Value of endorectal ultrasonography in the assessment of invasion staging of low rectal cancer with local progression after neoadjuvant radiochemotherapy / Valor de la ultrasonografía endorectal en la evaluación de la estadificación de la invasión del cáncer rectal bajo con progresión local, después de administrar radioquimioterapia neoadyuvante

Abstract Although stages T3 and T4 rectal cancer can be reduced to T1 or T2 after neoadjuvant radiochemotherapy, the accuracy of the endorectal ultrasonography (ERUS) for the post-radiochemotherapy evaluation of low rectal cancer has seldom been reported. We aimed to investigate the value of ERUS in the assessment of invasion staging in low rectal cancer with local progression, and the factors affecting its accuracy, after neoadjuvant radiochemotherapy. A total of 114 patients administered with neoadjuvant radiochemotherapy for stages II and III low rectal cancer (local stage T3/T4) from February 2018 to December 2020 were enrolled in the study. The changes in local lesions were evaluated using ERUS before and after radiochemotherapy, and compared with the pathological T staging. The accuracy of post-neoadjuvant radiochemotherapy re-staging examined with ERUS was evaluated, and univariate analysis was used to identify the factors affecting the accuracy. After neoadjuvant radiochemotherapy, the blood flow distribution within the lesion significantly declined (P<0.05), the max length and max thickness of the longitudinal axis of the lesion were reduced (P<0.05), and the uT staging was decreased (P<0.05), when compared with lesions before the treatment. Compared with postoperative pathological T staging, the accuracies of ERUS in T1, T2, T3 and T4 stages were 11.11%, 28.57%, 27.27% and 100%, respectively. Univariate analysis indicated that review time of ERUS, post-operative T staging and Wheeler rectal regression stage were factors affecting the accuracy of ERUS re-staging. ERUS is more accurate for T4 re-staging, follow-up reviewed six weeks after neoadjuvant radiochemotherapy and low regression tumors, with a high application value for the assessment of the efficacy of neoadjuvant radiochemotherapy for low rectal cancer.

Resumen Aunque el cáncer de recto en estadios T3 y T4 se puede reducir a T1 o T2 después de la radioquimioterapia neoadyuvante, rara vez se ha informado la precisión de la ecografía endorrectal (ERUS) para la evaluación posterior a la radioquimioterapia del cáncer de recto inferior. Nuestro objetivo fue investigar el valor de ERUS en la evaluación de la estadificación de la invasión en el cáncer de recto inferior con progresión local, después de la radioquimioterapia neoadyuvante y los factores que afectan su precisión. Se incluyeron en el estudio un total de 114 pacientes a los que se les administró radioquimioterapia neoadyuvante para el cáncer de recto inferior en estadios II y III (estadio local T3/T4), desde febrero de 2018 hasta diciembre de 2020. Los cambios en las lesiones locales se evaluaron mediante ERUS antes y después de la radioquimioterapia y se compararon con la estadificación patológica T. Se evaluó la precisión de la re-estadificación examinada con ERUS, después de la radioquimioterapia neoadyuvante y se utilizó un análisis univariado para identificar los factores que afectan su precisión. Después de la radioquimioterapia neoadyuvante, la distribución del flujo sanguíneo dentro de la lesión disminuyó significativamente (P<0,05), la longitud máxima y el espesor máximo del eje longitudinal de la lesión se redujeron (P<0,05) y la estadificación uT disminuyó (P<0,05), en comparación con las lesiones antes del tratamiento. En comparación con la estadificación T patológica posoperatoria, las precisiones de ERUS en las etapas T1, T2, T3 y T4 fueron del 11,11%, 28,57%, 27,27% y 100%, respectivamente. El análisis univariable indicó que el tiempo de revisión de ERUS, la estadificación T postoperatoria y la etapa de regresión rectal de Wheeler fueron factores que afectaron la precisión de la re-estadificación con ERUS. ERUS es más preciso para la re-estadificación de T4, el seguimiento seis semanas después de la radioquimioterapia neoadyuvante y en tumores de baja regresión, con un alto valor de aplicación para la evaluación de la eficacia de la radioquimioterapia neoadyuvante para el cáncer rectal bajo.

