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Long-term outcomes in patients with ypT0 rectal cancer after neoadjuvant chemoradiotherapy and curative resection

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Chinese Journal of cancer Research 2018年第2期30卷 272-281页

作者： Zhao Lu Pu Cheng Fu Yang Zhaoxu Zheng Xishan Wang Department of Colorectal Surgery National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College

Objective： For patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy（NCRT）, significant pathological response of the primary tumor has been proposed to identify candidates for organ preservation. However, this does not address metastatic lymph nodes in the mesorectum. The aim of this study was to assess the incidence of lymph node metastases in ypT0 patients treated with NCRT and curative resection and to explore risk factors associated with survival.Methods： This was a retrospective study of patients with ypT0 rectal cancer after NCRT and curative resection at a tertiary care center in China from 2005 to 2014.Results： A total of 60（18.6%） patients who underwent surgery after NCRT and achieved ypT0 were enrolled in this study; one patient was excluded owing to lack of follow-up. Of these 59 patients, lymph node metastases were found in the mesorectum（ypT0N＋） in eight（13.6%） patients. After a median follow-up of 52 months, 5-year recurrence-free survival（82.7% vs. 62.5%, P=0.014） and overall survival（OS）（90.9% vs. 70.0%, P=0.032） were much higher in ypN0 than yp N＋ patients. Multivariate analyses showed that ypN＋ status（P=0.009） and perioperative blood transfusion（BT）（P=0.001） were significantly independent risk factors associated with recurrence; however, no factor was correlated with 5-year OS.Conclusions： Patients with ypT0N0 rectal cancer can achieve excellent long-term outcomes; however, positive lymph nodes or tumor deposits can still be found in 13.6% of ypT0 patients. Nodal positivity in the mesorectum and perioperative BT are independent risk factors for recurrence.

关键词： rectal cancer neoadjuvant chemoradiotherapy pathological response lymph node risk factor

Better prognostic determination of cT3 rectal cancer through measurement of distance to mesorectal fascia:A multicenter study

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Chinese Journal of cancer Research 2021年第5期33卷 606-615页

作者： Xiaoyan Zhang Qiaoyuan Lu Xiangjie Guo Wuteng Cao Hongmei Zhang Tao Yu Xiaoting Li Zhen Guan Xueping Li Ruijia Sun Yingshi Sun Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Department of RadiologyPeking University Cancer Hospital&InstituteBeijing 100142China Department of Forensic Medicine Shanxi Medical UniversityTaiyuan 030001China Department of Radiology the Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhou 510655China Department of Radiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Medical Imaging Cancer Hospital of China Medical UniversityShenyang 110042China

Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with comparison of cT3 substage.Methods:This was a retrospective,multicenter cohort study including cT3 rectal cancer patients undergoing neoadjuvant chemoradiotherapy followed by radical surgery from January 2013 to September 2014.DMRF and cT3 substage were evaluated from baseline MRI.The cutoff of DMRF was determined by disease progression.Multivariate cox regression was used to test the prognostic values of baseline variables.Results:A total of 804 patients were included,of which 226(28.1%)developed progression.A DMRF cutoff of7 mm was chosen.DMRF category,the clock position of the deepest position of tumor invasion(CDTI)and extramural venous invasion(EMVI)were independent predictors for disease progression,and hazard ratios(HRs)were 0.26[95%confidence interval(95%CI),0.13-0.56],1.88(95%CI,1.33-2.65)and 1.57(95%CI,1.13-2.18),respectively.cT3 substage was not a predictor for disease progression.Conclusions:The measurement of DMRF value on baseline MRI can better distinguish cT3 rectal cancer prognosis rather than cT3 substage,and was recommended in clinical evaluation.

关键词： rectal cancer T3 stage substage distance to mesorectal fascia magnetic resonance imaging

Prediction of pathological nodal stage of locally advanced rectal cancer by collective features of multiple lymph nodes in magnetic resonance images before and after neoadjuvant chemoradiotherapy

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Chinese Journal of cancer Research 2019年第6期31卷 984-992页

作者： Haitao Zhu Xiaoyan Zhang Xiaoting Li Yanjie Shi Huici Zhu Yingshi Sun Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Department of Radiology Peking University Cancer Hospital & Institute

Objective:To predict pathological nodal stage of locally advanced rectal cancer by a radiomic method that uses collective features of multiple lymph nodes(LNs)in magnetic resonance images before and after neoadjuvant chemoradiotherapy(NCRT).Methods:A total of 215 patients were included in this study and chronologically divided into the discovery cohort(n=143)and validation cohort(n=72).In total,2,931 pre-NCRT LNs and 1,520 post-NCRT LNs were delineated from all visible rectal LNs in magnetic resonance images.Geometric,first-order and texture features were extracted from each LN before and after NCRT.Collective features are defined as the maximum,minimum,mean,median value and standard deviation of each feature from all delineated LNs of each participant.LN-model is constructed from collective LN features by logistic regression model with L1 regularization to predict pathological nodal stage(ypN0 or ypN+).Tumor-model is constructed from tumor features for comparison by using DeLong test.Results:The LN-model selects 7 features from 412 LN features,and the tumor-model selects 7 features from 82 tumor features.The area under the receiver operating characteristic curve(AUC)of LN-model in the discovery cohort is 0.818[95%confidence interval(95%CI):0.745-0.878],significantly(Z=2.09,P=0.037)larger than 0.685(95%CI:0.602-0.760)of the tumor-model.The AUC of LN-model in validation cohort is 0.812(95%CI:0.703-0.895),significantly(Z=3.106,P=0.002)larger than 0.517(95%CI:0.396-0.636)of the tumor-model.Conclusions:The usage of collective features from all visible rectal LNs performs better than the usage of tumor features for the prediction of pathological nodal stage of locally advanced rectal cancer.

