Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer

BACKGROUND This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery(NOSES) using a prolapsing technique and the conventional laparoscopic-assisted approach for low rectal cancer.AIM To further explore the application value of the transanal placement of the anvil and to evaluate the short-term efficacy of NOSES for resecting specimens of low rectal cancer, as well as to provide a theoretical basis for its extensive clinical application.METHODS From June 2015 to June 2018, 108 consecutive laparoscopic-assisted low rectal cancer resections were performed at our center. Among them, 26 specimens were resected transanally using a prolapsing technique(NOSES), and 82 specimens were resected through a conventional abdominal wall small incision(LAP). A propensity score matching method was used to select 26 pairs of matched patients, and their perioperative data were analyzed.RESULTS The baseline data were comparable between the two matched groups. All 52 patients underwent the surgery successfully. The operative time, blood loss,number of harvested lymph nodes, postoperative complication rate,circumferential margin involvement, postoperative follow-up data, and postoperative anal function were not statistically significant. The NOSES group had shorter time to gastrointestinal function recovery(2.6 ± 1.0 d vs 3.4 ± 0.9 d, P= 0.006), shorter postoperative hospital stay(7.1 ± 1.7 d vs 8.3 ± 1.1 d, P = 0.003),lower pain score(day 1: 2.7 ± 1.8 vs 4.6 ± 1.9, day 3: 2.0 ± 1.1 vs 4.1 ± 1.2, day 5: 1.7± 0.9 vs 3.3 ± 1.0, P < 0.001), a lower rate of additional analgesic use(11.5% vs61.5%, P = 0.001), and a higher satisfaction rate in terms of the aesthetic appearance of the abdominal wall after surgery(100% vs 23.1%, P < 0.001).CONCLUSION NOSES for low rectal cancer can achieve satisfactory short-term efficacy and has advantages in reducing postoperative pain, shortening the length of postoperative hospital stay, and improving patients' satisfaction in terms of a more aesthetic appearance of the abdominal wall.

Low-pressure pneumoperitoneum with abdominal wall lift in laparoscopic total mesorectal excision for rectal cancer:initial experience

AIM To evaluate the safety and feasibility of a new technology combining low-pressure pneumoperitoneum(LPP) and abdominal wall lift(AWL) in laparoscopic total mesorectal excision(TME) for rectal cancer.METHODS From November 2015 to July 2017,26 patients underwent laparoscopic TME for rectal cancer using LPP(6-8 mm Hg) with subcutaneous AWL in Qilu Hospital of Shandong University,Jinan,China.Clinical data regarding patients' demographics,intraoperative monitoring indices,operation-related indices andpathological outcomes were prospectively collected.RESULTS Laparoscopic TME was performed in 26 cases(14 anterior resection and 12 abdominoperineal resection) successfully,without conversion to open or laparoscopic surgery with standard-pressure pneumoperitoneum.Intraoperative monitoring showed stable heart rate,blood pressure and paw airway pressure.The mean operative time was 194.29 ± 41.27 min(range:125-270 min) and 200.41 ± 20.56 min(range:170-230 min) for anterior resection and abdominoperineal resection,respectively.The mean number of lymph nodes harvested was 16.71 ± 5.06(range:7-27).There was no positive circumferential or distal resection margin.No local recurrence was observed during a median follow-up period of 11.96 ± 5.55 mo(range:5-23 mo).CONCLUSION LPP combined with AWL is safe and feasible for laparoscopic TME.The technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.

Colonic pouch confers better bowel function and similar postoperative outcomes compared to straight anastomosis for low rectal cancer

BACKGROUND With advancements in laparoscopic technology and the wide application of linear staplers,sphincter-saving procedures are increasingly performed for low rectal cancer.However,sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome.Colonic pouch anastomosis improves the quality of life of patients with rectal cancer>7 cm from the anal margin.But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.AIM To compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.METHODS We conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses.Functional evaluations were completed preoperatively and at 1,6,and 12 mo postoperatively.We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.RESULTS There were no significant differences in mean operating time,blood loss,time to first passage of flatus and excrement,and duration of hospital stay between the colonic pouch and straight anastomosis groups.The incidence of anastomotic leakage following colonic pouch construction was lower(11.4%vs 16.2%)but not significantly different than that of straight anastomosis.Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group,suggesting better bowel function(preoperative:4.71 vs 3.89,P=0.43;1 mo after surgery:34.2 vs 34.7,P=0.59;6 mo after surgery:22.70 vs 29.0,P<0.05;12 mo after surgery:15.5 vs 19.5,P=0.01).The overall recurrence and metastasis rates were similar(4.3%and 11.4%,respectively).CONCLUSION Colonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections.Moreover,colonic pouch construction may provide better functional outcomes compared to straight anastomosis.

