AIM To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy(RHCPD) for locally advanced right-sided colon cancer(LARCC).METHODS We retrospectively reviewed the database of Saitama Medical ...AIM To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy(RHCPD) for locally advanced right-sided colon cancer(LARCC).METHODS We retrospectively reviewed the database of Saitama Medical Center, Jichi Medical University, between January 2009 and December 2016. During this time, 299 patients underwent radical right hemicolectomy for right-sided colon cancer. Among them, 5 underwent RHCPD for LARCC with tumor infiltration to adjacent organs. Preoperative computed tomography(CT) was routinely performed to evaluate local tumor infiltration into adjacent organs. During the operation, we evaluated the resectability and the amount of infiltration into the adjacent organs without dissecting the adherent organs from the cancer. When we confirmed that radical resection was feasible and could lead to R0 resection, we performed RHCPD. The clinical data were carefully reviewed, and the demographic variables, intraoperative data, and postoperative parameters were recorded.RESULTS The median age of the 5 patients who underwent RHCPD for LARCC was 70 years. The tumors were located in the ascending colon(three patients) and transverse colon(two patients). Preoperative CT revealed infiltration of the tumor into the duodenum in all patients, the pancreas in four patients, the superior mesenteric vein(SMV) in two patients, and tumor thrombosis in the SMV in one patient. We performed RHCPD plus SMV resection in three patients. Major postoperative complications occurred in 3 patients(60%) as pancreatic fistula(grade B and grade C, according to International Study Group on Pancreatic Fistula Definition) and delayed gastric empty. None of the patients died during their hospital stay. A histological examination confirmed malignant infiltration into the duodenum and/or pancreas in 4 patients(80%), and no patients showed any malignant infiltration into the SMV. Two patients were histologically confirmed to have tumor thrombosis in the SMV. All of the tumors had clear resection margins(R0). The median follow-up time was 77 mo. During this period, two patients with tumor thrombosis died from liver metastasis. The overall survival rates were 80% at 1 year and 60% at 5 years. All patients with node-negative status(n = 2) survived for more than seven years.CONCLUSION This study showed that the long-term survival is possible for patients with LARCC if RHCPD is performed successfully, particularly in those with node-negative status.展开更多
Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alter...Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemora?diotherapy(neo CRT) followed by surgery as treatment of selected patients with unresectable LASCC.Methods: We studied the patients with unresectable LASCC who received neo CRT followed by surgery between October 2010 and December 2012. The neoadjuvant regimen consisted of external?beam radiotherapy to 50 Gy and capecitabine?based chemotherapy every 3 weeks. Surgery was scheduled 6–8 weeks after radiotherapy.Results: Twenty?one patients were included in this study. The median follow?up was 42 months(range, 17–57 months). All patients completed neo CRT and surgery. Resection with microscopically negative margins(R0 resection) was achieved in 20 patients(95.2%). Pathologic complete response was observed in 8 patients(38.1%). Multivisceral resection was necessary in only 7 patients(33.3%). Two patients(9.5%) experienced grade 2 postopera?tive complications. No patients died within 30 days after surgery. For 18 patients with pathologic M0(yp M0) disease, the cumulative probability of 3?year local recurrence?free survival, disease?free survival and overall survival was 100.0%, 88.9% and 100.0%, respectively. For all 21 patients, the cumulative probability of 3?year overall survival was 95.2% and bladder function was well preserved.Conclusion: For patients with unresectable LASCC, preoperative chemoradiotherapy and surgery can be performed safely and may result in an increased survival rate.展开更多
