Robotic natural orifice specimen extraction surgery I-type F method vs conventional robotic resection for lower rectal cancer

BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.

Laparoscopy-assisted transanal total mesorectal excision for lower rectal cancer:A feasible and innovative technique

BACKGROUND Transanal total mesorectal excision(taTME)is a new technique with many potential technical advantages.Laparoscopy-assisted taTME is a combination of transabdominal taTME and transluminal endoscopic surgery taTME.Laparoscopy-assisted taTME is a combination of techniques such as minimally invasive surgery,intersphincter-assisted resection,natural orifice extraction,ta minimally invasive surgery,and ultralow-level preservation of the anus.AIM To verify the feasibility and safety of an innovative technique of taTME for treatment of cancer located in the lower rectum.METHODS From January 2016 to March 2018,we attempted to perform laparoscopy-assisted taTME surgery in 24 patients with lower rectal cancer.RESULTS The new technique of laparoscopy-assisted taTME was successfully performed in all 24 patients.Mean operating time was 310.0 min and mean intraoperative blood loss was 69.1 mL.The mean time to passing of first flatus was 3.1 d,and mean postoperative hospital stay was 9.2 d.Two patients were given postoperative analgesics due to anal pain.Twenty-three patients were able to walk in first 2 d,and five patients had postoperative complications.CONCLUSION Laparoscopy-assisted taTME is suitable for selected patients with lower rectal cancer,and this technique is worthy of further recommendation.

Assessments of Pudendal Motor and Sensory Nerves in Patients with or without Fecal Incontinence after Low Anterior Resection for Lower Rectal Cancer

Background:?To clarify the pudendal motor (PMN) and sensory (PSN) nerves?play in preventing fecal incontinence (FI) after low anterior resection (LAR) for lower rectal cancer, the PMN and PSN functions were studied. Methods:?Sixty patients were divided into groups A (n = 20, FI) and B (n = 40, continence). These were compared with group C (n = 30, control subjects). PMN latency (PMNL) (right, left, and posterior sides of the anal canal) was studied by sacral magnetic stimulation. Anal mucosal electric sensitivity (AMES) was measured at the lower, dentate line (DL), and upper zones. Results:?The distance of anastomosis from anal verge (DAAV) in group A was significantly shorter than in group B (p?value p?value p?value p?value Conclusion:?FI after LAR with a short DAAV?may?lead to?external anal sphincter dysfunction due to damage of both PMN and PSN.

Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin

AIM: Local recurrence after curative surgical resection for rectal cancer remains a major problem. Several studies have shown that incomplete removal of cancer deposits in the distal mesorectum contributes a great share to this dismal result. Clinicopathologic examination of distal mesorectum in lower rectal cancer was performed in the present study to assess the incidence and extent of distal mesorectal spread and to determine an optimal distal resection margin in sphincter-saving procedure.METHODS: We prospectively examined sepecimens from 45 patients with lower rectal cancer who underwent curative surgery. Large-mount sections were performed to microscopically observe the distal mesorectal spread and to measure the extent of distal spread. Tissue shrinkage ratio was also considered. Patients with involvement in the distal mesorectum were compared with those without involvement with regard to clinicopathologic features.RESULTS: Mesorectal cancer spread was observed in 21patients (46.7%), 8 of them (17.8%) had distal mesorectal spread. Overall, distal intramural and/or mesorectal spreads were observed in 10 patients (22.2%) and the maximum extent of distal spread in situ was 12 mm and 36 mm respectively. Eight patients with distal mesorectal spread showed a significantly higher rate of lymph node metastasis compared with the other 37 patients without distal mesorectal spread (P = 0.043).CONCLUSION: Distal mesorectal spread invariably occurs in advanced rectal cancer and has a significant relationship with lymph node metastasis. Distal resection margin of 1.5 cm for the rectal wall and 4 cm for the distal mesorectum is proper to those patients who are arranged to receive operation with a curative sphincter-saving procedure for lower rectal cancer.

Neoadjuvant Radiotherapy in Stage I Cancer of the Lower Rectum

Introduction: The mortality rate in cancer of the lower rectum is related to the incidence of local recurrence, in the first 5 years. For stage I tumors, local excision has being increasingly used, but recent studies showed a higher incidence rate of local recurrence. Therefore, preoperative radiotherapy should be considered even for these tumors, as an attempt to prevent recurrence and provide cure. Objective: To show the effectiveness of neoadjuvant radiotherapy in stage I cancer of the lower rectum of a cohort population. Materials and Method: A cohort study in a prospective database was made with a total of 75 patients considered as stage I cancer of the lower rectum. Preoperative long course of 4500 cG radiotherapy was performed in this selected group of patients and followed up for a minimum period of five years. Results: Stage I/TI group had 27 patients. All of them presented complete response to the treatment and did not need to be submitted to surgery. Five years follow up with no recurrence. The stage I/TII group had 48 patients. After neoadjuvant radiotherapy, 8 patients had to be submitted to surgery for persistent tumor. All were submitted to full total local excision (FTLE), but anatomopathological examination showed no residual cancer. Conclusion: Preoperative long course of 4500 cG irradiation, not only reduced the local recurrence and mortality rate in lower rectal cancer, but also reduced indication for surgery in patients with stage I cancer of the lower rectum.

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。

基于Autar评估的手术室护理对腹腔镜直肠癌根治术患者发生DVT的影响

目的:基于Autar评估的手术室护理对腹腔镜直肠癌根治术后发生下肢深静脉血栓(DVT)的影响。方法:根据护理方式不同将100例行腹腔镜直肠癌根治术治疗的直肠癌患者分为对照组和观察组,每组各50例。对照组采用手术室常规护理;观察组采用基于Autar评估的手术室护理。比较两组患者DVT风险分级、DVT发生率及血栓最大宽度,两组患者不同时间点D-二聚体水平及血流动力学指标,并记录两组患者住院期间其他不良反应发生情况。结果:两组患者DVT风险分级差异无统计学意义(P>0.05);相较于对照组,观察组患者DVT发生率更低(P<0.05),血栓最大宽度更小(P<0.05)。术后1 d,两组患者术后D-二聚体均随时间推移先上升后下降(P<0.05),且各时间点观察组低于对照组(P<0.05)。术后3 d,两组患者血流峰速度及血流平均速度均较术前下降(P<0.05),但观察组高于对照组(P<0.05)。相较于对照组,观察组患者不良反应发生率更低(P<0.05)。结论:基于Autar评估的手术室护理能显著降低腹腔镜直肠癌根治术患者DVT发生率。

高分辨MRI在评估下段直肠癌术前TN分期及环周切缘中的敏感性分析

探讨高分辨MRI在评估下段直肠癌术前TN分期及环周切缘中的敏感性。选择65例下段直肠癌患者,对其实施盆腔高分辨MRI平扫,记录瘤体下缘与肛门外缘的距离、瘤体矢状位与斜轴位直径,完善MRI-TN分期,评估直肠系膜筋膜(MRF)及环周切缘受累状况,与术后病理结果进行对比。结果显示,65例下段直肠癌患者,MRI-T分期正确率为84.6%,与病理T分期的一致性好(Kappa值为0.757)。MRI-N分期正确率为67.7%,与病理N分期的一致性一般(Kappa值为0.514)。MRI对MRF受累与否的诊断准确率为90.8%(59/65),MRI-MRF与术后病理的一致性较好(Kappa值为0.789)。MRI检查明确环周切缘肿瘤浸润与否的准确率是92.3%(60/65),MRI-MRF与术后病理的一致性较好(Kappa值为0.662)。研究发现,高分辨MRI检查能准确进行直肠癌术前TN分期,可判断环周切缘的肿瘤发生率,有助于临床合理选择治疗方案。

腹腔镜下低位直肠癌保肛根治术75例分析

目的:探讨腹腔镜下低位直肠癌保肛根治术的可行性。方法:回顾性分析75例腹腔镜下低位直肠癌保肛根治术的临床资料。结果:75例患者均顺利完成手术后出院,68例患者获得随访,随访期内,除5例术后1年内复查发现肝转移,1例原位复发外,其余均健在。结论:随着腹腔镜技术的进步,吻合器的应用以及全直肠系膜切除术技术的成熟,使得手术操作视野扩大,有利于低位肠段的游离和吻合,增加了低位直肠癌患者保肛的机会。

腹腔镜与开腹低位直肠癌Miles术疗效与安全性的对照研究

目的 比较腹腔镜与开腹直肠癌Miles术在低位直肠癌治疗中的疗效与安全性. 方法 选取我院2009-06～2014-06收治的163例低位直肠癌患者作为研究对象,参照患者选取的手术方式将其分为腹腔镜组75例与开腹组88例,其中腹腔镜组患者行腹腔镜Miles术,开腹组患者行开腹Miles术,比较两组患者的手术疗效与安全性、术后并发症情况.结果 腹腔镜组患者的术中出血量、术后并发症发生率明显少于开腹组（P＜0.05）,术后恢复明显快于开腹组（P＜0.05）,腔镜组手术平均用时、淋巴结清扫数量、近期复发率和病死率与开腹组相比差异无统计学意义（P＞0.05）. 结论 两种手术治疗方法均能在低位直肠癌治疗应用中获得良好的临床效果,但与传统的低位直肠癌开腹手术相比,腹腔镜Miles术创伤更小,且术后恢复快,并发症发生率低,总体安全性更高.

