Rectal cancer classification is important to determine the preoperative chemoradiation therapy and to select appropriate surgical technique. We reviewed the Western and Japanese rectal cancer classification and we pro...Rectal cancer classification is important to determine the preoperative chemoradiation therapy and to select appropriate surgical technique. We reviewed the Western and Japanese rectal cancer classification and we propose our new classification based of Magnetic resonance imaging(MRI). We determine the relation of the tumor to fixed parameters in MRI, which areperitoneal reflection and levator ani muscle. Then, we classify the rectal cancer into four levels based on tumor distal margin and invasion to MRI parameters. We applied all three classifications to 60 retrospectively collected patients of different rectal cancer distance and we compared our classifications to the others. Based on each level we standardize our surgical approach. For stages Ⅰ-Ⅲ, We found that level Ⅰ where tumor distal margin is located above the peritoneal reflection and all of them were received low anterior resection(LAR) without chemoradiation. Level Ⅱ where tumor distal margin is located from the peritoneal reflection and above the levator ani insertion on the rectum. 90% of them were received LAR ± chemoradiation. Level Ⅲ where tumor distal margin is located at the level of levator ani insertion or invading any part of the levator ani. 60% of them had ULAR + coloanal anastomosis ± chemoradiation. Level Ⅳ where the tumor distal margin is located below the levator ani insertion; 77% were received APR ± chemoradiation. The overall kappa for all levels between surgeons and radiologist was 0.93(95%CI: 0.87-0.99), which is indicating almost perfect agreement. We concluded that the management of rectal tumors differed among each tumor level and our new MRI based classification might facilitate the prediction of surgical and chemoradiation management with better communication among a multidisciplinary team comparing to other classifications.展开更多
目的探讨3.0 T磁共振成像(MRI)联合多层螺旋电子计算机断层扫描(MSCT)对肛瘘临床分型的诊断价值。方法回顾性分析2020年1月至2022年5月在石家庄市中医院经手术证实的126例肛瘘病人临床资料,术前均行3.0 T MRI和MSCT检查。根据Parks分类...目的探讨3.0 T磁共振成像(MRI)联合多层螺旋电子计算机断层扫描(MSCT)对肛瘘临床分型的诊断价值。方法回顾性分析2020年1月至2022年5月在石家庄市中医院经手术证实的126例肛瘘病人临床资料,术前均行3.0 T MRI和MSCT检查。根据Parks分类法对比3.0 T MRI和MSCT对肛瘘病人检查的准确率,分析两项联合对肛瘘临床分型的诊断价值。结果3.0 T MRI联合MSCT诊断肛瘘外口的准确率(99.03%)高于MSCT单独诊断(90.29%),联合诊断主瘘管的准确率(100.00%)高于3.0 T MRI、MSCT各自单独诊断(93.65%、91.27%)(P<0.01),联合诊断肛瘘内口、瘘管分支、脓肿与各自单独诊断比较均差异无统计学意义(P>0.05);3.0 T MRI联合MSCT诊断括约肌间型、经括约肌型、括约肌上型、括约肌外型与手术结果的符合率分别为98.48%、100.00%、100.00%、100.00%。结论3.0 T MRI联合MSCT对肛瘘临床分型有良好的诊断价值。展开更多
For patients with different clinical stages of rectal cancer,tailored surgery is urgently needed.Over the past 10 years,our team has conducted numerous anatomical studies and proposed the“four fasciae and three space...For patients with different clinical stages of rectal cancer,tailored surgery is urgently needed.Over the past 10 years,our team has conducted numerous anatomical studies and proposed the“four fasciae and three spaces”theory to guide rectal cancer surgery.Enlightened by the anatomical basis of the radical hysterectomy classification system of Querleu and Morrow,we proposed a new classification system of radical surgery for rectal cancer based on membrane anatomy.This system categorizes the surgery into four types(A–D)and incorporates corresponding subtypes based on the preservation of the autonomic nerve.Our surgical classification unifies the pelvic membrane anatomical terminology,validates the feasibility of classifying rectal cancer surgery using the theory of“four fasciae and three spaces,”and lays the theoretical groundwork for the future development of unified and standardized classification of radical pelvic tumor surgery.展开更多
目的探讨直肠癌患者神经浸润(perineuralinvasion,PNI)的临床病理特征及其影响因素,为直肠癌治疗方案选择提供依据。方法选取2017年9月~2018年12月安徽医科大学第一附属医院普外科行直肠癌根治术的243例患者临床病理资料。根据有无PNI...目的探讨直肠癌患者神经浸润(perineuralinvasion,PNI)的临床病理特征及其影响因素,为直肠癌治疗方案选择提供依据。方法选取2017年9月~2018年12月安徽医科大学第一附属医院普外科行直肠癌根治术的243例患者临床病理资料。根据有无PNI将患者分为PNI组和无PNI组。收集患者手术前1周内血常规、肿瘤标志物等指标,包括淋巴细胞计数、单核细胞计数、中性粒细胞计数、血小板计数、癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原19-9(Carbohydrate antigen19-9,CA19-9)。记录患者性别、年龄、体重指数(Body mass index,BMI)、原发肿瘤(T分期)、区域淋巴结(N分期)、远处转移(M分期)、Duke分期、临床病理分期(pTNM)、组织学分型、组织分化等级、脉管癌栓、大体分型、肿瘤最大径等相关数据。采用单因素和多因素分析PNI的影响因素。结果两组在年龄、性别、BMI、术前NLR、术前PLR、组织学分型方面差异均无统计学意义(P>0.05),在脉管癌栓、pTNM分期、T分期、N分期、M分期、Duke分期、分化等级、肿瘤直径、大体分型、CEA、CA19-9方面差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明,脉管癌栓、大体分型、分化等级为PNI的独立危险因素。结论术前CEA、CA19-9对PNI有提示作用,多因素分析下,大体分型、分化等级可作为影响直肠癌患者PNI的独立危险因素。展开更多
Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide.Several studies have indicated that rectal cancer is significantly different from colon cancer interms of treatment, prognosis, and metasta...Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide.Several studies have indicated that rectal cancer is significantly different from colon cancer interms of treatment, prognosis, and metastasis. Recently, the differential mRNA expression of coloncancer and rectal cancer has received a great deal of attention. The current study aimed to identifysignificant differences between colon cancer and rectal cancer based on RNA sequencing (RNA-seq)data via support vector machines (SVM). Here, 393 CRC samples from the The Cancer GenomeAtlas (TCGA) database were investigated, including 298 patients with colon cancer and 95 withrectal cancer. Following the random forest (RF) analysis of the mRNA expression data, 96 genessuch as HOXB13, PR4C, and BCLAFI were identified and utilized to build the SVM classificationmodel with the Leave-One-Out Cross-validation (LOOCV) algorithm. In the training (n= 196)and the validation cohorts (n=197), the accuracy (82. 1 % and 82.2 %, respectively) and the AUC(0.87 and 0.91, respectively) indicated that the established optimal SVM classification modeldistinguished colon cancer from rectal cancer reasonably. However, additional experiments arerequired to validate the predicted gene expression levels and functions.展开更多
BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,...BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.展开更多
文摘Rectal cancer classification is important to determine the preoperative chemoradiation therapy and to select appropriate surgical technique. We reviewed the Western and Japanese rectal cancer classification and we propose our new classification based of Magnetic resonance imaging(MRI). We determine the relation of the tumor to fixed parameters in MRI, which areperitoneal reflection and levator ani muscle. Then, we classify the rectal cancer into four levels based on tumor distal margin and invasion to MRI parameters. We applied all three classifications to 60 retrospectively collected patients of different rectal cancer distance and we compared our classifications to the others. Based on each level we standardize our surgical approach. For stages Ⅰ-Ⅲ, We found that level Ⅰ where tumor distal margin is located above the peritoneal reflection and all of them were received low anterior resection(LAR) without chemoradiation. Level Ⅱ where tumor distal margin is located from the peritoneal reflection and above the levator ani insertion on the rectum. 90% of them were received LAR ± chemoradiation. Level Ⅲ where tumor distal margin is located at the level of levator ani insertion or invading any part of the levator ani. 60% of them had ULAR + coloanal anastomosis ± chemoradiation. Level Ⅳ where the tumor distal margin is located below the levator ani insertion; 77% were received APR ± chemoradiation. The overall kappa for all levels between surgeons and radiologist was 0.93(95%CI: 0.87-0.99), which is indicating almost perfect agreement. We concluded that the management of rectal tumors differed among each tumor level and our new MRI based classification might facilitate the prediction of surgical and chemoradiation management with better communication among a multidisciplinary team comparing to other classifications.
文摘目的探讨3.0 T磁共振成像(MRI)联合多层螺旋电子计算机断层扫描(MSCT)对肛瘘临床分型的诊断价值。方法回顾性分析2020年1月至2022年5月在石家庄市中医院经手术证实的126例肛瘘病人临床资料,术前均行3.0 T MRI和MSCT检查。根据Parks分类法对比3.0 T MRI和MSCT对肛瘘病人检查的准确率,分析两项联合对肛瘘临床分型的诊断价值。结果3.0 T MRI联合MSCT诊断肛瘘外口的准确率(99.03%)高于MSCT单独诊断(90.29%),联合诊断主瘘管的准确率(100.00%)高于3.0 T MRI、MSCT各自单独诊断(93.65%、91.27%)(P<0.01),联合诊断肛瘘内口、瘘管分支、脓肿与各自单独诊断比较均差异无统计学意义(P>0.05);3.0 T MRI联合MSCT诊断括约肌间型、经括约肌型、括约肌上型、括约肌外型与手术结果的符合率分别为98.48%、100.00%、100.00%、100.00%。结论3.0 T MRI联合MSCT对肛瘘临床分型有良好的诊断价值。
基金supported by the National Natural Science Foundation of China[No:81874201]Project of Shanghai Medical Innovation Research[No:20Y11908300]Project of Shanghai Municipal Health Commission[No:202040122].
