Diagnosis of degree of serosal invasion of carcinoma of the colon by angiography

Angiography (AG) using Prostaglandin E1 was performed on 35 cases of carcinoma of the colon in order to diagnose the degree of serosal invasion. The findings of AG were classified into 4 groups: AG-S3, abnormal change (like irregularity and/or encasement) up to marginal vessels; AG-S2, abnormality up to vasa recta; AG-S1, abnormality of penetrating branches of vasa recta; AG-S0, no distinct findings of above mentioned vessels. 1) Diagnosis of AG is in accord with the visible postoperative findings in 82.9%. 2) Diagnosis of AG is in accord with the histopathological findings in 32.4%. 3) Postoperative examinations confirmed the AG diagnosis precisely but the conflict with histopathological findings should not be overlooked. This may be the results of inflammatory change, adhesion and fibrosis around the carcinoma of the colon.     

CDX-2和KAI-1在结肠癌中的表达及临床意义

目的探讨尾型同源盒转录因子-2（CDX-2）和抑癌基因KAI-1在结肠癌中的表达并分析其临床意义。方法应用免疫组织化学SP法检测50例结肠癌组织及相应癌旁组织和25例正常结肠黏膜组织中CDX-2和KAI-1蛋白的表达,分析其表达与结肠癌患者临床病理特征的关系以及二者表达的相关性。结果①在结肠癌组织及相应癌旁组织（距癌组织≤2cm）和正常结肠黏膜组织中CDX-2蛋白表达阳性率分别为34％（17／50）、54％（27／50）及88％（22／25）,KAI-1蛋白表达阳性率分别为30％（15／50）、58％（29／50）及92％（23／25）,CDX-2和KAI-1在结肠癌组织中的蛋白表达阳性率均分别明显低于相应癌旁组织（P〈0．05）及正常结肠黏膜组织（P〈0．05）,其在癌旁组织中的表达阳性率也均明显低于正常结肠黏膜组织（P〈0．05）。②CDX-2和KAI-1蛋白表达阳性率与结肠癌淋巴结转移、浸润深度及分化程度均有关（P〈0．05）,即在有淋巴结转移、浸润深度浸及浆膜及分化程度较低者中CDX-2和KAI-1蛋白表达阳性率均明显低于其在无淋巴结转移、浸润深度未及浆膜及分化程度较高者（P〈0．05）,二者均与患者的发病年龄和性别无关（P〉0．05）。③Spearman等级相关分析表明,CDX-2和KAI-1蛋白阳性表达呈正相关（rs=0．544,P〈0．01）。结论CDX-2和KAI-1的表达可能与结肠癌的发生、发展、浸润、转移及预后相关,联合评价其功能可能对结肠癌治疗具有一定指导意义。     

直肠癌根治术后髂内动脉加门静脉置泵化疗预防局部复发和肝转移的研究

目的探讨髂内动脉加门静脉置泵化疗预防直肠癌术后局部复发和肝转移的价值.方法将我院96例直肠癌术前随机分成两组,门静脉加髂内动脉灌注化疗组(治疗组)48例与外周静脉化疗组(对照组)48例,对其疗效进行分析.结果治疗组1、3、5年生存率分别是100%、83%、52%;局部复发率和肝转移率是13%、13%.对照组是88%、68%、32%,26%、28%.两组各项指标分别比较,差异有显著意义(P<0.01).结论置泵灌注化疗在预防直肠癌术后局部复发和肝脏转移的治疗效果优于外周静脉全身化疗.     

A prospective clinicopathologic study of venous invasion in colorectal cancer

We performed a long-term prospective study on venous invasion of colorectal cancer. The degree of venous invasion was divided into four stages (V0 through V3). Venous invasion was classified into three types by location (Vx, Vy, and Vz). Hepatic metastasis occurred in 27%, 33%, and 20% of patients with V2, V3, and Vz tumors, respectively. Local recurrence occurred in 33% and 15% of the V3 and Vz groups, respectively. However, there were no significant differences among the groups in terms of the rate of pulmonary metastasis. The 6-year survival rate for Dukes' stage B tumors was 94%, 88%, and 74% in the V0, V1, and V2 groups, respectively. There was a significant difference in the survival rate between patients with V0 tumors and V2 and V3 tumors. However, no significant difference was noted in the location. In Dukes' stage C tumors, on the other hand, the survival rate was 77%, 56%, and 44% in the V1, V2, and V3 groups, respectively. Also, it was 85%, 73%, and 45% in Vx, Vy, and Vz cases, respectively. Significant differences were noted between V1 and V3 (or V2), and between Vz and Vx (or Vy). It appears that the degree and location of venous invasion influence not only hepatic metastasis, local recurrence, and survival rates but also have prognostic value.     

