ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:This study was designed to establish scientific evidence for and clinical results of preoperative mechanical bowel cleansing before elective colorectal surgery.METHODS:Systematic literature searches in electronic databases, conference proceedings, and hand searches of reference lists of previously retrieved literature without any language restrictions were used. Only randomized trials were included. A quality assessment of each retrieved trial was performed. Outcome measures were surgical infections, mortality, and anastomotic dehiscence. Meta‐analyses of the selected trials were performed using the Peto odds ratio.RESULTS:The results of each outcome were as follows. 1) Overall anastomotic leakage—six studies: 5.5 percent with cleansing compared with 2.9 percent without cleansing; odds ratio 1.94, 95 percent confidence interval: 1.09 to 3.43 (P = 0.02). 2) Peritonitis—three studies: 5.1 percent with cleansing compared with 2.8 percent without cleansing; odds ratio 1.90, 95 percent confidence interval: 0.78 to 4.64 (not significant). 3) Wound infection—six studies: 7.4 percent with cleansing compared with 5.7 percent without cleansing; odds ratio 1.34, 95 percent confidence interval: 0.85 to 2.13 (not significant).CONCLUSIONS:There is no evidence in the literature for beneficial effects from the use of bowel cleansing before elective colorectal surgery. Cleansing seems to be associated with an increased risk of more anastomotic dehiscence. Further studies stratifying between rectal and colonic surgery are warranted.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Results of the few extant reports concerning the clinical significance of so‐called “occult micrometastases” of lymph nodes of patients with Dukes A and B colorectal cancer have been variable. We examined the presumably negative nodes of a larger cohort of such patients who were enrolled in the National Surgical Adjuvant Breast and Bowel Project clinical trials R‐01 and C‐01 for the influence of what we preferably designate as nodal mini micrometastases on parameters of survival.METHODS:Mini micrometastases were detected by immunohistochemical staining of the original lymph node sections with anticytokeratin A1/A3 in a total of 241 Dukes A and B patients with rectal and 158 with colonic cancers. Their frequency, as well as that of nuclear and histologic grades, and an estimation of their relationship to relative risks were correlated with overall and recurrence‐free survival by univariate and multivariate analyses.RESULTS:Nodal mini micrometastases were detected in 73 of 399 (18.3 percent) patients of this cohort. They failed to exhibit any significant relationship to overall or recurrence‐free survival. No association between the assessments of tumor differentiation and mini micrometastases was found. Nuclear and histologic grades also failed to further discriminate overall or recurrence‐free survival in patients with A or B stages of colonic or rectal cancers in this cohort.CONCLUSION:The immunohistochemical demonstration of nodal mini micrometastases failed to discriminate high‐ and low‐risk groups of patients with colorectal cancer who were designated as being node‐negative after routine pathologic examination.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:The majority of anal tumors are squamous‐cell carcinomas. These may be tumors of the anal canal or margin. They are best treated by combination of chemotherapy and radiotherapy. T1 and T2 tumors in this regime do not receive radiotherapy to the inguinal regions despite approximately 5 to 10 percent incidence of inguinal lymph node involvement. If the nodal status of the inguinal region could be accurately assessed, then a more tailored radiotherapy regime may be given. This article describes a novel method of assessment of the status of the inguinal lymph nodes in patients.METHODS:Patients with anal squamouscell carcinoma had four injections of 0.2 ml of antimony sulfide (30 MBq) around the tumor. Under a gamma camera, a distant high‐intensity signal was located, and this point was marked on the overlying skin using an indelible ink pen. In the operating theater, patent blue dye was injected all around the tumor. The localized lymph node was removed and sent for histopathology.RESULTS:This procedure was performed on 12 patients. The sentinel node was localized to the inguinal region and removed in eight of these patients. In two patients, metastatic squamous‐cell carcinoma was identified histologically in the sentinel node.CONCLUSION:We advocate that this as a safe technique for detecting metastatic disease in the inguinal nodes in patients with anal squamous‐cell carcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal.METHODS:Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue‐stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3).RESULTS:Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal.CONCLUSIONS:The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:The