BACKGROUND Endoscopy allows for the direct observation of primary tumor characteristics and responses after neoadjuvant treatment. However, reports on endoscopic evaluation following neoadjuvant immunotherapy remain limited. AIM To examine the predictive value of endoscopic findings of primary tumors for responses to neoadjuvant immunotherapy. METHODS This retrospective study, conducted at a tertiary center in China, evaluated 74 patients with colorectal cancer, including 17 with deficient mismatch repair (dMMR) and 15 with proficient mismatch repair (pMMR) tumors. Patients underwent neoadjuvant immunotherapy followed by surgery. Endoscopic findings before and after neoadjuvant immunotherapy were reviewed and compared with the pathology of the resected specimens. RESULTS In the pMMR group (n = 57 evaluable patients), endoscopy identified 11/17 patients who achieved a complete response (CR), while misidentifying 1/40 patients with residual disease as CR (64.7% vs 2.5%, P < 0.01). Conversely, 22/40 patients with residual disease were accurately identified as achieving a partial response (PR), with 1/17 patients who achieved CR misclassified as PR (55.0% vs 5.9%, P < 0.01). The sensitivity, specificity, and accuracy of endoscopic diagnosis for pathological CR were 64.7%, 97.5%, and 87.7%, respectively. In the dMMR cohort, endoscopy classified 9/17 patients as CR and 2 of the remaining patients with residual tumors as PR (64.3% vs 66.7%, P = 0.73). The method demonstrated 100% sensitivity and 82.4% accuracy in diagnosing pathological CR. CONCLUSION Endoscopic evidence of CR or PR was well correlated with postoperative pathological outcomes in the pMMR cohort. Despite endoscopic indications of tumor residue, a complete pathological response post-surgery was possible in the dMMR cohort.

BackgroundNeoadjuvant combination immunotherapy is a potential treatment option for patients with proficient mismatch repair/microsatellite stable colorectal cancer. Preoperative screening via endoscopy and imaging examinations could help identify patients who may potentially achieve a complete response after neoadjuvant combination immunotherapy. This study aims to evaluate the diagnostic accuracy of endoscopic and imaging examinations in predicting pathological complete response after neoadjuvant combination immunotherapy.MethodsThis single-center, retrospective, observational study included patients diagnosed with colorectal cancer by biopsy between 2015 and 2023 at a tertiary referral center. The main outcome measures included endoscopic examination, imaging findings, and pathological results after neoadjuvant combination immunotherapy.ResultsThis study included 36 patients with locally advanced proficient mismatch repair colorectal cancer. Postoperative pathology revealed that 17 patients (47.2%) achieved a complete response (ypT0N0). The sensitivity, specificity, and accuracy of the endoscopic ypT0N0 diagnosis were 62.5%, 80.0%, and 80.6%, respectively; those of imaging-based ypT0N0 diagnosis were 43.8%, 100%, and 75.0%, respectively; and those of the combined diagnosis were 37.5%, 100%, and 72.2%, respectively. The areas under the receiver-operating characteristic curve for the endoscopic and imaging ypT0N0 diagnoses were 0.768 and 0.706, respectively.ConclusionsThe specificities of endoscopy and imaging for diagnosing complete response after neoadjuvant combination immunotherapy for colorectal cancer were high; however, sensitivities were low. Therefore, radical surgery should still be recommended for patients with an incomplete response based on either examination. Larger scale studies are required to determine if a watch-and-wait strategy is suitable for patients with a complete response based on these two examinations.

There have been previously reported associations between the gut microbiota, immune cells, and colorectal cancer; however, the specific mechanisms underlying these relationships remain largely unexplored and require further research. Therefore, in this study, we aimed to unravel the interactions between the gut microbiota, immune cells, and colorectal cancer. The analysis used genome-wide association study (GWAS) data encompassing 207 microbial taxa and 205 functional pathways and data on 731 immune cell phenotypes. Colorectal cancer data on 6 581 cases and 463 421 controls were sourced from the Integrative Epidemiology Unit Open GWAS Project. Univariate inverse-variance weighted Mendelian randomization analysis was used to identify gut microbial taxa associated with colorectal cancer. Mediation analysis was used to identify the mediating role of specific immune cells in the link between gut bacteria and colorectal cancer. Univariate inverse-variance weighted Mendelian randomization analysis revealed that several microbial taxa from the Actinobacteria and Firmicutes phyla were significantly associated with colorectal cancer. Coriobacteriaceae (odds ratio [OR]: 0.84, 95

