Controversies and progress in adjuvant chemotherapy for patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy / 中华胃肠外科杂志

Colorectal cancer is one of the most common malignant tumors worldwide. Surgical resection is the most important and decisive method in the treatment of rectal cancer. Total mesorectal excision (TME) has greatly reduced the local recurrence rate of middle and low rectal cancer. However, local recurrence and distant metastasis remain the leading cause of death in patients with rectal cancer. 5-fluorouracil (5-FU)-based neoadjuvant chemoradiotherapy has been widely accepted in locally advanced rectal cancer and was recommended by various clinical practice guidelines as the standard treatment option. Tumors often achieve satisfactory reduced stage after neoadjuvant radiotherapy, and some patients even achieve pathological complete regression, which brings much controversies to the choice of adjuvant chemotherapy. This article intends to introduce evidence-based evidences for adjuvant chemotherapy for rectal cancer, impact of current neoadjuvant models on choice of adjuvant chemotherapy strategies, controversies and considerations for adjuvant chemotherapy in the context of neoadjuvant radiotherapy.

Principle of surgical management for rectal cancer patients with complete clinical response after neoadjuvant therapy / 中华胃肠外科杂志

A proportion of patients with locally advanced rectal cancer will achieve clinical complete response (cCR) or pathologic complete response (pCR) after neoadjuvant chemoradiotherapy. With the proposal of the concept of total neoadjuvant therapy (TNT), higher complete response rates will be observed. The management of patients with cCR has long been an issue of controversy and is attractive for clinical trials. A "watch and wait" strategy for patients with cCR has been put forward by some scholars. A non-operative approach can preserve the organfunction and avoid complications after radical surgery. The safety and feasibility of a "watch and wait" strategy have been established in several non-randomized controlled studies. There is no consensus on how to make an optimal decision for patients with cCR. For example, it is only observed in partial patients that cCR is consistent with pCR and the molecular biomarkers for predicting pCR are suboptimal. Besides, cCR is inconsistently defined and surveillance recommendations varies. Furthermore, there are insufficient high-level evidence for the "watch and wait" strategy. For patients with good response after chemoradiotherapy, local excision is an attractive alternative to total mesorectal excision, however with uncertain indications and challenged oncological safety. For patients with cCR, we implement the therapeutic principles of goal-orientation, layered treatment and the whole process management.

Significance of the preservation of left colic artery in laparoscopic resection of rectal cancer / 中华胃肠外科杂志

Controversy remains on how to manage left colic artery (LCA) when it comes to laparoscopic proctectomy. With regard to the level of detachment, a high tie of inferior mesenteric artery (IMA) is meant as a ligation at the origin of aorta, while the low tie is the ligation of IMA below the initiation part of left colic artery which is left. Several key points of LCA preservation, including clinical value, oncologic safety and the difficulty of operation, have always been debated. Some scholars hold the point of view that the preservation of LCA will hamper the lymph nodes dissection around the inferior mesenteric artery, resulting in incorrect pathological staging and dismal outcome. Of note, low tie prolongs the duration of operation and increases the anastomotic tension. However, increasing research results have established its clinical values. The value for reducing the risk of anastomotic leakage and the effect on the lymph nodes dissection at the root of inferior mesenteric artery will be discussed based on previous studies and our clinical practice. We came up with a novel concept of "the lymph nodes in the triangular domain of inferior mesenteric artery which consists of abdominal aorta, inferior mesenteric vein(IMV)/LCA and IMA" instead of traditional No.235 lymph nodes. In our innovative approach of total mesorectal excision guided by vessel, a crack was made at the root of aorta and the dissection was performed along IMA, reaching the origin of LCA. The lymph nodes will be harvested as a whole. After achieving process standardization, vessel-oriented approach and left colic artery preservation makes this region susceptible to lymphadenectomy, protecting submesenteric plexus and guarantying the oncological safety without increasing operative difficulty.

The research of diffusion tensor imaging on different stages of neurocysticercosis / 中华放射学杂志

Objective To study the staging of cerebral parenchymal cysticercosis by fractional anisotropy(FA) value and average diffusion coefficient(DCavg) value on diffusion tensor imaging(DTI). Methods Forty-eight patients (30 men and 18 wemen) with cerebral parenchymal cysticercosis were admitted to the First Affiliated Hospital of Dali University from January in 2015 to December in 2016.Their averge age was(34±11)years(rang from 19 to 65 years).Eight patients with subclinical stage, 13 patients with vesicular stage, 15 patients with colloidal-vesicular stage,and 12 patients with granular-nodular stage of cerebral neurocysticercosis were included in this study. The data of FA and DCavg of lesions with different stages were measured, as well as the contralateral normal brain parenchyma. The FA values and DCavg values of lesions were analyzed by variance analysis,respectively.Paired t test was used to compare the FA and DCavg values of the lesions and the contralateral brain.Results The FA values of lesions with subclinical stage, vesicular stage, colloidal-vesicular stage, and granular-nodular stage of cerebral parenchymal cysticercosis were 0.074 7±0.002 5,0.105 8±0.003 1,0.127 3±0.002 1,and 0.159 3±0.001 4, respectively.The differences were statistically significant among the stages(F=639.17,P<0.05).The DCavg values were(1.312 5±0.006 7)×10-3,(1.514 2±0.005 9)×10-3,(1.112 1±0.005 8)×10-3,and(1.093 2±0.008 4)× 10-3mm2/s for lesions with each stage, respectively. There was a significant difference in the DCavg values among the stages(P<0.05).The data of FA and DCavg for lesions with every stage had a significant difference from those of normal contralateral brain(F=491.24, P<0.05). Conclusion The parameters FA and DCavg values of diffusion tensor imaging may be helpful in the diagnosis of different stages of cerebral parenchymal cysticercosis,and may provide guidance for clinical treatment.

