Experience in the use of Y-shaped anastomosis during surgical treatment of acute colonic ileus of tumoral genesis

Among the total number of patients suffered from colonic cancer the incidence of acute ileus constitutes 32%. In 1978-1997 we studied 198 patients with such pathology. In 1993-1997 the Y-form anastomosis was applied in 33 patients (37.9% of the cases); anastomosis incompetence was not observed. 1 month after operation the anastomosis provided the natural passage over intestine and in 2-3 months allowed performance of early and safe extraperitoneal closure of unloading stoma. The use of Y-form anastomosis in colonic surgery against the background of acute ileus (of tumoral genesis) permits to decrease the postoperative lethality and to conduct rapid social-and-labor rehabilitation of the patients with the help of early safe extraperitoneal reconstruction operations.     

Safety of simultaneous colon and liver resection for colorectal liver metastases

BACKGROUND/AIM: Surgical strategy for the treatment of resectable synchronous hepatic metastases of colorectal cancer (CRC) remains controversial. The aim of this study was to assess safety of simultaneous colon and liver rese cions and the direct effects of this type of treatment upon morbidity and mortality of the patients with synchronus hepatic metastases of CRC. METHODS: Intraoperative and postoperative data of 31 patients with simultaneous liver and colorectal resection were compared with the data of 51 patients who had undergone colon and hepatic resection in the staging setting. Analized were demographic data, number of metastases, type of the liver resection, operation time, intraoperative blood loss, percentage of postoperative complications, morbidity and mortality and lenght of hospitalisation. RESULTS: In the group of the patients operated simultaneously 5 hepatectomies, 3 sectionectomies, 2 trisegmentectomies, 3 bisegmentectomy, 6 segmentectomies, and 12 metastasectomies were combined with colon resection. In this group operation time (280 vs. 330 minutes) and in traoperative blood loss (450 vs. 820 ml) were lower than those in the two staged operation group. Postoperative complication rate was lower in the simultaneous group (19.35%o) than in the two-staged operation group (19.60%), without statistical significance. There was no hospital mortality in both groups. The patients having simultaneous resection required fewer days in the hospital (median 10.2 days) than the patients undergone operation in the two stage (18.34 days). CONCLUSION: By avoiding a second laparotomy, overall operation time, blood loss, hospital stay and complication rate are reduced with no change in hospital mortality, so simultaneous colon and hepatic resection performed by the competent surgeons are safe and efficient for the treatment of synchronous colorectal liver metastases.     

结直肠癌根治术后复发转移患者的预后因素分析

目的探讨影响结直肠癌根治术后复发转移患者生存时间的临床病理因素,为治疗方案的选择提供更多理论依据。方法收集2002年1月1日-2007年12月31日收治的住院与随访资料完整的132例结直肠癌根治术后复发转移患者的临床资料,回顾性分析其临床病理因素与生存时间的关系。结果单因素分析结果显示,单发转移者生存率高于多发转移者,直肠癌复发转移者生存率高于结肠癌复发转移者,再次手术治疗者生存率高于采用非手术治疗者。Cox回归模型多因素分析表明,复发转移后的治疗方式、复发转移部位的数目、原发肿瘤的侵袭深度、淋巴结转移等与患者的生存时间相关,其中复发转移后的治疗方式是最重要的影响因素。结论结直肠癌根治术后复发转移者以直肠癌居多,但其预后优于结肠癌复发转移者;复发转移后再次手术治疗有助于改善预后。     

Use of computed tomography in the management of colorectal cancer

Computed tomography (CT) plays an important role in the management of colorectal cancer (CRC). The use of CT (colonography) as a screening tool for CRC has been validated and is expected to rise over time. The results of prior studies suggest that CT is suboptimal for assessment of local T stage and moderate for N stage disease. Recent advances in CT technology are expected to lead to some improvement in staging accuracy. At present, the main role of CT in pre-treatment imaging assessment lies in its use for the detection of distant metastases, especially in the liver. In a select group of patients, routine post-treatment surveillance with CT confers survival benefits. The role of CT for post-treatment assessment has been radically altered and improved with the advent of fusion positron emission tomography/CT. Perfusion CT shows promise as another functional imaging modality but further experience with this technique is necessary before it can be applied to routine clinical practice.     

