Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer related deaths in the United States. Almost 90% of the patients diagnosed with CRC die due to metastases. MicroRNAs (mi...Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer related deaths in the United States. Almost 90% of the patients diagnosed with CRC die due to metastases. MicroRNAs (miRNAs) are evolutionarily conserved molecules that modulate the expression of their target genes post-transcriptionally, and they may participate in various physiological and pathological processes including CRC metastasis by influencing various factors in the human body. Recently, the role miRNAs play throughout the CRC metastatic cascade has gain attention. Many studies have been published to link them with CRC metastasis. In this review, we will briefly discuss metastatic steps in the light of miRNAs, along with their target genes. We will discuss how the aberration in the expression of miRNAs leads to the formation of CRC by effecting the regulation of their target genes. As miRNAs are being exploited for diagnosis, prognosis, and monitoring of cancer and other diseases, their high tissue specificity and critical role in oncogenesis make them new biomarkers for the diagnosis and classification of cancer as well as for predicting patients’ outcome. MiRNA signatures have been identified for many human tumors including CRC, and miRNA-based therapies to treat cancer have been emphasized lately. These will also be discussed in this review.展开更多
Objective:This study aimed to evaluate and validate the performance of a Chinese version of a Likerttype death anxiety scale for colorectal cancer patients.Methods:This study assessed the death anxiety of 50 colorecta...Objective:This study aimed to evaluate and validate the performance of a Chinese version of a Likerttype death anxiety scale for colorectal cancer patients.Methods:This study assessed the death anxiety of 50 colorectal cancer patients,which were selected by convenience sampling method,by using the Chinese version of a Likert-type Templer death anxiety scale(CL-TDAS)on the first day of admission.Results:Most of the respondents finished the entire scale in 3e5 min,and the recovery rate was 94.0%.Cronbach's a indicated that the internal consistency was 0.821 for the complete 15 items,and the correlation between the CL-TDAS and the C-TDAS(non-Likert-type)was 0.79(P<0.05).The structural validity of the CL-TDAS revealed that the scale items accounted for>63.78%of the total variability,and that the four-component structure of the data well fitted the model.The mean score of the CL-TDAS was 36.16±9.99(first day of admission).Conclusion:The CL-TDAS showed reliable performance and can thus be a promising instrument for evaluating the death anxiety of cancer patients.Death anxiety varied for different periods and different genders.展开更多
Colorectal cancer represents the third cancer worldwide. Studies showed thatinsufficient levels of vitamin D may result in colorectal cancer. Genetic variations in genes controlling vitamin D activity would play a rol...Colorectal cancer represents the third cancer worldwide. Studies showed thatinsufficient levels of vitamin D may result in colorectal cancer. Genetic variations in genes controlling vitamin D activity would play a role in determining susceptibility to colorectal cancer. Aim of the work: to study the different genotypes of VDR polymorphisms and detect the association between serum levels of 25(OH)VitD and 1,25(OH)2VitD among sample of Egyptian patients with different stages of colorectal cancer. Methods: Ninety patients (60 with different stages of colorectal cancer and 30 patients with benign pathology of the colon) together with 30 healthy controls were examined using PCR-RFLP analysis for FokI, ApaI and TaqI polymorphisms. Results: Genotype distribution for ApaI polymorphism showed no statistically significant difference between patients (colorectal cancer and benign) and controls with p = 0.1. There was no statistically significant difference in FokI polymorphism where p = 0.26 and genotype distribution for TaqI was also insignificant with p = 0.016. The median serum level of 25(OH)VitD was low in cancer cases compared to the control group and benign cases with (p 0.001). There was no statisticallysignificant difference of median serum level of 1,25(OH)2VitD between benign and cancer cases. There was statistically significant difference of median serum level of 25(OH)VitD and 1,25(OH)2VitD between stage I and stage II with (p = 0.004) and (p 0.001), and between stage I and stage III with (p = 0.001)and (p 0.001), but no statistically significant difference between stage II and III with (p = 0.514). Conclusions: There is ethnic variability in vitamin D receptor gene polymorphisms. The lack of significant association of the studied gene polymorphism in our population suggests that its association with other functionally known gene polymorphism might have a role in the pathogenesis of colorectal cancer.展开更多
