Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this...Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one.For this reason a review of all the literature examining robotic surgery for rectal cancer was performed.Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE)using the key words"rectum","rectal","cancer","laparoscopy","robot".After the initial screen of 266 articles,43 papers were selected for review.A total of 3013 patients were included in the review.The most commonly performed intervention was low anterior resection(1450 patients,48.1%),followed by anterior resections(997 patients,33%),ultra-low anterior resections(393 patients,13%)and abdominoperineal resections(173 patients,5.7%).Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function.Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times.This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative,clinical outcomes and incidence of complications.In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide,until now,any significant clinical advantages to the patients.展开更多
BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic...BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.展开更多
AIM: To give a comprehensive review of current litera-ture on robotic rectal cancer surgery.METHODS: A systematic review of current literature via PubMed and Embase search engines was per-formed to identify relevant a...AIM: To give a comprehensive review of current litera-ture on robotic rectal cancer surgery.METHODS: A systematic review of current literature via PubMed and Embase search engines was per-formed to identify relevant articles from january 2007 to november 2013. The keywords used were: "robotic surgery", "surgical robotics", "laparoscopic computer-assisted surgery", "colectomy" and "rectal resection". RESULTS: After the initial screen of 380 articles, 20 pa-pers were selected for review. A total of 1062 patients(male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review.Out of 1062 robotic-assisted operations, 831(78.2%) anterior and low anterior resections, 132(12.4%) in-tersphincteric resection with coloanal anastomosis, 98(9.3%) abdominoperineal resections and 1(0.1%) Hart-mann's operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has con-tinued to evolve to its current state with promising re-sults; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.展开更多
BACKGROUND Anastomotic leakage(AL)after restorative surgery for rectal cancer(RC)is associated with significant morbidity and mortality.AIM To ascertain the risk factors by examining cases of AL in rectal surgery in t...BACKGROUND Anastomotic leakage(AL)after restorative surgery for rectal cancer(RC)is associated with significant morbidity and mortality.AIM To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study.METHODS To identify risk factors for AL,a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed.Clinical,demographic and operative features,intraoperative outcomes and oncological characteristics were evaluated.RESULTS The incidence of AL was 10.4%,with a mean time interval of 6.2±2.1 d.Overall mortality was 0.8%.Mortality was higher in patients with AL(4.9%)than in patients without leak(0.4%,P=0.009).Poor bowel preparation,blood transfusion,median age,prognostic nutritional index<40 points,tumor diameter and intraoperative blood loss were identified as risk factors for AL.Location of anastomosis,number of stapler cartridges used to divide the rectum,diameter of circular stapler,level of vascular section,T and N status and stage of disease were also correlated to AL in our patients.The diverting ileostomy did not reduce the leak rate,while the use of the transanastomic tube significantly did.CONCLUSION Clinical,surgical and pathological factors are associated with an increased risk of AL.It adversely affects the morbidity and mortality of RC patients.展开更多
In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment...In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.展开更多
BACKGROUND Radical surgery is a preferred treatment for colorectal carcinoma,wherein nursing intervention is essential for postoperative recovery and prevention of complications.Recently,the application of humanistic ...BACKGROUND Radical surgery is a preferred treatment for colorectal carcinoma,wherein nursing intervention is essential for postoperative recovery and prevention of complications.Recently,the application of humanistic care in medical care has attracted attention.Humanistic care emphasizes comprehensive care,with importance attached to patients’physical needs as well as psychological and emotional support to provide more humane and personalized care services.However,no clinical reports have examined the use of humanistic care in patients undergoing radical surgery for colorectal carcinoma.AIM To investigate the influence of humanistic care-based operating room nursing on the safety,postoperative recovery,and nursing satisfaction of patients who have undergone radical surgery for colorectal carcinoma.METHODS In total,120 patients with rectal cancer who underwent surgery in Zhongnan Hospital of Wuhan University between August 2023 and March 2024 were selected and grouped based on the nursing methods employed.Of these patients,55 were treated with routine nursing intervention(control group)and 65 were provided humanistic care-based operating room nursing(research group).The patients’vital signs were recorded,including systolic/diastolic blood pressure(SBP/DBP)and heart beats per minute(BPM),as well as serum stress indices,including norepinephrine(NE),adrenal hormone(AD),and cortisol(Cor).Postoperative recovery and complications were also recorded.Patients’negative emotions,life hope,and nursing satisfaction were evaluated using the Self-rating Depression/Anxiety Scale(SDS/SAS),Herth Hope Index(HHI),and self-deve-loped nursing satisfaction questionnaire,respectively.RESULTS During emergence from anesthesia,SBP,DBP,and BPM levels were found to be lower in the research group than those in the control group,also serum Cor,AD,and NE levels were lower.In addition,the research group had shorter operative,awakening,anal exhaust,first postoperative ambulation,drainage tube removal,intestinal recovery,and hospital times.The total complication rate and the SDS and SAS scores were lower in the research group than those in the control group.The HHI and nursing satisfaction scores were higher in the research group.CONCLUSION Humanistic care-based operating room nursing can mitigate physiological stress responses,reduce postoperative complications,promote postoperative recovery,relieve adverse psychological emotions,and enhance life hope and nursing satisfaction in patients undergoing radical surgery for colorectal carcinoma,which can be popularized in clinical practice.展开更多
BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,...BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.展开更多
Introduction:Robotic systems are designed to address the limitations of laparoscopic surgery,leading to a growing interest in robotic rectal surgery.However,certain technical limitations associated with the previous s...Introduction:Robotic systems are designed to address the limitations of laparoscopic surgery,leading to a growing interest in robotic rectal surgery.However,certain technical limitations associated with the previous systems(da Vinci S&Si)have arguably slowed down its wholesale adoption.The latest robotic platform,the da Vinci Xi,addresses these limitations.This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems.Materials and methods:All consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases.The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed.Results:A total of 240 patients were identified(124 Si,116 Xi).Median operation-time and length-of-stay were 260 minutes and 6 days respectively.Conversion and 30-day mortality rates were 0.The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group(230 vs 300 min,p=0.000)but length-of-stay,lymph node yield and circumferential resection margin favoured the Xi group(7 vs 5 days,p=0.010;17 vs 21,p=0.000;92.7%vs 99.1%,p=0.020).Conclusion:Single-docking fully-robotic rectal cancer surgery is safe,feasible and can lead to good shortterm outcomes,making it a good alternative to laparoscopic rectal cancer surgery.The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion.展开更多
Objective: to explore the effect of the concept of accelerated repair on postoperative complications of rectal cancer patients complicated with lower rectal cancer undergoing anorectal endoscopic repair. Methods: a ra...Objective: to explore the effect of the concept of accelerated repair on postoperative complications of rectal cancer patients complicated with lower rectal cancer undergoing anorectal endoscopic repair. Methods: a random number table was used to investigate 80 rectal cancer patients in our hospital, and they were divided into control group and follow-up group from 2019 to 2021. Different from the control group, the combined therapy of abdominal cavity and anus endoscope was adopted in this group. The operation concept of accelerating rehabilitation was adopted in both groups of patients, and the patients discharge and discharge conditions within one month were observed. Results: the main research found that the total incidence of postoperative complications was significantly reduced (7.50%, 27.50%), which was significantly higher than that of the normal group (P<0.05). Conclusion: the rapid rehabilitation therapy combined with laparoscopic and anorectal endoscopic resection has no obvious change in gastrointestinal function after rectal cancer surgery, and the postoperative recovery is better, which can reduce the complications of rectal cancer.展开更多
To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE<sup>...To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE<sup>®</sup> and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.RESULTSThis is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.CONCLUSIONA series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.展开更多
Endoluminal vacuum-assisted therapy(EVT)has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients.Its application has been mainly reserved to low colorectal and c...Endoluminal vacuum-assisted therapy(EVT)has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients.Its application has been mainly reserved to low colorectal and colo-anal anastomoses.The main advantage of this new procedure is to ensure continuous drainage of the abscess cavity,to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess cavity.The reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement,percutaneous drainage,endoscopic clipping of the anastomotic defect or stent placement.Nevertheless,despite this procedure is gaining acceptance among the surgical community,indications,inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous,making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new procedure.Moreover,long-term and functional results are poorly reported.The present review is focused on critically analyzing the theoretical benefits and risks of the procedure,short-and long-term functional results and future direction in the application of EVT.展开更多
BACKGROUND Since Heald proposed the total mesorectal excision(TME)procedure,the prognosis of patients with rectal cancer has been significantly improved.But Heald did not specifically describe the anterior surgical pl...BACKGROUND Since Heald proposed the total mesorectal excision(TME)procedure,the prognosis of patients with rectal cancer has been significantly improved.But Heald did not specifically describe the anterior surgical plane in female patients.And the surgical plane for mobilizing the anterior rectal wall during TME surgery in female patients remains controversial.AIM To investigate the anatomy of the female pelvis and identify the optimal plane for mobilizing the anterior rectal wall.METHODS We retrospectively collected surgical procedure videos and clinical data of female patients diagnosed with middle or low rectal cancer who underwent the TME procedure between January 2020 and October 2022 across six hospitals.The patients were divided into two groups based on the surgical approach used to mobilize the anterior rectal wall:The experimental group was to open the peritoneum at the lowest point of the peritonea reflection and enter the plane for mobilizing,while the control group was cut at 0.5-1 cm above the peritoneal reflection and enter another plan.Then,we compared the preoperative and postoperative information between the two groups.We also dissected and observed ten adult female pelvises to analyze the anatomic structure and compare the entry plane between the two approaches.Finally,we researched the pathological structure between the rectum and the vagina.RESULTS Finally,77 cases that met the criteria were included in our study.Our