Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions.Following the int...Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions.Following the introduction of laparoscopic abdominal surgery,the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic resection.Following some early concerns regarding its safety and oncological efficacy during the latter part of that decade,laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled trials.This article provides an evidence-based summary of this evolutionary process as it relates to both benign and malignant colorectal disease,as well as discussion of the next phase of new technologies such as robotic surgery.展开更多
The advances of laparoscopic surgery since the early 1990 s have caused one of the largest technical revolutions in medicine since the detection of antibiotics(1922,Flemming),the discovery of DNA structure(1953,Watson...The advances of laparoscopic surgery since the early 1990 s have caused one of the largest technical revolutions in medicine since the detection of antibiotics(1922,Flemming),the discovery of DNA structure(1953,Watson and Crick),and solid organ transplantation(1954,Murray).Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive surgery.Procedure-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis,fewer wound complications,lower risk for incisional hernias and for subsequent adhesionrelated small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological parameters.The future will have to determine the specific role of various technical approaches,define prognostic factors of success and true progress,and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes.展开更多
AIM:To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS:A broad literature search was performed with the terms"col...AIM:To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS:A broad literature search was performed with the terms"colorectal","colectomy","PAOS","previous surgery"and"PAOS".Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS,whether descriptive or comparative.Endpoints of interest were conversion rates,inadvertent enterotomy and morbidity.Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.RESULTS:From a total of 394 citations,13 full-texts achieved selection criteria to be included in the study.Twelve of them compared patients with and without PAOS.All studies were retrospective and comparative and two were case-matched.The selected studies comprised a total of 5005 patients,1865 with PAOS.Among the later,only 294(16%)had history of a midline incision for previous gastrointestinal surgery.Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopywas more prevalent in 3 of 5 studies that disclosed this event.Morbidity was similar in the majority of studies.A quantitative analysis(meta-analysis)could not be performed due to heterogeneity of the studies.CONCLUSION:Conversion rates were slightly higher in PAOS groups,although not statistical significant in most studies.History of PAOS did not implicate in higher morbidity rates.展开更多
Objective: While interest in elective robotic surgery is growing, use in emergency setting remainslimited due to challenges posed by sicker patients, advanced pathology and logistical issues. During theCOVID-19 pandem...Objective: While interest in elective robotic surgery is growing, use in emergency setting remainslimited due to challenges posed by sicker patients, advanced pathology and logistical issues. During theCOVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from thebedside and reducing the number of directly exposed medical staff. The objective of this study was toreport patient outcomes and initial learning experience of emergency robotic colorectal surgery duringthe COVID-19 pandemic.Methods: A case series study was conducted, including patients undergoing emergency robotic colorectalsurgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK.Patient data were collected from an ethics approved prospective database. Patient demographics,operative time, conversions and postoperative complications were recorded. In addition, readmissions,length of stay and short-term oncological outcomes were analyzed.Results: Ten patients with median age 64 y (range, 36-83 y) were included. Four patients had roboticcomplete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease inemergency setting. All were R0 with a mean lymph node harvest of 54 ± 13. Mean operative time was249 ± 117 min, the median length of stay was 9.4 d (range, 5-22 d). Only one patient was given atemporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality.Conclusions: Provided an experienced team and peri-operative planning, emergency robotic colorectalsurgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncologicalcases and avoidance of diverting stoma.展开更多
BACKGROUND The incidence of colorectal cancer(CRC)has increased in recent decades,and ranks fourth among males and third among females in China.Surgical resection remains the most important treatment modality for cura...BACKGROUND The incidence of colorectal cancer(CRC)has increased in recent decades,and ranks fourth among males and third among females in China.Surgical resection remains the most important treatment modality for curative intent in CRC.Several studies found that surgeon volumes and specialization appeared to be associated with improved overall survival(OS).Moreover,numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC surgery.However,few studies have specifically examined the role and long-term survival of all stage CRC in a real-world study.AIM To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world study.METHODS A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was performed.Standard demographic,clinicopathologic,surgical and follow-up data were obtained from the CRC database.Surgeon specialty was categorized as colorectal surgeon(CS)and general surgeon(GS).CRC patients who underwent primary surgical resection were enrolled.RESULTS A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated,1748(34.0%)of these by CS.The percentage of minimally invasive procedures in the CS group showed an increasing trend.There was no benefit associated with surgeon specialization for stage I,II and IV patients.Surgeon specialization exhibited a significant association with OS solely among stage III patients,with 5-year OS rates of 76%and 67%for the CS and GSgroups,respectively(P<0.01).Further analyses found that surgeon specialization was significantly associated with survival only in stage III rectal patients,and the 5-year OS rate in the CS group and GS group was 80%and 67%,respectively(P<0.01).CONCLUSION Surgeon specialization is associated with improved OS after primary surgery in stage III rectal patients.An appropriate surgical technique,perioperative program and adjuvant therapy may contribute to survival benefit in these patients.展开更多
