Objective To summary the early experience of Dixon procedures with Da Vinci robotics surgical system for rectal cancer. Methods Eleven patients with rectal cancer underwent the combination of laparoscope and Da Vinci robotics surgical system with 4 trocars in our hospital from May. 2011 to Jan. 2012. Laparoscopy was firstly used to identify the possibility of the surgical procedure， then placed the 4 trocars， and maked sure the suspension of the sigmoid colon and the uterus. Transections of rectum were performed by a conventional laparoscopic method， and endoscopic separations were performed by Da Vinci robotics surgical system. The clinical data were retrospectively analyzed and the experience was summarized. Results The Da Vinci robotics-assisted Dixon procedures were successfully performed in 11 patients and no one turned to laparotomy. The operating time was 210-330min （mean 288.6min）；the blood loss was 20-100ml （mean 40ml）； The number of lymph nodes dissected was 12-21 per case （mean 13.9 per case）；the duration of bowel movement and hospital stay were 18-26h （mean 22h） and 7-16d （mean 11.5d）， respectively. There were no intraoperative or postoperative complications related to the use of robotics， and no residual cancer cells at resection margin. Conclusions Da Vinci robotics-assisted Dixion procedure with 4 trocars and suspension of sigmoid colon are safe and feasible， and it is beneficial to the recovery of patients
Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.
Objective To compare the clinical effect between neo-adjuvant chemotherapy combined with operation and simple operation under multi-disciplinary team in rectal cancer. Methods A survey of 72 patients with rectal cancer from Nov. 2007 to Mar. 2008 were studied. Patients were divided into two groups using a simple random method: 33 cases in combined therapy group were treated with single period neo-adjuvant chemotherapy as well as operation and 39 cases in control group received operation only. To compare the differences of perioperative period indexes between two groups. Results During the differences of indexes of age, gender, differentiation degree, clinicopathologic stage as well as the distance to dentate line of tumor, there was no statistical significance between combined therapy group and control group (Pgt;0.05). And at the same time, the operative type, operative time and bleeding quantity in operation had no statistically significant difference between two groups (Pgt;0.05). As for the postoperative rehabilitation indexes, the time of vent to normal in combined therapy group was earlier than that in control group, but the intake time was later than that in control group （Plt;0.05）. Falling range from preoperative CEA to postoperative CEA was larger in combined therapy group than that in control group （Plt;0.05）; and the falling range from preoperative WBC to postoperative WBC had no significant difference between two groups （Pgt;0.05）. Conclusion The clinical effect of combined therapy is obviously superior to simple operation, suggesting that neo-adjuvant chemotherapy combined with operation is feasible and safe.
Objective To observe the histopathological changes of tumor tissue after intraoperative regional chemotherapy of rectal cancer. Methods After the treatment of intraoperative regional chemotherapy with 5-FU (15 mg/kg)， the histopathological changes of tumor tissue were detected. Results Slight changes with cancer cells in all the cases accepted intraoperative regional chemotherapy were found under light microscope such as karyopyknosis, nuclear swelling, coagulation and necrosis of cytoplasm, hydropsia of intercellular substance, invasion of inflammatory cells, and 9/15 cases with slight inflammation of vessels were observed; While those changes were found in individual cells of the cases without regional chemotherapy. The more enlarged intercellular space of cancer cell was observed under electron microscope in the case with regional chemotherapy. Conclusion The intraoperative regional chemotherapy of rectal tumor can change the histopathological appearance of tumor tissue, that is significant in preventing cancer cells diffusing during operation and relapsing after operation.
【Abstract】ObjectiveTo detect the spreading scope of rectal cancer to mesorectum by RT-PCR using carcinoembryonic antigen (CEA) mRNA as a marker and to investigate the excision scope of mesorectum in resection of rectal cancer. MethodsForty specimens from 40 rectal cancer patients who underwent curative operation was employed to detect the metastatic deposits scattered in the mesorectum by RT-PCR using CEA as a marker. ResultsNine of 40 (22.5%) specimens contained metastatic deposits scattered in the mesorectum. The metastasis was just within the range of 4cm mesorectum under the verge of tumor. The tumor spreading to mesorectum is correlated with Dukes stages，the infiltrated depth of bowel wall, tumor differentiation and tumor type(P＜0.05), and is not correlated with the size of tumor and the level of CEA(Pgt;0.05). ConclusionThe excision of mesorectum should be within the range of 5cm under the verge of tumor in surgical management of rectal cancer.
