[Efficacy and safety of sunitinib on patients with imatinib-resistant gastrointestinal stromal tumor]

OBJECTIVE

To investigate the efficacy and safety of sunitinib on the management of gastrointestinal stromal tumors (GIST) patients with imatinib resistance.

METHODS

Clinical data of 48 patients with imatinib-resistant GIST received sunitinib therapy from May 2008 to April 2012 in the Union Hospital of Fujian Medical University were analyzed retrospectively. Eighteen patients received 50 mg/d of sunitinib in a protocol of 4/2 (4 weeks on and 2 weeks off) [50 mg/d (4/2)], and 30 patients received a protocol of 37.5 mg of sunitinib continuous daily dose (37.5 mg/d CDD).

RESULTS

The median duration of sunitinib administration of all the 48 patients was 56 weeks, and the short-term efficacy was evaluated at 24 weeks after the initial treatment according to the Choi criteria. The response rate was 27.1% (13/48), including 1 case with complete response (CR), 12 cases with partial response (PR), and 21 cases with stationary disease (SD). The disease control rate was 70.8% (34/48). The mean follow-up time of 48 patients was 89 weeks. The median progression-free survival (PFS) and overall survival (OS) were 48 weeks and 92 weeks respectively. Stratified analyses indicated that the median PFS of patients previously treated by imatinib 400 mg/d and >400 mg/d were 53 weeks and 35 weeks respectively (P=0.018), and the median OS of these two groups were 157 weeks and 71 weeks respectively (P=0.003). Patients with exon 11 mutations had a significantly shorter OS compared with those with exon 9 mutations (71 weeks vs 157 weeks, P=0.008). Hand-foot syndrome was the most common adverse effect (25/48, 52.1%), followed by nausea (24/48, 50.0%), fatigue (23/48, 47.9%), neutropenia(21/48, 41.7%). The sub-group analysis of two protocols of sunitinib administration showed that the incidence of diarrhea and hand-foot syndrome were higher in 50 mg/d (4/2) group than those in 37.5 mg/d CDD group (P=0.027, P=0.048).

CONCLUSIONS

Sunitinib is effective for the patients with imatinib-resistant GIST. After 400 mg/d imatinib treatment failure, sunitinib should be prescribed instead of increased dosage of imatinib. Patients with KIT exon 9 mutations present better prognosis than those with KIT exon 11 mutations. The protocol of sunitinib 37.5 mg/d CDD possesses better safety.

Laparoscopic extralevator abdominoperineal resection for rectal carcinoma with transabdominal levator transection

BACKGROUND

The extralevator abdominoperineal resection (ELAPR) is a new surgical technique for patients with low advanced rectal cancer. This technique requires an extra excision of the levator muscles to avoid the surgical waist caused by the conventional abdominoperineal resection, with the patient's position changed to a prone jackknife position and using a myocutaneous flap to repair the pelvic defect. To simplify this operation, we applied a laparoscopic technique to perform controlled transabdominal transection of the levator muscles under direct visualization without a position change and pelvic floor reconstruction using human acellular dermal matrix (HADM).

METHODS

In our department from 2010-2011, six patients with rectal adenocarcinoma within 3 cm of the anal verge underwent laparoscopic ELAPR with transabdominal levator transection, with no position change during the perineal operation. In three patients, pelvic reconstruction was performed with HADM.

RESULTS

All procedures were successfully performed without any intraoperative complications, laparoscopy-associated morbidity, or conversion to the open approach. The mean operation time and intraoperative blood loss were 186.7 min and 101.7 ml. All specimens had a cylindrical shape with levator muscles attached to the mesorectum and negative circumferential margins. No complications were seen with the use of HADM.

CONCLUSIONS

Laparoscopic transabdominal transection of the levator muscles without position change and with pelvic floor reconstruction using human acellular dermal matrix mesh is feasible. With the transection of the levator muscles under laparoscopic surveillance, the procedure of the extralevator abdominoperineal resection, which is aggressively invasive and operatively complicated, is simplified and has an advantage of minimal invasiveness.

[Comparison of the incidence of postoperative ileus following laparoscopic and open radical resection for colorectal cancer: a meta-analysis]

OBJECTIVE

To compare the incidence of postoperative ileus following laparoscopic and open radical resection for colorectal cancer using meta-analysis.

