Transanal total mesorectal excision for locally advanced middle-low rectal cancers.

BACKGROUND: This study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid-low rectal cancer. METHODS: Patients with mid-low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short-term survival and functional outcomes, were analysed. RESULTS: Thirty-eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m2 . Tumours were 3-9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand-sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months. CONCLUSION: Although this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity.

ANTECEDENTES: La escisión total del mesorrecto transanal (transanal total mesorectal excision, TaTME) combinada con la laparoscopia convencional se ha descrito como un procedimiento prometedor para el tratamiento del cáncer de recto medio-inferior localmente avanzado. El objetivo de este estudio fue investigar los resultados de TaTME combinados con la laparoscopia para el cáncer de recto medio-inferior localmente avanzado. MÉTODOS: Se incluyeron de forma prospectiva los pacientes con cáncer de recto medio-inferior localmente avanzado (≥ T3 y/o N+) a los que se realizó una resección anterior de recto con la técnica TaTME. Se excluyeron aquellos pacientes con metástasis a distancia, neoplasias múltiples, obstrucción intestinal o perforación y aquellos que presentaron una respuesta clínica completa después de la quimiorradioterapia. Los pacientes recibieron tratamiento neoadyuvante de acuerdo con las guías de práctica clínica internacionales. Se analizaron los resultados postoperatorios entre los que se incluyen la morbilidad, la evaluación del margen de resección circunferencial (circumferential resection margin, CRM) y la supervivencia a corto plazo junto con los resultados funcionales. RESULTADOS: Se seleccionaron 38 pacientes, 25 con el tumor en el recto medio y 13 con el tumor en el recto inferior que se sometieron a una resección anterior de recto electiva por TaTME desde marzo de 2015 hasta septiembre de 2018. Las localizaciones de los tumores oscilaron entre 3 y 9 cm desde el margen anal. La relación varón/mujer fue de 1,93, la edad media fue de 58,2 ± 16,4 años y el IMC medio de 24,2 ± 2,5 kg/m2 . El tiempo medio operatorio fue de 210 ± 42 minutos. En la todos los pacientes se realizó una anastomosis manual y una ileostomía de protección. No se registró ninguna conversión, ninguna amputación abdomino-perineal y ninguna muerte postoperatoria en toda la cohorte. Cuatro pacientes (10,5%) presentaron alguna complicación, incluidos tres abscesos presacros (7,9%), todos tratados mediante drenaje a través de la anastomosis. La continencia a los 3 meses del cierre de la ileostomía fue grado I según la clasificación de Horgan en todos los pacientes. Las características clínicas fueron similares en los cánceres de recto medio e inferior, sin embargo, este último grupo presentó un diámetro tumoral medio mayor en la estadificación clínica (4,8 en el cáncer de recto medio versus 6,0 cm en el cáncer de recto inferior; P = 0,03). En comparación con los tumores del recto medio, aunque en una cohorte muy pequeña, los tumores del recto inferior presentaron una tasa de afectación del CRM significativamente mayor (3 casos de afectación del CRM versus ninguno, P = 0,02) y así como un mayor número con escisión completa del mesorrecto grado 2 (4 pacientes versus 1 paciente; P = 0,02). No se encontraron diferencias significativas en los resultados oncológicos después de una mediana de seguimiento de 17 meses. CONCLUSIÓN: Aunque este estudio es el resultado de una pequeña cohorte, se debe prestar especial atención a los tumores de recto inferior voluminosos para reducir la tasa de positividad de CRM.

Puerarin protects against damage to spatial learning and memory ability in mice with chronic alcohol poisoning

We evaluated the effect of puerarin on spatial learning and memory ability of mice with chronic alcohol poisoning. A total of 30 male C57BL/6 mice were randomly divided into model, puerarin, and control groups (n=10 each). The model group received 60% (v/v) ethanol by intragastric administration followed by intraperitoneal injection of normal saline 30 min later. The puerarin group received intragastric 60% ethanol followed by intraperitoneal puerarin 30 min later, and the control group received intragastric saline followed by intraperitoneal saline. Six weeks after treatment, the Morris water maze and Tru Scan behavioral tests and immunofluorescence staining of cerebral cortex and hippocampal neurons (by Neu-N) and microglia (by Ib1) were conducted. Glutamic acid (Glu) and gamma amino butyric acid (GABA) in the cortex and hippocampus were assayed by high-performance liquid chromatography (HPLC), and tumor necrosis factor (TNF)-α and interleukin (IL)-1β were determined by ELISA. Compared with mice in the control group, escape latency and distance were prolonged, and spontaneous movement distance was shortened (P<0.05) by puerarin. The number of microglia was increased in both the cortex and hippocampal dentate gyrus (P<0.01), and neurons were reduced only in the hippocampal dentate gyrus (P<0.01) in puerarin-treated mice. In the model group, Glu and GABA levels decreased (P<0.05), and Glu/GABA, TNF-α, and IL-1β increased (P<0.01) with puerarin treatment, returning to near normal levels. In conclusion, puerarin protected against the effects of chronic alcohol poisoning on spatial learning and memory ability primarily because of anti-inflammatory activity and regulation of the balance of Glu and GABA.

Puerarin protects against damage to spatial learning and memory ability in mice with chronic alcohol poisoning.

We evaluated the effect of puerarin on spatial learning and memory ability of mice with chronic alcohol poisoning. A total of 30 male C57BL/6 mice were randomly divided into model, puerarin, and control groups (n=10 each). The model group received 60% (v/v) ethanol by intragastric administration followed by intraperitoneal injection of normal saline 30 min later. The puerarin group received intragastric 60% ethanol followed by intraperitoneal puerarin 30 min later, and the control group received intragastric saline followed by intraperitoneal saline. Six weeks after treatment, the Morris water maze and Tru Scan behavioral tests and immunofluorescence staining of cerebral cortex and hippocampal neurons (by Neu-N) and microglia (by Ib1) were conducted. Glutamic acid (Glu) and gamma amino butyric acid (GABA) in the cortex and hippocampus were assayed by high-performance liquid chromatography (HPLC), and tumor necrosis factor (TNF)-α and interleukin (IL)-1ß were determined by ELISA. Compared with mice in the control group, escape latency and distance were prolonged, and spontaneous movement distance was shortened (P<0.05) by puerarin. The number of microglia was increased in both the cortex and hippocampal dentate gyrus (P<0.01), and neurons were reduced only in the hippocampal dentate gyrus (P<0.01) in puerarin-treated mice. In the model group, Glu and GABA levels decreased (P<0.05), and Glu/GABA, TNF-α, and IL-1ß increased (P<0.01) with puerarin treatment, returning to near normal levels. In conclusion, puerarin protected against the effects of chronic alcohol poisoning on spatial learning and memory ability primarily because of anti-inflammatory activity and regulation of the balance of Glu and GABA.