Objective To determine the role of multimodal preoperative evaluation (MPE) system of transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in assessment of preoperative staging and selection of operative procedures of the lower and middle rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 150 patients, who were diagnosed definitely as lower and middle rectal cancer (distance of tumor to the dentate line ≤10 cm) at West China Hospital of Sichuan University from November 2008 to March 2009, randomly assigned into two groups. In one group named MPE group, MPE consisting of TRUS, MSCT and SAA were made for the preoperative evaluation. In another group named MSCT+SAA group, both MSCT and SAA were made preoperatively. Then, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Furthermore, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathological factors. Results According to the criteria, 146 patients with lower and middle rectal cancer were randomly assigned into MPE group (n=74) and MSCT+SAA group (n=72). The baselines characteristics of two groups were statistically identical. For MPE group the accuracy of preoperative staging T, N, M and TNM were 94.6% (70/74), 85.1% (63/74), 100% （74/74） and 82.4% (61/74), respectively; For MSCT+SAA group the corresponding rates were 77.8% (56/72), 84.7% (61/72), 100% （72/72） and 81.9% (59/72), respectively. The analysis showed a statistically difference in the accuracy of preoperative T staging between two groups (P=0.003) while there was no statistically significant difference of the accuracies of preoperative N, M and TNM staging between two groups (Pgt;0.05). There wasn’t a statistically significant increasing of the accuracy of prediction to operative procedures in MPE group compared with MSCT+SAA group 〔95.9% (71/74) vs.88.9% (64/72), P=0.106〕. When analyzing the relationship between multiple clinicopathologic factors and the operative procedures of lower and middle rectal cancer, there were statistical correlations between the pathological T staging (r=0.216， P=0.009), N staging (r=0.264， P=0.001), TNM staging (r=0.281， P=0.001), serum level of SAA before operation (r=0.252， P=0.002) or the distance of tumor to the dentate line (r=－0.261， P=0.001) and the operative procedures. Conclusion MPE system could display the accurate preoperative staging for lower and middle rectal cancer, on which the prediction of operative procedures can rest convincingly.
目的 探讨全直肠系膜切除术（total mesorectal excision,TME）在治疗中低位直肠癌中的技术操作与效果。方法 对47例应用TME技术治疗的中低位直肠癌患者的临床资料进行回顾性分析。结果 27例行低位前切除术，20例行腹会阴联合切除术（Miles术），全部病例均顺利完成手术并出院，平均出血量250 ml； 术后发生吻合口漏2例； 术后随访0.5～3年，局部复发5例，因肝转移死亡2例。结论 应用TME技术治疗中低位直肠癌有其适应证，术中须遵循其操作规范，同时应注意采取适当的措施预防吻合口漏。
【Abstract】ObjectiveTo explore selective criteria of sphincter preservation operation (SPO) for middle to low third rectal cancer, and analyze clinicopathologic parameters resulting in the selective criteria. MethodsTwo hundred and seventynine cases of middle to low third rectal cancer who accepted operative treatment from 1996 to 2004 were analyzed retrospectively. One hundred and eightyseven rectal tumours were located in 5-10 cm from anus, 92 rectal tumours in below 5 cm from anus. Among them 127 cases were treated by abdominalperineal resection (APR), and 152 cases were treated by SPO in which there were 130 Dixon operations, 12 Bacon operations, and 10 Parks operations. Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically. ResultsGender, age, size, tumor types, site of tumor, degree of differentiation, infiltrated circumference of intestine, and lymph node metastasis, depth of invasion and Dukes stages were not significantly different between APR and SPO groups. SPO performed rate was 54.48% in all. SPO was performed in 48 lower third rectal cancer cases (52.17%, 48/92). Regional recurrence rate was 6.81% （19/279）.Middle survival time was （65.00±6.87）months and 5year survival rate was 63.51% in SPO group. Middle survival time was （52.23±5.63） months and 5year survival rate was 52.50% in APR group. ChiSuqare was 18.14 by Logrank test (P=0.054 1). ConclusionThere is no statistically difference in survival rate between APR and SPO groups.
