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中国结直肠肿瘤经自然腔道取标本手术患者短期疗效与肿瘤学预后分析:一项5055例患者的数据库研究

Science Bulletin 2022年第13期67卷 1331-1334,M0003页

作者：关旭胡茜玥姜争韦烨孙东辉吴淼周海涛姚宏亮宋军民王贵玉胡军红任明扬徐庆蔡建春彭健马丹郑阳春何庆泗江波王泽军李太原燕速陈路川李铁钢熊治国池畔康亮于刚邓小东张宏谢铭韦建宝宫红彦孙学军臧卫东宋永茂赫鹏文政琦张春旭王昱晟陈瑛罡谢光伟李明章俞少俊刘海鹰蒲敏傅传刚王锡山中国经自然腔道取标本手术联盟 department of colorectal surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China department of General surgery Zhongshan HospitalFudan UniversityShanghai 200032China department of Gastrointestinal and Anal surgery Jilin University First HospitalChangchun 130021China department of Gastrointestinal surgery The Second People’s Hospital of YibinYibin 644000China department of Gastrointestinal surgery The Second Xiangya HospitalCentral South UniversityChangsha 410011China department of Anorectal surgery First Affiliated HospitalZhengzhou UniversityZhengzhou 450052China Department of Colorectal Cancer Surgery The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150081China department of Gastrointestinal surgery Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000China department of Gastrointestinal surgery Renji HospitalShanghai JiaoTong University School of MedicineShanghai 200240China department of Gastrointestinal surgery Zhongshan Hospital of Xiamen UniversityXiamen 361004China department of General surgery Xiangya HospitalCentral South UniversityChangsha 410008China department of General surgery Xinqiao HospitalThird Military Medical UniversityChongqing 400037China department of Gastrointestinal surgery Sichuan Cancer HospitalChengdu 610041China department of General surgery Shandong University Qilu HospitalJinan 250012China department of colorectal and Anal surgery Shanxi Cancer HospitalTaiyuan 030013China department of Gastrointestinal surgery The Affiliated Cancer Hospital of Guizhou Medical UniversityGuiyang 550008China department of General surgery The First Affiliated Hospital of Nanchang UniversityNanchang 330006China department of Gastrointestinal surgery Qinghai University Affiliated HospitalXining 810012China department of Gastrointestinal surgery Fujian Medical University Cancer HospitalFuzhou 350014China Depar

经自然腔道取标本手术(NOSES)通过无切口理念与常规手术器械的结合,表现出极佳的微创效果,并带给患者全新的就医感受.目前,尽管NOSES已广泛用于结直肠肿瘤治疗,大量研究也表明相比常规腹腔镜手术,NOSES具有恢复快、创伤小、疼痛轻等优势... 详细信息

经自然腔道取标本手术(NOSES)通过无切口理念与常规手术器械的结合,表现出极佳的微创效果,并带给患者全新的就医感受.目前,尽管NOSES已广泛用于结直肠肿瘤治疗,大量研究也表明相比常规腹腔镜手术,NOSES具有恢复快、创伤小、疼痛轻等优势,但绝大多数研究均为小样本、单中心回顾性研究.本研究旨在通过分析我国5055例结直肠肿瘤NOSES患者数据,进一步探讨NOSES的短期疗效与预后.研究对象中,经直肠NOSES占整体比例的90.3%,经阴道NOSES占9.7%.NOSES术后短期并发症发生率为14.1%,吻合口瘘发生率为4.9%,腹盆腔感染率为1.9%.患者3年总生存率为93.2%,无病生存率为82.2%,局部复发率为3.6%.研究结果提示NOSES具有较好的安全性与可行性,为其应用于结直肠肿瘤治疗提供了证据.

