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Radical resection of rectal cancer is a safe and effective treatment, but there remain several complications related to anastomosis. We aimed to assess the risk factors and incidence of rectal anastomotic stenosis (AS) after rectal cancer resection. We conducted a systematic review and meta-analysis after searching PubMed, Embase, Web of Science, and Medline databases from inception until May 2023. Data are reported as the combined odds ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables. Six hundred and fifty-nine studies were retrieved, nine (3031 patients) of which were included in the meta-analysis. Young age (WMD = -3.09, P = 0.0002), male sex (OR = 1.53, P = 0.0002), smoking (OR = 1.54, P = 0.009), radiotherapy (OR = 2.34, P = 0.0002), protective stoma (OR = 2.88, P = 0.007), intersphincteric resection surgery (OR = 6.28, P = 0.05), anastomotic fistula (OR = 3.72, P = 0.003), and anastomotic distance (WMD = -3.11, P = 0.0006) were identified as factors that increased the risk of AS, while staple (OR = 0.39, P < 0.001) was a protective factor. The incidence of AS after rectal cancer resection was approximately 17% (95% CI: 13%-21%). We identified eight risk factors and one protective factor associated with AS after rectal cancer resection. These factors may be combined in future studies to develop a more comprehensive and accurate prediction model related to AS after rectal cancer resection.
Subject(s)
Rectal Neoplasms , Humans , Anastomosis, Surgical/adverse effects , Anastomotic Leak/etiology , Constriction, Pathologic/epidemiology , Constriction, Pathologic/etiology , Rectal Neoplasms/surgery , Rectal Neoplasms/etiology , Rectum/surgery , Retrospective Studies , Risk FactorsABSTRACT
Objective: To investigate the effect of different treatment methods of the left colic artery (LCA) on postoperative rehabilitation of patients undergoing laparoscopic radical resection of rectal cancer. Methods: Retrospective analysis was performed on 70 patients undergoing laparoscopic radical resection of rectal cancer who were admitted to The Affiliated Suqian Hospital of Xuzhou Medical University from January, 2020 to December, 2022 were selected and divided into two groups according to different treatment methods of LCA. The preservation group (LCA group) (n=34 cases) and the non-preservation group (NLCA group) (n=36 cases). Both groups were treated with laparoscopic radical resection of rectal cancer. IMA was preserved in the LCA group, but not in the NLCA group. The efficacy indicators, surgical treatment and rehabilitation-related indicators, gastrointestinal hormone indicators (motilin (MTL), gastrin (GAS)), and postoperative complications risk were compared between the two groups before and after surgery. Results: No statistically significant difference was observed between the two groups in terms of efficacy indicators (total number of lymph nodes dissected and number of lymph nodes at the root of the IMA), operation time, intraoperative blood loss, and postoperative drainage tube placement time (p>0.05). However, postoperative anal flatus and hospital stay in the LCA group were considerably shorter than those in the NLCA group (p<0.05). Postoperatively, the levels of MTL and GAS in the two groups were significantly decreased, and the LCA group decreased slightly compared with the NLCA group (p<0.05). Moreover, the incidence of complications in the LCA group (5.88%) was significantly lower than that in the NLCA group (27.78%) (p<0.05). Conclusion: Preservation of LCA and no-preservation of LCA in laparoscopic radical resection of rectal cancer are comparable in terms of therapeutic effect, and the surgery with preservation of LCA is worthy of clinical promotion due to its various benefits such as less impact on gastrointestinal hormone indicators, lower risk of complications, and faster postoperative recovery.