Effect of laparoscopic surgery combined with neoadjuvant chemotherapy on serum CEA, VEGF, CA724, CA242, LEP and T lymphocyte subsets in patients with low rectal cancer

Objective: To study the effect of laparoscopic surgery combined with neoadjuvant chemotherapy on serum CEA, VEGF, CA724, CA242, LEP and T lymphocyte subsets in patients with low rectal cancer. Methods A total of 80 patients with low rectal cancer in our hospital from June 2014 to June 2017 were enrolled in this study. The subjects were divided into the control group (n=40) and the treatment group (n=40) randomly. The control group were treated with laparoscopic surgery, the treatment group were treated with laparoscopic surgery combined with neoadjuvant chemotherapy, and both the two groups were treated for 6 periods with neoadjuvant chemotherapy after surgery. The serum CEA, VEGF, CA724, CA242, LEP levels and peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups before and after treatment were compared. Results: There were no significantly differences of the serum CEA, VEGF, CA724, CA242, LEP levels and peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups before treatment. The serum CEA, VEGF, CA724, CA242 and LEP levels of the two groups after treatment were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group.The peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups of the two groups after treatment were significantly lower than before treatment, and that of the treatment group were significantly higher than the control group. Conclusion: Laparoscopic surgery combined with neoadjuvant chemotherapy can significantly reduce the serum CEA, VEGF, CA724, CA242, LEP levels, improve the immunologic function, and it was worthy clinical application.

Neoadjuvant radiotherapy for rectal cancer management

Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.

Impact of interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients

BACKGROUND Epidemiologically,in China,locally advanced rectal cancer is a more common form of rectal cancer.Preoperative neoadjuvant concurrent chemoradiotherapy can effectively reduce the size of locally invasive tumors and improve disease-free survival(DFS)and pathologic response after surgery.At present,this modality has become the standard protocol for the treatment of locally advanced rectal cancer in many centers,but the optimal time for surgery after neoadjuvant therapy is still controversial.AIM To investigate the impact of time interval between neoadjuvant therapy and surgery on DFS and pathologic response in patients with locally advanced rectal cancer.METHODS A total of 231 patients who were classified as having clinical stage II or III advanced rectal cancer and underwent neoadjuvant chemoradiation followed by surgery at the National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from November 2014 to August 2017 were involved in this retrospective cohort study.The patients were divided into two groups based on the different time intervals between neoadjuvant therapy and surgery:139(60.2%)patients were in group A(≤9 wk),and 92(39.2%)patients were in group B(>9 wk).DFS and pathologic response were analyzed as the primary endpoints.The secondary endpoints were postoperative complications and sphincter preservation.RESULTS For the 231 patients included,surgery was performed at≤9 wk in 139(60.2%)patients and at>9 wk in 92(39.8%).The patients’clinical characteristics,surgical results,and tumor outcomes were analyzed through univariate analysis combined with multivariate regression analysis.The overall pathologic complete response(pCR)rate was 27.2%(n=25)in the longer time interval group(>9 wk)and 10.8%(n=15)in the shorter time interval group(≤9 wk,P=0.001).The postoperative complications did not differ between the groups(group A,5%vs group B,5.4%;P=0.894).Surgical procedures for sphincter preservation were performed in 113(48.9%)patients,which were not significantly different between the groups(group A,52.5%vs group B,43.5%;P=0.179).The pCR rate was an independent factor affected by time interval(P=0.009;odds ratio[OR]=2.668;95%CI:1.276-5.578).Kaplan-Meier analysis and Cox regression analysis showed that the longer time interval(>9 wk)was a significant independent prognostic factor for DFS(P=0.032;OR=2.295;95%CI:1.074-4.905),but the time interval was not an independent prognostic factor for overall survival(P>0.05).CONCLUSION A longer time interval to surgery after neoadjuvant therapy may improve the pCR rate and DFS but has little impact on postoperative complications and sphincter preservation.