AIM: To hypothesize that in patients with colon cancer showing heavy intestinal wall invasion without distant metastasis(T4b N0-2M0), small tumor size would correlate with more aggressive tumor behaviors and therefore...AIM: To hypothesize that in patients with colon cancer showing heavy intestinal wall invasion without distant metastasis(T4b N0-2M0), small tumor size would correlate with more aggressive tumor behaviors and therefore poorer cancer-specific survival(CSS).METHODS: We analyzed T4 b N0-2M0 colon cancer patients in the Surveillance, Epidemiology and End Results(SEER) database. A preliminary analysis of T4 b N0-2M0 colon cancer patients at the Fudan University Shanghai Cancer Center is also presented.RESULTS: A total of 1734 T4 b N0-2M0 colon cancer patients from the SEER database were included. Kaplan-Meier analysis revealed decreasing CSS with decreasing tumor size(P < 0.001). Subgroup analysis showed a significant association between poorer CSS with smaller tumor size in T4 b N0 patients(P = 0.024), and a trend of association in T4 b N1(P = 0.182) and T4 b N2 patients(P = 0.191). Multivariate analysis identified tumor size as an independent prognostic factor for CSS in T4 b N0-2M0 patients(P = 0.024). Preliminary analysis of Fudan University Shanghai Cancer Center samples suggested the 5-year CSS was 50.0%, 72.9% and 77.1% in patients with tumors ≤ 4.0 cm, 4.0-7.0 cm and ≥ 7.0 cm.CONCLUSION: Smaller tumor size is associated with poorer CSS in the T4 b N0-2M0 subset of colon cancer, particularly in the T4 b N0M0 subgroup.展开更多
Locally advanced colorectal cancer complicated with adjacent organic invasion may remain confined to the local area with minimal metastasis.In the present paper,we report on a patient with advanced right colon cancer,...Locally advanced colorectal cancer complicated with adjacent organic invasion may remain confined to the local area with minimal metastasis.In the present paper,we report on a patient with advanced right colon cancer,including liver,gallbladder,and duodenal invasion behind the scene of liver abscess.En bloc resection was performed on the patient,with right-hemicolectomy,cholecystectomy,partial duodental resection,and hepatectomy.Postoperative management was administered,including nutritional support in the early postoperative period,effective anti-infection treatment,and adjuvant chemotherapy(FOLFOX4).The patient survived for 16 months after the operation.Common clinical manifestations of colorectal cancer were digestive symptoms and changes in defecation.However,the clinical manifestation of locally advanced colon cancer was extremely complicated.Extended or multivisceral resection may offer patients a chance to survive an acute crisis and allow for treatment with adjuvant therapy.展开更多
目的探讨新辅助化疗方案OxMdG在结肠癌患者中的可行性和有效性，试图确定局部晚期结肠癌患者最好的初次意向治疗策略是先行术前新辅助治疗抑或根治性切除术。方法该研究为随机对照研究，共纳入2008年5月-2012年9月100例患者，通过门诊...目的探讨新辅助化疗方案OxMdG在结肠癌患者中的可行性和有效性，试图确定局部晚期结肠癌患者最好的初次意向治疗策略是先行术前新辅助治疗抑或根治性切除术。方法该研究为随机对照研究，共纳入2008年5月-2012年9月100例患者，通过门诊电子病历系统随机化对患者进行分组，分层因素包括年龄、影像学上的T、N分期，肿瘤的部位以及是否行预防性结肠造口术，尽可能匹配分入住院部两个不同病区。新辅助化疗组C（C组）（3个疗程的OxMdG，每两周1次，然后手术以及进一步的9个疗程的OxMdG）和标准术后化疗组S（S组）（12个疗程的OxMdG）。所行患者化疗前行KRAS基因检测，对于KRA野生型肿瘤患者按1：1的比例接受或不接受帕尼单抗治疗，帕尼单抗治疗方案为化疗的前6周，每2周按6 mg／kg的剂量用药。采用意向治疗分析策略对研究结果进行分析，主要评价指标包括预实验的可行性、安全性、患者对术前化疗的耐受性以及影像学分期方法的准确性。结果C组的52例患者中，51例按计划治疗，1例诊断局部穿孔后立即手术。92．