ObjectiveTo investigate the effect of suprapubic catheterization(SPC) by using central venous catheter (CVC) on the perioperative complications in middle and low rectal cancer surgery. MethodsThe clinical data of 141 patients with middle and low rectal cancer underwent operation in Shengjing Hospital of China Medical University from April 2012 to January 2015 were collected. There were 65 patients performed SPC by using CVC, 76 patients performed routine transurethral catheterization(TUC). The incidences of bacteriuria and urinary retention, recatheterization rate, duration of catheterization, and catheter-related pain were analyzed and compared between these two groups. Results①Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of bacteriuria(P=0.002), espe-cially in female(P=0.006), ≥60 years old(P=0.001), low rectal cancer(P=0.003), open surgery(P=0.018), Miles(P=0.016), and Dixon(P=0.032).②There was no significant difference in the incidence of urinary retention(P=0.464) between the SPC by using CVC and the TUC.③Compared with the TUC, the SPC by using CVC could significantly reduce the inci-dence of recatheterization rate(P=0.001), especially in the patients with male(P=0.016), ≥60 years old(P=0.008), low rectal cancer(P=0.019), laparoscopic surgery(P=0.013), and Miles(P=0.037).④Compared with the TUC, the point of catheter-related pain was significantly lower in the SPC by using CVC(P=0.001), no matter males(P=0.005) or females(P=0.010), aged 60 years and older(P=0.023) or younger(P=0.034), middle rectal cancer(P=0.017) or low rectal cancer(P=0.046), open surgery(P=0.033) or laparoscopic surgery(P=0.021), Dixon(P=0.019) or Miles(P=0.035).⑤The duration of catheterization was similar between the SPC by using CVC and the TUC(P=0.597). ConclusionSPC by using CVC is a safer, more effective and more acceptable method of bladder drainage in middle and low rectal cancer surgery as compared with routine TUC.
ObjectiveTo investigate risk factors of anastomotic fistula after total mesorectum excision (TME) in middle and low rectal cancer. MethodsThe clinical data of 446 patients with middle and low rectal cancer received TME surgery from June 2004 to June 2014 were retrospectively analyzed.Single-factor analysis of risk factors was used by χ2 test,multiple-factor analysis was used by logistic regression analysis. ResultsThere were 36 patients with anastomotic fistula in these 446 patients,which of 22 patients were recovered after conservative treatment,of 14 patients were recovered after colostomy.The results of single-factor analysis showed that the age>60 years,preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,distance from anasto-mosis to anus<5 cm,non-strengthen suture by hand were the risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05).The results of multiple-factor analysis showed that the preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,and distance from anastomosis to anus<5 cm were the independent risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05). ConclusionsRisk of anastomotic fistula after TME in middle and low rectal cancer is higher.Basic complications of patient and local conditions of anastomosis,and intraoperative factors could affect incidence of anastomotic fistula,it should be paid enough attention.In general,most of anastomotic fistula could be cured with conservative treatment,in case of conservative treatment is invalid,colostomy is feasible.
