LASSO-based nomogram predicts the risk factors of low anterior resection syndrome for middle and low rectal cancer underwent robotic surgery.

BACKGROUND: This study aims to analyze the influencing factors of postoperative Low Anterior Resection Syndrome (LARS) in patients with middle and low rectal cancer who underwent robotic surgery. It also seeks to predict the probability of LARS through a visual, quantitative, and graphical nomogram. This approach is expected to lower the risk of postoperative LARS in these patients and improve their quality of life through effective prevention and early intervention. PATIENTS AND METHODS: This research involved patients with middle and low rectal cancer who underwent robotic surgery in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Nanchang University from January 2015 to October 2022. A series of intestinal dysfunction symptoms arising from postoperative rectal cancer were diagnosed and graded using LARS scoring criteria. After the initial screening of all variables related to LARS with Lasso regression, they were included in logistic regression for further univariate and multivariate analysis to identify independent risk factors for LARS. A prediction model was then constructed. RESULTS: The study included 358 patients. The parameters identified by Lasso regression included obstruction, BMI, tumor localization, maximum tumor diameter, AJCC stage, stoma, neoadjuvant therapy (NAT), and postoperative adjuvant therapy (AT). Univariate and multivariate analyses indicated that a higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and postoperative adjuvant therapy were independent risk factors for total LARS. The AUC of the prediction nomogram was 0.834, with a sensitivity of 0.825 and specificity of 0.741. The calibration curve demonstrated excellent concordance with the nomogram, indicating the prediction curve fit the diagonal well. CONCLUSION: Higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and adjuvant therapy were identified as independent risk factors for total LARS. A new predictive nomogram for postoperative LARS in patients with middle and low rectal cancer undergoing robotic surgery was developed, proving to be stable and reliable. This tool will assist clinicians in managing the postoperative treatment of these patients, facilitating better clinical decision-making and maximizing patient benefits.

Comparison of transabdominal wall specimen retrieval and natural orifice specimen extraction robotic surgery in the outcome of colorectal cancer treatment.

Background: Natural orifice specimen extraction surgery (NOSES), as a new star of minimally invasive techniques, has been increasingly favored and promoted in the field of surgery around the world. Most previous studies were comparative studies of laparoscopic NOSES and conventional laparoscopic surgery. However, there is little research on comparing robotic colorectal cancer NOSES with conventional robotic-assisted colorectal cancer resection surgery. Participant and methods: This study is a retrospective study of propensity score matching (PSM). This study included Ninety-one propensity score-matched pairs of the participant who had undergone robotic colorectal cancer resection surgery at our center between January 2017 and December 2020. The covariates used in the propensity score included gender, age, BMI, ASA score, maximum tumor diameter, the tumor's height from the anal verge, histological differentiation, AJCC stage, T stage, N stage, and history of previous abdominal surgery. The outcome measurement criteria included postoperative complications, inflammatory response, pelvic floor function, anal function, cosmetic outcome, quality of life, disease-free survival (DFS), and overall survival (OS). Results: The robotic NOSES group had faster recovery time from gastrointestinal function (P = 0.014), shorter abdominal incision length (P < 0.001), less pain (P < 0.001), less additional analgesia required (P < 0.001), and lower postoperative indicators of white blood cell count (P < 0.001) and C-reactive protein content compared to the robotic-assisted resection surgery (RARS) group (P = 0.035). Additionally, the robotic NOSES group had significantly better body imagery (P < 0.001), cosmetic scores (P < 0.001), somatic function (P = 0.003), role function (P = 0.039), emotional function (P = 0.001), social function (P = 0.004), and overall function (P < 0.001) than the RARS group. The two groups demonstrated no significant difference between DFS and OS. Conclusion: Robotic colorectal cancer NOSES is a safe and feasible minimally invasive procedure and offers shorter abdominal incisions, less pain, less surgical stress response, and better postoperative quality of life. Therefore, this technique can be further promoted for colorectal cancer patients eligible for NOSES.

Conversion managment of colorectal cancer with simultaneous unresectable hepatic metastasis / 中华普通外科杂志

Objective:To investigate the efficacy of different conversion therapies for colorectal cancer with unresectable simultaneous liver metastasis.Methods:A total of 170 patients of colorectal cancer complicated with liver metastasis who were admitted to the First Affiliated Hospital of Nanchang University from Jan 2015 to Dec 2020 were included in the study. Patients were divided into an initial resectable group (42 cases) and an initial non-resectable group (128 cases).Results:There were no significant differences in OS and PFS between patients with CRLM (colorectal cancer with liver metastasis) who were resected initially and those successfully underwent transformation therapy ( P>0.05). The median OS was 36 months in the group with successful transformation, while it was 21 months in the group with simple primary tumor resection and no liver metastasis resection ( P=0.014), HR=0.48 (0.27-0.86). The median PFS was 28 months in the successful conversion group, while it was 10 months in the primary tumor resection only and no liver metastasis resection ( P=0.005), HR=0.43 (0.24-0.77). The OS difference between the group with simple primary tumor resection and no resected liver metastasis and the group with neither primary tumor nor liver metastasis resection was statistically significant: (21 months vs.13 months), HR=0.52 (0.32-0.86) ( P=0.01), while the PFS between the two groups was not statistically significant, ( P>0.05). Conclusions:Chemotherapy combined with targeted therapy has the best effect among the conversion therapies, and can improve the resection rate and survival rate of patients undergoing R 0 surgery. Resection of the primary lesion alone can also prolong the patient's survival.