腹腔镜辅助经肛外翻拖出式超低位直肠癌根治术的应用体会

目的 评价腹腔镜辅助经肛外翻拖出式直肠切除治疗低位直肠癌根治术的安全性和疗效.方法 对我院2008年12月至2010年6月接受腹腔镜辅助经肛直肠外翻拖出式直肠癌根治术的30例低位直肠癌患者(肿瘤下缘距齿状线3～5 cm,A组)资料进行回顾性分析,在数据库中,抽取同期接受腹腔镜辅助直肠前切除直肠癌根治术(Dixon)的中低位直肠癌30例作为对照组(肿瘤下缘距齿状线5～10 cm,B组).观察两组手术近期并发症发生率、术后肛门排便功能和短期局部复发率.结果 两组60例均保留了有控制大便功能的肛门,A组术后恢复进食两周内每天大便次数多于B组(P=0.025),术后6个月后.两组每天排便次数无统计学差异(P=0.652).两组均各有1例吻合口漏,B组有1例吻合口出血,无手术死亡,随访6个月至2年,两组均有1例局部复发.结论 腹腔镜辅助经肛直肠外翻拖出式直肠癌根治术操作方便,安全可行、疗效确切,提高了患者生存质量.     

经双吻合器直肠拖出式切除吻合行超低位直肠癌保肛术的疗效

目的探讨在超低位直肠癌保肛术中实施经双吻合器直肠拖出式切除吻合的疗效。方法选择实施经双吻合器直肠拖出式切除吻合手术治疗的62例超低位直肠癌患者为研究组,选取同期经腹直肠前切除吻合术患者58例为对照组,比较两组患者的结果。结果所有患者经双吻合器直肠拖出式切除吻合全部成功,两组患者复发情况、生存情况相近,差异无统计学意义。研究组术后6个月的肛门功能明显优于对照组,两组12个月的肛门功能情况相近。结论在超低位直肠癌保肛术中,实施经双吻合器直肠拖出式切除吻合有一定优势,值得推广应用。     

无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治的临床研究

目的：探讨无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治的临床应用价值。方法：回顾性分析术前Dukes A期26例患者,行无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治术的临床病理资料,其中直肠癌Dixon术式21例,Miles术式5例。结果：26例直肠癌均在完全腹腔镜下完成手术,无死亡病例,上端切缘距肿瘤大于10cm,下端切缘大于3cm;病理均为腺癌,切缘无癌组织残留。术中出血量（15-310）ml,平均87.89ml;手术时间（109-297）min,平均173.45min;术后肠蠕动恢复时间（27-88）h,平均49.97h;术后住院（7-12）d,平均8.69d;淋巴结清扫（2-20）枚,平均12.3枚。术后有1例吻合口出血,无吻合口瘘和狭窄等并发症,术后短期随访局部复发l例,其他患者无复发、转移及trocar切口的种植转移。结论：无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治手术是安全可行的,患者痛苦小,并发症少,可获最佳美容,术后恢复快,与常规开腹手术疗效相当。     

无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治的临床研究

目的:探讨无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治的临床应用价值.方法:回顾性分析术前Dukes A期26例患者,行无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治术的临床病理资料,其中直肠癌Dixon术式21例,Miles术式5例.结果:26例直肠癌均在完全腹腔镜下完成手术,无死亡病例,上端切缘距肿瘤大于10cm,下端切缘大于3cm;病理均为腺癌,切缘无癌组织残留.术中出血量(15-310)ml,平均87.89ml;手术时间(109-297)min,平均173.45min;术后肠蠕动恢复时间(27-88)h,平均49.97h;术后住院(7-12)d,平均8.69d;淋巴结清扫(2-20)枚,平均12.3枚.术后有1例吻合口出血,无吻合口瘘和狭窄等并发症,术后短期随访局部复发l例,其他患者无复发、转移及trocar切口的种植转移.结论:无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治手术是安全可行的,患者痛苦小,并发症少,可获最佳美容,术后恢复快,与常规开腹手术疗效相当.     

