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Objective To evaluate the effect of double stapling technique for sphincter preservation operation in mediate-low rectal carcinoma.Methods The resection through double stapling technique for sphincter preservation approach was performed on 30 patients with mediate-low rectal carcinoma from January 2004 to November 2007.The distance between the anal verge and the lower margin of the tumor was 4～8cm(averaged 6.5 cm),including 22 patients in Dukes A stage,6 Dukes B and 2 Dukes C.Results Fecal continences were preserved successfully in all patients.2 cases had got anastomotic narrowing(6.6%) after operation.At a median follow-up of 46 months,two patients had local recurrences(6.6%).There was no urinary dysfunction in this series.Conclusion Double stapling technique for sphinceter preservation operation was feasible and safe,provide a original operative style for mediate-low rectal carcinoma.
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Objective To explore the feasibility of laparoscopy-assisted total mesorectal excision(TME) for anterior resection of rectal cancer.Methods The clinical records of 42 patients with rectal cancer who underwentlaparoscopic TME from April 2006 to July 2008 were analyzed retrospectively.Results All the laparoscopic TME with anal sphincter preservation operations were successful;no case was converted to open procedure.The distal end of rectum was anastomosed by a reusable linear stapler.The average operative time was 195 min(170-230 min) and the operative blood loss 15 mL(10-30 mL).The time for bowel functionrecovery was 32 hours.One patient had postoperative dysuria,and one had intraoperative subcutaneousemphysema.No anastomotic leakage or infection of incisional wound occurred.Conclusions Laparoscopy-assisted anterior resection for rectal cancer is safe and feasible.
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Objective To investigate the therapeutic effect of total mesorectal excision(TME) for low rectal cancer.Methods One hundred nineteen patients with rectal cancer,located on an average within 8 cm of the anal verge,were included in the study.Fifty-four patients underwent traditional operation,and sixty-five patients underwent total mesorectal excision.Operation time,loss of blood at operation and local recurrence rates were compared between the two groups.Results The average operation time and blood loss were 118 minutes,and 100mL respectively in TME group,and they were 182 minutes,and 340 ml respectively in traditional operation group.There were significant differences between them(all P0.05).Conclusions In TME group,operation time was shorter,operative blood loss was less,and local recurrence rate was lower.TME should be applicated for patients with low rectal cancer.
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0.05).Sexual dysfunction was 13.8% and 46.5% respectively,and was significant(P
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Objective To explore the possibility of anal preserving after total mesorectal excision combined with stapling technique in radical resection of low rectal cancers. Methods We retrospectively summarized the data of 93 cases of low rectal cancer treated by radical resection and anal preservation, and made specific assessment of post operative rectal sensation and anal function. Results All of the cases were free of cancer invasion of the distal margin of resected bowel.The rate of local recurrence at 2 years after operation was 5.3 %, and 93.5% of patients had good rectal sensation and anal function. Conclusions Anal preserving operation for low rectal cancers using total mesorectal excision combined with stepling technique can improve the postoperative quality of life, and is safe and feasible.
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ObjectiveTo evaluate the indication, the operation pattern and therapeutic effect of the ano-saving surgery in low rectal carcinoma. MethodsAccording to anorectal finger-examination, IRUS,and CT, 94 out the 161 rectal cancer patients were selected to have ano-saving surgery from August 1993 to December 1994.Excreting function, 5-year survival rate and local recurrence rate of the various operation were compared. ResultsThe perfomed rate of ano-saving operation in low rectal cancer was 58.4%. Among them, low anastomosis was done in 6 cases, ultra-low anastomosis in 48 cases,Park′s operation in 25 cases,and Bacon operation in15 . The death rate was 2.1%(2 cases).Incidence of anastomotic leakage after the surgery was 3.2%(3 cases), and only 13 cases had anastomotic narrowing(13.8%) within 1 year. The successful rates of excreting function after the surgery were respectively as follows: low anastomosis 100%, ultra-low anastomosis 97.9%,Park′s surgery 88.0%,and Bacon surgery 53.3%. The 5 year survival rates and the local recurrence rates were respectively,as follows: low anastomosis 83.3% and 0; ultra-low anastomosis 79.2% and 4.2%; Park′s 64.0% and 12.0%; and Bacon 66.7% and 13.3%,respectively. ConclusionsUltra-low colo rectum anastomosis becomes the main operative pattern to preserve anal sphincter in low rectal cancer.There is no difference in the 5-year survival rate and the excreting function among low, ultra-low anastomosis and Park′s operation, but the low and ultra-low colo-rectum anastomosis were obviously better than that of Bacon and Miles operation.The local recurrence rates of low and ultra-low colon-rectum anastomosis are lower than that of Miles′.There is no difference in the 5-year survival rate and local recurrence rate between Park′s, Bacon and Miles operation.
