Relationship between body mass index and short-term postoperative prognosis in patients undergoing colorectal cancer surgery

BACKGROUND Obesity is a state in which excess heat is converted into excess fat,which accumulates in the body and may cause damage to multiple organs of the circulatory,endocrine,and digestive systems.Studies have shown that the accumulation of abdominal fat and mesenteric fat hypertrophy in patients with obesity makes laparoscopic surgery highly difficult,which is not conducive to operation and affects patient prognosis.However,there is still controversy regarding these conclusions.AIM To explore the relationship between body mass index(BMI)and short-term prognosis after surgery for colorectal cancer.METHODS PubMed,Embase,Ovid,Web of Science,CNKI,and China Biology Medicine Disc databases were searched to obtain relevant articles on this topic.After the articles were screened according to the inclusion and exclusion criteria and the risk of literature bias was assessed using the Newcastle-Ottawa Scale,the prognostic indicators were combined and analyzed.RESULTS A total of 16 articles were included for quantitative analysis,and 15588 patients undergoing colorectal cancer surgery were included in the study,including 3775 patients with obesity and 11813 patients without obesity.Among them,12 articles used BMI≥30 kg/m^(2)and 4 articles used BMI≥25 kg/m^(2)for the definition of obesity.Four patients underwent robotic colorectal surgery,whereas 12 underwent conventional laparoscopic colorectal resection.The quality of the literature was good.Meta-combined analysis showed that the overall complication rate of patients with obesity after surgery was higher than that of patients without obesity[OR=1.35,95%CI:1.23-1.48,Z=6.25,P<0.0001].The incidence of anastomotic leak after surgery in patients with obesity was not significantly different from that in patients without obesity[OR=0.99,95%CI:0.70-1.41),Z=-0.06,P=0.956].The incidence of surgical site infection(SSI)after surgery in patients with obesity was higher than that in patients without obesity[OR=1.43,95%CI:1.16-1.78,Z=3.31,P<0.001].The incidence of reoperation in patients with obesity after surgery was higher than that in patients without obesity;however,the difference was not statistically significant[OR=1.15,95%CI:0.92-1.45,Z=1.23,P=0.23];Patients with obesity had lower mortality after surgery than patients without obesity;however,the difference was not statistically significant[OR=0.61,95%CI:0.35-1.06,Z=-1.75,P=0.08].Subgroup analysis revealed that the geographical location of the institute was one of the sources of heterogeneity.Robot-assisted surgery was not significantly different from traditional laparoscopic resection in terms of the incidence of complications.CONCLUSION Obesity increases the overall complication and SSI rates of patients undergoing colorectal cancer surgery but has no influence on the incidence of anastomotic leak,reoperation rate,and short-term mortality rate.

Establishment and application of three predictive models of anastomotic leakage after rectal cancer sphincter-preserving surgery

BACKGROUND Anastomotic leakage(AL)occurs frequently after sphincter-preserving surgery for rectal cancer and has a significant mortality rate.There are many factors that influence the incidence of AL,and each patient’s unique circumstances add to this diversity.The early identification and prediction of AL after sphincter-preserving surgery are of great significance for the application of clinically targeted preventive measures.Developing an AL predictive model coincides with the aim of personalised healthcare,enhances clinical management techniques,and advances the medical industry along a more precise and intelligent path.AIM To develop nomogram,decision tree,and random forest prediction models for AL following sphincter-preserving surgery for rectal cancer and to evaluate the predictive efficacy of the three models.METHODS The clinical information of 497 patients with rectal cancer who underwent sphincter-preserving surgery at Jincheng People’s Hospital of Shanxi Province between January 2017 and September 2022 was analyzed in this study.Patients were divided into two groups:AL and no AL.Using univariate and multivariate analyses,we identified factors influencing postoperative AL.These factors were used to establish nomogram,decision tree,and random forest models.The sensitivity,specificity,recall,accuracy,and area under the receiver operating characteristic curve(AUC)were compared between the three models.RESULTS AL occurred in 10.26%of the 497 patients with rectal cancer.The nomogram model had an AUC of 0.922,sensitivity of 0.745,specificity of 0.966,accuracy of 0.936,recall of 0.987,and accuracy of 0.946.The above indices in the decision tree model were 0.919,0.833,0.862,0.951,0.994,and 0.955,respectively and in the random forest model were 1.000,1.000,1.000,0.951,0.994,and 0.955,respectively.The DeLong test revealed that the AUC value of the decision-tree model was lower than that of the random forest model(P<0.05).CONCLUSION The random forest model may be used to identify patients at high risk of AL after sphincter-preserving surgery for rectal cancer owing to its strong predictive effect and stability.

