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1.
Int J Clin Oncol ; 24(2): 141-152, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30612269

RESUMO

BACKGROUND: Simultaneous detection of multiple molecular biomarkers is helpful in the prediction of treatment response and prognosis for colorectal cancer (CRC) patients. METHODS: A 22-gene panel consisting of 103 hotspot regions was utilized in the formalin-fixed paraffin-embedded (FFPE) tissue samples of 207 CRC patients, using the next-generation sequencing (NGS)-based multiplex PCR technique. Those 22 genes included AKT1, ALK, BRAF, CTNNB1, DDR2, EGFR, ERBB2, ERBB4, FBXW7, FGFR1, FGFR2, FGFR3, KRAS, MAP2K1, MET, NOTCH1, NRAS, PIK3CA, PTEN, SMAD4, STK11, and TP53. RESULTS: Of the 207 patients, 193 had one or more variants, with 170, 20, and 3 having one, two, and three mutated genes, respectively. Of the total 414 variants identified in this study, 384, 25, and 5 were single-nucleotide variants, deletion, and insertion. The top four frequently mutated genes were TP53, KRAS, PIK3CA, and FBXW7. There was high consistency between the results of NGS-PCR technique and routine ARMS-PCR in KRAS and BRAF mutation detection. Univariate and multivariate analyses demonstrated that advanced TNM stage, elevated serum CEA, total variants number ≥ 2, AKT1 and PTEN mutation were independent predictors of shorter DFS; poor differentiation, advanced TNM stage, total variants number ≥ 2, BRAF, CTNNB1 and NRAS mutation were independent predictors of shorter OS. CONCLUSIONS: It is feasible to detect multiple gene mutations with a 22-gene panel in FFPE CRC specimens. TNM stage and total variants number ≥ 2 were independent predictors of DFS and OS. Detection of multiple gene mutations may provide additional prognostic information to TNM stage in CRC patients.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias Colorretais/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Mutação , Inclusão em Parafina , Transcriptoma , Idoso , Neoplasias Colorretais/genética , Feminino , Formaldeído , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
2.
Sci Rep ; 7(1): 7882, 2017 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-28801584

RESUMO

To compare protein expression levels, gene mutation and survival among Right-Sided Colon Cancer (RSCC), Left-Sided Colon Cancer (LSCC) and rectal cancer patients, 57 cases of RSCC, 87 LSCC and 145 rectal cancer patients were included retrospectively. Our results demonstrated significant differences existed among RSCC, LSCC and rectal cancer regarding tumor diameter, differentiation, invasion depth and TNM stage. No significant difference was identified in expression levels of MLH1, MSH2, MSH6, PMS2, ß-Tubulin III, P53, Ki67 and TOPIIα, and gene mutation of KRAS and BRAF among three groups. Progression Free Survival (PFS) of RSCC was significantly lower than that of LRCC and rectal cancer. In univariate analyses, RSCC, preoperative chemoradiotherapy, poor differentiation, advanced TNM stage, elevated serum CEA and CA19-9 level, tumor deposit, perineural and vascular invasion were found to be predictive factors of shorter PFS. In multivariate analyses, only differentiation and TNM stages were found to be independent predictors of PFS. In conclusion, compared with LSCC and rectal cancer, RSCC has larger tumor size, poor differentiation, advanced TNM stage and shorter survival. The shorter survival in RSCC might be attributed to the advanced tumor stage caused by its inherent position feature of proximal colon rather than genetic difference.


Assuntos
Neoplasias do Colo/metabolismo , Proteoma/metabolismo , Proteômica/métodos , Proteínas Proto-Oncogênicas B-raf/metabolismo , Proteínas Proto-Oncogênicas p21(ras)/metabolismo , Neoplasias Retais/metabolismo , Idoso , Colo/metabolismo , Colo/patologia , Neoplasias do Colo/genética , Neoplasias do Colo/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Mutação , Estadiamento de Neoplasias , Prognóstico , Intervalo Livre de Progressão , Proteoma/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Neoplasias Retais/genética , Neoplasias Retais/terapia , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 96(1): e5845, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28072746