G-CSF受体及其mRNA在结直肠癌和其附近正常黏膜中的表达

目的研究粒细胞集落刺激因子受体(CrCSFR)在结直肠癌中的表达情况，了解G-CSF在结直肠癌发生、发展中的作用。方法应用免疫组化RT-PCR法分别检测42例结直肠癌及其附近正常黏膜组织中G-CSFR蛋白和其mRNA表达情况，并分析结直肠癌肿瘤细胞G-CSFR的表达及与临床病理因素的关系。结果免疫组化表明结直肠癌中有明显的G-CSFR蛋白的表达(31／42，73．81％)，并明显高于正常黏膜(20／42，47．62％，P＜0．001)，许多Cr-CSFR表达强阳性的结直肠癌，相应的正常黏膜G-CSFR阴性或弱阳性表达。G-CSFR的表达与肿瘤病理分期、分化程度相关(P=0．001、P＜0．001)，与病人性别、年龄、肿瘤大小无明显相关(P=O．346、P=0．686：P=O．459)。RT-PCR结果示42例肿瘤标本中21例呈G-CSFR mRNA阳性表达，而相应正常黏膜仅11例。结论C-CSFR在结直肠癌中的表达较正常黏膜明显上调，结直肠癌患者应用G-CSF时应考虑其对肿瘤细胞的影响。     

侧方入路半椎板切除治疗脊髓哑铃形肿瘤和脊髓腹侧肿瘤(附35例报告)

采用侧方入路半椎板切除治疗脊髓肿瘤35例,其中颈段17例,胸段14例,腰段4例;哑铃形神经鞘瘤24例,脊膜瘤8例,脊髓髓内肿瘤2例,脊索瘤1例。术前均有神经功能缺失。本入路适用于巨大、复发性哑铃形肿瘤,脊髓腹侧肿瘤,对肿瘤的根治率高,住院时间短,术后脊柱畸形的发生率低。但术中要尽可能采用显微外科技术及高速电钻。     

二联式肛外手工吻合联合腹腔镜治疗超低位直肠癌疗效评价

目的评价腹腔镜下超低位直肠癌保肛术的安全性及临床价值。方法应用超声刀在腹腔镜下对43例超低位直肠癌患者实施全直肠系膜切除原则的根治性手术,肛门部用二联式手工吻合法完成结-直肠/肛管吻合。术后3、6个月测试其直肠肛管功能,包括每日排便次数、排便感觉及控便功能。结果 43例患者手术经过均顺利,全组无手术死亡病例,术后发生吻合口瘘4例(占9.3%),肛门粪渍性湿疹8例(占18.6%),术后局部复发4例(占9.3%),随访中有2例死亡;2～3个月恢复预感便意,3～4个月恢复控便能力,平均每天排便3～4次,无大便失禁,术后6个月排便控制优良率达88.37%,6个月后各项测试结果与术前比较无统计学差异。结论超低位直肠癌行腹腔镜下超低位切除、肛门部二联式手工吻合保肛术具有安全、经济、创伤小、疗效可靠,住院时间短等优点。     

Detection of colorectal carcinoma on double contrast barium enema when double reporting is routinely performed: an audit of current practice

PURPOSE: To determine the sensitivity of double contrast barium enema (DCBE) in the detection of colorectal carcinoma (CRC) when double reporting is routinely performed. METHOD AND MATERIALS: Over a 1-year period all patients with a diagnosis of CRC within a large teaching hospital were identified. Using computer records, any patient with CRC who had had a DCBE within 5 years of diagnosis was identified. During this time period all DCBE were double reported by the radiographer or radiology trainee who performed the enema and by a consultant radiologist specializing in gastrointestinal radiology. RESULTS: Over the 1-year period 169 patients were identified with a diagnosis of CRC. Seventy patients had had a DCBE within the preceding 5 years. Sixty-four patients had had CRC diagnosed on the DCBE. One patient had a sessile polyp diagnosed, which was removed at colonoscopy and found to be an invasive adenocarcinoma. In five cases (7%) the CRC was not diagnosed on DCBE. In three cases the lesions could be seen retrospectively, in one case the lesion could not be seen and in one case the examination had been incomplete. CONCLUSION: In our series the miss-rate for CRC was 7%. Previous studies have shown miss-rates of 15-24%. These studies have not routinely employed double reporting. Our results suggest that double reporting of DCBE significantly reduces the miss-rate and that this reduction is due to fewer perceptive errors.     

