Local excision of early rectal cancer: A multi-centre experience of transanal endoscopic microsurgery from the United Kingdom

BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.

Duodenum-preserving local excision of a gastrointestinal stromal tumor

BACKGROUND:Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. METHODS:We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. RESULT:Reconstruction was successful with a duodeno-jejunostomy and protected by a nasoduodenal drain. CONCLUSION:The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin.

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

Local excision for middle-low rectal cancer after neoadjuvant chemoradiation:A retrospective study from a single tertiary center

BACKGROUND Rectal cancer has become one of the leading malignancies threatening people’s health.For locally advanced rectal cancer(LARC),the comprehensive strategy combining neoadjuvant chemoradiotherapy(NCRT),total mesorectal excision(TME),and adjuvant chemotherapy has emerged as a standard treatment regimen,leading to favorable local control and long-term survival.However,in recent years,an increasing attention has been paid on the exploration of organ preservation strategies,aiming to enhance quality of life while maintaining optimal oncological treatment outcomes.Local excision(LE),compared with low anterior resection(LAR)or abdominal-perineal resection(APR)was introduced dating back to 1970’s.LE has historically been linked to a heightened risk of recurrence compared to TME,potentially due to occult lymph node metastasis and intraluminal recurrence.Recent evidence has demonstrated that LE might be an alternative approach,instead of LAR or APR,in cases with favorable tumor regression after NCRT with potentially better quality of life.Therefore,a retrospective analysis of clinicopathological data from mid-low LARC patients who underwent LE after NCRT was conducted,aiming to evaluate the treatment's efficacy,safety,and oncologic prognosis.AIM To explore the safety,efficacy,and long-term prognosis of LE in patients with mid-low rectal cancer who had a good response to NCRT.METHODS Patients with LE between 2012 to 2021 were retrospectively collected from the rectal cancer database from Gastro-intestinal Ward III in Peking University Cancer Hospital.The clinicopathological features,postoperative complications,and long-term prognosis of these patients were analyzed.The Kaplan-Meier method was used to create cancer-specific survival curve,and the log-rank test was used to compare the differences regarding outcomes.RESULTS A total of 33 patients were included in this study.The median interval between NCRT and surgery was 25.4(range:8.7-164.4)weeks.The median operation time was 57(20.0-137.0)minutes.The initial clinical T staging(cT):9(27.3%)patients were cT2,19(57.6%)patients were cT3,and 5(15.2%)patients were cT4;The initial N staging(cN):8 patients(24.2%)were cN negative,25 patients(75.8%)were cN positive;The initial M stage(cM):2 patients(6.1%)had distant metastasis(ycM1),31(93.9%)patients had no distant metastasis(cM0).The pathological results:18(54.5%)patients were pathological T0 stage(ypT0),6(18.2%)patients were ypT1,7(21.2%)patients were ypT2,and 2(6.1%)patients were ypT3.For 9 cT2 patients,5(5/9,55.6%)had a postoperative pathological result of ypT0.For 19 cT3 patients,11(57.9%)patients were ypT0,and 2(40%)were ypT0 in 5 cT4 patients.The most common complication was chronic perineal pain(71.4%,5/7),followed by bleeding(43%,3/7),stenosis(14.3%,1/7),and fecal incontinence(14.3%,1/7).The median follow-up time was 42.0(4.0-93.5)months.For 31 patients with cM0,the 5-year disease-free survival(DFS)rate,5-year local recurrence-free survival(LRFS)rate,and 5-year overall survival(OS)rate were 88.4%,96.7%,and 92.9%,respectively.There were significant differences between the ycT groups concerning either DFS(P=0.042)or OS(P=0.002)in the Kaplan-Meier analysis.The LRFS curve of ycT≤T1 patients was better than that of ycT≥T2 patients,and the P value was very close to 0.05(P=0.070).The DFS curve of patients with ypT≤T1 was better than that of patients with ypT≥T2,but the P value was not statistically significant(P=0.560).There was a significant difference between the ypT groups concerning OS(P=0.014)in the Kaplan-Meier analysis.The LRFS curve of ypT≤T1 patients was better than that of ypT≥T2 patients,and the P value was very close to 0.05(P=0.070).Two patients with initial cM1 were alive at the last follow-up.CONCLUSION LE for rectal cancer with significant tumor regression after NCRT can obtain better safety,efficiency,and oncological outcome.Minimally invasive or nonsurgical treatment with patient participation in decision-making can be performed for highly selected patients.Further investigation from multiple centers will bring better understanding of potential advantages regarding local resection.