2％（47／51）完成6周的治疗，4例因毒副反应中止治疗。C组与S组所有患者接受了手术切除。c组其计10例未完成术后化疗，S组93．0％（40／43）完成了第一个6周的化疗，3例患者出现严重的手足综合征退出治疗。CT检查可准确判定固有肌层浸润和检测淋巴结转移。S组较C组患者需要更长的手术时间（206．0±22．1 vs165．0±11．2，P=0．062），并发症的发生率（包括腹腔感染、切口感染、肺部并发症等）比较差异无统计学意义（P=0．089）。吻合口瘘发生率比较差异无统计学意义（P=0．158）。术后病理诊断，C组淋巴结阳性患者所占比例较s组更低（38．4％[20／52]vs 64．6％[31／48]，P=0．009）。采用T期进行降期评估，C组与S组病理诊断T分期出现显著差异（P=0．022）。CT分期显示C组新辅助化疗前后肿瘤缓解情况，38．5％（20／52）在新辅助化疗后行影像学评估同样显示降期，其中有2例完全缓解降为Tn，且无CT影像学分期升高。肿瘤浸润固有肌层浸润深度（10．7±2．1 vs 6．3±1．4；P=0．0022）和肿瘤最大垂直径（68．7±5．7 vs 43．2±6．8；P=0．0018）均降低。结论新辅助化疗对可手术切除局部晚期（影像学分期）的原发性结肠癌患者是可行的，毒副反应少，围手术期并发症发生率低，肿瘤病理缓解率高。展开更多
目的探讨显微镜辅助下结肠区段切除术(MALC)在裸鼠非局部晚期结肠癌(NLACC)模型中的技术可行性和肿瘤学安全性。方法利用已被荧光素酶标记的鼠源性CT-26结直肠癌细胞株建立BALB/c裸鼠NLACC模型。1周后,将NLACC模型随机分成MALC组和假手...目的探讨显微镜辅助下结肠区段切除术(MALC)在裸鼠非局部晚期结肠癌(NLACC)模型中的技术可行性和肿瘤学安全性。方法利用已被荧光素酶标记的鼠源性CT-26结直肠癌细胞株建立BALB/c裸鼠NLACC模型。1周后,将NLACC模型随机分成MALC组和假手术组(每组10只),MALC组施行显微镜下结肠区段切除术,而假手术组在显微镜辅助下仅进行开关腹手术(MAOCS)。模型制作后,定期用小动物活体成像系统(IVIS)监测模型体内肿瘤细胞的行为学变化。术后第3周处死所有裸鼠,比较两组模型建模情况和评估手术的近期疗效。结果BALB/c裸鼠NLACC模型制作的成功率为100%(20/20)。两组裸鼠术中无1例死亡。术后MALC组的裸鼠无结肠原位肿瘤的复发,而假手术组结肠原位肿瘤的质量和体积呈进行性增长趋势。除此之外,MALC组在血性腹水(0 vs 40%)、局部侵袭(0 vs 100%)、肠梗阻(0 vs 100%)、淋巴结转移(0 vs 10%)发生率上均明显低于假手术组(P<0.05)。影像学分析提示,MALC组裸鼠体内的肿瘤细胞的生物发光信号即ROI值(region of interest value)显著低于假手术组,差异有统计学意义(P<0.05)。结论MALC模型在技术层面上可行,且其在裸鼠NLACC中的近期肿瘤学行为上安全可靠,但其远期肿瘤学行为仍有待于进一步研究。展开更多
文摘AIM To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy(RHCPD) for locally advanced right-sided colon cancer(LARCC).METHODS We retrospectively reviewed the database of Saitama Medical Center, Jichi Medical University, between January 2009 and December 2016. During this time, 299 patients underwent radical right hemicolectomy for right-sided colon cancer. Among them, 5 underwent RHCPD for LARCC with tumor infiltration to adjacent organs. Preoperative computed tomography(CT) was routinely performed to evaluate local tumor infiltration into adjacent organs. During the operation, we evaluated the resectability and the amount of infiltration into the adjacent organs without dissecting the adherent organs from the cancer. When we confirmed that radical resection was feasible and could lead to R0 resection, we performed RHCPD. The clinical data were carefully reviewed, and the demographic variables, intraoperative data, and postoperative parameters were recorded.RESULTS The median age of the 5 patients who underwent RHCPD for LARCC was 70 years. The tumors were located in the ascending colon(three patients) and transverse colon(two patients). Preoperative CT revealed infiltration of the tumor into the duodenum in all patients, the pancreas in four patients, the superior mesenteric vein(SMV) in two patients, and tumor thrombosis in the SMV in one patient. We performed RHCPD plus SMV resection in three patients. Major postoperative complications occurred in 3 patients(60%) as pancreatic fistula(grade B and grade C, according to International Study Group on Pancreatic Fistula Definition) and delayed gastric empty. None of the patients died during their hospital stay. A histological examination confirmed malignant infiltration into the duodenum and/or pancreas in 4 patients(80%), and no patients showed any malignant infiltration into the SMV. Two patients were histologically confirmed to have tumor thrombosis in the SMV. All of the tumors had clear resection margins(R0). The median follow-up time was 77 mo. During this period, two patients with tumor thrombosis died from liver metastasis. The overall survival rates were 80% at 1 year and 60% at 5 years. All patients with node-negative status(n = 2) survived for more than seven years.CONCLUSION This study showed that the long-term survival is possible for patients with LARCC if RHCPD is performed successfully, particularly in those with node-negative status.