Evolving treatment strategies for colorectal cancer: A critical review of current therapeutic options

Management of rectal cancer has markedly evolved over the last two decades.New technologies of staging have allowed a more precise definition of tumor extension.Refinements in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this malignancy.Although,preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors,many controversial matters in management of rectal cancer still need to be defined.These include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy,the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor resection.In this article,after an extensive search in PubMed and Embase databases,we critically review the current strategies and the most debatable matters in treatment of rectal cancer.

Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer

AIM: To compare quality of life (QoL) outcomes in Chinese patients after curative laparoscopic vs open surgery for rectal cancer. METHODS: Eligible Chinese patients with rectal cancer undergoing curative laparoscopic or open sphincterpreserving resection between July 2006 and July 2008 were enrolled in this prospective study. The QoL outcomes were assessed longitudinally using the validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQCR38 questionnaires before surgery and at 4, 8, and 12 mo after surgery. The QoL scores at the different time points were compared between the laparoscopic and open groups. A higher score on a functional scale indicated better functioning, whereas a higher score on a symptom scale indicated a higher degree of symptoms.RESULTS: Seventy-four patients (49 laparoscopic and 25 open) were enrolled. The two groups of patients were comparable in terms of sociodemographic data, types of surgery, tumor staging, and baseline mean QoL scores. There was no significant decrease from baseline in global QoL for the laparoscopic group at different time points, whereas the global QoL was worse compared to baseline beginning at 4 mo but returned to baseline by 12 mo for the open group (P = 0.019, Friedman test). Compared to the open group, the laparoscopic group had significantly better physical (89.9±1.4 vs 79.2±3.7, P = 0.016), role (85.0±3.4 vs 63.3±6.9, P = 0.005), and cognitive (73.5±3.4 vs 50.7±6.2, P = 0.002) functioning at 8 mo, fewer micturition problems at 4-8 mo (4 mo: 32.3±4.7 vs 54.7±7.1, P = 0.011; 8 mo: 22.8±4.0 vs 40.7±6.9, P = 0.020), and fewer male sexual problems from 8 mo onward (20.0±8.5 vs 76.7±14.5, P = 0.013). At 12 mo after surgery, no significant differences were observed in any functional or symptom scale between the two groups, with the exception of male sexual problems, which remained worse in the open group (29.2±11.3 vs 80.0±9.7, P = 0.026). CONCLUSION: Laparoscopic sphincter-preserving resection for rectal cancer is associated with better preservation of QoL and fewer male sexual problems when compared with open surgery in Chinese patients. These findings, however, should be interpreted with caution because of the small sample size of the study.

Low rectal cancer:Sphincter preserving techniques-selection of patients,techniques and outcomes

Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.

From basic to clinical:Anatomy of Denonvilliers’fascia and its application in laparoscopic radical resection of rectal cancer

The total mesorectal excision(TME)approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer.This approach is widely accepted to minimize the risk of local recurrence and increase the long-term survival rate of patients undergoing surgery.However,standardized TME causes urogenital dysfunction in more than half of patients,thus lowering the quality of life of patients.Of note,pelvic autonomic nerve damage during TME is the most pivotal cause of postoperative urogenital dysfunction.The anatomy of the Denonvilliers’fascia(DVF)and its application in surgery have been investigated both nationally and internationally.Nevertheless,controversy exists regarding the basic to clinical anatomy of DVF and its application in surgery.Currently,it is a hotspot of concern and research to improve the postoperative quality of life of patients with rectal cancer through the protection of their urinary and reproductive functions after radical resection.Herein,this study systematically describes the anatomy of DVF and its appli-cation in surgery,thus providing a reference for the selection of surgical treatment modalities and the enhancement of postoperative quality of life in patients with middle and low rectal cancer.

Quality of life in rectal cancer surgery:What do the patient ask?

