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...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.展开更多
Résumé: Objectif Lobjectif de ce travail est detablir une méthode danalyse du polymorphisme de la conformation monochaine (PCMC), capable de détecter la mutation ponctuelle du gène hMLH1...Résumé: Objectif Lobjectif de ce travail est detablir une méthode danalyse du polymorphisme de la conformation monochaine (PCMC), capable de détecter la mutation ponctuelle du gène hMLH1 dans le cancer colique en utilisant l l ctrophor se capillaire associée a la fluorescence laser-induite (FLI-EC). Méthodes Les exons 12 du gène hMLH1 du sang périphérique de 42 patients de cancer colo-rectal sporadique et 20 sujets sains témoins sont amplifiés par la PCR. Le PCMC des produits du PCR est analysé par FLI-EC. Les échantillons anormaux ont été confirmés par séquen age EC. Les effets de la concentration du milieu (LPA), de la température de séparationet du voltage de séparation sur le comportement de EC ont été aussi etudiés. Résultats Lanalyse de PCMC par la methode FLI-EC a retrouvé une mutation hétérozygote chez 4 des 42 patients. La mutation ponctuelle de T1151A a été objectivée par la séquen age EC de ces échantillons, aucune mutation na été retrouvée chez les 20 sujets sains témoins. La séparation des pics dADN monochainaux a été facilitée par une légère augmentation de la concentration de LPA (4%-6%), une légère baisse de la température de séparation (20℃) et une légère élévation du voltage de séparation (9kV). Conclusion Une concentration adéquate de LPA, une température de séparation appropriée et un voltage de séparation bien approprié améliorent considérablement l’efficacité du FLI-EC. L’application de cette méthode pour détecter la mutation ponctuelle du gène hMLH1 est d’une rapidité, d’une efficacité, et d’uneéreproductivit consid rables. Cette méthode de réalisation facile reste très prometteur pour le dépistage rapide et massive des mutations génétiques.展开更多
Background: Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of prim...Background: Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of primary rectal cancer is curative surgical resection;however, a fine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. Methods: Forty nine (49) patients with low rectal carcinoma were included in a prospective study, between Jan 2007 and Jan 2012. Preoperative chemoradiation was administrated to all patients and subjected to different techniques of sphincter saving surgery. Stage I and Stage IV disease at diagnosis were excluded from the study. Results: Forty nine patients were included in the study. 27 (55%) patients were male and 22 (45%) were female;the age ranges from 23 years to 70 years with the median age 46 years. The main presenting symptoms were bleeding per rectum and tenesmus, Stage II 18 patients (36.7%), stage III 31 patients (63.3%). Complete clinical and pathological response in 3 patients (6%), and complete clinical response with only microscopically residual carcinoma in 20 patients (41%), partial response in 18 patients (36.7%), and no significant response in 8 patients (16%) 7 from 8 were mucoid carcinoma. Low anterior resection (LAR) in 22 patients (44.9%), Hartman’s procedure in 4 patients (8.1%), Coloanal pull-through (COP) was done in 19 patients (38.9%) and perineal colostomy in 4 patients (8.1%). For patients with colo-anal pull-through technique complete dehiscent and retraction observed in 2 cases, Major leakage in one case, stenosis in 4 cases. Conclusion: There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter saving surgery. Coloanal pull-through technique is not a widely spread technique for low rectal cancer with good oncological safety and acceptable functional outcome.展开更多
文摘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.
文摘Résumé: Objectif Lobjectif de ce travail est detablir une méthode danalyse du polymorphisme de la conformation monochaine (PCMC), capable de détecter la mutation ponctuelle du gène hMLH1 dans le cancer colique en utilisant l l ctrophor se capillaire associée a la fluorescence laser-induite (FLI-EC). Méthodes Les exons 12 du gène hMLH1 du sang périphérique de 42 patients de cancer colo-rectal sporadique et 20 sujets sains témoins sont amplifiés par la PCR. Le PCMC des produits du PCR est analysé par FLI-EC. Les échantillons anormaux ont été confirmés par séquen age EC. Les effets de la concentration du milieu (LPA), de la température de séparationet du voltage de séparation sur le comportement de EC ont été aussi etudiés. Résultats Lanalyse de PCMC par la methode FLI-EC a retrouvé une mutation hétérozygote chez 4 des 42 patients. La mutation ponctuelle de T1151A a été objectivée par la séquen age EC de ces échantillons, aucune mutation na été retrouvée chez les 20 sujets sains témoins. La séparation des pics dADN monochainaux a été facilitée par une légère augmentation de la concentration de LPA (4%-6%), une légère baisse de la température de séparation (20℃) et une légère élévation du voltage de séparation (9kV). Conclusion Une concentration adéquate de LPA, une température de séparation appropriée et un voltage de séparation bien approprié améliorent considérablement l’efficacité du FLI-EC. L’application de cette méthode pour détecter la mutation ponctuelle du gène hMLH1 est d’une rapidité, d’une efficacité, et d’uneéreproductivit consid rables. Cette méthode de réalisation facile reste très prometteur pour le dépistage rapide et massive des mutations génétiques.
文摘Background: Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of primary rectal cancer is curative surgical resection;however, a fine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. Methods: Forty nine (49) patients with low rectal carcinoma were included in a prospective study, between Jan 2007 and Jan 2012. Preoperative chemoradiation was administrated to all patients and subjected to different techniques of sphincter saving surgery. Stage I and Stage IV disease at diagnosis were excluded from the study. Results: Forty nine patients were included in the study. 27 (55%) patients were male and 22 (45%) were female;the age ranges from 23 years to 70 years with the median age 46 years. The main presenting symptoms were bleeding per rectum and tenesmus, Stage II 18 patients (36.7%), stage III 31 patients (63.3%). Complete clinical and pathological response in 3 patients (6%), and complete clinical response with only microscopically residual carcinoma in 20 patients (41%), partial response in 18 patients (36.7%), and no significant response in 8 patients (16%) 7 from 8 were mucoid carcinoma. Low anterior resection (LAR) in 22 patients (44.9%), Hartman’s procedure in 4 patients (8.1%), Coloanal pull-through (COP) was done in 19 patients (38.9%) and perineal colostomy in 4 patients (8.1%). For patients with colo-anal pull-through technique complete dehiscent and retraction observed in 2 cases, Major leakage in one case, stenosis in 4 cases. Conclusion: There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter saving surgery. Coloanal pull-through technique is not a widely spread technique for low rectal cancer with good oncological safety and acceptable functional outcome.