RESUMO

BACKGROUND: Competing endogenous RNA (ceRNA) regulation is a novel hypothesized mechanism that states RNA molecules share common target microRNAs (miRNAs) and may competitively combine into the same miRNA pool. METHODS: Zinc finger protein 148 (ZNF148) and TOP2A expression were analyzed in 742 colorectal cancer (CRC) tissues using immunohistochemistry (IHC). ZNF148 mRNA, TOP2A mRNA, miR101, miR144, miR335, and miR365 expression were estimated in 53 fresh frozen CRC tissues by reverse transcription polymerase chain reaction. Mechanisms underpinning ceRNA were examined using bioinformatics, correlation analysis, RNA interference, gene over-expression, and luciferase assays. RESULTS: Protein levels of ZNF148 and TOP2A detected by IHC positively correlated (Spearman correlation coefficient [rs] = 0.431, P < 0.001); mRNA levels of ZNF148 and TOP2A also positively correlated (r = 0.591, P < 0.001). Bioinformatics analysis demonstrated that ZNF148 and TOP2A mRNA had 13 common target miRNAs, including miR101, miR144, miR335, and miR365. Correlation analysis demonstrated that levels of ZNF148 mRNA were negatively associated with levels of miR144, miR335, and miR365. Knockdown and overexpression tests showed that ZNF148 mRNA and TOP2A mRNA regulated each other in HCT116 cells, respectively, but not in Dicer-deficient HCT116 cells. Luciferase assays demonstrated that ZNF148 and TOP2A regulated each other through 3'UTR. Overexpression of ZNF148 mRNA and TOP2A mRNA caused significant downregulation of miR101, miR144, miR335, and miR365 in the HCT116 cells. We also found that knockdown of ZNF148 and TOP2A significantly promoted cell growth, and overexpression of ZNF148 and TOP2A inhibited cell proliferation, which was abrogated in Dicer-deficient HCT116 cells. CONCLUSION: ZNF148 and TOP2A regulate each other through ceRNA regulatory mechanism in CRC, which has biological effects on cell proliferation.


Assuntos
Antígenos de Neoplasias , Proliferação de Células/genética , Neoplasias Colorretais , DNA Topoisomerases Tipo II , Proteínas de Ligação a DNA , Fatores de Transcrição , Antígenos de Neoplasias/genética , Neoplasias Colorretais/genética , Neoplasias Colorretais/metabolismo , DNA Topoisomerases Tipo II/genética , Proteínas de Ligação a DNA/genética , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Imuno-Histoquímica , MicroRNAs/análise , Proteínas de Ligação a Poli-ADP-Ribose , Fatores de Transcrição/genética , Dedos de Zinco
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 16(4): 363-6, 2013 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-23608800

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of colonoscopy-guided placement of self-expandable metallic stent without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction. METHODS: Clinical data of 42 patients (24 males and 18 females with a mean age of 64.3 years) undergoing colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between January 2010 and June 2012 were reviewed retrospectively. RESULTS: The obstruction was located in the rectum (n=19), sigmoid (n=9), descending colon (n=8), splenic flexure (n=1), hepatic flexure (n=3), and ascending colon (n=2). Technical success was achieved in all the 42 patients (100%). The mean time of operation was (11.8±10.4) min (range 1.1-51.0 min). No serious procedure-related complication occurred. Minor bleeding occurred in 3 cases (7.1%). One patient died on the second day after surgery because of heart failure. CONCLUSIONS: Colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe with shorter operative time.


Assuntos
Colonoscopia , Obstrução Intestinal/terapia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/complicações , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 15(12): 1244-6, 2012 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-23268269

RESUMO

OBJECTIVE: To investigate the emergency therapeutic strategy for sigmoid vovulus in the elderly. METHODS: Clinical data of 14 elderly patients with sigmoid vovulus were analyzed retrospectively. RESULTS: The mean age was(79.1±7.2) years(range, 70-93), and 11 patients (78.6%) were male. Emergency decompression and restoration with colonoscopy was performed in all the patients with a success rate of 100%. No patient required emergent surgery. Four patients(28.6%) recurred and they were managed well by repeat colonoscopic restoration. CONCLUSION: Emergency colonoscopic restoration is the first treatment of choice for sigmoid vovulus in the elderly because it is safe and effective, and can be performed repeatedly.