Objective:To explore the core acupoints and combination rules of acupuncture therapy for postoperative urinary retention after hemorrhoidectomy,and,further to analyze the characteristics of the prescription of acupunc...Objective:To explore the core acupoints and combination rules of acupuncture therapy for postoperative urinary retention after hemorrhoidectomy,and,further to analyze the characteristics of the prescription of acupuncture therapy for postoperative urinary retention after hemorrhoidectomy.Methods:Relevant clinical studies in seven databases were searched systematically from database inception to 1 st October 2020.Based on data mining techniques,the core acupoints,characteristics and combination rules of acupuncture therapy for postoperative urinary retention after hemorrhoidectomy were analyzed comprehensively.Statistics collected and analysis of acupoint selection included the frequency of usage of acupoints,the meridian of acupoints,the location of acupoints and the combination of acupoints.Cluster and association analysis were performed utilizing Excel 13.0 and SPSS 26.0.Results:In the 36 studies included,the most frequently adopted acupoint was Sānyīnjiāo(三阴交 SP6);the most frequently adopted meridian was the foot-taiyin spleen meridian;the most frequently involved location was the lower limbs;and the most frequently adopted combination of acupoints was SP6 and Zhōngjí(中极CV 3).Cluster analysis showed that the acupoints could be divided into three categories:the first group comprised SP6 alone;the second group included CV3,Guānyuán(关元CV4),Yīnlíngquán(阴陵泉SP9) and Zúsānlǐ(足三里ST36);and the third group included Pángguāngshū(膀胱俞BL28),Chéngshān(承山BL57),Tàichōng(太冲LR3),Zhìbiān(秩边 BL54),Tàixī(太溪KI6),Hégǔ(合谷 LI4),Xuèhǎi(血海SP10),Qìhǎi(气海CV6) and Shǔidào(水道ST28).Conclusion:It was found that acupuncture therapy for postoperative urinary retention after hemorrhoidectomy mainly follows the four characteristic rules:the selection of acupoints following the meridian,selection of acupoints at local points,selection of acupoints at distal points and selection of acupoints according to special symptoms.展开更多
In an effort to minimize the limitations of laparoscopy,a robotic surgery system was introduced,but its role for gastric cancer is still unclear.The objective of this article is to assess the current status of robotic...In an effort to minimize the limitations of laparoscopy,a robotic surgery system was introduced,but its role for gastric cancer is still unclear.The objective of this article is to assess the current status of robotic surgery for gastric cancer and to predict future prospects.Although the current study was limited by its small number of patients and retrospective nature,robot-assisted gastrectomy with lymphadenectomy for the treatment of gastric cancer is a feasible and safe procedure for experienced laparoscopic surgeons.Most studies have reported satisfactory results for postoperative short-term coutcomes,such as:postoperative oral feeding,gas out,hospital stay and complications,compared with laparoscopic surgery;the difference is a longer operation time.However,robotic surgery showed a shallow learning curve compared with the familarity of conventional open surgery;after the accumulation of several cases,robotic surgery could be expected to result in a similar operation time.Robotic-assisted gastrectomy can expand the indications of minimally invasive surgery to include advanced gastric cancer by improving the ability to perform lymphadenectomy.Moreover," total" robotic gastrectomy can be facilitated using a robotsewing technique and gastric submucosal tumors near the gastroesophageal junction or pylorus can be resected safely by this novel technique.In conclusion,robotassisted gastrectomy may offer a good alternative to conventional open or laparoscopic surgery for gastric cancer,provided that long-term oncologic outcomes can be confirmed.展开更多
AIM: To demographically and clinically characterize inflammatory bowel disease (IBD) from the local registry and update data previously published by our group.METHODS: A descriptive study of a cohort based on a regist...AIM: To demographically and clinically characterize inflammatory bowel disease (IBD) from the local registry and update data previously published by our group.METHODS: A descriptive study of a cohort based on a registry of patients aged 15 years or older who were diagnosed with IBD and attended the IBD program at Clínica Las Condes in Santiago, Chile. The registry was created in April 2012 and includes patients registered up to October 2015. The information was anonymously downloaded in a monthly report, and the information on patients with more than one visit was updated. The registry includes demographic, clinical and disease characteristics, including the Montreal Classification, medical treatment, surgeries and hospitalizations for crisis. Data regarding infection with Clostridium difficile (C. difficile) were incorporated in the registry in 2014. Data for patients who received consultations as second opinions and continued treatment at this institution were also analyzed.RESULTS: The study included 716 patients with IBD: 508 patients (71%) were diagnosed with ulcerative colitis (UC), 196 patients (27%) were diagnosed with Crohn’s disease (CD) and 12 patients (2%) were diagnosed with unclassifiable IBD. The UC/CD ratio was 2.6/1. The median age was 36 years (range 16-88), and 58% of the patients were female, with a median age at diagnosis of 29 years (range 5-76). In the past 15 years, a sustained increase