Can the Rectum Balloon Minimize Rectal Toxicity During Irradiation Therapy of Prostate Cancer?

The irradiation of the rectum cancer occurs in many institutes by using a rectum balloon in order to reduce the mobility of the target organ and to distance the rectum from the target organ. The objective is to reduce side effects quantitatively as well as qualitatively. On the basis of two hospitals using identical techniques for the prostate irradiation with the sole difference of the rectum balloon the toxicity has been evaluated with the result of no significant difference between the cohorts concerning diarrhea, rectal pain symptoms and rectal bleedings. Therefore the authors consider the use of the rectum balloon prior to each irradiation not necessary for the reduction of toxicity particularly due to the fact that the application is often very painful, especially for patients with hemorrhoids. The rectum balloon as a tool for the reduction of the prostate mobility was not objective of this study.

Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum

Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the high incidence of recurrence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the pectinate line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients – 400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radiotherapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducing the number of undifferentiated cells and in diminishing the tumor volume and the carcinomatous infiltration of the rectal wall.

Neoadjuvant Radiotherapy in Stage I Cancer of the Lower Rectum

Introduction: The mortality rate in cancer of the lower rectum is related to the incidence of local recurrence, in the first 5 years. For stage I tumors, local excision has being increasingly used, but recent studies showed a higher incidence rate of local recurrence. Therefore, preoperative radiotherapy should be considered even for these tumors, as an attempt to prevent recurrence and provide cure. Objective: To show the effectiveness of neoadjuvant radiotherapy in stage I cancer of the lower rectum of a cohort population. Materials and Method: A cohort study in a prospective database was made with a total of 75 patients considered as stage I cancer of the lower rectum. Preoperative long course of 4500 cG radiotherapy was performed in this selected group of patients and followed up for a minimum period of five years. Results: Stage I/TI group had 27 patients. All of them presented complete response to the treatment and did not need to be submitted to surgery. Five years follow up with no recurrence. The stage I/TII group had 48 patients. After neoadjuvant radiotherapy, 8 patients had to be submitted to surgery for persistent tumor. All were submitted to full total local excision (FTLE), but anatomopathological examination showed no residual cancer. Conclusion: Preoperative long course of 4500 cG irradiation, not only reduced the local recurrence and mortality rate in lower rectal cancer, but also reduced indication for surgery in patients with stage I cancer of the lower rectum.

三维后装与二维后装对宫颈癌患者膀胱、乙状结肠及直肠受照剂量的影响

目的探讨三维后装与二维后装对宫颈癌患者膀胱、乙状结肠及直肠受照剂量的影响。方法将55例宫颈癌患者,按照后装治疗技术分为两组,二维组(25例)、三维组(30例),所有患者均接受调强外放疗及顺铂同步化疗,二维组进行二维后装放疗,三维组进行三维后装放疗,观察比较两组临床疗效、直肠和膀胱受照剂量,放疗急性不良反应。结果三维组临床疗效有效率(96.67%)较二维组(80.00%)高(P<0.05);三维组患者治疗后膀胱和直肠受照剂量均低于二维组(P<0.05);三维组放疗急性直肠炎、急性膀胱炎、乙状结肠炎发生率分别为76.67%、10.00%和3.33%,均较二维组(96.00%、32.00%、20.00%)低(P<0.05)。结论三维后装放疗相比于二维后装放疗,临床治疗效果更好,且对直肠、膀胱危及器官照射剂量更低,急性放疗不良反应发生率更低。

