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1.
Chinese Journal of Gastrointestinal Surgery ; (12): 603-606, 2023.
Article in Chinese | WPRIM | ID: wpr-986826

ABSTRACT

Transanal total mesorectal resection (taTME) has come a long way since it was first used in the clinic in 2010.The learning curve of this procedure is long due to different surgical approaches, different perspectives and different anatomical positions. Many surgeons experience complications during this procedure. Although the advantages and problems of this procedure have been reported in much literature, the anatomy and operation methods of taTME introduced in literatures and training centers are too complicated, which makes many surgeons encounter difficulties in carrying out taTME surgery. According to the author's experience in learning and carrying out this operation, spatial expansion process of ultralow rectal cancer was divided into three stages. At each stage, according to different pulling forces, three different schemes of triangular stability mechanics model were adopted for separation. From point to line, from line to plane, the model can protect the safety of peripheral blood vessels and nerves while ensuring total mesorectal excision . This model simplifies the complex surgical process and is convenient for beginners to master taTME surgical separation skills.


Subject(s)
Humans , Rectum/surgery , Laparoscopy/methods , Transanal Endoscopic Surgery/methods , Rectal Neoplasms/surgery , Proctectomy/methods , Postoperative Complications , Treatment Outcome
2.
Chinese Journal of Surgery ; (12): 753-760, 2023.
Article in Chinese | WPRIM | ID: wpr-985819

ABSTRACT

Objective: To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer. Methods: This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 patients were enrolled, aged (M(IQR)) 62 (18)years (range: 14 to 100). There were 963 males and 687 females. The median follow-up period was 51 months. The Cox proportional hazardous regression model was utilized to select high-risk pathological factors, establish the nomogram and scoring system. The Bootstrap resampling method was utilized for internal validation of the model, the concordance index (C-index) was used to assess discrimination and calibration curves were presented to assess model calibration. The Kaplan-Meier method was used to plot survival curves after risk grouping, and Cox regression was used to compare disease-free survival between subgroups. Results: Age (HR=1.020, 95%CI: 1.008 to 1.033,P=0.001), T stage (T3:HR=1.995,95%CI:1.062 to 3.750,P=0.032;T4:HR=4.196, 95%CI: 2.188 to 8.045, P<0.01), N stage (N1: HR=1.834, 95%CI: 1.307 to 2.574, P<0.01; N2: HR=3.970, 95%CI: 2.724 to 5.787, P<0.01) and number of lymph nodes examined (≥36: HR=0.438, 95%CI: 0.242 to 0.790, P=0.006) were independently associated with disease-free survival. The C-index of the scoring model (model 1) based on age, T stage, N stage, and dichotomous variables of the lymph nodes examined (<12 and ≥12) was 0.723, and the C-index of the scoring model (model 2) based on age, T stage, N stage, and multi-categorical variables of the lymph nodes examined (<12, 12 to <24, 24 to <36, and ≥36) was 0.726. A scoring system was established based on age, T stage, N stage, and multi-categorical variables of lymph nodes examined, the 3-year DFS of the low-risk (≤1), middle-risk (2 to 4) and high-risk (≥5) group were 96.3%(n=711), 89.0%(n=626) and 71.4%(n=313), respectively. Statistically significant difference was observed among groups (P<0.01). Conclusions: The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.

3.
Journal of Experimental Hematology ; (6): 539-542, 2022.
Article in Chinese | WPRIM | ID: wpr-928750

ABSTRACT

OBJECTIVE@#To investigate the difference of therapeutic effects on children with thalassemia at different age after hematopoietic stem cell transplantation.@*METHODS@#The clinical data of children with thalassemia treated in our hospital were retrospectively analyzed. The children were divided into 2-5 years old group and 6-12 years old group. The success rate of implantation, transplant-related mortality, GVHD incidence, and other transplant-related complications, as well as thalassemia-free survival (TFS) were compared between the two groups.@*RESULTS@#The incidence of GVHD, hemorrhagic cystitis and severe oral mucositis after transplantation in the 2-5 years old group were significantly lower than those in the 6-12 years old group, while there was no statistically significant difference in the TFS between the two groups.@*CONCLUSION@#Children in the low age (2-5 years old) group show fewer complications and higher quality of life after transplantation, therefore, stem cell transplantation at 2-5 years old is more conducive to rehabilitation of the children with thalassemia.


Subject(s)
Child , Child, Preschool , Humans , Graft vs Host Disease/complications , Hematopoietic Stem Cell Transplantation , Quality of Life , Retrospective Studies , Thalassemia/therapy , beta-Thalassemia/therapy
4.
Journal of Experimental Hematology ; (6): 957-962, 2021.
Article in Chinese | WPRIM | ID: wpr-880175

