Objective To determine the role of multimodal preoperative evaluation (MPE) system of transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in assessment of preoperative staging and selection of operative procedures of the lower and middle rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 150 patients, who were diagnosed definitely as lower and middle rectal cancer (distance of tumor to the dentate line ≤10 cm) at West China Hospital of Sichuan University from November 2008 to March 2009, randomly assigned into two groups. In one group named MPE group, MPE consisting of TRUS, MSCT and SAA were made for the preoperative evaluation. In another group named MSCT+SAA group, both MSCT and SAA were made preoperatively. Then, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Furthermore, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathological factors. Results According to the criteria, 146 patients with lower and middle rectal cancer were randomly assigned into MPE group (n=74) and MSCT+SAA group (n=72). The baselines characteristics of two groups were statistically identical. For MPE group the accuracy of preoperative staging T, N, M and TNM were 94.6% (70/74), 85.1% (63/74), 100% （74/74） and 82.4% (61/74), respectively; For MSCT+SAA group the corresponding rates were 77.8% (56/72), 84.7% (61/72), 100% （72/72） and 81.9% (59/72), respectively. The analysis showed a statistically difference in the accuracy of preoperative T staging between two groups (P=0.003) while there was no statistically significant difference of the accuracies of preoperative N, M and TNM staging between two groups (Pgt;0.05). There wasn’t a statistically significant increasing of the accuracy of prediction to operative procedures in MPE group compared with MSCT+SAA group 〔95.9% (71/74) vs.88.9% (64/72), P=0.106〕. When analyzing the relationship between multiple clinicopathologic factors and the operative procedures of lower and middle rectal cancer, there were statistical correlations between the pathological T staging (r=0.216， P=0.009), N staging (r=0.264， P=0.001), TNM staging (r=0.281， P=0.001), serum level of SAA before operation (r=0.252， P=0.002) or the distance of tumor to the dentate line (r=－0.261， P=0.001) and the operative procedures. Conclusion MPE system could display the accurate preoperative staging for lower and middle rectal cancer, on which the prediction of operative procedures can rest convincingly.
Objective To establish the optimal morphological criteria combined with fibrinogen level for evaluation of lymph node metastasis in colorectal cancer. Methods A consecutive series of 690 patients who underwent curative surgery for colorectal cancer, were examined by abdominopelvic enhanced multi-slice spiral computed tomography (MSCT) scan. If regional lymph nodes appeared, the maximal long-axis diameter (MLAD), maximal short-axis diameter (MSAD), and axial ratio (MSAD/MLAD) were recorded. At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover, preoperative plasma level of fibrinogen was retrospectively examined to identify metastatic or inflammatory lymph node combined with MSCT image. Both modalities, MSCT plus fibrinogen and MSCT alone, were compared based on the pathologic findings. Results The study population consisted of 100 patients with regional lymph nodes show. No significant difference was found between metastatic and inflammatory lymph nodes in imaging characteristics (Pgt;0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with the sensitivity of 46.8%, specificity of 68.4%, accuracy of 55.0%, PPV of 70.7% and NPV of 44.1%. The best cut-off value of MLAD was 8 mm with the sensitivity of 43.5%, specificity of 63.2%, accuracy of 51.0%, PPV of 65.9% and NPV of 40.7%. Using hyperfibrinogenemia (FIB ≥3.5 g/L) to identify small metastatic lymph node, of which MSAD lt;6 mm or MLAD lt;8 mm, showed statistical diagnostic value (Kappa=0.256, P=0.047). Compared with MSAD (6 mm) alone, MSAD (6 mm) combined with hyperfibrinogenemia had a higher sensitivity (79.0% vs. 46.8%, Plt;0.001), but a similar accuracy (66.0% vs. 55.0%, Pgt;0.05) and a lower specificity (44.7% vs. 68.4%, P=0.037). MLAD (8 mm) combined with hyperfibrinogenemia led to a greater diagnostic value in sensitivity (80.6% vs. 43.5%, Plt;0.001) and accuracy (66.0% vs. 51.0%, P=0.031) than MLAD (8 mm) alone, with a no-significantly decreasing specificity (42.1% vs. 63.2%, Pgt;0.05). Conclusions This present study recommend MSAD ≥6 mm or MLAD ≥8 mm as the optimal criteria for preoperative N staging in colorectal cancer. Moreover, the sensitivity and even accuracy could be improved by combining hyperfibrinogenemia for lymph node metastasis identification.
