Biologic behavior and management of rectal cancer differ significantly from that of colon cancer. The surgical treatment is challenging since the rectum has dual arterial blood supply and venous drainage, extensive ly...Biologic behavior and management of rectal cancer differ significantly from that of colon cancer. The surgical treatment is challenging since the rectum has dual arterial blood supply and venous drainage, extensive lymphatic drainage and is located in a bony pelvic in close proximity to urogenital and neurovascular structures that are invested with intricate fascial covering. The rectum is encased byfatty lymphovascular tissue(mesorectum) that is surrounded by perirectal fascia that act as barrier to the spread of the cancer and constitute the surgical circumferential margin. Locoregional recurrence after rectal cancer surgery is influenced by tumor-related factors and adequacy of the resection. Local recurrence is associated with incomplete excision of circumferential margin, violation of perirectal fascia, transmesorectal dissection, presence of isolated deposits in the mesorectum and tumor in regional lymph nodes and incomplete lymph node clearance. Hence to eradicate the primary rectal tumor and control regional disease, the rectum, first area of lymph node drainage and surrounding tissue must be completely excised while maintaining an intact fascial envelope around the rectum and preserving surrounding structures. This is achieved with extrafascial dissection and removal of the entire mesorectum including the portion distal to the tumor(total mesorectal excision) within its enveloping fascia as an intact unit. Total mesorectal excision is the standard of care surgical treatment of mid and low rectal cancer and can be performed in conjunction with low anterior resection,abdominoperineal resection, extralevator abdominoperineal resection, and extraregional dissection. To accomplish such a resection, thorough knowledge of the surgical anatomy of the rectum and pelvic structures and fascial planes is paramount.展开更多
Breast cancer can metastasize to other organs following initial treatment.Bones, liver, and the lung are the most common sites of breast cancer metastases.The digestive tract, on the other hand, is rarely involved.The...Breast cancer can metastasize to other organs following initial treatment.Bones, liver, and the lung are the most common sites of breast cancer metastases.The digestive tract, on the other hand, is rarely involved.The incidence of mesorectal metastasis(a special category of rectal metastases) from breast cancer has not been described before.The case reported herein concerns a 68-year-old woman who underwent mastectomy.A pelvic mass with no symptoms was subsequently identified by computed tomography in the patient.We ultimately confirmed that this mass was a metastasis from breast cancer located in the mesorectum using surgical exploration and pathology results.展开更多
AIM: To study the distribution of positive lymph nodes within mesorectum and to investigate the possible micrometastasis in negative lymph nodes. METHODS: Large slice technique combined with tissue microarray was used...AIM: To study the distribution of positive lymph nodes within mesorectum and to investigate the possible micrometastasis in negative lymph nodes. METHODS: Large slice technique combined with tissue microarray was used in the pathologic study of 31 specimens.RESULTS: A total of 992 lymph nodes were harvested and cancer metastasis was found in 148 lymph nodes. Some positive lymph nodes were located in the outer layer of mesorectum and more at the same site of mesorectum as the primary tumor. Circumferential margin lymph node metastasis was observed in nine cases. No significant difference in occurrence of micrometastasis was observed in different stage tumors. CONCLUSION: Positive lymph nodes are distributed in mesorectum and micrometastasis can be found in negative lymph nodes.展开更多
Background:Pre-operative assessment with high-resolution magnetic resonance imaging(MRI)is useful for assessing the risk of local recurrence(LR)and survival in rectal cancer.However,few studies have explored the clini...Background:Pre-operative assessment with high-resolution magnetic resonance imaging(MRI)is useful for assessing the risk of local recurrence(LR)and survival in rectal cancer.However,few studies have explored the clinical importance of the morphology of the anterior mesorectum,especially in patients with anterior cancer.Hence,the study aimed to investigate the impact of the morphology of the anterior mesorectum on LR in patients with primary rectal cancer.Methods:A retrospective study was performed on 176 patients who underwent neoadjuvant treatment and curative-intent surgery.Patients were divided into two groups according to the morphology of the anterior mesorectum on sagittal MRI:(1)linear type:the anterior mesorectum was thin and linear;and(2)triangular type:the anterior mesorectum was thick and had a unique triangular shape.Clinicopathological and LR data were compared between patients with linear type anterior mesorectal morphology and patients with triangular type