Objective:To evaluate the safety and effectiveness of vacuum-assisted excision for benign intraductal papilloma of breast.Methods:The databases including PubMed,Embase,Cochrane Library,WangFang,CNIK,VIP and Web of Sci...Objective:To evaluate the safety and effectiveness of vacuum-assisted excision for benign intraductal papilloma of breast.Methods:The databases including PubMed,Embase,Cochrane Library,WangFang,CNIK,VIP and Web of Science were searched by computer,according the inclusion and exclusion criteria after screening of literature.The Cochrane handbook and Newcastle-Ottawa scale was used to evaluate the studies.Then the Review Manager 5.3 software was to used analyze the data.Results:A total of 1016 patients was included in 9 articles.The amount of blood loss in vacuum-assisted surgery was less than that in open surgery[MD=-6.38,95%CI(-9.90,-2.86),P<0.05].The drainage[MD=-2.56,95%CI(-4.97,-0.15,P<0.05]and drainage time[MD=-0.25,95%CI(-0.40,-0.09),P<0.05]in vacuum-assisted surgery was less than that in open surgery.There were also few postoperative complications than that in open surgery[RR=0.43,95%CI(0.29,0.64),P<0.05].Compared with open surgery,the postoperative recurrence rate was lower in vacuum-assisted surgery[RR=0.26,95%CI(0.14,0.49),P<0.05].Last,there was no statistically significant difference in the operative time between vacuum-assisted surgery and open surgery,[SD=-12.82,95%CI(-25.70,0.06),P=0.05].Conclusion:Compared with open surgery,vacuum-assisted excision has the advantages of less blood loss and lower postoperative complications,but the operative time is not statistically significant compared with open surgery.In addition,compared with open surgery in this study,vacuum-assisted excision has the advantages of lower recurrence rate,but it still needs long-term dynamic observation.展开更多
Background: Ultrasound-guided, vacuum-assisted excision [UGVAE] of fibroadenomas is an emerging minimally invasive procedure. UGVAE is being increasingly employed by breast radiologists and surgeons. It has been appro...Background: Ultrasound-guided, vacuum-assisted excision [UGVAE] of fibroadenomas is an emerging minimally invasive procedure. UGVAE is being increasingly employed by breast radiologists and surgeons. It has been approved for this use since 2006 by the National Institute for Health and Clinical Excellence in the UK. The aim of this systematic review is to evaluate the efficacy and safety of this procedure based on the up to date available evidence. Methods: A comprehensive literature search of the Cochrane library, Medline, Embase, PubMed, Google scholar, Trip-database, Internet, and the reference lists of relevant articles was performed. We searched for literature with sizeable cases of therapeutic vacuum-assisted excision of fibroadenomas. All prospective studies with more than 20 study participants were screened. The study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach. All were in English. Results: Of the four case series that fulfilled the inclusion criteria there were 516 patients in which 520 procedures were performed. Overall complete excision rate was 89.4%. In two of the studies, this was 100% when the lesions were less than 1.5 cm but reduced to 61% when between 1.5 and 2 cm. Most common significant complication was bleeding with 2 cases of pneumothorax. None of the studies can be regarded as high quality going by GRADE approach. Conclusion: Within the limit of the current published case series, UGVAE appears to be an effective and safe procedure for excision of small fibroadenomas of less than 15 mm in size. A well designed case control study or randomized controlled trials with a sufficient sample size is needed to further assess its safety, effectiveness and more importantly, patients’ satisfaction especially in larger sized fibroadenomas.展开更多
Background:Ultrasound‑guided vacuum-assisted excision(UGVAE)and breast biopsy are widely used for the diagnosis and treatment of both benign and suspicious breast lesions.In this retrospective study,we aimed to determ...Background:Ultrasound‑guided vacuum-assisted excision(UGVAE)and breast biopsy are widely used for the diagnosis and treatment of both benign and suspicious breast lesions.In this retrospective study,we aimed to determine the safety of UGVAE for benign breast lesions and provide guidance for clinical practice.Methods:We analyzed clinical and pathological data of female patients who had undergone UGVAE between January 2015 and December 2017 at our institution.All breast lesions were categorized according to the Breast Imaging Reporting and Data System(BI-RADS)before performing UGVAE.Results:In our study cohort,UGVAE was used to resect 10,378 breast lesions from 5789 patients,and selected clinical and histopathological data were analyzed.The most common adverse events were postoperative bleeding(0.24%)and skin hypersensitivity(0.67%).The residual lesion rate was 2.27%.Fibroadenomas accounted for most of the benign lesions(7932 of 10,193;77.82%).Breast cancer was diagnosed in 150 lesions from 128 patients.Multivariable