Analysis of Ethical Review of Clinical Study on Defecation Function of Patients with Rectal Cancer after sphincter-preserving Surgery / 中国医学伦理学

In order to understand the status quo of ethical review of clinical research on the defecation function of patients with rectal cancer after sphincter-preserving surgery, analyze its causes and put forward corresponding suggestions, to arouse researchers’ attention to ethical review in subsequent relevant clinical studies. The ethical review of literatures related to the defecation function of patients with rectal cancer after sphincter-preserving surgery published on CNKI in recent 10 years was sorted out and summarized. The results showed that the ethical review of clinical research papers on defecation function of patients with rectal cancer after sphincter-preserving surgery was not optimistic. We should strengthen the ethical training of researchers, improve the ethical awareness of researchers, strictly implement the ethical norms of paper publication, strengthen the ethical requirements of manuscript contracts, perfect the ethical review system, and pay attention to the examination and supervision of informed consent, so as to promote the construction of ethical examination and approval norms of clinical research documents.

Clinical efficacy of redo rectal resection and coloanal anastomosis / 中华消化外科杂志

Objective:To investigate the clinical efficacy of redo rectal resection and coloanal anastomosis.Methods:The retrospective and descriptive study was conducted. The clinicopatholo-gical data of 49 patients who underwent redo rectal resection and coloanal anastomosis for the treatment of local recurrence of tumors and failure of colorectal or coloanal anastomosis after rectal resection in the Sixth Affiliated Hospital of Sun Yat-sen University from November 2012 to December 2021 were collected. There were 32 males and 17 females, aged 57(range,31-87)years. Redo rectal resection and coloanal anastomosis was performed according to the patient′s situations. Observa-tion indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. Results:(1) Surgical situations. All 49 patients underwent redo rectal resection and coloanal anastomosis successfully, with the interval between the initial surgery and the reopera-tion as 14.2(7.1,24.3)months. The operation time and volume of intraoperative bold loss of 49 patients in the redo rectal resection and coloanal anastomosis was 313(251,398)minutes and 125(50,400)mL, respectively. Of the 49 patients, there were 38 cases receiving laparoscopic surgery including 12 cases with transanoscopic laparoscopic assisted surgery, 11 cases receiving open surgery including 2 cases as conversion to open surgery, there were 20 cases undergoing Bacon surgery, 14 cases undergoing Dixon surgery, 12 cases undergoing Parks surgery, 2 cases undergoing intersphincter resection and 1 case undergoing Kraske surgery, there were 20 cases undergoing rectum dragging out excision and secondary colonic anastomosis, 13 cases undergoing dragging out excision single anastomosis, 12 cases undergoing rectum dragging out excision double anastomosis, 4 cases undergoing first-stage manual anastomosis, there were 21 cases with enterostomy before surgery, 16 cases with prophylactic enterostomy after surgery, 12 cases without prophylactic enterostomy after surgery. The duration of postoperative hospital stay of 49 patients was (14±7)days. (2) Postoperative situations. Fifteen of 49 patients underwent postoperative complications, including 8 cases with grade Ⅱ Clevien-Dindo complications and 7 cases with ≥grade Ⅲ Clevien-Dindo complications. None of 49 patient underwent postoperative transferring to intensive care unit and no patient died during hospitalization. Results of postoperative histopathological examination in 23 patients with tumor local recurrence showed negative incision margin of the surgical specimen. (3) Follow-up. All 49 patients underwent post-operative follow-up of 90 days. There were 42 cases undergoing redo rectal resection and coloanal anastomosis successfully and 7 cases failed. Of the 37 patients with enterostomy, 20 cases failed in closing fistula, and 17 cases succeed. There were 46 patients receiving follow-up with the median time as 16.1(7.5,34.6)months. The questionnaire response rate for low anterior resection syndrome (LARS) score was 48.3%(14/29). Of the patients who underwent redo coloanal anastomosis and closure of stoma successfully, there were 9 cases with mild-to-moderate LARS.Conclusion:Redo rectal resection and coloanal anastomosis is safe and feasible for patients undergoing local recurr-ence of tumors and failure of colorectal or coloanal anastomosis after rectal resection, which can successfully restore intestinal continuity in patients and avoid permanent enterostomy.

