ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to identify and categorize the independent prognostic effects of patient, clinical, operative, and pathology variables on long‐term survival after anterior resection or abdominoperineal excision of the rectum for cancer.METHODS:Proportional hazards regression analysis was used to analyze prospective data from 709 patients who underwent surgery at Concord Hospital during a 23‐year period. No patient received adjuvant therapy.RESULTS AND CONCLUSIONS:After adjusting for age and clinicopathologic stage, significantly poorer survival was experienced by males, patients with extensive tumor adherent to other organ(s), those with a high‐grade tumor or a tumor showing venous invasion, those who had a postoperative cardiovascular or respiratory complication, and those who did not undergo surgery by a colorectal surgeon specialist. The nature of the operation performed had no independent effect on survival.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colon cancer will benefit from palliative surgery and which will not.METHODS:Charts of 68 patients with incurable colon cancer were reviewed. Fifty‐seven patients underwent resection, six had a bypass of a nonresectable cancer, and five had no surgery at all. Time to death was the major end point of the study. Minor end points were postoperative morbidity and mortality. Independent variables analyzed were comorbidity, preoperative carcinoembryonic antigen, liver function tests, extent of liver metastases, stage and site of tumor, and tumor cell differentiation.RESULTS:There were six postoperative deaths, and six patients had complications. Mean survival after palliative resection was 10.6 months, after bypass was 3.4 months, and after diagnosis in patients not operated on was 2 months. Patients with >50 percent of their liver replaced by cancer had significantly worse survival than those with <50 percent involvement (mean, 4.2 ± 4 standard deviation (SD)vs.14.4 ± 10.6 SD;P< 0.003, Wilcoxon's rank‐sum test). Tumor differentiation also influenced survival (poor, mean 8.4 ± 8.2 SD; well/moderate, 12.5 ±9.2 SD;P< 0.02). No other variable had a significant effect on survival.CONCLUSION:Resection of primary colon cancer in patients with incurable disease has a relatively high postoperative mortality but is worthwhile as long as hepatic metastases occupy less than 50 percent of liver volume.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was designed to determine incidence and patterns of recurrence after curative resection of colorectal carcinoma and to determine which variables are significant in predicting outcome.METHOD:A retrospective review of 524 patients operated on by one surgeon from 1975 to 1992 was conducted. Variables recorded included age, gender, location, gross morphology, histology, stage of each primary and evidence of perforation and direct extension at time of original operation. Overall survival and pattern of recurrence were documented.RESULTS:Overall recurrence rate was 27.9 percent. Anastomotic recurrence rate was 11.7 percent. Anastomotic recurrences were higher for rectal than colon lesions (20.3vs.6.2 percent;P= 0.001). Distant metastases developed in 14.4 percent of patients, 13.9 percent for colon carcinoma and 15.5 percent for rectal carcinoma. Average time for anastomotic recurrence was 16.2 monthsvs.22.9 months for distant disease. T1,2,N0,M0 lesions had a 17.6 percent recurrence rate, T3,N0,M0 was 23.4 percent, and T1,2,3,N1,M0 was 43.7 percent(P=.001). Patients who did not undergo any intervention after diagnosis of recurrence survived an average of 28 months. Those who received palliative treatment survived an average of 39 months. Twenty‐four percent of patients had reresection for cure, and 47 percent of these patients were alive at a mean of 80 months; those who died of their disease did so at an average of 53 months. Positive predictive factors for recurrence include site of lesion (rectumvs.colon), stage, invasion of contiguous organs, and presence of perforation. Age, gender, degree of differentiation, mucin secretion, and gross morphology were not found to be predictive factors in this study.CONCLUSIONS:Recurrence after resection for rectal carcinoma is higher than after colon carcinoma. In those patients in whom reresection is possible, up to 50 percent may have long‐term survival. Understanding patterns of recurrence and features that predispose to them may guide the physician in aggressive but more selective adjuvant therapy and recommendations for targeted surveillance in follow‐up.