EphrinA1在原发性肝细胞癌中的表达及临床意义

目的探讨原发性肝细胞癌中EphrinA1的mRNA和蛋白表达水平及其临床意义。方法应用逆转录聚合酶链反应（RT-PCR）及免疫组织化学方法检测EphrinA1的mRNA及蛋白在40例肝癌及相应的癌旁肝组织和10例正常肝组织中的表达水平,并分析其与临床病理学特点之间的关系。结果40例肝癌组织及相应的癌旁肝组织和10例正常肝组织中均有EphrinA1 mRNA的表达。RT-PCR分析显示EphrinA1mRNA在肝癌组织（0．5413±0．1527）中的表达显著高于癌旁肝组织（0．3895±0．0549,P〈0．05）和正常肝组织（0．3770±0．1055,P〈0．05）,而在癌旁肝组织（0．3895±0．0549）和正常肝组织（0．3770±0．1055）中的表达差异无统计学意义（P〉0．05）。从正常肝组织、癌旁肝组织到肝癌组织,EphrinA1蛋白的阳性表达率分别为20％（2／10）、35％（14／40）和62％（25／40）,呈递增趋势（x^2=14．762,P〈0．05）。EphrinA1蛋白的过表达与肝癌细胞的分化程度、门静脉癌栓的形成及淋巴结转移等临床病理因素有关（P〈0．05）。结论EphrinA1蛋白的过表达与肝癌细胞的分化程度、淋巴结转移和门静脉癌栓有密切联系,提示其可能在肝癌的恶性转化、侵袭和转移过程中发挥重要作用。     

Clinicopathologic study on venous invasion of colo-rectal cancer: a prospective study

Metachronous liver metastasis developed less than in 5% of v0 and v1 groups, while it developed in 22% of v2 and v3 groups. In addition, it developed in 15% of EF(I) group, in 19% of EF group, in 10% of Intramural greater than Extramural group and in 16% of the Intramural less than or equal to Extramural group. Six-year survival rate of v0, v1, v2 and v3 groups in the cases of curative resection for advanced colo-rectal cancer were 97%, 85%, 57% and 51%, respectively. Also those of E, EF, EI(F), Intramural, Intramural greater than Extramural and Intramural less than or equal to Extramural groups were 83%, 65%, 55%, 86%, 80% and 55%, respectively. Non-hematogenous recurrence developed in 19.4% of v3 group, in 13.6% of EF(I) group and in 15% of Intramural less than or equal to Extramural group. Conclusions were as follows: (1) There was a close relationship between venous invasion and development of liver metastasis (or of non-hematogenous recurrence) and survival of patients. (2) It was proved that the diagnostic criteria of venous invasion established by the authors were good indices to predict survival of colo-rectal cancer patients.     

Experimental liver metastasis. Implications of clonal proclivity and organ specificity

"Spontaneous" lung metastases develop in over 50% of the animals bearing subcutaneous isografts of WB-2054, a rat colon carcinoma. A metastatic variant has been developed by "Fidler" type in vivo selection, yielding 100% lung metastasis. In a five-week assay to test the organ specificity of this lung metastatic variant, however, "experimental" liver and lung metastases could be induced in 100% and 60% of animals on portal venous and intravenous injections, respectively. The results demonstrate selection of a metastatic variant from heterogeneous primary tumor, and suggest at least two interacting mechanisms: (1) mechanical (the anatomy of the blood-borne metastatic pathways) and (2) biologic (factors intrinsic to primary tumor subpopulations that can be selected for metastatic proclivity). In addition, liver metastases were successfully established from colon tumors induced by cecal wall injection of tumor cells. Such a spontaneous liver metastasis model will be useful to study the specific mechanisms involved during metastasis of colon cancer to the liver.     