binary logistic regression analyses showed that older age(odds ratio[OR]=2.034,95%confidence interval[CI]:1.668–2.480,p<0.001),higher BI-RADS category(OR=9.514,95%CI:6.790–13.332,p<0.001),and larger legion size(OR=1.048,95%CI:1.019–1.077,p=0.001)were associated with an increased likelihood of breast cancer.Ninety-six patients with breast cancer had undergone follow-up treatment,achieving a 3-year disease-free survival rate of 97.2%and a 3-year overall survival rate of 100%.Conclusions:UGVAE is a safe and effective means of removing benign breast lesions,causing minimal postoperative trauma and fewer complications compared with open surgery.Moreover,UGVAE had little impact on the follow-up treatment and survival of patients diagnosed with breast cancer.展开更多
Objective To compare and evaluate the efficacy of diagnosis and excision for appropriately selected breast multi-focal lesions and solitary lesion by ultrasound-guided vacuum-assisted biopsy(UGVAB).Methods Among 392 a...Objective To compare and evaluate the efficacy of diagnosis and excision for appropriately selected breast multi-focal lesions and solitary lesion by ultrasound-guided vacuum-assisted biopsy(UGVAB).Methods Among 392 appropriately selected patients,187 patients with multi-focal lesions and 205 patients with solitary lesion were treated by the 8-gauge UGVAB from May 2007 to June 2009.All lesions were removed as completely as possible.The patients with benign pathology underwent physical and ultrasound examinations at one week and 6 months after procedure.Results During the procedure,only three patients had vasovagal syncope and twenty others complained of other intraoperative discomfort.An accurate pathological diagnosis was obtained in all lesions.There was no apparent false-negative result among the 696 lesions with benign pathology at a follow-up of 6 months after procedure.The rates of malignant or premalignant pathology,postoperative complications and residual lesions in patients with multi-focal lesions were higher than those in patients with solitary lesion.If each lesion was considered as a subject of study,there was no significant difference between the two groups.Conclusion UGVAB is an effective method for diagnosis and excision of appropriately selected breast multi-focal lesions and can be used routinely.展开更多
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be...BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.展开更多
In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(...In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(LapTME)in the management of low-lying locally advanced rectal cancer(LARC).We focus specifically on the rate of postoperative complications between the two using existing data from the literature.We additionally introduce robotic total mesorectal excision(RTME)and look at its postoperative complications relative to the TaTME and LapTME.LARC has been conventionally approached by open surgery.However,minimally invasive techniques have emerged over the past two decades as alternatives to open total mesorectal excision,namely robotic,laparoscopic,and transanal.Each approach has its supporters,but conflicting data on resection outcomes and complications has fueled ongoing debate over the optimal minimally invasive technique for low/mid-LARC.This article aims to extend on the data regarding the use of TaTME and RTME in the treatment of low/mid-LARC and further elaborate on their comparative efficacy relative to LapTME.展开更多
Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or force...Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or forceps to save the newborn. The purpose of this study was to determine the prevalence of vacuum-assisted vaginal delivery (VAVD) and its associated short-term maternal and neonatal outcomes at Ndola Teaching Hospital. Methods: A retrospective cross-sectional descriptive study through the analysis of routine data for women with singleton-term pregnancies who delivered by vacuum compared with spontaneous vaginal delivery was done at a tertiary hospital for the years 2020 and 2021. Chi-square and Logistic regression were used to investigate factors of vacuum delivery and to adjust for potential confounders. Results: Results showed that VAVD was mostly performed in women who had delayed second stage of labour (25.4%), maternal exhaustion (16.0%), foetal distress in the second stage of labour (12.3%). The overall VAVD prevalence was 3.7% (581/15591). Logistic regression showed that multiparous women were noted to be 87.5% (aOR 0.125;95% CI 0.025 - 0.629;p = 0.012) less likely to undergo VAVD compared to nulliparous women. Registrars were almost 6 times (aOR 5.650;95% CI 1.458 - 22.222, p = 0.012) more likely to conduct VAVD compared to midwives. Episiotomy was 3 times (aOR 3.390;95% CI 1.185 - 9.524;p Conclusion: The findings indicate the underutilisation of VAVD at NTH based on the low prevalence of 3.7%. VAVD outcomes were affected by multiparity, skill level and Episiotomy procedure, in addition, VAVD influenced admission to the NICU. Hence, there is a need to increase skills in VAVD among first-line healthcare workers such as midwives and intern doctors.展开更多
