AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent p...AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.展开更多
Surgical resection is the only curative treatment modality for colorectal cancer limited locally.Evidence for the kind of resection procedure that is effective for improving prognosis is insufficient.Prognosis improve...Surgical resection is the only curative treatment modality for colorectal cancer limited locally.Evidence for the kind of resection procedure that is effective for improving prognosis is insufficient.Prognosis improvement is expected with the no-touch isolation technique(NTIT),making it the most important resection procedure.We are conducting a multicenter randomized controlled trial(RCT) to confirm the efficacy of NTIT in patients with colorectal cancer.The present review serves as a preface to our trial,as it focuses on basic and clinical studies that support the efficacy of NTIT.The detection ratios of circulating tumor cells(CTCs) of peripheral blood indicate the progress and prognosis of colorectal cancer.In a rabbit liver tumor model,metastases increased after surgical manipulation.Also,CTCs increased during the radical excision of colorectal cancer.However,NTIT decreased the detection of CTCs of intraoperative portal vein blood in patients with colorectal cancer.Although these aforementioned results support the use of NTIT,a previous controlled prospective trial was not able to confirm the clinical benefit of NTIT,as it had an insufficient sample size and many patients were lost to follow-up.Therefore,we initiated a large-scale highquality RCT to confirm the efficacy of NTIT for colorectal cancer.展开更多
Background: Aquaporins (AQPs), the family of water-selective channels, are localized in various organs and tissues, including the gastrointestinal (GI) tract. However, the roles of AQPs in the GI tract remain unclear....Background: Aquaporins (AQPs), the family of water-selective channels, are localized in various organs and tissues, including the gastrointestinal (GI) tract. However, the roles of AQPs in the GI tract remain unclear. Materials and Methods: Male SD rats were subjected to subtotal colectomy (Group C, n = 22) or a sham operation (Group S, n = 16) and were sacri-ficed on postoperative days 7, 14, and 28. Total RNAs from the distal ileum and rectum were extracted. Quantitative RT-PCR was performed to measure AQP8 mRNA expression. For light-microscopy or immunohistochemistry, paraffin-embedded sections of 4 μm were prepared with H-E staining or anti-AQP8 antibody reaction. Mann-Whitney U-test was performed to compare the AQP8 distributions between the two groups, and the statistical significance was defined as展开更多
A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at ...A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient’s bowel disease.展开更多
文摘AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.
基金Supported by National Cancer Research and Development Fund,No.26-A-4
文摘Surgical resection is the only curative treatment modality for colorectal cancer limited locally.Evidence for the kind of resection procedure that is effective for improving prognosis is insufficient.Prognosis improvement is expected with the no-touch isolation technique(NTIT),making it the most important resection procedure.We are conducting a multicenter randomized controlled trial(RCT) to confirm the efficacy of NTIT in patients with colorectal cancer.The present review serves as a preface to our trial,as it focuses on basic and clinical studies that support the efficacy of NTIT.The detection ratios of circulating tumor cells(CTCs) of peripheral blood indicate the progress and prognosis of colorectal cancer.In a rabbit liver tumor model,metastases increased after surgical manipulation.Also,CTCs increased during the radical excision of colorectal cancer.However,NTIT decreased the detection of CTCs of intraoperative portal vein blood in patients with colorectal cancer.Although these aforementioned results support the use of NTIT,a previous controlled prospective trial was not able to confirm the clinical benefit of NTIT,as it had an insufficient sample size and many patients were lost to follow-up.Therefore,we initiated a large-scale highquality RCT to confirm the efficacy of NTIT for colorectal cancer.
文摘Background: Aquaporins (AQPs), the family of water-selective channels, are localized in various organs and tissues, including the gastrointestinal (GI) tract. However, the roles of AQPs in the GI tract remain unclear. Materials and Methods: Male SD rats were subjected to subtotal colectomy (Group C, n = 22) or a sham operation (Group S, n = 16) and were sacri-ficed on postoperative days 7, 14, and 28. Total RNAs from the distal ileum and rectum were extracted. Quantitative RT-PCR was performed to measure AQP8 mRNA expression. For light-microscopy or immunohistochemistry, paraffin-embedded sections of 4 μm were prepared with H-E staining or anti-AQP8 antibody reaction. Mann-Whitney U-test was performed to compare the AQP8 distributions between the two groups, and the statistical significance was defined as
文摘A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient’s bowel disease.