Comparison of clinicopathological characteristics between resected ampullary carcinoma and carcinoma of the second portion of the duodenum

BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically close locations.AIM To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis(LNM), between AC and DC-Ⅱ.METHODS This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-Ⅱ who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.RESULTS The patients with AC and DC-Ⅱ did not exhibit significant differences in 5-year overall survival(66.0% and 67.1%, respectively) and 5-year relapse-free survival(63.5% and 62.2%, respectively). Compared to the patients with DC-Ⅱ, the rate of preoperative biliary drainage was higher(P = 0.042) and the rates of digestive symptoms(P = 0.0158), ulcerative-type cancer(P < 0.0001), large tumor diameter(P < 0.0001), and advanced tumor stage(P = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-Ⅱ,respectively, without significant difference(P = 0.23). The rates of LNM to hepatic nodes(N-He)and pyloric nodes(N-Py) were significantly higher in patients with DC-Ⅱ than in those with AC(metastasis to N-HE: 18.5% and 5% in patients with DC-Ⅱ and AC, respectively;P = 0.0432;metastasis to N-Py: 11.1% and 0% in patients with DC-Ⅱ and AC, respectively;P = 0.0186)CONCLUSION Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-Ⅱ than in those with AC.

Local excision of ciliary body tumors： a long-term prospective cohort study in China

Background Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. Local excision of ciliary body tumors has become effective with the development of the modern vitrectomy, but long-term outcomes are still not clear. Therefore, we reported the outcome of locally excised ciliary body tumors after long-term follow-up. Methods Twenty-two patients （22 eyes）, who had been diagnosed with ciliary body tumors in Beijing Tongren Hospital from January 1996 to June 2001, were enrolled in this prospective cohort study. Localized lamellar sclera-ciliary excisions were performed. In some cases, vitrectomies, scleral graft transplantations, and further excisions of the anterior choroid were performed. Diagnoses were confirmed by histopathologic examination. Patients were followed from five to eleven years after surgery. Their visual acuity, intraocular pressure and local recurrence were recorded with descriptive percentages. Results After surgery, all patients maintained normal eyeball appearances. Six patients maintained circular pupils. The final best corrected visual acuities （BCVA） varied from 0.02-1.00, including 18 patients （81.82%） who had BCVA equal to or better than that before surgery. Fifteen patients （68.18%） had BCVA better than 0.3. Only two patients had intraocular pressure （lOP） of less than 10 mmHg and the other patients maintained normal lOP. Nine cases （40.91%） were given confirmed diagnosis of malignant melanoma, four （18.18%） of melanocytoma, six （27.27%） of nonpigmented ciliary epithelial adenoma, two （9.09%） of neurofibroma, and one （4.55%） of neurinoma. Twenty patients （90.91%） had no recurrence during the follow-up period. In one case melanocytoma recurred seven years after surgery and enucleation was performed. One patient, whose operation removed a malignant melanoma with a diameter of 16 mm, died of hepatic metastasis five years after the operation. Conclusion For some ciliary body tumors, especially in the early stages, local excision is an effective and safe method to save the vision and the eyeball.

Neoadjuvant therapy followed by local excision and two-stage total mesorectal excision:a new strategy for sphincter preservation in locally advanced ultra-low rectal cancer

Background:With the increased usage of neoadjuvant chemoradiotherapy,improved surgical technique and stapling devices,sphincter-preserving resection has become more frequent for patients with rectal cancer.However,as for locally advanced ultra-low rectal cancer,sphincter-preservation is still facing an enormous challenge.Objective:To introduce an NLT strategy of sphincter-preservation-neoadjuvant therapy(NT)followed by local excision(LE)and two-stage total mesorectal excision(TME)-into the treatment of locally advanced ultra-low rectal cancer(lesions with anal sphincter invasion).Methods:From October 2010 to October 2011,nine patients with locally advanced rectal cancer located less than 3 cm from the anal verge were treated by the NLT strategy.All patients had shown good clinical response to NT.The LE procedure was carried transanally 6-8 weeks after completion of the NT.TME was performed to dissect mesorectal lymph nodes 4-6 weeks after LE.Results:Of the nine patients,the lesion was assessed as T2 in two,T3 in five,and T4 in two before NT,and lymph node metastasis was detected in five patients.The median distance from the tumor to the anal verge was 2.5 cm(range:1-3 cm).The median follow-up was 27 months(range:24-34 months).No distant metastasis was detected.Only one patient(11.1%)developed local recurrence at 12 months post-operatively and then underwent abdomino-perineal resection.The remaining eight patients had preserved long-term continence and the median Wexner score at two years post-operation was 4(range:2-6).Conclusion:The new NLT strategy can achieve sphincter-preservation in some patients with ultra-low rectal cancer,with favorable oncological outcome and preservation of normal anal sphincter function.