Assuntos
Colo Sigmoide/cirurgia , Volvo Intestinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Descompressão Cirúrgica , Emergências , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 15(4): 363-6, 2012 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-22539382

RESUMO

OBJECTIVE: To demonstrate the association of tumor budding with clinicopathological features and prognosis in T2 rectal cancer. METHODS: Clinicopathological data of 123 patients who underwent potentially curative resection for T2 rectal carcinoma between 2001 and 2005 at the Changhai Hospital were collected. All pathology slides were stained with hematoxylin and eosin for microscopic examinations. The maximum value of tumor buds(MV) and average value of tumor buds(AV) were calculated, which were classified as low value (≤5), median value (5 < bud value < 10), and high value (≥10). RESULTS: Univariate analysis and multivariate analysis revealed that MV(P=0.000), AV(P=0.001), and lymphatic invasion (P=0.006) were independent predictors for lymph node metastasis in T2 rectal cancer. Neural invasion and poorly differentiation were significantly associated with MV(P<0.05). Neural invasion, vascular invasion and poorly differentiation were were significantly associated to AV (P<0.01). Disease-free survival (DFS) of patients with low AV, median AV and high AV was 110.5 months, 95.8 months, and 60.0 months respectively. There were significance differences in DFS of low AV with median and high AV(P<0.05). DFS of patients with low MV, median MV and high MV was 115.1 months, 98.5 months, and 86.0 months respectively. There were significance differences in DFS between low and high AV, and median and high MV(P<0.01 and P<0.05), while no significant difference existed between low and median MV. CONCLUSION: Tumor budding is a useful marker to indicate high invasiveness of rectal cancer and a valuable prognostic predictor.


Assuntos
Neoplasias Retais/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Prognóstico , Neoplasias Retais/cirurgia
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 14(8): 586-8, 2011 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-21866447

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of surgical treatment for recurrent colorectal carcinoma in the elderly. METHODS: The clinical and follow up data of 24 elderly patients with recurrent colorectal carcinoma who were treated between January 2000 and June 2009 at the Changhai hospital of the Second Military Medical University were analyzed retrospectively. RESULTS: Among the 24 patients there were 14 men and 10 women. The mean age of the patients was 76.9 ± 5.3 years. The local recurrence was found in 15 patients. In 9 patients, both distant metastases and local recurrence were found. A total of 24 patients received operation, including radical resection in 15 patients and palliative resection in 8 patients. One patient had laparotomy only because of diffuse metastases in the abdomen and involvement of the duodenum and common bile duct.The patient received stent placement in the common bile duct and chemotherapy after the surgery. Postoperative complication occurred in 7(29.2%) patients, which included ileus(n=1), pulmonary infection(n=1), urinary infection(n=1), wound infection(n=2), wound dehiscence(n=1), and wound fat liquefaction(n=1). There were no perioperative deaths. The median survival time was 6 months in the entire cohort. The median survival time was 33 months in patients undergoing radical resection, and the 1-, 3-, and 5-year survival rate was 71.4%, 28.6%, and 14.3%. The median survival time was 3 months in patients who underwent palliative resection, and the 1-year survival rate was 0. The difference between the two groups was statistically significant(P<0.01). CONCLUSION: Outcomes are acceptable after radical resection for elderly patients with recurrent colorectal cancer if careful preoperative evaluation and perioperative management are performed.


Assuntos
Neoplasias Colorretais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 14(8): 627-30, 2011 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-21866459

RESUMO

OBJECTIVE: To explore the correlation between multi-drug resistance-associated protein 4(MRP4) and the sensitivity of rectal cancer to radiation. METHODS: A total of 95 patients with advanced rectal cancer and received radiation therapy between January 2000 and January 2009. MRP4 and P53 protein expression in the paraffin-embedded specimen were detected by immunohistochemistry. Logistic regression analysis was used to evaluate factors associated with the sensitivity of rectal cancer to radiation. RESULTS: Forty patients(42%) were sensitive to radiation therapy, of whom 10(11%) achieved pathological complete remission. Fifty-five patients were (58%) not responsive to radiation. Patients with low expression of MRP4 had a 66.7%(24/36) response rate, significantly higher than that of patients with high MRP4 expression (29.1%,16/59)(P<0.05). Patients with low expression of P53 had a 63.9%(23/36) response rate, significantly higher than that of patients with high P53 expression(28.8%,17/59)(P<0.01). The response rate after long course radiation therapy was 83.3%(20/24), significantly higher than that of patients who underwent short and medium course radiation[(31.3%, 5/16) and(27.3%,15/55)](P<0.01). Multivariate Logistic regression analysis showed radiation regimen, the expression of P53 and MRP4 protein were independently associated with the sensitivity of rectal cancer to radiation(P<0.05). CONCLUSION: MRP4 may serve as a predictive marker for the sensitivity of rectal cancer to preoperative radiation.