腹腔镜与开腹保留盆腔自主神经的低位直肠癌根治术对男性性功能的影响

目的:探讨腹腔镜与开腹保留盆腔自主神经(pelvic automatic nerve preservation,PANP)的低位直肠癌根治术对男性患者术后性功能的影响。方法:选取2008年9月至2013年12月分别行腹腔镜PANP手术(n=105)和开腹PANP手术(n=72)的男性直肠癌患者177例,采用勃起及射精功能分级分别对患者术后6、12个月性功能进行随访,评估这两种手术方式对男性患者性功能的影响。结果:腹腔镜组患者术后6、12个月勃起功能障碍的发生率低于开腹组,其射精功能障碍发生率也低于开腹组;两组患者术后6、12个月性功能分级比较,腹腔镜组均优于开腹组(P<0.05)。结论 :腹腔镜PANP低位直肠癌根治术与开腹PANP手术相比,术中能更清晰地显露盆腔植物神经并予以保护,有效减少了术后性功能障碍的发生率。

新辅助治疗在进展期低位直肠癌术前的应用

背景与目的：提高进展期低位直肠癌的根切率和保肛率是一个难题，本研究探讨术前联合放化疔（新辅助治疗）在进展期低位直肠癌中的疗效。方法：23例进展期低位直肠癌患者，按术前评价均需行腹-会阴联合切除术的患者进行术前联合放化疗。放疔每周5d，每次200cCy，共4周20次，总剂量4000cGy。化疗的给药方式以放疔期间持续静脉滴注，采用草酸铂（Oxa）130mg/（m^2·d1），5-FU 500mg/（m^2·d1-5），加CF300mg/（m^2·d1-5），休息4～6周进行手术。结果：15例的病例肿瘤分期降级，施行了保留肛门的直肠癌根治术，保肛率达65％（15／23），其中82％的患者肛门括约肌功能良好。结论：进展期低位直肠癌的患者在接受新辅助治疗后，能使肿瘤降期，切除率增加，提高保肛率，同时副反应轻，患者依顺性较好。

低位直肠癌患者经结肠肛管吻合术的护理

目的总结低位直肠癌患者经结肠肛管吻合术(Parks术)的护理要点。方法给予56例低位直肠癌患者行Parks术,术前给予患者进行肠道准备、心理护理及营养饮食的护理;术后做好吻合口漏及吻合口狭窄的护理,并加强肛门功能锻炼。结果所有患者手术过程顺利,肿瘤均获根治性切除;各有1例吻合口出血和吻合口漏,分别经结肠造口和保守治疗而痊愈;9例患者发生吻合口轻度狭窄,经过扩肛处理后均有好转;2例肛门扩约肌功能不良,肛门括约肌功能优良率为92.2%。结论术前护士应对患者进行心理疏导,增强患者治疗的信心;术后加强吻合口的观察护理,指导患者进行肛门功能的锻炼,可减少术后并发症,促进患者早日康复。

Miles术与Dixon术治疗低位直肠癌的Meta分析

目的:对于低位直肠癌的患者,在腹会阴联合直肠癌根治术(Miles手术)与经腹直肠癌切除术(Dixon手术)两种术式之间选择最适术式存在一个很大的争议.本文旨在从循证医学角度为选择上述两种术式提供询证依据.方法:利用美国国立医学图书馆(Medline)、荷兰医学文摘(Embase)、医学生物中心(BioMed Central)、中国知网(CNKI)、万方数据(Wangfang)及中国生物医学文献数据库(CBM)等数据库搜索报道比较两种术式的5年生存率、局部复发率、CRM及术后并发症的发生率的文献,从而比较两种术式的安全性、可行性及最优性.结果:共有11篇文献符合要求,其中包括6544例手术.分析显示D i x o n术的5年生存率更高(pooled RR=1.18,95%CI:1.08-1.30,P<0.00001 random-effect),Miles术却伴随着更高的局部复发率(pooled RR=0.67,95%CI:0.57-0.78,P<0.00001 fixed-effect)、CRM(4trials reported the data,pooled RR=0.49,95%CI:0.38-0.62,P<0.00001 random-effect)及术后并发症(pooled RR=0.60,95%CI:0.38-0.93,P=0.02 random-effect).结论:Miles术后的患者局部复发率、CRM及并发症高于Dixon术后的患者,且行Miles术的患者肿瘤预后也不及选择Dixon术的患者.因此对于低位直肠癌的患者,Dixon术应优先考虑.

