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At least 613 records · Page 34Linked to original sources
PubMed2001

[Long survival in a case of unresectable hepatic metastasis from rectal carcinoma treated with second-look hepatectomy plus pharmacokinetic modulating chemotherapy (PMC)].

A 67-year-old female with rectal cancer and multiple liver metastases underwent low anterior resection by total mesorectal excision (TME), cholecystectomy and hepatic arterial cannulation in June 1995. She was treated with hepatic arterial infusion chemotherapy (HAI) (5-FU 600 mg/m2/day x 2 days/w) and oral UFT (400 mg/body, 5 days/w) once a week for 6 months on an outpatient basis. As the metastatic foci of the liver significantly decreased (83.3%) and extrahepatic disease were not observed, partial resection of the liver (second-look hepatectomy) was performed in March 1996. She continued arterial infusion PMC and venous infusion PMC as an outpatient. During the follow-up period a lung metastasis appeared in November 1997. Her regimen was changed to modified PMC with MMC (mitomycin C) and CPT-11. She has been managed at our outpatient clinic while the lung metastasis remained but with no liver metastasis for 57 months after the first operation, until the present. Second-look hepatectomy and PMC with a two-way port system was a useful option for unresectable hepatic metastases from colorectal carcinoma.

Adenocarcinoma↗
PubMed2001

[Rectal carcinoma--oncologically adequate resection].

The local recurrence rate is besides distant metastatic spread the most relevant factor for the longterm survival of patients with rectal cancer. Of decisive importance are the experienced surgeon and special techniques such as the precise mesorectal dissection with respect of the holy planes. Total mesorectal excision (TME) for carcinomas of the lower and middle third of the rectum and a sufficient distal margin of 2 cm reduced the local recurrence rate to below 10% and allow sphincter preservation in more than 80%. The local excision is ideal for low-risk-patients with circumscript T1-tumors. In high-risk-patients the operation should be followed by additional chemoradiation therapy. Multivisceral surgery and pelvic exenteration do have a place in patients with locally advanced tumors, which should be treated by neoadjuvant radiochemotherapy. Laparoscopic operations of rectal cancer show first promising results but should, however, be restricted to controlled clinical trials.

Chemotherapy, Adjuvant↗
PubMedDate not supplied

Adjuvant treatment for colorectal cancer.

Colorectal cancer is a leading cause of cancer in Western countries. Surgery remains the only way to cure it. Recent trials led to the general acceptance of adjuvant chemotherapy in Dukes C cancer by identifying bolus 5FU and leucovin during 6 months (5 days monthly) as the current standard. The role of adjuvant chemotherapy remains questionable in Dukes B2 (stage II) colon cancer, in rectal cancer and after curative resection of liver metastases. The development of total mesorectum excision (TME) technique has dramatically resulted in improving local recurrence control and will be the standard in rectal cancer surgery; preoperative irradiation is widely used in Europe for stage II and III rectal cancer but its definite place and its optimal regimen await further assessment as well as the role of adjuvant chemotherapy in rectal cancer. New chemotherapeutic combinations based on new effective agents in colorectal cancer such as CPT-11 and oxaliplatine have been currently used for downstaging liver metastases initially unresectable. This new approach, combined with the development of local ablative therapies such as cryotherapy and radiofrequency allows curative strategies in a significant number of patients primarily unfit for surgical resection of liver mets. The present paper aims to review the different aspect of (neo)adjuvant therapies in the multimodal curative management of colorectal cancers.

Aged↗
PubMed2001

[Surgical strategy in rectosigmoidal cancer].

Colorectal cancer is frequent and diagnosed earlier thanks to the screening and to the progresses in the preoperative assessment. The precocity of the surgical resection takes advantage from the complete resection of vascular and nodes involvement. The rectal localisation of the cancer requires to take the reconstruction into account. If preoperative radiotherapy is helpful in T4 and T3 N2 and locally advanced tumour, the surgeon should consider the four approaches of rectal cancer: the anterior resection (Dixon-Wangensteen) (DW) with total mesorectal excision (TME), the colo-anal anastomosis with a J pouch, the abdomino-perineal approach (Miles procedure) requiring a definitive left colostomy, and in some rare cases the transanal local resection.

