Comparison of the detection rates of colorectal cancer liver metastasis using different MRI sequences and enhanced CT / 中华肝胆外科杂志

Objective:To study the detection rates of using different MRI sequences and enhanced CT in colorectal cancer liver metastasis (CRLM).Methods:The imaging data of CRLM patients who were treated at Peking University Third Hospital from March 2018 to September 2021 were retrospectively analyzed. Sixty-six CRLM lesions with a maximum diameter ≤10 mm were selected. Different MRI sequences such as T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion weighted imaging (DWI), dynamic enhanced phase of MRI (MR-Dyn), gadolinium-etoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), enhanced hepatobiliary phase of MRI (HBP) and CT enhancement phase (CT-Dyn) were reviewed independently to determine whether the target lesions were detected. The pathological results were used as the gold standard. Paired chi-square test was used to compare the detection rate of CRLM in each group. Results:Among the 66 liver metastases, 15, 31, 55, 21, 56 and 20 were detected by T 1WI, T 2WI, DWI, MR-Dyn, HBP and CT-Dyn, respectively. Their detection rates were 22.7%, 47.0%, 83.3%, 31.8%, 84.8% and 30.3%, respectively. The detection rates of HBP and DWI were higher than those of T 2WI, MR-Dyn, CT-Dyn and T 1WI, respectively (all P<0.05). The detection rate of T 2WI was higher than that of MR-Dyn, CT-Dyn and T 1WI (all P<0.05). The detection efficiencies of non-contrast MRI and Gd-EOB-DTPA enhanced MRI for CRLM were highly consistent ( Kappa=0.745). Conclusions:The detection rates of HBP, DWI and T 2WI for CRLM were high. Non-contrast MRI could replace Gd-EOB-DTPA enhanced MRI for detection of large CRLM.

Laparoscopic simultaneous resection of synchronous colorectal cancer liver metastases / 中华肝胆外科杂志

Objective:This research was designed to investigate the safety and efficiency of laparoscopic simultaneous resection in the treatment of synchronous colorectal cancer liver metastases (sCRLM).Methods:From January 2009 to December 2019, 121 patients diagnosed as sCRLM received radical resection in Peking University Third Hospital were included in the research. According to the surgery approaches, the patients were divided into laparoscopic surgery group and open surgery group. Statistical analysis of general patient data, surgical data, postoperative complications and follow-up of the two groups of patients.Results:There were 79 cases in the laparoscopic surgery group including 30 females and 49 males, and the average age was 61.5 years. There were 42 cases in the open surgery group including 15 females and 27 males, and the average age was 63.2 years. There were no significant differences in the preoperative demographic characteristics, the location of primary tumor, gene status, the size of liver metastases, the proportion of multiple liver metastases, the level of tumor markers and the proportion of neoadjuvant chemotherapy between laparoscopic surgery group and the open surgery group ( P>0.05). The complication rate was 15.2% (12/79) in the laparoscopic surgery group and 23.8% (10/42) in the open surgery group. There were no significant differences between the two groups ( P>0.05). The 3-year and 5-year survival rates in laparoscopic surgery group were 52.9% and 44.4%, which were 42.5% and 23.0% respectively in open surgery group. There were no significant differences between the two groups ( P>0.05). The 1-year and 3-year disease-free survival rate in laparoscopic surgery group were 50.6% and 41.2%, which were 44.7% and 19.4% respectively in open surgery group. There were no significant differences between the two groups ( P>0.05). Conclusions:Laparoscopic simultaneous resection was safe and feasible for patients with sCRLM. Comparing with the open surgery, the laparoscopic surgeries had similar incidence of perioperative complications and long-term oncological efficiency.

Outcomes evaluation of laparoscopic radical coloproctectomy and hepatectomy for resectable colorectal cancer with liver metastases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and safety of laparoscopic radical coloproctectomy and hepatectomy for resectalble colorectal cancer with liver metastases (CRCLM), and evaluate the survival outcomes of short-middle term for these patients.</p><p><b>METHODS</b>Totally 36 cases of CRCLM which were evaluated to undergo laparoscopic coloproctectomy and hepatectomy preoperatively, were enrolled from January 2009 to January 2014, including 28 synchronous and 8 metachronous CLM respectively. Laparoscopic colorectal resection and hepatectomies were performed in 35 cases, including 24 male and 11 female patients, with a mean age of (64 ± 12) years and a median age of 67 years (ranging from 35 to 80 years). Management strategies were made by a board of multi-disciplinary team. Intra-operative ultrasonography was used to detect the metastases in all cases. Overall survival and disease free survival were calculated by Kaplan-Meier curve.</p><p><b>RESULTS</b>Radical total colectomy, right hemicolectomy, left hemicolectomy, sigmoidectomy, and proctectomy and were performed in 1 case of familial adenomatous polyposis with transverse colon cancer, 5 cases of cecal or asending colon cancer, 1 case of descending colon cancer, 14 cases of sigmoid colon cancer, and 14 cases of rectal cancer respectively. Metastasectomy only, anatomic hepatectomy only, and metastasectomy plus anatomic hepatectomy were done in 21, 10 and 4 cases respectively. Totally 35 colorectal tumors and 62 liver lesions were removed. The mean blood loss of colorectal and liver surgery were (80 ± 32) and (212 ± 153) ml, the median blood loss was 70 ml and 150 ml respectively. Colorectal and hepatic specific complications were not observed in all cases except a case of biliary leakage following right hemihepatectomy. Relapses were observed in 15 cases during a mean follow-up of (26 ± 16) months (median follow-up of 22 months). Four cases died of late-stage cachexia. The 1- and 3-year cumulative overall survival rates were 92.9% and 79.4% respectively. The 1- and 3-year cumulative disease free survival rates were 61.1% and 49.4% respectively.</p><p><b>CONCLUSIONS</b>Laparoscopic coloproctectomy and hepatectomy for resectable CRCLM in carefully selected cases is safe and feasible, which makes simultaneous surgery possible. The oncologic outcome of short-middle term is acceptable, and long-term survival is expected.</p>

Minimally invasive surgery for resectable colorectal cancer with liver metastases: a prospective study / 中华肝胆外科杂志

Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1％ and 71.0％,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.

A study on clinical topography of lateral ligament of the rectum / 中国普通外科杂志

Objective To study the clinical topography of lateral ligament of the rectum.MethodsDissection in the mesorectal plane was performed on cadavers of semi-pelvis sectioned in the sagittal plane. Results Ten of 14 semi-pelvises had substantial connective tissue between the mesorectum and the pelvic side wall. Eight of 10 lateral ligaments had middle rectal artery. Six of 8 middle rectal arteries run in the lateral ligament. The median height of the lateral ligament above the denticulate line was 14 mm (ranging 10～44 mm). Eight of 12 surgical cases had lateral ligament bilaterally, the remaining had lateral ligament unilaterally. Histologically the lateral ligament was composed of connective tissue. It consisted of vessel and nerve. The outer diameter of vessel in the lateral ligament was no more than 1.5 mm. Conclusions 1. The lateral ligament of the rectum presents in most people. The site and structure of lateral ligament was not constant, especially in vascular tissue. 2. Half of the cadavers have middle rectal artery. The rectal artery was tiny. Most of middle rectal artery runs in the lateral ligament. 3. The nerve in the lateral ligament was the part of rectal nerve plexus.