Objective To analyze the relation between the marital status of patients with colorectal cancer and neoadjuvant therapy (NAT) regimen decision-making and outcomes in the current version of the Database from Colorectal Cancer (DACCA). Methods The version of DACCA selected for this analysis was updated on June 29, 2022. The patients were enrolled according to the established screening criteria and then assigned to 5 groups: the unmarried, married, divorced, remarried and widowed groups. The differences in the NAT regimen decision-making and changes of symptom, imaging, and cancer markers in these 5 groups were analyzed. Results A total of 3 053 data that met the screened criteria were enrolled. The results of statistical analysis reflected that the difference in the constituent ratio of patients chosen NAT strategies among 5 groups was obviously statistically significant (χ2=27.944, P=0.004), showing that remarried patients were inclined to adopt combined target drug. No statistical differences were found in changes of symptom (H=5.717, P=0.221), image (H=8.551, P=0.073), and cancer markers (H=11.351, P=0.183) of the 5 groups after NAT. Conclusion Through analysis of DACCA data, it is found that in the selection of NAT strategy for colorectal cancer, more married and remarried patients tended to choose chemotherapy combined target drug regimen.
ObjectiveTo analyze the follow-up data of colorectal cancer in the Database from Colorectal Cancer (DACCA).MethodsThe information in the Dacca database was screened, and the one whose operative date and follow-up date were not blank in the total data was selected. The follow-up data were analyzed, including length of follow-up, survival outcomes, coping styles (doctors’ attitude and reaction for follow-up), follow-up path (whether to choose out-patient, Wechat, QQ tools, phone call, text message, mobile application, face-to-face), the number of follow-up (the number of out-patient follow-up, the number of telephone follow-up, and the number of follow-up within 5 years).ResultsA total of 6 437 data items were analyzed for colorectal cancer adjuvant follow-up. ① The follow-up period of five years (2004–2015) was 56.6% (3 642/6 437), and the follow-up time was 0–201, 67 (26, 97) months. ② The highest data composition ratio of survival outcomes was “Survival” (79.7%, 4 611/5 787), and in the data with five-year follow-up period (2004–2015), the highest data composition ratio of survival outcomes was “Survival” (75.0%, 2 550/3 401), and the survival rate of the five-year follow-up period in 2008 was the highest (91.4%, 235/257). ③ The highest data composition ratio of the coping styles was the doctors’ active follow-up (76.8%, 2 121/2 762). ④ The highest data composition ratio of the follow-up path was out-patient service (90.6%, 4 236/4 676). ⑤ The highest data composition ratio of the number of out-patient follow-up was conducted by the original surgical team (100%, 4 380/4 380), the specific number was 0–130、5 (2, 10) times. The data composition ratio of telephone follow-up was 86.9% (3 808/4 380) and the specific number was 0–68、0 (0, 1) times. The highest frequency of follow-up was in the first year (89.9%, 3 044/3 386) and the specific number was 0–73、5 (3, 9) times.ConclusionBy expounding the characteristics of the colorectal cancer follow-up from colorectal cancer in DACCA, it provides some references for using big data to determine prognosis.
ObjectiveTo investigate the progress and controversy of membrane anatomy theory in laparoscopic surgery for mid-low rectal cancer. MethodThe literature related to membrane anatomy theory in recent years was reviewed and summarized. ResultsThe membrane anatomy theory not only improved the effect of total mesorectal excision, ensured the integrity of the mesorectum, more standardized the operation and principles of rectal cancer surgery, but also provided the operator with a broad vision and clear anatomical hierarchy. The theory of membrane anatomy had important clinical significance for tumor radical resection, organ resection and functional protection. However, this theory had not been unified, and the establishment of membrane plane and the choice of surgical plane were still needed to be studied and explored. ConclusionAt present, scholars at home still regard the theory of membrane anatomy as the theoretical support and reference basis for the endoscopic treatment of mid-low rectal cancer, which can provide surgeons with new treatment prospects and research direction, and improve the survival expectancy and quality of life of patients with intestinal cancer in the future.
ObjectiveTo analyze the safety and feasibility of laparoscopic intersphincteric resection with stapled colo-anal anastomosis under direct vision for low rectal cancer. MethodsFrom January 2001 to March 2012, 138 patients were underwent intersphincteric resection for low rectal cancer, 45 cases of whom were received laparoscopic surgery and stapled colo-anal anastomosis (SCAA group), and the other 93 cases (55 open and 38 laparoscopic) of whom were received hand-sewn colo-anal anastomosis (HCAA group). The morbidity comparison only involed the data of relevant to the anastomosis. The anus functional outcomes, including those from the Saito function questionnaire and Wexner score, were compared and only involved the data of relevant to the laparoscope. Results①The anastomotic complications rates were similar for the fistula, bleeding, and rectal mucosal prolapse (P > 0.05); the rate of anastomosis leakage and the degree of anastomotic stricture in the SCAA group were significantly lower (or milder) than those in the HCAA group (P=0.001 and P=0.022, respectively).②As for the functional results, the incidence of dyschesia in the SCAA group was significantly lower than that in the HCAA group (P=0.016), and the other 7 items of Saito function questionnaire and Wexner score were similar between these two groups (P > 0.05). ConclusionsCompared with traditional intersphincteric resection for low rectal cancer, laparoscopic surgery with stapled colo-anal anastomosis could reduce the morbidity and the anus function is non-inferior to the former.