Colectomy↗
PubMedDate not supplied

[Role of intersphincter resection among the surgical options for cancer of the distal rectum].

The surgical treatment of low rectal cancer has yet to be standardised. The aims of the study were to define the curative role of intersphincteric resection and to evaluate its indications and functional results through a retrospective clinical experience. From 1988 to 2000, out of 783 operations for primary rectal cancers (resectability rate 96%; restorative resections 83% and APR 10%) an intersphincteric resection was performed in 48 patients (31 male, 17 female, average age 62) for tumours located at a mean distance of 4.5 cm from the anal verge. Clinical stage: 27 T3 (56.3%), 12 T2, 5 T4 and 4 T1. All the operations were rated R0. TME with N-S, endo-anal distal transection and manual colo-anal anastomosis with a protective stoma were systematically performed. The mean follow-up was 46 months (range: 12-80). Functional results were evaluated with a prospective standardised questionnaire. There was no hospital mortality (30 days). The total morbidity rate was 22% with anastomotic leakage (clinical or X-ray evidence) in 12.5%. Four anal stenoses needed dilatation. Only one local recurrence six years after operation (2.1%). Nine patients died of systemic metastases within 3 years of surgery; the others are still alive and disease-free. Minor faecal incontinence with frequency and urgency occurred in 68.7% of cases at 3 months after protective stoma closure and in 37.5% after 6 months. After one year continence was good in 85.4% of survivors. Only one case required a permanent stoma for poststenotic total incontinence. The best functional results were achieved by colonic pouch reconstruction. For selected low rectal cancers (T2/T3) without voluntary sphincter infiltration, intersphincteric resection is safe and effective for oncological and functional purposes. The procedure requires accuracy in dissecting the anorectal junction. Preoperative radiotherapy may increase the indications for intersphincteric resection as well as the availability of a disease-free margin. A manual colo-anal anastomosis with colonic pouch interposition is strongly recommended.

Adult↗
PubMed2000

[Total meso-rectal excision in low anterior resection with double stapling technique].

OBJECTIVE: To elucidate the value of total meso-rectal excision (TME) in low anterior resection with double stapling technique. METHODS: During January 1993 to October 1998, 306 cases of rectal lesions were treated by total meso-rectal excision in low anterior resection (LAR) with double stapling technique. Among the patients with rectal cancer, 235 (78.86%) were treated by low anterior resection and 97 (41.28%) by ultra-low anterior resection. RESULTS: No operative death was noted, and anastomotic leakage occurred in 9 (2.94%) patients. Ureter injury occurred in 2 (0.65%) patients. 32 (10.46%) patients suffered from anastomotic stenosis, 31 mm diameter of stapler for 27 (12.68%) patients and 33 mm diameter of stapler for 5 patients (5.38%). Local recurrence occurred in 20 (6.71%) patients: Dukes'B 4 (2.33%) patients, Dukes'C 9 (12.5%) patients, and Dukes'D 7 (53.85%) patients. CONCLUSIONS: Total meso-rectal excision can effectively reduce the local recurrence rate after LAR with double stapling technique. Since the recurrence is closely related to the stage of the disease, early detection, early diagnosis and early treatment are extremely important.

Adult↗
PubMedDate not supplied

[Functional results of colorectal and coloanal anastomosis with and without pouch].

In the last two decades one of the main targets of anorectocolonic surgery has been to develop sphincter saving procedure able to achieve good results with acceptable five-years survivals, optimal local control of the diseases and low rate of local cancer recurrence. Partially the development of new operative techniques such as low colorectal and coloanal anastomoses with or without pouch, the TME operation and the nerve sparing procedure have reach this target. In fact, often after these operations we can observe a functional syndrome called "Post Anterior Resection Syndrome". The basis of this syndrome have to researched in anatomical and physiological alterations that followed a reconstructive operation. It is characterized by frequency and fragmentation of the stool, feeling of incomplete evacuation, tenesmus and urgency. Fecal continence may be compromised to different levels: usually with alteration limited to soiling and impaired control of flatus, occasionally with loss of liquid stool, rarely with loss of solid stools. The anorectal function will be altered for long time following the surgical procedure and the stabilization of functional results may require 1-3 years. On the basis of these considerations, the authors examine the etiopathogenesis and clinical presentation of the "Post Anterior Resection Syndrome", suggesting some expedients to prevent the functional problems. Analysing our experience and a wide specific bibliography, they also underline the indispensable point to achieve a good functional results after a reconstructive procedure. The author conclude asserting that the absence of these points have to be carefully valued because, in these situations, a simply colostomy is able to guarantee a better quality of life that a colorectal/coloanal anastomoses with or without pouch but associated to functional problems.