Objective The role of selective decontamination with oral antibiotics(OABs)and mechanical bowel preparation(MBP)prior to elective colorectal surgery is still widely debated.The objective of this study was to compare t...Objective The role of selective decontamination with oral antibiotics(OABs)and mechanical bowel preparation(MBP)prior to elective colorectal surgery is still widely debated.The objective of this study was to compare the outcomes of selective decontamination with neomycin,metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation.Methods Selective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital,a major Australian tertiary referral hospital,between June 2017 and January 2023.Comparisons between short-term outcomes of OAB+MBP and MBP/no preparation were made using prospectively collected data on length of stay(LOS),readmission,mortality within 30 days,anastomotic leakage(AL),surgical site infection(SSI),urinary tract infection,deep venous thrombosis and/or pulmonary embolism,pneumonia,and ileus.Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery.The Mann-Whitney U test was used to analyse continuous data,and the chi-square test was used for categorical data.Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL.Results Patients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI(2.7%vs.7.6%,p=0.043)and overall complications(32.7%vs.44.6%,p=0.020),particularly Clavien-Dindo 1 complications(7.3%vs.16.5%,p=0.009).However,the differences in AL(2.7%vs.4.5%,p=0.369)and organ/space SSI(1.3%vs.3.7%,p=0.327)were not statistically significant.The median LOS(6 d vs.6 d,p=0.370)was not different between the groups.Conclusion Selective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications.There was a trend to toward a lower AL,but this difference was not statistically significant.展开更多
Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the hea...Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.展开更多
As surgical techniques continue to move towards less invasive techniques,single incision laparoscopic surgery(SILS),a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surger...As surgical techniques continue to move towards less invasive techniques,single incision laparoscopic surgery(SILS),a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery,was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis,postoperative pain,recovery time,and quality of life at the drawback of higher technical skill required. In this article,we review the history,describe the available technology and techniques,and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature.展开更多
Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recover...Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor's radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future.展开更多
Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferre...Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.展开更多
BACKGROUND Despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications. AIM To determine...BACKGROUND Despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications. AIM To determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery. METHODS Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. We included patients older than 18 years, who underwent colorectal surgery with primary low pelvic anastomosis, and with the creation of a diverting loop ileostomy, at elective or emergency settings for the treatment of benign or malignant conditions. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations. RESULTS Of the 102 patients included in the study, 23.5%(n = 24) suffered high output related complications. In this group of patients at least one visit to the emergency department (mean 1.6), and at least one readmission to the hospital was needed. The factors associated with high-output ileostomy, in the univariate analysis, were: urgent surgical intervention (OR = 2.6;P = 0.047), the development of postoperative complications (OR = 3;P = 0.024), have ulcerative colitis (OR = 4.8;P = 0.017), use of steroids (OR = 4.3;P = 0.010), mean output at discharge greater than 1000 mL/24 h (OR = 3.2;P = 0.016), and use of loperamide at discharge (OR = 2.8;P = 0.032). Multivariate logistic regression analysis identified two independent risk factors for high output related complications: ulcerative colitis [OR = 7.6 (95%CI: 1.81-31.95);P = 0.006], and ileostomy output at discharge ≥ 1000 mL/24 h [OR = 3.3 (1.18-9.37);P = 0.023]. CONCLUSION In our study, patients with ulcerative colitis and those with an ileostomy output above 1000 mL/24 h at discharge, were at increased risk of high output related complications.展开更多
During the last decade there has been a significant upward trend in colon and rectal minimally invasive surgery which can be attributed largely to the acceptance of robotic surgery platforms such as the da Vinci?robot...During the last decade there has been a significant upward trend in colon and rectal minimally invasive surgery which can be attributed largely to the acceptance of robotic surgery platforms such as the da Vinci?robotic system.The fourth generation da Vinci?system,introduced in 2014,includes integrated table motion,intelligent laser targeted docking and more sophisticated instrumentation and imaging.These developments have enabled more surgeons to efficiently and safely perform multi-quadrant operations.Firefly?technology allows assessment of colon perfusion and identification of ureters,and has shown potential in detecting occult recurrence or metastasis using molecular-labelled tumor markers.Wristed instrumentation has increased the technical ease of intracorporeal anastomosis(ICA)for many surgeons,leading to more common use of ICA during right colectomy.Advanced imaging has shown potential to decrease the incidence of presacral nerve injury and improve urogenital outcomes after pelvic surgery,as has been the case in robotic urologic procedures.Finally,the robotic platform lends itself to surgical simulation for surgical trainees,as a pre-operative tool for mock operations and as an ongoing assessment tool for established colorectal surgeons.Given these advantages,surgeons should anticipate continued and increased utilization of this beneficial technology.展开更多
Enhanced recovery after surgery (ERAS) protocols are now achieving worldwide diffusion in both university and district hospitals with special interest in colorectal surgery. The optimization of the patient’s preopera...Enhanced recovery after surgery (ERAS) protocols are now achieving worldwide diffusion in both university and district hospitals with special interest in colorectal surgery. The optimization of the patient’s preoperative clinical conditions, the careful intraoperative administration of fluids and drugs and the postoperative encouragement to resume the normal physiological functions as early as possible has produced results in a large amounts of studies. These approaches successfully challenged long-standing and well-established perioperative managements and finally achieved the status of gold standard treatments for the perioperative management of uncomplicated colorectal surgery. Even more important, it seems that the clinical improvement of the patient’s clinical management through ERAS protocols is now reaching his best outcomes (length of stay of 4-6 d after the operation) and therefore any further measures add little to the results already established (i.e., the adjunct of laparoscopic surgery to ERAS). Still dedicated meetings and courses around the world are exploring new aspects including the improvement the preoperative nutrition status to provide the energy necessary to face the surgical stress, the preoperative individuation of special requirements that could be properly addressed before the date of surgery and therefore would reduce the number of unnecessary days spent in hospital once fully recovered (i.e., rehabilitation, social discharges), and finally the development of an important web of out-of-hours direct access in order to individuate alarm symptoms in those patients at risk of complications that could prompt an early readmission.展开更多