BACKGROUND:Diverting stoma (DS) is routinely proposed in intersphincteric resection for ultralow rectal cancer, but it is associated with increased stoma-related complications and economic burden. Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation. AIM:To select patients who may not require DS. METHODS:This study enrolled 505 consecutive patients, including 84 who underwent stoma-free (SF) intersphincteric resection. After matching, patients were divided into SF (n = 78) and DS (n = 78) groups. The primary endpoint was the anastomotic leakage (AL) rate within 6 months and its protective factors for both the total and SF cohorts. The secondary endpoints included overall survival and disease-free survival. RESULTS:The AL rate was greater in the SF group than in the DS group (12.8% vs 2.6%, P = 0.035). Male sex [(odds ratio (OR) = 2.644, P = 0.021], neoadjuvant chemoradiotherapy (nCRT) (OR = 6.024, P < 0.001), and tumor height from the anal verge ≤ 4 cm (OR = 4.160, P = 0.007) were identified as independent risk factors. Preservation of the left colic artery (LCA) was protective in both the total cohort (OR = 0.417, P = 0.013) and the SF cohort (OR = 0.312, P = 0.027). The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL (2/97, 2.1%). The 3-year overall survival or disease-free survival did not significantly differ between the groups. CONCLUSION:Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.

To identify the clinical and molecular factors that effectively predict pathological complete response (pCR) and assess the safety of patients receiving neoadjuvant combination immunotherapy. This retrospective study evaluated 81 patients with colorectal cancer (CRC) at a Chinese tertiary center between 2015 and 2023. The cohort included 24 patients with deficient mismatch repair (dMMR) and 57 patients with proficient mismatch repair (pMMR) tumors. Patients were treated with a neoadjuvant combination of immunotherapy and surgery. We divided 81 patients into pCR (40.7

BACKGROUND:Colorectal cancer (CRC) patients with stage pT4b are a complex group as they show differences in tumor-infiltrated organs. Patients with the same stage often exhibit differences in prognosis after multivisceral resection (MVR). Thus far, some important prognostic factors have not been thoroughly investigated. Here, we identified the prognostic factors influencing CRC patients at the pT4bN0M0 stage to stratify the prognostic differences among patients. MATERIALS AND METHODS:A retrospective analysis was conducted on patients diagnosed with locally advanced CRC and who underwent MVR at three medical institutions from January 2010 to December 2021. The prognostic factors affecting the survival of CRC patients at pT4bN0M0 stage were identified by multivariate Cox proportional hazard models. We then classified the prognosis into different grades on the basis of these independent prognostic factors. RESULTS:We enrolled 690 patients with locally advanced CRC who underwent MVR; of these, 172 patients with pT4bN0M0 were finally included. Patients with digestive system [overall survival (OS): hazard ratio (HR)=0.441; 95% confidence interval (CI)=0.217-0.900; P =0.024; disease-free survival (DFS): HR=0.416; 95% CI=0.218-0.796; P =0.008) or genitourinary system invasion (OS: HR=0.405; 95% CI=0.193-0.851; P =0.017; DFS: HR=0.505; 95% CI=0.267-0.954; P =0.035) exhibited significantly better OS and DFS as compared to those with gynecological system invasion, while the OS and DFS were similar between the digestive system and genitourinary system invasion groups (OS: HR=0.941; 95% CI=0.434-2.042; P =0.878; DFS: HR=1.211; 95% CI=0.611-2.403; P =0.583). Multivariate analysis showed that age (OS: HR=2.121; 95% CI=1.157-3.886; P =0.015; DFS: HR=1.869; 95% CI=1.116-3.131; P =0.017) and type of organs invaded by CRC (OS: HR=3.107; 95% CI=1.121-8.609; P =0.029; DFS: HR=2.827; 95% CI=1.142-6.997; P =0.025) were the independent prognostic factors that influenced the OS and DFS of CRC patients with pT4bN0M0 disease. The OS and DFS of patients showing invasion of the gynecological system group were significantly worse ( P =0.004 and P =0.003, respectively) than those of patients with invasion of the nongynecological system group. On the basis of the above-mentioned two independent prognostic factors, patients were assigned to high-risk, medium-risk, and low-risk groups. Subgroup analysis showed that the OS and DFS of the medium-risk and high-risk groups were significantly worse ( P =0.001 and P =0.001, respectively) than those of the low-risk group. CONCLUSION:Patients with pT4bN0M0 CRC show significant differences in their prognosis. The type of organs invaded by CRC is a valuable indicator for prognostic stratification of CRC patients with pT4bN0M0.