Anal Canal↗
PubMed2000

[Effects of retinoic acid on proliferation and differentiation of human lung squamous carcinoma cell line].

Human lung squamous carcinoma cell line(TUL cell) was treated with 5 x 10(-6) mol.L-1 all-trans retinoic acid(ATRA). Cell numbers were estimated by 0.4% trypon blue stain. MTT test was used for determining the percentage of cell growth inhibition(GI). DNA syntheses of cells were evaluated by 3H-thymidine incorporation. Cell ultrastructure was examined by transmission electron microscope(TEM). TUL cells were treated with or without ATRA, and transplanted in cutaneous of Balb/c nude mice. The results showed that: 1. The speed of cell growth in study group was smaller than that in control group. 2. The GI of cell lines TUL was 42.3%. 3. The percentage of 3H-thymidine incorporation of TUL cells was declined significantly. 4. Ultrastructure under TME showed that TUL cells treated with ATRA was suppressed. These results suggest that ATRA has the effects on growth-inhibition and differentiation-induction of TUL cell.

Animals↗
PubMed2002

[Colonic pouch: indications and technique].

Early functional outcome after low anterior resection with total mesorectal excision (TME) and colo-anal anastomosis for colorectal carcinoma can be improved by the restoration of the colonic reservoir. This can be achieved by the construction of a colonic J-pouch. The technique is safe and has been refined during the last years. A decrease in stool frequency, urgency, and incontinence rates during the first two postoperative years with an improved quality of life has been observed. Alternative methods with similar functional results are provided by the ileocecal reservoir, the transverse coloplasty pouch or the side-to-end anastomosis. Colonic J-pouch reconstruction should be considered as an superior alternative to straight coloanal anastomosis in patients undergoing anterior resection.

Colonic Pouches↗
PubMed1992

The establishment of radioimmunoassay of cyclic AMP.

Succinyl cyclic AMP, coupled with human albumin, was injected into rabbit to elicit antibodies to the cyclic nucleotide hapten. The succinyl cyclic nucleotides were conjugated to human albumin through a carbodiimide coupling procedure. The radioligand was prepared essentially by the modified method of Hunter and Greenwood. The resulting radiolabeled 125-ScAMP-TME was subsequently purified by reverse phase chromatography on Seppak C18 cartridge and used as tracers. Free and bound form of labeled antigens in the assay system were separated according to their differences in adsorption to solid material, i.e., charcoal. The antisera in routine use had 8% cross-reactivity with cyclic GMP, but had no cross-reactivity with ADP, 5'-AMP or ATP. The sensitivity of the assay in standard was around 0.05 pmol/ml. The sequential saturation analysis system was superior to the equilibrium study in terms of its sensitivity in standard curve determination. The media dilution and recovery studies showed good parallelism with the standard curve. The intra-assay and inter-assay coefficient variations were 5% and 7%, respectively. It showed that a significant increase in tracer binding to the antibodies in equilibrium incubating system was obtained when they were incubated at 4 degrees C for up to 72 hours. When the standard curve was derived for Scatchard plot analysis, Kd of the curve decreased inversely with the increase of the antibodies diluted, the total binding capacity of the antibody would not alter. A thyroid-stimulating hormone produced a normal response of cyclic AMP concentrations in FRTL-5 tissue cultures.

Animals↗
PubMed2003

[Multimodality therapy in progressive rectal carcinoma].

