%0 Journal Article %~ PubMed %A Krishna, Arun %A Rickard, Matthew J F X %A Keshava, Anil %A Dent, Owen F %A Chapuis, Pierre H %T A comparison of published rates of resection margin involvement and intraoperative perforation between standard and "cylindrical" abdominoperineal excision for low rectal cancer. %B Colorectal Disease %D 2013 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 15 %N 1 %P 57-65 %@ 1463-1318 %X Aim:??? The study aimed to compare recent reports on standard and alternative methods of abdominoperineal excision for low rectal cancer regarding the rates of circumferential resection margin involvement and intraoperative bowel perforation. Method:??? Data on rates of margin involvement and perforation were obtained from eight recently published reports and also from a prospective registry of resections at Concord Hospital. Rates of these outcomes and their 95 percent confidence intervals were evaluated. Results:??? There was no evidence that extralevator abdominoperineal excision yielded significantly lower rates of resection margin involvement or intraoperative bowel perforation compared with standard abdominoperineal excision in six independent hospital and population-based patient series. Abdominosacral resection of the rectum, on the other hand, did show significantly lower rates of these end points, albeit in selected patients. Conclusion:??? The role of extralevator abdominoperineal excision and abdominosacral resection of the rectum should be investigated further in randomized controlled trials. ?? 2012 The Authors Colorectal Disease ?? 2012 The Association of Coloproctology of Great Britain and Ireland. %Z FOR Codes: 1103 %0 Journal Article %~ PubMed %A Chapuis, Pierre H %A Bokey, Les %A Keshava, Anil %A Rickard, Matthew J F X %A Stewart, Peter %A Young, Christopher J %A Dent, Owen F %T Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. %B Annals of Surgery %D 2013 %C United States %I Lippincott Williams & Wilkins %V 257 %N 5 %P 909-915 %@ 0003-4932 %X %Z FOR Codes: 110323 111204 %0 Journal Article %~ PubMed %A Jankova, Lucy %A Robertson, Graham %A Chan, Charles %A Tan, King L %A Kohonen-Corish, Maija %A Fung, Caroline L-S %A Clarke, Candice %A Lin, Betty P C %A Molloy, Mark %A Chapuis, Pierre H %A Bokey, Les %A Dent, Owen F %A Clarke, Stephen J %T Glutathione S-transferase Pi expression predicts response to adjuvant chemotherapy for stage C colon cancer: a matched historical control study. %B BMC Cancer %D 2012 %C United Kingdom %I BioMed Central Ltd. %V 12 %N %P 196 %@ 1471-2407 %X ABSTRACT: %Z FOR Codes: 111209 %0 Journal Article %~ PubMed %A Kho, P S S %A Jankova, L %A Fung, C L-S %A Chan, C %A Clarke, C %A Lin, B P C %A Robertson, G %A Molloy, M %A Chapuis, P H %A Bokey, E L %A Dent, O F %A Clarke, S %T Overexpression of protein S100A4 is independently associated with overall survival in stage C colonic cancer but only in cytoplasm at the advancing tumour front. %B International Journal of Colorectal Disease %D 2012 %C Germany %I Springer %V 27 %N 11 %P 1409-1417 %@ 1432-1262 %X PURPOSE: S100A4, a multifunctional protein, has been linked to the invasive growth and metastases of several human cancers. This study investigated the association between S100A4 and overall survival and other clinicopathological features in patients with stage C colonic cancer. METHODS: Clinical and pathological data were obtained from a prospective hospital registry of 409 patients who had a resection for stage C colonic cancer. Tissue microarrays for immunohistochemistry were constructed from archived tissue. S100A4 staining intensity and percentage of stained cells were assessed in nuclei and cytoplasm for both the central part of the tumour and at the advancing front. Overall survival was analysed by the Kaplan-Meier method and Cox regression. RESULTS: Only a high percentage of cells with S100A4 cytoplasmic staining in frontal tissue was associated with poor survival (hazard ratio, 1.6; 95??% CI 1.1-2.2; p???