Colorectal cancer is the second largest cause of cancer-related death in the world, and ranks as the third most common malignant tumor in the world. Approximately 25% of patients present with colorectal liver metastases(CRLM) at first diagnosis, and surgical treatment is often considered necessary for the potential long-term survival of patients with CRLM. The median overall survival (OS) of patients who achieved R0 resection in CRLM was 42 months, and the 5-year survival rate was 35%~40%. The initial resectable rate is less than 20%. Therefore, surgical resection of initial unresectable CRLM after conversion therapy will significantly improve the prognosis of patients with CRLM. In this review, we introduce the latest literature on initial unresectable CRLM conversion therapy,and discuss the advances in diagnosis, treatment methods and therapeutic effects, so as to guide clinical practice.
The role of intraoperative near-infrared fluorescence angiography with indocyanine green in reducing anastomotic leakage (AL) has been demonstrated in colorectal surgery, however, its perfusion assessment mode, and efficacy in reducing anastomotic leakage after laparoscopic intersphincteric resection (LsISR) need to be further elucidated. Aim was to study near-infrared fluorescent angiography to help identify bowel ischemia to reduce AL after LsISR. A retrospective case-matched study was conducted in one referral center. A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL). After matching, the study group (n = 109) and control group (n = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6
Objective:We analyzed the clinical data of patients treated by colonoscope assisted transcolonic specimen extraction surgery, summarized the clinical treatment experience, and explored its clinical feasibility.Methods:The clinical data, surgical methods, pathology, and follow-up results of 8 colonic neoplasm patients treated with transcolonic NOSES in the First Affiliated Hospital of Zhengzhou University from January 2016 to May 2022 were analyzed retrospectively.Results:The tumors were completely resected in all 8 patients, and the specimens were successfully extracted through anus by colonoscope. The median operation time was 190 (160, 210) minutes. The median intraoperative blood loss was 60 (40, 80) mL. The median VAS pain score was 4 (2, 5) on the first day after operation. The median number of lymph nodes retrieved was 13 (12, 14). There was one case of pulmonary infection on the fourth day after operation, and one case of ileus on the sixth day after operation. Both recovered after conservative symptomatic treatment. No patient had anastomotic leakage and abdominal infection. Follow up for 6 to 50 months showed no implantation, recurrence, or death.Conclusion:Colonoscope assisted transcolonic specimen extraction surgery is a safe, reliable and effective surgical method with excellent application prospects and clinical value.
Recently, due to the improvement of surgical techniques, there are more and more units in China that carry out lateral lymph nodes dissection (LLND) for rectal cancers. However, there are still some controversies over the diagnostic criteria for lateral lymph nodes metastases, indications for surgery, whether the patient benefits and other aspects. This article reviewed the historical studies of lateral lymph nodes dissection, and also reviewed key issues such as the feasibility of prophylactic lateral lymph nodes dissection, the relationship between LLND and neoadjuvant chemoradiotherapy(nCRT), and the optimal surgical indications, provided a reference for follow-up studies.
Currently, the incidence of colorectal cancer is increasing year by year, and the mortality rate also ranks among the front of malignant tumors. The proportion of rectal cancer is also increasing year by year, and most of them are locally advanced rectal cancer(LARC) with extremely poor prognosis. Preoperative neoadjuvant therapy for LARC has been widely recognized in clinical practice, and how to accurately predict the efficacy of neoadjuvant therapy has been a hot spot of scholars' attention. In recent years, many scholars have explored that some blood biomarkers have good predictive ability for the efficacy of neoadjuvant therapy. Reviewing the studies in the field of rectal cancer, these blood biomarkers can be broadly divided into three directions: inflammation-related biomarkers, nutrition-related biomarkers, and intestine-specific tumor markers. For these biomarkers, different scholars have adopted different time points for sampling, mainly including before, during and after neoadjuvant therapy. In this paper, we review and summarize the research progress of these blood biomarkers in the neoadjuvant treatment of rectal cancer based on previous studies.
