Objective To explore the clinical effect of neo-adjuvant/adjuvant chemotherapy combined with operation on colorectal cancer patients in the multi-disciplinary team (MDT). Methods The data were collected retrospectively from January to December in 2007. The patients were classified as non-adjuvant chemotherapy group and adjuvant chemotherapy group according to the treatment strategy. Non-adjuvant chemotherapy group had accepted only surgery followed by preoperative neo-adjuvant chemotherapy, and adjuvant chemotherapy group had taken postoperative adjuvant chemotherapy after preoperative neo-adjuvant chemotherapy and operation. The clinical effect of two groups were compared. Results Totally 789 patients were treated among 2007, and 195 patients who were firstly diagnosed as colorectal cancer were included, and there were 109 males and 86 females, 59 colonic cancers and 136 rectal cancers. Average age was 59.98 years old. All of the included patients were followed up for 5-17 months. Three cases missed, no recurrence and no death happened. The baseline between non-adjuvant chemotherapy and adjuvant chemotherapy group was nearly same. There were no differences between two groups about the internal medicine complications, the cancer related obstruction, preoperative transfusion or not (P＞0.05). Whether the patients were transfused or not during the procedure and Dukes stage were significantly different between two groups(P＜0.05), while the other surgical and pathological index didnt show any statistical significance (P＞0.05). After operation, more patients in non-adjuvant chemotherapy group had accepted transfusion (P＜0.05). However, the postoperative rehabilitative indexes during hospitalization were not different between two groups. And the differences about the postoperative complications and defecation were not significant (P＞0.05). The values of CEA and CA19-9 were greatly different between two groups in the 1st and 3rd month follow-up. Conclusion The strategy of neo-adjuvant chemotherapy/operation/adjuvant chemotherapy didnt affect the rehabilitation and increase the risk of complications, however, more researches were necessary to prove whether the clinical effect were improved or not.
Objective To investigate the current status of multi-disciplinary team (MDT) in outpatient clinics of medical institutions in Sichuan, and to provide reference for further promoting the MDT model in outpatient clinics. Methods In November 2022, questionnaires were distributed to the outpatient management personnel of Sichuan Outpatient Management and Medical Quality Control Center from various medical institutions. The questionnaire included the basic information of the survey subjects and medical institutions, the current status of outpatient MDT work, the current status of operation and management, and the internal and external influencing factors of MDT development. Results A total of 106 questionnaires were received, of which 104 were valid. There were 70 hospitals that had provided outpatient MDT services, with a development rate of 67.31%, mainly concentrated in the past 5 years. A total of 60 hospitals (85.71%) had established MDT related systems, but only 14 hospitals (20.00%) had carried out relevant quality evaluation work. Among the 104 outpatient management personnel surveyed, 83.65% believed that the external factor affecting the development of outpatient MDT was the lack of correct understanding of MDT by patients, and 78.85% believed that the internal factor affecting the development of outpatient MDT was the low participation enthusiasm of departments and doctors. Conclusions The outpatient MDT in Sichuan is still in its early stages of development, and the outpatient MDT model has not yet been unified in terms of establishment standards, organizational methods, operational management, and fee standards. In the future, relevant departments and medical institutions still need to work together to promote its sustainable development.
Objective To explore the application of multi-disciplinary team (MDT) clinics in fetal developmental abnormalities. Methods A retrospective analysis method was used to collect case data of fetal developmental abnormalities and completion of prenatal MDT clinics diagnosis and treatment in pregnant women who were registered in the Department of Obstetrics of West China Second Hospital, Sichuan University between December 2021 and November 2022. The situation of pregnant women and fetuses was summarized and analyzed. Results There were 19362 registered pregnant women, of which 1125 (5.8%) had abnormal fetal development. Among them, 272 (24.2%) received prenatal MDT clinics diagnosis and treatment. Fetal developmental abnormalities were mainly characterized by structural abnormalities (208 cases, 76.5%), with the top three being central nervous system abnormalities, circulatory system abnormalities, and multiple malformations. There were 202 pregnant women who continue to conceive, and 70 cases had undergone induced labor, with an induced labor rate of 25.7%. The top three main causes of induced abortion were multiple malformations, central nervous system abnormalities, and circulatory system abnormalities. After prenatal MDT clinics diagnosis and treatment, the diagnosis of fetal developmental abnormalities in 46 pregnant women were corrected. Conclusion Prenatal MDT clinics are helpful for the early comprehensive evaluation of fetal developmental abnormalities and the determination of diagnosis and treatment plans.
