AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advan...AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.展开更多
The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results.However,the incidence of bladder and se...The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results.However,the incidence of bladder and sexual dysfunction remains high.This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur.The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes.In this review,we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle,the lateral pelvic wall and dissection around the urogenital organs.Surgical techniques in these areas are discussed.We also discuss the results in functional outcomes of the various techniques including open,laparoscopic and robotic over the last 30 years.展开更多
Background:The impact of a patient’s gender on the development of anastomotic leak(AL)in rectal cancer patients following total mesorectal excision(TME)remains controversial.The aim of this study was to evaluate the ...Background:The impact of a patient’s gender on the development of anastomotic leak(AL)in rectal cancer patients following total mesorectal excision(TME)remains controversial.The aim of this study was to evaluate the association between patients’gender and the risk of AL.Methods:All rectal cancer patients following TME with a primary anastomosis during the study period from 2010 to 2014 were examined.Comparisons of the post-operative AL incidence rate between male and female patients were performed.Results:Of all patients examined(n¼956),587(61.4%)were males and 369(38.6%)were females.Male patients were more likely to have a history of smoking and drinking alcohol,but less likely to have a history of abdominal surgery compared to female patients.A higher incidence rate of pre-operative bowel obstruction and larger tumor volume in male patients was observed in our study.Of all the patients,81(8.5%)developed post-operative AL.More male patients(n¼62,10.6%)suffered from AL than females(n¼19,5.1%)(P¼0.003).Multivariate logistic regression analyses confirmed the association between male gender and AL[odds ratio(OR):2.41,95%confidence interval(CI):1.37–4.23,P¼0.002].Similar results were also obtained in patients who underwent laparoscopic TME(OR:2.11,95%CI:1.15–3.89,P¼0.016).Conclusions:Male patents were found to have an increased risk for AL following TME with a primary anastomosis.A temporary protecting stoma may help to protect the anastomosis and lessen the risk for AL especially in male patients.展开更多
Throughout history,surgeons have been on a quest to refine the surgical treatment options for their patients and to minimize operative trauma.During the last three decades,there have been tremendous advances in the fi...Throughout history,surgeons have been on a quest to refine the surgical treatment options for their patients and to minimize operative trauma.During the last three decades,there have been tremendous advances in the field of minimally invasive colorectal surgery,with an explosion of different technologies and approaches offered to treat well-known diseases.Laparoscopic surgery has been shown to be equal or superior to open surgery.The boundaries of laparoscopy have been pushed further,in the form of single-incision laparoscopy,natural-orifice transluminal endoscopic surgery and robotics.This paper critically reviews the pathway of development of minimally invasive surgery,and appraises the different minimally invasive colorectal surgical approaches available to date.展开更多
It is a comparatively convenient technique to investigate the motion of a particle with the help of the differential geometry the-ory,rather than directly decomposing the motion in the Cartesian coordinates.The new mo...It is a comparatively convenient technique to investigate the motion of a particle with the help of the differential geometry the-ory,rather than directly decomposing the motion in the Cartesian coordinates.The new model of three-dimensional (3D) guidance problem for interceptors is presented in this paper,based on the classical differential geometry curve theory.Firstly,the kinematical equations of the line of sight (LOS) are gained by carefully investigating the rotation principle of LOS,the kinematic equations of LOS are established,and the concepts of curvature and torsion of LOS are proposed.Simultaneously,the new relative dynamic equations between interceptor and target are constructed.Secondly,it is found that there is an instan-taneous rotation plane of LOS (IRPL) in the space,in which two-dimensional (2D) guidance laws could be constructed to solve 3D interception guidance problems.The spatial 3D true proportional navigation (TPN) guidance law could be directly introduced in IRPL without approximation and linearization for dimension-reduced 2D TPN.In addition,the new series of augmented TPN (APN) and LOS angular acceleration guidance laws (AAG) could also be gained in IRPL.After that,the dif-ferential geometric guidance commands (DGGC) of guidance laws in IRPL are advanced,and we prove that the guidance commands in arc-length system proposed by Chiou and Kuo are just a special case of DGGC.Moreover,the performance of the original guidance laws will be reduced after the differential geometric transformation.At last,an exoatmospheric intercep-tion is taken for simulation to demonstrate the differential geometric modeling proposed in this paper.展开更多
文摘AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.