in the number of patients diagnosed with IBD was observed, where 87% of the patients were diagnosed between the years 2001 and 2015. In the cohort examined in the present study, extensive colitis (50%) and colonic involvement (44%) predominated in the patients with UC and CD, respectively. In CD patients, non-stricturing/non-penetrating behavior was more frequent (80%), and perianal disease was observed in 28% of the patients. There were significant differences in treatment between UC and CD, with a higher use of corticosteroids, and immunosuppressive and biological therapies was observed in the patients with CD (P < 0.05 and P < 0.01). Significant surgical differences were also observed: 5% of the UC patients underwent surgery, whereas 38% of the CD patients required at least one surgery (P < 0.01). The patients with CD were hospitalized more often during their disease course than the patients with UC (55% and 35% of the patients, respectively; P < 0.01). C. difficile infection was acquired by 5% of the patients in each group at some point during the disease course. Nearly half of the patients consulted at the institution for a second opinion, and 32% of these individuals continued treatment at the institution.CONCLUSION: IBD has continued to increase in the study cohort, slowly approaching the level reported in developed countries.展开更多
Objective:This study aims to evaluate the feasibility,acceptability,and efficacy of StomieCare for rectal cancer patients undergoing surgery with a temporary stoma.StomieCare(three individual sessions)comprises themat...Objective:This study aims to evaluate the feasibility,acceptability,and efficacy of StomieCare for rectal cancer patients undergoing surgery with a temporary stoma.StomieCare(three individual sessions)comprises thematic discussions,information and education,and teaching problem-solving and cognitive restructuring.Methods:Thirty-seven rectal cancer participants treated by surgery and temporary stoma were recruited and randomized to control(routine care approach,n=20)and intervention(routine care and StomieCare,n=17)groups.Outcomes were psychological distress(anxiety and depression,HADS),body image(BIS,ESS),and quality of life(FACT-C),at one week before surgery(T1)and 3 months after stoma closure(T2).Interand intragroup statistical analyses were performed.Results:This study demonstrated that StomieCare is feasible and acceptable.At T2,depression scores were higher for controls than for the intervention group.The mean scores for quality of life,depression,and body image decreased in the control group but remained stable in the intervention group.Anxiety scores significantly decreased between T1 and T2 only for the control group.Conclusion:StomieCare is a feasible and acceptable intervention for the prevention of depressive symptomatology.展开更多
Colonic polypectomy remained the first colonoscopic therapeutic intervention which was successfully accomplished with the help of an early snare. This therapeutic procedure was executed by Dehyle in Europe and Shinya ...Colonic polypectomy remained the first colonoscopic therapeutic intervention which was successfully accomplished with the help of an early snare. This therapeutic procedure was executed by Dehyle in Europe and Shinya in USA in 1971 [1]. Thus, these two colonoscopists acquired the pioneer’s position of therapeutic colonoscopy. Now the colonoscopy has achieved a special status in treating colorectal diseases because of its unique therapeutic aspect. The common uses of therapeutic colonoscopy are broadly classified in to the four major categories because of its unique therapeutic properties. These uses include resection and ablation, hemostasis, decompression with or without recanalization and foreign body extraction. Colonic perforation remained an absolute contraindication to therapeutic colonoscopy which is analogous to diagnostic colonoscopy. Good Communication plays a vital role in accomplishment of successful therapy with the help of colonoscopy. Consent process remained a complex process which should be well organized and tailored as per patient’s needs. There are lot of advancements in colonoscopy in recent years and many new procedures and treatment modalities have become available to treat colorectal diseases with the help of colonoscope. The recent advancement in colonoscopy has led to having many novel techniques. This therapeutic colonoscopy has made a significant change in current colorectal cancer management as polyps can be treated in the early stage, thus reducing the incidence of colorectal cancer. This is the basis of the United Kingdom existing bowel screening program, which is only feasible because of colonoscopy-induced interventions. The successful uses of these techniques obviate the need for a major surgical operation and colorectal disease can be treated with minimally invasive colonoscopic methods. These attributes make colonoscopy a true therapeutic icon.展开更多
