National Cancer Institute®
Last Modified: April 1, 2002
UI - 10910241
AU - Tocchi A; Mazzoni G; Lepre L; Costa G; Liotta G; Agostini N; Miccini M
TI - Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis.
SO - Dis Colon Rectum 2000 Jul;43(7):951-5
AD - First Department of Surgery, Rome La Sapienza University Medical School, Italy.
PURPOSE: The aim of this study was to investigate the role of omentoplasty, by means of intact omentum, in preventing anastomotic leakages after rectal resection. METHODS: Between 1992 and 1997 a total of 112 patients (64 males) with a mean age of 64.7 (range, 39-83) years were randomly assigned to undergo omentoplasty (Group A) or not (Group B) to reinforce the colorectal anastomosis after anterior resection for rectal cancer. The primary end point was anastomotic leakage; the secondary end point included morbidity and mortality related to omentoplasty. RESULTS: The two groups were comparable in terms of preoperative and intraoperative characteristics. Staple-ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients (P = not significant). Two leakages were evident clinically in Group A and seven in Group B (P < 0.05). Three leaks were documented radiologically in Group A and eight in Group B (P = not significant). No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At followup, one stricture developed in Group A and three in Group B (P = not significant) CONCLUSIONS: Despite a similar incidence of staple-ring defects, a strikingly lower rate of clinically and radiologically detected leaks developed in patients submitted to omentoplasty. Although not affecting the incidence of anastomotic disruption, omentoplasty seems to contain the severity of anastomotic leakage.
UI - 11552476
AU - Carlomagno N; Scarano MI; Gargiulo S; De Rosa M; Panariello L; Izzo P;
TI - Renda A [Familial colonic polyposis: effect of molecular analysis on the diagnostic-therapeutic approach]
SO - Ann Ital Chir 2001 Mar-Apr;72(2):207-14
AD - Chirurgia Generale ad Indirizzo Addominale, Universita Federico II, Napoli. email@example.com
Germline mutations of the Adenomatous polyposis gene (APC) are responsible for Familial Adenomatous Polyposis (FAP), an inherited condition that predisposes to the development of hundreds to thousands benign adenomas in the colo-rectum. If not surgically removed, they inevitably progress into malignant adenocarcinoma. To date more than 450 germline mutations have been described allowing the establishment of genotype/phenotype correlation between the site and type of molecular defects and their morbid consequences. Authors reviewed their experience concerning 22 FAP affected patients and their 26 first degree relatives, in whom the mutational analysis of the APC gene had been carried out. Site and type of mutations were associated with clinical parameters (age of onset, rectal involvement, extracolonic manifestations, presence of colorectal cancer) and treatments. The impact of mutational analyses on the clinical approach could be very interesting in the future, modifying both surveillance programs and therapeutical choices.
UI - 11805563
AU - Mehta VK; Poen J; Ford J; Edelstein PS; Vierra M; Bastidas AJ; Young H;
TI - Fisher G Radiotherapy, concomitant protracted-venous-infusion 5-fluorouracil, and surgery for ultrasound-staged T3 or T4 rectal cancer.
SO - Dis Colon Rectum 2001 Jan;44(1):52-8
AD - Department of Radiation Oncology, Stanford University Medical Center, Stanford, California 94305, USA.