无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治术的临床应用价值

目的探讨无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治术的临床疗效。方法选取2015年9月至2016年6月期间高州市人民医院收治的95例直肠癌患者,采用随机数字表分为观察组(n=47)和对照组(n=48)。对照组行腹腔镜直肠前切除术治疗,观察组行无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治术。观察两组患者术中术后一般情况、术后并发症发生情况、术后排便情况和预后情况。结果观察组患者手术出血量少于对照组,胃肠功能恢复时间和术后平均住院时间短于对照组,住院费用少于对照组(P0.05);观察组患者术后并发症发生率低于对照组(P0.05);观察组患者术后2周内日均排便次数和术后半年内日均排便次数均高于对照组,差异有统计学意义(P0.05);两组患者术后2年生存率和复发率比较均无统计学意义(P0.05)。结论无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治术安全可靠,疗效显著。     

腹腔镜辅助直肠外翻低位直肠癌前切除27例

  目的  遵循直肠癌全直肠系膜切除(Total Mesoreetal Exeision, TME)原则的前提下, 探讨应用腹腔镜辅助直肠外翻技术完成低位直肠癌骶前切除及吻合的新方法。  方法  选择性地对2007年6月到2009年7月间收治的27例低位及超低位直肠癌患者实施腹腔镜辅助直肠癌根治术, 术中将远端直肠经肛门外翻来确定肿瘤远端切缘, 完成低位保肛术。  结果  所有27例患者手术顺利, 切缘病检阴性, 术后恢复顺利, 无吻合口漏, 随访6~31个月, 26例无瘤生存。  结论  将直肠肿物经肛门外翻确定肿瘤远端切割线的方法可以弥补腹腔镜下术者手感不足的缺点, 能够准确地确定直肠远端安全切缘, 同时还可以节省手术费用, 让更多的患者受益于腹腔镜直肠癌手术。      

无切口腹腔镜下直肠外翻技术的直肠癌低位前切除术的近期疗效

目的 探讨经肛门自然腔道标本取出的无切口腹腔镜低位前切除术治疗中低位直肠癌患者的可行性、适应证和近期疗效.方法 收集应用直肠外翻拖出技术,行无切口的腹腔镜直肠癌低位前切除术患者的临床资料,分析患者术后排气时间、淋巴结清扫数目、吻合口瘘发生率等临床特征.结果 27例患者均行全腹腔镜直肠癌低位保肛术,中位手术时间为135 min,中位手术出血量为50 ml,中位术后恢复排气时间为48 h,中位术后住院时间为9d.27例患者远端切缘均未发现癌细胞,中位淋巴结清扫数目为18枚,术后发生吻合口瘘1例.结论 在经选择的适合此术式的患者中,利用直肠外翻技术的无切口腹腔镜直肠癌低位前切除术切实可行、安全可靠、近期疗效满意.     

直肠拖出双吻合器21例超低位直肠癌保肛手术应用

[目的]探讨直肠拖出双吻合器保肛术在超低位直肠癌的临床应用价值。[方法]1999年1月～2006年12月对21例超低位直肠癌采用直肠拖出双吻合器技术行保肛手术切除。[结果]全组21例患者手术均获得成功,术后发生吻合口瘘1例,发生率为4．8％。术后控便功能优12例、良8例、差1例,术后肿瘤复发3例（14.3％1,出现吻合口狭窄3例（14．3％）,无手术死亡。[结论]直肠拖出双吻合器技术行超低位直肠癌保肛术能较好保留排尿、排便及性功能,提高了超低位直肠癌保肛手术的成功率。     

腹腔镜辅助下大肠外翻拖出式手术对结肠癌VEGF-A、VEGF-C及VEGF-D表达的影响

目的探讨腹腔镜辅助下大肠外翻拖出式手术治疗结肠癌的临床效果及对表皮生长因子(VEGF)-(A、C、D)表达的影响。方法选择64例结肠癌患者作为对象,随机数字表分为对照组(n=32)和观察组(n=32)。对照组给予腹腔镜辅助下直肠前切除术治疗,观察组采用腹腔镜辅助下大肠外翻拖出式手术治疗,术后5 d对患者效果进行评估。2组手术前、手术后均采用酶联免疫吸附试验(ELISA)测定患者VEGF-A、VEGF-C及VEGF-D表达水平,比较2组手术参数、VEGF-A、VEGF-C及VEGF-D表达水平及术后并发症及复发率。结果 2组手术时间比较,差异无统计学意义(P> 0. 05);观察组日均排便次数,多于对照组(P <0. 05);观察组术后肠道恢复、住院时间、术中出血量,均短(少)于对照组(P <0. 05)。观察组手术后5 d VEGF-A、VEGF-C及VEGF-D水平,均低于对照组(P <0. 05)。观察组手术后吻合口瘘、切口感染、皮下气肿、腹腔出血发生率及术后6个月复发率,均低于对照组(P <0. 05)。结论将腹腔镜辅助下大肠外翻拖出式手术治疗结肠癌手术创伤较小,并能降低VEGF-A、VEGF-C及VEGF-D表达水平,且术后并发症、复发率较低,值得推广应用。     