Objective To summarize recent advances on preoperative staging strategies in rectal cancer. Methods Relevant references about preoperative staging strategies were collected and reviewed. The multimodal preoperative evaluation (MPE) system recently documented was focused on. Results The comparably accurate T and M stage could be achieved preoperatively by following an appropriate available method; however, the N stage’s accuracy was still not satisfying. The MPE system， incorporating with the advantages of transrectal ultrasound， computerized tomography and serum amyloid A protein in a multi-disciplinary mode could display the most accurate preoperative staging for rectal cancer currently. Conclusion The MPE has potential prospects in preoperative staging of rectal cancer， and can provide the most accurate preoperative staging for rectal cancer at present.
Objective To summarize the progress in diagnosis and treatment of hilar cholangiocarcinoma at present. Methods The literatures about diagnosis and treatment of hilar cholangiocarcinoma at home and aboard were collected to make an review. Results The diagnosis of hilar cholangiocarcinoma mainly depended on serum tumor molecular markers and imaging examinations. Preoperative excision and prognostic evaluation were required, including tumor classification and staging, preoperative yellow reduction, residual liver volume assessment, and so on. Radical resection was the first choice, as well as liver transplantation, radiotherapy, chemotherapy, and photodynamic therapy could be selected according to the patient’s condition. Conclusions The appearance of new diagnosis and treatment technology promotes the clinical development of hilar cholangiocarcinoma. The integrated diagnosis and treatment mode, which is based on surgery, will become the inevitable direction of the development of hilar cholangiocarcinoma.
ObjectiveBased on the current version of Database from Colorectal Cancer (DACCA), we aimed to analyze the preoperative specialized examination and evaluation of colorectal cancer.MethodsThe DACCA version selected for this data analysis was updated on July 25, 2019. The data items included: combined preoperative stage, integrating degree of combined preoperative stage, preoperative diagnostic intensity, accuracy of colonoscopy, tumorous type by biopsy, tumor differentiation by biopsy, completion of chest CT, CT stage, accuracy of CT stage, outcome of transrectal ultrasound, outcome of liver ultrasound, MRI stage, accuracy of MRI stage, outcome of PET-CT, outcome of bone scanning, diagnostic way at first visit, misdiagnosis and mistreatment. Characteristic analysis was performed on each selected data item.ResultsA total of 4 484 admitted data were filtered from the DACCA database. The effective data of accuracy of preoperative CT examination, evaluation of preoperative CT staging, preoperative MRI accuracy, preoperative MRI evaluation stage, the accuracy of preoperative transrectal ultrasound, preoperative liver ultrasound accuracy, the accuracy of preoperative bone scan, preoperative PET-CT accuracy, completion of colonoscopy, preoperative colonoscopy biopsy pathology type, strength of diagnosis, integrating degree of total preoperative staging, preoperative staging and pathological staging, factors of the first diagnosis, misdiagnosis and mistreatment were 3 877 (86.5%), 3 166 (70.6%), 3 480 (77.6%), 286 (6.4%), 3 607 (80.4%), 2 736 (61.0%), 3 570 (79.6%), 3 490 (77.8%), 3 847 (85.8%), 3 636 (81.1%), 3 981 (88.8%), 2 346 (52.3%), 2 209 (49.3%), 3 466 (77.3%), and 3 411 (76.1%), respectively. Among the preoperative CT stages, phase Ⅳ had the highest accuracy (86.6%), phase Ⅰ had the highest rate of underestimation (30.4%), and phase Ⅲ had the highest rate of overestimation (21.8%). Preoperative CT accuracy, excluding errors caused by too few data rows, was 66.8%–83.7% in other years. Among the preoperative MRI stages, stage Ⅳ showed the highest accuracy (89.1%), stage Ⅰ showed the highest rate of underestimation (33.3%), and stage Ⅲ showed the highest rate of overestimation (13.3%). Preoperative MRI evaluation accuracy gradually increased from 2016 to 2019. The accuracy of transrectal