The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer

Inadvertent perforation of the bowel during curative resection for colorectal cancer has serious consequences. In 174 curative resections with spillage, five-year survival was 29 per cent. In 67 patients where the cancer itself was disrupted during dissection, five-year surival fell to 14 per cent in the colon and to 9.3 per cent in the rectum. Local recurrence developed in 65 per cent of spillage cases. In Dukes' C tumors that were perforated during surgery, local recurrence occurred in 87 per cent. As surgeons, our efforts must be directed toward preventing injury to the bowel during definitive resection of colorectal cancers. The instillation of tumoricidal solutions within the bowel lumen and the application of bowel ligatures prior to dissection may help toward preventing recurrence, should inadvertent perforation and spillage occur.     

结直肠肿瘤内镜黏膜下层剥离术穿孔的临床危险因素

目的 探讨和分析结直肠肿瘤内镜黏膜下层剥离术（endoscopic submucosal dissection,ESD）穿孔的危险因素.方法 选取2009年10月-2013年2月接受结直肠肿瘤ESD的199例患者.首先,对穿孔的发生率和临床操作过程进行评价.其次,对患者相关的变量（年龄、性别、阿司匹林或抗血小板制剂服用史及合并症）、内镜下的相关变量（肿瘤大小、位置和形态）、手术相关变量（手术者的经验、手术时间、黏膜下注射的药品）、病理诊断进行分析.结果 病变的平均大小为（15.9±10.6） mm.整体切除率为90.5%.20例（10.1%）患者发生了穿孔.16例（8.0%）患者保守治疗成功.肿瘤的类型（侧向发育型肿瘤）和位置（右半结肠）、内镜操作经验缺乏（〈50例）、未行黏膜下层透明质酸钠溶液注射与穿孔的高发生率相关（P〈0.05）.结论 若是侧向发育型的肿瘤类型,ESD需更加谨慎及防止穿孔,进行长期黏膜保护尤为重要.     

Meta analysis of risk factors for colorectal cancer

AIM: To study the risk factors for colorectal cancer in China. METHODS: A meta-analysis of the risk factors of colorectal cancer was conducted for 14 case-control studies, and reviewed 14 reports within 13 years which included 5034 cases and 5205 controls. Dersimonian and Laird random effective models were used to process the results. RESULTS: Meta analysis of the 14 studies demonstrated that proper physical activities and dietary fibers were protective factors (pooled OR<0.8), while fecal mucohemorrhage, chronic diarrhea and polyposis were highly associated with colorectal cancer (all pooled OR>4). The stratified results showed that different OR values of some factors were due to geographic factors or different resources. CONCLUSION: Risks of colorectal cancer are significantly associated with the histories of intestinal diseases or relative symptoms, high lipid diet, emotional trauma and family history of cancers. The suitable physical activities and dietary fibers are protective factors.     

Perioperative blood transfusion increases the risk of recurrence in colorectal cancer

A retrospective study was conducted on 519 patients undergoing curative resection for colorectal carcinoma between 1969 and 1980. Recurrence was diagnosed in 214 patients (41.2 percent), 179 of whom (34.5 percent) had received blood transfusions and 35 of whom (6.7 percent) had not (P<.001). Exclusion of the right-sided colonic tumors still showed that recurrence was more common in transfused than nontransfused patients (135 [47.2 percent] vs. 25 [22.5 percent];P<.001). Recurrence in patients transfused only during surgery (N=201) was higher than in nontransfused patients (P<.001) and, similarly, all patients transfused during surgery (N=297) had an increased risk (P<.001). Among patients with rectal cancer, transfusion increased the risk of recurrence in those treated by abdominoperineal resection (P<.02), but this was not the case in those treated by sphincter-saving resection (P=.2). Hierarchical log linear analysis of all dependent factors (Dukes' stage, histologic grade, age, sex, site, elective, or emergency procedure) showed that Dukes' stage and blood transfusion had the most significant effects on the development of recurrence (χ²=54.04, df=6,P<.0001 and χ²=13.93, df=3,P<.003). The risk of recurrence following curative surgery for colorectal cancer is markedly increased by blood transfusion on the day of operation. Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17, 1988.     

结直肠癌高危因素研究进展

恶性肿瘤严重威胁人类健康和社会经济发展,是我国乃至全球的主要公众健康问题。结直肠癌在经济发达地区较为常见,近年来一些低风险的国家由于饮食习惯、生活方式等的改变发病率也开始上升。我们查阅国内外相关文献,从社会人口学因素、医学因素、行为生活方式、饮食因素四方面对结直肠癌高危因素进行综述。     

Extracapsular invasion as a risk factor for disease recurrence in colorectal cancer

AIM: To evaluate the presence of extracapsular invasion (ECI) in positive nodes as a predictor of disease recurrence disease in colorectal cancer. METHODS: Two hundred and twenty-eight consecutive patients who underwent colorectal resection were identified for inclusion in this study, of which 46 had positive lymph nodes. Among 46 cases with stage Ⅲcolorectal cancer, 16 had ECI at positive nodes and 8 had disease recurrence. The clinical and pathological features of these cases were reviewed. RESULTS: In th...     