Several Critical Issues of Low Rectal Cancer Surgery / 肿瘤防治研究

Colorectal cancer is one of the top three malignant tumors in the world. With the rapid development of medical technology and the strengthening of national awareness of cancer screening, rectal cancer has been diagnosed and treated timely. At present, the application of low rectal tumor preservation operation is becoming more and more common. Anastomotic leakage and anterior resection syndrome are the most common complications of low rectal cancer. How to preserve anal and reduce the incidence of complications has always been the concern of scholars at home and abroad. In order to improve the survival time and quality of life of patients with low rectal cancer, this paper expounds five key problems: fully preoperative evaluation of anorectal function and staging, reasonable neoadjuvant therapy, safe distal margin, the selection of surgical methods and the timing of preventive stoma.

ELAPE: rol actual en el tratamiento del cáncer de recto bajo / ELAPE: current role in the treatment of low rectal cancer

Resumen En este artículo se discute el origen del concepto ELAPE ( extralevator abdominoperineal excision) en el tratamiento quirúrgico del cáncer del recto bajo, las variantes técnicas asociadas con la resección "cilíndrica", las indicaciones actuales, las limitaciones técnicas asociadas y los resultados publicados en la literatura mundial. Considerando la evidencia actual se propone la utilización en casos seleccionados de acuerdo al estudio clínico y por imágenes, donde la resonancia magnética de la pelvis tiene un rol predominante. La técnica tradicional de la amputación abdominoperineal (comúnmente asociada a Miles) se mantiene como una alternativa válida en el manejo quirúrgico de algunos pacientes con un tumor localmente avanzado del recto bajo.

This article discusses the origin of the ELAPE concept (abdominoperineal excision extralevator) in the surgical treatment of low rectal cancer, the technical variants associated with "cylindrical" resection, current indications, associated technical limitations and the results published in the world literature Considering the current evidence, the use is proposed in selected cases according to the clinical study and imaging, where the magnetic resonance of the pelvis has a predominant role. The traditional abdominal-perineal amputation technique (commonly associated with Miles) remains a valid alternative in the surgical management of some patients with a locally advanced tumor of the lower rectum.

Opciones terapéuticas en el cáncer de recto inferior. Actualización / Therapeutic options in lower rectal cancer. Upgrade

Motiva esta presentación el hecho que desde el Relato "Opciones terapéuticas del Cáncer de Recto Inferior" en el año 2008 han pasado 10 años y por supuesto aparecieron algunos progresos y cambios. Se conoce gran heterogeneidad genética debido que puede desarrollarse por diferentes vías. Nuevos fármacos han aparecido para lograr terapia eficiente. La clasificación clínica TNM fue actualizada en el año 2018. Los métodos de diagnóstico siguen teniendo vigencia. La resección local endoanal se presenta como una conducta factible con resultados favorables debido al progreso instrumental. Combinado con R/T y Q mostró excelentes resultados ("Watch and Wait"). La escisión total de mesorecto sigue ocupando un lugar importante. En la amputación abdomino perineal debemos incluir la resección de ambos músculos elevadores del ano. La cirugía laparoscópica ocupa cada vez más lugar siendo tan segura como la convencional. Se adjuntan los algoritmos terapéuticos. Continuarán las investigaciones para mejorar los resultados. (AU)

The aim of this presentation is to update the one written in 2008 "Low rectal cancer therapeutic options" since some progress and changes have appeared after ten years. Great genetic heterogeneity is known because it can develop in different pathways. New drugs have appeared to achieve efficient therapy. The TNM clinical classification was updated in 2018. The diagnosis methods are still in effect. Endoanal local resection is presented as feasible behavior with favorable results due to instrumental progress. Combined with R/T and Ch showed excellent results (Watch and Wait). The total mesorectal continues to occupy an important place. The resection of both elevator muscles of anus must be included in the abdominoperineal amputation. Laparoscopic surgery is increasingly in place, being as safe as the conventional. Therapeutic algorithms are attached. Research will continue to improve results. (AU)