Influence of different sphincter-preserving surgeries on postoperative defecation function / 中华胃肠外科杂志

Advances in surgical techniques and treatment concept have allowed more patients with low rectal cancer to preserve sphincter without sacrificing survival benefit. However, postoperative dysfunctions such as fecal incontinence, frequency, urgency, and clustering often occur in patients with low rectal cancer. The main surgical procedures for low rectal cancer include low anterior rectum resection (LAR), intersphincteric resection (ISR), coloanal anastomosis (Parks) and so on. The incidence of major LARS after LAR is up to 84.6%. The postoperative function of ISR is even worse than LAR. Moreover, the greater the extent of resection ISR surgery, the worse the postoperative function. There are few studies on the function of Parks procedure. Current evidence suggests that the short-term function of Parks procedure is inferior to LAR, but function can gradually recovered over time. Colorectal surgeons have attempted to improve postoperative defecation by modifying bowel reconstructions. Current evidence suggests that J pouch or end-to-side anastomosis during LAR does not reduce the incidence of defecation disorders. Pouch reconstruction during ISR cannot reduce the incidence of severe LARS either. In general, the protection of postoperative defecation function in patients with low rectal cancer still has a long way to go.

Chinese expert consensus on protective ostomy for mid-low rectal cancer (version 2022) / 中华胃肠外科杂志

The rate of sphincter-preserving surgery for mid-low rectal cancer is increasing, but anastomotic leakage remains to be one of the common serious complications after operation. How to reduce the morbility and mortality of anastomotic leakage is always a hot and difficult point in colorectal surgery. Protective ostomy is a common method to deal with the above problems in clinical practice. However, some problems such as inappropriate stoma and stoma-related complications etc. become the current clinical challenges. The purpose of this consensus focusing on indication of ostomy, clinical value, ostomy skills, prevention of stoma complications, reversion of stoma and stoma nursing aims to provide guidance for the clinical practice of protective ostomy in the operation of mid-low rectal cancer in China.

Current status and influencing factors of bowel function in patients with rectal cancer after sphincter-preserving surgery / 中国实用护理杂志

Objective:To understand the status and influencing factors of the bowel function in patients with rectal cancer after sphincter-preserving surgery, and then to improve the patients′ quality of life.Methods:From January 2017 to April 2020, a total of 179 patients with rectal cancer after sphincter-preserving surgery in Sun Yat-sen University Cancer Center were selected as study subjects. General questionnaire and the scale about bowel function of patients with rectal cancer after sphincter-preserving surgery were used to investigate.Results:The total score of bowel function in patients with rectal cancer after sphincter-preserving surgery was (71.82±7.67), and the average score of all the items was (3.99 ± 0.43). In all dimensions of intestinal function, the average score of "defecation affected by diet" was the highest (4.39 ± 0.80), followed by "frequent and urgent defecation" (4.22 ± 0.49), and the average score of "defecation paresthesia" was the lowest (3.03 ± 0.67). Tumor distance from the anal border was the influencing factor of bowel function in patients with rectal cancer after sphincter-preserving surgery ( P<0.05). Conclusions:The bowel function of patients with rectal cancer after sphincter-preserving surgery was well, while the bowel function of patients with rectal cancer after sphincter-preserving surgery with the distance between the tumor and the lower edge of the anus <5.0 cm was relatively poor.

Investigation on the status quo of diagnosis and treatment related to the protection of defecation function in sphincter-preserving resections for rectal cancer: a cross-sectional study of Chinese colorectal surgeons / 中华胃肠外科杂志

Objective: To understand the current status of diagnosis and treatment regarding the protection of defecation function in Chinese surgeons performing sphincter-preserving resections (SPR) for rectal cancer in order to discover the problems existing in the function protection during SPR and provide support and reference for the standardized clinical management of rectal cancer. Methods: A cross-sectional survey was performed. Colorectal surgeons who obtained the medical qualifications and volunteered to participate in this study were included, and respondents with incomplete information were excluded. From October 18 to 22, 2020, randomized sampling was conducted among Chinese colorectal surgeons from Chinese Association of Colorectal Surgeons, Chinese Colorectal Cancer Committee, Chinese Sexology Association Anal functional Surgery Committee and National Health Commission Capacity Building and Continuing Education Committee. The questionnaire included basic information of the respondents, assessment of defecation function before SPR, intraoperative details, postoperative follow-up, evaluation and intervention of patients with low anterior resection syndrome (LARS). Observation indicator: results of the questionnaire survey. Result: A total of 231 questionnaires were collected, and 230 were effective, with an effective rate of 99.6%. Among these participants, 217 (94.3%) were males; 107 (46.5%) had medical doctor degrees; 129 (56.1%) were national commission members in colorectal surgery; 137 (59.6%) performed more than 50 SPR operations per year; 211 (91.7%) assessed defection function by auxiliary examinations before SPR. Rigid sigmoidoscopy (n=116, 55.0%) and anorectal manometer (n=81, 38.4%) were the most commonly used method. Among the 230 respondents, 64.8% (n=149) of surgeons used 2D laparoscopy for SPR surgery most commonly, and 51.3% (n=118) of surgeons performed direct colorectal anastomosis for reconstruction, and 98.3% (n=226) used staplers during anastomosis. All the surgeons indicated that they would follow up patients after SPR, and outpatient clinic was the most common method (84.4%, 184/230). When LARS occurred, 50.0% (115/230) of surgeons chose defecation function scale and 78.7% (181/230) actively provided guidance and intervention for patients. Conclusions: Chinese colorectal surgeons still have shortcomings in the protection of defecation function during SPR for rectal cancer. They do not make enough preoperative functional evaluation and postoperative functional recovery estimate for patients. The knowledge and use of defecation function scales and interventions on LARS are expected to be standardized.

Emphasize on the postoperative anal function of middle and low rectal cancer patients / 中国实用外科杂志

Organ function preservation emphasizes the application of various therapeutic techniques to avoid or reduce the influence of tumor treatment process on the normal function of cancer organs and adjacent organs under thepremise of ensuring the best prognosis of oncology. Modern surgical treatment of middle and low rectal cancer does requireanal organ function preservation, but the current rectal cancer guidelines lack guidance on how to protect organ function. Inthe author's opinion,modern colorectal surgeons should recognize that anal function is an important factor affecting the quality of life after rectal cancer surgery. Functional considerations should be raised to the same level as techniqueas to whether the patient should preserve the anus. Correct evaluation of postoperative defecation function of patients isthe basis of selecting anal preservation indications.Preoperative evaluation of risk factors for anal dysfunction are helpful to predict postoperative functional status. The rational use of multidisciplinary strategies is recommended to reduce surgical trauma and improve anastomosis techniques to achieve functional preservation in middle and low rectal cancer.

Current state and progress of preserving anal function in treatment of low or ultral-low rectal cancer / 中国内镜杂志

As the development of society, people pay more attention to life quality. Nowadays, the therapeutic strategy to low or ultra-low rectal cancer has turned to anussaving as important as radical resection. Following the deep research in biology rule-rs of rectal cancer and a series of important theories, such as the 2 cm distal resection margin, total mesorectal excision technique, pelvic autonomic nerve preservation, variet-y of surgical methods can be chose in dealing with low or ultra-low rectal cancer a-nd achieving the goal of anus preservation. But, because of so many organs around the low or ultra-low rectal cancer and complicated anatomy, we should select patients strictly in order to avoid preserve one's anus blindly. if not, patients will face the condition of residual neoplasms or severe incontinence.

Clinical efficacy of preoperative SIB-IMRT for 26 cases of locally-advanced low rectal cancer / 中华放射肿瘤学杂志