Adaptive Biorthogonal Local Discrete Cosine Transform for Interference Excision in Direct Sequence Spread Spectrum Communications

A novel time-frequency domain interference excision technique is proposed. The technique is based on adaptive biorthogonal local discrete cosine trans form (BLDCT). It uses a redundant library of biorthogonal local discrete cosine bases and an efficient concave cost function to match the transform basis to the interfering signal. The main advantage of the algorithm over conventional trans form domain excision algorithms is that the basis functions are not fixed but ca n be adapted to the time-frequency structure of the interfering signal. It is w e ll suited to transform domain compression and suppression of various types of in terference. Compared to the discrete wavelet transform (DWT) that provides logar ithmic division of the frequency bands, the adaptive BLDCT can provide more flex ible frequency resolution. Thus it is more insensitive to variations of jamming frequency. Simulation results demonstrate the improved bit error rate (BER) perf ormance and the increased robustness of the receiver.

Is repeat wide excision plus radiotherapy of localized rectal melanoma another choice before abdominoperineal resection?A case report

BACKGROUND Rectal melanoma is an uncommon neoplasm that accounts for approximately 1 percent of rectal cancer cases.Abdominoperineal resection was regarded as the radical procedure for disease control.Nevertheless,it led to more postoperative complications than sphincter-sparing wide local excision(WLE)and reduced the patient’s quality of life(QOL)owing to creation of colostomy.Therefore,in this study,WLE,radiotherapy(RT),and a second WLE were conducted on a patient who had been diagnosed with localized rectal melanoma.CASE SUMMARY The patient was a 79-year-old woman who had been experiencing anal pain and bloody stool for 1 mo.Colonoscopy,magnetic resonance imaging,positron emission tomography–computed tomography,and histological analysis of tissue biopsy using the histological markers Melan-A(+),S-100(+),and Ki-67(+,50%)lead to the diagnosis of localized rectal melanoma.The patient had initially undergone WLE to resolve problem of anal bleeding,followed by RT to treat the residual lesion with partial response.Subsequently,the residual lesion was removed with margin-free resection by the second WLE.The patient’s postoperative course was smooth and uneventful.During the 2-year follow-up,no local recurrence was observed.Additionally,a good functional outcome and improved QOL were reported.CONCLUSION Combining WLE,RT,and repeat WLE is proposed as a viable alternative for treating rectal melanoma accompanied by bleeding symptoms that cannot be completely resected at the beginning.

腹腔镜下D2根治术联合CME对局部进展期胃癌术后腹腔游离癌细胞检出率及预后的影响

目的:探讨腹腔镜下D2根治术联合完整系膜切除术(complete mesocolic excision,CME)对局部进展期胃癌腹腔游离癌细胞及预后的影响。方法:回顾性分析2021年06月至2022年06月于医院住院治疗的128例局部进展期胃癌患者临床资料,将64例实施腹腔镜下D2根治术的患者纳入对照组,64例实施腹腔镜下D2根治术联合CME的患者纳入研究组。记录两组手术、住院及并发症情况,采用生活质量综合评定问卷-74(GQOLI-74)评定生活质量。分别于腹腔镜探查后和肿瘤切除后收集腹腔冲洗液,应用细胞学检查检测腹腔游离癌细胞。术后随访1年,记录总生存期(OS)及无进展生存期(PFS)情况。结果:研究组淋巴结清扫总数及阳性淋巴结数量显著大于对照组(P<0.05)。与术前比较,研究组术后腹腔游离癌细胞阳性率显著降低(P<0.05)。与术前比较,两组术后GQOLI-74评分均显著增加,且研究组高于对照组(P<0.05)。两组腹腔感染/积液、胃排空障碍、肠梗阻、吻合口瘘、胰瘘、淋巴漏发生率及不良反应总发生率比较,差异均无统计学意义(P>0.05)。研究组术后1年PFS率和OS率均显著高于对照组(P<0.05)。结论:腹腔镜下D2根治术联合CME有利于彻底清除局部进展期胃癌淋巴结,减少术后复发,促进术后康复,且不增加腹腔游离癌细胞脱落和手术并发症风险,具有临床推广价值。