Assuntos
Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tolerância a Radiação , Neoplasias Retais/metabolismo , Resultado do Tratamento , Proteína Supressora de Tumor p53/metabolismo
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 14(4): 245-8, 2011 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-21538263

RESUMO

OBJECTIVE: To investigate factors associated with lymph node metastasis and prognosis in patients with T1-2 colorectal cancer. METHODS: Patients with pT1-2 colorectal cancer between January 1999 to January 2005 were included. Chi-square test and multivariable logistic analysis were performed to evaluate risk factors associated with lymph node metastasis. Survival outcomes were analyzed using Kaplan-Meier and Cox regression model. RESULTS: Tumor location and depth of invasion were independent risk factors for lymph node metastasis(P<0.01 and P<0.05). Gender, age, tumor gross pattern, tumor differentiation, carcinoembryonic antigen level, and tumor diameter were not associated with lymph node metastasis. Lymph node metastasis and distant metastasis on postoperative follow-up were independent risk factors for survival(P<0.05 and P<0.01). CONCLUSION: Factors associated with lymph node metastasis in pT1-2 colorectal cancer do not affect the survival. However, lymph node metastasis and distant metastasis are predictive for survival.


Assuntos
Neoplasias Colorretais/patologia , Linfonodos/patologia , Metástase Linfática/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Neoplasias Colorretais/diagnóstico , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Metástase Linfática/diagnóstico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
10.
World J Surg ; 35(9): 2134-42, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21607819

RESUMO

OBJECTIVE: This study was designed to explore causes for local recurrence of presacral lesions after intended curative surgery and discuss prevention strategies. METHODS: Medical data of presacral lesions in our hospital from January 2001 to September 2009 were retrospectively studied, including preoperative examinations, intraoperative findings, and postoperative histopathologies. RESULTS: Of 39 patients (29 women and 10 men) with presacral lesions, who ranged in age from 14 to 71 (mean, 39.56) years, 7 patients were diagnosed with recurrent presacral lesions on admission. Preoperative pelvic MRI, pelvic CT, and endorectal ultrasonography (ERUS) were performed in 23, 22, and 8 cases, respectively. MRI/CT showed that five cases had two coexisting lesions and three cases had lobulated or dumbbell shaped lesions, all of which were confirmed by intraoperative findings. ERUS suspected involvement of the rectal wall in three cases: adhesion to the rectal wall in two cases, and tumor invasion in the remaining case. During the operation, 26, 8, and 2 cases were resected by the transsacral, transabdominal, and combined abdominosacral approach, respectively. Four patients underwent simultaneous coccygectomy, and three patients received simultaneous resection of the sacrum and coccyx. Simultaneous partial resection of the invaded sigmoid colon or rectum was performed in two patients, respectively. By postoperative pathological examination, three cases were found to have ruptured cystic lesions, three had previous cyst rupture history, and five had infected lesions. CONCLUSIONS: Presacral lesions are likely to be multiple, lobulated, infected, ruptured, and adhesive to the sacrococcyx and rectum, which contribute to the high local recurrence rate. Preoperative CT/MRI/ERUS and careful intraoperative exploration are required to direct surgical treatment and to reduce local recurrence. Optimal selection of surgical approach also is very important to reduce local recurrence. Presacral lesions attached to the sacrococcyx or rectum require simultaneous partial resection of the sacrococcyx or rectum to reduce local recurrence.


Assuntos
Recidiva Local de Neoplasia/patologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Sacro/patologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Colectomia/métodos , Intervalo Livre de Doença , Endossonografia/métodos , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Neoplasias Retais/diagnóstico , Neoplasias Retais/mortalidade , Estudos Retrospectivos , Medição de Risco , Sacro/cirurgia , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
11.
Int J Colorectal Dis ; 26(8): 1051-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21476029

