Objective To prospectively evaluate the health-related quality of life (HRQOL) outcomes in patients undergoing laparoscopic total mesorectal excision (LTME) with anal sphincter preservation (ASP) for low rectal cancers. Methods From June 2001 to March 2004, 125 patients undergoing LTME and 103 patients undergoing OTME were included in this study. The international standard questionnaires (QLQ-C30 and QLQ-CR38) were used to evaluate the conditions of patients at 3 periods after surgery respetively: 3-6 months, 12-18 months, gt;24 months. Results In contrast to OTME patients, the LTME ones showed significantly better physical function during 3-6 months after surgery, less micturition problems within 12-18 months, less male sexual problems and better sexual function during 12-18 months after surgery, with better sexual enjoyment after postoperative 24 months. Both groups showed significant improvement in most subscales from the first to the second assessment, and improvement in sexual enjoyment from the second to the third assessment. The sexual function, micturition problems and male sexual problems in LTME group significantly improved from the first to the second assessment, whereas the sexual function in OTME group improved from the second to the third assessment.Conclusion Patients undergoing LTME for low rectal cancers have bette postoperative HRQOL than patients undergoing OTME, with better physical function, micturition function, overall sexual and male sexual functions in short term, and better sexual enjoyment in the long term. The HRQOL of both LTME and OTME patients may be expected to improve over time, particularly in the first postoperative year.
After more than 10 years of development, transanal total mesorectal excision (taTME) has played an important role in anus-preserving surgery for low rectal cancer. Existing studies have shown that taTME is not significantly different from traditional laparoscopy in the short-term and long-term efficacy of the treatment of low rectal cancer, and that taTME has potential advantages in postoperative functional recovery. With the maturity of taTME technology, transanal endoscopic approach has gradually been clinically applied to other rectal tumors, anastomotic stenosis, lateral lymph node dissection and other scenarios. Clinical practice shows that the transanal endoscopic approach can dissect pelvic tissues more accurately, greatly reduce the difficulty of surgery for complex pelvic diseases, improve the safety of surgery, and provide new ideas for clinical practice.
ObjectiveTo evaluate the postoperative anal function of rectal cancer patients treated with transanal total mesorectal excision (taTME), and to analyze the influencing factors which resulted in low anterior resection syndrome (LARS) after taTME in this paper, so as to provide guidance for clinical practice.MethodsThe data about the patients with rectal cancer treated with taTME were collected at the Affiliated Nanchong Central Hospital of North Sichuan Medical College from December 2018 to December 2019, including the clinical data and follow-up data. Postoperative recovery condition of the patients’ anal function and the affecting factors caused the occurrence of severe LARS after taTME were analyzed. The patients’ anal function within 1, 6, and 12 months after taTME were evaluated, and the evaluation tools were LARS scale and Wexner scale. The follow-up period was up to December 30, 2020.ResultsA total of 67 patients were completed preoperative and postoperative follow-up at 1, 6, and 12 months. In terms of anal function, within 1 month after taTME was the worst period in which the anal function was the worst among all the points of time evaluated (1.49±0.33, 10.28±0.64, 6.42±0.60, and 3.73±0.61, respectively), and there was time trend during the follow-up period (F=66.101, P<0.001). In the first year after taTME, the patient’s anal function was in a state of continuous recovery, and the differences between the three points of time at 1, 6, and 12 months after taTME and preoperative anal function were statistically significant (P<0.010). The results of multivariate analysis indicated that the distance between the anastomotic stoma and the anal verge was independent risk factor affecting the postoperative anal function of the patients with taTME at 1 month and 6 months (P<0.010).ConclusionsWith time going, the postoperative anal function of the patients with taTME can be recovered to a certain extent. The distance between the anastomotic stoma and the anal verge was the independent factor affecting the postoperative function of the rectal cancer patients received taTME.
Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.
Objective To observe the expressions of P53 and CD34 in rectal cancer and distal mucosa and to explore the safe distal margin of radical surgery for rectal cancer at molecular pathologic level. Methods Forty-five cases of rectal cancer were marked before operation， and then the cases were detected by PET/CT. P53 and CD34 expressions in rectal tissues were detected by immunohistochemistry technique. Results P53 expression and microvessel density (MVD) in rectal cancer were significantly higher than those in distal mucosa， which in distal mucosa were decreased along the anal direction. P53 and CD34 were still found in the normal rectal tissue. P53 expression and MVD were not significantly different between in more than 1.5 cm distal rectal mucosa and in normal rectal tissue. Besides MVD was related to size of tumor in rectal cancer and distal 0.5 cm rectal mucosa tissue, P53 and CD34 in rectal cancer and distal mucosa rectal tissue were not associated with tumor diameter, stage and differentiation of rectal cancer. Conclusion From the molecular pathologic view, the resection of 2.0 cm rectal distal tissue should be safe for excision of rectal cancer.