Rectal carcinoma cannot be controlled only by surgical technique despite radical resection (TME, systematic lymphadenectomy). Therefore, progressive rectal carcinoma of stage 2 + 3 that are detectable pre-operatively by CT and 3-D endosonography, should be treated by a multimodal concept. Based on recent Scandinavian and Dutch studies, we introduced a modified post-operative short-term radiation in which the acute toxicity on tumor tissue corresponds to that of the Swedish and Dutch studies (5 x 5 Gy), its late toxicity, however, is reduced by 20%. Thus, we expect to reduce long-term damages to the pelvic organs, i.e. incontinence. A phase 2 study revealed good therapeutic management due to interdisciplinary tumor conference and a high acceptance by patients. The post-operative rate of wound healing is a bit higher, but does not influence the time of hospitalization.

Carcinoma↗
PubMed2004

[A molecular-epidemiologic study on TEM-1 genes of Neisseria gonorrhoeae in Wuxi area].

OBJECTIVE: In order to study the epidemiology of TEM-1 genes of Neisseria gonorrhoeae (Ng) in Wuxi area. METHODS: In the light from foreign literature that positive Ng strains of beta-lactamase contain plasmid sequences of TEM-1 genes, heminested PCR for TME-1 genes of Ng detection was self-designed. Ng of 195 strains were detected, that were isolated in Wuxi area from Jan to the Oct, 2002. RESULTS: There were 138 TEM-1 genes positive in 195 isolated strains with a positive rate of 70.8%. There was one case of heminested PCR product of TEM-1 genes which showed the homogeneity was 99% in Wuxi area, when comparing with pFA7 sequences of positive Ng plasmid of beta-lactase from register GenBank. CONCLUSION: Data showed that the Ng strains with TEM-1 genes were the prevalent ones in Wuxi area.

China↗
PubMed2004

[Unusual late recurrence of cervix uteri carcinoma in colon].

A rare case of SCC of the colorectal region is reported. A 64-year-old Polish woman with a past history of early stage (IA) SCC of the cervix 6 years previously suffered sudden onset of tenesmus and additional symptoms like pain on defecation and blood in the stool were present. In the ulcerated tumor located 15 cm from the anal verge, SCC, which was histologically similar to that of primary lesion, was observed. Female was treated with total mesorectal excision (TME). Primary SCC of the colorectal region is very rare. Female secondary SCC of this region, caused by tumor metastasis, especially by metastasis from the cervical cancer was not observed before. The present case draws attention to the possibility of late recurrence of cervical cancer, even in cases treated radically in early stages.

Carcinoma, Squamous Cell↗
PubMed2004

[Radical resection with total mesorectal excision under the laparoscope in the treatment of rectal cancer].

OBJECTIVE: To evaluate the effect of radical resection with total mesorectal excision under the laparoscope in the treatment of rectal cancer. METHODS: Under the laparoscope and with the ultrasonic scalpel, total mesorectal excision in 38 patients with rectal cancer was performed. In operation, alone the parietal layer of pelvic fascia and inside the autonomic nerve trunk, the mesorectum was excised. All patients were followed up for 2 years. RESULTS: All cases were underwent successfully and no complication was observed. Postoperative flatus and feces were passed at 32 hours and postoperational hospital stay were 7.5 days. No trocar port implantation and no death case was observed. Two local recurrence developed in 2 years follow-up. CONCLUSIONS: Radical resection with TME is a new progress of less damageable operation, which has advantages of low postoperative local recurrence rate and help for pelvic autonomic nerve.

Adult↗
PubMed2004

[Long-term result of low anterior resection with stapling devices for rectal cancer].

BACKGROUND & OBJECTIVE: Currently, to preserve the anal function and improve the patients' quality of life, low anterior resection has become the preferred option in curative rectal cancer surgery. As the use of stapling instruments provides more reliable anastomoses in low anterior resection for rectal cancer, it enlarges the indication of this procedure. The aim of this study was to review the operation results and their outcomes of 449 rectal cancer patients who recieved of curative low anterior resections with stapling devices, and intent to find some measures that can reduce complications and improve long-term effects of this procedure. METHODS: The study included 449 patients who had a potentially curative anterior resection with stapled anastomosis in rectal cancer between Jan.1990 and Sept. 2002 at Sun Yat-sen University Cancer Center. All patients had complete follow-up data. All data were analyzed by SPSS8.0 software, risk factors for anastomotic leakage and recurrence were analyzed by Logistic regression, survival was analyzed by life table, and prognostic factors were screened by multivariate COX model. RESULTS: There were 11 cases of anastomotic leakage and 23 cases of anastomotic recurrence after operation. The 5-year survival rate was 78.4%. Age of >/= 65 years, and tumor involvement of more than half circumference were risk factors for anastomotic leakage, blood transfusion during operation was the risk factor for anastomotic recurrence. The independent factors for poor survival were stage of disease and tumor differentiation. CONCLUSIONS: Stapling devices can improve the anal reservation rate in low rectal cancer surgery, and stapled anastomoses is safe and feasible. Adequate preparation of bowel ends, a tension-free anastomosis with excellent blood supply and skilled stapled anastomoses were key measures to reduce anastomotic leakage, While TME, multidisciplinary therapy and the principle of avoiding medical spread, were key measures to improve treatment effect of rectal cancer.