RESUMO

PURPOSE: Familial adenomatous polyposis (FAP) is a colorectal disease treated by proctocolectomy. While ileal pouch-anal anastomosis preserves the anus, defecation dysfunction and incontinence can occur. We herein report the results of an improved laparoscopic-assisted ileal pouch-rectal muscle sheath anastomosis after total proctocolectomy which preserves anal function, and compare the results with ileal pouch-anal anastomosis. METHODS: A total of 22 patients with FAP were randomized to receive either ileal pouch-anal anastomosis (n = 11) or ileal pouch-rectal muscle sheath anastomosis (n = 11) after total proctocolectomy. Operation time, intraoperative blood loss, postoperative complications, length of hospitalization and postoperative anal pressure, defecation frequency, and quality of life were recorded and compared between the two groups. RESULTS: All patients completed a minimum follow-up of 1 year. At the 1 year after the surgery, the daytime defecation frequency was 4.64 ± 0.92 times/day in the ileal pouch-rectal muscle sheath anastomosis group and 6.55 ± 1.13 times/day in the ileal pouch-anal anastomosis group (P = 0.004). Resting anal pressure, maximum squeeze pressure, and average number of daytime defecations in the ileal pouch-rectal muscle sheath group were all better than in the ileal pouch-anal anastomosis group (all, P < 0.05) CONCLUSIONS: Ileal pouch-rectal muscle sheath anastomosis is associated with better anal function than ileal pouch-anal anastomosis.


Assuntos
Polipose Adenomatosa do Colo/cirurgia , Bolsas Cólicas , Laparoscopia , Músculos/cirurgia , Reto/cirurgia , Polipose Adenomatosa do Colo/fisiopatologia , Adolescente , Adulto , Canal Anal/fisiopatologia , Anastomose Cirúrgica , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Qualidade de Vida , Reto/fisiopatologia , Adulto Jovem
12.
Zhonghua Wai Ke Za Zhi ; 48(13): 968-71, 2010 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-21054977

RESUMO

OBJECTIVE: To investigate the lymph node metastasis and its risk factors in T1-2 staging invasive rectal carcinoma. METHODS: The data of 1116 patients with rectal cancer treated with total mesorectal excision (TME) technique from January 2000 to April 2009 was analyzed retrospectively. The clinicopathological factors analyzed included gender, age, primary symptom type, number of symptoms, duration of symptom, synchronous polyps, preoperative serum carcino-embryonic antigen level, preoperative serum CA19-9 level, the distance of tumor from the anal verge, tumor size, tumor morphological type, tumor circumferential extent, tumor differentiation and tumor T staging. Statistical analysis was performed by using Logistic regression analysis and Chi-square test. RESULTS: A total of 1116 patients were enrolled, and 358 cases (32.1%) were classified as with T1-2 staging tumor. Two cases (5.6%, 2/36) in patients with a T1 staging tumor were found with lymph node metastasis, and 75 cases (23.3%, 75/322) in patients with a T2 staging tumor, respectively. Compared with patients with T3-4 staging tumor, lymph node metastasis rate of the patients with T1-2 staging tumor was significantly lower [21.5% (77/358) vs. 51.6% (391/758), P < 0.05]. Only the tumor T staging was found as the independent risk factor for the lymph node metastasis in patients with T1-2 staging tumor on multivariate Logistic regression analysis (odds ratio: 5.162; 95%CI: 1.212 to 21.991; P = 0.026). CONCLUSIONS: A substantial proportion of T1-2 staging rectal cancers harbor metastatic lymph nodes and the clinicopathological features except for T staging fail to predict the lymph node metastasis. Further research is warranted to identify the risk factors and guide the clinical practice in patient with T1-2 staging tumor.


Assuntos
Linfonodos/patologia , Metástase Linfática/patologia , Neoplasias Retais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 13(6): 406-8, 2010 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-20577915

RESUMO

OBJECTIVE: To evaluate the accuracy and value of the placement of metallic clips during colonoscopy in the localization of colorectal cancer and incision selection. METHODS: A total of 30 patients received metallic clip placement by colonoscopy before operation. Abdominal plain film (supine and upright position) was taken and incision was determined by the projection of clips on the abdominal wall. RESULTS: The inaccuracy rate of localization by colonoscopy was 30%(9/30). Colonoscopy combined with the placement of metallic clips achieved an accurate incision rate of 100% (30/30). CONCLUSIONS: There is a considerable rate of inaccuracy for localization in colonic cancer by colonoscopy. Colonoscopy combined with placement of metallic clips should be considered in order to select a reasonable incision.


