Effect of dexmedetomidine on inflammatory factors and immune function in elderly patients undergoing laparoscopic radical resection of colorectal cancer

Objective:To investigate the effect of dexmedetomidine on inflammatory factors and immune function in elderly patients undergoing laparoscopic radical resection of colorectal cancer. Methods: From April 2016 to April 2017, 86 cases of elderly laparoscopic radical resection of colorectal cancer in our hospital were selected and randomly divided into the observation group and the control group. 2 groups of patients were open venous access, oxygen mask, monitoring heart rate (HR), blood pressure (BP), electrocardiogram (ECG), oxygen saturation (SpO2), bispectral index (BIS), after induction of anesthesia, the observation group was given dexmedetomidine 0.4 g/kg to 20 mL of normal saline control. Group of 20 mL saline, 15 min infusion is completed, and the observation group of dexmedetomidine in 0.4 g/kg - h continuous infusion of normal saline control group, continuous infusion, until the end of surgery. Before induction of anesthesia (T0), 2 h after operation beginning (T1), at the end of operation (T2), 24 h after operation (T3) in venous blood, using ELISA method for the determination of serum interleukin-2 receptor (sIL-2R) and interleukin-6 (IL-6), tumor necrosis factor alpha (the level of TNF-alpha);on preoperative and postoperative 4 h, 12 h, 24 h after operation in venous blood serum epinephrine ELISA method (E), norepinephrine (NE), endothelin-1 (ET-1) level;on preoperative and postoperative 4 h, 12 h after surgery, 24 h venous blood flow cytometry determination of CD3+, CD4+, CD8+, CD4+/CD8+.Results:compared with before operation, the observation group after 4 h, 12 h, 24 h NE, and the lower control group E, NE and ET-1 increased, the observation group after 4 h, 12 h, 24 h E, NE, ET-1 lower than that of the control group;compared with T0, 2 patients in group T2, T3 sIL-2R, IL-6, TNF-alpha were increased, the observation group T2, T3 sIL-2R, IL-6, TNF- were lower than that of the control group;compared with the preoperative, 2 group after 4 h, 12 h, 24 h CD3+, CD4+, CD8+ and CD4+/CD8+ decreased, the observation group after 4 h, 12 h, 24 h CD3+, CD4+, CD8+, CD4+/CD8+ higher than those in the control group.Conclusion: Dexmedetomidine has a good analgesic effect on elderly patients undergoing laparoscopic radical resection of colorectal cancer. It can effectively relieve the stress reaction and inflammatory reaction during perioperative period, and effectively improve the immune function of the patients.

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/m2,and 51 males and 23 females in the nonreconstruction group,aged(58.77±6.1)years,with a BMI(23.6±2.7)kg/m2.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.

Clinical Efficacy of Laparoscopic Radical Colorectal Cancer Treatment for Colorectal Cancer and Its Effect on Immune Function

Objective:To explore the therapeutic effect of laparoscopic radical colorectal cancer treatment in colorectal cancer patients.Methods:A total of 50 colorectal cancer patients treated between August 2018 and August 2023 were randomly divided into two groups:Group A underwent laparoscopic radical colorectal cancer surgery,while Group B received open surgery.Clinical indicators,inflammatory factors,immune function indicators,and complications were compared between the two groups.Results:Group A showed significantly shorter operation times,faster recovery times,and reduced hospital stays compared to Group B.Additionally,Group A had less abdominal drainage and intraoperative bleeding(P<0.05).Levels of interleukin(IL)-4,IL-6,ultrasensitive C-reactive protein(hs-CRP),and tumor necrosis factor-alpha(TNF-α)were lower in Group A compared to Group B(P<0.05).Furthermore,immune function indicators,including CD3+,CD4+,CD8+,and CD4+/CD8+ratios,were better in Group A(P<0.05).The complication rate in Group A was also lower than in Group B(P<0.05).Conclusion:Laparoscopic radical treatment for colorectal cancer is efficient and feasible,causing minimal immune function impairment and inflammatory response.It also shortens postoperative recovery time.

