The therapeutic efficacy prominently differs in individual patients with colorectal cancer (CRC). Based on the understanding of the mechanisms of gene and tumor medications, using biomarkers that predicts the therapeutic effect of cancer treatment before patients undergo the treatment has gradually been widely accepted. Specifically, the genotypes of UGT1A1 polymorphism and ERCC1 overexpression are used to predict patients’ ability to metabolize chemotherapeutic agents, accompanied with the use of molecular diagnostic techniques to predict the effectiveness of radiotherapy and chemotherapy on CRC patients as well as the early recurrence of CRC in postoperative surveillance. In addition, mismatch repair protein has been found to be related to various prognostic and predictive values on cancers. Regarding the advancement of surgical techniques, we have integrated latest surgical instruments and innovative methods to develop various surgical techniques, which have been used in traditional laparotomy, sphincter preservation procedure for low-lying rectal cancer, and minimally invasive surgeries such as mini-laparotomy that adopts the Alexis retractor, conventional laparoscopy, single-port laparoscopy, and da Vinci surgery.
These techniques can reduce postoperative pain, reduce the possibility of wound infection, shorten the length of hospital stay, facilitate patients’ recovery, and provide patients with customized surgical methods. This project focused on the development of personalized medicine and aimed to develop innovative treatment for the precision medicine for CRC. Specifically, adequate and safe surgery and postoperative chemotherapy and targeted therapy were designed according to the biomarkers of the disease or drug metabolism genotypes and customized for patients with distinct needs, disease severity, molecular mechanisms of cancer, and socioeconomic statuses. The project could save unnecessary medical costs and enhance the therapeutic effect, with an ultimate goal of prolonging the overall survival time of patients with CRC.
Services and Advantages:
Our team has dedicated to relevant research on cancer and molecular biology and clinical services in recent years. The projects funded by the Academia Sinica, Taiwanthat we have participated primarily focused on the molecular pathogenesis of cancers, cancer metastasis mechanism, research and development of biochips for cancers, and the pharmacogenomics of cancers. The team has released numerous molecular biology studies on CRC and applied the research results in clinical practice. Through the integration of clinical application with the biochip technology, we expect to develop a noninvasive, rapid, and simple examination method.
Approximately 30%–40% of the CRC occurs in the colon and rectosigmoid junction. In the past, if the location of the tumor is within 7 cm from the anal aperture, preserving the sphincter would be challenging. Therefore, a permanent colostomy must be created through the abdominal wall into intestine, which considerably influenced patients’ quality of life (QoL). Some patients cannot accept the colostomy and are unwilling to undergo the surgery, and thus lose the opportunity to cure the disease. To maximize the effectiveness of the surgery and the possibility to preserve the sphincter, the preoperative concurrent chemoradiotherapy is to administer radiotherapy and chemotherapy concurrently before the surgery to shrink the tumor and lower the cancer staging. The treatment for patients with CRC not only requires the reduction of local recurrence and increase the survival rate, but also emphasizes the maintenance of patients’ QoL by preserving the sphincter.
According to the result of our study, combining the new concurrent chemoradiotherapy that adopts the neoadjuvant FOLFOX therapy and prolonged waiting time with the da Vinci surgery system to perform surgical resection significantly increased the pathological complete response rate (31.6%) and sphincter preservation rate (95%), reduced the perineural invasion in the removed specimen (3.2%), and further reduced the local recurrence and increase the survival rate. The da Vinci surgery system was used to perform surgical resection for very low-lying rectal cancer, accompanied with the technique of robotic-assisted high-dissection and low ligation surgery with inter-sphincter resection and natural orifice specimen extraction, to increase the success rate of the sphincter-preserving surgery and enhance patients’ postoperative QoL and satisfaction.