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ObjectiveTo determine the effect of total mesorectal excision with double anastomosis instruments(DAIs) in lower rectal carcinoma. MethodsFrom 1995 to 1998,57 cases of middle and lower segement rectal carcinoma were treated by total mesorectal excision with DAIs, and were followed for 3 years. Results No operative death and no anastomotic leakage were noted. Two patients suffered from anastomotic stenosis,but no dysuria and sexual dysfunction occurred. Local recurrence rate was 5.3%(3/57)in the follow-up period. ConclusionsTotal mesorectal excision with DAIs is not only an effective method to maintain pelvic organ function in lower rectal cancer, but also able to improve the living quality of patients and reduce local reccurence.
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We summarized and evaluated the radical effect and feasibility of the ano-saving operation for low rectal carcinoma by reviewing literature in recent years about the operative indication, the excision dimension, total mesorectum excision, selection of operative mode, 5-year survival rate and follow-up of the anal saving operation in low rectal carcinoma.The main points are as follows: (1)The operative indication of ano-saving operation is done according to the location,invasion depth and pelvic lymphatic metastasis of low rectal carcinoma.(2)The preoperative digital anal examination,rectal intraluminal ultrasound,pelvic CT and MRI can direct the selection of operative indication.(3)The operation of low rectal carcinoma should adhere to total mesorectum excision,but the lateral lymphadenectomy is necessary.(4)The wtra low resection is the major operative mode for low rectal carcionoma.(5)We should simultaneously perform the ano-saving operation through treating and preventing hepatic metastasis.The ano-saving operation can not only have radical treatment effect,but also improve the quality of life in patients with low rectal carcinoma.
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Objective To study the effect of hand-assisted laparoscopic anterior resection for rectal cancer(RC).Methods The clinical data of 28 cases of RC operated with hand-assisted laparoscopy were analyzed retrospectively. Results The operations in all the 28 cases were successfully performed, and no intra-or post-operative complications were observed.The number of resected lymph nodes and the resected margins from the tumor were sufficient.After operation,the patients felt less pain, recovered quicker and bowel movement recovered early;first postoperative flatus was appeared at 32 hours after operation;average postoperative hospital stay was 7 days.All the patients were followed-up for 8 to 19 months,and no trocar port tumor implantation or local recurrence occurred.Conclusions The results demonstrate that hand-assisted laparoscopic anterior resection in the treatment of RC have many advantages,such as safe,less trauma,the patients recover quicker,resection of the tumor more complete etc,so it can be used extensively.
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Objective To evaluate the indication,operation pattern and therapeutic effect of ano-saving surgery for lower rectal carcinoma. Methods Retrospective analysis on the clinical feature of 320 patients with lower rectal carcinoma (postoperative time ≥5 years)treated by ano-saving surgery, the 5-year survival rate, local recurrence rate, and mortality were compared in the various operations. Results The success performed rate of ano-saving operation for lower rectal cancer was 58.5%(320/547).Among them, anastomotic leakage after surgery occurred in 4 cases (1.25%), and 26 cases had anastomostic narrowness (8.13%) within 1 year after surgery.The defecation function after surgery, in patients received colonic J pouch or transverse coloplasty pouch was much better than that in patients received coloanal or colorectal anastomosis. 5-year survival rates, and anastomostic recurrence rates were as follows:In ultra-low anastomosis were 63.24% and 10.27%. Park′s operation 66.67% and 5.13%, local resection 89.46% and 10.71%, respectively. 5-year recurrence rate in the pelvic soft tissue was 3.44%(11/320).Two cases died after operation. Conclusions Lower or ultra-low colon-rectum anastomosis becomes the main operative pattern in preserving anal sphincter in lower rectal cancer.Local resection of lower rectal tumor might be considered if the indecation is selected strictly. Colonic-J-pouch or transverse coloplasty pouch is good for improving the defecation function after ano-saving surgery for lower rectal cancer.
