ObjectiveTo explore the pathogenesis, clinical characteristics, and key points of the diagnosis and treatment of postoperative gastroparesis (POG) complicated by Wernicke’s encephalopathy (WE) after sigmoid colon malignant tumor resection so as to improve the understanding of Wernicke’s encephalopathy occurring after gastrointestinal surgery.MethodsThe clinical data of a patient who developed WE due to POG and prolonged fasting following sigmoid colon cancer resection were retrospectively reviewed, and a comprehensive analysis was conducted in combination with relevant literature.ResultsThe research team retrospectively analyzed a case of intestinal surgery complicated by gastroparesis and long-term fasting, with the patient subsequently presenting with neurological symptoms such as confusion and somnolence. Initially misdiagnosed as an energy deficiency or intracranial lesions, the diagnosis was confirmed by magnetic resonance imaging (MRI) and therapeutic response.ConclusionGastrointestinal dysfunction and poor nutritional absorption after sigmoid colon resection can induce Wernicke’s encephalopathy. Early clinical identification of this disease is particularly important. Postoperative nutritional management and monitoring of neurological symptoms should be emphasized to enable timely intervention.

Colorectal cancer is the second and third most prevalent gastrointestinal tract malignancy among women and men. Over the past few decades, the incidence and mortality of colorectal cancer has gradually increased in China. Many studies have indicated that the robotic surgery system addresses several limitations of laparoscopic surgery and is a safe and feasible surgical approach. However, preservation of the left colic artery (LCA) during robotic total mesorectal excision (R-TME), along with short-term surgical outcomes and complications, has always been the focus of surgeons. Therefore, the present study aimed to analyze the short-term surgical effects of LCA preservation and postoperative complications within 30 days in patients with and without LCA preservation during R-TME. In this retrospective cohort study, we collected and analyzed the clinical data of R-TME performed at the anorectal Department of Gansu Provincial Hospital between January 2018 and January 2023. (In our center, the robotic Da Vinci Xi surgical system is utilized for surgical procedures.) The patients were divided into 2 groups according to whether the LCA was preserved during total mesorectal excision. A total of 150 patients were included in this study; 69 patients underwent LCA preservation, and 81 underwent LCA non-preservation surgeries. In the LCA preservation group, the first postoperative ventilation time (3.2 ± 1.3 days vs 4.2 ± 1.8 days, P = .000) and the time of the first postoperative fluid diet (4.9 ± 1.1 days vs 5.1 ± 1.6 days, P = .001) were significantly improved, and the incidence of protective ileostomy (4.3% vs 14.8%, P = .033) was significantly reduced compared with that in the LCA non-preservation group ( P < .05). The overall complication rates within 30 days in the 2 groups were not significantly different. However, the incidence of anastomotic leakage in the LCA preservation group was significantly lower than that in the LCA non-preservation group (0.0% vs 7.4%, P = .021). R-TME is safe and feasible for the preservation of the LCA, and LCA preservation can promote gastrointestinal function recovery. In addition, LCA preservation ensures the extent of No. 253 lymph node dissection, significantly reduces the incidence of anastomotic leakage and ileal protective fistula and improves the patients’ quality of life.

Objective:Currently, there is no standardized finite element analysis method for investigating the safe compression range of circular end-to-end anastomosis stapler. This study aims to develop a finite element analysis framework based on stress thresholds and the volumetric distribution of tissue states, and to investigate the effects of tissue thickness and compression ratio on the risk of compression-induced injury during anastomosis. The evaluation is conducted by calculating the proportion of the volume of elements categorized as "effective fixation" or "damaged" based on equivalent stress. Methods:A disposable circular end-to-end anastomosis stapler was used as the reference model to create a 1:1 scale 3D model of the key components at the contact surface, including the anvil, staple cartridge, and cutting washer. Finite element models of intestinal tissue with varying thicknesses were established within the environment of the circular stapler. Different compression ratios were applied to analyze the stress distribution in the intestinal tissue. Results:Across experiments with intestinal tissues of all thicknesses, the safe compression ratio consistently centered around 60%. The maximum equivalent stress on the lower intestinal segment was always greater than that on the upper segment, while the average equivalent stress of the upper and lower intestinal segments exhibited a collinear distribution across experiments with varying tissue thickness. An increase in total tissue thickness positively contributed to the expansion of the safe compression range. In asymmetric tissue thickness models, the side with greater thickness demonstrated a broader safe compression range. Conclusion:The safe compression range of staplers is closely related to the properties and thickness of the tissue. This study provides a framework for simulating and determining the safe compression range of staplers.