BACKGROUND: A prospective study was undertaken to evaluate the response and toxicity of neoadjuvant chemoradiotherapy for ultrasound-staged T3 or T4 rectal cancer. PATIENTS AND METHODS: Since 1995, 30 patients (18 males; median age, 56 (range, 25-83) years) have received preoperative chemoradiotherapy for ultrasound-staged T3 or T4 rectal cancer. All patients underwent an endorectal ultrasound, CT scan, and review in our multidisciplinary Gastrointestinal Tumor Board before treatment. All patients had pathology-demonstrated invasive adenocarcinoma of the rectum. Eleven patients were Stage T3N0, 14 were T3N1, and five were T4N1. Patients received radiotherapy to the primary tumor and draining lymph nodes (45 Gy) followed by a tumor boost (50.4-54 Gy). Protracted-venous-infusion 5-fluorouracil (225 mg/m2 per day, seven days per week) was administered throughout treatment. Surgical resection was performed six to ten weeks after completing chemoradiotherapy. Using endorectal ultrasound measurements, the primary tumor was a median of 4 (range, 0-12) cm from the anal verge, encompassed 50 (range, 20-90) percent of the rectal circumference, and was 6 (range, 3-12) cm in diameter. RESULTS: No Grade 4 toxicity was observed during chemoradiotherapy. Three patients experienced Grade 3 toxicity (diarrhea), and four patients required a treatment interruption of greater than three days. All patients completed at least 90 percent of the prescribed radiotherapy dose. All patients underwent surgical resection. Ninety-four percent had clear surgical margins. All pathologic specimens had significant evidence of necrosis, hyalinization, and fibrosis. Thirty-three percent of the specimens had a complete pathologic response (defined as no evidence of viable tumor cells). Of the 19 patients with ultrasound-staged N1 disease, only five had pathologic evidence of nodal involvement after chemoradiotherapy. Of the 25 patients with ultrasound-staged T3 disease, pathologic staging revealed eight with T0, two with T1, five with T2, and ten with T3 disease. Of the five patients with ultrasound-staged T4 disease, pathologic staging revealed two with T0, one with T2, and two with T3 disease. No patient developed progressive disease while on treatment. Two patients have experienced local failure at 6 and 20 months, and one patient failed in the liver at seven months. Twenty-seven patients remain free of disease with a median follow-up of 20 (range, 3-53) months. CONCLUSION: Our experience suggests that preoperative chemoradiotherapy is well tolerated, down-stages tumors, and sterilizes regional lymph nodes.
UI - 11776494
AU - Onaitis MW; Noone RB; Fields R; Hurwitz H; Morse M; Jowell P; McGrath K;
TI - Lee C; Anscher MS; Clary B; Mantyh C; Pappas TN; Ludwig K; Seigler HF; Tyler DS Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival.
SO - Ann Surg Oncol 2001 Dec;8(10):801-6
AD - Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
BACKGROUND: Up to 30% of patients with locally advanced rectal cancer have a complete clinical or pathologic response to neoadjuvant chemoradiation. This study analyzes complete clinical and pathologic responders among a large group of rectal cancer patients treated with neoadjuvant chemoradiation. METHODS: From 1987 to 2000, 141 consecutive patients with biopsy-proven, locally advanced rectal cancer were treated with preoperative 5-fluorouracil-based chemotherapy and radiation. Clinical restaging after treatment consisted of proctoscopic examination and often computed tomography scan. One hundred forty patients then underwent operative resection, with results tracked in a database. Standard statistical methods were used to examine the outcomes of those patients with complete clinical or pathologic responses. RESULTS: No demographic differences were detected between either clinical complete and clinical partial responders or pathologic complete and pathologic partial responders. The positive predictive value of clinical restaging was 60%, and accuracy was 82%. By use of the Kaplan-Meier life table analysis, clinical complete responders had no advantage in local recurrence, disease-free survival, or overall survival rates when compared with clinical partial responders. Pathologic complete responders also had no recurrence or survival advantage when compared with pathologic partial responders. Of the 34 pathologic T0 tumors, 4 (13%) had lymph node metastases. CONCLUSIONS: Clinical assessment of complete response to neoadjuvant chemoradiation is unreliable. Micrometastatic disease persists in a proportion of patients despite pathologic complete response. Observation or local excision for patients thought to be complete responders should be undertaken with caution.
UI - 11862418
AU - Andoh A; Shimada M; Araki Y; Fujiyama Y; Bamba T
TI - Sodium butyrate enhances complement-mediated cell injury via down-regulation of decay-accelerating factor expression in colonic cancer cells.