observations revealed that the experimental group underwent a smooth procedure,entering the plane amidst the mesorectal fascia and adventitia of the vagina,whereas the control group entered the plane between the vaginal adventitia and muscle layers.Compared to the control group,the experimental group showed a significant decrease in intraoperative bleeding[22.5(19.5-50)mL vs 17(5-20)mL,P=0.01],as well as a shorter duration of hospitalization[9(7-11.25)d vs 7(6-10)d,P=0.03].Through the examination of surgical videos and cadaveric studies,we discovered that Denonvilliers'fascia is absent in females.Additionally,pathological sections further revealed the absence of Denonvilliers'fascia in females,with only loose connective tissue present between the mesorectal fascia and adventitia of the vagina.CONCLUSION The plane amidst the mesorectal fascia and vaginal adventitia is the optimal surgical plane to mobilize the anterior rectal wall for female patients undergoing the TME procedure.展开更多
In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of n...In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended.The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.展开更多
Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis. Curative resection is currently the only effective treatment, and the efficacy of chemotherapy is unclear. This represents the first c...Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis. Curative resection is currently the only effective treatment, and the efficacy of chemotherapy is unclear. This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma. We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases. He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil, leucovorin and oxaliplatin plus bevacizumab, FOLFIRI consisting of 5-fluorouracil, leucovorin and irinotecan plus bevacizumab, and irinotecan plus cetuximab. One of the liver tumors showed a different response to chemotherapy and was diag-nosed as a leiomyosarcoma following histopathological examination. This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas. The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors.展开更多
Objective: to analyze the effect of acupoint massage of traditional Chinese medicine nursing combined with acupoint application of fructus evodia on postoperative gastrointestinal function recovery of rectal cancer pa...Objective: to analyze the effect of acupoint massage of traditional Chinese medicine nursing combined with acupoint application of fructus evodia on postoperative gastrointestinal function recovery of rectal cancer patients. Methods: 30 patients with rectal cancer were included in the observation, and the time was set from January 2020 to January 2021. According to nursing differences, the patients were divided into control group and observation group. The former was given routine nursing, while the latter was combined with acupoint massage and acupoint application of fructus evodia. Results: the recovery effect of gastrointestinal function was better than that of control group (P < 0.05). Compared with the data of the control group, the incidence of complications in the observation group was lower, P < 0.05;Compared with the control group, the nursing satisfaction in the observation group was significantly higher (P < 0.05). Conclusion: combined with acupoint massage and evodia rutaecarpa acupoint application, the recovery effect of gastrointestinal function in patients with rectal cancer after operation is better, and can reduce the incidence of complications. At the same time, it has obtained the satisfactory evaluation degree of most patients, which is worthy of promotion.展开更多
Introduction Temporary ileostomy or colostomy is often required in low anterior resection for rectal cancer,especially after neoadjuvant chemoradiotherapy or insufficient blood supply at the anastomosis site.A common ...Introduction Temporary ileostomy or colostomy is often required in low anterior resection for rectal cancer,especially after neoadjuvant chemoradiotherapy or insufficient blood supply at the anastomosis site.A common complication in these cases is diversion colitis(DC),a nonspecific inflammation of the defunctioned colon.First described in 1972,DC occurs in up to 100%of colonoscopies postsurgery,with around 30%of patients experiencing symptoms like abdominal pain,diarrhea,mucus,or hematochezia[1].展开更多
Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy.This pro...Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy.This problematic complication could lead to multiple operations,stoma formation,sexual dysfunction,fecal incontinence and psychosocial ramifications.This review comprehensively covers an overview of its incidence,risk factors,presentation and evaluation,management(ranging from conservative measures,endoscopic treatment and local tissue repair to radical resection and redo anastomosis)and treatment outcomes of rectovaginal fistula after low anterior resection.Notably,these therapeutic options and outcomes are influenced by several factors,including the size and location of the fistula,tumor clearance,cancer staging,quality of colorectal anastomosis and surrounding tissue,presence of diverting stoma,previous attempted repair,and the surgeon’s experience.Also,strategies to prevent rectovaginal fistula after low anterior resection are presented with illustrations.Finally,a decision-making algorithm for managing this complication is proposed.展开更多
文摘Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one.For this reason a review of all the literature examining robotic surgery for rectal cancer was performed.Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE)using the key words"rectum","rectal","cancer","laparoscopy","robot".After the initial screen of 266 articles,43 papers were selected for review.A total of 3013 patients were included in the review.The most commonly performed intervention was low anterior resection(1450 patients,48.1%),followed by anterior resections(997 patients,33%),ultra-low anterior resections(393 patients,13%)and abdominoperineal resections(173 patients,5.7%).Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function.Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times.This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative,clinical outcomes and incidence of complications.In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide,until now,any significant clinical advantages to the patients.