The number of colorectal cancer patients is increasing year by year and the proportion of patients with locally advanced cancer was higher in China. The Pelvic tissue can be invaded by tumor, especially in the cases with upper rectal cancer or sigmoid cancer. The bladder is the most commonly invaded tissue. There are some controversies about surgical treatment for locally advanced rectal cancer. In this video, laparoscopic expanded radical resection for rectal cancer with bladder invasion was shown, and partial cystectomy also has been performed in this case. Postoperatively, six cycles of adjuvant chemotherapy (Xelox) was performed for the patient, and no obvious recurrence was observed during one year follow-up. The appropriate treatment plan should be formulated according to the state of the tumor, especially in the cases with locally advanced rectal cancer with bladder invasion with the purpose of increasing the chance of R0 resection.
Colorectal cancer ranks top three on the morbidity and is the second most common cause of cancer death globally. The tumorigenesis of colorectal cancer is closely related to the tumor microenvironment, in which cancer-associated fibroblasts have the capacity of controlling cancer progression. A better understanding of cancer-associated fibroblasts may help us develop new ways of cancer diagnosis, treatment, and prognosis. Herein, we introduce the origin and heterogeneity of cancer-associated fibroblasts, also summarize the role of cancer-associated fibroblasts in colorectal cancer cell proliferation, metastasis, remodeling of extracellular matrix, angiogenesis, tumor immunity, chemotherapy resistance, as well as discussing new advances in targeted therapy.
Right hemicolectomy is currently the most important and effective method for the treatment of right hemicolectomy. With the development of surgical technology, right hemicolectomy has also ushered in many new surgical methods and challenges. From open surgery to laparoscopic surgery, minimally invasive surgery has attracted the attention of surgeons. At present, more and more patients benefit from minimally invasive surgery, which also motivates colorectal surgeons to take on new challenges with minimally invasive techniques for right hemicolectomy. The exploration from conventional five-hole laparoscopy to three-hole laparoscopy and the innovation of single-hole laparoscopy have also aroused more attention and controversy. However, the application of robot represents another great progress in surgical technology. Robotic surgery is better than laparoscopic surgery for early postoperative recovery and the number of lymph nodes obtained. However, whether robotic surgery can bring long-term benefits to patients is the main research goal of surgeons. In addition, the current unified idea for right hemicolectomy is total mesocolectomy and whether D3 lymph node dissection is a hot topic of discussion. Ileocolon anastomosis after right hemicolectomy has also become a problem of current concern. No consensus has been reached between in vivo anastomosis and in vitro anastomosis, and the main concern is the occurrence of abdominal infection. This paper will review the hot topics and controversies in the study of right hemicolectomy.
Objective:Laparoscopic intersphincter resection (Ls-ISR) has been used as an extreme anal sparing surgery for low rectal cancer within 5 cm of the anal margin. However, the long-term oncological outcomes and risk factors affecting survival need further clarification.Methods:We retrospectively analyzed patients treated with Ls-ISR between 2012 and 2018. Cox regression analysis of OS and DFS prognostic factors. Kaplan-Meier survival curve was plotted according to prognostic risk factors by Log-rank test.Results:A total of 177 patients were included in the study, and the median follow-up time was 60 months. Among which, six patients had local recurrence, twenty-five patients had distant metastasis, and 28 patients died. The 1-year, 3-year and 5-year OS rates were 96.0%, 88.7% and 85.2%, respectively. The 1-year, 3-year and 5-year DFS were 94.4%, 85.3 % and 80.0%, respectively, and 5-year cancer-specific survival (CSS) was 88.1%. Univariate analysis showed that age over 60 years, lymph-vascular invasion, nerve invasion, (y)pT3 stage and low differentiation were common risk factors for OS and DFS, and (y)pN+ was a risk factor for DFS. In multivariate analysis, age over 60 years (HR=2.515, 95%CI=1.121~5.642, P=0.025) and (y)pT3 stage (HR=2.591, 95%CI=1.006~6.672, P=0.049) were independent risk factors for OS. Age over 60 years (HR=1.758, 95%CI=1.061~2.912, P=0.028), (y)pT3 stage (HR=2.010, 95%CI=1.090~3.710, P=0.025), (y)pN+ (HR=2.347, 95%CI=1.397~3.945, P=0.001) were independent risk factors for DFS.Conclusions:Age and stage are important factors affecting the prognosis of low rectal cancer Ls-ISR. Preoperative evaluation of primary tumor stage and lymph node metastasis in order to develop the best surgical treatment strategy.