Human epidermal growth factor receptor 2 (HER2) is an anti-cancer drug target for colon cancer. Among patients with colorectal malignancy (colorectal cancer, CRC), those with HER2 mutations have a poor overall prognosis and a significantly increased drug resistance. In recent years, anti-HER2 therapeutic drugs have developed rapidly. According to several clinical studies and case reports, anti-HER2 therapy, as an emerging anti-cancer approach, plays a crucial role in the treatment of HER2-positive CRC patients. Here, we present a case of HER2-positive descending colon cancer with peritoneal metastasis. The patient is a 26-year-old male, diagnosed with malignant tumor of the descending colon with peritoneal metastasis in April 2020. After multiple treatment modalities, the disease progressed. After chemotherapy with Trastuzumab Deruxtecan (T-DXd/DS-8201), the metastatic foci significantly shrank, and after surgical resection, a tumor-free state (NED) was achieved. Up to now, the patient’s survival period has reached 56 months.

Lateral lymph node dissection (LLND), a critical surgical intervention for patients with low rectal cancer, plays a pivotal role in clinical practice. Its primary objective is to completely resect lateral pelvic lymph nodes, block the metastatic pathway of tumor cells, minimize the risk of postoperative recurrence, and provide a foundation for long-term survival. In Japan, LLND has become a standard surgical procedure for low rectal cancer and is widely applied. However, in Europe and North America, neoadjuvant chemoradiotherapy (nCRT) is regarded as the dominant treatment standard, which has led LLND to remain controversial and face doubts in clinical application. This article integrates the latest clinical research findings, explores the trajectory of technical evolution, analyzes clinical efficacy, objectively presents key points of academic controversy, and prospectively considers future developments. It aims to provide a comprehensive professional analysis for the rational application and continuous optimization of this technique in the treatment of low rectal cancer.

ObjectiveOur objective was to estimate the effect of flexible sigmoidoscopy (FS)-based screening on colorectal cancer (CRC) incidence and mortality by conducting an updated meta-analysis of randomized controlled trials (RCTs).MethodsPubMed, Web of Science, Embase, and Cochrane Library searched for RCTs from database inception to December 2022. The methodological quality of the RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. RevMan 5.4 was used for this meta-analysis.ResultsFour RCTs involving 457, 871 patients were included. This meta-analysis revealed that FS-based screening was associated with a 20% relative risk reduction in CRC incidence [RR = 0.80; 95% CI (0.75, 0.86); P < 0.00001], and a 24% reduction in CRC mortality [RR = 0.76; 95% CI (0.70, 0.82); P < 0.00001]. In addition, this meta-analysis revealed that FS-based screening reduced the incidence[RR = 0.68; 95% CI (0.60, 0.77); P < 0.00001] and mortality[RR = 0.64; 95% CI (0.49, 0.83); P = 0.0007] of distal CRC, but had no significant effect on proximal colon cancer.ConclusionFS-based screening appeared to be effective in reducing distal CRC incidence and mortality in patients at average risk compared to no intervention, but had no significant effect on proximal colon cancer.

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:To evaluate the efficacy of primary tumor resection（PTR）plus chemotherapy versus chemotherapy alone in patients with unresectable asymptomatic colorectal cancer with metastases.Methods:To search relevant studies published in PubMed，Embase，Web of science，Cochrane Library，CNKI，Wanfang and VIP databases from the establishment of the database to October 2022. Meta analysis of survival data was performed by Review Manager 5.4 and Stata 16.0. HR and its 95% CI were used to evaluate the survival risk of patients，Q test and I2 test were used to evaluate the heterogeneity between studies，sensitivity analysis was used to evaluate the reliability of the results，subgroup analysis was used to find the source of heterogeneity，and Egger's test and funnel plot were used to evaluate publication bias between studies.Results:A total of 10 studies were included，including 5 randomized controlled trials（RCTS）and 5 retrospective cohort studies（RCS）. Meta-analysis showed no significant differences in overall survival（OS）and progression-free survival（PFS）between the two treatments. The results of subgroup analysis also suggested no additional survival benefit from PTR. The results of funnel plot and Egger's test（t=-0.360，P=0.730）showed that there was no significant publication bias in the studies reporting patients' OS.Conclusions:Compared with chemotherapy alone，PTR plus chemotherapy can not bring more survival benefits to patients. However，due to the limitations of this study，follow-up large-sample randomized controlled trials are still needed for verification.

