The application value of enhanced recovery surgery in perioperative period of Laparoscopic assisted colorectal cancer surgery / 实用肿瘤学杂志

Objective The objective of this study was to explore the value of enhanced recovery surgery(ERAS)in perioperative period of laparoscopic assisted colorectal cancer surgery.Methods From November 2015 to July 2016,86 patients with colorectal cancer treated with colorectal surgery were divided into ERAS group and routine treatment group.All patients underwent laparoscopic radical resection of colorectal cancer.The operative situation,postoperative recovery and complications were analyzed in this study.Results There was no difference in the operation time and bleeding volume between the operation group and the conventional treatment group(P>0.05).The postoperative ventilation and defecation time in the ERAS group were earlier than those in the routine treatment group.The postoperative hospital stay and the postoperative pain score were lower than those in the routine treatment group.The rate of postoperative complications was lower than that in the routine treatment group(P<0.05).Conclusion The operation of laparoscopic colorectal cancer under the guidance of ERAS can help patients to recover from hospital,shorten the hospitalization time and reduce the cost of hospitalization.The further application of ERAS should be combined with various disciplines.

Analysis of treatment and prognostic factors in colorectal cancer liver metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors of colorectal cancer patients with liver metastasis in order to provide reference for clinical practice.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 264 cases of colorectal liver metastasis in our department from January 1997 to January 2012 were analyzed retrospectively. Among these 264 patients, 217 underwent primary colorectal cancer resection, 33 underwent combined resection of primary colorectal lesion plus liver metastasis, and 14 received stoma creation alone. Besides, 197 patients received adjuvant chemotherapy, 14 received adjuvant radiotherapy, and 42 underwent interventional treatment. Clinicopathological features and treatment scheme affecting prognosis were analyzed and prognostic stratification analysis was performed according to emergence time of liver metastasis (synchronous or metachronous).</p><p><b>RESULTS</b>Of 264 patients, 1-, 3-, and 5-year overall survival rates were 77.0%, 31.7%, and 14.0%; median survival time was 25 months; 1-, 3-, and 5-year survival rates of synchronous colorectal liver metastasis were 68.8%, 22.3%, and 7.7%; 1-, 3-, and 5-year survival rates of metochronous colorectal liver metastasis were 95.8%, 49.0%, and 21.3%, whose difference was statistically significant (P<0.05). Multivariate analysis showed that primary tumor differentiation, CEA level, adjuvant chemotherapy, and radical resection were independent prognostic factors of colorectal cancer patients with liver metastasis (all P<0.05), while primary tumor differentiation, CEA level, and radical resection were independent prognostic factors of synchronous liver metastasis (all P<0.05), and primary tumor location and CEA level were independent prognostic factors of metachronous liver metastasis (all P<0.05).</p><p><b>CONCLUSIONS</b>Radical operation and adjuvant chemotherapy should be emphasized for colorectal liver metastasis, especially for synchronous colorectal liver metastasis. Simple resection of primary tumor can not improve the overall survival of patients with colorectal liver metastasis.</p>

Effects of metabolic abnormality on the incidence of colorectal cancer / 中华消化外科杂志

Metabolic abnormality is correlated with the incidence of colorectal cancer.Metabolic syndrome is consisting of abdominal obesity,dyslipidemia,high blood pressure,sugar metabolic abnormality,and all of these factors are associated with colorectal cancer.Abdominal obesity and sugar metabolic abnormality may be the primary factors causing rectal cancer.Visceral fat is physiologically more active than subcutaneous fat.Visceral fat can produce and secret hormones and cytokines,which are involved in inflammation and metabolism,therefore the amount of visceral fat may directly or indirectly related to the occurrence of colorectal cancer.Obesity acts as a risk factor for colorectal cancer by several mechanisms,including high blood insulin,insulin-like growth factor,and the change of the adipose cytokines concentrations.Metabolic biomarkers may not only provide clues of colorectal carcinogenesis from the point of view of etiology,but also can help to explore new obesity phenotypes that is relevant to incidence risk of colorectal cancer.

Effect of transanal excision in the treatment of rectal cancer / 中华胃肠外科杂志

The surgical approach for rectal cancer includes trans-abdominal and transanal excision. Total mesorectal excision(TME) is the golden standard for surgical treatment. In the functional surgery era, more and more evidence shows that under strict indications, traditional abdominal radical surgery and transanal excision can achieve similar survival in patients with early stage cancer. However, the local recurrence rate of local resection was significantly higher compared to TME, suggesting strict patients selection for transanal excision. Preoperative accurate evaluation is critical in clinical practice.