Purpose Surgical techniques and the prognosis of posterior pelvic exenteration for locally advanced primary rectal cancer in female patients pose challenges that need to be addressed. Therefore, we investigated the short-term and survival outcomes of posterior pelvic exenteration in female patients using a novel Peking classification. Methods We retrospectively analysed a prospective database from China PelvEx Collaborative across three tertiary referral centres. A total of 172 patients who underwent combined resection for locally advanced primary rectal cancer were classified based on four subtypes (PPE-I [64/172], PPE-II [68/172], PPE-III [21/172], and PPE-IV [19/172]) according to the Peking classification; perioperative characteristics and short-term and oncological outcomes were analysed. Results Differences were significant among the four groups regarding colorectal reconstruction (p < 0.001), perineal reconstruction (p < 0.001), in-hospital complications (p < 0.05), and urinary retention (p < 0.05). The R0 resection rates for PPE-I, PPE-II, PPE-III, and PPE-IV were 90.6%, 89.7%, 90.5%, and 89.5%, respectively. The 5-year overall survival rates of the PPE-I, PPE-II, PPE-III, and PPE-IV groups were 73.4%, 68.8%, 54.7%, and 37.3%, respectively. Correspondingly, their 5-year disease-free survival rates were 76.0%, 62.5%, 57.7%, and 43.1%, respectively. Notably, the PPE-IV group demonstrated the lowest 5-year overall survival rate (p < 0.001) and 5-year disease-free survival rate (p < 0.001). Conclusion The Peking classification can aid in determining suitable surgical techniques and conducting prognostic assessments in female patients with locally advanced primary rectal cancer.

Tumor-infiltrating lymphocytes can influence tumorigenesis and progression. We found PD-L1 can inhibit the infiltration of memory T (Tm) cells in vivo and in vitro by reducing the secretion of CXCL9, CXCL10 in colorectal cancer. Patients with high PD-L1 expression have minimal Tm cell infiltration, accompanied with a higher incidence of tumor metastasis. Single-cell sequencing revealed that PD-L1 mainly inhibited the infiltration of a specific Tm cell subset characterized by the expression of FGFBP2 gene. To clarify the distribution of FGFBP2(+)Tm cells, peripheral blood, lymph nodes, colon polyps, primary tumor, and liver metastases samples were collected. As the tumor progressed, the infiltration of FGFBP2(+) memory T cells gradually increased and accumulated in liver metastases. By establishing a mouse metastasis model, we found in high PD-L1 expression group, the luciferin intensity of metastatic tumor was significantly higher, the number of metastatic nodules and the weight of metastases were also increased. The number of FGFBP2(+) Tm cells in peripheral blood and in liver/lung metastases were increased. Therefore, the expression of PD-L1 in primary tumor can promote the occurrence of metastases, and FGFBP2(+)Tm cells may be involved in the formation of metastases. Furthermore, the result showed that the number of FGFBP2(+) Tm cells in metastases was positively correlated with the number of vessels in liver/lung metastases. In conclusion, we confirmed that the expression of PD-L1 in primary tumor can increase the number of FGFBP2(+) Tm cells in peripheral blood and promote tumor metastasis, which is likely to be caused by the angiogenesis of FGFBP2(+) Tm cells in metastases.

Background Radical surgery remains the primary option for locally recurrent rectal cancer (LRRC) as it has the potential to considerably extend the patient's lifespan. At present, the effectiveness of laparoscopic surgery for LRRC remains unclear. Methods The clinical data of LRRC patients who were admitted to the Cancer Hospital of the Chinese Academy of Medical Sciences between 2015 and 2021 were retrospectively analyzed in this study. Patients were categorized into two groups, namely the open group and the laparoscopic group, based on the surgical method used. The short-term outcomes and long-term survival between the two groups were compared. Results Curative surgery was performed on 111 patients who were diagnosed with LRRC. After propensity score matching, a total of 84 patients were included and divided into the laparoscopic group (42 patients) and the open group (42 patients). The laparoscopic group had less intraoperative bleeding (100 vs. 300, P = 0.023), a lower postoperative complication rate (19.0% vs. 42.9%, P = 0.018), and a lower incidence of wound infection (0 vs. 14.3%, P = 0.026). Additionally, the laparoscopic group had a higher R0 resection rate than the open group (92.9% vs. 83.3%, P = 0.313), as well as a shorter length of hospital stay (9.5 vs. 11.5 days, P = 0.304), although these differences were not statistically significant. The laparoscopic group had higher 3-year overall survival (86.3% vs. 58.9%, P = 0.022) and 3-year disease-free survival (60.6% vs 32.7%, P = 0.015). Conclusions In comparison to open surgery, laparoscopic surgery is linked to less bleeding during the operation, quicker recovery after the surgery, and a lower incidence of infections at the surgical site. Moreover, laparoscopic surgery for LRRC might yield superior long-term survival outcomes.

目的 探讨腹腔镜直肠癌经括约肌间切除术(Ls-ISR)后发生顽固性吻合口狭窄的影响因素及列线图预测模型构建.方法 采用回顾性病例对照研究方法.收集2012年6月至2021年12月2家医学中心收治的495例(北京大学第一医院448例、中国医学科学院肿瘤医院47例)行Ls-ISR患者的临床病理资料;男311例,女184例;年龄为61(20～84)岁.观察指标:(1)吻合口狭窄发生情况.(2)影响Ls-ISR后发生顽固性吻合口狭窄的因素分析.(3)Ls-ISR后发生顽固性吻合口狭窄列线图预测模型构建及评价.采用门诊、电话等方式进行随访,了解患者术后吻合口漏和吻合口狭窄情况.随访时间截至2022年8月.正态分布的计量资料以(x)±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示.计数资料以绝对数表示,组间比较采用x2检验.单因素和多因素分析均采用Logistic回归模型.将单因素分析中P＜0.10的因素纳入多因素分析.采用R软件(3.6.3)构建列线图预测模型.绘制受试者工作特征曲线,以曲线下面积评价效能.结果 (1)吻合口狭窄发生情况.495例患者均施行Ls-ISR,无中转开腹.495例患者术后均获得随访,随访时间为47(8～116)个月.495例患者随访期间,458例未发生吻合口狭窄、37例发生吻合口狭窄.37例发生吻合口狭窄患者中,A级15例、B级3例、C级19例;其中22例为顽固性狭窄.15例A级吻合口狭窄患者扩肛治疗后缓解;3例B级吻合口狭窄患者经球囊扩张及内镜治疗好转;19例C级吻合口狭窄患者行永久性肠造口术.495例 患者随访期间,发生吻合口漏42例(17例顽固性吻合口狭窄);未发生吻合口漏453例(5例顽固性吻合口狭窄),发生吻合口漏和未发生吻合口漏患者中顽固性吻合口狭窄比较,差异有统计学意义(x2=131.181,P＜0.05).(2)影响Ls-ISR后发生顽固性吻合口狭窄的因素分析.多因素分析结果显示:行新辅助治疗、肿瘤距肛缘距离≤4cm、临床N分期为N1～4期是影响Ls-ISR后发生顽固性吻合口狭窄的独立危险因素(风险比=7.297,3.898,2.672,95％可信区间为 2.870～18.550,1.050～14.465,1.064～6.712,P＜0.05).(3)Ls-ISR后发生顽固性吻合口狭窄列线图预测模型构建及评价.根据多因素分析结果,纳入新辅助治疗、肿瘤距肛缘距离、临床N分期,构建Ls-ISR后顽固性吻合口狭窄发生风险的列线图预测模型.受试者工作特征曲线结果显示:Ls-ISR后发生顽固性吻合口狭窄列线图预测模型的曲线下面积为0.739(95％可信区间为0.646～0.833).结论 行新辅助治疗、肿瘤距肛缘距离≤4cm、临床N分期为N1～4期是影响Ls-ISR后发生顽固性吻合口狭窄的独立危险因素,其列线图预测模型可预测患者术后顽固性吻合口狭窄发生率.

Colorectal cancer is the second common cause of cancer death. Immunotherapy has became a new therapy apart from traditional therapy such as surgery,etc. There are controversial about the efficiency and adverse reaction of anti-PD-1/PD-L1 drugs. In this article, the research and application of PD-1 pathway blockage are reviewed from the aspects of PD-1 pathway and blockage, clinical applications of anti-PD-1/PD-L1 drugs in colorectal cancer, treatment resistance, adverse reactions and biomarkers of effective prediction.