AIM To summarize the current consensus on the defnition of remission and the endpoints employed in clinical trials.METHODSA bibliogragraphic search was performed from 1946 to 2016 sing online databases （National Libr...AIM To summarize the current consensus on the defnition of remission and the endpoints employed in clinical trials.METHODSA bibliogragraphic search was performed from 1946 to 2016 sing online databases （National Library of Medicine’s PubMed Central Medline, OVID SP MEDLINE, OVID EMBASE, the Cochrane Library and Conference Abstracts） with key words： （“ulcerative colitis”） AND （“ulcerative colitis endoscopic index of severity” OR “UCEIS”） AND （“remission”） as well as （“ulcerative colitis”） AND （“ulcerative colitis disease activity index”） OR “UCDAI” OR “UC disease activity index” OR “Sutherland index”） AND （“remission”）.RESULTSThe search returned 37 and 116 articles for the UCEIS and UCDAI respectively. For the UCEIS, 12 articles were cited in the final analysis of which 9 validation studies have been identified. Despite the UCEIS has been more extensively validated in all three aspects （validity, responsiveness and reliability）, it has been little employed to monitor disease in randomised clinical trials. For the UCDAI, 37 articles were consider-ed for the final analysis. Although the UCDAI is only partially validated, 29 randomised clinical trials were acknowledged to use the UCDAI to determine endpoints and disease remission, though no clear protocol was identifed.CONCLUSIONAlthough the UCEIS has been more widely validated than the UCDAI, it has not been refected in the moni-toring of disease activity in clinical trials. Conversely, the UCDAI has been used in numerous large clinical trials to defne their endpoints and disease remission, however, it is challenging to determine the best possible outcomes due to a lack of homogeneity of the clinical trial protocols. Before determining a gold standard index, international agreement on remission is urgently needed to advance patient care.展开更多
Restorative low anterior resection(LAR)for rectal cancer carries a significant risk of anastomotic leak:One of the most feared complications in colorectal surgery.Operative management may include takedown of the anast...Restorative low anterior resection(LAR)for rectal cancer carries a significant risk of anastomotic leak:One of the most feared complications in colorectal surgery.Operative management may include takedown of the anastomosis and end colostomy which,in some cases,is permanent.Other contemporary operative measures include over the scope clips and Endosponge.Recently,there have been case reports and a Society of American Endoscopic and Gastrointestinal Surgeons video on the novel use of transanal minimally invasive surgery(TAMIS)in the management of anastomotic leak.We present a 59-year-old female who underwent LAR after declining radiotherapy for a bulky 9 cm rectal tumour 9-10 cm from the anal verge.Following clinical deterioration,computed tomography demonstrated an anastomotic leak communicating with a 5-cm pelvic collection containing gas.At laparoscopy,pus and faeculent material were washed from the pelvic cavity and drains were placed.Intra-operative endoscopy demonstrated a 7-8 mm dehiscence at the anastomosis.The defect(approximately 7 cm from the anal verge)was successfully closed using TAMIS and a running V-lock suture.The patient recovered well and was discharged home on post-operative day 20.In this case,a low colorectal anastomotic leak was successfully rescued with TAMIS.This novel technique may be useful in the armamentarium of colorectal surgeons experienced in TAMIS.展开更多
In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and ...In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.展开更多
Development and Application of Artificial Intelligence Recognition Systems in Rectal Cancer Staging Whether for surgical treatment or for neoadjuvant chemoradiotherapy,imaging evaluation has become an important basis ...Development and Application of Artificial Intelligence Recognition Systems in Rectal Cancer Staging Whether for surgical treatment or for neoadjuvant chemoradiotherapy,imaging evaluation has become an important basis to perform the treatment plans.[1]The reading of imaging results requires a large number of experienced radiologists to complete,but shortages and uneven distributions of personnel cause delays and biases in imaging results.Therefore,independent research and development of automatic recognition systems of rectal cancer staging based on artificial intelligence(AI)platforms aim to partially replace practitioners’work and achieve rapid and accurate identification of rectal cancer staging.展开更多
The incidence and mortality of colon cancer in China are increasing each year.At present,treatment selection for colon cancer patients mainly depends on imaging results,which require a large number of radiologists to ...The incidence and mortality of colon cancer in China are increasing each year.At present,treatment selection for colon cancer patients mainly depends on imaging results,which require a large number of radiologists to interpret.In China,there is a shortage and uneven distribution of experienced radiologists,which leads to delays and bias in the evaluation of imaging data.Based on these considerations,the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association in collaboration with experts at Beihang University has independently developed an artificial intelligence(AI)-based recognition system for the preoperative determination of colon cancer stage to partially replace the work of and relieve the pressure on radiologists.These guidelines aim to standardize the use of AI-based recognition systems in the preoperative staging of colon cancer and guide their clinical application.展开更多