Local excision(LE)is an effective treatment option for rectal cancer that shows significant regression following neoadjuvant chemoradiotherapy.Compared to traditional total mesorectal excision(TME),LE can achieve comp...Local excision(LE)is an effective treatment option for rectal cancer that shows significant regression following neoadjuvant chemoradiotherapy.Compared to traditional total mesorectal excision(TME),LE can achieve comparable on-cological outcomes while preserving function and improving quality of life(QoL).The indications for LE have been gradually expanded,but there are uncertainties regarding postoperative oncological results.Long-term follow-up prospective randomized controlled trials comparing TME and LE in terms of both oncological outcomes and QoL could help reduce uncertainties between these two approaches and contribute to the development of evidence-based guidelines for rectal cancer treatment.展开更多
AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patie...AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics,tumor characteristics,operative details,postoperative outcomes,pathologic findings,and follow-ups. RESULTS:Full-thickness excision using TEM was performed as a primary excision(n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy(n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm,and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min,and the mean blood loss was 13.5 ± 6.6 m L. No minor morbidities,transient fecal incontinence,or wound dehiscence was found. Histopathologically,all tumors showed typical histology without lymphatic or vessel infiltration,and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy,9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. Norecurrence was noted during the median of 3 years' follow-up.CONCLUSION:Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.展开更多
AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal c...AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal cancer underwent laparoscopic radical resection and the specimen was retrieved by two different ways:transvaginal or transanal rectal removal.Transvaginal specimen extraction approach was strictly limited to elderly post-menopausal women who need hysterectomy.Patients aged between 30 and 80 years,with a body mass index of less than 30 kg/m2, underwent elective surgery.The surgical technique and the outcomes related to the specimen extraction,such as duration of surgery,length of hospital stay,and the complications were retrospectively reviewed. RESULTS:Laparoscopic resection using a natural orifice removal approach was successful in all of the 21 patients.Median operating time was 185 min(range,122-260 min)and the estimated blood loss was 48 mL. The mean length of hospital stay was 7.5 d(range,2-11 d).One patient developed postoperative ileus and had an extended hospital stay.The patient complained of minimal pain.There were no postoperative complications or surgery-associated death.The mean size of the lesion was 2.8 cm(range,1.8-6.0 cm),and the mean number of lymph nodes harvested was 18.7(range, 8-27).At a mean follow-up of 20.6 mo(range,10-37 mo),there were no functional disorders associated with the transvaginal and transanal specimen extraction. CONCLUSION:Transvaginal or transanal extraction in L-TME is a safe and effective procedure.Natural orifice specimen extraction can avoid the abdominal wall incision and its potential complications.展开更多
AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.METHODS: This is a retrospective study on a prospectively collected database containing 111 patien...AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.展开更多
AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal ...AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016.Patients were classified into the modified primary closure group(32 patients) and the biological mesh closure group(44 patients).The total operating time,reconstruction time,postoperative stay duration,total cost,postoperative complications and tumor recur-rence were compared.RESULTS All surgery was successfully performed.The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group,which was significantly longer than that of the biological mesh closure group(7.2 ± 1.9 min,P < 0.001).The total operating time was not different between the two groups(236 ± 20 min vs 248 ± 43 min,P = 0.143).The postoperative hospital stay duration was 8.1 ± 1.9 d,and the total cost was 9297 ± 1260 USD for the modified primary closure group.Notably,both of these categories were significantly lower in this group than those of the biological mesh closure group(P = 0.001 and P = 0.003,respectively).There were no differences observed between groups when comparing other perioperative data,long-term complications or oncological outcomes.CONCLUSION The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible,safe and cost-effective.展开更多