=???0.008) after adjustment for other prognostic variables. There was no association between frontal cytoplasmic S100A4 expression and any of 13 other clinicopathological variables. CONCLUSIONS: High expression of S100A4 in cytoplasm at the advancing front of stage C colonic tumours indicates a poor prognosis. Whether S100A4 can predict response to adjuvant chemotherapy remains to be investigated in a randomised clinical trial. %Z FOR Codes: 111209 %0 Journal Article %~ PubMed %A Kho, Patricia %A Chapuis, Pierre H %A Beale, Philip %A Bokey, Les %A Dent, Owen F %A Clarke, Stephen %T Use of adjuvant chemotherapy in stage C (III) rectal cancer: Comparison of data from matched patients in a teaching hospital's clinico-pathological database. %B Asia-Pacific Journal of Clinical Oncology %D 2012 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 8 %N 4 %P 346-355 %@ 1743-7563 %X Aims:??? Controversy continues regarding the treatment of patients with resectable rectal cancer, particularly in regard to the effects of adjuvant therapies on long-term survival. The benefits of adjuvant chemotherapy alone in patients with stage III rectal cancer after curative resection remain unclear. The aim of this study was to compare the overall survival of patients who had received adjuvant chemotherapy after resection of a stage III rectal cancer (111 patients) with the survival of a historical control group who had surgery alone before chemotherapy was introduced (129 patients). Methods:??? Treatment and outcomes data were drawn from a prospective hospital registry of consecutive patients who had a resection for stage III rectal cancer. Results:??? The estimated Kaplan-Meier overall 5-year survival rate in patients who received chemotherapy (68.7%, 95% CI 58.3-77.1%, log-rank P???40% stained was associated significantly with high grade, invasion beyond the muscularis propria, involvement of a free serosal surface or apical node, and invasion into an adjacent organ or structure. After adjustment of other predictors, GST Pi expression remained independently prognostic for reduced overall survival (hazard ratio 1.4, P???=???0.002). Conclusions:??? In patients with clinicopathological stage C colonic cancer, GST Pi expression is associated with features of tumour aggressiveness and with reduced overall survival. Further appropriately designed studies should aim to discover whether GST Pi can predict response to adjuvant chemotherapy. %Z FOR Codes: 111209 %0 Journal Article %~ PubMed %A Chapuis, Pierre H %A Chan, Charles %A Dent, Owen F %T Clinicopathological staging of colorectal cancer: Evolution and consensus-an Australian perspective. %B Journal of Gastroenterology and Hepatology %D 2011 %C Australia, Japan, Hong Kong %I Wiley-Blackwell Publishing Asia %V 26 %N Suppl 1 %P 58-64 %@ 0815-9319 %X In 1991 this journal published the report of an international working party to the World Congress of Gastroenterology regarding the clinicopathological staging of colorectal cancer. Since that time staging has continued to evolve as further prognostic factors in colorectal cancer have been elucidated in studies of increasingly large databases in several countries. This review summarizes several of the key issues that have arisen during this evolutionary process and raises matters which still remain controversial in staging at the present time. %Z FOR Codes: 110323 110316 %0 Journal Article %~ PubMed %A Dent, O F %A Chapuis, P H %A Haboubi, N %A Bokey, L %T Magnetic Resonance Imaging Cannot Predict Histological Tumour Involvement of a Circumferential Surgical Margin in Rectal Cancer. %B Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland %D 2011 %C United Kingdom, Unit %I Wiley-Blackwell Publishing Ltd. %V 13 %N 9 %P 974-81 %@ 1463-1318 %X Several recent studies have attempted to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting the likelihood of tumour involvement of the postoperative circumferential resection margin (CRM) in rectal cancer with the intention of selecting patients who might benefit from neoadjuvant therapy and as a guide to surgery. The aim of this study was to assess whether such studies can provide a valid answer as to whether preoperative MRI can accurately predict CRM involvement by tumour. %Z FOR Codes: 1103 %0 Journal Article %~ PubMed %A Jankova, Lucy %A Chan, Charles %A Fung, Caroline L S %A Song, Xiaomin %A Kwun, Sun Y %A Cowley, Mark J %A Kaplan, Warren %A Dent, Owen F %A Bokey, Elie L %A Chapuis, Pierre H %A Baker, Mark S %A Robertson, Graham R %A Clarke, Stephen J %A Molloy, Mark P %T Proteomic comparison of colorectal tumours and non-neoplastic mucosa from paired patient samples using iTRAQ mass spectrometry. %B Molecular bioSystems %D 2011 %C United Kingdom %I Royal Society of Chemistry %V 7 %N 11 %P 2997-3005 %@ 1742-2051 %X Quantitative mass spectrometry using iTRAQ was used to identify differentially expressed proteins from 16 colorectal cancer (CRC) tumours compared to patient-paired adjacent normal mucosa. Over 1400 proteins were identified and quantitated, with 118 determined as differentially expressed by >1.3-fold, with false discovery rate < 0.05. Gene Ontology analysis indicated that proteins with increased expression levels in CRC tumours include those associated with glycolysis, calcium binding, and protease inhibition. Proteins with reduced levels in CRC tumours were associated with loss of ATP production through: (i) reduced ??