Reassessment of intersphincteric resection in the sphincter-preserving operation for ultra-low rectal cancer / 中华胃肠外科杂志

Intersphincteric resection (ISR), as an ultra-low sphincter-preserving operation, is widely used in clinical practice at present. ISR can allow some patients with very low rectal cancer to avoid the pain of anal resection while ensuring oncological efficacy. However, the procedure of ISR requires wider intersphincteric dissection which may cause nerve damage, and the removal of partial or total internal anal sphincter as an "inherent defect" of ISR can result in poor anal function postoperatively. Based on the in-depth understanding of regional anatomy and physiological function, the author proposed a new functional sphincter preservation operation for very low rectal cancer-conformal sphincter preservation operation (CSPO) which has achieved good outcome in clinical practice. This article will revisit the brief history of rectal cancer surgery and discuss the main mechanisms underlining the poor anal function after ISR. Based on the anatomical study of the pelvic floor and anal canal, CSPO can improve the postoperative anal function of very low rectal cancer patients by reducing the damage of the autonomic nerves, receptor corpuscles and muscle fibers in the intersphincteric space, retaining more dentate line and internal sphincter with the design of resection line of tumor lower border under direct vision, and elevating the anastomosis height. At the same time, the future treatment prospect of low rectal cancer is envisioned.

Clinical efficacy of anus-preserving operation for ultra low rectal cancer / 中华消化外科杂志

Objective To investigate the clinical value of anus-preserving operation for ultra low rectal cancer.Methods The clinical data of 226 patients with ultra low rectal cancer who were admitted to the Yijishan Hospital between January 2009 and September 2013 were retrospectively analyzed.All the patients were divided into the anus-preserving group (117 patients underwent traditional or modified Dixon operation) and the control group (109 patients underwent Miles operation).The operation time,volume of intraoperative blood loss,number of lymph node dissection,recovery time of intestinal function,postoperative short-term amplications,local recurrence and distal metastasis of tumors,survival rate and quality of life in the 2 groups were analyzed.The measurement data with normal distribution were presented as (x) ± s and analyzed using t test,count data were analyzed using Pearson chi-square test.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed using the Log-rank test.The patients were followed up by regular out-patient examination and telephone interview up to September 2014.Results The traditional Dixon operation was performed on 108 patients,modified Dixon operation on 9 patients and Miles operation on 109 patients in the control group.The operation time and volume of blood loss were (117 ± 12) minutes and (110 ± 51) mL in the anus-preserving group,which were significantly different from (122 ± 8) minutes and (155 ± 44) mL in the control group (t =3.80,7.09,P ＜ 0.05).The number of lymph node dissected and time of intestinal function recovery were 13 ±4 and (2.8 ± 0.8)days in the anus-preserving group and 13 ±4 and (2.7 ± 0.7)days in the control group,respectively,with no significant difference (t =0.90,0.83,P ＞ 0.05).Among the 184 patients receiving postoperative chemotherapy,19 patients terminated the chemotherapy due to serious response to chemotherapy,17 patients received radiotherapy after chemotherapy,9 patients received interventional treatment for liver after chemotherapy and 42 patients didn't receive the chemotherapy.The incidence of perianal eczema were 15.38％ (18/117) in the anus-preserving group and 3.67％ (4/109) in the control group,with a significant difference between the 2 groups (x2=8.81,P ＜0.05).The cases of anastomotic leakage,intra-abdominal bleeding,intra-abdominal infection,postoperative urinary retention,infection of incision and incision dehiscence were 4,3,5,10,7 and 9 in the anus-preserving group,which were not significantly different from 0,2,4,11,8 and 5 in the control group (x2=1.86,0.14,0.05,0.16,0.19,0.94,P ＞ 0.05).One-hundred and ninety patients were followed up for a median time of 34.5 months (range,12.0-57.0 months).The rate of local tumor recurrence,rate of distant metastasis and 1-and 3-year survival rate were 8.55％ (10/117),5.98％ (7/117),94.8％ and 76.2％ in the anus-preserving group and 8.26％ (9/109),5.50％ (6/109),95.7％ and 76.1％ in the control group,with no significant difference between the 2 groups (x2 =0.01,0.02,0.08,0.00,P ＞ 0.05).The score of life quality was 66 ± 14 in the anus-preserving group,which was significantly higher than 49 ± 11 in the control group (t =10.13,P ＜ 0.05).Conclusion The anus-preserving operation for ultra low rectal cancer is safe and feasible based on strictly grasping operative indications,meanwhile,it can improve the postoperative life quality of patients.

Laparoscopic-assisted transanal pull-through resection and anastomosis for ultra-low rectal cancer / 中华消化外科杂志

Objective To investigate the feasibility of laparoscopic-assisted transanal pull-through resection and anastomosis in the treatment of ultra-low rectal cancer.Methods From November 2005 to December 2006,21 patients with ultra-low rectal cancer had undergone laparoscopic-assisted transanal pull-through resection and anastomosis in Southwest Hospital.The perioperative condition,postoperative complications and the result of follow-up were retrospectively analyzed.Results The operation was successfully performed on all the patients.The mean operation time and postoperative hospital stay were(216±25)minutes(170-260 minutes)and(9.4±1.0)days(7-11 days),respectively.The time needed for the recovery of gastrointestina]function was(65±14)hours(38-88 hours).The mean perioperative blood loss was(140±49)ml(80-250 ml).All the patients were followed up for(22±4)months(15-28 months),and no anastomotic bleeding or fistula was observed.Six patients developed mild to moderate anastomotic striclure,1 local recurrence and 1 liver metastasis.Conclusions Laparoscopic-assisted transanal pull-through resection and anastomosis for ultra-low rectal cancer is safe and feasible,and the short-term effect is satisfactory.