Objective To compare the effects of double stapling technique （DST） and single stapling technique （SST） in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer. Methods The clinical data of 351 patients with rectal caner， who were treated with low or ultralow anterior resection and colon-anal canal anastomosis in West China Hospital from Jan. 2009 to Dec. 2010， were collected and analyzed retrospectively. Operative and postoperative indexes of patients treated with DST （n=302） and SST （n=49） were compared. Results Compared with DST group， the distance from the dentate line to the edge of tumor， the length of the distal surgical margin 〔（1.83±0.59） cm vs. （2.07±0.56） cm〕， and hospitalization cost 〔（24 350.48±7 812.73） yuan vs.（29 455.32±7 869.33） yuan〕 of SST group were shorter or lower （P＜0.05）， but operative time was longer 〔（112.86±39.29） min vs. （100.10±36.75） min， P＜0.05〕. There were no significant differences on blood loss， duration of firstambulation， duration of first passing flatus， duration of first bowel movement， duration of pulling out nasogastric tube， duration of pulling out urinary catheter， duration of pulling out drain， postoperative hospital stay， total length of hospital stay， and the incidence of complication between the 2 groups （P＞0.05）. All patients were in functional recovery of anal control after operation. All patients were followed-up for 6-24 months （average 16 months）. During the followed-up， only 1 case suffered local tumor recurrence （SST group）， 3 cases suffered distant metastases （all in DST group）， and 15 cases （4.27％） died， of which 13 cases （4.30％） in DST group and 2 cases （4.08％） in SST group. Conclusions As in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer， SST results in shorter distal surgical margin than DST， so SST is suitable for the patients with shorter distance from the dentate line to the edge of tumor. What’s more， it saves the hospitalization cost effectively.
Objective To investigate the measures to prevent the anastomotic leakage following anterior resection of rectum. Methods A series of seventy-four patients with rectal cancer undergoing anterior resection from January 1991 to October 1998 were analyzed.Results The clinical anastomotic leakage rate was 4.05 per cent (3/74). The causes of leakage were presacral infection and insufficiency of blood supply in incisional margin. Conclusion The proximal colon must be completely mobilized and blood supply of incisional margin should be sufficient. Persistent postoperative presacral suction must be performed to protect fluid accumulation resulting in infection. Intracolonic drainage is an important factor in prevention of anastomotic leakage. Temporary stoma is not necessary.
Objective To analyze the relationship between Glasgow prognostic score （GPS）， liver metastasis， and prognosis of rectal caner. Methods Clinical data of 223 patients with rectal cancer who underwent operation in Chinese PLA General Hospital from Jun. 2005 to Dec. 2011 were retrospectively analyzed， and the relationship between preoperative GPS score， liver metastasis， and prognosis of rectal cancer were analyzed. Results Preoperative GPS score of patients with rectal cancer was related to invasion depth （P＜0.001）， vascular or lymphatic invasion （P＜0.001）， liver metastasis （P＜0.001）， TNM stage （P＜0.001）， levels of carcinoembryonic antigen （P=0.009）， levels of CA19-9（P＜0.001）， and levels of CA724 （P＜0.001）. Multivariate analysis results revealed that differentiation of tumor （poorly：OR=10.688）， vascular or lymphatic invasion （OR=4.918）， lymph node metastasis （OR=3.359）， and preoperative GPS score （score 2：OR=15.907） were related to liver metastasis；age （RR=2.121）， differentiation of tumor （poorly：RR=2.846）， invasion depth （RR=1.754）， TNM stage （stageⅡ：RR=7.447， stageⅢ：RR=9.030， stage Ⅳ：RR=13.325）， and preoperative GPS score （score 2：RR=2.471） were the independently prognostic factors of rectal cancer. The preo- perative GPS score were related with both liver metastasis and prognosis of rectal cancer. Conclusion Preoperative GPS score is associated with liver metastasis of rectal cancer， and it is considered to be a useful predictor of postoperative prognosis in rectal cancer.