Rectal cancer surgery has dramatically changed with the introduction of the total mesorectal excision(TME), which has demonstrated to significantly reduce the risk of local recurrence. The combination of TME with radiochemotherapy has led to a reduction of local failure to less than 5%. On the other hand, surgery for rectal cancer is also impaired by the potential for a significant loss in quality of life. This is a new challenge surgeons should think about nowadays: If patients live more, they also want to live better. The fight against cancer cannot only be based on survival, recurrence rate and other oncological endpoints. Patients are also asking for a decent quality of life. Rectal cancer is probably a paradigmatic example: Its treatment is often associated with the loss or severe impairment of faecal function, alteration of body anatomy, urogenital problems and, sometimes, intractable pain. The evolution of laparoscopic colorectal surgery in the last decades is an important example, which emphasizes the importance that themes like scar, recovery, pain and quality of life might play for patients. The attention to quality of life from both patients and surgeons led to several surgical innovations in the treatment of rectal cancer: Sphincter saving procedures, reservoir techniques(pouch and coloplasty) to mitigate postoperative faecal disorders, nerve-sparing techniques to reduce the risk for sexual dysfunction. Even more conservative procedures have been proposed alternatively to the abdominal-perineal resection, like the local excisions or transanal endoscopic microsurgery, till the possibility of a wait and see approach in selected cases after radiation therapy.

Magnetic resonance imaging-based deep learning model to predict multiple firings in double-stapled colorectal anastomosis

BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to predict preoperatively the need for multiple linear stapler cartridges during DST anastomosis.AIM To develop a deep learning model to predict multiple firings during DST anastomosis based on pelvic magnetic resonance imaging(MRI).METHODS We collected 9476 MR images from 328 mid-low rectal cancer patients undergoing LAR with DST anastomosis,which were randomly divided into a training set(n=260)and testing set(n=68).Binary logistic regression was adopted to create a clinical model using six factors.The sequence of fast spin-echo T2-weighted MRI of the entire pelvis was segmented and analyzed.Pure-image and clinical-image integrated deep learning models were constructed using the mask region-based convolutional neural network segmentation tool and three-dimensional convolutional networks.Sensitivity,specificity,accuracy,positive predictive value(PPV),and area under the receiver operating characteristic curve(AUC)was calculated for each model.RESULTS The prevalence of≥3 linear stapler cartridges was 17.7%(58/328).The prevalence of AL was statistically significantly higher in patients with≥3 cartridges compared to those with≤2 cartridges(25.0%vs 11.8%,P=0.018).Preoperative carcinoembryonic antigen level>5 ng/mL(OR=2.11,95%CI 1.08-4.12,P=0.028)and tumor size≥5 cm(OR=3.57,95%CI 1.61-7.89,P=0.002)were recognized as independent risk factors for use of≥3 linear stapler cartridges.Diagnostic performance was better with the integrated model(accuracy=94.1%,PPV=87.5%,and AUC=0.88)compared with the clinical model(accuracy=86.7%,PPV=38.9%,and AUC=0.72)and the image model(accuracy=91.2%,PPV=83.3%,and AUC=0.81).CONCLUSION MRI-based deep learning model can predict the use of≥3 linear stapler cartridges during DST anastomosis in laparoscopic LAR surgery.This model might help determine the best anastomosis strategy by avoiding DST when there is a high probability of the need for≥3 linear stapler cartridges.

Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer

Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries(SPS)for rectal cancer.The bowel dysfunction usually manifests in the form of low anterior resection syndrome(LARS),which has a negative impact on the patients'quality of life.This study reviewed the LARS after SPS,its mechanism,risk factors,diagnosis,prevention,and treatment based on previously published studies.Adequate history taking,physical examination of the patients,using validated questionnaires and other diagnostic tools are important for assessment of LARS severity.Treatment of LARS should be tailored to each patient.Multimodal therapy is usually needed for patients with major LARS with acceptable results.The treatment includes conservative management in the form of medical,pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation.If this treatment failed,fecal diversion may be needed.In conclusion,Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS.Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery

Background::Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery.However,the complications of stoma and stoma reversal surgery should not be underestimated.Furthermore,in some patients,stoma reversal failed.Here,we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed.Methods::In total,154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed.Patients were divided into two groups according to whether their stoma got reversed or not.The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed.Results::The mean follow-up time was 47.54(range 4.0-164.0)months.During follow-up,19.5%of the patients suffered stoma-related long-term complications.Only 79(51.3%)patients had their stomas reversed.The morbidity of complications after reversal surgery was 45.6%,and these mainly consisted of incision-related complications.Multivariate analyses showed that pre-treatment comorbidity(HR=3.17,95%CI 1.27-7.96,P=0.014),postoperative TNM stage(HR=2.55,95%CI 1.05-6.18,P=0.038),neoadjuvant therapy(HR=2.75,95%CI 1.07-7.05,P=0.036),anastomosis-related complications(HR=4.52,95%CI 1.81-11.29,P=0.001),and disease recurrence(HR=24.83,95%CI 2.90-213.06,P=0.003)were significant independent risk factors for a defunctioning stoma to be permanent.Conclusions::Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage,but the stoma itself and its reversal procedure are associated with high morbidity of complications,and many defunctioning stomas eventually become permanent.Therefore,surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients.In addition,doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.