In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factor...In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factors that have been shown to delay postoperative recovery (pain, gut dysfunction, immobility) and combine a series of interventions to reduce perioperative stress and organ dysfunction. With due differences, the programs of enhanced recovery are generally based on the preoperative amelioration of the patient's clinical conditions with whom they present for the operation, on the intraoperative and postoperative avoidance of medications that could slow the resumption of physiological activities, and on the promotion of positive habits in the early postoperative period. Most of the studies were conducted on elective patients undergoing colorectal procedures (either laparotomic or laparoscopic surgery). Results showed that ERAS protocols significantly improved the lung function and reduced the time to resumption of oral diet, mobilization and passage of stool, hospital stay and return to normal activities. ERAS' acceptance is spreading quickly among major centers, as well as district hospitals. With this in mind, is there also a role for ERAS in non-colorectal operations?展开更多
Objective: To establish that the laparoscopic approach to colorectal resection is safe with regards to post- operative morbidity and mortality in patients eighty years of age and over. Methods: Prospectively collect- ...Objective: To establish that the laparoscopic approach to colorectal resection is safe with regards to post- operative morbidity and mortality in patients eighty years of age and over. Methods: Prospectively collect- ed data for consecutive patients aged eighty years and older who underwent laparoscopic colorectal resec-tion by the same surgeon (Dr Daniel R. Kozman) from 1st January 2009 till 31st March 2011, were retrospectively analysed. Data collected included baseline demographic information, operative indication, American Society of Anaesthesiologists (ASA) grading, procedure type, length of procedure, post-operative course, length of hospital stay, dis-charge destination and complications. Results: Thirty-one patients underwent laparoscopic colectomy during the study period, 28 for adenocarcinoma. The median age was 85.5 (range 80 - 92) years, 15 patients were male and 25 patients were from home. The mean operating time was 118.4 minutes (range 45 - 271). Conversion was required in only 4 of 31 cases (13%). The mortality rate was 10% in total, and 0% in elective cases. Three patients required re-operation, 2 of which initially presented in the emergency setting and were subsequently deceased. For survivors, the length of hospital stay was 8.1 days (range 3 - 30) with 100% returning to original place of residence. Conclusion/ Interpretation: Laparoscopic surgery in patients eighty years and over is safe and may be beneficial in the elective setting. This is evident by low complication rate, fast return to bowel function, short length of hospital stay, and likely return to pre-operative place of residence and low mortality rate in elective patients. Careful consideration should be given to its use in an emergency setting.展开更多
Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer(CRC). This review aimed to illustrate the rol...Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer(CRC). This review aimed to illustrate the role of cellular therapy in promotion of wound healing and management of metastatic CRC. An organized literature search for the role of cellular therapy in promotion of wound healing and management of metastatic CRC was conducted. Electronic databases including PubMed/Medline, Scopus, and Embase were queried for the search process. Two types of cellular therapy have been recognized, the mesenchymal stem cells(MSCs) and bone marrow-mononuclear cells(BM-MNCs) therapy.These cells have been shown to accelerate and promote healing of various tissue injuries in animal and human studies. In addition, experimental studies have reported that MSCs may help suppress the progression of colon cancer in rat models. This article reviews the possible mechanisms of action and clinical utility of MSCs and BM-MNCs in promotion of healing and suppression of tumor growth in light of the published literature. Cellular therapy has a potentially important role in colorectal surgery, particularly in the promotion of wound healing and management of metastatic CRC. Future directions of cellular therapy in colorectal surgery were explored which may help stimulate futures studies on the role of cellular therapy in colorectal surgery.展开更多
BACKGROUNDPostoperative ileus is a common complication after colorectal cancer surgery,affecting recovery quality and hospital stay duration.Early activity intervention,as an important component of enhanced recovery a...BACKGROUNDPostoperative ileus is a common complication after colorectal cancer surgery,affecting recovery quality and hospital stay duration.Early activity intervention,as an important component of enhanced recovery after surgery,requires systematicevaluation of its exact effects on intestinal motility recovery and multidimensionalimpact.AIMTo comprehensively investigate the effects of early activity intervention onintestinal motility recovery and related indicators in patients after colorectalcancer surgery.METHODSUsing a retrospective comparative study design,80 patients who underwentcolorectal cancer surgery in our hospital from August 2023 to December 2024were retrospectively analyzed and divided into experimental and control groupswith 40 patients each based on the postoperative care protocols they received.Thecontrol group had received routine postoperative care,while the experimentalgroup had additionally received a systematic early activity intervention program,including bed-based passive activities within 6 hours post-surgery,active bed exercises from 6-24 hours,bedside activities from 24-48 hours,and in-ward walking after 48 hours.Assessmentindicators were retrospectively collected from medical records and included intestinal motility recovery,inflammatorystress response,postoperative complications,enteral nutrition tolerance,pain scores,nursing workload,patient psychological state,sleep quality,and nursing satisfaction.RESULTSThe experimental group demonstrated significantly shorter time to first flatus(48.2±10.6 hours vs 67.5±12.3hours,P<0.001)and first defecation(72.4±13.8 hours vs 94.6±15.7 hours,P<0.001);lower abdominal distensionscores at 72 hours post-surgery(2.1±0.6 vs 3.4±0.8,P<0.001);and reduced overall complication rates(7.5%vs20.0%,P=0.039).Inflammatory markers including C-reactive protein,interleukin-6,and tumor necrosis factor-αwere significantly lower in the experimental group(P<0.001).Pain scores at 72 hours post-surgery(1.8±0.5 vs 3.2±0.8,P<0.001)and additional analgesic requests(2.3±1.1 times vs 4.8±1.6 times,P<0.001)were markedlyreduced.Good enteral nutrition tolerance was higher(90.0%vs 72.5%,P=0.045),with earlier initiation of liquiddiet(62.3±9.6 hours vs 83.7±12.4 hours,P<0.001).Daily nursing time from postoperative day 3-7(78.3±15.6minutes vs 96.2±20.3 minutes,P<0.001)and extra interventions for complications(1.2±1.0 times/patient vs 2.8±1.5 times/patient,P<0.001)were reduced.Anxiety and depression scores were lower,sleep quality improved(Pittsburgh Sleep Quality Index:6.3±1.4 vs 9.2±2.1,P<0.001),and nursing satisfaction was significantly higher(92.6±5.8 vs 85.3±7.2,P<0.001).CONCLUSIONEarly activity intervention is a safe and effective non-pharmacological measure that not only significantly promotesintestinal motility recovery in patients after colorectal cancer surgery but also reduces inflammatory response andpostoperative pain,improves enteral nutrition tolerance,decreases postoperative complication rates,reducesnursing workload,improves patient psychological state and sleep quality,increases nursing satisfaction,andshortens hospital stay.This comprehensive intervention,being easy to implement and cost-effective,is worthy ofwidespread application in clinical practice.展开更多