ABSTRACT

OBJECTIVE@#To investigate the clinical correlation of expression level changes of miR-181b and miR-194 to the pathogenesis of acute graft-versus-host disease (aGVHD), and determine plasma miR-181b and miR-194 as the potential biomarkers for aGVHD.@*METHODS@#The plasma samples were collected from 31 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at before HSCT, 15 days after HSCT and onset of aGVHD. The expression levels of miR-181b and miR-194 were detected by quantitative real-time PCR. Receiver-operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to assess the sensitivity and specificity of miRNA biomarkers for the diagnosis of aGVHD.@*RESULTS@#MiR-181b and miR-194 downregulated after treatment were significantly upregulated in the plasma at onset of aGVHD (P0.05). The expressions of plasma miR-181b and miR-194 collected on day 15 after HSCT were significantly upregulated in the patients with aGVHD in comparison with non-GVHD patients (P<0.05). Moreover, these elevated miRNAs were detected before aGVHD. The AUC of miR-181b predicting aGVHD was 0.91±0.05 (specificity was 0.94, sensitivity was 0.69). The AUC of miR-194 predicting aGVHD was 0.91±0.06 (specificity was 0.94, sensitivity was 0.77).@*CONCLUSION@#MiR-181b and miR-194 may serve as early biomarkers for the diagnosis and prognosis of aGVHD.


Subject(s)
Humans , Acute Disease , Biomarkers , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , MicroRNAs , Transplantation, Homologous
5.
Chinese Journal of Gastrointestinal Surgery ; (12): 672-677, 2021.
Article in Chinese | WPRIM | ID: wpr-942942

ABSTRACT

Transanal total mesorectal excision (taTME) is one of the hotspots in colorectal surgery in recent years. Although most studies confirm that taTME is safe and feasible, some studies still showed that the morbidity of complication and local recurrence rate of taTME were higher than traditional laparoscopic surgery. This article reviews and analyzes the short-term and long-term outcomes of taTME and the related progress of postoperative function. The results showed that there were no significant differences in the main short-term and long-term efficacy between taTME and traditional laparoscopic TME, but taTME had potential advantages in postoperative functional recovery. The results of case study after passing the learning curve suggested that taTME had better short-term and long-term efficacy. Moreover, with the maturity of taTME technology, transanal endoscopic surgery has gradually shown its advantages in the treatment of complex pelvic diseases. In the future, the application of single-port robot will further promote the development of natural orifice transluminal endoscopic colorectal surgery.


Subject(s)
Humans , Neoplasm Recurrence, Local , Proctectomy , Rectal Neoplasms/surgery , Rectum/surgery , Transanal Endoscopic Surgery
6.
Chinese Journal of Gastrointestinal Surgery ; (12): 530-535, 2021.
Article in Chinese | WPRIM | ID: wpr-942919

ABSTRACT

Objective: To explore the efficacy and feasibility of transanal hand-sewn reinforcement of low stapled anastomosis in preventing anastomotic leak after transanal total mesorectal excision (taTME). Methods: A descriptive cohort study was conducted. Clinical data of 51 patients with rectal cancer who underwent taTME with transanal hand-sewn reinforcement of low stapled anastomosis at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020 were retrospectively collected. Inclusion criteria: (1) age >18 years old; (2) rectal cancer confirmed by preoperative pathology; (3) distance from tumor to anal verge ≤ 8 cm according to pelvic MR; (4) the lesion was evaluated to be resectable before operation; (5) with or without neoadjuvant chemotherapy and radiotherapy; (6) taTME, end-to-end stapled anastomosis, and reinforcement in the anastomosis with absorbable thread intermittently were performed, and the distance between anastomosis and anal verge was ≤ 5 cm. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) emergency surgery due to intestinal obstruction, bleeding or perforation; (3) patients with local recurrence or distant metastasis; (4) the period of postoperative follow-up less than 3 months. The procedure of transanal hand-sewn reinforcement was as follows: firstly, no sign of bleeding was confirmed after checking the anastomosis. Then, the anastomosis was reinforced by suturing the muscle layer of rectum intermittently in a figure-of-eight manner using 3-0 single Vicryl. The entry site of the next suture was close next to the exit site of the last one. Any weak point of the anastomosis could also be reinforced according to the specimen from the circular stapler. The primary outcome were the incidence of anastomotic leak, methods of the secondary operation, anastomotic infection, anastomotic stricture, and conditions of Intraoperative and postoperative. Results: All the 51 enrolled patients completed surgery successfully without any conversion to open surgery. The median operative time was 169 (109-337) minutes, and the median intraoperative blood loss was 50 (10-600) ml. The median postoperative hospital stay was 8 (5-16) days. The mssorectum was complete and distal resection margin was negative in all patients. Postive circumferential resection margin was observed in 1 patients (2.0%). Twelve (23.5%) patients underwent prophylactic ileostomy. One patient developed anastomosis stricture which was cured by digital dilatation of the anastomosis. ISREC grade C anastomotic leak was observed in 3 (5.9%) male patients, of whom 2 cases did not received prophylactic ileostomy during the operation, and were cured by a second operation with the ileostomy and anastomotic repair. The other one healed by transanal repair of the anastomosis and anti-infection therapy. One (2.0%) patient suffered from perianal infection and healed by sitz bath and anti-infection therapy. No death was reported within 30 days after operation. Conclusion: Transanal hand-sewn reinforcement in low rectal stapled anastomosis in preventing anastomotic leak after taTME is safe and feasible.


