National Cancer Institute®
Last Modified: September 1, 2002
UI - 12019503
AU - Rix T; Jourdan L
TI - 'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery (Br J Surg 2001;88:1533-8).
SO - Br J Surg 2002 May;89(5):625; discussion 625
UI - 11860226
AU - Brivio F; Lissoni P; Perego MS; Lissoni A; Fumagalli L
TI - Abrogation of surgery-induced IL-6 hypersecretion by presurgical immunotherapy with IL-2 and its importance in the prevention of postoperative complications.
SO - J Biol Regul Homeost Agents 2001 Oct-Dec;15(4):370-4
AD - Third Surgery Division, S. Gerardo Hospital, Monza, Milan, Italy.
Because of its immunosuppressive effect, surgery-induced immunosuppression may depend at least in part on the postoperative hypersecretion of IL-6, which is also responsible for surgical complications. Most of the immunosuppressive events induced by surgery, including lymphocytopenia, NK and T lymphocyte decline, and dendritic cell deficiency have been proven to be abrogated by a preoperative injection of IL-2 for few days. However, the cytokine mechanisms responsible for IL-2-induced abrogation of surgery-related immunosuppression need to be better investigated and understood. This study was performed to analyze the influence of IL-2 presurgical immunotherapy on IL-6 secretion in the postoperative period. The study was performed in 12 operable colorectal cancer patients, who were preoperatively pretreated with IL-2 (12 million lU/day subcutaneously for 3 consecutive days before surgery). The control group consisted of 21 age-and disease-matched colorectal cancer patients who underwent surgery without a preoperative immunotherapy with IL-2. Serum levels of IL-6 were measured by an enzyme immunoassay before surgery, and at days 3 and 7 of the postoperative period. A significant increase in mean serum levels of IL-6 occurred in the postoperative period only in the control patients, whereas in the IL-2 pretreated group no significant difference was seen between presurgical and postoperative IL-6 mean concentrations. The difference between controls and IL-2 group was particularly evident for patients with abnormally elevated presurgical values of IL-6. This study, by showing that a presurgical injection of IL-2 may prevent surgery-induced IL-6 enhanced secretion, would suggest that the previously described neutralization of surgery-induced immunosuppression by IL-2 preoperative immunotherapy may depend at least in part on the inhibition of postoperative production of IL-6, whose immunosuppressive effects have been well demonstrated at least on anticancer immunity.
UI - 11873635
AU - Lucci S; Rivolta R; Redler A; Giordano R; Merlino G; Fazi M
TI - [Current role of traditional endoscopy and prospects for virtual colonoscopy in the management of colorectal neoplastic lesions]
SO - G Chir 2001 Nov-Dec;22(11-12):373-83
AD - Dipartimento di Scienze Chirurgiche, Universita degli Studi La Sapienza, Roma.
The Authors, reviewing their surgical experience with colo-rectal cancer in the last 13 years, conclude that, in the management of this condition, the routine use of traditional endoscopy will continue to have a crucial role in terms of prevention, cure and/or survival. It is possible that in the future present limits of endoscopic techniques will be seperated by routine use of endoscopic ultrasounds and virtual colonoscopy.
UI - 11873641
AU - Lucci S; Rivolta R; Redler A; Giordano R; Merlino G; Fazi M
TI - [Current role of endoscopic ultrasonography in the treatment of colorectal neoplastic lesions]
SO - G Chir 2001 Nov-Dec;22(11-12):410-2
AD - Dipartimento di Scienze Chirurgiche, Universita degli Studi La Sapienza, Roma.
The Authors examined the value of endoscopic ultrasounds in the tmanagement of colo-rectal lesions, particularly neoplastic ones, on the basis of their surgical experience, concluding that to date such technique cannot substitute traditional endoscopy, but surely can be a valid complementary tool for imaging diagnostics, expecially to study wall tumoral infiltration or extra-parietal relapses.
UI - 11890335
AU - Waisberg J; Bromberg SH; Franco MI; Matheus CO; Zanotto A; Petrolino LF;
TI - Beltrami AM; Godoy AC Primary non-Hodgkin lymphoma of the right colon: a retrospective clinical-pathological study.