Impact of visceral obesity on the short-term outcomes after radical operation for mid-low rectal cancers / 中国肿瘤临床

Objective: To investigate the effect of visceral obesity on the short-term outcomes after radical operation for mid-low rectal cancers. Methods: We conducted a prospective study on patients who underwent selective rectal cancer resection at The Second Affili-ated Hospital of Wenzhou Medical University between April 2017 and October 2018. The cutoff visceral fat area (VFA) for visceral obe-sity was≥134.6 cm2 for men and≥91.1 cm2 for women. Results: A total of 127 patients were included in the study, of whom 64 were diagnosed as having visceral obesity and 63 as having non-visceral obesity. The patients with visceral obesity had a higher body mass index (BMI) (P<0.001) than those without visceral obesity. The proportions of female patients and those who had a laparoscopy-assist-ed surgery were higher in the visceral obesity group than in the non-visceral obesity group. We found no significant differences in age, albumin level, hemoglobin count, American Society of Anesthesiologists (ASA) stage, Nutritional Risk Screening (NRS) 2002 score, Charlson comorbidity index, tumor location, TNM stage, lymphatic invasion, and laparoscopy-assisted surgery between the two groups. The postoperative complication rate was significantly higher in the visceral obesity group than in the non-visceral obesity group (35.9% vs . 19% , P=0.033). A multivariate Logistic regression analysis revealed that visceral obesity [odds ratio (OR)=2.732, P=0.019] and NRS 2002 scores of≥3 (OR=2.574, P=0.042) were independent risk factors for postoperative complications. Conclusions:Visceral obesity was an independent risk factor for complications after surgery for mid-low rectal cancers.

Clinical Value of Neutrophil/Lymphocyte Ratio in StageⅡand Ⅲ Middle and Low Rectal Cancer / 中国医科大学学报

Objective To explore the clinical value of neutrophil/lymphocyte ratio (NLR) in staging of stage Ⅱ/Ⅲ middle and low rectal cancer. Methods The clinical and pathological data of 111 patients with middle and low rectal cancer who underwent surgical treatment were retrospectively analyzed. The NLR values along with various clinical factors and pathological parameters were also statistically analyzed, and then the relationship between preoperative NLR and various clinical factors was determined. All patients were divided into high and low groups based on NLR, with the cut-off value of 1.99. Then, the clinical, pathological parameters and disease-free survival of the two groups were analyzed. Results The maximum diameter of the tumor and the NLR value were positively correlated (P ＜ 0.05). The patients with high and low NLR had significant differences in age, stage Ⅱ and Ⅲ, N stage, pathological type, maximum diameter of the tumor, and disease-free survival (P ＜ 0.05). Conclusion Preoperative NLR values may be used as predictive values for the pathological parameters of stage Ⅱ and Ⅲ middle and low rectal cancer, and NLR may be an indicator of its prognostic assessment.

Safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure for low rectal cancer / 中华消化外科杂志