关键词： Lymph node neoadjuvant therapy radiomics rectal cancer

Anatomical Basis and Clinical Research of Pelvic Autonomic Nerve Preservation with Laparoscopic Radical Resection for rectal cancer

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2016年第2期36卷 211-214页

作者：刘彦卢晓明陶凯雄马建华蔡开琳王琳芳牛彦峰王国斌 Department of Gastrointestinal Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and Technology

The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation（PANP） was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation（PANP） from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients（18.37%） presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients（21.82%） in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed（P〉0.05）. It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction.

关键词： laparoscopy rectal cancer surgery pelvic autonomic nerves

Feasibility of MRI Radiomics for Predicting KRAS Mutation in rectal cancer

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Current Medical Science 2020年第6期40卷 1156-1160页

作者： Xiao-fang GUO Wen-qian YANG Qian YANG Zi-long YUAN Yu-lin LIU Xiao-hui NIU Hai-bo XU Department of Radiology Zhongnan Hospital of Wuhan UniversityWuhan 430071China Department of Radiology Hubei Cancer HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430079China College of Informatics Huazhong Agricultural UniversityWuhan 430070China

The mutation status of KRAS is a significant biomarker in the prognosis of rectal cancer.This study investigated the feasibility of MRI-based radiomics in predicting the mutation status of KRAS with a composite index which could be an important criterion for KRAS mutation in clinical practice.In this retrospective study,a total of 127 patients with rectal cancer were enrolled.The 3D Slicer was used to extract the radiomics features from the MRI images,and sparse support vector machine(SVM)with linear kernel was applied for feature reduction.The radiomics classifier for predicting the KRAS status was then constructed by Linear Discriminant Analysis(LDA)and its performance was evaluated.The composite index was determined with LDA model.Out of 127 rectal cancer subjects,there were 44 KRAS mutation cases and 83 wild cases.A total of 104 radiomics features were extracted,54 features were filtered by linear SVM with L1-norm regularization and 6 features that had no significant correlations within them were finally selected.The radiomics classifier constructed using the 6 features featured an AUC value of 0.669(specificity:0.506;sensitivity:0.773)with LDA.Furthermore,the composite index(Radscore)had statistically significant difference between the KRAS mutation and wild groups.It is suggested that the MRI-based radiomics has the potential in predicting the KRAS status in patients with rectal cancer,which may enhance the diagnostic value of MRI in rectal cancer.

关键词： rectal cancer KRAS mutation MRI radiomics

Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery

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Chronic Diseases and Translational Medicine 2020年第3期6卷 188-197页

作者： Lin Zhang Wei Zheng Jian Cui Yun-Long Wu Tian-Lei Xu Hai-Zeng Zhang Department of Colorectal Surgery State Key Lab of Molecular OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100021China

Background::Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery.However,the complications of stoma and stoma reversal surgery should not be underestimated.Furthermore,in some patients,stoma reversal failed.Here,we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed.Methods::In total,154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed.Patients were divided into two groups according to whether their stoma got reversed or not.The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed.Results::The mean follow-up time was 47.54(range 4.0-164.0)months.During follow-up,19.5%of the patients suffered stoma-related long-term complications.Only 79(51.3%)patients had their stomas reversed.The morbidity of complications after reversal surgery was 45.6%,and these mainly consisted of incision-related complications.Multivariate analyses showed that pre-treatment comorbidity(HR=3.17,95%CI 1.27-7.96,P=0.014),postoperative TNM stage(HR=2.55,95%CI 1.05-6.18,P=0.038),neoadjuvant therapy(HR=2.75,95%CI 1.07-7.05,P=0.036),anastomosis-related complications(HR=4.52,95%CI 1.81-11.29,P=0.001),and disease recurrence(HR=24.83,95%CI 2.90-213.06,P=0.003)were significant independent risk factors for a defunctioning stoma to be permanent.Conclusions::Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage,but the stoma itself and its reversal procedure are associated with high morbidity of complications,and many defunctioning stomas eventually become permanent.Therefore,surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients.In addition,doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.

