Influence of humanistic care-based operating room nursing on safety,recovery,and satisfaction after radical surgery for colorectal carcinoma

BACKGROUND Radical surgery is a preferred treatment for colorectal carcinoma,wherein nursing intervention is essential for postoperative recovery and prevention of complications.Recently,the application of humanistic care in medical care has attracted attention.Humanistic care emphasizes comprehensive care,with importance attached to patients’physical needs as well as psychological and emotional support to provide more humane and personalized care services.However,no clinical reports have examined the use of humanistic care in patients undergoing radical surgery for colorectal carcinoma.AIM To investigate the influence of humanistic care-based operating room nursing on the safety,postoperative recovery,and nursing satisfaction of patients who have undergone radical surgery for colorectal carcinoma.METHODS In total,120 patients with rectal cancer who underwent surgery in Zhongnan Hospital of Wuhan University between August 2023 and March 2024 were selected and grouped based on the nursing methods employed.Of these patients,55 were treated with routine nursing intervention(control group)and 65 were provided humanistic care-based operating room nursing(research group).The patients’vital signs were recorded,including systolic/diastolic blood pressure(SBP/DBP)and heart beats per minute(BPM),as well as serum stress indices,including norepinephrine(NE),adrenal hormone(AD),and cortisol(Cor).Postoperative recovery and complications were also recorded.Patients’negative emotions,life hope,and nursing satisfaction were evaluated using the Self-rating Depression/Anxiety Scale(SDS/SAS),Herth Hope Index(HHI),and self-deve-loped nursing satisfaction questionnaire,respectively.RESULTS During emergence from anesthesia,SBP,DBP,and BPM levels were found to be lower in the research group than those in the control group,also serum Cor,AD,and NE levels were lower.In addition,the research group had shorter operative,awakening,anal exhaust,first postoperative ambulation,drainage tube removal,intestinal recovery,and hospital times.The total complication rate and the SDS and SAS scores were lower in the research group than those in the control group.The HHI and nursing satisfaction scores were higher in the research group.CONCLUSION Humanistic care-based operating room nursing can mitigate physiological stress responses,reduce postoperative complications,promote postoperative recovery,relieve adverse psychological emotions,and enhance life hope and nursing satisfaction in patients undergoing radical surgery for colorectal carcinoma,which can be popularized in clinical practice.

Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging parameters and serum tumor markers in rectal carcinoma prognosis

BACKGROUND Rectal carcinoma(RC),one of the most common malignancies globally,presents an increasing incidence and mortality year by year,especially among young people,which seriously affects the prognosis and quality of life of patients.At present,dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)parameters and serum carbohydrate antigen 19-9(CA19-9)and CA125 Levels have been used in clinical practice to evaluate the T stage and differentiation of RC.However,the accuracy of these evaluation modalities still needs further research.This study explores the application and value of these methods in evaluating the T stage and differentiation degree of RC.AIM To analyze the diagnostic performance of DCE-MRI parameters combined with serum tumor markers(TMs)in assessing pathological processes and prognosis of RC patients.METHODS A retrospective analysis was performed on 104 RC patients treated at Yantai Yuhuangding Hospital from May 2018 to January 2022.Patients were categorized into stages T1,T2,T3,and T4,depending on their T stage and differentiation degree.In addition,they were assigned to low(L group)and moderate-high differentiation(M+H group)groups based on their differentiation degree.The levels of DCE-MRI parameters and serum CA19-9 and CA125 in different groups of patients were compared.In addition,the value of DCE-MRI parameters[volume transfer constant(Ktrans),rate constant(Kep),and extravascular extracellular volume fraction(Ve)in assessing the differentiation and T staging of RC patients was discussed.Furthermore,the usefulness of DCE-MRI parameters combined with serum CA19-9 and CA125 Levels in the evaluation of RC differentiation and T staging was analyzed.RESULTS Ktrans,Ve,CA19-9 and CA125 were higher in the high-stage group and L group than in the low-stage group and M+H Group,respectively(P<0.05).The areas under the curve(AUCs)of the Ktran and Ve parameters were 0.638 and 0.694 in the diagnosis of high and low stages,respectively,and 0.672 and 0.725 in diagnosing moderate-high and low differentiation,respectively.The AUC of DCE-MRI parameters(Ktrans+Ve)in the diagnosis of high and low stages was 0.742,and the AUC in diagnosing moderate-high and low differentiation was 0.769.The AUCs of CA19-9 and CA-125 were 0.773 and 0.802 in the diagnosis of high and low stages,respectively,and 0.834 and 0.796 in diagnosing moderate-high and low differentiation,respectively.Then,we combined DCE-MRI(Ktrans+Ve)parameters with CA19-9 and CA-125 and found that the AUC of DCE-MRI parameters plus serum TMs was 0.836 in the diagnosis of high and low stages and 0.946 in the diagnosis of moderate-high and low differentiation.According to the Delong test,the AUC of DCE-MRI parameters plus serum TMs increased significantly compared with serum TMs alone in the diagnosis of T stage and differentiation degree(P<0.001).CONCLUSION The levels of the DCE-MRI parameters Ktrans and Ve and the serum TMs CA19-9 and CA125 all increase with increasing T stage and decreasing differentiation degree of RC and can be used as indices to evaluate the differentiation degree of RC in clinical practice.Moreover,the combined evaluation of the above indices has a better effect and more obvious clinical value,providing important guiding importance for clinical condition judgment and treatment selection.