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Objective To explore the feasibility and efficacy of laparoscopic total mesorectal excision(TME) with preservation of anal sphincter for rectal cancer.Methods From October 2001 to March 2004,54(patients) with rectal cancer underwent laparoscopic total mesorectal excision(TME) with preservation of anal sphincter.In 51 of the 54 cases,the operation was completed laparoscopically,including 14 cases of(laparoscopic) anterior resection(AR) with the anastomosis level above the peritoneal reflection;20 cases of laparoscopic low anterior resection(LAR) with the anastomosis level more than 2cm above the dentate line;16 cases of laparoscopic ultralow anterior resection(ULAR) with the level of anastomosis within 2cm of the dentate line;and 2 cases of laparoscopic coloanal anastomosis(CAA) with the level of the anastomosis at or below the dentate line.whereas conversion to an open approach was required in three cases.Results The average operating time was 145 minutes(range 110~210min),and mean operative blood loss was 50 mL(range 30~80mL).Bowel function was restored and diet was resumed at 48 to 36 hours after operation.The average hospital stay was 9 days(range 7~14d).TME was completed successfully in 51 patients.Postoperative analgesics were used in 20 patients.No intraoperative or postoperative complications were(observed).Follow-up time was from 6~36 months in 51 patiebts,and there was no port-site or local tumor recurrence.Conclusions Laparoscopic TME is feasible and safe.It is a perspective technique with the(benefits) of minimally invasive technique and lower blood loss during operation,and rapid recovery.
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Objective To compare the postoperative complications rate of total mesorectal excision(TME) performed by laparoscopic and conventional laparotomy method in treatment of rectal cancer.Methods The clinical data of patients with rectal cancer treated by laparoscopic surgery(n=42) or traditional laparotomy(n=50) were retrospectively analysed to analysis of the cause and occurrence rate of complications.(Results) The laparoscopic group had an advantage over the conventional laparotomy group in bowel movement recovery,earlier mobility and short hospital stay time.There was no difference in intraoperative injury,(anastomotic) leakage,sexual function preservation,long-term urinary dysfunction,and local recurrence or(incision) metastasis rates.Conclusions Laparoscopic TME treatment of rectal cancer had the same therapeutic effect as the conventional laparotomy procedure did,and has a better subjective outcome.
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Objective To improve the diagnosis and management of neurogenic bladder disorder after radical operation for rectal cancer. Methods 23 paticnts with neurogenic bladder disodrer after surgery for rectal cancer underwent urodynamic examination to establish the diagnosis, and received treatment according to the findings. The results of treatment were observed.Results After management, 22 patients regained normal urination , and one case of urinary incontinence did not return to normal urination at follow-up 6 months later. Conclusions Patients with neurogenic bladder disorder after radical operation for rectal cancer should take the urodynamic examimation and given symtomatic management according to the urodynamic examination.
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Objective To evaluate the therapeutic effect of total mesorectal excision in radical operation of rectal carcinoma.Methods From 1997 to 2007,126 consecutive patients with middle and inferior rectal carcinoma underwent surgical operation according to the principle of total mesorectal excision.Results Two patients(1.6%) died of postoperative pulmonary infection,and postoperative anastomotic leakage occurred in 2 cases(1.6%).The postoperative follow-up of 1-5 years showed that local recurrence rate 2 years after surgical operation was 4%(5/126),the 3-,5-year survival rate was 93.6%(116/124) and 84.7%(105/124),respectively.Conclusions Total mesorectal excision can decrease the frequency of postoperative local recurrence of rectal cancer without increasing complications as long as its correct indications are selected.
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Objective To summarize the experience in transanal local excision (LE) for rectal cancer (RC). Methods The clinical data of 28 cases of RC treated by LE from 1988 to 1998 were analyzed retrospectively. Results In this series, five-year survival rate was 83.4?6.2%, and the local recurrence rate (LRR) was 17.8%. In well-differentiated carcinoma, 4 cases were convinced as local recurrence with a LRR of 17.4%(4/23); in moderately- differentiated carcinoma, one case with a LRR of 20.0%(1/5). The LRR in T 1 and T 2 group was 15.0% (3/20) and 25.0% (2/8) respectively. LRR was 16.7% (4/24) in patients with less than 1/3 bowel wall involved, LRR was 16.7%(4/24),whereas LRR was 25.0%(1/4) in more than 1/3 bowel wall involved group. In total bowel wall resection group the LRR was 16.7%(3/18) while in partial resection group was 20.0% (2/10). In patients with tumour size larger than 4 cm LRR was 22.2% (2/9), tumour size smaller than 4 cm LRR was 15.7% (3/19). Conclusion LE for RC might only be successfully performed in selected patients (T 1～T 2, N 0M 0, well or moderately-differentiated carcinoma,low RC within 6 cm from anal edge). The indications of transanal LE must be controlled strictly. Total excision of tumor and prevention of implantation of carcinoma are the main points in the prophylaxes of recurrence. Postoperative follow-up is needed in order to find local recurrence as early as possible.
