ABSTRACT
Objective:To compare and analyze the efficacy of supraumbilical longitudinal auxiliary incision and left lower abdominal oblique auxiliary incision during laparoscopic radical resection of rectal cancer.Methods:The data of 196 patients with rectal cancer treated in the Second Affiliated Hospital of Xiamen medical college from January 2015 to December 2020 were analyzed retrospectively. Different abdominal auxiliary incisions were used for grouping. The control group (101 cases) used the oblique auxiliary incision of the left lower abdomen, and the observation group (95 cases) used the longitudinal auxiliary incision of the upper umbilical cord. The intraoperative indicators (operative time, intraoperative blood loss, auxiliary incision length, distance between anastomotic teeth and dentate line), postoperative indicators (first postoperative exhaust time, postoperative pain score, fluid intake time, first out of bed time and hospital stay) and operative complications between the two groups were compared.Results:The first postoperative exhaust time ((56.8±4.3) h vs. (70.3±5.8) h, t=4.796) and the first postoperative out of bed time ((38.81±2.04) h vs. (47.93±2.63) h, t=5.113) in the observation group were significantly shorter than those in the control group, and the pain scores at 24 hours ((2.01±0.22) vs.(2.43±0.40), t=5.882) and 48 hours pain score ((2.23±0.44) vs. (3.14±0.72), t=6.58) after operation were significantly lower than those in the control group (all P<0.05). The incidence of incision hernia in the observation group was significantly lower than that in the control group (5.3% (5/95) vs.9.9% (10/101), χ 2=4.29)( P<0.05). Conclusion:Compared with the left lower abdominal oblique auxiliary incision,the supraumbilical longitudinal auxiliary incision in laparoscopic radical resection of rectal cancer can not only significantly reduce the postoperative pain scores and recover the postoperative intestinal function as soon as possible, but also significantly reduce the incidence of postoperative incision hernia.
ABSTRACT
A 65-year-old woman presented with intermittent right hand numbness and elevated serum creatinine for more than 2 months. The histological examination of kidney biopsy showed renal arterioles occlusion and interstitial fibrosis. Pathological abnormality was originally considered as a part of systemic atherosclerosis. Thus, rosuvastatin 20 mg/d, fosinopril 10 mg/d, metoprolol 47.5 mg/d and aspirin 0.1g/d were administrated. No improvement of renal function was seen. Further Congo red staining was applied. Diffuse amorphous eosinophilic substance was deposited in interlobular artery and small arteriolar artery. Combined with the abnormal free light chain (FLC) level and ratio (serum κ 340 mg/L, κ/λ 10.932), the diagnosis of systematic light-chain amyloidosis was confirmed. The patient received 3 courses of chemotherapy regimen as BCD (bortezomib 2 mg d1, 8, 15, 22, cyclophosphamide 0.3 g d1, 8, 15, 22 and dexamethasone 40 mg d1, 8, 15, 22). A hematologic partial response was achieved and serum creatinine decreased to 180 μmol/L.
ABSTRACT
OBJECTIVE@#To explore the efficacy of radiotherapy combined with surgery for locally advanced rectal mucinous adenocarcinoma.@*METHODS@#Clinical data of patients with locally advanced rectal mucinous adenocarcinoma (T3-4 and/or N+) diagnosed by postoperative pathology from 1992 to 2013 were retrieved from the US Surveillance, Epidemiology, and End Results (SEER) database. Patients with local excision only, tumor biopsy or combined organ excision and incomplete follow-up information were excluded. All the enrolled patients were divided into three groups according to different treatments, including surgery alone (SA) group, preoperative radiotherapy combined with surgery (RT+S) group and surgery combined with postoperative radiotherapy (S+RT) group. The extracted data included basic data of patients and tumor, treatment status, and follow-up results. The χ² test was used to compare the count data. Kaplan-Meier method was used to draw the survival curve and calculate the survival rate. The survival was analyzed and compared by Log-rank test. The R language 2.8.1 was used to match the patients as 1:1 pairing through the propensity score matching (PSM). The matching variables included gender, age at diagnosis, year at diagnosis, ethnicity, degree of tissue differentiation, TNM stage, depth of invasion, making the baseline data of subgroups comparable. The Cox proportional hazard model was used for multivariate analysis of prognostic factors.@*RESULTS@#A total of 2 149 patients with locally advanced rectal mucinous adenocarcinoma were enrolled in the study, including 1 255 males (58.4%) and 894 females (41.6%). There were 706 patients (32.9%) in the SA group, 772 patients (35.9%) in the RT+S group and 671 patients (31.2%) in the S+RT group. In SA, RT+S and S+RT groups, the median overall survival time was 39, 85, and 74 months respectively; the 5-year overall survival (OS) rate was 38.7%, 56.5%, and 55.2% respectively; the median cancer-specific survival (CSS) time was 86, 127, and 111 months respectively, and the 5-year CSS rate was 53.7%, 62.2% and 60.7% respectively. In comparison among the 3 groups, the 5-year OS rate and CSS rate in the SA group were significantly lower than those in the RT+S group and S+RT group (all P<0.001); the 5-year OS rate and CSS rate between RT+S group and S+RT group were not significantly different (P=0.166 and 0.392,respectively). After the baseline data of subgroups were corrected through PSM, the 5-year OS rate and CSS rate in the SA group (n=375) were significantly lower than those in the RT+S group (n=375)(OS:40.1% vs. 54.5%, P<0.001; CSS:54.3% vs. 63.3%, P=0.023). The 5-year OS rate and CSS rate in the SA group (n=403) were also lower than those in the S+RT group (n=403) (OS:37.4% vs. 54.7%,P<0.001;CSS:51.6% vs. 61.0%,P=0.031). The 5-year OS rate and CSS rate between RT+S group (n=363) and S+RT group (n=363) were not significantly different (OS:51.7% vs. 55.5%, P=0.789; CSS:57.7% vs. 60.5%, P=0.484). Cox multivariate analysis showed that radiotherapy (HR=0.845, 95%CI: 0.790 to 0.903, P=0.001) was an independent prognostic factor for OS of locally advanced rectal mucinous adenocarcinoma; radiotherapy (HR=0.907, 95% CI: 0.835 to 0.985, P=0.021) was also an independent prognostic factor affecting CSS in patients with locally advanced rectal mucinous adenocarcinoma.@*CONCLUSION@#As compared with surgery alone, surgery combined with preoperative or postoperative radiotherapy is beneficial to the long-term survival of patients with locally advanced rectal mucinous adenocarcinoma.