-oxidation of fatty acids, (ii) reduced NADH production by the tricarboxylic acid cycle and (iii) decreased oxidative phosphorylation activity. Additionally, biosyntheses of glycosaminoglycans and proteoglycans were significantly reduced in tumour samples. Validation experiments using immunoblotting and immunohistochemistry (IHC) showed strong concordance with iTRAQ data suggesting that this workflow is suitable for identifying biomarker candidates. We discuss the uses and challenges of this approach to generate biomarker leads for patient prognostication. %Z FOR Codes: 111202 %0 Journal Article %~ PubMed %A Fung, Caroline L-S %A Chan, Charles %A Jankova, Lucy %A Dent, Owen F %A Robertson, Graham %A Molloy, Mark %A Bokey, Les %A Chapuis, Pierre H %A Lin, Betty P C %A Clarke, Stephen J %T Clinicopathological correlates and prognostic significance of maspin expression in 450 patients after potentially curative resection of node-positive colonic cancer. %B Histopathology %D 2010 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 56 %N 3 %P 319-330 %@ 0309-0167 %X AIMS: The tumour suppressor maspin has been investigated for its association with conventional histopathological features in colorectal cancer and for its potential as an independent predictor of survival and response to adjuvant chemotherapy. The aim of this study was to examine associations between maspin expression, other histopathology and survival in a large consecutive series of patients after potentially curative resection of node-positive colonic adenocarcinoma. METHODS AND RESULTS: Nuclear and cytoplasmic maspin expression in both superficial and deep parts of the tumour were assessed retrospectively by tissue microarray and immunohistochemistry in specimens from 450 patients whose other histopathology had been recorded in a prospective hospital registry of large bowel cancer resections from 1971 to 2001 with a minimum follow-up of 5 years. Among 13 clinicopathological features examined, the only associations that persisted across all four maspin assessments were stronger expression in right- than in left-sided tumours (P=0.001-0.011) and stronger expression in high-grade tumours (P<0.001-0.007). There was no significant association between intensity of maspin expression and overall survival. CONCLUSIONS: In this large and thoroughly documented series of patients with clinicopathological stage C colonic tumour, maspin expression was correlated with few other conventional histopathology variables and was not a significant prognostic factor. %Z FOR Codes: 111202 %0 Journal Article %~ PubMed %A Chan, Charles %A Jankova, Lucy %A Fung, Caroline L S %A Clarke, Candice %A Robertson, Graham %A Chapuis, Pierre H %A Bokey, Les %A Lin, Betty P C %A Dent, Owen F %A Clarke, Stephen %T Fascin Expression Predicts Survival After Potentially Curative Resection of Node-positive Colon Cancer. %B The American journal of surgical pathology %D 2010 %C United States %I Lippincott Williams & Wilkins %V 34 %N 5 %P 656-66 %@ 1532-0979 %X Fascin, an actin-bundling protein, is expressed in many neoplasms including colorectal cancer. It is considered to be a mediator of tumor cell invasion and an indicator of aggressive phenotype; however, there are few reports on the association between fascin and prognosis in colorectal cancer. The aims of this study were to: (a) investigate the expression of fascin in the central part of the tumor and at the invasive front in patients who had a potentially curative resection for node-positive colonic carcinoma; (b) examine the method of scoring fascin expression; and (c) investigate the association between fascin expression and overall survival and other clinicopathologic features. Fascin expression was assessed by immunostaining of microarrays from archived tissue of 470 patients who were followed for a minimum of 5 years after resection. Other clinicopathologic data had been recorded prospectively according to a