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This study was designed to compare the outcomes of laparoscopic anterior resection with open operation for mid and upper rectal cancer. A total of 265 patients who underwent elective laparoscopic or open anterior resection for cancer of the mid and upper rectum from June 2000 to December 2004 were included. Data about the patients’ demographics, operative details, postoperative outcome, and disease status were collected prospectively. Comparison of the outcome between laparoscopic and open resection was performed. The median age of the 265 patients was 69 (range, 27–91) years, and laparoscopic anterior resection was performed in 98 patients (37 percent). There was no difference in the age, gender, comorbidities, and level of tumor between the two groups. The operating time was longer in the laparoscopic group (200 vs. 127 minutes; P < 0.01), but the blood loss was less (200 vs. 250 ml; P = 0.027). The overall operative mortality was 1.8 percent, and the complication rate was 27.9 percent. Significantly more patients with early diseases (Stage I and Stage II) were operated with laparoscopic approach. There was no difference in the mortality or morbidity between the two groups. Anastomotic leakage occurred in five patients with open resection and one with laparoscopic resection (P = 0.418). Patients with laparoscopic resection had an earlier return of bowel function and earlier resumption of diet as well as a shorter median hospital stay (7 vs. 8 days; P < 0.001). With the median follow-up of the surviving patients for 21.2 months, the three-year local recurrence rates for those with open and laparoscopic resection were 4.9 and 3.3 percent, respectively (P = 0.513). In patients with Stage I and Stage II disease, the three-year cancer-specific survivals for open and laparoscopic resection were 89.8 and 88.6 percent, respectively (P = 0.882), whereas those of patients with Stage III disease were 65.6 and 55.5 percent, respectively (P = 0.911). Laparoscopic anterior resection for mid and proximal rectal cancer is a safe option with short-term advantages compared with open operation. The oncologic outcomes of patients who underwent laparoscopic anterior resection were not compromised, with similar local recurrence rate and the cancer-specific survival rate as patients who underwent open resection.

This study aimed to compare the outcomes of patients who suffered from obstructing left-sided colorectal cancer, treated with self-expanding metallic stent (SEMS) as a bridge to surgery, with those who underwent emergency operation. Twenty patients who had acute obstruction due to left-sided colorectal cancer underwent surgical resection after insertion of SEMS (group I) were matched to 40 patients with emergency colonic resection (group II). The two groups were compared for the incidence of primary anastomosis, stoma rate, hospital stay, duration of intensive care, postoperative morbidity, and mortality. Both groups had similar preoperative comorbidity and stage of disease, but the tumors in group I were more distally located (P0.001). In group I, one patient developed colon perforation and required Hartmann's operation. All the other patients underwent elective operation with primary anastomosis. In group II, primary anastomosis was performed in 29 patients (72.5%; P = 0.047). The operative mortality of group I and group II was 5% and 12.5%, respectively (P = 0.653). Significantly shorter median postoperative hospital stay and median stay in the intensive care unit (ICU) were observed in group I (9 days [range, 5-39 days] vs. 12 days [range, 8-49 days], P = 0.015 and 0 day [range, 0-17 days] vs. 0.5 day [range, 0-18 days], P = 0.022, respectively). There were no differences in hospital mortality (P = 0.653) or 30-day mortality (P = 0.653). Both groups had similar reoperation rates, surgical complications, and medical complications. When compared with emergency resection, insertion of SEMS as a bridge to surgery for obstructing left-sided colorectal cancer is associated with a higher rate of primary anastomosis as well as a better outcome in terms of hospital stay and stay in the ICU. The wider application of this treatment option for obstructing colorectal cancer warranted further studies.

Background This study evaluated the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and colorectal (CR) POSSUM in laparoscopic colorectal resection. Methods Observed mortality and morbidity rates in 400 patients who underwent laparoscopic colorectal resection were compared with those predicted by POSSUM, P-POSSUM and CR-POSSUM. Results Observed mortality and morbidity rates were 0·5 and 19·0 per cent respectively. Mortality rates predicted by POSSUM, P-POSSUM and CR-POSSUM were 10·8, 4·0 and 5·6 per cent respectively, and the morbidity rate predicted by POSSUM was 43·0 per cent. The predicted and observed mortality and morbidity rates showed significant lack of fit. The conversion rate to open surgery was 11·5 per cent. The mortality rate for patients having conversion was 2 per cent and was not significantly different to that predicted by P-POSSUM (4 per cent; P = 0·493) or CR-POSSUM (5 per cent; P = 0·370). In this group, the observed and POSSUM-predicted morbidity rates were also similar (43 versus 48 per cent respectively; P = 0·104). Conclusion POSSUM, P-POSSUM and CR-POSSUM overestimated mortality and morbidity in patients who underwent laparoscopic colorectal resection. However, the mortality rate in patients who required conversion fitted the models of P-POSSUM and CR-POSSUM, and the morbidity rate was comparable to that predicted by POSSUM.

Endoscopic removal of large sessile polyps is sometimes technically difficult and is associated with an increased risk of complications. Moreover, the incidence of invasive carcinoma within these polyps is not negligible. Laparoscopic colorectal resection has been recommended in the treatment of these large polyps. This study aimed to evaluate the outcomes of laparoscopic colorectal resection for polyps that were not suitable for colonoscopic removal.Forty-five patients (28 men and 17 women) who underwent laparoscopic colorectal resection with the preoperative diagnosis of colorectal polyps were analyzed. The reasons for surgical resection were large sessile polyps (n = 34), difficult position (n = 2), recurrence after transanal endoscopic microsurgery (n = 1), and the presence of intramucosal malignancy on histology after colonoscopic polypectomy (n = 8).The mean age of the patients was 66.7 years (range, 33-89). Previous abdominal operation had been performed in 12 patients (26.7%). Two patients underwent subtotal colectomy because of multiple polyps (14 and 19, respectively). Synchronous resection of other organs was performed in two patients (a right salpingo-oophorectomy and a right adrenalectomy). Intraoperative complications occurred in two patients, and two patients (4.5%) required conversion because of perforation of the colon during dissection and dense adhesions, respectively. There was no postoperative mortality. Complications occurred in seven patients (15.6%), and they included postoperative ileus (n = 4), anastomotic leakage (n = 1), urinary retention (n = 1), and urinary tract infection (n = 1). Reoperation was required in one patient for anastomotic leakage. The median hospital stay was 6 days. The histopathology of colorectal polyps showed tubular (n = 12), tubulovillous (n = 13), and villous adenoma (n = 12); mixed adenomatous/hyperolastic polyps (n = 2); inflammatory polyp (n = 1); and colonic lipoma (n = 1). Four patients, who had previous polypectoray with intramucosal malignancy, had no residual pathology. The median size was 3.0 cm. Invasive carcinoma was found in 16 patients (35.6%). The median number of lymph node sampling was six, and two patients had lymph node metastases.Colonic polyps that were not amendable for colonoscopic removal were associated with a high incidence of malignant invasion. Laparoscopic colectomy offers safe and effective management of these polyps with the benefits of early postoperative recovery.