Subject(s)
Adolescent , Humans , Male , Anal Canal/surgery , Anastomosis, Surgical , Anastomotic Leak/prevention & control , Cohort Studies , Laparoscopy , Postoperative Complications/prevention & control , Rectal Neoplasms/surgery , Rectum/surgery , Retrospective Studies , Treatment Outcome
7.
Chinese Journal of Practical Surgery ; (12): 694-697, 2019.
Article in Chinese | WPRIM | ID: wpr-816448

ABSTRACT

OBJECTIVE: To identify the influencing factors of pathologic complete response(pCR) after neoadjuvant chemoradiotherapy(nCRT) for rectal cancer.METHODS: The clinical data of 185 locally advanced rectal cancer patients admitted at the Sixth Affiliated Hospital Sun Yat-sen University between January 2013 and October 2016 were analyzed retrospectively. Patients were divided into two groups according to their responses to neoadjuvant therapy: the pCR(49 patients)and non-pCR groups(136 patients). The correlation between clinicopathological factors and PCR was analyzed.RESULTS:The rate of pathologic complete response(pCR) was 26.5%,and downstaging rate(ypStage 0 to 1)was achieved 55.8%. In univariate analyses,carcinoembryonic antigen concentration(P=0.039),clinical stage T(P=0.004),stage N(P=0.032)and neoadjuvant chemoradiotherapy with oxaliplatin(P=0.003)were significantly associated with pCR. In multivariate analysis,clinical stage T2 and neoadjuvant chemoradiotherapy with oxaliplatin were significantly associated with pCR,while CEA level was a marginally significant risk factor.CONCLUSION: Stage T2 cancer and fluorouracil-based neoadjuvant chemoradiotherapy with oxaliplatin are independent clinical predictors for achieving pCR.

8.
Chinese Journal of Gastrointestinal Surgery ; (12): 207-210, 2019.
Article in Chinese | WPRIM | ID: wpr-774406

ABSTRACT

The surgical treatment of low rectal diseases has gradually changed from open radical operation to endoscopic minimally invasive operation. Transanal total mesorectal excision (taTME) combines endoscopic technique with transanal approach, and solves the problem of surgery exposure in lower rectal cancer. It has become an option for colorectal surgeons in lower rectal cancer. We named this operation as transanal endoscopic surgery, for the appropriateness when it is applied for other colorectal diseases. Transanal endoscopic surgery belongs to the category of natural orifice transluminal endoscopic surgery, which achieves the same pathological outcomes with less invasiveness and better organ functions compared with traditional surgery. It represents the tendency of low rectal surgery.


Subject(s)
Humans , Digestive System Surgical Procedures , Minimally Invasive Surgical Procedures , Natural Orifice Endoscopic Surgery , Rectal Neoplasms , Transanal Endoscopic Surgery
9.
Chinese Journal of Gastrointestinal Surgery ; (12): 220-223, 2019.
Article in Chinese | WPRIM | ID: wpr-774403

ABSTRACT

Transanal total mesorectal excision (taTME) for rectal cancer is a hot spot in the field of colorectal surgery in recent years, because this technique has the advantages of clear distal margin, early separation of tumor leision, in the treatment of low rectal cancer. However, this technique is not popularized yet, and there are only a few colorectal surgeons who have enough experience. This article shares the experience of taTME in our hospital, including the details of purse string suture, spiral dissection of rectum, and the anatomic markers of anterior and posterior of rectum, conjoined longitudinal muscle and capillary of pelvic nerves locating in pelvic fascia. We sum up the crucial techniques as transanal operation, single port endoscopic technique and mucosal surgical principle (from inside to outside and from bottom to top), aiming to help colorectal surgeons to grasp the essentials of the techniques with initial cases as soon as possible, and to shorten the learning curve, so that more and more patients can benefit.


Subject(s)
Humans , Anal Canal , Colorectal Surgery , Rectal Neoplasms , General Surgery , Rectum , Transanal Endoscopic Surgery
10.
Chinese Journal of Gastrointestinal Surgery ; (12): 246-254, 2019.
Article in Chinese | WPRIM | ID: wpr-774398