SO - Int Surg 2001 Jan-Mar;86(1):20-5
AD - Department of Digestive Surgery, Hospital do Servidor Publico Estadual, Sao Paulo, Brazil. jaqueswaisberguol.com.br
The objective of this study was to analyze the results of surgical treatment of primary non-Hodgkin lymphomas of the right colon. Ten patients were operated on with curative intention. Dawson's criteria were used to characterize the colonic lymphoma as a primary lymphomas. In the staging of the tumor, the Ann Arbor classification for gastrointestinal lymphomas modified by Musshoff and Schmidt-Vollmer was used. The histological classification was made by using the International Working Formulation Group system. All patients were submitted to radical right colectomy and 6 of them received postoperative chemotherapy. The overall average survival was 39.2 months. Four of the patients are still alive, without active disease, with an average survival of 85.2 months. Six patients died due to relapse in the abdomen, with an average survival of 8.2 months. These results suggest that it is advantageous to patient survival to have them submitted for resection of their lesions at an initial stage of the disease (IE and IIE1). Chemotherapy must be used as a complementary treatment in locally advanced lesions, in an attempt to control the residual microscopic disease.
UI - 12170025
AU - Delaney CP; Lavery IC; Brenner A; Hammel J; Senagore AJ; Noone RB; Fazio
TI - VW Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers.
SO - Ann Surg 2002 Aug;236(2):203-7
AD - Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. email@example.com
OBJECTIVE: To examine the effect of preoperative radiotherapy (PRT) on patients who undergo rectal resection with total mesorectal excision (TME) for stage T3 low rectal cancers. SUMMARY BACKGROUND DATA: Evidence for the value of PRT before rectal cancer surgery is weakened by variability in the use of TME. Many surgeons have concluded that PRT is unnecessary for small rectal tumors if TME is performed, but there are no prospective data to support this opinion. METHODS: Since 1980, 2,200 patients with rectal cancer have been enrolled in a prospective database. Of these, 259 underwent curative anterior or abdominoperineal resection with TME for pathologically confirmed T3 lesions within 8 cm of the anal verge. Patients were grouped by receiving PRT (n = 92) or not receiving PRT (n = 167). Five-year overall survival and 5-year local recurrence rates were evaluated. RESULTS: Overall survival was increased from 52% in patients not receiving PRT to 63% in those receiving PRT. PRT increased overall survival for node-negative patients from 58% to 82%, with no benefit for node-positive patients. There was no significant difference in local recurrence rates. When categorized by tumor size, there was no difference in overall survival or local recurrence for 0- to 2-cm tumors or those larger than 5 cm, but PRT increased overall survival from 50% to 72% for patients with 2- to 5-cm tumors. Similar results were observed for patients with tumors staged as T3 on preoperative endoluminal ultrasound. CONCLUSIONS: Patients with pT3 low rectal cancers undergoing resection with TME have an improved survival with PRT. The effect is most beneficial for patients with node-negative and 2- to 5-cm tumors, although this group may include larger and node-positive tumors that have been downstaged by PRT. PRT should be advocated for all patients with T3 rectal cancers less than 8 cm from the anal verge, even if the surgery includes a properly performed TME.
UI - 12170663
AU - Bulman J
TI - Changes in diet following the formation of a colostomy.
SO - Br J Nurs 2001 Feb 8-21;10(3):179-86
AD - Good Hope NHS Trust, Sutton Coldfield.
The main aim of this small study was to discover if the formation of a colostomy could adversely affect the long-term dietary intake of patients. While it would seem that there were few adverse effects on nutrient intake after surgery, it became apparent that patients had a need for clear dietary advice. It seemed that this area of their care was lacking. Because of the small number of patients recruited for the study statistical validation was not possible. Therefore, this study is only able to point the way forward for further research into the dietary needs of colostomy patients and the health professional role in this area of care.
UI - 12177109
AU - Cascinu S; Catalano V; Cordella L; Labianca R; Giordani P; Baldelli AM;
TI - Beretta GD; Ubiali E; Catalano G Neuroprotective effect of reduced glutathione on oxaliplatin-based chemotherapy in advanced colorectal cancer: a randomized, double-blind, placebo-controlled trial.
