Relationship between intracranial pressure and neurocognitive function among older adults after radical resection of rectal cancer

BACKGROUND Older patients are prone to postoperative cognitive decline after laparoscopic rectal cancer surgery,which may be associated with increased intraoperative intracranial pressure(ICP).This study investigated the correlation between intra-operative ICP changes,as indicated by measurements of the optic nerve sheath diameter(ONSD)using ultrasonography,and subsequent cognitive function to provide better patient care.AIM To evaluate changes in ICP and associated postoperative neurocognition in older adults after laparoscopic radical resection for rectal cancer.METHODS We included 140 patients who visited the Mianyang Central Hospital for malig-nant rectal tumors,measured their ONSDs before surgery and 30 and 60 minutes after the Trendelenburg position during surgery,and evaluated the patients’cog-nitive function 1 day before surgery and 1,4,and 7 days after surgery.The Mini-Mental State Examination(MMSE)and confusion assessment method(CAM)scores of the patients with different ONSDs were compared at different times after surgery.RESULTS In patients with an ONSD greater than 5.00 mm(group A1),the MMSE scores at 1 day and 4 days after surgery were significantly lower than those of patients with an ONSD less than or equal to 4.00 mm(group A2)(P<0.05).The CAM scores of group A1 were significantly higher than those of group A2(P<0.05).The MMSE scores of group A1 on days 1 and 4 after surgery were significantly lower than those 1 day before and 7 days after surgery(P<0.05),while the CAM scores 1 day and 4 days after surgery were significantly higher than those 1 day before and 7 days after surgery.CONCLUSION Decline in cognitive function among older adults after the procedure may be related to intracranial hypertension during 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.

Effects of Laparoscopic Pelvic Autonomic Nerve-Preserving Radical Resection of Rectal Cancer on Urinary and Sexual Function

Objective:To investigate and analyze the effect of laparoscopic pelvic autonomic nerve-preserving radical resection of rectal cancer on urinary and sexual function.Methods:Cases of laparoscopic radical resection of rectal cancer in our hospital from April 2018 to April 2023 were selected,and 60 patients who met the requirements were included as research subjects.The patients were divided into an experimental group and a reference group by a double-blind mechanism,with 30 cases in each group.The experimental group underwent laparoscopic pelvic autonomic radical resection,while the reference group underwent ordinary radical resection.The voiding function,urodynamics,sexual function,and blood indexes of the patients of both groups were compared.Results:The total incidence of voiding dysfunction in the experimental group was significantly lower than in the reference group(P<0.05).Urodynamics such as abdominal leak point pressure(ALPP),maximum urethral pressure(MUP),maximum urethral closure pressure(MUCP),and functional urethral length(FUL)in the experimental group were significantly better than those in the reference group(P<0.05).The incidences of erectile dysfunction and ejaculatory dysfunction in the experimental group were significantly lower than those in the reference group(P<0.05).Before the surgery,there were no significant differences in the blood indexes such as C-reactive protein(CRP),cortisol(Cor),and pre-albumin(PA)between the two groups(P>0.05);after the operation,the blood indexes of the patients in the experimental group were significantly better than those in the reference group(P<0.05).Conclusion:Laparoscopic pelvic autonomic nerve-preserving radical resection of rectal cancer has lesser effects on urinary and sexual functions.

Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study

BACKGROUND Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide,necessitating surgical resection as the sole treatment option.Over the years,there has been a growing adoption of minimally invasive surgical techni-ques such as robotic and laparoscopic approaches.Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques.While previous studies have reported favo-rable perioperative outcomes for robot-assisted radical resection in rectal cancer patients,further evidence regarding its oncological safety is still warranted.AIM To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection(LALAR)procedures.METHODS The clinical data of 125 patients who underwent robot-assisted low anterior resection(RALAR)and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed.After performing a 1:1 propensity score matching,the patients were divided into two groups:The RALAR group and the LALAR group(111 cases in each group).Subsequently,a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.RESULTS Compared to the LALAR group,the RALAR group exhibited a significantly earlier time to first flatus[2(2-2)d vs 3(3-3)d,P=0.000],as well as a shorter time to first fluid diet[4(3-4)d vs 5(4-6)d,P=0.001].Additionally,the RALAR group demonstrated reduced postoperative indwelling catheter time[2(1-3)d vs 4(3-5)d,P=0.000]and decreased length of hospital stay after surgery[5(5-7)d vs 7(6-8)d,P=0.009].Moreover,there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group[10777(10780-11850)dollars vs 10550(8766-11715)dollars,P=0.012].No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups.Furthermore,no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.CONCLUSION Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection,while maintaining similar perioperative and 3-year oncological outcomes.