Objective To evaluate the feasibility and clinical efficacy of preoperative simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with neoadjuvant chemotherapy of capecitabine in patients with locally-advanced low rectal cancer.Methods Between 2015 and 2016,26 patients admitted to 301 Hospital who were diagnosed with locally-advanced low rectal cancer,which was located within 5 cm from the anal verge,were enrolled in this investigation.Dose fractionation pattern was delivered:58.75 Gy in 25 fractions (2.35 Gy/fraction) for rectal cancer and lymph node metastasis and 50 Gy in 25 fractions for the pelvic lymphatic drainage area and simultaneously combined with capecitabine chemotherapy (825 mg/m2,bid d 1-5 weekly).One cycle of capecitabine (1 250 mg/m2,twice daily,d 1-14)was given at one week after the completion of chemoradiotherapy (CRT).Total mesorectal excision (TME)was performed at 6 to 8 weeks after the completion of CRT.The primary endpoints included pathological complete response rate (ypCR) and sphincter-preserving rate.The secondary endpoints included acute toxicity,tumor downstaging rate and postoperative complications.Results Twenty-six patients successfully completed neoadjuvant CRT,25 of them underwent surgical resection and one patient failed to receive surgery due to pxrianal edema.Postoperative ypCR rate was 32％ (8/25),the sphincter-preserving rate was 60％ (15/25),the tumor downstaging rate was 92％ (23/25) and the R0 resection rate was 100％.During the period of CRT,grade 1 and 2 adverse events occurred in 24 patients,grade 3 radiation dermatitis was noted in 2 cases.No ≥ grade 4 acute adverse event was observed.Postoperative complications included ureteral injury in one case and intestinal obstruction in one patient.Conclusions Preoperative SIB-IMRT combined with neoadjuvant chemotherapy of capecitabine is a feasible and safe treatment for patients with locallyadvanced low rectal cancer,which yields expected ypCR rate,R0 resection rate and sphincter-preserving rate.Nevertheless,the long-term clinical benefits remain to be elucidated.Clinical Trial Registry Chinese Clinical Trial Registry,registration number:ChiCTR-ONC-12002387.

Clinical study of low/low pressure drainage radical resection in the treatment of high perianal abscess / 中国综合临床

Objective To investigate the clinical effect of low/low pressure drainage radical resection in the treatment of high perianal abscess.Methods Eighty-six patients with high perianal abscess treated in Tangshan Traditional Chinese Medicine Hospital from Octorber 2014 to Octorber 2016 were selected and randomly divided into the observation group(44 cases)and the control group(42 cases).The observation group was treated with decompression and drainage radical surgery,while the control group was treated with one-stage incision and thread drawing radical surgery.The postoperative conditions of the two groups were observed, including pain,anal function,healing time and clinical effect,and statistical analysis was made on the quantitative scores of the above indexes.Results The cure rate of the observation group was 100%(44/44), significantly higher than that in the control group(90.47%(38/42)),and the difference between the two groups was statistically significant(χ2=4.395,P=0.036).The postoperative pain score of the observation group was(1.681±0.945)points,significantly lower than that in the control group((3.328±1.300)points),and the difference was statistically significant(t=-4.504,P=0.000); The number of recurrence(0 cases)was significantly lower than that in the control group(4 cases)(P=0.036).The healing time of the observation groups was(22.08± 2.12)d, significantly lower than that in the control group((37.552± 2.61)d),and the difference between the two groups was statistically significant(t=29.0411,P=0.000);The anal function score of the observation group was(1.681±0.838)points,significantly lower than that in the control group((2.809 ±0.928)points),and the difference between the two groups was statistically significant(t = -3.217,P=0.000).Conclusion Low pressure drainage radical is an effective surgical method for sphincter preserving radical treatment of high perianal abscess,which not only preserves the sphincter and anus straight ring,but also reduces the postoperative anal function and the degree of morphological damage and the surgery the pain and length of hospital stay and cost saving.

De la resección abdominoperineal a las técnicas conservadoras de esfínteres en la cirugía laparoscópica del cáncer del recto / From abdominoperineal resection to conservative techniques of interest in relation to laparoscopic surgery for rectal cancer

Introducción: la principal regla en el manejo del cáncer del recto es la cura oncológica y el mantenimiento de la calidad de vida. El advenimiento de la cirugía laparoscópica ha tenido un impacto en la cirugía gastrointestinal en los últimos 20 años. Tres décadas después de su original descripción por Heald, la escisión total del mesorrecto se ha convertido en la regla de oro para la resección curativa del cáncer del recto. Objetivos: revisar las diferentes opciones técnicas de las que se dispone en la actualidad para el tratamiento laparoscópico del cáncer del recto, mediante la descripción de sus resultados, ventajas y desventajas. Métodos: se realizó una revisión en las bases de datos bibliográficas accesibles por Infomed, que incluyó artículos que trataran el tema en español e inglés, mediante los descriptores de DeCS y MeSH. Resultados: el cáncer del último tercio del recto plantea un cambio significativo para el cirujano. La resección abdominoperineal ha sido considerada como la regla de oro para el tratamiento de los adenocarcinomas situados en el tercio medio y bajo del recto. Sin embargo, con el incremento del conocimiento de la enfermedad, el desarrollo de las técnicas quirúrgicas, la mejor instrumentación, y el uso de la radioquimioterapia preoperatoria, se ha llegado a un cambio en el tratamiento del cáncer de recto que va de la resección abdominoperineal con colostomía permanente a la cirugía preservadora del esfínter mediante las técnicas mínimamente invasivas. Conclusiones: la cirugía conservadora de esfínteres para el cáncer del recto mediante las técnicas mínimamente invasivas es posible en la mayoría de los pacientes con unos resultados a largo plazo iguales a los de la resección abdominoperineal(AU)