Purpose Transanal total mesorectal excision (TaTME) has the potential advantages for patients with low rectal cancer. The objective of this meta-analysis was to identify the pathologic outcomes between the TaTME and laparoscopic total mesorectal excision (LaTME) in rectal cancer. Methods The literature searches were conducted in PubMed, Cochrane Library, and EMBASE with English language restriction. The primary endpoint was circumferential margin (CRM), and the secondary endpoints were distal resection margin (DRM), mesorectal excision quality, and harvested lymph nodes. Results Our research identified 1090 articles, and 26 studies met the inclusion criteria for the meta-analysis. The positive CRM was lower in the TaTME than the LaTME (OR = 0.72; 95% CI = 0.53, 0.98; P = 0.04). There was no significant difference in the positive CRM between the TaTME and LaTME published after 2016 (OR = 0.80; 95% CI = 0.57, 1.12; P = 0.19), prospective study (OR = 2.70; 95% CI = 0.51, 14.24; P = 0.24), respective study (OR = 0.76; 95% CI = 0.55, 1.04; P = 0.09), BMI > 26 (OR = 1.00; 95% CI = 0.63, 1.58; P = 0.98), or sample size > 100 (OR = 0.84; 95% CI = 0.57, 1.23; P = 0.38). In addition, there was no significant difference observed between the TaTME and LaTME in terms of DRM, mesorectum incompleteness, and harvested lymph nodes. Conclusions The TaTME is associated with lower positive CRM compared to the LaTME and similar pathologic outcomes including DRM, harvested lymph node, and mesorectal excision quality.

目的 探讨关闭盆底腹膜与否对腹腔镜下直肠全系膜切除术的近期疗效.方法 选取2018年10月至2019年10月康乐县人民医院普外科49例实施腹腔镜下直肠全系膜切除术的患者,根据统计资料进行回顾性分析,按照盆底腹膜关闭与否分为观察组(26例)和对照组(23例),观察组在行腹腔镜下直肠全系膜切除术并关闭盆底腹膜,对照组不关闭盆底腹膜,观察2组患者的术后并发症及相关手术指标.结果 观察组的手术时间较对照组长,术后引流管放置时间短于对照组,差异均有统计学意义(P<0.05);2组术中失血量、引流量、术后排气时间、流质饮食时间、住院时间、肠梗阻发生率、伤口感染发生率、吻合口瘘发生率、腹腔脓肿发生率、吻合口出血发生率比较,差异均无统计学意义(P>0.05).结论 是否关闭盆底腹膜对于腹腔镜下直肠全系膜切除术的近期疗效差异不大.

Objective:To compare the short-term outcomes of conventional laparoscopic total mesorectal excision (L-TME) and robot-assisted total mesorectal excision (R-TME) on rectal cancer.Methods: A total of 235 patients underwent R-TME (120) or L-TME (115) after diagnosed with rectal cancer from January 2019 to December 2019 were included in this study. Patients' characteristics, perioperative characteristics and pathologic characteristics were evaluated between the R-TME group and the L-TME group.Results: Compared with the L-TME group, the R-TME group showed less intraoperative blood loss (123.7ml Vs 167.2ml,P=0.003), less first flatus time (79.2h Vs 118.3h,P<0.001), less first liquid diet time (91.0h Vs 123.0h,P<0.001), less volume of abdominal drainage (315.4ml Vs 397.0ml,P=0.042) and shorter hospital stay (8.1d Vs 8.9d,P=0.017) . However, the R-TME group had more expensive total hospitalization costs (80193.9CNY Vs 65791.0CNY,P<0.001). No significant differences were observed between the two groups in respect to operation time, total number of examined lymph nodes, time of abdominal drainage and postoperative complications. The pathologic characteristics of the two groups were not significantly different.Conclusion:This study shows that the robot-assisted total mesorectal excision is superior to laparoscopic one in terms of short-term outcomes in surgeries of rectal cancer, it is safe and feasible to treat rectal cancer.

荧光成像技术最初用于乳腺癌和结直肠癌患者的前哨淋巴结活检,随后此方法在外科肿瘤的各个领域中的应用得到广泛认可,并成为指导癌症治疗的有效诊断工具,而且在许多常规的外科手术中取得了很大成功.达芬奇手术系统在2010年集成了近红外摄像头,利用荧光成像将技术优势和微创优势相结合,这一技术优势逐渐被一些经验丰富的外科医生所认可.但目前大多数研究集中于荧光成像技术在开刀手术和腹腔镜手术中的应用,很少关于达芬奇手术系统荧光成像技术在结直肠外科手术中应用的研究.本文旨在回顾达芬奇手术系统荧光成像技术在结直肠外科手术中的发展背景 、应用进展、技术争论以及展望.

Objective: To compare the feasibility and safety of laparoscopic and robotic colectomy in right-sided colon cancer.Methods: 48 patients underwent laparoscopic colectomy (LC group) and 58 patients underwent robotic colectomy (RC group) for right-sided colon cancer from June 2016 to August 2019 at Gansu Provincial Hospital were enrolled in this study. The operation time, estimated blood loss, time to first flatus, duration of the liquid diet, number of harvested lymph nodes, postoperative hospital stay and total costs of the two groups were analyzed and compared.Results: The conversion rate to open surgery due to technical issues in the LC group was 2％ (1/48) and in the RC group was 0％ (0/58). The mean postoperative hospital stay of patients underwent RC was shorter than patients underwent LC (P<0.001). The 30-day mortality was zero and no significant difference was observed in respect to specific complications between the two groups. The total number of harvested lymph nodes was 14.24 in the RC group and 14.35 in the LC group.Conclusion: The present study suggests that RC is more beneficial for patients due to its shorter hospital stay. However, further randomized controlled trials are needed to determine any significant benefit on the use of RC compared to LC.

目的 评价机器人腹腔镜经括约肌间切除术(intersphincteric resection,ISR)治疗低位直肠癌的临床疗效.方法 检索中国生物医学文献数据库、中国知网、万方数据库、PubMed、Embase及Cochrane library的相关文献.检索时间为各数据库建库至2019年4月1日,用Review Manager 5.2软件对相关的指标进行meta分析.结果 共有5篇文献510例患者纳入分析,其中机器人组273例,传统腹腔镜组237例.与腹腔镜组相比,机器人组的手术时间[MD=43.27,95％CI(16.48,70.07),P=0.002]增加、术中出血量[MD=-19.98.27,95％CI(-33.14,-6.81),P=0.003]减少、中转开腹率[MD=0.20,95％CI (0.04,-0.95),P=0.04]降低、淋巴结获取数目[MD=-1.71,95％CI (-3.21,-0.21),P=0.03]减少以及住院时间[MD=-1.61,95％CI(-2.26,-0.97),P＜0.000 01]缩短,其差异均具有统计学意义.但术后肛门排气时间[MD=-0.01,95％CI(-0.48,0.46),P=0.96]、进食时间[MD=-0.20,95％CI(-0.67,0.27),P=0.41]、并发症发生率[OR=0.76,95％CI (0.50,1.14),P=0.18]、肿瘤距远切缘距离[MD=0.00,95％CI(-0.17,0.17),P=0.98]以及环周切缘阳性率[OR=0.61,95％CI(0.27,1.37),P=0.23]与腹腔镜组比较,差异均无统计学意义.结论 机器人和腹腔镜ISR治疗低位直肠癌显示了相似的围手术期结果;尽管机器人ISR手术时间更长、淋巴结获取数目更少,但术中出血更少、中转开腹率更低以及住院时间更短.机器人ISR是一种安全有效的治疗低位直肠癌的技术.

为探讨艰难梭菌毒素A(Tcd A)对结肠癌SW480细胞增殖及凋亡的影响,利用四氮唑蓝比色法(M TT法)检测Tcd A对结肠癌SW480细胞增殖的影响,以流式细胞术(FCM)观察细胞凋亡情况,并利用细胞荧光染色技术观测Tcd A作用后的细胞形态学改变.结果显示,不同浓度的Tcd A均能抑制SW480细胞的增殖,并且其抑制率呈剂量依赖性(P<0.05).Tcd A浓度为800 ng/mL、作用48 h时抑制率最大,为42.50%.不同浓度Tcd A作用于SW480细胞48 h后,也能显著诱导SW480细胞发生凋亡,并且具有显著差异(P<0.05).Annexin V-FITC/PI染色可见晚期凋亡细胞,可观察到黄-红色的胞质、红色的胞核和环绕细胞的绿色胞膜,还可见胞膜皱缩和起泡.结果表明,Tcd A不仅能抑制SW480细胞的增殖,还能诱导其发生凋亡.