Short- and long-term results of open vs laparoscopic multisegmental resection and anastomosis for synchronous colorectal cancer located in separate segments

BACKGROUND It remains unclear whether laparoscopic multisegmental resection and ana-stomosis(LMRA)is safe and advantageous over traditional open multisegmental resection and anastomosis(OMRA)for treating synchronous colorectal cancer(SCRC)located in separate segments.AIM To compare the short-term efficacy and long-term prognosis of OMRA as well as LMRA for SCRC located in separate segments.METHODS Patients with SCRC who underwent surgery between January 2010 and December 2021 at the Cancer Hospital,Chinese Academy of Medical Sciences and the Peking University First Hospital were retrospectively recruited.In accordance with the RESULTS LMRA patients showed markedly less intraoperative blood loss than OMRA patients(100 vs 200 mL,P=0.006).Compared to OMRA patients,LMRA patients exhibited markedly shorter postoperative first exhaust time(2 vs 3 d,P=0.001),postoperative first fluid intake time(3 vs 4 d,P=0.012),and postoperative hospital stay(9 vs 12 d,P=0.002).The incidence of total postoperative complications(Clavien-Dindo grade:≥II)was 2.9%and 17.1%(P=0.025)in the LMRA and OMRA groups,respectively,while the incidence of anastomotic leakage was 2.9%and 7.3%(P=0.558)in the LMRA and OMRA groups,respectively.Furthermore,the LMRA group had a higher mean number of lymph nodes dissected than the OMRA group(45.2 vs 37.3,P=0.020).The 5-year overall survival(OS)and disease-free survival(DFS)rates in OMRA patients were 82.9%and 78.3%,respectively,while these rates in LMRA patients were 78.2%and 72.8%,respectively.Multivariate prognostic analysis revealed that N stage[OS:HR hazard ratio(HR)=10.161,P=0.026;DFS:HR=13.017,P=0.013],but not the surgical method(LMRA/OMRA)(OS:HR=0.834,P=0.749;DFS:HR=0.812,P=0.712),was the independent influencing factor in the OS and DFS of patients with SCRC.CONCLUSION LMRA is safe and feasible for patients with SCRC located in separate segments.Compared to OMRA,the LMRA approach has more advantages related to short-term efficacy.

Preoperative blood markers and intra-abdominal infection after colorectal cancer resection

BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process.However,the factors influencing abdominal infection after CRC surgery remain unclear;further,prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.AIM To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.METHODS The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed.These patients were categorized into IAI(n=15)and non-IAI groups(n=65)based on whether IAI occurred.Influencing factors were compared;general data and laboratory indices of both groups were identified.The relationship between the indicators was assessed.Further,a nomogram prediction model was developed and evaluated;its utility and clinical applic-ability were assessed.RESULTS The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and carcinoembryonic antigen(CEA)levels.NLR was correlated with PLR and SII(r=0.604,0.925,and 0.305,respectively),while PLR was correlated with SII(r=0.787).The nomogram prediction model demonstrated an area under the curve of 0.968[95%confidence interval(CI):0.948-0.988]in the training set(n=60)and 0.926(95%CI:0.906-0.980)in the validation set(n=20).The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048,respectively,indicating a good model fit.The decision curve analysis curves demonstrated high net income above the 5%threshold,indicating the clinical practicality of the model.CONCLUSION The nomogram model constructed using NLR,PLR,SII,and CEA levels had good accuracy and reliability in predicting IAI after radical resection of CRC,potentially aiding clinical treatment decision-making.

Incidence,characteristics and risk factors for alveolar recruitment maneuver-related hypotension in patients undergoing laparoscopic colorectal cancer resection

BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects.An ARM was repeated every 30 min during intraoperative mechanical ventilation.The primary endpoint was ARM-related hypotension,defined as a mean arterial pressure(MAP)<60 mmHg during an ARM or within 5 min after an ARM.The risk factors for hypotension were identified.The peri-ARM changes in blood pressure were analyzed for the first three ARMs(ARM_(1,2,3))and the last ARM(ARMl_(ast)).RESULTS Thirty-four subjects(24.3%)developed ARM-related hypotension.Of all 1027 ARMs,37(3.61%)induced hypotension.More ARMs under nonpneumoperitoneum(33/349,9.46%)than under pneumoperitoneum conditions(4/678,0.59%)induced hypotension(P<0.01).The incidence of hypotension was higher at ARM_(1)points than at non-ARM_(1)points(18/135,13.3%vs 19/892,2.1%;P<0.01).The median percentage decrease in the MAP at ARM1 was 14%.Age≥74 years,blood loss≥150 mL and peak inspiratory pressure under pneumoperitoneum<24 cm H_(2)O were risk factors for ARM-related hypotension.CONCLUSION When the ARM was repeated intraoperatively,a quarter of subjects developed ARM-related hypotension,but only 3.61%of ARMs induced hypotension.ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state,and in elderly subjects.Fortunately,ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.

A Comparative Study of the Short-Term Efficacy of Laparoscopic Radical Resection of Right-Sided Colon Cancer with Two Different Surgeon Positions and Trocar Placements

Objective: To investigate the short-term efficacy of laparoscopic radical resection of right-sided colon cancer with two different surgeon positions and trocar placements. Methods: The data of 78 patients who underwent laparoscopic radical resection of right-sided colon cancer between January 2018 and August 2019 were retrospectively analysed. The surgical method was selected by the patients. The patients were divided into two groups according to the surgeons’ positioning habits and trocar placements. The group with the lead surgeon standing between the patient’s legs had 35 patients, and the group with the lead surgeon standing at the left side of the patient had 43 patients. The operation time, intraoperative blood loss, postoperative anal gas evacuation time, postoperative urinary catheter indwelling time, postoperative hospital stay, C-reactive protein (CRP) level on the first day after surgery, and postoperative pathological data and complications were compared between the two groups. Results: All patients underwent the laparoscopic radical resection of right-sided colon cancer, none converting to laparotomy. No significant difference (P > 0.05) in intraoperative blood loss (57.6 ± 21.3 ml vs 60.2 ± 35.3 ml), postoperative anal gas evacuation time (3.5 ± 1.1 d vs 3.8 ± 1.3 d), postoperative urinary catheter indwelling time (2.6 ± 1.3 d vs 2.4 ± 1.2 d), postoperative hospital stay (7.1 ± 1.8 d vs 7.5 ± 2.1 d), or CRP level on the first day after surgery (54.7 ± 9.6 mg/L vs 53.9 ± 8.2 mg/L) was detected between the two groups. The operation time was shorter in the group with the lead surgeon standing between the patient’s legs (185.2 ± 25.6 min vs 196.2 ±19.7 min) (P < 0.05). The two groups did not differ significantly in the tumour length (4.2 ± 1.3 cm vs 3.9 ± 1.5 cm), number of dissected lymph nodes (27.5 ± 11.6 vs 25.1 ± 15.4), pathological type, or postoperative pathological tumour-node-metastasis stage (P > 0.05). No patients died or had anastomotic fistula during their postoperative hospital stay, and the incidence of postoperative complications did not differ between the two groups (22.9% (8/35) vs 23.3% (10/42);P > 0.05). Conclusion: Under the principle of radical resection, the surgeon should adopt the most suitable standing position and trocar placement according to the specific situation. If the surgeon stands between the patient’s legs, this might shorten the operation time and promote a smoother surgery.

Effect of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress in patients

Objective: To investigate the effects of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress. Methods: A total of 96 patients with rectal cancer radical resection from January 2017 to December 2017 in our hospital, were selected as the research objects, the patients were randomly divided into the observation group (48 cases) and the control group (48 cases). The observation group received laparoscopic radical resection of rectal cancer, while the control group underwent open radical resection of rectal cancer. The levels of gastrin (GAS), motilin (MTL), vasoactive intestinal peptide (VIP), transferrin (TRF), retinol binding protein (RbP), albumin (ALB), prealbumin (PRE), P substance (SP), bradykinin (BK), and prostaglandin-E2 (PGE2) were measured and compared in the two groups. Results: Before operation, there was no significant difference in GAS, MTL and VIP between the two groups. 1, 3, and 5 d after operation, the GAS, MTL and VIP of the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3, and 5 d after operation, GAS of the observation group were (66.60±5.79) μmol/L, (71.95±6.16) μmol/L and (77.68±6.38) μmol/L respectively, MTL were (225.68±19.83) pg/mL, (253.76±21.42) pg/mL and (289.98±24.74) pg/mL, VIP were (1.99±0.42) μmol/L, (2.43±0.46) μmol/L, (2.80±0.51) μmol/L, respectively, which were higher than that of the control group at the same time, and the difference was statistically significant. Before operation, there was no significant difference in TRF, RbP, ALB and PRE levels in the two groups. 1, 3 and 5 d after operation, the TRF, RbP, ALB and PRE levels in the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3 and 5 d after operation, TRF of the observation group were (1.64±0.33) ng/L, (1.44±0.30) ng/L, (1.46 ±0.32) ng/L, RbP were (19.05±3.85) mg/L, (21.83±4.26) mg/L and (24.54±4.45) mg/L respectively, and ALB were (31.49±2.54) ng/L, (28.21±2.05) ng/L and (28.43±1.99) ng/L, PRE were (0.20±0.06) ng/L, (0.16±0.05) ng/L, (0.15±0.05) ng/L, which were all higher than those in the control group at the same time, and the differences were statistically significant. Before operation, there was no significant difference in SP, BK and PGE2 between the two groups. 1, 3 and 5 d after operation, the SP, BK and PGE2 of the two groups were significantly higher than those before operation and the differences were statistically significant. 1, 3 and 5 d after operation, SP of the observation group was (7.31±0.87) μg/mL, (5.43±0.51) μg/mL and (3.10±0.24) μg/mL, BK was (9.53±0.80) μg/L, (7.81±0.79) μg/L and 6.30±0.53) pg/mL, and PGE2 were (152.42±14.80) pg/mL, (131.22±13.35) pg/mL, (117.86±11.95) pg/mL, which were all lower than those in the control group at the same time, and the differences were statistically significant. Conclusion: Laparoscopic radical resection of rectal cancer can help patients recover gastrointestinal function faster and cause less pain stress.

Has the open surgical approach in colorectal cancer really become uncommon?

Colorectal cancer is the third most common cancer in the world.Surgery is man-datory to treat patients with colorectal cancer.Can colorectal cancer be treated in laparoscopy?Scientific literature has validated the oncological quality of laparo-scopic approach for the treatment of patients with colorectal cancer.Randomized non-inferiority trials with good remote control have answered positively to this long-debated question.Early as 1994,first publications demonstrated technical feasibility and compliance with oncological imperatives and,as far as short-term outcomes are concerned,there is no difference in terms of mortality and post-operative morbidity between open and minimally invasive surgical approaches,but only longer operating times at the beginning of the experience.Subsequently,from 2007 onwards,long-term results were published that demonstrated the ab-sence of a significant difference regarding overall survival,disease-free survival,quality of life,local and distant recurrence rates between open and minimally in-vasive surgery.In this editorial,we aim to summarize the clinical and technical aspects which,even today,make the use of open surgery relevant and necessary in the treatment of patients with colorectal cancer.

