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70 2009 1 16 1 Chin J Bases Clin General Surg, Vol. 16, No. 1, Jan. 2009 1007-9424( 2009) 01-0070 - 05 1, 2, 2, 2, 2, 1 (multi2disciplinary team, MD T), 2006 11 2007 6,, 438,260,178 216,10. 61,1.

1 Chin J Bases Clin General Surg, Vol. 16, No. 1, Jan ( 2009) , 2, 2, 2, 2, 1 (multi2disciplinary team, MD T), ,, 438,260, ,10. 61,1. 43,( r) = , P = ( r = , P = ) X ( r = , P = ) ( r = , P = ), ( r = , P = ) CT (r = , P = ) ( r = , P = ),( P = ) ( P = ),,, ; ; ; R R A Preliminary Exploration to Clinical Application of Colorectal Preoperative Workup in Multi2Disciplinary Team W A N G Xiao2dong 1, L Β Dong2hao 2, Z EN G Tian2f ang 2, L IU Dan 2, Z HA N G L u 2, L I L i Department of A nal2colorec2 tal S urgery, West China Hos pital, S ichuan Universit y, Cheng du , China; 2. West China Medical School, S ichuan Universit y, Cheng du , China Corres ponding A uthor : L I L i, E2mail : d com AbstractObjective To explore application of preoperative examination in the colorectal cancer patients. Methods The preoperative examination data of patients diagnosed definitely as colorectal cancer at West China Hos2 pital of Sichuan University f rom November 2006 to J une 2007 was retrospectively study, and the application situa2 tion and relationship among all preoperative examination in the colorectal cancer patients were analyzed. Results According to the inclusion criteria, 438 colorectal cancer patient s were included which involved 260 males and 178 females. Preoperative examinations included two to sixteen items, with an average of items. According to correlation analysis, positive correlation existed among lung function and blood type ( r = , P = ), tumor marker ( r = , P = ), chest X2ray ( r = , P = ), routine electrocardiogram ( r = , P = ), while lung function and immune and stress reaction exhibit a negative correlation ( r = , P = ) with preoperative examinations. At the same time, immune and stress reaction had positive correlation to CT examinations of abdomen ( r = , P = ) as well as endorectal ultrasound ( r = , P = ). Using univariate analysis, the influence of tumor location ( P = ) and operative method ( P = ) on the number of examination items was significant. Conclusion Preoperative examination of colorectal tumor surgery mainly includes routine examination, neoplasm2related examination and important organs f unction detection. And three levels of pre2 operative menu can be set up in early stage. Establishment of normalization preoperative combined examination may be helpf ul to consummate preoperative evaluation and improve medical quality. Key wordsmulti2disciplinary team ; Colorectal cancer ; Auxiliary examination ; Before operation Foundation itemsichuan Provincial Health Department Research Project (No ) (: ) 1. (610041) ; 2. (610041), E2mail : com ( ),,,,,,E2mail : com

2 Chin J Bases Clin General Surg, Vol. 16, No. 1, Jan , CT MRI, [13 ] ;, [ 4 ],, (multi2disciplinary team,md T) [ 5 ], 438, ,260,178,2587, : 24,103, 168,39,49,27, 2,26 ; : 66,37,36,41, 6,2,72, 178 ; : 178 (: 38,29,22, 78,11 ),260 (250,10 ) ; : 382,10,3,43 ; : 398, 40 ; : 60, 20,10, 53, 45, 12,238 ; TNM : 74, 158, 139, MD T [6 ],: : ; : B CTMRI ; : X CTMRI ; : CT MRI ; : ; : PET2CT,,: ASA TNM ( T N M ) ( ) 1. 3 SPSS Spearman, U nivariate = ,10. 61,2 ( ) ( ) ( P> 0. 05) 2 12 ( P> 0. 05) 2. 2 Spearman, 100 %, (> 80 %) 2, ( r) = , P = ) X ( r = , P = ) ( r = , P = ), ( r = , P = ) CT ( r = , P = ) ( r = , P = ) CT ( r = , P = ) CT ( r = , P = ) ( r = , P = ) CT CT ( r = , P = ) CT ( r = , P = ) CT ( r = , P = ) CT ( r = , P = ) : MRI MRI MRI : MRI