ObjectiveTo investigate the cause of stoma recurrence after anterior resection of rectal cancer and discover the methods of prevention and treatment.MethodsA total 91 patients with stoma recurrence after anterior resection of rectal cancer (or Dixon) were analysed retrospectively between 1985 and 1996. Fourtyseven patients experienced reradical resection (Miles), 27 cases palliative resection, and 11 cases only exploration. Thirtytwo cases had been followed up for 5 years and obtained 1，3，5year survival rate for reradical radical resection (Miles). Diagnosis and treatment of stomal recurrence after Dixon were evaluated. ResultsOne, three and fiveyear survival rate of reradical resection (Miles) was 93%，77%，45% respectively.ConclusionTo amplify blindly the adaptation of Dixon is to raise the rate of stoma recurrence. Digital rectal examination and fiberopic colonoscopy (and biopsy) are very essential methods for the diagnosis of stoma recurrence, and we strive to do reradical resection (Miles) for the patients with stoma recurrence after Dixon’s operation.
ObjectiveTo study the significance of lateral lymph nodes sweeping in lower rectal cancer. MethodsRoutine pathological methods were used to detect the regularity of lateral lymph nodes metastasis and the survival rate of the patient. All the data was analysed by χ2 test. Results①Lateral lymph nodes metastasis was observed in 12.5% rectal cancer below the peritoneum,and it was the main lymph metastatic way. ②Low differented adenocarcinoma and mucous adenocarcinoma had more lateral lymph nodes metastasis than other types. Lateral lymph nodes metastasis was also related with invaded degree of invasion. ③The survival rate of the case with lateral lymph node metastasis was 42.2%.ConclusionLateral lymph nodes should be swept in advanced rectal cancer to prevent remains of lymph nodes remained and increase the survival rate.
ObjectiveTo investigate the anatomical mark of attachment edge in mesorectal tail and the effect of its morphologic distribution in performing total mesorectal excision (TME). MethodsThe gross specimens of 220 consecutive patients with the middlelower rectal cancer were collected by a group of surgeons.Patients were divided into two groups.①Group in saving sphincter. Ⅰa group, low anterior resection (LAR): 81 patients with lesions between 5 and 6 cm from the anal verge underwent LAR ; Ⅰb group, anterior resection (AR): 68 patients with lesions between 7 and 8 cm from the anal verge underwent AR.②Group in resecting sphincter. Abdominoperineal resection (APR): 71 patients with lesions between anal verge and 5 cm from the anal verge underwent APR. Results①The circular edge of mesorectal tail is attached on rectal wall of 1 cm above anal hiatus of levators,which level parallels the lower margin of lower rectal cancer.In order to reset distal rectal wall of 2 and 3 cm,undergoing LAR must avoid injuring rectal wall when dissecting muscular vessel of rectum continue along the levators fascia to the anal hiatus.②The attachment morphology of mesorectal tail is a circular flake and not circular linear in shape. There are a little of fat tissue between posterior rectal wall and mesorectal tail,the length of its longitudinal attachment is (1.269±0.171) cm (81 cases in LAR group and 71 cases in APR gourp).Because the distal resective margin of rectum undergoing AR just locate in area of flake attachment of mesorectum, removing mesorectum around rectal wall must avoid injuring the rectal wall. Conclusion The mesorectal tail is a circular flake and attaches on rectal wall of 1.0 cm above anal hiatus of levatorani.Undergoing LAR or AR must avoid to injure rectal wall,which may result in leakage of anastomosis when removing mesorectal tissuce around distal rectal wall.
ObjectiveTo investigate the relationship between rules of local metastasis and the operation for rectal cancer. MethodsLiteratures about rules of local metastasis and operation for rectal cancer were reviewed and analysed. ResultsThe study of rules of local metastasis results in the change and refinement of the operation for rectal cancer. Conclusion With the development of basic research for rectal cancer,the operation for rectal cancer is changing and refining, and the result of the treatment is more favourable.
Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.