Treatment of colorectal liver metastasis with biliary and portal vein tumor thrombi by hepatopancreatoduodenectomy

We present a case of a large colorectal liver metastasis with portal vein and biliary tumor thrombi and duodenal and jejunal direct invasion that required hepatopancreatoduodenectomy. A 38-year-old woman presented to her local hospital with right back pain and jaundice. She had undergone transverse colectomy and limited liver resection for transverse colon cancer with a synchronous liver metastasis in September 1991, and low anterior resection for rectal carcinoma in January 1996. She was diagnosed as having colorectal liver metastasis and was referred to our hospital for possible surgery. Radiologic and endoscopic examinations revealed a large liver tumor occupying the right lobe, biliary dilation in the left lateral section, and a portal vein tumor thrombus. Invasion of the inferior vena cava and the right renal vein were also suspected. Intraoperative findings revealed a large liver tumor that occupied the right lobe and invaded the duodenum and jejunum. The tumor was resected successfully by right trisectionectomy, caudate lobectomy, pancreatoduodenectomy, partial resection of the jejunum, and combined portal vein resection and reconstruction. The inferior vena cava, right kidney, and renal vein could be detached from the tumor. The patient has enjoyed an active life without recurrence for 2 years since the operation.     

内镜超声检查对胰腺癌进展程度的评估

目的：正确诊断胰腺癌对周围脏器的侵犯程度。方法：在１８０例经超声内镜（ＥＵＳ）诊断的胰腺癌中,分析６０例同时具有病理学、体外Ｂ超（ＵＳ）、ＣＴ和ＥＲＣＰ检查的６０例病人。比较以上４种影像学检查方法对胰腺癌７种进展程度指标（胰前方被膜侵犯、胰后方组织侵犯、胆总管胰段侵犯、十二指肠侵犯、门静脉侵犯、动脉侵犯及局部淋巴结转移）的诊断正确率。结果：ＥＵＳ诊断准确率分别达８９％,９０％,８２％,７１％,７６％,８６％,７５％,均高于ＵＳ、ＣＴ和ＥＲＣＰ,其中ＥＲＣＰ仅能显示胆总管胰段,但其诊断胆总管胰段侵犯正确率与ＥＵＳ相当（８０％）。结论：ＥＵＳ对胰腺癌进展程度的诊断有较大价值。     

人结肠鳞癌直肠鳞腺癌SCID鼠原位移植高转移模型的建立及其生物学特性的研究

目的 建立人结肠鳞癌直肠鳞腺癌SCID鼠原位移植高转移模型,为探讨理想的治疗结肠癌肝转移和预防结肠癌根治术后肝转移的方法提供实验工具。方法 采用组织学完整的结肠癌手术标本植入SCID鼠结直肠（粘膜层）壁内,观察原位移植的成瘤、移植瘤的侵袭和转移及其形态学特征（光镜、电镜、免疫组织化学）。结果 两株人结肠癌SCID鼠均获原位移植成功。人结肠鳞癌SCID鼠原位移植模型HCS-HMN-1已传至19代,人直肠鳞癌SCID鼠原位移植模型HRSA-HMN-2已传至23代,共移植SCID鼠223只,其移植生长率和自发转移率及液氮冻存复苏成活率均为100％,移植瘤在结直肠内呈广泛原位侵袭性生长、淋巴结转移、肝转移和全腹腔播散转移。并具有分泌CEA的功能。移植瘤细胞病理学和电镜观察、流式细胞仪DNA含量检测及染色体核型分析与瘤源人结直肠癌细胞完全一致。结论 本研究所建立的两株人结直肠癌SCID鼠高转移模型完整地模拟了人结直肠癌侵袭和转移的临床过程。为进一步研究结直肠癌肝转移、治疗和预防结直肠癌根治术后肝转移的方法提供了理想的实验动物模型。     

Intraportal endovascular ultrasonography in the diagnosis of portal vein invasion by pancreatobiliary carcinoma.