内镜切割吻合器在经肛门局部切除中低位直肠肿瘤中的应用

目的:回顾性分析中低位直肠肿瘤经肛门局部切除治疗中采用内镜切割吻合器的应用价值。方法:纳入我院经检查诊断的24例中低位直肠肿瘤患者,使用内镜切割吻合器对直肠肿瘤进行经肛门局部切除,总结分析患者临床病理资料特征及影像学诊断特点,评价该手术方式的安全性及可行性。结果:24例患者便潜血阳性者14例,症状以便血为主,肿瘤位置以前壁为主。随着肿瘤直径的增大,增强CT、MRI、EUS诊断的准确率升高,准确率方面EUS>MRI>增强CT,三者联合评估准确率提高。术后病理结果显示4例为上皮下来源肿瘤(SM层3例,MP层1例)。20例为上皮来源肿瘤,其中上皮来源良性肿瘤9例,为低级别管状腺瘤或低级混合状腺瘤;高级别上皮内瘤变2例;直肠癌9例,其中M层1例,SM层3例,MP层4例,S层1例。24例患者病灶完全切除率为100%,手术完成率为100%,无中转腹腔镜或开腹手术,手术平均时间、手术平均出血量、术后首次排气平均时间、术后住院平均天数分别为(29.25±6.42)min、(15.04±4.12)mL、(35.38±5.94)h、(3.17±0.92)d;术后7例患者出现WBC反应性升高,术后2~4天后均恢复正常,所有患者RBC及HGB计数较术前均降低,但均处于正常值范围,所有患者均无术后并发症。结论:内镜切割吻合器经肛门切除中低位直肠肿瘤具有操作时间短、副损伤小、术后应激反应低、恢复快的优势,该手术方式具有广泛的临床应用前景。

改良经腹膜外腹腔镜全筋膜内根治性前列腺切除术对局限性前列腺癌患者勃起功能、尿流动力学的影响

目的探讨局限性前列腺癌(PCa)患者采用改良经腹膜外腹腔镜全筋膜内根治性前列腺切除术(RP)对其勃起功能、尿流动力学的改善效果。方法回顾性选取浙江中医药大学附属第一医院庆元分院2020年1月至2022年6月收治的局限性PCa患者82例,依据术中筋膜处理方式的不同分为对照组(41例)和观察组(41例)。两组均行经腹膜外腹腔镜RP,对照组术中给予常规筋膜间保留血管神经束,观察组术中给予改良全筋膜内切除。比较两组手术相关指标、勃起功能、尿流动力学指标、疼痛状况及并发症。结果两组手术时间、出血量、引流管留置时间、住院时间、切缘阳性占比比较,差异均无统计学意义(P>0.05)。术后6个月两组国际勃起功能指数-5(IIEF-5)评分相比术前均升高;观察组术后6个月IIEF-5评分及勃起功能恢复率高于对照组,视觉模拟评分法(VAS)评分低于对照组,差异具有统计学意义(P<0.05)。两组术后6个月最大膀胱容量(MBC)、最大尿道闭合压(MUCP)比术前升高,观察组高于对照组;术后6个月充盈期膀胱顺应性值(BC)、残余尿量(PVR)、逼尿肌不稳定率(DI)比术前降低,观察组低于对照组,差异均具有统计学意义(P<0.05)。观察组术后6个月随访的总并发症发生率低于对照组,差异具有统计学意义(P<0.05)。结论改良经腹膜外腹腔镜全筋膜内RP应用于局限性PCa患者可促进勃起功能恢复,减轻疼痛症状,调节尿流动力学指标水平,安全性良好。

Microscopic transduodenal excision of an ampullary adenoma:A case report and review of the literature