Objective To evaluate the effects of neoadjuvant long-course chemoradiotherapy (CRT), neoadjuvant short-course radiotherapy (SCRT), and total neoadjuvant treatment (TNT) on chemoradiotherapy related complications and perioperative safety in mid-low rectal cancer patients. Methods The clinical data of 63 rectal cancer patients who received neoadjuvant (chemo) radiotherapies and surgery treatment in West China Hospital from Jul. 2014 to Feb. 2016 were retrospectively analyzed. According to the neoadjuvant regimen, the patients were divided into CRT group (n=15), SCRT group (n=30), and TNT group (n=18), and then the effects of these 3 kinds of neoadjuvant regimen on chemoradiotherapy related complications and perioperative safety were compared. Results ① Chemoradiotherapy related complications: among all the included 63 patients, 29 patients (46.0%) occurred chemoradiotherapy related complications, including radiation enteritis in 9 patients and bone marrow suppression in 25 patients. There were significant differences in the overall incidence of chemoradiotherapy related complications, incidence of radiation enteritis and bone marrow suppression (P≤0.001). The overall incidence of chemoradiotherapy related complications and incidence of bone marrow suppression of SCRT group were lower. ② Perioperative safety: no significant differences were found in the incidence of surgical complications, incidence of specific surgical complication, operation duration, intraoperative blood loss, and postoperative flatus time (P<0.05), but there was significant difference in the postoperative hospital stay among 3 groups (P=0.033), the postoperative hospital stay of SCRT group was shorter. Conclusion CRT, SCRT, and TNT have similar effect on the safety in the mid-low rectal cancer patients, which suggests that SCRT is worthy of further research and promotion.
ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.
ObjectiveTo evaluate the efficacy, safety, and feasibility of fecal drainage technique on rectal anastomosis for preventing anastomotic leakage after operation for middle-low rectal cancer.MethodsThe retrospective analysis was used to collect the middle-low rectal cancer which completed operation in this hospital from 2014 to 2019. According to the way of preventing annstomotic leakage, the patients were divided into two groups: fecal drainage on rectal anastomosis group (Abbreviation: fecal drainage group) and end ileum prophylactic stoma group (Abbreviation: ileostomy group). The incidence of anastomotic leakage after operation and the different treatment methods following leakage were compared between the two groups.ResultsA total of 231 cases were recorded, including 84 cases in the fecal drainage group, 147 cases in the ileostomy group. There were no significant differences in the baseline data such as the gender, age, preoperative complications, operation mode, etc. between the two groups (P>0.050). There were no significant differences in the operation time, intraoperative blood loss, incision infection, postoperative intestinal obstruction, total hospitalization cost, death, anastomotic leakage (overall, each grade, treatment, and outcome) between the two groups (P>0.050). Although the length of hospital stay except the patients with anastomotic leakage in the fecal drainage group was significantly longer than that in the ileostomy group (P<0.001), there was no significant difference in the total length of hospital stay between the two groups (P>0.050), and the incidence of anastomotic stenosis in the fecal drainage group was significantly lower than that in the ileostomy group (P=0.029).ConclusionAccording to the results of this study, fecal drainage technique on rectal anastomosis is effective, safe, and feasible in preventing anastomotic leakage after operation for middle-low rectal cancer.
Objective To investigate the risk factors of liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy. MethodsThe clinical data of 89 patients with middle and low rectal cancer of Ⅱ–Ⅲ stage admitted to the Dongnan Hospital of Xiamen University from January 2019 to June 2020 were retrospectively analyzed. All patients were treated with short-course radiotherapy combined with chemotherapy before operation. The risk factors of postoperative liver metastasis were analyzed by multivariate logistic regression. ResultsThe 89 patients were followed up for 7–53 months, with a median follow-up time of 33 months. During the follow-up period, 25 patients developed liver metastasis, the onset time was 7–35 months, and the median time of liver metastasis was 17 months. Among them, 5 patients (5.6%) developed liver metastasis in the first year after surgery, 15 patients (16.8%) developed liver metastasis at the second year after surgery, 5 patients (5.6%) developed liver metastasis at the 3rd year after surgery. Multivariate logistic regression results showed that lymph node metastasis [OR=3.550, 95%CI (1.425, 8.953), P=0.041], vascular invasion [OR=3.335, 95%CI (1.011, 11.001), P=0.048], maximum tumor diameter ≥5 cm [OR=4.477, 95%CI (1.273, 15.743), P=0.019], and peri-tumor diameter ≥1/2 [OR=4.633, 95%CI (1.387, 15.475), P=0.013] were risk factors for liver metastasis. ConclusionsLymph node metastasis, vascular invasion, maximum tumor diameter ≥5 cm, and circumferential tumor diameter ≥1/2 are risk factors for liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy.