively. RESULTS: Postoperative pathologic examination revealed 28 pTis cases, 48 pT(1) cases, and 21 pT(2) cases. Eighty-nine patients underwent transanal excision, 7 transsacral excision, and 1 transvaginal excision. Twenty-two(45.8%) patients with T(1) tumors and 14(66.7%) patients with T(2) tumors were treated with postoperative radiotherapy with or without 5-fluorouracil. Seventeen(17.5%) patients presented recurrence, including 13 local recurrence, 2 local and distant recurrence, and 2 distant recurrence. The local recurrence rate was 15.5%. Median time to relapse was 27 months(range 4-73). The incidence of local recurrence were 7.1%, 12.5%, and 33.3% for patients with pTis, pT(1), and pT(2)(P=0.031) respectively. The local recurrence rate was 10.5%, 13.7%, and 3/5 for patients with pedunculated, sessile, and ulcerative carcinoma(P=0.017). The local recurrence of patients with T(2) tumors treated via local excision with or without chemoradiotherapy was 21.4%(3/14) and 4/7, but the difference was no significance(P=0.127). All the 15 patients with local recurrence underwent salvage resection, and the 5-year survival rate after salvage surgery was 59.6%. CONCLUSIONS: Higher rates of recurrence are seen in patients with T(2) tumors and ulcerative carcinoma. Chemoradiotherapy or radical surgery should be chosen for T(2) tumors following local excision. Salvage resection should be considered after local recurrence.

[Influence of Wnt-1 recombinant adenovirus on differentiation of human epidermal stem cells].

OBJECTIVE: To observe the influence of Wnt-1 recombinant adenovirus on differentiation tendency of human epidermal stem cells. METHODS: Wnt-1 recombinant adenovirus was transduced into hESCs (E group), while normal hESCs were used as control (C) group. The diameter, proliferation,and labeling molecular expression of hESC were determined. The content of MMP-2 and MMP-7 in supernate were also assayed. RESULTS: There was no obvious difference in diameter of hESC between two groups. The density of hESC in E group was (1.45 +/- 0.09) x 10(5)/mL, which was obviously higher than that in C group [(1.18 +/- 0.10) x 10(5)/mL, P < 0.05]. There were no obvious differences in expression of markers between two groups,including keratin 5 (KS), K6, K7, KS, K14, CD44, carcinoembryonic-like antigen (CEAA), ER, PR (P > 0.05) ,while the expression of K 10 was different among groups [(60 +/- 3)% in E group, 0 in C group], also K18 [(34.3 +/- 2.1)% in E group vs. (13.8 +/- 1.7)% in C group, P < 0.05], and K19 [(17.1 +/- 1.8)% in E group vs. (24.4 +/- 1.5)% in C group, P < 0.05].The contents of MMP-2 and MMP-7 in E group were higher than those in C group (P < 0.01). CONCLUSION: Wnt-1 recombinant adenovirus can induce the differentiation of hESCs to glandular epithelium-like cells.

[Clinical analysis of 98 cases of primary gastric lymphoma].

OBJECTIVE: To explore the clinical characteristics, diagnosis and treatment regimens for the primary gastric lymphoma (PGL). METHODS: The data of 98 PGL patients treated from January 1994 to December 2006 were collected and analyzed retrospectively. RESULTS: Abdominal pain was the common symptom of PGL. All the patients were at stage I or stage II, and the preoperative diagnosis rate was 56.5%. The overall 1-, 3- and 5-year survival rates were 95.1%, 86.0% and 73.0% respectively. The 5-year survival rates of stage I and stage II patients were 89.5% and 66.7% respectively, and the difference was significant. The 5-year survival rate of patients received operations was 77.2% and that without operation was 75.0%, the difference was not significant. CONCLUSIONS: The therapy based on chemotherapy is preferred for the treatment of PGL. In the cases of serious gastrointestinal complications, indefinite pathological diagnosis or non-effective chemotherapy, operations should be considered.

[Surgical management of ovarian metastasis from colorectal cancer].

OBJECTIVE: To investigate the surgical treatment of ovarian metastasis from colorectal cancer. METHODS: The clinical data of 62 cases suffering from ovarian metastasis from colorectal cancer, collected from Jan. 1990 to Dec. 2005, were analyzed retrospectively. RESULTS: The median survival time of 62 colorectal cancer patients with ovarian metastasis was 23 months. The median survival time of 19 patients with simple ovary metastasis was 31 months, while that of 43 patients with ovary and other organ metastasis was 21 months. The median survival time of 28 patients (45.2%) treated with radical resection was 31 months, while that of 34 patients (52.8%) treated with palliative resection was 20 months, the difference between two groups was significant. Fifty-one patients (82.3%) were treated with double-sided ovarian resection, and 42 of them (17.7%) received hysterectomies at the same time. Eleven patients received one-sided ovarian resection, and 8 of them were resected the metastatic ovaries on the other side in 3 to 10 months. CONCLUSIONS: The patients with ovarian metastases from colorectal cancer need double-sided ovarian resection, and radical resection is able to prolong the survival time.

[Recurrence patterns and surgical treatment for recurrent colon cancer after radical resection].

OBJECTIVE: To investigate the surgical treatment for recurrent colon cancer after radical resection. METHODS: Clinical data of 87 cases with recurrence colon cancer after radical resection from Jan. 1999 to Dec. 2005 were analyzed retrospectively. RESULTS: The resection rate of recurrent colon cancer was 74.7% . 55.2% (48/87) of the cases received radical resection,and the median survival was 49 months,while 19.5% (17/87) received palliative resection with a median survival of 24 months, 25.3% (22/87) only exploration or by- pass operation with a median survival of 10 months. There were significant differences in survival among the different surgical treatments (P=0.003). CONCLUSION: The resection rate of recurrent colon cancer is high,and reoperation can prolong the survival of such patients.

[Analysis of recurrence and prognosis after surgical resection for I stage lower rectal carcinoma].

OBJECTIVE: To investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for I stage lower rectal carcinoma. METHODS: The related clinicopathologic factors for recurrence and prognosis of 166 patients with I stage lower rectal carcinoma after surgical resection were retrospectively analyzed using univariate and multivariate methods. RESULTS: A total of 138 patients with I stage lower rectal carcinoma received radical resection according to the operative rules of total mesorectal excision (TME). Ninety-three patients received abdominoperineal resection (APR) operation, 45 patients received sphincter preserving operation, and 28 patients received local excision. The local recurrence rates were 6.5% (6/93), 2.2% (1/45), 17.9% (5/28), respectively . Histological differentiation and operative procedures were associated with local recurrence. The 5-year survival rates were 91.1% in APR group, 95.5% in sphincter preservation group and 82.6% in local resection group. Univariate analysis revealed that histological differentiation and local recurrence were correlated with prognosis. Multivariate analysis revealed that local recurrence was the most important prognostic factor for I stage lower rectal carcinoma. CONCLUSIONS: Radical resection of I stage lower rectal carcinoma has low recurrence rate and better prognosis. Sphincter preserving operation and local excision must be strictly selected in proper patients.