standardized protocol. Analysis of overall survival was by the Kaplan-Meier method and Cox regression. For both central tumor tissue and the invasive front, it was found that the percentage of stained cells was a sufficient measure of fascin expression in relation to survival, with staining intensity providing no significant additional information. At both levels, there was a significant independent association between high fascin expression and diminished survival, although this association was much stronger in the central region (adjusted hazard ratio 1.6, P<0.001) than at the invasive front (adjusted hazard ratio 1.1, P=0.044). Fascin expression predicted overall survival but did not displace other routinely collected clinicopathologic predictors. %Z FOR Codes: 111209 %0 Journal Article %A Lam, Francis F %A Jankova, Lucy %A Dent, Owen %A Molloy, Mark P %A Kwun, Sun Young %A Clarke, Candice %A Chapuis, Pierre %A Robertson, Graham %A Beale, Philip %A Clarke, Stephen %A Bokey, Les %A Chan, Charles %T Identification of distinctive protein expression patterns in colorectal adenoma %B PROTEOMICS - Clinical Applications %D 2010 %C Germany %I Wiley - VCH Verlag GmbH & Co. KGaA %V 4 %N 1 %P 60-70 %@ 1862-8346 %X %Z FOR Codes: 111201 %0 Journal Article %~ PubMed %A Owen, Gareth %A Keshava, Anil %A Stewart, Peter %A Patterson, James %A Chapuis, Pierre %A Bokey, Elie %A Rickard, Matthew %T Plugs unplugged. Anal fistula plug: the Concord experience. %B ANZ Journal of Surgery %D 2010 %C Australia %I Wiley-Blackwell Publishing Asia %V 80 %N 5 %P 341-343 %@ 1445-2197 %X Purpose: The purpose of this study was to analyse preliminary experience and outcomes with the Cook Surgisis AFP anal fistula plug (Cook Medical, Bloomington, IN, USA) with respect to the treatment of complex anal fistulae in a specialist colorectal unit. Methods: Data on all patients who were treated with the Surgisis AFP between October 2006 and January 2009 were retrospectively reviewed. The plug was placed in accordance with the Cook guidelines. Successful closure of the anal fistula was defined as absence of drainage at final follow-up with no subsequent abscess formation or further intervention required. Results: Thirty-two patients underwent a total of 35 anal fistula plug insertion procedures. No patients were lost to follow-up. The median follow-up was 15 months (2-29 months). The overall success rate was 13 out of 35 (37%). For those in the subgroups of Crohn''s disease and cryptoglandular disease, the success rate was 1 out of 3 (33%) and 11 out of 31 (35%), respectively. Conclusion: This series demonstrates a success rate for the Cook Surgisis AFP of 37%. These results in patients managed in a specialist unit confirm that the Surgisis AFP is a useful option in the management of complex fistulae. %Z FOR Codes: 110323 %0 Journal Article %~ PubMed %A Chapuis, Pierre %A Fahrer, Marius %A Eizenberg, Norman %A Fahrer, Claude %A Bokey, Les %T Should there be a national core curriculum for anatomy? %B ANZ journal of surgery %D 2010 %C Australia %I Wiley-Blackwell Publishing Asia %V 80 %N 7-8 %P 475-7 %@ 1445-2197 %X %Z FOR Codes: 130209 69999 %0 Journal Article %~ PubMed %A Zhou, Jerry %A Belov, Larissa %A Huang, Pauline Y %A Shin, Joo-Shik %A Solomon, Michael J %A Chapuis, Pierre H %A Bokey, Leslie %A Chan, Charles %A Clarke, Candice %A Clarke, Stephen J %A Christopherson, Richard I %T Surface antigen profiling of colorectal cancer using antibody microarrays with fluorescence multiplexing. %B Journal of Immunological Methods %D 2010 %C Netherlands %I Elsevier BV %V 355 %N 1-2 %P 40-51 %@ 0022-1759 %X A procedure is described for the disaggregation of colorectal cancers (CRC) and normal intestinal mucosal tissues to produce suspensions of viable single cells, which are then captured on customized antibody microarrays recognising 122 different surface antigens (DotScan CRC microarray). Cell binding patterns recorded by optical scanning of microarrays provide a surface profile of antigens on the cells. Sub-populations of cells bound on the microarray can be profiled by fluorescence multiplexing using monoclonal antibodies tagged with Quantum Dots or other fluorescent dyes. Surface profiles are presented for 6 CRC cell lines (T84, LIM1215, SW480, HT29, CaCo and SW620) and surgical samples from 40 CRC patients. Statistical analysis revealed significant differences between profiles for CRC samples and mucosal controls. Hierarchical clustering