Results of a pulmonary metastasectomy in patients with colorectal cancer

Purpose  

The lung is one of the key sites of hematogenous metastasis in patients with colorectal cancer. A metastasectomy of the lung is reported to improve the prognosis of colorectal cancer. We reviewed our experience in evaluating the surgical outcomes in colorectal cancer patients who have undergone a pulmonary metastasectomy.     

Robotic-assisted colorectal surgery in obese patients: a case-matched series

Surgical Endoscopy - Reports demonstrate laparoscopic colorectal surgery in obese patients is associated with higher conversion to laparotomy and complication rates. While several advantages of...     

Follow-up of patients with colorectal cancer

In our follow-up study of 65 patients after curative surgery for colorectal cancer, tests other than history and physical examination detected only two cases of potentially curable recurrent colorectal cancer. As a routine follow-up test, carcinoembryonic antigen determination is preferable to computerized tomographic scanning, since the sensitivity and specificity of carcinoembryonic antigen and computerized tomographic scanning were found to be equivalent and carcinoembryonic antigen is much less expensive. There was no benefit to the routine use of liver function tests or chest roentgenograms during follow-up. Since barium enema contributed little to what colonoscopy accomplished with greater comfort to the patient, barium enemas should be used only when colonoscopy is not totally successful in reaching the cecum. The most beneficial aspect of the follow-up of these patients is probably the elimination of future metachronous lesions by removal of small, benign polyps.     

Operative risks in patients with colorectal cancer

This study emphasizes the risks in the operative treatment of patients with colorectal cancer. In dissecting our overall operative mortality of 7.4 per cent in consecutive patients over a 5-year period, three factors influencing the outcome were identified. These were the age of the patient, the stage of the disease, and the availability of preoperative bowel preparation by mechanical cleansing and antibiotic suppression of the colonic bacterial flora. Earlier diagnosis and elective resection of prepared bowel offers marked improvement in the operative risk for patients with colorectal cancer.     

Insulin resistance in patients with colorectal cancer

The euglycaemic glucose clamp technique has been used to assess insulin resistance in patients with colorectal adenocarcinoma. Ten cancer patients were studied and compared with control subjects matched for age, sex and nutritional status. Forty-one euglycaemic clamps were performed at one of five different insulin infusion rates (20, 30, 40, 100 or 200 milliunits min-1 m-2). Glucose disposal was significantly decreased in the cancer group at all insulin infusion rates, whilst attained insulin levels and metabolic clearance rates of insulin were comparable in the control and cancer groups. Analysis of dose-response data allowed assessment of sensitivity (insulin concentration of half maximal glucose disposal) and responsiveness (maximal glucose disposal). Responsiveness was significantly reduced in the cancer group (40.3 versus 71.5 mumol kg-1 min-1; P less than 0.001), whilst sensitivity was similar (93.7 milliunits l-1 in controls versus 90.8 milliunits l-1 in cancer patients), suggesting a postreceptor defect in insulin action in the cancer group.     

The influence of a colorectal service on the outcome of patients with colorectal cancer

Objective To perform a prospective audit of outcomes and survival of all patients presenting to a colorectal service with colorectal cancer, and to compare these results with an historical control group. Patients and methods At a community based teaching hospital, a prospective audit of outcomes and survival of patients with colorectal cancer was compared with a historical control. The study included all patients referred to a colorectal service with colorectal cancer from 1996 to 2000 (5‐year period). The control group was a retrospective review of patients presenting to the same hospital with colorectal cancer from 1989 to 1994 (6‐year period). A Kaplan‐Meier survival analysis compared the overall survival (all‐cause mortality) between the two groups. Results When comparing the study periods 1989–95 (n = 477) to 1996–2000 (n = 323), there has been a significant reduction in postoperative stay (16.2 vs 8.0 days, P < 0.05), and a reduction in postoperative mortality (4.5%vs 2.7%, n.s.). There was a significant increase in the overall 2 years survival for patients with colorectal cancer (62% to 71%, P < 0.01). There was also a significant increase in the overall 2 years survival of patients with rectal cancer (66% to 74%, P < 0.01), patients with ACPS C colon cancers (64% to 83%, P < 0.05), and ACPS C rectal cancers (74% to 85%, P < 0.01). Conclusions There have been significant gains in the survival of patients presenting to a community based teaching hospital with colorectal cancer. These improvements have been most notable in patients with nodal metastases at the time of diagnosis.     

