Objective Surgical treatment for rectal cancer has been developed for centuries. After anesthetic technics are applied， classic operation procedures for rectal cancer resection are still cited repeatedly. There are few articles regarding to the development history of surgical treatment for rectal cancer， and we summarize it chronologically. Methods We searched articles in the past 20 years， dated back to the original journal and explored the development of the operation type. Results We summarized more than 100 articles and listed more than 40 articles here. According to the articles retrieved， the surgery for rectal cancer could be dated back to 1739， spanning for more than 270 years. In the premier one hundred years， the resection area was limited and the effect of the treatment was not good. And in the recent one hundred years， the development of surgery conceptions was huge and the related knowledge and skills had been rapidly develop. The operation type for rectal cancer was gradually getting mature. Conclusions Surgery treatment for rectal cancer has been through a development of more than two hundred years， with new concepts and technics continuously fused in. Thus the meaning of surgery treatment for rectal cancer has been renewed. Introduction of total mesorectum excision， conception of 2 cm distal resective margin， development of stapling devices， preoperative chemoradiation and appplication of laparoscopic surgery have fasciliated function-preserving operations with minimal invasion， rapid recovery and high survival rate. Appearance of new drugs and improvement of local excision， preoperative chemoradiation， as well as new agents for chemotherapy and target therapy have promoted surgical resection for rectal cancer to a multidisciplinary model.
Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.
The technique of laparoscopic radical right hemicolectomy is becoming mature, but there are still controversies on some key steps, including the extent of lymph node dissection, the scope of bowel resection, the choice of surgical access and anastomosis. The new function-preserving surgery and natural-orifice transluminal endoscopic surgery (NOTES) have further enhanced the minimally invasive nature of surgery. The author’s have reviewed the latest domestic and international literature, combined with the experience of the author’s center, and elaborated on the current focus issues of laparoscopic radical surgery for right-sided colon cancer.
【Abstract】Objective To analyze the clinical features of multiple primary colorectal carcinoma(MPCC). Methods Data in 21 patients with MPCC during the past 10 years in our hospital were analyzed retrospectively. Results The incidence of synchronous and metachronous carcinoma was 1.1% and 1.2% respectively. The sites and pathologic stages of tumors showed no significant difference compared with single colorectal carcinoma. 47.6% of the cases accompanied with colorectal adenoma. 77.8% of the MPCC could be found during operation. Patients with carcinoma involved rectum had relatively poor survival. Conclusion The full-course colonoscopy, careful intraoperative exploration and regular postoperative colonoscopic follow-up are essential in improving the diagnosis and prognosis of patients with MPCC.
ObjectiveTo explore the effect of fetal bovine serum (FBS) of different concentrations in the culture medium on osteogenic growth peptide (OGP) promoting bone marrow mesenchymal stem cells (BMSCs) proliferation and differentiation. MethodsBMSCs were separated from limb bones of 8 Sprague Dawley rats (5 weeks old) and purified by adherence method, and BMSCs at passage 3 were divided into 4 groups according to OGP concentration: OGP 1×10-10 mol/L group, OGP 1×10-9mol/L group, OGP 1×10-8 mol/L group, and control group without OGP; and 0, 2%, 5%, 8%, and 10%FBS concentration gradient was used in each group. The cell proliferation rate was detected by MTT method at 1, 3, 5, 7, 9, and 12 days after culture, and the activity of intracellular alkaline phosphatase (ALP) was determined by the method of p-nitrophenyl phosphate disodium at 9 days after culture. ResultsBMSCs showed adherent growth, rapid proliferation, long fiber vortex, and typical morphology. MTT analysis showed that cells could not sustain proliferation when FBS concentration was less than 5% in each group; when FBS concentration was above 8%, cells proliferated continually. Proliferation promoting effect of OGP 1×10-8 mol/L and 1×10-9 mol/L groups was significantly higher than that of the control group in all serum concentrations (P<0.05); when FBS concentration was lower than 10%, the proliferation promoting effect of OGP 1×10-8 mol/L group was significantly higher than that of the other 2 OGP groups (P<0.05), but when FBS concentration was 10%, OGP 1×10-8 mol/L group had no advantage of promoting proliferation. ALP test results showed that as the FBS concentration increased, ALP activity of all groups also significantly increased (P<0.05). Under the condition of 5%FBS and 8%FBS, the ALP activity of each OGP group was significantly greater than that of the control group, and it was the highest in OGP 1×10-8 mol/L group (P<0.05). Under the condition of 10%FBS, the ALP activity of each OGP group was still greater than that of the control group (P<0.05), but no significant difference was found between the OGP 1×10-8 mol/L group and OGP 1×10-9 mol/L group (P>0.05). ConclusionThe concentration of 8%FBS is the best concentration of serum for OGP promoting the proliferation and differentiation of BMSCs, and the most suitable concentration of promoting the proliferation and differentiation of BMSCs is OGP 1×10-8 mol/L.