Objective To investigate the safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LARP-PPC) for low rectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 132 patients with low rectal cancer who were admitted to Ruijin Hospital of Shanghai JiaoTong University School of Medicine from January 2014 to December 2017 were collected.There were 81 males and 51 females,aged from 45 to 83 years,with an average age of 62 years.Among the 132 patients,60 undergoing LARP-PPC were allocated into LARP-PPC group,and 72 patients undergoing conventional LARP were allocated into LARP group.All the patients received standardized preoperative and postoperative treatments.Observation indicators:(1) surgical and postoperative conditions;(2) postoperative pathological examination;(3) postoperative complications.The measurement data with normal distribution were expressed as Mean±SD,and the t test was used for comparison between groups.The measurement data with skewed distribution were expressed as M (range),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute numbers,and the chi-square test or the Fisher exact probability was used for comparison between groups.Mann-Whitney U test was used for comparison of ordinal data between groups.Results (1) Surgery and postoperative conditions:all the patients in the two groups underwent successful surgery without conversion to open surgery.The operation time,volume of intraoperative blood loss,time to first flatus,and time to first liquid intake of the LARP-PPC group were (163±45) minutes,168 mL(range,85-280 mL),2 days(range,1-5 days),3 days(range,2-6 days),versus (155±39) minutes,160 mL(range,100-305 mL),3 days(range,1-7 days),4 days(range,2-7 days) of the LARP group;there was no differencebetween the two group (t =1.113,Z =-1.623,-1.468,-0.321,P＞0.05).The duration of postoperative hospital stay in the LARP-PPC group and the LARP group were 16 days (range,11-21 days) and 19 days (14-24 days),respectively,with a significant difference between the two groups (Z =-5.888,P＜0.05)].In the LARP-PPC group,time of PPC was (13± 3) minutes.(2) Postoperative pathological examination:the length of specimen,the number of lymph node dissection,tumor diameter,cases with high-,middle-,and low-differentiated tumor in the LARP-PPC group was (18±4)cm,16±t5,(3.7±1.4)cm,10,34,16 in the LARP-PPC group,and (18±4)cm,16±5,(3.9±1.5) cm,13,41,18 in the LARP group,showing no significant difference between the two groups (t =0.779,0.390,0.703,Z=-0.267,P＞0.05).(3) Postoperative complications:cases with perineal wound infection,delayed perineal wound healing,intestinal obstruction,and perineal hernia were 2,1,1,0 in the LARP-PPC group,and 12,10,8,6 in the LARP group,showing significant differences between the two groups (x2 =6.137,6.400,P＜0.05).There were 2 and 4 patients with urinary tract infection in the LARP-PPC group and the LARP group,respectively,showing no significant difference between the two groups (P ＞ 0.05).Conclusion LARP-PPC is safe and feasible for the treatment of low rectal cancer,which can significantly reduce postoperative perineal-related complications and consequently shorten postoperative hospital stay.

Extralevator abdominoperineal excision versus abdominoperineal excision for low rectal cancer: a meta-analysis / 中华医学杂志(英文版)

Background@#Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.@*Methods@#The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.@*Results@#This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42-1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75-1.94, P= 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39-0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21-0.41, P < 0.001) when compared with APE.@*Conclusions@#The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.

Correlation between intestinal flora imbalance and anastomotic leakage after operation for middle to low rectal cancer / 中国实用外科杂志

OBJECTIVE: To analyze the risk factors and relationship between intestinal flora imbalance and anastomotic leakage after laparoscopic rectal cancer lower anterior resection(LAR)in patients with middle-low rectal cancer.METHODS: Clinical data of 155 patients with mid to low rectal cancer who underwent laparoscopic lower anterior resection at Peking Union Medical College Hospital from November 2016 to April 2019 were retrospectively analyzed.Postoperative intestinal flora imbalance and anastomotic leakage were evaluated,and statistical results were gained.RESULTS: Of the 155 patients,34(21.9%)patients had postoperative intestinal flora imbalance. Twenty patients of anastomotic leakage after operation(12.9%)were discovered,and 18 patients(11.6%)had both anastomotic leakage and intestinal flora imbalance. Univariate and multivariate logic regression analysis showed that intestinal flora imbalance(χ~2=25.674,OR=90.398,P0.05).CONCLUSION: The early diagnosis of postoperative intestinal floraimbalance in rectal cancer patients depends more on clinical experience. Intestinal floraimbalance,the enlargement of tumor diameterare risk factors for anastomotic leakage,and protective enterostomy would reduce the incidence of anastomotic leakage.

