AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between...AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial.Based on the MS or the NICE classifications,patients were randomised for real-time endoscopic diagnosis.This was followed by biopsies,endoscopic or surgical resection.The endoscopic diagnosis was then compared to the final(blinded) histopathology.The primary endpoint was the sensitivity(Sn),specificity(Sp),positive predictive value(PPV) and negative predictive value(NPV) of differentiating neoplastic and non-neoplastic polyps(MSⅡ/Ⅱo/Ⅲa/Ⅲb vs I or NICE 1 vs 2/3).The secondary endpoints were "endoscopic resectability"(MSⅡ/Ⅱo/Ⅲa vs Ⅰ/Ⅲb or NICE 2 vs 1/3),NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTS A total of 348 patients were evaluated.The Sn,Sp,PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were,98.9%,85.7%,98.2% and 90.9% for MS;and 99.1%,57.7%,95.4% and 88.2% for NICE,respectively.The area under the receiver operating characteristic curve(AUC) for MS was 0.92(95%CI:0.86-0.98);and AUC for NICE was 0.78(95%CI:0.69,0.88).The Sn,Sp,PPV and NPV in predicting "endoscopic resectability" were 98.9%,86.1%,97.8% and 92.5% for MS;and 98.6%,66.7%,94.7% and 88.9% for NICE,respectively.The AUC for MS was 0.92(95%CI:0.87-0.98);and the AUC for NICE was 0.83(95%CI:0.75-0.90).The AUC values were statistically different for both comparisons(P = 0.0165 and P = 0.0420,respectively).The accuracy for diagnosis of sessile serrated adenoma/polyp(SSA/P) with high confidence utilizing MS classification was 93.2%.The differentiation of SSA/P from other lesions achieved Sp,Sn,PPV and NPV of 87.2%,91.5%,89.6% and 98.6%,respectively.The NPV for predicting adenomas in diminutive rectosigmoid polyps(n = 150) was 96.6% and 95% with MS and NICE respectively.The calculated accuracy of post-polypectomy surveillance for MS group was 98.2%(167 out of 170) and for NICE group was 92.1%(139 out of 151).CONCLUSION The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability.Both classifications met ASGE PIVI thresholds.展开更多
Colorectal cancer(CRC) is the 2^(nd) most common cancer in women and 3^(rd) most common cancer in men worldwide. Most CRCs develop from adenomatous polyps arising from glandular epithelium. Tumor growth is initiated b...Colorectal cancer(CRC) is the 2^(nd) most common cancer in women and 3^(rd) most common cancer in men worldwide. Most CRCs develop from adenomatous polyps arising from glandular epithelium. Tumor growth is initiated by mutation of the tumor suppressor gene APC and involves other genetic mutations in a stepwise process over years. Both hereditary and environmental factors contribute to the development of CRC. Screening has been proven to reduce the incidence of CRC. Screening has also contributed to the decrease in CRC mortality in the United States. However,CRC incidence and/or mortality remain on the rise in some parts of the world(Eastern Europe,Asia,and South America),likely due to factors including westernized diet,lifestyle,and lack of healthcare infrastructure. Multiple screening options are available,ranging from direct radiologic or endoscopic visualization tests that primarily detect premalignant or malignant lesions such as flexible sigmoidoscopy,optical colonoscopy,colon capsule endoscopy,computed tomographic colonography,and double contrast barium enema- to stool based tests which primarily detect cancers,including fecal DNA,fecal immunochemical test,and fecal occult blood test. The availability of some of these tests is limited to areas with high economic resources. This article will discuss CRC epidemiology,pathogenesis,risk factors,and screening modalities with a particular focus on new technologies.展开更多
