No abstract

Background and Objectives: There is no consensus on the safety and indications of lateral pelvic lymph node dissection (LPND) for patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT).Methods: We retrospectively analyzed 151 patients who underwent total mesorectal excision (TME) + LPND and divided them into two groups: nCRT group (n = 73) and non-nCRT group (n = 78).Results: Thirty-one (20.5%) patients had LPNM by pathology. The operative time was significantly longer in the nCRT group (291.9 vs. 237.0 min, p < 0.001); however, the two groups had comparable intraoperative blood loss (87.3 vs. 78.9 ml, p = 0.607) and morbidity (19.2% vs. 15.7%, p = 0.537). Additionally, in the nCRT group, multivariate logistic regression analysis showed that poor/mucinous/signet adenocarcinoma (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 1.03-43.03, p = 0.047) and post-nCRT LPN size ≥7 mm (OR = 26.67, 95% CI = 2.87-247.91, p = 0.004) were independent risk factors for pathological LPNM.Conclusion: nCRT before TME + LPND is safe and feasible with a comparably low mortality and acceptable morbidity. Poor/mucinous/signet adenocarcinoma and post-nCRT LPN size ≥7 mm were independent predictive factors of pathological LPNM after nCRT for rectal cancer patients with clinical LPNM, and patients with these characteristics should consider LPND after nCRT.

Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective routine treatments for colorectal peritoneal metastasis (PM). However, the safety and efficacy of neoadjuvant chemotherapy (NAC) before CRS+HIPEC are poorly understood. Therefore, this study aimed to assess the perioperative safety and long-term efficacy of NAC prior to CRS+HIPEC for patients with synchronous colorectal PM. Methods Patients with synchronous colorectal PM who received NAC prior to CRS+HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. The clinicopathologic characteristics, perioperative parameters, and survival rates of patients who underwent CRS+HIPEC with NAC (NAC group) and patients who underwent CRS+HIPEC without NAC (non-NAC group) were compared. Results The study enrolled 52 patients, with 20 patients in the NAC group and 32 in the non-NAC group. In the NAC group, the proportion of patients with a peritoneal carcinomatosis index (PCI) score < 12 was significantly higher than that in the non-NAC group (80.0% vs 50.0%, P = 0.031), and more patients achieved complete cytoreduction (80.0% vs 46.9%, P = 0.018). The two groups had comparable grade III/IV complications and similar reoperation and mortality rates (P > 0.05). However, patients who received NAC had lower platelet counts (151.9 vs 197.7 × 109/L, P = 0.036) and neutrophil counts (4.7 vs 7.2 × 109/L, P = 0.030) on postoperative day 1. More patients survived for 2 years in the NAC group than in the non-NAC group (67.4% vs 32.2%, respectively, P = 0.044). However, the completeness of cytoreduction score (HR, 2.99; 95% CI, 1.14–7.84; P = 0.026), rather than NAC, was independently associated with overall survival (OS) in the multivariate analysis after controlling for confounding factors. Conclusion NAC administration before CRS+HIPEC can be regarded as safe and feasible for patients with colorectal PM with comparably low mortality rates and acceptable morbidity rates. Nevertheless, large-sample randomized controlled studies are needed to confirm whether the administration of NAC before CRS+HIPEC confers a survival benefit to patients.

Paeonia lactiflora Pall., one of the most famous classical herbal medicine, has been used to treat diseases for over 1200 years. In this research, the functional ingredients were purified by online‐switch two‐dimensional high‐speed counter‐current chromatography combined with inner‐recycling and continuous injection mode. The antioxidant activity was evaluated by investigating the 2,2′‐azobis (2‐amidinopropane) dihydrochloride‐induced oxidant damage in vitro and confirmed through molecular docking. n‐Butanol/ethyl acetate/water (2:3:5, v/v) solvent system was used for the first‐dimensional separation and optimized the sample loading. Two pure compounds and a polyphenol‐enriched fraction were separated. The polyphenol‐enriched fraction was separated with a solvent system n‐hexane/ethyl acetate/methanol/water (2:8:4:6, v/v) with continuous injection mode. Five compounds were successfully separated, including gallic acid (1), methyl gallate (2), albiflorin (3), paeoniflorin (4), and ethyl gallate (5). Their structures were identified by mass spectrometry and NMR spectroscopy. The results from the antioxidant effect showed that albiflorin had stronger antioxidant activity. Molecular docking results indicated that the affinity energy of the identified compounds ranged from ‐3.79 to ‐8.22 kcal/mol and albiflorin showed the lowest affinity energy. Overall, all those findings suggested that the strong antioxidant capacity of albiflorin can be potentially used for the treatment of diseases caused by oxidation.

