Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and...Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and stable view, articulated instruments, and reduction of physiologic tremors leading to superior dexterity and ergonomics. Therefore, robotic platforms could potentially address limitations of laparoscopic rectal surgery. It was aimed at reviewing current literature on short-term clinical and oncological(pathological) outcomes after robotic rectal cancer surgery in comparison with laparoscopic surgery. A systematic review was performed for the period 2002 to 2014. A total of 1776 patients with rectal cancer underwent minimally invasive robotic treatment in 32 studies. After robotic and laparoscopic approach to oncologic rectal surgery, respectively, mean operating time varied from 192-385 min, and from 158-297 min; mean estimated blood loss was between 33 and 283 mL, and between 127 and 300 mL; mean length of stay varied from 4-10 d; and from 6-15 d. Conversion after robotic rectal surgery varied from 0% to 9.4%, and from 0 to 22% after laparoscopy. There was no difference between robotic(0%-41.3%) and laparoscopic(5.5%-29.3%) surgery regarding morbidity and anastomotic complications(respectively, 0%-13.5%, and 0%-11.1%). Regarding immediate oncologic outcomes, respectively among robotic and laparoscopic cases, positive circumferential margins varied from 0% to 7.5%, and from 0% to 8.8%; the mean number of retrieved lymph nodes was between 10 and 20, and between 11 and 21; and the mean distal resection margin was from 0.8 to 4.7 cm, and from 1.9 to 4.5 cm. Robotic rectal cancer surgery is being undertaken by experienced surgeons. However, the quality of the assembled evidence does not support definite conclusions about most studies variables. Robotic rectal cancer surgery is associated to increased costs and operating time. It also seems to be associated to reduced conversion rates. Other short-term outcomes are comparable to conventional laparoscopy techniques, if not better. Ultimately, pathological data evaluation suggests that oncologic safety may be preserved after robotic total mesorectal excision. However, further studies are required to evaluate oncologic safety and functional results.展开更多
2D thermo-mechanical models are constructed to investigate the effects of oceanic and continental crustal eclogitization on plate dynamics at three successive stages of oceanic subduction, slab breakoff, and continent...2D thermo-mechanical models are constructed to investigate the effects of oceanic and continental crustal eclogitization on plate dynamics at three successive stages of oceanic subduction, slab breakoff, and continental subduction. Crustal eclogitization directly increases the average slab density and accordingly the slab pull force, which makes the slab subduct deeply and steeply. Numerical results demonstrate that the duration time from initial continental collision to slab breakoff largely depends on the slab pull force. Specifically, eclogitization of subducted crust can greatly decrease the duration time, but increase the breakoff depth. The detachment of oceanic slab from the pro-continental lithosphere is accompanied with obvious exhumation of the subducted continental crust and a sharp uplift of the collision zone in response to the disappearance of downward drag force and the induced asthenospheric upwelling, especially under the condition of no or incomplete crustal eclogitization. During continental subduction, the slab dip angle is strongly correlated with eclogitization of subducted continental lower crust, which regulates the slab buoyancy nature. Our model results can provide several important implications for the Himalayan-Tibetan collision zone. For example, it is possible that the lateral variations in the degree of eclogitization of the subducted Indian crust might to some extent contribute to the lateral variations of subduction angle along the Himalayan orogenic belt. Moreover, the accumulation of highly radiogenic sediments and upper continental crustal materials at the active margin in combination with the strong shear heating due to continuous continental subduction together cause rising of isotherms in the accretionary wedge, which facilitate the development of crustal partial melting and metamorphism.展开更多