基金supported by the Grants from National Natural Science Funding of China (No.81071891)Guangdong Provincial Science and Technology Funding (No.2010B080701)
文摘Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemora?diotherapy(neo CRT) followed by surgery as treatment of selected patients with unresectable LASCC.Methods: We studied the patients with unresectable LASCC who received neo CRT followed by surgery between October 2010 and December 2012. The neoadjuvant regimen consisted of external?beam radiotherapy to 50 Gy and capecitabine?based chemotherapy every 3 weeks. Surgery was scheduled 6–8 weeks after radiotherapy.Results: Twenty?one patients were included in this study. The median follow?up was 42 months(range, 17–57 months). All patients completed neo CRT and surgery. Resection with microscopically negative margins(R0 resection) was achieved in 20 patients(95.2%). Pathologic complete response was observed in 8 patients(38.1%). Multivisceral resection was necessary in only 7 patients(33.3%). Two patients(9.5%) experienced grade 2 postopera?tive complications. No patients died within 30 days after surgery. For 18 patients with pathologic M0(yp M0) disease, the cumulative probability of 3?year local recurrence?free survival, disease?free survival and overall survival was 100.0%, 88.9% and 100.0%, respectively. For all 21 patients, the cumulative probability of 3?year overall survival was 95.2% and bladder function was well preserved.Conclusion: For patients with unresectable LASCC, preoperative chemoradiotherapy and surgery can be performed safely and may result in an increased survival rate.
文摘AIM: To hypothesize that in patients with colon cancer showing heavy intestinal wall invasion without distant metastasis(T4b N0-2M0), small tumor size would correlate with more aggressive tumor behaviors and therefore poorer cancer-specific survival(CSS).METHODS: We analyzed T4 b N0-2M0 colon cancer patients in the Surveillance, Epidemiology and End Results(SEER) database. A preliminary analysis of T4 b N0-2M0 colon cancer patients at the Fudan University Shanghai Cancer Center is also presented.RESULTS: A total of 1734 T4 b N0-2M0 colon cancer patients from the SEER database were included. Kaplan-Meier analysis revealed decreasing CSS with decreasing tumor size(P < 0.001). Subgroup analysis showed a significant association between poorer CSS with smaller tumor size in T4 b N0 patients(P = 0.024), and a trend of association in T4 b N1(P = 0.182) and T4 b N2 patients(P = 0.191). Multivariate analysis identified tumor size as an independent prognostic factor for CSS in T4 b N0-2M0 patients(P = 0.024). Preliminary analysis of Fudan University Shanghai Cancer Center samples suggested the 5-year CSS was 50.0%, 72.9% and 77.1% in patients with tumors ≤ 4.0 cm, 4.0-7.0 cm and ≥ 7.0 cm.CONCLUSION: Smaller tumor size is associated with poorer CSS in the T4 b N0-2M0 subset of colon cancer, particularly in the T4 b N0M0 subgroup.
基金This work was supported by the National Natural Science Foundation of China(Grant Nos.30872482 and 81072051).
文摘Locally advanced colorectal cancer complicated with adjacent organic invasion may remain confined to the local area with minimal metastasis.In the present paper,we report on a patient with advanced right colon cancer,including liver,gallbladder,and duodenal invasion behind the scene of liver abscess.En bloc resection was performed on the patient,with right-hemicolectomy,cholecystectomy,partial duodental resection,and hepatectomy.Postoperative management was administered,including nutritional support in the early postoperative period,effective anti-infection treatment,and adjuvant chemotherapy(FOLFOX4).The patient survived for 16 months after the operation.Common clinical manifestations of colorectal cancer were digestive symptoms and changes in defecation.However,the clinical manifestation of locally advanced colon cancer was extremely complicated.Extended or multivisceral resection may offer patients a chance to survive an acute crisis and allow for treatment with adjuvant therapy.