Background:Postoperative ileus is a major complication of patients undergoing abdominal surgery.The purpose of this study was to determine the effects of operative time and the method of surgery on postoperative ileus...Background:Postoperative ileus is a major complication of patients undergoing abdominal surgery.The purpose of this study was to determine the effects of operative time and the method of surgery on postoperative ileus.Methods:After institutional review board approval,121 patients were studied in two groups.Group 1 consisted of 86 patients with colorectal cancers and Group 2 included 35 patients with diverticulitis.Various surgical procedures were performed in both groups.In all patients,the nasogastric(NG)tube was removed after termination of surgery.Clear liquids were offered commencing on the first postoperative day,followed by a regular diet as tolerated.GI-1 was the postoperative time to toleration of clear liquids,whereas GI-2 was the postoperative time to first bowel movement or flatus and toleration of a regular diet.Statistical analysis was performed using a linear regression model by disease with the first bowel movement or flatus as the dependent variable and operative time and category as explanatory variables.Results:Vomiting after oral feeding occurred in 18(20.9%)patients with cancer and in 7(20.0%)patients with diverticular disease.An NG tube was reinserted in 13(15.1%)patients in the cancer group and in 3(8.6%)patients in the diverticular disease group.In patients with cancer,the duration of operation was associated with GI-2(P=0.011),whereas in patients with diverticulitis,the duration of operation was associated with GI-1(P=0.001)and GI-2(P=0.044).In the diverticulitis group,a significant relationship was found between GI-2 and operative category(P=0.03).Conclusion:Longer operations led to more prolonged postoperative ileus after both laparoscopy and laparotomy,regardless of malignant or benign pathology.In anticipation of and/or following longer operations,surgeons should consider measures to shorten postoperative ileus.展开更多
BACKGROUND Natural orifice specimen extraction(NOSE)via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel inc...BACKGROUND Natural orifice specimen extraction(NOSE)via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision.Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma.These techniques reduce the surgical wound size as well as the risk of incisionrelated morbidity.AIM To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery.METHODS Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified.Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction Surgery for colorectal cancer.Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded.The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020.Matching was performed in the ratio of 1:4 based on age,gender,type of resection,and p-tumor node metastasis staging.RESULTS Over the eight-month study duration,14 consecutive cases(nine female,five male)of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer.Median age and body mass index were 70(range 43-82)years and 24.1(range 20.0-31.7)kg/m2 respectively.Six patients underwent transanal NOSE and eight had transvaginal NOSE.Median operative time,intraoperative blood loss and postoperative length of stay were 208(range 165-365)min,30(range 10-150)mL and 3(range 2-6)d respectively.Two(14%)suffered minor postoperative compilations not attributable to the NOSE procedure.Median follow-up duration was 12(range 8-15)mo.No instances of mortality,local or distant disease recurrence were recorded in this cohort.Compared to the conventional surgery cohort of 56 patients,the 3-port NOSE cohort had significantly quicker mean return of bowel function(2.6 vs 1.2 d,P<0.001),reduced postoperative pain and patientcontrolled analgesia use,and decreased length of hospital stay(6.4 vs 3.4 d,P<0.001).There were no statistical differences in surgical duration and perioperative complication rates between the NOSE and non-NOSE cohorts.CONCLUSION 3-port laparoscopic colorectal surgery with NOSE is a feasible technique,augmenting the minimally invasive nature of surgery and producing good outcomes.Appropriate patient selection and expertise in conventional laparoscopy are required.展开更多
AIM:To identify the predictors of distant metastasis in pathologically T1(pT1)colorectal cancer(CRC)after radical resection. METHODS:Variables including age,gender,preoperative carcinoembryonic antibody(CEA)level,tumo...AIM:To identify the predictors of distant metastasis in pathologically T1(pT1)colorectal cancer(CRC)after radical resection. METHODS:Variables including age,gender,preoperative carcinoembryonic antibody(CEA)level,tumor location,tumor size,lymph node status,and histological grade were recorded.Patients with and without metastasis were compared with regard to age,gender,CEA level and pathologic tumor characteristics using the independent t test orχ 2 test,as appropriate.Risk factors were determined by logistic regression analysis. RESULTS:Metastasis occurred in 6(3.8%)of the 159 patients during a median follow-up of 67.0(46.5%) mo.The rates of distant metastasis in patients with pT1 cancer of the colon and rectum were 6.7%and 2.9%, respectively(P<0.001).The rates of distant metastasis between male and female patients with T1 CRC were 6.25%and 1.27%,respectively(P<0.001).The most frequent site of distant metastasis was the liver. Age(P=0.522),gender(P=0.980),tumor location(P =0.330),tumor size(P=0.786),histological grade(P =0.509),and high serum CEA level(P=0.262)were not prognostic factors for lymph node metastasis.Univariate analysis revealed that age(P=0.231),gender(P =0.137),tumor location(P=0.386),and tumor size (P=0.514)were not risk factors for distant metastasis after radical resection for T1 colorectal cancer.Postoperative metastasis was only significantly correlated with high preoperative serum CEA level(P=0.001).Using multivariate logistic regression analysis,high preoperative serum CEA level(P=0.004;odds ratio 15.341; 95%CI 2.371-99.275)was an independent predictor for postoperative distant metastasis. CONCLUSION:The preoperative increased serum CEA level is a predictive risk factor for distant metastasis in CRC patients after radical resection.Adjuvant chemotherapy may be necessary in such patients,even if they have pT1 colorectal cancer.展开更多
文摘Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions.Following the introduction of laparoscopic abdominal surgery,the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic resection.Following some early concerns regarding its safety and oncological efficacy during the latter part of that decade,laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled trials.This article provides an evidence-based summary of this evolutionary process as it relates to both benign and malignant colorectal disease,as well as discussion of the next phase of new technologies such as robotic surgery.
