Impact Of Imbedding 5-FU Retarder In Rectum Submucosa Preoperation To Lymphatic Metastasis In Progression Of Rectal Cancer

Objective: To approach the significance of imbedding 5—FU retarder in rectum submucosa preoperation to lymphatic metastasis in progression of rectal cancer, confirmed its treatment value of lymphatic metastasis in rectal cancer and the influence to the anastomotic stoma. Methods: Animal experimen part: Eight healthy rabbits were randomly divided into 2 groups. To all rabbits cut the rectum above the peritoneal fold line and anastomose it. In the experimental group ,rabbits was implanted 5-FU 10 mg / kg retarder in rectum submucosa at anastomotic stoma distally. Observate their postoperative recovery. Respectively, on the postoperative 10 days and 30 days cut the animal's belly open to observe anastomotic status .And anastomotic stoma was cut to sent to biopsy . Clinical experimen part:96 patients with Dukes B,C rectal cancer were divided into two groups randomly,45 patients in experimental group and 51 patients in control group , patients in experimental group were imbedded 5-Fu retarder 200mg / m~2 in rectum submucosa preoperation. All patients were subjected to Dixon technique. To every example, obtain focus and adjacent rectum tissue of tumor and normal rectum tissue. To stain with D2—40 monoclonal antibody, calculate their lymphatic vessel density (LVD). Mesorectal lymph nodes and inferior mesenteric lymph nodes were stained with HE, calculated the rate of lymph node metastasis (metastaticlymph nodes ratio, MLR) and transfer degrees (lymph nodes metastasis ratio, LNR). Calculated the apoptosis index(AI) to positive lymph node. the lymph node-negative were immunohistochemistry stained with CK19 to know lymph node MM. Results: The anastomotic stoma of experimental group rabbits were healing well. No anastomotic stenosis and anastomotic leakage appeared . The tissue near the rectum anastomotic stoma no abnormalities were observed .Monoclonal antibody D2-40 stained lymphatic vessels. In two groups of patients the LVD in the bowel tissue nearby tumor than tumor tissue and normal bowel tissue's LVD (P <0.001), and lymphoid cavity were large pipe and without regular pattern. The LVD in the bowel tissue nearby tumor in experimental group was less than the control group, but no significant difference (P = 0.087),and the same is the LVD in the tumor tissue(P=0.141). In experimental group ,there were 769 lymph nodes, in 311 lymph nodes of 17 cases Dukes C patients, 77 positive lymph nodes, 234 lymph node-negative.And 457 lymph node-negative were detected in 28 cases of Dukes B patients. In control group, 840 lymph nodes were detected, among the total 419 lymph nodes belong to 23 cases Dukes C patients , and 105 positive lymph nodes, 314 lymph node negative in them. In dukes B patients with 28 cases, a total of 421 negative lymph nodes. MLR and LNR in experimental group were lower than the control group but were no statistical significance (P= 0.468 and 0.937, respectively). AI in HE masculine lymph nodes in experimental group was 0.086±0.047,and 0.036±0.042 in control group.Between experimental group and control group, AI had significant statistical difference (t = 35.038, p <0.001). All of the lymph node-negative in two groups of patients were immunohistochemistry stained with CK19.Experimental group, 45 cases of patients who had five cases with MM , the rateof lymph node MM was 11.1%, and all of five were Dukes C patients .In totalof 110 lymph nodes, there were 26 HE staining metastatic lymph nodes and 84lymph node-negative, CK19 staining MM node 7 were detected in 84 lymphnode-negative , the lymph node MM transfer degree was 8.3%. In experimentalgroup patients with Dukes B were not found lymph node MM. In control group,51 cases of patients who have 15 cases with MM , the rate of lymph node MMwas 29.4%. 11 of 15 cases were Dukes C patients , and 4 cases were Dukes Bpatients.IN the all of 299 lymph node number of 15 cases of patients, HEstaining 61 metastatic lymph nodes and 238 lymph node-negative, MM nodes46, the lymph node MM transfer degree was 19.3%.The rate of lymph nodeMM and the lymph node MM transfer degree in two groups had significantstatistical difference (P = 0.028 and < 0.001 respectively). There was ashort-time sense of the expansion at imbedding 5-FU retarder in rectumsubmucosa. Injection site hemorrhage less than 5ml. No obvious toxicity ofchemotherapy appeared ,In the surgical specimens, the injection site pathologyexamination revealed a small number of submucosal inflammatory cellinfiltration, intestinal mucosa and the muscle tissue without necrosis. Bothexperimental groups and control groups had one case with symptoms ofanastomotic leakage (p= 0.899). Conclusion: The therapy with imbedding5-FU retarder in rectum submucosa preoperation to lymph node metastasis andmicro-metastasis had inhibitory effect.But the LVD in the bowel tissue nearby tumor and in tumor -tissue were not cut down .The therapy to rectal cancer patiants was simple ,safety and toxicity of chemotherapy was not obvious and no significant impact to anastomotic stoma.