关键词：结直肠肿瘤肿瘤学并发症发生率无病生存率吻合口瘘回顾性研究总生存率经直肠

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结直肠癌微创手术的重新评价与思考

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Gastroenterology Report 2017年第1期5卷 1-10,I0001页

作者： Mahmoud Abu Gazala Steven D.Wexner department of colorectal surgery Cleveland Clinic FloridaWestonFLUSA

纵观整个外科史,外科医师一直在努力优化外科术式,减少手术创伤。过去30年间,随着新技术和新术式的开展,结直肠微创手术取得了巨大的进展。腹腔镜手术已显示出等同于甚至优于开放术式的治疗效果。而且,腹腔镜手术已经突破了传统的界限,... 详细信息

纵观整个外科史,外科医师一直在努力优化外科术式,减少手术创伤。过去30年间,随着新技术和新术式的开展,结直肠微创手术取得了巨大的进展。腹腔镜手术已显示出等同于甚至优于开放术式的治疗效果。而且,腹腔镜手术已经突破了传统的界限,衍生出单孔腹腔镜、经自然腔道内镜手术及机器人手术等新的微创术式。本文回顾了微创手术的发展历程,并对目前各种结直肠微创术式进行了评价。

关键词：结肠癌直肠癌微创手术腹腔镜机器人手术经肛全直肠系膜切除术经自然腔道标本取出

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经自然腔道取标本手术(NOSES)治疗结直肠癌的国际共识

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Gastroenterology Report 2019年第1期7卷 24-31,I0001页

作者： Xu Guan Zheng Liu Antonio Longo Jian-Chun Cai William Tzu-Liang Chen Lu-Chuan Chen Ho-Kyung Chun Joaquim Manuel da Costa Pereira Sergey Efetov Ricardo Escalante Qing-Si He Jun-Hong Hu Cuneyt Kayaalp Seon-Hahn Kim Jim S.Khan Li-Jen Kuo Atsushi Nishimura Fernanda Nogueira Junji Okuda Avanish Saklani Ali A.Shafik Ming-Yin Shen Jung-Tack Son Jun-Min Song Dong-Hui Sun Keisuke Uehara Gui-Yu Wang Ye Wei Zhi-Guo Xiong Hong-Liang Yao Gang Yu Shao-Jun Yu Hai-Tao Zhou Suk-Hwan Lee Petr V.Tsarkov Chuan-Gang Fu Xi-Shan Wang The International Alliance of NOSES department of colorectal surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBejingChina department of Coloproctology and Pelvic Diseases Humanitas GavazzeniBergamoItaly department of Gastrointestinal surgery Zhongshan Hospital of Xiamen UniversityXiamenChina department of surgery China Medical University HospitalTaichungTaiwanChina department of Abdominal surgery Fujian Medical University Cancer HospitalFuzhouChina department of surgery Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea department of surgery Hospital de BragaBragaPortugal colorectal surgery department Sechenov First Moscow State Medical UniversityMoscowRussia Universidad Central de Venezuela Centro Medico LoiraCaracasVenezuela department of General surgery Shandong University Qilu HospitalJinanChina department of General surgery Huaihe Hospital of Henan UniversityKaifengChina department of Gastrointestinal surgery Inonu UniversityMalatyaTurkey department of surgery Korea University Anam HospitalKorea University College of MedicineSeoulSouth Korea department of colorectal surgery Portsmouth Hospitals NHS TrustQueen Alexandra HospitalPortsmouthUK Division of colorectal surgery Taipei Medical University HospitalTaipeiTaiwanChina department of surgery Nagaka Chuo General HospitalNagaoka CityJapan Innovation Unit/colorectal cancer Osaka Medical College Hospital Cancer CenterOsakaJapan department of GI Surgical Oncology Tata Memorial HospitalMumbaiIndia department of colorectal surgery Cairo UniversityCairoEgypt department of Anorectal surgery First Affiliated HospitalZhengzhou UniversityZhengzhouChina department of Gastric and colorectal surgery Jilin University First HospitalChangchunChina Division of Surgical Oncology Nagoya University Graduate School of MedicineNagoyaJapan Department of Colorectal Cancer Surgery The Second Affiliated Hospital of Harbin Medical

近年来,经自然腔道取标本手术(NOSES)治疗结直肠癌已引起了广泛关注。NOSES应用于结直肠手术的潜在优势包括减轻术后疼痛,减少伤口并发症,减少对术后镇痛的需求,加快肠道功能的恢复,缩短住院时间,更好的美容效果,以及给患者带来了更佳... 详细信息