BACKGROUND Transduodenal local excision is an alternative treatment approach for benign ampullary tumors.However,this procedure has technical difficulties,especially during reconstruction of the pancreaticobiliary ducts.An operating microscope has been widely used by surgeons for delicate surgery due to its major advantages of magnification,illumination,and stereoscopic view.The application of an operating microscope in transduodenal excision of ampullary tumors has not been reported.CASE SUMMARY A 55-year-old woman was admitted for investigation of recurrent upper abdominal pain.Physical examination and laboratory tests found no abnormalities.Imaging identified a large mass in the descending part of the duodenum.Esophagogastroduodenoscopy revealed a 3.5-cm-sized villous growth over the major duodenal papilla.Pathology of the endoscopic biopsy indicated a villous adenoma with low-grade dysplasia.Microscopic transduodenal excision of the ampullary tumor was performed.The final pathological diagnosis was villous-tubular adenoma with low-grade dysplasia.The patient was discharged on postoperative day 12 after an uneventful recovery.Endoscopic retrograde cholangiopancreatography was performed 3 mo postoperatively and showed no bile duct or pancreatic duct strictures and no tumor recurrence.The patient is continuing follow-up at our clinic and remains well.CONCLUSION Operating microscope-assisted transduodenal local excision is a feasible and effective option for benign ampullary tumors.

Transanal excision of a malignant fibrous histiocytoma of anal canal:A case report and literature review

Malignant fibrous histiocytoma, which is composed of spindle-shaped cells arranged in a pleomorphic and storiform pattern, is rarely found in the colorectum. Although complete surgical excision remains the main stem of therapy, an optimal treatment strategy according to the stage has not been elucidated. We report a case of a 63-year-old woman with an ulcerative lesion in the anorectal junction and a final diagnosis of malignant fibrous histiocytoma. We introduced an access for transanal local excision and adjuvant radiotherapy because the patient refused abdominoperineal resection. No local recurrences or distant metastases were observed 15 mo after the operation. To our knowledge, this is the first case reported in the English literature of a malignant fibrous histiocytoma treated with the transana local excision and adjuvant radiotherapy. This report showed that this approach is selectively reserved for early-stage malignant fibrous histiocytoma and for those patients who refuse radical surgery because of the risk in a permanent colostomy.

ERCC1 mRNA和X线修复交叉互补组1基因多态性联合检测在局部晚期鼻咽癌患者放化疗中的应用价值

目的 探讨核苷酸切除修复交叉互补组1(ERCC1)m RNA和X线修复交叉互补组1(XRCC1)基因多态性联合检测在局部晚期鼻咽癌患者放化疗中的应用价值。方法 选取2020年1月至2021年1月在江西省上饶市人民医院接受放化疗的41例局部晚期鼻咽癌患者,采用定量反转录聚合酶链反应检测外周血中ERCC1 mRNA的表达水平,采用限制性片段长度多态性聚合酶链反应检测XRCC1基因型(Arg194Trp、Arg280His、Arg399Gln),探讨ERCC1 mRNA和XRCC1多态性与局部晚期鼻咽癌患者放化疗效果、肿瘤复发及药物不良反应(ADR)的关系,并采用logistic回归分析局部晚期鼻咽癌患者ADR的影响因素。结果 完全缓解和部分缓解患者的ERCC1 mRNA及XRCC1多态性与疾病稳定和疾病进展患者比较差异无统计学意义(P>0.05)。肿瘤复发患者的ERCC1 mRNA及XRCC1多态性与非复发患者比较差异无统计学意义(P>0.05)。ADR患者XRCC1 Arg194Trp位点携带AG基因型、ERCC1 mRNA高表达的频率均高于非ADR患者,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,XRCC1 Arg194Trp AG基因型(OR=1.876)、ERCC1mRNA高表达(OR=1.109)是局部晚期鼻咽癌患者放化疗期间发生ADR的影响因素(P<0.05)。结论 与单一检测相比,ERCC1 mRNA和XRCC1多态性联合检测预测局部晚期鼻咽癌患者放化疗期间ADR的价值更高,值得临床应用。

Sphincter-preserving R0 total mesorectal excision with resection of internal genitalia combined with pre-or postoperative chemoradiation for T4 rectal cancer in females

AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.

Simple instruments facilitating achievement of transanal total mesorectal excision in male patients

AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.

