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Clinical efficacy and pathological outcomes of transanal endoscopic intersphincteric resection for low rectal cancer

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 933-944页

作者： Zhi-Wen Xu Jing-Tao Zhu Hao-Yu Bai Xue-Jun Yu Qing-Qi Hong Jun You Department of Gastrointestinal Oncology Surgery The First Affiliated Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityXiamen 361000Fujian ProvinceChina

BACKGROUND Transanal endoscopic intersphincteric resection(ISR)surgery currently lacks sufficient clinical research and *** To investigate the clinical effectiveness of transanal endoscopic ISR,in order to promote the clinical application and development of this *** This study utilized a retrospective case series *** and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were *** patients underwent transanal endoscopic ISR as the surgical *** conducted this study to determine the perioperative recovery status,postoperative complications,and pathological specimen charac-teristics of this group of *** This study included 45 eligible patients,with no perioperative *** overall incidence of early complications was 22.22%,with a rate of 4.44%for Clavien-Dindo grade≥III *** patients(4.4%)developed anastomotic leakage after surgery,including one case of grade A and one case of grade *** pathological examination confirmed negative circumferential resection margins and distal resection margins in all *** mean distance between the tumor lower margin and distal resection margin was found to be 2.30±0.62 *** transanal endoscopic ISR procedure consistently yielded high quality pathological *** Transanal endoscopic ISR is safe,feasible,and provides a clear anatomical *** is associated with a low incidence of postoperative complications and favorable pathological outcomes,making it worth further research and application.

关键词： Intersphincteric resection Transanal rectal cancer Complications Endoscopic

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Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer

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World Journal of Gastroenterology 2024年第18期30卷 2418-2439页

作者： Xiao-Cong Zhou Shi-Wei Guan Fei-Yue Ke Gaurav Dhamija Qiang Wang Bang-Fei Chen Medical University(Wenzhou Central Hospital) Wenzhou 325000Zhejiang ProvinceChina Department of Hepatobiliary Surgery The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital)Wenzhou 325000Zhejiang ProvinceChina Postgraduate Training Base Alliance of Wenzhou Medical University Wenzhou Central HospitalWenzhou 325000Zhejiang ProvinceChina School of International Studies Wenzhou Medical UniversityWenzhou Central HospitalWenzhou 325000Zhejiang ProvinceChina Department of Radiology The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital)Wenzhou 325000Zhejiang ProvinceChina Department of Colorectal Surgery The Affiliated Zhejiang HospitalZhejiang University School of Medicine(Zhejiang Hospital)Hangzhou 310000Zhejiang ProvinceChina

BACKGROUND Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic ***,it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical *** To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for rectal *** We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincterpreserving surgery for rectal ***-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography(CT)*** difficulty was categorized as either high or low,and multivariate logistic regression analysis was employed to identify predictors of operative difficulty,ultimately creating a *** Out of 162 patients,21(13.0%)were classified in the high surgical difficulty group,while 141(87.0%)were in the low surgical difficulty *** logistic regression analysis showed that the surgical approach using laparoscopic intersphincteric dissection,intraoperative preventive ostomy,and the sacrococcygeal distance were independent risk factors for highly difficult laparoscopic radical sphincter-sparing surgery for rectal cancer(P<0.05).Conversely,the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance was identified as a protective factor(P<0.05).A nomogram was subsequently constructed,demonstrating good predictive accuracy(C-index=0.834).CONCLUSION The surgical approach,intraoperative preventive ostomy,the sacrococcygeal distance,and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance could help to predict the difficulty of laparoscopic radical sphincter-preserving surgery.

关键词： Nomogram rectal cancer Laparoscopic operation Sphincter-preserving surgery Technical difficulty

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Chemoradiotherapy plus tislelizumab for mismatch repair proficient rectal cancer with supraclavicular lymph node metastasis:A case report

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 2219-2224页

作者： Wen-Tao Zhong Yuan Lv Qian-Yu Wang Ran An Gang Chen Jun-Feng Du The Second School of Clinical Medicine Southern Medical UniversityGuangzhou 510515Guangdong ProvinceChina Department of General Surgery The 7^(th)Medical Center of PLA General HospitalBeijing 100700China Department of Pathology The 7^(th)Medical Center of PLA General HospitalBeijing 100700China

BACKGROUND According to the latest report,colorectal cancer is still one of the most prevalent cancers,with the third highest incidence and mortality *** of advanced rectal cancer with distant metastases is usually unsatisfactory,especially for mismatch repair proficient(pMMR)rectal cancer,which leads to poor prognosis and *** SUMMARY We report a case of a pMMR rectal adenocarcinoma with metastases of multiple lymph nodes,including the left supraclavicular lymph node,before treatment in a 70-year-old *** received full courses of chemoradiotherapy(CRT)followed by 4 cycles of programmed death 1 inhibitor Tislelizumab,and a pathologic complete response(pCR)was achieved,and the lesion of the left supraclavicular lymph node also *** pMMR advanced rectal cancer with preserved intact distant metastatic lymph nodes may benefit from full-course CRT combined with immunotherapy.

关键词： rectal cancer Metastasis Chemoradiotherapy Immunotherapy Prognosis Case report

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Preoperative prediction of perineural invasion of rectal cancer based on a magnetic resonance imaging radiomics model:A dual-center study

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World Journal of Gastroenterology 2024年第16期30卷 2233-2248页

作者： Yan Liu Bai-Jin-Tao Sun Chuan Zhang Bing Li Xiao-Xuan Yu Yong Du Department of Radiology The Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Department of Radiology The Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina.duyong@***

BACKGROUND Perineural invasion(PNI)has been used as an important pathological indicator and independent prognostic factor for patients with rectal cancer(RC).Preoperative prediction of PNI status is helpful for individualized treatment of ***,several radiomics studies have been used to predict the PNI status in RC,demonstrating a good predictive effect,but the results lacked *** preoperative prediction of PNI status is still challenging and needs further *** To establish and validate an optimal radiomics model for predicting PNI status preoperatively in RC *** This retrospective study enrolled 244 postoperative patients with pathologically confirmed RC from two independent *** patients underwent preoperative high-resolution magnetic resonance imaging(MRI)between May 2019 and August *** radiomics features were extracted and selected from oblique axial T2-weighted imaging(T2WI)and contrast-enhanced T1WI(T1CE)*** radiomics signatures were constructed using logistic regression analysis and the predictive potential of various sequences was compared(T2WI,T1CE and T2WI+T1CE fusion sequences).A clinical-radiomics(CR)model was established by combining the radiomics features and clinical risk *** internal and external validation groups were used to validate the proposed *** area under the receiver operating characteristic curve(AUC),DeLong test,net reclassification improvement(NRI),integrated discrimination improvement(IDI),calibration curve,and decision curve analysis(DCA)were used to evaluate the model *** Among the radiomics models,the T2WI+T1CE fusion sequences model showed the best predictive performance,in the training and internal validation groups,the AUCs of the fusion sequence model were 0.839[95%confidence interval(CI):0.757-0.921]and 0.787(95%CI:0.650-0.923),which were higher than those of the T2WI and T1CE sequence *** CR model constructed by combinin

关键词： rectal cancer Perineural invasion Magnetic resonance imaging Radiomics Nomogram

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Clinical application of eight-zone laparoscopic dissection strategy for rectal cancer:Experience and discussion

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World Journal of Gastroenterology 2024年第30期30卷 3574-3583页

作者： Chang Chen Xiang Zhang Xin Li Yan-Lei Wang Department of General Surgery Rongchang People's HospitalChongqing 250012China Department of Colorectal Surgery Qilu HospitalShandong UniversityJinan 250012Shandong ProvinceChina Department of General Surgery Huantai Branch of Qilu Hospital of Shandong UniversityZibo 255000Shandong ProvinceChina

BACKGROUND The incidence of rectal cancer is increasing worldwide,and surgery remains the primary treatment *** the advent of total mesorectal excision(TME)technique,the probability of tumor recurrence post-surgery has significantly ***'focus has gradually shifted towards minimizing the impact of surgery on urinary and sexual *** these concerns,the optimal dissection of the rectal lateral ligaments and preservation of the pelvic floor neuro-vascular bundle have become *** explore the optimal surgical technique for TME and establish a standardized surgical protocol to minimize the impact on urinary and sexual functions,we propose the eight-zone dissection strategy for pelvic floor *** To compare the differences in surgical specimen integrity and postoperative quality of life satisfaction between the traditional pelvic floor dissection strategy and the innovative eight-zone dissection *** We analyzed the perioperative data of patients who underwent laparoscopic radical resection of rectal cancer at Qilu Hospital of Shandong University between January 1,2021 and December 1,*** study included a total of 218 patients undergoing laparoscopic radical surgery for rectal cancer,among whom 109 patients underwent traditional pelvic floor dissection strategy,and 109 patients received the eight-zone dissection *** There were no significant differences in general characteristics between the two *** in the eight-zone dissection group had higher postoperative specimen integrity(88.1%vs 78.0%,P=0.047).At the 3-month followup,patients in the eight-zone surgery group had better scores in urinary issues(6.8±3.3 vs 5.3±2.5,P=0.045)and male sexual desire(2.2±0.6 vs 2.5±0.5,P=0.047)compared to the traditional surgery strategy *** This study demonstrates that the eight-zone dissection strategy for laparoscopic lateral ligament dissection of rectal cancer is safe and ***

关键词： Eight-zone dissection strategy rectal cancer Lateral ligament dissection Nerve injury Total mesorectal excision surgery

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Study on sex differences and potential clinical value of threedimensional computerized tomography pelvimetry in rectal cancer patients

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 773-786页

作者： Xiao-Cong Zhou Fei-Yue Ke Gaurav Dhamija Hao Chen Qiang Wang Department of Colorectal Surgery The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital)Wenzhou 325000Zhejiang ProvinceChina Postgraduate Training Base Alliance of Wenzhou Medical University Wenzhou Central HospitalWenzhou 325000Zhejiang ProvinceChina School of International Studies Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina Department of Radiology The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital)Wenzhou 325000Zhejiang ProvinceChina

BACKGROUND Laparoscopic rectal cancer radical surgery is a complex procedure affected by various ***,the existing literature lacks standardized parameters for the pelvic region and soft tissues,which hampers the establishment of consistent *** To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography(CT)-based three-dimensional(3D)reconstruction,providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical *** We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer,and utilized CT data for 3D pelvic *** anatomical points were carefully marked and measured using advanced 3D modeling *** analyze the pelvic and soft tissue parameters,we emp-loyed statistical methods including paired sample t-tests,Wilcoxon rank-sum tests,and correlation *** The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue *** demonstrated larger measurements in pelvic depth and overall curvature,smaller measurements in pelvic width,a larger mesorectal fat area,and a larger anterior-posterior abdominal *** contrast,females exhibited wider pelvises,shallower depth,smaller overall curvature,and an increased amount of subcutaneous fat ***,there were no significant sex differences observed in certain parameters such as sacral curvature height,superior pubococcygeal diameter,rectal area,visceral fat area,waist circumference,and transverse abdominal *** The reconstruction of 3D CT data enabled accurate pelvic measurements,revealing significant sex differences in both pelvic and soft tissue *** study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially“difficult pelvis”,ultimately improving surgical ***

关键词： Computerized tomography rectal cancer Three-dimensional reconstruction Pelvimetry Sex differences

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Magnetic resonance imaging-based lymph node radiomics for predicting the metastasis of evaluable lymph nodes in rectal cancer

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1849-1860页

作者： Yong-Xia Ye Liu Yang Zheng Kang Mei-Qin Wang Xiao-Dong Xie Ke-Xin Lou Jun Bao Mei Du Zhe-Xuan Li Department of Radiology The Affiliated Cancer Hospital of Nanjing Medical University&Jiangsu Cancer Hospital&Jiangsu Institute of Cancer ResearchNanjing 210011Jiangsu ProvinceChina Department of Colorectal Surgery Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjing 210000Jiangsu ProvinceChina1 Department of Pathology The Affiliated Cancer Hospital of Nanjing Medical University&Jiangsu Cancer Hospital&Jiangsu Institute of Cancer ResearchNanjing 210011Jiangsu ProvinceChina Colorectal Center The Affiliated Cancer Hospital of Nanjing Medical University&Jiangsu Cancer Hospital&Jiangsu Institute of Cancer ResearchNanjing 210011Jiangsu ProvinceChina

BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient *** radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI)poses a *** To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable *** In this retrospective study,270 LNs(158 nonmetastatic,112 metastatic)were randomly split into training(n=189)and validation sets(n=81).LNs were classified based on pathology-MRI *** MRI features[size,shape,margin,T2-weighted imaging(T2WI)appearance,and CE-T1-weighted imaging(T1WI)enhancement]were *** radiomics models used 3D features from T1WI and T2WI ***,a nomogram model combining conventional MRI and radiomics features was *** model used univariate analysis and multivariable logistic *** employed the receiver operating characteristic curve,with DeLong test for comparing diagnostic *** performance was assessed using calibration and decision curve *** The nomogram model outperformed conventional MRI and single radiomics models in evaluating *** the training set,the nomogram model achieved an area under the curve(AUC)of 0.92,which was significantly higher than the AUCs of 0.82(P<0.001)and 0.89(P<0.001)of the conventional MRI and radiomics models,*** the validation set,the nomogram model achieved an AUC of 0.91,significantly surpassing 0.80(P<0.001)and 0.86(P<0.001),*** The nomogram model showed the best performance in predicting metastasis of evaluable LNs.

关键词： Radiomics Lymph node metastasis rectal cancer Magnetic resonance imaging

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Crossed renal ectopia with rectal cancer:A case report

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World Journal of Clinical Cases 2024年第12期12卷 2122-2127页

作者： Zhen-Wei Tang Hui-Feng Yang Zhao-Yu Wu Chang-You Wang Department of General Surgery North China University of Science and Technology Affiliated HospitalTangshan 063000Hebei ProvinceChina

BACKGROUND Crossed renal ectopia(CRE)occurs when one kidney crosses the midline from the primary side to the contralateral side while the ureter remains on the primary *** cancer,one of the most common malignant tumors of the digestive tract,refers to cancer from the dentate line to the rectosigmoid *** concurrent presentation of CRE alongside rectal cancer is an uncommon clinical *** SUMMARY Herein,we report a 69-year-old male patient with rectal cancer who was diagnosed with CRE via computed tomography during *** thorough preoperative evaluations,the patient underwent Dixon *** We performed laparoscopic radical resection of rectal cancer and adequate lymph node removal in a patient with CRE with no postoperative discomfort.

关键词： rectal cancer Crossed renal ectopia Anatomy Laparoscopic surgery Case report

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Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1271-1279页

作者： Hao Yang Gang Yang Wen-Ya Wu Fang Wang Xue-Quan Yao Xiao-Yu Wu The Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing University of Chinese MedicineNanjing 210029Jiangsu ProvinceChina Department of Surgical Oncology The Affiliated Hospital of Nanjing University of Chinese MedicineNanjing 210029Jiangsu ProvinceChina

BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely *** is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal *** To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME *** A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September *** patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was *** There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME *** were no differences in demographics,conversion rates,or postoperative complication *** L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was *** The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic *** the learning

关键词： Robotic surgery Laparoscopy rectal cancer Total mesorectal excision Elderly

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Non-operative management of rectal cancer: Highlighting the controversies

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1501-1506页

作者： Sameh Hany Emile Anjelli Wignakumar Department of Colorectal Surgery Cleveland Clinic FloridaWestonFL 33331United States

There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to *** is clearly shown by the discordance between various national and international guidelines on NOM of rectal *** main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical *** many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is ***,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.

关键词： Non-operative Management rectal cancer Highlighting Controversies

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