METHODS

The Cochrane library, Pubmed, Ovid databases were searched as of October 2011. Two reviewers extracted the data and assessed the methodological quality independently. The homogeneity of studies was evaluated and the meta-analysis was conducted by the Cochrane Collaboration RevMan 5.0 software.

RESULTS

Seven studies including 3630 cases were analyzed. A total of 1814 patients received laparoscopic surgery, of whom 58 developed postoperative ileus. There were 1816 cases undergoing open surgery, of whom 105 developed early postoperative ileus. The pooled relative risk was 0.55 with a 95% confidence interval of 0.41-0.76. The difference was statistically significant(P<0.01).

CONCLUSION

Compared with open surgery, laparoscopic colorectal resection can reduce the incidence of postoperative ileus.

[Comparison of the incidence of postoperative complications following laparoscopic and open colorectal cancer resection]

OBJECTIVE

To compare the postoperative complications following laparoscopic and open colorectal cancer resection.

METHODS

From January 2000 to September 2011, 910 patients underwent laparoscopic surgery and 434 open surgery. The postoperative complications were compared between the two groups.

RESULTS

Forty-eight patients (5.3%, 48/910) in the laparoscopic group were converted to open operation, of whom 36 (75.0%, 36/48) were due to difficulty in procedure and exposure from obesity and narrow pelvis. The overall complication rate was 20.3% (185/910) in the laparoscopic group and 25.3%(110/434) in the open group (χ2=4.316, P<0.05). For patients with a diverting stoma, the anastomotic leak rate was 2.1% (3/145) and 2.2% (2/93) (χ2=0.002, P>0.05), anastomotic bleeding rate was 3.4% (5/145) and 4.3% (4/93) (χ2=0.113, P>0.05). For patients without a diverting stoma, the anastomotic leak rate was 3.1% (22/699) and 1.0% (3/301) (χ2=3.993, P<0.05), anastomotic bleeding rate was 1.6% (11/699) and 2.3% (7/301) (χ2=0.673, P>0.05), bowel obstruction rate was 3.4% (31/910) and 5.8% (25/434) (χ2=4.077, P<0.05), chyle leak rate was 5.8% (53/910) and 3.7% (16/434) (χ2=2.757, P>0.05), urinary retention rate was 1.5% (14/910) and 1.6% (7/434) (χ2=0.011, P>0.05), wound infection rate was 2.2% (20/910) and 4.6% (20/434) (χ2=5.913, P<0.05), pulmonary infection rate was 6.4% (58/910) and 10.6% (46/434) (χ2=7.349, P<0.05).

CONCLUSION

The overall postoperative complication rate in laparoscopic surgery is significantly lower than that in open surgery.

[Laparoscopic cylindrical abdominoperineal resection with transabdominal approach for lower rectal cancer]

OBJECTIVE

To evaluate the safety and feasibility of laparoscopic cylindrical abdominoperineal resection.

METHODS

Six patients with rectal adenocarcinoma within 3 cm above the anal verge underwent laparoscopic cylindrical abdominoperineal resection. Transabdominal levator transaction was performed laparoscopically, with no position change during the perineal operation. Pelvic reconstruction was achieved using human acellular dermal matrix mesh in 3 patients.

RESULTS

All the procedures were successfully performed without any intraoperative complications, laparoscopy-associated complications, or conversion to the open approach. The mean operation time was 186.7 minutes and intraoperative blood loss was 101.7 ml. All the specimens had a cylindrical shape with levator muscles attached to the mesorectum and circumferential margins were all negative. No adverse incidence followed the pelvic reconstruction using human acellular dermal matrix mesh.

CONCLUSIONS

Laparoscopic transabdominal transection of the levator muscles without position change and pelvic floor reconstruction with human acellular dermal matrix mesh is feasible. This procedure simplifies cylindrical abdominoperineal resection which is aggressively invasive and technically complicated. The oncologic outcomes are acceptable and complications are less.