Introduction: the main rule for the management of rectal cancer is oncologic cure and the maintenance of quality of life. The advent of laparoscopic surgery has had an impact on gastrointestinal surgery over the last 20 years. Three decades following its original description by Heald, total mesorectal excision has become the gold standard for the curative resection of rectal cancer. Objectives: To review the different technical options currently available for the laparoscopic treatment of rectal cancer, by describing their outcomes, advantages and disadvantages. Methods: A review was performed in the bibliographical databases accessible from Infomed, including articles on the topic written in Spanish and English, using DeCS and MeSH descriptors. Results: Cancer of the lower third of the rectum signifies a fundamental change for the surgeon. Abdominoperineal resection has been considered as the gold standard for the treatment of adenocarcinomas located in the middle and lower rectum. However, with increased knowledge of the disease, the development of surgical techniques, better instrumentation, and the use of preoperative radiochemotherapy, a change has been achieved in treating rectal cancer, which goes from abdominoperineal resection with permanent colostomy to conservative surgery of the sphincter using minimal invasive techniques. Conclusions: The conservative surgery of the sphincters for rectal cancer by minimal invasive techniques is possible to be performed in most patients, with long-term results similar to those of the abdominoperineal resection(AU)

Effect of behavior-changes-in-stages theory on defecation function of lower rectal cancer after sphincter-preserving operation / 现代临床护理

Objective To study the effect of behavior-changes-in-stages theory on defecation function of lower rectal cancer after sphincter-preserving operation. Methods 84 patients with lower rectal cancer undergoing sphincter-preserving operation from June 2013 to June 2016 were divided into control group (n=42)and intervention group (n=42)according to their willingness to care.The control group implemented routine nursing,mainly for diet intervention,wound care,bowel function training and in the intervention group the behavior-changes-in-stages theory was used.Comparisons were done between the groups in terms of the anus incontinence defecation function and quality of life for 6 months after operation. Result The degrees of anus incontinence and defecation function in the intervention group were both significantly better than those in the control group 6 months after the operation (P<0.05). Conclusions The behavior-change-in-stages plays a significant role in the postoperative rehabilitation.It can significantly reduce the anus incontinence, better the bowel function,improve the quality of life and promote rehabilitation.

Application of terminal ileum suspension in laparoscopic operation for low rectal cancer / 实用医学杂志

Objective To explore the value of terminal ileum suspension in the treatment of low rectal cancer.Methods 80 patients with low rectal cancer who underwent laparoscopic operation in our hospital from June 2015 to February 2017,were randomly divided into two groups:the control group (group C) and the test group (group T),40 cases in each group.In group C,laparoscopic radical resection of rectal cancer (Dixon) was performed and in group T Dixon was combined with terminal ileum suspension.Peripheral blood nutritional indicators (total plasma protein,albumin,pre-albumin,transferrin) and major electrolytes of two groups were observed 1 day before operation and 1,3 and 7 days after operation.The two groups were compared in terms of first exhaust time,postoperative hospital stay,total costs for hospitalization,postoperative discomforts and complications.Results There were no statistical differences in the levels of nutrition indicators and electrolytes between them (P ＞ 0.05) and neither it was with first exhaust time,hospital stay,total costs of hospitalization,incidence of postoperative discomforts and complications (P ＞ 0.05).The re-operation rate of group T with anastomotic leak was significantly lower than group C (P ＜ 0.05).Conclusion Terminal ileal suspension does not affect patients' postoperative recovery without increasing the patient's suffering and economic burden,and can effectively reduce the reoperation rate caused by anastomotic leak.It is easy to operate.