腹腔镜或机器人胰腺肿瘤局部切除术围手术期安全性评价

目的:探讨腹腔镜或达芬奇机器人辅助局部切除术治疗胰腺良性及低度恶性肿瘤的围手术期安全性及可行性。方法:回顾分析2020年12月至2021年5月收治的33例行腹腔镜或达芬奇机器人辅助局部切除的胰腺良性肿瘤及低度恶性肿瘤患者的临床资料。肿瘤位于胰头部14例,钩突部5例,胰颈部及体部14例。肿瘤直径平均(3.2±0.8)cm。结果:33例患者中21例行腹腔镜手术,12例行达芬奇机器人手术,手术均获成功,无一例中转开腹,切除肿瘤边界完整。病理结果:导管内乳头状黏液瘤9例,实性假乳头状瘤1例,胰腺神经内分泌肿瘤6例,囊腺瘤17例。术后发生胰瘘29例,其中生化漏16例,B级胰瘘13例,未发生C级胰瘘;腹腔出血1例。无围手术期死亡病例,平均住院(9.8±3.0)d。结论:对于胰腺良性或低度恶性肿瘤,腹腔镜或达芬奇机器人辅助胰腺肿瘤局部切除术创伤小,围手术期安全性高,严重并发症发生率低,可最大限度地保留胰腺功能,减少术后内外分泌功能缺失,值得临床推广。

腔镜直线切割吻合器用于T1期中低位直肠癌经肛门局部切除术的疗效及安全性

目的:探讨应用腔镜直线切割吻合器(endoscopic linear cutters, ENDOPATH)行经肛门局部切除术治疗T_(1)期中低位直肠癌的疗效和安全性。方法:回顾性分析2011年01月至2017年12月我院收治的92例T_(1)期中低位直肠癌患者的临床资料。根据手术方式分为经肛门局部切除术组(TAE组)与直肠癌传统根治术组(根治术组)。TAE组使用腔镜直线切割吻合器行经肛门全层局部切除术,共39例;根治术组按全直肠系膜切除原则行传统根治术,共53例(包括16例Miles手术和37例Dixon手术)。对两组患者的一般资料、术中及术后相关指标及预后情况进行比较。结果:TAE组和根治术组患者在性别、年龄、肿瘤病理分型、肿瘤大小、距肛缘距离方面对比分析,无显著性差异(P>0.05),两组资料有可比性。两组患者在手术时间[(TAE组:(37.74±10.66)min,根治术组:(117.66±41.78)min]、术后住院时间[TAE组:(6.85±1.06)天,根治术组:(10.70±1.72)天]、术中出血量[TAE组:(30.21±2.97)mL,根治术组:(78.96±12.65)mL]、术后并发症发生率(TAE组:2.56%,根治术组:43.39%)方面差异均有统计学意义(P<0.01)。两组患者的3年无病生存率均为100.00%,两组患者3年内均无复发,相比较无统计学差异(P> 0.05)。两组患者的生存质量评分[TAE组:(90.31±3.82)分,根治术组:(71.59±6.33)分]差异有统计学意义(P<0.01)。结论:与传统根治术相比,应用腔镜直线切割吻合器对T1期中低位直肠癌行经肛门局部切除术同样安全有效。应用腔镜直线切割吻合器行经肛门局部切除术创伤小、并发症少、恢复快,患者术后生活质量等方面明显优于根治术。应用腔镜直线切割吻合器行经肛门局部切除术可作为早期无淋巴转移的中低位直肠癌患者优先选择的一种术式。

阴道镜联合LEEP术在子宫颈癌前病变患者中的应用及对局部创伤的控制效果观察

目的:探究及观察阴道镜联合子宫颈环形电切(LEEP)术在子宫颈癌前病变患者中的应用效果及对局部创伤的控制效果。方法:选择福州市长乐区医院2019年10月—2021年12月收治的90例子宫颈癌前病变患者,按照随机数表法分为对照组和观察组,各45例。对照组进行微波治疗,观察组则进行阴道镜联合LEEP术治疗。比较两组的治疗总有效率、手术时间、术中出血量、术后出血时间、手术前后的分泌物炎症指标[降钙素原(PCT)与C反应蛋白(CRP)]及宫颈局部微循环指标(局部血流灌注、微血管管径及红细胞聚集率)。结果:观察组的治疗总有效率显著高于对照组,手术时间及术后出血时间显著短于对照组,术中出血量显著少于对照组,差异均有统计学意义(P<0.05)。术前,两组的分泌物炎症指标及宫颈局部微循环指标比较,差异无统计学意义(P>0.05);术后2周,观察组的CRP及PCT显著低于对照组(P<0.05)。术后1、2周,观察组的宫颈局部微循环指标显著优于对照组,差异有统计学意义(P<0.05)。结论:阴道镜联合LEEP术在子宫颈癌前病变患者中的应用效果相对较好,且对局部创伤的控制效果更好,因此在子宫颈癌前病变患者中的应用价值较高。