Lentivirus-mediated RNA interference targeting WWTR1 in human colorectal cancer cells inhibits cell proliferation in vitro and tumor growth in vivo

WW domain-containing transcription regulator 1 (WWTR1) was initially identified as a transcriptional coactivator involved in the differentiation of stem cells as well as the development of multiple organs. Recently, WWTR1 has also been identified as a major component of the novel Hippo signalling pathway important for the development of breast and lung cancer. Here, we show for the first time that WWTR1 has an oncogenic function in colorectal cancer cell lines. Knockdown of WWTR1 by lentivirus-mediated RNA interference in human colorectal cancer cells significantly decreased cell proliferation and the colony formation of RKO cells in vitro and tumor growth in vivo. Furthermore, we found that the decreased proliferation was due to cell cycle arrest and increased apoptosis. In addition, efficient knockdown of WWTR1, demonstrated by quantitative real-time PCR, led to upregulation of ASNS and downregulation of SMAD3, LTBR, BAX and BAK1 in WWTR1 knockdown cells, suggesting that these genes may be involved in the repression of cell proliferation. Our findings indicate that WWTR1 is an oncogene and has an important role in the proliferation of colorectal cancer cells and in tumor growth in vivo.

[Diagnosis and treatment of abdominal chyle leak after resection of colorectal cancer]

Chyle leak is a rare complication after abdominal surgery. According to the statistical results from our center, we summarized the experiences in the diagnosis, treatment and prevention of abdominal chyle leak after radical resection of colorectal cancer. Early prevention, early diagnosis, and early treatment may result in earlier recovery, shorter hospital stay, lower incidence, and better prognosis.

Identification of Nkx2-3 and TGFB1I1 expression levels as potential biomarkers to predict the effects of FOLFOX4 chemotherapy

This study was designed to detect global gene expressions of primary advanced colorectal cancer (ACC) patients who have undergone FOLFOX4 chemotherapy and screen valuable biomarkers to predict the effects of chemotherapy. Samples from primary ACC patients who have undergone FOLFOX4 chemotherapy were collected. Their chemotherapy effects were evaluated and divided into chemotherapy sensitive group (experimental group) and non-sensitive group (control group). Cancerous tissue gene expression profiles were detected by chip technology. Two groups with differentially expressed genes were screened by cluster analysis and significance analysis of microarrays (SAM). Valuable biomarkers were screened by bioinformatics analysis. Immunohistochemical analysis was performed to characterize the pattern of Nkx2-3 and TGFB1I1 expression. Nkx2-3 and TGFB1I1 signal log ratio were used Receiver Operating Characteristic (ROC) analyses to calculate its own predicting accuracy. Thirty cases were divided into experimental group (13 cases) and control group (17 cases). There was evident difference in the tumor cell biology states of the two groups; that is, 25 ESTs (21 genes) were upregulated and 5 ESTs (5 genes) were downregulated. Nkx2-3 protein was observed on the nucleus of the cancer cells and TGFB1I1 protein was observed on the nucleus and cytoplasm of the cancer cells in experimental group. Their prediction accuracies were 85.3% and 76.7% respectively. Nkx2-3 and TGFB1I1 expressions in control group are very low, but highly expressed in the experimental group; Nkx2-3 and TGFB1I1 may be classified as valuable biomarkers, as these can predict the effects of primary ACC patients who will undergo FOLFOX4.

[Risk factors of postoperative chyle leak following complete mesocolic excision for colon cancer]

OBJECTIVE

To investigate the incidence, risk factors and preventative methods associated with chyle leak following complete mesocolic excision(CME) for colon cancer.

METHODS

Clinical data of 592 patients with colon cancer undergoing CME in the department of Colorectal Surgery in the Fujian Medical University Union Hospital from September 2000 to September 2011 were analyzed retrospectively.

RESULTS

Chyle leak occurred in 46 patients(7.7%). The incidence of postoperative chyle leak following right CME hemicolectomy was 13.3%(30/226), significantly higher than that after left CME hemicolectomy (4.4%). On univariate analysis, chyle leak following CME was associated with tumor size(P<0.05), tumor location(P<0.01), and lymph nodes harvested(P<0.01). Multivariate logistic regression revealed that tumor location and lymph nodes harvested were independent risk factors associated with chyle leak following CME(P<0.05).

CONCLUSIONS

Tumor location and lymph nodes harvested are independent risk factors for chyle leak following complete mesocolic excision for colon cancer. When the drainage output suddenly increases after oral intake resumption, the chyle test of ascitic fluid should be performed for early diagnosis and prompt management.