基金Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01C297.
文摘BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.
文摘AIM: To give a comprehensive review of current litera-ture on robotic rectal cancer surgery.METHODS: A systematic review of current literature via PubMed and Embase search engines was per-formed to identify relevant articles from january 2007 to november 2013. The keywords used were: "robotic surgery", "surgical robotics", "laparoscopic computer-assisted surgery", "colectomy" and "rectal resection". RESULTS: After the initial screen of 380 articles, 20 pa-pers were selected for review. A total of 1062 patients(male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review.Out of 1062 robotic-assisted operations, 831(78.2%) anterior and low anterior resections, 132(12.4%) in-tersphincteric resection with coloanal anastomosis, 98(9.3%) abdominoperineal resections and 1(0.1%) Hart-mann's operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has con-tinued to evolve to its current state with promising re-sults; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.
文摘BACKGROUND Anastomotic leakage(AL)after restorative surgery for rectal cancer(RC)is associated with significant morbidity and mortality.AIM To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study.METHODS To identify risk factors for AL,a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed.Clinical,demographic and operative features,intraoperative outcomes and oncological characteristics were evaluated.RESULTS The incidence of AL was 10.4%,with a mean time interval of 6.2±2.1 d.Overall mortality was 0.8%.Mortality was higher in patients with AL(4.9%)than in patients without leak(0.4%,P=0.009).Poor bowel preparation,blood transfusion,median age,prognostic nutritional index<40 points,tumor diameter and intraoperative blood loss were identified as risk factors for AL.Location of anastomosis,number of stapler cartridges used to divide the rectum,diameter of circular stapler,level of vascular section,T and N status and stage of disease were also correlated to AL in our patients.The diverting ileostomy did not reduce the leak rate,while the use of the transanastomic tube significantly did.CONCLUSION Clinical,surgical and pathological factors are associated with an increased risk of AL.It adversely affects the morbidity and mortality of RC patients.
文摘In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.
文摘BACKGROUND Radical surgery is a preferred treatment for colorectal carcinoma,wherein nursing intervention is essential for postoperative recovery and prevention of complications.Recently,the application of humanistic care in medical care has attracted attention.Humanistic care emphasizes comprehensive care,with importance attached to patients’physical needs as well as psychological and emotional support to provide more humane and personalized care services.However,no clinical reports have examined the use of humanistic care in patients undergoing radical surgery for colorectal carcinoma.AIM To investigate the influence of humanistic care-based operating room nursing on the safety,postoperative recovery,and nursing satisfaction of patients who have undergone radical surgery for colorectal carcinoma.METHODS In total,120 patients with rectal cancer who underwent surgery in Zhongnan Hospital of Wuhan University between August 2023 and March 2024 were selected and grouped based on the nursing methods employed.Of these patients,55 were treated with routine nursing intervention(control group)and 65 were provided humanistic care-based operating room nursing(research group).The patients’vital signs were recorded,including systolic/diastolic blood pressure(SBP/DBP)and heart beats per minute(BPM),as well as serum stress indices,including norepinephrine(NE),adrenal hormone(AD),and cortisol(Cor).Postoperative recovery and complications were also recorded.Patients’negative emotions,life hope,and nursing satisfaction were evaluated using the Self-rating Depression/Anxiety Scale(SDS/SAS),Herth Hope Index(HHI),and self-deve-loped nursing satisfaction questionnaire,respectively.RESULTS During emergence from anesthesia,SBP,DBP,and BPM levels were found to be lower in the research group than those in the control group,also serum Cor,AD,and NE levels were lower.In addition,the research group had shorter operative,awakening,anal exhaust,first postoperative ambulation,drainage tube removal,intestinal recovery,and hospital times.The total complication rate and the SDS and SAS scores were lower in the research group than those in the control group.The HHI and nursing satisfaction scores were higher in the research group.CONCLUSION Humanistic care-based operating room nursing can mitigate physiological stress responses,reduce postoperative complications,promote postoperative recovery,relieve adverse psychological emotions,and enhance life hope and nursing satisfaction in patients undergoing radical surgery for colorectal carcinoma,which can be popularized in clinical practice.
