Objective Surgical treatment for rectal cancer has been developed for centuries. After anesthetic technics are applied， classic operation procedures for rectal cancer resection are still cited repeatedly. There are few articles regarding to the development history of surgical treatment for rectal cancer， and we summarize it chronologically. Methods We searched articles in the past 20 years， dated back to the original journal and explored the development of the operation type. Results We summarized more than 100 articles and listed more than 40 articles here. According to the articles retrieved， the surgery for rectal cancer could be dated back to 1739， spanning for more than 270 years. In the premier one hundred years， the resection area was limited and the effect of the treatment was not good. And in the recent one hundred years， the development of surgery conceptions was huge and the related knowledge and skills had been rapidly develop. The operation type for rectal cancer was gradually getting mature. Conclusions Surgery treatment for rectal cancer has been through a development of more than two hundred years， with new concepts and technics continuously fused in. Thus the meaning of surgery treatment for rectal cancer has been renewed. Introduction of total mesorectum excision， conception of 2 cm distal resective margin， development of stapling devices， preoperative chemoradiation and appplication of laparoscopic surgery have fasciliated function-preserving operations with minimal invasion， rapid recovery and high survival rate. Appearance of new drugs and improvement of local excision， preoperative chemoradiation， as well as new agents for chemotherapy and target therapy have promoted surgical resection for rectal cancer to a multidisciplinary model.
Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.
【Abstract】Objective To analyze the clinical features of multiple primary colorectal carcinoma(MPCC). Methods Data in 21 patients with MPCC during the past 10 years in our hospital were analyzed retrospectively. Results The incidence of synchronous and metachronous carcinoma was 1.1% and 1.2% respectively. The sites and pathologic stages of tumors showed no significant difference compared with single colorectal carcinoma. 47.6% of the cases accompanied with colorectal adenoma. 77.8% of the MPCC could be found during operation. Patients with carcinoma involved rectum had relatively poor survival. Conclusion The full-course colonoscopy, careful intraoperative exploration and regular postoperative colonoscopic follow-up are essential in improving the diagnosis and prognosis of patients with MPCC.
The technique of laparoscopic radical right hemicolectomy is becoming mature, but there are still controversies on some key steps, including the extent of lymph node dissection, the scope of bowel resection, the choice of surgical access and anastomosis. The new function-preserving surgery and natural-orifice transluminal endoscopic surgery (NOTES) have further enhanced the minimally invasive nature of surgery. The author’s have reviewed the latest domestic and international literature, combined with the experience of the author’s center, and elaborated on the current focus issues of laparoscopic radical surgery for right-sided colon cancer.
ObjectivesTo assess the methodological and reporting quality of surgical meta-analyses published in English in 2014.MethodsAll meta-analyses investigating surgical procedures published in 2014 were selected from PubMed and EMbase. The characteristics of these meta-analyses were collected, and their reporting and methodological quality were assessed by the PRISMA and AMSTAR, respectively. Independent predictive factors associated with these two qualities were evaluated by univariate and multivariate analyses.ResultsA total of 197 meta-analyses covering 10 surgical subspecialties were included. The mean PRISMA and AMSTAR score (by items) were 22.2±2.4 and 7.8±1.2, respectively, and a positive linear correlation was found between them with a R2 of 0.754. Those meta-analyses conducted by the first authors who had previously published meta-analysis was significantly higher in reporting and methodological quality than those who had not (P<0.001). Meanwhile, there were also significant differences in these reporting (P<0.001) and methodological (P<0.001) quality between studies published in Q1 ranked journals and (Q2+Q3) ranked jounals. On multivariate analyses, region of origin (non-Asiavs. Asia), publishing experience of first authors (ever vs. never), rank of publishing journals (Q1 vs. Q2+Q3), and preregistration (presence vs. absence) were associated with better reporting and methodologic quality, independently.ConclusionThe reporting and methodological quality of current surgical meta-analyses remained suboptimal, and first authors' experience and ranking of publishing journals were independently associated with both qualities. Preregistration may be an effective measure to improve the quality of meta-analysis, which deserves more attention from future meta-analysis reviewers.
Objective To investigate the operative effects of gluteal muscle contracture. Methods A total of 128 cases of gluteal muscle contracture treated with operative methods from February 2001 to May 2009 were reviewed. Results All the patients received operation. Most patients were satisfied with the treatment via function exercise in the early stage. No severe complication was found. The patients were followed up for 6 to 84 months, at the average of 36 months. According to Huang Yaotians criteria, 67.9% (87/128) of the patients were excellent; 27.3% (35/128) were good; 3.9% (5/128) were fair; and 0.8% (1/128) were poor in effectiveness. Conclusion Operation and function exercise after operation have advantages of minitrauma and good function recovery, and it is a satisfactory method to treat the gluteal muscle contracture.
ObjectiveTo sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital (PUMCH). MethodsSix cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed. Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope, colonoscopy, abdominal CT scan, arteriography, 99Tcm radionuclide imaging, and double-balloon intestinal endoscope. None was made a definite diagnosis before operation with only one uncertain case. All cases received operation and pathological examination. Results All cases admitted were male. The chief complaints included intestinal bleeding, abdominalgia, intestinal obstruction, and abdominal mass. Five out of six patients received gastroscope, colonoscopy, and abdominal CT scan while three received mesenteric arteriography, but none was found any suggestion for ileal duplication. Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding. Three received doubleballoon intestinal endoscope, paying attention that only one discovered with ileal duplication. In a concluding, none was made a definite diagnosis before operation with only one uncertain case. All the cases received operation. The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation. Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications． Two cases were found with ectopic gastric mucosa, another two with diverticulum, and one with ectopic pancreas， in addition the remaining with inflammatory fibrous pseudotumor. Prognosis were good for all after operation. ConclusionsIleal duplications are rarely seen in adults, gender prefer male． Without specific clinical symptoms and inspections, definite diagnosis before operation is hard to make. But maybe doubleballoon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result. Surgeons should be aware of this condition when performing abdominal exploration. Once discovered, resection is necessary.