SO - Cancer Immunol Immunother 2002 Feb;50(12):663-72
AD - Department of Internal Medicine, Shiga University of Medical Science, Seta-Tukinowa, Otsu 520-2192, Japan. firstname.lastname@example.org
Decay-accelerating factor (DAF) expressed on the surface of colonic cancer cells presents a barrier to complement-mediated clearance by contributing to the ineffectiveness of the humoral immune response. In this study, to investigate the mechanisms responsible for the anti-tumor effects of butyrate, we evaluated how butyrate modulates DAF expression in colonic cancer cells. Three colonic cancer cell lines (HT-29, Caco-2, and T84 cells) were studied. DAF protein expression was assessed by western blot, and DAF mRNA expression was evaluated by northern blot. Complement C3 deposition on the surface of colonic cancer cells was determined by enzyme-linked immunosorbent assay (ELISA). The promoter activity of the DAF gene was assessed by a reporter gene-luciferase assay. Butyrate reduced the basal and interleukin-4 (IL-4)- and tumor necrosis factor-alpha (TNF-alpha)-induced expression of DAF protein and mRNA in HT-29 cells. It increased the susceptibility to complement attack and enhanced C3 deposition on HT-29 cells. The inhibitory effect of butyrate on DAF mRNA expression was also observed in T84 and Caco-2 cells. Butyrate decreased basal DAF expression at both transcriptional and post-transcriptional levels. The inhibitory effect of butyrate on IL-4-induced DAF expression was closely associated with a blockade of IL-4-induced DAF mRNA stability. TNF-alpha-induced transcriptional activation and the increased stability of the DAF gene were also blocked by butyrate. Similar but weak effects were induced by trichostatin A, a potent histone deacetylase inhibitor, suggesting that histone acetylation might participate in butyrate activity. These observations indicate that both a down-regulation of DAF expression and the induction of susceptibility to complement attack contribute to the anti-tumor effects of butyrate in colonic cancer.
UI - 11290635
AU - Borras JM; Sanchez-Hernandez A; Navarro M; Martinez M; Mendez E; Ponton
TI - JL; Espinas JA; Germa JR Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial.
SO - BMJ 2001 Apr 7;322(7290):826
AD - Cancer Prevention and Control Unit, Catalan Institute of Oncology, Gran Via Km 2,7 s/n, 08907-Hospitalet, Spain. email@example.com
OBJECTIVE: To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment. DESIGN: Randomised controlled trial. SETTING: Large teaching hospital. PARTICIPANTS: 87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer. INTERVENTIONS: Treatment with fluorouracil (with or without folinic acid or levamisole) at outpatient clinic or at home. MAIN OUTCOME MEASURES: Treatment toxicity; patients' compliance with treatment, quality of life, satisfaction with care, and use of health resources. RESULTS: 42 patients were treated at outpatient clinic and 45 at home. The two groups were balanced in terms of age, sex, site of cancer, and disease stage. Treatment related toxicity was similar in the two groups (difference 7% (95% confidence interval -12% to 26%)), but there were more voluntary withdrawals from treatment in the outpatient group than in the home group (14% v 2%, difference 12% (1% to 24%)). There were no differences between groups in terms of quality of life scores during and after treatment. Levels of patient satisfaction were higher in the home treatment group, specifically with regard to information received and nursing care. There were no significant differences in use of health services. CONCLUSIONS: Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment.
UI - 11852390
AU - Bedenne L
TI - [Follow-up after resection for cure of colorectal cancer: searching for the missing rationale]
SO - Gastroenterol Clin Biol 2001 Oct;25(10):879-80
AD - Service d'Hepato-Gastroenterologie, CHU Le Bocage, Dijon, France. firstname.lastname@example.org
UI - 11852391
AU - Borie F; Daures JP; Millat B; Folschveiller-Bruggeman M; Tretarre B
TI - [Follow-up of patients with colorectal cancer resected for cure in the Herault area. A medico-economical study]
SO - Gastroenterol Clin Biol 2001 Oct;25(10):881-4
AD - Service de Chirurgie Digestive A, Hopital Saint-Eloi, Montpellier, France. email@example.com
Optimal modalities of surveillance of colorectal cancers (CRC) resected for cure have not been determined so far and the overall improvement of 5-year survival related to surveillance has not been demonstrated. AIM OF THE STUDY: To retrospectively evaluate modalities, results and costs of follow-up of patients during the 5 years following the resection for cure of CRC. METHODS: We studied medical and economical data from records of 256 patients registered in the cancer registry of the Herault area who underwent a potentially curative resection of CRC in 1992. We analyzed comparatively modalities of follow-up in patients who were followed according to recommendations from the 1998 French consensus conference (standard follow-up) and in those who had a simplified follow-up. We evaluated cumulative costs of follow-up. RESULTS: Nine patients died in the postoperative period. Recurrence rate was 27% (69 patients). Sixty-nine patients had a standard follow-up (30% of the 231 classified patients) and 162 patients (70%) had a simplified follow-up. The specific survival rate (taking into account only death related to CRC) 5 years after resection for cure was 75%. The 5-year specific survival rate after diagnosis of recurrence was 12% in the patients with recurrent disease within the 5 years after initial therapy. The 5-year survival rate after standard and simplified follow-up were 85% and 79%, respectively (P=0.25). Total cost of follow-up of the 256 patients was 1 085 507 French francs (FF). Mean follow-up cost per patient was 5 527 FF. Cost of the examinations not recommended by the consensus conference represented 30% of the expenses. Individual total cost of the follow-up of patients alive 5 years after the diagnosis of the recurrence was 120 356 FF. CONCLUSION: In Herault area, clinicians carried out in 70% of the patients a simplified follow-up and in 30% of the cases a reinforced follow-up in comparison with French recommendations. Survival rates were not significantly different between the 2 groups.