重视低位直肠癌保肛策略规划

基于多学科诊疗模式背景和患者日益增长的高质量生活意愿,近年来低位直肠癌保肛策略发生改变。随着新辅助治疗模式的优化、手术术式的精化以及术后保肛理念的深入人心,低位直肠癌保肛策略逐渐从传统的单纯手术转变为综合治疗,保肛手术也更倾向于精准、极限保肛。综合治疗旨在为患者保留良好的肛门功能,减轻手术损伤。但低位直肠癌保肛综合治疗仍处于新兴发展阶段,对保肛的策略规划尚未达成共识。因此,总结各类低位直肠癌术前、术中、术后的治疗策略,对于低位直肠癌患者保肛方案的选择具有重要意义。本文着重探讨新辅助治疗模式的优化、“观察等待”方案、保肛技术的发展以及术后保肛策略等,旨在对低位直肠癌保肛策略规划的现状进行综述。

腹腔镜外翻拖出式经括约肌间切除联合改良Bacon术在低位直肠癌超低位保肛中的应用(附6例报道)

目的探讨腹腔镜外翻拖出式经括约肌间切除(ISR)联合改良Bacon术在低位直肠癌超低位保肛中的应用。方法回顾性分析2023年3月至12月四川省肿瘤医院大肠外科采用外翻拖出式ISR联合改良Bacon术进行腹腔镜根治性切除、超低位保肛的6例低位直肠癌患者的临床资料,探讨近期临床效果,总结手术技巧。结果6例患者均顺利完成手术,手术时间200~320 min,平均256.7 min;术中失血量20~100 mL,平均48.3 mL。术后1例患者出现外置肠段脱垂,行再次手术切除;2例患者出现外置肠段系膜局部缺血,行保守治疗后好转。所有患者均顺利恢复,术后6~11 d出院,平均术后住院时间8.2 d。所有患者均于术后21 d施行二期外置肠段切除和肛门成形术,术后3~6 d好转出院,平均术后住院时间4.3 d。随访至2024年3月,所有患者无肿瘤复发或转移,二期术后3个月Wexner肛门失禁评分1~5分,平均3.2分,肛门控便功能满意。结论腹腔镜外翻拖出式ISR联合改良Bacon术有助于实现肿瘤远端的精准切除,能极大降低经肛切除的操作难度,而且避免了预防性肠造口,术后肛门功能满意,有望成为低位直肠癌行超低位保肛手术的新选择。

腹腔镜下低位直肠癌根治术与传统开腹手术的疗效与安全性比较

目的观察腹腔镜下低位直肠癌根治术与常规开腹直肠癌根治术的近期疗效和安全性。方法选取2021年4月~2023年4月收治的80例低位直肠癌患者,采用随机数字表法分为观察组和对照组,各40例。观察组行腹腔镜下低位直肠癌根治术,对照组行常规开腹直肠癌根治术。比较两组围术期指标、环周切缘状态和保肛率、术后恢复情况、血清炎症因子水平及术后并发症发生率。结果两组手术时间、淋巴结清扫数目差异无统计学意义(P>0.05);观察组与对照组术中出血量分别为(90.24±23.34)ml、(148.02±18.67)ml,切口长度分别为(5.17±0.94)cm、(14.75±2.26)cm,观察组术中出血量少于对照组,切口长度短于对照组(P<0.05);两组患者手术后环周切缘阳性率和保肛率差异无统计学意义(P>0.05);观察组与对照组术后肛门首次排气时间分别为(2.07±0.85)d、(2.75±0.91)d,拔除尿管时间分别为(2.21±0.67)d、(3.45±1.22)d,术后首次下床活动时间分别为(4.55±1.17)d、(6.28±1.36)d,术后住院时间分别为(10.69±2.27)d、(12.86±3.61)d,观察组均短于对照组(P<0.05);手术后观察组与对照组血清白细胞介素-6(IL-6)水平分别为(63.09±7.25)ng/L、(69.71±8.43)ng/L,皮质醇(Cor)水平分别为(328.95±41.75)μg/L、(451.37±53.62)μg/L,C反应蛋白(CRP)水平分别为(22.64±7.78)mg/L、(34.51±11.92)mg/L,观察组均低于对照组(P<0.05);观察组与对照组术后并发症发生率分别为5.00%、20.00%,观察组低于对照组(P<0.05)。结论腹腔镜下低位直肠癌根治术与常规开腹手术治疗低位直肠癌在手术时间、淋巴结清扫数目、保肛率等方面效果接近,但腹腔镜下低位直肠癌根治术手术创伤较小,有利于减轻炎症反应、减少术后并发症,有助于术后早期康复。