结肠癌肝转移细胞增殖能力减弱

目的 通过阶梯转移法在裸鼠中筛选出人结肠癌肝转移细胞,然后对结肠癌肝转移细胞的生长增殖能力进行鉴定.方法 通过SW1116细胞株裸鼠皮下连续5次传代后取皮下种植瘤裸鼠结肠原位种植,分别取肝脏转移灶和皮下5代细胞进行原代培养,获得大肠癌肝转移细胞和皮下5代的原代细胞,分别命名为结直肠癌肝转移细胞1代(CHM-1)和皮下第5代(P5),通过CCK-8测生长曲线、流式检测细胞周期以及细胞周期相关的蛋白的免疫细胞化学来对SW1116、CHM-1和P5增殖能力进行检测.结果 细胞增殖实验显示CHM-1生长速度明显慢于SW1116和P5细胞(P＜0.05);流式细胞周期分析中CHM-1细胞G41期(68.390±2.865)%比例高于SW1116(50.440±1.472)%和P5(53.930±2.651)%(P＜0.05),G2期CHM-19(13.530±4.411)%比例要低于SW1116(32.030±5.645)%和P5(29.720±3.559)%(P＜0.05),S期3种细胞差异无统计学意义(18.250±6.901)%、(19.050±4.162)%、(18.930±0.169)%(P＞0.05);免疫细胞化学分析发现细胞周期蛋白Cyclin DI在CHM-1(23.7±4.7)%中的表达比SW1116(30.2±5.1)%和P5(32.1±4.2)%减少(P＜0.05).结论 发现侵袭能力和生长增殖能力具有反向关联,即结肠癌肝转移细胞具有更强的侵袭能力,但生长增殖速度比其他细胞更慢.

Abstract：

Objective To study the proliferation ability of liver metastatic colorectal cancer cells by establishing stepwise metastatic colorectal carcinoma cell model via in vivo selection.Methods SW1116 cells were transplanted into the subcutis of nude mice and serially passaged for 5 times,and then the subcutaneous tumor was implanted into the cecal wall of new nude mice.The liver metastatic lesions and the subcutaneous carcinoma cells of the fifth generation were picked for primary culture.Two cell lines named CHM-1 and P5 were obtained.Proliferation levels were analyzed by testing of cell growth curve,cell cycle analyses by flow cytometry and Cyclin D1 analysis by immunocytochemistry.Results CHM-1 grew much slower than P5 and SW 1116 although there was no difference between P5 and SW 1116 in cell proliferation assay ( P＜0.05 ).Cell cycle analysis revealed that the percentage of cells in G0/G1 phase was higher (P＜0.05) in CHM-1 (68.390 ±2.865)% than in SW1116 (50.440 ± 1.472)% and P5 (53.930 ± 2.651)%,but that in G2/M phase was lower ( P＜0.05 ) in CHM-1 ( 13.530 ± 4.411 )% than in SW1116 (32.030 ±5.645)% and P5 (29.720 ±3.559)% rough there was no difference in S phase ( 18.250 ± 6.901 )%,( 19.050 ± 4.162 )%,( 18.930 ± 0.169 )% ( P ＞ 0.05 ).The expression of cell cycle proteins Cyclin D1 was decreased ( P＜0.05 ) in CHM-1 ( 23.7 ± 4.7 )% as compared with thoseinP5(32.1±4.2)% and SW1116 (30.2 ±5.1)%.Conclusion In the same cell line,there was a reverse relationship between the ability of invasion and proliferation.     

Metachronous colorectal cancer risk in patients with a moderate family history

Aim Lifetime risk of a metachronous colorectal cancer (mCRC) is 0.6–3% following sporadic colorectal cancer (CRC) and 15–26% in Lynch syndrome. The lifetime incidence of CRC in individuals with moderate familial risk is 8–17%. Risk of mCRC is unknown. Method A retrospective longitudinal study of the Regional Familial CRC Registry was performed. Patients who had at least one CRC were categorized as follows: moderate risk (n = 383), Lynch syndrome (n = 528) and average (population) risk (n = 409). The Kaplan–Meier estimate (1‐KM) and the cumulative incidence function were used to calculate the risk of mCRC. The 1‐KM gives the risk for individuals remaining at risk (alive) at a given time point and thus is useful for counselling. The cumulative incidence function gives the risk for the whole population. Results The 1‐KM and the cumulative incidence function demonstrated that the risk of mCRC was significantly higher in moderate‐risk patients compared with average (population)‐risk patients (1‐KM, P = 0.008; cumulative incidence function, P = 0.00097). However, the risk of mCRC was higher in patients with Lynch syndrome than in moderate‐risk or average (population)‐risk patients. The 1‐KM in moderate‐risk patients was 2.7%, 6.3% and 23.5% at 5, 10 and 20 years, respectively. In average (population)‐risk patients, the 1‐KM was 1.3%, 3.1% and 7.0% at 5, 10 and 20 years, and the cumulative incidence function was 0.3%, 0.6% and 2.4% at the same time points, respectively. Conclusion These data indicate that the risk of mCRC is significantly higher in patients with a moderate family history of CRC than in those with an average (population) risk. This justifies proactive lifelong surveillance.     