Objective To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.
Objective To investigate the expressions of tumor necrosis factor related apoptosis inducing ligand （TRAIL） and its receptors (DR4, DcR1) in human rectal cancer tissues and normal rectal tissues. MethodsThe expressions of TRAIL and its receptors (DR4, DcR1) in 31 cases of human rectal cancer tissues and 20 cases of normal rectal tissues were detected by immunohistochemical staining. ResultsThe positive expression rates of TRAIL, DR4 and DcR1 （32.26%， 29.03%， 0） were lower than those of normal rectal tissues （55.00%， 70.00%， 65.00%）, the difference was statistically significant(P=0.015， P=0.000， P=0.000). There were no relation between the expressions of TRAIL, DR4 and DcR1 and clinicopathologic characteristics (Pgt;0.05). ConclusionThe expressions of TRAIL and its receptors (DR4, DcR1) in human rectal cancer tissues were lower than those of normal rectal tissues, which may suggest that the apoptotic effect induced by the interaction between TRAIL and its receptors has attenuated in human rectal cancer.
Objective To investigate the application of air leak test combined with methylene blue solution leak test in the detection of anastomotic leakage after total mesorectal excision （TME） in rectal cancer. Methods In total of132 patients with rectal cancer underwent Dixon according to TME in our hospital from Mar. 2010 to Mar. 2013 were enrolled. All patients were randomly divided into air leak test group （n=65） and air leak＋methylene blue solution leak test group （n=67）. The intestinal anastomosis of patients in air leak test group were clamped at 2 cm from the upper endof bowel， then injecting 500 mL distilled water to pelvic， and placing 24# Foley catheter through the anus. The catheter balloon was injected with water to close anus， and then injected with 50 mL gas to find the anastomotic leakage where bubbles happened， and then repaired it. Patients of air leak＋methylene blue solution leak test group were treated with methylene blue solution test in addition. After sucking out of the distilled water in pelvic and gas in the rectum， 1 bottle of methylene blue solution （20 mg） and 50 mL saline were injected， observing the location where the methylene blue solutionleaking out and repaired it. Results Three cases （4.62%） of anastomotic leakage were found during operation in air leak test group， and 9 cases （13.85%） were found after operation. Of the 9 cases， 5 cases were cured with placement of adeq-uate drainage and symptomatic treatment， 3 cases were cured with anal patch， and 1 case was cured with transverse colon fistula and drainage. In total of 15 cases （22.39%） were found anastomotic leakage， 2 cases of them were found by air leak test and another 13 cases were found by methylene blue solution leak test during operation in air leak＋methylene bluesolution leak test group， but no one suffered anastomotic leakage after operation. Compared with air test group， detectionrate of anastomotic leakage during operation was higher （P＜0.05）， and incidence rate of anastomotic leakage after opera-tion was lower in air leak＋methylene blue solution leak test group （P＜0.05）. Conclusions Large anastomotic leakage can be found by using air leak test， and small and hidden leakage can be found by using methylene blue solution leak test， combination method of the two experiments is better. Repair can be performed effectively under direct vision.
ObjectiveTo explore the efficacy of da Vinci robotic surgical system-assisted radical resection of rectal cancer. MethodsThe clinical data of 456 patients who received radical resection of rectal cancer by the da Vinci robotic surgical system at the Southwest Hospital from March 2010 to March 2016 were retrospectively analyzed. Operative time, operative blood loss, number of harvested lymph nodes, hospital stay, and morbidity were evaluated. Resultsda Vinci robotic surgical system-assisted radical resection of rectal cancer were successfully carried out in 445 patients, and other 11 patients were converted to open surgery (2.4%). Of 456 patients, 322 patients underwent anterior resection of rectum procedure (70.6%), 126 patients underwent abdominoperineal excision procedure (27.6%), 8 patients underwent Hartmann procedure (1.8%). The mean operative time was (192±60) min, the mean operative blood loss was (110±93) mL, the mean number of harvested lymph nodes were 19±6, the mean length between distal resection margin and tumor were (3.5±1.8) cm, the mean time for patients taking normal activity was (2.9±1.5) d, the mean time of passage of the first flatus was (2.7±1.7) d, the mean hospital stay was (7.1±1.6) d. Surgical complications occurred in 40 patients (8.8%), and all the patients were recovery before leaving hospital. The mean follow-up time was 29.1-month (3-75 months). There were 70 patients suffered from occurrence or metastasis (16.2%), and 60 patients died (13.9%). Conclusionda Vinci robotic surgical system-assisted radical resection for rectal cancer is a feasible and safe surgical procedure with the minimal trauma, fast recovery, and satisfactory clinical efficacy.