Laparoscopic Sphincter Preserving Surgery for Ultra Low Rectal Cancer：Report of 108 Cases / 中国微创外科杂志

Objective To explore advantages of laparoscopic sphincter preserving surgery for ultra low rectal cancer . Methods From April 2006 to January 2015, we performed laparoscopic sphincter preserving surgery in 108 cases of ultra-low rectal cancer.After laparoscopic mesorectal resection and lymph node dissection were completed , transection of the rectum was performed with the Endo-GIA at 2 cm from the lower margin of the tumor .The right lower abdomen main operation port was expanded to remove the lesion and introduce the stapler base .The proximal colon was returned and the pneumoperitoneum was re-established .A colorectal end-to-end anastomosis was conducted through the anus by using a carliber 29 circular stapler . Results Laparoscopic operation was successfully accomplished in all the 108 cases.No conversion to open surgery was required .No operative mortality was encountered . The operation time was 68 -145 min ( mean, 104 min ) , the intraoperative blood loss was 10 -100 ml ( mean, 40 ml ) , the postoperative flatus time was 1-3.5 d (mean, 2.3 d), and the number of removed lymph nodes was 8-37 (mean, 12.5).There were 98 patients followed up for 6-62 months (mean, 24.6 months).No tumor metastasis or recurrence was found . Conclusion Laparoscopic total mesorectal excision of ultra low sphincter preserving operation is feasible .

New progress in the surgical treatment of low rectal cancer / 国际外科学杂志

Rectal cancer is one of the common malignant tumors in China,and the incidence rate is rising year by year.Comprehensive treatment based on surgical operation is the major treatment of low rectal cancer.The treatment concept requires not only radical resection of tumor,but also preservation of the anal and urogenital function,to improve the quality of patients' life.By improving the accuracy of preoperative staging of rectal cancer,neoadjuvant therapy,and following the principle of total mesorectal excision,patients can benefit in terms of increased resection rate,decreased operation complication incidence,increased sphincter preservation,decreased local recurrence and increased overall survival rate.With the development of medical technology,minimally invasive surgery of low rectal cancer has been developed rapidly.In this paper,new progress in the surgical treatment of low rectal cancer will be reviewed.

Multivariate Analysis of Risk Factors Associated With the Nonreversal Ileostomy Following Sphincter-Preserving Surgery for Rectal Cancer

PURPOSE: A loop ileostomy is used to protect an anastomosis after anal sphincter-preserving surgery, especially in patients with low rectal cancer, but little information is available concerning risk factors associated with a nonreversal ileostomy. The purpose of this study was to identify risk factors of ileostomy nonreversibility after a sphincter-saving resection for rectal cancer. METHODS: Six hundred seventy-nine (679) patients with rectal cancer who underwent sphincter-preserving surgery between January 2004 and December 2011 were evaluated retrospectively. Of the 679, 135 (19.9%) underwent a defunctioning loop ileostomy of temporary intent, and these patients were divided into two groups, that is, a reversal group (RG, 112 patients) and a nonreversal group (NRG, 23 patients) according to the reversibility of the ileostomy. RESULTS: In 23 of the 135 rectal cancer patients (17.0%) that underwent a diverting ileostomy, stoma reversal was not possible for the following reasons; stage IV rectal cancer (11, 47.8%), poor tone of the anal sphincter (4, 17.4%), local recurrence (2, 8.7%), anastomotic leakage (1, 4.3%), radiation proctitis (1, 4.3%), and patient refusal (4, 17.4%). The independent risk factors of the nonreversal group were anastomotic leakage or fistula, stage IV cancer, local recurrence, and comorbidity. CONCLUSION: Postoperative complications such as anastomotic leakage or fistula, advanced primary disease (stage IV), local recurrence and comorbidity were identified as risk factors of a nonreversal ileostomy. These factors should be considered when drafting prudential guidelines for ileostomy closure.