近年来,经自然腔道取标本手术(NOSES)治疗结直肠癌已引起了广泛关注。NOSES应用于结直肠手术的潜在优势包括减轻术后疼痛,减少伤口并发症,减少对术后镇痛的需求,加快肠道功能的恢复,缩短住院时间,更好的美容效果,以及给患者带来了更佳的心理状态。尽管NOSES的手术创伤显著减轻,然而该技术也存在一些潜在问题。尤其随着这项新技术的兴起,人们对其无菌的把控、肿瘤学结果和病例选择等问题表示出关切。因此,迫切需要一部操作指南来规范NOSES手术在结直肠癌中的开展。经过国际NOSES联盟全体成员的三轮讨论,最终形成了该部共识。这一共识有助于NOSES在全球范围内的长远发展。

关键词： colorectal cancer natural orifice specimen extraction surgery(NOSES) laparoscopy natural orifice transluminal endoscopic surgery(NOTES) transanal total mesorectal excision(TaTME)

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Effect of intra-operative chemotherapy with 5-fluorouracil and leucovorin on the survival of patients with colorectal cancer after radical surgery: a retrospective cohort study

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Chinese Medical Journal 2023年第7期136卷 830-839页

作者： Xuhua Hu Zhaoxu Zheng Jing Han Baokun Li Ganlin Guo Peiyuan Guo Yang Yang Daojuan Li Yiwei Yan Wenbo Niu Chaoxi Zhou Zesong Meng Jun Feng Bin Yu Qian Liu Guiying Wang The Second department of General surgery The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China department of colorectal surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China department of Medical Oncology The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China department of cancer Institute The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China department of Pediatrics The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050001China department of General surgery The Second Hospital of Hebei Medical UniversityShijiazhuangHebei 050050China

Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.Methods:1820 patients were recruited,and 1263 received IOC and 557 did not.Clinical and demographic data were collected,including overall survival(OS),clinicopathological features,and treatment strategies.Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models.A regression model was developed to analyze the independent effects of IOC.Results:Proportional hazard regression analysis showed that IOC(hazard ratio[HR]=0.53,95%confidence intervals[CI][0.43,0.65],Psurgery.Trial registration:***,ChiCTR 2100043775.

关键词： colorectal cancer Intra-operative chemotherapy Overall survival Retrospective cohort study Stage

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Prediction of overall survival following colorectal cancer surgery in elderly patients

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World Journal of Gastrointestinal surgery 2019年第5期11卷 247-260页

作者： Isaac Seow-En Winson Jianhong Tan Sreemanee Raaj Dorajoo Sharon Hui Ling Soh Yi Chye Law Soo Yeun Park Gyu-Seok Choi Wah Siew Tan Choong Leong Tang Min Hoe Chew department of colorectal surgery Singapore General HospitalSingapore 169608Singapore department of General surgery Sengkang General HospitalSingapore 544886Singapore department of Pharmacy National University of SingaporeSingapore 117559Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore colorectal cancer Center Kyungpook National University Chilgok HospitalKyungpook National University School of MedicineDaegu 702-210South Korea

BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis.The primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)mo.Median OS was 78(IQR 65-85)mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumincancers.Despite the clinicopathologic differences,there was successful validation of the

关键词： colorectal cancer surgery Elderly Overall survival Pre-operative prognostic score

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Preoperative carcinoembryonic antibody is predictive of distant metastasis in pathologically T1 colorectal cancer after radical surgery

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World Journal of Gastroenterology 2013年第3期19卷 389-393页

作者： Zheng Lou Rong-Gui Meng Wei Zhang En-Da Yu Chuan-Gang Fu department of colorectal surgery Changhai Hospital

