An analysis of long-term survival after laparoscopic radical resection for rectal cancer / 中华普通外科杂志

Objective To evaluate the efficacy of laparoscopic radical resection for rectal cancer by collecting and analyzing long-term outcomes of patients and to investigate prognostic factors of overall survival and disease free survival.Methods The clinicopathological data of 235 patients who underwent laparoscopic radical resection for rectal cancer from Jan 2007 to Dec 2010 were retrospectively analyzed.COX proportional hazards regression model was used to determine the risk factors for overall survival and disease free survival.Results A total of 235 patients were included in this analysis.Local recurrence rate were 8.1％ at 3 years and 9.8％ at 5 years.Overall and disease free survival were 85.2％ and 75.1％ at 3 years,77.1％ and 69.6％ at 5 years,respectively.Factors found to significantly and independently predict a poor overall and disease free survival were laparoscopic Hartmann,postoperative complications,stage Ⅲ tumor and ulcerative type tumor.Neural invasion was also an adverse prognostic factor of overall survival.Conclusions Laparoscopic Hartmann,postoperative complications,stage Ⅲ tumor and ulcerative type tumor were independently associated with overall and disease free survival.In addition to this,neural invasion was also an adverse prognostic factor of overall survival.

MRI-detected extramural venous invasion for predicting the response to preoperative chemoradiatiotherapy in locally advanced rectal cancer / 中华普通外科杂志

Objective To evaluate the efficacy of MRI-detected extramural venous invasion (mrEMVI) in predicting tumor responses to preoperative chemoradiatiotherapy (pre-CRT) in patients with locally advanced rectal cancer (LARC).Methods The clinicopathological data,tumor response and mrEMVI information of 47 LARC from February 2013 to December 2014 were retrospectively collected.mrEMVI was given 0-4 score according to the degree,3-4 score were defined as mrEMVI positive;patients with mrEMVI positive were divided into three subgroups according to vascular size (large,middle and small).Association between different mrEMVI subgroup and tumor response was analyzed using Fisher exact test.Result 26 patients were mrEMVI positive.18 and 8 patients scored 3 and 4 for mrEMVI positive,respectively;16,6 and 4 patients were small,middle and larger vessels of mrEMVI positive,respectively.Patients with mrEMVI positive had less TRG 0-1 than mrEMVI negative (P =0.019).Scored 4 and larger vessel of mrEMVI positive had less TRG 0-1 than mrEMVI negative (P =0.038 and 0.017).Conclusions mrEMVI positive score 4 or larger vessel predict poor tumor response to pre-CRT in patients of locally advanced rectal cancer.

Laparoscopic Surgery for Rectal Cancer：Overseas Current Status and Future Perspective / 中国微创外科杂志

[Summary] Colorectal cancer is the one of the most common malignancies in the world .Currently, surgery is the main treatment for colorectal cancer .Although laparoscopic surgery for colon cancer has been widely accepted , laparoscopic approach for rectal cancer is still in clinical trials .At present, several trails have shown that the short-and long-term outcomes of laparoscopic rectal cancer resection are similar with open surgery , but others have shown that pathological outcomes and total resection rates of laparoscopic surgery are unsatisfactory .Laparoscopic rectal cancer surgery needs more grade Ⅰ evidences .Nowadays , researchers are exploring new ways to treat rectal cancer .

Risk factor analysis on postoperative complications after laparoscopic total mesorectal excision with preventive terminal ileostomy and timing of stoma closure in rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the application of protective terminal ileostomy in laparoscopic total mesorectal excision for rectal cancer patients, and explore the risk factors associated with postoperative complications and timing of stoma closure.</p><p><b>METHODS</b>Clinical data of 77 patients with middle or low rectal cancer undergoing laparoscopic total mesorectal excision (TME) with preventive terminal ileostomy in our department from January 2007 to December 2013 were retrospectively analyzed. Independent risk factors associated to postoperative complications of terminal ileostomy were examined by logistic regression and timing of stoma closure was investigated.</p><p><b>RESULT</b>The total postoperative complication morbidity was 57.1% (44/77). Electrolyte disturbance was found in 39 cases (50.6%, 39/77), including 1 case of hypovolemic syncope. Parastomal hernia occurred in 9 cases (11.7%, 9/77). Peristomal dermatitis and subcutaneous abscess was observed in 1 case (1.3%, 1/77). The result of the single factor analysis of the water electrolyte disturbance after operation, the risk factors of P<0.2 were new adjuvant chemotherapy (P=0.094), tumor antigen (P=0.086) and TNM staging (P=0.026); Postoperative parastomal hernia of the single factor analysis results, the risk factors of P<0.2 included uses of antidiabetic drugs (P=0.172), ASA anesthesia (P=0.168) grading and TNM stage(P=0.161); But multivariate analysis revealed no risk factors associated with the above complications (all P>0.05). Sixty-five patients underwent stoma closure during follow-up, including 2 cases (3.1%) within 90 days, 20 cases (30.8%) from 90 to 180 days, and 43 cases (66.2%) more than 180 days.</p><p><b>CONCLUSIONS</b>No risk factors were found to be associated with main postoperative complications of protective terminal ileostomy after laparoscopic TME for rectal cancer patients, such as electrolytes imbalance and parastomal hernia. The timing of stoma closure should be longer than 180 days.</p>