从全国结直肠癌手术病例数据库论述结直肠癌外科诊断与治疗的规范化

中国有全世界最大的结直肠癌患者群体,但鲜见来自中国的国际性结直肠癌诊断与治疗指南,或者来自中国的高等级循证医学研究证据。近年来,中国结直肠外科得到快速发展,无论在临床实践还是临床研究方面都取得长足进步,然而还存在诸多不平衡和欠规范之处。2018年中华医学会外科学分会结直肠外科学组牵头建立全国结直肠癌手术病例数据库,通过回顾性及前瞻性研究收集相关数据,并开展统计学分析发现:中国结直肠癌诊断与治疗过程以及数据管理的规范化都亟待提高,临床科研意识亦有待加强。因此,基于中国结直肠癌手术的数据库建设,如何开展中国结直肠癌手术相关临床研究,并获得高等级循证医学研究证据,是中国结直肠外科面临的最严峻考验。     

5G在结直肠外科应用中的机遇与挑战

近年来,随着我国结直肠外科的迅速发展,结直肠癌病人预后明显改善,但地区发展不均衡导致的医疗水平差距依然存在。第5代移动通信技术(简称5G)作为未来网络发展方向,拥有高带宽、大连接等优势,有利于远程医疗的发展。笔者结合结直肠外科发展现状,探讨5G在结直肠外科中应用的机遇与挑战。希望利用网络技术的独特优势,解决结直肠外科现有问题并创新诊断与治疗方法,推动结直肠外科的进一步发展。     

2008结直肠肿瘤外科新技术新进展协和论坛会议通知

为了促进结直肠肿瘤诊治新技术的普及和推广，增进国内与国际结直肠外科的学术交流，由北京协和医院基本外科与中华医学会继续教育委员会联合举办的”2008结直肠肿瘤外科新技术新进展协和论坛”拟于2008年9月27～30日在北京召开。论坛拟采用学术讲座、现场手术演示和专题讨论相结合的形式进行，会议将邀请知名专家就直肠癌新辅助治疗、结直肠癌的腹腔镜手术、经肛门内镜微创手术（TEM）、低位直肠癌的保肛手术、直肠癌的局部切除、直肠癌术后吻合口瘘的预防等结直肠外科的热点话题进行学术探讨。     

结直肠外科2021年研究进展及学科展望

近年来,免疫评分及液体活检已经用于指导结直肠癌精准诊疗,结直肠外科技术向着更趋于理性和科学性发展,结直肠外科器官功能保护策略愈受关注,而靶向治疗和免疫治疗等综合治疗的开展为结直肠癌的治疗选择提供了更多策略。同时,结直肠良性疾病的外科进展也在进一步挑战传统理念。医学的进步和理念的革新对我国结直肠外科发展提出了新的要求,努...     

中国结直肠外科20年回顾与展望

进入21世纪以来,我国结直肠外科发展迅猛,新技术、新设备不断涌现,理念不断革新。我国结直肠外科同道在顺应世界潮流的同时,积极开展和推广普及新技术,开展高质量的临床研究,并在获得高质量循证医学证据的基础上制订相应的结直肠癌外科治疗指南与专家共识。目前我国对于结直肠癌患者的治疗已进入个体化精准微创医疗时代。在这样的时代背景...     

结直肠癌腹腔镜手术与开腹手术的分析比较

结直肠癌是危害人类健康的主要恶性肿瘤之一,手术仍然是目前主要的治疗手段.腹腔镜结直肠癌手术已开展了十余年,不断发展,在结直肠外科领域逐渐巩固了地位.本文就结直肠癌的腹腔镜手术与开腹手术在安全性、对机体病理生理的影响、疗效等方面进行比较,探讨腹腔镜在结直肠癌治疗中的应用价值.     