Breast cancer(BC) is the most common cancer among women worldwide. The aetiology and carcinogenesis of BC are not clearly defined, although genetic, hormonal, lifestyle and environmental risk factors have been establi...Breast cancer(BC) is the most common cancer among women worldwide. The aetiology and carcinogenesis of BC are not clearly defined, although genetic, hormonal, lifestyle and environmental risk factors have been established. The most common treatment for BC includes breast-conserving surgery followed by a standard radiotherapy(RT) regimen. However, radiation hypersensitivity and the occurrence of RT-induced toxicity in normal tissue may affect patients' treatment. The role of DNA repair in cancer has been extensively investigated, and an impaired DNA damage response may increase the risk of BC and individual radiosensitivity. Single nucleotide polymorphisms(SNPs) in DNA repair genes may alter protein function and modulate DNA repair efficiency, influencing the development of various cancers, including BC. SNPs in DNA repair genes have also been studied as potential predictive factors for the risk of RT-induced side effects. Here, we review the literature on the association between SNPs in base excision repair(BER) genes and BC risk. We focusedon X-ray repair cross complementing group 1(XRCC1), which plays a key role in BER, and on 8-oxoguanine DNA glycosylase 1, apurinic/apyrimidinic endonuclease 1 and poly(ADP-ribose) polymerase-1, which encode three important BER enzymes that interact with XRCC1. Although no association between SNPs and radiation toxicity has been validated thus far, we also report published studies on XRCC1 SNPs and variants in other BER genes and RT-induced side effects in BC patients, emphasising that large well-designed studies are needed to determine the genetic components of individual radiosensitivity.展开更多
Objective： To evaluate the feasibility and safety of total mesopancreas excision （TMpE） in the treatment of pancreatic head cancer. Methods： The clinical and pathological data of 120 patients with pancreatic head ...Objective： To evaluate the feasibility and safety of total mesopancreas excision （TMpE） in the treatment of pancreatic head cancer. Methods： The clinical and pathological data of 120 patients with pancreatic head cancer who had undergone TMpE in our center from May 2010 to January 2014 were retrospectively analyzed. Results： The mean operative time was （275.0±50.2） min and the average intra-operative blood loss was （390.0±160.5） mL. Post-operative complications were reported in 45 patients, while no peri-operative death was noted. The specimen margins were measured in three dimensions, and 86 patients （71.6%） achieved R0 resection. Conclusions： TMpE is safe and feasible for pancreatic head cancer and is particularly helpful to increase the R0 resection rate.展开更多
Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have goo...Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.展开更多
Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as...Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.展开更多
Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and ...Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail,focusing on the latest studies of the mesenteric organ,its dissection by mesofascial and retrofascial cleavage planes,and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen,yielded through mesocolic,intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence,overall and disease-free survival,according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence,which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection,laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery,with all the advantages of laparoscopic techniques,both in faster recovery and better immunological response. The importance of minimally invasive mesoresectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.展开更多
The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and ...The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.展开更多
Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses recei...Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasoundguided vacuum-assisted system.The pathology of patients,results of hematoma development and outcome,influence factors for hematoma occurrence(nodule size,nodule location,number of nodule,breast shape,menstrual period,efficacy time of bandage,and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions,fibroadenosis in 127 lesions,intraductal papillomas in 39 lesions,inflammatory change in 4 lesions,retention cyst of the breast in 3 lesions,and benign phyllodes tumor in 1 lesion.Thirty hematomas were observed in patients(9.6%).Finally,97.0%hematomas were absorbed completely within 6 months follow-up.The incidence rates of hematoma were increased by 24.7%,10.0%,63.2%,13.9%in the nodule diameter larger or equal to 25 mm group,removal of larger or equal to two nodules once time from one patient group,menstrual period group,and larger and loose breast group,respectively(all P<0.05).However,the incidences were decreased by 60.6%in the bandage performed for 12-24 hours or beyond 24 hours group(P<0.05).The multiple logistic regression models revealed that nodule size(x^2=15.227,P<0.001),number of nodule(x^2=7.767,P=0.005),menstrual period(x^2=24.530,P<0.001),and breast shape(x^2=9.559,P=0.002) were independent risk factors associated with hematoma occurrence,but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size,number of nodule,menstrual period,breast shape,and efficacy time of bandage.展开更多
Transanal total mesorectal excision(TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the ...Transanal total mesorectal excision(TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the limits of standard low anterior resection. TaTME might help to decrease the conversion rate especially in difficult patients, and to improve the pathological results, while preserving the urogenital function. Evaluation of data from large registries and randomized studies should help to draw firmer conclusions. Beyond these technical considerations, the next challenge seems to be clearly the safe introduction of this approach, motivating the development of dedicated courses.展开更多
基金This study was supported by Key R&D Program of Hainan Province(No.ZDYF2017087)In-Hospital Project of the Second Affiliated Hospital of Hainan Medical University[The Second Affiliated Hospital of Haiyi Medical University(No.2018-11)]。
文摘Objective:To evaluate the safety and effectiveness of vacuum-assisted excision for benign intraductal papilloma of breast.Methods:The databases including PubMed,Embase,Cochrane Library,WangFang,CNIK,VIP and Web of Science were searched by computer,according the inclusion and exclusion criteria after screening of literature.The Cochrane handbook and Newcastle-Ottawa scale was used to evaluate the studies.Then the Review Manager 5.3 software was to used analyze the data.Results:A total of 1016 patients was included in 9 articles.The amount of blood loss in vacuum-assisted surgery was less than that in open surgery[MD=-6.38,95%CI(-9.90,-2.86),P<0.05].The drainage[MD=-2.56,95%CI(-4.97,-0.15,P<0.05]and drainage time[MD=-0.25,95%CI(-0.40,-0.09),P<0.05]in vacuum-assisted surgery was less than that in open surgery.There were also few postoperative complications than that in open surgery[RR=0.43,95%CI(0.29,0.64),P<0.05].Compared with open surgery,the postoperative recurrence rate was lower in vacuum-assisted surgery[RR=0.26,95%CI(0.14,0.49),P<0.05].Last,there was no statistically significant difference in the operative time between vacuum-assisted surgery and open surgery,[SD=-12.82,95%CI(-25.70,0.06),P=0.05].Conclusion:Compared with open surgery,vacuum-assisted excision has the advantages of less blood loss and lower postoperative complications,but the operative time is not statistically significant compared with open surgery.In addition,compared with open surgery in this study,vacuum-assisted excision has the advantages of lower recurrence rate,but it still needs long-term dynamic observation.
文摘Background: Ultrasound-guided, vacuum-assisted excision [UGVAE] of fibroadenomas is an emerging minimally invasive procedure. UGVAE is being increasingly employed by breast radiologists and surgeons. It has been approved for this use since 2006 by the National Institute for Health and Clinical Excellence in the UK. The aim of this systematic review is to evaluate the efficacy and safety of this procedure based on the up to date available evidence. Methods: A comprehensive literature search of the Cochrane library, Medline, Embase, PubMed, Google scholar, Trip-database, Internet, and the reference lists of relevant articles was performed. We searched for literature with sizeable cases of therapeutic vacuum-assisted excision of fibroadenomas. All prospective studies with more than 20 study participants were screened. The study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach. All were in English. Results: Of the four case series that fulfilled the inclusion criteria there were 516 patients in which 520 procedures were performed. Overall complete excision rate was 89.4%. In two of the studies, this was 100% when the lesions were less than 1.5 cm but reduced to 61% when between 1.5 and 2 cm. Most common significant complication was bleeding with 2 cases of pneumothorax. None of the studies can be regarded as high quality going by GRADE approach. Conclusion: Within the limit of the current published case series, UGVAE appears to be an effective and safe procedure for excision of small fibroadenomas of less than 15 mm in size. A well designed case control study or randomized controlled trials with a sufficient sample size is needed to further assess its safety, effectiveness and more importantly, patients’ satisfaction especially in larger sized fibroadenomas.
基金Military Key Clinical Speciality(Grants:51561Z23612)Chongqing Talent Program Project(Grants:cstc2022ycjh-bgzxm0091)+1 种基金Chongqing Major Medical Research Program(Joint Program of Chongqing Municipal Health Commission and Science and Technology Bureau)(Grants:2024DBXM001)Chongqing Clinical Diagnosis and Treatment Center of Breast Cancer(Grants:425Z2a1).