Background The aim of this study was to compare the operative results and oncological outcomes of patients who had mid or distal rectal cancer treated by abdominoperineal resection (APR) with those treated without sphincter ablation (non-APR). Methods Five hundred and four consecutive patients (308 men and 196 women) with rectal cancer within 12 cm from the anal verge underwent radical resection with curative intent. Sharp mesorectal dissection was used. Operative results and long-term outcomes were compared between those treated by APR and those by non-APR. Results Sixty-nine patients had APR and 435 patients were treated with radical resection without perineal resection (anterior resection, 419; Hartmann's operation, 16). The overall operative mortality and morbidity rates were 1·6 and 31·0 per cent respectively. Age, sex, duration of surgery, blood loss, duration of hospital stay, operative mortality and overall morbidity were similar in the two groups. Local recurrence was more frequent after curative APR than after non-APR (23 versus 10·2 per cent at 5 years; P = 0·010). Five-year cancer-specific survival rates after APR and non-APR were 60 and 74·0 per cent respectively (P = 0·006). APR was an independent factor for poor cancer-specific survival in multivariate analysis. Conclusion Although postoperative mortality and morbidity rates were similar in patients with or without sphincter ablation, local control and survival were worse in those treated by APR.

The value of surgery for patients with incurable colorectal cancer is controversial. This study evaluated outcomes in patients undergoing non-curative surgery for colorectal cancer and aimed to identify patients who would benefit from palliative surgery. Demographics, tumour characteristics, operating details and outcomes were reviewed for 180 patients undergoing surgery for incurable colorectal cancer; palliative resection was performed in 150 cases. Seventeen patients died in the postoperative period. Risk factors for postoperative mortality and poor survival were analysed with univariate and multivariate analysis. Multivariate analysis showed that operative mortality was significantly higher in patients with non-resection surgery and in those with ascites. Median survival of patients with resection was significantly longer than in those without resection (30 vs. 17 weeks). Other independent factors that were significantly associated poor survival were the presence of ascites, presence of bilobar liver metastasis and absence of chemotherapy and/or radiation therapy. Non-curative surgery is associated with high mortality in patients without resection and in the presence of ascites. These two factors, together with the presence of bilobar liver metastasis and the absence of chemotherapy and/or radiation therapy, are associated with poor survival. In the presence of these factors the balance between the benefit and risk of surgery should be carefully considered before decision for operative treatment.

We report a patient with obstructing cancer of the sigmoid colon initially treated with a self-expanding metallic stent. The metallic stent successfully relieved the intestinal obstruction, and laparoscopic anterior resection was performed subsequently. The use of this approach in the management of patients with obstructing colorectal cancer is discussed.

Metastasis of breast cancer to the colon is rare. We report a case of a 49-year-old female who presented with a stenotic tumor of the descending colon five years after treatment of breast cancer with mastectomy and pedicled transverse rectus abdominis musculocutaneous flap. Laparotomy showed a diffusely infiltrated tumor over the descending colon. Anterior resection with loop ileostomy was performed, and the pathology showed that the colonic wall and the mesentery were diffusely infiltrated with poorly differentiated adenocarcinoma, which stained strongly for cytokeratin 7. The histologic diagnosis is consistent with colonic metastasis from ductal carcinoma of breast origin. In a patient with a history of breast cancer, colonic metastasis from the breast primary cancer should be considered, especially if the colonic lesion is scirrhous in nature. The incision for laparotomy and the probable stoma site should be planned carefully in females after breast reconstructive surgery.

Background The overall prognosis of colorectal cancer (CRC) patients is unsatisfactory due to cancer metastasis after operation. This study aims to investigate the clinical significance of plasma osteopontin (OPN) levels as minimally invasive, predictive, and surrogate biomarkers for prognosis of CRC patients. Methods This randomized study design consists of pre-operative and post-operative plasma samples from a total of 79 patients. We determined plasma levels of OPN by ELISA and examined their correlation with the clinicopathological parameters of CRC patients. The effects of endogenous and exogenous OPN on CRC metastasis were investigated by examination of the effect on regulators of epithelial to messenchymal transition and migration assay. Results Our findings demonstrated for the first time the clinical correlation of plasma OPN with metastasis of CRC patients. High post-operative plasma OPN level (>153.02 ng/ml) associated with development of metastasis after curative resection (p, published_or_final_version

Rectal cancer surgery has undergone a rapid evolution in the last few decades. Adoption of total mesorectal excision (TME) dramatically reduced the local recurrence rate and improved the survival rate. TME became the standard procedure for cancer of the middle and lower rectum soon after its introduction. The use of laparoscopic approach in resection of colorectal cancer started in the early 1990s. Laparoscopic resection for colon cancer was widely advocated subsequently as most randomized trials had proven that the oncological outcome comparable to that of open colectomy could be achieved, in addition to the intrinsic benefits of minimally invasive surgery. Rectal cancer was rarely included in early randomized trials comparing laparoscopic and open surgery because of the relative complexity of rectal cancer resection, in particular, TME. The first laparoscopic TME was only reported in 2001. Concerns about oncological safety of laparoscopic TME existed as there were limited studies to compare the long-term outcomes of laparoscopic and open TME on a randomized setting.