ultrasound, liver ultrasound, bone scan, and PET-CT were 287 (76.7%), 145 (99.3%), 301 (98.7%), and 15 (93.8%), respectively. The most pathological type under colonoscopy was adenocarcinoma, accounting for 82.2%. The lowest was stromal tumor and lymphoma, each below 0.1%. The diagnostic efficiency were 3 445 (86.5%) with grade A, 316 (7.9%) with grade B, and 220 (5.5%) with grade C. In the preoperative total staging, 109 data rows (4.9%) were appeared as stage Ⅰ, 615 (27.5%) as stage Ⅱ, 1 263 (56.6%) as stage Ⅲ, and 245 (11.0%) as stage Ⅳ. The preoperative total staging integrating degree in stage Ⅳ was the highest (98.7%), while the underestimate rate in stage Ⅱ was the highest (28.3%), and the overestimate rate in stage Ⅲ was the highest (20.6%). From 2008 to 2019, the integrating degree between preoperative comprehensive staging and final pathology staging ranged from 70.8% to 87.7%. Among the factors of the first diagnosis, digital examination was found the frequently (64.0%), followed by symptoms such as bleeding and obstruction (28.2%). Considering family history, the proportion of patients with colorectal cancer was the least (less than 0.1%). There were 442 cases (13.0%) of misdiagnosis and mistreatment behaviors, among which 207 cases (46.8%) were misdiagnosed as hemorrhoids.ConclusionsTo significantly improve the long-term survival rate of colorectal cancer patients requires preoperative imaging diagnosis efficiency and multi-factor evaluation staging to break through the limitation of development, so as to optimize the choice of treatment plan, increasing the prevalence of early screening for colorectal cancer, and reducing the rate of misdiagnosis and mistreatment at the first visit of colorectal cancer.
ObjectiveTo elaborate the contents and concrete concepts of preoperative specialized examination and evaluation of colorectal cancer of the Database from Colorectal Cancer (DACCA) in the West China Hospital. MethodThe article was described in the words.ResultsThe components, stage, accuracy, preoperative comprehensive evaluation, clinical factors of initial diagnosis, misdiagnosis and mistreatment of colorectal cancer in the DACCA were defined and elaborated in the detail. The data label corresponding to each item in the database and the required structured way in the application stage of large data were also described in detail, and the corrective precautions for all classified items were described.ConclusionsThrough the detailed description of the preoperative specialized examination and evaluation of colorectal cancer of DACCA in West China Hospital, it might provide the standard and basis for the clinical application of database in the future, and provide reference for other peers who wish to build a colorectal cancer database.
Aortic valve disease is one of the major diseases threatening human health. Transcatheter aortic valve replacement (TAVR) is a new treatment for aortic disease. Preoperative evaluation is of great significance to the successful operation and the long-term quality of life of patients. The 3D printing technology can fully simulate the cardiac anatomy of patients, create personalized molds for patients, improve surgical efficiency, reduce surgical time and surgical trauma, and thus achieve better surgical results. In this review, the relevant literatures were searched, and the evaluation effect of 3D printing technology on the operation of TAVR was reviewed, so as to provide clinical reference.
Preoperative evaluation is crucial for heart valvular surgery. This article discusses some issues that need to be emphasized: the impact of hypertension on the severity of aortic valve lesions, and how to improve the accuracy of clinical assessment; the identification of functional tricuspid regurgitation, in order to choose the appropriate surgical technique; the need for right ventricular function testing, and the use of risk scoring models, to better grasp surgical timing and indications and improve efficacy; and the importance of evaluating atrial mitral and/or tricuspid regurgitation complications in chronic atrial fibrillation, and making rational choices for interventional and surgical treatment.