SO - J Clin Oncol 2002 Aug 15;20(16):3478-83
AD - Department of Medical Oncology, Azienda Ospedaliera-Universitaria di Parma, via Gramsci 14, 43100 Parma, Italy. firstname.lastname@example.org
PURPOSE: We performed a randomized, double-blind, placebo-controlled trial to assess the efficacy of glutathione (GSH) in the prevention of oxaliplatin-induced neurotoxicity. PATIENTS AND METHODS: Fifty-two patients treated with a bimonthly oxaliplatin-based regimen were randomized to receive GSH (1,500 mg/m(2) over a 15-minute infusion period before oxaliplatin) or normal saline solution. Clinical neurologic evaluation and electrophysiologic investigations were performed at baseline and after four (oxaliplatin dose, 400 mg/m(2)), eight (oxaliplatin dose, 800 mg/m(2)), and 12 (oxaliplatin dose, 1,200 mg/m(2)) cycles of treatment. RESULTS: At the fourth cycle, seven patients showed clinically evident neuropathy in the GSH arm, whereas 11 patients in the placebo arm did. After the eighth cycle, nine of 21 assessable patients in the GSH arm suffered from neurotoxicity compared with 15 of 19 in the placebo arm. With regard to grade 2 to 4 National Cancer Institute common toxicity criteria, 11 patients experienced neuropathy in the placebo arm compared with only two patients in the GSH arm (P =.003). After 12 cycles, grade 2 to 4 neurotoxicity was observed in three patients in the GSH arm and in eight patients in the placebo arm (P =.004). The neurophysiologic investigations (sural sensory nerve conduction) showed a statistically significant reduction of the values in the placebo arm but not in the GSH arm. The response rate was 26.9% in the GSH arm and 23.1% in the placebo arm, showing no reduction in activity of oxaliplatin. CONCLUSION: This study provides evidence that GSH is a promising drug for the prevention of oxaliplatin-induced neuropathy, and that it does not reduce the clinical activity of oxaliplatin.
UI - 11918234
AU - Ho YH; Cheng C; Tay SK
TI - Total pelvic exenteration: results from a multispecialty team approach to complex cancer surgery.
SO - Int Surg 2001 Apr-Jun;86(2):107-11
AD - Department of Colorectal Surgery, Singapore General Hospital, Singapore. HoYH@sgh.gov.sg
Total pelvic exenteration is often the only curative option for recurrent or locally advanced pelvic cancers, but it carries a high risk of mortality and morbidity. A dedicated multispecialty team operative approach may provide the expertise to perform this uncommon procedure with favorable outcomes. Data were analyzed from a prospectively collected computerized database. There were 14 patients (2 men; mean age, 54.6 +/- 3.6 years) with mainly cervical cancers, of which 71.4% were recurrent. Anesthetic time was 5 +/- 0.9 hours, intraoperative blood loss was 2.1 +/- 0.5 liters, and postoperative hospitalization was 22 +/- 9.9 days. An ileal conduit was performed in all patients, but intestinal continuity was restorable with colonic J-pouch in 71.4% of the patients. There was no mortality at 30 days or during hospitalization. Complication rates were 35.7%, accounting for reoperations in 28.6%. Recurrences were detected in 50% patients at a mean follow-up of 53.1 +/- 9.2 months. The mean time for cancer recurrence was 13.3 +/- 3.3 months. Fifty percent of those patients had otherwise survived to date. We conclude that a dedicated multispecialty team may perform total pelvic exenteration with minimum mortality and acceptable morbidity.
UI - 12101116
AU - Keller JJ; Offerhaus GJ; Hylind LM; Giardiello FM
TI - Rectal epithelial apoptosis does not predict response to sulindac treatment or polyp development in presymptomatic familial adenomatous polyposis patients.
SO - Cancer Epidemiol Biomarkers Prev 2002 Jul;11(7):670-1
AD - Department of Pathology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands. email@example.com
UI - 12149316
AU - Gedlicka C; Scheithauer W; Schull B; Kornek GV
TI - Effective treatment of oxaliplatin-induced cumulative polyneuropathy with alpha-lipoic acid.
SO - J Clin Oncol 2002 Aug 1;20(15):3359-61
UI - 12044507
AU - Feliu J; Mel JR; Camps C; Escudero P; Aparicio J; Menendez D; Garcia
TI - Giron C; Rodriguez MR; Sanchez JJ; Gonzalez Baron M; Oncopaz Cooperative Group Associated Hospitals Raltitrexed in the treatment of elderly patients with advanced colorectal cancer: an active and low toxicity regimen.