ObjectiveTo analyze whether transanal total mesorectal excision (taTME) can achieve high-quality TME, explore the non-patient factors affecting the quality of taTME, improve the quality of taTME.MethodsThe clinical data of 76 patients undergoing taTME from January 2015 to September 2018 in the Department of Gastrointestinal Surgery of Nanchong Central Hospital were retrospectively analyzed. The operative time, intra-operative bleeding volume, positive rate of circumferential margin, integrity of mesorectum, positive rate of margin and complications were taken as the observation indexes of operative quality. The improvement of surgical equipment, structured training, and the accumulation of surgical cases (No. 1–25 cases was early group, No. 26–50 cases was mid-term group, No. 51–76 cases was later stage group) were compared as grouping conditions, and various factors affecting the quality of taTME were analyzed.Results① Pre- and post-the improvement of surgical equipment: compared to the pre-improvement of surgical equipment group, the distance between tumors and anal margin of patients in the post-improvement of surgical equipment was closer ［(4.9±1.3) cm vs. (5.9±2.7) cm, P=0.040］ and the postoperative hospital stay was shorter ［(10.6±3.9) d vs. (12.4±2.7) d, P=0.023］, while there were no significant difference in the amount of bleeding, the positive rate of circumferential margin, the integrity of mesorectum, the positive rate of margin and the complications in the two groups (P>0.05). ② Pre- and post-training for surgeon: compared to the pre-training group, the operative time in the post-training group was shortened ［(224.6±70.2) min vs. (275±77.0) min, P=0.020］, while there were no statistical differences in the amount of bleeding, the integrity of mesorectum, the difference of the positive rate of circumferential margin, the positive rate of distal margin, postoperative complications and postoperative hospital stay (P>0.05). ③ The cumulative grouping of cases: compared to the later stage group ［（218.8±69.5）min］, the operative time in the early group ［(275.2±82.6) min］ and the mid-term group ［(278.8±37.5) min］ were shortened with statistical difference (P=0.022, P=0.003). Moreover, compared to the early group ［(12.9±2.4) d］, the postoperative hospital stay in the mid-term group ［(10.8±4.0) d］ and the later stage group ［(10.2±3.6) d］ were shortened with statistical significance (P=0.032, P=0.007). However, there were no significant difference in the volume of bleeding, the positive rate of circumferential margin, the positive rate of incisal margin and the degree of mesangial integrity among the three groups (P>0.05).ConclusionstaTME can achieve high-quality TME. With the improvement of equipment, the participation of structured training and the accumulation of surgical cases, taTME achieved consistent quality in about 50 cases. The improvement of surgical equipment is the guarantee of the quality of taTME. Structured training is the key to improve the surgical quality of taTME.
ObjectiveTo investigate the progress and controversy of membrane anatomy theory in laparoscopic surgery for mid-low rectal cancer. MethodThe literature related to membrane anatomy theory in recent years was reviewed and summarized. ResultsThe membrane anatomy theory not only improved the effect of total mesorectal excision, ensured the integrity of the mesorectum, more standardized the operation and principles of rectal cancer surgery, but also provided the operator with a broad vision and clear anatomical hierarchy. The theory of membrane anatomy had important clinical significance for tumor radical resection, organ resection and functional protection. However, this theory had not been unified, and the establishment of membrane plane and the choice of surgical plane were still needed to be studied and explored. ConclusionAt present, scholars at home still regard the theory of membrane anatomy as the theoretical support and reference basis for the endoscopic treatment of mid-low rectal cancer, which can provide surgeons with new treatment prospects and research direction, and improve the survival expectancy and quality of life of patients with intestinal cancer in the future.
目的探讨低位局部进展期直肠癌新辅助放化疗后完全缓解病例的进一步治疗方案及效果。 方法回顾性分析江苏省中医院肿瘤外科2008年1月至2010年5月期间行新辅助放化疗后初步判断达到病理完全缓解（pCR）的14例低位局部进展期直肠癌患者的临床资料。 结果14例患者中接受手术者10例，术后真正达到pCR者5例；术后2例复发或转移，其中死亡1例，1例带瘤生存，余8例患者均无瘤生存。未行手术的4例患者中，有3例复发或转移，其中2例死亡，1例带瘤生存；余1例无瘤生存。4例未行手术病例中CEA水平正常者（<5 μg/L）2例（1例复发或转移），CEA升高的2例均发生转移；10例手术病例中CEA水平正常者6例（均无瘤生存，4例真正达到pCR），升高者4例（1例真正达到pCR，2例复发或转移）。 结论接受新辅助放化疗后初步判断达到pCR的病例，尤其是CEA值高于正常者，应接受规范的全直肠系膜切除（TME）手术以达到根治的目的。
ObjectiveTo summarize the functional outcomes of transanal total mesorectal excision (TaTME).MethodThe literatures about functional outcomes and existing problems secondary to TaTME in China and abroad were collected to make a review.ResultsNeither the TaTME or the laparoscopic TME (LTME) had few serious impact on the quality of life of patients. At present, only a few studies were involved in the postoperative sexual function, and no definite conclusion could be drawn. From the current data only, the TaTME had few serious impact on the sexual function and it didn’t show some advantages as compared with the LTME. The urinary and defecation functions showed no obvious differences between the TaTME and the LTME, which of the patients after the TaTME might be impaired to some extent. The defecation disorders mainly occurred in 1—6 months after the TaTME, but it would recover to a certain extent as time went on.ConclusionsAlthough TaTME has more advantages in protecting pelvic autonomic nerves, there is no obvious difference in postoperative organ function as compared with LTME surgery at present. Multi-center, large sample size, and long-term follow-up studies are still needed to validate long-term results.
Objective To introduce the total mesorectal excision (TME)under the laparoscope and with the ultrosonic scalpel. Methods Under the laparoscope and with the ultrosonic scalpel, total mesorectal excision in 3 patients was performed. In operation, alone the parietal layer of pelvic fascia and inside the automatic nerve trunk, the mesorectum was excised with the ultrasonic scalpel. Results Three patients got final recovery, no damage to the viscera in operation occurred. Average hemorrhage amount was about 100ml. Intestinal function recovered within 24 hours, average in hospital time was 10.3 days. After 4 months, 3 patients got good living quality without recurrence and metastasis.Conclusion TME under the laparoscope is a new progress of less damageable operation. Compared with the traditional open laparotomy,it has some advantage. But it requires high technology and expensive equipments, and the case is still very limited in use.