基于行为分阶段改变理论的护理干预在低位直肠癌保肛术后患者中的应用

目的探讨基于行为分阶段改变理论为指导的护理干预对低位直肠癌保肛术后患者排便功能及生活质量的影响。方法选择2013年6月至2016年6月在本院住院的84例低位直肠癌保肛术后患者,根据入院时间分为对照组和干预组,每组各42例。对照组院内进行伤口护理、饮食、生活指导及肛门功能锻炼指导;院外实施电话随访和家访,共6个月。干预组院内和院外实施基于行为分阶段改变理论为指导的护理干预,院外共干预6个月。比较两组患者术后6个月后肛门失禁程度、排便功能和生活质量的差异。结果干预组术后大便失禁程度轻于对照组;排便功能和生活质量优于对照组(P<0.05,P<0.001)。结论基于行为分阶段改变理论为指导的护理干预可减轻低位直肠癌保肛术后患者大便失禁程度,改善排便功能,进而提高其生活质量。

J型贮袋在低位直肠癌前切除术中的疗效观察

目的观察J型贮袋在低位直肠癌前切除术后对改善排便功能的疗效。方法选取低位直肠癌前切除病例67例,随机分为无袋组34例及有袋组33例,比较两组术后并发症的发生情况并对术后排便功能进行评估。结果无袋组与有袋组术后并发症的发生率分别为5.9%、9.1%(P>0.05);有袋组在术后6个月内日平均大便次数及失禁综合评分优于无袋组(P<0.05);有袋组的延缓排便能力及区分排便排气能力在术后1个月内优于无袋组(P<0.05)。结论J型贮袋在低位直肠癌前切除术中不会增加手术风险,在术后6个月内可以改善排便功能。

骨盆三维重建及测量在直肠癌手术中的应用

目的帮助医生进行诊断、术前预测和实际手术操作,提出一种三维重建、测量的方法。方法利用直肠癌患者的CT扫描结果建立骨盆三维模型,回顾性分析97例中低位直肠癌患者的影像资料,最后进行统计学分析。结果经过对测量数据进行多因素分析,找出几组影响中低位直肠癌保肛手术关键性的解剖限制性因素。结论应用骨盆三维模型可以获得传统骨盆测量学没有提出的解剖径线和空间测量数据,能更加客观地评价骨盆的解剖因素对保肛手术乃至盆腔手术的限制性作用。

新辅助放化疗在低位直肠癌保肛术中的作用

探讨新辅助放化疗低位进展期直肠癌近期疗效及其在保肛手术中的临床意义。回顾性收集50例进行新辅助放化疗的低位进展期直肠癌患者的临床资料,TNMⅡ期17例、TNMⅢ期33例。均行三维适形放疗,每次2Gy,每天1次,每周5天,总剂量50Gy。同时口服替吉奥化疗,治疗结束休息4周后行临床疗效评价,决定手术方法。全部患者完成治疗,6例患者肿瘤完全消失,其中3例继续放化疗未行手术,行保肛手术33例,保肛率72%(36/50),Miles手术12例,2例术前因远处转移未手术。新辅助放化疗低位进展期直肠癌近期疗效显著,降期明显,提高了保肛率。新辅助放化疗能使低位进展期直肠癌肿瘤降期,提高根治性切除率和保肛成功率,降低局部复发率,是低位进展期直肠癌综合治疗的一种有效方法。

高龄患者直肠癌保肛术后控便管理方法的探讨

目的评价高龄患者低位直肠癌保肛手术后的大便管理能力。方法对年龄在75岁以上、肿瘤距肛缘5 cm以下、采用保肛手术治疗的33例低位直肠癌患者随机分为观察组和对照组。对照组患者按直肠癌术后护理常规,观察组在此基础上进行术前缩肛功能指导及早期排便功能训练和控制大便训练,并对术后肛周皮肤护理方法做出新的探讨。结果术后1月两组排便功能差异有统计学意义,观察组优于对照组。结论术前缩肛功能指导及早期排便功能训练和控便训练有利于提高患者控便能力,术后初期预防性使用皮肤护理产品有利于保护皮肤,值得临床推广。

新辅助放化疗治疗低位进展期直肠癌的临床研究

目的探讨术前辅助放化疗对低位进展期直肠癌治疗效果。方法 47例低位进展期直肠癌患者(cTNMⅡ期和Ⅲ期),进行术前联合放化疗。放疗每周5d,每次1.8～2Gy,总剂量45～60Gy。同时持续口服卡培他滨1250mg/m2化疗,休息4～8周进行手术。结果新辅助放化疗的急性毒副反应较小,一般为Ⅰ～Ⅱ度反应,全部患者均完成了治疗,其中施行了保肛手术44例(93.6%),Miles手术3例。肿瘤分期降低明显,术后局部复发率明显下降,仅为4.3%。结论新辅助放化疗能使低位进展期直肠癌肿瘤降期,提高根治性切除率和保肛成功率,降低局部复发率,是低位进展期直肠癌综合治疗的一种有效方法。