Crohn’s disease with infliximab treatment complicated by rapidly progressing colorectal cancer:A case report

BACKGROUND Crohn's disease(CD)causes a range of digestive symptoms including recurrent diarrhea,abdominalgia,and flatulence,and severely impacts the quality of life of patients.Infliximab,a monoclonal antibody against tumor necrosis factor alpha,has recently been promoted as a therapeutic treatment for CD,but its safety margins remain uncertain.We report a case of rapidly progressive colorectal cancer that was diagnosed in a patient with CD who had previously been treated with infliximab.CASE SUMMARY This case report refers to a 40-year-old male with a 6-year history of CD.The patient underwent transverse colostomy because of inflammatory ileus in 2017.He subsequently received infliximab treatment in 2018.Ten months later,worsening contracture of the transverse colostomy was observed.Imaging tests indicated that the patient may have developed colon cancer with extensive peritoneal implantation.At the same time,colonoscopy revealed a rectal mass and pathological examination indicated well-differentiated adenocarcinoma.Palliative ileostomy was performed to improve defecation in 2019.During the operation,a small nodular mass in the mesentery of the small intestine was identified and pathological examination of the mass revealed advanced adenocarcinoma.The patient was diagnosed with advanced colorectal cancer and administered palliative chemotherapy.He died in June 2020.CONCLUSION We stress the importance of recognizing the possible occurrence of malignance in patients with CD receiving infliximab.

Lymph node staging in colorectal cancer:Old controversies and recent advances

Outcome prediction based on tumor stage reflected by the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC)tumor node metastasis(TNM)system is currently regarded as the strongest prognostic parameter for patients with colorectal cancer.For affected patients,the indication for adjuvant therapy is mainly guided by the presence of regional lymph node metastasis.In addition to the extent of surgical lymph node removal and the thoroughness of the pathologist in dissecting the resection specimen,several parameters that are related to the pathological work-up of the dissected nodes may affect the clinical significance of lymph node staging.These include changing definitions of lymph nodes,involved lymph nodes,and tumor deposits in different editions of the AJCC/UICC TNM system as well as the minimum number of nodes to be dissected.Methods to increase the lymph node yield in the fatty tissue include methylene blue injection and acetone compression.Outcome prediction based on the lymph node ratio,defined as the number of positive lymph nodes divided by the total number of retrieved nodes,may be superior to the absolute numbers of involved nodes.Extracapsular invasion has been identified as additional prognostic factor.Adding step sectioning and immunohistochemistry to the pathological work-up may result in higher accuracy of histological diagnosis.The clinical value of more recent technical advances,such as sentinel lymph node biopsy and molecular analysis of lymph nodes tissue still remains to be defined.

Nomograms for colorectal cancer:A systematic review

AIM: To assist in the selection of suitable nomograms for obtaining desired predictions in daily clinicalpractice.METHODS: We conducted electronic searches for journal articles on colorectal cancer(CRC)-associated nomograms using the search terms colon/rectal/colorectal/nomogram. Of 174 articles initially found, we retrieved 28 studies in which a nomogram for CRC was developed.RESULTS: We discuss the currently available CRCassociated nomograms, including those that predict the oncological prognosis, the short-term outcome of treatments, such as surgery or neoadjuvant chemoradiotherapy, and the future development of CRC. Developing nomograms always presents a dilemma. On the one hand, the desire to cover as wide a patient range as possible tends to produce nomograms that are too complex and yet have C-indexes that are not sufficiently high. Conversely, confining the target patients might impair the clinical applicability of constructed nomograms.CONCLUSION: The information provided in this review should be of use in selecting a nomogram suitable for obtaining desired predictions in daily clinical practice.