anterior mesorectal morphology.Results:Morphometric analysis showed that 90(51.1%)patients had linear type anterior mesorectal morphology,while 86(48.9%)had triangular type anterior mesorectal morphology.Compared to triangular type anterior mesorectal morphology,linear type anterior mesorectal morphology was more common in females and was associated with a higher risk of circumferential resection margin involvement measured by MRI(35.6%[32/90]vs.16.3%[14/86],P=0.004)and a higher 5-year LR rate(12.2%vs.3.5%,P=0.030).In addition,the combination of linear type anterior mesorectal morphology and anterior tumors was confirmed as an independent risk factor for LR(odds ratio=4.283,P=0.014).Conclusions:The classification established in this study was a simple way to describe morphological characteristics of the anterior mesorectum.The combination of linear type anterior mesorectal morphology and anterior tumors was an independent risk factor for LR and may act as a tool to assist with LR risk stratification and treatment selection.展开更多
目的了解直肠癌保肛术后老年患者焦虑及抑郁与生存质量现状,并探讨其相关性。方法采用自行设计的患者一般资料调查问卷、医院综合焦虑抑郁量表(hospital anxiety and depression scale,HADS)和SF-36健康调查量表(the MOS 36 items short...目的了解直肠癌保肛术后老年患者焦虑及抑郁与生存质量现状,并探讨其相关性。方法采用自行设计的患者一般资料调查问卷、医院综合焦虑抑郁量表(hospital anxiety and depression scale,HADS)和SF-36健康调查量表(the MOS 36 items short form health survey,SF-36)对60例直肠癌保肛术后老年患者进行调查。患者焦虑及抑郁与生活质量的相关性采用Pearson相关分析。结果直肠癌保肛术后老年患者SF-36总分为(64.20±11.76)分;其焦虑阳性者占36.67%,抑郁阳性者占30.00%。直肠癌保肛术后老年患者焦虑及抑郁与生存质量均呈负相关(r值分别为-0.312和-0.495,均P<0.05)。结论护理人员应积极给予直肠癌保肛术后老年患者心理情感支持,指导其采用放松疗法等措施,以减轻患者焦虑及抑郁情绪,从而提高其生存质量。展开更多
Rectal cancer constitutes a major public health issue.Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s.Removal of all lymph node...Rectal cancer constitutes a major public health issue.Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s.Removal of all lymph nodes located in the mesorectum has indeed improved pathological and oncological outcomes.However,when cancer spreads to the lateral lymph nodes(located along the iliac and obturator arteries)Western and Japanese practices differ.Where the Western guidelines consider this condition as an advanced form of the disease and use neoadjuvant radiochemotherapy liberally,the Japanese guidelines define it as a local disease and proceed to lateral lymph node dissection with or without neoadjuvant treatment.Herein,we review the current literature regarding both therapeutic strategies,with the aim of contributing to potential improvements in treatment and outcome for patients with low and mid rectal cancer.展开更多
文摘Biologic behavior and management of rectal cancer differ significantly from that of colon cancer. The surgical treatment is challenging since the rectum has dual arterial blood supply and venous drainage, extensive lymphatic drainage and is located in a bony pelvic in close proximity to urogenital and neurovascular structures that are invested with intricate fascial covering. The rectum is encased byfatty lymphovascular tissue(mesorectum) that is surrounded by perirectal fascia that act as barrier to the spread of the cancer and constitute the surgical circumferential margin. Locoregional recurrence after rectal cancer surgery is influenced by tumor-related factors and adequacy of the resection. Local recurrence is associated with incomplete excision of circumferential margin, violation of perirectal fascia, transmesorectal dissection, presence of isolated deposits in the mesorectum and tumor in regional lymph nodes and incomplete lymph node clearance. Hence to eradicate the primary rectal tumor and control regional disease, the rectum, first area of lymph node drainage and surrounding tissue must be completely excised while maintaining an intact fascial envelope around the rectum and preserving surrounding structures. This is achieved with extrafascial dissection and removal of the entire mesorectum including the portion distal to the tumor(total mesorectal excision) within its enveloping fascia as an intact unit. Total mesorectal excision is the standard of care surgical treatment of mid and low rectal cancer and can be performed in conjunction with low anterior resection,abdominoperineal resection, extralevator abdominoperineal resection, and extraregional dissection. To accomplish such a resection, thorough knowledge of the surgical anatomy of the rectum and pelvic structures and fascial planes is paramount.
基金Supported by Affiliated Zhongshan Hospital of Dalian University,Dalian,Liaoning,China
文摘Breast cancer can metastasize to other organs following initial treatment.Bones, liver, and the lung are the most common sites of breast cancer metastases.The digestive tract, on the other hand, is rarely involved.The incidence of mesorectal metastasis(a special category of rectal metastases) from breast cancer has not been described before.The case reported herein concerns a 68-year-old woman who underwent mastectomy.A pelvic mass with no symptoms was subsequently identified by computed tomography in the patient.We ultimately confirmed that this mass was a metastasis from breast cancer located in the mesorectum using surgical exploration and pathology results.