Selection of anal preservation surgery of low rectal cancer / 中国实用外科杂志

With the promotion of neoadjuvant therapy,the development of minimally invasive techniques and new surgical techniques,the anal preservation rate of low rectalcancer is increasing year by year. To improve postoperative quality of life is an important goal in the treatment of low rectal cancer. At present,the main important low anal preservation surgery is as follows: Intersphincteric resection(ISR),including complete ISR,subtotal ISR,partial ISR and modified partial ISR; Transanal local resection,including transanal endoscopic microsurgery(TEM) and transanal minimally invasive surgery(TAMIS); Anterior perineal planefor ultra-low anterior resection of the rectum(APPEAR),which is performed through a separate perineal incision,israrely used at present; Transanal total mesorectal excision(TaTME) proposed in recent years. Preliminary studies have proven safe and effective for low advanced rectal cancer.TaTME require a learning curve. It is now making expertcon sensus and operation specification,operation training and conducting multi-center prospective study. TaTME isexpected to become the important operation for low rectalcancer.

Precise preoperative staging of low rectal cancer assessed by imaging / 中国实用外科杂志

The goal of treatment strategy for patients who has low rectal cancer is preserving sphincter and function and keeping decrease of local recurrence and increase overall survival. In the result of narrow space between tumor and surrounding structure,the positive resection margin increases the local recurrence in patient with low rectal cancer. Magnetic resonance imaging(MRI)preoperatively predict circumferential resection margin according to the relationship between tumor and the low rectal cancer surgical resection plane. MRI,which has been validated by previous studies,low rectal plane assessment,reducing pCRM involvement and avoiding overtreatment through selective preoperative therapy and rationalized use of permanent colostomy. However,surgical treatment of low rectal cancer is controversial,and one of the reasons is the lack of definition and standardization of surgery in low rectal cancer. Classification of low rectal cancers and standardization of surgery according to distance between lowest edge of tumor and depth of tumor invasion permit sphincter and function preserving surgery in of patients with low rectal cancer. In patients with rectal cancer who achieve clinical complete response after neoadjuvant chemoradiotherapy,“watch and wait” is a novel management strategy with potential to avoid major surgery. However,how to select proper candidates and how to assess the complete clinical response need further research.

The prognostic significance of primary tumor volume by MRI in cT3 low rectal cancer / 中国实用外科杂志

OBJECTIVE: To evaluate the clinical significance of primary tumor volume(PTV) by preoperative highresolution MRI measurement in subgroup of cT3 low rectal cancer. METHODS: A total of 99 patients with low rectal cancer who confirmed by pathology and assessed at stage-cT3 by MRI,did not undergo neoadjuvant chemoradiotherapy(nCRT) treated in Department of Colorectal Surgery,Fujian Medical University Union Hospital from June 2010 to December 2012 were adopted in the study. The relations between PTV and the depths of tumor infiltration out of mesorectum were analyzed through Spearman correlation analysis. The receiver-operating characteristic(ROC) curve was used to analyze the PTV and 3-year disease-free survival. Cox proportional hazard model was performed for influence factors analysis. RESULTS: The depth of tumor infiltration mesorectum and the PTV were revealed significantly correlated(P 15 cm~3 or PTV≤14.8 cm~3/>14.8 cm~3. The difference between groups revealed significant in the 3-year disease-free survival rate,the local recurrence rate and the distant metastases rate.COX regression analysis was utilized for 3-year disease-free survival,and the multivariate analysis indicated that PTV was an independent impact factor(HR=0.180,95%CI 0.078-0.415,P<0.05). CONCLUSION: The primary tumor volume (PTV) by preoperative high-resolution MRI measurement might be used as a new prognostic parameter for cT3 low rectal cancer.