At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operati...At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operative recovery,short hospital stay,and positive psychological impact.However,NOSES for the treatment of gastric cancer(GC)is still in its infancy,and there is great potential to improve its theoretical system and clinical practice.Especially,several key points including oncological outcomes,bacteriological concerns,indication selection,and standardized surgical procedures are raised with this innovative technique.Therefore,it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES,which is of great significance for healthy and orderly development of NOSES worldwide.展开更多
文摘Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer related deaths in the United States. Almost 90% of the patients diagnosed with CRC die due to metastases. MicroRNAs (miRNAs) are evolutionarily conserved molecules that modulate the expression of their target genes post-transcriptionally, and they may participate in various physiological and pathological processes including CRC metastasis by influencing various factors in the human body. Recently, the role miRNAs play throughout the CRC metastatic cascade has gain attention. Many studies have been published to link them with CRC metastasis. In this review, we will briefly discuss metastatic steps in the light of miRNAs, along with their target genes. We will discuss how the aberration in the expression of miRNAs leads to the formation of CRC by effecting the regulation of their target genes. As miRNAs are being exploited for diagnosis, prognosis, and monitoring of cancer and other diseases, their high tissue specificity and critical role in oncogenesis make them new biomarkers for the diagnosis and classification of cancer as well as for predicting patients’ outcome. MiRNA signatures have been identified for many human tumors including CRC, and miRNA-based therapies to treat cancer have been emphasized lately. These will also be discussed in this review.
文摘Objective:This study aimed to evaluate and validate the performance of a Chinese version of a Likerttype death anxiety scale for colorectal cancer patients.Methods:This study assessed the death anxiety of 50 colorectal cancer patients,which were selected by convenience sampling method,by using the Chinese version of a Likert-type Templer death anxiety scale(CL-TDAS)on the first day of admission.Results:Most of the respondents finished the entire scale in 3e5 min,and the recovery rate was 94.0%.Cronbach's a indicated that the internal consistency was 0.821 for the complete 15 items,and the correlation between the CL-TDAS and the C-TDAS(non-Likert-type)was 0.79(P<0.05).The structural validity of the CL-TDAS revealed that the scale items accounted for>63.78%of the total variability,and that the four-component structure of the data well fitted the model.The mean score of the CL-TDAS was 36.16±9.99(first day of admission).Conclusion:The CL-TDAS showed reliable performance and can thus be a promising instrument for evaluating the death anxiety of cancer patients.Death anxiety varied for different periods and different genders.
文摘Colorectal cancer represents the third cancer worldwide. Studies showed thatinsufficient levels of vitamin D may result in colorectal cancer. Genetic variations in genes controlling vitamin D activity would play a role in determining susceptibility to colorectal cancer. Aim of the work: to study the different genotypes of VDR polymorphisms and detect the association between serum levels of 25(OH)VitD and 1,25(OH)2VitD among sample of Egyptian patients with different stages of colorectal cancer. Methods: Ninety patients (60 with different stages of colorectal cancer and 30 patients with benign pathology of the colon) together with 30 healthy controls were examined using PCR-RFLP analysis for FokI, ApaI and TaqI polymorphisms. Results: Genotype distribution for ApaI polymorphism showed no statistically significant difference between patients (colorectal cancer and benign) and controls with p = 0.1. There was no statistically significant difference in FokI polymorphism where p = 0.26 and genotype distribution for TaqI was also insignificant with p = 0.016. The median serum level of 25(OH)VitD was low in cancer cases compared to the control group and benign cases with (p 0.001). There was no statisticallysignificant difference of median serum level of 1,25(OH)2VitD between benign and cancer cases. There was statistically significant difference of median serum level of 25(OH)VitD and 1,25(OH)2VitD between stage I and stage II with (p = 0.004) and (p 0.001), and between stage I and stage III with (p = 0.001)and (p 0.001), but no statistically significant difference between stage II and III with (p = 0.514). Conclusions: There is ethnic variability in vitamin D receptor gene polymorphisms. The lack of significant association of the studied gene polymorphism in our population suggests that its association with other functionally known gene polymorphism might have a role in the pathogenesis of colorectal cancer.