文摘Background:Ultrasound‑guided vacuum-assisted excision(UGVAE)and breast biopsy are widely used for the diagnosis and treatment of both benign and suspicious breast lesions.In this retrospective study,we aimed to determine the safety of UGVAE for benign breast lesions and provide guidance for clinical practice.Methods:We analyzed clinical and pathological data of female patients who had undergone UGVAE between January 2015 and December 2017 at our institution.All breast lesions were categorized according to the Breast Imaging Reporting and Data System(BI-RADS)before performing UGVAE.Results:In our study cohort,UGVAE was used to resect 10,378 breast lesions from 5789 patients,and selected clinical and histopathological data were analyzed.The most common adverse events were postoperative bleeding(0.24%)and skin hypersensitivity(0.67%).The residual lesion rate was 2.27%.Fibroadenomas accounted for most of the benign lesions(7932 of 10,193;77.82%).Breast cancer was diagnosed in 150 lesions from 128 patients.Multivariable binary logistic regression analyses showed that older age(odds ratio[OR]=2.034,95%confidence interval[CI]:1.668–2.480,p<0.001),higher BI-RADS category(OR=9.514,95%CI:6.790–13.332,p<0.001),and larger legion size(OR=1.048,95%CI:1.019–1.077,p=0.001)were associated with an increased likelihood of breast cancer.Ninety-six patients with breast cancer had undergone follow-up treatment,achieving a 3-year disease-free survival rate of 97.2%and a 3-year overall survival rate of 100%.Conclusions:UGVAE is a safe and effective means of removing benign breast lesions,causing minimal postoperative trauma and fewer complications compared with open surgery.Moreover,UGVAE had little impact on the follow-up treatment and survival of patients diagnosed with breast cancer.
文摘Objective To compare and evaluate the efficacy of diagnosis and excision for appropriately selected breast multi-focal lesions and solitary lesion by ultrasound-guided vacuum-assisted biopsy(UGVAB).Methods Among 392 appropriately selected patients,187 patients with multi-focal lesions and 205 patients with solitary lesion were treated by the 8-gauge UGVAB from May 2007 to June 2009.All lesions were removed as completely as possible.The patients with benign pathology underwent physical and ultrasound examinations at one week and 6 months after procedure.Results During the procedure,only three patients had vasovagal syncope and twenty others complained of other intraoperative discomfort.An accurate pathological diagnosis was obtained in all lesions.There was no apparent false-negative result among the 696 lesions with benign pathology at a follow-up of 6 months after procedure.The rates of malignant or premalignant pathology,postoperative complications and residual lesions in patients with multi-focal lesions were higher than those in patients with solitary lesion.If each lesion was considered as a subject of study,there was no significant difference between the two groups.Conclusion UGVAB is an effective method for diagnosis and excision of appropriately selected breast multi-focal lesions and can be used routinely.
基金Supported by Health Research Project of Hunan Provincial Health Commission,No.D202315018915.
文摘BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.
文摘In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(LapTME)in the management of low-lying locally advanced rectal cancer(LARC).We focus specifically on the rate of postoperative complications between the two using existing data from the literature.We additionally introduce robotic total mesorectal excision(RTME)and look at its postoperative complications relative to the TaTME and LapTME.LARC has been conventionally approached by open surgery.However,minimally invasive techniques have emerged over the past two decades as alternatives to open total mesorectal excision,namely robotic,laparoscopic,and transanal.Each approach has its supporters,but conflicting data on resection outcomes and complications has fueled ongoing debate over the optimal minimally invasive technique for low/mid-LARC.This article aims to extend on the data regarding the use of TaTME and RTME in the treatment of low/mid-LARC and further elaborate on their comparative efficacy relative to LapTME.
文摘Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or forceps to save the newborn. The purpose of this study was to determine the prevalence of vacuum-assisted vaginal delivery (VAVD) and its associated short-term maternal and neonatal outcomes at Ndola Teaching Hospital. Methods: A retrospective cross-sectional descriptive study through the analysis of routine data for women with singleton-term pregnancies who delivered by vacuum compared with spontaneous vaginal delivery was done at a tertiary hospital for the years 2020 and 2021. Chi-square and Logistic regression were used to investigate factors of vacuum delivery and to adjust for potential confounders. Results: Results showed that VAVD was mostly performed in women who had delayed second stage of labour (25.4%), maternal exhaustion (16.0%), foetal distress in the second stage of labour (12.3%). The overall VAVD prevalence was 3.7% (581/15591). Logistic regression showed that multiparous women were noted to be 87.5% (aOR 0.125;95% CI 0.025 - 0.629;p = 0.012) less likely to undergo VAVD compared to nulliparous women. Registrars were almost 6 times (aOR 5.650;95% CI 1.458 - 22.222, p = 0.012) more likely to conduct VAVD compared to midwives. Episiotomy was 3 times (aOR 3.390;95% CI 1.185 - 9.524;p Conclusion: The findings indicate the underutilisation of VAVD at NTH based on the low prevalence of 3.7%. VAVD outcomes were affected by multiparity, skill level and Episiotomy procedure, in addition, VAVD influenced admission to the NICU. Hence, there is a need to increase skills in VAVD among first-line healthcare workers such as midwives and intern doctors.