大肠癌APE1的表达特点及临床意义

目的 探讨脱嘌呤／脱嘧啶核酸内切酶（APE1）在大肠癌发生、发展中的作用。方法 应用免疫组化SP法检测125例大肠癌、72例大肠腺瘤、60例癌旁大肠黏膜和40例正常大肠黏膜中APE1的表达情况,并分析APE1与大肠癌临床病理之间的关系。结果 正常大肠黏膜APE1呈胞核表达,大肠腺瘤和大肠癌组织APE1表达特征发生改变,呈胞核表达、单纯胞质表达或核浆共同表达。APE1胞质异位表达率大肠癌组织为73．6％,大肠腺瘤组织为83．3％,二者无显著性差异（P〉0．05）,但均显著高于癌旁大肠黏膜（10％）和正常大肠黏膜（0％,P〈0．01）。APE1胞质异位表达与大肠癌临床分期和淋巴结转移有关（P〈0．01,P〈0．05）。结论 APE1胞质异位表达可能在大肠癌的发生、发展中起重要作用。     

The impact of FDG-PET on the management algorithm for recurrent colorectal cancer.

Positron emission tomography (PET) has been successfully used to image colorectal cancer (CRC). This study evaluated the accuracy of 2-[(18)F]-fluoro-2-deoxy- D-glucose (FDG) PET for the detection and staging of recurrent CRC and the consequent impact on clinical management. Forty-two patients previously treated for CRC were investigated for suspected recurrence and, if recurrence was confirmed, the extent of disease was evaluated. All patients underwent whole-body FDG-PET and computed tomography (CT) scan and results were compared to assess sensitivity, specificity and diagnostic accuracy for each modality. We then assessed the FDG-PET directed alteration in clinical management from that planned on the basis of spiral CT results. FDG-PET was more sensitive (93%) than CT (73%) for detection of recurrence (specificity 58% and 75%, respectively). FDG-PET yielded a correct diagnosis in 35 (83%) out of 42 patients, while CT did so in 31 patients (74%). FDG-PET was more accurate than CT for staging local recurrence (sensitivity 100%, specificity 86% with FDG-PET vs 75% and 100%, respectively, with CT) and CRC liver metastases (sensitivity 100% vs 45%; specificity 100% for both). Overall, PET upstaged 8 out of 30 patients (27%) and altered patient management in 16 (38%) cases. This study confirms that FDG-PET is more sensitive than CT for the detection and staging of recurrent CRC. The results also indicate that FDG-PET is an accurate means of selecting appropriate patients for operative treatment. When applied to routine clinical practice, patient management is altered.     

Contrast-enhanced CT colonography with 64-slice MDCT compared to endoscopic colonoscopy in the follow-up of patients after colorectal cancer resection

BackgroundSeventy percent of newly diagnosed colorectal cancer cases are potential candidates for curative surgery, but after resection, in 30%, the tumor will recur.Postoperative follow-up includes endoscopic colonoscopy (EC) and computed tomography (CT). There have been only a few publications on the use of contrast-enhanced CT colonography (CECTC) in the follow-up of these patients.MethodsTwenty-nine consecutive patients after resection of colorectal cancer underwent CECTC and EC on the same day. CECTC studies were reviewed for identification of strictures, recurrence, polyps and metastases.ResultsThe anastomosis was identified in 96% of patients on CECTC and in 82% on endoscopic colonoscopy. One stricture was identified by both techniques. One extraluminal recurrence was depicted only on CECTC. Sensitivity in detecting polyps was per polyp 93% and per patient 100%.ConclusionCECTC performed on a 64-slice multidetector CT is reliable in imaging the postoperative colon for the follow-up of patients after resection of colorectal cancer.     

