Objective To investigate the surgical treatment effect for patients with gastrointestinal stromal tumor (GIST) of the rectum and its clinical characteristics. Methods The medical records of 22 patients who had undergone surgery for GIST of the rectum between March 2003 and February 2010 in this hospital were analyzed. Results There were 14 males and 8 females with a median age of 51 years (range 27－81 years). There were 12 patients without symptoms, 10 patients with clinical symptoms, included: hematochezia 4 cases, difficult defecation 2 cases, shape of defecate change 2 cases, crissum pain 1 case, times of defecate increase 1 case. Course of disease was 2 weeks-18 months with average 6 months. All patients underwent curative resection: in form of abdominoperineal resection in 3 patients, transanal excision in 8 patients, Mason operation in 8 patients, and transanal endoscopic microsurgery in 3 patients. The median tumor size was 3.1 cm (range 0.4－18.5 cm). The diameter of tumor lt;2.0 cm was 11 cases, 2.1-5.0 cm was 8 cases, 5.1-10.0 cm was 2 cases, gt;10.0 cm was 1 case. Twentyone of 22 cases were positive for CD117, 18 cases positive for CD34, 5 cases positive for αsmooth muscle actin (SMA), and 2 cases positive for Desmin. Local recurrence or hepatic metastasis developed in 2 patients with average 26 months of follow-up (range 1 month to 7 years), and who were then treated with imatinib for more than 1 year. Conclusions The primarily treatment of rectal GIST is surgical. Imatinib therapy is effective against local and systemic recurrent GIST of the rectum.
Objective To evaluate initial experience with shape memory alloy stent as an alterative to colostomy in patients with intestinal obstruction of rectal cancer. Methods Twenty-one patients with acute and chronic rectal obstructions from malignant causes underwent stent placement. After rectal stent was slenderized in ice water, it was inserted into the strictured rectum by hand or sigmoidoscope. Nitinol mesh stent were deployed in hot water. Results Eighteen patients who had underwent rectal stent placement achieved clinical decompression within 5 hours. Colostomy underwent in 3 patients due to stent failure. Eighteen patients with stent were followed-up, 14 cases died in 56-720 days and 4 other cases were still alive without intestinal obstruction in 2-15 months. Conclusion Nitinol mesh stent may be useful in the management of terminal or high-risk surgical patients for palliative purposes shuning colostomy. Palliation of stent combined with chemotherapy and immunotherapy can be performed to improve survival.
Objective To summarize recent advances on preoperative staging strategies in rectal cancer. Methods Relevant references about preoperative staging strategies were collected and reviewed. The multimodal preoperative evaluation (MPE) system recently documented was focused on. Results The comparably accurate T and M stage could be achieved preoperatively by following an appropriate available method; however, the N stage’s accuracy was still not satisfying. The MPE system， incorporating with the advantages of transrectal ultrasound， computerized tomography and serum amyloid A protein in a multi-disciplinary mode could display the most accurate preoperative staging for rectal cancer currently. Conclusion The MPE has potential prospects in preoperative staging of rectal cancer， and can provide the most accurate preoperative staging for rectal cancer at present.
ObjectiveTo evaluate the possible role of the expression of insulin-like growth factor-1 receptor (IGF-1R) in determining rectal cancer radiosensitivity. MethodsThe paired preradiation biopsy specimens and postoperative specimens were obtained from 87 patients with rectal cancer in the department of digestive tumor surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2009 to December 2010. The IGF-1R expression was examined by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR). The tumor radiosensitivity was defined according to Rectal Cancer Regression Grade, then the relation between the IGF-1R expression and tumor radiosensitivity was evaluated. ResultsCompared with the preradiation biopsy specimens, IGF-1R expression significantly increased in the paired postoperative specimens of the residual cancer cells (Plt;0.001). The IHC result demonstrated IGF-1R overexpression was significantly associated with a poor response to radiotherapy (rs=0.401, Plt;0.001); RT-PCR detection of IGF-1R expression on preradiation biopsy specimens also showed that IGF-1R mRNA negative patients had a higher radiation sensitivity (rs=0.497, Plt;0.001). ConclusionDetection of IGF-1R expression may predict radiosensitivity of preoperative irradiation for rectal cancer.
【Abstract】ObjectiveTo study the distal intramural spread of rectal carcinoma, and provide evidence for modification of rectal carcinoma surgery. MethodsSixty patients with rectal carcinoma admitted to the first affiliated hospital of Chongqing university of medical science from November 2001 to October 2002 were included. The specimens were extended to its original size and shape by the fat clearing method. Mesenteric lymph nodes were dissected by using transillumination to examine metastases histologically, then a lymph nodes map was produced which including the site of the primary lesion, the vascular distribution, and the sites of dissected nodes. The specimen below the distal margin of the tumor was cut continuously with 0.5 cm interval then sectioned for histopathological examination. ResultsTumor spread to the distal intramural was observed in 11 of 60 patients (18.3%) with the range within 1.5 cm, of which less than 0.5 cm in 5 case, 5 cm to 1.0 cm in 2 cases, 1.0 cm to 1.5 cm in 4 cases. The tumor invasion was correlated with gross type, histological type and infiltrative depth, but not with sex, age, location of the tumor, size of the tumor, lymph nodes metastases and Dukes stage. Conclusion The range of distal mural excision should exceed 1.5 cm to tumor margin in radical surgery for rectal carcinoma. This rule should be emphasized for patients with poor cell differentiation and deep infiltration.
Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) on the selection of operative procedures of upper rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 110 patients, who were diagnosed definitely as upper rectal cancer (distance of tumor to the dentate line gt;7 cm) at West China Hospital of Sichuan University from August 2007 to October 2008, randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only MSCT was made preoperatively. Then, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathologic factors. Furthermore, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Results According to the criteria, 106 patients with upper rectal cancer were randomly assigned into MSCT+SAA group (n=52) and MSCT group (n=54). The baseline characteristics of two groups were statistically identical. When analyzing the proportion of multiple clinicopathologic factors in different operative procedures of upper rectal cancer, there were statistical differences in the preoperative N staging (P=0.003), M staging (P=0.022), TNM staging (P=0.003), serum level of SAA (P=0.005) and general category of tumor (P=0.027). For MSCT+SAA group the accuracies of preoperative staging T, N, M and TNM were 84.6%, 86.5%, 100% and 86.5%, respectively; For MSCT group the corresponding rates were 83.3%, 2.9%, 100% and 64.8%, respectively. There were statistically significant differences accuracies of preoperative N staging and TNM staging (P=0.005, P=0.009, respectively) in two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (96.2% vs. 81.5%, P=0.017). Conclusion Combinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, and thus provide higher predictive coincidence rate to operative procedures for surgeon.
ObjectiveTo investigate the value of postoperative CT examination for evaluation of local complications in patients with low rectal carcinoma after total mesorectal excision with anal sphincter preservation. MethodsThe patients with low rectal carcinoma who received total mesorectal excision (TME) with anal sphincter preservation were examined using contrastenhanced CT in one year period from May 2009 to May 2010. Particular attention was paid to the presence of anastomotic leakage, local recurrence and status of lymph nodes. ResultsTotal of 82 patients (52 men, 30 women； mean age 57.8 years old； range 25.74 years old) were included in the study. Over a mean 10-month follow-up， 8 cases （9.8%） had clinically or surgically confirmed anastomotic leak, 6 cases （7.3%） had local recurrence around the anastomotic site， and 4 cases （4.9%） showed pelvic and distant metastatic lymphadenopathy. ConclusionPostoperative CT examination, including baseline and follow-up CT studies, is very useful for diagnosing anastomotic leakage, local tumor recurrence and lymphadenopathy.
Objective To study the relationship between blood metastasis of colorectal cancer and cancer metastasis related factors.MethodsCK20 mRNA in peripheral blood was investigated by reverse transcription polymerase chain reaction (RTPCR) and proteins of CD44v6 and p53 in cancer tissues were examined by immunohistochemical in 50 cases of colorectal neoplasm. ResultsThe results showed that the positive rates of peripheral blood micrometastasis of colorectal cancer were 68%. It escalated along with the rising of the Dukes stage, the rates in Dukes C and D stage were significantly higher than that in Dukes A and B stage. The positive rates of CD44v6,p53 expression in colorectal cancer were 74% and 62% respectively. The positive rates of CD44v6 and p53 in Dukes A and B stage were significantly lower than those in Dukes C and D stage,in peripheral blood and colorectal cancer micrometastasispositive group were significantly higher than that in the micrometastasisnegative group. CK20 mRNA was significantly correlated with expressions of CD44v6 and p53 in cancer tissues. Conclusion The detection of CK20 mRNA in blood before operation and after operation examination of CD44v6 and p53 in cancer tissues are helpful for prediction of blood metastasis of colorectal neoplasm and postoperative treatment.
Objective To determine the role of multi-slice spiral computed tomography (MSCT) compared with transrectal ultrasound (TRUS) in preoperative staging of rectal cancer. Methods Patients with rectal cancer from January to May 2009 in Department of Anal-Colorectal Surgery of West China Hospital were enrolled. All patients were preoperatively examined by both MSCT and TRUS for T and N staging, which were compared with postoperative pathological findings. Results The study population consisted of 81 patients. Regarding depth of tumor invasion, the accuracy of TRUS (88.89%) was not significantly higher than that of MSCT (77.78%), P=0.168. Regarding lymph node metastasis, the result of MSCT was more accurate than that of TRUS (66.67% vs. 48.15%, P=0.034). Conclusions Although TRUS remains the advantages in evaluating local invasion, the gap between MSCT and TRUS are significantly diminished. MSCT is superior to TRUS in evaluation of lymph node metastasis, however, further improvement on the diagnostic accuracies would be warranted in both modalities.
Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.