直肠癌根治性切除术后局部复发的再手术治疗

目的 探讨对直肠癌根治性切除术后局部复发(LRRC)患者采用再手术治疗的效果和影响患者预后的因素.方法 回顾性分析1998年11月至2005年4月北京大学临床肿瘤学院收治的43例LRRC患者采用再手术治疗的临床资料,统计患者术后5年生存率、手术并发症发生率、围手术期死亡率,并用Kaplan-Meier法计算术后生存率,采用单因素分析和Cox回归模型对预后因素进行分析.结果 43例患者中35例行根治性切除,8例行姑息性切除或单纯造口术.手术并发症发生率为26%(11/43),围手术期死亡率为2%(1/43),术后5年生存率为9%(4/43).单因素分析显示,再手术方式选用根治性切除、原发肿瘤为TNM Ⅱ期、复发时间<24个月、CEA水平在正常范围的患者能获得较好的预后(χ~2=21.30,14.17,5.93,5.53,P<0.05).多因素分析中仅显示再次手术方式和原发肿瘤TNM分期是影响LRRC患者预后的独立因素(χ~2=8.89,6.96,P<0.05).结论 对于TNM分期较早的LRRC患者行根治性切除,其预后较好.     

直肠癌术后复发再治疗的疗效探讨

目的探讨直肠癌术后局部复发再治疗的疗效。方法对1990年1月至2000年12月收治的217例直肠癌根治术后复发患者不同治疗方法的疗效进行回顾性分析。结果217例患者中单纯手术(Ⅰ组)72例,手术切除加放疗(Ⅱ组)48例,单纯放疗(Ⅲ组)58例;未治疗(对照组)39例。Ⅰ、Ⅱ、Ⅲ组及未治疗组中位存活期分别为25、27、14及4个月。Ⅰ、Ⅱ组1、3年生存率显著优于Ⅲ组(P<0.01)。结论提高直肠癌复发患者疗效的关键是密切随访、早期诊断和实行手术或以手术为主的综合治疗。     

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目的 回顾性比较分析直肠癌术后局部复发不同治疗方法的疗效。方法 1990年1月至1997年12月收治的直肠癌根治术后复发病人154例，再次接受治疗117例，其中I组（单纯手术）44例，Ⅱ组（手术切除加放疗）28例，Ⅲ组（单纯放疗）45例。结果 I、Ⅱ、Ⅲ及未治疗组中位存活期分别为26.8、21、14及4个月。I组1、3年生存率显著优于Ⅲ组（P＜0．05）。结论 提高直肠癌复发病人的疗效关键是密切随访，早期诊断，争取手术或以手术为主的综合治疗。     

Obesity paradox in prostate cancer: increased body mass index was associated with decreased risk of metastases after surgery in 13,667 patients

Introduction

Obesity might negatively affect prostate cancer (PCa) outcomes. However, evidence according to the associations between obesity and metastases-free survival after radical prostatectomy (RP) is still inconsistent.

Methods

We relied on PCa patients treated with RP at the Martini-Klinik Prostate Cancer Center between 2004 and 2015. First, multivariable Cox regression analyses examined the impact of obesity on metastases after RP. Last, in a propensity score matched cohort, Kaplan–Meier analyses assessed metastases-free survival according to body mass index (kg/m²) (BMI) strata (≥ 30 vs. < 25).

Results

Of 13,667 individuals, 1990 (14.6%) men were obese (BMI ≥ 30). Median follow-up was 36.4 month (IQR 13.3–60.8). Obese patients were less likely to exhibit metastases after RP (HR 0.7, 95% CI 0.5–0.97, p = 0.03). Similarly, after propensity score adjustment, obesity was associated with increased metastases-free survival (log rank p = 0.001).

Conclusion

We recorded the obesity paradox phenomenon in PCa patients. In particular, high BMI (≥ 30) was associated with decreased risk of metastases after RP, despite an increased risk being anticipated. Whether statin use might have affected the results was not assessed. Further research is needed to unravel the controversially debated association between obesity and PCa.

     

直肠癌根治术后局部复发的因素和预防要点

直肠癌根治术后局部复发已引起临床广泛关注并成为研究难点。影响直肠癌术后局部复发因素较多,但主要有肿瘤远切缘、环周切缘肿瘤浸润程度、直肠系膜切除范围,肿瘤组织分化程度,临床肿瘤TNM分期,手术方式选择等。重视手术操作规范,合理选择手术方式,术中确保远近切缘及环周切缘阴性,坚持全直肠系膜切除（TME）原则,给予新辅助放化疗等综合治疗是预防直肠癌术后复发的关键。     

Risk factors associated with local recurrence after curative resection for rectal cancer