UI - 11778366
AU - Lengyel L; Szakats T; Koti C
TI - [Primary resection of obstructive left-sided colon and rectal tumors without intraoperative lavage]
SO - Orv Hetil 2001 Dec 2;142(48):2681-5
AD - Teruleti Korhaz Berettyoujfalu, Sebeszeti Osztaly.
Of the study is to show the results of early postoperative period of left-sided large bowel obstruction (LBO) and methods of decompression without colonic lavage and primary resection. Retrospective analysis of 28 patients admitted to the Surgical Department with LBO between years 1996 and 2000 were treated with ortograde decompression, and primary resection without on table colonic lavage. The surgical method, complications and mortality are pointed out. The patients average age were 71 +/- 9.7 years and only one was free of comorbidity. The average time of operative interventions was 116 +/- 42 minutes. 9 patients out of 28 had rectum cancer their anastomosis were made by instrumental way and the others by hand. The bowel movement was restored (in 89%) on the fourth day of operation. Surgical complications were observed at 3/28 patients (10.7%), and non surgical complication at three patients. Mortality rate 3.5%, one patient was lost. The average hospital stay was 12 +/- 5 days, 70% of the patients were at home within 11 days. The emergency surgical treatment of left-sided colonic obstruction caused by cancer treated by ortograde decompression and primary resection without colonic lavage is a safe method in experienced surgeon hand. The patients have a short recovery period and better quality of life.
UI - 11855920
AU - Gunther K; Dworak O; Remke S; Pfluger R; Merkel S; Hohenberger W;
TI - Reymond MA Prediction of distant metastases after curative surgery for rectal cancer.
SO - J Surg Res 2002 Mar;103(1):68-78
AD - Department of Surgery, Biometry and Epidemiology of the University of Erlangen, Erlangen, D-91054 Germany.
BACKGROUND: This study was performed to define selection criteria for adjuvant therapy in rectal cancer. MATERIALS AND METHODS: An immunohistochemical analysis using nine monoclonal antibodies against CEA, CD15s, CD44v6, DCC, E-cadherin, EGF-R, NM23, PAI-1, and P53 was performed on paraffin sections of two matched (age, gender, UICC stage [I-III], year of operation [1982-1991]) groups of patients (n = 2 x 64) with rectal carcinoma curatively treated by surgery alone. The two groups differed only with regard to metachronous distant metastatic spread. In order to exclude the influence of surgery, all patients had to meet the selection criterion "free of locoregional disease." Follow-up was prospective (median 80 months). Conventional staining procedures and immunohistochemical evaluation were used. Tumor grading and lymphatic and extramural venous invasion were also investigated. Analysis was performed with Fisher's exact test and Kaplan-Meier estimates of disease-free survival (log rank). The Cox model was used for multivariate analysis. RESULTS: In univariate analysis only grading (P < 0.001) and extramural venous invasion (P < 0.001) correlated significantly with metachronous metastases. In multivariate analysis, beside grading (P = 0.010) and extramural venous invasion (P = 0.011), CD15s (P = 0.042) was also of significance. All other immunohistochemical markers failed. CONCLUSIONS: The histopathological parameters grading and extramural venous invasion appear to be acceptable predictors of metachronous distant spread in curatively resected rectal cancer. In contrast to the immunohistochemical markers, grading seems to better reflect the individual tumor phenotype and its behavior.
