Clinical application of eight-zone laparoscopic dissection strategy for rectal cancer:Experience and discussion

BACKGROUND The incidence of rectal cancer is increasing worldwide,and surgery remains the primary treatment modality.With the advent of total mesorectal excision(TME)technique,the probability of tumor recurrence post-surgery has significantly decreased.Surgeons'focus has gradually shifted towards minimizing the impact of surgery on urinary and sexual functions.Among these concerns,the optimal dissection of the rectal lateral ligaments and preservation of the pelvic floor neuro-vascular bundle have become critical.To explore the optimal surgical technique for TME and establish a standardized surgical protocol to minimize the impact on urinary and sexual functions,we propose the eight-zone dissection strategy for pelvic floor anatomy.AIM To compare the differences in surgical specimen integrity and postoperative quality of life satisfaction between the traditional pelvic floor dissection strategy and the innovative eight-zone dissection strategy.METHODS We analyzed the perioperative data of patients who underwent laparoscopic radical resection of rectal cancer at Qilu Hospital of Shandong University between January 1,2021 and December 1,2023.This study included a total of 218 patients undergoing laparoscopic radical surgery for rectal cancer,among whom 109 patients underwent traditional pelvic floor dissection strategy,and 109 patients received the eight-zone dissection strategy.RESULTS There were no significant differences in general characteristics between the two groups.Patients in the eight-zone dissection group had higher postoperative specimen integrity(88.1%vs 78.0%,P=0.047).At the 3-month followup,patients in the eight-zone surgery group had better scores in urinary issues(6.8±3.3 vs 5.3±2.5,P=0.045)and male sexual desire(2.2±0.6 vs 2.5±0.5,P=0.047)compared to the traditional surgery strategy group.CONCLUSION This study demonstrates that the eight-zone dissection strategy for laparoscopic lateral ligament dissection of rectal cancer is safe and effective.Compared with the traditional pelvic floor dissection strategy,this approach can reduce the risk of nerve injury and minimize the impact on urinary and sexual functions.Therefore,we recommend the clinical application of this strategy to better serve patients with rectal cancer.

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

Application of modified primary closure of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer

AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016.Patients were classified into the modified primary closure group(32 patients) and the biological mesh closure group(44 patients).The total operating time,reconstruction time,postoperative stay duration,total cost,postoperative complications and tumor recur-rence were compared.RESULTS All surgery was successfully performed.The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group,which was significantly longer than that of the biological mesh closure group(7.2 ± 1.9 min,P < 0.001).The total operating time was not different between the two groups(236 ± 20 min vs 248 ± 43 min,P = 0.143).The postoperative hospital stay duration was 8.1 ± 1.9 d,and the total cost was 9297 ± 1260 USD for the modified primary closure group.Notably,both of these categories were significantly lower in this group than those of the biological mesh closure group(P = 0.001 and P = 0.003,respectively).There were no differences observed between groups when comparing other perioperative data,long-term complications or oncological outcomes.CONCLUSION The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible,safe and cost-effective.

Effects of decompression joint Governor Vessel electro-acupuncture on rats with acute upper cervical spinal cord injury

Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui（GV14） and Baihui（GV 20）（2 Hz,15 minutes） once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression（48 hours） is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression（12 hours） can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.

Duodenal-jejunal bypass reduces serum ceramides via inhibiting intestinal bile acid-farnesoid X receptor pathway

BACKGROUND Bile acids play an important role in the amelioration of type 2 diabetes following duodenal-jejunal bypass(DJB).Serum bile acids are elevated postoperatively.However,the clinical relevance is not known.Bile acids in the peripheral circulation reflect the amount of bile acids in the gut.Therefore,a further investigation of luminal bile acids following DJB is of great significance.AIM To investigate changes of luminal bile acids following DJB.METHODS Salicylhydroxamic acid(SHAM),DJB,and DJB with oral chenodeoxycholic acid(CDCA)supplementation were performed in a high-fat-diet/streptozotocininduced diabetic rat model.Body weight,energy intake,oral glucose tolerance test,luminal bile acids,serum ceramides and intestinal ceramide synthesis were analyzed at week 12 postoperatively.RESULTS Compared to SHAM,DJB achieved rapid and durable improvement in glucose tolerance and led to increased total luminal bile acid concentrations with preferentially increased proportion of farnesoid X receptor(FXR)-inhibitory bile acids within the common limb.Intestinal ceramide synthesis was repressed with decreased serum ceramides,and this phenomenon could be partially antagonized by luminal supplementation of FXR activating bile acid CDCA.CONCLUSION DJB significantly changes luminal bile acid composition with increased proportion FXR-inhibitory bile acids and reduces serum ceramide levels.There observations suggest a novel mechanism of bile acids in metabolic regulation after DJB.