文摘The advances of laparoscopic surgery since the early 1990 s have caused one of the largest technical revolutions in medicine since the detection of antibiotics(1922,Flemming),the discovery of DNA structure(1953,Watson and Crick),and solid organ transplantation(1954,Murray).Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive surgery.Procedure-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis,fewer wound complications,lower risk for incisional hernias and for subsequent adhesionrelated small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological parameters.The future will have to determine the specific role of various technical approaches,define prognostic factors of success and true progress,and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes.
文摘AIM:To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS:A broad literature search was performed with the terms"colorectal","colectomy","PAOS","previous surgery"and"PAOS".Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS,whether descriptive or comparative.Endpoints of interest were conversion rates,inadvertent enterotomy and morbidity.Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.RESULTS:From a total of 394 citations,13 full-texts achieved selection criteria to be included in the study.Twelve of them compared patients with and without PAOS.All studies were retrospective and comparative and two were case-matched.The selected studies comprised a total of 5005 patients,1865 with PAOS.Among the later,only 294(16%)had history of a midline incision for previous gastrointestinal surgery.Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopywas more prevalent in 3 of 5 studies that disclosed this event.Morbidity was similar in the majority of studies.A quantitative analysis(meta-analysis)could not be performed due to heterogeneity of the studies.CONCLUSION:Conversion rates were slightly higher in PAOS groups,although not statistical significant in most studies.History of PAOS did not implicate in higher morbidity rates.
文摘Objective: While interest in elective robotic surgery is growing, use in emergency setting remainslimited due to challenges posed by sicker patients, advanced pathology and logistical issues. During theCOVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from thebedside and reducing the number of directly exposed medical staff. The objective of this study was toreport patient outcomes and initial learning experience of emergency robotic colorectal surgery duringthe COVID-19 pandemic.Methods: A case series study was conducted, including patients undergoing emergency robotic colorectalsurgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK.Patient data were collected from an ethics approved prospective database. Patient demographics,operative time, conversions and postoperative complications were recorded. In addition, readmissions,length of stay and short-term oncological outcomes were analyzed.Results: Ten patients with median age 64 y (range, 36-83 y) were included. Four patients had roboticcomplete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease inemergency setting. All were R0 with a mean lymph node harvest of 54 ± 13. Mean operative time was249 ± 117 min, the median length of stay was 9.4 d (range, 5-22 d). Only one patient was given atemporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality.Conclusions: Provided an experienced team and peri-operative planning, emergency robotic colorectalsurgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncologicalcases and avoidance of diverting stoma.
文摘BACKGROUND The incidence of colorectal cancer(CRC)has increased in recent decades,and ranks fourth among males and third among females in China.Surgical resection remains the most important treatment modality for curative intent in CRC.Several studies found that surgeon volumes and specialization appeared to be associated with improved overall survival(OS).Moreover,numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC surgery.However,few studies have specifically examined the role and long-term survival of all stage CRC in a real-world study.AIM To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world study.METHODS A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was performed.Standard demographic,clinicopathologic,surgical and follow-up data were obtained from the CRC database.Surgeon specialty was categorized as colorectal surgeon(CS)and general surgeon(GS).CRC patients who underwent primary surgical resection were enrolled.RESULTS A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated,1748(34.0%)of these by CS.The percentage of minimally invasive procedures in the CS group showed an increasing trend.There was no benefit associated with surgeon specialization for stage I,II and IV patients.Surgeon specialization exhibited a significant association with OS solely among stage III patients,with 5-year OS rates of 76%and 67%for the CS and GSgroups,respectively(P<0.01).Further analyses found that surgeon specialization was significantly associated with survival only in stage III rectal patients,and the 5-year OS rate in the CS group and GS group was 80%and 67%,respectively(P<0.01).CONCLUSION Surgeon specialization is associated with improved OS after primary surgery in stage III rectal patients.An appropriate surgical technique,perioperative program and adjuvant therapy may contribute to survival benefit in these patients.