Objective To investigate the surgical treatment effect for patients with gastrointestinal stromal tumor (GIST) of the rectum and its clinical characteristics. Methods The medical records of 22 patients who had undergone surgery for GIST of the rectum between March 2003 and February 2010 in this hospital were analyzed. Results There were 14 males and 8 females with a median age of 51 years (range 27－81 years). There were 12 patients without symptoms, 10 patients with clinical symptoms, included: hematochezia 4 cases, difficult defecation 2 cases, shape of defecate change 2 cases, crissum pain 1 case, times of defecate increase 1 case. Course of disease was 2 weeks-18 months with average 6 months. All patients underwent curative resection: in form of abdominoperineal resection in 3 patients, transanal excision in 8 patients, Mason operation in 8 patients, and transanal endoscopic microsurgery in 3 patients. The median tumor size was 3.1 cm (range 0.4－18.5 cm). The diameter of tumor lt;2.0 cm was 11 cases, 2.1-5.0 cm was 8 cases, 5.1-10.0 cm was 2 cases, gt;10.0 cm was 1 case. Twentyone of 22 cases were positive for CD117, 18 cases positive for CD34, 5 cases positive for αsmooth muscle actin (SMA), and 2 cases positive for Desmin. Local recurrence or hepatic metastasis developed in 2 patients with average 26 months of follow-up (range 1 month to 7 years), and who were then treated with imatinib for more than 1 year. Conclusions The primarily treatment of rectal GIST is surgical. Imatinib therapy is effective against local and systemic recurrent GIST of the rectum.
Objective To explore whether mutations of p53 gene and hMLH1 gene may be an early event of carcinogenesis in rectal cancer. Methods The expressions of p53 and hMLH1 protein in 32 patients with early rectal cancer, 32 patients with rectal adenoma， and 30 patients with normal rectal mucosa were detected by PV-9000 immunohistochemical method between February 2003 and July 2009 in this hospital. Results ① The positive expression rates of p53 protein were 0 (0/30), 59.38% (19/32), and 68.75% (22/32) in the normal rectal mucosa, rectal adenoma, and early rectal cancer, respectively. There was no difference between the rectal adenoma and early rectal cancer (Pgt;0.05), but which were higer than that of the normal rectal mucosa (Plt;0.01). The negative expression rates of hMLH1 protein were 0 (0/30), 12.50% (4/32), and 50.00% (16/32) in the normal rectal mucosa, rectal adenoma, and early rectal cancer, respectively. The negative expression rate of hMLH1 protein in the early rectal cancer was significantly higher than that in the rectal adenoma or the normal rectal mucosa (Plt;0.01). ② The positive expression of p53 concomitant negative expression of hMLH1 in the rectal adenoma and early rectal cancer were 9.38% (3/32) and 37.50% (12/32), respectively, the difference was statistically significant (P=0.008). ③ In the early rectal cancer, the positive expression of p53 and the negative expression of hMLH1 were closely related to the degree of differentiation (Plt;0.05), but which weren’t related to the patient’s gender, age, tumor maximum diameter, depth of invasion or fecal occult blood (Pgt;0.05). ④ The positive expression of p53 was closely related to higher adenoma hyperplasia (P=0.009), while not of negative expression of hMLH1 (Pgt;0.05). Conclusion Simultaneous mutations of p53 gene and hMLH1 gene may be an early event of carcinogenesis in rectal cancer.
Objective To determine the accuracy of endorectal ultrasonography (ERUS) in preoperative staging of rectal cancer and investigate the limitations and pitfalls of ERUS. Methods Ninety-four patients with rectal cancer were examined preoperatively by ERUS between September 2008 and November 2009 in this hospital. The size, shape, echo pattern, infiltration depth, and extra-rectal invasion of lesions were observed. The results of ERUS staging were compared with histopathology findings of the resected specimens. Results The overall accuracy of ERUS in T staging was 63.8% (60/94). The accuracies of ERUS for pT1, pT2, pT3, and pT4 tumor were 87.2% (82/94), 76.6% (72/94), 76.6% (72/94), and 97.9% (92/94), respectively. The sensitivity, specificity, and accuracy of ERUS for advanced rectal cancer (pT3+pT4) were 70.8% (34/48), 78.3% (36/46), and 74.5% (70/94), respectively. The sensitivity, specificity, and accuracy of ERUS in lymph node metastasis were 75.0% (42/56), 42.1% (16/38), and 61.7% (58/94), respectively. There was no significant difference of accuracy among various tumor locations above anocutaneous line (P＝0.495). The accuracy of ERUS for T staging improved with experience, the T staging accuracy improved from 40.0% after assessment of 30 cases to 81.3% after 94 cases were examined (P＝0.026). Conclusions The ERUS provides a good accuracy rate for assessment of the depth of tumor invasion and lymph node metastasis of rectal cancer, and has become an important imaging tool for preoperative staging rectal cancer. The operator experience, peritumoral inflammation mainly influences the accuracy of ERUS.