Heterotopic ossification beneath the upper abdominal incision after radical gastrectomy:Two case reports

BACKGROUND Heterotopic ossification(HO)is a rare clinical phenomenon that refers to bone formation in nonossifying tissues.CASE SUMMARY This report presents two cases of HO beneath the upper abdominal median incision after radical gastrectomy.The first patient had postoperative pain below the incision area.There were no signs of anastomotic leakage,and the wound healed.Computed tomography(CT)findings 2 wk postoperatively were negative for HO,but the 6-wk CT showed HO beneath the incision.The patient refused reoperation,and after conservative therapy,the pain was gradually relieved after 2 wk.In the second case,postoperative recovery was uneventful,and HO was only detected on routine follow-up CT after 4 mo.An anti-adhesion membrane was applied beneath the peritoneum in both patients.Our findings suggest that HO beneath the abdominal incision might form at approximately 1 mo postoperatively.It may cause intractable pain;however,reoperation is usually not required.CONCLUSION In our cases,we suspect that HO may be related to the use of foreign materials beneath the peritoneum,which needs to be further investigated.

Fusobacterium Nucleatum Is a Risk Factor for Metastatic Colorectal Cancer

Objective Increasing evidence has indicated that there is a correlation between Fusobacterium nucleatum(F.nucleatum)abundance and poor prognosis of colorectal cancer(CRC).Furthermore,tumor metastasis plays a decisive role in the prognosis of CRC patients.Therefore,it was hypothesized that the abundance of F.nucleatum in CRC tissues affects the tumor metastasis.Methods In the present study,F.nucleatum DNA obtained from 141 resected CRC samples was quantified by qPCR to determine whether there were differences in F.nucleatum abundance between groups with and without CRC metastasis.Results The results revealed that F.nucleatum was more abundant in CRC patients with metastasis,and CRC tissues enriched with F.nucleatum had a higher risk of lymph node metastasis and distant metastasis.The receiver operating characteristic curve indicated that F.nucleatum in CRC tissues could be used as an indicator for CRC metastasis,to some extent.Furthermore,the in vitro experiments(electron microscopy,and migration and invasion trials)revealed that F.nucleatum was a highly invasive bacterial strain,and could significantly enhance the invasion and migration capacity of SW480 and SW620 cells.In addition,a meta-analysis comprehensively indicated a slight correlation between F.nucleatum abundance and advanced CRC stage(RR=1.17,95%CI:1.00–1.37,P=0.04,random effect).Conclusion There is a correlation between F.nucleatum abundance and CRC metastasis,and F.nucleatum may serve as a metastasis biomarker for CRC patients.

Network meta-analysis of five acupuncture treatments for lumbar disc herniation

Objective:To evaluate the effectiveness of different acupuncture treatments in the treatment of lumbar disc herniation.Methods:Searching PubMed,EMBASE,Cochrane Library,web of by computer Science,Chinese Journal Full-text Database,Wanfang database,VIP database and Chinese biomedical literature database,the retrieval time is from the establishment of the database to January 1,2020.Two researchers conducted literature screening,quality evaluation and data extraction according to the nano platoon standard,and used stata16.0 for network meta-analysis.Results:a total of 69 RCTs were included,involving 6168 patients with lumbar disc herniation,5 kinds of acupuncture therapy(warm acupuncture,fire acupuncture,electroacupuncture,acupuncture thread embedding,general acupuncture).The results of network meta-analysis showed that the effect of electroacupuncture was inferior to that of warm acupuncture,acupuncture thread embedding,and the effect of general acupuncture was inferior to that of warm acupuncture,fire acupuncture,electroacupuncture,acupuncture thread embedding,and the difference was statistically significant.In terms of efficiency,acupuncture and moxibustion embedding thread>warming acupuncture and moxibustion>fire acupuncture>electroacupuncture>ordinary acupuncture.Conclusion:in the treatment of lumbar disc herniation,the clinical effect of acupuncture thread embedding is better than the other four interventions.However,the quality and quantity of literature in this study are limited,and the conclusion of this study needs to be verified by high-quality RCT with multiple centers and large samples.

Meta-analysis of clinical efficacy of Duhuo Jisheng Decoction in the treatment of lumbar intervertebral disc herniation

Objective:To explore the clinical effect of Duhuo Jisheng Decoction in the treatment of lumbar disc herniation.Methods:CNKI,VIP,Wan Fang Data,Pubmed,Cochrane Library,Medline Complete and Embase databases were searched by computer.The randomized controlled trial(RCT)of Duhuo Jisheng Decoction combined with western medicine in the treatment of lumbar intervertebral disc herniation was studied.The searching time was from the establishment of the database to July 20,2019.Data were extracted and analyzed by Revman 5.3 software.Results:Twenty-four literatures involving 1980 patients were included.Meta-analysis showed that the total effective rate of Duhuo Jisheng Decoction group was significantly higher(OR=5.26,95%CI(4.13,6.69),Z=13.47,P<0.00001)and the incidence of adverse reactions was significantly lower(OR=0.45,95%CI(0.23,0.87),Z=2.36,P=0.00001)than that of Western medicine group.02).Conclusion:Duhuo Jisheng Decoction is effective and safe in the treatment of lumbar intervertebral disc herniation.However,the literature included in this study is limited,and the quality of the literature is low.It is necessary to carry out in-depth verification of high-quality,large-sample RCT.