文摘Objective:To explore the core acupoints and combination rules of acupuncture therapy for postoperative urinary retention after hemorrhoidectomy,and,further to analyze the characteristics of the prescription of acupuncture therapy for postoperative urinary retention after hemorrhoidectomy.Methods:Relevant clinical studies in seven databases were searched systematically from database inception to 1 st October 2020.Based on data mining techniques,the core acupoints,characteristics and combination rules of acupuncture therapy for postoperative urinary retention after hemorrhoidectomy were analyzed comprehensively.Statistics collected and analysis of acupoint selection included the frequency of usage of acupoints,the meridian of acupoints,the location of acupoints and the combination of acupoints.Cluster and association analysis were performed utilizing Excel 13.0 and SPSS 26.0.Results:In the 36 studies included,the most frequently adopted acupoint was Sānyīnjiāo(三阴交 SP6);the most frequently adopted meridian was the foot-taiyin spleen meridian;the most frequently involved location was the lower limbs;and the most frequently adopted combination of acupoints was SP6 and Zhōngjí(中极CV 3).Cluster analysis showed that the acupoints could be divided into three categories:the first group comprised SP6 alone;the second group included CV3,Guānyuán(关元CV4),Yīnlíngquán(阴陵泉SP9) and Zúsānlǐ(足三里ST36);and the third group included Pángguāngshū(膀胱俞BL28),Chéngshān(承山BL57),Tàichōng(太冲LR3),Zhìbiān(秩边 BL54),Tàixī(太溪KI6),Hégǔ(合谷 LI4),Xuèhǎi(血海SP10),Qìhǎi(气海CV6) and Shǔidào(水道ST28).Conclusion:It was found that acupuncture therapy for postoperative urinary retention after hemorrhoidectomy mainly follows the four characteristic rules:the selection of acupoints following the meridian,selection of acupoints at local points,selection of acupoints at distal points and selection of acupoints according to special symptoms.
基金Supported by A grant from the National R & D Program for Cancer Control,Ministry of Health and Welfare,Republic of Korea(1020410)
文摘In an effort to minimize the limitations of laparoscopy,a robotic surgery system was introduced,but its role for gastric cancer is still unclear.The objective of this article is to assess the current status of robotic surgery for gastric cancer and to predict future prospects.Although the current study was limited by its small number of patients and retrospective nature,robot-assisted gastrectomy with lymphadenectomy for the treatment of gastric cancer is a feasible and safe procedure for experienced laparoscopic surgeons.Most studies have reported satisfactory results for postoperative short-term coutcomes,such as:postoperative oral feeding,gas out,hospital stay and complications,compared with laparoscopic surgery;the difference is a longer operation time.However,robotic surgery showed a shallow learning curve compared with the familarity of conventional open surgery;after the accumulation of several cases,robotic surgery could be expected to result in a similar operation time.Robotic-assisted gastrectomy can expand the indications of minimally invasive surgery to include advanced gastric cancer by improving the ability to perform lymphadenectomy.Moreover," total" robotic gastrectomy can be facilitated using a robotsewing technique and gastric submucosal tumors near the gastroesophageal junction or pylorus can be resected safely by this novel technique.In conclusion,robotassisted gastrectomy may offer a good alternative to conventional open or laparoscopic surgery for gastric cancer,provided that long-term oncologic outcomes can be confirmed.
