Discussion On The Diagnosis And Treatment Of Low Rectal High Grade Intraepithelial Neoplasia

Objective: This retrospective study was designed to analysis of clinical and pathological characteristics of low rectal high grade intraepithelial neoplasia,to discuss the pathological diagnosis differences of the preoperative,intraoperative and postoperative,and to discuss the treatment principles and strategies.Methods: Collect 40 cases of high grade intraepithelial neoplasia patients diagnosed by the preoperative endoscopic biopsy and accept operation treatment and intraoperative rapid pathological examination from the low rectal tumor patients in the First Affiliated Hospital of Wangnan Medical College during January 2010 to December 2012,classify and arrange these cases,to observe the clinical characteristics of these cases,to statistic the differentiation type and stage of the cancer cases,to statistic the operation mode of all cases,to statistic the pathological diagnosis results of the preoperative,intraoperative and postoperative and to compare the differences,to statistic the digital rectal examination results before operation and to analyse the correlation with carcinogenesis,to statistic tumor size and analyse the correlation of its size and carcinogenesis,to statistic the distance of tumor from the anal verge and analyse the correlation of its distance from the anal verge and its operation choice,through the follow-up after operation,to observe and compare the postoperative complications,local recurrence and survival rate.Results: Of the 40 cases of high grade intraepithelial neoplasia patients diagnosed by the preoperative endoscopic biopsy, the intraoperative pathological diagnosis results showed that 14 cases were high-grade intraepithelial neoplasia and 26 cases were adenocarcinoma,and the postoperative pathological diagnosis results showed that 12 cases were high-grade intraepithelial neoplasia,1 cases of high differentiated adenocarcinoma,24 cases of moderately differentiated adenocarcinoma,2 case of low differentiated adenocarcinoma and 1 case of mucinous adenocarcinoma.There were 12 cases with stageⅠ,5 cases with stage and 11 cases with stage Ⅱ Ⅲ. Of the 40 cases,11 cases(27.5%) had regional lymph nodes metastasis.Of the 40 cases,5 had transanal local excisions,2 had endoscopic mucosal resection,3 had endoscopic submucosal dissection, 20 cases had radical Dixon operation after previous transanal excisions(Laparotomy in 13 cases,laparoscopic in 7 cases),the remaining 10 had radical Miles operation after previous transanal excisions(Laparotomy in 6 cases,laparoscopic in 4 cases).The anus preservation rate was 75%.The pathological results difference in preoperative were statistically significant with intra-and post-operative(P < 0.001).The difference in intra-and post- operative specimens was not statistically significant(P >0.05).Comparison of pre-and post- operative specimens showed poor consistency,the Kappa value was 0.076.Between the high grade intraepithelial neoplasia and cancer,the difference in digital rectal examination was statistically significant(P<0.01).In the 12 cases of high-grade intraepithelial neoplasia,their maximum diameter,minimum diamete and median diameter respective were 3.2cm,1.3cm and 1.9cm.In the 28 cases of adenocarcinoma,their maximum diameter,minimum diameter and median diameter respective were 6.1cm,1.5cm and 3.8cm. Diameter over 3cm final diagnosis tend to adenocarcinoma.Of the 20 cases radical Dixon operation,the minimum distance of tumors located in the rectum from the anal verge was 5.0cm,with a median distance of 6cm.Of the 10 cases radical Miles operation,the minimum distance of tumors located in the rectum from the anal verge was 3.0cm,with a median distance of 4cm.Of the factors involved in preservation and non-preservation of the anus,only the distance from anal verge was found to be significant(P<0.001).Of the 40 cases,1 cases underwent radical Dixon with postoperative anastomotic leakage and 1 cases underwent radical Miles with postoperative incision infection,the other 38 patients had no complications after operation.Completed 12 months follow-up of 40 cases,no deaths,no local recurrence.Completed more than 36 months follow-up of 10 cases,no deaths,1 case occurred distant metastasis.Conclusion: We have found that of the cases preoperative diagnosed as high grade intraepithelial neoplasia have differences with the postoperative pathological diagnosis,approximately 70% already have cancerous changes,27.5% even have the tumor lymph node metastasis. But the difference between the intraoperative rapid pathological diagnosis and the postoperative pathological diagnosis is no significant.The tumo r≥3cm is more likely cancer.We should pay attention to the preoperative digital rectal examination,according to the digital rectal examination situation to give further auxiliary examination.We should pay attention to the rapid intraoperative pathological examination,according to the pathological results to develop treatment plans for the next step, so as to avoid excessive or lack of treatment.