低位直肠癌保肛术后行早期排便功能训练护理模式对肛门功能的影响分析

目的 研究早期排便功能训练护理模式应用在低位直肠癌保肛术后患者的临床可行性,并深入探究有无影响肛门功能。方法 通过计算机1:1随机数列方式对本院2021年5月—2023年6月收治的低位直肠癌保肛术后患者82例均分两组。其中,参照组(n=41)采用常规护理,研究组(n=41)采用早期排便功能训练护理模式,比较护理后的效果。结果 研究组护理后的排便功能优良率以及护理工作满意度评分较参照组高,组间差异有统计学意义(P<0.05)。护理质量评分方面,研究组心理护理、训练干预、专业技术和护理中心等分值较参照组高,组间差异有统计学意义(P<0.05)。护理前两组患者的SAS评分和SDS评分对比,差异无统计学意义(P>0.05);护理后研究组SAS评分和SDS评分较参照组低,组间差异有统计学意义(P<0.05)。结论 低位直肠癌保肛术后患者选取科学有效的护理方法至关重要,其中早期排便功能训练护理模式对肛门功能的恢复具有积极的效果,护理工作满意度以及护理质量均明显提高,不良心理得到显著改善,具有较高的可行性。

回肠末端改良自闭式造口术治疗低位直肠癌腹腔镜保肛手术患者的疗效及安全性

目的探讨回肠末端改良自闭式造口术治疗低位直肠癌腹腔镜保肛手术患者的疗效及安全性。方法选取80例低位直肠癌患者,均接受腹腔镜保肛手术,根据造口方式的不同分为对照组(n=50)和改良组(n=30),对照组患者给予回肠末端袢式造口术,改良组患者给予回肠末端改良自闭式造口术。比较两组患者的术中相关指标、术后相关指标及并发症发生情况。结果两组患者手术时间、造口时间、术中出血量、肠功能恢复时间、首次进食时间比较,差异均无统计学意义(P﹥0.05),改良组患者住院时间明显短于对照组,住院费用明显低于对照组,差异均有统计学意义(P﹤0.01)。两组患者住院期间及远期并发症总发生率比较,差异均无统计学意义(P﹥0.05)。结论回肠末端改良自闭式造口术与回肠末端袢式造口术疗效及安全性均较好,但前者可明显缩短术后住院时间,减轻经济压力。

低位直肠癌患者保肛术后肛门功能锻炼方案的构建研究

目的 构建低位直肠癌患者保肛术后肛门功能锻炼护理方案并验证其临床应用效果。方法 通过文献查阅、小组讨论及直肠癌患者术后实际情况,制定符合直肠癌保肛术后渐进性肛门功能锻炼方案。选取我科2021年1月-2022年6月收治的低位直肠癌患者80例,按随机数字表法分为对照组和观察组,每组各40例;对照组采用常规术后肛门功能锻炼法,观察组在对照组基础上采用保肛术后肛门功能锻炼操进行训练。比较2组患者术后肛门功能锻炼执行率情况、肛门功能的恢复情况、并发症发生情况。结果 观察组患者术后肛门功能锻炼执行率优于对照组,差异有统计学意义(P<0.05)。观察组患者肛门功能评分低于对照组,差异有统计学意义(P<0.05)。观察组患者术后腹泻、肠梗阻的并发症发生少于对照组,差异有统计学意义(P<0.05)。结论 本研究构建的低位直肠癌患者保肛术后肛门功能锻炼康复方案在临床中应用效果较好,不但解决了患者术后肛门功能恢复差、并发症多等问题,还对患者术后肛门功能康复起到了很好的促进作用,提高患者生活质量。