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was designed to evaluate the frequency of microscopic distal intramural spread in rectal adenocarcinoma and its correlation to other histopathologic prognostic factors.METHODS:We examined 55 patients with adenocarcinomas of the lower one‐third of the rectum and measured the extent of distal intramural spread in the submucosa and/or muscular layer in comparison with Dukes Stage, diameter of tumor, distance of distal margin of resection from tumor, depth of infiltration into perirectal adipose tissue, nodal status, neoplastic infiltration of lymphatic vessels, blood vessels, and nervous branches.RESULTS:Distal intramural spread was found in 40 percent of patients, 77 percent of whom had advanced tumors with nodal metastases. Distal intramural spread appeared to be strictly related to tumor size (superior to 40 mm), infiltration of the perirectal adipose tissue, multiple positive lymph nodes, presence of neoplastic emboli in the intramural lymphatic vessels, and neoplastic invasion of the nervous branches. Local recurrence occurred in one Dukes Stage B patient with a positive distal margin of resection and in four patients with a negative distal margin of resection: three Dukes Stage C and one Dukes Stage B patients with neoplastic involvement of the circumferential margin of resection of the mesorectum.CONCLUSION:These preliminary data suggest that distal intramural spread may carry little importance in determining local recurrence of rectal adenocarcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Colonic J‐pouch reconstruction is designed to improve functional outcome of coloanal anastomosis. Most surgeons use a diverting colostomy to avoid severe pelvic sepsis caused by anastomotic breakdown.METHODS:We report the outcome of 30 consecutive patients with colonic J‐pouch‐anal anastomosis without a diverting colostomy performed between November 1992 and October 1993. All patients had carcinoma of the lower two‐thirds of the rectum. Patients were seen every three months. Functional results were compared with those of 21 rectal cancer patients with straight coloanal anastomosis who underwent surgery in the same period and 20 normal patients.RESULTS:There were two anastomotic leakages and one postoperative death. After one year, patients with pouch anastomosis had significantly less frequency of defecation and rectal urgency compared with those with straight anastomosis(P<0.01); 48 percent of patients with straight anastomosis had more than five bowel movements per day, whereas all patients with pouch anastomosis had five or less bowel movements per day. Manometric studies showed maximum tolerable volume was significantly higher in patients with pouch anastomosis (81vs.152 ml;P<0.01).CONCLUSIONS:Stapled colonic J‐pouch‐anal anastomosis without a diverting colostomy is a reliable procedure that provides good, long‐term functional results.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Despite the National Institutes of Health consensus regarding use of adjuvant chemotherapy in colorectal carcinoma, many general surgeons question the efficacy of this approach when considering costs involved for both the individual patient and society at large.PURPOSE:This study was designed to determine the real impact of adjuvant chemotherapy on five‐year survival rates of patients.METHOD:A qualitative and quantitative meta‐analysis of results from 39 randomized clinical trials published from 1959 to 1993 is described.RESULTS:Design quality of clinical trials had a mean score of 48.6 percent (±6.2 standard deviation). A small benefit of therapy in terms of overall survival was noted, with a mortality odds ratio (OR) of 0.91 (confidence interval (CI) 95 percent, 0.83‐0.99). For the group of colon carcinomas, the OR was 0.81 (CI 95 percent, 0.69‐0.94) with an OR of 0.64 (CI 95 percent, 0.48‐0.85) for the group of rectal carcinomas. The effect size was 0.09 for the colon group and 0.20 for the rectal group. For those patients who receive chemotherapy, this effect size implies that we can expect an increase of 5 percent in the survival rate in the group with colon carcinoma and a 9 percent increase in the survival rate in the group with rectal carcinoma.CONCLUSION:Given the high incidence of colorectal carcinoma, the small benefit observed for those patients receiving chemotherapy is far from negligible. However, indications for adjuvant chemotherapy warrant further discussion.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This retrospective study was designed to evaluate the efficacy of suction‐irrigation drainage systems in reducing anastomotic complications. The current trend for lesions of the upper and middle rectum emphasizes maintaining an intact anal sphincter mechanism as long as limits of resection are not compromised. Removal of the rectosigmoid colon with an anastomosis below the peritoneal reflection accomplishes this goal but with appreciable morbidity and mortality, which is in great part related to subsequent anastomotic breakdown and resultant pelvic abscess and fecal fistula formation. The presence of collections of blood, serum, and cellular debris contribute significantly to anastomotic disruption by serving as a culture medium in which bacteria may thrive, leading to abscess formation with subsequent deleterious effects on the integrity of the adjacent low lying anastomosis. Many surgeons accepted this risk and routinely performed diverting colostomies to minimize