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Fluorouracil-based preoperative chemoradiotherapy with or without oxaliplatin for stage Ⅱ/Ⅲ rectal cancer:a 3-year follow-up study

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Chinese Journal of Cancer Research 2015年第6期27卷 588-596页

作者： Dexin Jiao Rui Zhang Zhiqiang Gong Fang Liu Yue Chen Qinrui Yu Liping Sun Hongyan Duan Shendong Zhu Fei Liu Jian Wang Jianhui Jia department of Radiotherapy Liaoning Cancer Hospital&Institute department of colorectal Surgery Liaoning Cancer Hospital&Institute

Background： Fluorouracil-based preoperative chemoradiotherapy has become the standard treatment for stage Ⅱ/Ⅲ rectal cancer. In order to improve the overall survival （OS） and disease-flee survival （DFS）, we added oxaliplatin to the standard treatment, and compared the effectiveness of these two treatment patterns. Methods： A total of 206 patients enrolled in the prospective study had histologically confirmed rectal cancer of clinical stage Ⅱ/Ⅲ during July 2007 to July 2010. They were randomized into the experimental group received oxaliplatin and capecitabine in combination with radiotherapy, and the control group received capecitabine in combination with radiotherapy. All patients received surgery in 6-10 weeks after chemoradiotherapy and adjuvant chemotherapy with mFOLFOX6. The primary endpoints were DFS and OS, and the secondary endpoints included toxicity, compliance, and histopathological response. Results： The 3-year OS in the experimental group and the control group was 90.29% vs. 86.41% （P〉0.05）, and the 3-year DFS was 80.58% vs. 69.90% （P〉0.05）. The pathological complete remission （pCR） rates were 23.30% and 19.42%, respectively （P=0.497）. The 3-year local recurrence rates were 4.85% vs. 5.83% （P=0.694）, and the 3-year distant metastasis rates were 16.50% and 28.16%, respectively （P=0.045）. There were no significant differences in most grade 3-4 toxicities between two groups, however, grade 3-4 diarrhea occurred in 16.50% （17/103） of the experimental group, compared with 6.80% （7/103） of the control group （P=0.030）. Also, the total grade 3-4 acute toxicity showed a significant difference （10.68% vs. 21.36%, P=0.037）. Conclusions： The experimental treatment did not lead significantly improved OS and DFS, and thus longer follow-up is warranted for our patient cohort. Adding oxaliplatin to capecitabine-based preoperative chemoradiotherapy can significantly reduce metastasis, but has only minimal impact on local recurrence. Although grade 3-4 toxicity rate incr

关键词： Oxaliplatin capecitabine preoperative chemoradiotherapy rectal adenocarcinoma

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Redo sphincteroplasty:are the results sustainable?

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Gastroenterology Report 2016年第1期4卷 39-42,I0002页

作者： Kwangdae Hong Giovanna Dasilva John T.Dollerschell David Maron Steven D.Wexner department of colorectal Surgery Cleveland Clinic FloridaWestonFLUSA

Objective:This study aimed to investigate the long-termoutcomes of patients who undergo redo sphincteroplasty(RS).Methods:Patients with fecal incontinence(FI)who underwent RS between November 1988 and December 2011 were retrospectively identified from a prospective database.A questionnaire and telephone survey assessed current Cleveland Clinic Fecal Incontinence Score(CCFFIS;best 0,worst 20)and Fecal Incontinence Quality of Life(FIQoL;best 4.1,worst 1)*** was defined as no further continence surgery,no stoma and CCFFIS<9 at completion of *** Wilcoxon and Mann-Whitney U tests were used for comparing quantitative *** logistic regression analysis was done to identify predictive factors for ***:Fifty-six(66.7%)of 84 patients who underwent RS were available for evaluation at a median follow-up of 74(range:12-283)*** mean CCFFIS decreased from 16.563.7 to 11.966.6(P<0.001)at last *** patients(21.4%)underwent further continence surgery for failed sphincteroplasty,three(5.4%)of whom had a permanent *** patients(32.1%)had a CCFFIS<9 at the completion of follow-up,and 16(28.6%)had long-term *** patients evaluated for FIQoL had a mean value of 2.6(range:1.0-4.1).Postoperative CCFFIS was correlated with FIQoL(Spearman’s correlation coefficient?0.854,P<0.001).Logistic regression analysis did not reveal any significant predictive variables for success of ***:Based on our criteria for success,the long-term success rate for RS over a median of 74 months is poor.