Clinical observation of laparoscopic abdominoperineal intersphincteric resection com-bined with ileostomy for treatment of ultra-low rectal cancer / 中国肿瘤临床

Objective: To observe and evaluate the clinical efficacy of laparoscopic abdominoperineal intersphincteric resection com-bined with ileostomy for the treatment of ultra-low rectal cancer. Methods: Clinicopathologic data of 74 patients undergoing laparo-scopic radical resection for ultra-low rectal cancer at Coloproctology Hospital of Chengdu from January 2015 to June 2017 were retro-spectively analyzed. In total, 43 patients underwent laparoscopic abdominoperineal intersphincteric resection combined with ileosto-my (ISR group), and 31 patients underwent laparoscopic low anterior resection combined with ileostomy (LAR group). The periopera-tive condition, radical resection of tumor, and postoperative anal function were compared between the two groups. Results: There were no significant differences in blood loss, postoperative hospital stay, and postoperative complications between the groups (all P>0.05). The mean operative time was (306.6 ± 25.1) minutes in the ISR group and (239.7 ± 26.4) minutes in the LAR group (P=0.010). There were no significant differences in pT and pN between the groups (all P values>0.05). The coincidence rate of T stage diagnosis was 93.0% in the ISR group and 93.5% in the LAR group. The positive rate of circumferential resection margin in the two groups was 0. The mean distance of the distal margin was (2.3±0.1) cm in the ISR group and (1.4±0.3) cm in the LAR group (P<0.001). All patients were followed up for 12-42 (mean 23.4) months. The local recurrence rate was 0 in the ISR group and 12.9% (4/31) in the LAR group (P=0.027); no distant metastasis was observed in any of the groups. There was no significant difference in the results of the anorectal manometry test between the groups (P>0.05). The proportion of patients with good continence of anal function after closure of ileos- tomy was 83.7% in the ISR group and 87.1% in the LAR group (P>0.05). Conclusions: Laparoscopic abdominoperineal intersphincteric resection combined with ileostomy is safe and feasible for the treatment of ultra-low rectal cancer, and it leads to satisfactory anal function and a short-term curative effect.

Critical and Challenging Issues in the Surgical Management of Low-Lying Rectal Cancer

Despite innovative advancements, the management of distally located rectal cancer (RC) remains a formidable endeavor. The critical location of the tumor predisposes it to a circumferential resection margin that tends to involve the sphincters and surrounding organs, pelvic lymph node metastasis, and anastomotic complications. In this regard, colorectal surgeons should be aware of issues beyond the performance of total mesorectal excision (TME). For decades, abdominoperineal resection had been the standard of care for low-lying RC; however, its association with high rates of tumor recurrence, tumor perforation, and poorer survival has stimulated the development of novel surgical techniques and modifications, such as extralevator abdominoperineal excision. Similarly, difficult dissections and poor visualization, especially in obese patients with low-lying tumors, have led to the development of transanal TME or the “bottom-to-up” approach. Additionally, while neoadjuvant chemoradiotherapy has allowed for the execution of more sphincter-saving procedures without oncologic compromise, functional outcomes remain an issue. Nevertheless, neoadjuvant treatment can lead to significant tumor regression and complete pathological response, permitting the utilization of organ-preserving strategies. At present, an East and West dualism pervades the management of lateral lymph node metastasis, thereby calling for a more global and united approach. Moreover, with the increasing importance of quality of life, a tailored, individualized treatment approach is of utmost importance when taking into account oncologic and anticipated functional outcomes.

Meta-analysis of lateral lymph node dissection for low rectal cancer / 中国现代普通外科进展

Objective:To explore the significance of lateral lymph node dissection for low rectal cancer.Methods:Retrieval the Cochrane Library,PubMed,EMBASE,CBM,VIP,CNKI,WANFANG DATA,the time is from January 2000 to October 2015.Bring into the comparative studies about lateral lymph node dissection for low rectal cancer.Processing data using the revman 5.2 to reaserch the significance of lateral lymph node dissection for low rectal cancer.Results:9 clinical comparative studies were included in this study.The observation group was the lateral lymph node dissection group and the control group was the traditional operation group.Results showed that the length of incision of the observation group was longer [MD=-42.48,95％CI (32.92,-52.04),P＜0.00001],The amount of bleeding in observation group was more[MD=-18.72,95％Cl(5.60,31.83),P＜0.005],The local recurrence rate in the observation group was Iower[OR=-0.52,95％CI (0.38,0.71),P＜0.0001],The 3 year survival rate and the 5 year survival rate in the observation group were higher than those in the control group,the difference was statistically significant,Their combined OR and 95％CI were [OR=2.65,95％ CI (1.76,3.99),P＜0.00001] and [OR=3.57,95％ CI (2.05,6.22),P＜0.00001].Conclusion:Lateral lymph node dissection increasing operation time、hemorrhage volume and postoperative complication risk,but could increase the survival rate of the patients.