文摘Objective The role of selective decontamination with oral antibiotics(OABs)and mechanical bowel preparation(MBP)prior to elective colorectal surgery is still widely debated.The objective of this study was to compare the outcomes of selective decontamination with neomycin,metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation.Methods Selective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital,a major Australian tertiary referral hospital,between June 2017 and January 2023.Comparisons between short-term outcomes of OAB+MBP and MBP/no preparation were made using prospectively collected data on length of stay(LOS),readmission,mortality within 30 days,anastomotic leakage(AL),surgical site infection(SSI),urinary tract infection,deep venous thrombosis and/or pulmonary embolism,pneumonia,and ileus.Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery.The Mann-Whitney U test was used to analyse continuous data,and the chi-square test was used for categorical data.Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL.Results Patients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI(2.7%vs.7.6%,p=0.043)and overall complications(32.7%vs.44.6%,p=0.020),particularly Clavien-Dindo 1 complications(7.3%vs.16.5%,p=0.009).However,the differences in AL(2.7%vs.4.5%,p=0.369)and organ/space SSI(1.3%vs.3.7%,p=0.327)were not statistically significant.The median LOS(6 d vs.6 d,p=0.370)was not different between the groups.Conclusion Selective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications.There was a trend to toward a lower AL,but this difference was not statistically significant.
文摘Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.
文摘As surgical techniques continue to move towards less invasive techniques,single incision laparoscopic surgery(SILS),a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery,was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis,postoperative pain,recovery time,and quality of life at the drawback of higher technical skill required. In this article,we review the history,describe the available technology and techniques,and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature.
文摘Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor's radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future.
文摘Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.
文摘BACKGROUND Despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications. AIM To determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery. METHODS Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. We included patients older than 18 years, who underwent colorectal surgery with primary low pelvic anastomosis, and with the creation of a diverting loop ileostomy, at elective or emergency settings for the treatment of benign or malignant conditions. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations. RESULTS Of the 102 patients included in the study, 23.5%(n = 24) suffered high output related complications. In this group of patients at least one visit to the emergency department (mean 1.6), and at least one readmission to the hospital was needed. The factors associated with high-output ileostomy, in the univariate analysis, were: urgent surgical intervention (OR = 2.6;P = 0.047), the development of postoperative complications (OR = 3;P = 0.024), have ulcerative colitis (OR = 4.8;P = 0.017), use of steroids (OR = 4.3;P = 0.010), mean output at discharge greater than 1000 mL/24 h (OR = 3.2;P = 0.016), and use of loperamide at discharge (OR = 2.8;P = 0.032). Multivariate logistic regression analysis identified two independent risk factors for high output related complications: ulcerative colitis [OR = 7.6 (95%CI: 1.81-31.95);P = 0.006], and ileostomy output at discharge ≥ 1000 mL/24 h [OR = 3.3 (1.18-9.37);P = 0.023]. CONCLUSION In our study, patients with ulcerative colitis and those with an ileostomy output above 1000 mL/24 h at discharge, were at increased risk of high output related complications.
文摘During the last decade there has been a significant upward trend in colon and rectal minimally invasive surgery which can be attributed largely to the acceptance of robotic surgery platforms such as the da Vinci?robotic system.The fourth generation da Vinci?system,introduced in 2014,includes integrated table motion,intelligent laser targeted docking and more sophisticated instrumentation and imaging.These developments have enabled more surgeons to efficiently and safely perform multi-quadrant operations.Firefly?technology allows assessment of colon perfusion and identification of ureters,and has shown potential in detecting occult recurrence or metastasis using molecular-labelled tumor markers.Wristed instrumentation has increased the technical ease of intracorporeal anastomosis(ICA)for many surgeons,leading to more common use of ICA during right colectomy.Advanced imaging has shown potential to decrease the incidence of presacral nerve injury and improve urogenital outcomes after pelvic surgery,as has been the case in robotic urologic procedures.Finally,the robotic platform lends itself to surgical simulation for surgical trainees,as a pre-operative tool for mock operations and as an ongoing assessment tool for established colorectal surgeons.Given these advantages,surgeons should anticipate continued and increased utilization of this beneficial technology.
文摘Enhanced recovery after surgery (ERAS) protocols are now achieving worldwide diffusion in both university and district hospitals with special interest in colorectal surgery. The optimization of the patient’s preoperative clinical conditions, the careful intraoperative administration of fluids and drugs and the postoperative encouragement to resume the normal physiological functions as early as possible has produced results in a large amounts of studies. These approaches successfully challenged long-standing and well-established perioperative managements and finally achieved the status of gold standard treatments for the perioperative management of uncomplicated colorectal surgery. Even more important, it seems that the clinical improvement of the patient’s clinical management through ERAS protocols is now reaching his best outcomes (length of stay of 4-6 d after the operation) and therefore any further measures add little to the results already established (i.e., the adjunct of laparoscopic surgery to ERAS). Still dedicated meetings and courses around the world are exploring new aspects including the improvement the preoperative nutrition status to provide the energy necessary to face the surgical stress, the preoperative individuation of special requirements that could be properly addressed before the date of surgery and therefore would reduce the number of unnecessary days spent in hospital once fully recovered (i.e., rehabilitation, social discharges), and finally the development of an important web of out-of-hours direct access in order to individuate alarm symptoms in those patients at risk of complications that could prompt an early readmission.
文摘In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factors that have been shown to delay postoperative recovery (pain, gut dysfunction, immobility) and combine a series of interventions to reduce perioperative stress and organ dysfunction. With due differences, the programs of enhanced recovery are generally based on the preoperative amelioration of the patient's clinical conditions with whom they present for the operation, on the intraoperative and postoperative avoidance of medications that could slow the resumption of physiological activities, and on the promotion of positive habits in the early postoperative period. Most of the studies were conducted on elective patients undergoing colorectal procedures (either laparotomic or laparoscopic surgery). Results showed that ERAS protocols significantly improved the lung function and reduced the time to resumption of oral diet, mobilization and passage of stool, hospital stay and return to normal activities. ERAS' acceptance is spreading quickly among major centers, as well as district hospitals. With this in mind, is there also a role for ERAS in non-colorectal operations?