Anterior resection for rectal carcinoma-risk factors for anastomotic leaks and strictures

AIM:To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection(AR)and its subsequent management.METHODS:Retrospective analysis of data from 108 patients with rectal carcinoma who underwent AR or low anterior resection(LAR)to identify the various preoperative,operative,and post operative factors that might have influence on anastomotic leaks and strictures.RESULTS:There were 68 males and 40 females with an average of 47 years(range 21-75 years).The median distance of the tumor from the anal verge was 8 cm(range 3-15 cm).Sixty(55.6%)patients underwent handsewn anastomosis and 48(44.4%)were stapled.The median operating time was 3.5 h(range2.0-7.5 h).Sixteen(14.6%)patients had an anastomotic leak.Among these,11 patients required reexploration and five were managed expectantly.The anastomotic leak rate was similar in patients with and without diverting stoma(8/60,13.4%with stoma and 8/48;16.7%without stoma).In 15(13.9%)patients,resection margins were positive for malignancy.Ninteen(17.6%)patients developed anastomotic strictures at a median duration of 8 mo(range 3-20 mo).Among these,15 patients were successfully managed with per-anal dilatation.On multivariate analysis,advance age(>60 years)was the only risk factor for anastomotic leak(P=0.004).On the other hand,anastomotic leak(P=0.00),mucin positive tumor(P =0.021),and lower rectal growth(P=0.011)were found as risk factors for the development of an anastomotic stricture.CONCLUSION:Advance age is a risk factor for an anastomotic leak.An anastomotic leak,a mucin-secreting tumor,and lower rectal growth predispose patients to develop anastomotic strictures.

Neoadjuvant Therapy for Advanced Rectal Carcinoma in China:Whether Radiochemotherapy Is Superior to Radiotherapy?

Objective： To verify whether the 30 Gy preoperative radiotherapy regimen is effective to advanced rectal cancer, and whether the preoperative chemoradiation offers an advantage in sphincter preservation and tumor control compared with irradiation alone. Methods： A total of 141 patients administered neoadjuvant treatment with resectable lower rectal carcinoma from 2002 to 2006 were collected retrospectively. The patients were divided into two groups： preoperative radiotherapy alone （30Gy by 10 fractions） （PRT group） and preoperative chemoradiotherapy （PCRT group）. All patients underwent radical surgery after neoadjuvant treatment. Results： The overall sphincter-preservation rate was 68.8% （97/141）, with no significant difference between the two groups. The overall downstaging rate was 48.2% （68/141）, including 4 patients completely response （2.8%）. The T and N downstaging rate were 30.5% （43/141） and 53.8% （57/106） respectively, showing no statistically difference between the two groups. The 2-year overall survival rate was 93.6%; no survival benefit were observed in PCRT group. The 2-year cumulative local recurrence rates were similar as well （4.2% vs 6.7%, P=0.63）. Two patients with severe marrow suppression higher than grade 3 and 1 patient with severe perineum ulcer was observed in PCRT group, which did not occur in PRT group. Conclusion： The preoperative adjuvant treatment of 30Gy radiotherapy alone may be an optional treatment for Chinese lower rectal carcinoma. Preoperative chemoradiotherapy does not show actual superiority compared with radiotherapy alone.

