Application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision for advanced low rectal cancer / 中华消化外科杂志

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.

Preliminary report on prospective, multicenter, open research of selective surgery after expandable stent combined with neoadjuvant chemotherapy in the treatment of obstructive left hemicolon cancer / 中华胃肠外科杂志

OBJECTIVE@#To evaluate the safety and feasibility of neoadjuvant chemotherapy prior elective surgery following self-expanding metallic stents (SEMS) for complete obstructive left hemicolon cancer.@*METHODS@#This prospective, multicenter, open-labelled trial was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University(2016-ke-161-1) and registered in Clinicaltrials.gov (NCT02972541).@*INCLUSION CRITERIA@#(1)age between 18 and 75 years old;(2) adenocarcinoma confirmed by pathology;(3) left hemicolon cancer confirmed by clinical manifestations and imaging examinations with the distance to anal verge > 15 cm; (4) resectable cancer evaluated by imaging examination without distant metastasis; (5) Eastern Cooperative Oncology Group (ECOG) score ≤ 1 or Karnofsky Performance Scale (KPS) > 70, indicating tolerance of neoadjuvant chemotherapy and operation; (6) absence of chemotherapy or radiotherapy within past six months; (7) bone marrow system and hepatorenal function: hemoglobin ≥ 90 g/L, neutrophil ≥ 1.5×10/L, platelet ≥ 80×10/L, total bilirubin ≤ 1.5×ULN(upper limits of normal), serum transaminase ≤ 2.5×ULN, serum creatinine ≤ 1.0×ULN, endogenous creatinine clearance rate > 50 ml/min; (8) sign for informed consent.@*EXCLUSION CRITERIA@#(1) multiple primary colorectal cancer; (2) rejection of operation;(3) presenting peritonitis or bowel perforation before SEMS; (4) unqualified conditions proved by inspector from registration data. According to inclusion criteria, 62 consecutive patients receiving neoadjuvant chemotherapy prior to elective surgery following SEMS for complete obstructive left hemicolon cancer from Beijing Chaoyang Hospital of Capital Medical University (n=31), Qilu Hospital of Shandong University (n=14), the Third Xiangya Hospital of Central South University (n=13), Zhongnan Hospital of Wuhan University (n=2), the Fourth Hospital of Hebei Medical University (n=2) between December 2015 and December 2017 were prospectively enrolled in this study. Patients were divided into neoadjuvant chemotherapy group and elective surgery group according to the investigator's clinical experience and patient's preference. Patients in the elective surgery group received surgery within one to two weeks after SEMS placement without neoadjuvant chemotherapy. Those in the neoadjuvant chemotherapy group received 2 cycles of CapeOX or 3 cycles of mFOLFOX6 neoadjuvant chemotherapy within one to two weeks after SEMS placement, and then underwent surgery within 3 weeks after finishing neoadjuvant chemotherapy. Data between groups were compared using Student t-test, chi-square analysis or Fisher exact test analysis, including basic clinical informations, operational conditions and postoperative complications. The adverse reactions during the neoadjuvant chemotherapy were recorded. Surgical difficulty was assessed using visual analog scales ranging from 1 to 10, where 1 represented the lowest and 10 the highest degree of surgical difficulty, as judged by the surgeon.@*RESULTS@#The study included 38 males and 24 females with mean age of (64.8±8.8) years. The clinical baseline data between 2 groups were not significantly different (all P>0.05) except the average time interval between SEMS and surgery was significantly longer in neoadjuvant chemotherapy group [(61.6±13.5) days vs. (10.4±5.2) days, t=16.679, P0.05).@*CONCLUSION@#Neoadjuvant chemotherapy prior elective surgery following SEMS is a relatively safe and feasible approach in the treatment for obstructive left hemicolon cancer, and is associated with less stoma, more laparoscopic surgery, shorter operative time, less blood loss, lower surgical difficulty, and faster postoperative recovery as compared with conventional elective surgery.

Short-term outcomes of incisionless laparoscopic low anterior resection using prolapsing technique for rectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Laparoscopic-assisted surgery for colorectal cancer has been widely spread worldwide. To avoid the invasiveness of abdominal wound and get better good-looking, incisionless laparoscopic low anterior resection with transanal natural orifice specimen extraction using prolapsing technique for rectal cancer has been developed in our center. The aim of this study was to evaluate the feasibility, safety and short-term outcomes of this technique.</p><p><b>METHODS</b>From January 2013 to October 2013, twenty-seven patients with rectal carcinoma were treated by incisionless laparoscopic low anterior resection, and the data of these patients were collected and retrospectively analyzed to assess the value of this technique.</p><p><b>RESULTS</b>All operations were successfully accomplished without conversion to open surgery or laparoscopic-assisted surgery. The mean operation time was 135 minutes. The mean blood loss was 50 ml. The mean first bowel movement was 48 hours. The post-operative hospital stay was 9 days. All patients had clean distal margin and the mean number of dissected lymph nodes was 18. One patient had anastomotic leakage.</p><p><b>CONCLUSIONS</b>Incisionless laparoscopic low anterior resection with transanal natural orifice specimen extraction using prolapsing technique for rectal cancer appears to be feasible, safe and oncologically acceptable with a satisfactory short-term outcome for selected cases.</p>

Clinical analysis of 53 cases of retroperitoneal schwannoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics, diagnosis and treatment regimens for retroperitoneal schwannoma.</p><p><b>METHODS</b>Clinicopathological data of 53 retroperitoneal schwannoma patients treated from January 1999 to April 2013 in our hospital were collected and analyzed using SPSS 13.0 statistical software.</p><p><b>RESULTS</b>Symptoms of the retroperitoneal schwannoma were vague and nonspecific. 12 patients had interrupted abdominal pain, 9 patients had abdominal discomfort, and only 6 patients presented with abdominal mass while 24 patients were detected by health checkup. There were some characteristics but not specific findings in imaging examination such as CT, ultrasonography and MRI, so preoperative diagnosis rate was low with only 9 patients diagnosed as retroperitoneal schwannoma and 21 patients diagnosed as neurogenic tumor. S-100 immunohistochemisty was very important in pathological diagnosis, and the patients with benign retroperitoneal schwannoma got 100% tumor specific 5-year survival after complete excision while the 5-year survival of malignant retroperitoneal schwannoma was only 50.0%.</p><p><b>CONCLUSIONS</b>Retroperitoneal schwannoma is a rare disease. Most of them are benign tumors, and complete surgical excision is the effective treatment.</p>