Short-term outcomes of overlapped delta-shaped anastomosis, an innovative intracorporeal anastomosis technique, in totally laparoscopic colectomy for colon cancer

AIM To introduce an innovative intracorporeal anastomosis technique named overlapped delta-shaped anastomosis(ODA)for colon cancer cases undergoing totally laparoscopic colectomy(TLC)and to assess its feasibility and safety. METHODS From January 2016 to March 2017,a total of 20consecutive patients with colon cancer accepted TLC and the ODA technique at our medical center.Patient demographics,operative outcomes,perioperative complications,and pathological results were collected and analyzed. RESULTS We successfully completed TLC and the ODA procedure in all 20 cases,including 6(30%)males and 14(70%)females.In total,11(55%),2(10%),and 7(35%)cases accepted right hemicolectomy,transverse hemicolectomy,and left hemicolectomy,respectively.None of the surgeries were converted to an open operation.Mean operative time was 178.5 min,and mean estimated blood loss was 58.5 m L.Mean time to first flatus was 2.5 d,and mean postoperative hospitalization duration was 6.8 d.No severe complications occurred,such as anastomotic leakage,snastomotic stenosis,anastomotic bleeding,and wound infection,except for one case who suffered from an abdominal infection and another case who suffered from gastric paralysis syndrome.Tumor recurrence was not observed in any patient during the follow-up period. CONCLUSION The ODA technique for colon cancer cases undergoing TLC appears to be safe and feasible,although our current results need to be verified in further studies.

Surgical specimen extraction via a prophylactic ileostomy procedure: A minimally invasive technique for laparoscopic rectal cancer surgery

AIM To retrospectively evaluate the safety and feasibility of surgical specimen extraction via a prophylactic ileostomy procedure in patient with rectal cancer. METHODS We systematically reviewed 331 consecutive patients who underwent laparoscopic anterior resection for rectal cancer and prophylactic ileostomy in our institution from June 2010 to October 2016, including 155 patients who underwent specimen extraction via a prophylactic ileostomy procedure(experimental group), and 176 patients who underwent specimen extraction via a small lower abdominal incision(control group). Clinical data were collected from both groups andstatistically analyzed. RESULTS The two groups were matched in clinical characteristics and pathological outcomes. However, mean operative time was significantly shorter in the experimental group compared to the control group(161.3 ± 21.5 min vs 168.8 ± 20.5 min; P = 0.001). Mean estimated blood loss was significantly less in the experimental group(77.4 ± 30.7 mL vs 85.9 ± 35.5 mL; P = 0.020). The pain reported by patients during the first two days after surgery was significantly less in the experimental group than in the control group. No wound infections occurred in the experimental group, but 4.0% of the controls developed wound infections(P = 0.016). The estimated 5-year disease-free survival and overall survival rate were similar between the two groups.CONCLUSION Surgical specimen extraction via a prophylactic ileostomy procedure represents a secure and feasible approach to laparoscopic rectal cancer surgery, and embodies the principle of minimally invasive surgery.

Mini-invasive surgery for colorectal cancer

Laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades. Accumulating data have demonstrated that laparoscopic colectomy is associated with better short-term outcomes and equivalent oncologic outcomes when compared with open surgery. However, some controversies regarding the oncologic quality of mini-invasive surgery for rectal cancer exist. Meanwhile, some progresses in colorectal surgery, such as robotic technology, single-incision laparoscopic surgery, natural orifice specimen extraction, and natural orifice transluminal endoscopic surgery, have been made in recent years. In this article, we review the published data and mainly focus on the current status and latest advances of mini-invasive surgery for colorectal cancer.

Effect of preoperative injection of carbon nanoparticle suspension on the outcomes of selected patients with mid-low rectal cancer

Background:Carbon nanoparticles show significant lymphatic tropism and can be used to identify lymph nodes surrounding mid-low rectal tumors.In this study,we analyzed the effect of trans anal injection of a carbon nanoparticle suspension on the outcomes of patients with mid-low rectal cancer who underwent laparoscopic resection.Methods:We collected the data of 87 patients with mid-low rectal cancer who underwent laparoscopic resection between November 2014 and March 2015 at Cancer Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College.For 35 patients in the experimental group,the carbon nanoparticle suspension was injected transanally into the submucosa of the rectum around the tumor 30 min before the operation;52 patients in the control group underwent the operation directly without the injection of carbon nanoparticle suspension.We then compared the operation outcomes between the two groups.Results:In the experimental group,the rate of incomplete mesorectal excision was lower than that in the control group,but no significant difference was found(2.9%vs.7.7%,P = 0.342).The distance between the tumor and the circumferential resection margin was 5.8 ± 1.4 mm in the experimental group and 4.8 ±1.1 mm in the control group(P = 0.001).The mean number of lymph nodes removed was 28.2 ± 9.4 in the experimental group and 22.7 ± 7.3in the control group(P = 0.003);the mean number of lymph nodes smaller than 5 mm in diameter was 10.1 ± 7.5and 4.5 ±3.7,respectively(P< 0.001).Three patients in the experimental group received lateral lymph node resection.Among the three patients,we retrieved three nodes(one stained node) from the first patient,three nodes(two stained nodes) from the second patient,and two nodes(no stained nodes) from the third patient.Conclusions:Injecting a carbon nanoparticle suspension improved the outcomes of patients who underwent laparoscopic resection for mid-low rectal cancer;it also improved the accuracy of pathologic staging.Moreover,for selected patients,this technique narrowed the scope of lateral lymph node dissection.

Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer

Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete response(pCR) to preoperative CRT have been reported to have better outcomes than those without pCR.However,the factors that predict the response to neoadjuvant CRT have not been well defined.In this study,we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.Methods:A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT,followed by curative surgery,between 2005 and 2013 were included.Patients were divided into two groups according to their responses to neoadjuvant therapy:the pCR and non-pCR groups.The clinical parameters were analyzed by univariate and multivariate analyses,with pCR as the dependent variable.Results:Of the 323 patients,75(23.2%) achieved pCR.The two groups were comparable in terms of age,sex,body mass index,tumor stage,tumor location,tumor differentiation,radiation dose,and chemotherapy regimen.On multivariate analysis,a pretreatment carcinoembryonic antigen(CEA) level of <5 ng/mL[odds ratio(OR) = 2.170,95%confidence interval(CI) = 1.195-3.939,P = 0.011]and an interval of >7 weeks between the completion of chemoradiation and surgical resection(OR = 2.588,95%CI = 1.484-4.512,P = 0.001) were significantly associated with an increased rate of pCR.Conclusions:The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR.These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.

Application of indocyanine green-enhanced near-infrared fluorescence-guided imaging in laparoscopic lateral pelvic lymph node dissection for middle-low rectal cancer

BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.

Directional motion of dust particles at different gear structuresin a plasma

Directional motion of dust particles in a dusty plasma ratchet is observed experimentally.The dusty plasma ratchet consists of two concentric gears with asymmetric sawtooth.It is found that the sawtooth number affects the directional motion of dust particles along the saw channel.With the increase of the sawtooth number,the particle velocity increases firstly and then decreases,and there is an optimum number of the sawtooth which could induce fast rotation of dust particles.The velocities of dust particles change as they are flowing along the saw channel.We also explore the force acting on the dust particle experimentally.

腔内三角吻合在腹腔镜右半结肠癌切除术中的应用:一项安全有效的消化道重建技术

背景:腔内三角吻合(IDA)是腹腔镜消化道重建技术的一个重要进展。我们将该技术应用于腹腔镜右半结肠癌切除术,并对其与传统腔外吻合技术(EA)的短期疗效进行比较。方法:2016年1月1日至2017年10月1日间,分别有36例和50例腹腔镜右半结肠癌手术患者采用了IDA和EA进行消化道重建。收集并比较两组患者临床病理特征、手术资料、术后恢复情况及术后并发症。结果:除了IDA组患者手术切口长度相对较短外[(4.660.6)vs(5.660.7)cm,P<0.001],两组患者临床病理特征及手术指标相似。术后下地活动时间、进流食时间和术后住院时间两组患者的差异均无统计学意义,但术后排气时间IDA组明显快于EA组[(2.860.5)vs(3.260.8)days,P=0.004]。术后第1和第3天视觉模拟疼痛评分IDA组均低于EA组(分别为:4.060.7 vs 4.561.0,P=0.002和2.760.6 vs 3.460.6,P<0.001)。IDA组和EA组患者术后并发症发生率分别为8.3%和16.0%(P=0.470)。无一例患者出现吻合口出血、狭窄或漏等吻合口并发症。结论:腔内三角吻合是一项安全可行的消化道重建方式,其短期疗效较传统腔外吻合更为满意。

Clinicopathological characteristics and prognostic factors for the recurrence of abdominal desmoid tumors: a retrospective study of 113 patients from two Chinese hospitals

To the Editor:Desmoid tumors(DTs)show local aggressiveness to surrounding structures and exhibit a propensity to recur,leading to a high local recurrence rate and significant functional impairments and morbidity.[1]It has been shown that DTs located in the abdominal wall and abdominal cavity are relatively minimally invasive and have a relatively low recurrence rate,[2]which indicated abdominal desmoid tumors(ADTs)may have different biological make-ups and genes.This study was aimed to delineate the clinicopathological features and determine the prognostic factors for recurrence-free survival(RFS)in ADTs after macroscopic complete surgical resection.

袖套式吻合在低位直肠癌腹腔镜保肛手术中的应用:一种无需预防性造口的重叠式端端吻合技术

Introduction With recent advances in laparoscopic-surgery techniques and neoadjuvant therapy options,there have been improvements in sphincter-preservation outcomes in patients with low rectal cancer[1-3].However,several issues remain controversial,such as the incidence of anastomotic leakage,the local recurrence rate,and anal-function outcome[4-5].Moreover,prophylactic stoma at the end of sphincter-preserving surgery is necessary to prevent anastomotic leakage,especially in patients undergoing neoadjuvant chemoradiotherapy[7].To avoid prophylactic colostomy and decrease excessive expense,we developed a new method of overlapped end-to-end anastomosis for treating low rectal cancer—a technique referred to as‘oversleeve anastomosis’.