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.

Preliminary Outcome of Individualized Abdominoperineal Excision for Locally Advanced Low Rectal Cancer / 中华医学杂志(英文版)

<p><b>Background</b>The introduction of individualized abdominoperineal excision (APE) may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer.</p><p><b>Methods</b>Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin (CRM) involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0.</p><p><b>Results</b>Fifty (89%) patients received preoperative chemoradiotherapy: 51 (91%) patients were treated with the sacrococcyx preserved; 27 (48%) patients with the levator ani muscle partially preserved bilaterally; 20 (36%) patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 (13%) patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 (4%) patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction (12%), perineal wound complications (13%), urinary retention (7%), and chronic perineal pain (5%). A positive CRM was demonstrated in 3 (5%) patients, and intraoperative perforations occurred in 2 (4%) patients. On multiple logistic regression analysis, longer operative time (P = 0.032) and more intraoperative blood loss (P = 0.006) were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months (range: 30-74 months).</p><p><b>Conclusion</b>With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with acceptable oncological outcomes.</p>

Perioperative Pharmaceutical Care for Low Rectal Cancer and Its Experience / 中国药房

OBJECTIVE:To explore the role of clinical pharmacists in perioperative pharmaceutical care for patients with low rectal cancer(LRC). METHODS:Clinical pharmacists participated in the perioperative drug therapy and pharmaceutical care for a LRC patient. They assisted physicians to develop pharmaceutical care from aspects of medication objective,individual medication, evaluation of medication rationality. RESULTS:Clinical pharmacists provided medication education for patients,bowel preparation and preanesthetic medication before surgery and offered drug therapy monitoring of fluid replacement,nutritional support,analge-sia, expectorcont, hemostasis, anti-infective agents and antitumor agents. The patient was discharged successfully. CONCLU-SIONS:Clinical pharmacists participate in perioperative pharmaceutical care and adjust medication timely according to disease con-dition to reduce postoperative complications and ADR,guarantee the safety of drug use and promote rational drug use during periop-erative period.

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.

Role and significance of PANP in laparoscopic surgery for low rectal cancer / 中国现代普通外科进展

Objective:To investigate the clinical significance of preserving autonomic nerve (PANP) in patients with low rectal cancer.Methods:The clinical data of 68 cases of patients with low rectal cancer who underwent laparoscopic surgery in our hospital from March 2014 to January 2016 were retrospectively analyzed.According to the surgical methods,the patients were divided into PANP group and non PANP group.Two groups of patients with postoperative micturition function,sexual function and quality of life were observed,compared with the two groups of patients with postoperative satisfaction differences.Results:In retention of PANP group of patients with postoperative ultrasonic residual urine volume was lower than that in non retention in PANP group were less and recovery of automatic micturition time is short retention in PANP group,IPSS score was lower than that in non low retention in PANP group,the difference is statistically significant(P＜0.05);The female and male patients with retention of PANP group were better than those of non retention PANP group,and the difference was statistically significant (P＜0.05);There was no significant difference in quality of life between the two groups before surgery.After surgery,the quality of life of the two groups was lower than before treatment,and the decrease of PANP group was more obvious than that of the non retention group (P＜0.05).Conclusions:The autonomic nerve preservation in the operation of low rectal cancer has a good protective effect on the urinary function and sexual function,and can obviously improve the quality of life of patients after operation.