Preoperative Rectal Submucosal Implantation 5-Fu Release Agent On The Prognosis Of Advanced Colorectal Cancer

bjective:To investigate clinical observation of rectum cancer patients with lower recurrence by preoperative use of fluorouracil implants. Methods:To choose 143 cases of patients with DukesB,C rectum cancer in our department randomly from Aug.2007 to Mar.2008,among the total 69 cases in experimental group,74 cases in control group;to implant 5-Fu retarder 200mg/m2 trans anorectal mucosa 5 to 10 days before operation.All patients were operated in radical resection of rectal carcinoma.To recheck blood routine test,CEA,CA19,CA72-4,type-B ultrasonic of liver,chest X-ray,digital rectal examination once a month within 6 months after operation.For patients with abnormal serum CEA,CA199,CA72-4,we carried out further examinations like colonofiberscope,CT and added up local recurrence,recurrence rate,hepatic metastasis,pulmonary metastasis,brain metastases and tumor markers such as CEA(CarCino-embryonic antigen),CA19-9(Carbohy-drate antigen 19-9),CA72-4(Carbohy-drate antigen CA72-4) within two years.And analyzed the recurrence and recurrence-related factors.Results:There are 69 cases in experimental group,3 cases loses to follow up within two years due to residence change or phone change,66 cases are available follow-ups,local recurrence rate is 10.60%(7/66).There are 74 cases in control group,4 cases loses to follow up within two years due to the same reasons as those in experimental group, the two-year local recurrence rate is 20.00%(14/70).Cases of local recurrence are all in the two-year follow-up period in the two groups,and the differences of local recurrence rate between the two groups are of statistical significance(P<0.05).Local recurrence of the two groups:there are 7 cases of local recurrence in experimental group,of which 5 cases occur in anastomotic stoma, and among the 5 cases,one case accompanies by extensive hepatic metastasis.2 cases occur in left wall of pelvic cavity and causes hydrops in left kidney due to invasion of left uretur.Palliative radiotherapy is carried out in 2 cases because they are located at the wall of pelvic cavity and hard to remove, radical surgery excision is carried out in 4 cases; there are 14 cases of local recurrence in control group. Among which three cases are of extensive metastasis in abdominal cavity and accompanied by hepatic metastasis; recurrence in anastomotic stoma occurs in eleven cases,including seven cases with simple recurrence in anastomotic stoma, one case with recurrence in anastomotic stoma accompanied by metastasis in both lungs,two cases with recurrence in anastomotic stoma accompanied by multi-metastasis in liver,one case with recurrence in right posterolateral wall of pelvic cavity accompanied by invision of right iliac vessel. Among them,radical surgery excision is carried out once again in five cases.Only palliative radiotherapy and chemotherapy are carried out in nine cases.In experimental group and control group,sex difference,age difference(young and middle-aged under 65 years of age and the aged over 65 years of age),tumor location(colon or rectum),metastasis of lymph node,depth of intestinal wall invision are none of the influential factors of local recurrence.Median survival time in experimental group after recurrence is 15 months(7 to 24 months),median survival time in control group is 11 months(2 to 28 months),difference of median survival time between two groups is of statistical significance(P<0.05);difference of prognosis of local recurrence after radical resection of rectal carcinoma is of statistical significance between experimental group and control group.Difference of way of diagnosis of local recurrence is of no statistical significance between two groups(P>0.05)7 cases of local recurrence in experimental group are found during recheck,of which 1 case is accompanied by hepatic metastasis(1/7);14 cases of local recurrence in control group are found during recheck, of which 3 cases have been accompanied by hepatic or pulmonary metastasis(3/14).Difference of way of treatment of local recurrence is of no statistical significance between two groups(P>0.05).Conclusion:It is safe to implant 5-Fu retarder trans-rectal mucosa before operation and is positive in decreasing the recurrence rate of post-laparoscopic colorectal-carcinoma surgery.It functions well in improving prognosis of rectum cancer,decreasing the post-surgery recurrence and metastasis.It paves a new way of therapy for new adjunctive therapy.