Fifteen-year-old colon cancer patient with a 10-year history of ulcerative colitis

Inflammatory bowel disease (IBD) is regarded as one of the risk factors for colorectal cancer, and early detection of cancer in these patients may be difficult, especially in pediatric patients. Prognosis of pediatric colorectal cancer is known to be poor, because of delayed diagnosis and unfavorable differentiation. We report a case of a pediatric patient with a 10-year history of ulcerative colitis who was diagnosed with sigmoid colon cancer when he was 15 years old. He underwent proctocolectomy with ileal pouch anal anastomosis. Postoperative pathological examination of the tumor revealed adenocarcinoma. The pericolic tissue layer was infiltrated, but metastases were not found in either of the two lymph nodes. Children with a long history of predisposing factors such as IBD need particular attention to the possibility of colorectal cancer. Early diagnosis through regular screening with colonoscopy is one of the most important critical factors for a good prognosis.

Complete radiotherapy response in rectal cancer:A reviewof the evidence

Complete response to chemoradiotherapy for rectal cancer is becoming a common clinical entity. Techniques to diagnose complete response and how to survey these patients without operative intervention are still unclear. We review the most recent evidence. Barriers to firm conclusions regarding this are heterogeneity ofdiagnostic definitions, differing surveillance protocols, and a lack of randomised studies.

Computed tomography and magnetic resonance imaging findings of metastatic rectal linitis plastica from prostate cancer:A case report and review of literature

Linitis plastica is a rare condition showing circumferentially infiltrating intramural anaplastic carcinoma in a hollow viscus, resulting in a tissue thickening of the involved organ as constricted, inelastic, and rigid. While most secondary rectal linitis plastica(RLP) is caused by metastasis from stomach, breast, gallbladder, or bladder cancer, we report an extremely rare and unique case of secondary RLP due to prostate cancer with computed tomography(CT) and magnetic resonance imaging(MRI) findings, including diffusion weighted imaging(DWI). A 78-year-old man presented with approximately a 2-mo history of constipation and without cancer history. On sigmoidoscopy, there was a luminal narrowing and thickening of rectum with mucosa being grossly normal in its appearance. On contrast-enhanced CT,marked contrast enhancement with wall thickening of rectum was noted. On pelvic MRI, rectal wall thickening showed a target sign on both T2-weighted imaging and DWI. A diffuse infiltrative lesion was suspected in the prostate gland based on low signal intensity on T2-weighted imaging and restricted diffusion. A transanal full-thickness excisional biopsy revealed metastasis from a prostate adenocarcinoma invading the submucosa to the muscularis propria consistent with metastatic RLP. We would like to emphasize the CT and MRI findings of metastatic RLP due to prostate cancer.

RELATIONSHIP BETWEEN INTERNAL ANAL SPHINCTER FUNCTION AND LENGTH OF REMAINING RECTUM AFTER RESECTING RECTAL CARCINOMA

Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively, 21 patients were evaluated via patients' clinical date, including anal resting pressure (resting pressure) assay. Six months postoperatively, repeated manometric studies and clinical evaluations were performed to assess the level of continence . The formula use for calculating post operative resting pressure is as follows: postoperative resting pressure=0.42×preoperative resting pressure+1.56×length of remaining recturm+12.37(R 2=0.58; P <0.01).Degree of continence was graded based on severity of the dysfunction and grade of the continence score. Results: It was demonstrated the patients with low postoperative resting pressures (<4.0 Kpa) had incontinence, and those with high postoperative resting pressures (>4.7 Kpa) were continent. There were significant correlations between length of the remaining rectum and ratio of the decrease in maximum resting pressure (postoperative/preoperative maximum resting pressure;r=0.62; P <0.01). Conclusion: Continence of rectum is influenced by maximum resting pressure of function of the internal anal sphincter, length of remaining rectum is shorter, the more damage to the internal anal sphincter. It is able to foretell stool incontinence by using the postoperative resting pressure formula, and to determine the length of the remaining rectum.