关键词： fecal incontinence redo sphincteroplasty long-term outcome

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Short-term outcomes of laparoscopic total mesorectal excision compared to open surgery

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World Journal of Gastroenterology 2012年第48期18卷 7308-7313页

作者： Jing Gong De-Bing Shi Xin-Xiang Li San-Jun Cai Zu-Qing Guan Ye Xu department of colorectal Surgery Fudan University Shanghai Cancer Center department of Oncology Shanghai Medical CollegeFudan University

AIM:To investigate the short-term outcome of laparoscopic total mesorectal excision(TME) in patients with mid and low rectal ***:A consecutive series of 138 patients with middle and low rectal cancer were randomly assigned to either the laparoscopic TME(LTME) group or the open TME(OTME) group between September 2008 and July 2011 at the department of colorectal Cancer of Shanghai Cancer Center,Fudan University and pathological data,as well as surgical technique were reviewed ***-term clinical and oncological outcome were compared in these two *** were followed in the outpatient clinic 2 wk after the surgery and then every 3 mo in the first year if no adjuvant chemoradiation was *** analysis was performed using SPSS 13.0 ***:Sixty-seven patients were treated with LTME and 71 patients were treated with OTME(sex ratio 1.3:1vs 1.29:1,age 58.4 ± 13.6 years vs 59.6 ± 9.4 years,respectively).The resection was considered curative in all *** sphincter-preserving rate was 65.7%(44/67) vs 60.6%(43/71),P = 0.046;mean blood loss was 86.9 ± 37.6 mL vs 119.1 ± 32.7 mL,P = 0.018;postoperative analgesia was 2.1 ± 0.6 d vs 3.9 ± 1.8 d,P = 0.008;duration of urinary drainage was 4.7 ± 1.8 d vs 6.9 ± 3.4 d,P = 0.016,*** conversion rate was 2.99%.The complication rate,circumferential margin involvement,distal margins and lymph node yield were similar for both *** port site recurrence,anastomotic recurrence or mortality was observed during a median follow-up period of 21 mo(range:9-56 mo).CONCLUSION:Laparoscopic TME is safe and feasible,with an oncological adequacy comparable to the open *** studies with more patients and longer follow-up are needed to confirm the present results.

关键词： Rectum Neoplasms colorectal surgery Laparoscopy Treatment outcome

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Robotic surgery for rectal cancer: A systematic review of current practice

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World Journal of Gastrointestinal Oncology 2014年第6期6卷 184-193页

作者： Tony Wing Chung Mak Janet Fung Yee Lee Kaori Futaba Sophie Sok Fei Hon Dennis Kwok Yu Ngo Simon Siu Man Ng Division of colorectal Surgery Department of Surgery The Chinese Uni-versity of Hong Kong Prince of Wales Hospital department of colorectal Surgery University Hospital Birmingham NHS Trust

AIM: To give a comprehensive review of current litera-ture on robotic rectal cancer ***: A systematic review of current literature via PubMed and Embase search engines was per-formed to identify relevant articles from january 2007 to november 2013. The keywords used were: "robotic surgery", "surgical robotics", "laparoscopic computer-assisted surgery", "colectomy" and "rectal resection". RESULTS: After the initial screen of 380 articles, 20 pa-pers were selected for review. A total of 1062 patients(male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the *** of 1062 robotic-assisted operations, 831(78.2%) anterior and low anterior resections, 132(12.4%) in-tersphincteric resection with coloanal anastomosis, 98(9.3%) abdominoperineal resections and 1(0.1%) Hart-mann's operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has con-tinued to evolve to its current state with promising re-sults; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.

关键词： Rectal cancer Robotics Minimal invasive surgery Systematic review Rectal surgery

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OPA3 overexpression modulates lipid droplet production and sensitizes colorectal cancer cells to bevacizumab treatment

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BIOCELL 2024年第6期48卷 971-980页

作者： HONGBIAO WU DONGFANG LIU department of colorectal and Anal Surgery Ningbo First HospitalNingbo315010China

Background:colorectal cancer(CRC)represents a substantial risk to public ***,theﬁrst US FDA-approved antiangiogenic drug(AAD)for human CRC treatment,faces resistance in *** role of lipid metabolism,particularly through OPA3-regulated lipid droplet production,in overcoming this resistance is under ***:The protein expression pattern of OPA3 in CRC primary/normal tissues was evaluated by bioinformatics ***3-overexpressed SW-480 and HCT-116 cell lines were established,and bevacizumab resistance and OPA3 effects on cell malignancy were ***3 protein/mRNA expression and lipid droplet-related genes were measured with Western blot and ***3 subcellular localization was detected using immunoﬂ*** and apoptosis were assessed via colony formation andﬂow *** formation assays were conducted to assess the angiogenic potential of human umbilical vein endothelial cells(HUVECs).Lipid analysis was used to measure the phosphatidylcholine(PC)and lysophosphatidylcholine(LPC)levels in CRC ***:Bioinformatics analysis revealed that OPA3 was downregulated in *** of OPA3 inhibited CRC cell proliferation,stimulated apoptosis,and suppressed the angiogenic ability of ***3 effectively reversed the resistance of CRC cells to bevacizumab and decreased lipid droplet production in CRC ***,OPA3 reversed the bevacizumab-induced lipid droplet production in CRC cells,thereby increasing CRC cell sensitivity to bevacizumab ***:This study suggests that OPA3 modulates lipid metabolism in CRC cells and reduces resistance to bevacizumab in CRC ***,OPA3 may be a potential therapeutic target against the AAD resistance in CRC.

