ABSTRACT
Colorectal surgery has been developed rapidly in China because of the advance of minimally invasive surgical techniques, perioperative comprehensive treatment strategies and clinical research in recent years. Comparing the current diagnosis and treatment of colorectal cancer between China and western industrialized countries, it can be found that the specialized construction and standardized diagnosis and treatment of colorectal surgery in western industrialized countries are very mature, and the multidisciplinary diagnosis and treatment model of colorectal cancer has been standardized. Although there is almost no difference between high-level colorectal cancer centers in the eastern coastal areas of China and western countries, due to the vast size and uneven regional development of China, standardized surgery and standardized treatment concepts of colorectal surgery still need to be popularized. Combined with the current diagnosis and treatment of colorectal cancer in China, more high-quality clinical research should be carried out to seek new development and breakthroughs in the field of colorectal surgery. Combined with the experience of international and domestic clinical research that has been participated in or carried out, the author believes that quality control of clinical research should be carried out from the following two points: 1. structured training and quality control of research; 2. establishment and management of databases. In a word, we should not only focus on colon surgery itself, but also complete the transformation to research-oriented doctors and research-oriented disciplines, cultivate the concept of data collection and clinical research, enhance the scientific awareness of clinical research, and integrate high-quality data collection and clinical research into daily clinical practice. Only in this way can we fundamentally improve the comprehensive strength of China's colorectal surgery, effectively carry out surgical-related clinical research based on the current situation colorectal diseases in China, and obtain high-level evidence-based medical evidence based on the research results of the population of patients in China, and form a guide for the diagnosis and treatment of colorectal surgery in China, which will also guide the clinical practice of patients with colorectal diseases in China. This will certainly be a new direction for the development of Chinese colorectal surgery.
Subject(s)
Humans , China , Colorectal Surgery , Data Collection , Digestive System Surgical Procedures , Minimally Invasive Surgical ProceduresABSTRACT
OBJECTIVE: to introduce the study method of Chinese Transanal Total Mesorectal Excision(TaTME) registry Collaborative(CTRC),and report the short-term clinical-oncological outcomes from CTRC. METHODS: Based upon the concept of real world evidence,Data of 601 cases were retrospectively and prospectively analyzed from a nationwide multi-center registry system of CTRC.The safety and effectiveness of these cases were evaluated. RESULTS: The results of the CTRC database showed that:(1) 68.7% of 601 patients were male,the average age of all patients was(59.5±11.4)years,the average BMI was 23.9±3.6. There were 558 cases of rectal cancer among the total enrolled cases. The average distance between the distal edge of rectal cancer and the anal verge was(48.1±14.8)mm,and the ratio of neoadjuvant therapy was 31.7%.(2) 24.6% of the surgical cases were completed under the supervision of TaTME experts. The mean volume of intraoperative blood loss was(115.2 ± 366.5)mL,and the mean operating time was(247.1±87.5)min. Circle stapler was used to make the anastomosis among 74.8% of rectal cancer cases. The protective stoma was performed among 49.6% of the cases of rectal cancer. Maintaining a stable pneumopelvis and excessive smoke obscuring the pelvic view,were the main intraoperative difficulties encountered during transanal procedure. According to the grading of quality and completeness of the mesorectum in the total mesorectal excision specimen,the incidence rates of TaTME specimen graded as "complete", "nearly complete" and "incomplete" were79.6%,16.8% and 0.2% respectively by the evaluation of surgeons.(3)The incidence of postoperative complications was20.2%,and the anastomotic leakage rate was 7.0%.(4) There were 8 cases of specimen perforation. The average number of lymph node harvest was 15.4±7.9. CONCLUSION: TaTME procedure seems be safe and effective regarding to the shortterm clinical-pathological outcomes. The completeness of distal mesorectal dissection,circumferential resection margin and distal resection margin can be promised by the procedure of TaTME. However,the data quality in the database of CTRC needs to be improved,and structured training for TaTME surgery is indispensable. Further national multicenter prospective clinical trials are needed to evaluate the efficacy of TaTME versus TME.
ABSTRACT
Objective To explore the effect of transanal total mesorectal excision (TaTME) structured training on the operation of frozen cadaver specimens in mainland China.Methods The retrospective crosssectional study was conducted.The data of 9 trainees who participated in the 1st TaTME structured training between April 12 and 13,2018 were collected.Chinese Society of Colorectal Surgery,Chinese Society of TaTME Surgeons and Beijing Anatomy Society were the host of TaTME structured training,Beijing Friendship Hospital of Capital Medical University and Clinical Applied Anatomy Science and Technology Training Center of Beijing Society for Anatomy Society were the undertakers.The courses included theoretical teaching,operation demonstration and frozen cadaveric specimens operation.Nine trainees were allocated into the 3 groups,including trainees A,C,E in group 1,trainees B,D,F in group 2 and trainees G,H,I in group 3.The special questionnaire survey was carried out on all the trainees at 3 months after the end of the training,contents included the number and proficiency of TaTME before and after training,reasons for not performing TaTME,learning curve of TaTME,TaTME-related complications and adverse reactions,whether or not to continue TaTME in future,effects of training,whether or not necessary to take training before TaTME.Observation indicators:(1) situations of trainees taking part in theoretical lectures and operation demonstration;(2) situations of trainees taking part in frozen cadaveric specimens operation;(3) questionnaire survey situations of trainees at 3 months after training.Comparison of trainees before and after training was done by the rank-sum test.Results (1) Situations of trainees taking part in theoretical lectures and operation demonstration:9 trainees received theoretical lectures and operation demonstration.The theoretical lectures helped deepen understanding of the TaTME,and operation demonstration gave an intuitive feel of technical points and considerations for TaTME.(2) Situations of trainees taking part in frozen cadaveric specimens operation:9 trainees performed successfully frozen cadaveric specimens operation under the guidance of the instructors to achieve training purposes.Overall evaluation of the instructors:anastomotic stoma was intact in 3 groups;grading 2 of Quirke grading of mesorectum was detected in group 1 and 2,and grading 3 in group 3;the main difficulty of complications was incorrect interstice operation and poor smog control,and urethral injury occurred in group 3.(3) Questionnaire survey situations of trainees at 3 months after training:2,2,2 and 3 trainees after training carried respectively on more than 10,6-10,1 and 0 times TaTME,2,2,1 and 4 trainees before training carried respectively on 6-10,2-5,1 and 0 in number of TaTME before and after training,with no statistically significant difference (Z =1.000,P＞ 0.05).Three trainees didn't perform TaTME due to no suitable patient,no equipment for TaTME and incompletely master operating of TaTME.After training,1 trainee was very proficient for TaTME,3,3 and 2 trainees respectively needed to 1/4,1/2 and 3/4 of guidance;before training,1,4 and 3 trainees needed to respectively 1/4,1/2 and 3/4 of guidance,and 3 trainees were very inaptitude for TaTME,with no statistically significant difference in proficiency of TaTME before and after training (Z=1.243,P＞0.05).Five of 9 trainees thought that finishing learning curve needed 10 times TaTME.TaTME-related complications and adverse reactions included urethral injury,bleeding,incorrect interstice operation and incomplete specimens.Eight of 9 trainees expressed that would continue to carry on TaTME.All trainees thought TaTME structured training was very necessary and training should be finished before TaTME.Conclusions The TaTME structured training program on the operation of frozen cadaver specimens is a new attempt.The structured and standardized TaTME training is a necessary condition for clinical performing of TaTME,which is conductive to improving the safety and effectiveness of TaTME.