A retrospective study was conducted to identify the factors related to locoregional recurrence in patients who underwent curative resections for primary rectal cancer between January 1986 and April 1994 at Ankara Oncology Hospital in Turkey. A step-wise logistic regression analysis was applied for 116 patients who had complete follow-up. Age, sex, macroscopic size of the lesion, tumor location in the rectum as determined by the distance from the anal verge, obstruction at presentation, tumor histology, lymphatic invasion, venous invasion, stage according to TNM classification, differentiation of the tumor, surgical treatment modality, radical abdominopelvic lymphadenectomy (RAPL), and blood transfusion were used as the clinico-pathologic variables. Locoregional recurrent disease was found after a mean follow-up period of 52 months in 28 (24.1%) patients, while the median recurrence-free period was 12 months. Univariate analysis demonstrated that age, disease stage, tumor grade, obstruction, RAPL, blood transfusion, and venous and lymphatic invasion were significant risk factors (P<0.05); however, using multivariate analysis, an increased risk for the development of locoregional recurrence was found to be associated with: age (P=0.0052), stage (P=0.0379), blood transfusion (P=0.0276), obstruction (P=0.0035), and RAPL (P=0.0069).     

直肠癌术后局部复发的再治疗

目的　探讨直肠癌术后局部复发的原因及再手术的重要性。方法　回顾性分析 2 9例直肠癌术后局部复发病例 ,结合文献复习并进行讨论。结果　Dixon术后复发 17例 ,Miles术后复发 8例 ,经腹直肠切除结肠拉出术后复发 2例 ,经肛局部切除术后复发 2例 ;再手术中行Dixon术 3例 ,Miles术 14例 ,Hartmann术 5例 ,后盆腔脏器切除术 1例 ,全盆腔脏器切除术 2例 ,局部姑息治疗 4例。结论　保肛手术指征不能过度放宽 ;注重直肠癌围手术期综合治疗 ;对局部复发病例应采取积极的再治疗。     

High-dose radioactive iodine therapy is associated with decreased risk of recurrence in high-risk papillary thyroid cancer

Objectives

We aimed to determine the effect of adjuvant radioactive iodine dose on recurrence rate in high-risk papillary thyroid cancer.

Obesity is associated with a decreased leptin transport across the blood-brain barrier in rats

Leptin exerts important effects on the regulation of food intake and energy expenditure by acting in the brain. Leptin is secreted by adipocytes into the bloodstream and must gain access to specific regions in the brain involved in regulating energy balance. Its action is mediated by interaction with a receptor that is mainly expressed in the hypothalamus but is also present in other cerebral areas. To reach these target areas, leptin most likely needs to cross the blood-brain barrier (BBB). In this study, we compared the permeability of leptin at the BBB in homozygous lean (FA/FA), high-fat diet-induced (HFD) obese rats (FA/FA rats on a highfat diet), and genetically obese fa/fa Zucker rats by quantifying the permeability coefficient surface area (PS) product after correction for the residual plasma volume (Vp) occupied by leptin in the vessel bed of different brain regions. The intravenous bolus injection technique was used in the cannulated brachial vein and artery using leptin radioiodinated with 2 isotopes of iodine (125I and 131I) to separately determine the PS and Vp values. The PS for leptin at the BBB in lean FA/FA rats ranged from 11.0 +/- 1.6 at the cortex to 14.8 +/- 1.4 x 10(-6) ml x g(-1) x ml(-1) at the posterior hypothalamus. The PS for leptin in HFD obese FA/FA and obese fa/fa rats ranged from 3.0- to 4.0-fold lower than in lean FA/FA rats. The Vp values were not significantly different among the 3 groups studied. SDS-PAGE analysis of the radioiodinated leptin after 60 min of uptake revealed intact protein in the 8 different brain regions. Plasma leptin levels were significantly higher in both obese rat groups compared with those in lean FA/FA rats. Leptin levels in cerebrospinal fluid were not significantly different among the 3 groups of rats. These findings strongly suggest that the leptin receptor (OB-R) in the BBB can be easily saturated. Saturation of the BBB OB-R in obese individuals would explain the defect in leptin transport into the brain described in this study.     

Laparoscopic colectomy is associated with decreased postoperative gastrointestinal dysfunction

Background  Major abdominal surgery is associated with early postoperative gastrointestinal dysfunction, which may lead to abdominal distention and vomiting, requiring nasogastric (NGT) tube insertion. This study aimed to compare the rates of early postoperative NGT insertion after open and laparoscopic colorectal surgery. Methods  A retrospective chart review was performed for patients who underwent colorectal surgery with removal of the NGT at completion of surgery. Patients who required reinsertion of the NGT in the early postoperative course were identified. The reinsertion rate for patients who underwent laparoscopic surgery was compared with that for the open group. Results  There were 103 patients in the open group and 227 in the laparoscopic group. In the laparoscopic group, 42 patients underwent conversion to open surgery. Reinsertion of the NGT was required for 18.4% of the patients in the open group, compared with 8.6% of the patients for whom the procedure was completed laparoscopically (p = 0.02). Conversion to open surgery resulted in a reinsertion rate of 17%. Conclusion  Laparoscopic colorectal surgery is associated with decreased postoperative gastrointestinal dysfunction, resulting in a significantly lower NGT reinsertion rate. Presented as a poster at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, (SAGES), Dallas, Texas, 26–29 April 2006, and at the annual meeting of the European Society for Endoscopic Surgeons (EAES), Berlin, Germany, 13–16 September 2006.     

