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Morphology of the anterior mesorectum:a new predictor for local recurrence in patients with Rectal cancer

Chinese Medical Journal 2022年第20期135卷 2453-2460页

作者： Xiaojie Wang Zhifang Zheng Min Chen Jing Lin Xingrong Lu Ying Huang Shenghui Huang Pan Chi Department of Colorectal Surgery Union HospitalFujian Medical UniversityFuzhouFujian 350001China Department of Gynaecology and Obstetrics Fujian Provincial Maternity and Children's HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouFujian 350001China Integrated Information Section Fujian Children's HospitalFuzhouFujian 350001China

Background:Pre-operative assessment with high-resolution magnetic resonance imaging(MRI)is useful for assessing the risk of local recurrence(LR)and survival in Rectal cancer.However,few studies have explored the clinical importance of the morphology of the anterior mesorectum,especially in patients with anterior cancer.Hence,the study aimed to investigate the impact of the morphology of the anterior mesorectum on LR in patients with primary Rectal cancer.Methods:A retrospective study was performed on 176 patients who underwent neoadjuvant treatment and curative-intent surgery.Patients were divided into two groups according to the morphology of the anterior mesorectum on sagittal MRI:(1)linear type:the anterior mesorectum was thin and linear;and(2)triangular type:the anterior mesorectum was thick and had a unique triangular shape.Clinicopathological and LR data were compared between patients with linear type anterior mesorectal morphology and patients with triangular type anterior mesorectal morphology.Results:Morphometric analysis showed that 90(51.1%)patients had linear type anterior mesorectal morphology,while 86(48.9%)had triangular type anterior mesorectal morphology.Compared to triangular type anterior mesorectal morphology,linear type anterior mesorectal morphology was more common in females and was associated with a higher risk of circumferential resection margin involvement measured by MRI(35.6%[32/90]vs.16.3%[14/86],P=0.004)and a higher 5-year LR rate(12.2%vs.3.5%,P=0.030).In addition,the combination of linear type anterior mesorectal morphology and anterior tumors was confirmed as an independent risk factor for LR(odds ratio=4.283,P=0.014).Conclusions:The classification established in this study was a simple way to describe morphological characteristics of the anterior mesorectum.The combination of linear type anterior mesorectal morphology and anterior tumors was an independent risk factor for LR and may act as a tool to assist with LR risk stratification and treatment selection.

关键词： Local recurrence Magnetic resonance imaging Morphology of the anterior mesorectum Rectal cancer

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Parallel pathways:A chronicle of evolution in rectal and breast cancer surgery

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1091-1096页

作者： Antonio Pesce NicolòFabbri Diletta Iovino Carlo Vittorio Feo Unit of General Surgery University of FerraraAzienda USL of FerraraFerrara 44023LagosantoItaly

In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.

关键词： Rectal cancer History Breast surgery Demolitive treatment Conservative surgery

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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 cavities.Therefore,it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical difficulties.AIM To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for Rectal cancer.METHODS We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincterpreserving surgery for Rectal cancer.Three-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography(CT)scans.Operative difficulty was categorized as either high or low,and multivariate logistic regression analysis was employed to identify predictors of operative difficulty,ultimately creating a nomogram.RESULTS 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 group.Multivariate 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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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： Yang, Hao Yang, Gang Wu, Wen-Ya Wang, Fang Yao, Xue-Quan Wu, Xiao-Yu Nanjing Univ Chinese Med Affiliated Hosp Nanjing 210029 Jiangsu Peoples R China Nanjing Univ Chinese Med Dept Surg Oncol Affiliated Hosp 155 Hanzhong Rd Nanjing 210029 Jiangsu Peoples R China

BACKGROUND Da Vinci Robotics-assisted total mesorectal excision (TME) surgery for Rectal cancer is becoming more widely used. There is no strong evidence that robotic-assisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for Rectal cancer. AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery. METHODS 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 2023. The patients were divided into a robot-assisted group (the R-TME group) and a laparoscopic group (the L-TME group), and the short-term efficacy of the two groups was compared. RESULTS There were 45 elderly patients (>= 60 years) in the R-TME group and 50 elderly patients (>= 60 years) in the L-TME group. There were no differences in demographics, conversion rates, or postoperative complication rates. The 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 outcomes 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 restored. CONCLUSION 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 an

关键词： Robotic surgery Laparoscopy Rectal cancer Total mesorectal excision Elderly RESECTION CONVERSION

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The“terminal line”:a novel sign for the identification of distal mesorectum end during TME for Rectal cancer

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Gastroenterology Report 2022年第1期10卷 468-475页

作者： Waleed M.Ghareeb Xiaojie Wang Xiaozhen Zhao Meirong Xie Sameh H.Emile Sherief Shawki Pan Chi Department of Colon and rectal Surgery Union Hospital of Fujian Medical UniversityFuzhouFujianP.R.China Department of Surgery Faculty of MedicineSuez Canal UniversityIsmailiaEgypt Department of Colon and rectal Surgery Mayo ClinicRochesterMNUSA Laboratory of Clinical Applied Anatomy Fujian Medical UniversityFuzhouFujianP.R.China Basic Medical College Fujian Medical UniversityFuzhouFujianP.R.China Department of Colorectal Surgery Cleveland Clinic FloridaWestonFLUSA Colorectal Surgery Unit General Surgery DepartmentMansoura University HospitalsMansouraEgypt

Background:Although the clinical importance of complete,intact total mesorectal excision(TME)is the widely accepted standard for decreasing local recurrence of Rectal cancer,the residual mesorectum still represents a significant component of resection margin involvement.This study aimed to use a visible intraoperative sign to detect the distal mesorectal end to ensure complete inclusion of the mesorectum and avoid unnecessary over-dissection.Methods:The distal mesorectum end was investigated retrospectively through a review of 124 operative videos at the Union Hospital of Fujian Medical University(Fujian,China)and Cleveland Clinic(Ohio,USA)by two independent surgeons who were blinded to each other.Furthermore,28 cadavers and 44 post-operative specimens were prospectively examined by hematoxylin and eosin(H&E)staining and Masson’s staining to validate and confirm the findings of the retrospective part.Univariate and multivariate analyses were carried out to detect the independent factors that can affect the visualization of the distal mesorectal end.Results:The terminal line(TL)is the distal mesorectal end of the transabdominal and transanal TME(taTME)and appears as a remarkable pearly white fascial structure extending posteriorly from 2 to 10 o’clock.Histopathological examination revealed that the fascia propria of the rectum merges with the presacral fascia at the TL,beyond which the mesorectum ends,with no further downward extension.In the retrospective observation,the TL was seen in 56.6%of transabdominal TME and 56.0%of taTME operations.Surgical approach and tumor distance from the anal verge were the independent variables that directly influenced the detection of the TL(P=0.03 and P=0.01).Conclusion: The TL is a visible sign where the transabdominal TME should end and the taTME should begin. Recognitionof the mesorectal end may impact the certainty of complete mesorectum inclusion. Further clinical trials are needed toconfirm the preliminary findings.

关键词： Rectal cancer total mesorectal excision taTME TAMIS laparoscopy robotic

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Mechanisms of microRNA action in Rectal cancer radiotherapy

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Chinese Medical Journal 2022年第17期135卷 2017-2025页

作者： Lili Zhu Mojin Wang Na Chen Yujie Zhang Tao Xu Wen Zhuang Shuomeng Xiao Lei Dai Department of Gastrointestinal Surgery West China HospitalSichuan UniversityChengduSichuan 610041China State Key Laboratory of Biotherapy and cancer Center West China HospitalSichuan University and Collaborative Innovation Center for BiotherapyChengduSichuan 610041China Department of Gastrointestinal Surgery Sichuan Cancer Hospital and InstituteChengduSichuan 610041China

Preoperative neoadjuvant chemoradiotherapy,combined with total mesorectal excision,has become the standard treatment for advanced localized Rectal cancer(RC).However,the biological complexity and heterogeneity of tumors may contribute to cancer recurrence and metastasis in patients with radiotherapy-resistant RC.The identification of factors leading to radioresistance and markers of radiosensitivity is critical to identify responsive patients and improve radiotherapy outcomes.MicroRNAs(miRNAs)are small,endogenous,and noncoding RNAs that affect various cellular and molecular targets.miRNAs have been shown to play important roles in multiple biological processes associated with RC.In this review,we summarized the signaling pathways of miRNAs,including apoptosis,autophagy,the cell cycle,DNA damage repair,proliferation,and metastasis during radiotherapy in patients with RC.Also,we evaluated the potential role of miRNAs as radiotherapeutic biomarkers for RC.

关键词： MicroRNAs Rectal cancer Radiotherapy Mechanisms

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Transanal total mesorectal excision combined with intersphincteric resection has similar long-term oncological outcomes to laparoscopic abdominoperineal resection in low Rectal cancer:a propensity score-matched cohort study

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Gastroenterology Report 2022年第1期10卷 377-385页

作者： Zhi-Hang Liu Zi-Wei Zeng Hai-Qing Jie Liang Huang Shuang-Ling Luo Wen-Feng Liang Xing-Wei Zhang Liang Kang Department of Colorectal Surgery The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China

Background Transanal total mesorectal excision(taTME)or intersphincteric resection(ISR)has recently proven to be a valid and safe surgical procedure for low Rectal cancer.However,studies focusing on the combination of these two technologies are limited.This study aimed to evaluate perioperative results,long-termoncologic outcomes,and anorectal functions of patients with low Rectal cancer undergoing taTME combined with ISR,by comparing with those of patients undergoing laparoscopic abdominoperineal resection(laAPR).Methods After 1:1 propensity score matching,200 patients with low Rectal cancer who underwent laAPR(n=100)or taTME combined with ISR(n=100)between September 2013 and November 2019 were included.Patient demographics,clinicopathological characteristics,oncological outcomes,and anal functional results were analysed.Results Patients in the taTME-combined-with-ISR group had less intraoperative blood loss(79.6672.6 vs 107.3665.1 mL,P=0.005)and a lower rate of post-operative complications(22.0%vs 44.0%,PRectal cancer undergoing laAPR and those undergoing taTME combined with ISR.Patients receiving taTME combined with ISR had acceptable post-operative anorectal function.

关键词： Rectal cancer transanal totalmesorectal excision laparoscopic abdominoperineal resection oncological outcomes

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Treatment of anastomotic stricture after Rectal cancer operation by magnetic compression technique: A case report

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WORLD JOURNAL OF GASTROINTESTINAL SURGERY 2024年第5期16卷 1443-1448页

作者： Zhang, Miao-Miao Sha, Huan-Chen Xue, Hai-Rong Qin, Yuan-Fa Dong, Fang-Fang Zhang, Li Lyu, Yi Yan, Xiao-Peng Xi An Jiao Tong Univ Affiliated Hosp 1 Dept Hepatobiliary Surg 277 West Yanta Rd Xian 710061 Shaanxi Peoples R China Xi An Jiao Tong Univ Affiliated Hosp 1 Shaanxi Prov Key Lab Magnet Med Xian 710061 Shaanxi Peoples R China Xi An Jiao Tong Univ Affiliated Hosp 1 Dept Gastroenterol Xian 710061 Shaanxi Peoples R China

BACKGROUND The treatment of postoperative anastomotic stenosis (AS) after resection of coloRectal cancer is challenging. Endoscopic balloon dilation is used to treat stenosis in such cases, but some patients do not show improvement even after multiple balloon dilations. Magnetic compression technique (MCT) has been used for gastrointestinal anastomosis, but its use for the treatment of postoperative AS after coloRectal cancer surgery has rarely been reported. CASE SUMMARY We report a 72-year-old man who underwent radical resection of coloRectal cancer and ileostomy one year ago. An ileostomy closure was prepared six months ago, but colonoscopy revealed a narrowing of the rectal anastomosis. Endoscopic balloon dilation was performed three times, but colonoscopy showed no significant improvement in stenosis. The AS was successfully treated using MCT. CONCLUSION MCT is a minimally invasive method that can be used for the treatment of postoperative AS after coloRectal cancer surgery.

关键词： Rectostenosis Magnetic surgery Magnetic Surgery Clinic Rectal cancer Magnetic compression technique Case report OSTOMY

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Predictors of complications after prophylactic ileostomy reversal for Rectal cancer: A retrospective study

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WORLD JOURNAL OF GASTROINTESTINAL SURGERY 2024年第5期16卷 1354-1362页

作者： Lv, Quan Shu, Xin-Peng Peng, Dong Li, Si-Qi Xiang, Zheng Chongqing Med Univ Dept Gastrointestinal Surg Affiliated Hosp 1 1 Youyi Roud Chongqing 400016 Peoples R China Chongqing Med Univ Affiliated Hosp 1 Chongqing Key Lab Dept Gen Surg Chongqing 400016 Peoples R China

BACKGROUND Previous studies have analyzed the risk factors for complications after ileostomy reversal for Rectal cancer (RC), but there were significant differences in the reported risk factors for complications after stoma reversal. No studies have analyzed the risk factors for stoma-related complications and overall postoperative complications separately. AIM To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC. METHODS This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022. Continuous variables are expressed as the mean +/- SD and were analyzed with independent-sample t tests, while frequency variables are expressed as n (%), and the chi(2) test or Fisher's exact test was used. Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications. RESULTS The overall complication rate after ileostomy reversal was 11.4%. Patients with lower preoperative albumin concentration (P < 0.01), greater blood loss (P = 0.017), and longer operative times (P < 0.01) were more likely to experience postoperative complications. The incidence of stoma-related complications was 6.4%. Analysis of the study showed that a higher body mass index (BMI) (P < 0.01), preoperative comorbid hypertension (P = 0.049), time from primary surgery to ileostomy reversal (P < 0.01) and longer operation time (P = 0.010) were more likely to result in stoma-related complications postoperatively. Multivariate logistic regression analysis revealed that a lower preoperative albumin level (P < 0.01, OR = 0.888, 95%CI: 0.828-0.958) was an independent risk factor for overall complications. Moreover, multivariate analysis revealed that BMI (P < 0.01, OR = 1.176, 95%CI: 1.041-1.330) and time from primary surgery to ileostomy reversal (P < 0.01, OR = 1.140, 95%CI: 1.038-1.252) were independent ri

关键词： Ileostomy Reversal Risk factors Complications Rectal cancer LOW ANTERIOR RESECTION RISK-FACTORS ANASTOMOTIC LEAKAGE COLOrectal-cancer SERUM-ALBUMIN CLOSURE STOMA MORBIDITY METAANALYSIS REOPERATION

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Predictors of pathologic complete response in patients with residual flat mucosal lesions after neoadjuvant chemoradiotherapy for locally advanced Rectal cancer

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Chinese Journal of cancer Research 2022年第4期34卷 383-394页

作者： Changlong Li Zhen Guan Yi Zhao Tingting Sun Zhongwu Li Weihu Wang Zhexuan Li Lin Wang Aiwen Wu Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Department of RadiologyPeking University Cancer Hospital&InstituteBeijing 100142China Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Department of PathologyPeking University Cancer Hospital&InstituteBeijing 100142China Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Department of Radiation OncologyPeking University Cancer Hospital&InstituteBeijing 100142China Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Department of Cancer EpidemiologyPeking University Cancer Hospital&InstituteBeijing 100142China

Objective:The accurate prediction of tumor response to neoadjuvant chemoradiotherapy(nCRT)remains challenging.Few studies have investigated pathologic complete response(ypCR)prediction in patients with residual flat mucosal lesions after treatment.This study aimed to identify variables for predicting ypCR in patients with residual flat mucosal lesions after nCRT for locally advanced Rectal cancer(LARC).Methods:Data of patients with residual flat mucosal lesions after nCRT who underwent radical resection between 2009 and 2015 were retrospectively collected from the LARC database at Peking University cancer Hospital.Univariate and multivariate analyses of the association between clinicopathological factors and ypCR were performed,and a nomogram was constructed by incorporating the significant predictors.Results:Of the 246 patients with residual flat mucosal lesions included in the final analysis,56(22.8%)had ypCR.Univariate and multivariate analyses showed that pretreatment cT stage(pre-cT)≤T2(P=0.016),magnetic resonance tumor regression grade(MR-TRG)1-3(P=0.001)and residual mucosal lesion depth=0 mm(P<0.001)were associated with a higher rate of ypCR.A nomogram was developed with a concordance index(C-index)of0.759 and the calibration curve showed that the nomogram model had good predictive consistency.The follow-up time ranged from 3.0 to 113.3 months,with a median follow-up time of 63.77 months.The multivariate Cox regression model showed that the four variables in the nomogram model were not risk factors for disease-free survival(DFS)or overall survival(OS).Conclusions:Completely flat mucosa,early cT stage and good MR-TRG were predictive factors for ypCR instead of DFS or OS in patients with LARC with residual flat mucosal lesions after nCRT.Endoscopic mucosal re-evaluation before surgery is important,as it may contribute to decision-making and facilitate nonoperative management or organ preservation.

关键词： Rectal cancer preoperative chemoradiotherapy tumor regression grade flat mucosal lesions pathologic complete response

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