purpose of the study was to examine the effect of communication on rectal cancer patients' quality of life over four years. Previous studies have either used short follow‐up periods or examined only certain aspects of quality of life, such as anxiety and depression.METHODS:In a prospective, observational study, rectal cancer patients, recruited by clinicians over a two‐year period, were sent questionnaires over four years. The clinical details of these patients were recorded by the Munich Cancer Registry. The psychological scores from the European Organization for Research and Treatment of Cancer QLQ‐C30 and CR38 were the main outcome variables.RESULTS:Thirty‐nine percent of the sample reported that some aspect of the communication they received was unclear (incomprehensible or too little). More than 60 percent wished to speak more with their physician. Younger patients and those in larger hospitals were more likely to report unclear communication (P < 0.05). Analyses of covariance, controlled for age, gender, adjuvant therapy, stoma, education, clinic, and comorbidity, demonstrated that role, emotional, and social functioning scores were consistently lower in patients reporting unclear communication. Additionally, these patients experienced more problems sleeping, poorer body image, more financial worries, and a worse future perspective. Repeated measures analyses indicated that sleeping problems and emotional and social functioning difficulties persisted for at least three years.CONCLUSION:Reports of unclear communication were associated with poorer quality of life in rectal cancer patients without disease progression.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:This study was conducted to investigate the feasibility of laparoscopic resection of rectal cancer and to compare early outcome data with the results of the conventional technique.METHODS:From January 1996 to March 2002, 435 patients with primary rectal cancer were operated on at our institution. Low‐risk, small rectal tumors treatable by local excision, rectal cancer recurrences, and emergency cases were excluded from the analysis. Three hundred thirty‐four patients were operated on by the conventional open approach. One hundred one selected patients underwent surgery by the laparoscopic technique.RESULTS:Because of the selection process, significantly more patients with early tumor stages were operated on by laparoscopy. There were no differences in mean operation time, morbidity, mortality, or the anastomotic leakage rate; however, the need for intraoperative transfusion, mean stay in the intensive care unit, and length of hospital stay were reduced significantly.CONCLUSIONS:In terms of the intraoperative and early postoperative course, the laparoscopic resection of rectal cancer in a selected cohort of patients compares favorably with the open technique. Because follow‐up time is limited to date, only very preliminary information can be given on tumor‐related outcome data. However, these preliminary data appear to suggest that rectal cancer resection can be performed by laparoscopy in accordance with established principles of cancer therapy and that port‐site metastases are not a relevant clinical problem. Prospective, randomized trials are required to determine whether the laparoscopic approach will play a significant role in the treatment of rectal cancer in the future.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to identify indicators that can predict patients at high risk of tumor recurrence in Stage II, T3 colon cancer.METHODS:A total of 138 patients classified as Stage II, T3 underwent curative resection of colon cancer between 1981 and 1993. Clinical variables included age, gender, bowel obstruction, tumor location, and emergency presentation. For each colon tumor specimen, the following histopathological variables were assessed: maximum tumor diameter (<5 vs. ≥5 cm), depth, tumor grade (well and moderate vs. other), lymphatic and venous invasion (absent vs. present), perineural invasion, tumor necrosis, and tumor margin (expanding vs. infiltrating). We also categorized tumor budding, defined as a single cancer cell or small clusters of undifferentiated cancer cells in the invasive frontal lesion, into two categories: none or minimal (BD‐1), and moderate or severe (BD‐2). Univariate analysis for factors regarding recurrence and disease‐specific survival were performed with the logistic regression model and the log‐rank test.RESULTS:Among the factors analyzed, tumor budding was the only factor that was significantly associated with recurrence and survival. The numbers of patients with BD‐1 and BD‐2 tumors were 111 and 27, respectively. Forty‐eight percent of BD‐2 tumor patients developed recurrence, compared with 4.5 percent of BD‐1 tumor patients (P < 0.0001). The cumulative disease‐specific survival rates at five years for patients with BD‐1 and BD‐2 tumors were 98 and 74 percent, respectively (P < 0.0001).CONCLUSION:The presence of moderate or severe budding at the invasive margin in Stage II, T3 colon cancer indicated a high risk of tumor recurrence after curative surgery, providing useful information for the decision regarding postoperative adjuvant chemotherapy.