Objective To explore application of preoperative examination in the colorectal cancer patients. Methods The preoperative examination data of patients diagnosed definitely as colorectal cancer at West China Hospital of Sichuan University from November 2006 to June 2007 was retrospectively study, and the application situation and relationship among all preoperative examination in the colorectal cancer patients were analyzed. Results According to the inclusion criteria, 438 colorectal cancer patients were included which involved 260 males and 178 females. Preoperative examinations included two to sixteen items, with an average of 10.61 items. According to correlation analysis, positive correlation existed among lung function and blood type ( r =0.161, P =0.001), tumor marker ( r =0.118, P =0.014), chest X-ray ( r =0.113, P =0.018), routine electrocardiogram ( r =0.198, P =0.000) , while lung function and immune and stress reaction exhibit a negative correlation ( r =-0.106, P = 0.027) with preoperative examinations. At the same time, immune and stress reaction had positive correlation to CT examinations of abdomen ( r =0.151, P =0.001) as well as endorectal ultrasound ( r =0.330, P =0.000). Using univariate analysis, the influence of tumor location ( P =0.012) and operative method ( P =0.004) on the number of examination items was significant. Conclusion Preoperative examination of colorectal tumor surgery mainly includes routine examination, neoplasm-related examination and important organs function detection. And three levels of preoperative menu can be set up in early stage. Establishment of normalization preoperative combined examination may be helpful to consummate preoperative evaluation and improve medical quality.
Objective To compare the clinical effect between neo-adjuvant chemotherapy combined with operation and simple operation under multi-disciplinary team in rectal cancer. Methods A survey of 72 patients with rectal cancer from Nov. 2007 to Mar. 2008 were studied. Patients were divided into two groups using a simple random method: 33 cases in combined therapy group were treated with single period neo-adjuvant chemotherapy as well as operation and 39 cases in control group received operation only. To compare the differences of perioperative period indexes between two groups. Results During the differences of indexes of age, gender, differentiation degree, clinicopathologic stage as well as the distance to dentate line of tumor, there was no statistical significance between combined therapy group and control group (Pgt;0.05). And at the same time, the operative type, operative time and bleeding quantity in operation had no statistically significant difference between two groups (Pgt;0.05). As for the postoperative rehabilitation indexes, the time of vent to normal in combined therapy group was earlier than that in control group, but the intake time was later than that in control group （Plt;0.05）. Falling range from preoperative CEA to postoperative CEA was larger in combined therapy group than that in control group （Plt;0.05）; and the falling range from preoperative WBC to postoperative WBC had no significant difference between two groups （Pgt;0.05）. Conclusion The clinical effect of combined therapy is obviously superior to simple operation, suggesting that neo-adjuvant chemotherapy combined with operation is feasible and safe.
Objective To discuss the safety and clinical differences among elderly people being treated with neo-adjuvant chemotherapy combined with operation. Methods To analyze retrospectively the data of patients diagnosed definitely as colorectal cancer in West China Hospital of Sichuan University from June 2007 to December 2007, and to compare the clinical effect differences between elderly group (≥60 years) and non-elderly group (lt;60 years) with combined therapy. Results Among preoperative indexes, the constituent ratios of elderly group combined with cardiac vessels system diseases, endocrine system diseases or other system diseases were all obviously higher than those of non-elderly group, the differences showed statistical significance (Plt;0.05); Constituent ratio of elderly patients with hypertension or diabetes mellitus was also higher than that of non-elderly patients, there were still statistical significance (Plt;0.05), but no statistical significances among other preoperative indexes (Pgt;0.05); Differences of indexes during operation between two groups showed no statistical significance (Pgt;0.05). But during postoperative indexes, complications in elderly group were higher than those of non-elderly group, and the differences had statistical significance (Plt;0.05), and the time of removing gastric canal, urinary catheter and drainage tube between two groups showed no statistical significance (Pgt;0.05); Meanwhile, the intake time, venting time and defecation time after operation and out-of-bed activity time after operation also had no statistical significance (Pgt;0.05). As to the adverse effect relate to chemotherapy, there were no statistical significances (Pgt;0.05). Conclusion Elderly patients may have more poor physical condition and it maybe more difficult to treat them. In spite of this, the comprehensive treatment of neo-adjuvant chemotherapy combined with surgical operation will not lead to the delay of surgical therapy, in addition, operating modus during surgical intervention will not be effected and its therapeutic effect in the near future was optimistic. So the application of this combined therapy has some clinical effects and would be safety.