SO - Eur J Cancer 2002 Jun;38(9):1204-11
AD - Medical Oncology Service, Hospital La Paz, Madrid, Spain. firstname.lastname@example.org
In spite of the high prevalence of advanced colorectal cancer in the elderly, we have little data on the efficacy and toxicity of chemotherapy in this age group. Raltitrexed is a thymidylate synthetase inhibitor with known activity in the treatment of advanced colorectal cancer. The objective of this study was to analyse the efficacy and tolerance of raltitrexed in elderly patients with advanced colorectal cancer. 92 patients diagnosed with advanced colorectal cancer aged >or=70 years were entered into the study. Raltitrexed was given at a dose of 3 mg/m(2) once every 3 weeks for a minimum of three cycles. A total of 511 cycles were given with a median of five cycles per patient. 20 out of the 90 patients evaluable for response achieved a partial response (PR) (22%, 95% Confidence Interval (CI): 17-36%), 43 (48%) remained stable and 27 showed progression (30%). The mean duration of response was 24 weeks and the progression-free interval was 15 weeks. The overall median survival was 41 weeks. 31 patients (39%, 95% CI: 28-50%) experienced a clinical benefit (improvement of the performance status without a worsening of symptoms or relief of symptoms without a worsening of the performance status). The main toxicities were gastrointestinal and haematological. 12 patients (13%) developed grade 3-4 side-effects: 7 had nausea/vomiting (8%), 6 a transaminase increase (7%), 4 asthenia (4%), 3 diarrhoea (3%), 2 neutropenia (2%), 2 anaemia (2%) and 1 thrombocytopenia (1%). Three toxic deaths occurred (3%). The group of patients with a creatinine clearance
UI - 12074797
AU - Stief CG; Jonas U; Raab R
TI - Long-term follow-up after surgery for advanced colorectal carcinoma involving the urogenital tract.
SO - Eur Urol 2002 May;41(5):546-50
AD - Department of Urology, Urologische Klinik, MHH, D-30623 Hannover, Germany. email@example.com
OBJECTIVES: Advanced colorectal carcinomas frequently involve the urogenital tract. In the following we evaluate the long-term survival after radical surgical extirpation and the prognostic significance of extirpation of an advanced colorectal carcinoma involving the urogenital tract.RESULTS: Of 68 men and 33 women, 40 presented with primary and 61 with recurrent carcinoma. As far as urological organs are concerned, the ureter was removed in 82 patients, followed by bladder (n=52), seminal vesicles (n=25), prostate (n=22), kidney, testicle and penis. Histology revealed cancerous infiltration in 52% of the organs resected. A negative surgical margin was obtained in 54% of the patients, 43% showed positive lymph nodes. There was a 41% peri-operative complication with a mortality rate of 5%. Five year overall survival was 24.4% (median 23 months) with prognostic factors being type of tumour (primary versus recurrent), surgical margin and lymph node status. Stratification according to these factors showed removal of bladder and prostate to be a favourable and ureteral removal to be an omnious factor.CONCLUSION: We conclude that multivisceral extirpation of advanced colorectal carcinomas involving the urogenital tract should be recommended in selected patients. Our data showed it to be a safe surgical procedure, which is associated with favourable long-term outcome in non-metastatic patients in whom complete surgical resection could be achieved.
UI - 12163961
AU - Hazebroek EJ; The Color Study Group
TI - COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer.
SO - Surg Endosc 2002 Jun;16(6):949-53
BACKGROUND: Laparoscopic surgery has proven to be safe and effective. However, the value of laparoscopic resection for malignancy in terms of cancer outcome can only be assessed by large prospective randomized clinical trials with sufficient follow-up. METHODS: COLOR (COlon carcinoma Laparoscopic or Open Resection) is a European multicenter randomized trial that began in 1997. In 27 hospitals in Sweden, The Netherlands, Germany, France, Italy, Spain, and the United Kingdom, 1200 patients will be included. The primary endpoint of the study is cancer-free survival after 3 years. RESULTS: In <3.5 YEARS, >850 patients have been randomized for right hemicolectomy (47%), left hemicolectomy (11%), and sigmoidectomy (42%). Fifty seven patients were excluded after randomization. Forty six months after the start of the trial, the overall recurrence rate is 6.8%. The distribution of stage of disease is as follows: stage I, 25%; stage II, 41%; stage III, 32%; stage IV, 2%. CONCLUSION: Although laparoscopic surgery appears to be of value in the treatment of colorectal cancer, the final, results of randomized trials need to be considered to determine its definitive role. Given the current accrual rate, the COLOR study will be completed in 2002.
