Laparoscopic anterior resection with doubling-stapling technique anastomosis for rectal cancer / 中华胃肠外科杂志

Double-stapling technique (DST) has brought a revolutionary change for rectal cancer surgery. It has overcome the shortcomings of manual intestinal anastomosis operational difficulties caused by the narrow space of pelvic surgery, shortened the operation time, improved anal sphincter preservation rate, and reduced the risk of anastomotic leakage. The author gives a comprehensive and detail description of laparoscopic DST based on his ten years experience of laparoscopic colorectal resection for colorectal cancer.

Electroacupuncture at Zhongji (CV 3) for treatment of benign hyperplasia of prostate: a multi-central randomized controlled study / 中国针灸

<p><b>OBJECTIVE</b>To assess the role of Zhongji (CV 3) in treatment of benign hyperplasia of prostate.</p><p><b>METHODS</b>Multi-central, randomized, controlled, single bland clinical method was adopted, and 276 cases were divided into an electroacupuncture (EA) group and a medication group, 138 cases in each group. The EA group were treated with EA at Zhongji (CV 3) and the medication group with oral administration of Qianliekang tablets. After treatment of 1 course, their therapeutic effects and changes of international prostate symptom (I-PSS) cumulative score, life quality index (L) cumulative score, nocturia times, urine stream state, lower abdominal symptom, maximal volume of urine flow, residual urine volume, prostatic volume, etc. Were assessed in the two groups.</p><p><b>RESULTS</b>The total effective rate was 96.4% in the EA group and 86.2% in the medication group, the former being better than the latter (P<0. 01); the two groups were effective in improvement of international prostate symptom (I-PSS) cumulative score, life quality index (L) cumulative score, nocturia times, urine stream state, hypogastrium symptom, maximal volume of urine flow, residual urine volume, prostatic volume, etc. with the former better than the latter.</p><p><b>CONCLUSION</b>Acupuncture at Zhongji (CV 3) has a significant therapeutic effect for treatment of benign hyperplasia of prostate.</p>

Preoperative chemoradiotherapy with FOLFOX in low rectal cancer: a multicenter study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the toxicity and safety of FOLFOX regimen concurrent with radiotherapy in neoadjuvant setting in patients with low rectal cancer.</p><p><b>METHODS</b>Fifty-six patients with stage T(3-4)N(0)M(0) and T(1-4)N(1-2)M(0) were eligible from Aug. 2004 to Jul. 2007. Upon entry the study, they received 4 cycles of chemotherapy with FOLFOX regimen. Radiotherapy was added from the second cycle of chemotherapy (CT). The total dose of radiotherapy (RT) was 46 Gy (2 Gy x 23). Total mesorectal excision (TME) was performed 4-8 weeks after RT.</p><p><b>RESULTS</b>Among them, 54 cases received 4 cycles of CT, 1 patient stopped CT after the second cycle of CT because of unrecovery from neutropenia. One patient stopped chemoradiotherapy(CRT) because of complicating with active pulmonary tuberculosis after 2 cycles of CT and 10 times of RT. Two occurred liver, lung and bone metastases after CT. Totally 220 cycles of CT were administrated. Fifty-two patients received operation after CRT, 50 with anal interior sphincter reservation, 19 with prophylactic ileac stoma. Anastomotic leakage occurred in 2 patients after operation, and rectal vaginal fistula in 2 patients 1 month after operation. According to the pathologic results, 7 patients achieved complete response, 41 partial response, 4 stable disease, and the objective response rate was 85.7%.</p><p><b>CONCLUSION</b>Concomitant treatment of FOLFOX regimen and RT in neoadjuvant setting of rectal cancer was safe and tolerable, and it suggests that protective ileostomy for anastomotic leakage following anus-preserving operation should be performed.</p>

Total mesorectal excision versus conventional radical surgery for rectal cancer: a meta analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare treatment outcomes of total mesorectal excision (TME) with those of conventional radical surgery (CRS) for rectal cancer.</p><p><b>METHODS</b>Literature reviews were performed with key words, such as rectal cancer, total mesorectal excision, TME on all studies reported on TME versus CRS for rectal cancer between January 1986 to May 2006. According to the same screening criteria, 17 clinical studies were included in our systematic reviews. Two of our co-authors drew the details of trial design, characteristics of participants, results and so on from the studies included. Data analyses were performed by using RevMan 4.2.</p><p><b>RESULTS</b>Sample volume in this Meta analysis was 5267 rectal cancer cases. Quality and quantity analyses were performed within all included studies, prospective studies (prospective nonrandomized studies and multicenter prospective nonrandomized studies) and retrospective studies. The results showed that postoperative survival rate was significantly increased [OR 1.81 (95%CI 1.55-2.11, P<0.00001), OR 1.79 (95%CI 1.49-2.15, P<0.00001) and OR 1.84 (95%CI 1.39-2.45, P<0.00001)] and local recurrence rate was significantly reduced [OR 0.35 (95%CI 0.29-0.43, P<0.00001), OR 0.41 (95%CI 0.32-0.53, P<0.00001) and OR 0.29 (95%CI 0.22-0.39, P<0.00001)] after TME was used. The results of all study analyses agreed with those from prospective studies analyses, in which postoperative mortality was significantly reduced [OR 0.51 (95%CI 0.32-0.87, P=0.007) and OR 0.56 (95%CI 0.33-0.94, P=0.04)] after TME treatment, meanwhile the results of retrospective study analyses indicated that there was no significant difference between TME group and CRS group in postoperative mortality [OR 0.39 (95%CI 0.14-1.10, P=0.07)]. TME was a risk factor for postoperative anastomotic leak according to the results of all included studies and prospective study analyses, but no difference between TME group and CRS group had been found [OR 1.24 (95%CI 0.84-1.83, P=0.29) OR 1.98 (95%CI 0.85-4.61, P=0.11)].</p><p><b>CONCLUSIONS</b>TME is still the standard operative technique for rectal cancer. As compared with CRS, TME results in lower postoperative local recurrence rate and higher survival rate.</p>

Comparative study of colostomy in the laparoscopic-assisted abdominoperineal resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare two different procedures of colostomy in the laparoscopic- assisted abdominoperineal resection(LAPR), and to reduce the related complications of colostomy.</p><p><b>METHODS</b>Sixty- three cases with anorectal cancer undergone LAPR from June 2001 to December 2005 were registered and followed up. Circular stapler anastomosis with sigmoid colon and abdominal skin were applied on 61 cases of the colostomy, and 2 cases were hand sutured. All patients were assigned to group A and B. Thirty- seven cases received the procedure of colostomy through the rectus abdominis peritoneally in group A,other 26 cases through extraperitoneal tunnel and the rectus abdominis in group B.</p><p><b>RESULTS</b>Descending colon, sigmoid colon and rectum were dissected using laparoscopic instruments in 63 cases. No conversion to open procedure and no operative death occurred in two groups of patients. There was no significant difference between two groups in mean operation time, but significant differences were found in the time of return of bowl function[A group (2.4 +/- 1.1)d vs B group (1.9 +/- 0.8)d,P < 0.05], duration of postoperative hospital stay [A group (19.9 +/- 7.8)d vs B group (14.5 +/- 3.9)d,P < 0.01] and stoma related complications(A group 29.4% vs B group 4.0%,P < 0.05). Postoperative hospital stay were shorter, and less colostomy related complications were found in group B.</p><p><b>CONCLUSION</b>Colostomy through extraperitoneal tunnel and the rectus abdominis is a better procedure in LAPR, which can reduce the related complications of colostomy and shorten postoperative hospital stay.</p>