Background Rectal carcinoids are an uncommon entity comprising only 1%–2% of all rectal tumors. Rectal carcinoids are frequently diagnosed during colonoscopy, but management after polypectomy is still controversial. The aims of this study were to review the surgical procedures for rectal carcinoids and to compare the outcomes of patients after different treatment modalities in a university hospital in Hong Kong. Methods All rectal carcinoids diagnosed between January 2003 and September 2012 were reviewed retrospectively, including clinicopathological characteristics, their management, and surgical outcomes. Results There were 54 patients with a median age of 60 years, and 32 were males (59.3%). All patients underwent colonoscopy, and the most had rectal bleeding (53.7%). Two patients were diagnosed incidentally in the surgical specimens of rectal tissues. Eighteen patients were diagnosed to have rectal carcinoids after snaring polypectomy, and no further intervention was required. Twenty-five patients had local resection either by means of transanal resection or transanal endoscopic operation. Radical resection was performed in seven patients in which one had T3N1 disease and the others did not have any lymph node metastasis. In the median follow-up of 30 months (10–108 months), there was no recurrence in the “incidental” or post-polypectomy group. However, two patients with transanal resection and two patients with radical resection developed hepatic metastases after 13–24 months post-treatment. The 5-year overall survival was 100% in patients having snaring polypectomy only, 83% for those with local resection, and 63% in patients who underwent radical surgery (p = 0.04). Conclusions Our data suggested that that local resection was an effective treatment for small rectal carcinoids and generally brought about good oncological and surgical outcomes. For larger tumors, radical resection seemed to provide acceptable oncological outcomes. Regular surveillance with colonoscopy and endorectal ultrasound is highly recommended for high-risk patients for long-term management. By sharing our experience, we hope to provide more evidence on the management on rectal carcinoids which, together with evidence from further studies, may guide us in the long-term management of these patients in the future.

Open colorectal surgery in the elderly has been associated with higher morbidity and mortality rates. The favorable short-term outcomes of laparosocopic colorectal resection might reduce the morbidity in elderly patients. This study compares results of elderly patients (aged 70 and above) who underwent laparoscopic colorectal resection with those having open surgery.Consecutive patients aged 70 and above who had elective colorectal resection from June 2000 to December 2001 were included. Data concerning demographics, diseases, details of operations, and postoperative events were collected prospectively. Comparisons between results of laparoscopic surgery and open surgery were made.Sixty-five patients had laparoscopic colectomy and 89 had open surgery during the study period. Median ages were 77 years and 75 years in the open and laparoscopic groups, respectively. Presence of premorbid medical conditions, American Society of Anesthesiology score, and incidence of previous surgery were similar in the two groups. Median operative time was longer (180 minutes versus 135 minutes, p0.001), but blood loss was less (100 mL versus 200 mL, p = 0.001) in the laparoscopic group. Conversion to open surgery occurred in eight patients. One patient died in the laparoscopic group and five died in the open group. Laparoscopic resection was associated with earlier return of bowel function (3 days versus 4 days, p = 0.004), earlier resumption of solid diet (3 days versus 5 days, p0.001), shorter hospital stay (7 days versus 9 days, p = 0.001), and less cardiopulmonary morbidity (7.7% versus 22.4%, p = 0.033) when compared with open colorectal resection.Laparoscopic colorectal resection is a safe option for elderly patients and is associated with more favorable short-term outcomes in terms of earlier return of bowel function, earlier resumption of diet, and shorter hospital stay. It is also associated with less cardiopulmonary morbidity, which is an important complication after colorectal surgery in the elderly.

Background The aim of this study was to compare loop ileostomy and loop transverse colostomy as the preferred mode of faecal diversion following low anterior resection with total mesorectal excision for rectal cancer. Methods Patients who required proximal diversion after low anterior resection with total mesorectal excision were randomized to have either a loop ileostomy or a loop transverse colostomy. Postoperative morbidity, stoma-related problems and morbidity following closure were compared. Results From April 1999 to November 2000, 42 patients had a loop ileostomy and 38 had a loop transverse colostomy constructed following low anterior resection. Postoperative intestinal obstruction and prolonged ileus occurred more commonly in patients with an ileostomy (P = 0·037). There was no difference in time to resumption of diet, length of hospital stay following stoma closure and incidence of stoma-related complications after discharge from hospital. A total of seven patients had intestinal obstruction from the time of stoma creation to stoma closure (six following ileostomy and one following colostomy; P = 0·01). Conclusion Intestinal obstruction and ileus are more common after loop ileostomy than loop colostomy. Loop transverse colostomy should be recommended as the preferred method of proximal faecal diversion.

This study reviewed the local recurrence rate in patients who had undergone total mesorectal excision and double-stapling low anterior resection for mid and distal rectal cancers. It also aimed to identify risk factors for local recurrence through univariate and multivariate analyses. Consecutive patients with rectal cancers within 12 cm of the anal verge treated with total mesorectal excision and double-stapling low anterior resection from August 1993 to December 2000 were studied. The demographic data, operative details, tumor characteristics, and follow-up data were collected prospectively. Factors that might affect the local recurrence rate were analyzed with univariate and multivariate analyses. A total of 270 patients were included in the study (156 men, 114 women). The mean +/- SD age was 64.83 +/- 11.27 years. The mean +/- SD level of the tumor was 7.17 +/- 1.90 cm. All anastomoses were performed within 5 cm of the anal verge. During the mean follow-up of 35.5 months, 12 patients developed local recurrence. The 5-year actuarial local recurrence rate was 7.3%. The presence of lymphovascular invasion and the resection margin of < or = 1 cm were found to be risk factors for local recurrence in the univariate analysis. In the multivariate analysis, the presence of lymphovascular invasion was the only independent factor for local recurrence. In the group of patients with lymphovascular invasion, proximal tumors (6-12 cm from the anal verge) were shown to have a significantly lower local recurrence than those within 6.1 cm from the anal verge (4.2% vs. 37.8%; p