Study of circumferential resection margin in patients with middle and lower rectal carcinoma

AIM: To clarify the relationship between circumferential resection margin status and local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma. The relationship between circumferential resection margin status and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. METHODS: Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. RESULTS: Local recurrence occurred in 12.5% (7 of 56 cases) of patients with middle and lower rectal carcinoma. Distant recurrence occurred in 25% (14 of 56 cases) of patients with middle and lower rectal carcinoma. Twelve patients (21.4%) had positive circumferential resection margin. Local recurrence rate of patients with positive circumferential resection margin was 33.3% (4/12), whereas it was 6.8% (3/44) in those with negative circumferential resection margin (P = 0.014). Distant recurrence was observed in 50% (6/12) of patients with positive circumferential resection margin; conversely, it was 18.2% (8/44) in those with negative circumferential resection margin (P = 0.024). Kaplan-Meier survival analysis showed significant improvements in median survival (32.2 ± 4.1 mo, 95% CI: 24.1-40.4mo vs 23.0 ± 3.5 mo, 95% CI: 16.2-29.8 mo) for circumferential resection margin-negative patients over circumferential resection margin-positive patients (log-rank, P < 0.05). 37% T3 tumors examined were positive for circumferential resection margin, while only 0% T1 tumors and 8.7% T2 tumors were examined as circumferential resection margin. The difference between these three groups was statistically significant (P = 0.021). In 18 cancer specimens with tumor diameter ≥ 5 cm 7 (38.9%) were detected as positive circumferential resection margin, while in 38 cancer specimens with a tumor diameter of < 5 cm only 5 (13.2%) were positive for circumferential resection margin (P = 0.028). CONCLUSION: Our findings indicate that circumferential resection margin involvement is significantly associated with depth of tumor invasion and tumor diameter. The circumferential resection margin status is an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.

The extent and value of lymphadenectomy in the surgical treatment of gastroesophageal junction carcinoma

Objective： We studied the extent and value of the lymphadenectomy in surgical treatment of carcinoma of gastroesophageal junction （GEJ）. Methods： 217 patients with GEJ who underwent surgical resection were retrospectively analyzed. The extent of lymphadenectomy was divided into 5 types （DO to D4） and the curability of operation was graded as A, B and C. Results： The patients had been treated as follows： 186 with proximal gastrectomy, 31 with total gastrectomy, 97 with a combined-visceral resection. The patients who underwent D1, D2 and D3 lymphadenectomy were respectively 158, 58 and 1. The patients who were performed with resection of grade A, B and C were 53, 107 and 57 respectively. All patients were performed with a lymphadenectomy and well registered. The lymph node metastasis occurred in 157 cases （72.4%）. The lymph node metastasis rate in the group 1, 2, 3, 4, 7, 9, 12 and 110 as well as in the pulmonary ligament group were higher than other groups. 2868 lymph nodes were removed, in which 655 （22.8%） demonstrated the existence of metastasis. The total lymph node metastatic degree in these groups was higher compared to the other groups. Conclusion： The survival rate in the D1 lymphadenectomy and D2 is similar for all patients, and there may be some differences in the 2nd and 3rd years for the DI lymphadenectomy and D2 in the stage-Ⅲb patients. The survival rate of D2 lymphadenectomy in stage Ⅲb is better than D1 and that of D2 lymphadenectomy is superior to D1 in stage-Ⅳ patients. The survival rate of grade A and B operation is much better than grade C, and the survival rate of grade A is also higher than B.

Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

AIM： To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS： Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People＇s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS： Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients （12.5%）, and was significantly associated with family history （Х^2= 3.929, P = 0.047）, high CEA level （Х^2 = 4.964, P = 0.026）, cancerous perforation （Х^2 = 8.503, P = 0.004）, tumor differentiation （Х^2 = 9.315, P = 0.009） and vessel cancerous emboli （Х^2 = 11.879, P = 0.001）. In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age （Х^2 = 0.506, P = 0.477）, gender （Х^2 = 0.102, Z2 = 0.749）, tumor diameter （Х^2 = 0.421, P = 0.516）,tumor infiltration （Х^2 = 5.052, P = 0.168）, depth of tumor invasion （Х^2 = 4.588, P = 0.101）, lymph node metastases （Х^2 = 3.688, P = 0.055） and TNM staging system （Х^2 = 3.765, P = 0.152）. The local recurrence rate of middle and lower rectal carcinoma was 33.3% （4/12） in patients with positive circumferential resection margin and 6.8% （3/44） in those with negative circumferential resection margin. There was a significant difference between the two groups （Х^2 = 6.061, P = 0.014）. Local recurrence of rectal carcinoma occurred in 6 of 36 patients （16.7%） with mesorectal metastasis, and in 1 of 20 patients （5.0%） without mesorectal metastasis. However, there was no significant difference between the two groups （Х^2 = 1.600, P = 0.206）. CONCLUSION： Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.

DIAGNOSTIC FACTOR OF N STAGING IN RECTAL CARCINOMA:A COMPUTERED TOMOGRAPHY STUDY CORELATED WITH PATHOLOGICAL FINDING

Objective： To investigate the characteristic findings in CT images associated with N-staging of rectal carcinoma. Methods： Fifty nine patients underwent radical resection for rectal carcinoma after preoperative CT examinations, pN0, pN1, and pN2 were classified based on the pathological examination of excised specimens according to the AJCC N-staging criterion. Images were reviewed by two radiologists using CT cine blindly, reaching a consensus on size, number and distribution of lymph nodes, serosa behavior and circumferential infiltration of rectal carcinoma. The relationship between lymph node metastases and CT findings was analyzed statistically with SAS using k-w test and x^2 test. Results： Lymph nodes were depicted in all node-positive cases. The mean diameters of the largest nodes displayed in the groups of pN0, pN1, pN2 were 3.84 mm, 5.60 mm and 6.79 mm respectively; the diameters showed a statistically significant increase with N-stage developing （H=23.842, P〈0.01）. The mean numbers of lymph nodes in the groups of pN0, pN1 and pN2 were 3.0, 4.5 and 9.0 respectively, which also showed an increasing trend and significant differences from each other （H=21.834, P〈0.01）. The summation diameters of all depicted nodes also showed a significant difference in the NO, N1 and N2 groups （H=32.037, P〈0.001）. Positive nodes were seen in 25% （3/12） of cases with perirectaUy displayed nodes, in 58.6%（17/29） of cases with lymph nodes distributed both perirectally and along the superior rectal artery, and in 72.7%（8/11） of cases with nodes detected along iliac vessels combined with either one of the previous two distributions patterns. The distribution patterns of lymph nodes were significantly different in NO, N1 and N2 groups （x^2=19.517, P〈0.05）. The disorder of serosa behavior and circumferential infiltration of rectal carcinoma were more likely to occur in node positive group than negative group with statistical significance （x^2=8.979, P〈0.01, x^2=5.107, P〈0.05）. Conclusion： Comprehensively considering the size, number, distribution of depicted lymph node, as well as serosa disorder and circumferential infiltration of rectal carcinoma would be helpful for improving the N-staging of CT in patients with rectal carcinoma preoperatively.