Synchronous resections of primary colorectal tumor and liver metastasis by laparoscopic approach

Liver metastasis of colorectal cancer is common. Resection of solitary tumors of primary and metastatic colorectal cancer can have a favorable outcome. Open resection of primary colorectal tumor and liver metastasis in one operation or in separate operations is currently common practice. Reports have shown that synchronous resections do not jeopardize short or long-term surgical outcomes and that this is a safe and effective approach in open surgery. The development of laparoscopic colorectal surgery and laparoscopic hepatectomy has made a minimally invasive surgical approach to treating colorectal cancer with liver metastasis feasible. Synchronous resections of primary colorectal tumor and liver metastasis by laparoscopy have recently been reported. The efficacy and safety of laparoscopic colorectal resection and laparoscopic hepatectomy have been proven separately but synchronous resections by laparoscopy are in hot debate. As it has been shown that open resection of primary colorectal tumor and liver metastasis in one operation results in an equally good short-term outcome when compared with that done in separate operations, laparoscopic resection of the same in one single operation seems to be a good option. Recent evidencehas shown that this new approach is a safe alternative with a shorter hospital stay. Large scale randomized controlled trials are needed to demonstrate the effectiveness of this minimally invasive approach.

Simultaneous laparoscopic multi-organ resection combined with colorectal cancer:Comparison with non-combined surgery

AIM: To access the short-term outcomes of simultaneous laparoscopic surgery combined with resection for synchronous lesions in patients with colorectal cancer. METHODS: Between March 1996 and April 2010 prospectively collected data were reviewed from 93 consecutive patients who had colorectal cancer and underwent simultaneous multiple organ resection (combined group) and 1090 patients who underwent conventional laparoscopic right hemicolectomy or laparoscopic low/ anterior resection for colorectal cancer (non-combined group). In the combined group, there were nine gastric resections, three nephrectomies, nine adrenalectomies, 56 cholecystectomies, and 21 gynecologic resections. In addition, f ive patients underwent simultaneous laparoscopic resection for three organs. The patient demographics, intra-operative outcomes, surgical morbidity, and short-term outcomes were compared between thetwo groups (the combined and non-combined groups). RESULTS: There were no signifi cant differences in the clinicopathological variables between the two groups. The operating time was signifi cantly longer in the combined group than in the non-combined group, regardless of tumor location (laparoscopic right hemicolectomy and laparoscopic low/anterior resection groups; P = 0.048 and P < 0.001, respectively). The other intraoperative outcomes, such as the complications and open conversion rate, were similar in both groups. The rate of post-operative morbidity in the combined group was similar to the non-combined group (combined vs non-combined, 15.1% vs 13.5%, P = 0.667). Oncological safety for the colon and synchronous lesions were obtained in the combined group. CONCLUSION: Simultaneous laparoscopic multiple organ resection combined with colorectal cancer is a safe and feasible option in selected patients.

Significance of postoperative follow-up of patients with metastatic colorectal cancer using circulating tumor DNA

BACKGROUND One of the most notable applications for circulating tumor DNA(ctDNA)detection in peripheral blood of patients with metastatic colorectal cancer(mCRC)is a long-term postoperative follow-up.Sometimes referred to as a“liquid(re)biopsy”it is a minimally invasive procedure and can be performed repeatedly at relatively short intervals(months or even weeks).The presence of the disease and the actual extent of the tumor burden(tumor mass)within the patient’s body can be monitored.This is of particular importance,especially when evaluating radicality of surgical treatment as well as for early detection of disease progression or recurrence.AIM To confirm the radicality of surgery using ctDNA and compare available methods for detection of recurrence in metastatic colorectal cancer.METHODSA total of 47 patients with detected ctDNA and indications for resection of mCRC were enrolled in the multicenter study involving three surgical centers.Standard postoperative follow-ups using imaging techniques and the determination of tumor markers were supplemented by ctDNA sampling.In addition to the baseline ctDNA testing prior to surgery,a postoperative observation was conducted by evaluating ctDNA presence up to a week after surgery and subsequently at approximately three-month intervals.The presence of ctDNA was correlated with radicality of surgical treatment and the actual clinical status of the patient.RESULTS Among the monitored patients,the R0(curative)resection correlated with postoperative ctDNA negativity in 26 out of 28 cases of surgical procedures(26/28,93%).In the remaining cases of R0 surgeries that displayed ctDNA,both patients were diagnosed with a recurrence of the disease after 6 months.In 7 patients who underwent an R1 resection,4 ctDNA positivities(4/7,57%)were detected after surgery and associated with the confirmation of early disease recurrence(after 3 to 7 months).All 15 patients(15/15,100%)undergoing R2 resection remained constantly ctDNA positive during the entire follow-up period.In 22 cases of recurrence,ctDNA positivity was detected 22 times(22/22,100%)compared to 16 positives(16/22,73%)by imaging methods and 15 cases(15/22,68%)of elevated tumor markers.CONCLUSION ctDNA detection in patients with mCRC is a viable tool for early detection of disease recurrence as well as for confirmation of the radicality of surgical treatment.

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

AIM To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision(RTME) vs laparoscopic total meso-rectal excision(LTME).METHODS Standard medical electronic databases such as Pub-Med, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in pati-ents undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference(SMD) and dichotomous data was presented in odds ratio(OR).RESULTS One RCT(ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time(SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus(P = 0.002), lower risk of conversion(P = 0.00001) and shorter hospitalization(P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blo-od loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence(P = 0.96), number of harvested nodes(P = 0.49) and positive circumferential resection margin risk(P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups. CONCLUSION RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many sur-gical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.

Evolution of laparoscopy in colorectal surgery:An evidencebased review

Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions.Following the introduction of laparoscopic abdominal surgery,the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic resection.Following some early concerns regarding its safety and oncological efficacy during the latter part of that decade,laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled trials.This article provides an evidence-based summary of this evolutionary process as it relates to both benign and malignant colorectal disease,as well as discussion of the next phase of new technologies such as robotic surgery.

Correlation between invasive microbiota in margin-surrounding mucosa and anastomotic healing in patients with colorectal cancer

BACKGROUND Impaired anastomotic healing is one of the major complications resulting from radical resection in colorectal cancer(CRC).Accumulating evidence suggests that intestinal microbiota is correlated with anastomotic healing.AIM To explore the microbiota structural shift in margin-surrounding mucosa and evaluate the predictive ability of selected bacterial taxa for impaired anastomotic healing.METHODS Margin-surrounding mucosa samples derived from 37 patients were collected to characterize the microbial community structure by 16 s r RNA gene sequencing.The patients were divided into two groups according to the healing status of anastomoses:well-healing group(n=30)and impaired-healing group(n=7).Statistic differences in bacteria taxa were compared by Wilcoxon test and chisquared test.The predictive ability of the selected bacterial taxa for the healing status of anastomoses was evaluated by the area under the receiver operator characteristic curve.RESULTS Community structure shifts were observed in the impaired-healing group andwell-healing group.Six bacterial species were found to be significantly correlated with anastomotic healing,and among these species,Alistipes shahii,Dialister pneumosintes,and Corynebacterium suicordis were considered as the predictive factors.Taking the known risk factor age into consideration,Alistipes shahii,Dialister pneumosintes,and Corynebacterium suicordis improved predictive ability for the healing status of anastomoses.CONCLUSION These data show that Alistipes shahii,Dialister pneumosintes,and Corynebacterium suicordis could be considered as supplementary factors in the prediction of anastomosis healing status in patients after CRC radical resection.