Comparative analysis of anorectal function after anus-preserving laparoscopic rectal resection in ultra low rectal cancer / 肿瘤研究与临床

Objective To comparative analyze the anorectal function before and after anus-preserving laparoscopic rectal resection in ultra low rectal cancer.Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel on 43 patients based on the concept of TME and ultra low colorectal/ anal anastomosis was perfomed by applying the manual anastomosis with two operations out of anus.The time of guid being controlled in the rectus,rectual rest pressure (RRP),anal rest pressure (ARP) and anal maximal contraction pressure (AMCP) were tested before operation.The function of their rectus and anus was tested,including the number of bowel movement in one day of 1,3,6 months after operation,the time of guid being controlled in the rectus,RRP,ARP and AMCP after 3,6 months of operation et al.Results All the operations were finished successfully,four cases were converted to open surgery,but there was no serious damage.All cases were followed up for 6 to 36 months with average of 20 months.After 3 months of operation,the retention time of liquid in rectus,the defecate feel function,the anus control function,RRP and ARP was statistically significant (P ＜ 0.05) compared to them before operation,there was no statistical significance (including AMCP) (P ＞ 0.05) after 6 months of operation.The results of tests in annus and rectus were near normal level after 6 month of operation.Conclusion The manual anastomosis with two operations out of anus in the laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive and shorter hospital stay,it is worth to be widely used.

Evaluation of anus-preserved procedures on life quality in patients with ultra-low rectal cancer / 中国综合临床

Objective To evaluate the influence of anus-preserved procedures on life quality of patients with low rectal carcinoma.Methods One hundred and forth cases with low rectal carcinoma who underwent double stapling technique(DST) (n =64) or support binding procedure(SBP) (n =50) were selected as our subjects.Patients in both group were undergone total mesorectal excision (TME) to sever mesorectum.Anal Function was assessed by Xu Zhongfa Anal-Function's criterion after operation.All patients were performed a 5 years follow-up.Results The 5-years survival rate and local recurrence rate were 65.63％ (37/64),20.03％ (13/64) respectively in DST group,and 76.0％ (38/50),6.0％ (3/50) in SBP group.The differences were significant (P =0.049,0.032).The postoperative general occurrence rate of dysuria,dysporia and sexual disorder in the DST group were 31.25％ (20/64),17.19％ (11/64) and 45.31％ (29/64) respectively,higher than those of SBP group(14.00％ (7/50),4.00％ (2/50) and 26.00％ (13/50) ;P =0.037,0.045,0.034).Conclusion Both DST and SBP therapy are proved to be effective in terms of anus-preserved treatment for low rectal cacinoma.5-year survival rate is similar in the two groups,while the survival quality is better in SBP group than in DST group.

Strategies of local recurrence after sphincter preserving surgery for low rectal cancer / 中国医师进修杂志

Objective To investigate the treatment of local recurrence after sphincter preserving surgery for low rectal cancer. Methods Fifty-six patients with local recurrence after sphincter preserving surgery for low rectal cancer were divided into three groups, 20 cases underwent radical resection (group A), 21 cases underwent palliative resection combined with 3 dimensional conformal radiation therapy (group B), and 15 cases only received 3 dimensional conformal radiation therapy (group C). Results All the patients were followed up from 6 months to 3 years. The 1-year,2-year and 3-year survival rates were 100.0%(20/20),80.0% (16/20),65.0% (13/20) in group A,90.5% (19/21),52.4% (11/21),33.3% (7/21) in group B and 80.0%(12/15),40.0%(6/15),20.0%(3/15) in group C respectively. Both 2-year and 3-year survival rates in group A were significantly higher than those in group B and group C (P <0.05). Conclusions The first choice of patients with local recurrence after sphincter preserving surgery for low rectal cancer is radical resection. Palliative resection combined with 3 dimensional conformal radiation therapy is the second choice.

Function of Contour in the sphincter-preserving surgery in low rectal cancer / 中国综合临床

Objective To study the function of Contour stapler in the sphincter-preserving surgery in 121 cases with low rectal cancer. Methods One hundred and twenty-one cases enrolled were divided into 2 groups randomly and accepted Contour or other kinds of staplers after operation respectively. Further comparison were performed on the rate of sphincter-preserving,anastomosis stricture and leakage,infection of incision and stool frequency between two groups. Results We found no significant differences in the comparison of rate of anastomosis stricture or leakage,stool frequency,but the Contour group had significant higher rate of sphincter-preserving (98. 3%)than other stapler group(68. 9%),and lower rate of infection of incision(3.94%)than control(11.9%)(P ＜0. 05 respectively). Conclusions It is secure,reliable and practical to use Contour stapler in operation on low rectal cancer,which can increase the opportunity of sphincter-preserving,decrease the the rate of infection of incision.