Expression and role of Tie-2 in rectal carcinoma

Objective To investigate the expression of Tie-2 in rectal carcinoma and its relationship with invasion and metastasis in rectal carcinoma.Materials S-P immunohistochemical assay was used to detect the expression of Tie-2 in 40 cases of rectal carcinoma and 10 cases of normal rectal tissues.Results Tie-2 was mainly localized in the cytoplasm and nucleus of vascular endothelial cells in cancerous tissues and partly in the cytoplasm of some cancerous cells.The expression of Tie-2 in rectal carcinoma was significantly higher than that in normal rectal tissues(P<0.05);however,Tie-2 expression was not associated with differentiation,invasion depth and Dukes stage(P>0.05),but with lymphatic metastasis(P<0.05).Conclusion Tie-2 plays a key role in carcinogenesis and lymph node metastasis of rectal carcinoma.

SIGNIFICANCE OF CEA AND CA242 IN THE DIAGNOSIS OF COLORECTAL CARCINOMA

Carcinoembryonic antigen (CEA) is frequently used in the diagnosis of the colorectal carcinoma. CA242 is a novel unique tumor-associated antigen characterized by higher tumor specificity and sensitivity for colorectal cancer, as compared with other mucin antigens. In this study, preoperative levels of serum CEA and CA242 were measured in 63 cases of colorectal carcinoma. It was disclosed that the positive rate of CA242 was higher than that of CEA, particularly in patients with colon cancer.The combined determination of CEA and CA242 significantly increased the sensitivity and accuracy in the detection of colorectal cancer as compared with the use of CEA alone (P<0.o1). In patients with advanced disease the positive rate was markedly elevated, especially in patients with liver metastasis. The results indicate that the combined use of CEA and CA242 assays is an useful adjunct diagnostic measure for colorectal carcinoma, and is helpful in the assessment of the stage of the disease as well as in making treatment Plan.

The effect of complete and incomplete Pelvic Autonomic nerves Preservation on Urination Function in Patient With Resection of Rectal Carcinoma

Objective： To evaluate the influence of complete and incomplete pelvic autonomic nerve preservation （PANP） on urination function in patients with resection of rectal carcinoma. Methods： The changes of pre-and post-operative residual urine volume （RUV） in patient undergoing complete PANP （n = 15） and incomplete PANP （n = 17） were observed. Results： In fifteen cases with complete PANP, preoperative RUV was 4.09 ml, 14 days and 3 months after operation RUV were 8.00 ml and 7.02 ml （P 〉 0.05）. In seventeen cases with incomplete PANP, preoperative RUV was 3.90 ml, 14 days and 3 months after operation RUV were 36.55 ml and 22.64 ml （P 〈 0.001 ）. Conclusion： Complete and incomplete pelvic autonomic preservation may affect urination function in patients with resection of rectal carcinoma and RUV is an effective indicator if the pelvic autonomic nerves are preserved completely.

Penile metastasis from rectal carcinoma: A case report

BACKGROUND Metastasis to the penis is an unusual event,and penile metastasis from rectal carcinoma(PMRC)is extremely rare and associated with a dismal prognosis.Thus far,approximately 80 cases have been reported.CASE SUMMARY Herein,we report the case of a 49-year-old man with PMRC.The patient presented to the urology clinic with a complaint of penile pain during urination.The patient underwent the Dixon operation for rectal carcinoma 2 mo before the presentation.During hospitalisation,abdominal computed tomography revealed a nodular lesion on the left penis.The postoperative pathological examination revealed a typical intestinal-type adenocarcinoma.Previous cases of PMRC were retrieved from PubMed to characterise the clinicopathological features and identify the prognostic factors of PMRC.CONCLUSION The analysis suggested that approximately 24 mo is the median time to metastasis occurrence and 150 d is the survival time after diagnosis.Furthermore,poor pathological differentiation,lymph node involvement of the primary RC,metastasis time<6 mo,penile metastatic nodule diameter>1 cm,and treatment abandonment are negative predictors of survival outcomes.Close follow-up,surgical resection,chemotherapy,and radiotherapy may potentially improve the prognosis of patients.

Long-term complete response in metastatic poorly-differentiated neuroendocrine rectal carcinoma with a multimodal approach: A case report

BACKGROUND Neuroendocrine gastrointestinal tumors(NETs)are rare and have different natural behaviors.Surgery is the gold standard treatment for local disease while radiotherapy has been demonstrated to be ineffective.Poorly differentiated neuroendocrine carcinomas(NECs)represent only 5%-10%of digestive NETS.Due to aggressive growth and rapid metastatic diffusion,early diagnosis and a multidisciplinary approach are mandatory.The role of surgery and radiotherapy in this setting is still debated,and chemotherapy remains the treatment of choice.CASE SUMMARY A 42-year-old male with an ulcerated bleeding rectal lesion was diagnosed with a NEC G3(Ki67 index>90%)on May 2015 and initially treated with 3 cycles of first-line chemotherapy,but showed early local progressive disease at 3 mo and underwent sphincter-sparing open anterior low rectal resection.In September 2015,the first post-surgery total-body computed tomography(CT)scan showed an early pelvic disease relapse.Therefore,systemic chemotherapy with FOLFIRI was started and the patient obtained only a partial response.This was followed by pelvic radiotherapy(50 Gy).On April 2016,a CT scan and 18F-fluorodeoxy-glucose positron emission tomography imaging showed a complete response(CR)of the pelvic lesion,but pathological abdominal inter-aortocaval lymph nodes were observed.Due to disease progression of abdominal malignant nodes,the patient received radiotherapy at 45 Gy,and finally obtained a CR.As of January 2021,the patient has no symptoms of relapse and no late toxicity after chemotherapy or radiotherapy.CONCLUSION This case demonstrates how a multimodal approach can be successful in obtaining long-term CR in metastatic sites in patients with high grade digestive NECs.

Significance of extracellular signal-regulated kinase (ERK) in the development of rectal carcinoma

Objective: To study the ERK expression and its significance in the development of human rectal carcinoma. Methods: Samples were obtained from 62 patients with rectal carcinoma, including tumor tissue and adjacent normal rectal tissue. Western blot was used to measure the expression of ERK-1 and ERK-2. S-P immunohistochemical method was used to count the microvessel density (MVD). Results: ERK-1 and ERK-2 protein levels were increased in rectal carcinoma tissue compared with those in adjacent normal tissues (t = 2.980 and 2.194, P < 0.01 and 0.05 respectively). The MVD was higher in patients with higher ERK-1 and/or ERK-2 protein levels than that in cases with lower ERK-1 and/or ERK-2 levels. Conclu- sion: Overexpression of ERK-1 and/or ERK-2 may play an important role in the development of human rectal carcinoma, the overexpression can enhance the growth of tumor microvessel and promote the development of human rectal carcinoma.

Clinical value of extended lymphadenectomy in radical surgery for pancreatic head carcinoma at different T stages

BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.

Effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing resection of rectal carcinoma

BACKGROUND Rectal carcinoma(RC)treatment primarily involves laparoscopic surgery,which may induce significant hemodynamic changes and weaken immune function.Certain anesthetic approaches using opioid drugs(including remifentanil and sufentanil)pose risks,such as hypotension.AIM To determine the effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing RC resection.METHODS A total of 211 patients one hundred and four patients with RC treated at the First Affiliated Hospital of Dalian Medical University between November 2018 and November 2022 were retrospectively analyzed.Among them,the remifentanil group included 45 patients receiving remifentanil with propofol anesthesia and the sufentanil group included 59 patients receiving sufentanil with propofol anesthesia.Changes in the hemodynamic index,oxidative stress index,general data,consumption of remifentanil,and use of vasoactive drugs were compared.The incidences of adverse reactions were calculated.RESULTS The two groups did not significantly differ in terms of operation,anesthesia,and extubation times(P>0.05).At 1 min after intubation,the sufentanil group showed a notably higher heart rate,systolic blood pressure(SBP),diastolic blood pressure,and mean arterial pressure(MAP)compared with the remifentanil group(P<0.05),whereas the sufentanil group showed a notably higher SBP and MAP compared with the remifentanil group at 5 min after pneumoperitoneum(P<0.05).Thirty minutes after surgery,the remifentanil group showed significantly lower plasma cortisol,noradrenaline,and glucose levels than the sufentanil group(P<0.001).The remifentanil group consumed significantly less remifentanil than the sufentanil group(P<0.05),and the adoption frequency of ephedrine was lower in the remifentanil group than that in the sufentanil group(P<0.05).The incidence of hypotension was notably higher in the sufentanil group than that in the remifentanil group(P<0.05).CONCLUSION Remifentanil combined with propofol can improve hemodynamics and relieve oxidative stress in patients undergoing RC resection.

Laparoscopic right radical hemicolectomy: Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy - How I do it?

In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraaortic lymph nodes.While NCCN guidelines recommend the removal of 10-12 lymph nodes for ade-quate oncological resection,achieving complete oncological resection involves more than just meeting these numerical targets.Various techniques have been developed and studied over time to attain optimal oncological outcomes.A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric vessels.Complete excision of the visceral and parietal mesocolon ensures the intact removal of the specimen,while D3 lymphade-nectomy targets all draining regional lymph nodes.Although these principles emphasize different aspects,they ultimately converge to achieve the same goal of complete oncological resection.This article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.

Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract

Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical templatebased lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with p T2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy,which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy,but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease,even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy.

Vagina vasorum dissection during D2 lymphadenectomy for gastric carcinoma

AIM: To explore the relationship between metastasis and vagina vasorum in the progress of gastric carcinoma and to find some facts and references for gastric surgeons. METHODS: One hundred and seven specimens of left or right gastric arteries (55 left and 52 right) were gathered from 59 patients undergoing radical gastrectomy for gastric carcinoma. All the frozen specimens were cut into 3 μm-thick sections and stained with hematoxylin-eosin (HE) and immunohistochemical method separately. Cytokeratin (CK) and mesothelial cells (MC) were stained with immunohistochemical method. Cancer cells inside vagina vasorum were detected and the structure of artery wall was observed under microscope. RESULTS: Metastatic cancer cells or tubercles were found inside vagina vasorum in some stage Ⅲ or Ⅳ specimens, but not in stageⅠor Ⅱ specimens. Tumor cells in vagina vasorum were CK positive in 26 specimens of 14 tumors. Among them, stage Ⅲ was found in 4 specimens of 2 tumors, and stage Ⅳ in 22 specimens of 12 tumors. None of these specimens was positive for MC. The positive rate of CK increased with TNM staging. Compared with the lower part, tumors in the upper and middle parts of stomach were more likely to metastasize into vagina vasorum. CONCLUSION: Vagina vasorum dissection should be performed during D2 lymphadenectomy for TNM stage Ⅲ or Ⅳ gastric carcinoma.

Preoperative chemoradiation and extended pelvic lymphadenectomy for rectal cancer:Two distinct principles

Extended pelvic lymphadenectomy(EPL) with total mesorectal excision(TME) has been reported to provide oncological benefit in lower rectal cancer in Japan.In Western countries EPL is not widely accepted because of frequent morbidity but instead preoperative chemoradiation(CRT) followed by TME has been established as a standard treatment for decreasing local recurrence.Recently,several studies have focused on the comparison between these two distinct therapeutic approaches in Western countries and Japan.A study comparing Dutch trial data and Japanese data revealed that EPL and RT are almost equivalent in decreasing local recurrence in lower rectal cancer as compared with TME alone.Considering that almost 45 survival can be achieved by EPL even in the presence of metastatic lateral lymph nodes(LLNs),EPL performed by experienced surgeons definitely contributes to decrease local recurrence.On the other hand,a randomized controlled trial in Japan that compared EPL with conventional TME following preoperative RT revealed that EPL is associated with a higher frequency of sexual and urinary dysfunction without oncological benefits in the presence of preoperative RT.On this point,preoperative CRT followed by conventional TME without EPL would be a better therapeutic approach in patients without evident metastatic LLNs.For future treatment,it would be desirable to have a narrower indication for EPL using full advantage of recent improvement in image diagnosis.Although objective comparison of these two principles between Japan and the West is difficult due to differences in patient groups,further studies would lead to the next great step towards future improvement in treating lower rectal cancer.