UI - 11902527
AU - Adlard JW; Richman SD; Seymour MT; Quirke P
TI - Prediction of the response of colorectal cancer to systemic therapy.
SO - Lancet Oncol 2002 Feb;3(2):75-82
AD - Academic Department of Pathology, University of Leeds, UK. firstname.lastname@example.org
Adjuvant chemotherapy with fluorouracil and folinic acid improves overall survival for resected carcinoma of the colon of Dukes' stage C by 10-12%. In metastatic disease, response rates with fluorouracil-based regimens are about 25%. Combination with newer agents such as irinotecan and oxaliplatin can improve response rates to more than 50% in selected patients. New treatments with novel molecular targets will soon be entering clinical use. Despite these improvements, many patients undergo chemotherapy for resistant cancer, thus incurring side-effects without benefit. Expression of particular genes can be tested at the protein or RNA level and can be correlated with response or resistance to particular systemic therapies. Thus, predictive-factor testing of tumour biopsy samples may allow us to select chemotherapy or immunotherapy treatments with a high likelihood of benefit for the individual patient.
UI - 11788909
AU - Munemoto Y; Iida Y; Abe J; Saito H; Fujisawa K; Kasahara Y; Mitsui T;
TI - Asada Y; Miura S Significance of postoperative adjuvant immunochemotherapy after curative resection of colorectal cancers: Association between host or tumor factors and survival.
SO - Int J Oncol 2002 Feb;20(2):403-11
AD - Department of Surgery, Prefecture of Saiseikai Fukui Hospital, Fukui 918-8503, Japan. email@example.com
We examined the relationship between host as well as tumor factors and postoperative survival rate in patients who received combination therapy of mitomycin C + fluoropyrimidine oral antineoplastics + protein-bound polysaccharide K (PSK) (MFP therapy) after curative resection of colorectal cancer. Markers that determine prognosis, such as preoperative humoral factors (complement 3 and 4), immunosuppressive acidic protein (IAP), lymphocyte transformation (cellular factors) induced by phytohemagglutinin (PHA), pokeweed mitogen (PWM), and PSK, and various tumor markers (CEA, CA19-9) were measured. For each parameter, patients were divided into a high-level and a low-level group according to a predetermined cut-off value, and survival rates were compared between the two groups. The host factors that determined prognosis were 1-month postoperative IAP level [IAP(1M)], preoperative PHA value, and preoperative CA19-9 level. The levels of IAP(1M) <740 microg/ml, preoperative PHA > or =210 (SI value), and preoperative CA19-9 <13 U/ml were associated with a favorable prognosis. When combined with the tumor factors, the prognosis was favorable in Dukes A+B cases with preoperative CA19-9 <13 U/ml, and in Dukes C cases with preoperative PHA > or =210 SI. By the Cox proportional hazard model analysis, among IAP, PHA and CA19-9, CA19-9 was the strongest host factor associated with the prognosis of MFP therapy.
UI - 11865378
AU - Liang JT; Shieh MJ; Chen CN; Cheng YM; Chang KJ; Wang SM
TI - Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection for management of complex polyps of the sigmoid colon.