AIM:To identify the predictors of distant metastasis in pathologically T1(pT1)colorectal cancer(CRC)after radical resection. METHODS:Variables including age,gender,preoperative carcinoembryonic antibody(CEA)level,tumor location,tumor size,lymph node status,and histological grade were recorded.Patients with and without metastasis were compared with regard to age,gender,CEA level and pathologic tumor characteristics using the independent t test orχ 2 test,as appropriate.Risk factors were determined by logistic regression analysis. RESULTS:Metastasis occurred in 6(3.8%)of the 159 patients during a median follow-up of 67.0(46.5%) mo.The rates of distant metastasis in patients with pT1 cancer of the colon and rectum were 6.7%and 2.9%, respectively(Pcolorectal cancer.Postoperative metastasis was only significantly correlated with high preoperative serum CEA level(P=0.001).Using multivariate logistic regression analysis,high preoperative serum CEA level(P=0.004;odds ratio 15.341; 95%CI 2.371-99.275)was an independent predictor for postoperative distant metastasis. CONCLUSION:The preoperative increased serum CEA level is a predictive risk factor for distant metastasis in CRC patients after radical resection.Adjuvant chemotherapy may be necessary in such patients,even if they have pT1 colorectal cancer.

关键词： colorectal cancer Risk factor Metastasis Pathologically T1 Carcinoembryonic antigen

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评述“经自然腔道标本取出术(NOSES)治疗结直肠癌的国际共识”

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Gastroenterology Report 2020年第6期8卷 487-489,I0003页

作者： Joseph W.Nunoo-Mensah Mariam Rizk department of colorectal surgery King’s College Hospital Foundation NHS TrustLondonSE59AEUK

Natural-orifice specimen-extraction surgery(NOSES)for colorectal disease is not a new surgical procedure,although its lack of penetration into common colorectal surgical practice may make it a relatively new procedure.Stewart et al.[1]were among the first to report the extraction of a colectomy specimen through the vagina in 1991 and,shortly thereafter,Franklin et al.[2]published the first report of partial colectomy with naturalorifice specimen extraction(NOSE)via the anus.Since then,there have been several publications on the extraction of both malignant and benign colonic diseases from the caecum to the distal rectum through natural-orifice extraction sites.Unlike procedures such as laparoscopic cholecystectomy,which was introduced in 1985 and rapidly diffused into the surgical community over a 2-to 3-year period,the dispersion of NOSES has not been equivocal[3].As there are several reasons why some new surgical innovations may be taken up more quickly than others,the adoption curves of new procedures can take many forms.However,the tipping point that describes the onset of the peak rate of diffusion of the new technology usually occurs after the first 10%–20%of users have adopted it[3].From a global perspective,the adoptions curve for NOSES has not obtained a peak rate of diffusion and appears to have arrested in the developmental and explorative phase of innovation[3].

关键词： orifice colorectal Stewart

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Recurrent colorectal cancer after endoscopic resectionwhen additional surgery was recommended

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World Journal of Gastroenterology 2016年第7期22卷 2336-2341页

作者： Yukiko Takatsu Yosuke Fukunaga Shunsuke Hamasaki Atsushi Ogura Jun Nagata Toshiya Nagasaki,Takashi Akiyoshi Tsuyoshi Konishi Yoshiya Fujimoto Satoshi Nagayama Masashi Ueno department of Gastroenterological surgery Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyo 135-8550Japan

AIM: To evaluate the type of recurrence after endoscopic resection in colorectal cancer patients and whether rescue was possible by salvage operation.METHODS: Among 4972 patients who underwent surgical resection at our institution for primary or recurrent colorectal cancers from January 2005 to February 2015, we experienced eight recurrent colorectal cancers after endoscopic resection when additional surgical resection was recommended.RESULTS: The recurrence patterns were: intramural local recurrence(five cases), regional lymph node recurrence(three cases), and associated with simultaneous distant metastasis(three cases). Among five cases with lymphatic invasion observed histologically in endoscopic resected specimens, four cases recurred with lymph node metastasis or distant metastasis. All cases were treated laparoscopically and curative surgery was achieved in six cases. Among four cases located in the rectum, three cases achieved preservation of the anus. Postoperative complications occurred in two cases(enteritis).CONCLUSION: For high-risk submucosal invasive colorectal cancers after endoscopic resection, additional surgical resection with lymphadenectomy is recommended, particularly in cases with lymphovascular invasion.