文摘目的探讨新辅助化疗方案OxMdG在结肠癌患者中的可行性和有效性，试图确定局部晚期结肠癌患者最好的初次意向治疗策略是先行术前新辅助治疗抑或根治性切除术。方法该研究为随机对照研究，共纳入2008年5月-2012年9月100例患者，通过门诊电子病历系统随机化对患者进行分组，分层因素包括年龄、影像学上的T、N分期，肿瘤的部位以及是否行预防性结肠造口术，尽可能匹配分入住院部两个不同病区。新辅助化疗组C（C组）（3个疗程的OxMdG，每两周1次，然后手术以及进一步的9个疗程的OxMdG）和标准术后化疗组S（S组）（12个疗程的OxMdG）。所行患者化疗前行KRAS基因检测，对于KRA野生型肿瘤患者按1：1的比例接受或不接受帕尼单抗治疗，帕尼单抗治疗方案为化疗的前6周，每2周按6 mg／kg的剂量用药。采用意向治疗分析策略对研究结果进行分析，主要评价指标包括预实验的可行性、安全性、患者对术前化疗的耐受性以及影像学分期方法的准确性。结果C组的52例患者中，51例按计划治疗，1例诊断局部穿孔后立即手术。92．2％（47／51）完成6周的治疗，4例因毒副反应中止治疗。C组与S组所有患者接受了手术切除。c组其计10例未完成术后化疗，S组93．0％（40／43）完成了第一个6周的化疗，3例患者出现严重的手足综合征退出治疗。CT检查可准确判定固有肌层浸润和检测淋巴结转移。S组较C组患者需要更长的手术时间（206．0±22．1 vs165．0±11．2，P=0．062），并发症的发生率（包括腹腔感染、切口感染、肺部并发症等）比较差异无统计学意义（P=0．089）。吻合口瘘发生率比较差异无统计学意义（P=0．158）。术后病理诊断，C组淋巴结阳性患者所占比例较s组更低（38．4％[20／52]vs 64．6％[31／48]，P=0．009）。采用T期进行降期评估，C组与S组病理诊断T分期出现显著差异（P=0．022）。CT分期显示C组新辅助化疗前后肿瘤缓解情况，38．5％（20／52）在新辅助化疗后行影像学评估同样显示降期，其中有2例完全缓解降为Tn，且无CT影像学分期升高。肿瘤浸润固有肌层浸润深度（10．7±2．1 vs 6．3±1．4；P=0．0022）和肿瘤最大垂直径（68．7±5．7 vs 43．2±6．8；P=0．0018）均降低。结论新辅助化疗对可手术切除局部晚期（影像学分期）的原发性结肠癌患者是可行的，毒副反应少，围手术期并发症发生率低，肿瘤病理缓解率高。
文摘目的探讨显微镜辅助下结肠区段切除术(MALC)在裸鼠非局部晚期结肠癌(NLACC)模型中的技术可行性和肿瘤学安全性。方法利用已被荧光素酶标记的鼠源性CT-26结直肠癌细胞株建立BALB/c裸鼠NLACC模型。1周后,将NLACC模型随机分成MALC组和假手术组(每组10只),MALC组施行显微镜下结肠区段切除术,而假手术组在显微镜辅助下仅进行开关腹手术(MAOCS)。模型制作后,定期用小动物活体成像系统(IVIS)监测模型体内肿瘤细胞的行为学变化。术后第3周处死所有裸鼠,比较两组模型建模情况和评估手术的近期疗效。结果BALB/c裸鼠NLACC模型制作的成功率为100%(20/20)。两组裸鼠术中无1例死亡。术后MALC组的裸鼠无结肠原位肿瘤的复发,而假手术组结肠原位肿瘤的质量和体积呈进行性增长趋势。除此之外,MALC组在血性腹水(0 vs 40%)、局部侵袭(0 vs 100%)、肠梗阻(0 vs 100%)、淋巴结转移(0 vs 10%)发生率上均明显低于假手术组(P<0.05)。影像学分析提示,MALC组裸鼠体内的肿瘤细胞的生物发光信号即ROI值(region of interest value)显著低于假手术组,差异有统计学意义(P<0.05)。结论MALC模型在技术层面上可行,且其在裸鼠NLACC中的近期肿瘤学行为上安全可靠,但其远期肿瘤学行为仍有待于进一步研究。