Assuntos
Neoplasias do Colo/cirurgia , Colonoscopia , Instrumentos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
World J Surg ; 34(10): 2477-86, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20559636

RESUMO

BACKGROUND: Diffuse cavernous hemangioma of the rectum (DCHR) is a rare benign vascular disease, which is often misdiagnosed and difficult to treat. METHODS: Seventeen cases of DCHR in our hospitals from 1995 to 2009 were identified. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: Seven, three, two, and one patient were mistaken as having hemorrhoids, colitis, portal hypertension, and rectal polypus, respectively. The mean delay time between initial symptoms and final diagnosis was 17.63 years (range = 0-48 years). Colonoscopy and MRI were important in the diagnosis of DCHR because of their high positive rates and specific features. All of the lesions originated from the dentate line, extending to the proximal colorectal wall. Most of the lesions were found to be restricted to the rectosigmoid wall and the rectal mesentery. Involvement of right gluteus maximus and right leg was revealed by MRI in two patients. After admission, six patients underwent coloanal sleeve anastomosis and seven patients underwent pull-through transection and coloanal anastomosis. The latter procedure was superior to the former with respect to length of operation, intraoperative blood loss, intraoperative blood transfusion, and perioperative complications. CONCLUSION: DCHR is often misdiagnosed. Preoperative colonoscopy and MRI are essential in making the correct diagnosis and to depict the extent of the lesion accurately. Due to its origination from the dentate line and the involvement of the whole layer of the rectal wall and the rectal mesentery, the treatment of choice for DCHR is complete resection by the pull-through transection and coloanal anastomosis.


Assuntos
Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/cirurgia , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Adolescente , Adulto , Colonoscopia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
15.
Zhonghua Wei Chang Wai Ke Za Zhi ; 12(6): 569-72, 2009 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-19921565

RESUMO

OBJECTIVE: To analyze the impact of meticulousness of pathologists on the lymph node harvest after radical resection of invasive rectal carcinoma. METHODS: From January 2008 to May 2009, the clinical data of rectal cancer patients undergone operation were reviewed retrospectively. After multidisciplinary cooperation on rectal cancer, a new rule was applied to request the pathologists to find no less than 15 nodes in single colorectal specimen from January 2009. Patients were divided into two groups (2008 group and 2009 group) and the node harvest numbers were compared. Excluded criteria were recurrent colorectal tumor, Tis tumor, R(1) or R(2) resection, tumor resection transanally or endoscopically, the cases enrolled in other prospective research, synchronous diseases affecting the surgical procedure for the rectal cancer (familial adenomatous polyposis, synchronous colorectal carcinoma) and rectal cancer receiving neoadjuvant chemoradiation. Statistical analysis was performed using One-Sample Kolmogorov- Smirnov test, Mann-Whitney test, Independent-Samples T test and Chi-Square test(SPSS 15.0). RESULTS: A total of 232 patients were identified, including 76 cases in the 2009 group and 156 cases in 2008 group. The lymph node retrieval in the 2009 group was significantly more than that in 2008 group (16.0+/-0.3 vs 11.4+/-0.3, P<0.01). A significantly higher percentage of patients was found in 2009 group with a lymph node harvest equal to or more than 12 nodes (72/76 vs 71/156, P<0.01). There were no significant differences in gender (46/76 vs 86/156, P=0.436), age (58.1+/-1.3 vs 59.2+/-1.1, P=0.527), distance from tumor to anal verge (7.4+/-0.4 vs 7.1+/-0.3, P=0.761), proportion of sphincter-sparing surgery (67/76 vs 140/156, P=0.715), ratio of well and moderate differentiated tumors (68/76 vs 125/156, P=0.074) and overall TNM stage (P=0.167) between the two groups. CONCLUSIONS: The lymph node harvest in 2009 group is significantly more than that in 2008 group. The good performance of pathologists could produce adequate number of lymph nodes for rectal cancer without neoadjuvant chemoradiation.