文摘AIM: To demographically and clinically characterize inflammatory bowel disease (IBD) from the local registry and update data previously published by our group.METHODS: A descriptive study of a cohort based on a registry of patients aged 15 years or older who were diagnosed with IBD and attended the IBD program at Clínica Las Condes in Santiago, Chile. The registry was created in April 2012 and includes patients registered up to October 2015. The information was anonymously downloaded in a monthly report, and the information on patients with more than one visit was updated. The registry includes demographic, clinical and disease characteristics, including the Montreal Classification, medical treatment, surgeries and hospitalizations for crisis. Data regarding infection with Clostridium difficile (C. difficile) were incorporated in the registry in 2014. Data for patients who received consultations as second opinions and continued treatment at this institution were also analyzed.RESULTS: The study included 716 patients with IBD: 508 patients (71%) were diagnosed with ulcerative colitis (UC), 196 patients (27%) were diagnosed with Crohn’s disease (CD) and 12 patients (2%) were diagnosed with unclassifiable IBD. The UC/CD ratio was 2.6/1. The median age was 36 years (range 16-88), and 58% of the patients were female, with a median age at diagnosis of 29 years (range 5-76). In the past 15 years, a sustained increase in the number of patients diagnosed with IBD was observed, where 87% of the patients were diagnosed between the years 2001 and 2015. In the cohort examined in the present study, extensive colitis (50%) and colonic involvement (44%) predominated in the patients with UC and CD, respectively. In CD patients, non-stricturing/non-penetrating behavior was more frequent (80%), and perianal disease was observed in 28% of the patients. There were significant differences in treatment between UC and CD, with a higher use of corticosteroids, and immunosuppressive and biological therapies was observed in the patients with CD (P < 0.05 and P < 0.01). Significant surgical differences were also observed: 5% of the UC patients underwent surgery, whereas 38% of the CD patients required at least one surgery (P < 0.01). The patients with CD were hospitalized more often during their disease course than the patients with UC (55% and 35% of the patients, respectively; P < 0.01). C. difficile infection was acquired by 5% of the patients in each group at some point during the disease course. Nearly half of the patients consulted at the institution for a second opinion, and 32% of these individuals continued treatment at the institution.CONCLUSION: IBD has continued to increase in the study cohort, slowly approaching the level reported in developed countries.
文摘Objective:This study aims to evaluate the feasibility,acceptability,and efficacy of StomieCare for rectal cancer patients undergoing surgery with a temporary stoma.StomieCare(three individual sessions)comprises thematic discussions,information and education,and teaching problem-solving and cognitive restructuring.Methods:Thirty-seven rectal cancer participants treated by surgery and temporary stoma were recruited and randomized to control(routine care approach,n=20)and intervention(routine care and StomieCare,n=17)groups.Outcomes were psychological distress(anxiety and depression,HADS),body image(BIS,ESS),and quality of life(FACT-C),at one week before surgery(T1)and 3 months after stoma closure(T2).Interand intragroup statistical analyses were performed.Results:This study demonstrated that StomieCare is feasible and acceptable.At T2,depression scores were higher for controls than for the intervention group.The mean scores for quality of life,depression,and body image decreased in the control group but remained stable in the intervention group.Anxiety scores significantly decreased between T1 and T2 only for the control group.Conclusion:StomieCare is a feasible and acceptable intervention for the prevention of depressive symptomatology.
文摘Colonic polypectomy remained the first colonoscopic therapeutic intervention which was successfully accomplished with the help of an early snare. This therapeutic procedure was executed by Dehyle in Europe and Shinya in USA in 1971 [1]. Thus, these two colonoscopists acquired the pioneer’s position of therapeutic colonoscopy. Now the colonoscopy has achieved a special status in treating colorectal diseases because of its unique therapeutic aspect. The common uses of therapeutic colonoscopy are broadly classified in to the four major categories because of its unique therapeutic properties. These uses include resection and ablation, hemostasis, decompression with or without recanalization and foreign body extraction. Colonic perforation remained an absolute contraindication to therapeutic colonoscopy which is analogous to diagnostic colonoscopy. Good Communication plays a vital role in accomplishment of successful therapy with the help of colonoscopy. Consent process remained a complex process which should be well organized and tailored as per patient’s needs. There are lot of advancements in colonoscopy in recent years and many new procedures and treatment modalities have become available to treat colorectal diseases with the help of colonoscope. The recent advancement in colonoscopy has led to having many novel techniques. This therapeutic colonoscopy has made a significant change in current colorectal cancer management as polyps can be treated in the early stage, thus reducing the incidence of colorectal cancer. This is the basis of the United Kingdom existing bowel screening program, which is only feasible because of colonoscopy-induced interventions. The successful uses of these techniques obviate the need for a major surgical operation and colorectal disease can be treated with minimally invasive colonoscopic methods. These attributes make colonoscopy a true therapeutic icon.
