Minimally invasive treatment of colorectal cancer

By | January 21, 2012

Large intestine (including rectal and colon) epithelial cells from colorectal cancer occurred.
The traditional treatment of colorectal cancer is surgery and chemotherapy. Surgical trauma, bleeding, bowel function recovered slowly, even with a standard colorectal cancer surgery and postoperative chemotherapy and regular treatment, still 10% -20% of patients had local recurrence. Regional lymph node involvement, or violations of adjacent organs, the higher the possibility of local recurrence. About 75% of patients relapse can not be completely resected or not resected, but the application of minimally invasive techniques can overcome these deficiencies. With advances in minimally invasive techniques, the treatment outcome is equal or similar to the traditional surgical method, but the trauma patient body compared with traditional surgical methods were significantly reduced.
Common minimally invasive therapy of colorectal cancer has the following 9 methods:
(1) common minimally invasive treatment of colorectal cancer endoscopic resection of colorectal cancer in the early colonoscopy guided treat colorectal cancer, advanced colorectal cancer can also be used for palliative treatment, previously dominated. Conventional endoscopic snare resection including the removal of heat coagulation, heat removal and biopsy forceps resection coagulation devices, but could easily lead to bleeding, perforation, residual tumor, especially for larger tumors, a wide base, flat element pedicle and depression type of colorectal cancer, more likely. In recent years, some new technique of endoscopic resection of colorectal cancer better efficacy, fewer complications.
endoscopic mucosal resection. Focused on a broad base sessile polyps, flat or sunken lesions.
anal endoscopic micro-surgery, the technique is applicable to the sigmoid colon from the dentate line to the low between the intestinal length of 20cm within the excision.
oxygen knife or laser ablation. Can be used for early or advanced colorectal cancer resection, with no bleeding, mild trauma, quicker recovery and so on. Patients after thermal ablation treatment, can quickly relieve the symptoms of intestinal obstruction, abdominal distention, bloody mucus rapidly reduced physical improvement.
cryosurgery. Colonoscopy can be under the guidance of the tumor with the CO2 or N2O freeze to death, more effective.
(2), photodynamic therapy (PDT)
Is to give patients with systemic photosensitive drugs, 24-48 hours, including fiber to the laser microscope, tumor site, with the appropriate wavelength of the laser local irradiation of tumor, can cause cancer cells to necrosis. Can be used for smaller tumors or larger tumors, the tumor can not be surgery or some other residual tumor after treatment (such as endoscopic laser therapy and endoscopic resection). Patients treated by PDT can significantly ease symptoms, abdominal distension, bloody mucus significantly reduced, improving physical fitness, hemoglobin have different degrees of recovery.
PDT treatment of chemotherapy combined with local applications, improve the outcome.
(3) Laparoscopic resection of colorectal cancer can be used for the surgical resection of right colon and transverse colon; left colon and high, with a median laparoscopic rectal cancer resection; laparoscopic rectal cancer surgery and laparoscopic Miles colectomy.
Laparoscopic treatment of colorectal cancer with less trauma, less blood loss, earlier recovery of intestinal function and shorter hospital stay and postoperative pain and other advantages. Although perforation, bleeding, anastomotic leakage, ureteral injury and the unique complications of pneumoperitoneum, but the overall complication rate of colorectal cancer with traditional radical surgery was no significant difference.
(4) common minimally invasive treatment of colorectal cancer, 125I radioactive seed implantation treatment of advanced pelvic recurrence of colorectal cancer pelvic recurrence after surgery, about 75% of colorectal cancer can no longer be able to complete surgical resection or surgical resection, radiotherapy and chemotherapy at the same time as greater toxicity, but also the choice of treatment can not be longer, and 125 I radioactive particles for this part of the permanent implantation in patients with a new, effective and minimally invasive treatment.