文摘The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results.However,the incidence of bladder and sexual dysfunction remains high.This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur.The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes.In this review,we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle,the lateral pelvic wall and dissection around the urogenital organs.Surgical techniques in these areas are discussed.We also discuss the results in functional outcomes of the various techniques including open,laparoscopic and robotic over the last 30 years.
基金supported by National Natural Science Foundation of China(No.81400603)Guangdong Natural Science Foundation(No.2015A030310190)Science and Technology Planning Project of Guangdong Province(No.2015B020229001).
文摘Background:The impact of a patient’s gender on the development of anastomotic leak(AL)in rectal cancer patients following total mesorectal excision(TME)remains controversial.The aim of this study was to evaluate the association between patients’gender and the risk of AL.Methods:All rectal cancer patients following TME with a primary anastomosis during the study period from 2010 to 2014 were examined.Comparisons of the post-operative AL incidence rate between male and female patients were performed.Results:Of all patients examined(n¼956),587(61.4%)were males and 369(38.6%)were females.Male patients were more likely to have a history of smoking and drinking alcohol,but less likely to have a history of abdominal surgery compared to female patients.A higher incidence rate of pre-operative bowel obstruction and larger tumor volume in male patients was observed in our study.Of all the patients,81(8.5%)developed post-operative AL.More male patients(n¼62,10.6%)suffered from AL than females(n¼19,5.1%)(P¼0.003).Multivariate logistic regression analyses confirmed the association between male gender and AL[odds ratio(OR):2.41,95%confidence interval(CI):1.37–4.23,P¼0.002].Similar results were also obtained in patients who underwent laparoscopic TME(OR:2.11,95%CI:1.15–3.89,P¼0.016).Conclusions:Male patents were found to have an increased risk for AL following TME with a primary anastomosis.A temporary protecting stoma may help to protect the anastomosis and lessen the risk for AL especially in male patients.
文摘Throughout history,surgeons have been on a quest to refine the surgical treatment options for their patients and to minimize operative trauma.During the last three decades,there have been tremendous advances in the field of minimally invasive colorectal surgery,with an explosion of different technologies and approaches offered to treat well-known diseases.Laparoscopic surgery has been shown to be equal or superior to open surgery.The boundaries of laparoscopy have been pushed further,in the form of single-incision laparoscopy,natural-orifice transluminal endoscopic surgery and robotics.This paper critically reviews the pathway of development of minimally invasive surgery,and appraises the different minimally invasive colorectal surgical approaches available to date.
文摘It is a comparatively convenient technique to investigate the motion of a particle with the help of the differential geometry the-ory,rather than directly decomposing the motion in the Cartesian coordinates.The new model of three-dimensional (3D) guidance problem for interceptors is presented in this paper,based on the classical differential geometry curve theory.Firstly,the kinematical equations of the line of sight (LOS) are gained by carefully investigating the rotation principle of LOS,the kinematic equations of LOS are established,and the concepts of curvature and torsion of LOS are proposed.Simultaneously,the new relative dynamic equations between interceptor and target are constructed.Secondly,it is found that there is an instan-taneous rotation plane of LOS (IRPL) in the space,in which two-dimensional (2D) guidance laws could be constructed to solve 3D interception guidance problems.The spatial 3D true proportional navigation (TPN) guidance law could be directly introduced in IRPL without approximation and linearization for dimension-reduced 2D TPN.In addition,the new series of augmented TPN (APN) and LOS angular acceleration guidance laws (AAG) could also be gained in IRPL.After that,the dif-ferential geometric guidance commands (DGGC) of guidance laws in IRPL are advanced,and we prove that the guidance commands in arc-length system proposed by Chiou and Kuo are just a special case of DGGC.Moreover,the performance of the original guidance laws will be reduced after the differential geometric transformation.At last,an exoatmospheric intercep-tion is taken for simulation to demonstrate the differential geometric modeling proposed in this paper.
