Prevention and treatment of complications of transanal total mesorectal excision / 中华消化外科杂志

Transanal total mesorectal excision is a new surgical procedure which has emerged in the recent years.This procedure performs a "bottom-to-up" resection of the rectum and its surrounding mesenteries through the anus,which provides better view compared with laparoscopic or open total mesorectal excision.However,it is undeniable that as a new surgical procedure,transanal total mesorectal excision is also bound to have some complications of surgery.Therefore,how to prevent and treat the complications of transanal total mesorectal excision is still a problem that must be faced in the future.This article intends to review the prevention and treatment of surgical complications and provide some experience for the development of transanal total mesorectal excision.

Postoperative short-term complications of laparoscope-assisted transanal total mesorectal excision for rectal cancer after neoadjuvant therapy and their management: a single center report / 中华胃肠外科杂志

OBJECTIVE@#To summarize and analyze the postoperative short-term complications of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer patients after neoadjuvant therapy.@*METHODS@#A prospectively established database on taTME patients at Peking University Cancer Hospital was screened with the following conditions: data retrieval from June 2016 to August 2018, pathologically confirmed adenocarcinoma, receiving preoperative neoadjuvant chemoradiotherapy or chemotherapy. The transabdominal procedure and the transanal procedure were performed simultaneously in the taTME operation. Occurrence of complications during perioperative period (within postoperative 3 months) in these patients, especially anastomosis-related complications and their management were analyzed. The relevant complications were recorded according to the Clavien-Dindo (CD) grading criteria. The severity of anastomotic leakage and anastomotic stenosis was evaluated according to criteria developed by the International Rectal Cancer Research Group.@*RESULTS@#A total of 29 patients were enrolled in this study. In the 29 patients, 25 (86.2%) were male and 4 (13.8%) were female, the median age was 60 (range, 30 to 72) years, the median body mass index was 25.8 (range, 19.8 to 36.4) kg/m, the median distance from the tumor to anal verge was 4 (range, 2 to 8) cm. All the patients completed laparoscope-assisted taTME operations successfully without conversion to laparotomy, intra-operative severe complication or death. The median operation time was 300 (range, 198 to 405) minutes, and the median intra-operative blood loss was 100 (range, 50 to 200) ml. All the TME specimens were complete according to the Nagtegaal standard. All the patients underwent prophylactic ileostomy. Hartmann procedure was performed in one case due to poor blood supply in the proximal bowel without the possibility of anastomosis. Anal sphincter preservation rate was 96.6% (28/29). The median postoperative exhaust time was 2 (range, 1 to 10) days, and the median postoperative hospital stay was 9 (range, 7 to 24) days. Fifteen patients (51.7%) had postoperative complications, among which serious complication (CD grade IIIb and above) accounted for 6.9% (2/29). No perioperative death was observed. Five patients (17.2%) presented anastomosis-related complications, including 2 cases of grade C anastomotic leakage due to anastomotic rupture, who underwent abdominal perineal resection 1 month after operation; 2 cases of grade B anastomotic leakage, who improved after conservative treatment; 1 case of grade A anastomotic stenosis, who improved with anal expansion 1 month after operation. The incidence of postoperative infection was 24.1% (7/29), including 6 cases of pelvic infection and 1 case of trocar site infection, all of which were CD grade II. One case had incomplete intestinal obstruction (CD grade II); 1 case had gastroplegia; 1 case had abdominal trocar hernia. All the patients were followed up for a median of 12.0 (range, 3.9 to 29.9) months. Seven cases did not undergo ileal stoma closure. The anal sphincter preservation rate was 75.9% (22/29).@*CONCLUSION@#Pelvic infection and anastomosis-related complications are common after laparoscope-assisted taTME surgery for rectal cancer patients following neoadjuvant chemoradiotherapy, which require active management and appropriate treatment.

Stereopsis function of presbyopia effected by correcting of monovision contact lens / 中华实验眼科杂志

Objective This study was to study the effect of monovision contact lens (MV-CL) on distant and near vision,distant and near stereopsis,and to identify the effect of degree of monovision on vision function.Methods A prospective case observational study was designed.The clinical data of sixty-eight eyes of 47 cases were collected from November 2010 to August 2014 in Henan Provincial Corps Hospital,Chinese People's Armed Police Forces.Sixty-eight eyes of 47 cases wore contact lenses to improve near vision,in which the other eye of 21 cases with hyperopia wearing contact lenses to improve distant vision.Besides,far and near stereopsis were measured before and two weeks after wearing lenses respectively;and scotopia were measrued with lenses and in naked eyes respectively.Compared the changes of vision and stereopsis in patients before and after the MV-CL,and conducted the patient satisfaction survey.Results There were 89％ (42/47 cases) and 6％ (3/47 cases) of the patients whose naked far and near vision was 0.8/0.33 (J4) at 2 weeks after MV-CL and before MV-CL,respectively.There were no statistical significance about change of near stereopsis with Titmus stereopicture and the Yan's near random-dot stereogram (x2=1.30,0.56;both at P＞0.05).There were no statistical significance about change with apparent machine random dot stereogram iterative crossed parallax and uncrossed disparity (x2 =0.16,0.11;both at P＞0.05).The far distance fusion range and far stereopsis were not significantly different between before and after MV-CL (x2 =0.22,0.16;both at P＞0.05).Titmus stereopicture tests showed that there was a decrease in the number of people who had foveal stereopsis,while an increase was found in people who had macular stereopsis after MV-CL,but the difference had no statistical significance (x2 =2.28,P ＞ 0.05).Conclusions Near vision can be obviously increased and presbytism can be relieved by MV-CL.Stereopsis of some patients are decreased after MV-CL,but this can be accepted by the patients and there is no obvious decrease in far range of fusion.