1251 permanent implantation of radioactive particles, can enhance the local tumor radiation dose, but also to ensure minimum damage normal tissue around the tumor. Mainly adapted to the following patients: advanced colorectal cancer without surgical indications; pathologically confirmed pelvic recurrence of colorectal cancer surgery and who can not; no distant metastasis, or even distant metastasis, but the transfer is not life-threatening persons; WBC> = 3X 109 / L, platelets> = 100 X 109 / L, hemoglobin ~ 90g / L.
(5) Electrochemical treatment of rectal cancer surgery on the loss of time or not willing to accept patients with low rectal cancer surgery is an effective treatment. Mainly adapted from a low of less than 7cm anal cancer, surgery can not keep embryos at the gate; the longest tumor diameter <12cm, clinical staging of the Dukes A or less; no serious heart, lung, liver and kidney dysfunction. Reported in the literature overall response rate (complete response rate + partial response rate) was 70%.
(6) perfusion chemotherapy treatment of advanced colorectal cancer perfusion chemotherapy surgery, ie radical tumor resection or palliative line the end of closed abdominal surgery before, heated chemotherapy, many studies have confirmed that the prevention of postoperative local rectal cancer recurrence is an effective method.
After perfusion chemotherapy may be, that is, tumor resection, abdominal cavity puncture perfusion chemotherapy, the clinical effect is also very good. Local radio can also be heated by microwave or the method or combined with local chemotherapy, to achieve the purpose of palliative treatment.
(7) seed implantation treatment of colorectal cancer chemotherapy, chemotherapy particles (such as Cisplatin ,5-FU release preparation) implantation in the treatment of colorectal cancer is a clinical application in recent years, new chemotherapy, the indications for the surgery suspicious residual tumor, unresectable tumors and tumor recurrence. Intraoperative chemotherapy can direct implantation or percutaneous implantation of chemotherapy, endoscopic implantation and other methods. Applications can also be combined with radiation particles to achieve the purpose of concurrent radiotherapy and chemotherapy.
(8), stent placement in the treatment of colon, rectum, noninvasive technique applied by the narrow gate placed metal stents Wang colon, intestinal obstruction or end direct, rectal fistula, with a non-invasive, safe, quick, reproducible and able to maintain normal physiological discharge passage features, there are surgical conditions to include late stage cancer patients, including those who provide effective palliative treatment.
intestine caused by malignant infiltration of oppression Erzhi bowel stenosis or obstruction, or bowel disorders poor; left colon stent placement, tumor location in the 8cm from the edge of more than dirty;
colon, rectum fistula;
Postoperative colon, rectal anastomotic stenosis;
before surgery can also be used as emergency treatment of the transition period. Place commonly used methods:
First, the lead enema or colonoscopy, the nature of specific diseases, scope, length, narrow lumen and into angles in order to choose the most appropriate support. Body in the mirror under the guidance of the guide wire inserted into the intestine and along the guide wire into the bracket with push device, the X-ray released under the optional bracket. Colonoscopy re-enter the location and expansion of stent lumen observe the situation.
Residue after surgery to eat less semi-liquid food 1-2 weeks, then gradually increase the semi-solid, solid food,
maintain smooth stool. Prevention of infection, bleeding, support symptomatic treatment. 1 week, 2 months to do five months leading agent angiography or endoscopic examination or follow-up, usually after 2-6 months or 1 year review time.
From a clinical effect, the stent is effective treatment for adverse reactions. Survival period of patients self-care ability and quality of life of patients than surgery significantly improved lean manufacturing, less damage to patients, easy for the patients in the future is expected to replace the traditional lean manufacturing operation.
In recent years, many reports, with particles of the stent carrying 125 I treatment of malignant neoplasms, not only smooth the intestinal tract, and brachytherapy for tumors were obtained satisfactory results.