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Objective To investigate the predictive value of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in surgical site infection (SSI) following radical resection for rectal cancer. Methods Retrospective analysis of clinical data was performed about 298 patients undergoing radical resection of rectal cancer in the Chinese PLA General Hospital from January 2015 to February 2018. According to whether SSI occurred 30 days after surgery, patients were divided into SSI group (n=20) and control group (n=278). Gender, age, preoperative neoadjuvant chemoradiation, surgical procedure, T stage, and preoperative neutrophil count, lymphocyte count, platelet count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), albumin, and hemoglobin level were compared between the two groups. Subgroup analysis was performed in the SSI group according to laparotomy and minimally invasive surgery. Gender, age, preoperative neoadjuvant chemoradiation (CRT), T stage, and preoperative neutrophil count, lymphocyte count, platelet count, NLR, PLR, albumin, and hemoglobin level were compared between two the subgroups. The predictive value of preoperative NLR and preoperative PLR in surgical site infection following radical resection for rectal cancer were analyzed by receiver operating characteristic (ROC) curve. Results The ratio of male to female in the SSI group is higher than control group (19/1 vs. 178/100, P=0.005). There was no significant difference in other demographic and clinical data such as age, non-restorative operation ratio, minimally invasive surgery ratio, neoadjuvant CRT ratio, T stage, preoperative albumin and preoperative hemoglobin between the two groups (P>0.05). There was no significant difference in preoperative neutrophils count [(3.96±1.03)×109/L vs. (3.62±1.28)×109/L, P=0.245], lymphocytes count [(1.47±0.45)×109/L vs. (1.71±0.64)×109/L, P=0.103] and platelets count [(249.10±57.42)×109/L vs. (230.21±68.53)×109/L, P=0.231] between the two groups. Preoperative NLR in the SSI group was significantly higher than that in the control group (2.77±0.52 vs. 2.39±1.23, P=0.010). Preoperative PLR in the SSI group was higher than that in the control group (184.46±69.54 vs. 152.93±73.82, P=0.065), but the difference was not statistically significant. In the SSI group, the age of the laparotomy subgroup was significantly lower than that of the minimally invasive surgery subgroup (49.20±5.54 vs. 61.87±10.24, P=0.018). There was no significant difference in gender, non-restorative operation ratio, neoadjuvant CRT ratio, T stage, preoperative neutrophil count, lymphocyte count, platelet count, NLR, PLR, albumin, and hemoglobin level between two the subgroups (P>0.05). ROC curve analysis showed that AUC of preoperative NLR in prediction of SSI following radical resection for rectal cancer was 0.711(95%CI 0.643-0.779). When the optimal cut off point was 2.13, its sensitivity and specificity was 95.0% and 51.4%, respectively. AUC of preoperative PLR in prediction of SSI following radical resection for rectal cancer was 0.665(95% CI 0.553-0.777). When the optimal cut off point was 150.69, its sensitivity and specificity was 75.0% and 59.7%. Conclusion Preoperative NLR and PLR have predictive value for SSI following radical resection for rectal cancer.
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Objective@#To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from February 2018 to March 2019 were collected. There were 39 males and 21 females, aged from 45 to 81 years, with an average age of 67 years. All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation. The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering. The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction, and the CT images of venous vessels with small density difference were abstracted by region growing method. Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added. All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team, and were identified inferior mesenteric artery (IMA) and branches after being bared vessels, including anatomic course of left colonic artery (LCA), sigmoid artery (SA), and superior rectal artery (SRA). Observation indicators: (1) anatomic courses of IMA, LCA, SA, and SRA on the 3D images and their consistency with intraoperative anatomic courses; (2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels; (3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels. Measurement data were represented as Mean±SD, and count data were represented as absolute numbers and percentages.@*Results@#(1) Anatomic courses of IMA, LCA, SA and SRA on the 3D images and their consistency with intraoperative anatomic courses: of the 60 patients, 31 (51.7%) had type Ⅰ anatomic course of IMA on the 3D images, with LCA and SA from the common trunk; 9 (15.0%) had type Ⅱ, with LCA and SA from the common trunk; 18 (30.0%) had type Ⅲ, with LCA, SA, and SRA from the common trunk; 2 (3.3%) had type Ⅳ, with no LCA. The consistency of anatomic courses of IMA, LCA, SA, and SRA on the 3D images with intraoperative anatomic courses of bared IMA, LCA, SA, and SRA was 100.0%(60/60). (2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels: of the 60 patients, 49 (81.7%) had LCA as the first branch of IMA, 11 (18.3%) had SRA or SA as the first branch of IMA. The distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels were (41±6)cm and (42±7)cm. (3) The spatial relationship between the horizontal level of LCA and the IMV on the 2D CT images and 3D images of blood vessels: two patients of type Ⅳ were excluded from the 60 patients. On the 2D CT images of the rest 58 patients, 39 (67.2%) had LCA adjacent to IMV and 19 (32.8%) had LCA distal to IMV at the horizontal level of IMA root. On the 3D images of blood vessels in the rest 58 patients, 37 (63.8%) had the LCA located at the ventral side of IMV, and 21 (36.2%) had the LCA located at the dorsal side of the IMV.@*Conclusion@#Muiti-slice CTA and image fusion technology can visually display the anatomic course and variation of IMA and its branches, which has high clinical application value.