回眸2019——聚焦中国结直肠外科的发展与研究

虽然结直肠疾病的手术治疗进展较慢,但借助于近年来微创外科技术、围手术期综合治疗策略和临床研究的进步,中国结直肠外科亦得以快速发展。经肛全直肠系膜切除、盆腔侧方淋巴结清扫、直肠癌新辅助治疗临床完全缓解的“等待与观察”策略、机器人结直肠外科手术等仍然是近年来结直肠外科的热点议题。笔者结合全国性结直肠癌手术病例登记数据库建设以及临床研究等展开论述,以期为同道们梳理结直肠外科的发展脉络,共谋中国结直肠外科的发展。     

从临床研究和数据收集的角度看结直肠外科的发展方向

得益于近年来微创外科技术的发展、围手术期综合治疗策略和临床研究的进步,我国的结直肠外科也得到了快速发展。但对比我国与欧美发达国家的结直肠癌诊疗现状可以发现,西方发达国家的结直肠外科的专科化建设和规范化诊疗已经非常成熟,结直肠癌的多学科诊疗模式业已规范化运行。尽管我国东部沿海地区的高水平结直肠癌诊疗中心与西方国家相比已几...     

腹腔镜技术在低位直肠癌保肛手术中的应用

微创外科是未来外科学的一个重要发展方向，近年来有了长足的发展并取得了丰硕的成果。在结直肠外科领域，从1992年Kockerling首次成功运用腹腔镜技术完成第1例直肠癌根治术以来，大宗前瞻性对比研究已证实，腹腔镜结直肠癌手术与开腹手术的复发率及长期生存率无明显差异，而安全性、降低术后并发症等方面优于传统术式。     

腹腔镜与传统开腹结直肠癌根治手术疗效比较

腹腔镜在结直肠外科的成功施行是结直肠外科手术技术发展的里程碑。多项随机对照实验显示腹腔镜结直肠癌手术较传统肝腹手术有着诸多优点．其短期疗效已得到广泛认可。     

结直肠外科医生应具备的基本素质

虽然结直肠外科是普外科的一部分,但当前在中国结直肠外科医师正在成为一个专科医师,就像胸外科、心血管外科、泌尿科医师等。因为他们具有特殊的知识和技术,因此作为结直肠外科医师应在某些方面比普外科医师接受更多相关的训练并具有较高素质。     

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一项手术能否成为某一疾病治疗的金标准,往往需要有成熟的技术、充分的循证医学证据、经过规范的推广与普及,并最终受到广泛认可与实施。腹腔镜结直肠癌手术具有创伤小,恢复快等一系列优势,其与传统开放手术的操作技术与淋巴结清扫范围基本相同,且初步的疗效亦相当,随着腹腔镜结直肠癌手术的肿瘤根治效果和远期疗效逐步获得证实,在不久的将来,腹腔镜手术将有望成为根治结直肠癌的金标准手术。但就目前而言,是否成为金标准手术,则取决于地区发展水平、医院等级、术者是否经过规范培训等才能决定。     

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??What fundamental quality should colorectal surgeons be ? YU Bao-ming. Department of Colorectal Surgery , Shanghai No.8 People’s Hospital, Shanghai 200235 ,China Abstract Though colorectal surgery is just a branch of general surgery but in our country colorectal surgeon has now becoming a specialist in general surgeon just like thoracic surgeon , cardio-vascular surgeon , urologist , pedologic surgeon , orthopedist , neurologic surgeon , etc. due to its special field of knowledge and technique in surgery . So as a specialist colorectal surgeon one must be trained in several related aspects more than general surgeon and should be a higher fundamental quality surgeon .     