ABSTRACT

OBJECTIVE@#To compare the effects of transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (laparoscopic TME) on patients' postoperative long-term bowel function.@*METHODS@#A retrospective cohort study was used in this study. We analyzed the clinical data of 134 patients with locally advanced mid-low rectal cancer, who underwent transanal TME or laparoscopic TME in the TaLaR randomized controlled trial at the Sixth Affiliated Hospital, Sun Yat-sen University from April 2016 to November 2017. Inclusion criteria included age of 18 to 80 years old, distance from tumor low margin to anal edge ≤10 cm, preoperative staging of T1-3NxM0, and single rectal adenocarcinoma. Exclusion criteria included local recurrence, distant metastases, abdominoperineal resection, unreduced stoma, new stoma, less than 1 year after protectomy or stoma reduction, or preoperative poor anal function or incontinence. Patients were divided into taTME group and laparoscopic TME group. The taTME group received hybrid transanal and transabdominal approach performed simultaneously. The effects of surgical procedures on postoperative bowel function were evaluated with LARS (low anterior resection syndrome) scale, where 0-20 was defined as " no LARS" , 21-29 as " minor LARS" , and 30-42 as " major LARS" . Univariate and multivariate logistic regression analyses were performed to determine the risk factors associated with major LARS, with surgical approach as a pre-selected variate.@*RESULTS@#A total of 107 patients were included. Of the 54 patients in the taTME group, 35 were male, median age was 57.2 (26.0-77.0) years old, and 22 cases had a tumor less than 5 cm from anal verge. Of the 53 patients in the laparoscopic TME group, 35 were male, median age was 62.0 (33.0-73.0) years old, and 25 cases had a tumor less than 5 cm from anal verge. All baseline clinical data including age, gender, preoperative staging, and tumor height were comparable between the two groups (all P>0.05). All operations in both groups were performed successfully. The operation time, intra-operative blood loss, postoperative anastomotic complication, postoperative hospital stay were comparable between the two groups (all P>0.05), except for a lower diverting stoma rate in the taTME group [37.0% (20/54) vs. 64.2% (34/53), χ²=7.866, P=0.005]. Of the 107 patients, 27 (25.2%) had no LARS, 32 (29.9%) had minor LARS, and 48 (44.9%) had major LARS, after a median follow-up of 17.2 (12.1-30.4) months. No significant difference was found between the two groups in overall bowel function [major LARS: 48.1% (26/54) vs. 41.5% (22/53), Z=-0.994, P=0.320]. Compared with the laparoscopic TME group, the taTME group experienced worse clustering of stools [68.5% (37/54) vs. 45.3% (24/53), Z=-2.354, P=0.019]. However, there were no significant differences between the two groups in terms of gas incontinence, liquid stool incontinence, frequency of defecation, and urgency (all P>0.05). Multivariate analysis identified preoperative radiotherapy (OR=5.073, 95% CI: 1.336 to 19.259, P=0.017) and anastomotic height (OR=3.633, 95% CI: 1.501 to 8.802, P=0.004) as independent risk factors for major LARS, but no impact of taTME on LARS (OR=1.442, 95% CI: 0.638 to 3.261, P=0.379).@*CONCLUSIONS@#Compared with laparoscopic TME, taTME has similar outcomes of postoperative long-term bowel function. Preoperative radiotherapy and anastomotic height, but not surgical approach, are independent risk factors for postoperative bowel function.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Defecation , Laparoscopy , Neoplasm Recurrence, Local , Postoperative Complications , Rectal Neoplasms , General Surgery , Rectum , Retrospective Studies , Syndrome , Transanal Endoscopic Surgery
11.
Chinese Journal of Digestive Surgery ; (12): 792-796, 2019.
Article in Chinese | WPRIM | ID: wpr-753018

ABSTRACT

Objective To investigate the long-term efficacy of pure transanal total mesorectal excision (PtaTME) for middle-low rectal cancer.Methods The retrospective descriptive study was conducted.The clinicopathological data of 18 patients with middle-low rectal cancer who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from July 2014 to August 2016 were collected.There were 7 males and 11 females,aged (58±13) years,with a range from 40 to 84 years.The body mass index was (22±3) kg/m2.All the 18 patients underwent PtaTME.Observation indicators:(1) surgical and postoperative conditions;(2) postoperative pathological examination;(3) follow-up and survival.Follow-up using inpatient reexamination,outpatient examination,and telephone interview were performed to detect anastomotic complications,anal function,urinary retention,sexual dysfunction,survival and tumor recurrence and metastasis once every 3 months within postoperative 6 months,once every 6 months from 6 months to 3 years,and once a year after 3 years up to June 2019.The measurement data with normal distribution were represented as Mean±SD,and the measurement data with skewed distribution were represented as M (range).Count data were expressed as percentages.Survival rates were calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative conditions:18 patients successfully underwent PtaTME,without conversion to open surgery.The operation time,volume of intraoperative blood loss,distance between anastomosis and anal verge,time to first flatus,time to urinary catheter removal,and duration of postoperative hospital stay were (202±68) minutes,50 mL (range,20-400 mL),(4.5± 2.0)cm,2 days (range,2-7 days),3 days (range,2-5 days),and 7 days (range,5-10 days) in the 18 patients,respectively.There was no perioperative complication.Among 18 patients,4 underwent preventive ileostomy.(2) Postoperative pathological examinations:the length of surgical specimens,the number of lymph node dissection,distance from tumor to the distal margin were (11.0±3.0)cm,12±6,and 1.0 cm (range,0.8-3.7 cm),respectively.The 18 patients had complete mesorectal membrane excision,with negative proximal margin,distal margin,and circumferential margin.Tumor pathological staging:there were 2 cases in Tis stage,4 in T1 stage,7 in T2 stage,and 5 in T3 stage;16 in N0 stage,1 in N1 stage,and 1 in N2 stage.Tumor histological classification:2 patients had carcinoma in situ,9 had moderately differentiated adenocarcinoma,and 7 had high-differentiated adenocarcinoma.(3) Follow-up and survival:18 patients were followed up for 34.0-59.0 months,with a median follow-up time of 57.5 months.During the follow-up,4 patients developed grade B anastomotic leakage and were cured after conservative treatment.One patient developed anastomotic recurrence at 2 years after surgery,and no recurrence was found after surgical resection of the recurrent lesion.Four patients with prophylactic ileostomy had the stoma closured,and the anus function was satisfactory after surgery.There was no urinary retention or sexual dysfunction in the 18 patients.Of the 18 patients,17 had tumor free survival after surgery.The 3-year disease-free survival rate was 94.4%,and the 3-year overall survival rate was 100.0% in 18 patients.Conclusion PtaTME can achieve high quality of specimen,which is safe and feasible for the treatment of rectal cancer.

