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How important is it to prevent recurrence and metastasis after rectal cancer surgery?

时间：2026-04-16　人气：

In February 2022, Ms. Shan experienced abdominal distension and discomfort. Upon undergoing a colonoscopy at the hospital, an irregular lateral growth-shaped polyp with an area of approximately 3cm was found at a position 7cm from the anal opening, and a flat polyp with a diameter of 0.8cm was found in the sigmoid colon. Electrocoagulation resection was performed, and the pathology revealed: highly differentiated adenocarcinoma of the rectum, with some presenting in the form of villous adenoma.

Ms. Shan underwent laparoscopic anterior resection of the rectum on March 15th. Postoperative pathology: rectal protruding moderately differentiated adenocarcinoma with high-grade tumor budding and low-differentiated tumor cell clusters, visible vascular thrombi , no clear nerve invasion. Adjacent to the cancer, villous tubular adenoma was found, accompanied by low-grade and focal high-grade epithelial neoplasia. The cancer tissue invaded to the submucosal layer, without involvement of the muscularis propria. Lymph nodes outside the capsule (intestinal wall lymph nodes 1/2; mesenteric lymph nodes 0/9) were involved. Immunohistochemical results showed: BRAF-V600E(-), C-MET(2+), HER2(1+), MLH1(+), MSH2(+), MSH6(+), PMS2(+), Desmin (indicating muscularis mucosae) . Chemotherapy was administered for 4 cycles from April to June 2022.

Ms. Shan had previously undergone surgery for breast cancer in 2010, Ms. Shan is a patient with dual primary cancers of breast and rectum, Regarding the introduction of "multiple primary malignancies", you can click on this article to view

Dual Primary Lung and Breast Cancer: Choosing the Right Approach to Regain Hope for Survival .

Precancerous lesions - adenoma

Colorectal cancer (CRC) has an annual incidence rate of 1.3 million new cases globally, making it the third most common malignant tumor worldwide. In most regions, the incidence rate in males is significantly higher than that in females, and it is also the second leading cause of cancer-related deaths globally. The incidence rate of CRC in China currently ranks third. In 2011, the incidence rate of CRC in China was 23.03 per 100,000 individuals. Many studies have confirmed that the incidence of CRC is shifting towards younger age groups, with the number of cases among young people gradually increasing over the past decade.

Among the various mechanisms underlying the development of CRC, colorectal adenoma (CRA) is a significant factor. According to the adenoma-carcinoma sequence hypothesis, which describes the development pattern of normal mucosa-adenoma-carcinoma, 85% of intestinal cancers develop from adenomatous polyps.

CRA can progress from low-grade dysplasia to tumor cells. Based on different histopathological classifications, polyps can be divided into adenomatous and non-adenomatous types. Adenomatous polyps can further be classified into tubular adenomas with less than 20% villous component, tubular-villous adenomas (also known as mixed adenomas) with 20% to 80% villous component, villous adenomas with more than 80% villous component, and less common serrated adenomas.

In advanced adenomas, a higher villous component is a high-risk factor for the development of CRC. Tubular-villous adenomas have the potential to develop into invasive cancers. Therefore, early screening, diagnosis, and intervention of precancerous lesions are particularly important. Endoscopic resection of adenomas can effectively prevent CRA from progressing to CRC and improve public health.

Ms. Shan underwent surgery to remove the primary lesion and received four courses of chemotherapy. To prevent tumor recurrence, after extensive research, Ms. Shan and her family learned about Professor Zhang Minghui's vNKT technology from Tsinghua University School of Medicine through a friend's recommendation, and carefully reviewed the demonstration cases of vNKTcell therapy. They were particularly eager to try it to reduce the risk of tumor recurrence and delay the time of recurrence and metastasis.

After reviewing Ms. Shan's medical records, Professor Zhang Minghui made the following analysis and judgment:

1. The patient underwent radical resection for rectal cancer, and the postoperative pathology showed vascular tumor thrombus and lymph node metastasis. Although chemotherapy was administered, radiotherapy was not performed, posing a risk of metastatic recurrence.

2. The patient, being elderly, has undergone surgery and chemotherapy, which have caused significant damage to their immune system. Restoring immunity as soon as possible is of utmost importance.

3. The patient has dual primary cancers of breast and rectum, and a cancerous constitution requires heightened vigilance.

4. vNKT therapy utilizes powerful immune cells to eliminate tumor cells that may remain undetected in the body and have essentially no side effects, which can reduce the risk of tumor recurrence.

Ms. Shan started vNKT cell immunotherapy in August 2022 and had completed 11 courses by June 7, 2023. Follow-up evaluations showed no signs of recurrence or metastasis.

CEA: within normal range from February 2022 to November 2022;

CA199: within normal range from February 2022 to May 2022, increased in June 2022, and decreased to within normal range upon reexamination in November 2022.

Ms. Shan achieved the expected results after undergoing vNKT cell therapy, feeling more energetic and experiencing fewer colds and fevers during spring and winter. Her quality of life score improved significantly to 90.5 (previously 88).

Colorectal cancer is a digestive disease that seriously affects human health. Surgery is the only means of radical cure for colorectal cancer, but there is a problem of postoperative recurrence and metastasis. For most advanced rectal cancer, despite postoperative combined chemoradiotherapy, the recurrence rate is still as high as 40%. The postoperative survival time and prognosis of patients are influenced by recurrence-free survival (RFS). Once metastatic lesions are detected, the 5-year survival rate drops to less than 5%, and the average survival period is also shortened to only 7 months^[^1-3^] . Therefore, preventing recurrence and metastasis after radical resection of colorectal cancer is a key focus.

Studies have shown that tumor length >5cm, lymph node metastasis, vascular cancer thrombus, and no adjuvant therapy after surgery are all independent risk factors affecting early recurrence and metastasis. If patients do not undergo adjuvant therapy promptly after surgery due to various reasons, this increases the probability of cancer recurrence and metastasis^[4^]

Despite completing surgery and chemotherapy, Ms. Shan still faces the risk of recurrence and metastasis due to risk factors such as vascular cancer thrombus and lymph node metastasis. Cancer cells can colonize various parts of the body through blood flow, forming micro-lesions that are latent within the body. Regardless of how extensive the resection of the primary cancer is, it does not affect the continuous growth of metastatic lesions. vNKT therapy utilizes powerful immune cells to eliminate tumor cells that may remain undetected in the body, strengthening the patient's immune system and serving as a powerful barrier for consolidating the achievements of surgery and chemotherapy.

References:

[1] VAN DER STOK E P, SPAANDER M C W, GRÜNHAGEN D J, et al. Surveillance after curative treatment for colorectal cancer [J]. Nat Rev Clin Oncol, 2017, 14(5): 297-315.

[2] Chen Ningbo, Zeng Jie. Clinical study on postoperative recurrence patterns of colorectal cancer and prognostic analysis of reoperation [J]. Chinese Journal of Clinicians (Electronic Edition), 2016, 10(2): 198-202.

[3] NOZAWA H, SONODA H, ISHII H, et al. Postoperative chemotherapy is associated with prognosis of stage Ⅳ colorectal cancer treated with preoperative chemotherapy/chemoradiotherapy and curative resection [J]. Int J Colorectal Dis, 2020, 35(1): 177-180.

[4] Zhu Xueke The relationship between postoperative recurrence and metastasis of rectal cancer patients and their clinical pathological characteristics [J]. Journal of Practical Medical Technology, 2022, 29(08): 810-813. DOI: 10.19522/j.cnki.1671-5098.2022.08.006.

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