Trends in incidence,treatment and survival of patients with stage IV colorectal cancer: a population‐based series

Aim The incidence, patterns of care and survival were determined in patients with stage IV colorectal cancer (CRC) in a population‐based series. Method Computer records for patients diagnosed with stage IV CRC diagnosed from 1 January 1995 to 31 December 2007 were retrieved from the Rotterdam Cancer Registry. Surgical resection of the primary tumour, chemotherapy use, hepatic surgery and survival were evaluated according to year of diagnosis, age, gender and primary tumour site. Results In the southwestern part of the Netherlands, 19 014 new patients with CRC were diagnosed and synchronous metastatic disease was found in 3482 (18%). This proportion increased during the study period, from 16% to 21%. Surgical resection of the primary tumour was performed in approximately 50% of the patients and did not change over time. Postoperative 30‐day mortality was 8%. Chemotherapy use increased from 18% in the first period to 56% in the latest period. Liver surgery increased from 4% in the first period to 10% in the latest period. Median survival increased from 7 months to 12 months and 2‐year survival increased from 14% to 28%. Two‐year survival declined with increasing age and was significantly worse for right‐sided tumours (14%). Conclusion Survival of patients with stage IV CRC has improved over time and this is probably a result of the increased use of chemotherapy and the increased numbers of patients who underwent hepatic surgery.     

Management of colorectal cancer in patients with cirrhosis and a LeVeen shunt

Two cirrhotic patients with a LeVeen shunt presented with a large bowel cancer. In one patient, the shunt was removed and the venous catheter was ligated prior to the performance of a colon resection. The postoperative course was uneventful. A new valve was inserted and connected to the venous catheter two months later. The second patient had a carcinoma of the rectum. In order to prevent ascites and to ease the colorectal resection he had preliminary construction of a portacaval shunt. Six weeks later, he underwent an anterior resection of the rectum. The postoperative course was uneventful except for a self limiting episode of febrile subacute intestinal obstruction. These two cases demonstrate that it is possible to resect colorectal cancer in patients with cirrhosis, ascites and a peritoneovenous shunt provided measures are taken to avoid specific complications due to the presence of the shunt, ascites or portal hypertension.     

Circulating immune complexes in patients with colorectal cancer

We have attempted to better define host humoral immune response in neoplasia by quantitating serial circulating immune complex values before and after surgery in patients with primary or metastatic colorectal cancer. Circulating immune complex levels were correlated with serial carcinoembryonic antigen values and tumor courses in patients with primary resectable colorectal cancer (four patients), resectable liver metastases (three patients), diffuse liver metastases treated with regional chemotherapy (three patients), and untreated intrahepatic (one patient) and extrahepatic metastases (one patient). Circulating immune complex levels, as measured by an antigen-nonspecific assay, which utilized 4 percent polyethylene glycol insolubilization, were increased in all patients at presentation (734 delta OD450 +/- 381) when compared with normal human control sera (202 +/- 4, p less than 0.05). No particular relation was found between presenting circulating immune complex levels and tumor burden. Progressive circulating immune complex increases were demonstrated only in patients whose tumors were either completely removed or dramatically responded to regional therapy (that is, when the tumor antigen load, as reflected by the carcinoembryonic antigen value, rapidly diminished). Serum samples obtained at times of presumed antibody excess in the patients with gastrointestinal cancers were found to contain unexpectedly high concentrations of IgA. We believe these data demonstrate the kinetics of circulating immune complex change during tumor course and they have allowed us to begin to identify circulating immune complex components in patients with colorectal cancer. The results confirm our earlier findings in patients with gestational tumors and differ from accepted relations between immune complexes and tumor growth.     