Objective To evaluate the feasibility and clinical outcomes of laparoscopic total mesorectal excision (TME) in treating mid-low rectal cancer. Methods From March 2005 to July 2008, 74 patients with mid-low rectal cancer undergoing laparoscopic TME in Zhejiang Cancer Hospital were collected. The data of clinicopathologic parameters were analyzed. Results Laparoscopic TME was performed on 74 patients with mid-low rectal cancer. No operative death occurred in this group. No case was converted to open procedure. The mean operation time was 187 min. The mean operative blood loss was 90 ml. The mean postoperative hospital stay was 10 d. Bowel function was restored on 46 h after operation on average. The mean distance between tumor and the section edge was 3.1 cm. The average number of lymph node dissection was 19.7. The sphincter preservation rate was 97% in patients with tumor 6 cm above the anal verge. The follow-up times were 2-44 months, average 25 months. The incidence of complications was 9.5%. No tumor cell port site implantation or distant metastasis happened. One case was pelvic recurrence， no patient was dead.Conclusion Laparoscopic TME is a feasible, safe and minimally invasive technique for the patients with mid-low rectal cancer, achieving the principles of TME.
ObjectiveTo systematically review the effects of chewing gun on the promotion of intestinal function recovery after colorectal cancer surgery. MethodsWe searched PubMed, The Cochrane Library, CBM and CNKI databases from their inception to December 2014, to collect randomized controlled trials (RCTs) assessing chewing gun in patients after colorectal cancer surgery. References of included studies were also retrieved. Two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsNine RCTs involved 686 patients were included. The results of meta-analysis indicated that, compared with the control group, chewing gun could significantly reduce the time to first passage of flatus (MD=-17.33, 95%CI -23.96 to -10.70, P<0.000 01), the time to the first defecation (MD=-22.25, 95%CI -36.45 to -8.05, P=0.002) and postoperative hospital stay (MD=-1.37, 95%CI -2.25 to -0.49, P=0.002) after colorectal cancer surgery, and could also reduce the intestinal obstruction caused by intestinal paralysis (OR=0.33, 95%CI 0.14 to 0.77, P=0.01). However, no significant difference in the incidence of nausea and vomiting was found. ConclusionEarly chewing gum can promote the recovery of gastrointestinal function in patients after colorectal cancer operation.
【Abstract】Objective To investigate the recent studies on the biocharacters of keratin family (e.g. genetic mutations and abnormal expressions) and their relationships with the malignant tumors. Methods The literatures of recent years on the biocharacters of keratin family (e.g. genetic mutations and abnormal expressions) and their relationships with the malignant tumors were reviewed. Results Keratin family is a kind of structural proteins in cell which plays an important role in cytomechanics and regulates cell-cycle. The mutations of keratin genes (mRNA) or the overexpression of keratin proteins would interfere with the order of cell-cycle or the integrity of cytomechanics, and lead to some diseases and malignant tumors finally. Conclusion The studies on biocharaters of keratin family (e.g. genetic mutations and abnormal expressions) are helpful in the diagnosis, staging and the evaluation of prognosis of some diseases and cancers, e.g. liver cirrhosis, breast cancer, rectum carcinoma, etc.