AIM:To explore the problems in the screening of colorecta carcinoma in the elderly. METHODS:Three models of colorectal cancer prevention were examined:standard screening,active check-up of suspected cases and summons ...AIM:To explore the problems in the screening of colorecta carcinoma in the elderly. METHODS:Three models of colorectal cancer prevention were examined:standard screening,active check-up of suspected cases and summons to have endoscopic check- up for previously diagnosed colorectal polyps.The study was performed among three groups of elderly individuals: Group 1 (167 cases),hospitalized asymptomatic individuals without symptoms in large intestines.Group 2 (612 cases): old individuals at home for the aged,out of which 32 showed symptoms of colon disorders;Group 3 (44 cases):elderly people with diagnosed polyps.As a result of 1788 rectosigmoidoscopies,we identified 61 individuals with polyps,out of which 44 patients were over 65 years old. However,only 9 of these 44 individuals agreed to have the endoscopy performed again. RESULTS:One cancer and 13 polyps were detected in Group 1,and two polyps in Group 2.However,it should be noted that only eleven individuals from Group 2 agreed to have the endoscopy.In Group 3,there were no relapses of the polyps among the nine individuals who came back for the endoscopy. CONCLUSION:Poor understanding of the screening procedures is one of the greatest problems in early detection of the cancer in the aged.Paradoxically,the cooperation is better with hospitalized patients,than with 'successfully old' persons.展开更多
BACKGROUND In recent years,neoadjuvant chemotherapy(NAC)has been increasingly used in patients with resectable colorectal liver metastases.However,the efficacy and safety of NAC in the treatment of resectable colorect...BACKGROUND In recent years,neoadjuvant chemotherapy(NAC)has been increasingly used in patients with resectable colorectal liver metastases.However,the efficacy and safety of NAC in the treatment of resectable colorectal liver metastases(CRLM)are still controversial.AIM To assess the efficacy and application value of NAC in patients with resectable CRLM.METHODS We searched PubMed,Embase,Web of Science,and the Cochrane Library from inception to December 2020 to collect clinical studies comparing NAC with non-NAC.Data processing and statistical analyses were performed using Stata V.15.0 and Review Manager 5.0 software.RESULTS In total,32 studies involving 11236 patients were included in this analysis.We divided the patients into two groups,the NAC group(that received neoadjuvant chemotherapy)and the non-NAC group(that received no neoadjuvant chemotherapy).The meta-analysis outcome showed a statistically significant difference in the 5-year overall survival and 5-year disease-free survival between the two groups.The hazard ratio(HR)and 95%confidence interval(CI)were HR=0.49,95%CI:0.39-0.61,P=0.000 and HR=0.4895%CI:0.36-0.63,P=0.000.The duration of surgery in the NAC group was longer than that of the non-NAC group[standardized mean difference(SMD)=0.41,95%CI:0.01-0.82,P=0.044)].The meta-analysis showed that the number of liver metastases in the NAC group was significantly higher than that in the non-NAC group(SMD=0.73,95%CI:0.02-1.43,P=0.043).The lymph node metastasis in the NAC group was significantly higher than that in the non-NAC group(SMD=1.24,95%CI:1.07-1.43,P=0.004).CONCLUSION We found that NAC could improve the long-term prognosis of patients with resectable CRLM.At the same time,the NAC group did not increase the risk of any adverse event compared to the non-NAC group.展开更多
