Objective To study the effect of laparoscopic total mesorectal excision and per anum rectal pull-type of anastomosis on male patients with low rectal cancer. Methods The successful experiences of anus saving operation on 23 male patients with low rectal cancer were summarized. Results A laparoscopic total mesorectal excision technique was used, with the full separation of the rectum at the bottom. After pulling out the distal rectum together with the cancer from the anus, the transection of the proximal tumor was performed. The end-to-end anastomosis of rectum and descending colon was performed by tubular stapler. Anus was reserved successfully in the 23 cases. There was no left-tumor stump after surgery detected by postoperative pathological examinations, no anastomotic leakage, and no operative death. Conclusions To the relatively narrow male pelvis, laparoscopic total mesorectal excision and per anum rectal pull-through resection and anastomosis is safe and reliable for anus saving in low rectal cancer. It can simplify the operation, and raise the success rate of sphincter preserving in surgery of low rectal cancer.
ObjectiveTo evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.MethodsA literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.ResultsA total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].ConclusionsRobotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.
ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.
目的总结低位直肠癌采用柱状经腹会阴切除术（APR）的应用体会。 方法徐州医学院附属医院普通外科于2010年1月至2013年7月期间采用柱状APR治疗22例低位直肠癌患者（柱状APR组），并与同期行传统APR治疗的35例患者（传统APR组）进行对比，分析术中、术后和随访的各项指标。 结果与传统APR组比较，柱状APR组的环周切缘阳性率及术中穿孔率明显降低〔4.55%（1/22）比34.29%（12/35）和4.55%（1/22）比31.43%（11/35）〕，差异有统计学意义（P＜0.05）；2组手术时间、术中出血量、并发症发生率比较，差异无统计学意义（P＞0.05）。术后随访3～30个月（平均21个月），柱状APR组无肿瘤复发及远处转移患者，未见死亡病例；传统APR组出现盆底局部复发4例，远处转移3例，死亡2例。2组局部复发、远处转移及死亡率比较差异均无统计学意义（P＞0.05）。 结论柱状APR可以切除更多的肿瘤周围组织，降低环周切缘阳性率，减少术中肠穿孔的发生，降低局部复发。
目的 探讨CT仿真内镜（CT virtual endoscopy，CTVE）在低位直肠癌术前分期中的价值。方法 收集我院2008年8月1日至2011年3月1日期间的直肠癌患者57例，术前行直肠CTVE检查，详细记录患者直肠癌周围组织浸润和淋巴结转移的情况；患者术后常规进行病理检查，比较两者结果的差异。结果 术前直肠CTVE检查与术后石蜡病理检查对直肠癌周围淋巴结转移的判断经四格表χ2检验，差异无统计学意义（χ2=2.5，P＞0.05），其对直肠癌周围淋巴结转移预测的敏感性为66.67%，特异性为93.94%。术前直肠CTVE预测直肠癌周围组织浸润和术后病理检查结果经四格表χ2检验，差异有统计学意义（χ2=4.4，P＜0.05），其对直肠癌周围组织浸润判断的敏感性为27.78%，特异性为42.86%。结论 CTVE在术前评估直肠癌周围淋巴结转移有较高的可信性，但对直肠癌周围组织浸润的评价较差。
ObjectiveTo investigate risk factors of anastomotic fistula after total mesorectum excision (TME) in middle and low rectal cancer. MethodsThe clinical data of 446 patients with middle and low rectal cancer received TME surgery from June 2004 to June 2014 were retrospectively analyzed.Single-factor analysis of risk factors was used by χ2 test,multiple-factor analysis was used by logistic regression analysis. ResultsThere were 36 patients with anastomotic fistula in these 446 patients,which of 22 patients were recovered after conservative treatment,of 14 patients were recovered after colostomy.The results of single-factor analysis showed that the age>60 years,preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,distance from anasto-mosis to anus<5 cm,non-strengthen suture by hand were the risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05).The results of multiple-factor analysis showed that the preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,and distance from anastomosis to anus<5 cm were the independent risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05). ConclusionsRisk of anastomotic fistula after TME in middle and low rectal cancer is higher.Basic complications of patient and local conditions of anastomosis,and intraoperative factors could affect incidence of anastomotic fistula,it should be paid enough attention.In general,most of anastomotic fistula could be cured with conservative treatment,in case of conservative treatment is invalid,colostomy is feasible.