文摘Objective: To establish that the laparoscopic approach to colorectal resection is safe with regards to post- operative morbidity and mortality in patients eighty years of age and over. Methods: Prospectively collect- ed data for consecutive patients aged eighty years and older who underwent laparoscopic colorectal resec-tion by the same surgeon (Dr Daniel R. Kozman) from 1st January 2009 till 31st March 2011, were retrospectively analysed. Data collected included baseline demographic information, operative indication, American Society of Anaesthesiologists (ASA) grading, procedure type, length of procedure, post-operative course, length of hospital stay, dis-charge destination and complications. Results: Thirty-one patients underwent laparoscopic colectomy during the study period, 28 for adenocarcinoma. The median age was 85.5 (range 80 - 92) years, 15 patients were male and 25 patients were from home. The mean operating time was 118.4 minutes (range 45 - 271). Conversion was required in only 4 of 31 cases (13%). The mortality rate was 10% in total, and 0% in elective cases. Three patients required re-operation, 2 of which initially presented in the emergency setting and were subsequently deceased. For survivors, the length of hospital stay was 8.1 days (range 3 - 30) with 100% returning to original place of residence. Conclusion/ Interpretation: Laparoscopic surgery in patients eighty years and over is safe and may be beneficial in the elective setting. This is evident by low complication rate, fast return to bowel function, short length of hospital stay, and likely return to pre-operative place of residence and low mortality rate in elective patients. Careful consideration should be given to its use in an emergency setting.
文摘Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer(CRC). This review aimed to illustrate the role of cellular therapy in promotion of wound healing and management of metastatic CRC. An organized literature search for the role of cellular therapy in promotion of wound healing and management of metastatic CRC was conducted. Electronic databases including PubMed/Medline, Scopus, and Embase were queried for the search process. Two types of cellular therapy have been recognized, the mesenchymal stem cells(MSCs) and bone marrow-mononuclear cells(BM-MNCs) therapy.These cells have been shown to accelerate and promote healing of various tissue injuries in animal and human studies. In addition, experimental studies have reported that MSCs may help suppress the progression of colon cancer in rat models. This article reviews the possible mechanisms of action and clinical utility of MSCs and BM-MNCs in promotion of healing and suppression of tumor growth in light of the published literature. Cellular therapy has a potentially important role in colorectal surgery, particularly in the promotion of wound healing and management of metastatic CRC. Future directions of cellular therapy in colorectal surgery were explored which may help stimulate futures studies on the role of cellular therapy in colorectal surgery.
文摘BACKGROUNDPostoperative ileus is a common complication after colorectal cancer surgery,affecting recovery quality and hospital stay duration.Early activity intervention,as an important component of enhanced recovery after surgery,requires systematicevaluation of its exact effects on intestinal motility recovery and multidimensionalimpact.AIMTo comprehensively investigate the effects of early activity intervention onintestinal motility recovery and related indicators in patients after colorectalcancer surgery.METHODSUsing a retrospective comparative study design,80 patients who underwentcolorectal cancer surgery in our hospital from August 2023 to December 2024were retrospectively analyzed and divided into experimental and control groupswith 40 patients each based on the postoperative care protocols they received.Thecontrol group had received routine postoperative care,while the experimentalgroup had additionally received a systematic early activity intervention program,including bed-based passive activities within 6 hours post-surgery,active bed exercises from 6-24 hours,bedside activities from 24-48 hours,and in-ward walking after 48 hours.Assessmentindicators were retrospectively collected from medical records and included intestinal motility recovery,inflammatorystress response,postoperative complications,enteral nutrition tolerance,pain scores,nursing workload,patient psychological state,sleep quality,and nursing satisfaction.RESULTSThe experimental group demonstrated significantly shorter time to first flatus(48.2±10.6 hours vs 67.5±12.3hours,P<0.001)and first defecation(72.4±13.8 hours vs 94.6±15.7 hours,P<0.001);lower abdominal distensionscores at 72 hours post-surgery(2.1±0.6 vs 3.4±0.8,P<0.001);and reduced overall complication rates(7.5%vs20.0%,P=0.039).Inflammatory markers including C-reactive protein,interleukin-6,and tumor necrosis factor-αwere significantly lower in the experimental group(P<0.001).Pain scores at 72 hours post-surgery(1.8±0.5 vs 3.2±0.8,P<0.001)and additional analgesic requests(2.3±1.1 times vs 4.8±1.6 times,P<0.001)were markedlyreduced.Good enteral nutrition tolerance was higher(90.0%vs 72.5%,P=0.045),with earlier initiation of liquiddiet(62.3±9.6 hours vs 83.7±12.4 hours,P<0.001).Daily nursing time from postoperative day 3-7(78.3±15.6minutes vs 96.2±20.3 minutes,P<0.001)and extra interventions for complications(1.2±1.0 times/patient vs 2.8±1.5 times/patient,P<0.001)were reduced.Anxiety and depression scores were lower,sleep quality improved(Pittsburgh Sleep Quality Index:6.3±1.4 vs 9.2±2.1,P<0.001),and nursing satisfaction was significantly higher(92.6±5.8 vs 85.3±7.2,P<0.001).CONCLUSIONEarly activity intervention is a safe and effective non-pharmacological measure that not only significantly promotesintestinal motility recovery in patients after colorectal cancer surgery but also reduces inflammatory response andpostoperative pain,improves enteral nutrition tolerance,decreases postoperative complication rates,reducesnursing workload,improves patient psychological state and sleep quality,increases nursing satisfaction,andshortens hospital stay.This comprehensive intervention,being easy to implement and cost-effective,is worthy ofwidespread application in clinical practice.