Evolution and prospect of colorectal anastomosis / 中华胃肠外科杂志

Colorectal cancer is the third most common malignant tumor among men, and the second most common malignant tumor among women worldwide. As one of the most common malignant tumor, colorectal cancer has a great threat to the health of people. Although the development of radiotherapy and chemotherapy could improve the prognosis of colorectal cancer, surgery, the complete resection of the tumor, remains the only chance for the cure of this disease. Over the past hundred years, surgical oncology went in the direction of protecting organ function and improving quality of life. Anus-preserving surgery for low rectal cancer and laparoscopic colorectal surgery are exactly following this tendency. In colorectal surgery, surgeons need to perform intestinal anastomosis and recover the intestinal continuity after the excision of the abnormal bowel, thus a series of colorectal anastomosis techniques occur, including manual anastomosis, stapled anastomosis, compression anastomosis, and radiofrequency-induced thermo-fusion of intestinal anastomoses, which is currently being studied by many researchers at home and abroad. Manual anastomosis is divided into single- and two-layer anastomosis, continuous and interrupted sutures, and inverting and everting sutures performed in different ways. In this paper, we offer an overview of evolution, evaluate the safety and effectiveness, and compare the incidence of complications, particularly anastomotic leakage and anastomotic stenosis of different anastomotic techniques. After the objective elucidation of advantages and disadvantages, we are also looking forward to better colorectal anastomosis techniques in the future.

Effect of abnormal left ventricular diastolic function on occurrence of atrial or ventricular arrhythmia in elderly essential hypertensive patients / 中华老年医学杂志

Objective To study the effect of abnormal left ventricular diastolic function(LVDF)on the onset and severity of atrial or ventricular arrhythmia in elderly essential hypertensive patients.Methods The 210 elderly essential hypertensive patients were enrolled in this study. Their arrhythmias were monitored by 24-hour ambulatory electrocardiogram. The essential hypertensive patients were referred for Doppler echocardiography to evaluate left ventricular function, while patients with abnormal systolic function were excluded, and then the patients were classified as normal LVDF and abnormal LVDF including, impaired relaxation, pseudonormal, and restrictivelike filling patterns. Results In 210 elderly essential hypertensive patients, 147 (70%) cases were diagnosed as atrial arrhythmia and 102 (49%) cases as ventricular arrhythmia (χ2 = 19. 975, P ＜ 0.05 ).Morbidities of atrial (89%) or complex atrial arrhythmia (49%) as well as ventricular (63%) orcomplex ventricular arrhythmia (30%) were significantly higher in abnormal LVDN group than in normal LVDN group (40%, 13%, 26% and 7%, χ2 = 56. 723 、 28. 359 、 28. 076、15. 9102 , all P＜0. 05). The morbidities of arrhythmias were higher in hypertensive patients with pseudonormal and restrictiveike filling patterns than in other groups 93.6% and 96. 4%. Conclusions Abnormal left ventricular diastolic function affects on the onset and severity of atrial or ventricular arrhythmia in elderly essential hypertensive patients, and complex atrial or ventricular arrhythmia is easier found in hypertensive patients with pseudonormal and restrictivelike filling patterns.

Efficacy of laparoscopic Roux-en-Y gastric bypass in the treatment of morbid obesity complicated with type 2 diabetes mellitus / 中华消化外科杂志

Objective To evaluate the efficacy of laparoscopic Roux-en-Y gastric bypass(LRYGB)in the treatment of morbid obesity complicated with type 2 diabetes mellitus,and to discuss the mechanism of LRYGB in the treatment of type 2 diabetes mellitus.Methods The clinical data of 30 type 2 diabetes mellitus patients with body mass index(BMI)≥35.00 who had undergone LRYGB from January 2007 to July 2007 in Cleveland Clinic were prospectively analyzed.The pre-and postoperative clinical parameters wcl"e analyzed by t test.Results The BMI,fasting plasma glucose and glycosylated hemoglobin were significantly decreased 6 months after the operation(t=27.399,23.025.15.593,P＜0.05).The cure rate at the end ofthe second month was 70%(21/30),and it was increased to 90%at the end of sixth month(27/30).The condition of the remaining 3 patients were improved.At the end of the second and sixth month',ffter operation,the BMIs of the patients who were cured by LRYGB were decreased by 27.89%±5.51%and 45.73%±2.82%.and the BMIs of the patients whose condition was improved were decreased by 35.65%±1.97%and 58.00%±3.05%(t=5.755,7.081,P＜0.05).Conclusions LRYGB is effective in the treatment of morbid obesity complicated with type 2 diabetes mellitus.The curability of morbid obesity increases as the BMI decreases.