文摘For patients with different clinical stages of rectal cancer,tailored surgery is urgently needed.Over the past 10 years,our team has conducted numerous anatomical studies and proposed the“four fasciae and three spaces”theory to guide rectal cancer surgery.Enlightened by the anatomical basis of the radical hysterectomy classification system of Querleu and Morrow,we proposed a new classification system of radical surgery for rectal cancer based on membrane anatomy.This system categorizes the surgery into four types(A–D)and incorporates corresponding subtypes based on the preservation of the autonomic nerve.Our surgical classification unifies the pelvic membrane anatomical terminology,validates the feasibility of classifying rectal cancer surgery using the theory of“four fasciae and three spaces,”and lays the theoretical groundwork for the future development of unified and standardized classification of radical pelvic tumor surgery.
文摘目的探讨直肠癌患者神经浸润(perineuralinvasion,PNI)的临床病理特征及其影响因素,为直肠癌治疗方案选择提供依据。方法选取2017年9月~2018年12月安徽医科大学第一附属医院普外科行直肠癌根治术的243例患者临床病理资料。根据有无PNI将患者分为PNI组和无PNI组。收集患者手术前1周内血常规、肿瘤标志物等指标,包括淋巴细胞计数、单核细胞计数、中性粒细胞计数、血小板计数、癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原19-9(Carbohydrate antigen19-9,CA19-9)。记录患者性别、年龄、体重指数(Body mass index,BMI)、原发肿瘤(T分期)、区域淋巴结(N分期)、远处转移(M分期)、Duke分期、临床病理分期(pTNM)、组织学分型、组织分化等级、脉管癌栓、大体分型、肿瘤最大径等相关数据。采用单因素和多因素分析PNI的影响因素。结果两组在年龄、性别、BMI、术前NLR、术前PLR、组织学分型方面差异均无统计学意义(P>0.05),在脉管癌栓、pTNM分期、T分期、N分期、M分期、Duke分期、分化等级、肿瘤直径、大体分型、CEA、CA19-9方面差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明,脉管癌栓、大体分型、分化等级为PNI的独立危险因素。结论术前CEA、CA19-9对PNI有提示作用,多因素分析下,大体分型、分化等级可作为影响直肠癌患者PNI的独立危险因素。
基金supported by the Six Talent Peaks Project in Jiangsu Province(No.2014-wsw-017)Beijing Medical Award Foundation(No.YJHYXKYJJ-432)+2 种基金Foundation of Social Development Project of the Science and Technology Department of Jiangsu Province(No.BE2015719)Social Development Key Research and Development Plan of Jiangsu Province(No.BE2017694)The Foundation of Nanjing Medical University(No.2017NJMUZD140).
文摘Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide.Several studies have indicated that rectal cancer is significantly different from colon cancer interms of treatment, prognosis, and metastasis. Recently, the differential mRNA expression of coloncancer and rectal cancer has received a great deal of attention. The current study aimed to identifysignificant differences between colon cancer and rectal cancer based on RNA sequencing (RNA-seq)data via support vector machines (SVM). Here, 393 CRC samples from the The Cancer GenomeAtlas (TCGA) database were investigated, including 298 patients with colon cancer and 95 withrectal cancer. Following the random forest (RF) analysis of the mRNA expression data, 96 genessuch as HOXB13, PR4C, and BCLAFI were identified and utilized to build the SVM classificationmodel with the Leave-One-Out Cross-validation (LOOCV) algorithm. In the training (n= 196)and the validation cohorts (n=197), the accuracy (82. 1 % and 82.2 %, respectively) and the AUC(0.87 and 0.91, respectively) indicated that the established optimal SVM classification modeldistinguished colon cancer from rectal cancer reasonably. However, additional experiments arerequired to validate the predicted gene expression levels and functions.
基金the National Natural Science Foundation of China,No.81874201Technology Plan Project,No.20Y11908300+2 种基金Shanghai Medical Key Specialty Construction Plan,No.ZK2019A19Shanghai Municipal Commission of Health and Family Planning,No.202040122and Shanghai Pujiang Program,No.21PJD066.
文摘BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.
