Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.
ObjectiveTo investigate the cause of stoma recurrence after anterior resection of rectal cancer and discover the methods of prevention and treatment.MethodsA total 91 patients with stoma recurrence after anterior resection of rectal cancer (or Dixon) were analysed retrospectively between 1985 and 1996. Fourtyseven patients experienced reradical resection (Miles), 27 cases palliative resection, and 11 cases only exploration. Thirtytwo cases had been followed up for 5 years and obtained 1，3，5year survival rate for reradical radical resection (Miles). Diagnosis and treatment of stomal recurrence after Dixon were evaluated. ResultsOne, three and fiveyear survival rate of reradical resection (Miles) was 93%，77%，45% respectively.ConclusionTo amplify blindly the adaptation of Dixon is to raise the rate of stoma recurrence. Digital rectal examination and fiberopic colonoscopy (and biopsy) are very essential methods for the diagnosis of stoma recurrence, and we strive to do reradical resection (Miles) for the patients with stoma recurrence after Dixon’s operation.
Objective To introduce the surgical technique and results of total mesorectal excision (TME) for rectal cancer. Methods Reviews.Results As a result of TME, local recurrence rates have declined from 20%-30% to 3%-8%, 5-year survival rate have risen to 75%, and the rates of sphincter preservation have risen too.Conclusion Total mesorectal excision reduces the local recurrence rates and raise the survival figures after excision of rectal cancer. Patients have a high quality of life.
Objective To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone. Methods Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection. Results Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients. Conclusion For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.
Objective To approach the surgical therapeutic efficacy of local recurrence of rectal cancer. Methods Fifty-six patients with local recurrence of rectal cancer suffered from reoperation from January 2003 to January2011 in this hospital were collected. Chi-square test was performed to analyze the complete excision rates of reoperation for different recurrent time after radical resection and different surgical procedures after primary radical resection of rectalcancer. The method of log-rank test was used for survival analysis of the Miles and Dixon procedure. Results ①The opera-tion time and intraoperative bleeding of reoperation for local recurrence of rectal cancer were more than those of the primary radical resection of rectal cancer （P＜0.05）. ②The complete resection rate of the local recurrence of rectal cancer in 5 years after primary radical resection of rectal cancer was higher than that of the local recurrence of rectal cancer within 2 years after primary radical resection of rectal cancer， and the difference was statistically significant （P＜0.01）. ③The complete resection rate of the local recurrence of rectal cancer of the technique of Dixon in the primary radical resection of rectal cancer was higher than that of Miles， and the difference was statistically significant （P＜0.05）. ④The median survival time and 2-year survival rate and 5-year survival rate of the technique of Dixon in the reoperation were longer or higher than those of Miles， and the differences were statistically significant （P＜0.05）. Conclusions Surgical procedure and postoperative recurrence time after primary operation can both influence complete excision rate of reoperation for local recurrence of rectal cancer. And reoperation for local recurrence of rectal cancer can prolong the survival time.
Objective To investigate the situation and prospect of local recurrence of rectal cancer by using CT and MRI. Method Relevant references about the imaging diagnosis of local recurrence of rectal cancer， which were published domestic and abroad in recent years， were collected and reviewed. Results In the diagnosis of local recurrence of rectal cancer， the sensitivity of CT was higher than that of MRI， while the specificity and accuracy were not. Perfusion CT， dynamic contrast-enhanced MRI， and diffusion weighted imaging were valuable in diagnosing local recurrence of rectal cancer， as new diagnostic techniques. Conclusion Both CT and MRI are important and valuable methods in diagnosing for local recurrence of rectal cancer.
Objective To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.
Objective To evaluate the efficacy and safety of intraoperative mesenchymal chemotherapy with 5-FU implants in radical gastrectomy of advanced gastric cancer. Methods From January 2008 to September 2009， 102 patients with historically proven advanced gastric cancer were enrolled in our department and were allocated to undergo either radical gastrectomy and intraoperative mesenchymal chemotherapy with 5-FU implants 800 mg（treatment group， n=51）， or radical gastrectomy alone （control group， n=51）. The postoperative complications and recurrence rate between two groups were compared. Results There were no significant differences on the volume of abdominal cavity drainage， count of white blood cells， albumin level， and gastrointestinal adverse events between the two groups （P＞0.05）. After a median follow-up of 28 months， the local recurrence rate was lower among patients in treatment group than that in control group （16.3% vs. 39.1%， P＜0.05）， the survival rate of 3-year was higher in treatment group than that in control group （85.8% vs. 67.3%， P＜0.05）. Conclusions Compared with the control group， there are no significant adverse reactions on patients with advanced gastric cancer who were implanted fluorouraci1 implants during operation， which can reduce local recurrence rates and improve the survival rates.
Objective To investigate surgical combined management of local recurrence of rectal cancer after anterior resection. Methods Relevant references about the surgical combined treatment of local recurrence of rectal cancer， which were published recently domestic and abroad were collected and reviewed. Results The surgical combined treatment for local recurrence of rectal cancer can markedly improve the survival ratio. Conclusion The surgical combined management of local recurrence of rectal cancer after anterior resection should be performed. The active and effective surgical combined management may help prolong the survival time and improve life quality.
【Abstract】ObjectiveTo investigate the prophylactic effect of lamivudine monotherapy on the recurrence of hepatitis B after liver transplantation. MethodsThirtyone patients with hepatitis B related benign decompensated cirrhosis who underwent liver transplantation between February 1999 to June 2002 and survived more than 3 months were analyzed retrospectively. Lamivudine was administered to each patient after operation and some patients before operation for the prophylaxis of HBV recurrence. The HBV markers and HBV DNA in serum and bioptic liver tissues in all patients were evaluated before and after operation. ResultsTotal HBV recurrence rate was 19.4％（6/31） during average 38.2 months (3.2-70.2 months) follow up. HBV recurrence rate was 7.1％(2/28), 16.0％(4/25), 26.1％(6/23) and survival rate was 87.1％(27/31), 80.6％(25/31), 66.1％(20.5/31) after 1-, 3-and 5-year, respectively. One hundred milligram lamivudine administration peroral daily for 2 weeks prior to transplantation enable HBeAg 54.5％(6/11) and HBV DNA 50.0％(5/10) positive patients convert to negative respectively. ConclusionPreoperative administration of lamivudine monotherapy can effectively prevent allograft from HBV re-infection after liver transplantation. Lamivudine should be used to convert HBV DNA and HBeAg to negative.