三维适形放射治疗结合化疗治疗直肠癌术后复发疗效观察

目的 探讨三维适形放射治疗结合化疗治疗直肠癌术后复发的疗效。方法 回顾性分析56例直肠癌术后复发患者采取三维适形放射治疗(2Gy／次,5次／周,总剂量66～68Gy,6～7周完成)结合化疗(5-氟尿嘧啶0．75g／m^2,d1-5和d29-33;顺铂40mg／m^2,d1-3和d29-31)的疗效,生存分析采用Kaplan-Meier法。结果 患者1、2、3年肿瘤局部控制率分别为87．5％、66．1％、38．2％;1、2、3年生存率分别为88．3％、66．8％、44．2％,中位生存期25．3个月;1、2、3年无瘤生存率分别为82．7％、56．6％、30．1％。急性放射反应主要是急性放射性肠炎,多为1～2级。无晚期放射反应发生。结论 三维适形放射治疗结合化疗是治疗直肠癌术后复发的有效治疗方法。     

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近二十余年来,由于外科技术的不断提高,吻合器及双吻合技术的广泛应用,我国保肛手术的比例明显增加。但是如果不严格掌握其适应证,易导致术后局部复发。文献报道术后局部复发率为 5% ~20%,是影响直肠癌术后生存率的重要原因之一。所以研究术后局部复发形式,分析其原因,进而严格掌握保肛手术的适应证,是预防术后局部复发,提高治疗水平的重要课题。1　直肠癌术后局部复发形式及原因分析直肠癌根治术后由于切除了足够的原发病灶并清除了足够范围系膜及周围淋巴结,所以被认为是避免术后局部复发的理想术式。据文献报告直肠癌术后局部复发率…     

直肠癌局部复发的应对策略

直肠癌局部复发（locally recurrent rectal cancer,LRRC）在临床上较为常见．但目前尚无规范和权威性的分类和分期。通常．临床上将LRRC分为3种类型,即直肠腔内复发、盆腔复发和会阴部复发。我国直肠癌在结直肠癌中的比例超过50％．而北美和欧洲在30％左右。     

Tumour budding correlates with local recurrence of rectal cancer

Aim Predictive tools for local recurrence (LR) of rectal cancer are needed. This study assessed the predictive value of tumour budding detected by MNF‐116 and laminin‐5 γ2 chain (Ln‐5 γ2). Method In a case–control study, the surgical specimens of 48 patients with LR after from primary resection of rectal carcinoma and 82 control patients matched for gender and preoperative radiation from a population of 1180 patients operated with total mesorectal excison were studied. The presence of budding was examined using immunohistochemistry with Ln‐5 γ2 and pan‐cytokeratin staining with MNF‐116. Results Tumour budding counts ranged from 0 to 106 buds (mean 43, median 38) for all patients. Significantly more tumours with more than 35 buds were seen in the LR than in the control group (67 vs 44%; P = 0.02). The spread of budding was also more extensive in the LR than in the control group (63 vs 49%, P = 0.03). In a multivariate analysis with tumour, node, metastasis stage, MNF‐116‐stained budding was an independent predictor of local failure (P = 0.02). The budding frequency was higher in irradiated tumours in comparison with tumours that had not received irradiation (mean 53 vs 38, P = 0.03). For Ln‐5 γ2, more tumours with ≥10 buds were seen in the group with LR than among the control patients, but this difference was not statistically significant (73 vs 57%; P = 0.09). No additive value was found in the multivariate logistic regression model when Ln‐5 γ2‐stained budding frequency was added to MNF‐116 and tumour, node, metastasis stage. The agreement between budding frequency determined by MNF‐116 and Ln‐5 γ2 was moderate, with a κ‐coefficient of 0.34 (0.16–0.51). Conclusion Tumour budding determined by MNF‐116 staining may serve as a predictive marker for LR in rectal cancer.     

Local recurrence in colon and rectal cancer

Data on the incidence of colorectal cancer are alarming and reveal that it is currently the second cause of death from cancer. Most of these deaths are due to recurrence after surgery with curative intent. The factors associated with locoregional recurrence are mainly related to the tumor's histopathological characteristics and grade of invasion. With adequate training the surgeon should not appear among these factors. In rectal cancer this training involves the technique of mesorectal excision, adequate circumferential margin and selective neoadjuvant chemoradiotherapy. After curative resection, patients should be followed-up to detect asymptomatic recurrence. Isolated local recurrence occurs in 20-30% of patients, but even with liver or lung metastases curative surgery can be attempted and success depends on correct multidisciplinary preoperative evaluation. If the diagnosis is made when the tumor is in an incurable phase, the aim is to improve the patient's quality of life.