结肠肛管套式拖出吻合术治疗低位直肠癌的临床分析

目的评价结肠肛管套式吻合术治疗低位直肠癌的临床安全性及效果。方法回顾性分析我院1993-2002年以来33例低位直肠癌应用结肠肛管套式拖出吻合术的治疗情况,即肿瘤切除后使直肠远端外翻,近端结肠经外翻的直肠拖出,于肛门外行结肠一期吻合,并立即送回盆腔的外科技术。结果随访5-10年,随访率100％。肛门功能正常及良好者28例,占84.8％(28/33);较差者5例,占15.2％(5/33)。本组1例放疗后完全失去大便控制能力,改为Niles术。吻合口瘘1例,占3.0％。局部复发率15.2％;5年生存率60.6％(20/33),10年生存率39.4％(13/33)。结论保留肛门括约肌的结肠肛管套式拖出吻合术治疗低位直肠癌应选择合适的病例,可获得较高的生存率及生活质量。     

Laparoscopic rectal resection versus open rectal resection with minilaparotomy for invasive rectal cancer

Background

The minilaparotomy approach is technically feasible for the resection of rectal cancer in selected patients with rapid postoperative recovery and small incision. The study aimed to compare the clinical and oncological outcomes of minilaparotomy and laparoscopic approaches in patients with rectal cancer.

Methods

The 122 included patients with rectal cancer were assigned to either minilaparotomy group (n=65) or laparoscopic group (n=57) which ran from January 2005 to January 2008. Clinical characteristics, perioperative outcomes, postoperative and long-term complications, pathological results and survival rates were compared between the groups.

Results

The demographic data of the two groups were similar. The time to normal diet (P=0.024) and the hospital stay (P=0.043) were less in the laparoscopic group than that in the minilaparotomy group. Compared with the minilaparotomy group, the mean operation time was significantly longer [low anterior resection (LAR), P=0.030; abdominoperineal resection (APR), P=0.048] and the direct costs higher for laparoscopic group (P<0.001). The morbidity and mortality were comparable between the two groups. Local recurrence was similar (5.3% laparoscopic, 1.5% minilaparotomy, P=0.520). The 5-year overall and disease-free survival rates were also similar (overall survival is 87.1% in laparoscopic group, and 82.5%in minilaparotomy group, P=0.425; disease-free survival is 74.2% in the laparoscopic group, and 71.4% in mini- laparotomy group, P=0.633).

Conclusions

The minilaparotomy approach was similarly safe and oncologically equivalent to laparoscopic approach for patients with rectal cancer. At the expense of a longer operative time and higher cost, laparoscopic surgery was associated with faster postoperative recovery.     

Interstitial irradiation of rectal carcinoma with rectal template

Using Iridium-192 wires through a rectal template after Syed, interstitial brachytherapy was conducted in a patient with inoperable adenocarcinoma of the rectum. 67-year-old man with constipation and change in the stool caliber underwent external radiotherapy (4,000 cGy/4 W) to the whole pelvis including the perineum, followed by interstitial implant using a template, at the Department of Radiology, Osaka University Hospital. Marked tumor regression, marked circumferential fibrosis and a remarkable decline of CEA titers (pre-RT: 35.8 ng/ml, post-RT: 6.2 ng/ml) were observed until 7 months post-RT. The domestic production of Iridium-192 wires has made possible the integrated use of brachytherapy in the perineal region in Japan.     

Sphincter and rectal preservation approaches for early stage distal rectal cancers

In rectal cancer, the problem of sphincter preservation is of increasing interest. This paper is a review of recent data regarding sphincter preservation. Randomized trials give the best evidence of any improvement in sphincter preservation. Such trials have been performed for T3 and T2 rectal cancers. For T2-3 rectal tumors immediate surgery after preoperative radiotherapy or the addition of chemotherapy to radiotherapy did not improve the chance of sphincter preservation. Only dose escalation with endocavitary contact x-ray and delayed surgery was able to achieve a 30% increase in sphincter preservation. Ongoing clinical research is exploring the role of preoperative chemoradiotherapy in early T2 (T3) rectal cancers combined with local excision. This approach is of special interest in elderly patients. Sphincter preservation is a very complex issue in rectal cancer requiring great clinical experience to select properly the patients to perform the optimal treatment.     