© 2015 Chow et al.Background: In colorectal carcinoma (CRC), activation of the Raf/MEK/ERK signaling pathway is commonly observed. In addition, the commonly used 5FU-based chemotherapy in patients with metastatic CRC was found to enrich a subpopulation of CD26+ cancer stem cells (CSCs). As activation of the Raf/MEK/ERK signaling pathway was also found in the CD26+ CSCs and therefore, we hypothesized that an ATP-competitive pan-Raf inhibitor, Raf265, is effective in eliminating the cancer cells and the CD26+ CSCs in CRC patients. Methods: HT29 and HCT116 cells were treated with various concentrations of Raf265 to study the anti-proliferative and apoptotic effects of Raf265. Anti-tumor effect was also demonstrated using a xenograft model. Cells were also treated with Raf265 in combination with 5FU to demonstrate the anti-migratory and invasive effects by targeting on the CD26+ CSCs and the anti-metastatic effect of the combined treatment was shown in an orthotopic CRC model. Results: Raf265 was found to be highly effective in inhibiting cell proliferation and tumor growth through the inhibition of the RAF/MEK/ERK signaling pathway. In addition, anti-migratory and invasive effect was found with Raf265 treatment in combination with 5FU by targeting on the CD26+ cells. Finally, the anti-tumor and anti-metastatic effect of Raf265 in combination with 5FU was also demonstrated. Conclusions: This preclinical study demonstrates the anti-tumor and anti-metastatic activity of Raf265 in CRC, providing the basis for exploiting its potential use and combination therapy with 5FU in the clinical treatment of CRC., published_or_final_version

Our aim is to determine supportive care needs trajectories over the first year following colorectal cancer (CRC) surgery and identify factors differentiating these trajectories in a sample of Hong Kong Chinese CRC patients.Overall, 247/274 Chinese patients diagnosed with CRC were recruited and assessed following admission for colorectal surgery, then at 1, 4, 8, and 12 months post-surgery. Supportive care needs were assessed at each assessment point. Latent growth mixture modeling identified trajectories within each of five assessed needs domains: health system and information (HSI), psychological (PSY), physical daily living (PDL), patient care and support (PCS), and sexuality (SEX) needs.Results indicated four needs trajectories each for HSI, PSY, and PDL domains, three for the PCS and two for the SEX domains. Most patients showed stable low levels of unmet PSY (86%), PDL (86%), PCS (81%), and SEX (98%) supportive care needs. One in seven patients showed persistent high, unmet HSI needs. The coexistence of two or more unmet need domains were found among patients in the high-decline needs group. HSI trajectories were predicted by education level and positive cancer-related rumination, PSY and PCS needs; PSY trajectories were predicted by stoma and HSI needs; PDL trajectories were predicted by physical symptom distress, stoma, PCS, and HSI needs; PCS trajectories were predicted by negative cancer-related rumination, depression, HSI, and PSY needs.These Chinese CRC patients showed generally low stable supportive care needs, but a minority demonstrated high persistent unmet needs. Supportive care services should target those at risk of prolonged high unmet needs.

The study aimed to compare the outcomes of laparoscopic and open resection for rectal cancer in 1,063 consecutive cases in a single center. We performed an analysis of 11 years of experience in rectal cancer surgery and compared the outcome of laparoscopic and open surgery. Multivariate and subgroup analysis was performed to look at the effect of the level of tumor and stage of disease on short-term outcomes like conversion rate, anastomotic leak rate, length of stay, complication rate, 30-day mortality, and long-term outcomes like local recurrence and survival. A total of 1,063 patients underwent rectal resection with 470 (44.2 %) patients undergoing the laparoscopic approach. Groups were comparable in terms of age, sex, or co-morbidities, and the operating time was longer in the laparoscopic group (210 vs. 150 min; p value

Background and aims: Right-sided diverticulitis is rare in Western societies but is not uncommon in Asian countries. Many of the patients are operated with the presumptive diagnosis of appendicitis. This study compared the results of emergency surgery for patients with right-sided and left-sided diverticulitis. Patients and methods: Demographic data, type of operation, and surgical outcome were recorded in 60 patients who had undergone emergency surgery for colonic diverticulitis (37 right-sided, 23 left-sided). Results: Patients with right-sided disease were significantly younger (mean age 41.9 vs. 74.2), and there was a tendency to male predominance (78.4% vs. 56.5%). All patients with right-sided disease had localized peritonitis while 74% of patients with perforated left-sided diverticulitis had generalized faecal or purulent peritonitis. Mortality rates for right-sided disease and left-sided disease were 0% and 13%, respectively, and morbidity was 14.2% and 61%, respectively. Longer hospital stay was also found in patients with left-sided diverticulitis. Conclusions: There are major differences in the demographics, presentation, type of operation and outcome of patients who had emergency surgery for colonic diverticulitis, with emergency operation for left-sided diverticulitis being associated with higher mortality and morbidity.

BACKGROUND: Fifteen to twenty percent of patients with primary colorectal cancers present with intestinal obstruction. Traditionally, different approaches have been used in the management of right-sided and left-sided colonic obstruction. Recently, single-stage resection with primary anastomosis in left colonic obstruction has been shown to have good results. The objective of this study was to compare the operative results of patients who had emergency operations for right-sided and left-sided obstructions from primary colorectal cancers. STUDY DESIGN: This is a retrospective study including 243 patients who underwent emergency operations for obstructing colorectal cancers from 1989 to 1997. Primary resection of the tumor-bearing segment followed by primary anastomosis was attempted when the conditions were feasible. The operative results of patients with right-sided tumors were compared with those of patients with left-sided tumors. RESULTS: One hundred seven patients had obstruction at or proximal to the splenic flexure (right-sided lesions), and 136 had lesions distal to the splenic flexure (left-sided lesions). The primary resection rate was 91.8%. Of the 223 patients with primary resection, primary anastomosis was possible in 197 patients. Among the 101 primary anastomoses in patients with left-sided obstruction, segmental resection with on-table lavage was performed in 75 patients and subtotal colectomy was performed in 26. The overall operative mortality rate was 9.4%, although that of the patients with primary resection and anastomosis was 8.1%. The anastomotic leakage rate for those with primary resection and anastomosis was 6.1%. There were no differences in the mortality or leakage rates between patients with right-sided and left-sided lesions (mortality: 7.3% versus 8.9%, p=0.79; leakage: 5.2% versus 6.9%, p=0.77). Colocolonic anastomosis did not show a significant difference in leakage rate when compared with ileocolonic anastomosis (6.1% versus 6.0%, p=1.0). CONCLUSIONS: This study showed that primary resection and anastomosis for left-sided malignant obstruction, either by segmental resection with on-table lavage or subtotal colectomy, was not more hazardous than primary anastomosis for right-sided obstruction. The single-stage procedure should be the objective for the treatment of patients with obstructing colorectal cancers, except when patients are hemodynamically unstable during surgery or when the condition of the bowel is not optimal for primary anastomosis.

