Objective To evaluate the diagnostic accuracy of the aberrant methylation of genes in stool for colorectal tumor. Methods Databases including The Cochrane Library, PubMed, EMbase, CBM, Web of Science, CNKI and WanFang Data were searched to collect the diagnostic trials on the aberrant methylation of genes in stool for colorectal tumor published from January 1990 to February 2012. QUADAS items were used to evaluate the quality of the included studies, and the meta-analysis was conducted using Meta-Disc 1.4 software. Results A total of 32 studies involving 3 951 patients were included. The results of meta-analysis showed that, for detecting the colorectal tumor, the weighted sensitivity, specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristic (SROC) curve and Q were 92% (95%CI 91% to 93%), 63% (95%CI 61% to 65%), 20.79 (95%CI 15.13 to 28.57), 0.861 9 (SE=0.020 4), and 0.792 6 (SE=0.019 8), respectively. For detecting the colorectal cancer, the weighted sensitivity, specificity and area under the curve (AUC) were 91% (95%CI 89% to 92%), 75% (95%CI 73% to 77%), and 0.900 7, respectively. For detecting the colorectal adenoma, the weighted sensitivity, specificity and AUC were 79% (95%CI 76% to 83%), 75% (95%CI 73% to 77%), and 0.845 7, respectively. Conclusion With high sensitivity (92%) and moderate specificity (63%), aberrant methylation of genes in stool can be used as an optional noninvasive method for the diagnosis of colorectal tumor.
Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
Objective To summarize the experience of single incision laparoscopic colorectal surgery and to discuss the operative techniques. Methods The clinical data of 21 cases who underwent single incision laparoscopic colorectal surgery in Shengjing Hospital from Jan. 2010 to Jun. 2011 were collected and analyzed. Results Of 21 cases underwent single incision laparoscopic surgery， right hemicolectomy performed in 5 cases， sigmoidectomy performed in 2 cases， rectal anterior resection performed in 9 cases， rectal abdominoperineal resection performed in 2 cases， total colectomy performed in 1 case， and colostomy performed in 2 cases. Twenty cases completed by single incision， but 1 case was added an extra 12 mm incision in order to dissect the lower segment of rectum. The operative time was （189±75） min （40-335min）；the postoperative hospitalization time was （11.5±3.4） d （7-16d）. There were no bleeding， anastomosis leakage or intestinal obstruction after operation， and no incision infection， rupture or hernia were founded. No recurrence was found within 6 months’ follow up after operation. Conclusions Under reasonable selection of indication， single incision laparoscopic colorectal surgery is safe and feasible， and it also has a satisfactory cosmetic effect and better minimally invasive effect.
Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.
Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.
Objective To build a systematic, comprehensive, high efficient and maneuverable follow-up system in multi-disciplinary team (MDT). Methods Comparing with abroad follow-up practical management, the advantages and disadvantages were analyzed by using multiple follow-up forms and the construct of staffs to guide and evaluate the postoperative patients in colorectal carcinoma at the beginning of follow up system. Results Follow-up system was made rationalized, and an effective follow-up model was built up to extend in MDT. Conclusion Following up the present situation with patients of colorectal cancer in this country, the correct direction which is based on current follow-up system would be put out. That would be the important study to improve the medical treatment in next stage.
Objective To analyze the primary status of database in multi-disciplinary team （MDT） of colorectal cancer, and to explore the tendency in construction of database in the future. Methods Described the current status of different database respectively, and analyzed the data statistically, involving the patients’ general information, essential information of duration of hospital stay, therapy and MDT from the database of patients. Results The development of different database was uncoordinated. Among the total, the database of patients was advanced, the database of reference and the database of specialists were also developing in certain. Conclusion The primary reason, which results in the lag of construction of database currently, is the long span of database and the cost of much time in data acquisition. The direction of development of database involves consummation of database gradually, refreshment of it promptly, and expanding the research of informatics related clinical medicine.
【Abstract】ObjectiveTo study the distal intramural spread of rectal carcinoma, and provide evidence for modification of rectal carcinoma surgery. MethodsSixty patients with rectal carcinoma admitted to the first affiliated hospital of Chongqing university of medical science from November 2001 to October 2002 were included. The specimens were extended to its original size and shape by the fat clearing method. Mesenteric lymph nodes were dissected by using transillumination to examine metastases histologically, then a lymph nodes map was produced which including the site of the primary lesion, the vascular distribution, and the sites of dissected nodes. The specimen below the distal margin of the tumor was cut continuously with 0.5 cm interval then sectioned for histopathological examination. ResultsTumor spread to the distal intramural was observed in 11 of 60 patients (18.3%) with the range within 1.5 cm, of which less than 0.5 cm in 5 case, 5 cm to 1.0 cm in 2 cases, 1.0 cm to 1.5 cm in 4 cases. The tumor invasion was correlated with gross type, histological type and infiltrative depth, but not with sex, age, location of the tumor, size of the tumor, lymph nodes metastases and Dukes stage. Conclusion The range of distal mural excision should exceed 1.5 cm to tumor margin in radical surgery for rectal carcinoma. This rule should be emphasized for patients with poor cell differentiation and deep infiltration.
【Abstract】ObjectiveTo detect the spreading scope of rectal cancer to mesorectum by RT-PCR using carcinoembryonic antigen (CEA) mRNA as a marker and to investigate the excision scope of mesorectum in resection of rectal cancer. MethodsForty specimens from 40 rectal cancer patients who underwent curative operation was employed to detect the metastatic deposits scattered in the mesorectum by RT-PCR using CEA as a marker. ResultsNine of 40 (22.5%) specimens contained metastatic deposits scattered in the mesorectum. The metastasis was just within the range of 4cm mesorectum under the verge of tumor. The tumor spreading to mesorectum is correlated with Dukes stages，the infiltrated depth of bowel wall, tumor differentiation and tumor type(P＜0.05), and is not correlated with the size of tumor and the level of CEA(Pgt;0.05). ConclusionThe excision of mesorectum should be within the range of 5cm under the verge of tumor in surgical management of rectal cancer.