基金The authors thank Paula Strassmann and Maristela Percivale for their assistance with the study design and statistical evaluation.
文摘Background:Postoperative ileus is a major complication of patients undergoing abdominal surgery.The purpose of this study was to determine the effects of operative time and the method of surgery on postoperative ileus.Methods:After institutional review board approval,121 patients were studied in two groups.Group 1 consisted of 86 patients with colorectal cancers and Group 2 included 35 patients with diverticulitis.Various surgical procedures were performed in both groups.In all patients,the nasogastric(NG)tube was removed after termination of surgery.Clear liquids were offered commencing on the first postoperative day,followed by a regular diet as tolerated.GI-1 was the postoperative time to toleration of clear liquids,whereas GI-2 was the postoperative time to first bowel movement or flatus and toleration of a regular diet.Statistical analysis was performed using a linear regression model by disease with the first bowel movement or flatus as the dependent variable and operative time and category as explanatory variables.Results:Vomiting after oral feeding occurred in 18(20.9%)patients with cancer and in 7(20.0%)patients with diverticular disease.An NG tube was reinserted in 13(15.1%)patients in the cancer group and in 3(8.6%)patients in the diverticular disease group.In patients with cancer,the duration of operation was associated with GI-2(P=0.011),whereas in patients with diverticulitis,the duration of operation was associated with GI-1(P=0.001)and GI-2(P=0.044).In the diverticulitis group,a significant relationship was found between GI-2 and operative category(P=0.03).Conclusion:Longer operations led to more prolonged postoperative ileus after both laparoscopy and laparotomy,regardless of malignant or benign pathology.In anticipation of and/or following longer operations,surgeons should consider measures to shorten postoperative ileus.
文摘BACKGROUND Natural orifice specimen extraction(NOSE)via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision.Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma.These techniques reduce the surgical wound size as well as the risk of incisionrelated morbidity.AIM To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery.METHODS Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified.Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction Surgery for colorectal cancer.Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded.The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020.Matching was performed in the ratio of 1:4 based on age,gender,type of resection,and p-tumor node metastasis staging.RESULTS Over the eight-month study duration,14 consecutive cases(nine female,five male)of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer.Median age and body mass index were 70(range 43-82)years and 24.1(range 20.0-31.7)kg/m2 respectively.Six patients underwent transanal NOSE and eight had transvaginal NOSE.Median operative time,intraoperative blood loss and postoperative length of stay were 208(range 165-365)min,30(range 10-150)mL and 3(range 2-6)d respectively.Two(14%)suffered minor postoperative compilations not attributable to the NOSE procedure.Median follow-up duration was 12(range 8-15)mo.No instances of mortality,local or distant disease recurrence were recorded in this cohort.Compared to the conventional surgery cohort of 56 patients,the 3-port NOSE cohort had significantly quicker mean return of bowel function(2.6 vs 1.2 d,P<0.001),reduced postoperative pain and patientcontrolled analgesia use,and decreased length of hospital stay(6.4 vs 3.4 d,P<0.001).There were no statistical differences in surgical duration and perioperative complication rates between the NOSE and non-NOSE cohorts.CONCLUSION 3-port laparoscopic colorectal surgery with NOSE is a feasible technique,augmenting the minimally invasive nature of surgery and producing good outcomes.Appropriate patient selection and expertise in conventional laparoscopy are required.
基金Supported by Changhai Hospital 1255 Project Fund,No.CH125542500
文摘AIM:To identify the predictors of distant metastasis in pathologically T1(pT1)colorectal cancer(CRC)after radical resection. METHODS:Variables including age,gender,preoperative carcinoembryonic antibody(CEA)level,tumor location,tumor size,lymph node status,and histological grade were recorded.Patients with and without metastasis were compared with regard to age,gender,CEA level and pathologic tumor characteristics using the independent t test orχ 2 test,as appropriate.Risk factors were determined by logistic regression analysis. RESULTS:Metastasis occurred in 6(3.8%)of the 159 patients during a median follow-up of 67.0(46.5%) mo.The rates of distant metastasis in patients with pT1 cancer of the colon and rectum were 6.7%and 2.9%, respectively(P<0.001).The rates of distant metastasis between male and female patients with T1 CRC were 6.25%and 1.27%,respectively(P<0.001).The most frequent site of distant metastasis was the liver. Age(P=0.522),gender(P=0.980),tumor location(P =0.330),tumor size(P=0.786),histological grade(P =0.509),and high serum CEA level(P=0.262)were not prognostic factors for lymph node metastasis.Univariate analysis revealed that age(P=0.231),gender(P =0.137),tumor location(P=0.386),and tumor size (P=0.514)were not risk factors for distant metastasis after radical resection for T1 colorectal cancer.Postoperative metastasis was only significantly correlated with high preoperative serum CEA level(P=0.001).Using multivariate logistic regression analysis,high preoperative serum CEA level(P=0.004;odds ratio 15.341; 95%CI 2.371-99.275)was an independent predictor for postoperative distant metastasis. CONCLUSION:The preoperative increased serum CEA level is a predictive risk factor for distant metastasis in CRC patients after radical resection.Adjuvant chemotherapy may be necessary in such patients,even if they have pT1 colorectal cancer.