基金the National Natural Science Foundation of China,No.81874201Technology Plan Project,No.20Y11908300+2 种基金Shanghai Medical Key Specialty Construction Plan,No.ZK2019A19Shanghai Municipal Commission of Health and Family Planning,No.202040122and Shanghai Pujiang Program,No.21PJD066.
文摘BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.
文摘Introduction:Robotic systems are designed to address the limitations of laparoscopic surgery,leading to a growing interest in robotic rectal surgery.However,certain technical limitations associated with the previous systems(da Vinci S&Si)have arguably slowed down its wholesale adoption.The latest robotic platform,the da Vinci Xi,addresses these limitations.This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems.Materials and methods:All consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases.The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed.Results:A total of 240 patients were identified(124 Si,116 Xi).Median operation-time and length-of-stay were 260 minutes and 6 days respectively.Conversion and 30-day mortality rates were 0.The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group(230 vs 300 min,p=0.000)but length-of-stay,lymph node yield and circumferential resection margin favoured the Xi group(7 vs 5 days,p=0.010;17 vs 21,p=0.000;92.7%vs 99.1%,p=0.020).Conclusion:Single-docking fully-robotic rectal cancer surgery is safe,feasible and can lead to good shortterm outcomes,making it a good alternative to laparoscopic rectal cancer surgery.The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion.
文摘Objective: to explore the effect of the concept of accelerated repair on postoperative complications of rectal cancer patients complicated with lower rectal cancer undergoing anorectal endoscopic repair. Methods: a random number table was used to investigate 80 rectal cancer patients in our hospital, and they were divided into control group and follow-up group from 2019 to 2021. Different from the control group, the combined therapy of abdominal cavity and anus endoscope was adopted in this group. The operation concept of accelerating rehabilitation was adopted in both groups of patients, and the patients discharge and discharge conditions within one month were observed. Results: the main research found that the total incidence of postoperative complications was significantly reduced (7.50%, 27.50%), which was significantly higher than that of the normal group (P<0.05). Conclusion: the rapid rehabilitation therapy combined with laparoscopic and anorectal endoscopic resection has no obvious change in gastrointestinal function after rectal cancer surgery, and the postoperative recovery is better, which can reduce the complications of rectal cancer.
文摘To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE<sup>®</sup> and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.RESULTSThis is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.CONCLUSIONA series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
文摘Endoluminal vacuum-assisted therapy(EVT)has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients.Its application has been mainly reserved to low colorectal and colo-anal anastomoses.The main advantage of this new procedure is to ensure continuous drainage of the abscess cavity,to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess cavity.The reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement,percutaneous drainage,endoscopic clipping of the anastomotic defect or stent placement.Nevertheless,despite this procedure is gaining acceptance among the surgical community,indications,inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous,making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new procedure.Moreover,long-term and functional results are poorly reported.The present review is focused on critically analyzing the theoretical benefits and risks of the procedure,short-and long-term functional results and future direction in the application of EVT.
基金Supported by Huadong Medicine Joint Funds of the Zhejiang Provincial Natura Science Foundation of China,No.LHDMY22H160002.