UI - 12163970
AU - Poulin EC; Schlachta CM; Gregoire R; Seshadri P; Cadeddu MO; Mamazza J
TI - Local recurrence and survival after laparoscopic mesorectal resection forrectal adenocarcinoma.
SO - Surg Endosc 2002 Jun;16(6):989-95
AD - Centre for Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Ontario, Canada M5B1W8. firstname.lastname@example.org
BACKGROUND: Laparoscopic resection for rectal cancer is controversial. Actuarial survival and local recurrence rates have not been determined. METHODS: A prospective database containing 80 consecutive unselected laparoscopic resections of rectal cancers performed between November 1991 and 1999 was reviewed. Local recurrence was defined as any detectable local disease at follow-up assessment occurring either alone or in conjunction with generalized recurrence. The tumor node metastases (TNM) classification for colorectal cancers and the Kaplan-Meier method were used to determine staging and survival curves. The mesorectal excision technique was used during surgery. RESULTS: The median follow-up period was 31 months for patients with stages I, II, and III cancer, and 15.5 months for patients with stage IV cancer. The overall 5-year survival rate was 65.1% for all cancer stages and 72.1% for stages I, II, and III cancer. No trocar-site recurrence was observed. The overall local recurrence rate was 3.75% (3/80) for all cancer stages, and 4.3% (3/70) for stages I, II, and III cancer. CONCLUSIONS: The survival and local recurrence rates for patients with rectal cancer treated by laparoscopic mesorectal excision do not differ negatively from those in the literature for open mesorectal excision. Further validation is needed.
UI - 9054073
AU - Bulow S; Moesgaard FA; Billesbolle P; Harling H; Holm J; Madsen MR;
TI - Myrhoj T; Nymann T; Okholm M; Qvist N; Riber C [Anastomotic leakage after low anterior resection for rectal cancer]
SO - Ugeskr Laeger 1997 Jan 13;159(3):297-301
AD - H:S Bispebjerg Hospital, Kirurgisk afdeling K.
A series of 377 consecutive patients were operated upon with low anterior resection for rectal cancer in the nine Danish departments of surgical gastroenterology during 1992-1993. A retrospective analysis was carried out to calculate the frequency of anastomotic leakage and to evaluate factors of potential influence on the development of leakage according to the literature. Sixty-three patients (17%) developed leakage, which was followed by an increased mortality within the first three postoperative months. Only two variables significantly influenced the leakage rate: male gender was associated with a higher leakage rate (p = 0.02), whereas departments with a low number of rectal cancer surgeons had a low rate of anastomotic leakage (p = 0.02). In conclusion, the rather high frequency of anastomotic leakage calls for further clinical and pathogenetic research in this field. Until then, we recommend the routine use of a peroperative leakage test and selective use of prophylactic ostomy in cases of unsatisfactory anastomosis. Furthermore, it is recommended that low anterior resection for rectal cancer is limited to few surgeons in each department in order to ensure a uniform quality and hopefully also thereby reduce the rate of anastomotic leakage.
UI - 11412248
AU - Tang CL; Eu KW; Tai BC; Soh JG; MacHin D; Seow-Choen F
TI - Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer.
SO - Br J Surg 2001 Jun;88(6):801-7
AD - Department of Colorectal Surgery, Singapore General Hospital, Singapore.
BACKGROUND: Laparoscopic surgery is believed to produce an attenuated metabolic stress response and to have a less dampening effect on the immune response than open surgery. To date, the effect has not been studied in a randomized clinical trial of colorectal cancer. METHODS: The study was a two-armed randomized prospective trial conducted in parallel with the UK Medical Research Council's Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial comparing laparoscopically assisted colorectal surgery for left-sided tumours with conventional open surgery. Systemic immunity was assessed by determining the T- and B-cell counts, the CD4 : CD8 ratio, the natural killer cell counts, the immunoglobulin (Ig) G, IgM and IgA levels, and C3 and C4 levels. The white cell phagocytic activity (nitroblue tetrazolium test) was studied before operation and on the third postoperative day. RESULTS: A total of 236 patients were 161 had complete preoperative and postoperative assays for the analysis of results. There was no difference in mean response between the two surgical groups for each of the immune parameters studied. The unadjusted difference for the primary endpoint, T-cell count, 3 days after operation was - 1.6 per cent (95 per cent confidence interval - 5.0 to 1.8 per cent). CONCLUSION: There is no difference in the systemic immune response in patients having laparoscopically assisted colectomy compared with those undergoing conventional open surgery for colorectal cancer.