Assuntos
Biópsia , Excisão de Linfonodo , Linfonodos/patologia , Neoplasias Retais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Neoplasias Retais/cirurgia , Reto/patologia , Estudos Retrospectivos
16.
Zhonghua Wai Ke Za Zhi ; 47(8): 594-8, 2009 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-19595039

RESUMO

OBJECTIVE: To analyze the factors associated with anastomotic leakage after anterior resection in rectal cancer with the technique of total mesorectal excision (TME). METHODS: From January 2005 and December 2007, 738 consecutive patients with rectal cancer underwent anterior resection. The data of those patients was collected and reviewed retrospectively. The associations between anastomotic leakage and 9 patient-related variables as well as 7 surgical-related variables were examined. RESULTS: Low rectal cancer (located 7 cm or less above the anal edge), non-specialized surgeon and transanal tube use were the risk factors associated with anastomotic leakage on univariate analysis. The anastomotic leakage rate of low-rectal cancer was significantly higher than that of high-rectal cancer (5.9% vs. 0.9%, P = 0.003). The anastomotic leakage rate of the cases operated by colorectal surgeon was significantly lower than that of the cases operated by non-specialized surgeon (3.9% vs. 11.3%, P = 0.031). There was a tendency for colorectal surgeons to operate on a greater proportion of low rectal cancer than non-specialized surgeons (72.1% vs. 52.8%, P = 0.003). The leakage rate of transanal tube group was unexpectedly higher than that in patients without transanal tube (14.5% vs. 3.6%, P < 0.001). On multivariate logistic regression analysis, diabetes mellitus (P = 0.027), distance less than 1 cm from tumor to distal resection margin (P = 0.009) and defunctioning stoma (P = 0.031) were also associated with anastomotic leakage rate besides low rectal cancer, non-specialized surgeon and transanal tube use. In a further analysis of 522 patients with low rectal cancer, the leakage rate of defunctioning stoma group was significantly lower than that of non-stoma group (2.9% vs. 8.5%, P = 0.007). By contract, the leakage rate of transanal tube group was still higher than that in patients without transanal tube (15.1% vs. 4.9%, P = 0.008) because of its poor protective effect as well as the selection bias. CONCLUSIONS: Low-rectal cancer, non-specialized surgeons and diabetes mellitus are risk factors of anastomotic leakage after rectal surgery. A defunctioning stoma was effective in preventing leakage after low-rectal cancer surgery.


Assuntos
Fístula Retal/etiologia , Neoplasias Retais/cirurgia , Estomas Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Reto/cirurgia , Estudos Retrospectivos , Fatores de Risco
17.
World J Surg ; 33(6): 1292-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19363687

RESUMO

BACKGROUND: The aim of the present study was to analyze the factors associated with anastomotic leakage after anterior resection for rectal cancer. METHODS: Retrospectively collected consecutive data of 738 rectal cancer patients who underwent anterior resection in our hospital between 2005 and 2008 were reviewed. The associations between 15 patient-related and surgery-related variables and anastomotic leakage were studied with both the univariate chi-square test and multivariate logistic regression analysis. RESULTS: Univariate analysis showed that risk factors associated with anastomotic leakage were low rectal cancer (located 5 cm or less above the dentate line) (5.9% vs. 0.9%; P = 0.003), non-specialized surgeon (3.9% vs. 11.3%; P = 0.031), and defunctioning transanal catheter placement (14.5% vs. 3.6%; P < 0.001). It should be noted that the mean surgeon case volumes of anterior resection of colorectal surgeons and non-specialized general surgeons were 43 per year and 2 per year, respectively (P < 0.001). In addition, there was a tendency for colorectal surgeons to operate on a greater proportion of low rectal cancers (72.1% vs. 52.8%; P = 0.003). In the multivariate analysis, besides low rectal cancer, non-specialized surgeon, and transanal catheter placement, three other factors were associated with anastomotic leakage: diabetes mellitus (P = 0.027), free distal margins less than 1 cm (P = 0.009), and a defunctioning stoma (P = 0.031). In a further analysis of 522 patients with low rectal cancer, the leakage rate in patients with a defunctioning stoma was significantly lower (2.9% vs. 8.5%; P = 0.007). By contrast, the leakage rate in the transanal catheter placement group was higher (15.1% vs. 4.9%; P = 0.008), because of its poor protective effect as well as the selection bias. CONCLUSIONS: From the findings of this study, we believe that low rectal cancer, non-specialized surgeons, and diabetes mellitus are risk factors for anastomotic leakage after rectal surgery, and that a defunctioning stoma could significantly reduce the incidence of leakage in low rectal cancer patients.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Retais/cirurgia , Deiscência da Ferida Operatória/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 8(6): 496-9, 2005 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-16299649