A comparative dosimetric study of neoadjuvant 3D conformal radiotherapy for operable rectal cancer patients versus conventional 2D radiotherapy in NCI-Cairo

Objective:This study was to compare this multiple-field conformal technique to the AP-PA technique with respect to target volume coverage and dose to normal tissues.Methods:We conducted a single institutional prospective comparative dosimetric analysis of 22 patients who received neoadjuvant radiation therapy for rectal cancer presented to radiotherapy department in National Cancer Institute,Cairo in period between June 2010 to September 2011 using 3D conformal radiotherapy technique for each patient,a second radiotherapy treatment plan was done using an anteroposterior (AP-PA) fields,the two techniques were then compared using dose volume histogram (DVH) analysis.Results:Comparing different DVHs,it was found that the planning target volume (PTV) was adequately covered in both (3D & 2D) plans while it was demonstrates that this multiple field conformal technique produces superior distribution compared to 2D technique,with considerable sparing of bladder,ovaries and head of both femora.Conclusion:From the present study,it shows that it is recommended to use 3D planning for preoperative cases of cancer rectum so far it produces good coverage of the target as well as good sparing of the surrounding critical organs.

Syphilitic proctitis mimicking rectal cancer:A case report

Syphilitic proctitis is a rare disease. It usually presents as proctitis, ulcer and neoplasm but lacks pathognomonic clinical symptoms. It is, therefore, difficult to diagnose and is occasionally treated inappropriately. We report the case of a 51-year-old man who had a hard, ulcerated mass, which occupied the circumference of the rectal wall and which mimicked a rectal tumor. Fortu nately, positive finding from routine toluidine red un heated serum test and treponema pallidum particle ag glutination tests made us reevaluate the patient and led us to suspect syphilitic proctitis. This diagnosis was finally confirmed after successful penicillin G benzathine therapy which made surgery unnecessary.

Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was34 mm. The surgical procedure through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy 70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%, anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection 95.1%. Pathologic complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal margin20 mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal cancer. Oncologic and functional, outcomes after are acceptable.

直肠经肛门拖出切除术治疗低位直肠癌的疗效及预后

目的分析直肠经肛门拖出切除术对低位直肠癌的疗效及预后的影响。方法将患者分为研究组(采用直肠经肛门拖出切除术)和对照组(采用腹腔镜下直肠低位前切除术),并比较2组患者的临床疗效等。结果研究组手术时间、术中出血量等均显著优于对照组(P<0.05);术后研究组患者血清相关的胃肠动力指标改善情况较对照组更优(P<0.05);术后两组肛门功能及预后情况比较均无差异(P>0.05)。结论直肠经肛门拖出切除术治疗直肠癌的疗效更为显著,值得临床推广。

应用腹腔镜下直肠侧方膜解剖完整全直肠系膜切除根治术治疗直肠癌的临床效果

目的探讨应用腹腔镜下直肠侧方膜解剖完整全直肠系膜切除根治术治疗中下段直肠癌的临床效果。方法选取2019年3月—2021年9月中国人民解放军联勤保障部队第九〇八医院收治的60例男性中下段直肠癌(rectal cancer,RC)患者作为研究对象,随机将患者分为A组和B组,各30例。A组采用腹腔镜下直肠侧方膜解剖完整全直肠系膜切除根治术(total mesorectal excision,TME),B组采用常规腹腔镜全直肠系膜切除根治术,对比2组术中外科指标、术后恢复指标、尿动力指标水平及并发症发生率。结果A组手术时间、术中出血量低于B组,自由尿流率、排尿量高于B组(P<0.05);A组术后住院时间、排气和恢复进食时间、第1天盆腔引流量、拔除盆腔引流管时间和术后尿管拔除时间均短于B组,残尿量低于B组(P<0.05);2组排尿障碍及勃起功能障碍发生率比较,差异无统计学意义(P>0.05)。结论腹腔镜下直肠侧方膜解剖完整全直肠系膜切除术对RC患者的治疗效果显著,可加快患者康复速度,促进患者生活质量改善,值得临床借鉴。