12.
Chinese Journal of Digestive Surgery ; (12): 736-740, 2019.
Article in Chinese | WPRIM | ID: wpr-753009

ABSTRACT

Transanal total mesorectal excision (TaTME) is a hot topic in the field of colorectal surgery.After nearly ten years of development,it has entered a period of rapid development.Due to the difference between the traditional surgical approach and the previous one,more sufficient preconditions are needed to carry out TaTME cautiously.Therefore,systematic and stan-dardized training is indispensable.Compared with the mature foreign cadaver training courses,the domestic cadaver training is limited,while the traditional laparoscopic animal training model has limited effects on the training of transanal endoscopic surgery.Therefore,how to use the existing domestic conditions to build a training system suitable for Chinese national conditions,so as to standardize the implementation of transanal total mesorectal excision,improve the safety of new technologies,has become an urgent problem to be solved.This article has reviewed deve-lopment history of TaTME training and investigated establishment of TaTME training system,intending to provide references for standardization of TaTME.

13.
Chinese Journal of Gastrointestinal Surgery ; (12): 781-785, 2019.
Article in Chinese | WPRIM | ID: wpr-810856

ABSTRACT

Objective@#To evaluate the feasibility and safety of transanal lateral lymph node dissection for mid-low rectal cancer.@*Methods@#A descriptive case series research method was used. Clinical and pathological data of 5 mid-low rectal cancer patients who underwent transanal lateral lymph node dissection at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from November 2018 to May 2019 were retrospectively collected and analyzed. Of 5 cases, 4 were male and 1 was female with mean age of (43.2±13.2) years and mean body mass index of (21.2±2.6) kg/m2; the mean diameter of tumor was (3.2±2.4) cm; the mean distance between tumor and anus was (6.3±2.5) cm; 3 received preoperative neoadjuvant chemotherapy. In preoperative TNM staging, 2 cases were T3N1M0, 1 was T3cN2aM0, 1 was T3cN2bM0, and 1 was T2N1M0. All the patients had no intestinal obstruction before operation. Surgical methods: (1) total mesorectal excision: using general transanal and transabdominal methods to mobilize and resect total mesorectum, and dissect No.252, No.253 lymph nodes; (2) transanal lateral lymph node dissection: dissect the adipose lymphoid tissue on the surface of the iliococcygeal muscle, the coccygeal muscle, and the obturator muscle (the No.283 lymph nodes) upward, and dissect No.263d and No.263p lymph nodes with fat tissue sequentially till the bifurcation of the internal and external iliac artery; (3) take out the specimen from anus, and make anastomosis between proximal colon and anal canal. Intraoperative and postoperative variables was observed.@*Results@#All the 5 patients completed surgery successfully, and no patient needed to convert to open approach. The mean operative time was (295.6±97.7) minutes, and the median intraoperative blood loss was 70 (50-500) ml. The mean length of specimen was (12.9±3.0) cm, and the mean number of harvested lymph node was 30.4±9.9. The positive lateral lymph nodes were founder in 4 patients. The median distance between tumor and distal resection margin was 1.5 (1.2-8.0) cm. The resection margin in all the patients was negative. The mean time to postoperative flatus was (4.2±1.6) days, the mean postoperative spontaneous urination was (3.0±1.9) days, time to drainage tube removal was (5.6±1.9) days, and the mean postoperative hospital stay was (9.4±2.1) days. The postoperative TNM staging by pathology was 1 case with T1N0M0, 1 with T2N1M0, 1 with T3N2bM0, and 2 with T3N2M0. Five patients were moderately differentiated adenocarcinoma. Only 1 patient developed postoperative abdominal bleeding, who was healed after conservative treatment. The other 4 patients did not develop any perioperative complications, such as incision infection, presacral abscess, pelvic abscess, anastomotic leakage, or anastomotic stricture. Four patients underwent postoperative chemotherapy. All the patients were followed up for 2 to 28 weeks after surgery and they all felt well. The patients with stoma had fluent bowel.@*Conclusions@#Transanal lateral lymph node dissection is feasible and safe in the treatment of mid-low rectal cancer, which can achieve the purpose of extended radical resection of mid-low movement rectal cancer. Moreover, this procedure is a new method to treat rectal cancer patients with lateral lymph node metastasis.