Identifying Stage B colorectal cancer patients at high risk of tumor recurrence and death

PURPOSE: This study was designed to determine clinical and pathologic variables associated with poor outcome following resection of Stage B colorectal cancer. METHODS: This was a retrospective study of 117 patients with Stage B cancer who underwent curative surgery and survived the postoperative period. Fourteen clinical and pathologic features were studied. Clinical data were extracted from a prospective colorectal cancer database, and histologic slides were retreived and examined by a pathologist blinded as to clinical details and outcome. RESULTS: After a median follow-up period of 8.2 years, bowel obstruction was significantly related to a poor prognosis (log-rank test; P=0.03). Extensive necrosis (P =0.01) and perineural invasion (P = 0.03) were also associated with decreased survival. Vascular invasion was associated with poor long-term outcome in the subgroup of patients with rectal (P =0.07) but not colonic (P =0.57) cancer. Multivariate regression analysis identified both tumor necrosis (P =0.01) and perineural invasion (P =0.03) as independently related to outcome. CONCLUSION: Further study of prognostic indicators might result in an algorithm to distinguish Stage B cases at high risk of tumor recurrence and death. Such patients could be included in future trials of adjuvant therapies.Presented in part at the meeting of the American Gastroenterological Association, Boston, Massachusetts, May 16 to 19, 1993. Published in abstract form in Gastroenterology 1993;104:A432.     

Nested case-control study on the risk factors of colorectal cancer

AIM: To investigate the risk factors of colon cancer and rectal cancer. METHODS: A nested case-control study was conducted in a cohort of 64 693 subjects who participated in a colorectal cancer screening program from 1989 to 1998 in Jiashan county, Zhejiang, China. 196 cases of colorectal cancer were detected from 1990 to 1998 as the case group and 980 non-colorectal cancer subjects, matched with factors of age, gender, resident location, were randomly selected from the 64 693 cohort as controls. By using univariate analysis and multivariate conditional logistic regression analysis, the odds ratio (OR) and its 95 % confidence interval (95 %CI) were calculated between colorectal cancer and personal habits, dietary factors, as well as intestinal related symptoms. RESULTS: The multivariate analysis results showed that after matched with age, sex and resident location, mucous blood stool history and mixed sources of drinking water were closely associated with colon cancer and rectal cancer, OR values for the mucous blood stool history were 3.508 (95 %CI: 1.370-8.985) and 2.139 (95 %CI: 1.040-4.402) respectively; for the mixed drinking water sources, 2.387 (95 %CI: 1.243-4.587) and 1.951 (95 %CI: 1.086-3.506) respectively. All reached the significant level with a P-value less than 0.05. CONCLUSION: The study suggested that mucous blood stool history and mixed sources of drinking water were the risk factors of colon cancer and rectal cancer. There was no any significant association between dietary habits and the incidence of colorectal cancer.     

Postoperative infections in colorectal cancer patients

BACKGROUND/AIMS: Colorectal surgery is associated with some of the highest rates of infective complications, and especially surgical site infections. It has recently been reported that postoperative infection in colorectal cancer surgery increases the risk of recurrence. The aim of this study was to analyze factors associated with the occurrence of postoperative infections in patients with colorectal cancer. METHODOLOGY: A total of 81 patients operated for colorectal cancer was included. Patients' characteristics and postoperative course were recorded and analyzed. RESULTS: Patients with tumors located in the rectum had significantly higher rate of postoperative infectious complications compared to patients with tumors located in the colon (p=0.002). In a logistic regression model, among all evaluated predictors, only preoperative hemoglobin concentration was found to be an independent significant predictor of postoperative infection (p=0.01). CONCLUSIONS: Preoperative anemia was found to be significant independent predictor of postoperative infection. Meticulous surgical technique with minimal blood loss is an important means of reduction of postoperative infections in colorectal surgery.     

Specific metabolic biomarkers as risk and prognostic factors in colorectal cancer

Advances in genomics,molecular pathology and metabolism have generated many candidate biomarkers of colorectal cancer with potential clinical value.Epidemiological and biological studies suggest a role for adiposity,dyslipidaemia,hyperinsulinemia,altered glucose homeostasis,and elevated expression of insulin-like growth factor(IGF)axis members in the risk and prognosis of cancer.This review discusses some recent past and current approaches being taken by researches in obesity and metabolic disorders.The authors describe three main systems as the most studied metabolic candidates of carcinogenesis:dyslipidemias,adipokines and insulin/IGF axis.However,each of these components is unsuccessful in defining the diseases risk and progression,while their co-occurrence increases cancer incidence and mortality in both men and women.     

Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence?

