BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS...BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.展开更多
BACKGROUND Small-cell neuroendocrine carcinoma(SNEC)of the rectum is a rare tumor associated with poor prognosis.CASE SUMMARY We report a case of a 77-year-old male who came into our hospital because of blood with his...BACKGROUND Small-cell neuroendocrine carcinoma(SNEC)of the rectum is a rare tumor associated with poor prognosis.CASE SUMMARY We report a case of a 77-year-old male who came into our hospital because of blood with his stool.An endoscopy revealed a cauliflower-like neoplasm in his rectum.Imaging examination showed that the lesion in the upper rectum was likely rectal cancer,and there was no evidence of metastasis.The patient was treated with surgery.Pathological examination confirmed SNEC of the rectum and an R0 resection was achieved.However,1 mo after the operation,the patient developed intestinal and ureteral obstructions due to peritoneal metastases.Finally,the patient died from renal failure.CONCLUSION SNEC of the rectum is a high-grade carcinoma with an aggressive phenotype,and surgery should be cautiously considered.展开更多
BACKGROUND The effect of chronic kidney disease(CKD)on the outcomes of colorectal cancer(CRC)patients after primary CRC surgery is controversial.AIM To analyze whether CKD had specific effect on the outcomes after CRC...BACKGROUND The effect of chronic kidney disease(CKD)on the outcomes of colorectal cancer(CRC)patients after primary CRC surgery is controversial.AIM To analyze whether CKD had specific effect on the outcomes after CRC surgery.METHODS We searched the PubMed,Embase,Cochrane Library databases and CNKI,from inception to March 14,2022.Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis,and we used RevMan 5.3 was used for data analysis.RESULTS A total of nine studies including 47771 patients were eligible for this metaanalysis.No significant difference was found in terms of overall postoperative complications[odds ratio(OR)=1.78,95%CI:0.64-4.94,P=0.27].We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection(OR=2.70,95%CI:1.82-4.00,P<0.01),cardiovascular complications(OR=3.39,95%CI:2.34-4.91,P<0.01)and short-term death(OR=3.01,95%CI:2.20-4.11,P<0.01).After pooling the hazard ratio(HR),the CKD group had worse overall survival(OS)(HR=1.51,95%CI:1.04-2.20,P=0.03).We performed subgroup analyses of the dialysis and non-dialysis groups,and no significant difference was found in the non-dialysis group(HR=1.20,95%CI:0.98-1.47,P=0.08).The dialysis group had worse OS(HR=3.36,95%CI:1.92-5.50,P<0.01)than the non-dialysis group.The CKD group had worse disease-free survival(DFS)(HR=1.41,95%CI:1.12-1.78,P<0.01),and in the subgroup analysis of the dialysis and non-dialysis groups,no significant difference was found in the non-dialysis group(HR=1.27,95%CI:0.97-1.66,P=0.08).The dialysis group had worse OS(HR=1.95,95%CI:1.23-3.10,P<0.01)than the non-dialysis group.CONCLUSION Preexisting CKD was associated with higher rates of pulmonary infection,higher rates of shortterm death,and worse OS and poorer DFS following CRC surgery.展开更多
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...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.展开更多
BACKGROUND The Hartmann procedure is currently recognized as a common,safe,and feasible surgical procedure.However,its reversal rate is low,and the optimal timing for Hartmann reversal surgery is controversial.CASE SU...BACKGROUND The Hartmann procedure is currently recognized as a common,safe,and feasible surgical procedure.However,its reversal rate is low,and the optimal timing for Hartmann reversal surgery is controversial.CASE SUMMARY A 65-year-old man came to our hospital with a complaint of an intestinal fistula next to the stoma.The patient had undergone a Hartmann procedure 13 years prior.We performed colonoscopy,computed tomography,and other diagnostics before successfully reversing the stoma.CONCLUSION Although the optimal time for Hartmann procedure reversal is controversial,time may ultimately not be a factor in the success of reversal.展开更多
文摘BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.
文摘BACKGROUND Small-cell neuroendocrine carcinoma(SNEC)of the rectum is a rare tumor associated with poor prognosis.CASE SUMMARY We report a case of a 77-year-old male who came into our hospital because of blood with his stool.An endoscopy revealed a cauliflower-like neoplasm in his rectum.Imaging examination showed that the lesion in the upper rectum was likely rectal cancer,and there was no evidence of metastasis.The patient was treated with surgery.Pathological examination confirmed SNEC of the rectum and an R0 resection was achieved.However,1 mo after the operation,the patient developed intestinal and ureteral obstructions due to peritoneal metastases.Finally,the patient died from renal failure.CONCLUSION SNEC of the rectum is a high-grade carcinoma with an aggressive phenotype,and surgery should be cautiously considered.
文摘BACKGROUND The effect of chronic kidney disease(CKD)on the outcomes of colorectal cancer(CRC)patients after primary CRC surgery is controversial.AIM To analyze whether CKD had specific effect on the outcomes after CRC surgery.METHODS We searched the PubMed,Embase,Cochrane Library databases and CNKI,from inception to March 14,2022.Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis,and we used RevMan 5.3 was used for data analysis.RESULTS A total of nine studies including 47771 patients were eligible for this metaanalysis.No significant difference was found in terms of overall postoperative complications[odds ratio(OR)=1.78,95%CI:0.64-4.94,P=0.27].We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection(OR=2.70,95%CI:1.82-4.00,P<0.01),cardiovascular complications(OR=3.39,95%CI:2.34-4.91,P<0.01)and short-term death(OR=3.01,95%CI:2.20-4.11,P<0.01).After pooling the hazard ratio(HR),the CKD group had worse overall survival(OS)(HR=1.51,95%CI:1.04-2.20,P=0.03).We performed subgroup analyses of the dialysis and non-dialysis groups,and no significant difference was found in the non-dialysis group(HR=1.20,95%CI:0.98-1.47,P=0.08).The dialysis group had worse OS(HR=3.36,95%CI:1.92-5.50,P<0.01)than the non-dialysis group.The CKD group had worse disease-free survival(DFS)(HR=1.41,95%CI:1.12-1.78,P<0.01),and in the subgroup analysis of the dialysis and non-dialysis groups,no significant difference was found in the non-dialysis group(HR=1.27,95%CI:0.97-1.66,P=0.08).The dialysis group had worse OS(HR=1.95,95%CI:1.23-3.10,P<0.01)than the non-dialysis group.CONCLUSION Preexisting CKD was associated with higher rates of pulmonary infection,higher rates of shortterm death,and worse OS and poorer DFS following CRC surgery.
基金Supported by Chongqing Key Diseases Research and Application Demonstration Program(Colorectal Cancer Prevention and Treatment Technology and Research Application Demonstration),No.2019ZX003.
文摘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.
基金Supported by Chongqing Key Diseases Research and Application Demonstration Program(Colorectal Cancer Prevention and Treatment Technology Research and Application Demonstration),No.2019ZX003.
文摘BACKGROUND The Hartmann procedure is currently recognized as a common,safe,and feasible surgical procedure.However,its reversal rate is low,and the optimal timing for Hartmann reversal surgery is controversial.CASE SUMMARY A 65-year-old man came to our hospital with a complaint of an intestinal fistula next to the stoma.The patient had undergone a Hartmann procedure 13 years prior.We performed colonoscopy,computed tomography,and other diagnostics before successfully reversing the stoma.CONCLUSION Although the optimal time for Hartmann procedure reversal is controversial,time may ultimately not be a factor in the success of reversal.
