BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,...BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.展开更多
For patients with different clinical stages of rectal cancer,tailored surgery is urgently needed.Over the past 10 years,our team has conducted numerous anatomical studies and proposed the“four fasciae and three space...For patients with different clinical stages of rectal cancer,tailored surgery is urgently needed.Over the past 10 years,our team has conducted numerous anatomical studies and proposed the“four fasciae and three spaces”theory to guide rectal cancer surgery.Enlightened by the anatomical basis of the radical hysterectomy classification system of Querleu and Morrow,we proposed a new classification system of radical surgery for rectal cancer based on membrane anatomy.This system categorizes the surgery into four types(A–D)and incorporates corresponding subtypes based on the preservation of the autonomic nerve.Our surgical classification unifies the pelvic membrane anatomical terminology,validates the feasibility of classifying rectal cancer surgery using the theory of“four fasciae and three spaces,”and lays the theoretical groundwork for the future development of unified and standardized classification of radical pelvic tumor surgery.展开更多
Background:Several studies suggested that hypertension is positively related to cancer incidence and mortality.In this study,we investigated the association between perioperative blood pressure(BP) and long?term survi...Background:Several studies suggested that hypertension is positively related to cancer incidence and mortality.In this study,we investigated the association between perioperative blood pressure(BP) and long?term survival out?comes in patients with rectal cancer.Methods:This study included a cohort of 358 patients with stages I–III rectal cancer who underwent a curative resection between June 2007 and June 2011.Both pre? and postoperative BPs were measured,by which patients were grouped(low BP:<120/80 mm Hg;high BP:ints were di≥120/80 mm Hg).The survival outcomes were compared between these two groups.The primary endposease?free survival(DFS) and cancer?specific survival(CSS).Results:Univariate analysis showed that patients with high preoperative systolic BP had lower 3?year DFS(67.2% vs.82.1%,P = 0.041) and CSS rates(81.9% vs.94.8%,P = 0.003) than patients with low preoperative systolic BP,and the associations remained significant in the Cox multivariate analysis,with the adjusted hazard ratios equal to 1.97 [95% confidence interval(CI) = 1.08–3.60,P = 0.028] and 2.85(95% CI = 1.00–8.25,P = 0.050),respectively.Similarly,in postoperative evaluation,patients with high systolic BP had significantly lower 3?year CSS rates than those with low systolic BP(78.3% vs.88.9%,P = 0.032) in univariate analysis.Moreover,high pre? and/or postoperative systolic BP presented as risk factors for CSS in the subgroups of patients who did not have a history of hypertension,with and/or without perioperative administration of antihypertensive drugs.Conclusions:High preoperative systolic BP was an independent risk factor for both CSS and DFS rates,and high postoperative systolic BP was significantly associated with a low CSS rate in rectal cancer patients.Additionally,our results suggest that rectal cancer patients may get survival benefit from BP control in perioperative care.However,further studies should be conducted to determine the association between BP and CSS and targets of BP control.展开更多
基金the National Natural Science Foundation of China,No.81874201Technology Plan Project,No.20Y11908300+2 种基金Shanghai Medical Key Specialty Construction Plan,No.ZK2019A19Shanghai Municipal Commission of Health and Family Planning,No.202040122and Shanghai Pujiang Program,No.21PJD066.
文摘BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.
基金supported by the National Natural Science Foundation of China[No:81874201]Project of Shanghai Medical Innovation Research[No:20Y11908300]Project of Shanghai Municipal Health Commission[No:202040122].
文摘For patients with different clinical stages of rectal cancer,tailored surgery is urgently needed.Over the past 10 years,our team has conducted numerous anatomical studies and proposed the“four fasciae and three spaces”theory to guide rectal cancer surgery.Enlightened by the anatomical basis of the radical hysterectomy classification system of Querleu and Morrow,we proposed a new classification system of radical surgery for rectal cancer based on membrane anatomy.This system categorizes the surgery into four types(A–D)and incorporates corresponding subtypes based on the preservation of the autonomic nerve.Our surgical classification unifies the pelvic membrane anatomical terminology,validates the feasibility of classifying rectal cancer surgery using the theory of“four fasciae and three spaces,”and lays the theoretical groundwork for the future development of unified and standardized classification of radical pelvic tumor surgery.
基金provided by the National Basic Research Program of China (973 Program) (No.2015CB554001,JW )the National Natural Science Foundation of China (No.81472257,YL+6 种基金No.81201920,YLNo.81502022,XW )the Natural Science Foundation of Guangdong Province (No.S2013010013607,YL)the Science and Technology Program of Guangzhou (No.201506010099,YL)the Fundamental Research Funds for the Central Universities (Sun Yat-sen University) (No.2015ykzd10,YLNo.13ykpy37,YL)Wu Jieping Medical Foundation (320675015173 HY)
文摘Background:Several studies suggested that hypertension is positively related to cancer incidence and mortality.In this study,we investigated the association between perioperative blood pressure(BP) and long?term survival out?comes in patients with rectal cancer.Methods:This study included a cohort of 358 patients with stages I–III rectal cancer who underwent a curative resection between June 2007 and June 2011.Both pre? and postoperative BPs were measured,by which patients were grouped(low BP:<120/80 mm Hg;high BP:ints were di≥120/80 mm Hg).The survival outcomes were compared between these two groups.The primary endposease?free survival(DFS) and cancer?specific survival(CSS).Results:Univariate analysis showed that patients with high preoperative systolic BP had lower 3?year DFS(67.2% vs.82.1%,P = 0.041) and CSS rates(81.9% vs.94.8%,P = 0.003) than patients with low preoperative systolic BP,and the associations remained significant in the Cox multivariate analysis,with the adjusted hazard ratios equal to 1.97 [95% confidence interval(CI) = 1.08–3.60,P = 0.028] and 2.85(95% CI = 1.00–8.25,P = 0.050),respectively.Similarly,in postoperative evaluation,patients with high systolic BP had significantly lower 3?year CSS rates than those with low systolic BP(78.3% vs.88.9%,P = 0.032) in univariate analysis.Moreover,high pre? and/or postoperative systolic BP presented as risk factors for CSS in the subgroups of patients who did not have a history of hypertension,with and/or without perioperative administration of antihypertensive drugs.Conclusions:High preoperative systolic BP was an independent risk factor for both CSS and DFS rates,and high postoperative systolic BP was significantly associated with a low CSS rate in rectal cancer patients.Additionally,our results suggest that rectal cancer patients may get survival benefit from BP control in perioperative care.However,further studies should be conducted to determine the association between BP and CSS and targets of BP control.