CT脑灌注联合血管成像在烟雾病血管重建术中的应用价值

目的探讨CT灌注(CTP)联合CT血管成像(CTA)分析在烟雾病(MMD)血管重建术中的意义。方法对18例烟雾病患者于术前及直接重建术后1周、间接重建术后3个月分别行CTP、CTA检查,对手术前、后术侧额、颞叶的CBV、CBF、MTT、TTP进行定量、定性及对比分析,评估颈内、颅内、外动脉的血管情况,为血管重建术术前制定手术方案、选择手术侧别,术后评价吻合血管的通常及手术疗效。结果 18例患者中1例行直接重建,术后吻合血管通畅,手术后术侧额、颞叶与术前比较,CBV、CBF增加,MTT不变、TTP延长,17例行间接重建,术后侧枝吻合血管形成,手术前、后术侧额、颞叶比较,CBF、CBV增加,MTT、TTP降低,差异有统计学意义(P0.05)。结论 CTP联合CTA能获得血管成像及全脑灌注成像,有助于MMD术前治疗方法的选择和术后疗效观察。     

Associations in breast and colon cancer screening behavior in women

RATIONALE AND OBJECTIVES: Gender-based psychosocial factors appear to influence colorectal cancer (CRC) screening adherence. Given its near-universal acceptance by the public, screening mammography represents a potential "teachable moment" for educating patients about the risk of CRC. Accordingly, to better understand screening behaviors among women, data from the Behavioral Risk Factors Surveillance Survey (BRFSS) were analyzed to identify potential relationships that would allow interventions to enhance CRC screening. MATERIALS AND METHODS: Women 50 years and older who participated in the BRFSS 2001 survey were included in the analysis. Colorectal, breast, and cervical cancer screening adherence with American Cancer Society guidelines was determined. We identified the association between breast and cervical cancer screening adherence and general health and demographic characteristics with CRC screening adherence. RESULTS: After adjustment for sociodemographic factors in a multivariate analysis, women 60-69 years old (adjusted odds ratio [OR], 1.50; P < .01) and 70-79 years old (adjusted OR, 1.39; P < .01), having achieved at least some high school (adjusted OR, 1.62; P < .01) or college (adjusted OR, 2.11; P < .01) education, having health coverage (adjusted OR, 1.67; P < .01) or a personal physician (adjusted OR, 1.60; P < .01), and adherence to screening mammography (adjusted OR, 2.42; P < .01) and Pap smear (adjusted OR, 1.70; P < .01) were independently associated with an increased likelihood CRC screening adherence. Women in self-reported good general health were less likely to have adhered to CRC screening guidelines (adjusted OR, 0.79; P < .01). Current smokers were also less likely to have adhered to CRC screening guidelines than were women who never smoked or formerly smoked (adjusted OR, 0.76; P < .01). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening (51.5% CRC screening adherence) compared with women who adhered to neither screening test (8.2% CRC screening adherence), with an adjusted OR of 5.67 (P < .001). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening than were women who adhered to either screening test (38.0% CRC screening adherence) with an adjusted OR of 1.94 (P < .001). CONCLUSION: Women with up-to-date mammography and cervical cancer screening were more likely to be up-to-date with CRC screening. Regardless of the increased association between non-CRC-related cancer screening and CRC screening, rates of CRC screening utilization remained low in these otherwise compliant populations.     