SO - World J Surg 2002 Mar;26(3):377-83
AD - Department of Surgery, National Taiwan University Hospital, No. 7 Chung Shan South Road, Taipei, Taiwan, R.O.C. firstname.lastname@example.org
Laparoscopy-assisted colectomy is technically feasible, but objective evidence of its benefits remains scarce. This study was done to evaluate the outcomes and operative stress of laparoscopy-assisted colectomy versus the traditional open method in the management of sigmoid complex polyps that cannot be safely or adequately removed by colonofibroscopy. equally randomized to the laparoscopy group and the laparotomy group by the blocked randomization method. Three patients randomized to the laparoscopy group did not complete the trial; therefore 18 patients treated by laparoscopy-assisted sigmoidectomy and the other 21 treated by the open method were prospectively evaluated. These two groups of patients were well matched in age, gender, symptoms, tumor location, localization method, tumor size, morphology, histopathology, and the accuracy of the clinical diagnosis. Two standardized surgical strategies, the lateral-to-medial and medial-to-lateral dissection sequences, were performed in 14 and 4 patients of the laparoscopy group, respectively, according to whether their tumors were located above or below 20 cm above the anal verge. After evaluating the surgical outcomes, we found that the laparoscopy group was significantly better than the laparotomy group in regard to parameters that included severity of postoperative pain, wound size, postoperative complication rate, and the duration of postoperative ileus, hospitalization, and disability. There was no significant difference in the operating times for these two groups. However, the costs of the laparoscopy group were significantly higher. To evaluate the surgical stress, we measured the serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), total lymphocyte count, and CD4+/CD8+ ratio 24 hours before and after surgery. We found that the postoperative serum CRP level and the ESR were significantly less elevated and the total lymphocyte counts and CD4+/CD8+ ratio were significantly less depressed in the laparoscopy group than in the laparotomy group. We thus concluded that laparoscopy-assisted sigmoidectomy can be safely performed with shorter convalescence and less operative stress but at a higher cost. We strongly recommended the use of this technique in the management of sigmoid complex polyps if the patient's economic status permits.
UI - 11870158
AU - Cure H; Chevalier V; Adenis A; Tubiana-Mathieu N; Niezgodzki G;
TI - Kwiatkowski F; Pezet D; Perpoint B; Coudert B; Focan C; Levi F; Chipponi J; Chollet P Phase II trial of chronomodulated infusion of high-dose fluorouracil and l-folinic acid in previously untreated patients with metastatic colorectal cancer.
SO - J Clin Oncol 2002 Mar 1;20(5):1175-81
AD - Centre Jean Perrin and L'Institut National de la Sante et de la Recherche Medicale U484, Clermont-Ferrand, France.
PURPOSE: To study tolerability and efficacy of an intensified chronomodulated schedule of fluorouracil (5-FU) and l-folinic acid (l-FA) as first-line treatment of metastatic colorectal cancer, 5-FU was given near individually determined dose-limiting toxicity in a multicenter phase II trial. PATIENTS AND METHODS: One hundred patients (68 men and 32 women, median age 62 years, World Health Organization performance status less-than-or-equal 2) with previously untreated and inoperable metastases received chronomodulated daily infusion of 5-FU/l-FA (from 10:00 PM to 10:00 AM with peak at 4:00 AM). 5-FU dose was escalated from 900 to 1,100 mg/m(2)/d with fixed dose of l-FA at 150 mg/m(2)/d for 4 days every 14 days. RESULTS: 5-FU dose escalation was achieved in 66% of the patients. Grade 3 to 4 toxicities mainly consisted of nausea or vomiting (14% of patients and 1.5% of courses), hand-foot syndrome (38% of patients and 8% of courses), mucositis (26% of patients and 4% of courses), and diarrhea (21% of patients and 2.3% of courses). Objective response rate (ORR) was 41% (95% confidence interval, 31.5% to 50.5%). Twenty patients underwent metastases surgery; among these, 12 had a complete resection. Median progression-free survival was 7 months. Median survival was 17 months; 28% of the patients were alive at 2 years and 18.6% at 3 years. CONCLUSION: The ORR achieved with intensified chronomodulated delivery of 5-FU/l-FA was nearly twice as high as that earlier obtained by our cooperative group using less intensive 5-FU/FA chronotherapy.
UI - 11870160
AU - Potosky AL; Harlan LC; Kaplan RS; Johnson KA; Lynch CF
TI - Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer.