UI - 11412255
AU - Holm T; Johansson H; Rutqvist LE; Cedermark B
TI - Tumour location and the effects of preoperative radiotherapy in the treatment of rectal cancer.
SO - Br J Surg 2001 Jun;88(6):839-43
AD - Department of Surgery, Karolinska Hospital, S-171 76 Stockholm, Sweden. email@example.com
BACKGROUND: Preoperative radiotherapy improves local control and survival in rectal cancer, but may also increase postoperative morbidity and mortality rates. Establishing selection criteria for preoperative radiotherapy is crucial. The tumour level above the anus may be one such criterion. The effect of preoperative radiotherapy in relation to the distance between the tumour and the anus was therefore assessed. METHODS: In 457 patients operated for cure included in the Stockholm II Trial the local recurrence rate in irradiated and non-irradiated patients was analysed in relation to the tumour location (low, mid or upper rectum). RESULTS: Radiotherapy reduced the local recurrence rate from 30 to 20 per cent in low rectal cancer, from 25 to 11 per cent in mid rectal cancer and from 21 to 5 per cent for tumours in the upper rectum. CONCLUSION: With conventional surgical techniques preoperative radiotherapy plays an important role in rectal cancer irrespective of the location of the tumour. To irradiate only patients with tumours in the lower rectum and to omit this treatment for patients with tumours in the mid and upper rectum cannot be recommended. Whether this statement is valid with standardized total mesorectal excision (TME) surgery is not known. Until this knowledge is available the current indications for preoperative radiotherapy should probably also be used with TME surgery.
UI - 11466988
AU - Bulow S; Moesgaard FA; Crone PO; Gandrup P; Holm J; Kronborg O;
TI - Hemmert-Lund H; Myrhoj T; Petersen RH; Qvist N; Raskov HH; Thomsen H [Recurrence and survival after conventional low anterior resection for rectal cancer]
SO - Ugeskr Laeger 2001 Jul 2;163(27):3793-7
AD - H:S Bispebjerg Hospital, kirurgisk afdeling K. firstname.lastname@example.org
INTRODUCTION: The aim of the study was to evaluate the incidence of recurrence of local cancer, distant metastases and survival after conventional low anterior resection for cure in patients with rectal carcinoma, on the basis of the poor prognosis after colorectal cancer in Denmark. MATERIAL AND METHODS: Consecutive patients operated on in the nine Danish departments of surgical gastroenterology in 1992-1993. Retrospective collection of data on recurrence of local cancer, distant metastases, and over-all survival at the end of 1996. RESULTS: Of 268 patients, 77 (29%) developed recurrent local cancer and/or distant metastases. Forty-eight (18%) had local recurrence with a cumulative 5-year rate of 39%. Distant metastases were seen in 54 (20%). The local recurrence rate increased with increasing Dukes' tumour stage and was higher after operation by a non-specialist (30%) than by a consultant, another specialist, or a surgeon under training and supervised by a consultant (15-17%) (p = 0.04). Multiple regression showed that the recurrence rate was independent of tumour localisation, blood loss, transfusion, anastomotic leakage, and status of the surgeon. The cumulative crude 5-year survival was 50% and independent of the status of the surgeon. DISCUSSION: Our relatively high local recurrence rate and the results in the literature after total mesorectal excision (TME) indicate that the conventional technique should be replaced by TME, which has become the recommended method in recent years. Furthermore, we propose a changed strategy in the treatment of rectal cancer. The patients should be treated in fewer departments with established teams of rectal cancer specialists taking part in all operations for rectal cancer.
UI - 11488795
AU - Wichmann MW; Muller C; Hornung HM; Lau-Werner U; Schildberg FW;
TI - Colorectal Cancer Study Group Gender differences in long-term survival of patients with colorectal cancer.
SO - Br J Surg 2001 Aug;88(8):1092-8
AD - Department of Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany.