of CRC data identified several disease clusters that showed some correlation with clinico-pathological stage as determined by conventional histopathological analysis. Fluorescence multiplexing using Phycoerythrin- or Alexa Fluor 647-conjugated antibodies was more effective than multiplexing with antibodies labelled with Quantum Dots. This relatively simple method yields a large amount of information for each patient sample and, with further application, should provide disease signatures and enable the identification of patients with good or poor prognosis. %Z FOR Codes: 111202 %0 Journal Article %~ PubMed %A Sy, Joanne %A Fung, Caroline L-S %A Dent, Owen F %A Chapuis, Pierre H %A Bokey, Les %A Chan, Charles %T Tumor budding and survival after potentially curative resection of node-positive colon cancer. %B Diseases of the Colon and Rectum %D 2010 %C United States %I Lippincott Williams & Wilkins %V 53 %N 3 %P 301-307 %@ 0012-3706 %X PURPOSE: The aim of this study was to investigate the relationship between tumor budding and other pathology features and overall survival after resection of clinicopathological stage III colon cancer. METHODS: The number of buds and other histopathological features were assessed in 477 patients who were operated on between 1971 and 2001, with follow-up to December 2006. Overall survival was analyzed using the Kaplan-Meier method and Cox regression. RESULTS: The number of buds was dichotomized as low (0 to 8) vs high (>or=9). High budding was more common in men, in high-grade tumors, in the presence of venous invasion, and where the tumor had involved a free serosal surface, but budding was not associated with 8 other clinical and pathological features. The 5-year survival rate for patients with 0 to 8 buds was 51.0% (95% confidence interval, 44.9-55.1), whereas that for patients with 9 or more buds was 33.9% (95% confidence interval, 25.2-42.8). This association, however, disappeared after adjustment for other variables independently associated with survival (hazard ratio, 1.2; 95% confidence interval, 0.94-1.54; P = .139). CONCLUSION: In stage III colon cancer, tumor budding did not provide additional independent prognostic information beyond that given by routine pathology reporting. %Z FOR Codes: 1103 %0 Journal Article %~ PubMed %A Chapuis, Pierre H %A Bokey, E Leslie %A Clarke, Stephen %A Beale, Philip %A Dent, Owen F %T Adjuvant chemotherapy for stage C colonic cancer in a multidisciplinary setting. %B ANZ Journal of Surgery %D 2009 %C Australia %I Wiley-Blackwell Publishing Asia %V 79 %N 10 %P 685-692 %@ 1445-2197 %X BACKGROUND: In this study of patients undergoing adjuvant chemotherapy for clinicopathological stage C colonic cancer after optimal surgery, the aims were: to describe their immediate experience of chemotherapy, to assess disease-free survival, to compare overall survival with that of a matched untreated historical control group, and to evaluate the associations between previously identified adverse risk factors and survival. METHODS: Data were drawn from a comprehensive, prospective hospital registry of resections for colorectal cancer between 1971 and 2004, with retrospective data on adjuvant chemotherapy. The main end point was overall survival. Statistical analysis employed the chi-squared test, Kaplan-Meier estimation and proportional hazards regression. RESULTS: From May 1992 to December 2004, there were 104 patients who received adjuvant chemotherapy. Duration of treatment, withdrawal from treatment, toxicity and other immediate treatment outcomes were similar to those in other equivalent studies. There were no toxicity-associated deaths. Overall survival was significantly longer in the treated patients than in the control group (3-year rates 81% and 66%, respectively, P = 0.009). A significant protective effect of adjuvant therapy was found (hazard ratio 0.5, 95% confidence interval 0.3-0.8, P = 0.001) after adjustment for histopathology features previously shown to be negatively associated with survival (high grade, venous invasion, apical node metastasis, free serosal surface involvement). CONCLUSIONS: For patients who have had a curative resection for lymph node positive colonic cancer in a specialist colorectal surgical unit and been managed by a multidisciplinary team, post-operative adjuvant chemotherapy is safe and provides the same survival advantage as seen in randomized trials. %Z FOR Codes: 110307 111209 %0 Journal Article %~ PubMed %A Frye, J %A Bokey, E L %A Chapuis, P H %A Sinclair, G %A Dent, O F %T Anastomotic leakage after resection of colorectal cancer generates prodigious use of hospital resources. %B Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland %D 2009 %C United Kingdom %I Wiley-Blackwell %V 11 %N 0 %P 917-20 %@ 1463-1318 %X The aim of this study was to determine the demand for hospital resources generated by anastomotic leakage, including surgical, medical, imaging, pathology, and other allied health consultations or services and length of postoperative hospital stay. %Z FOR Codes: 110312 1112 %0 Journal Article %~ PubMed %A Walsh, Michael D %A Dent, Owen F %A Young, Joanne P %A Wright, Caroline M %A Barker, Melissa A %A Leggett, Barbara A %A Bokey, Les %A Chapuis, Pierre H %A Jass, Jeremy R %A Macdonald, Graeme A %T HLA-DR expression is associated with better prognosis in sporadic Australian clinicopathological Stage C colorectal cancers. %B International Journal of Cancer %D 2009 %C United States, Switz %I John Wiley & Sons, Inc. %V 125 %N 5 %P 1231-1237 %@ 1097-0215 %X Predicting patient outcome for colorectal carcinoma (CRC) with lymph node but not distant metastases remains challenging. Various prognostic markers have been identified including microsatellite instability (MSI) and possibly expression of the MHC Class II protein, HLA-DR. About 15% of sporadic CRC exhibits MSI associated with methylation of the DNA mismatch repair gene hMLH1 promoter. In addition, a significant proportion of unselected CRC demonstrates expression of HLA-DR. We sought to examine the relationship between HLA-DR expression, MSI status and prognosis in sporadic Australian Clinicopathological (ACP) Stage C CRC. Two hundred seventy consecutive patients with sporadic ACP Stage C CRC were treated at Concord Repatriation General Hospital between 1986 and 1992. None of these patients received adjuvant chemotherapy and all were followed for a minimum of 5 years or until death. DNA was extracted from paraffin sections and MSI status determined by PCR. HLA-DR expression was determined immunohistochemically using an antibody against the HLA-DR alpha chain. MSI status could be assigned in 235 cases: 176 CRCs (74.9%) were microsatellite stable, whereas 23 (9.8%) had high levels of MSI (MSI-H) and 36 (15.3%) had low levels of MSI (MSI-L). HLA-DR expression by CRC cells was seen in 148 (60.1%) cases and correlated with the presence of tumor-infiltrating lymphocytes (p = 0.0005) and peritumoral lymphocytes (p = 0.003), but not other clinicopathological features or MSI status. HLA-DR-positive CRCs were strongly associated with better patient outcome (p < 0.0001). %Z FOR Codes: 1112 %0 Journal Article %~ PubMed %A Dent, Owen F %A Chapuis, Pierre H %A Renwick, Andrew A %A Bokey, E L %T The importance of tumor stage and relative survival analysis for the association between sex and survival after resection of colorectal cancer. %B Annals of surgery %D 2009 %C United States %I Lippincott Williams & Wilkins %V 249 %N 3 %P 402-408 %@ 0003-4932 %X OBJECTIVE: The aim of this study was to determine whether the previously noted poorer survival of men after resection of colorectal cancer varied among clinicopathological tumor stages. SUMMARY BACKGROUND DATA: The question of whether sex is independently associated with prognosis after resection of colorectal cancer has been examined in numerous studies over the past 2 decades, but with conflicting results. METHODS: Data on 3,301 patients were drawn from a comprehensive, prospective hospital registry of all resections for colorectal cancer performed between January 1971 and December 2005. Statistical analysis employed Kaplan Meier estimation and relative survival analysis to adjust for differential male/female life expectancy in the general population. RESULTS: The relative survival of males was significantly less than that of females (P = 0.004) only in stage B. This was not accounted for by other negative pathology features and cause of death did not differ significantly between males and females. However, men with stage B tumor were more likely than women to experience postoperative morbidity, particularly a respiratory complication or a surgical complication requiring urgent reoperation. The sex difference in relative survival persisted among patients who had either a respiratory complication or an urgent reoperation (P = 0.003) but disappeared among those who had neither (P = 