Machine learning model for prediction of low anterior resection syndrome following laparoscopic anterior resection of rectal cancer:A multicenter study

BACKGROUND Low anterior resection syndrome(LARS)severely impairs patient postoperative quality of life,especially major LARS.However,there are few tools that can accurately predict major LARS in clinical practice.AIM To develop a machine learning model using preoperative and intraoperative factors for predicting major LARS following laparoscopic surgery of rectal cancer in Chinese populations.METHODS Clinical data and follow-up information of patients who received laparoscopic anterior resection for rectal cancer from two medical centers(one discovery cohort and one external validation cohort)were included in this retrospective study.For the discovery cohort,the machine learning prediction algorithms were developed and internally validated.In the external validation cohort,we evaluated the trained model using various performance metrics.Further,the clinical utility of the model was tested by decision curve analysis.RESULTS Overall,1651 patients were included in the present study.Anastomotic height,neoadjuvant therapy,diverting stoma,body mass index,clinical stage,specimen length,tumor size,and age were the risk factors associated with major LARS.They were used to construct the machine learning model to predict major LARS.The trained random forest(RF)model performed with an area under the curve of 0.852 and a sensitivity of 0.795(95%CI:0.681-0.877),a specificity of 0.758(95%CI:0.671-0.828),and Brier score of 0.166 in the external validation set.Compared to the previous preoperative LARS score model,the current model exhibited superior predictive performance in predicting major LARS in our cohort(accuracy of 0.772 for the RF model vs 0.355 for the preoperative LARS score model).CONCLUSION We developed and validated a robust tool for predicting major LARS.This model could potentially be used in the clinic to identify patients with a high risk of developing major LARS and then improve the quality of life.

Application of electroacupuncture in the prevention of low anterior resection syndrome after rectal cancer surgery

BACKGROUND Low anterior resection syndrome(LARS)is one of the common postoperative complications in patients with rectal cancer,which seriously affects their postoperative recovery and quality of life(QoL).Electroacupuncture therapy is one of the characteristic therapies of traditional Chinese medicine.There are few reports on the prevention and treatment of LARS by electroacupuncture therapy.AIM To explore the clinical effectiveness of electroacupuncture in managing rectal cancer patients with postoperative LARS.METHODS A total of 50 patients with LARS after rectal cancer surgery were retrospectively selected as the research subjects.According to the treatment methods,they were divided into an observation group(n=25)and a control group(n=25).During the four-week treatment period,the control group received standard defecation function training,while the observation group received electroacupuncture care and traditional defecation function training.The anal pressure index(which includes anal resting pressure,anal systolic pressure,and maximum tolerable volume),European Organization of Research and Treatment of Cancer(EORTC)QoL C30(QLQ-C30)score,LARS Scale(LARSS)score,Wexner anal incontinence scale score,Xu Zhongfa five-item 10-point scale score,and the occurrence of adverse reactions were compared between the two groups before and after treatment.RESULTS The experimental group showed considerably enhanced LARSS scores compared to those in the control group after four weeks of treatment.In the first week,second week,and fourth week,the LARSS score and Wexner anal incontinence scale score decreased,and the Xu Zhong method five-item 10-point scale score increased,with significant differences(P<0.05).The experimental group showed substantial improvements in anal resting pressure,anal systolic pressure,and maximum tolerance volume after undergoing 4 wk of therapy in the untreated group(P<0.05).The experimental group's QLQ-C30 score on the EORTC QoL questionnaire was higher than that of the control group during the 1st,2nd,and 4th wk(P<0.05).No significant variation between the groups in the frequency of adverse reactions(P>0.05)was observed.CONCLUSION Electroacupuncture positively impacted LARS following rectal cancer surgery,effectively improving clinical symptoms and anal pressure indicators and patients’standard of life.

Effects of fluid therapy combined with a preoperative glucose load regimen on postoperative recovery in patients with rectal cancer

BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of complications.Therefore,it is of great significance to apply appropriate rehydration regimens to patients un-dergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of patients.AIM To analyze the effects of goal-directed fluid therapy(GDFT)with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal cancer.METHODS Patients with rectal cancer who underwent radical resection(n=184)between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group(n=92 in each group).Both groups received a preoperative glucose load regimen,and routine fluid replacement and GDFT were additionally implements in the control and observation groups,res-pectively.The operative conditions,blood levels of lactic acid and inflammatory markers,postoperative recovery,cognitive status,hemodynamic indicators,brain oxygen metabolism,and complication rates were compared between the groups.RESULTS The colloidal fluid dosage,total infusion,and urine volume,as well as time to first exhaust,time to food intake,and postoperative length of hospital stay,were lower in the observation group(P<0.05).No significant differences were observed between the two groups in terms of operation time,bleeding volume,crystalloid liquid consumption,time to tracheal extubation,complication rate,heart rate,or mean arterial pressure(P>0.05).Compared with the control group,in the ob-servation group the lactic acid level was lower immediately after the surgery(P<0.05);the Mini-Mental State Examination score was higher on postoperative day 3(P<0.05);the pulse pressure variability(PPV)was lower at 30 min after pneumoperitoneum(P<0.05),though the differences in the PPV of the two groups was not significant at the remaining time points(P>0.05);tumor necrosis factor-αand interleukin-6 levels were lower on postoperative day 3(P<0.05);and the left and right regional cerebral oxygen saturation was higher immediately after the surgery and 30 min after pneumoperitoneum(P<0.05).CONCLUSION GDFT combined with the preoperative glucose load regimen is a safe and effective treatment strategy for im-proving postoperative recovery and risk of complications in patients with rectal cancer undergoing radical re-section.

Superior mesenteric venous thrombosis after laparoscopic radical resection of rectal cancer: a report of a rare case and literature review

Mesenteric venous thrombosis(MVT) is rare, but life-threatening. MVT is often characterized by occult and nonspecific signs and symptoms. Diagnosis requires a high index of clinical suspicion, and emergency surgery is necessary to optimize patient survival, especially in people aged more than 70 years. MVT is a rare but fatal complication after laparoscopic radical surgery for rectal cancer. This study reports a case of extensive intestinal ischemic infarction caused by acute MVT after laparoscopic radical surgery for rectal cancer in a 70-year-old male.

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.

LOW ANTERIOR RESECTION TREATMENT FOR MIDDLE AND LOWER RECTAL CANCER

Objective:To evaluate the results of low anteriorresection treatment for middle and lower rectal cancer. Methods:Clinical and follow-up data of 196 patients with middle and lower rectal cancer who received low anteriorresection treatment from June 1991 to June 2001 wereretrospectively analyzed. Results: anterior resectiontechnique including double stapling technique、pull-through and Park抯 operations could get a standard radicalresection and had no significant differences in 1, 3, 5 and 10 years survival rates comparing with the abdominoperineal resection(Miles?. Conclusion:The experience suggests that the low anterior resection technique was safe and simplehad less bleeding and fewer complications and couldincrease the life-quality of the patients with rectal cancer.

Analysis of the Clinical Effect of Laparoscopic Total Mesorectal Excision for the Treatment of Middle and Low Rectal Cancer

The purpose of this study was to analyze the clinical efficacy of laparoscopic total mesorectal excision for the treatment of middle and low rectal cancer.First,30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparotomy group to receive laparotomy.30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparoscopic group to receive laparoscopic surgery.The postoperative and complications of total rectal mesorectal excision were compared between the two groups.The results showed that the amount of blood loss during laparoscopy was(169.36±106.96)mL,and that during laparoscopy was(180.65±153.22)mL,which was significantly lower than that of the open group(209.65±186.65)mL and(356.54±170.32)mL.Intraoperative blood loss in laparoscopic patients was significantly lower than that in the open group,and the difference was statistically significant(t=2.95,2.87,P<0.05).The duration of anal sparing surgery in the laparoscope group was(232.65±56.35)min,which was longer than that in the laparoscope group(227.65±68.65)min.The duration of non-sparing anal surgery in the laparoscopic group was(246.95±52.65)min,which was significantly shorter than that in the open group(299.65±64.32)min.There was no statistically significant difference in the duration of operation between the laparoscopic group and the open group.The recovery time of intestinal function in the laparoscopic group was(2.11±1.82)days,which was significantly shorter than that in the open group(4.63±1.52)days.The postoperative hospital stay in the laparoscopic group was(11.32±10.01)d,which was significantly shorter than that in the open group(26.62±12.43 d).The recovery time of intestinal function and postoperative hospital stay of patients in the laparoscopic group were shorter than those in the open group,with statistically significant differences(T=2.31,2.43,P<0.05).The tumor diameter was(4.03±1.20)cm in the laparoscopic group and(3.95±1.43)cm in the open group.The number of lymph nodes in the laparoscopic group was(12.75±6.51)cm,while that in the open group was(13.62±7.05).There was no significant difference in the number of lymph nodes dissected or tumor diameter between the two groups(t=0.11,0.22,P>0.05).The complication rate of the abdominal group was 20.00%,significantly lower than that of the open group(66.67%).Complications after total mesorectal resection were significantly higher in the open group than in the laparoscopic group,and the difference between the two groups was statistically significant(χ2=13.30,P<0.05).Therefore,laparoscopic total rectal mesorectal resection for patients with middle and low rectal cancer is safer and can be used as a reliable treatment plan.