3 Chin J Bases Clin General Surg, Vol. 16, No. 1, Jan MRI ( r = , P = ), MRI ( r = , P = ) ; MRI MRI ( r = , P = ),( r = , P = ) PET2CT( r = , P = ) ( r = , P = ) ( r = , P = ) CT ( r = , P = ), ( P > 0. 05), MRI CT MRICTMRI PET2CT,, 2. 3 ( ASA T N M ), ( P = ) ( P = ), 3 1 ( %) Table 1 Application of preoperative examination in colorectal cancer case( %) Preoperative examination Total utilization n = 438 Rectal cancer n = 260 Colon cancer n = 178 Preoperative examination Total utilization n = 438 Rectal cancer n = 260 Colon cancer n = 178 Bloody exami2 nation Blood routine Biochemical exa2 mination Blood coagu2 lation Blood type Complete set before blood transfusion Tumor marker Immune and stress reaction Imaging of abdo2 men and pelvic B Abdominal ultrasound Endorectal ultrasound CT Abdominal CT MRI Abdominal MRI Virtual coloscopy Heart and lung function exa2 mination Conventional ECG 438 (100) 260 (100) 178 (100) 438 (100) 260 (100) 178 (100) 433 (98. 9) 258 (99. 2) 175 (98. 3) 430 (98. 2) 255 (98. 1) 175 (98. 3) 427 (97. 5) 253 (97. 3) 174 (97. 8) 404 (92. 2) 243 (93. 5) 161 (90. 4) 9 (2. 1) 4 (1. 5) 5 (2. 8) 398 (90. 9) 233 (89. 6) 165 (92. 7) 131 (29. 9) 78 (30. 0) 53 (29. 8) 8 (1. 8) 5 (1. 9) 3 (1. 7) 420 (95. 9) 248 (95. 4) 172 (96. 6) Echocardio2 gram Dynamic elec2 trocardiog2 ram X Chest X2ray CT Chest CT MRI Chest MRI Lung fun2 ction Nervous system examination CT Head CT MRI Head MRI Endoscopy exa2 mination Coloscope Bronchoscope Nuclear medical examination Whole body bone ima2 ging 30 (6. 8) 14 (5. 4) 16 (9. 0) 2 (0. 5) 1 (0. 4) 1 (0. 6) 417 (95. 2) 246 (94. 6) 171 (96. 1) 12 (2. 7) 6 (2. 3) 6 (3. 4) 255 (58. 2) 144 (55. 4) 111 (62. 4) 6 (1. 4) 3 (1. 2) 3 (1. 7) 2 (0. 5) 2 (0. 8) 0 (0) 367 (83. 8) 223 (85. 8) 144 (80. 9) 2 (0. 5) 1 (0. 4) 1 (0. 6) 4 (0. 9) 3 (1. 2) 1 (0. 6) PET2CT

4 Chin J Bases Clin General Surg, Vol. 16, No. 1, Jan ( > 80 %) Table 2 Correlation among preoperative examination items applied rate > 80 % Examination item Blood coag2 ulation Complete set before blood transfusion Blood type Tumor marker X Chest X2ray B Abdominal ultr2 asound Conventional ECG Coloscope Blood coagu2 lation Complete set anterior blood t ransfusion Blood type Tumor marker X Chest X2ray B Abdominal ul2 t rasound Conventional ECG Coloscope r, 3 P < ; 3 3 P < Correlation among preoperative examination items showed by correlation coefficient ( r), 3 P < ; 3 3 P < Factor Gender Education Occupation ASA ASA class T T stage N N stage M M stage Degree of Sum of freedom square 3 Table 3 Multivariate analysis results of preoperative examination items influencing factor Mean square F F value P P value : Factor Total clini2 cal stage Disease state Tumor his2 tology type Tumor lo2 cation Operation type Note : Independent variable was t he number of preoperative examination items Degree of Sum of freedom square Mean square F F value P P value ,,, [7 ], MD T [8 ], : :, ; :, ; :,

5 Chin J Bases Clin General Surg, Vol. 16, No. 1, Jan %, X B,,,,, 80 % NCCN (National Com2 prehensive Cancer Network) [ 9 ],CEA / / CT,MRI,, CT %, 0. 2 %, CT/ MRI, CEA CT,,CT TNM [ 10 ],, 10 %,,,,,,, ;,,80 % ( P < 0. 05),:,, CT ( P < 0. 01), 3,(58. 2 %) (6. 8 %), MD T 3 : () ( ) ( ),,,, 1 Huh J W, Park YA, J ung EJ, et al. Accuracy of endorectal ul2 trasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation [J ]. J Am Coll Surg, 2008 ; 207 (1) 7 2 de Haas RJ, Wichert s DA, Flores E, et al. R1 resection by ne2 cessity for colorectal liver metastases : is it still a contraindica2 tion to surgery? [J ]. Ann Surg, 2008 ; 248 (4) Low G, Tho L M, Leen E, et al. The role of imaging in t he pre2operative staging and post2operative follow2up of cancer [J ]. Surgeon, 2008 ; 6 (4) 222 rectal 4 Leu M, Reilly M, Czene K. Evaluation of bias in familial risk estimates : a study of common cancers using Swedish population2 based registers [J ]. J Natl Cancer Inst, 2008 ; 100 (18) ,,. [J ]., 2007 ; 14 (1) 114 6,,,. [J ]., 2007 ; 14 (6) 713 7,,. Cr2POSSUM [J ]., 2008 ; 29 (7) 934 8,. [J ]., 2007 ; 14 (4) NCCN Clinic Practice Guidelines in Oncology for Rectal Cancer (V ) http :/ / www. nccn. org/ professionals/ physician _ gls/ PDF/ rectal. pdf 10 Gollub MJ, Schwartz L H, Akhurst T. Update on colorectal cancer imaging [J ]. Radiol Clin Nort h Am, 2007 ; 45 (1) 85 ( , ) ( )

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