Lateral lymph-node dissection for rectal cancer: meta-analysis of all 944 cases undergoing surgery during 1975-2004.

BACKGROUND: Colorectal cancer is the third most common cancer and leading cause of cancer-related death in Japan. One of the major problems in rectal cancer surgery is local recurrence. Pelvic sidewall dissection (PSD) has the potential to reduce local recurrence. PATIENTS AND METHODS: This study included all 994 patients with rectal cancer who underwent curative surgery from January 1975 until December 2004, at the Kurume University Hospital in Fukuoka, Japan. The patients were analyzed to determine whether lateral lymph node (LLN) metastasis correlates with clinicopathological factors, and to determine a diagnostic tool based on magnetic resonance imaging (MRI) findings. RESULTS: The rate of positive LLNs in patients who underwent PSD was 7.5% in the upper rectum, and 14.5% in the lower rectum. Logistic regression analysis disclosed that perirectal lymph nodes metastasis was associated with an increased incidence of positive LLNs and had a greater hazard ratio. Positive LLNs were frequently found to be located along the internal iliac artery (47 patients; 89%) or around the oburator vessels and nerve (17 patients; 32%). MRI has become a promising diagnostic tool in patients with rectal cancer including LLN estimation. CONCLUSION: We speculate that PSD may be a good candidate as an effective strategy for lower rectal cancer. In further studies, it is important to investigate the validity of PSD for its potential clinical use in lower rectal cancer therapy and prognosis.

[A case of remnant liver metastases after resection of liver metastases from rectal cancer following treatment with 5-FU, L-OHP and CPT-11, with markedly effective treatment by cetuximab plus S-1].

FOLFOX or FOLFIRI are commonly used as first- or second-line chemotherapy for unresectable colorectal cancer or its metastases.Recently, it had become a trend to add bevacizumab or cetuximab(Cmab)limited to the K-ras wild-type or panitumumab(Pmab)limited to the K-ras wild-type.At the present time, a common third-line chemotherapy is CPT-11 plus Cmab limited to the K-ras wild-type, or Cmab/Pmab.However, the results are unsatisfactory.With Cmab plus S-1 we treated a case of remnant liver metastases from rectal cancer which was a K-ras wild-type, after treating 5-FU, L-OHP and CPT-11. The tumor marker dropped and 7 focuses of liver metastases disappeared after 6 courses of treatment(complete response: CR in)and CR was achieved after 9 courses treatment.After 10 courses of treatment, a new lesion appeared on S5 of the liver and we performed percutaneous radiofrequency ablation.

[Efficacy of Elental on prevention for chemotherapy-induced oral mucositis in colorectal cancer patients].

BACKGROUND: The present study was designed to evaluate the preventive effects of elemental diet Elental (ED) on chemotherapy-induced stomatitis in patients with colorectal cancer. MATERIALS AND METHODS: A total of 23 patients with colorectal cancer experiencing grade 1-3 stomatitis during treatment with chemotherapy (2- or 3-week per cycle) entered the current study. Their average age was 67 years, ranging from 44 to 84 years. RESULTS: A total of 22 patients received the same chemotherapy regimen, but also received more than 80 g of Elental (ED) (including 1, 932 mg of L-glutamine), per day. FOLFOX, FOLFIRI or XELOX-based chemotherapy was used. A dose reduction of 5-FU, capacitabine or S-1 was performed in 5 patients who experienced grade 2 or 3 stomatitis. The maximum grade of stomatitis decreased in 18 of the 22 patients after the first treatment course, and decreased in 20 of 22 patients after the second course with ED.The preventive efficacy of ED on stomatitis was noted in a dose-dependent manner.Similarly, the maximum grade of neutropenia decreased in 10 of 11 patients after their first or second treatment course with ED. CONCLUSION: We conclude that ED can significantly decrease the severity of chemotherapy-induced stomatitis in colorectal cancer patients in association with the control of neutropenia.