14.
Chinese Journal of Digestive Surgery ; (12): 204-207, 2018.
Article in Chinese | WPRIM | ID: wpr-699100

ABSTRACT

In colorectal cancer,the incidence of rectal cancer (RC) is relatively higher.Most of RC patients have chosen surgical treatment,while patient's own conditions,inadequate preoperative preparation,less surgical experiences of doctors,improper postoperative management and other factors lead to the appearance of anastomotic complications,such as anastomotic leakage,anastomotic stenosis and anastomotic bleeding.The risk of postoperative anastomotic complications is higher in low RC.However,it still has some controversies for the definition and classification of anastomotic complications,and the cause of complication is still not clear.The different treatment methods for anastomotic complications can be chosen,and most of them are effective.Since the anastomotic complications will affect the prognosis of patients,the prevention of complications is essential and some effective treatment methods should be used.

15.
Chinese Journal of Gastrointestinal Surgery ; (12): 73-78, 2018.
Article in Chinese | WPRIM | ID: wpr-338403

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the value of MRI with CUBE sequence in early evaluation of the efficacy of neoadjuvant therapy (NAT) for locally advanced rectal cancer.</p><p><b>METHODS</b>Inclusion criteria: (1) rectal cancer proven by biopsy; (2) locally advanced rectal cancer (T3-4 or positive lymph nodes) with distance from lower edge of tumor to anal verge within 12 cm diagnosed by MRI before NAT; (3) acceptance of NAT treatment regulations and completion of NAT; (4) completion of routine MRI scan and CUBE scan before and after 2-course NAT chemotherapy (including new neoadjuvant chemotherapy and chemoradiotherapy); (5) completion of surgery 6-8 weeks after NAT; (6) exclusion of any previous NAT due to rectal malignant tumor or other tumors; (7) exclusion of poor image quality of preoperative routine MRI insufficient for rectal cancer staging or of CUBE image insufficient for tumor volume measurement. Fifty patients with advanced local rectal cancer were recruited in our hospital from February 2014 to January 2016. All the patients underwent MRI before and after 2-course neoadjuvent therapy. Tumor volume on CUBE were measured and the volume changes were calculated: volume difference= pre-treatment volume-post-treatment volume, volume change rate= (pre-treatment volume-post-treatment volume)/ pre-treatment volume. All the patients were categorized into sensitive and non-sensitive group according to postsurgical pathology. Comparisons were made between both groups before and after therapy. ROC curve was used to evaluate the value of CUBE-associated parameters in predicting the efficacy of rectal cancer.</p><p><b>RESULTS</b>Among enrolled 50 patients with rectal cancer, 31 were male and 19 were female, with mean age of 49.1 years (range 21 to 70 years). T-staging by MRI before NAT was T2N1-2 in 1 case, T3 in 43 cases, T4 in 6 cases. The number of patients after NAT from tumor regression grading (TRG) 0 to TRG3 was 14, 13, 18, 5, respectively. The sensitive group and insensitive group were 45 cases and 5 cases. Mean tumor volume before and after preoperative 2-course NAT was 18.70 (4.14 to 91.77) cmand 9.26 (1.02 to 52.58) cm, respectively, whose difference was significant (U=-5.826, P<0.001). Both measure values of overall tumor volume before and after preoperative NAT between sensitive group and insensitive group did not show significant differences(all P>0.05). While sensitivity group had significantly higher volume difference and change rate compared to insensitive group [ (11.90±10.01) cmvs. (0.65±3.93) cm, P=0.005; 0.45±0.28 vs. 0.09±0.36, P=0.010]. ROC curve revealed that the optimal cutoff value of accurate identification of patients with NAT sensitive was 1.96 cmfor volume difference with sensitivity 86.7% and specificity 80%, and 0.06 for volume change rate with sensitivity 93.3% and specificity 60%.</p><p><b>CONCLUSION</b>MRI CUBE can predict the efficacy of NAT for early rectal cancer patients accurately and sensitively through the detection of tumor volume change before and after NAT.</p>