文摘BACKGROUND Since Heald proposed the total mesorectal excision(TME)procedure,the prognosis of patients with rectal cancer has been significantly improved.But Heald did not specifically describe the anterior surgical plane in female patients.And the surgical plane for mobilizing the anterior rectal wall during TME surgery in female patients remains controversial.AIM To investigate the anatomy of the female pelvis and identify the optimal plane for mobilizing the anterior rectal wall.METHODS We retrospectively collected surgical procedure videos and clinical data of female patients diagnosed with middle or low rectal cancer who underwent the TME procedure between January 2020 and October 2022 across six hospitals.The patients were divided into two groups based on the surgical approach used to mobilize the anterior rectal wall:The experimental group was to open the peritoneum at the lowest point of the peritonea reflection and enter the plane for mobilizing,while the control group was cut at 0.5-1 cm above the peritoneal reflection and enter another plan.Then,we compared the preoperative and postoperative information between the two groups.We also dissected and observed ten adult female pelvises to analyze the anatomic structure and compare the entry plane between the two approaches.Finally,we researched the pathological structure between the rectum and the vagina.RESULTS Finally,77 cases that met the criteria were included in our study.Our observations revealed that the experimental group underwent a smooth procedure,entering the plane amidst the mesorectal fascia and adventitia of the vagina,whereas the control group entered the plane between the vaginal adventitia and muscle layers.Compared to the control group,the experimental group showed a significant decrease in intraoperative bleeding[22.5(19.5-50)mL vs 17(5-20)mL,P=0.01],as well as a shorter duration of hospitalization[9(7-11.25)d vs 7(6-10)d,P=0.03].Through the examination of surgical videos and cadaveric studies,we discovered that Denonvilliers'fascia is absent in females.Additionally,pathological sections further revealed the absence of Denonvilliers'fascia in females,with only loose connective tissue present between the mesorectal fascia and adventitia of the vagina.CONCLUSION The plane amidst the mesorectal fascia and vaginal adventitia is the optimal surgical plane to mobilize the anterior rectal wall for female patients undergoing the TME procedure.
文摘In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended.The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.
文摘Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis. Curative resection is currently the only effective treatment, and the efficacy of chemotherapy is unclear. This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma. We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases. He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil, leucovorin and oxaliplatin plus bevacizumab, FOLFIRI consisting of 5-fluorouracil, leucovorin and irinotecan plus bevacizumab, and irinotecan plus cetuximab. One of the liver tumors showed a different response to chemotherapy and was diag-nosed as a leiomyosarcoma following histopathological examination. This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas. The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors.
文摘Objective: to analyze the effect of acupoint massage of traditional Chinese medicine nursing combined with acupoint application of fructus evodia on postoperative gastrointestinal function recovery of rectal cancer patients. Methods: 30 patients with rectal cancer were included in the observation, and the time was set from January 2020 to January 2021. According to nursing differences, the patients were divided into control group and observation group. The former was given routine nursing, while the latter was combined with acupoint massage and acupoint application of fructus evodia. Results: the recovery effect of gastrointestinal function was better than that of control group (P < 0.05). Compared with the data of the control group, the incidence of complications in the observation group was lower, P < 0.05;Compared with the control group, the nursing satisfaction in the observation group was significantly higher (P < 0.05). Conclusion: combined with acupoint massage and evodia rutaecarpa acupoint application, the recovery effect of gastrointestinal function in patients with rectal cancer after operation is better, and can reduce the incidence of complications. At the same time, it has obtained the satisfactory evaluation degree of most patients, which is worthy of promotion.
基金supported in part by the Beijing Municipal Natural Science Foundation[grant number 7222192].
文摘Introduction Temporary ileostomy or colostomy is often required in low anterior resection for rectal cancer,especially after neoadjuvant chemoradiotherapy or insufficient blood supply at the anastomosis site.A common complication in these cases is diversion colitis(DC),a nonspecific inflammation of the defunctioned colon.First described in 1972,DC occurs in up to 100%of colonoscopies postsurgery,with around 30%of patients experiencing symptoms like abdominal pain,diarrhea,mucus,or hematochezia[1].
文摘Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy.This problematic complication could lead to multiple operations,stoma formation,sexual dysfunction,fecal incontinence and psychosocial ramifications.This review comprehensively covers an overview of its incidence,risk factors,presentation and evaluation,management(ranging from conservative measures,endoscopic treatment and local tissue repair to radical resection and redo anastomosis)and treatment outcomes of rectovaginal fistula after low anterior resection.Notably,these therapeutic options and outcomes are influenced by several factors,including the size and location of the fistula,tumor clearance,cancer staging,quality of colorectal anastomosis and surrounding tissue,presence of diverting stoma,previous attempted repair,and the surgeon’s experience.Also,strategies to prevent rectovaginal fistula after low anterior resection are presented with illustrations.Finally,a decision-making algorithm for managing this complication is proposed.