This review is intended to shed new light on the role of neutrophils in colorectal cancer and in the meanwhile emphasiz</span><span style="font-family:Verdana;">e</span><span style="...This review is intended to shed new light on the role of neutrophils in colorectal cancer and in the meanwhile emphasiz</span><span style="font-family:Verdana;">e</span><span style="font-family:""><span style="font-family:Verdana;"> the differences between rectal and colon cancer, strengthen and highlight the possibility of a clinical prognostic and predictive scoring (Sarandria Score). A novel scoring system described in this review can be used as inclusion criteria and as a predictive and prognostic scoring for stage III rectal cancer patients. </span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Colorectal Cancer (CRC) is a major public health problem, representing the third most commonly diagnosed cancer in males and the second in females. Various studies have reported relevant differences related to CRC primary location site (right-sided colon, left-sided colon, rectum) including response to adjuvant chemotherapy and prognosis. In stage III CRC patients, previous findings showed that higher density of tumor-associated neutrophils (TANs) was associated with better response to 5-FU-based chemotherapy. </span><b><span style="font-family:Verdana;">Main topics:</span></b><span style="font-family:Verdana;"> In this review</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the current knowledge status on the role of neutrophils in colorectal cancer is assessed, including novel finding discovered by Dr</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> Nicola Sarandria on the role of neutrophils in rectal cancer. It includes different factors which point to an anti-tumoral role of neutrophils in rectal cancer when in presence of chemotherapeutic agents (such as 5-fluorouracil). The clinical significance of TANs was assessed and whether it can be different depend</span><span style="font-family:Verdana;">ed</span><span style="font-family:""><span style="font-family:Verdana;"> on the location of the primary CRC (right-sided colon, left-sided colon, rectum). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> This review officially highlights the possibility of a new clinical prognostic and predictive scoring (Sarandria Score) involving intratumoral neutrophilic infiltration in rectal cancer and the possibility of a new inclusion criteri</span></span><span style="font-family:Verdana;">on</span><span style="font-family:Verdana;"> based on this infiltrate for Stage III rectal cancer patients treated with 5-FU therapy. This review includes knowledge from data published on my medical degree thesis showing that higher levels of TANs densities were associated with better disease-free survival (DFS) in 5-FU treated patients affected by rectal cancer (while it was inversely related in patients without 5-FU therapy). This </span><span style="font-family:Verdana;">i</span><span style="font-family:Verdana;">s also further evidence in support of a possible conceptual division of what is now known as colorectal cancer into two separate entities: colon and rectal cancer.展开更多
文摘Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and stable view, articulated instruments, and reduction of physiologic tremors leading to superior dexterity and ergonomics. Therefore, robotic platforms could potentially address limitations of laparoscopic rectal surgery. It was aimed at reviewing current literature on short-term clinical and oncological(pathological) outcomes after robotic rectal cancer surgery in comparison with laparoscopic surgery. A systematic review was performed for the period 2002 to 2014. A total of 1776 patients with rectal cancer underwent minimally invasive robotic treatment in 32 studies. After robotic and laparoscopic approach to oncologic rectal surgery, respectively, mean operating time varied from 192-385 min, and from 158-297 min; mean estimated blood loss was between 33 and 283 mL, and between 127 and 300 mL; mean length of stay varied from 4-10 d; and from 6-15 d. Conversion after robotic rectal surgery varied from 0% to 9.4%, and from 0 to 22% after laparoscopy. There was no difference between robotic(0%-41.3%) and laparoscopic(5.5%-29.3%) surgery regarding morbidity and anastomotic complications(respectively, 0%-13.5%, and 0%-11.1%). Regarding immediate oncologic outcomes, respectively among robotic and laparoscopic cases, positive circumferential margins varied from 0% to 7.5%, and from 0% to 8.8%; the mean number of retrieved lymph nodes was between 10 and 20, and between 11 and 21; and the mean distal resection margin was from 0.8 to 4.7 cm, and from 1.9 to 4.5 cm. Robotic rectal cancer surgery is being undertaken by experienced surgeons. However, the quality of the assembled evidence does not support definite conclusions about most studies variables. Robotic rectal cancer surgery is associated to increased costs and operating time. It also seems to be associated to reduced conversion rates. Other short-term outcomes are comparable to conventional laparoscopy techniques, if not better. Ultimately, pathological data evaluation suggests that oncologic safety may be preserved after robotic total mesorectal excision. However, further studies are required to evaluate oncologic safety and functional results.