OBJECTIVE:To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on enhanced recovery after surgery (ERAS) in laparoscopic colorectal cancer resection and its clinical significance.METHODS:...OBJECTIVE:To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on enhanced recovery after surgery (ERAS) in laparoscopic colorectal cancer resection and its clinical significance.METHODS:Sixty-four patients undergoing laparoscopic colorectal resection were randomly divided into two groups,the control group (group A) and the TEAS group (group B).Patients in the TEAS group received electroacupuncture stimulation of bilateral Zusanli (ST 36) at 30 min before anesthesia to the end of surgery.The patients in the control group were not given the stimulation.Perioperative anesthesia management of the two groups were performed according to the ERAS guidelines,and postoperative patient-controlled intravenous analgesia (PCIA) was used.The amount of remifentanil used in the two groups was observed and recorded,and the visual analogue scale (VAS) of the 4,12,24 and 48 h after surgery in the two groups was recorded.Moreover,postoperative anal exhaust time,postoperative feeding time,postoperative first ambulation time and postoperative hospital stay length were compared between the two groups.RESULTS:Compared with group A,the VAS score of group B decreased significantly at 48 h after operation (P < 0.05).The postoperative anal exhaust time in group B was significantly shorter than that of group A (P < 0.05).There was no significant difference between the two groups with regards to remifentanil consumption,postoperative feeding time,postoperative first ambulation time and postoperative hospital stay (all P > 0.05).CONCLUSION:TEAS can promote the recovery of postoperative gastrointestinal function and reduce the pain intensity 48 h after surgery,thus satisfying the need of early postoperative analgesia.展开更多
目的比较腹腔镜手术(LS)与开腹手术(OS)治疗结直肠癌的临床效果。方法检索1991年1月—2010年7月公开发表的LS与OS治疗结直肠癌的随机对照试验(RCT)文献,根据入选标准筛选文献,提取有关临床效果指标进行Meta分析。结果按照筛选标准,共有1...目的比较腹腔镜手术(LS)与开腹手术(OS)治疗结直肠癌的临床效果。方法检索1991年1月—2010年7月公开发表的LS与OS治疗结直肠癌的随机对照试验(RCT)文献,根据入选标准筛选文献,提取有关临床效果指标进行Meta分析。结果按照筛选标准,共有14篇RCT共计5 478例结直肠癌患者纳入分析。LS组与OS组患者基本特征均衡。LS组术中出血量较OS组减少125 m l(P<0.001),手术时间延长42 m in(P<0.001),肿瘤直径、淋巴结检出数量、纵向切缘阳性率和环周切缘阳性率两组差异均无统计学意义(P>0.05);LS组术后并发症切口感染、麻痹性肠梗阻的发生率以及围术期病死率均较OS组明显降低(P<0.001),其他并发症间差异均无统计学意义(P>0.05)。远期疗效如3年生存率、5年生存率、局部复发和远处转移两组差异均无统计学意义(P>0.05),但LS组穿刺孔肿瘤种植较OS组切口肿瘤种植的发生率明显增高(P=0.04)。结论 LS创伤小,可安全地根治结直肠癌,远期效果与OS无差异。展开更多
文摘AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial.Based on the MS or the NICE classifications,patients were randomised for real-time endoscopic diagnosis.This was followed by biopsies,endoscopic or surgical resection.The endoscopic diagnosis was then compared to the final(blinded) histopathology.The primary endpoint was the sensitivity(Sn),specificity(Sp),positive predictive value(PPV) and negative predictive value(NPV) of differentiating neoplastic and non-neoplastic polyps(MSⅡ/Ⅱo/Ⅲa/Ⅲb vs I or NICE 1 vs 2/3).The secondary endpoints were "endoscopic resectability"(MSⅡ/Ⅱo/Ⅲa vs Ⅰ/Ⅲb or NICE 2 vs 1/3),NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTS A total of 348 patients were evaluated.The Sn,Sp,PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were,98.9%,85.7%,98.2% and 90.9% for MS;and 99.1%,57.7%,95.4% and 88.2% for NICE,respectively.The area under the receiver operating characteristic curve(AUC) for MS was 0.92(95%CI:0.86-0.98);and AUC for NICE was 0.78(95%CI:0.69,0.88).The Sn,Sp,PPV and NPV in predicting "endoscopic resectability" were 98.9%,86.1%,97.8% and 92.5% for MS;and 98.6%,66.7%,94.7% and 88.9% for NICE,respectively.The AUC for MS was 0.92(95%CI:0.87-0.98);and the AUC for NICE was 0.83(95%CI:0.75-0.90).The AUC values were statistically different for both comparisons(P = 0.0165 and P = 0.0420,respectively).The accuracy for diagnosis of sessile serrated adenoma/polyp(SSA/P) with high confidence utilizing MS classification was 93.2%.The differentiation of SSA/P from other lesions achieved Sp,Sn,PPV and NPV of 87.2%,91.5%,89.6% and 98.6%,respectively.The NPV for predicting adenomas in diminutive rectosigmoid polyps(n = 150) was 96.6% and 95% with MS and NICE respectively.The calculated accuracy of post-polypectomy surveillance for MS group was 98.2%(167 out of 170) and for NICE group was 92.1%(139 out of 151).CONCLUSION The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability.Both classifications met ASGE PIVI thresholds.