STATUS OF SURGICAL TREATMENT OF RECTAL CANCER IN CHINA

The multimodality treatment methods of rectal cancer in China are presented. Extended radical excisions are used for Dukes’ B and C cases to reduce local recurrence. These include: high ligation with clearance of proximal lymph nodes at origin of inferior mesenteric artery, lateral pelvic lymphadenectomy, posterior or total pelvic exenterations in selected cases; but controversy exists. Radical sphincter-saving resections are advocated to improve the quality of life. Prerequisites of sphincter-saving resection are adequate resection of bowel and mesentery distal to the lesion, depending on the macroscopic type of lesion and degree of differentiation. The decisive factor in the choice of type of operation is the length of rectal stump above levator ani after resection. Bacon’s pull through resection was modified by preservation of levator ani and dentate margin, much better functional results were obtained postoperatively. Transanal full thickness local excision is advocated for small, protuberant, mobile, well differentiated lesions below the peritoneal reflection. Pre- or postoperative adjuvant radiation therapy is sometimes used for Dukes’ B and C cases. Adjuvant 5-Fu chemotherapy is usually used intraoperatively (intraluminal) or postoperatively (intravenous). The superiority of preoperative intrarectal 5-Fu emulsionover the conventional intravenous route has been demonstrated by experimental and clinical studies, which showed much higher and lasting concentration of 5-Fu in the rectal wall tissues and mesenteric lymph nodes, and a much lower concentration of 5-Fu in bone marrow after intrarectal administration. Several surgical groups employed varying techniques of sphincteric reconstruction of perineal colostomy after abdominoperineal excision, utilizing the gracilis or gluteus maximus sling, or intussusception of the colonic stump; with favorable late results in reported cases. However, controversy exists, so strict appropriate case selection is emphasized to avoid unnecessary sacrifice of the normal anus.

Therapeutic effects of Buzhong Yiqi decoction in patients with spleen and stomach qi deficiency after routine surgery and chemotherapy for colorectal cancer

BACKGROUND According to the theory of traditional Chinese medicine(TCM),the spleen and stomach are the basis of acquired nature and the source of qi and blood biochemistry.After surgery and chemotherapy,patients with colorectal cancer often develop spleen and stomach qi deficiency syndrome,leading to decreased immune function.Buzhong Yiqi decoction,a classic TCM prescription,has the effect of tonifying middle-jiao and invigorating qi,boosting Yang,and suppressing immune-related inflammation.Moreover,it is widely used in the treatment of spleen and stomach qi deficiency syndrome.AIM To investigate the effect of Buzhong Yiqi decoction on spleen and stomach qi deficiency in patients with colorectal cancer.METHODS One hundred patients with colorectal cancer who underwent preoperative chemotherapy and laparoscopy at The First TCM Hospital of Changde from January 2022 to October 2023 were retrospectively analyzed.The patients were divided equally into control and observation groups.Both groups underwent conventional rehabilitation surgery,and the observation group was supplemented with Buzhong Yiqi decoction.SPSS 26.0 was used for statistical analyses.Theχ2 test was used for univariate analysis;independent sample t-tests were used in all cases.RESULTS No significant differences were observed preoperatively in the general characteristics of the two groups.Fourteen days post-surgery,the abdominal distension,emaciation,loose stool,loss of appetite,and vomiting scores were significantly lower in the observation group than in the control group(P<0.05).Immune function and interleukin(IL)-10 levels in the observation group were significantly higher than those of the control group,whereas IL-6,tumor necrosis factor-α,and C-reactive protein levels,tumor biological indexes,and adverse reactions in the observation group were significantly lower than those of the control group(P<0.05).One month after surgery,the patients’quality of life in the observation group was significantly higher than that of the patients in the control group(P<0.05).CONCLUSION Buzhong Yiqi decoction can regulate inflammatory responses and metabolic processes by enhancing immune function,thereby promoting overall immune nutrition and restoring the body’s balance.

基于MRI的三维重建技术在保留盆腔自主神经的腹腔镜直肠癌D3根治术中的应用价值

目的 评估利用MRI图像三维重建直肠癌患者盆腔自主神经以及周围器官在腹腔镜直肠癌D3根治术中的应用价值。方法 将56例直肠癌患者随机分为重建组和对照组,重建组术前依照MRI三维重建结果制定手术方案,对照组按常规方式制定手术方案,比较2组术中及术后功能恢复相关指标。结果 重建的三维模型能个体化呈现患者盆腔自主神经以及周围器官分布关系。与对照组相比,重建组的手术时间缩短[(143.7±13.3)min vs.(151.5±12.1)min,P=0.040)],失血量减少[(31.3±12.1)mLvs.(39.4±11.6) mL,P=0.024)],国际前列腺症状评分(IPSS)更优[(6.0±1.3)分vs.(7.9±2.6)分,P=0.003)]。此外,重建组的术后拔除尿管时间较对照组短[2.0(2.0,2.0)d vs.3.5(3.0,4.0)d,P <0.001]。结论 基于MRI的盆腔自主神经三维重建能准确呈现盆腔自主神经及器官的解剖关系,提高了D3根治术的效率和安全性,可为术者制定精细化、个性化的手术方案提供重要参考。