Objective To analyse the causes of missed diagnosis in colorectal cancers and improve the early diagnosis. Methods A retrospective analysis was made to investigate the cause of missed diagnosis in 380 cases suffering from colorectal cancers.Results Of the 1 020 patients treated in our hospital in the past ten years (1984-1993), 380 patients were missed diagnosed, with the missed diagnosis rate of 37.3%. The main causes included: ①lacking attention to the early symptoms of colorectal cancers, neglecting the need to conduct certain tests such digital rectal examination and stool occult blood examination, ②delaying of seeking medical advice on the part of the patients, ③being satisfied with the diagnosis and treatment of benign disease, and ④neglecting certain special tests such as enteroscopy and barium enema examination of colon.Conclusion Routine use of rectal touch, occult blood examination and necessary use of special tests such as enteroscopy, barium enema examination of colon in patients suffering from stool change will increase the rate of accurate diagnosis of colorectal cancer.
ObjectiveTo evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.MethodsA literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.ResultsA total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].ConclusionsRobotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.
Objective To summarize the advancement on Lewis-Selectin metastasis pathway and anti-tumor treatment of cimetidine in colorectal cancer.Methods Domestic and international publications involving Lewis-Selectin metastasis pathway and antitumor role of cimetidine in recent years were collected and reviewed. Results The expression of sialyl Lewis X (sLeX) was most significant in Lewis-Selectin metastasis pathway in colorectal cancer. Cancer cells could interact with E-selectin and P-selectin of activated vascular endothelial cells by sLeX ligand on the cell surface, thereby prompting invasion and metastasis. Cimetidine could inhibit the growth of tumor, improve immune response of the host to tumor cell, inhibit angiogenesis of tumor and metastasis. The curative effect of cimetidine on colorectal cancer patients with positive sLeX expression was better than that with negative sLeX expression. Conclusion Lewis-Selectin metastasis pathway is one of the important metastasis pathway in colorectal cancer. Cimetidine can prevent metastasis of colorectal cancer by blocking sLeX expression.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
ObjectiveTo analyze the association between the cultural level and hospitalization management process and length of hospitalization of the colorectal patients served by West China Hospital of Sichuan University as a regional center in the current version of the Database from Colorectal Cancer (DACCA). MethodAccording to the established screening criteria, eligible colorectal cancer patients were collected from the updated version of DACCA on June 29, 2022. The analyzed data items included gender, age, BMI, blood type, marriage, waiting time before admission, preoperative hospitalization time, postoperative hospitalization time, total hospitalization time, and management process, and patients were divided into illiterate group, primary education group, medium education group, and higher education group according to their educational level, then compared the hospitalization management process and length of hospitalization of each group. ResultsA total of 4 765 eligible data were screened, with secondary education being the most prevalent (2 792, 58.6%), followed by primary (1 337, 28.1%) and higher education (417, 8.7%), and illiteracy being the least prevalent (219, 4.6%). In the classification of management processes, “regular” account for the majority (4 219, 88.5%), followed by “enhanced”(274, 5.8%), “individual” was third (231, 4.8%), and “rapid” was the least (41, 0.9%). There was no statistically significant difference in the comparison of waiting time before admission, preoperative hospitalisation time and postoperative hospitalisation time among patients with different literacy levels (P=0.371, P=0.095, P=0.352), but there was a statistically significant difference in total hospitalisation time (P=0.021), with a significant difference in total hospitalisation length between illiterate patients and patients with medium education (P=0.041). There was no statistically significant difference in the comparison of inpatient management processes of patients in different literacy groups (χ2=15.2, P=0.085). ConclusionsAnalysis of the DACCA data revealed a statistically significant difference in total hospitalisation time between patients with illiteracy and those with medium education. However, the choice of hospitalisation management process was similar for patients with different literacy levels, which needs to be further analysed for the reasons.
ObjectiveTo analyze the relation between the marital status of patients with colorectal cancer and surgical treatment options decision-making and outcomes in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe version of DACCA selected for this analysis was updated on August 31, 2022. The patients were enrolled according to the established screening criteria and then assigned to 3 groups: the unmarried, married, and divorced or widowed groups. The differences in the surgical modality decisions, surgical quality, and surgical complications among these 3 groups were analyzed. ResultsA total of 7 634 data that met the screened criteria were enrolled. It was found that the difference in the composition of the willingness to conserve anus among patients with different marital status was statistically significant (χ2=28.635, P<0.001), reflecting that the willingness to conserve anus was “strong” among unmarried and married patients, and the overall willingness to conserve anus was relatively more positive among unmarried patients, while the willingness to conserve anus was “rational” among widowed or divorced patients. No statistical differences were found in the surgical modality decisions (rectal surgery: χ2=0.493, P=0.782; colon surgery: χ2=0.213, P=0.899), including the presence of prophylactic stoma for the patient with radical resection (χ2=5.156, P=0.076）, surgical quality (H=3.452, P=0.178）, presence of surgical in-hospital complications (χ2=1.663, P=0.435), and the presence of short-term surgical complications (χ2=1.695, P=0.428). ConclusionsAnalysis of the data in DACCA reveals that there is difference in willingness to preserve anus among colorectal cancer patients with different marital status. Married and unmarried patients have stronger anal preservation intention, suggesting that clinical care and family support should be strengthened during clinical diagnosis and treatment.