Optimizing the efficacy of first-line chemotherapy plus bevacizumab in metastatic colorectal cancer: analysis of multiple methods

OBJECTIVE

To assess the efficacy and safety of first-line standard chemotherapy plus bevacizumab in metastatic colorectal cancer and to explore how to optimize therapeutic efficacy.

DESIGN

First, meta-analysis and pooled analysis of three randomized, controlled trials were used to compare response rate (RR), progression-free survival (PFS), overall survival (OS), and grade 3 or 4 adverse events (G3/4AEs) of chemotherapy plus bevacizumab (n = 1169) with those of chemotherapy alone (n = 1148). Second, using six different regimens plus bevacizumab, the Spearman method was used to analyze the correlation between these regimens and OS. Finally, one-way ANOVA was used to compare OS in these regimens.

RESULTS

Overall, chemotherapy plus bevacizumab increased RR by 3.8%, prolonged PFS by 3.0 months and OS by 3.3 months, and increased G3/4AEs by 7.6%. Significant differences were found in PFS (hazard ratio [HR] = 0.65; p = 0.000), OS (HR = 0.79; p = 0.000), and G3/4AEs (risk ratio = 1.12; p = 0.006). However, no statistical difference was found in RR (odds ratio = 1.32; p = 0.17). The optimal regimens with regard to mean OS were capecitabine and irinotecan (CAPIRI) plus bevacizumab (24.00 months) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab (23.97 months).

CONCLUSION

First-line standard chemotherapy plus bevacizumab conferred a significant improvement in OS. In combination with bevacizumab, both CAPIRI and FOLFOX are favorable regimens, though further studies are needed to confirm these results.

Long-term outcomes of laparoscopic surgery versus open resection for middle and lower rectal cancer: an NTCLES study

BACKGROUND

Prognoses for treatment of middle and lower rectal cancer remain unclear because anatomical and complex surgical procedures specifically influence long-term outcomes. This study analyzes the long-term outcomes of laparoscopic versus open resection for middle and lower rectal cancer.

METHODS

Patients (laparoscopic, n = 113; open, n = 123) who underwent curative resection for middle and lower rectal cancer from 2000 to 2005 participated in the study. All operations were performed by the same surgical team with extensive experience in laparoscopic and open procedures. The mean follow-up time of all patients was 74.8 months.

RESULTS

No statistical differences in local recurrence rate (9.1% vs. 6.4%; log-rank = 0.432; p = 0.511) and in distant recurrence rate (19.7% vs. 15.5%; log-rank = 0.505; p = 0.477) between laparoscopic and open groups were observed within 5 years. The 5-year overall survival rates of the laparoscopic and open groups were 77.9 and 78.9%, respectively; no significant statistical difference was observed between them (log-rank = 0.012; p = 0.913). The 5-year survival rates between groups were not different between stages: stage I (91.7% vs. 92.0%; p = 0.950), stage II (82.8% vs. 79.4%; p = 0.643), and stage III (66.7% vs. 70.3%; p = 0.850). However, significant statistical differences between different stages were observed (log-rank = 11.156; p = 0.004).

CONCLUSION

Laparoscopic and open surgery for middle and lower rectal cancer offer similar long-term outcomes. The continued use of laparoscopic surgery in these patients can be supported.

Role of SUMO-1, MDM2 and P53 in 5-flurouracil-induced apoptosis of HepG2 cells

AIM: To investigate the role of small ubiquitin-like modifier-1 (SUMO-1), murine double minute gene 2 (MDM2) and P53 in 5-flurouracil (5-Fu)-induced apoptosis of HepG2 cells.

METHODS: Non-transfected HepG2 cells and HepG2 cells transfected with pMDM2 and pSUMO-1 plasmids, alone or both, were treated with different concentrations of 5-Fu for 36 hours. The expression of endogenous P53 protein in HepG2 cells was detected by Western blot.