Symptoms and signs in patients with colorectal cancer

The symptoms and signs of colorectal cancer vary from the general population to primary care and in the referred population to secondary care. This review aims to address the diverse symptoms, signs and combinations with relevance to colorectal cancer at various points in the diagnostic pathway and tries to shed light on this complex and confusing area. A move towards a lower threshold for referral and increased use of diagnostics might be a more reliable option for early diagnosis.     

Colon examination in patients with proven colorectal cancer

It has been recommended that all patients with proven colorectal cancer should have a total colon check. This prospective study examines the practical implementation of this recommendation. It demonstrates the extent to which clinical practice may appear to drift away from a guideline, whilst remaining entirely justifiable. This has implications for future attempts to audit the implementation of guidelines.     

Mortality in patients with obstructing colorectal cancer.

Of 1,033 patients with colorectal carcinoma, 238 (23%) presented with obstruction. The majority of tumours (74%) were potentially curable (Dukes B/C) at presentation. Tumours situated at the splenic flexure, transverse or descending colon were most likely to obstruct. Perioperative mortality was high following either primary resection (31%) or fashioning of a defunctioning stoma alone (25%) but was twice as high (40%) in patients over 70 than those under 70 (20%). Cardiorespiratory complications accounted for 55% of this mortality, while fatal technical complications occurred in 19%. Sixty seven patients (28%) had two operations, 51 patients (21%) had three operations.     

Intraoperative colonoscopy in patients with colorectal cancer.

Sixty-seven patients underwent intraoperative colonoscopy during elective surgery for colorectal cancer. Complete examination of the colon was achieved in 65 patients (97 per cent), albeit with insertion through a colotomy in three (4 per cent). A synchronous carcinoma was found in six patients (9 per cent), which necessitated a change of planned surgical procedure. Synchronous polyps were detected and removed in 24 patients (36 per cent); two had polyps with carcinoma in situ. The mean age of patients with synchronous carcinoma was significantly higher than that of those without (74.1 versus 61.2 years, P = 0.02). Intraoperative colonoscopy took a mean of 15 min surgical time and only two minor complications (serosal lacerations) were encountered. In patients with colorectal cancer, intraoperative colonoscopy allows complete assessment of the colon and identifies synchronous lesions.     

Energy expenditure in malnourished patients with colorectal cancer

To evaluate energy expenditure in patients who have colorectal cancer with varying stages of disease and to examine the possible determinants of energy expenditure in a group of patients with cancer who have the same type of tumor, we studied 73 patients with biopsy proven and pathologically staged adenocarcinomas of the colon and rectum. Resting energy expenditure (REE) was measured by indirect calorimetry and compared with predicted energy expenditure (PEE), which was calculated from the Harris-Benedict formulas. Nutritional and tumor characteristics were examined. Forty-nine percent of patients had abnormal REE (normal = PEE +/- 10%). One quarter of the patients were hypometabolic (REE less than 90% PEE). The abnormalities persisted despite normalization of REE to metabolic body size (kg0.75) or predicted values based on weight, height, age, and sex. There were no differences in nutritional status, as judged by the percent of weight loss and visceral protein levels, between those patients in the hypometabolic, normometabolic, or hypermetabolic categories, and there were no significant relationships between energy expenditure and the tumor burden. The mean duration of disease in the normometabolic group was 4.5 months, while the hypometabolic and hypermetabolic groups had mean durations of 9.5 and 14.2 months, respectively. The tumor site and duration of the disease are important variables in studies of energy expenditure in patients with cancer.     

大肠癌患者粪便标本的端粒酶活性研究

目的 探讨通过粪便途径筛查大肠癌的可行性和新方法。方法 应用聚合酶链端粒重复扩增（PCR－TRAP）银染技术,研究了43例大肠癌患者粪便中脱落细胞的端粒酶活性表达。结果 62．8％的大肠癌患者粪便标本中有端粒酶阳性表达。患者粪便标本中端粒酶阳性表达与其大肠癌Dukes分期、淋巴结转移和癌肿部位未见显著相关（P＞0．05）。1例结肠腺瘤患者粪便标本端粒酶表达阳性,其腺瘤组织也存在端粒酶活性表达。粪便端粒酶检测的敏感性、特异性和阳性预测值分别为62．8％、95．7％和96．4％。结论 PCR－TRAP银染检测大肠癌患者粪便脱落细胞的端粒酶活性表达为改善大肠癌筛查方法和大肠癌诊断作了新的尝试。