血清蛋白质指纹谱对结直肠癌根治术后复发转移的诊断价值

目的应用血清蛋白质指纹谱筛选与结直肠癌根治术后复发转移相关的特异性蛋白标志物。方法收集结直肠癌根治术后经至少2年随访、明确有复发转移的141例患者手术前后的血清标本,以及无复发转移的109例患者手术前后的血清标本,应用表面增强激光解吸离子化飞行时间质谱仪(SELDI-TOF-MS)检测所有患者的血清蛋白质指纹谱,并采用化学发光法测定血清CEA含量。筛选出与术后复发转移相关的血清标志蛋白,应用ROC曲线评价其对结直肠癌根治术后复发转移的诊断效能并与CEA进行比较。结果分析显示,在根治术后出现复发转移的结直肠癌患者中,M/Z为7763的血清蛋白不仅在术前表达增高,在明确有复发转移时仍呈显著高表达。该蛋白预测复发转移的灵敏度为92.0%,特异度为83.9%,约登指数指数为0.759,而CEA预测复发转移的灵敏度为52.0%,特异度为82.3%,Youden指数0.343。结论M/Z为7763的血清蛋白可能是结直肠癌根治术后复发转移的特异性标志蛋白,有望用于术后复发转移的监测。     

Miss rate of colorectal cancer at CT colonography in average-risk symptomatic patients

Objectives

Computed tomographic colonography (CTC) is a less burdensome alternative to colonoscopy in excluding colorectal cancer (CRC) in symptomatic patients. We evaluated the proportion of patients who underwent CTC in whom CRC was missed.

Methods

Patients who had undergone CTC in the period 1 January 2007 to 1 January 2011 were merged with all cases of CRC recorded in the Cancer Registry between 1 January 2007 and 1 July 2011 to identify all patients who had undergone CTC less than 2 years before CRC had been diagnosed.

Results

In 53 out of 1,855 patients who had undergone CTC, CRC was diagnosed. Of these, 40 patients had suspected CRC and 5 had large polyps at CTC. In five patients with an indeterminate mass, further investigation confirmed malignancy. One cancer in the caecum was missed because of poor distension. Two cancers were missed: one in the distal rectum and one in the ascending colon. Sensitivity of CTC for CRC was 94.3 % (95 % CI 88–100 %). The true miss rate, excluding the inadequate distended study, was 2 out of 53 (3.8 %).

Conclusion

This study shows that the miss rate for CTC is low, which means that CTC is accurate in excluding CRC in symptomatic patients at a relatively low risk of CRC.

Key Points

? The miss rate for colorectal cancer (CRC) on CT colonography (CTC) is low. ? CTC is accurate at excluding CRC in symptomatic patients. ? CTC is the method of choice in symptomatic patients to exclude CRC.     

Contrast-enhanced computed tomographic colonography in the follow-up of colorectal cancer patients: a feasibility study

The aim of our study was to assess whether contrast-enhanced CT colonography is a feasible alternative to both conventional colonoscopy and liver ultrasonography in the follow-up program of colorectal cancer patients. Thirty-five patients, surgically treated for colorectal cancer, underwent a follow-up program that included physical examination, carcinoembryonic antigen serum assay, conventional colonoscopy, liver ultrasonography, and chest X-ray. For these patients, we added a yearly contrast-enhanced CT colonography. All CT examinations were performed with a high-resolution protocol using a multidetector spiral CT scanner (Siemens, Erlangen, Germany) prior to and after the administration of 130 ml of i.v. contrast material. Images were directly analyzed on a dedicated workstation by two radiologists to determine colonic evaluation, visualization of colonic anastomosis, presence of polyps, and extra-colonic findings. Colonic evaluation was judged as optimal in 91.7% of all colonic segments. All mechanical surgical anastomoses were visualized with CT colonography. There was no evidence of anastomotic recurrence. Seven polyps were detected in five different patients with CT colonography, with two false-positive and no false-negative examinations. Three liver metastases and two basal pulmonary nodules were also identified. Contrast-enhanced CT colonography is a feasible alternative to both conventional colonoscopy and liver ultrasonography in the follow-up of patients operated on for colorectal cancer. Electronic Publication     

CT Colonography to exclude colorectal cancer in symptomatic patients

Objectives  

CT Colonography (CTC) is being increasingly used for the radiological evaluation of colorectal symptoms. Aim of this study was to assess the role of CTC in excluding a colorectal cancer (CRC) in older symptomatic patients.     