This study examines anastomotic leaks as a potential influence on the long term outcome of patients with colorectal cancer. 167 patients were studied who had clinical and radiological assessment of anastomotic integrity in the post-operative period, following potentially curative resections for left-sided colonic or rectal cancer. There was no evidence of a leak in 135 of these patients, while the remaining 32 developed a clinical and/or a radiological leak. At the end of a mean follow-up of 25 months, 15 patients with leaks (46.9%) developed tumour recurrence, compared with 25 of those without any leak (18.5%; p<0.001). Cancer specific mortality at 24 months was also significantly higher for patients with leaks (36.9%±9.7% versus 12.6%±3.3%; p<0.001). The influence of anastomotic leaks on the outcome was independent of tumour stage. These results suggest that in patients undergoing surgery for colorectal cancer development of an anastomotic leak is significantly associated with a poorer long-term outcome.

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Résumé Cette étude examine le risque potentiel du lâchage anastomotique sur l'évolution à long terme des patients atteints d'un cancer colo-rectal. 167 malades ont été étudiés chez qui l'examen clinique et radiologique affirmait l'intégrité de l'anastomose dans la période postopératoire après une résection potentiellement curative pour cancer du colon gauche ou du rectum. Il n'y avait aucune évidence de lâchage anastomotique chez 135 de ces patients tandis que pour les 32 restants il existait une fuite clinique ou radiologique. A la fin d'un suivi moyen de 25 mois, 15 des malades avec fuite (46.9%) ont développé une récidive tumorale par comparaison avec 25 de ceux qui n'avaient aucune fuite (18.5%; p<0.001). La mortalité spécifique par cancer à 24 mois était aussi significativement plus élevée pour les patients avec fuite anastomotique (36.9%±9.7% versus 12.6%±3.3%; p<0.001). L'influence de la fuite anastomotique sur l'évolution était indépendante du stade de la tumeur. Ces résultats suggèrent que chez les patients qui subissent une résection chirurgicale pour cancer colo-rectal, l'apparition d'une fuite anastomotique est significativement associée avec une évolution à long terme plus péjorative.

     

Identification of risk factors for lymph node metastasis of colorectal cancer

BACKGROUND/AIMS: Although lymph node metastasis is widely considered to be the potent prognostic factor in colorectal cancer patients, the clinical risk factors for lymph node metastasis in these patients have been scarcely analyzed. METHODOLOGY: The clinical records of 2125 patients who underwent colonoscopy and were diagnosed with colorectal cancer were reviewed. RESULTS: Multivariate analysis revealed that an increase in T stage (odds ratio (OR); 2.54, 95% confidence interval (CI) 2.17-2.98), and tumors with high grade pathology (OR; 1.63, 95% CI 1.10-2.41) were identified as the independent predictive factors for the presence of lymph node metastasis. On the other hand, the presence of synchronous adenomas (OR; 0.78, 95% CI 0.65-0.95) was a predictor for being free of lymph node metastasis. Stratification of the risk according to age and gender revealed that a tumor located in the right colon indicated significant risk for patients less than 50 years old (OR; 2.23, 95% CI 1.01-4.95), whereas tumors with high grade pathology indicated a significant risk only in female patients (OR; 1.74, 95% CI 1.01-3.00). CONCLUSIONS: The significant risk factors for lymph node metastasis were elucidated, and may facilitate surgeons in deciding the best surgical procedure to implement and pathologists in treating resected specimens.     

Epidemiology and risk factors for colorectal dysplasia and cancer in ulcerative colitis

Patients with UC are at increased risk of CRC, but a series of population-based studies published within the past 5 years suggest that this risk has decreased over time. The crude annual incidence rate of CRC in UC ranges from approximately 1 in 500 to 1 in 1600. In some cohorts, an elevated risk of CRC relative to the general population can no longer be demonstrated. The exact mechanism for this decrease in risk remains unclear but may be attributable to a combination of more widespread use of maintenance therapy and surveillance colonoscopy as well as more judicious reliance on colectomy. In addition to the classic risk factors of increased extent and duration of UC, it seems that PSC, a family history of sporadic CRC, severity of histologic bowel inflammation, and young age at colitis onset are independent risk factors for cancer.     

Telomerase subunit immunoreactivity and recurrence in colorectal cancer

BACKGROUND/AIMS: Telomerase is expressed in human germ tissues and in the majority of primary human tumors. The catalytic subunit of telomerase, hTERT is one of the most important components of telomerase. In this study we attempted to show by means of immunohistochemistry the association between hTERT expression and recurrence in 128 colorectal cancer patients surgically treated in the University of Tokyo Hospital. METHODOLOGY: Immunostaining was performed in a conventional manner using a commercial monoclonal antibody. RESULTS: In our results, negative TERT immunoreactivity in the primary lesion was significantly associated with advanced tumor stage (p=0.0007), the presence of lymph node metastasis (p=0.00018) and recurrence (p<0.0001). Recurrence-free survival rate was significantly lower in patients with negative TERT immunoreactivity (p=0.0002). In the same way, if limited in patients without metastatic lymph nodes at surgery or in patients with T3 or T4 tumor, the recurrence-free survival rate was significantly lower in those with negative TERT immunoreactivity (p=0.019, p=0.016). CONCLUSIONS: Negative TERT immunoreactivity may be a novel indicator for poor prognosis of colorectal cancer patients and additional studies with a larger number of patients may lead to identifying patients at high risk for recurrence more accurately.