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??A cross-sectional study on the occupational status and concept of colorectal surgeons in China Chinese Society of Colon and Rectal Surgeons, Beijing 100044, China
Author: GUO Peng, LIU Fan, WANG Chao
Corresponding authors: YE Ying-jiang, E-mail: yeyingjiang@pkuph.edu.cn; WANG Shan, E-mail: shwang60@sina.com
Abstract Objective To assess the occupational status and concept of colorectal surgeons in China. Methods Thiswas a cross-sectional study using convenience sampling to collect data through questionnaire among colorectal surgeons in China. Results A total of 660 effective questionnaire was received,(1) general status: 95.3% were male, 91.2% were more than 30 years old, 26.5% had a M.D. degree, 76.7% worked in a tertiary hospital and 72.7% had pursued an occupation on colorectal surgery more than 5 years. (2) occupational status: the median of total inpatients of department were 52 and the median of colorectal inpatients of department were 30; the median cases of total surgery per year of department were 900 and the median cases of colorectal surgery per year of department were 200; the median of total surgeons of department were 8 and the median of colorectal surgeons of department were 6; the median cases of total surgery per year of participant was 250 and the median cases of colorectal surgery per year of participant was 80; the median cases of colon surgery per year of participant was 50 and 62.5% were open surgery, 31.3% were laparoscopic surgery; the median cases of rectal surgery per year of participant was 50 and 50.0% were open surgery, 47.5% were laparoscopic surgery. (3) occupational concept: Out of 660 participants, 76.6% agreed colorectal surgeons should master endoscopy, 26.3% mastered endoscopy, only 11.4% mastered EMR/ESD. For early colorectal cancer, advanced colorectal, resectable liver metastasis of colorectal cancer, unresectable liver metastasis of colorectal cancer, there were 19.7%??33.8%??46.2%??59.1% participants agreed multidiciplinaryteam had decision-making power in treatment. Conclusion Colorectal surgeons of China still need to strengthen specialization. Some new technology and concept such as minimally invasive technique, endoscopic technique, multidiciplinaryteam still need to be extension.     

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??Application of laparoscopic technique in colorectal surgery: Controversy and consensus XIAO Yi. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730,Chnia
Abstract There are increasing evidences to support the application of laparoscopic technique in colorectal cancer surgery. With the improving devices in laparoscopic surgery, more and more surgeons like to handle the skill with enthusiasm. Laparoscopic technique has an important role in minimal invasive surgery and enhanced recovery after surgery. Compared with traditional open surgery, laparoscopic surgery has significant short-term efficacy, such as easily recognition of anatomical spaces, clearly lymphadenectomy, less intraoperative bleeding, fast recovery after operation. The technique also has comparable long-term oncological outcomes with open surgery. Lots of new concepts and operative approaches are derived from laparoscopic technique, such as natural-orifice specimen extraction (NOSES), transanal total mesorectal excision (TaTME), which expands the extent of minimal invasive surgery. How to properly implement the laparoscopic technique in colorectal surgery should become the aim to train young surgeons, which would make the technique popularized.     

腹腔镜结直肠手术进展及展望（2000-2020）

自20世纪90年代至今,腹腔镜结直肠手术技术经历了突飞猛进的发展,安全性逐渐得到广泛认可,已经成为结直肠癌的重要手术方式。与传统的开放结直肠手术对比,腹腔镜结直肠手术创伤更小,降低了术后的应激和炎症反应,使病人的免疫状态得到改善;腹腔镜结直肠手术可获得更好的近期疗效和相当的远期疗效。近年来相继报道腹腔镜结直肠手术安全性、有效性研究证据,NCCN指南中腹腔镜结直肠手术的指征也不断拓展。如今在完整系膜切除（CME）、全系膜切除（TME）原则的指导下,已发展出诸多腹腔镜结直肠手术术式。未来,在5G通信技术的支持下,在越来越多中国学者的多中心RCT研究结果揭晓后,腹腔镜结直肠手术必将迎来空前发展。     

