BACKGROUND Reports in the field of robotic surgery for rectal cancer are increasing year by year.However,most of these studies enroll patients at a relatively early stage and have small sample sizes.In fact,studies on...BACKGROUND Reports in the field of robotic surgery for rectal cancer are increasing year by year.However,most of these studies enroll patients at a relatively early stage and have small sample sizes.In fact,studies only on patients with locally advanced rectal cancer(LARC)and with relatively large sample sizes are lacking.AIM To investigate whether the short-term outcomes differed between robotic-assisted proctectomy(RAP)and laparoscopic-assisted proctectomy(LAP)for LARC.METHODS The clinicopathological data of patients with LARC who underwent robotic-or laparoscopic-assisted radical surgery between January 2015 and October 2019 were collected retrospectively.To reduce patient selection bias,we used the clinical baseline characteristics of the two groups of patients as covariates for propensity-score matching(PSM)analysis.Short-term outcomes were compared between the two groups.RESULTS The clinical features were well matched in the PSM cohort.Compared with the LAP group,the RAP group had less intraoperative blood loss,lower volume of pelvic cavity drainage,less time to remove the pelvic drainage tube and urinary catheter,longer distal resection margin and lower rates of conversion(P<0.05).However,the time to recover bowel function,the harvested lymph nodes,the postoperative length of hospital stay,and the rate of unplanned readmission within 30 days postoperatively showed no difference between the two groups(P>0.05).The rates of total complications and all individual complications were similar between the RAP and LAP groups(P>0.05).CONCLUSION This retrospective study indicated that RAP is a safe and feasible method for LARC with better short-term outcomes than LAP,but we have to admit that the clinically significant of part of indicators are relatively small in the practical situation.展开更多
BACKGROUND A rectoseminal vesicle fistula(RSVF)is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage(AL).Limited literature documenting this rare complic...BACKGROUND A rectoseminal vesicle fistula(RSVF)is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage(AL).Limited literature documenting this rare complication is available.We report four such cases and review the literature to investigate the etiology,clinical manifestations,and the diagnostic and treatment methods of RSVF in order to provide greater insight into this disorder.CASE SUMMARY Four cases of RSVF were presented and summarized,and a further 12 cases selected from the literature were discussed.The main clinical symptoms in these patients were pneumaturia,fever,scrotal swelling and pain,anal pain,orchitis,diarrhea,dysuria,epididymitis and fecaluria.Imaging methods such as pelvic Xray,computed tomography(CT),sinus radiography,barium enema and other techniques confirmed the diagnosis.CT was the imaging modality of choice.In cases presenting with reduced levels of AL,minimal surrounding inflammation,and controlled infection,the RSVF was conservatively treated by urethral catheterization,antibiotics administration and parenteral nutrition.In cases of severe RSVF,incision and drainage of the abscess or fistula and urinary or fecal diversion surgery successfully resolved the fistula.CONCLUSION This study provides an extensive analysis of RSVF,and outlines,summarizes and examines the causes,clinical manifestations,diagnostic procedures and treatment options,in order to prevent misdiagnosis and treatment errors.展开更多
BACKGROUND Abdominoperineal excision(APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss.The objective of the present study was to demonstrate the use...BACKGROUND Abdominoperineal excision(APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss.The objective of the present study was to demonstrate the use of preoperative embolization(PE)as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding,scheduled for APE.CASE SUMMARY A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus.The patient was diagnosed with bulky adenocarcinoma limited to the rectum.As the patient refused any clinical treatment,surgery without previous neoadjuvant chemoradiation was indicated.The patient underwent a tumor embolization procedure,two days before surgery performed via the right common femoral artery.The tumor was successfully devascularized and no major bleeding was noted during APE.Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence.CONCLUSION Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses.We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.展开更多
基金Supported by the Infrastructure Supporting Project of Jiangxi Scientific Research Institute,No.20142BBA13039.
文摘BACKGROUND Reports in the field of robotic surgery for rectal cancer are increasing year by year.However,most of these studies enroll patients at a relatively early stage and have small sample sizes.In fact,studies only on patients with locally advanced rectal cancer(LARC)and with relatively large sample sizes are lacking.AIM To investigate whether the short-term outcomes differed between robotic-assisted proctectomy(RAP)and laparoscopic-assisted proctectomy(LAP)for LARC.METHODS The clinicopathological data of patients with LARC who underwent robotic-or laparoscopic-assisted radical surgery between January 2015 and October 2019 were collected retrospectively.To reduce patient selection bias,we used the clinical baseline characteristics of the two groups of patients as covariates for propensity-score matching(PSM)analysis.Short-term outcomes were compared between the two groups.RESULTS The clinical features were well matched in the PSM cohort.Compared with the LAP group,the RAP group had less intraoperative blood loss,lower volume of pelvic cavity drainage,less time to remove the pelvic drainage tube and urinary catheter,longer distal resection margin and lower rates of conversion(P<0.05).However,the time to recover bowel function,the harvested lymph nodes,the postoperative length of hospital stay,and the rate of unplanned readmission within 30 days postoperatively showed no difference between the two groups(P>0.05).The rates of total complications and all individual complications were similar between the RAP and LAP groups(P>0.05).CONCLUSION This retrospective study indicated that RAP is a safe and feasible method for LARC with better short-term outcomes than LAP,but we have to admit that the clinically significant of part of indicators are relatively small in the practical situation.
文摘BACKGROUND A rectoseminal vesicle fistula(RSVF)is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage(AL).Limited literature documenting this rare complication is available.We report four such cases and review the literature to investigate the etiology,clinical manifestations,and the diagnostic and treatment methods of RSVF in order to provide greater insight into this disorder.CASE SUMMARY Four cases of RSVF were presented and summarized,and a further 12 cases selected from the literature were discussed.The main clinical symptoms in these patients were pneumaturia,fever,scrotal swelling and pain,anal pain,orchitis,diarrhea,dysuria,epididymitis and fecaluria.Imaging methods such as pelvic Xray,computed tomography(CT),sinus radiography,barium enema and other techniques confirmed the diagnosis.CT was the imaging modality of choice.In cases presenting with reduced levels of AL,minimal surrounding inflammation,and controlled infection,the RSVF was conservatively treated by urethral catheterization,antibiotics administration and parenteral nutrition.In cases of severe RSVF,incision and drainage of the abscess or fistula and urinary or fecal diversion surgery successfully resolved the fistula.CONCLUSION This study provides an extensive analysis of RSVF,and outlines,summarizes and examines the causes,clinical manifestations,diagnostic procedures and treatment options,in order to prevent misdiagnosis and treatment errors.
文摘BACKGROUND Abdominoperineal excision(APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss.The objective of the present study was to demonstrate the use of preoperative embolization(PE)as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding,scheduled for APE.CASE SUMMARY A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus.The patient was diagnosed with bulky adenocarcinoma limited to the rectum.As the patient refused any clinical treatment,surgery without previous neoadjuvant chemoradiation was indicated.The patient underwent a tumor embolization procedure,two days before surgery performed via the right common femoral artery.The tumor was successfully devascularized and no major bleeding was noted during APE.Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence.CONCLUSION Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses.We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.