Comparison of characteristics between true rectal neuroendocrine tumors and rectal hyperplastic polyps among patients with endoscope-diagnosed rectal neuroendocrine tumors

BackgroundTo explore the white light endoscopy and endoscopic ultrasonography (EUS) features of rectal hyperplastic polyps (rHP) misdiagnosed as rectal neuroendocrine neoplasms (rNENs). In rNENs with a diameter of 5–10 mm, the endoscopic findings are not typical and some of them are similar to rHP, so it is not uncommon to misdiagnose rNENs as rHP. However, misdiagnosis of rHP as rNENs has not been reported in the literature, which can alert clinicians to the existence of this possibility and avoid over-treatment.MethodsWe collected 245 cases of rectal submucosal tumor (SMT) diagnosed by endoscopy in our hospital from January 2015 to December 2020 and 103 patients with suspected rNENs identified through endoscopy. A retrospective analysis was conducted of the shape, color, vascular dilatation, and boundary on the surface of the lesion under white light endoscope, and the source, boundary, and echo characteristics of EUS. We also analyzed the endoscopic features of rHP misdiagnosed as rNENs. Endoscopic diagnosis and pathological diagnosis were reviewed by a senior endoscopic expert and pathologist respectively. The counting data were tested and analyzed by χ² test and Fisher exact probability method.ResultsA total of 103 cases of rNENs were diagnosed by endoscope, among whom 75 cases were confirmed as rNENs (72.8%) and 8 cases as rHP (7.8%) by histopathology. There was no significant difference between rNENs and rHP in terms of gender, age, clinical manifestation, shape and color of lesions, dilatation of blood vessels on the surface, and location of lesions. Meanwhile, there were significant differences in whether the boundary of the lesion was clear under white light endoscopy, and the source, echo, and boundary of the lesion under EUS.ConclusionsThe morphology of some rHP is similar to rNENs under endoscopy. The boundary is clear under white light endoscopy and the source, echo, and boundary under EUS are helpful for the diagnosis of rNENs and rHP.     

Prediction in rectal cancer

The treatment of rectal cancer largely depends on disease stage at diagnosis, based on which patients can be classified as low, intermediate, or high risk. Prognostic and predictive markers, specific to each risk category, can be applied for optimal risk classification and subsequent treatment allocation. These markers are either histopathological, determined with imaging, or have a biomolecular background. This review provides an overview of the current status of treatment options and the use of prognostic and predictive markers in each risk category. An effort was made to identify those markers that are currently lacking in, but have the potential to improve, the clinical decision process by discussing the data from recent studies aimed at the development of new prognostic and predictive markers. At this moment, none of the markers studied has been proven to be of significant, independent value, justifying implementation in daily clinical practice. However, recent developments in imaging techniques and biomolecular research do show great potential.     

Genetics of rectal cancer

Two operational subdivisions of hereditary colorectal cancer susceptibility are those with and those without premalignant adenomatous colonic polyp expression. In both of these subdivisions, reliable biomarkers of gene carriage would be of value in patient management as we have previously emphasized. Consideration must also be given to the familial (hereditary) occurrence of inflammatory bowel diseases associating with colorectal cancer susceptibility. The occurrence of rectal cancers should therefore alert the physician to investigate the possibility of a significant family medical history in order to fully elucidate the genetic heterogeneity of susceptibility to this disease. Clinicians should also be alert to the possibility of extracolonic malignancies where probable genetic colorectal cancer susceptibility is evident. Whenever possible, all potential biomarkers should be investigated to aid in definition of genetic heterogeneity.     

Laparoscopy for rectal cancer

Several large case series and single-institution trials have shown that laparoscopy is feasible for rectal cancer. Pending the results of the UK CLASICC, COLOR II, Japanese JCOG 0404, and ACOSOG Z6051 trials, the oncologic and long-term safety of laparoscopic rectal cancer surgery is unclear and the technique is best used at centers that can effectively collect and analyze outcomes data. Robotic and endoluminal techniques may change our approach to the treatment of rectal cancer in the future. Training, credentialing, and quality control are important considerations as new and innovative surgical treatments for rectal cancer are developed.