Background: Rectourethral fistula is a rare complication of radical prostatectomy. Risk factors include history of pelvic irradiation, cryotherapy, intraoperative rectal injury or transurethral resection of the prostate. Diagnosis of rectourethral fistula requires a high index of suspicion, and complete work-up with endoscopy and imaging studies. The majority of patients require operative intervention, with approaches ranging from transabdominal, transrectal, transanal, and transperineal routes. Method: We report two patients with rectourethral fistula after radical prostatectomy. The first patient was a 59-year-old man who underwent an uncomplicated laparoscopic radical prostatectomy for early prostate cancer in another hospital. The second patient was a 64-year-old man who had local recurrence after cryotherapy for prostate cancer. He underwent salvage radical prostatectomy in a private hospital, which was complicated by intraoperative rectal injury. Results: In both patients, the rectourethral fistulae were successfully repaired with a transperineal approach in the prone jack-knife position. Conclusion: We found that the transperineal approach in the prone jack-knife position offered excellent exposure, allowed versatile surgical manoeuvres and produced successful repair with good continence outcomes.

INTRODUCTION: The treatment of malignant obstruction of the left colon or rectum usually requires emergency surgery on poor-risk patients, and the creation of a stoma is usually inevitable. With the use of self-expanding metallic stents, the prompt relief of large-bowel obstruction without surgery has become possible. This report describes our results in the use of self-expanding metallic stents in the treatment of left-sided colonic obstruction resulting from advanced malignancies. METHODS: From November 1997 to March 1999, insertion of self-expanding metallic stents was attempted in 24 patients with acute left-sided colonic obstruction caused by primary or recurrent malignancies. All the procedures were performed by colorectal surgeons. The guidewire was inserted through the channel of the endoscope, and its position was confirmed with fluoroscopy. Uncovered Wallstent® esophageal endoprostheses were used in all except the first case. The insertion and deployment of the stents were under both endoscopic and fluoroscopic guidance. RESULTS: There were 24 patients (15 males) with a mean age of 63.6 (range, 36–98) years. Thirteen patients had primary colorectal cancer and 11 had recurrent cancers (colorectal cancer, 5; gastric cancer, 5; other, 1). In the treatment of primary colorectal cancer, seven procedures were palliative, and no subsequent surgery was planned because of extensive liver metastasis or poor medical risk. The other six patients underwent elective resection after mechanical bowel preparation. There was no mortality related to the procedure. Stenting was successful in the relief of obstruction in 23 patients. Perforation of the colon occurred in one patient, and an emergency Hartmann's operation was performed. Migration of the stents occurred in three patients. Only 3 of the 18 patients in the palliation group required the subsequent creation of stomas. CONCLUSION: The use of the self-expanding metallic stents can achieve rapid and effective nonsurgical means to relieve left-sided colonic obstruction. It provides good palliation for unresectable advanced tumors that cause colonic obstruction. It may also have a role in the temporary relief of obstruction so that subsequent colonic resection can be performed under elective conditions.

Locally recurrent rectal cancer is a difficult clinical problem, and surgical resection can be done only in selected patients. The aims of this study were to evaluate the results of resecting the local recurrence of rectal cancer and to analyze factors that might predict curative re-resection and those that affect survival. Forty-seven patients who underwent resection for locally recurrent rectal cancer formed the basis of the study. Twenty-four were curative in nature, and the others were palliative. There was no operative mortality, and the complication rate was 38%. The median survival of the whole group was 16.5 months. The ability to perform curative resection was found to be the only independent factor associated with improved survival. Female gender is a significant factor associated with curative resection of local recurrence. In patients with curative reresection, local control is up to 87%. It was concluded that resection of local recurrent rectal cancer can achieve good local control and can improve survival in selected patients. The ability to perform curative resection is associated with survival benefit, and female gender is associated with the increased possibility of carrying out curative resection.

Background: Since its first description in 1948, total pelvic exenteration has been a surgical option for the treatment of locally advanced rectal cancer in selected patients. During these 50 years, it has remained a formidable procedure with high mortality and substantial morbidity. This report describes the results of total pelvic exenteration for rectal cancer in terms of postoperative mortality, morbidity, and longterm survival in patients with locally advanced primary and recurrent rectal cancer. Study Design: A study of the patient records revealed that 24 patients underwent total pelvic exenteration as the treatment for locally advanced primary or recurrent cancer of the rectum from 1983 to 1998. The charts of the patients were reviewed, and morbidity and mortality were documented. The survival of the patients was also analyzed. Results: Fifteen patients had primary tumor and 9 had locally recurrent cancer. The mean age was 62 years old. There were no postoperative deaths, and the complication rate was 54%. In the treatment of primary tumor, bowel continuity was possible in 60% of the patients. Previous radiation or operation for recurrent disease was not associated with increased morbidity. The overall 5-year survival was 44%. The 5-year survival of patients with primary cancer was 64% and was significantly better than the rate for those with recurrent disease. Only one patient with recurrent disease survived more than 24 months. Conclusions: Total pelvic exenteration now can be performed with low mortality rates, but the morbidity remains high. In the treatment of primary rectal cancer, good survival (64%) can be achieved, but results are dismal for the treatment of recurrent disease. We suggest better selection of patients for this procedure, especially as a treatment for recurrent rectal cancer.

PURPOSE: Rubber band ligation is a common office procedure for hemorrhoids. Triple rubber band ligation in a single session has been shown to be a safe and economical way of treating hemorrhoids. However, postligation discomfort after triple rubber band ligation is not uncommon. The aim of this study was to evaluate the effectiveness of local anesthetic injection to the banded hemorrhoidal tissue in reducing postligation discomfort. METHODS: Patients attending an outpatient clinic for symptomatic hemorrhoids suitable for triple rubber band ligation were randomly assigned to two groups. In the treatment group rubber band ligation was performed at three columns of hemorrhoids, and 1 to 2 ml of 2 percent lignocaine was injected into the banded hemorrhoidal tissue. In the control group triple rubber band ligation was performed in a similar manner, but local anesthetic was not given. Patients were followed up by telephone at the second week and in the clinic after six weeks. RESULTS: From April to August 1996, 101 patients entered the trial and were treated with triple rubber band ligation. Sixty-two patients were randomly assigned to the local anesthetic injection group and 39 to the control group. Overall good to excellent results occurred in 89 percent of patients, and there was no difference between the two groups. Postligation pain occurred in 26 and 20 percent of patients in the treatment and control groups, respectively (P>0.05). Postligation tenesmus occurred in 32 and 41 percent of patients in the treatment and control groups, respectively (P>0.05). No patients suffered from septic complications or bleeding that required transfusion. CONCLUSION: Triple rubber band ligation in a single session is a safe, economical, and effective way of treating symptomatic hemorrhoids. Postligation pain and tenesmus occurred in 24 and 37 percent, respectively. Discomfort was usually tolerable. Local anesthetic injection to the banded hemorrhoidal tissue did not help to reduce postligation discomfort.

