Efficacy of laparoscopic low anterior resection for colorectal cancer patients with 3D-vascular reconstruction for left coronary artery preservation

BACKGROUND Laparoscopic low anterior resection(LLAR)has become a mainstream surgical method for the treatment of colorectal cancer,which has shown many advantages in the aspects of surgical trauma and postoperative rehabilitation.However,the effect of surgery on patients'left coronary artery and its vascular reconstruction have not been deeply discussed.With the development of medical imaging technology,3D vascular reconstruction has become an effective means to evaluate the curative effect of surgery.AIM To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery(LCA)preserved.METHODS A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital.All patients underwent LLAR of rectal cancer with the LCA preserved,and the intraoperative and postoperative data were complete.The patients were divided into a reconstruction group(72 patients)and a nonreconstruction group(74 patients)according to whether 3D vascular reconstruction was performed before surgery.The clinical features,operation conditions,complications,pathological results and postoperative recovery of the two groups were collected and compared.RESULTS A total of 146 patients with rectal cancer were included in the study,including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group.There were 47 males and 25 females in the reconstruction group,aged(59.75±6.2)years,with a body mass index(BMI)(24.1±2.2)kg/m^(2),and 51 males and 23 females in the nonreconstruction group,aged(58.77±6.1)years,with a BMI(23.6±2.7)kg/m^(2).There was no significant difference in the baseline data between the two groups(P>0.05).In the submesenteric artery reconstruction group,35 patients were type Ⅰ,25 patients were type Ⅱ,11 patients were type Ⅲ,and 1 patient was type Ⅳ.There were 37 type Ⅰ patients,24 type Ⅱ patients,12 type Ⅲ patients,and 1 type Ⅳ patient in the nonreconstruction group.There was no significant difference in arterial typing between the two groups(P>0.05).The operation time of the reconstruction group was 162.2±10.8 min,and that of the nonreconstruction group was 197.9±19.1 min.Compared with that of the reconstruction group,the operation time of the two groups was shorter,and the difference was statistically significant(t=13.840,P<0.05).The amount of intraoperative blood loss was 30.4±20.0 mL in the reconstruction group and 61.2±26.4 mL in the nonreconstruction group.The amount of blood loss in the reconstruction group was less than that in the control group,and the difference was statistically significant(t=-7.930,P<0.05).The rates of anastomotic leakage(1.4%vs 1.4%,P=0.984),anastomotic hemorrhage(2.8%vs 4.1%,P=0.672),and postoperative hospital stay(6.8±0.7 d vs 7.0±0.7 d,P=0.141)were not significantly different between the two groups.CONCLUSION Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss.Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.

Vascular reconstruction provides short-term and long-term survival benefits for patients with hilar cholangiocarcinoma:A retrospective,multicenter study

Background:In patients with hilar cholangiocarcinoma(HCCA),radical resection can be achieved by resection and reconstruction of the vasculature.However,whether vascular reconstruction(VR)improves long-term and short-term prognosis has not been demonstrated comprehensively.Methods:This was a retrospective multicenter study of patients who received surgery for HCCA with or without VR.Variables associated with overall survival(OS)and recurrence-free survival(RFS)were identified based on Cox regression.Kaplan-Meier curves were used to explore the impact of VR.Restricted mean survival time(RMST)was used for comparisons of short-term survival between the groups.Patients’intraoperative and postoperative characteristics were compared.Results:Totally 447 patients were enrolled.We divided these patients into 3 groups:VR with radical resections(n=84);non-VR radical resections(n=309)and non-radical resection(we pooled VRnonradical and non-VR nonradical together,n=54).Cox regression revealed that carbohydrate antigen 242(CA242),vascular invasion,lymph node metastasis and poor differentiation were independent risk factors for OS and RFS.There was no significant difference of RMST between the VR and non-VR radical groups within 12 months after surgery(10.18 vs.10.76 mon,P=0.179),although the 5-year OS(P<0.001)and RFS(P<0.001)were worse in the VR radical group.The incidences of most complications were not significantly different,but those of bile leakage(P<0.001)and postoperative infection(P=0.009)were higher in the VR radical group than in the non-VR radical group.Additionally,the levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)up to 7 days after surgery tended to decrease in all groups.There was no significant difference in the incidence of postoperative liver failure between the VR and non-VR radical groups.Conclusions:Radical resection can be achieved with VR to improve the survival rate without worsening short-term survival compared with resection with non-VR.After adequate assessment of the patient’s general condition,VR can be considered in the resection.

Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).Ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences,and reconstruction of the affected vessels.Currently,there is a scarcity of information regarding RHIVC reconstruction in ELRA.AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department.A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC:Group A with original RHIVC being repaired and reconstructed(n=64),group B with RHIVC being replaced(n=43),and group C with RHIVC being resected without reconstruction(n=7).The clinical data of patients,including the operation time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed up.The normally distributed continuous variables were expressed as means±SD,whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance.Survival curve was plotted by the Kaplan-Meier method.RESULTS All patients were routinely followed up for a median duration of 52(range,12-125)mo.The 30 d mortality rate was 7.0%(8/114)and 7 patients died within 90 d.Among all subjects,the inferior vena cava(IVC)-related complication rates were 17.5%(11/63)in group A and 16.3%(7/43)in group B.IVC stenosis was found in 12 patients(10.5%),whereas thrombus was formed in 6 patients(5.3%).Twenty-two patients had grade III or higher complications,with the complication rates being 17.2%,16.3%,and 57.1%in the three groups.The average postoperative hospital stay in the three groups was 32.3±19.8,26.7±18.2,and 51.3±29.4 d(P=0.03),respectively.CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration.The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen.The RHIVC resection without any reconstruction method should be considered with caution.

Borderline resectable pancreatic cancer and vascular resections in the era of neoadjuvant therapy

While pancreatic cancer is still characterized by early systemic spread and poor outcomes,the treatment of this disease has changed significantly in recent years due to major advancements in systemic therapy and advanced surgical techniques.Broader use of effective neoadjuvant approaches combined with aggressive surgical operations within a multidisciplinary setting has improved outcomes.Borderline resectable pancreatic cancer is characterized by tumor vascular invasion,and is a setting where the combination of potent neoadjuvant chemotherapy and aggressive surgical methods,including vascular resections and reconstructions,shows its full potential.Hopefully,this will lead to improved local control and curative treatment in a number of patients with this aggressive malignancy.

Vascular resections in minimally invasive surgery for pancreatic cancer

Pancreatic ductal adenocarcinoma(PDAC)is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide.With the advances in surgical technology,oncological treatment,and critical care,extended pancreatic resections including vascular resections have become more frequently performed in specialised centres.Furthermore,the boundaries of resectability continue to be pushed in order to achieve a potentially curative approach in selected patients in combination with neoadjuvant and adjuvant treatment strategies.This review gives an overview on the current state of venous and arterial resections in PDAC surgery with particular attention given to the minimally invasive approach.

Penile revascularization--contemporary update

Contemporary therapies for erectile dysfunction are generally targeted towards older men and universally engage pharmacological and/ or device related treatment options. Penile revascularization, using microvascular arterial bypass surgical techniques, is a non-pharmacological, non-device-related, and reconstructive surgical strategy for men with erectile dysfunction that was first described by Dr Vaclav Michal in 1973.

Protective Effects of Different Hypothermal Preservation Solutions on Structure and Function of Isolated Rat Arteries

Objective:With the increasing application of vascular reconstruction in surgical procedures,allogeneic vessels are becoming more popular in clinical practice due to their abundant sources,precise diameter matching,improved histocompatibility,and higher long-term patency rate.This study aimed to investigate the protective effect of various preservation solutions on the function and structure of the isolated rat abdominal aorta preserved under hypothermal conditions.Methods:The study utilized a total of 150 Sprague-Dawley(SD)rats,with 144 rats allocated to the experimental groups and 6 rats allocated to the control groups.The abdominal aorta of the rats was chosen as the subject of our research.The aorta in the experimental groups were randomly assigned to 4 groups:University of Wisconsin(UW)solution group,histidine-tryptophan-ketoglutarate(HTK)solution group,normal saline(NS)group,and sodium lactate Ringer's solution(RS)group.Samples were subjected to examination after preservation periods of 1 day,3 days,5 days,7 days,14 days,30 days,and 90 days.Evaluation of vascular physiological function involved detecting and assessing vasoconstriction ability and measuring cell viability through the MTT test.Evaluation of the vascular wall structure involved tension tolerance tests and pathological staining.Results:The pathogen-positive rate in the HTK group and NS group at 1 month was 16.7%.Regarding the vascular skeleton structure,both the UW group and HTK group exhibited intact structures after 2 weeks of preservation,with slightly edematous collagen and elastic fibers,which was significantly better than that of the NS group and RS group.In terms of cell activity and contractile function,all preservation groups showed similar effects within 2 weeks.However,after 2 weeks,the UW group showed the most favorable preservation effect(P<0.05).In terms of vascular tension,different groups exhibited similar effects within 1 week.However,after 2 weeks,the UW group showed the best preservation effect(P<0.05).Conclusion:All 4 types of preservation solution had a preservation effect on the structure and function of isolated blood vessels during short-term hypothermal preservation.However,after 2-week preservation,the UW solution was found to be the most suitable solution for the preservation of blood vessels.