the consequences of anastomotic disruption below the peritoneal reflection. The authors felt that if this risk could be sufficiently reduced, it would obviate the need for a protecting stoma.METHODS:From 1980 to 1988, 60 consecutive patients were subjected to anterior or low anterior resections in which a closed Shirley sump irrigation system was used to facilitate postoperative drainage of the pelvis and thus avoid hematoma formation. Since this original study group of 60 patients, another 100 consecutive patients have been entered into this study. This cohort group again consisted of patients with lesions of the upper, middle, and lower rectum who underwent anterior or low anterior resections of the rectum.RESULTS:Fifty‐three of the original 60 patients did not have protecting stomas. Clinical leak rate for this series was 1.67 percent. Clinical leak rate for this updated series of 100 patients was 1 percent, with overall clinical leak rate of 1.25 percent in 160 consecutive patients. There were no deaths in the series, and overall morbidity was 7.5 percent.CONCLUSIONS:The authors felt that removing blood, serum, and cellular debris from the pelvis following resections of all or part of the rectum minimizes the risk of anastomotic disruption. With this routine, covering colostomies are no longer required for most patients undergoing anterior or low anterior resections of all or part of the mesorectum.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was designed to evaluate the application of three‐dimensional (3D) transrectal ultrasound (TRUS) in diagnostics, staging, and treatment planning of rectal cancer.METHOD:Transversal images, generated during conventional TRUS examination, are recorded by means of a specially designed computer‐based system to obtain a 3D array of slices, covering the whole region of interest. Different structures (normal or pathologically affected) are segmented, isolated, and rendered using the tools of the system to produce a realistic spatial view of investigated organs. Dynamic movies are also generated and replayed for better realization of spatial interrelations of studied objects.RESULTS:Nineteen patients (18 with rectal cancer and 1 who was healthy) have been examined. In 15 patients, full 3D TRUS reconstruction was performed. Results are illustrated with several examples from the studied group.CONCLUSION:We consider 3D TRUS a useful add‐on to conventional TRUS. It may significantly improve understanding of the interrelation between normal and pathologic structures and help to exact preoperative staging and treatment planning of rectal carcinoma patients.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Cellular proliferative activity is a useful indicator of biologic aggressiveness in colorectal carcinoma. Immunohistochemical analysis of proliferating cell nuclear antigen (PCNA) has important advantages of maintaining tissue architecture and technical simplicity. The aim of this study was to investigate the correlation between proliferative activity and malignancy potential in colorectal carcinomas to determine whether proliferative index of cancer cells has prognostic significance using immunohistochemical technique.METHODS:Proliferation index at the invasive tumor margin of 86 paraffin sections of advanced colorectal carcinomas was assessed by immunohistochemical study using a mouse monoclonal antibody to PCNA (PC‐10) and was compared with conventional clinicopathologic factors and other possible prognostic parameters, including p53 over‐expression, tissue carcinoembryonic antigen immunoreactivity pattern, and flow cytometric DNA ploidy. In addition, recurrence and survival were analyzed in accordance with degree of PCNA expression.RESULTS:PCNA labeling index (PCNA‐LI) increased significantly as the Astler‐Coller stage advanced(P=0.0001). Strong correlations were observed between PCNA‐LI and various pathologic parameters, including histologic differentiation(P= 0.0027), lymphatic invasion(P= 0.0001), vascular invasion(P= 0.0001), lymph node metastasis(P= 0.0001), and liver metastasis(P= 0.0036). Mean PCNA‐LI was also significantly higher in tumors with DNA aneuploidy(P= 0.0006) and negative and cytoplasmic patterns of carcinoembryonic antigen immunoreactivity(P= 0.01). Linear relationships were demonstrated between PCNA‐LI and clinical outcomes; recurrence rate was significantly greater in the group with higher than the mean PCNA‐LI, who underwent curative resection(P< 0.01), and four‐year survival rates for both overall and curative cases with higher than the mean PCNA‐LI were significantly poorer than those with lower than mean PCNA‐LI(P< 0.005 andP< 0.01, respectively).CONCLUSION:Evaluation of PCNA‐LI at the invasive tumor margin in colorectal carcinomas is suggested to be valuable in predicting those people with a higher potential for metastasis and recurrence after surgery; thus, the evaluation is helpful in planning reasonable adjuvant therapy, even in the earlier stages.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID