AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMR). METHODS:Studies using the EMR technique to resect large colorecta...AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMR). METHODS:Studies using the EMR technique to resect large colorectal polyps were selected.Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection.Articles were searched for in Medline,Pubmed,and the Cochrane Control Trial Registry,among other sources. RESULTS:An initial search identified 2620 reference articles,from which 429 relevant articles were selected and reviewed.Data was extracted from 25 studies(n =5221)which met the inclusion criteria.All the studies used snares to perform EMR.Pooled proportion of en-bloc resections using a random effect model was 62.85%(95%CI:51.50-73.52).The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66%(95%CI:47.14-69.71).With higher patient load(>200 patients),this complete cure en-bloc resection rate improves from 44.19%(95%CI: 24.31-65.09)to 69.17%(95%CI:51.11-84.61). CONCLUSION:EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.展开更多
AIM:To investigate the short-term outcome of laparoscopic total mesorectal excision(TME) in patients with mid and low rectal cancers.METHODS:A consecutive series of 138 patients with middle and low rectal cancer were ...AIM:To investigate the short-term outcome of laparoscopic total mesorectal excision(TME) in patients with mid and low rectal cancers.METHODS:A consecutive series of 138 patients with middle and low rectal cancer were randomly assigned to either the laparoscopic TME(LTME) group or the open TME(OTME) group between September 2008 and July 2011 at the Department of Colorectal Cancer of Shanghai Cancer Center,Fudan University and pathological data,as well as surgical technique were reviewed retrospectively.Short-term clinical and oncological outcome were compared in these two groups.Patients were followed in the outpatient clinic 2 wk after the surgery and then every 3 mo in the first year if no adjuvant chemoradiation was indicated.Statistical analysis was performed using SPSS 13.0 software.RESULTS:Sixty-seven patients were treated with LTME and 71 patients were treated with OTME(sex ratio 1.3:1vs 1.29:1,age 58.4 ± 13.6 years vs 59.6 ± 9.4 years,respectively).The resection was considered curative in all cases.The sphincter-preserving rate was 65.7%(44/67) vs 60.6%(43/71),P = 0.046;mean blood loss was 86.9 ± 37.6 mL vs 119.1 ± 32.7 mL,P = 0.018;postoperative analgesia was 2.1 ± 0.6 d vs 3.9 ± 1.8 d,P = 0.008;duration of urinary drainage was 4.7 ± 1.8 d vs 6.9 ± 3.4 d,P = 0.016,respectively.The conversion rate was 2.99%.The complication rate,circumferential margin involvement,distal margins and lymph node yield were similar for both procedures.No port site recurrence,anastomotic recurrence or mortality was observed during a median follow-up period of 21 mo(range:9-56 mo).CONCLUSION:Laparoscopic TME is safe and feasible,with an oncological adequacy comparable to the open approach.Further studies with more patients and longer follow-up are needed to confirm the present results.展开更多
文摘AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMR). METHODS:Studies using the EMR technique to resect large colorectal polyps were selected.Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection.Articles were searched for in Medline,Pubmed,and the Cochrane Control Trial Registry,among other sources. RESULTS:An initial search identified 2620 reference articles,from which 429 relevant articles were selected and reviewed.Data was extracted from 25 studies(n =5221)which met the inclusion criteria.All the studies used snares to perform EMR.Pooled proportion of en-bloc resections using a random effect model was 62.85%(95%CI:51.50-73.52).The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66%(95%CI:47.14-69.71).With higher patient load(>200 patients),this complete cure en-bloc resection rate improves from 44.19%(95%CI: 24.31-65.09)to 69.17%(95%CI:51.11-84.61). CONCLUSION:EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.
文摘AIM:To investigate the short-term outcome of laparoscopic total mesorectal excision(TME) in patients with mid and low rectal cancers.METHODS:A consecutive series of 138 patients with middle and low rectal cancer were randomly assigned to either the laparoscopic TME(LTME) group or the open TME(OTME) group between September 2008 and July 2011 at the Department of Colorectal Cancer of Shanghai Cancer Center,Fudan University and pathological data,as well as surgical technique were reviewed retrospectively.Short-term clinical and oncological outcome were compared in these two groups.Patients were followed in the outpatient clinic 2 wk after the surgery and then every 3 mo in the first year if no adjuvant chemoradiation was indicated.Statistical analysis was performed using SPSS 13.0 software.RESULTS:Sixty-seven patients were treated with LTME and 71 patients were treated with OTME(sex ratio 1.3:1vs 1.29:1,age 58.4 ± 13.6 years vs 59.6 ± 9.4 years,respectively).The resection was considered curative in all cases.The sphincter-preserving rate was 65.7%(44/67) vs 60.6%(43/71),P = 0.046;mean blood loss was 86.9 ± 37.6 mL vs 119.1 ± 32.7 mL,P = 0.018;postoperative analgesia was 2.1 ± 0.6 d vs 3.9 ± 1.8 d,P = 0.008;duration of urinary drainage was 4.7 ± 1.8 d vs 6.9 ± 3.4 d,P = 0.016,respectively.The conversion rate was 2.99%.The complication rate,circumferential margin involvement,distal margins and lymph node yield were similar for both procedures.No port site recurrence,anastomotic recurrence or mortality was observed during a median follow-up period of 21 mo(range:9-56 mo).CONCLUSION:Laparoscopic TME is safe and feasible,with an oncological adequacy comparable to the open approach.Further studies with more patients and longer follow-up are needed to confirm the present results.