ObjectivesTo assess the methodological and reporting quality of surgical meta-analyses published in English in 2014.MethodsAll meta-analyses investigating surgical procedures published in 2014 were selected from PubMed and EMbase. The characteristics of these meta-analyses were collected, and their reporting and methodological quality were assessed by the PRISMA and AMSTAR, respectively. Independent predictive factors associated with these two qualities were evaluated by univariate and multivariate analyses.ResultsA total of 197 meta-analyses covering 10 surgical subspecialties were included. The mean PRISMA and AMSTAR score (by items) were 22.2±2.4 and 7.8±1.2, respectively, and a positive linear correlation was found between them with a R2 of 0.754. Those meta-analyses conducted by the first authors who had previously published meta-analysis was significantly higher in reporting and methodological quality than those who had not (P<0.001). Meanwhile, there were also significant differences in these reporting (P<0.001) and methodological (P<0.001) quality between studies published in Q1 ranked journals and (Q2+Q3) ranked jounals. On multivariate analyses, region of origin (non-Asiavs. Asia), publishing experience of first authors (ever vs. never), rank of publishing journals (Q1 vs. Q2+Q3), and preregistration (presence vs. absence) were associated with better reporting and methodologic quality, independently.ConclusionThe reporting and methodological quality of current surgical meta-analyses remained suboptimal, and first authors' experience and ranking of publishing journals were independently associated with both qualities. Preregistration may be an effective measure to improve the quality of meta-analysis, which deserves more attention from future meta-analysis reviewers.
ObjectiveTo investigate the expression of catechol O-methyltransferase (COMT) mRNA and its protein in colorectal adenoma tissues and corresponding adjacent tissues, colorectal cancer tissues and corresponding adjacent tissues. MethodsExpressions of COMT mRNA and its protein were evaluated by real-time PCR and immunohistochemistry method in colorectal adenoma tissues and corresponding adjacent tissues, colorectal cancer tissues and corresponding adjacent tissues. Meanwhile, the relationship between the expression of COMT and clinic-pathological features of colorectal adenoma and colorectal cancer were analyzed. Results①The expression of COMT mRNA in colorectal adenoma tissue/colorectal cancer tissue group was higher than that of corresponding adjacent tissue group (0.109 0 vs. 0.000 5, t=3.02, P=0.01; 0.041 8 vs. 0.013 5, t=2.71, P=0.02).②The rate of high-expression of COMT in colorectal adenoma tissue/colorectal cancer tissue group was higher than that of corresponding adjacent tissue group [72.34% (34/47) vs. 25.53% (12/47), χ2=28.72, P < 0.01; 66.67% (28/42) vs. 28.57% (12/42), χ2=4.97, P < 0.05].③High-expression of COMT was not related to age, gender, location of tumor, and pathological type in colorectal adenoma patients (P > 0.05). High-expression of COMT was not related to age, gender, location of tumor, and differentiation degree (P > 0.05), but was related to TNM staging, T staging, and N staging in colorectal cancer patients (P < 0.05), the patients of TNMⅠ+Ⅱstaging, T1+T2 staging, and N0 staging had higher rate of high-expression of COMT. ConclusionCompared with corresponding adjacent tissues, COMT expresses highly in colorectal adenoma tissues and colorectal cancer tissues, so it may play a partial role in the emergence and development of colorectal cancer.
ObjectiveTo understand the incidence of fecal incontinence after sphincter-preserving operation for middle and low rectal cancer, the factors influencing fecal incontinence, the relationship of fecal incontinence to anorectal manometry, and treatment. MethodThe literatures about fecal incontinence after sphincter-preserving operation for middle and low rectal cancer were reviewed. ResultsThe incidence of fecal incontinence after sphincter-preserving operation for middle and low rectal cancer was about 35.3%. Wexner fecal incontinence score was the most popular scale in assessing the severity of fecal incontinence, which had high validity and utility. When Wexner score≥9, the fecal incontinence-related quality of life was seriously damaged. Closer the anastomosis to the anal margin, the fecal incontinence was more likely to happen and much severer if it appeared. Surgeon could improve the anorectal function through some kinds of surgeries, like ultralow anterior resection with levator-sphincter reinforcement when the tumor site was rather low. The effect of chemoradiotherapy on fecal incontinence was uncertain now. Age itself was a risk factor for fecal incontinence, for elderly patients underwent sphincter-preserving operation needed to be careful. The relationship of fecal incontinence to anorectal function was not completely clear. The anal sphincter nerve function was a predicting factor whether neurogenic fecal incontinence was going to happen or not. Even though the retrograde colonic irrigation, sacral nerve stimulation, and biofeedback therapy had been proved to alleviate the symptoms and improve the quality of life after sphincter-preserving operation, much more prospective and controlled studies were needed to validate their efficacy and explore other new solutions. ConclusionsWe still need to come up with the objective criterion to assess fecal incontinence. Much more prospective studies are needed to analyze the influencing factors and to find effective prevention and treatment.