文摘Local excision(LE)is an effective treatment option for rectal cancer that shows significant regression following neoadjuvant chemoradiotherapy.Compared to traditional total mesorectal excision(TME),LE can achieve comparable on-cological outcomes while preserving function and improving quality of life(QoL).The indications for LE have been gradually expanded,but there are uncertainties regarding postoperative oncological results.Long-term follow-up prospective randomized controlled trials comparing TME and LE in terms of both oncological outcomes and QoL could help reduce uncertainties between these two approaches and contribute to the development of evidence-based guidelines for rectal cancer treatment.
文摘AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics,tumor characteristics,operative details,postoperative outcomes,pathologic findings,and follow-ups. RESULTS:Full-thickness excision using TEM was performed as a primary excision(n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy(n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm,and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min,and the mean blood loss was 13.5 ± 6.6 m L. No minor morbidities,transient fecal incontinence,or wound dehiscence was found. Histopathologically,all tumors showed typical histology without lymphatic or vessel infiltration,and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy,9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. Norecurrence was noted during the median of 3 years' follow-up.CONCLUSION:Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.
基金Supported by Jilin University,China,No.3R211P163428
文摘AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal cancer underwent laparoscopic radical resection and the specimen was retrieved by two different ways:transvaginal or transanal rectal removal.Transvaginal specimen extraction approach was strictly limited to elderly post-menopausal women who need hysterectomy.Patients aged between 30 and 80 years,with a body mass index of less than 30 kg/m2, underwent elective surgery.The surgical technique and the outcomes related to the specimen extraction,such as duration of surgery,length of hospital stay,and the complications were retrospectively reviewed. RESULTS:Laparoscopic resection using a natural orifice removal approach was successful in all of the 21 patients.Median operating time was 185 min(range,122-260 min)and the estimated blood loss was 48 mL. The mean length of hospital stay was 7.5 d(range,2-11 d).One patient developed postoperative ileus and had an extended hospital stay.The patient complained of minimal pain.There were no postoperative complications or surgery-associated death.The mean size of the lesion was 2.8 cm(range,1.8-6.0 cm),and the mean number of lymph nodes harvested was 18.7(range, 8-27).At a mean follow-up of 20.6 mo(range,10-37 mo),there were no functional disorders associated with the transvaginal and transanal specimen extraction. CONCLUSION:Transvaginal or transanal extraction in L-TME is a safe and effective procedure.Natural orifice specimen extraction can avoid the abdominal wall incision and its potential complications.
文摘AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.
基金Supported by the National Key and Development Program of China,No.2016YFC0106003the National Natural Science Foundation of China,No.81700708/H0712the Key and Development Program of Shandong Province,No.2016GSF201125
文摘AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016.Patients were classified into the modified primary closure group(32 patients) and the biological mesh closure group(44 patients).The total operating time,reconstruction time,postoperative stay duration,total cost,postoperative complications and tumor recur-rence were compared.RESULTS All surgery was successfully performed.The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group,which was significantly longer than that of the biological mesh closure group(7.2 ± 1.9 min,P < 0.001).The total operating time was not different between the two groups(236 ± 20 min vs 248 ± 43 min,P = 0.143).The postoperative hospital stay duration was 8.1 ± 1.9 d,and the total cost was 9297 ± 1260 USD for the modified primary closure group.Notably,both of these categories were significantly lower in this group than those of the biological mesh closure group(P = 0.001 and P = 0.003,respectively).There were no differences observed between groups when comparing other perioperative data,long-term complications or oncological outcomes.CONCLUSION The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible,safe and cost-effective.