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Objective To study the effect of applicaton of the implanted artificial defecation control device (IADCD) in patients with lower rectal cancer. Methods The "radical resection aiming at achieving automatically controlled defecation" was performed in 32 patients with lower rectal cancer, On the basis of Mile's operation, the IADCD was implanted in those patients. Postoperatively, the defection control, psychological effect of the defecation mode on the patients, complications and adverse effects were observed. Results In treatment group (32 cases), satisfactory defecation control was achieved in 31 cases 1 month after the operation, and in another case 2 month after operation, and no obvious complications and untoward effects. In control group(16 cases), 8 cases had 1～2 times formed stool 3 months after operation, 4 cases achieved 6 months after the operation. Conclusions For patients with lower rectal cancer, the "radical resection aiming at achieving automatically-controlled defecation" could achieve the complete resection of lower rectal tumor and near to normal defecation without obvious untoward effects.
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Objective To determine the role of double stapling technique(DST) in anus-saving operations for lower rectal cancer. Methods The clinical data of 96 patients with lower rectal carcinoma treated by DST were analyzed retrospectively. Results There were 63 males and 33 females,aged from 22 to 84 (an average of 57.7 yesars). The distance from the lower end to dens line was 4～7cm.Dukes classfication: 24 patients belonged to A class, 30 B class, 30 C class,and 12 D class. Histological type: 47patients had high differentiation adenocarcinoma, 27 median differentiation adenocarcinoma, 17 low differentiation adenocarcinoma,and 5 mucous adenocarcinoma. No one died after the operation but 12 had anastomotic leakage(12.5%)postoperatively and all healed after treatment; 5 patients had anastomotic constriction(5.2%)postoperatively and all healed with expanding anus. Conclusions DST is a safe alternation for anus-saving operation for patients with rectal cancer.Conservative therapy is effective in the treatment of anastomotic constriction and anastomotic leakage.
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Objective To evaluate the value and safety of the anterior transsphincteric operation for treating rectal villous adenoma.Methods The clinical data of 17 cases with rectal villous adenoma,including 6 cases with malignant change,operated by anterior transsphincteric approach at Changzheng hospital,from February 2000 to August 2006,were analyzed retrospectively.The distance between the anal verge and the lower margin of the tumor was 5～ 8 cm(average 7 cm).The tumors were 2～ 5 cm in diamater.Results The rectal villous adenoma was completely removed with negative resection margins in all the 17 patients.Fecal continence,urinary function and sexual function were preserved successfully in all the patients.No postoperative complications developed.The postoperative pathological stage of rectal villous adenoma with malignant change was pTisN0M0 in 3 cases,pT1N0M0 in 2,and pT2N0M0 in 1.At a median follow-up of 46 months,no patients had recurrence.Conclusions Anterior transsphincteric approach is useful and safe for operation of rectal villous adenomas and those with early mmalignant change.It is particularly valuable for large midrectal villous adenoma.
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Objective To introduce a new anus preserving operation for low rectal cancer-ultralow anterior resection and colorectal/coloanal anastomosis by using supporting-bundling up method.Methods The clinical data of 310 patients who underwent anus preserving operation by supporting-bundling up method for low rectal cancer were retrospectively reviewed.Results The mean distance of tumor from the anal verge was 4.7?1.2cm;the TNM stage was stage Ⅰin 40 cases,stage Ⅱ30 cases,stage Ⅲ109 cases and stage Ⅳ 31 cases.the mean distance of the anastomosis from the anal verge was 2cm(1-4cm).the occurrence rate of postoperative anastomosis leak was 2.3%,the rate of excellent anal sphincter control was 82.25%.The 5-year local recurcence rate was 5.8%.Conclusions Ultralow anterior resection and colorectal/coloanal anastomosis by supporting-bundling up method may be one of the best anus preserving operations for low rectal cancer.It is a safe and feasible operation,and the long-term outcome is excellent.
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0.05). Conclusions The choice of Miles opereration or ARP in the treatment of LRC is mainly according to patients condition. However, if a radical treatment can be assured. ARP is the best choice for LRC.