基金Supported by the Grants From the Key Project of National Outstanding Youth Foundation of China,No.39925032
文摘AIM: To study the distribution of positive lymph nodes within mesorectum and to investigate the possible micrometastasis in negative lymph nodes. METHODS: Large slice technique combined with tissue microarray was used in the pathologic study of 31 specimens.RESULTS: A total of 992 lymph nodes were harvested and cancer metastasis was found in 148 lymph nodes. Some positive lymph nodes were located in the outer layer of mesorectum and more at the same site of mesorectum as the primary tumor. Circumferential margin lymph node metastasis was observed in nine cases. No significant difference in occurrence of micrometastasis was observed in different stage tumors. CONCLUSION: Positive lymph nodes are distributed in mesorectum and micrometastasis can be found in negative lymph nodes.
基金National Clinical Key Specialty Construction Project (General Surgery) of China(No. 2012-649)National Natural Science Foundation of China(No. 81902378)+4 种基金Joint Funds for the innovation of Science and Technology, Fujian province(No. 2020Y9071)Medical Science Research Foundation of Beijing Medical and Health Foundation(No. B20062DS)Bethune Charitable Foundation(No. X-J2018-004)Fujian provincial health technology project(Nos. 2020CXA025, 2021GGA013)Natural Science Foundation of Fujian Province(No. 2020J011030)
文摘Background:Pre-operative assessment with high-resolution magnetic resonance imaging(MRI)is useful for assessing the risk of local recurrence(LR)and survival in rectal cancer.However,few studies have explored the clinical importance of the morphology of the anterior mesorectum,especially in patients with anterior cancer.Hence,the study aimed to investigate the impact of the morphology of the anterior mesorectum on LR in patients with primary rectal cancer.Methods:A retrospective study was performed on 176 patients who underwent neoadjuvant treatment and curative-intent surgery.Patients were divided into two groups according to the morphology of the anterior mesorectum on sagittal MRI:(1)linear type:the anterior mesorectum was thin and linear;and(2)triangular type:the anterior mesorectum was thick and had a unique triangular shape.Clinicopathological and LR data were compared between patients with linear type anterior mesorectal morphology and patients with triangular type anterior mesorectal morphology.Results:Morphometric analysis showed that 90(51.1%)patients had linear type anterior mesorectal morphology,while 86(48.9%)had triangular type anterior mesorectal morphology.Compared to triangular type anterior mesorectal morphology,linear type anterior mesorectal morphology was more common in females and was associated with a higher risk of circumferential resection margin involvement measured by MRI(35.6%[32/90]vs.16.3%[14/86],P=0.004)and a higher 5-year LR rate(12.2%vs.3.5%,P=0.030).In addition,the combination of linear type anterior mesorectal morphology and anterior tumors was confirmed as an independent risk factor for LR(odds ratio=4.283,P=0.014).Conclusions:The classification established in this study was a simple way to describe morphological characteristics of the anterior mesorectum.The combination of linear type anterior mesorectal morphology and anterior tumors was an independent risk factor for LR and may act as a tool to assist with LR risk stratification and treatment selection.
文摘目的了解直肠癌保肛术后老年患者焦虑及抑郁与生存质量现状,并探讨其相关性。方法采用自行设计的患者一般资料调查问卷、医院综合焦虑抑郁量表(hospital anxiety and depression scale,HADS)和SF-36健康调查量表(the MOS 36 items short form health survey,SF-36)对60例直肠癌保肛术后老年患者进行调查。患者焦虑及抑郁与生活质量的相关性采用Pearson相关分析。结果直肠癌保肛术后老年患者SF-36总分为(64.20±11.76)分;其焦虑阳性者占36.67%,抑郁阳性者占30.00%。直肠癌保肛术后老年患者焦虑及抑郁与生存质量均呈负相关(r值分别为-0.312和-0.495,均P<0.05)。结论护理人员应积极给予直肠癌保肛术后老年患者心理情感支持,指导其采用放松疗法等措施,以减轻患者焦虑及抑郁情绪,从而提高其生存质量。
文摘Rectal cancer constitutes a major public health issue.Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s.Removal of all lymph nodes located in the mesorectum has indeed improved pathological and oncological outcomes.However,when cancer spreads to the lateral lymph nodes(located along the iliac and obturator arteries)Western and Japanese practices differ.Where the Western guidelines consider this condition as an advanced form of the disease and use neoadjuvant radiochemotherapy liberally,the Japanese guidelines define it as a local disease and proceed to lateral lymph node dissection with or without neoadjuvant treatment.Herein,we review the current literature regarding both therapeutic strategies,with the aim of contributing to potential improvements in treatment and outcome for patients with low and mid rectal cancer.
