（承2008年第4期）2腹腔镜结直肠癌的手术适应证、禁忌证及手术的基本原则2.1适应证腹腔镜结直肠癌手术适应证与开腹手术大致相同，亦分姑息性手术与根治性手术。对晚期伴有广泛转移的结直肠癌病例行姑息性手术，包括腹腔镜肠造瘘、肠道转流及节段性结直肠切除术。根治性手术适用于结直肠任何一段的癌肿，其切除范围应包括癌肿所在肠襻、系膜及其区域淋巴结； 各根治术式的要求详见各节。主要术式包括： 腹腔镜右半结肠切除术、 腹腔镜左半结肠切除术、腹腔镜次全和全结肠切除术、腹腔镜TME直肠前切除术、腹腔镜TME腹会阴直肠切除术。 ......
ObjectiveTo summarize the progress in mutant gene sequences of different types of hereditary colorectal cancer.MethodThe relevant literatures about genetic mutations in hereditary colorectal cancer at home and abroad were reviewed.ResultsHereditary colorectal cancer coule be divided into two categories according to whether it was related to the germline mutations of known oncogenes. Among the known germline mutant genes, the gene of adenomatous polyposis coli (APC), MUTYH, thymidine glycol DNA glycosylase 1 (NTHL1), polymerase (DNA) epsilon, catalytic subunit (POLE), and polymerase (DNA) delta 1, catalytic subunit (POLD1) were closely related to adenomatous polyposis syndromes, mismatch repair (MMR)-related genes were related to Lynch syndrome, serine/threonine kinase 11 (STK-11) gene was related to Peutz-Jeghers syndrome, mutant genes of SMAD4 and bone morphogenetic protein receptor type 1A (BMPR1A) were found in JPS individuals, and Cowden syndrome was caused by phosphatase and tensin homology deleted on chromosome ten (PTEN) gene mutation. For colorectal cancer patients with unknown germline mutations but significant genetic characteristics (such as hyperplastic polyposis), relevant genes had also been gradually searched out, which needed further evidence.ConclusionsColorectal cancer is a malignant tumor with genetic characteristics. Compared with sporadic colorectal cancer, the time of hereditary colorectal cancer from adenoma to cancer is shorter, and the occurrence of heterogeneous tumor is also increased, but the survival rate after active intervention is higher than the sporadic one. To study the mutant gene sequences of hereditary colorectal cancer is the improvement and development of the diseases control in modern medicine.
ObjectiveTo explore effect of lymph node ratio (LNR) on prognosis for patients with stage Ⅲ colorectal cancer. MethodsThe clinicopathologic data of 1 424 stage Ⅲ patients who underwent curative resection in this hospital from January 2009 to December 2013 were analyzed retrospectively. These patients were divided into low LNR group (LNR<optimal cut-off value) and high LNR group (LNR≥optimal cut-off value) according to the optimal cut-off value by receiver operating characteristic curve. The correlation between prognosis and clinicopathologic features was analyzed by using univariate analysis and Cox's proportional hazards regression model. The 5-year cumulative disease-free survival (DFS) and overall survival (OS) were calculated by using Kaplan-Meier method. ResultsThe area under the receiver operating characteristic curve was 0.639, the optimal cut-off value of LNR was 0.267. The 5-year cumulative DFS and OS of the low LNR group were significantly higher than those of the high LNR group (DFS:53.8% versus 34.4%, P<0.001; OS:60.5% versus 44.5%, P<0.001). The results of univariate analysis showed that the preoperative carcinoembryonic antigen (CEA) level, degree of differentiation, TNM stage, pT stage, pN stage, vascular invasion, tumor diameter, and LNR were associated with the DFS and OS (P<0.05), but the number of lymph nodes retrieved was only associated with the DFS (P<0.05). The results of Cox analysis showed that the preoperative CEA level, degree of differentiation, TNM stage, and LNR were the independent prognostic factors for the DFS and OS (P<0.05), but the number of lymph nodes retrieved and the vascular invasion were only the independent prognostic factors for the DFS (P<0.05). ConclusionLNR is a prognostic factor in stage Ⅲ colorectal cancer, and it might be as a supplement for TNM staging system.
Objective To evaluate the adoption of carbon nano-particle in the pathologic examination of lymph node for lower rectal cancer. Methods Sixty consecutive patients with rectal cancers located at or below the peritoneal reflection were randomly allocated to the routine method group or the group using carbon nano-particle. Resultsof pathologic examination were compared. Results Altogether, 1 070 lymph nodes were examined from the 2 study groups. The average examined number of the carbon nano-particle group was (20.2±4.9)/case, which was significantly higher than the other group 〔(15.4±6.8)/case〕, P=0.003. More tiny lymph nodes were examined in the nano-particle group (P=0.029) and more metastases were proved from the lymph nodes dyed by nano-particle (P=0.000). The majority of examined lymph nodes were located along the superior rectal vessel and its branches. ConclusionAdoption of nano-particle in pathologic examination of rectal cancer surgery can increase the examined number of lymph nodes, while detect small nodes harboring cancer, thus ensuring the correctness of pathologic report. The distribution of mesorectal lymph nodes underlines the execution of TME principle in dissection.