Objective To compare the outcomes of low/ultra-low anterior rectal resection and valgus resection in elder patients with rectal or anal cancer. Methods The clinical data of 184 patients with rectal or anal cancer， who were treated with extreme sphincter preserving surgery in West China Hospital from January 2009 to December 2011， were collected and analyzed retrospectively. The intraoperative and postoperative indexes between low/ultra-low anterior rectal resection group and valgus resection group were compared. Results ①There were no significant differences in the age，body mass index， gender， diameter of tumor， TNM stage， degree of differentiation， histological type， gross type， and complications before operation， such as hypertension， chronic obstructive pulmonary disease， cardiovascular diseases， diabetes， renal disease， and hypoproteinemia in two groups （P＞0.05）. ②Compared with the low/ultra-low anterior rectal resection group， the distance from the anal verge to the tumor was shorter （P＜0.05） and the distance of distal resec-tion margin of tumor was longer （P＜0.05） in the valgus resection group. ③There were no significant differences in the operation time， blood loss， ASA grade， and the postoperative complications in two groups （P＞0.05）. ④There were no significant differences in the duration of pulling out nasogastric tube， urinary catheter， and drainage tube， the duration of first passing flatus， first defecation， first oral intake， and first ambulation， and hospitalization cost （P＞0.05）. But the postoperative hospital stay and total hospital stay in the valgus resection group were significantly longer than those in the low/ultra-low anterior rectal resection group （P＜0.05）. ⑤All the patients were followed-up for 6-24 months （average 13 months）. During the following-up， only 1 case suffered local tumor recurrence in the valgus resection group. One case suffered distant metastases in the ultra-low anterior rectal resection and valgus resection group， respectively. Eight cases （4.35%） died， of which 4 cases （4.04%） in the low/ultra-low anterior rectal group and 4 cases （4.71%） in the valgus resection group. All the patients were in functional recovery of anal control after operation. Conclusions As the extreme sphincter preserving surgery for elder patients with rectal or anal cancer， the low or ultra-low anterior rectal resection and valgus resection could both be used for elder patients with extreme-low rectal or anal cancer. However， valgus resection results in longer distal surgical margin than that low/ultra-low anterior rectal resection， and it is suitable for the patients with shorter distances from the anal verge to the tumor.
Objective To evaluate the impact of body mass index （BMI） on short-term outcomes after intersphi-ncteric resection （ISR） for rectal cancer and anal cancer. Methods One hundred and ninety-nine cases of rectal cancer and anal cancer who were treated in Department of Gastrointestinal Surgery of West China Hospital of Sichuan University from Jan. 2009 to Dec. 2011 were enrolled retrospectively，and these cases were divided into underweight group （n=23），normal group （n=114），and overweight group （n=62） according to BMI. Postoperative indexes in early rehabilitation and complication of 3 groups were studied and compared. Results On the recovery indexes after ISR in early stage，there were no significant differences on the duration of first flatus，first defecation，first oral intake，first ambulation，and hospital stay among 3 groups （P＞0.05）. On the tube management，there were no significant differences on the duration of pulling out nasogastric tube and urinary catheter （P＞0.05），but duration of pulling out drain was longer in normal group and over-weight group （P＜0.05）. There were no significant differences on the incidence of postoperative complications among the 3 groups （P＞0.05），including anastomotic leakage，anastomotic bleeding，perianal infection，ileus，gastric retention，urinary retention， septicemia，wound infection，and recto-vaginal fistula. Conclusions BMI has little impact on short-term outcomes after ISR. Obesity does not increase the incidence of common complications for patients after ISR and does not influence recovery indexes with proper postoperative managements.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
目的 探讨医生的专业化程度对直肠癌根治性切除术质量的影响。 方法 纳入2007年7月－2009年12月收治且确诊为直肠癌的手术患者共679例，分为专业组（470例）和非专业组（209例），收集患者年龄、体质量指数（BMI）、肿瘤TNM分期、手术持续时间、术中出血量、术后胃肠功能恢复时间、术后并发症等围手术期指标，进行相关统计学分析。 结果 两组患者手术持续时间相当（P=0.322），但在专业组中患者术中出血量较非专业组少（P=0.008）。专业组患者术后拔除胃管时间（P=0.000）、拔除引流管时间（P=0.000）、首次进流质食物时间（P=0.002）、首次排便时间（P=0.007）和下床活动时间（P=0.001）均较非专业组提前，术后住院时间（P=0.152）与住院总时间（P=0.983）两组差异无统计学意义，且专业组术后并发症总发生率较低（P＜0.05）。 结论 医生的专业化程度对直肠癌根治术患者围手术期的管理有显著影响，专业化程度高的直肠癌外科医生可为患者带来更好的手术效果。
Objective To determine whether neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are important prognostic factors in patients with colorectal cancer, and to clarify relationship between NLR or PLR and TNM staging in colorectal cancer. Methods The clinical data of 304 patients with colorectal cancer who were admitted to the same medical group from January 2013 to December 2013 in the West China Hospital of Sichuan University were analyzed retrospectively. The relationship between NLR or PLR and the clinicopathologic characteristics and its effects on prognosis of patients with colorectal cancer were analyzed. Results The critical values of NLR (sensitivity=51.0%, specificity=75.4%, area under the receiver operating characteristic curve=0.66) and PLR (sensitivity=73.0%, specificity=46.4%, area under the receiver operating characteristic curve=0.60) was 2.27 and 155.92, respectively, with a 3-year cumulative survival rate as the end point. According to the critical values of NLR and PLR, there were 133 cases in a low NLR group (NLR≤2.27), 171 cases in a high NLR group (NLR>2.27), 207 cases in a low PLR group (PLR≤155.92), 97 cases in a high PLR group (PLR>155.92). ① The 3-year survival rate was 91.5% and 77.2% in the low NLR group and the high NLR group, respectively, which was 89.0% and 72.8% in the low PLR group and the high PLR group, respectively. The survival curves of NLR and PLR on prognosis prediction had significant differences (P=0.002, P=0.001). ② The results of multivariate analysis showed that the NLR was the independent risk factor for colorectal cancer (P=0.004), whereas PLR was not the independent risk factor for colorectal cancer (P=0.408). ③ The NLR and PLR were associated with the tumor TNM staging (P=0.002, P=0.000), which in the colorectal cancer with stage Ⅳ was significantly higher than those with stage Ⅰ–Ⅲ (P<0.05). ④ The NLR and PLR were associated with T stage (P=0.006, P=0.031). The NLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅰ (P=0.015) or stage Ⅱ (P=0.032). The PLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅱ (P=0.013). ⑤ The NLR was not associated with N staging (P=0.118). The PLR was associated with N staging (P=0.007), which in the colorectal cancer with N2 stage was significantly higher than that with N0 stage (P=0.008) or N1 stage (P=0.019). ⑥ The NLR and PLR in the colorectal cancer with stage M1/M2 were significantly higher than those with stage M0 (P=0.004, P=0.001). Conclusions Preliminary results of this study show that NLR is an important independent prognostic indicator for patient with colorectal cancer. While PLR is significantly increased when lymph node metastasis occurs, and platelet elevation might be related to lymph node metastasis.