文摘AIM To summarize the current consensus on the defnition of remission and the endpoints employed in clinical trials.METHODSA bibliogragraphic search was performed from 1946 to 2016 sing online databases （National Library of Medicine’s PubMed Central Medline, OVID SP MEDLINE, OVID EMBASE, the Cochrane Library and Conference Abstracts） with key words： （“ulcerative colitis”） AND （“ulcerative colitis endoscopic index of severity” OR “UCEIS”） AND （“remission”） as well as （“ulcerative colitis”） AND （“ulcerative colitis disease activity index”） OR “UCDAI” OR “UC disease activity index” OR “Sutherland index”） AND （“remission”）.RESULTSThe search returned 37 and 116 articles for the UCEIS and UCDAI respectively. For the UCEIS, 12 articles were cited in the final analysis of which 9 validation studies have been identified. Despite the UCEIS has been more extensively validated in all three aspects （validity, responsiveness and reliability）, it has been little employed to monitor disease in randomised clinical trials. For the UCDAI, 37 articles were consider-ed for the final analysis. Although the UCDAI is only partially validated, 29 randomised clinical trials were acknowledged to use the UCDAI to determine endpoints and disease remission, though no clear protocol was identifed.CONCLUSIONAlthough the UCEIS has been more widely validated than the UCDAI, it has not been refected in the moni-toring of disease activity in clinical trials. Conversely, the UCDAI has been used in numerous large clinical trials to defne their endpoints and disease remission, however, it is challenging to determine the best possible outcomes due to a lack of homogeneity of the clinical trial protocols. Before determining a gold standard index, international agreement on remission is urgently needed to advance patient care.
文摘Restorative low anterior resection(LAR)for rectal cancer carries a significant risk of anastomotic leak:One of the most feared complications in colorectal surgery.Operative management may include takedown of the anastomosis and end colostomy which,in some cases,is permanent.Other contemporary operative measures include over the scope clips and Endosponge.Recently,there have been case reports and a Society of American Endoscopic and Gastrointestinal Surgeons video on the novel use of transanal minimally invasive surgery(TAMIS)in the management of anastomotic leak.We present a 59-year-old female who underwent LAR after declining radiotherapy for a bulky 9 cm rectal tumour 9-10 cm from the anal verge.Following clinical deterioration,computed tomography demonstrated an anastomotic leak communicating with a 5-cm pelvic collection containing gas.At laparoscopy,pus and faeculent material were washed from the pelvic cavity and drains were placed.Intra-operative endoscopy demonstrated a 7-8 mm dehiscence at the anastomosis.The defect(approximately 7 cm from the anal verge)was successfully closed using TAMIS and a running V-lock suture.The patient recovered well and was discharged home on post-operative day 20.In this case,a low colorectal anastomotic leak was successfully rescued with TAMIS.This novel technique may be useful in the armamentarium of colorectal surgeons experienced in TAMIS.
文摘In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.
基金International Practice Guideline Registry(No.IPGRP-2020CN175).
文摘Development and Application of Artificial Intelligence Recognition Systems in Rectal Cancer Staging Whether for surgical treatment or for neoadjuvant chemoradiotherapy,imaging evaluation has become an important basis to perform the treatment plans.[1]The reading of imaging results requires a large number of experienced radiologists to complete,but shortages and uneven distributions of personnel cause delays and biases in imaging results.Therefore,independent research and development of automatic recognition systems of rectal cancer staging based on artificial intelligence(AI)platforms aim to partially replace practitioners’work and achieve rapid and accurate identification of rectal cancer staging.
文摘The incidence and mortality of colon cancer in China are increasing each year.At present,treatment selection for colon cancer patients mainly depends on imaging results,which require a large number of radiologists to interpret.In China,there is a shortage and uneven distribution of experienced radiologists,which leads to delays and bias in the evaluation of imaging data.Based on these considerations,the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association in collaboration with experts at Beihang University has independently developed an artificial intelligence(AI)-based recognition system for the preoperative determination of colon cancer stage to partially replace the work of and relieve the pressure on radiologists.These guidelines aim to standardize the use of AI-based recognition systems in the preoperative staging of colon cancer and guide their clinical application.
文摘At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operative recovery,short hospital stay,and positive psychological impact.However,NOSES for the treatment of gastric cancer(GC)is still in its infancy,and there is great potential to improve its theoretical system and clinical practice.Especially,several key points including oncological outcomes,bacteriological concerns,indication selection,and standardized surgical procedures are raised with this innovative technique.Therefore,it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES,which is of great significance for healthy and orderly development of NOSES worldwide.