Adenocarcinoma↗
PubMedDate not supplied

[Anterior resection of the rectum for rectal cancer--options, limits, immediate complications].

A number of factors have recently led to a more conservative approach for middle or low rectal cancers, making possible sphincter preservation and reducing the number of abdomino perineal excisions of the rectum. We have performed a retrospective analysis on 510 patients operated on in our unit between 1994 and 2003 for rectal cancer. There were a number of 118 anterior resection of rectum; in 20 cases the TME has been performed and in 6 cases a very low anterior resection of rectum was done. The overall operative morbidity rate was 16.10% in direct relation with the distal limit of resection. We note urinary dysfunctions, anastomotic leakage, recto-vaginal fistulas as immediate postoperative complications. With the practice of total mesorectal excision, the use of abdomino perineal excision of the rectum is decreasing. The use of preoperative radiotherapy can increase the rate of operative morbidity but despite of these, its long-term benefit, is important.

Adenocarcinoma↗
PubMed2005

[Therapeutic effects of calcitonin on back pain in the patients with osteoporosis].

A prospective study was performed to clarify the therapeutic effect on calcitonin in the patients with osteoporosis using patient-based outcome measures. A total of 67 patients with primary osteoporosis who complained back pain were included in this study. All patients were administered calcitonin 20 Unit/week intramuscularly. The therapeutic effects were assessed using various patient-based outcome measures before treatment, 2, 4 weeks and 3 months after treatment. We used Short form 12 for measuring general well-being, Roland Morris disability questionnaire for functional status associated with back pain, and visual analogue scale for pain intensity. Statistic analysis was performed using paired-t test. Pain intensity and functional status were significantly recovered at 2 weeks follow-up time and the effects were continued at 3 months follow-up time. Physical component summary (PCS) was recovered at 3 months follow-up tme, whereas mental component summary (MCS) was improved at 2 weeks follow-up time. These facts suggest that improvement of back pain using calcitonin correlates directly with recovery in functional status, indirectly with recovery in general well being.

Aged↗
PubMed2004

Laparoscopic surgery for colon and rectal cancer.

Use of laparoscopic resection for colorectal malignancy has raised concerns regarding local cancer control and the lack of long-term results. Most reported data are preliminary and medium-term results, at best. The aim of this study is to analyse all patients who underwent a laparoscopic resection for colorectal cancer at our department between November 1992 and July 2003. The cohort comprised a total of 394 patients (194 rectal cancer and 200 colon carcinoma). The most common procedures were high and low anterior resection with total mesorectum excision (TME) (176), followed by sigmoidectomy (89), right hemicolectomy (57), and left hemicolectomy (42). Mean operating time was 176 minutes. Conversion was necessary in 4 of the patients. Mean number of lymph nodes removed was 27. The postoperative complication rate was 20.1% (rectum) and 12.5% (colon). One patient died of myocardial infarction. Mean follow up was 45 (0.3-135) months. Port site metastasis occurred in 2 patients. The local recurrence rate was 4.1% after curative rectum resection and 0.5% in the colon group. After curative resection, the overall 5-year survival rate was 76.9% (rectum), and 81.4% (colon). Cancer-related survival rate after 5 years was 87.7% (rectum), and 91.3% (colon). Our results demonstrate that laparoscopic resection for colorectal cancer is not associated with higher morbidity and mortality rates. Established oncological principles are respected and long-term results are at least as good as those after open surgery.

Adenocarcinoma↗