BACKGROUND: Significant differences exist in the immunological response to surgery. This raises the possibility that gender differences exist concerning the outcome after curative colorectal cancer resection. METHODS: To study this hypothesis, a database of patients with colorectal cancer was analysed prospectively. RESULTS: Some 894 patients were included, 500 (55.9 per cent) were men and 394 (44.1 per cent) were women. Median follow-up was 54.5 months for the entire group and 63.3 months for survivors. The mean(s.e.m.) patient age was 65.3(0.4) years (women 66.1(0.6), men 64.7(0.5) years; P < 0.05). Women lived significantly longer after cancer resection than men (57.8(1.5) versus 52.0(1.3) months; P < 0.05, log rank 0.009). Disease-free survival was significantly longer in women than in men (51.6(1.7) versus 46.0(1.4) months; P < 0.05). Subgroup analysis revealed significant gender differences in Union Internacional Contra la Cancrum (UICC) stages I (n = 195, log rank 0.01) and UICC IV (n = 38, log rank 0.021). Survival analysis after rectal cancer resection revealed significant advantages for women (log rank 0.02), while no gender differences were detected when comparing patients after resection for colonic cancer. Moreover, patients older than 50 years (n = 635) showed significant gender-related survival differences (log rank 0.015). CONCLUSION: Significant gender differences following curative rectal cancer resection were observed. In women disease-free and overall survival were significantly longer. Whether or not these gender differences are related to gender-specific immune functions or to other gender-related local or systemic factors remains to be determined.
UI - 11586562
AU - Silecchia G; Perrotta N; Basso N; Registro Nazionale della Societa
TI - Italiano di Chirurgia Endoscopica e Nuove Technologie [Laparoscopic surgery of the colorectum: analysis of results of the National Registry of the Italian Society of Endoscopic Surgery and New Technologies (S.I.C.E.)]
SO - Chir Ital 2001 Jul-Aug;53(4):447-52
AD - Policlinico Umberto I, Dipartimento di Chirurgia Paride Stefanini, Viale del Policlinico, 155, 00161 Roma.
The aim of this paper was to review the data from the Italian Registry of Laparoscopic Colo-Rectal Surgery sponsored by SICE. The Italian participated in the Registry, with 2,793 patients recorded (F = 1,409, M = 1,384), 1878 for malignancy and 915 for benign diseases. The median age was 63.7 years. The conversion rate was 10.8%. Mortality was 0.6% (18 cases) and major abdominal complications occurred in 11.1% of patients. The reoperation rate was 5.1%. After a median follow-up of 59 months, 16 patients (0.9%) presented abdominal wall metastases. Relapses occurred in 18.5% of patients after curative resections for rectal cancer, and in 12.7% after curative resections for colon cancer. Laparoscopic colo-rectal surgery has gained widespread acceptance. The reproducibility and safety of all the major laparoscopic colo-rectal procedures has been demonstrated. Nevertheless, the lack of long-term results of randomised trials in terms of oncological efficacy and the technical difficulties of the procedures suggests that laparoscopic colo-rectal surgery should be performed only in referral centres by skilled surgeons.
UI - 11760604
AU - Bartelink H
TI - [Total mesorectal excision and preoperative radiotherapy in patients with rectal carcinoma: good preliminary results]
SO - Ned Tijdschr Geneeskd 2001 Nov 24;145(47):2259-60
AD - Het Nederlands Kanker Instituut/Antoni van Leeuwenhoek Ziekenhuis, afd. Radiotherapie, Plesmanlaan 121, 1066 CX Amsterdam.
The value of a short course of radiotherapy prior to total mesorectal excision was studied in patients with resectable rectal cancer. The new surgical technique of total mesorectal excision was introduced under appropriate supervision and gave favourable treatment results. The incidence of local recurrence was markedly reduced by preoperative radiotherapy. Long term results should give greater insight into potential improvements in survival rates and any late side effects which may arise as a result of the radiation schedule.
UI - 11736975
AU - Camilleri-Brennan J; Steele RJ
TI - Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer.
SO - Br J Surg 2001 Dec;88(12):1617-22
AD - University Department of Surgery and Molecular Oncology, Level 6, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. email@example.com
BACKGROUND: Little is known of how the quality of life of patients with rectal cancer changes after surgery, and whether or not quality of life is associated with and predictive of survival. The aims of this study were to address these issues. METHODS: The Medical Outcomes Study Short Form 36 (SF-36), and the European Organization for the Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 quality of life questionnaires were administered to patients before surgery for rectal cancer, on discharge home and at 3-month intervals after operation for up to 1 year. Survival was measured in days from the time of surgery to death. RESULTS: Sixty-five patients with a median age of 67 years participated. Most quality of life scores dropped significantly below baseline in the early postoperative period. From the third month onwards some scores, such as the global quality of life score and emotional function score on the QLQ-C30, improved. Other scores, including role function, fatigue and pain on the QLQ-C30, were similar to baseline values after 3-6 months and remained unchanged. However, scores such as sexual enjoyment and male sexual problems on the QLQ-CR38 were worse than baseline in the early postoperative period and remained poor thereafter. Stepwise regression analyses showed that preoperative quality of life dimension scores for physical function, nausea/vomiting and sexual enjoyment, together with age, predicted postoperative 1-year survival with an accuracy of 76.8 per cent. CONCLUSION: The findings of this study confirm that quality of life after rectal cancer surgery changes with time. It is generally worst in the early postoperative period. Preoperative quality of life is a good predictor of survival at 1 year.