文摘Breast cancer(BC) is the most common cancer among women worldwide. The aetiology and carcinogenesis of BC are not clearly defined, although genetic, hormonal, lifestyle and environmental risk factors have been established. The most common treatment for BC includes breast-conserving surgery followed by a standard radiotherapy(RT) regimen. However, radiation hypersensitivity and the occurrence of RT-induced toxicity in normal tissue may affect patients' treatment. The role of DNA repair in cancer has been extensively investigated, and an impaired DNA damage response may increase the risk of BC and individual radiosensitivity. Single nucleotide polymorphisms(SNPs) in DNA repair genes may alter protein function and modulate DNA repair efficiency, influencing the development of various cancers, including BC. SNPs in DNA repair genes have also been studied as potential predictive factors for the risk of RT-induced side effects. Here, we review the literature on the association between SNPs in base excision repair(BER) genes and BC risk. We focusedon X-ray repair cross complementing group 1(XRCC1), which plays a key role in BER, and on 8-oxoguanine DNA glycosylase 1, apurinic/apyrimidinic endonuclease 1 and poly(ADP-ribose) polymerase-1, which encode three important BER enzymes that interact with XRCC1. Although no association between SNPs and radiation toxicity has been validated thus far, we also report published studies on XRCC1 SNPs and variants in other BER genes and RT-induced side effects in BC patients, emphasising that large well-designed studies are needed to determine the genetic components of individual radiosensitivity.
基金Supported by Shanghai municipal hospital burgeoning and leading edge technology projects No.SHDC12014109
文摘Objective： To evaluate the feasibility and safety of total mesopancreas excision （TMpE） in the treatment of pancreatic head cancer. Methods： The clinical and pathological data of 120 patients with pancreatic head cancer who had undergone TMpE in our center from May 2010 to January 2014 were retrospectively analyzed. Results： The mean operative time was （275.0±50.2） min and the average intra-operative blood loss was （390.0±160.5） mL. Post-operative complications were reported in 45 patients, while no peri-operative death was noted. The specimen margins were measured in three dimensions, and 86 patients （71.6%） achieved R0 resection. Conclusions： TMpE is safe and feasible for pancreatic head cancer and is particularly helpful to increase the R0 resection rate.
文摘Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.
文摘Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.
文摘Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail,focusing on the latest studies of the mesenteric organ,its dissection by mesofascial and retrofascial cleavage planes,and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen,yielded through mesocolic,intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence,overall and disease-free survival,according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence,which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection,laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery,with all the advantages of laparoscopic techniques,both in faster recovery and better immunological response. The importance of minimally invasive mesoresectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.
文摘The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.
基金Supported by the National Major Scientific Equipment Special Project(2012YQ16020304)
文摘Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasoundguided vacuum-assisted system.The pathology of patients,results of hematoma development and outcome,influence factors for hematoma occurrence(nodule size,nodule location,number of nodule,breast shape,menstrual period,efficacy time of bandage,and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions,fibroadenosis in 127 lesions,intraductal papillomas in 39 lesions,inflammatory change in 4 lesions,retention cyst of the breast in 3 lesions,and benign phyllodes tumor in 1 lesion.Thirty hematomas were observed in patients(9.6%).Finally,97.0%hematomas were absorbed completely within 6 months follow-up.The incidence rates of hematoma were increased by 24.7%,10.0%,63.2%,13.9%in the nodule diameter larger or equal to 25 mm group,removal of larger or equal to two nodules once time from one patient group,menstrual period group,and larger and loose breast group,respectively(all P<0.05).However,the incidences were decreased by 60.6%in the bandage performed for 12-24 hours or beyond 24 hours group(P<0.05).The multiple logistic regression models revealed that nodule size(x^2=15.227,P<0.001),number of nodule(x^2=7.767,P=0.005),menstrual period(x^2=24.530,P<0.001),and breast shape(x^2=9.559,P=0.002) were independent risk factors associated with hematoma occurrence,but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size,number of nodule,menstrual period,breast shape,and efficacy time of bandage.
文摘Transanal total mesorectal excision(TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the limits of standard low anterior resection. TaTME might help to decrease the conversion rate especially in difficult patients, and to improve the pathological results, while preserving the urogenital function. Evaluation of data from large registries and randomized studies should help to draw firmer conclusions. Beyond these technical considerations, the next challenge seems to be clearly the safe introduction of this approach, motivating the development of dedicated courses.