0.193). CONCLUSION: The poorer survival of men with stage B tumor was attributable to their greater postoperative morbidity which led to the earlier death of some due to causes unrelated to their colorectal cancer. %Z FOR Codes: 110323 %0 Journal Article %~ PubMed %A Darakhshan, Amir %A Lin, Betty P F C %A Chan, Charles %A Chapuis, Pierre H %A Dent, Owen F %A Bokey, Les %T Correlates and outcomes of tumor adherence in resected colonic and rectal cancers. %B Annals of surgery %D 2008 %C United States %I Lippincott Williams and Wilkins %V 247 %N 4 %P 650-658 %@ 0003-4932 %X OBJECTIVES: The aims of this study were to examine the associations between tumor adherence and other operative findings, postoperative complications, recurrence, and survival after resection of colorectal cancer. SUMMARY BACKGROUND DATA: The prognostic importance of tumor adherence to other organs or structures, either by direct invasion (T4) or simply by inflammatory adhesions, is yet to be clearly defined as earlier studies have been limited in size or have not used contemporary multivariable statistical techniques. METHODS: Data were drawn from a comprehensive, prospective hospital registry of all resections for colorectal cancer between January 1971 and December 2000 with follow-up to December 2005. Statistical analysis employed the chi test, Kaplan-Meier estimation, and proportional hazards regression with a significance level of <0.05 and 95% confidence intervals (CI). RESULTS: Tumor adherence was identified in 268 of 2504 resections (10.7%). Adherent tumors were more likely than nonadherent tumors to be spontaneously or surgically perforated or transected, to have nodal metastases and to be poorly differentiated. Venous invasion was more frequent in adherent colonic but not rectal tumors. Adherence was associated with only 5 of 16 medical and surgical complications considered. In rectal cancer, adherence was independently associated with pelvic recurrence (hazard ratio 1.8, 95% CI 1.2-2.7) and diminished survival (hazard ratio 1.6, 95% CI 1.3-2.0) after adjustment for other variables. CONCLUSION: In rectal cancer, tumor adherence indicates a poor prognosis after adjustment for other prognostic factors, regardless of whether actual tumor invasion of the adherent structure has occurred. However, adherence is not associated with survival after resection of colonic cancer. %Z FOR Codes: 111299 110323 %0 Journal Article %~ PubMed %A Dent, O F %A Haboubi, N %A Chapuis, P H %A Chan, C %A Lin, B P C %A Wong, S K C %A Bokey, E L %T Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer. %B Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland %D 2007 %C UK, germany. %I Blackwell Publishing Ltd %V 9 %N 2 %P 112-121; discussion 121-2 %@ 1462-8910 %X OBJECTIVE: Circumferential resection margin involvement (CRMI) after resection of rectal cancer is regarded as a risk factor for local recurrence. We have been able to identify only nine peer-reviewed English-language publications which focus primarily on this association, and they report widely differing rates of local recurrence. The aims of this study were to review possible reasons for this variability and to assess the evidence for the micrometrically measured threshold defining CRMI. METHOD: Methodological and statistical evaluation of relevant literature. RESULTS: Several factors which could account for this variability are discussed including the nature of the patient series, surgical technique, curative vs palliative resections, pathology technique, the definition of CRMI, adjuvant therapy, tumour stage, definition and ascertainment of local recurrence, length of follow-up and method of analysis. The objective evidence for the conventional definition of CRMI as tumour 1 mm or less from a circumferential margin is considered along with the evidence supporting a recent proposal that the margin be extended to 2 mm or less. The evidence is numerically weak in both cases and we believe that neither definition should be set in concrete at this stage. CONCLUSION: Pending further research, we recommend that routine pathology reports should record frank tumour transection, if present, or otherwise report the histological width of the margin between the tumour and the nearest circumferential line of resection in millimetres. The definition of CRMI should be simply histological evidence of tumour in a line of resection, that is, a margin of 0 mm. The definition of CRMI as a margin of