RESULTS: Treatment with 5-Fu significantly increased the relative expression level of endogenous P53 protein and the apoptosis rate of HepG2 cells in a concentration-dependent manner (90.15% ± 4.22% vs 11.27% ± 1.18%, 33.61% ± 3.15% vs 3.22% ± 0.60%, both P < 0.05). Cells transfected with the pMDM2 plasmid had an apparent resistance to 5-Fu-induced apoptosis of HepG2 cells. The relative expression level of P53 protein and the apoptosis rate in cells transfected with the pMDM2 plasmid were much lower than those in non-transfected cells treated with the same concentration of 5-Fu (51.80% ± 0.78% vs 90.15% ± 4.22%; 20.45% ± 2.23% vs 33.61% ± 3.15%, both P < 0.05). No significant differences were noted in the relative expression level of P53 protein and the apoptosis rate between cells co-transfected with the pSUMO-1 and pMDM2 plasmids and non-transfected cells (78.85% ± 2.43% vs 51.80% ± 0.78%, 29.83% ± 0.53% vs 20.45% ± 2.23%, both P < 0.05).

CONCLUSION: SUMO-1 could inhibit MDM2-induced degradation of P53 protein and enhance the nuclear expression of P53, thus promoting 5-Fu-induced cell apoptosis and elevating chemosensitivity.

Evolution of the management of colorectal cancer using integrative medicine

Colorectal cancer (CRC) remains one of the major causes of cancer death worldwide. In recent years, the development of new and effective management options, such as fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET), total mesorectal excision (TME) and monoclonal antibody novel "targeted" therapies has led to a considerable improvement in the outcome of this disease. In China, studies on CRC using integrative medicine (IM) have made remarkable progress. We therefore review the recent developments in CRC treatment through IM and Western medicine, including research studies such as the exploitation of Chinese herbs for the disruption of the tumor cell cycle or inhibition of tumor cell proliferation, induction of tumor cell apoptosis, improvement of the immune system, and the curative effect of chemotherapy. We also examine clinical studies such as those on special prescriptions and medicines and IM in anti-cancer therapy. Particularly, we analyze the advantages and disadvantages of management with IM, and propose a suggestion for the management of colorectal cancer with IM, such as screening for effective prescriptions. We also analyze Chinese medicine, studying the pharmacologic mechanism of its anti-cancer effect, further strengthening the study of IM on CRC.

Identification of prohibitin as a potential biomarker for colorectal carcinoma based on proteomics technology

Differential protein expression was analyzed in carcinoma tissue to determine the correlation between protein levels and the clinical and pathological parameters of patients with colorectal carcinomas (CRC). Two-dimensional electrophoresis (2-DE) revealed 40 protein spots that were differentially expressed at two or greater fold difference in CRC that were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/TOF MS). Among these proteins, prohibitin (PHB) was found to be overexpressed in CRC. It was selected for Western blot and immunohistochemistry assay in subsequent tissue microassays (TMA). Thirty-five distinct proteins were differentially expressed at least 2-fold among normal and CRC tissues. The expression of 17 proteins, including PHB, was increased by >2-fold in CRC tissues (p<0.01). Immunohistochemistry and Western blot assays found that PHB was overexpressed in CRC cases, and the expression was higher than adenoma and normal tissues (p<0.01), whereas there was no significant difference in expression of PHB between adenoma and normal tissues. Immunohistochemistry also suggested a link between PHB expression and poor differentiation (p<0.01). However, there was no difference in UICC stage, or location of CRC. Survival analysis suggested no significant correlation between PHB expression and poor prognosis. In summary, the overexpression of PHB might be associated with the transformation process from adenoma to CRC. Further, it is a potential diagnostic and differentiation biomarker of CRC in the clinic.

[Treatment of chyle leak following radical resection for colorectal cancer]

OBJECTIVE

To investigate the treatment of chyle leak following radical resection for colorectal cancer.

METHODS

The incidence of chyle leak was compared between the different surgical approaches (open vs. laparoscopic) as well as different tumor locations (right, left colon or rectum) in 1259 patients undergoing radical resection for colorectal cancer.

RESULTS

Overall incidence of chyle leak was 3.6% (46/1259) after surgery. Forty-five patients were successfully managed by conservative treatment and one patient required re-operation. No patients died. The incidence of chyle leak was not significantly different between the open (3.2%, 18/570) and laparoscopic (4.1%, 28/689) groups (P>0.05). However, right colectomy was associated with a significantly higher rate of chyle leak (9.6%, 16/167) as compared to left colectomy(2.6%, 7/268) and anterior resection (2.8%, 23/824) (P<0.05).