Lateral pelvic lymph node metastasis is the main cause of the recurrence of rectal cancer, and surgery is the main treatment method. However, in terms of treatment, whether to regard lateral lymph node dissection as the standard treatment, or to treat lateral lymph node metastasis as distant metastasis with radiotherapy and chemotherapy as the main treatment method, Eastern and Western scholars hold different views. In addition, due to the complicated operation of lateral lymph node dissection, it may bring serious postoperative complications. Besides, tissue swelling and fibrosis may occur after neoadjuvant therapy, which also increase the difficulty of the operation. As a result, the deployment of the technology is limited. Therefore, controlling the occurrence of postoperative complications and evaluating the surgical indications are too important to be ignored in the development of the lateral lymph node dissection treatment strategy.
Objective:To analyze the learning curve of fascia space priority approach laparoscopic lateral lymph node dissection in rectal cancer by a retrospective study.Methods:The clinical data of 108 patients who had fascia space priority approach laparoscopic lateral lymph node dissection in the initial stage in Tianjin Union Medical Center from June 2017 to April 2022 were collected. CUSUM curve analysis was performed on the operative time and intraoperative blood loss, so as to obtain the learning curve of the technique. The cut-off value was determined by the learning curve and then group analysis was taken.Results:A total of 108 patients were included. The cut-off value of operation time and intraoperative blood loss was 30 cases analyzed by CUSUM curve, including 12 cases with bilateral dissection, so a total of 42 unilateral lateral node dissection were performed. The 108 patients were divided into 3 groups, including 30 cases in the learning improvement stage, thirty cases and 48 cases in the proficiency stage. There were no statistically significant differences in baseline level and pathological condition among the three groups, while there were statistically significant differences in operative time and intraoperative bleeding. Learning time in the learning improvement stage was significantly higher than that in the proficiency stage (442.7 min vs. 356.5 min, 428.4 min, F=10.768, P＜0.01). Intraoperative blood loss in the learning improvement stage was significantly higher than that in the proficiency stage (200 mL vs. 150 mL, 150 mL, H=8.839,P=0.012).Conclusion:In order to enter proficiency stage, thirty cases (42 unilateral) of fascia space priority approach laparoscopic lateral lymph node dissection are necessary, that means it can be considered to have passed the learning curve and mastered the technique after 30 cases (42 unilateral) of this procedure conducted.
In recent years, the morbidity and mortality of colorectal cancer have been increasing, and the comprehensive treatment strategy based on surgery is the main treatment mode of colorectal cancer. The number of lymph nodes detected after colorectal cancer surgery is a necessary guarantee and prerequisite for evaluating the quality of surgery and achieving accurate tumor staging, and it also has important clinical significance for patients' follow-up treatment decisions. A large number of studies have shown that the number of lymph nodes detected is affected by various factors such as the overall treatment strategy, surgical resection, pathological detection techniques, individual differences in patients, and tumor heterogeneity. This has also led to increasing controversy over the requirement of "at least 12 lymph nodes to be harvested" in clinical guidelines. Based on this situation, the research on individualized detection of lymph nodes has become a hot topic in this field, which is also an important means and development trend that is expected to ensure the scientificity of lymph node detection. At present, cutting-edge technologies such as multi-omics data application and artificial intelligence analysis have also been gradually applied to the exploration of individualized detection of lymph nodes, and certain clinical results have been achieved, but most of the research results have yet to be transformed. Therefore, we also look forward to more high-quality clinical studies in the future to explore the individualized detection of lymph nodes, so as to better improve clinical staging, guide treatment and determine prognosis.