UI - 11917212
AU - Bonaiti-Pellie C
TI - Methodological aspects of investigating gene-nutrient interactions.
SO - Eur J Cancer Prev 2002 Feb;11(1):69-74
AD - Unite de Recherches en Epidemiologie des Cancers (INSERM U521), Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France. firstname.lastname@example.org
UI - 12015040
AU - He J; Pu Y; Zhu Z; Cao Z; Yang B; Dong L
TI - [Double-pump implantation chemotherapy for hepatic metastasis from colorectal cancer]
SO - Zhonghua Zhong Liu Za Zhi 2002 Mar;24(2):167-9
AD - 309th Hospital, PLA, Beijing 100091, China.
OBJECTIVE: To evaluate the value of infusion chemotherapy by pump implantation via hepatic artery or portal vein or both (double-pump chemotherapy, DPC) for hepatic metastasis from colorectal cancer. METHODS: Thirty patients with hepatic metastasis from colorectal cancer were divided into three groups: 1. Group I-DPC (12 patients). 2. Group II-hepatic artery implantation chemotherapy (10 patients) and 3. Group III-portal vein implantation chemotherapy (8 patients). RESULTS: Response rate was 66.7% in group I, 60% in group II and 37.5% in group III. The 0.5-, 1-, 2-year survival rates were 100.0%, 75.0%, 41.7% in group I, 90.0%, 60.0%, 30.0% in group II and 87.5%, 50.0%, 25.0% in group III. CONCLUSION: Double pump implantation chemotherapy is effective in treating hepatic metastasis from colorectal cancer. It is better than hepatic artery or portal vein pump-implantation chemotherapy alone.
UI - 12082858
AU - Kronborg O; Jakobsen AK
TI - [Rectal cancer]
SO - Ugeskr Laeger 2002 Jun 3;164(23):3046-8
AD - Kirurgisk afdeling A, Odense Universitetshospital, DK-5000 Odense C. email@example.com
UI - 12117879
AU - Khosraviani K; Weir HP; Hamilton P; Moorehead J; Williamson K
TI - Effect of folate supplementation on mucosal cell proliferation in high risk patients for colon cancer.
SO - Gut 2002 Aug;51(2):195-9
AD - Department of Surgery, Queen's University of Belfast, UK.
AIMS: Intracellular folate deficiency has been implicated in colonic carcinogenesis in epidemiological studies and animal and human cancer models. Our aim was to determine the effect of folate supplementation on patients with recurrent adenomatous polyps using rectal mucosal cell proliferation as a biomarker. PATIENTS AND METHODS: Eleven patients with recurrent adenomatous polyps of the colon were randomised into a treatment group (n=6) receiving a dietary supplement of 2 mg folic acid per day for three months and a control group (n=5) receiving a placebo. Rectal biopsies where taken at 10 cm from the anal verge prior to supplementation and repeated at four, 12, and 18 weeks from the start of the supplementation. Each biopsy was immediately incubated in culture medium enriched with bromodeoxyuridine (BrdU). The S phase cells which incorporated BrdU into their DNA were identified following immunohistochemical staining. Twenty five orientated crypts were identified for each time point and the number and position of BrdU positive and BrdU negative cells were counted. BrdU labelling indices (LIs) were calculated for the entire crypt and for each of five equal compartments running consequently from the base to the luminal surface. RESULTS: The LI of the treatment group (9.1 (6.7, 12.3)) and the control group (9.3 (7.8, 10.3)) were comparable at the start. Over the duration of the supplementation period, LI in the control group did not alter significantly (9.3 (7.8, 10.3) v 9.6 (8.9, 10.4)). However, LI of the folate treated group was lowered after 12 weeks of supplementation (9.1 (6.7, 12.3) v 7.4 (5.3, 9.6)). Analysis of