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.

New classification system for radical rectal cancer surgery based on membrane anatomy

BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.

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.