CONCLUSIONS

Conservative treatment is effective in early stage of chyle leak after radical resection for colorectal cancer. Right colectomy is associated with higher risk for chyle leak.

[Clinical study of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy for serosa-involved colorectal cancer]

OBJECTIVE

To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer.

METHODS

According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group(n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group(n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival(OS) rate of two groups were compared.

RESULTS

3-year and 5-year OS rates of stage II(B in study group were similar to those in control group(chi(2)=0.612,P=0.434). The above rates of stage III( in study group were higher than those in control group(chi(2)=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar(P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%,3.8% and 3.8% respectively, lower than those in control group(8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin(0.9% vs 8.8%,P=0.019), while the incidences of local recurrence and other distant metastasis were similar.

CONCLUSIONS

Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage III( serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliplatin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and 5-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.

[Comparing the influencing factors of anastomotic bleeding in rectal carcinoma resection between laparoscopic and open radical approaches]

OBJECTIVE

To observe the occurrence of anastomotic bleeding following laparoscopic and open radical resection for rectal carcinoma, and to explore its contributing factors.

METHODS

Two hundred and sixty-three cases of rectal carcinoma undergone radical resection were divided into 2 groups, laparoscopic surgery (LS) group (n=86) and open surgery (OS) group (n=177). According to the different locations of anastomotic stoma and with or without preventive colostomy, the two groups were divided into AR sub-group and LAR/UAR sub-group, colostomy sub-group and non-colostomy sub-group. After analyzing the incidence of anastomotic bleeding in each sub-group, a logistic regression model was established to determine the relationships between anastomotic bleeding and three contributing factors including surgical approaches (LS or OS), location of stoma (AR or LAR/UAR) and preventive colostomy.

RESULTS

Anastomotic bleeding occurred on 16 out of 263 patients with radical resection of rectal cancer (6.1%). The rates of anastomotic bleeding in LS group and OS group were 9.3% and 4.5%, in colostomy and non-colostomy were 8.1% and 5.5%, and in AR group and LAR/UAR group were 3.3% and 12.1% respectively, there were no significant differences between them (P>0.05). Comparing the two different surgical approaches (LS vs OS), the coefficient of regression, odd ratio and standard coefficient of regression for LS were 1.319, 3.741 and 0.342 respectively. In comparison of the locations of anastomosis (AR vs LAR/UAR), the three index for LAR/UAR were 2.460, 11.704, and 0.632 respectively. Comparing colostomy with non-colostomy, the three index for colostomy were -1.394, 0.248, and -0.327 respectively.

CONCLUSIONS

Anastomotic bleeding after radical rectectomy is related to the choice of surgical approach, location of anastomosis and with or without preventive colostomy. Both LS and LAR/UAR are risk factors, and preventive colostomy is a protective factor. Regarding to the significance of three factors, location of anastomosis takes the first place, following by surgical method and with or without preventive colostomy.

[Comparison of the incidence rates of anastomotic leak following lower anterior resection of rectal cancer between laparoscopic and open operation]

OBJECTIVE

To investigate and compare the incidence rates of postoperative anastomotic leak following laparoscopic (LP) versus open (OP) lower anterior resection for rectal cancer.

METHODS

Fifty-three cases of LP and 135 cases of OP lower anterior resection with rectal cancer site 5-8 cm away from anal edge were operated by the same surgeon team from Sep. 2000 to Dec. 2005. The differences of postoperative anastomotic leak of protective stomy and non-protective stomy between LP and OP groups were analysed.

RESULTS

In LP group, the incidence rates of the postoperative anastomotic leak of protective stomy and non-protective stomy were 4.6% (1/22) and 6.5% (2/31) respectively (P>0.05, chi(2)=0.088). In OP group, the incidence rates were 2.3% (1/43) and 8.7% (8/92) respectively (P>0.05, chi(2)=1.024). No significant difference existed between LP and OP groups with protective stomy (P=0.455), neither did LP and OP groups without protective stomy (P=0.288).

CONCLUSION

Laparoscopic low anterior resection of rectal cancer is a safe procedure. It doesn't increase the incidence rate of anastomotic leak as compared to traditional open surgery.