Management of retroperitoneal sarcoma involving the iliac artery:Single-center surgical experience

BACKGROUND Management of retroperitoneal sarcoma(RPS)involving the iliac artery is challenging and requires the concerted efforts of multidisciplinary team(MDT)members during surgical treatment.AIM To summarize the clinicopathologic features of RPS involving the iliac artery and our retroperitoneal soft tissue tumor MDT surgical experience.METHODS In this retrospective study,15 patients with RPS involving the iliac artery who underwent surgery at our retroperitoneal soft tissue tumor center from July 2004 to June 2020 were analyzed.Statistical analyses were performed by Student’s ttest with SPSS 16.0.RESULTS Complete tumor resection(R0/R1)and iliac artery reconstruction were achieved in all 15 patients.All the operations were successful,with no serious complications or perioperative death.Resection with bilateral iliac artery reconstruction required a higher intraoperative blood transfusion volume than resection with unilateral iliac artery reconstruction.Recurrent cases were more likely to bleed and required a higher blood transfusion volume than primary cases.As of January 2021,11 patients were alive,and 4 had died.Local recurrence occurred in two patients,one of whom developed liver metastasis.CONCLUSION Resection of RPS involving iliac vessels is feasible and effective when performed by MDT members.Iliac artery oncovascular resection and reconstruction are key to a successful operation.Adequate blood preparation is important for successful completion of surgery.

Clinical application of 3D reconstruction in pancreatic surgery: a narrative review

Progress in medicine requires not only innovation and development in the medical field but also the integration of the technology of other fields into the medical field. As an important technological advancement, three-dimensional (3D) reconstruction transforms traditional two-dimensional images into 3D images that are more consistent with the physiological habits of human eyes. It has been applied to the bones, heart, liver, and maxillofacial area, promoting the progress of medical technology and surgeons. This article introduces the progress of 3D reconstruction technology in the clinical application of pancreatic surgery, from the preoperative, intraoperative, and postoperative perspectives, as well as the education of young surgeons. It also puts forward new ideas for the further development of pancreatic surgery.

Skeleton Marching-based Parallel Vascular Geometry Reconstruction Using Implicit Functions

Fast high-precision patient-specific vascular tissue and geometric structure reconstruction is an essential task for vascular tissue engineering and computer-aided minimally invasive vascular disease diagnosis and surgery.In this paper,we present an effective vascular geometry reconstruction technique by representing a highly complicated geometric structure of a vascular system as an implicit function.By implicit geometric modelling,we are able to reduce the complexity and level of difficulty of this geometric reconstruction task and turn it into a parallel process of reconstructing a set of simple short tubular-like vascular sections,thanks to the easy-blending nature of implicit geometries on combining implicitly modelled geometric forms.The basic idea behind our technique is to consider this extremely difficult task as a process of team exploration of an unknown environment like a cave.Based on this idea,we developed a parallel vascular modelling technique,called Skeleton Marching,for fast vascular geometric reconstruction.With the proposed technique,we first extract the vascular skeleton system from a given volumetric medical image.A set of sub-regions of a volumetric image containing a vascular segment is then identified by marching along the extracted skeleton tree.A localised segmentation method is then applied to each of these sub-image blocks to extract a point cloud from the surface of the short simple blood vessel segment contained in the image block.These small point clouds are then fitted with a set of implicit surfaces in a parallel manner.A high-precision geometric vascular tree is then reconstructed by blending together these simple tubular-shaped implicit surfaces using the shape-preserving blending operations.Experimental results show the time required for reconstructing a vascular system can be greatly reduced by the proposed parallel technique.

Clinical application of 3D reconstruction in pancreatic surgery:a narrative review

Progress in medicine requires not only innovation and development in the medical field but also the integration of the technology of other fields into the medical field.As an important technological advancement,three-dimensional(3D)reconstruction transforms traditional two-dimensional images into 3D images that are more consistent with the physiological habits of human eyes.It has been applied to the bones,heart,liver,and maxillofacial area,promoting the progress of medical technology and surgeons.This paper introduces the progress of 3D reconstruction technology in the clinical application of pancreatic surgery,from the preoperative,intraoperative,and postoperative perspectives,as well as the education of young surgeons.It also puts forward new ideas for the further development of pancreatic surgery.

High-throughput drug screening models of mature adipose tissues which replicate the physiology of patients’Body Mass Index(BMI)

Obesity is a complex and incompletely understood disease,but current drug screening strategies mostly rely on immature in vitro adipose models which cannot recapitulate it properly.To address this issue,we developed a statistically validated high-throughput screening model by seeding human mature adipocytes from patients,encapsulated in physiological collagen microfibers.These drop tissues ensured the maintenance of adipocyte viability and functionality for controlling glucose and fatty acids uptake,as well as glycerol release.As such,patients’BMI and insulin sensitivity displayed a strong inverse correlation:the healthy adipocytes were associated with the highest insulin-induced glucose uptake,while insulin resistance was confirmed in the underweight and severely obese adipocytes.Insulin sensitivity recovery was possible with two type 2 diabetes treatments,rosiglitazone and melatonin.Finally,the addition of blood vasculature to the model seemed to more accurately recapitulate the in vivo physiology,with particular respect to leptin secretion metabolism.