OBJECTIVE: The purpose of this study was to determine the value of intraportal endovascular ultrasonography (IPEUS) in the diagnosis of portal vein invasion by pancreatobiliary carcinoma. The authors reported their experiences with this new technique and compared it with conventional imaging technologies, such as portography and computed tomography (CT). SUMMARY BACKGROUND DATA: Pancreatobiliary carcinoma often invades the portal vein. Observation of the echogenic band of the portal vein wall by means of a high-frequency, high-resolution intravascular ultrasound catheter allows for the accurate diagnosis of the portal vein invasion. METHODS: A prospective study of 30 consecutive patients with pancreatobiliary carcinoma (16 pancreatic carcinomas, 8 bile duct carcinomas and 6 gallbladder carcinomas) was performed. In 23 cases IPEUS was performed intraoperatively from the superior mesenteric venous route with an 8 French, 20 MHz intravascular ultrasound catheter. In 7 cases IPEUS was performed before surgery from the percutaneous transhepatic route with a 6 French, 20 MHz intravascular ultrasound catheter. The finding of IPEUS was confirmed by pathologic examination of resected specimens and surgical exploration. The results of IPEUS were compared to those of portography and CT. RESULTS: Intraportal endovascular ultrasonography visualized the portal vein wall as an echogenic band with a thickness of 0.5 mm to 1.0 mm. The diagnostic criterion of portal vein invasion was destruction of this echogenic band. Portal vein invasion was found in 15 of 30 cases. Vascular invasion was confirmed by pathologic examination of resected specimens in 10 patients and operative findings in 5. The sensitivity, specificity, and overall accuracy of IPEUS for diagnosis of portal vein invasion was 100%, 93.3%, and 96.7%, respectively. The values were 80%, 67.7%, and 73.3% for portography and 53.3%, 80%, and 66.7%, respectively, for CT. CONCLUSIONS: Intraportal endovascular ultrasonography provided precise information about the relationship between the pancreatobiliary tumor and the portal vein wall. It was capable of accurately detecting or excluding early invasion of the portal vein wall by pancreatobiliary carcinoma.     

结直肠癌肝转移的诊断和治疗

目的 探讨结直肠癌肝转移的诊断和治疗效果.方法 回顾性分析25 例结直肠癌肝转移的临床资料,其中原发盲升结肠癌9 例,横结肠癌3 例,降结肠癌2 例,乙状结肠癌8 例,直肠癌3 例.同时性肝转移癌9例,异时性肝转移癌16 例.肝左叶转移15 例,肝右叶转移4 例,左右叶转移6 例.单个转移15 例,多个转移10例.高分化腺癌13 例,中分化腺癌5 例,低分化腺癌6 例,未分化腺癌1 例.9 例同时性肝转移癌中施行肝左外叶切除7 例,其中加1 例门静脉插管埋泵化疗;右前叶切除2 例,1 例仅作门静脉和肝动脉双插管埋泵化疗.16例异时性肝转移癌中施行肝左外叶切除4 例,左半肝切除5 例,肝右前叶切除2 例,门静脉和肝动脉双插管埋泵化疗2 例,股动脉插管肝动脉介入治疗3 例.结果 全组均经3 年随访,同时性肝切除术8 例中5 例存活(62.5%),异时性肝切除术11 例中4 例存活(36.3%),仅作门静脉和肝动脉插管埋泵化疗或股动脉插管肝动脉介入化疗6 例中2 年内死亡5 例,3 年死亡1 例,3 年存活率仅16.6%.结论 同时性或异时性结直肠癌肝转移,只要全身情况和局部条件许可,均应首选手术切除治疗,以提高患者生存率.对不能切除的患者,可采用动、静脉插管埋泵或作股动脉插管肝动脉介入化疗,以延长患者生命.     

The clinical significance of venous invasion in cancer of the stomach

Specimens from 235 surgically treated cases of gastric cancer were examined for venous invasion in order to investigate its clinical significance. A total of 87 (37.0 per cent) cases showed histologic evidence of venous invasion, with the incidence being 48.3 per cent of 180 cases, after the exclusion of 55 cases where cancerous invasion was limited to the mucosa. The frequency of venous invasion varied with the gross type of tumor, the depth of penetration and the degree of differentiation, being highest in tumors of type 2 and moderately differentiated adenocarcinoma. It increased proportionately dependeing upon the depth of penetration and the incidence increased in cases where there was evident lymphatic invasion or lymph node metastasis. The long term survival rate significantly decreased in patients with venous invasion when compared to those without it. In this report, we also discuss the marked difference in the incidence of liver metastasis between gastric and colorectal carcinomas in relation to venous invasion of the primary tumor. Double staining with Victoria blue and hematoxylin-eosin for elastic fibers proved useful for detecting venous invasion in the carcinomatous tissue, though endothelial markers have great specificity for differentiating small veins from lymphatics.     