咪达唑仑对术前中重度焦虑老年患者结直肠癌根治术后谵妄的影响

目的探讨术前短期口服咪达唑仑对术前合并中重度焦虑老年患者结直肠癌根治术后谵妄的影响。方法选择择期行腹腔镜结直肠癌根治术的老年患者80例,男32例,女48例,年龄65~79岁,BMI 21~27 kg/m^(2),ASAⅡ或Ⅲ级,入院时状态特质焦虑量表(STAI-S)评分≥38分。采用随机数字表法将患者分为两组:对照组和咪达唑仑组,每组40例。咪达唑仑组予咪达唑仑7.5 mg每晚一次,连续服药3~4 d,直到术前1 d;对照组予外观相似的安慰剂半片。记录术前1 d STAI-S评分与术后3 d内谵妄的发生情况,记录入室时、麻醉诱导后30 min、1、2 h、拔管后30 min HR和MAP,记录术中丙泊酚、瑞芬太尼、右美托咪定用量及间羟胺使用情况,记录拔管后30 min、术后24、72 h视觉模拟评分(VAS)、曲马多使用情况以及拔管时间。结果与对照组比较,咪达唑仑组术前1 d STAI-S评分、术后谵妄发生率、术中间羟胺使用率、拔管后30 min、术后24 h VAS疼痛评分、曲马多使用率明显降低(P<0.05)。两组术中丙泊酚、瑞芬太尼、右美托咪定用量和拔管时间差异无统计学意义。结论术前口服咪达唑仑可有效降低合并术前中重度焦虑老年患者结直肠癌根治术后谵妄的发生。

地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者镇痛效果及围术期免疫和应激反应影响

目的探讨腹腔镜结直肠癌根治术患者使用地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛效果及对围术期免疫和应激反应影响。方法选取2020年4月—2022年5月择期行腹腔镜结直肠癌根治术患者100例,据麻醉镇痛方式不同均分为观察组和对照组,观察组给予全麻及地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛,对照组给予全麻及罗哌卡因局部浸润麻醉镇痛。记录2组麻醉诱导前5 min(T0)、术毕(T1)、拔管即刻(T2)、拔管后30 min(T3)、拔管后60 min(T4)时平均动脉压(MAP)、心率(HR)及血清皮质醇(Cor)、丙二醛(MDA)水平;比较术前、术后24 h 2组外周血CD4+、CD8+和CD4+/CD8+水平,术毕12、24、48 h视觉模拟评分法(VAS)评分,术前、术后3 d简易智力状态检查量表(MMSE)评分,以及2组麻醉恢复期间不良反应。结果T3时,2组MAP、HR高于T0时,且观察组低于对照组(P<0.05);T1、T2、T3、T4时,2组Cor、MDA均高于T0时,且观察组低于对照组(P<0.05)。术后24 h,2组CD4+、CD4+/CD8+降低,CD8+升高,且观察组CD4+、CD4+/CD8+较对照组升高,CD8+较对照组降低(P<0.05)。观察组术毕12、24、48 h VAS评分均较对照组降低(P<0.05)。术后3 d,2组MMSE评分均降低,且观察组低于对照组(P<0.05)。观察组麻醉恢复期间躁动发生率为6.00%(3/50)低于对照组的20.00%(10/50)(P<0.05)。结论全麻及地佐辛静脉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者免疫功能影响小,可减轻手术应激,镇痛效果好,且安全性高。