16.
Chinese Journal of Digestive Surgery ; (12): 703-708, 2017.
Article in Chinese | WPRIM | ID: wpr-616826

ABSTRACT

Objective To compare the clinical efficacies of transanal total mesorectal excision(TaTME) and laparoscopic total mesorectal excision (LapTME)for rectal cancer (RC).Methods The case-control matching method and retrospective cohort study were conducted.The clinicopathological data of 100 RC patients who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University between July 2014 and January 2016 were collected.Of 100 patients,50 undergoing TaTME and 50 undergoing LapTME were respectively allocated into the TaTME and LapTME groups by case-control matching method.Observation indicators:(1) operation situations:operation time,volume of intraoperative blood loss,cases with intraoperative complications and preventive stoma;(2) postoperative recovery:time for diet intake,time for out-of-bed activity,occurrence of complications within 30 days postoperatively and duration of hospital stay;(3) postoperative pathological examinations:postoperative pathological specimen length,number of lymph node harvest,distance from lower boundary of tumor to distant margin and cases with positive circumferential margin;(4) follow-up.Follow-up using outpatient examination and network tracing was performed to detect local tumor recurrence and distant metastasis up to December 2016.Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using the paired-samples t test.Measurement data with skewed distribution were represented as M (range).Comparisons of count data were analyzed using the chi-square test.Comparisons of measurement data with skewed distribution and ranked data were done by the nonparametric test.Results (1) Operation situations:operation time,volume of intraoperative blood loss,cases with intraoperative complications and preventive stoma were (259±111)minutes,100 mL (range,20-2 000 mL),2,28 in the TaTME group and (220± 80)minutes,50 mL (range,20-1 000 mL),1,33 in the LapTME group,respectively,with no statistically significant difference (t=1.90,Z=-0.30,x2 =0.34,0.01,P>0.05).(2) Postoperative recovery:time for diet intake and time for out-of-bed activity were (1.6±0.5) days,(2.6±0.6) days in the TaTME group and (2.4±0.5)days,(3.5 ±0.6)days in the LapTME group,respectively,with statistically significant differences (t =8.90,11.30,P<0.05).Cases with anastomotic fistula,bleeding and stenosis,intestinal obstruction,abdominal abscess and wound infection within 30 days postoperatively were 6,1,1,0,1,0 in the TaTME group and 5,1,2,2,1,2 in the LapTME group,respectively,with no statistically significant difference (x2=0.10,0.00,0.30,2.00,0.00,2.00,P>0.05).Cases with urinary retention within 30 days postoperatively were 3 and 0 in the TaTME and LapTME groups,respectively,with a statistically significant difference (x2 =3.00,P<0.05).Two and 2 patients with anastomic fistula underwent reoperation in the TaTME and LapTME groups respectively,and other patients were improved by symptomatic treatment.Duration of hospital stay was 7 days (range,5-36 days)and 8 days (range,6-29 days) in the TaTME and LapTME groups,respectively,with no statistically significant difference (Z =-0.90,P > 0.05).(3) Postoperative pathological examinations:postoperative pathological specimen length,number of lymph node harvest,distance from lower boundary of tumor to distant margin and cases with positive circumferential margin were (11±3)cm,13±5,(1.3±0.7)cm,0 in the TaTME group and (12±3) cm,13±5,(1.3±0.7)cm,1 in the LapTME group,respectively,with no statistically significant difference (t=0.50,0.20,0.10,x2=1.00,P>0.05).(4) Follow-up:100 patients were followed up for 9-27 months,with an average time of 18 months.During the follow-up,distant metastasis and local tumor recurrence were detected in 2,3 patients of TaTME group and in 2,2 patients of LapTME group,respectively,with no statistically significant difference (x2 =0.00,0.20,P>0.05).Conclusions TaTME for RC is safe and feasible.Compared with LapTME,TaTME not only achieves identical pathological quality without increasing intra-and postoperative complications,but also benefits postoperative recovery of patients.

17.
Chinese Journal of Gastrointestinal Surgery ; (12): 862-864, 2017.
Article in Chinese | WPRIM | ID: wpr-317542

ABSTRACT

Transanal total mesorectum excision (taTME) is a novel approach to treat rectal cancer by colorectal surgeons. How to standardize taTME is important for colorectal surgeons, especially at their initial attempt. They can start this approach cautiously only after they master skilled laparoscopic technique and pelvic anatomy, get the knowledge of taTME clearly, and are approved by healthcare department. The female patients with age <70 years old, distance of 5 to 7 cm from tumor inferior margin to anal verge, tumor size <3 cm, cTNM stage <T3aN0 are suitable for taTME. The instruments include laparoscopic equipment, anal retractor, anal pathway insufflator with constant pressure. There are three operative approaches, such as pure, combined laparoscopic hybrid and sequential hybrid taTME. The combined approach is easier to perform because it has advantages both of laparoscopic and transanal pathway. TaTME has the advanctages of less invasiveness and fast postoperative recovery, which is in accordance with the concept of enhanced recovery after surgery. This paper discusses the taTME from the following aspects: preoperative preparation, case selection, surgical instruments, surgical skills and perioperative management. We aim to help the colorectal surgeons to initiate taTME earlier, shorten the learning curve, and decrease the complications, resulting in benefits to patients.