胰头癌的临床病理特点与根治术后预后的关系

目的　探讨胰头癌临床病理特点与根治术后预后的关系。方法　回顾分析 5 6例行胰头十二指肠切除术的胰头癌病人的临床病理特点 ,并用Kaplan Meier法、log rank法及秩和检验分析术后生存时间及生存时间之间的差异。结果　胰腺前方被膜及组织被肿瘤侵犯的 19例较未被侵犯的 37例、门静脉系被肿瘤侵犯的 18例较未被侵犯的 38例、淋巴结转移的 2 9例较无转移的 2 7例、腹膜种植转移的 3例较无种植转移的 5 3例、肝转移的 5例较无转移的 5 1例、远隔脏器转移 (包括腹膜种植转移和肝转移在内 )的 11例较无转移的 4 5例术后生存率均低 (P >0 0 5 )。而肿瘤大小 ,胰后面组织、胰内胆管、十二指肠壁、动脉系、胰腺外神经丛等被肿瘤侵犯与否与术后生存率均无关。结论　在胰头癌 ,淋巴结转移、腹膜种植转移及肝等远隔脏器转移、胰腺前方被膜及组织和门静脉系受侵可能是胰头十二指肠切除术后的预后决定因素。     

Pancreatic carcinoma: < or = 2 cm versus > 2 cm in size.

BACKGROUND: Despite recent progress in diagnosis and therapy, the clinical course of patients with pancreatic carcinoma remains dismal. There have been several approaches to improve the clinical course of patients with pancreatic carcinoma, namely: (i) detection of small pancreatic carcinoma; (ii) radical resection with retroperitoneal clearance and portal vein resection; (iii) multidisciplinary therapy including chemoradiation; and so forth. METHODS: In this series, eight Japanese patients with small pancreatic carcinoma measuring less than 2 cm in diameter (including two with non-invasive carcinoma and one with minimally invasive carcinoma) and 53 with larger pancreatic carcinoma were reviewed to find the diagnostic and therapeutic clues to improve the clinical course of patients with pancreatic carcinoma. RESULTS: Lymphatic (ly) and perineural (pn) permeation was significantly more frequent and extensive in the 53 patients with large pancreatic carcinoma than in the eight with small pancreatic carcinoma (ly 0/1/2/3:3/24/18/8 versus 5/2/1/0, P = 0.0284; pn 011/2/3:4/29/14/6 versus 3/2/3/0, P = 0.0491). The surgical margin was affected by malignant cells in 18 (34%) of the 53 patients with large carcinoma but none (0%) of the eight with small carcinoma (P = 0.0004). The comprehensive stage was significantly earlier in the eight with small carcinoma than in the 53 with large carcinoma (comprehensive stage I/II/II/IV:4/0/3/1 versus 0/3/26/24, P < 0.0001). Comprehensive curability of the eight small carcinoma cases was significantly higher than that of the 53 large carcinoma cases (comprehensive curability A/B/C:5/3/0 versus 9/5/39; P = 0.0003). 1-year and 3-year cumulative survival rates of the eight patients with small carcinoma were 100% and 82%, whereas those of the 53 with large carcinoma were 51% and 17%, respectively (P = 0.0207). However, the eight small carcinoma cases already showed frequent invasion to the vascular (v), lymphatic (ly) and perineural (pn) structure [v(+): 3/8, ly(+): 5/8, pn(+):5 /8] and lymph node metastasis (n) [n(+): 3/8]. Out of the eight small pancreatic carcinomas, one minimally invasive carcinoma and two non-invasive carcinomas showed no vascular, lymphatic or perineural invasion or lymph node metastasis. All the three patients have been doing well 19, 32 and 44 months after the operation. The diagnostic clues in the three patients were dilatation of the main pancreatic duct in one and of the branch duct in the other two. CONCLUSIONS: These findings suggest that surgical resection frequently cures patients with small pancreatic carcinoma but more effective adjuvant therapy should be developed to control lymphatic permeation, venous invasion or perineural infiltration in surgical resection of large pancreatic carcinoma. The supreme goal is to detect non-invasive or minimally invasive pancreatic carcinoma with a dilatation of the main or branch pancreatic duct as a diagnostic aid.     

Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas

The aims of this study were to investigate morbidity, mortality, and survival of patients with ductal adenocarcinoma of the pancreas who underwent pancreatectomy without (group 1) or with (group 2) en bloc portal vein resection and to study the degree of carcinoma invasion of the portal vein in group 2. The medical records of 46 and 28 patients in groups 1 and 2, respectively, were reviewed. In addition, the degree of invasion of the wall of the portal vein was categorized histologically into three types: type I, transmural invasion involving the intima; type II, invasion of the wall of the vein without intimal involvement; and type III, compression of the wall of the vein by surrounding carcinoma without true invasion. The morbidity and mortality in group 1 (26% and 4%) were not different from those in group 2 (32% and 4%). Similarly, there was no difference in survival between the two groups. Survival tended to vary directly with the depth of invasion of the wall of the portal vein: type I 6.8 ± 1.9 months; type II 15.3 ± 6.4 months; type III 20.6 ± 13.0 months. These findings suggest that en bloc resection of the pancreas and the portal vein does not increase mortality and morbidity after pancreatectomy; survival after en bloc resection was similar to that of patients not requiring portal vein resection. Combined resection of the pancreas with the portal vein could be an option in the treatment of pancreatic cancer with direct invasion of the portal vein.     

The clinical significance of venous invasion in cancer of the stomach

Specimens from 235 surgically treated cases of gastric cancer were examined for venous invasion in order to investigate its clinical significance. A total of 87 (37.0 per cent) cases showed histologic evidence of venous invasion, with the incidence being 48.3 per cent of 180 cases, after the exclusion of 55 cases where cancerous invasion was limited to the mucosa. The frequency of venous invasion varied with the gross type of tumor, the depth of penetration and the degree of differentiation, being highest in tumors of type 2 and moderately differentiated adenocarcinoma. It increased proportionately depending upon the depth of penetration and the incidence increased in cases where there was evident lymphatic invasion or lymph node metastasis. The long term survival rate significantly decreased in patients with venous invasion when compared to those without it. In this report, we also discuss the marked difference in the incidence of liver metastasis between gastric and colorectal carcinomas in relation to venous invasion of the primary tumor. Double staining with Victoria blue and hematoxylin-eosin for elastic fibers proved useful for detecting venous invasion in the carcinomatous tissue, though endothelial markers have great specificity for differentiating small veins from lymphatics.     

门静脉冷灌注下全胰切除术

Cold perfusion of liver can significantly alleviate the ischemia-reperfusion injury caused by hepatic blood flow occlusion. We have modified the technique of cold perfusion of liver and applied it to total pancreatectomy for patients with pancreatic head carcinoma complicated with metastasis to the body and tail of pancreas and with portal invasion. After skeletonization of the hepatoduodenal ligament, the amputation of the portal vein and blockage of the superior mesentoric vein were performed before portal perfusion. Meanwhile, pancreatic head resection, duodenectomy, subtotal gastrectomy and partial resection of the superior mesenteric vein and portal vein were carried out. Superior mesenteric vein and portal vein bypass grafting was achieved with artificial vessels. The digestive tract was reconstructed after it was freed of the spleen and resection of the body and tail of pancreas to the left side of superior mesenteric vein, greater omentum and intestine from the end of the colon to splenic flexure of colon. The patient was followed up for 3 months, and the general condition was good, although diarrhea frequently occurred. No tumor metastasis occurred.     

大肠癌同时伴肝转移67例临床治疗分析

目的探讨大肠癌同时伴肝转移的外科治疗效果。方法回顾性分析2003年1月至2007年12月67例大肠癌伴肝转移经外科手术治疗的临床资料。结果13例全肝多个转移灶病人行原发病灶切除加门静脉化疗泵植入术,余54例行原发灶和肝转移灶同期切除。本组术后1、2、3年生存率分别为91．0％（61／67）、71．6％（48／67）和40．3％（27／67）。生存时间最短为8个月,最长为57个月,中位生存期为30．2个月。结论大肠癌肝转移病人行原发灶和肝转移灶同期切除辅以局部及全身化疗,亦可取得满意效果。