目的:探讨艰难梭菌毒素A(Tcd A)对结肠癌细胞株SW480增殖、凋亡的影响及其作用机制.方法:采用四唑蓝比色法(MTT)检测Tcd A对SW480细胞增殖的影响;流式细胞术(FCM)分析细胞凋亡情况和线粒体膜电位的变化;PI细胞荧光双染色法观察细胞凋亡的形态学变化.结果:Tcd A能显著抑制SW480细胞的增殖,且抑制率呈浓度依赖性;流式细胞仪分析处理组SW480细胞出现明显的凋亡以及线粒体膜电位的降低;细胞荧光染色观察到典型的凋亡形态学变化.结论:Tcd A可诱导SW480细胞发生凋亡,其机制可能是通过诱导线粒体膜电位的下降,破坏其外膜结构而诱发的.

Aim. The robotic technique has been established as an alternative approach to laparoscopy in colorectal surgery. The aim of this study was to compare short-term outcomes of robot-assisted and laparoscopic surgery in colorectal cancer. Methods. The cases of robot-assisted or laparoscopic colorectal resection were collected retrospectively between July 2015 and October 2017. We evaluated patient demographics, perioperative characteristics, and pathologic examination. A multivariable linear regression model was used to assess short-term outcomes between robot-assisted and laparoscopic surgery. Short-term outcomes included time to passage of flatus and postoperative hospital stay. Results. A total of 284 patients were included in the study. There were 104 patients in the robotic colorectal surgery (RCS) group and 180 in the laparoscopic colorectal surgery (LCS) group. The mean age was 60.5 ± 10.8 years, and 62.0% of the patients were male. We controlled for confounding factors, and then the multiple linear model regression indicated that the time to passage of flatus in the RCS group was 3.45 days shorter than the LCS group (coefficient = −3.45, 95% confidence interval [CI] = −5.19 to −1.71; P < .001). Additionally, the drainage of tube duration (coefficient = 0.59, 95% CI = 0.3 to 0.87; P < .001) and transfers to the intensive care unit (coefficient = 7.34, 95% CI = 3.17 to 11.5; P = .001) influenced the postoperative hospital stay. The total costs increased by 15501.48 CNY in the RCS group compared with the LCS group ( P = .008). Conclusions. The present study suggests that colorectal cancer robotic surgery was more beneficial to patients because of shorter postoperative recovery time of bowel function and shorter hospital stays.

Background: The aim of this study is to compare microRNA expression patterns in different stages of colorectal cancer (CRC) and to discuss the significance of the application of microRNAs in the clinical treatment of CRC. Methods: The study used gene chip technology to analyze genetic sequences in CRC tissues and surrounding normal tissues at different cancer stages. The bioinformatics profiles of the target genes of the different microRNAs were analyzed to clarify the target gene-related pathways and their functions in the disease. Results: A total of 368 target genes with differential expression, including 275 upregulated and 93 downregulated genes, were screened from CRC patients in different stages of the disease. These microRNAs participated widely in the occurrence and development processes of CRC. The microRNA expression profiles obviously differed in tissues at different CRC stages. Conclusion: microRNA regulation of CRC samples can be used as a tool to control the occurrence and development of tumor cells.

结直肠癌是消化系统常见的恶性肿瘤之一,在全世界的发病率和死亡率仍呈现逐年递增的趋势.全球范围内结直肠癌发病率位居女性恶性肿瘤的第2位,男性恶性肿瘤的第3位.中国的结直肠癌发病率为28.08/10万,死亡率为13.41/10万,位居恶性肿瘤致死病种的第5位,并且近年来直肠癌的发病趋势有所上升[1].据2014年的流行病学调查数据显示,由结直肠癌引起的预计死亡人数是50310,新发病例为136830,分别占所有癌症病例的8%和9%[2].