Learning curve in laparoscopic rectum surgery

Laparoscopic colorectal surgery has become increasingly more common since first being described in a publication in 1990. Despite a multitude of studies about the learning curve in laparoscopic colon surgery, there are almost no such studies with regard to laparoscopic rectum surgery. This paper aims to describe a surgeon's learning curve with regard to laparoscopic rectum surgery. Based on data collected in a prospective observational study of 180 patients, it can be established that a surgeon experienced in open colorectal surgery, with basic experience in laparoscopic surgery, after suitable preparation and having a personal interest in minimally invasive surgery, needs to perform about 35 laparoscopic rectum resections within 200 laparoscopic colon resections until selection rate, operating time and rates of general and surgical complications reach a plateau. A selection of cases suited to a surgeon's personal level of operating experience, is a prerequisite for a low rate of conversions and complications and for oncological long-term results comparable to those achieved through open surgery. However, the learning curve is dependent on a multitude of factors that are partly unknown at this point. Its duration most certainly varies between individual surgeons. Every surgeon is required to critically evaluate his or her own laparoscopic experience and select cases accordingly. Supervision by surgeons more experienced in laparoscopic colorectal surgery prevents disadvantages for patients in the early phases of the surgeon's learning curve. Training in laparoscopic colorectal surgery should take place only in institutions with a sufficient number of cases treated and a continuity in experienced teachers. CAMIC's efforts in establishing centres of competence and reference are therefore to be commended and supported.     

Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance

OBJECTIVE: The objective of this study was to clarify the incidence and risk factors for developing incisional surgical site infection (SSI) in both elective colon and rectal surgery. SUMMARY BACKGROUND DATA: SSI is a frequent complication after elective colorectal resection. The National Nosocomial Infection Surveillance system surveys all colorectal surgeries together, without differentiating the type of colorectal surgery performed. However, rectal surgery may have a higher risk for SSI, and identifying risk factors that are more specific to each procedure would be more predictive. METHODS: We conducted prospective SSI surveillance of all elective colorectal resections performed by a single surgeon in a single institution from November 2000 to July 2004. The data for colon and rectal surgeries were collected separately. The outcome of interest was incisional SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery. RESULTS: A total of 556 colorectal resections, consisting of 339 colon and 217 rectal surgeries, were admitted to the program. The incisional SSI rates in colon and rectal surgeries were 9.4% and 18.0%, respectively (P = 0.0033). Risk factors for developing incisional SSI in colon surgery were ostomy closure (OR = 7.3) and lack of oral antibiotics (OR = 3.3), while in rectal surgery, risk factors were preoperative steroids (OR = 3.7), preoperative radiation (OR = 2.8), and ostomy creation (OR = 4.9). CONCLUSIONS: Colon and rectal surgeries differ with regard to incidence and risk factors for developing incisional SSI. SSI surveillance for such surgeries should be performed separately, as this should lead to more efficient identification of risk factors and a reduction in SSI.     

Genetic alterations in normal epithelium of colorectal cancer patients may be a useful indicator for subsequent metachronous tumor development

Background We attempted to identify areas of microsatellite alterations specific to histologically normal colorectal epithelium and to clarify the correlations among those molecular events and clinicopathologic features. Methods We conducted a prospective observation study on 51 colorectal cancer patients. Preoperative blood and microdissected histologically normal colorectal epithelium and neoplastic tissues were collected. Microsatellite analyses with seven microsatellite loci were performed to examine the genetic potential of individual tumors and histologically normal colorectal epithelium. Results In the sporadic colorectal cancer group, p53 LOH in the neoplastic epithelium had a significant correlation with the maximum tumor diameter and the preoperative serum cancer antigen 19-9 level, but not with the depth of invasion of the primary tumor. Among the patients who had p53 LOH in the histologically normal colorectal epithelium, four additional tumors were discovered within 30 months after curative surgery. For those patients, microsatellite alterations in normal colorectal epithelium were more sensitive than tumor markers. Conclusions For accurate LOH analysis, nonmalignant lymphocytes from blood should be used as the appropriate normal DNA sample. Focusing on the identification of high-risk patients for microsatellite alterations in histologically normal colorectal epithelium can be a useful indicator of subsequent metachronous tumor development after colorectal surgery.