基金Supported by An American College of Gastroenterology Junior Faculty Development Award to Linda C Cummings
文摘Colorectal cancer(CRC) is the 2^(nd) most common cancer in women and 3^(rd) most common cancer in men worldwide. Most CRCs develop from adenomatous polyps arising from glandular epithelium. Tumor growth is initiated by mutation of the tumor suppressor gene APC and involves other genetic mutations in a stepwise process over years. Both hereditary and environmental factors contribute to the development of CRC. Screening has been proven to reduce the incidence of CRC. Screening has also contributed to the decrease in CRC mortality in the United States. However,CRC incidence and/or mortality remain on the rise in some parts of the world(Eastern Europe,Asia,and South America),likely due to factors including westernized diet,lifestyle,and lack of healthcare infrastructure. Multiple screening options are available,ranging from direct radiologic or endoscopic visualization tests that primarily detect premalignant or malignant lesions such as flexible sigmoidoscopy,optical colonoscopy,colon capsule endoscopy,computed tomographic colonography,and double contrast barium enema- to stool based tests which primarily detect cancers,including fecal DNA,fecal immunochemical test,and fecal occult blood test. The availability of some of these tests is limited to areas with high economic resources. This article will discuss CRC epidemiology,pathogenesis,risk factors,and screening modalities with a particular focus on new technologies.
文摘AIM:To explore the problems in the screening of colorecta carcinoma in the elderly. METHODS:Three models of colorectal cancer prevention were examined:standard screening,active check-up of suspected cases and summons to have endoscopic check- up for previously diagnosed colorectal polyps.The study was performed among three groups of elderly individuals: Group 1 (167 cases),hospitalized asymptomatic individuals without symptoms in large intestines.Group 2 (612 cases): old individuals at home for the aged,out of which 32 showed symptoms of colon disorders;Group 3 (44 cases):elderly people with diagnosed polyps.As a result of 1788 rectosigmoidoscopies,we identified 61 individuals with polyps,out of which 44 patients were over 65 years old. However,only 9 of these 44 individuals agreed to have the endoscopy performed again. RESULTS:One cancer and 13 polyps were detected in Group 1,and two polyps in Group 2.However,it should be noted that only eleven individuals from Group 2 agreed to have the endoscopy.In Group 3,there were no relapses of the polyps among the nine individuals who came back for the endoscopy. CONCLUSION:Poor understanding of the screening procedures is one of the greatest problems in early detection of the cancer in the aged.Paradoxically,the cooperation is better with hospitalized patients,than with 'successfully old' persons.
基金Supported by the Natural Science Foundation of Gansu Province,China,No.18JR3RA052the Gansu Province Da Vinci Robot High End Diagnosis and Treatment Personnel Training Project+1 种基金the National Key Research and Development Program Task Book,No.2018YFC1311506the Lanzhou Talent Innovation and Entrepreneurship Project Task Contract,No.2016-RC-56.
文摘BACKGROUND In recent years,neoadjuvant chemotherapy(NAC)has been increasingly used in patients with resectable colorectal liver metastases.However,the efficacy and safety of NAC in the treatment of resectable colorectal liver metastases(CRLM)are still controversial.AIM To assess the efficacy and application value of NAC in patients with resectable CRLM.METHODS We searched PubMed,Embase,Web of Science,and the Cochrane Library from inception to December 2020 to collect clinical studies comparing NAC with non-NAC.Data processing and statistical analyses were performed using Stata V.15.0 and Review Manager 5.0 software.RESULTS In total,32 studies involving 11236 patients were included in this analysis.We divided the patients into two groups,the NAC group(that received neoadjuvant chemotherapy)and the non-NAC group(that received no neoadjuvant chemotherapy).The meta-analysis outcome showed a statistically significant difference in the 5-year overall survival and 5-year disease-free survival between the two groups.The hazard ratio(HR)and 95%confidence interval(CI)were HR=0.49,95%CI:0.39-0.61,P=0.000 and HR=0.4895%CI:0.36-0.63,P=0.000.The duration of surgery in the NAC group was longer than that of the non-NAC group[standardized mean difference(SMD)=0.41,95%CI:0.01-0.82,P=0.044)].The meta-analysis showed that the number of liver metastases in the NAC group was significantly higher than that in the non-NAC group(SMD=0.73,95%CI:0.02-1.43,P=0.043).The lymph node metastasis in the NAC group was significantly higher than that in the non-NAC group(SMD=1.24,95%CI:1.07-1.43,P=0.004).CONCLUSION We found that NAC could improve the long-term prognosis of patients with resectable CRLM.At the same time,the NAC group did not increase the risk of any adverse event compared to the non-NAC group.
文摘OBJECTIVE:To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on enhanced recovery after surgery (ERAS) in laparoscopic colorectal cancer resection and its clinical significance.METHODS:Sixty-four patients undergoing laparoscopic colorectal resection were randomly divided into two groups,the control group (group A) and the TEAS group (group B).Patients in the TEAS group received electroacupuncture stimulation of bilateral Zusanli (ST 36) at 30 min before anesthesia to the end of surgery.The patients in the control group were not given the stimulation.Perioperative anesthesia management of the two groups were performed according to the ERAS guidelines,and postoperative patient-controlled intravenous analgesia (PCIA) was used.The amount of remifentanil used in the two groups was observed and recorded,and the visual analogue scale (VAS) of the 4,12,24 and 48 h after surgery in the two groups was recorded.Moreover,postoperative anal exhaust time,postoperative feeding time,postoperative first ambulation time and postoperative hospital stay length were compared between the two groups.RESULTS:Compared with group A,the VAS score of group B decreased significantly at 48 h after operation (P < 0.05).The postoperative anal exhaust time in group B was significantly shorter than that of group A (P < 0.05).There was no significant difference between the two groups with regards to remifentanil consumption,postoperative feeding time,postoperative first ambulation time and postoperative hospital stay (all P > 0.05).CONCLUSION:TEAS can promote the recovery of postoperative gastrointestinal function and reduce the pain intensity 48 h after surgery,thus satisfying the need of early postoperative analgesia.
文摘目的比较腹腔镜手术(LS)与开腹手术(OS)治疗结直肠癌的临床效果。方法检索1991年1月—2010年7月公开发表的LS与OS治疗结直肠癌的随机对照试验(RCT)文献,根据入选标准筛选文献,提取有关临床效果指标进行Meta分析。结果按照筛选标准,共有14篇RCT共计5 478例结直肠癌患者纳入分析。LS组与OS组患者基本特征均衡。LS组术中出血量较OS组减少125 m l(P<0.001),手术时间延长42 m in(P<0.001),肿瘤直径、淋巴结检出数量、纵向切缘阳性率和环周切缘阳性率两组差异均无统计学意义(P>0.05);LS组术后并发症切口感染、麻痹性肠梗阻的发生率以及围术期病死率均较OS组明显降低(P<0.001),其他并发症间差异均无统计学意义(P>0.05)。远期疗效如3年生存率、5年生存率、局部复发和远处转移两组差异均无统计学意义(P>0.05),但LS组穿刺孔肿瘤种植较OS组切口肿瘤种植的发生率明显增高(P=0.04)。结论 LS创伤小,可安全地根治结直肠癌,远期效果与OS无差异。