关键词： colorectal neoplasms colorectal surgery Laparoscopy Endoscopy Recurrence

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Incidence trends and predictors for cost and average lengths of stay in colorectal cancer surgery

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World Journal of Gastroenterology 2014年第2期20卷 532-538页

作者： Daw-Shyong Perng I-Cheng Lu Hon-Yi Shi Chih-Wen Lin Kuang-Wen Liu Ya-Fen Su King-Teh Lee department of Medicine E-Da Hospital I-Show University Graduate Institute of Healthcare Administration Kaohsiung Medical University Division of colorectal surgery Department of SurgeryE-Da Hospital

AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cancer surgery at E-Da Hospital in Taiwan from 2004 to 2009.These patients were from health examination,inpatient or emergency settings.The following attributes were analyzed in patients who had undergone CRC surgical procedures:gender,age,source,surgical type,tumor number,tumor size,number of lymph node metastasis,pathologic differentiation,chemotherapy,distant metastases,tumor site,tumor stage,average hospitalization cost and average lengths of stay(ALOS).The odds ratio and95%confidence intervals were calculated to assess the relative rate of change.Regression models were employed to predict average hospitalization cost and ALOS.RESULTS:The study sample included 458(58.87%)males and 320(41.13%)females with a mean age of64.53 years(standard deviation,12.33 years;range,28-86 years).The principal patient source came from inpatient and emergency room(96.02%).The principal tumor sites were noted at the sigmoid colon(35.73%)and rectum(30.46%).Most patients exhibited a tumor stage of 2(37.28%)or 3(34.19%).The number of new CRC surgeries performed per 100000 persons was12.21 in 2004 and gradually increased to 17.89 in 2009,representing a change of 46.52%.During the same period,the average hospitalization cost and ALOS decreased from$5303 to$4062 and from 19.7 to 14.4 d,respectively.The following factors were associated with considerably decreased hospital resource utilization:age,source,surgical type,tumor size,tumor site,and tumor stage.CONCLUSION:These results can be generalized to patient populations elsewhere in Taiwan and to other countries with similar patient profiles.

关键词： colorectal cancer Average hospitalization cost Ave

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Outcomes after natural orifice extraction vs conventional specimen extraction surgery for colorectal cancer: A propensity scorematched analysis

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World Journal of Clinical Oncology 2022年第10期13卷 789-801页

作者： Isaac Seow-En Lionel Raphael Chen Yi-Xin Li Yun Zhao Jing-Hui Chen Hairil Rizal Abdullah Emile Kwong-Wei Tan department of colorectal surgery Singapore General HospitalSingapore 169608Singapore department of surgery Duke-NUS Graduate Medical SchoolSingapore 169857Singapore department of Anaesthesiology Singapore General HospitalSingapore 169608Singapore

BACKGROUND Natural orifice specimen extraction(NOSE)via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision.Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma.These techniques reduce the surgical wound size as well as the risk of incisionrelated morbidity.AIM To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery.METHODS Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified.Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction surgery for colorectal cancer.Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded.The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020.Matching was performed in the ratio of 1:4 based on age,gender,type of resection,and p-tumor node metastasis staging.RESULTS Over the eight-month study duration,14 consecutive cases(nine female,five male)of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer.Median age and body mass index were 70(range 43-82)years and 24.1(range 20.0-31.7)kg/m2 respectively.Six patients underwent transanal NOSE and eight had transvaginal NOSE.Median operative time,intraoperative blood loss and postoperative length of stay were 208(range 165-365)min,30(range 10-150)mL and 3(range 2-6)d respectively.Two(14%)suffered minor postoperative compilations not attributable to the NOSE procedure.Median follow-up duration was 12(range 8-15)mo.No instances of mortality,local or distant disease recurrence were recorded in this cohort.Compared to the conventional surgery cohort of 56 patients,the 3-port NOSE cohort had significantly quicker mean

关键词： 3-port laparoscopy colorectal surgery Natural orifice specimen extraction Transanal Transvaginal Minimally invasive surgery

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