Since the introduction of total mesorectal excision as the standard approach in mid and low rectal cancer,the incidence of local recurrence has sharply declined.Similar attention to surgical technique in colon cancer(...Since the introduction of total mesorectal excision as the standard approach in mid and low rectal cancer,the incidence of local recurrence has sharply declined.Similar attention to surgical technique in colon cancer(CC) has resulted in the concept of complete mesocolic excision(CME),which consists of complete removal of the intact mesentery and high ligation of the vascular supply at its origin.Although renewed attention to meticulous surgical technique certainly has its merits,routine implementation of CME is currently unfounded.Firstly,in contrast to rectal cancer,local recurrence originating from an incompletely removed mesenteryis rare in CC and usually a manifestation of systemic disease.Secondly,although CME may increase nodal counts and therefore staging accuracy,this is unlikely to affect survival since the observed relationship between nodal counts and outcome in CC is most probably not causal but confounded by a range of clinical variables.Thirdly,several lines of evidence suggest that metastasis to locoregional nodes occurs early and is a stochastic rather than a stepwise phenomenon in CC,in essence reflecting the tumor-host-metastasis relationship.Unsurprisingly,therefore,comparative studies in CC as well as in other digestive cancers have failed to demonstrate any survival benefit associated with extensive,additional or extra-mesenteric lymphadenectomy.Finally,routine implementation of CME may cause patient harm by longer operating times,major vascular damage and autonomic nerve injury.Therefore,data from randomized trials reporting relevant endpoints are required before CME can be recommended as a standard approach in CC surgery.展开更多
AIM: To examine the expression of E-cadherin, β-catenin,γ-catenin, VEGF, and p53 in 39 patients with hepatic metastasis from colorectal cancer immunohistochemically.METHODS: The patients were divided into two groups...AIM: To examine the expression of E-cadherin, β-catenin,γ-catenin, VEGF, and p53 in 39 patients with hepatic metastasis from colorectal cancer immunohistochemically.METHODS: The patients were divided into two groups:those (n = 16) who had no chemotherapy for at least 6 mo before the liver resections and those (n = 23)who were treated with chemotherapy before liver resections. A score from 0 to 3 was given for the number of positive cells and from 0 to 3 for the intensity of staining in these cells, in both healthy and metastatic liver parenchyma.RESULTS: No significant differences in the expression of E-cadherin, β- and γ-catenin, VEGF and p53, could be observed between patients who received and did not receive chemotherapy, in both normal and metastatic liver parenchyma.CONCLUSION: Despite the assumption that chemotherapy had an effect on liver metastasis, no influences were noticed immunohistochemically.展开更多
基金Supported by The Fund for Scientific Research-Flanders(FWO)to Ceelen W(Senior Clinical Researcher)
文摘Since the introduction of total mesorectal excision as the standard approach in mid and low rectal cancer,the incidence of local recurrence has sharply declined.Similar attention to surgical technique in colon cancer(CC) has resulted in the concept of complete mesocolic excision(CME),which consists of complete removal of the intact mesentery and high ligation of the vascular supply at its origin.Although renewed attention to meticulous surgical technique certainly has its merits,routine implementation of CME is currently unfounded.Firstly,in contrast to rectal cancer,local recurrence originating from an incompletely removed mesenteryis rare in CC and usually a manifestation of systemic disease.Secondly,although CME may increase nodal counts and therefore staging accuracy,this is unlikely to affect survival since the observed relationship between nodal counts and outcome in CC is most probably not causal but confounded by a range of clinical variables.Thirdly,several lines of evidence suggest that metastasis to locoregional nodes occurs early and is a stochastic rather than a stepwise phenomenon in CC,in essence reflecting the tumor-host-metastasis relationship.Unsurprisingly,therefore,comparative studies in CC as well as in other digestive cancers have failed to demonstrate any survival benefit associated with extensive,additional or extra-mesenteric lymphadenectomy.Finally,routine implementation of CME may cause patient harm by longer operating times,major vascular damage and autonomic nerve injury.Therefore,data from randomized trials reporting relevant endpoints are required before CME can be recommended as a standard approach in CC surgery.
文摘AIM: To examine the expression of E-cadherin, β-catenin,γ-catenin, VEGF, and p53 in 39 patients with hepatic metastasis from colorectal cancer immunohistochemically.METHODS: The patients were divided into two groups:those (n = 16) who had no chemotherapy for at least 6 mo before the liver resections and those (n = 23)who were treated with chemotherapy before liver resections. A score from 0 to 3 was given for the number of positive cells and from 0 to 3 for the intensity of staining in these cells, in both healthy and metastatic liver parenchyma.RESULTS: No significant differences in the expression of E-cadherin, β- and γ-catenin, VEGF and p53, could be observed between patients who received and did not receive chemotherapy, in both normal and metastatic liver parenchyma.CONCLUSION: Despite the assumption that chemotherapy had an effect on liver metastasis, no influences were noticed immunohistochemically.