关键词： colorectal cancer OPA3 Bevacizumab Lipid droplet Antiangiogenic drug

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Clinical impact of atypical endoscopic features in rectal neuroendocrine tumors

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World Journal of Gastroenterology 2015年第47期21卷 13302-13308页

作者： Jong Hee Hyun Seong Dae Lee Eui Gon Youk Jae Bum Lee Enu-Jung Lee Hee Jin Chang Dae Kyung Sohn Center for colorectal Cancer National Cancer Center department of Surgery Daehang Hospital

AIM: To validate the association between atypical endoscopic features and lymph node metastasis(LNM).METHODS: A total of 247 patients with rectal neuroendocrine tumors(NETs) were analyzed. Endoscopic images were reviewed independently by two endoscopists, each of whom classified tumors by sized and endoscopic features, such as shape, color, and surface change(kappa coefficient 0.76 for inter-observer agreement). All of patients underwent computed tomography scans of abdomen and pelvis for evaluation of LNM. Univariate and multivariate analyses were performed to identify the factors associated with LNM. Additionally, the association between endoscopic atypical features and immunohistochemical staining of tumors was ***: Of 247 patients, 156(63.2%) were male and 15(6.1%) were showed positive for LNM. On univariate analysis, tumor size(P < 0.001), shape(P < 0.001), color(P < 0.001) and surface changes(P < 0.001) were significantly associated with LNM. On multivariate analysis, tumor size(OR = 11.53, 95%CI: 2.51-52.93, P = 0.002) and atypical surface(OR = 27.44, 95%CI: 5.96-126.34, P < 0.001) changes were independent risk factors for LNM. The likelihood of atypical endoscopic features increased as tumor size increased. Atypical endoscopic features were associated with LNM in rectal NETs < 10 mm(P = 0.005) and 10-19 mm(P = 0.041) in diameter. Immunohistochemical staining showed that the rate of atypical endoscopic features was higher in non L-cell ***: Atypical endoscopic features as well as tumor size are predictive factors of LNM in patients with rectal NETs.

关键词： Rectal neuroendocrine tumor Colonoscopy Lymph node metastasis

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Extramural vascular invasion and response to neoadjuvant chemoradiotherapy in rectal cancer: influence of the CpG island methylator phenotype

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World Journal of Gastrointestinal Oncology 2017年第5期9卷 209-217页

作者： Jeremy Stuart Williamson Huw Geraint Jones Namor Williams Anthony Paul Griffiths Gareth Jenkins John Beynon Dean Anthony Harris department of General and colorectal Surgery Singleton Hospital department of Pathology Singleton Hospital department of Life Sciences Swansea University

To identify whether CpG island methylator phenotype (CIMP) is predictive of response to neoadjuvant chemoradiotherapy (NACRT) and outcomes in rectal cancer. METHODSPatients undergoing NACRT and surgical resection for rectal cancer in a tertiary referral centre between 2002-2011 were identified. Pre-treatment tumour biopsies were analysed for CIMP status (high, intermediate or low) using methylation specific PCR. KRAS and BRAF status were also determined using pyrosequencing analysis. Clinical information was extracted from case records and cancer services databases. Response to radiotherapy was measured by tumour regression scores determined upon histological examination of the resected specimen. The relationship between these molecular features, response to NACRT and oncological outcomes were analysed. RESULTSThere were 160 patients analysed with a median follow-up time of 46.4 mo. Twenty-one (13%) patients demonstrated high levels of CIMP methylation (CIMP-H) and this was significantly associated with increased risk of extramural vascular invasion (EMVI) compared with CIMP-L [8/21 (38%) vs 15/99 (15%), P = 0.028]. CIMP status was not related to tumour regression after radiotherapy or survival, however EMVI was significantly associated with adverse survival (P < 0.001). Intermediate CIMP status was significantly associated with KRAS mutation (P = 0.01). There were 14 (9%) patients with a pathological complete response (pCR) compared to 116 (73%) patients having no or minimal regression after neoadjuvant chemoradiotherapy. Those patients with pCR had median survival of 106 mo compared to 65.8 mo with minimal regression, although this was not statistically significant (P = 0.26). Binary logistic regression analysis of the relationship between EMVI and other prognostic features revealed, EMVI positivity was associated with poor overall survival, advanced “T” stage and CIMP-H but not nodal status, age, sex, KRAS mutation status and presence of local or systemic recurre