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Objective To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Mfiliated Wuxi Second People's Hospital of Nanjing Medical University from February 2018 to March 2019 were collected.There were 39 males and 21 females,aged from 45 to 81 years,with an average age of 67 years.All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation.The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering.The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction,and the CT images of venous vessels with small density difference were abstracted by region growing method.Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added.All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team,and were identified inferior mesenteric artery (IMA) and branches after being bared vessels,including anatomic course of left colonic artery (LCA),sigmoid artery (SA),and superior rectal artery (SRA).Observation indicators:(1) anatomic courses of IMA,LCA,SA,and SRA on the 3D images and their consistency with intraoperative anatomic courses;(2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels;(3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels.Measurement data were represented as Mean±SD,and count data were represented as absolute numbers and percentages.Results (1) Anatomic courses of IMA,LCA,SA and SRA on the 3D images and their consistency with intraoperative anatomic courses:of the 60 patients,31 (51.7％) had type Ⅰ anatomic course of IMA on the 3D images,with LCA and SA from the common trunk;9 (15.0％) had type Ⅱ,with LCA and SA from the common trunk;18 (30.0％) had type Ⅲ,with LCA,SA,and SRA from the common trunk;2 (3.3％) had type Ⅳ,with no LCA.The consistency of anatomic courses of IMA,LCA,SA,and SRA on the 3D images with intraoperative anatomic courses of bared IMA,LCA,SA,and SRA was 100.0％ (60/60).(2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels:of the 60 patients,49 (81.7％) had LCA as the first branch of IMA,11 (18.3％) had SRA or SA as the first branch of IMA.The distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels were (41±6)cm and (42±7)cm.(3) The spatial relationship between the horizontal level of LCA and the IMV on the 2D CT images and 3D images of blood vessels:two patients of type Ⅳ were excluded from the 60 patients.On the 2D CT images of the rest 58 patients,39 (67.2％) had LCA adjacent to IMV and 19 (32.8％) had LCA distal to IMV at the horizontal level of IMA root.On the 3D images of blood vessels in the rest 58 patients,37 (63.8％) had the LCA located at the ventral side of IMV,and 21 (36.2％) had the LCA located at the dorsal side of the IMV.Conclusion Muiti-slice CTA and image fusion technology can visually display the anatomic course and variation of IMA and its branches,which has high clinical application value.
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Objective To explore the value of terminal ileum suspension in the treatment of low rectal cancer.Methods 80 patients with low rectal cancer who underwent laparoscopic operation in our hospital from June 2015 to February 2017,were randomly divided into two groups:the control group (group C) and the test group (group T),40 cases in each group.In group C,laparoscopic radical resection of rectal cancer (Dixon) was performed and in group T Dixon was combined with terminal ileum suspension.Peripheral blood nutritional indicators (total plasma protein,albumin,pre-albumin,transferrin) and major electrolytes of two groups were observed 1 day before operation and 1,3 and 7 days after operation.The two groups were compared in terms of first exhaust time,postoperative hospital stay,total costs for hospitalization,postoperative discomforts and complications.Results There were no statistical differences in the levels of nutrition indicators and electrolytes between them (P ＞ 0.05) and neither it was with first exhaust time,hospital stay,total costs of hospitalization,incidence of postoperative discomforts and complications (P ＞ 0.05).The re-operation rate of group T with anastomotic leak was significantly lower than group C (P ＜ 0.05).Conclusion Terminal ileal suspension does not affect patients' postoperative recovery without increasing the patient's suffering and economic burden,and can effectively reduce the reoperation rate caused by anastomotic leak.It is easy to operate.