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.

THE FACTORS AND TREATMENT OF LOCAL RECURRENCE AFTER RADICAL RESECTION RESERVING THE ANUS IN THE PATIENTS WITH RECTAL CANCER

Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.

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.

Role of protective stoma in low anterior resection for rectal cancer:A meta-analysis

AIM: To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer.

Laparoscopic low anterior resection for rectal carcinoma:Complications and management in 132 consecutive patients

AIM:To analyze the clinical manifestations and risk fac-tors of complications in laparoscopic low anterior resection(LAR)for rectal cancer patients.METHODS:A series of 132 consecutive patients who received laparoscopic LAR for rectal cancer in our center were included.The etiology,diagnosis,treatment and prevention of rectal cancer were studied among the patients with surgery-related complications using both univariate and multivariate regression analysis.RESULTS:No conversion to open surgery was observed and 5 cases converted to hand-assisted laparoscopic operation.The overall morbidity rate was 20.5%.Complications occurred during the operation in 7 patients(5.3%),within 30 postoperative days in 24 patients(18.2%),and within 3 mo in 2 patients(1.5%).The most significant complications were anastomotic leak-age(9.1%)and anastomotic hemorrhage(5.3%).Sizeand location of tumor,pathological staging and preoperative nutrition were significant factors associated with LAR complications,while gender,age and pathological type showed no relevance.Binary logistics regression showed that the size and location of tumor,and pathological staging were independent factors of laparoscopic LAR.All the complications were treated during their onset of clinical manifestations by interventional or conservative therapy.CONCLUSION:Anastomotic leakage is a major com-plication in laparoscopic LAR.The complications may be associated with tumor size and site,and pathological stage.Interventional therapies are of value in the management of laparoscopic LAR complications.

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.

Anal Sphincter Function after Intersphincteric Resection for Low Rectal Cancer

Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. Results： The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month, but had no significant difference one year after. On the other hand, the indexes of vectorial manometry still had significant difference one year later. The indexes after intersphincteric resection could not reach the normal level. Conclusion： The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term, although the long-term results can be accepted, it still can not reach the normal level.

Application of Succus Entericus Reinfusion in a Patient with Rectal Cancer and Jejunal Diverticulum: A Case Report and Literature Review

We herein report the case of a patient with rectal adenocarcinoma who underwent low anterior resection in our hospital. The patient experienced general peritonitis, septic shock, and ardent fever on postoperative day 3. An exploratory operation revealed a perforated proximal jejunal diverticulum.The patient then underwent total parenteral nutrition and succus entericus reinfusion. The metabolic disturbances and cacotrophy rapidly improved after reinfusion of intestinal secretions, and the patient was successfully cured without requiring a prolonged period of parenteral nutrition. Our data support the saying “If the gut is working, use it.” Our report also confirms the value of succus entericus reinfusion in the successful treatment of a spontaneous perforation of Meckel’s diverticulum after low anterior resection of the rectum.

Anus-preserving rectectomy via telescopic colorectal mucosal anastomosis for low rectal cancer: Experience from a Chinese cohort

AIM: To investigate the safety and efficacy of anus-preserving rectectomy via telescopic colorectal mucosal anastomosis (TCMA) for low rectal cancer. METHODS: From August 1993 to October 2012, 420 patients including 253 males and 167 females with low rectal cancer underwent transabdominal and transanal anterior resection, followed by TCMA. The distance be-tween the anus and inferior margin of the tumor ranged from 5 to 7 cm, and was 5 cm in 6 patients, 6 cm in 127, and 7 cm in 287 patients. Tumor-node-metastasis staging showed that 136 patients had stage Ⅰ, 252 had stage Ⅱ and 32 had stage Ⅲ. Fifty-six patients with T3 or over received preoperative neoadjuvant chemoradio-therapy. RESULTS: The postoperative follow-up rate was 91.9% (386/420) with a median time of 6.4 years. All 420 pa-tients underwent radical resection. No postoperativedeath occurred. Postoperative complications included anastomotic leakage in 13 (3.1%) patients and anas-tomotic stenosis in 7 (1.6%). The local recurrence rate after surgery was 6.2%, the hepatic metastasis rate was 13.2% and the pulmonary metastasis rate was 2.3%. The 5-year survival rate was 74.0% and the disease-free survival rate was 71.0%. Kirwan classification showed that continence was good in 94.4% of patients with stage I when scored 12 mo after resection. CONCLUSION: TCMA for patients with low rectal cancer leads to better quality of life and satisfactory defecation function, and lowers anastomotic leakage occurrence, and might be one of the safe operative procedures in anus-preserving rectectomy.