SO - J Clin Oncol 2002 Mar 1;20(5):1192-202
AD - Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. email@example.com
PURPOSE: Dissemination of efficacious adjuvant therapies for resectable colorectal cancer has not been comprehensively described. Trends, patterns, and outcomes of adjuvant therapy for colorectal cancer, focusing on age, sex, and racial/ethnic differences, are reported. MATERIALS AND METHODS: Population-based random samples of patients diagnosed with colorectal cancer diagnosed in nine geographic areas were collected annually between 1987 and 1991 and in 1995 (n = 4,706). Data were obtained from medical record reviews. Multiple logistic regression was used to assess the use of standard adjuvant chemotherapy for colon and rectal cancers. The Cox proportional hazards model was used to assess 9-year mortality. RESULTS: From 1987 until 1995, the use of adjuvant therapy increased in all age groups. There was an increase starting in 1989 for colon and in 1988 for rectal cancer. Use of standard therapy was 78% for those younger than 55 years and 24% for those older than 80 years. White patients received standard therapy more frequently than African-Americans (odds ratio, 1.75; 95% confidence interval [CI], 1.09 to 2.83). All-cause and cancer-specific mortality exceeding 9 years were lower in those who received standard therapy (all-cause risk ratio [RR], 0.73; 95% CI, 0.61 to 0.88; cancer-specific RR, 0.87; 95% CI, 0.70 to 1.09). CONCLUSION: Standard adjuvant therapies for colorectal cancer disseminated into community practices during the 1990s. However, evidence exists of differential use of therapies by older patients and by African-Americans. The use of standard therapies in the general population is associated with lower mortality. Improved dissemination of standard adjuvant therapies to all segments of the population could help reduce mortality.
UI - 11875693
AU - McArdle CS; Hole DJ
TI - Outcome following surgery for colorectal cancer: analysis by hospital after adjustment for case-mix and deprivation.
SO - Br J Cancer 2002 Feb 1;86(3):331-5
AD - University Department of Surgery, Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK. firstname.lastname@example.org
Outcome, adjusted for case-mix and deprivation, in 3200 patients undergoing resection for colorectal cancer in 11 hospitals in Central Scotland between 1991 and 1994 was studied. There were significant differences among individual hospitals in the proportion of elderly (P<0.001) and deprived (P<0.0001) patients, the mode (P=0.007) and stage (P<0.0001) at presentation, and the proportion of patients who underwent apparently curative resection (P<0.001). There were no significant differences in postoperative mortality. Cancer-specific survival at 5 years following apparently curative resection varied from 59 to 76%; cancer-specific survival at 2 years following palliative resection varied from 22 to 44%. The corresponding hazard ratios, adjusted for the above prognostic factors, for patients undergoing apparently curative resection varied among hospitals from 0.58 to 1.32; and the ratios for palliative resection varied from 0.73 to 1.26. This study demonstrates that, after adjustment for variations in case-mix and deprivation, significant differences in outcome among hospitals following resection for colorectal cancer persist. Copyright 2002 The Cancer Research Campaign
UI - 11875709
AU - Werther K; Christensen IJ; Nielsen HJ; Danish RANX05 Colorectal Cancer
TI - Study Group Prognostic impact of matched preoperative plasma and serum VEGF in patients with primary colorectal carcinoma.
SO - Br J Cancer 2002 Feb 1;86(3):417-23
AD - Department of Surgical Gastroenterology 435, Hvidovre University Hospital, University of Copenhagen, 2650 Hvidovre, Denmark. email@example.com
In serum, the major part of vascular endothelial growth factor derives from in vitro degranulation of granulocytes and platelets. Therefore, plasma may be preferred for vascular endothelial growth factor measurements. However, which specimen is the best predictor of survival is still debated. The present study analyzed the prognostic value of matched preoperative serum and plasma vascular endothelial growth factor concentrations in patients with colorectal cancer. To establish the reference range among healthy people, vascular endothelial growth factor was analyzed in 50 matched EDTA-plasma and serum samples from healthy blood donors. Preoperatively, in 524 patients with colorectal cancer, matched plasma and serum vascular endothelial growth factor concentrations were analyzed. In the colorectal cancer patients, the median plasma vascular endothelial growth factor concentration (44 pg ml(-1)) was significantly (P=0.01) higher than the median plasma vascular endothelial growth factor concentration (30 pg ml(-1)) in the healthy blood donors. In serum, no significant (P=0.30) difference in the median vascular endothelial growth factor concentration was found between colorectal cancer patients (268 pg ml(-1)) and healthy blood donors (220 pg ml(-1)). The preoperative vascular endothelial growth factor concentrations were dichotomized by the 95th percentile of the healthy blood donors (plasma=112 pg ml(-1), serum=533 pg ml(-1)). In univariate survival analyses, both high plasma vascular endothelial growth factor (>112 pg ml(-1)) and high serum vascular endothelial growth factor (>533 pg ml(-1)) predicted a reduced survival. In multivariate survival analyses, high serum vascular endothelial growth factor (>533 pg ml(-1)) independently predicted a reduced survival (HR=1.65, P=0.015), while high plasma vascular endothelial growth factor (>112 pg ml(-1)) did not (HR=1.27, P=0.23). This study indicates that preoperative serum vascular endothelial growth factor apparently is a better predictor of overall survival than the preoperative plasma vascular endothelial growth factor. Copyright 2002 The Cancer Research Campaign
UI - 11807360
AU - Heuschen UA; Hinz U; Allemeyer EH; Autschbach F; Stern J; Lucas M;
TI - Herfarth C; Heuschen G Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis.