基金financial supports by the National Natural Science Foundation of China(Nos.41490613,41190073 and 41304071)the National Basic Research Program of China(Nos.2014CB440901 and 2015CB856106)
文摘2D thermo-mechanical models are constructed to investigate the effects of oceanic and continental crustal eclogitization on plate dynamics at three successive stages of oceanic subduction, slab breakoff, and continental subduction. Crustal eclogitization directly increases the average slab density and accordingly the slab pull force, which makes the slab subduct deeply and steeply. Numerical results demonstrate that the duration time from initial continental collision to slab breakoff largely depends on the slab pull force. Specifically, eclogitization of subducted crust can greatly decrease the duration time, but increase the breakoff depth. The detachment of oceanic slab from the pro-continental lithosphere is accompanied with obvious exhumation of the subducted continental crust and a sharp uplift of the collision zone in response to the disappearance of downward drag force and the induced asthenospheric upwelling, especially under the condition of no or incomplete crustal eclogitization. During continental subduction, the slab dip angle is strongly correlated with eclogitization of subducted continental lower crust, which regulates the slab buoyancy nature. Our model results can provide several important implications for the Himalayan-Tibetan collision zone. For example, it is possible that the lateral variations in the degree of eclogitization of the subducted Indian crust might to some extent contribute to the lateral variations of subduction angle along the Himalayan orogenic belt. Moreover, the accumulation of highly radiogenic sediments and upper continental crustal materials at the active margin in combination with the strong shear heating due to continuous continental subduction together cause rising of isotherms in the accretionary wedge, which facilitate the development of crustal partial melting and metamorphism.
基金Supported by the National Natural Science Foundation of China(12171335,12301603)the Science Development Project of Sichuan University(2020SCUNL201)the Scientific Foundation of Nanjing University of Posts and Telecommunications(NY221026)。
文摘This review is intended to shed new light on the role of neutrophils in colorectal cancer and in the meanwhile emphasiz</span><span style="font-family:Verdana;">e</span><span style="font-family:""><span style="font-family:Verdana;"> the differences between rectal and colon cancer, strengthen and highlight the possibility of a clinical prognostic and predictive scoring (Sarandria Score). A novel scoring system described in this review can be used as inclusion criteria and as a predictive and prognostic scoring for stage III rectal cancer patients. </span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Colorectal Cancer (CRC) is a major public health problem, representing the third most commonly diagnosed cancer in males and the second in females. Various studies have reported relevant differences related to CRC primary location site (right-sided colon, left-sided colon, rectum) including response to adjuvant chemotherapy and prognosis. In stage III CRC patients, previous findings showed that higher density of tumor-associated neutrophils (TANs) was associated with better response to 5-FU-based chemotherapy. </span><b><span style="font-family:Verdana;">Main topics:</span></b><span style="font-family:Verdana;"> In this review</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the current knowledge status on the role of neutrophils in colorectal cancer is assessed, including novel finding discovered by Dr</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> Nicola Sarandria on the role of neutrophils in rectal cancer. It includes different factors which point to an anti-tumoral role of neutrophils in rectal cancer when in presence of chemotherapeutic agents (such as 5-fluorouracil). The clinical significance of TANs was assessed and whether it can be different depend</span><span style="font-family:Verdana;">ed</span><span style="font-family:""><span style="font-family:Verdana;"> on the location of the primary CRC (right-sided colon, left-sided colon, rectum). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> This review officially highlights the possibility of a new clinical prognostic and predictive scoring (Sarandria Score) involving intratumoral neutrophilic infiltration in rectal cancer and the possibility of a new inclusion criteri</span></span><span style="font-family:Verdana;">on</span><span style="font-family:Verdana;"> based on this infiltrate for Stage III rectal cancer patients treated with 5-FU therapy. This review includes knowledge from data published on my medical degree thesis showing that higher levels of TANs densities were associated with better disease-free survival (DFS) in 5-FU treated patients affected by rectal cancer (while it was inversely related in patients without 5-FU therapy). This </span><span style="font-family:Verdana;">i</span><span style="font-family:Verdana;">s also further evidence in support of a possible conceptual division of what is now known as colorectal cancer into two separate entities: colon and rectal cancer.