Objective To summarize recent advances on preoperative staging strategies in rectal cancer. Methods Relevant references about preoperative staging strategies were collected and reviewed. The multimodal preoperative evaluation (MPE) system recently documented was focused on. Results The comparably accurate T and M stage could be achieved preoperatively by following an appropriate available method; however, the N stage’s accuracy was still not satisfying. The MPE system， incorporating with the advantages of transrectal ultrasound， computerized tomography and serum amyloid A protein in a multi-disciplinary mode could display the most accurate preoperative staging for rectal cancer currently. Conclusion The MPE has potential prospects in preoperative staging of rectal cancer， and can provide the most accurate preoperative staging for rectal cancer at present.
ObjectiveTo explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).MethodsIn 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.ResultsThe detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ2=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.ConclusionThe MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.
Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) on the selection of operative procedures of upper rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 110 patients, who were diagnosed definitely as upper rectal cancer (distance of tumor to the dentate line gt;7 cm) at West China Hospital of Sichuan University from August 2007 to October 2008, randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only MSCT was made preoperatively. Then, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathologic factors. Furthermore, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Results According to the criteria, 106 patients with upper rectal cancer were randomly assigned into MSCT+SAA group (n=52) and MSCT group (n=54). The baseline characteristics of two groups were statistically identical. When analyzing the proportion of multiple clinicopathologic factors in different operative procedures of upper rectal cancer, there were statistical differences in the preoperative N staging (P=0.003), M staging (P=0.022), TNM staging (P=0.003), serum level of SAA (P=0.005) and general category of tumor (P=0.027). For MSCT+SAA group the accuracies of preoperative staging T, N, M and TNM were 84.6%, 86.5%, 100% and 86.5%, respectively; For MSCT group the corresponding rates were 83.3%, 2.9%, 100% and 64.8%, respectively. There were statistically significant differences accuracies of preoperative N staging and TNM staging (P=0.005, P=0.009, respectively) in two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (96.2% vs. 81.5%, P=0.017). Conclusion Combinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, and thus provide higher predictive coincidence rate to operative procedures for surgeon.
Objective To discuss the influence of the progress and result in rectal cancer operation through application of neo-adjuvant chemotherapy in multi-disciplinary team (MDT). Methods The patients treated in MDT model and non-MDT model between June to September 2007 were respectively analyzed, and the index about pathologic change, histologic transform and operative result between the two groups were compared.Results In the index of pathologic change, the incidence of abdominal adherence (13.5%, 7/52), ascites (7.7%, 4/52) and latent malignant intestinal obstruction (5.8%, 3/52) in MDT model group were obviously less than non-MDT model group (P=0.000). In the index of histologic transform, texture of mesentery in MDT model group was more fragile than non-MDT model group (P=0.000). The incidence of edema of pelvic tissues in MDT model group were more than non-MDT model group (P=0.000). However, the differences between the incidence of edema of pelvic peritoneum and adherence of mesorectum in two groups were insignificant (Pgt;0.05). In the index of operative results, the operative duration and intra-operative bleeding in MDT model group were less than non-MDT model group (P=0.000). And the protection of pelvic autonomic nerve in MDT model group was better than non-MDT model group (P=0.000). Meanwhile, accuracy rate in prediction of radical resection with anus-preserving in both groups were in high level (92.3% vs 76.2%). Conclusion Neo-adjuvant chemotherapy has certain influence in rectal cancer operation, but the successful operations are performed by standard and correct procedures. Therefore, optimizing combined therapy in MDT model and constructing preoperative evaluation system with neo-adjuvant chemotherapy, would be the next important focus.