18.
Chinese Journal of Digestive Surgery ; (12): 928-932, 2016.
Article in Chinese | WPRIM | ID: wpr-501956

ABSTRACT

Objective To investigate the clinical efficacy of unidirectional-loop caudal-medial approach for laparoscopic-assisted radical resection of right colon cancer.Methods The retrospective and descriptive study was performed.The clinical data of 37 patients who underwent laparoscopic-assisted radical resection of right colon cancer through unidirectional-loop caudal-medial approach at the Sixth Mfiliated Hospital of Sun Yat-sen University from January 2015 to March 2016 were collected.Tumor-free principle was followed and unidirectional-loop caudal-medial approach was conducted.Observation indicators included:(1) surgical situations:operation time,volume of intraoperative blood loss,(2) postoperative recovery:time to initial anal exsufflation,time of draining tube removal,postoperative complications,duration of postoperative hospital stay,(3) postoperative pathological examination:number of lymph node dissection,number of positive lymph node,length of specimen,incision margin,tumor pathological staging and type,(4) follow-up.All the patients were followed up using outpatient examination and telephone interview up to June 2016.Measurement data with normal distribution were presented as x ± s and measurement data with skewed distribution were presented as average (range).Results (1) Surgical situations:37 patients received successful operation,without conversion to open surgery and perioperative death.Operation time and volume of intraoperative blood loss in 37 patients were (170 ± 50)minutes and 50 mL (range,20-300 mL).(2) Postoperative recovery:time to initial anal exsufflation,time of draining tube removal and average duration of postoperative hospital stay were (3.5 ± 1.0) days,(4.3 ± 1.1) days and 10 days (range,6-21 days),respectively.Two patients with postoperative wound liquefaction were improved by symptomatic treatment,and the other patients had no complication.(3) Postoperative pathological examination:number of lymph node dissection,number of positive lymph node,number of central lymph node dissection and length of specimen in 37 patients were 22 ±8,0 (range,0-6),6 ±5 and (32 ±9)cm,respectively,with negative incision margins.Postoperative tumor pathological staging showed that stage pT1,pT2,pT3 and pT4a were detected in 0,1,33 and 3 patients,and stage pN0,pN1 and pN2 in 23,12 and 2 patients,respectively.Postoperative tumor pathological type showed that 3,7,23 and 4 patients were respectively diagnosed with mucinous adenocarcinoma,high-differentiated adenocarcinoma,moderate-differentiated adeno-carcinoma and low-differentiated adenocarcinoma.(4) Follow-up:37 patients were followed up for 3-17 months with a median time of 11 months.During the follow-up,1 patient was complicated with anastomotic recurrence and 4 with distant metastases,the other 32 patients had tumor-free survival.Conclusion Unidirectional-loop caudal-medial approach for laparoscopicassisted radical resection of right colon cancer is safe and feasible,with a good short-term outcome,and it should be widely spread.

19.
Chinese Journal of Gastrointestinal Surgery ; (12): 45-49, 2016.
Article in Chinese | WPRIM | ID: wpr-341579

ABSTRACT

<p><b>OBJECTIVE</b>To study the impact of neoadjuvant radiochemotherapy on erectile and urinary functions in mid-low rectal cancer patients.</p><p><b>METHODS</b>Seventy mid-low rectal cancer patients from January 2012 to May 2013 in The Sixth Affiliated Hospital, Sun Yat-sen University were prospectively enrolled. According to tumor staging and patient decision, patients received neoadjuvant radiochemotherapy(50 Grays administered over a six-week period and four cycles of concomitant mFOLFOX6 chemotherapy followed by operation (study group) or surgery alone(control group). Dropouts, loss to follow up and relapse during follow-up were removed from the analysis. A total of 30 patients stayed in study group and 29 patients in control group. To assess erectile and urination functions, the five-item version of the international index of erectile function (IIEF-5) and the international prostate symptom score (IPSS) questionnaires were used before therapy and 12 months after surgery.</p><p><b>RESULTS</b>In both study and control groups, total IIEF-5 score was decreased significantly at postoperative 12-month compared to initial assessment(P<0.01). Compared with control group, IIEF-5 score change was significantly higher in study group (9.6 ± 6.1 vs. 5.3 ± 5.3; P<0.01). Total IPSS score in both groups was increased significantly at postoperative 12-month compared to initial assessment(P<0.05). No significant difference was found in IPSS score change between the two groups (3.0 ± 3.4 vs. 1.5 ± 3.0, P>0.05). Univariate analysis on study group showed that age, tumor location and maximal diameter were associated with erectile dysfunction. Age was associated with urination dysfunction (all P<0.05).</p><p><b>CONCLUSION</b>Neoadjuvant radiochemotherapy has significant impact on erectile dysfunction after surgery in mid-low rectal cancer patients.</p>


Subject(s)
Humans , Male , Chemoradiotherapy , Erectile Dysfunction , Neoadjuvant Therapy , Neoplasm Staging , Prospective Studies , Rectal Neoplasms , Surveys and Questionnaires , Urinary Incontinence
20.
Chinese Journal of Gastrointestinal Surgery ; (12): 850-853, 2016.
Article in Chinese | WPRIM | ID: wpr-323564

ABSTRACT

Since the characteristics of metastasis and invasion of rectal cancer are confirmed gradually, the aim of surgical treatment in rectal cancer is to protect anal and reproductive function, and to minimize the damage of patients. With prominent advantages of identified lower tumor resection margin, enough circumference resection margin, more minimally invasive procedure and faster recovery, transanal total mesorectal excision(taTME) integrated with natural canal theory, transanal minimally invasive technique and TME can effectively solve the difficulties of transabdominal procedure and becomes the research hotspot in rectal cancer surgery worldwide. Though taTME is still at the initial stage and has certain problems, such as the definition of operational procedure, careful performance of standard operation, further summary of operational detail and skill, observation of long-term efficacy and optimization design of operational instruments, it will be supported by high-level evidence based on increasing cases, maturation of procedure, and clinical multicenter cohort researches. TaTME has a good application prospect and may become one of the main procedures of colorectal surgery to treat the middle or low rectal cancer.


Subject(s)
Humans , Abdomen , Anal Canal , Biopsy , Digestive System Surgical Procedures , Methods , Rectal Neoplasms , General Surgery
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