Needlescopic TEP hernioplasty has been shown to be a safe and feasible method for repair of unilateral inguinal hernia in selected patients. It is associated with significantly lower pain score when compared to conventional approach using 5mm ports. Though the mesh placement using tissue glue or tacker application can prevent migration and hence hernia recurrence, this may be technically challenging using needlescopic instruments and not feasible through 3mm working ports. A new design of laparoscopic self-fixating anatomical mesh can be used to attain the above result without increasing pain. We hereby illustrate a case of needlescopic TEP hernioplasty using laparoscopic self-fixating anatomical mesh.

Aim This study aimed to evaluate both the short- and long-term outcomes associated with colonic stenting as a bridge to surgery in patients with obstructing adenocarcinoma of the colon. Method Patients with potentially curable acute left-sided colonic obstruction treated with stenting as a bridge to surgery (n = 28) or with emergency surgical resection (n = 39) from January 1998 to December 2008 were identified from a prospectively maintained database. Short-term data on postoperative mortality, morbidity, necessity of intensive care and length of hospital stay were compared. Overall survival and disease-free survival were also analysed. Results Patients in the two study arms had similar demographic profiles. Those receiving preoperative stenting had a higher likelihood of a laparoscopic resection (P

This study determined the expression of microRNA-133a (MiR-133a) in colorectal cancer (CRC) and adjacent normal mucosa samples and evaluated its clinicopathological role in CRC. The expression of miR-133a in 125 pairs of tissue samples was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) and correlated with patient's clinicopathological data by statistical analysis. Endogenous expression levels of several potential target genes were determined by qRT-PCR and correlated using Pearson's method. MiR-133a was downregulated in 83.2% of tumors compared to normal mucosal tissue. Higher miR-133a expression in tumor tissues was associated with development of distant metastasis, advanced Dukes and TNM staging, and poor survival. The unfavorable prognosis of higher miR-133a expression was accompanied by dysregulation of potential miR-133a target genes, LIM and SH3 domain protein 1 (LASP1), Caveolin-1 (CAV1), and Fascin-1 (FSCN1). LASP1 was found to possess a negative correlation (γ=-0.23), whereas CAV1 exhibited a significant positive correlation (γ=0.27), and a stronger correlation was found in patients who developed distant metastases (γ=0.42). In addition, a negative correlation of FSCN1 was only found in nonmetastatic patients. In conclusion, miR-133a was downregulated in CRC tissues, but its higher expression correlated with adverse clinical characteristics and poor prognosis. © 2014 Timothy Ming-Hun Wan et al., published_or_final_version

Single-incision laparoscopic colectomy (SILC) is a new operative approach for laparoscopic colorectal surgery. All instruments are inserted through a special multichannel single port device which is inserted through a small incision at abdominal wall. SILC gives very good cosmetic results and is potentially associated with reduced operative trauma and earlier recovery. However, SILC increase operative difficulty and its practice should be carefully evaluated by well conducted clinical studies. This chapter reviewed current evidence for this new and controversial operation.

Single incision laparoscopic left colectomy has been well described as a feasible procedure. While the principles are the same as conventional multiport laparoscopy, one needs to adapt to technical challenges in single incision laparoscopic surgery such as limited retraction, loss of triangulation and clashing of instruments. Because of the learning curve and technical challenges, single incision laparoscopic surgery has yet to become a standard procedure for left-sided colonic lesions. Selecting the appropriate patient and optimal lesions can affect the chance of success. Specialized equipments like deflectable tip laparoscope, articulating or curved instruments could potentially facilitate the surgery. Poor retraction is overcome by novel techniques. Overall, additional skills have to be acquired in order to master single incision left colectomy. This chapter describes the technical aspect of single incision laparoscopic left colectomy.

Aim The TMN staging system is the most important tool for predicting the long-term survival of colorectal cancer patients. However, physiological conditions and the operation may also influence survival. This study evaluated the impact of the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and the colorectal version (CR-POSSUM) on the long-term survival of patients with rectal cancer. Method Prospectively collected data were included of consecutive patients who underwent rectal cancer resection between 2000 and 2004. The relationship between the POSSUM and CR-POSSUM scores and the physiological components with outcomes and survivals was analysed. Results The study included 343 patients (196 men, 263 open resections, 74 laparoscopic resections, six local resections) with a mean follow-up of 56.5 months. Thirty-five patients had had neoadjuvant chemoradiation and 115 had adjuvant chemotherapy. Their median POSSUM score was 34 (interquartile range 31–39) and the median CR-POSSUM score was 19 (interquartile range 18–21). The log rank test showed a significant difference (P

Consensus abstract Background The management of primary rectal cancer beyond total mesorectal excision planes (PRC-bTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional total mesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized web-based voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and March 2012, open discussion took place on areas in which there is a low level of consensus. Results The final consensus document included 51 voted statements, making recommendations on ten key areas of PRC-bTME and RRC. Consensus agreement was achieved on the recommendations of 49 statements, with 34 achieving consensus in over 95 per cent. The lowest level of consensus obtained was 76 per cent. There was clear identification of the need for referral to a specialist multidisciplinary team for diagnosis, assessment and further management. Conclusion The consensus process has provided guidance for the management of patients with PRC-bTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.