ObjectiveTo compare the perioperative safety and oncologic efficacy of transanal endoscopic intersphincteric resection (TaE-ISR) and the completely transabdominal approach intersphincteric resection (CTA-ISR) for the treatment of ultra-low rectal cancer. MethodsClinical data of patients who underwent TaE-ISR or CTA-ISR at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from June 2022 to June 2023, were retrospectively analyzed. A total of 38 cases of TaE-ISR and 16 cases of CTA-ISR were included. Comparison of surgery-related indexes (including operation time, injury of adjacent organs, protective stoma, and placement of anal tube), postoperative recovery and complications, and oncological results (including positive rate of circumferential resection margin, positive rate of distal resection margin, and number of lymph nodes) were compared between the 2 groups. ResultsThe distance of the lower edge of the tumor from the anal verge was lower in the TaE-ISR group than that in the CTA-ISR group [4.0 (3.4, 4.5) cm vs. 4.9 (4.1, 5.9) cm, P<0.001]. A longer duration of the surgery [(177.18±37.24) min vs (146.25±38.86) min], a higher rate of the anal tube [97.4% (37/38) vs 56.3% (7/16)], a higher rate of protective stoma [94.7% (36/38) vs 12.5% (2/16)], and a higher rate of transanal specimen extraction [92.1% (35/38) vs 0% (0/16)], faster time to first postoperative semi-liquid diet [4 (3, 5) d vs 6 (5, 6) d] were observed in the TaE-ISR group (P<0.05). No adjacent organ injuries occurred in the TaE-ISR group, whereas 2 patients in the CTA-ISR group had intraoperative adjacent organ injuries (0% vs 12.5%), the difference was statistically significant (P=0.026). There was no statistically significant difference between the 2 groups in terms of postoperative hospitalization, postoperative time to first flatus, Clavien-Dindo grading of postoperative complications, the incidence of anastomotic leakage and anastomotic stenosis, distal margin distance, the total number of lymph nodes cleared, and the number of positive lymph nodes (P>0.05). Postoperative specimens in all cases were adequate for distal margins and negative for circumferential margins.ConclusionTaE-ISR and CTA-ISR can both be applied to anus-preserving surgery for ultra-low rectal cancer, but TaE-ISR may be a more reasonable approach than CTA-ISR when the lower edge of the tumor is closer to the anal verge.
目的 探讨全直肠系膜切除术（total mesorectal excision,TME）在治疗中低位直肠癌中的技术操作与效果。方法 对47例应用TME技术治疗的中低位直肠癌患者的临床资料进行回顾性分析。结果 27例行低位前切除术，20例行腹会阴联合切除术（Miles术），全部病例均顺利完成手术并出院，平均出血量250 ml； 术后发生吻合口漏2例； 术后随访0.5～3年，局部复发5例，因肝转移死亡2例。结论 应用TME技术治疗中低位直肠癌有其适应证，术中须遵循其操作规范，同时应注意采取适当的措施预防吻合口漏。
Objective To explore the safety of neoadjuvant chemoradiotherapy combined with sphincter-preserving operation in treatment of locally advanced low rectal cancer. Methods The clinical data of thirty-four patients admitted into our hospital between June 2007 and June 2009 with T3 and T4 low rectal cancer treated by neoadjuvant chemoradiotherapy and sphincter-preserving operation were collected and analyzed retrospectively. Routine fraction of radiation was given with total dose of 40 Gy, five times a week, 2 Gy per fraction. Patients received oxaliplatin （150 mg/d1）, plus folinic (100 mg/d1-3) and 5FU (750 mg/d1-3) for total 1 cycles started from the 4th week of irradiation. Operation was performed 4 weeks after neoadjuvant therapy. Results After neoadjuvant therapy, all patients underwent surgical resection with average tumor size decreased by 41.2%, tumor T stage decreased in 67.6% （23/34) patients, and lymph nodenegative change rate was 58.8% (10/17). One patient had liver metastasis and one had local recurrence, but without stomal leak. And 88.2% (30/34) patients showed good function of sphincter. Conclusions Neoadjuvant chemoradiotherapy in advanced lower rectal cancer patients has shown its efficacy in down-staging, which is safe without increasing operation complications when combined with sphincterpreserving surgery.