Attaching importance to diagnosis and treatment of peritoneal metastases from colorectal cancer / 中华消化外科杂志

Peritoneal metastasis from colorectal cancer (CRC) are generally considered to be end-stage disease of CRC,which has greatly impacted the prognosis and quality of life of patients.In recent years,cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy following systemic control has gradually been accepted for the treatment of peritoneal metastasis from CRC.Unfortunately,it has not widely used in clinical practice for the reasons of instruments,experience,surgical complexity,postoperative complications and cost-effectiveness.There is still no sufficient importance attached to CRC with peritoneal metastasis.Researches on the mechanism and treatment of peritoneal metastasis should be encouraged.Screening of high risk patients for early intervention to reduce incidence of peritoneal metastasis,selecting effective regimens and exploring optimal model for patients with other distal metastasis to improve the outcome of patients may be of importance.

Short-term outcome of transanal total mesorectal excision for male low rectal cancer patients with "difficult pelvis" : a single center report from Peking University Cancer Hospital / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the applicable value of transanal total mesorectal excision (taTME) in male low rectal cancer patients with narrow pelvis-"difficult pelvis", which remains difficult for both open and laparoscopic sphincter-saving operations.</p><p><b>METHODS</b>Clinical data of male low rectal cancer patients diagnosed by pathology undergoing taTME between June 2016 and January 2018 at Peking University Cancer Hospital were collected. A retrospective cohort study was performed. Patients were selected according to the following criteria: (1) low rectal cancer, the distance between inferior margin of tumor and anal verge ≤5 cm; (2) the distance between two sciatic tubercles <5 cm; (3) body mass index (BMI) >25 kg/m; (4) tumor horizontal diameter ≤4 cm. Operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications and anal function were analyzed.</p><p><b>RESULTS</b>A total of 20 patients were included in this study. All the patients received preoperative neoadjuvant chemoradiation and hybrid transabdominal and transanal surgery. The median BMI was 27.7(26.2-36.4) kg/m; the median distance between two sciatic tubercles was 92.5 (78-100) mm; the median distance between the inferior margin of tumor to the anal verge was 4 (2-5) cm; the median operation time was 302 (215-402) min; the median intraoperative blood loss was 100 (50-200) ml; the median postoperative hospital stay was 9 (5-15) d. Postoperative complications occurred in 5 patients (25%), including 3 pelvic infection, 1 intestinal obstruction, 1 anastomotic leakage receiving sigmoid colostomy. There was no perioperative death. Sphincter-preservation rate was 100%. Nineteen patients received anal manometry 1 month after operation with normal resting pressure (41.5±8.6) mmHg and squeeze pressure (121.0±11.6) mmHg. All the patients were followed up to March 2018, and the median follow-up time was 4.5 months. Only 1 patient had supraclavicular lymph node metastasis and no local recurrence was found.</p><p><b>CONCLUSIONS</b>The safety of transanal total mesorectal excision for male patients with low rectal cancer and difficult pelvis is acceptable. TaTME is helpful to preserve the anal sphincter.</p>

Clinical characteristics analysis of cervical ancer in young women under 35 years / 中国综合临床

Objective To understand the clinical characteristics during clinical diagnose and treatment of young women patients under 35 years with cervical cancer. Methods The clinical data of 95 cervical cancer patients under 35 years was reviewed and analysed retrospectively. Results The percentage of the patients at this age set was 18. 59% ,accounting for almost one fifth of all the same period patients with cervical cancer. The most common primary clinical representation was sexual bleeding of vigina (90.53% ,86/95) ;28 cases (29. 47%, 28/95) were misdiagnosed by naked eye examination and local treated as cervicitis; 13 cases (13. 68%, 13/95) with severe pathological changes were missed diagnosed by biopsy under colposcopy ;53 cases (55. 79% ,53/95) had their ovary preserved by one or two and had no metastasis or recurrence with carcinoma. Conclusions Sexual intercourse bleeding is the most common manifestation of young women with cervical cancer,which demands more attention. The biopsy under colopscopy has certain limitations,and should be performed along with conization while necessary. It is safe and feasible to retain ovary in cervical cancer patients before Ⅱ stage.