18F-FDG PET/CT superior to serum CEA in detection of colorectal cancer and its recurrence

The aim of this study was to examine whether positron emission tomography (PET)/computed tomography (CT) can detect more cases of colorectal cancer (CRC) than serum carcinoembryonic antigen (CEA), both at initial staging and during surveillance for recurrence. A retrospective review of 639 CRC patients imaged with PET/CT was performed. PET/CT was superior to serum CEA in detecting CRC, identifying 2.5 times as many CRC at initial staging compared to serum CEA and 1.5 times as many CRC recurrences. The current guideline recommendations of utilizing PET/CT only in the context of a rising serum CEA will miss more than one third of all CRC recurrences.     

胃食管连接部/贲门癌根治术术式选择临床疗效分析

 目的 探讨胃食管连接部/贲门癌根治性切除术及重建术式的临床效果分析。方法 分析2004-10至2013-05行胃食管连接部/贲门癌根治切除术患者89例资料,其中26例为近端胃切除术后食管残胃吻合重建(食管胃吻合组),42例为全胃切除术后Roux-en-Y食管空肠吻合重建(食管空肠 Roux-en-Y吻合组),21例行近端胃切除术后限制性双通道折叠空肠间置重建(西京术式组),比较3组患者手术指标、术后并发症、营养状态以及术后生存率。结果 食管胃吻合组手术时间、出血量均明显少于另两组(均 P<0.05);食管空肠 Roux-en-Y吻合组淋巴结清扫数明显多于另两组,但营养指标方面不如另两组(均P<0.05);3组并发症总发生率均无统计学差异,但食管空肠Roux-en-Y吻合组倾倒综合征发生率明显高于另两组(均P<0.05);3组患者 1、3、5年生存率差异均无统计学意义(χ²=0.440,P=0.803;χ²=0.234,P=0.890;χ²=0.045,P=0.978)。 结论 三种胃食管连接部/贲门癌手术生存率相似,近端胃切除术加食管残胃吻合创伤性小,近端胃切除术加限制性双通道折叠空肠间置重建术后生活质量更高,临床应根据医师手术技巧和患者实际情况选择方案。
     

Magnetic resonance colonography versus colonoscopy as a diagnostic investigation for colorectal cancer: a meta-analysis

AIMS: Magnetic resonance colonography (MRC) is emerging as a potential complementary investigation for the diagnosis of colorectal cancer (CRC) and also for benign pathology such as diverticular disease. A meta-analysis reporting the use of MRC is yet to be performed. The aim of this study was to evaluate the diagnostic accuracy of MRC compared with the gold-standard investigation, conventional colonoscopy (CC). METHODS: A literature search was carried out to identify studies containing comparative data between MRC findings and CC findings. Quantitative meta-analysis for diagnostic tests was performed, which included the calculation of independent sensitivities, specificities, diagnostic odds ratios, the construction of summary receiver operating characteristic (SROC) curves, pooled analysis and sensitivity analysis. The study heterogeneity was evaluated by the Q-test using a random-effect model to accommodate the cluster of outcomes between individual studies. RESULTS: In all, 8 comparative studies were identified, involving 563 patients. The calculated pooled sensitivity for all lesions was 75% (95% CI: 47% to 91%), the specificity was 96% (95% CI: 86% to 98%) and the area under the ROC curve was 90% (weighted). On sensitivity analysis, MRC had a better diagnostic accuracy for CRC than for polyps, with a sensitivity of 91% (95% CI: 97% to 91%), a specificity of 98% (95% CI: 66% to 99%) and an area under the ROC curve of 92%. There was no significant heterogeneity between the studies with regard to the diagnostic accuracy of MRC for CRC. CONCLUSION: This meta-analysis suggests that MRC is an imaging technique with high discrimination for cases presenting with colorectal cancer. The exact diagnostic role of MRC needs to be clarified (e.g. suitable for an elderly person with suspected CRC). Further evaluation is necessary to refine its applicability and diagnostic accuracy in comparison with other imaging methods such as computed tomography colonography.