Objective:To explore the short-term outcomes of totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery in the surgical treatment of splenic flexure cancer.Methods:We retrospectively collected the 23 patients diagnosed with splenic flexure cancer who underwent the totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery in National Cancer Center/National Clinical Research Center for Cancer /Cancer Hospital from January 2018 to January 2022. Baseline variables, surgical outcomes, pathological characteristics, postoperative recovery and complications were analyzed.Results:All patients have successfully undergone the totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery. The median operation time was 165 min. The median estimated blood loss was 40 mL and the median incisional length was 5.0 cm. With regard to pathological characteristics, the median length of tumor was 4.3 cm. The median proximal and distal resection margin was 13.2 cm and 12.1 cm, respectively. The median time to first ground activities, first oral intake, first flatus passage, first defecation, and postoperative hospital stay were 17.5 h, 12 h, 33.5 h, 55.5 h, 5 d, respectively. One patient suffered from the abdominal infection, which was controlled after antibiotic therapy. Other patients were not suffered from incisional infection, anastomotic leakage, abdominal bleeding or intestinal obstruction during the 30-day follow-up period.Conclusion:Totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery could be applied in the surgical treatment of splenic flexure cancer with satisfactory short-term outcomes. But the long-term outcomes need to be explored.
Total mesorectal excision (TME) is the gold standard for surgical treatment of rectal cancer. In contrast, whether to add lateral lymph node dissection (LLND) is still controversial worldwide. By reviewing the research literature related to lateral lymph node dissection for rectal cancer in recent years, this paper summarizes the current research status, controversies, surgical techniques and approaches of lateral lymph node dissection, in order to comprehensively discuss the application status of lateral lymph node dissection in rectal cancer, and the research worth in the future. To provide theoretical support and literature reference for the accurate application of lateral lymph node dissection in rectal cancer.
Objective:To investigate the clinical and immunohistochemical features, treatment and prognosis of medullary carcinoma of colon (MC) .Methods:The clinical data of 9 patients with colonic MC from March 2019 to March 2022 were collected retrospectively, the clinicopathologic and molecular pathological features were analyzed with literature review.Results:Of the 9 patients, five were male and 4 were female, aged 30~84 years, 89% of them were in the right colon, seven cases were in Stage Ⅰ~Ⅱ, two cases were in Stage Ⅲ. The histopathologic features of the tumor were patchy and streaked infiltration of atypical cells, unclear cell boundaries, eosinophilic cytoplasm, vacuolated nuclei and prominent nucleoli, multiple lymphocyte infiltrates into the stroma and some of the tumor cells. The results of immunohistochemistry showed that MLH1 and PMS2 were absent in 8 cases, while CD20, CDX2 and P53 were mostly negative, which were different from common adenocarcinoma. No recurrence was found in the postoperative follow-up.Conclusion:Medullary carcinoma of the colon is a rare poorly differentiated or undifferentiated tumor of the colon. Its clinical manifestation and immunohistochemical features are obviously different from those of common adenocarcinoma, but the prognosis is relatively good.
Objective:To compare the curative effect of transverse colon resection and extended colon resection in the treatment of transverse colon cancer, and to find a suitable surgical method to provide reference for clinical treatment.Methods:The clinicopathological data of patients with transverse colon cancer who received surgical treatment in the gastrointestinal surgery department of Guangdong Provincial People's Hospital from January 2006 to December 2019 were collected. Analyze the differences in surgical survival and clinical indicators between the two groups.Results:A total of 366 patients were included, including 58 cases of transverse colon resection and 308 cases of extended colon resection. There was no significant difference in 5-year overall survival rate and 5-year disease-free survival rate between the transverse colon resection group and the extended colon resection group (all P＞0.05).There was no significant difference in the 5-year overall survival rate between the transverse colon resection group and the extended colon resection group in patients with TNM stage I, II and III (all P＞0.05).The amount of intraoperative bleeding in the transverse colon resection group was less than that in the extended colon resection group [(55.0±29.0) mL, (96.9±28.3) mL], and the number of lymph nodes cleared in the transverse colon resection group was less than that in the extended colon resection group [(19.5±8.4), (23.1±11.4)], which were statistically significant (all P＜0.05).The results of univariate analysis showed that postoperative T stage, postoperative N stage, vascular cancer thrombus invasion, postoperative chemotherapy, surgical approach, tumor gross classification, and tumor differentiation were risk factors affecting patient prognosis (all P＜0.05).The inclusion of single factor risk factors in multivariate analysis showed that postoperative T stage, postoperative N stage, vascular tumor thrombus invasion, postoperative chemotherapy, surgical approach, tumor gross classification, and tumor differentiation were all independent risk factors affecting patient survival and prognosis (all P＜0.05).Conclusion:Transverse colectomy has the same long-term prognosis as extended colectomy in the treatment of patients with transverse colon cancer. Transverse colectomy does not increase the risk of postoperative complications. Transverse colectomy can be safely used in patients with transverse colon cancer.