关键词： Rectal cancer CpG islands Methylation

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Role of gut microbiota in functional constipation

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Gastroenterology Report 2021年第5期9卷 392-401,I0001页

作者： Shengsheng Zhang Ruixin Wang Danyan Li Luqing Zhao Lixin Zhu Digestive disease Center Beijing Hospital of Traditional Chinese MedicineCapital Medical UniversityBeijingP.R.China department of colorectal Surgery Guangdong Institute of GastroenterologyGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China

Functional constipation(FC)is common,yet the etiology is not *** evidence suggests an association between FC and abnormal gut *** relationship between the gut microbiota and the gut transit is likely *** review summarizes the current evidence regarding the impact of gut microbiota on the pathogenesis of *** modulating the colonic motility,secretion,and absorption,gut microbiota may contribute to the development of FC through microbial metabolic activities involving bile acids,short-chain fatty acids,5-hydroxytryptamine,and *** support of the key roles of the gut microbiota in FC,treatment with probiotics,prebiotics,synbiotics,and traditional Chinese medicine often result in compositional and functional changes in the gut *** studies on the pathogenesis of FC and the therapeutic mechanism of microecological agents will provide a knowledge base for better management of FC.

关键词： gut microbiota functional constipation bile acids SCFA serotonin traditional Chinese medicine

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Insulin-like growth factor-1 induces lymphangiogenesis and facilitates lymphatic metastasis in colorectal cancer

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World Journal of Gastroenterology 2013年第43期19卷 7788-7794页

作者： Zhen-Jun Li Xiao-Jiang Ying Hong-Liang Chen Ping-Jiang Ye Zhi-Liang Chen Gang Li Hua-Feng Jiang Jiang Liu Shu-Zhen Zhou department of colorectal Surgery Shaoxing People’s Hospital Shaoxing Hospital of Zhejiang University

AIM:To investigate the expression of insulin-like growth factor-1(IGF-1)/insulin-like growth factor-1 receptor(IGF-1R)in colorectal cancer(CRC)tissues and to analyze their correlation with lymphangiogenesis and lymphatic ***:Immunohistochemistry was used to evaluate IGF-1 and IGF-1R expression and lymphatic vessel density(LVD)in 40 CRC *** correlation between IGF-1/IGF-1R and LVD was *** of IGF-1 on migration and invasion of CRC cells were examined using transwell chamber assays.A LoVo cell xenograft model was established to further detect the role of IGF-1 in CRC lymphangiogenesis in vivo. RESULTS:Elevated IGF-1 and IGF-1R expression in CRC tissues was correlated with lymph node metastasis(r=0.715 and 0.569,respectively,P<0.05)and tumor TNM stage(r=0.731 and 0.609,P<0.05).A higher LVD was also found in CRC tissues and was correlated with lymphatic metastasis(r=0.405,P<0.05).A positive correlation was found between LVD and IGF-1R expression(r=0.437,P<0.05).Transwell assays revealed that IGF-1 increased the migration and invasion of CRC *** vivo mouse studies showed that IGF-1 also increased LVD in LoVo cell ***:IGF-1/IGF-1R signaling induces tumorassociated lymphangiogenesis and contributes to lymphatic metastasis of CRC.

关键词： colorectal cancer Insulin-like growth factor-1 Insulin-like growth factor-1 receptor Lymphangiogenesis Lymphatic metastasis

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Cellular therapy:A promising tool in the future of colorectal surgery

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World Journal of Gastroenterology 2019年第13期25卷 1560-1565页

作者： Mohammed Mohammed El-Said Sameh Hany Emile colorectal Surgery Unit General Surgery Department Mansoura University Hospitals Mansoura University

Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer(CRC). This review aimed to illustrate the role of cellular therapy in promotion of wound healing and management of metastatic CRC. An organized literature search for the role of cellular therapy in promotion of wound healing and management of metastatic CRC was conducted. Electronic databases including PubMed/Medline, Scopus, and Embase were queried for the search process. Two types of cellular therapy have been recognized, the mesenchymal stem cells(MSCs) and bone marrow-mononuclear cells(BM-MNCs) *** cells have been shown to accelerate and promote healing of various tissue injuries in animal and human studies. In addition, experimental studies have reported that MSCs may help suppress the progression of colon cancer in rat models. This article reviews the possible mechanisms of action and clinical utility of MSCs and BM-MNCs in promotion of healing and suppression of tumor growth in light of the published literature. Cellular therapy has a potentially important role in colorectal surgery, particularly in the promotion of wound healing and management of metastatic CRC. Future directions of cellular therapy in colorectal surgery were explored which may help stimulate futures studies on the role of cellular therapy in colorectal surgery.

关键词： Cellular therapy Future colorectal surgery Stem cells

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