RESUMO

OBJECTIVE: To evaluate the bowel control of the anus-preserving operation for elderly patients over 75 years with low rectal cancer. METHODS: Thirty-nine elderly patients over 75 years with low rectal carcinoma (4-7 cm from anal verge) were treated during the study period. The patients were divided into different groups according to the surgical procedures and anastomotic locations. The bowel control and patients satisfaction were compared. RESULTS: The time of recovering normal defecation frequency was (9.8+/- 2.9) months. There were no differences in bowel control and anorectal manometric findings between the lower anastomosis group and super-lower anastomosis group, the lower anastomosis group and anorectal anastomosis group. The patients in anorectal anastomosis group displayed significantly better bowel control and anorectal manometric findings than those in the super-lower anastomosis group (P< 0.05). The time of recovering normal defecation frequency in colonic J-pouch-anal anastomosis group was (7.7+/- 1.7) months, shorter than (10.6+/- 2.8) months in direct anastomosis group (P< 0.01). The complication rate of I degree incontinence was 36.1%, but there was no difference between the two groups. The anorectal manometric findings were better in J-pouch-anal anastomosis group than those in direct anastomosis group (P< 0.05). CONCLUSION: Colonic J-pouch-anal anastomosis for lower rectal carcinoma can significantly improve the bowel control in a short term without increasing the complication rate.


Assuntos
Canal Anal/cirurgia , Defecação , Incontinência Fecal/etiologia , Neoplasias Retais/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Feminino , Humanos , Masculino , Período Pós-Operatório , Neoplasias Retais/cirurgia
19.
Ai Zheng ; 24(10): 1257-60, 2005 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-16219144

RESUMO

BACKGROUND & OBJECTIVE: Though anus-retained operation has became the first choice in radical cure operation for rectal cancer, most surgeons whom fear of dissatisfied bowel control after operation recommend permanent bowel stoma in abdomen for elderly low rectal cancer patients rather than anus-retained operation. This study was to evaluate the bowel control of elderly low rectal cancer patients after anus-retained operation. METHODS: A total of 80 elderly low rectal cancer patients were divided into > or =75-year old group (39 patients) and 60-74-year old group (41 patients). Clinical data and follow-up data of the 80 patients were analyzed; bowel function and continence of the 2 groups were compared. RESULTS: The postoperative 18-month survival rate of all patients was 98.8%. The bowel control statuses of 76 patients were evaluable, of which 36 were in > or =75-year old group, 40 were in 60-74-year old group. Three months after operation, the bowel function was significantly poorer in > or =75-year old group than in 60-74-year old group (P<0.05), but the difference dissolved 6 months after operation (P>0.05). The time of recovering normal defecation frequency was slightly longer in > or =75-year old group than in 60-74-year old group (P>0.05). The prevalence of grade I incontinence 6 months after operation was significantly higher in > or =75-year old group than in 60-74-year old group (36.1% vs. 12.5%, P<0.05), but all symptoms of incontinence were relieved after treatment. CONCLUSIONS: Most elderly low rectal cancer patients could maintain bowel control after anus-retained operation. Age alone should not be a contraindication to a restorative resection for low rectal cancer.


Assuntos
Canal Anal/fisiopatologia , Proctocolectomia Restauradora/métodos , Neoplasias Retais/cirurgia , Adenocarcinoma/fisiopatologia , Adenocarcinoma/cirurgia , Adenocarcinoma Mucinoso/fisiopatologia , Adenocarcinoma Mucinoso/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Canal Anal/cirurgia , Anastomose Cirúrgica , Defecação/fisiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Incontinência Fecal/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/fisiopatologia , Reto/cirurgia
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 8(4): 304-5, 2005 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-16167246

RESUMO

OBJECTIVE: To investigate the diagnosis and surgical management of adult Hirschsprung's disease. METHODS: Clinical data of 15 patients with adult Hirschsprung's disease were reviewed retrospectively from June 1992 to June 2004. RESULTS: Patients age ranged from 17 to 54 years old. The main manifestations included long-term (ranged from 9.5 month to 50 years) constipation and abdominal distention. Acute abdominal pain occurred in six patients, but no sign of de hydration and malnutrition occurred in all patients. Bowel stenosis and dilation could be examined by barium enema. Soave procedure was performed in 3 patients, subtotal colectomy with coloanal anastomosis was performed in twelve patients. The function of defecation was improved in all patients after operation. CONCLUSIONS: The diagnosis of adult Hirschsprung's disease mainly depends on the history of constipation from infant and barium enema. Subtotal colectomy with coloanal anastomosis is an effective and safe operative procedure.


Assuntos
Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
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