关键词： rectal cancer Low anterior resection Anastomotic complications Defunctioning stoma Stoma reversal surgery

Application of laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal cancer

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Journal of Innovative Optical Health Sciences 2016年第5期9卷 8-14页

作者： Yan Liu Xiao-Ming Lu Yan-Feng Niu Kai-Xiong Tao Guo-Bin Wang Department of Gastrointestinal Surgery Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 P.R.China

This study aimed to investigate the influence of laparoscopic total mesorectal excision combined with sphincter-preserving surgery on the postoperative defecation function,urinary function and sexual function in low or ultralow rectal cancer.A retrospective study was undertaken on 107 patients(65 laparoscopic resection and 42 laparoctomic resection)with rectal cancer undergoing laparoscopic or open laparoscopic total mesorectal excision combined with sph incter-preserving surgery from April 2009 to April 2013.The quality of life outcomes of all patients,including defection,urinary and sexual function,were assessed at 6,12 and 24 months after operation.Gastrointestinal quality of life index(GQOLI)was used to evaluate the fecal incont inence and bowel dysfunction.Urinary and sexual functions were studied by means of questionnaires on the basis of the international prostatic symptom score(IPSS)and international index of erectile function(IEF),respectively.In laparoscopic surgery group,there were two cases of anastomotic leakage,three cases of anast omotic strict ure,seven cases of local recurrence,ten cases of hepatic metastasis and five cases of lung metastasis.The satisfaction rates of patients about their defe-cation function reached 60.3%(35/58,84.5%(49/58)and 913%(53/58)at6,12,and 24 months follow-up,respectively.The assessment after one year showed that the overall incidence of uri-nary dysfunction was 10.7%(7/65);Among male patients,18.4%(7/36)sufered from erectile dysfunction and 27.8%(10/36)sufered from ejaculatory dysfunction;65.5%(19/29)female patients investigated were satisfied with their postoperative sexual life.In open surgery group,there were two cases of anastomotic leakage,two cases of anastomotic stricture,nine cases of local recurrence,ten cases of hepatic metastasis and seven cases of kung metastasis.The satisfaction rates of patients about their defecation function were 56.4%(22/39),82.1%(32/39)and 94.8%(37/39)at 6,12,and 24 months follow-up,respectively.The assessment after one year showed th

关键词： rectal cancer laparoscope sphincter-preserving surgery quality of life.

Current and future role of three-dimensional modelling technology in rectal cancer surgery:A systematic review

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1754-1769页

作者： Anna Przedlacka Gianluca Pellino Jordan Fletcher Fernando Bello Paris P Tekkis Christos Kontovounisios Department of Surgery and cancer Imperial College LondonLondon SW109NHUnited Kingdom Department of Advanced Medical and Surgical Sciences Universitàdegli Studi della Campania“Luigi Vanvitelli”Naples 80138CampaniaItaly Colorectal Surgery Vall d'Hebron University HospitalBarcelona 08029Spain Colorectal Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Surgery and cancer St Mark’s Hospital Academic InstituteImperial College LondonLondon HA13UJUnited Kingdom Centre for Engagement and Simulation Science Imperial College LondonLondon SW109NHUnited Kingdom Colorectal Surgery Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom

BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify

关键词： rectal cancer Three-dimensional modelling Three-dimensional printing Image-guided surgery Surgical navigation Surgical education

Gunsight suture with subcutaneous vacuum drainage during enterostomy decreased the surgical site infection rate in obese rectal cancer patients:A retrospective study

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Journal of Nutritional Oncology 2023年第3期8卷 151-157页

作者： Lei Zhang Zhi-Qiang Xiao Chang-Ling San Tong-Lin Miao Department of Gastrointestinal Surgery Jinxiang Hospital Affiliated to Jining Medical UniversityJining 272200ShandongChina

Background:Surgical site infection(SSI)is the most common complication after stoma closure and is particularly common in obese patients.To reduce the incidence of SSI,various skin closure techniques have been proposed;however,the best technique is still under debate.The purpose of this study was to explore the effectiveness of subcutaneous vacuum drains(SVDs)after two surgical suture techniques following stoma reversal in obese patients. Methods:Data from 190 obese patients with rectal cancer who underwent stoma reversal for enterostomy between February 2012 and April 2023 at Jinxiang Hospital Affiliated to Jining Medical University were retrospectively analyzed.These patients were divided into two groups:gunsight suture(GS)with SVD and primary linear suture(PLS)with SVD.The GS group and PLS group included 90 and 100 patients,respectively.The clinical characteristics and short-term outcomes were compared between the two groups.Postoperative pain scores were analyzed using a generalized estimation equation. Results:Surgery was successfully performed in both groups.The rate of SSI in the GS group was significantly lower than that in the PLS group(2.2%vs 9.0%,P=0.046).Patients in the GS group had a significantly shorter wound healing time than did patients in the PLS group,as well as a significantly shorter postoperative fasting time(P0.05).The results of the generalized estimation equation analysis showed that the GS group had significantly lower pain scores at 12,24,48,and 72 h after surgery than the PLS group(P<0.05).Moreover,the GS group showed significantly better alleviation of wound pain between 12 and 72 h after surgery(P<0.05). Conclusions:The GS technique with SVD may be recommended for wound closure of a nonfunctioning stoma in obese patients.

关键词： Stoma reversal Gunsight suture Subcutaneous vacuum drain Obese rectal cancer