SO - Ann Surg 2002 Feb;235(2):207-16
AD - Department of Surgery, University of Heidelberg, Heidelberg, Germany. Udo_Heuschen@med.uni-heidelberg.de
OBJECTIVE: To analyze the association between pre- and perioperative factors and pouch-related septic complications (PRSC) in ulcerative colitis (UC) and in familial adenomatous polyposis (FAP) after ileal pouch-anal anastomosis (IPAA). SUMMARY BACKGROUND DATA: For patients with UC and FAP, IPAA is the surgical therapy of choice, but in some patients the outcome is compromised by PRSC. METHODS: A total of 706 consecutive patients (494 UC, 212 FAP) were assessed in a study aimed at identifying subgroups of patients who were at high risk for PRSC. The rate of PRSC was analyzed as a time-dependent function (Kaplan-Meier estimation). Patients with UC and FAP were stratified separately according to associated factors (age, sex, surgeon's experience, temporary ileostomy, colectomy before IPAA, anastomotic tension, and several factors specific for UC). RESULTS: In all, 131 (19.2%) patients had PRSC (23.4% UC, 9.4% FAP). In patients with UC, the estimated 1-year PRSC rate was 15.6% and the estimated 3-year PRSC rate was 24.2%. In patients with FAP, the estimated 1-year and 3-year PRSC rates were 9.2%. The difference between the estimated rates of PRSC was significant (P <.001). In the univariate analysis, patients with UC younger than 50 years, with severe proctitis, with preoperative hemoglobin levels less than 10 g/L, or receiving corticoid medication had a significantly higher risk for PRSC (P =.039, P =.037, P =.047, P =.003, respectively). Multivariate analysis showed that patients with UC receiving a systemic prednisolone-equivalent corticoid medication of more than 40 mg/day had a significantly greater risk of developing pouch-related complications than patients with UC receiving 1 to 40 mg/day and patients with UC who were not receiving corticoid medication (RR: 3.78, 2.25, 1, respectively, P <.001). Patients with FAP proved to have a significantly higher risk for PRSC in the univariate and multivariate analyses if anastomotic tension had occurred (RR 3.60, P =.0086). CONCLUSIONS: Pouch-related septic complications occur as late complications and should therefore be considered in regular, specific long-term follow-up examinations. The authors identified significant risk factors for PRSC specific to patients with UC and FAP; these must be considered for each individual surgical strategy.
UI - 11807361
AU - Lehnert T; Methner M; Pollok A; Schaible A; Hinz U; Herfarth C
TI - Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients.
SO - Ann Surg 2002 Feb;235(2):217-25
AD - Section of Surgical Oncology, Department of Surgery, University of Heidelberg, Heidelberg, Germany. firstname.lastname@example.org
OBJECTIVE: To review a single-center experience with 201 multivisceral resections for primary colorectal cancer to determine the accuracy of intraoperative prediction of potential curability, to identify prognostic factors, and to examine the effect of surgical experience on immediate outcome and long-term results. SUMMARY BACKGROUND DATA: Locally advanced colorectal cancer may require an intraoperative decision for en bloc resection of surrounding organs or structures to achieve complete tumor removal. This decision must weigh the risk of complications and death of multivisceral resection against a potential survival benefit. Little is known about prognostic factors and the influence of surgical experience on the outcome of multivisceral resection for colorectal canc