Controversy remains regarding whether preoperative chemoradiation protocol should be applied uniformly to all rectal cancer patients regardless of tumor height. This pooled analysis was designed to evaluate whether preoperative chemoradiation can be safely omitted in higher rectal cancer. An international consortium of 7 institutions was established. A review of the database that was collected from January 2004 to May 2008 identified a series of 2102 patients with stage II/III rectal or sigmoid cancer (control arm) without concurrent chemoradiation. Data regarding patient demographics, recurrence pattern, and oncological outcomes were analyzed. The primary end point was the 5-year local recurrence rate. The local relapse rate of the sigmoid colon cancer (SC) and upper rectal cancer (UR) cohorts was significantly lower than that of the mid/low rectal cancer group (M-LR), with 5-year estimates of 2.5% for the SC group, 3.5% for the UR group, and 11.1% for the M-LR group, respectively. A multivariate analysis showed that tumor depth, nodal metastasis, venous invasion, and lower tumor level were strongly associated with local recurrence. The cumulative incidence rate of local failure was 90.6%, 92.5%, and 94.4% for tumors located within 5, 7, and 9 cm from the anal verge, respectively. Routine use of preoperative chemoradiation for stage II/III rectal tumors located more than 8 to 9 cm above the anal verge would be excessive. The integration of a more individualized approach focused on systemic control is warranted to improve survival in patients with upper rectal cancer.

Granulomatous appendicitis can be idiopathic or due to a number of specific causes. Idiopathic granulomatous appendicitis is regarded as a separate disease entity and usually has a benign course. We report on a case of granulomatous appendicitis, which progressed to fulminant Crohn's colitis shortly after appendicectomy. During the treatment with intravenous steroid, torrential gastro­intestinal bleeding developed and emergency subtotal colectomy had to be performed. The clinical and histological features of the case are presented and the literature on granulomatous appendicitis reviewed.

We investigated if 18F-FDG PET/CT, DW-MRI, and DCE-MRI are able to predict preoperative chemoradiation therapy (CRT) response in patients with T3-4 rectal adenocarcinomas. MRI and PET/CT scans were performed within 1 week, at baseline, early midtreatment (2 weeks of CRT), and posttreatment (6 weeks after completing CRT). Responders (n = 4) and nonresponders (n = 4) were defined according to tumor regression grade by histology. Only SUVmax (P = 0.030) at early midtreatment could significantly differentiate between responders and nonresponders, suggesting that 18F-FDG PET/CT may be effective to predict early treatment response compared with DW-MRI and DCE-MRI in T3-4 rectal cancer.

Early reports suggested that actopaxin, a member of the focal adhesion proteins, regulates cell migration. Here we investigated whether actopaxin is involved in hepatocellular carcinoma (HCC) progression and metastasis. We examined actopaxin expression in human HCC samples using immunohistochemistry and western blotting. The functional and molecular effect of actopaxin was studied in vitro by overexpression in a nonmetastatic HCC cell line, as well as repression in a metastatic cell line. The in vivo effect of actopaxin repression was studied in nonobese diabetic and severe combined immunodeficient mice. We found that actopaxin was frequently overexpressed in human HCC patients and its overexpression positively correlated with tumor size, stage, and metastasis. Actopaxin expression also correlated with the metastatic potential of HCC cell lines. Actopaxin overexpression induced the invasion and migration ability of nonmetastatic HCC cells, whereas down-regulation of actopaxin reverted the invasive phenotypes and metastatic potential of metastatic HCC cells through regulating the protein expression of certain focal adhesion proteins including ILK, PINCH, paxillin, and cdc42, as well as regulating the epithelial-mesenchymal transition pathway. Furthermore, there was a close association between actopaxin and CD29. HCC cells with stronger CD29 expression showed a higher actopaxin level, whereas actopaxin repression attenuated CD29 activity. Finally, actopaxin down-regulation enhanced the chemosensitivity of HCC cells towards oxaliplatin treatment by way of a collective result of suppression of survivin protein, β-catenin, and mammalian target of rapamycin pathways and up-regulation of p53. Conclusion: This study provides concrete evidence of a significant role of actopaxin in HCC progression and metastasis, by way of regulation of cell invasiveness and motility, an epithelial-mesenchymal transition process, and chemosensitivity to cytotoxic drugs. (Hepatology 2013;58:667-679)

Aim To report data supporting the development of tailored treatment strategies for rectal cancer. Method A comprehensive review of the literature on the impact of prognostic factors cur-rently not included in international guidelines in rectal cancer management. Results There is considerable variation in treatment guidelines for rectal cancer worldwide, especially for Stage II and Stage III disease. Long-term side effects of chemoradiotherapy are not considered in any guideline. Detailed knowledge, and the prognostic impact, of the circumferential resection margin, tumour grade and venous invasion should be factored into the development of a treatment strategy. Conclusion Factors additional to the TNM system should improve decision making for contemporary rectal cancer treatment. Optimized radiological and pathological evaluations, and a focus on detailed clinical factors, should be the basis for treatment decisions. International guidelines should consider all known prognostic factors for long-term oncological and functional outcomes.

Resection for colon cancer in the elderly is a major undertaking. However, data on the outcome and survival of elderly patients who underwent laparoscopic resection for colon cancer are limited. This study of patients older than 75 years compared outcome and survival between those who underwent laparoscopic resection and those who had open resection for colorectal cancer. From 2000 to 2009, 434 patients ages 75 years and older who underwent elective resection for colon cancer were included in the study. Patients who had rectal cancer or had undergone emergency operations were excluded. Preoperative diagnosis was determined by colonoscopy, and computed tomography scan was performed for preoperative staging. Data on the patients’ demographics, operative details, pathology results, postoperative results, and survival were collected prospectively. The patients who underwent laparoscopic surgery were compared with those who had open surgery. The study included 434 patients (210 men) with a median age of 80 years (range 75–95 years). Of these 434 patients, 189 underwent laparoscopic resection. Nine patients (4.8 %) required conversion to open operation. The patients did not differ in terms of age, gender, incidence of medical comorbidities, or stage of disease. The median operating time was longer in the laparoscopic group, but the blood loss was significantly less. Laparoscopic resection was associated with a lower mortality rate and a shorter hospital stay (p