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Intravenous fluorouracil and leucovorin for six to eight months is currently a standard adjuvant treatment for Stage III colon cancer; however, this regimen is complex, inconvenient, and has a high intolerability. Adjuvant chemotherapies are claimed for objective response rates with an acceptable safety profile and complexity. We investigated the benefits of oral protein‐bound polysaccharide K added to oral tegafur/uracil on curatively resected Stage II or III colorectal cancer.METHODS:We prospectively randomized 207 patients to treatments of either oral 3.0 g protein‐bound polysaccharide K plus 300 mg tegafur/uracil or 300 mg tegafur/uracil alone for two years following 12 mg/m2and 8 mg/m2mitomycin treatment on postoperative Days 1 and 2, respectively. The primary end points were disease‐free and overall survival, and recurrence rates.RESULTS:Three (1.4 percent) patients were declared ineligible, and three patients did not start treatment. In total, 201 patients were analyzed. The three‐year, disease‐free survival rate was 80.6 percent (standard error = 3.4 percent) in the protein‐bound polysaccharide K group (P = 0.02) compared with 68.7 percent (SE = 5.7 percent) in the control group after a median follow‐up of 3.7 years. The estimated relative risk of recurrence in the control group was 1.87 (95 percent confidence interval, 1.10‐3.20) at three years. The three‐year, overall survival rate was 87.3 percent (standard error = 2.9 percent) in the protein‐bound polysaccharide K group and 80.6 percent (standard error = 4.8 percent) in the control group (P = 0.24). The three‐year, overall survival rate in 80 pathological TNM Stage III patients was 83.0 percent (standard error = 5.2 percent) in the protein‐bound polysaccharide K group and 59.3 percent (standard error = 9.5 percent) in the control group (P = 0.02). Protein‐bound polysaccharide K prevented distant metastases (P = 0.05), particularly lung metastases (P = 0.01). The incidence of adverse effects was minimal, and compliance was good.CONCLUSION:Adjuvant therapy using a combination of oral protein‐bound polysaccharide K and tegafur/uracil is highly effective in preventing the recurrence of colorectal cancer in Stage II or III patients, and increases overall survival in pathological TNM Stage III. These results will be a sufficient proof to conduct a larger study to compare tegafur/uracil/protein‐bound polysaccharide K with 5‐fluorouracil/leucovorin.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:This study was designed to investigate the frequency of mutations in DNA mismatch repair genes in sporadic colorectal cancers.METHODS:Genomic DNAs procured from paraffin blocks of the pathologic specimens from 230 consecutive patients with colorectal cancer were examined for their microsatellite instability status using a mononucleotide microsatellite marker, BAT‐26, and also evaluated expressions of hMLH1, hMSH2, and hMSH6 proteins by immunohistochemical staining. Any of these 230 patients did not have family histories of hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis, colorectal cancer, or hereditary nonpolyposis colorectalrelated cancers, such as endometrial, small bowel, and ureteral and renal pelvic cancers. When microsatellite instability was positive, mutations in the simple repeated sequences of TGF‐&bgr;RII, BAX, IGF IIR, hMSH3, and hMSH6 genes were examined. In microsatellite instability‐positive or staining‐negative cases, polymerase chain reaction‐single‐strand conformation polymorphism and DNA sequencing detected mutations of hMLH1, hMSH2, and hMSH6 genes. If mutations were found in tumor tissue samples, we tested for a germline mutation with a microdissected corresponding normal tissue.RESULTS:Among 230 cases of sporadic colorectal cancer, 21 (9.1 percent) manifested microsatellite instability. In the immunohistochemical staining, 20 (8.6 percent) showed loss of expressions. All 20 staining‐negative cases were microsatellite instability‐positive. Only 1 of 21 (4.8 percent) microsatellite instability‐positive cases showed intact staining for three proteins. The frame‐shift mutations of the simple repetitive sequences were found in 17 cases (81.0 percent) in TGF‐&bgr;RII, 11 (52.4 percent) in BAX, 5 (23.8 percent) in IGF IIR, 7 (33.3 percent) in hMSH3, and 8 (38.1 percent) in hMSH6 genes. Germline mutation was observed in only one case, which accounts for 4.8 percent among positive microsatellite instability and 0.4 percent of total patients, and was found in hMSH2. Five somatic mutations (2 in hMLH1, 2 in hMSH2, and 1 in hMSH6) also were found.CONCLUSION:The results indicated that a germline mutation of DNA mismatch repair gene was a rare event in sporadic colorectal cancers.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID