Neoadjuvant chemotherapy with capecitabine combined with oxaliplatin for mid-low locally advanced rectal cancer with negative mesorectal fascia:Long-term outcomes of a prospective trial(PKUCH-R03 trial)

Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.

Role of protective stoma in low anterior resection for rectal cancer:A meta-analysis

AIM: To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer.

Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis:Does it really save lives?

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

Predictive value of serum alpha-fetoprotein for tumor regression after preoperative chemotherapy for rectal cancer

BACKGROUND Preoperative therapy is widely used in locally advanced rectal cancer.It can improve local control of rectal cancer.However,there are few indicators that can predict the effect of preoperative chemotherapy accurately.AIM To investigate whether the increase in serumα-fetoprotein(AFP)can predict better efficacy of preoperative chemotherapy.METHODS This was a retrospective study.We analyzed 125 patients admitted between 2017 and 2019 with locally advanced rectal cancer.All patients received six cycles of preoperative chemotherapy(mFOLFOX6 every 2 wk).Serum AFP of 26 patients rose slightly after three or four cycles of chemotherapy,and fell to normal again within 2 mo.The other 99 patients had a normal level of serum AFP during chemotherapy.Patients were divided into two groups(AFP risen and AFP normal).According to postoperative pathology,we compared tumor regression and complete response rate between the two groups.The primary outcome measure was the tumor regression grade(TRG)after chemotherapy.The difference in pathological complete response between the two groups was also investigated.RESULTS There were no tumor progression and distant metastasis in both groups during preoperative chemotherapy.Patients in the AFP risen group achieved better TRG 0/1 than those in the AFP normal group(61.5%vs 39.4%).The increase in AFP was a significant predictor for better tumor regression[χ2=4.144,odds ratio(OR)=2.666,P=0.04].In the AFP risen group,the complete response rate was 30.8%,which was higher than in the AFP normal group(30.8%vs 12.1%,χ2=4.542,OR=3.251,P=0.03).CONCLUSION Patients with a slight increase in serum AFP can achieve better tumor regression during preoperative chemotherapy,and are more likely to achieve pathological complete response.

Efficacy and safety of short duration radiotherapy combined with chemotherapy for advanced rectal cancer

BACKGROUND Radiotherapy or chemoradiotherapy is widely used for the treatment of rectal cancer preoperatively.Although the combination of radiotherapy and chemotherapy as an established preoperative neoadjuvant therapy shows high efficacy in the treatment of rectal cancer,some patients experience a response of poor tolerance and outcomes due to the long duration radiotherapy.The study compared short duration radiotherapy plus chemotherapy vs long duration radiotherapy plus chemotherapy for rectal cancer to determine whether short duration radiation treatment should be considered to diminish complications,reduce risk of recurrence and improve survival in patients with rectal cancer.AIM To evaluate the efficacy and safety of short duration radiotherapy combined with chemotherapy for the treatment of advanced rectal cancer.METHODS One hundred patients with stage IIIB or higher severe rectal cancer were selected as the study subjects at The First Affiliated Hospital of Hebei North University between December 2018 and December 2019.The patients were assigned to different groups based on the treatment regimens.Fifty patients who received preoperative short durations of radiotherapy plus chemotherapy were enrolled in an observation group and fifty patients who received conventional radiotherapy and chemotherapy were enrolled in a control group.Colonoscopic biopsy was performed for all patients with pathological diagnosis of rectal cancer.The expression of tumor-related factors such as RUNX3 and Ki-67 was quantitatively analyzed using immunohistochemistry in the tissues of the patients before and after treatment.Moreover,the duration of procedure,the amount of bleeding during the operation,the anus-conserving rate,the incidence of postoperative complications(wound infection,anastomotic leakage,postoperative intestinal obstruction,etc.)and postoperative pathology were compared between the two groups.The overall survival rate,recurrence rate and distant metastasis rate were also compared through postoperative reexamination and regular follow-up.RESULTS There was no significant difference in the positive expression rate of RUNX3 and Ki-67 between the two groups before the treatment(P>0.05).Compared with the pretreatment value,the positive rate of RUNX3 was increased and the positive rate of Ki-67 was decreased in both groups after the treatment(all P<0.05).The incidence of leukopenia,thrombocytopenia,neutropenia and diarrhea were higher in the observation group than in the control group(all P<0.05).There was no significant difference in the incidence of anemia,fatigue,neurotoxicity and nausea and vomiting between the two groups(all P>0.05).No significant difference was observed in the duration of procedure,intraoperative bleeding,the anus-conserving rate and the incidence of postoperative complications between the two groups(P>0.05).After 1 year of follow-up,the 1-yr survival rate was 80.0%in the observation group and 68.0%in the control group,the recurrence rate was 8.0%in the observation group and 10.0%in the control group,the distant metastasis rate was 6.0%in the observation group and 8.0%in the control group difference(all P<0.05).CONCLUSION Short duration radiotherapy combined with chemotherapy can improve the cure rate,prolong the survival time and reduce the incidence of complications in patients with advanced rectal cancer.

Multi-modal radiomics model to predict treatment response to neoadjuvant chemotherapy for locally advanced rectal cancer

BACKGROUND Neoadjuvant chemotherapy is currently recommended as preoperative treatment for locally advanced rectal cancer(LARC);however,evaluation of treatment response to neoadjuvant chemotherapy is still challenging.AIM To create a multi-modal radiomics model to assess therapeutic response after neoadjuvant chemotherapy for LARC.METHODS This retrospective study consecutively included 118 patients with LARC who underwent both computed tomography(CT)and magnetic resonance imaging(MRI)before neoadjuvant chemotherapy between October 2016 and June 2019.Histopathological findings were used as the reference standard for pathological response.Patients were randomly divided into a training set(n=70)and a validation set(n=48).The performance of different models based on CT and MRI,including apparent diffusion coefficient(ADC),dynamic contrast enhanced T1 images(DCE-T1),high resolution T2-weighted imaging(HR-T2WI),and imaging features,was assessed by using the receiver operating characteristic curve analysis.This was demonstrated as area under the curve(AUC)and accuracy(ACC).Calibration plots with Hosmer-Lemeshow tests were used to investigate the agreement and performance characteristics of the nomogram.RESULTS Eighty out of 118 patients(68%)achieved a pathological response.For an individual radiomics model,HR-T2WI performed better(AUC=0.859,ACC=0.896)than CT(AUC=0.766,ACC=0.792),DCE-T1(AUC=0.812,ACC=0.854),and ADC(AUC=0.828,ACC=0.833)in the validation set.The imaging performance for extramural venous invasion detection was relatively low in both the training(AUC=0.73,ACC=0.714)and validation(AUC=0.578,ACC=0.583)sets.The multi-modal radiomics model reached an AUC of 0.925 and ACC of 0.886 in the training set,and an AUC of 0.93 and ACC of 0.875 in the validation set.For the clinical radiomics nomogram,good agreement was found between the nomogram prediction and actual observation.CONCLUSION A multi-modal nomogram using traditional imaging features and radiomics of preoperative CT and MRI adds accuracy to the prediction of treatment outcome,and thus contributes to the personalized selection of neoadjuvant chemotherapy for LARC.

Neoadjuvant chemotherapy without radiation as a potential alternative treatment for locally advanced rectal cancer:A metaanalysis

BACKGROUND Neoadjuvant chemoradiotherapy(Neo-CRT)is the current standard strategy for treating locally advanced rectal cancer.However,it delays the administration of optimal chemotherapy and increases toxicity.AIM To compare the feasibility and efficacy of neoadjuvant chemotherapy(Neo-CT)and Neo-CRT for patients with locally advanced rectal cancer.METHODS The Cochrane,EMBASE,and PubMed databases were searched for relevant articles using MESH terms and free words.The hazard ratio of overall survival and the risk ratio(RR)for the pathological complete response,the sphincter preservation rate,and treatment-related adverse events were analyzed.RESULTS A total of 19 studies of 60870 patients were included in the meta-analysis.There was no significant difference in overall survival[hazard ratio=1.09,95%confidence interval(CI)=0.93–1.24;P=0.19]or the pathological complete response(RR=0.79,95%CI=0.61–1.03;P=0.086)between the Neo-CT and Neo-CRT groups.As compared to the Neo-CRT group,the incidences of anastomotic fistula(RR=0.49,95%CI=0.35–0.68;P=0.000)and temporary colostomy(RR=0.69,95%CI=0.58–0.83;P=0.000)were significantly lower in the Neo-CT group,with a simultaneous increase in the sphincter preservation rate(RR=1.07,95%CI=1.01–1.13;P=0.029).However,there was no significant difference in the tumor downstaging rate,overall complications,and urinary complications.CONCLUSION Neo-CT administration can lower the incidences of anastomotic fistula and temporary colostomy and increase the sphincter preservation rate as to compared to Neo-CRT and could provide an alternative to chemoradiotherapy for locally advanced rectal cancer.

Stage II/III Rectal Cancer Patients Benefit from Extremely Early Initiation of Postoperative Adjuvant Chemotherapy: A Retrospective Study

Background: For Stage II/III rectal cancer patients, curative resection is the primary treatment, prescribing of postoperative adjuvant chemotherapy (PAC) is regarded as a standard therapy. The interval between surgery and the initiation of PAC is usually within 8 weeks. However, the optimal cut-off is still controversial. This study aimed to explore the impact of extremely early initiation of PAC for II/III rectal cancer. Methods: Patients with Stage II/III rectal cancer treated from January 2013 to December 2015 were retrospectively collected at the Department of Tongji Hospital. According to the starting point of PAC, patients were categorized into two groups: extremely early group (The interval of PAC ≤ 2 weeks) and normal group (The interval of PAC within 3 - 5 weeks). For the sake of evaluating the effectiveness of different intervals, Overall Survival rate (OS), Progress-Free Survival rate (PFS) and Recurrence or Metastasis Rate (RMR) were analyzed, as well as the Quality of Life Score. To estimate the safety of the extremely early PAC, we evaluated the first post chemotherapy adverse reactions and defecation ability, and analyzed the variance laboratory indexes around the first postoperative adjuvant chemotherapy. Results: A total of 267 patients were included in this study. Compared to normal group (192 cases), extremely early group (75 cases) of patients attained a better tendency of OS and PFS, although there were no significant statistical differences (OS: P = 0.0930;PFS: P = 0.1058). However, the RMR was significant lower (P = 0.0452) and the Quality of Life Score was significantly higher (P = 0.0090) in extremely early group. Multivariate analysis also showed that extremely early group had better defecation ability (P = 0.0149) and less side reactions of post chemotherapy, such as vomiting (P , got a higher level of inflammatory cells (P Conclusion: For Stage II/III rectal cancer patients, extremely early to start PAC not only might be effectively prolonging the survival, but indeed decrease the tumor-related recurrence risk, increase the quality of life and decrease chemotherapy-associated adverse reactions. Meanwhile, appropriately controlling of inflammatory cells and protecting the liver function should be of concern to ensure the safety of early initial stage.

Adjuvant chemotherapy for rectal cancer:Is it needed?

Adjuvant chemotherapy has become a standard treatment of advanced rectal cancer in the West. The benefits of adjuvant chemotherapy after surgery alone have been well established. However,controversy surrounds the use adjuvant chemotherapy in patients who received preoperative chemoradiotherapy,despite it being recommended by a number of international guidelines. Results of recent multicentre randomised control trials showed no benefit of adjuvant chemotherapy in terms of survival and rates of distant metastases. However,concerns exist regarding the quality of the studies including inadequate staging modalities,out-dated chemotherapeutic regimens and surgical approaches and small sample sizes. It has become evident that not all the patients respond to adjuvant chemotherapy and more personalised approach should be employed when considering the benefits of adjuvant chemotherapy. The present review discusses the strengths and weaknesses of the current evidence-base and suggests improvements for future studies.

Value of Pretreatment Inflammation-nutrition Score to Predict Non-response to Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer

Objective To investigate the value of pretreatment inflammatory-nutritional biomarkers in predicting the pathological response of locally advanced rectal cancer(LARC)after neoadjuvant chemotherapy(nCT).Methods This retrospective study included eligible participants who underwent nCT followed by radical surgery.Pretreatment inflammatory nutritional biomarkers were calculated within one week prior to nCT.Correlations between biomarkers and pathological responses were analyzed.The cut-off values of the pretreatment biomarkers for predicting non-response were determined using receiver operating characteristic(ROC)curve analysis.The inflammation-nutrition score was calculated using the lymphocyte level,neutrophil-to-lymphocyte ratio(NLR),and prognostic nutritional index(PNI).Results A total of 235 patients were retrospectively recruited between January 2017 and September 2022.Lower lymphocyte levels,lymphocyte monocyte ratio(LMR),and PNI,and higher NLR and platelet-to-lymphocyte ratio(PLR)were observed in patients without response.Multivariate logistic regression analysis revealed that NLR could independently predict non-response to nCT in patients with LARC.The sensitivity and specificity of the inflammation-nutrition score for predicting nonresponse were 71.2%and 61.7%,respectively.Conclusion The pretreatment inflammation-nutrition score is a practical parameter for predicting nonresponse to nCT in patients with LARC.Patients with high scores were more likely to respond poorly to nCT.

Efficacy of transanal drainage tube in preventing anastomotic leakage after surgery for rectal cancer: A meta-analysis

BACKGROUND Anastomotic leakage(AL)following rectal cancer surgery is an important cause of mortality and recurrence.Although transanal drainage tubes(TDTs)are expected to reduce the rate of AL,their preventive effects are controversial.AIM To reveal the effect of TDT in patients with symptomatic AL after rectal cancer surgery.METHODS A systematic literature search was performed using the PubMed,Embase,and Cochrane Library databases.We included randomized controlled trials(RCTs)and prospective cohort studies(PCSs)in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was evaluated.The results of the studies were synthesized using the Mantel-Haenszel randomeffects model,and a two-tailed P value>0.05 was considered statistically significant.RESULTS Three RCTs and two PCSs were included in this study.Symptomatic AL was examined in all 1417 patients(712 with TDT),and TDTs did not reduce the symptomatic AL rate.In a subgroup analysis of 955 patients without a diverting stoma,TDT reduced the symptomatic AL rate(odds ratio=0.50,95%confidence interval:0.29–0.86,P=0.012).CONCLUSION TDT may not reduce AL overall among patients undergoing rectal cancer surgery.However,patients without a diverting stoma may benefit from TDT placement.

Five Year Survival Outcomes of Prospectively Recorded Cohort Data for Older Adults versus Younger Adults with Resected Primary Rectal Cancer

Background: Rectal cancer predominantly occurs in older adults. We aimed to compare the long-term outcomes of older adults (≥70 years) versus younger adults (<70 years) who had had a primary resection for stage I-IV rectal cancer. Methods: Consecutive patients who had resection of a primary rectal cancer between January 1, 2000 and December 31, 2010 were identified from a prospective database at the Concord Repatriation General Hospital and stratified into two age groups: <70 years and ≥70 years. Age-related differences in patients, cancer, and treatment characteristics were determined by Chi-square tests. 5-year Overall Survival (OS) and Cancer-Specific Survival (CSS) were determined by the Kaplan-Meier method and by multivariable Cox regression analysis. Results: Of 714 included patients, the mean age was 65.8 years (range, 21 - 92 years). 407 (57%) patients were aged < 70 years and 307 (43%) were aged ≥ 70 years. Older age (>70 years) predicted more comorbidity (p < 0.001) and earlier stage (p = 0.01). Of the patients with stage III rectal cancer, older adults (>70 years), compared with younger adults (<70 years), received less neoadjuvant chemotherapy [7/86 (8.1%) vs 25/147 (17.0%), p = 0.058], less neoadjuvant radiotherapy [8/86 (9.3%) vs 42/147 (28.6%), p = 0.001] and less adjuvant chemotherapy [30/86 (34.9%) vs 117/147 (79.6%), p < 0.001]. Older age was associated with worse OS and CSS in stage III (p < 0.001 and p = 0.02 respectively). Adjuvant chemotherapy independently predicted improved OS (p < 0.001) and CSS (p = 0.008) regardless of age. Conclusion: Older adults who had had a resection of stage I-IV primary rectal cancer received less neoadjuvant and adjuvant therapy and had worse OS and CSS than their younger counterparts.

Effect of postoperative adjuvant chemotherapyon the prognosis of patients with ypT0-3N0 rectalcancer undergoing neoadjuvant chemoradiotherapy

Objective The aim of this study was to investigate the effect of adjuvant chemotherapy (AC) on theprognosis of patients with ypT0-3N0 rectal cancer undergoing neoadjuvant chemoradiotherapy.Methods The study participants were 110 patients with locally advanced rectal cancer. Thirty-fourpatients did not receive postoperative AC treatment, and the other 76 patients received postoperative ACtreatment. The differences in the 5-year overall survival (OS) and disease-free survival (DFS) between thetwo groups were compared.Results Age was an important determinant of the patients’ decision to undergo postoperative treatment.Patients who did not receive AC treatment were significantly older than those who received AC treatment(P < 0.05). The tumor location (distance above anal margin) in the AC group was significantly larger thanthat in the non-AC group (P < 0.05). Moreover, there was no significant difference in the 5-year DFS andOS between the two groups. Postoperative AC did not significantly improve the prognosis of patients withrectal cancer. Age, tumor differentiation, and the number of resected lymph nodes were independent factorsaffecting the OS of patients (P < 0.05). Older patients, patients with lower degree of tumor differentiation,and patients with <12 resected lymph nodes showed worse prognosis (P < 0.05).Conclusion Patients with rectal cancer whose ypT0-3N0 stage is reduced after neoadjuvantchemoradiotherapy, especially those without adverse prognostic factors, do not need AC after surgery.

Effect of neoadjuvant chemotherapy on immune function, vascular endothelial function and LEP in patients with rectal cancer

Objective:To investigate the effect of neoadjuvant chemotherapy on immune function, vascular endothelial function and LEP in patients with rectal cancer.Methods: The clinical data of 110 patients undergoing laparoscopic rectal cancer radical resection in our hospital were retrospectively analyzed. They were divided into control group (n=55) and study group (n=55) according to the surgical procedure. The control group was treated with laparoscopic surgery, and the study group was treated with laparoscopic surgery combined with neoadjuvant chemotherapy. The tumor markers CA242 and CA19-9, immunological function indicators C3, C4, IgA, IgG, vascular endothelial function VEGF and VEGFR-2, LEP and IGF-1 were detected at 1 day before treatment and 1 day after treatment.Results:Before treatment, serum CA242, CA19-9, C3, C4, IgA, IgG, VEGF, VEGFR-2, LEP and IGF-1 levels were not significantly different between the two groups (P<0.05). After treatment, serum CA242 and CA19-9 levels were significantly lower in the two groups (P<0.05). The levels of CA242 and CA19-9 in the study group were (15.23±1.53) IU/mL and (20.13±2.01) U/mL, which were significantly lower than the control group (P<0.05). After treatment, serum IgA and IgG levels were significantly higher in both groups, and C3 and C4 levels were significantly increased in the study group (P<0.05). The levels of C3, C4, IgA and IgG in the study group were significantly higher (1.31±0.13) g/L, (0.34±0.03) g/L, (1.78±0.18) g/L and (11.02±1.13) g/L, which were higher those in the control group (P<0.05). After treatment, serum VEGF and VEGFR-2 levels were significantly lower in the two groups (P<0.05). The levels of VEGF and VEGFR-2 in the study group were (118.15±11.86) ng/L and (92.44±9.26) ng/L, which were significantly lower than those in the control group (P<0.05). After treatment, LEP levels were significantly increased in both groups, and IGF-1 levels were significantly lower in both groups (P<0.05). The LEP of the study group was (7.51±0.71) ng/mL, which were significantly higher than that of the control group, and the level of IGF-1 was (281.47±28.86) μg/L in the study group, which were significantly lower than the control group (bothP<0.05).Conclusion:Laparoscopic rectal cancer surgery combined with neoadjuvant chemotherapy can significantly improve the vascular endothelial function of patients with rectal cancer and improve the immune function of the body. It is worthy of clinical application.

Meta-analysis of the effect of continuing nursing on the psychological status of rectal cancer patients undergoing stoma

Objective:To systematically evaluate the effect of continuous nursing on the psychological status of rectal cancer patients undergoing stoma.Methods:Five databases including China HowNet,Chongqing Weipu Chinese Science and Technology Database,Wanfang Database,Embase and PubMed were searched.Randomized controlled trials were collected on the effect of continuing nursing on the psychological status of rectal cancer patients undergoing stoma.The searching time was from the establishment of the database to March 30,2019.RevMan 5.3 software was used to analyze the bias risk of the study after two researchers independently screened the researchers,extracted the data and evaluated the bias risk of the study.Results:A total of 15 studies were included.Meta-analysis showed that the continuing nursing group improved anxiety[MD=-10.89,95%CI(-13.52,-8.26),P<0.00001],depression[MD=-4.78,95%CI(-5.77,-3.80,P<0.00001],fear[MD=-6.06,95%CI(-7.70,-4.43),P<0.00001],hostile[MD=-7.00,95%CI(-13.62,-0.38),P=0.04<0.05],somatization[MD=-7.63,95%CI(-13.49,-1.77),P=0.01<0.05].The self-care ability[MD=38.24,95%CI(35.38,41.11),P<0.00001]was superior to the routine nursing group.Conclusion:Continuous nursing has more advantages than routine nursing,and it can improve the negative psychological state of rectal cancer patients undergoing stoma.Due to the limitations of the quantity and quality of the included studies,the above conclusions need to be verified by more high-quality studies.

Effect of laparoscopic surgery combined with neoadjuvant chemotherapy on serum CEA, VEGF, CA724, CA242, LEP and T lymphocyte subsets in patients with low rectal cancer

Objective: To study the effect of laparoscopic surgery combined with neoadjuvant chemotherapy on serum CEA, VEGF, CA724, CA242, LEP and T lymphocyte subsets in patients with low rectal cancer. Methods A total of 80 patients with low rectal cancer in our hospital from June 2014 to June 2017 were enrolled in this study. The subjects were divided into the control group (n=40) and the treatment group (n=40) randomly. The control group were treated with laparoscopic surgery, the treatment group were treated with laparoscopic surgery combined with neoadjuvant chemotherapy, and both the two groups were treated for 6 periods with neoadjuvant chemotherapy after surgery. The serum CEA, VEGF, CA724, CA242, LEP levels and peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups before and after treatment were compared. Results: There were no significantly differences of the serum CEA, VEGF, CA724, CA242, LEP levels and peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups before treatment. The serum CEA, VEGF, CA724, CA242 and LEP levels of the two groups after treatment were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group.The peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups of the two groups after treatment were significantly lower than before treatment, and that of the treatment group were significantly higher than the control group. Conclusion: Laparoscopic surgery combined with neoadjuvant chemotherapy can significantly reduce the serum CEA, VEGF, CA724, CA242, LEP levels, improve the immunologic function, and it was worthy clinical application.

Neoadjuvant radiotherapy for rectal cancer management

Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.

Treatment strategy for colorectal cancer with resectable synchronous liver metastases:Is any evidence-based strategy possible?

Fifteen percent to twenty-five percent of patients affected by colorectal cancer presents with liver metastases at diagnosis. In resectable cases, surgery is the only potentially curative treatment and achieves survival rates up to 50% at 5 years. Management is complex, as colorectal resection, liver resection, chemotherapy, and, in locally advanced mid/low rectal tumors, radiotherapy have to be integrated. Modern medical practice usually relies on evidence-based protocols. Levels of evidence for synchronous metastases are poor:published studies include few recent prospective series and several retrospective analyses collecting a limited number of patients across long periods of time. Data are difficult to be generalized and are mainly representative of single centre's experience, biased by local recruitment, indications and surgical technique. In this context, surgeons have to renounce to "evidence-based medicine" and to adopt a sort of "experience-based medicine". Anyway, some suggestions are possible. Simultaneous colorectal and liver resection can be safely performed whenever minor hepatectomies are planned, while a case-by-case evaluation is mandatory in case of more complex procedures. Neoadjuvant chemotherapy is preferentially scheduled for patients with advanced metastatic tumors to assess disease biology and to control lesions. It can be safely performed with primarytumor in situ , even planning simultaneous resection at its end. Locally advanced mid/low rectal tumor represents a further indication to neoadjuvant therapies, even if treatment's schedule is not yet standardized. In summary, several issues have to be solved, but every single HPB centre should define its proper strategy to optimize patient's selection, disease control and safety and completeness of surgery.

Adjuvant therapies for colorectal cancer

The management of colon and rectal cancer has changed dramatically over the last 25 years. The use of adjuvant therapies has become standard practice in locally advanced （stage M and selected stage 11） colorectal cancer. Improved surgical techniques, chemotherapeutics and radiotherapy are resulting in higher cure rates and the development of agents targeting proliferative and angiogenic pathways offer further promise. Here we explore risk factors for local and distant recurrence after resection of colon and rectal cancer, and the role of adjuvant treatments. Discussion will focus on the evidence base for adjuvant therapies utilised in colorectal cancer, and the treatment of sub-groups such as the elderly and stage 11 disease. The role of adjuvant radiotherapy in rectal cancer in reduction of recurrence will be explored and the role and optimal methods for surveillance post-curative resection with or without adjuvant therapy will also be addressed.

Bevacizumab in the pre-operative treatment of locally advanced rectal cancer: A systematic review

Despite advances in the management of patients with locally advanced, non-metastatic rectal adenocarcinoma (LARC), prognosis remains largely unsatisfactory due to a high rate of distant relapse. In fact, currently available neoadjuvant protocols, represented by fluoropyrimidine-based chemo-radiotherapy (CT-RT) or short-course RT, together with improved surgical techniques, have largely reduced the risk of local relapse, with limited impact on distant recurrence. Available results of phase III trials with additional cytotoxic agents combined with standard CT-RT are disappointing, as no significant reduction in the risk of recurrence has been demonstrated. In order to improve the control of micrometastatic disease, integrating targeted agents into neoadjuvant treatment protocols thus offers a rational approach. In particular, the antiangiogenic agent bevacizumab has demonstrated synergistic activity with both CT and RT in pre-clinical and clinical models, and thus may represent a suitable companion in the neoadjuvant treatment of LARC. Preliminary results of phase&#x02005;I-II clinical studies are promising and suggest potential clinical parameters and molecular predictive biomarkers useful for patient selection: treatment personalization is indeed the key in order to maximize the benefit while reducing the risk of more complex neoadjuvant treatment schedules.