No abstract

Aim It is still controversial whether the addition of lateral pelvic lymph node (LPN) dissection (LPND) to total mesorectal excision (TME) can provide a survival benefit after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients with pathological lateral lymph node metastasis (LPNM). Methods Patients with clinically suspected LPNM who underwent nCRT followed by TME + LPND were systematically reviewed and divided into the positive LPN group (n = 15) and the negative LPN group (n = 58). Baseline characteristics, clinicopathological data and survival outcomes were collected and analysed. Results Of the 73 patients undergoing TME + LPND after nCRT, the pathological LPNM rate was 20.5% (15/73). Multivariate analysis showed that a post-nCRT LPN short diameter ≥ 7 mm (OR 49.65; 95% CI 3.98–619.1; P = 0.002) and lymphatic invasion (OR 9.23; 95% CI 1.28–66.35; P = 0.027) were independent risk factors for pathological LPNM. The overall recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM (60.0% vs 27.6%, P = 0.018). Multivariate regression analysis identified that LPNM was an independent risk factor not only for overall survival (OS) (HR 3.82; 95% CI 1.19–12.25; P = 0.024) but also for disease-free survival (DFS) (HR 2.33; 95% CI 1.02–5.14; P = 0.044). Moreover, N1-N2 stage was another independent risk factor for OS (HR 7.41; 95% CI 1.63–33.75; P = 0.010). Conclusions Post-nCRT LPN short diameter ≥ 7 mm and lymphatic invasion were risk factors for pathological LPNM after nCRT. Furthermore, patients with pathological LPNM still show an elevated overall recurrence rate and poor prognosis after TME + LPND. Strict patient selection and intensive perioperative chemotherapy are crucial factors to ensure the efficacy of LPND.

Background It is unclear whether neoadjuvant chemoradiotherapy (nCRT) has a deleterious influence on urogenital function in rectal cancer patients who undergone lateral lymph node dissection (LLND). The purpose of this study was to determine the incidence of urogenital dysfunction following total mesorectal excision (TME) + LLND with or without nCRT for mid-low rectal cancer, as well as to investigate the factors that predict urogenital dysfunction. Methods From January 2015 to December 2020, a total of 106 consecutive patients who underwent TME + LLND surgery for mid-low rectal cancer were reviewed. Patients were divided into two groups based on whether they had undergone nCRT (n=51) or not (n=55). Results Overall, 106 patients responded to the questionnaires. nCRT was not associated with urinary dysfunction [International Prostatic Symptom Score (IPSS): 9.86 vs. 9.43, P=0.778; postoperative urinary dysfunction: 51.0% vs. 34.5%, P=0.087] or male sexual dysfunction [International Index Erectile Function (IIEF) score: 18.45 vs. 18.42, P=0.980; postoperative sexual dysfunction: 61.3% vs. 54.8%, P=0.607]. According to the univariable analyses, tumour distance from the anal verge ≤4 cm (P=0.029) and type of operation (P=0.020) were associated with an increased risk of urinary dysfunction; patients’ age (P=0.026) and type of LLND (P=0.044) were candidate risk factors for male sexual dysfunction. However, multivariable analyses showed that tumour distance from the anal verge was independently associated with urinary dysfunction (OR =2.505; 95% CI: 1.080–5.813; P=0.032); patients’ age was an independent risk factor for male sexual dysfunction (OR =3.654; 95% CI: 1.028–12.982; P=0.045). Conclusions In rectal cancer patients who had LLND, nCRT showed no significant additive effect on genitourinary function as compared to individuals who had TME + LLND alone. Urinary dysfunction was linked to the distance between the tumor and the anal margin, while age was an independent predictor of sexual dysfunction.

Background The aim of this study was to evaluate the efficacy of lateral pelvic lymph node (LPN) dissection (LPND) for rectal cancer patients with LPN metastasis (LPNM) and investigate the impact of LPNM on prognosis. Methods One hundred twenty-five matched pairs were selected and divided into the total mesorectal excision (TME) group and TME + LPND group for evaluation after propensity matching. Results No significant difference was observed in the 3-year local recurrence rate between the TME group and the TME + LPND group (10.7% vs 8.8%, P = 0.817); however, the rate of distant metastasis after TME + LPND was significantly higher (15.2% vs 7.2%, P = 0.044). When the mesorectal LN and LPN groups were subdivided, 3-year RFS was not significantly different between the internal LPN and N2 groups (57.1% vs. 55.3%, P = 0.613). There was no significant difference in RFS between the external group and the stage IV group (49.1% vs. 22.5%, P = 0.302), but RFS in the former group was significantly worse than that in the N2 group (49.1% vs. 55.3%, P = 0.044). Conclusion Although patients with suspected LPNM can achieve satisfactory local control after TME + LPND, systemic metastases are more likely to develop after surgery. Patients limited to internal iliac and obturator LN metastasis appear to achieve a survival benefit from LPND and can be regarded as regional LN metastasis. However, patients with LPNM in the external and common iliac LN metastasis have a poor prognosis that is significantly worse than that of N2 and slightly better than that of stage IV, and LPND should be carefully selected.