放疗对行化疗和手术的直肠癌患者的效果分析:一项基于SEER数据库的回顾性研究

目的·利用美国癌症监测、流行病学和结果 (Surveillance,Epidemiology and End Results,SEER)数据库评估新辅助放射治疗(放疗)和辅助放疗对行化学治疗(化疗)和手术的直肠癌患者生存的影响。方法·纳入SEER数据库2005—2015年经病理确诊为直肠癌,并接受化疗和手术治疗的患者;排除尸检或仅死亡证明为直肠癌、无随访时间和临床资料不全的患者。将所有患者分为新辅助放疗联合手术组(RT+S组)、手术治疗组(S组)和手术联合辅助放疗组(S+RT组)。采用倾向性评分匹配(propensity score matching,PSM)以1∶1的比例匹配各组纳入对象,采用受限平均生存时间(restricted mean survival time,RMST)估计直肠癌患者5年和10年内平均生存期,采用Cox比例风险模型确定新辅助放疗和辅助放疗对直肠癌患者总生存期(overall survival,OS)和肿瘤特异性生存期(cancer specific survival,CSS)的影响,通过对患者进行分层分析确定新辅助放疗和辅助放疗的具体获益人群。结果·2005—2015年,共纳入8 975例接受化疗和手术的直肠癌患者;其中S组1 079例,RT+S组5 991例,S+RT组1 905例。经PSM后,各组临床基础特征均衡可比。PSM后,与S组相比,RT+S组患者5年和10年的预后均显著改善(均P=0.000),而S+RT组患者仅5年预后显著改善(均P<0.05),10年预后改善不明显(均P>0.05)。多因素Cox回归分析结果显示,新辅助放疗是患者OS和CSS的独立保护因素(均P=0.000),而辅助放疗并不是(均P>0.05)。亚组分析显示:新辅助放疗对于年龄<50岁、肿瘤分化程度高、肿瘤直径≤30 mm或TNM分期Ⅰ~Ⅲ期患者OS和CSS没有明显的保护作用(均P>0.05);而辅助放疗对于肿瘤低分化/未分化、肿瘤直径>50 mm或TNM分期Ⅳ期的患者OS和CSS有明显的保护作用(均P<0.05)。结论·对于行化疗和手术的直肠癌患者,新辅助放疗有明显的生存获益,但可能不适用于年龄<50岁、肿瘤分化程度高、肿瘤直径≤30 mm或TNM分期Ⅰ~Ⅲ期的患者;而肿瘤低分化/未分化、肿瘤直径>50 mm或TNM分期Ⅳ期的患者可能从辅助放疗中获益。

两种入路腹腔镜下低位直肠腺癌远端直肠离断的效果比较

目的比较两种入路腹腔镜下低位直肠腺癌远端直肠离断的效果。方法选取2019年1月-2022年1月该院收治的80例直肠腺癌患者作为研究对象,采用随机数表法分为A组和B组,各40例,A组采用经闭孔神经前入路远端直肠离断的直肠癌根治术,B组采用腹腔镜辅助经肛门全直肠系膜切除术(TME),比较两组患者的临床疗效。结果A组术中出血量少于B组,拔出导尿管时间短于B组(P<0.05);术后两组患者血清胃动素和胃泌素水平均较术前降低,且A组低于B组(P<0.05)。A组术后并发症Clavien-Dindo分级为Ⅰ级的多于B组,术后肛门功能(Kirwan分级)优于B组,两组患者比较,差异均有统计学意义(P<0.05)。结论采用经闭孔神经前入路远端直肠离断的直肠癌根治术治疗直肠腺癌,可减少术中出血量,缩短术后拔除导尿管时间,促进胃肠动力,保留肛门功能,减轻术后并发症严重程度。