Single-incision laparoscopic colectomy (SILC) is a newly developed procedure with the benefit of better cosmetic outcome and potentially reduced wound pain compared with conventionally laparoscopic colectomy (CLC). However, the application of SILC requires careful evaluation to prove its benefit and safety. This randomized, controlled study compared the operative outcome of patients who underwent SILC and CLC.Patients who had small cancer (4 cm) or adenomatous polyp requiring colectomy were randomized to have SILC or CLC. The patients were blinded to the procedures and the postoperative pain was used as the primary outcome measure. All patients had patient-controlled analgesia with intravenous morphine after the operation and the nominal rating score on days 1-3 and day 14 were recorded by research staff, who did not known the types of operations. Other operative outcomes of the two groups of patients also were recorded prospectively and compared.There were 25 patients in each group. The patients' demographics, tumor characteristics, operating time, blood loss, complication rate, number of lymph nodes harvested, and resection margin have no statistically significant difference between the two groups. There was no operative mortality in both groups. The SILC group had consistently lower median pain score than CLC group in the whole postoperative course and the difference was statistically significant on day 1 (0 (0-5) vs. day 3 (0-6) respectively; p = 0.002) and day 2 (0 (0-3) vs. 2 (0-8) respectively; p = 0.014). The median hospital stay in the SILC group also was shorter the CLC group.In a selected group of patients with small tumor and good operative risk, SILC is a safe alternative to CLC. Single-port laparoscopic colectomy also is associated with the benefits of less postoperative pain and shorter hospital stay than CLC.

Objective To examine the responsiveness of generic and condition-specific instruments based on the anchor of self-reported level of global change in patients with colorectal cancer (CRC). Study Design and Setting Three hundred thirty-three patients with CRC were surveyed at two assessments at baseline and follow-up at 6 months from September 2009 to July 2010 using the Short Form-12 Health Survey version 2 (SF-12v2) and Functional Assessment of Cancer Therapy-Colorectal (FACT-C) measures. The responsiveness of the two measures was evaluated using standardized effect size, standardized response mean, responsiveness statistic, and receiver operating characteristic (ROC) curve analysis. Results In worsened group, internal responsiveness of detecting negative changes was satisfactory for most subscales of FACT-C and SF-12v2. The FACT-C subscales were significantly more responsive to positive changes detection than the SF-12v2 subscales in improved group. Physical well-being subscale, Trial Outcome Index (TOI), and total score of FACT-C were more externally responsive to ROC curve analysis. The FACT-C measure was generally more responsive to changes in health status compared with SF-12v2 measure. Conclusion TOI and total score of FACT-C were the most responsive among subscales of condition-specific measure, which were more responsive than all generic subscales with the exception of social domain. Complementary use of condition-specific and generic instruments to evaluate the health-related quality of life of CRC patients is encouraged.

Understanding cancer patients' supportive care needs can help optimize health-care systems and inform services development. We therefore examined the prevalence of supportive care needs in Chinese breast (BC) and colorectal cancer (CRC) patients to identify prevalence and correlates of unmet needs.We assessed supportive care needs (Supportive Care Needs Survey-Short Form), psychological distress (the Hospital Anxiety and Depression Scale), symptom distress (The Memorial Symptom Assessment Scale-Short Form), and satisfaction with care (Patient Satisfaction Questionnaire) among 210 Chinese BC (97) or CRC (104) outpatient clinic attendees.Breast cancer patients (89.7%) reported more unmet needs (χ(2) = 4.409, p = 0.027), but both CRC and BC samples ranked unmet needs prevalence similarly, with health system and information needs reported as the most common. Younger patients reported higher health system and information and sexuality needs. After multivariate adjustment, the strength of unmet needs did not differ by cancer type. Unmet psychological, physical and daily living, and sexuality needs were positively associated with greater symptom distress. Greater health system information needs were associated with high global distress and low depression scores, whereas greater psychological needs were associated with higher anxiety scores.Hong Kong Chinese BC and CRC patients strongly prioritized needs related to health systems and information provision. Symptoms and psychological distress were associated with unmet needs, reflecting a service shortfall in symptom management. Improving care provision by optimizing communication and clinic organization can better prepare cancer patients for their rehabilitation and improve symptom control.

To estimate the direct medical cost of colorectal neoplasia (CRN) from newly diagnosed to the completion of the tumour-specific treatment in the initial year of disease across stages and tumour primary sites.Only direct medical costs from the perspective of the health care service provider were incorporated in the cost analysis (in 2009 USD) using a bottom-up approach. Tumour-specific treatments of surgery, chemotherapy and radiotherapy data in the initial year of disease were identified from the 401 CRN adult patients by a review of their medical records. Service utilization for diagnosis, staging, pre-operative assessment and post-operative follow-up consultations was estimated from the recommendations of established surveillance and clinical practice guidelines.Direct medical cost for the care of a newly diagnosed CRN was ranging from $1941 for low-risk polyp to $45 115 for stage IV colorectal cancer in the initial year of care. Costs of care showed a gradient increase from $1748 for low-risk colonic polyps to $42 899 for stage IV colon cancer, and from $2232 for low-risk rectal polyps to $48 453 for stage IV rectal cancers. Diagnostic/pre-operative assessment and treatment accounted for most of total costs of colorectal polyp (58.9-76.7%) and cancer (60.8-85.2%) care.The results provided stage and site-specific estimations of the direct medical costs of CRN in a Chinese population that can assist policy decision making and facilitate health care service planning and cost-effectiveness evaluations.

To establish the validity and reliability of traditional Chinese version of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C).A total of 536 subjects self-administered (n = 331) or interviewer-administered (n = 205) FACT-C (version 4), EORTC QLQ-C30/CR38 and SF-12v2 instruments for health-related quality of life assessment. Construct validity was examined by item-scale correlation, scaling success and concurrent validity. Reliability was evaluated by test-retest reliability and internal consistency. Sensitivity was assessed by known-groups comparisons.The completion rates for FACT-C were almost perfect (98%). The FACT-C demonstrated item-internal consistency and item discriminant validity through item-scale correlation. Scaling success and concurrent validity were satisfactory to support the construct validity. The five subscales of the FACT-C showed good internal consistency with Cronbach alpha coefficient and substantial reproducibility, demonstrating good reliability. Sensitivity was supported when there were significant differences in scores related to physical condition between patients who were receiving treatment and those who were not.Traditional Chinese version of the FACT-C was demonstrated to have satisfactory psychometric properties in terms of applicability, reliability, validity and sensitivity in Chinese patients with colorectal neoplasm. The FACT-C was valid colorectal-specific health-related quality of life tool for the Chinese population.