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Objective To investigate the analgesia effects and duration ofultrasound-guided quadratus lumborum block (QLB)in radical resection of rectal cancer,and to evaluate its clinical effect, so as to provide new clinical ideas for intraoperative and postoperative analgesia. Methods Sixty patients who would undergo expected radical resection of transabdominal rectal cancer in our hospital from February,2016 to March,2017 were selected,of which 36 males and 24 fe-males,aged 30-70 years,ASA physical status Ⅰ or Ⅱ.They were randomly divided into two groups,30 cases in each.After induction,the patients in group QLB underwent ultrasound-guided bi-lateral QLB before surgury,40 ml of 0.375% ropivacaine was given to these patients.Patients in group C received general anesthesia alone.The values of systolic pressure (SBP),diastolic pressure (DBP),heart rate (HR)immediately before and 5 minutes after cutting were oberserved and recor-ded.The patients'incision reaction,the dosage of fentanyl intraoperative,the visual analogue scores (VAS)of 2,4,6,12,24,and 48 hours after operation,the first time pressing the analgesic pump button,the consumption of sufentanil,times of remedial analgesia,the time getting out of bed,the patient's satisfaction with postoperative analgesia were recorded in the two groups.Results The changes of SBP,DBP and HR 5 min before and after skin incision in group QLB were significantly lower than those in group C (P <0.05).The usage of fentanyl in group QLB significantly decreased compared with that in group C (P < 0.01 ).The first time pressing the analgesic pump button in group QLB was significantly later than that in group C (P <0.05).The usage of sufentanil signifi-cantly decreased in QLB group at 2,4,6,12 and 24 hours after operation compared with that in group C (P <0.05).The times of remedial analgesia in group QLB were lower than that in group C (P <0.05).The time getting out of bed and exhausting in group QLB were significantly earlier com-pared with those in group C (P <0.05).The patient's satisfaction with postoperative analgesia was significantly higher in group QLB compared with that in group C (P <0.05 ).Conclusion Bilateral quadratus lumborum blockage with 0.375% ropivacaine can reduce the opioid consumption for patients undergoing radical surgery of rectal cancer,and postoperative opioid usage was also reduced. The time getting out of the bed in group QLB was significantly shifted to an earlier date compared with those in group C.It can provide a satisfactory analgesia,and improve the patient's comfort and satisfaction.
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Objective To study effect of parecoxib on sufentanil dosage and its analgesic effect in patients with laparoscopic radical resection of rectal carcinoma under combined anesthesia.Methods 120 cases patients diagnosed with rectal cancer and prepared to laparoscopic radical resection of rectal cancer were selected in Kailuan General Hospital, and randomly divided into experimental group and control group, 60 cases in each group, experimental group induced anesthesia with 40mg parecoxib sodium intravenous injection, while the control group were treated with normal saline, the postoperative dosage of sufentanil, analgesia pump using frequency and other indicators were detected at 6,12,24 and 48 h, and analgesic effect were observed.Results Compared with control group, in experimental group, postoperative dosage of sufentanil was less ( P <0.05 ) , analgesia pump pressing times and effective pressing numbers were fewer (P<0.05), VAS pain score was lower (P<0.05) and Ramsay score was lower (P<0.05) at each time point.Conclusion Parecoxib could reduce the dosage of sufentanil after laparoscopic radical resection of rectal cancer, and enhance the analgesic effect.
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Objective To evaluate the effects of pelvic autonomic nerve preservation(PANP) on urinary and sexual functions in postoperative patients with radical resection for rectal cancer.Methods The radical resection of rectal cancer was carried out in 256 cases of patients with rectal cancer in our hospital from January 2002 to August 2008.Patients were divided into study group (n=156) with PANP and control group (n=100) without PANP.The preserved functions of automatic micturition,male erection,ejaculation,the change of female orgasm,and local recurrence of tumor were observed in the two groups.Results The preserved functions of urination,male erection,ejaculation and female sexual orgasm in study group were significantly stronger than those in control group (P<0.01),and there Was no significant difference of local recurrence of tumors between the two groups(P>0.05).Conclusions The radical operation with PANP for rectal cancer can improve postoperative micturition and sexual function,and this method does not increase local tumor recurrence after operation.