(9) common minimally invasive treatment of colorectal cancer sub-targeting drug cetuximab (cetuximab), trade name Erbitux (ERBITUX) 20042 month from the U.S. FDA approved for metastatic colon cancer. Clinical trials, cetuximab and irinotecan (chemotherapy drugs) can be applied Joint epidermal growth factor receptor expression in metastatic colorectal cancer, and irinotecan chemotherapy for non-sensitive patients. Cetuximab can also be used alone epidermal growth factor receptor expression and positive for metastatic colorectal cancer chemotherapy drug irinotecan in patients.
Avastin (bevacizumab), commodity (avastin)
Bevacizumab in combination with chemotherapy drugs (paclitaxel and card lead) results compared to chemotherapy alone, the total extension of survival, reducing the risk of death, now as a treatment for metastatic carcinoma of the colon or rectum in patients with first-line drugs, and intravenous injection of 5 – FU, leucovorin, or intravenous injection of 5 – cho, folic acid, topotecan combination chemotherapy. Bevacizumab is also used with very advanced colorectal cancer, poor physical condition can not tolerate traditional aggressive chemotherapy.
Panitumumab (ABX-EGF) is a fully human monoclonal antibody of the IgGz, the role of the epidermal growth factor receptor (EGFR). A single by ABX – EGF E-clinical trials showed that 48 cases of metastatic colorectal EGFR overexpression should be cancer (past received 5-FU and irinotecan or oxaliplatin lead to treatment failure), efficiency 10% stable 55%, 35% progress.
Lapatinib (lapatinib): Lynn is a choked derivatives, for the dual inhibitor of EGFR and HER -2, and its effect on tumor proliferation and inhibition of survival signaling is stronger than a single receptor inhibitors.
In an open, multi-center clinical trial in E, lapatinib monotherapy 86 patients with recurrent metastatic colorectal cancer (5 – FU + irinotecan or oxaliplatin lead to treatment failure). Oral lapatinib 1250mg / day, 54. 2% ErbB1-positive and 44.1% E from the B2 positive. 1 patient had a partial response (PR), 5 patients had minor responses (MR), 5 patients with stable disease over 20 weeks. TIP is an average of 8 weeks, overall survival (05) 42.9 weeks. Table Ming Lapa erlotinib in advanced metastatic colorectal cancer patients is still valid.
Typical cases:
Example l Mr. Liu, 58 years old, mainly due to "blood in the stool of more than 5 years, 3 years of perineal pain, increased a more than a month," admitted. Diagnosed with colorectal cancer liver metastases. Patients with poor general condition, weight loss, more than 10 bowel movements a day, straw bloody fluid. Charles colonoscopy after admission showed: from the upper rectum, anus door has a 9cm cauliflower disease, blocked intestine, anus door from 12 – 22cm luminal stenosis,
Deceive the surface of rotten, stenosis, endoscopic still capable of adoption.
After treatment: patients in the endoscopy room colonoscopy, the lesion reached the oxygen after the mass burning tool, repeated several times after treatment than before the widening of the lumen, and the bleeding site for coagulation. At the same time under the guidance of endoscopic injection of chemotherapy drugs to the tumor site. Then Avastin (bevacizumab) combined with FOLFOX4 program (5 FU + folic acid + oxaliplatin a uranium) 2 cycles of chemotherapy, patients with diarrhea, blood in the stool symptoms disappeared 2 months after the general condition of patients improved, and discharged.
Example 2 Mr Yang, 87 years old, because of abdominal pain, constipation hospitalized. Findings for the right ascending colon cancer, cancer of about 15cm, had blocked most of the lumen. Because of patient age, frequent incomplete intestinal obstruction, almost can not eat, poor physical fitness, family and the per capita refused surgical treatment and chemotherapy. Was decided to give local injection of chemotherapeutic drugs and photodynamic therapy. Local injection of first colonoscopy 5 – FU 500mg plus mitomycin 4 tons, and then give photodynamic therapy 2 times. After 2 weeks of basic relief in patients with symptoms of intestinal obstruction, to a small amount of food, a month after a marked improvement in patients with eating, weight gain, survival for 1 year.

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