Peritoneal adhesions are a common and unsolvable problem in clinical practice. Their occurrence is related to many factors such as surgery and radiotherapy. The complications associated with peritoneal adhesions affect the quality of life. This article combines the literature to discuss the etiology, mechanism, diagnosis and treatment of peritoneal adhesions, hoping to reduce the occurrence of iatrogenic peritoneal adhesions and provide clinicians with reasonable and effective diagnosis and treatment strategies.
Objective:To compare the surgical efficacy and short-term postoperative complications of anastomotic reinforcement (AR) and anastomotic unreinforcement (AU) in radical resection of middle and low rectal cancer.Methods:The propensity score matching method was used to match AR and AU in 498 patients with mid-low rectal cancer who underwent radical resection for rectal cancer from January 2019 to December 2021. The surgical effects and short-term postoperative complications were compared between the two groups.Results:A total of 238 patients were paired (119 patients in each group). The clinical characteristics of the two groups were similar. Compared with AU Group, AR group had longer operation time (95.6±13.5 min vs. 84.3±15.2 min, t=6.07, P＜0.001), lower proportion of stoma and intraoperative preventive stoma (5.88% vs. 22.69%, χ2=13.73, P＜0.001; 5.04% vs. 16.81%, χ2=8.46, P=0.004), lower incidence of symptomatic anastomotic leakage (Grade B/C) and anastomotic bleeding (3.36% vs. 11.76%, χ2=13.73, P=0.014; 3.36% vs. 17.65%, χ2=12.92, P＜0.001). There was no difference in intraoperative blood loss, intestinal function recovery and postoperative hospital stay between the two groups. In addition, male, BMI≥24 kg/m2, diabetes, neoadjuvant chemotherapy, distance＜5 cm from the anal verge were independent risk factors for anastomotic leakage. AR significantly reduced the incidence of anastomotic leakage in high-risk patients (risk factors ≥2) (χ2=5.10, P=0.024), while there was no difference in low-risk patients (risk factors <2).Conclusion:Intraoperative anastomotic reinforcement for middle and low rectal cancer has significant advantages in reducing stoma rate, anastomotic leakage and anastomotic bleeding, especially in high-risk patients.
In recent years, with the continuous development of medical technology and the continuous maturity of precision anastomosis instruments, the willingness of some patients to preserve anus has been realized, but at the same time, it has also increased the incidence of anastomotic leakage. Postoperative anastomotic leakage of rectal cancer is a life-threatening complication with an incidence of 2.4% to 15.9% and a mortality rate of about 16%. The main risk factors include smoking, alcohol consumption, obesity, diabetes and malnutrition. Anastomotic leakage not only affects the prognosis of patients, but also brings great psychological burden to patients. Therefore, to explore the risk factors of anastomotic leakage after rectal cancer surgery and to prevent the occurrence of anastomotic leakage has become the focus of clinicians. This article reviews the Influencing factors and predictive biomarkers of postoperative anastomotic leakage in rectal cancer, in order to provide help for clinicians.
Colorectal cancer (CRC) is one of the most common malignant tumors of the digestive system which is increasing year by year with the improvement of living standard. Colorectal liver metastases(CRLM) is the leading cause of death of patients. The molecular mechanism of colorectal cancer has not been fully elucidated, so the in-depth study of the molecular mechanism of CRLM will be helpful for the examination, diagnosis and treatment of patients with colorectal cancer. This paper summarized the domestic and foreign literature to introduce the current research status of CRLM.