Background The diagnostic criteria and effect of persistent descending mesocolon (PDM) on sigmoid and rectal cancers (SRCs) remain controversial. This study aims to clarify PDM patients' radiological features and short-term surgical results. Method From January 2020 to December 2021, radiological imaging data from 845 consecutive patients were retrospectively analyzed using multiplanar reconstruction (MRP) and maximum intensity projection (MIP). PDM is defined as the condition wherein the right margin of the descending colon is located medially to the left renal hilum. Propensity score matching (PSM) was used to minimize database bias. The anatomical features and surgical results of PDM patients were compared with those of non-PDM patients. Results Thirty-two patients with PDM and 813 patients with non-PDM were enrolled into the study who underwent laparoscopic resection. After 1:4 matching, patients were stratified into PDM ( n = 27) and non-PDM ( n = 105) groups. The lengths from the inferior mesenteric artery (IMA) to the inferior mesenteric vein (1.6 cm vs. 2.5 cm, p = 0.001), IMA to marginal artery arch (2.7 cm vs. 8.4 cm, p = 0.001), and IMA to the colon (3.3 cm vs. 10.2 cm, p = 0.001) were significantly shorter in the PDM group than those in the non-PDM group. The conversion to open surgery (11.1% vs. 0.9%, p = 0.008), operative time (210 min vs. 163 min, p = 0.001), intraoperative blood loss (50 ml vs. 30 ml, p = 0.002), marginal arch injury (14.8% vs. 0.9%, p = 0.006), splenic flexure free (22.2% vs. 3.8%, p = 0.005), Hartmann procedure (18.5% vs. 0.0%, p < 0.001) and anastomosis failure (18.5% vs. 0.9%, p = 0.001) were significantly higher in the PDM group. Moreover, PDM was an independent risk factor for prolonged operative time (OR = 3.205, p = 0.004) and anastomotic failure (OR = 7.601, p = 0.003). Conclusion PDM was an independent risk factor for prolonged operative time and anastomotic failure in SRCs surgery. Preoperative radiological evaluation using MRP and MIP can help surgeons better handle this rare congenital variant.

Laparoscopic total mesorectal excision (LaTME) is a technically challenging for ultralow-lying rectal cancer in obese male patients. Herein, we introduced modified serial techniques “ASTRO” to facilitate LaTME, and the short-term outcomes were presented. A prospective study (NCT05067413) was conducted between December 2020 and January 2022. The modified serial surgical techniques “ASTRO” included 5 key steps: (1) Anterior peritoneal reflection (APR) dissection at the highest line along with a “n”-shaped membrane bridge; (2) suspending the APR with a purse-string suture through the bladder peritoneum to enlarge the operating space of the anterior rectal wall; (3) traction and counter-traction continuously of the rectum applied with a cotton tape around the rectum; (4) resection of the pelvic rectum on tripartition, followed by the sequence of “posterior > anterior > lateral” principle; and (5) the trans-anterior Obturator nerve gateway was adapted to transect the distal rectum. The operative data and postoperative short-term outcomes were collected. Twenty-four consecutive patients underwent this procedure successfully. The average body mass index (BMI) was 29.9±1.3. The average of tumor height from anal verge was 4.0 cm (range, 3.0–4.5 cm). The median operating time and blood loss was 217 min (range, 165–420 min) and 50 ml (range, 20–100 ml) respectively. The anterior operation space at the midsagittal plane of the pelvis inlet was increased by 2.0 ± 0.3 cm. The calculated dominant angle was 20 ± 3°. The length of stapling line was 6.8 ± 1.0 cm with 11 cases by one cartridge and 13 cases by 2 cartridges. Eight patients developed postoperative complications including 4 with anastomosis leakage (16.7

As the concept of minimally invasive surgery is polpular and deeply impressed by the surgeon, natural orifice specimen extraction surgery (NOSES) quickly leads the world in minimally invasive surgery and enhanced recovery with the smallest surgical trauma. NOSES has expanded from single organ resection to combined organ resection, and from colorectal tumors to various benign and malignant diseases of the abdomen and pelvis. The safety and efficacy have been proved in clinical applications. At present, there is no reported case of the application of NOSES to pelvic retroperitoneal tumors. This article reports a case of a young female patient with pelvic retroperitoneal tumor who successfully completed laparoscopic pelvic retroperitoneal tumor resection with the specimen extraction through rectum.

Background Programmed cell death protein 1 (PD-1) receptor has two ligands,programmed death-ligand 1 (PD-L1) and PD-L2. When compared with PD-L1, PD-L2 has not received much attention, and its role remains unclear. Methods The expression profiles of pdcd1lg2 (PD-L2-encoding gene) mRNA and PD-L2 protein were analyzed using TCGA, ICGC, and HPA databases. Kaplan-Meier and Cox regression analyses were used to assess the prognostic significance of PD-L2. We used GSEA, Spearman’s correlation analysis and PPI network to explore the biological functions of PD-L2. PD-L2-associated immune cell infiltration was evaluated using the ESTIMATE algorithm and TIMER 2.0. The expressions of PD-L2 in tumor-associated macrophages (TAMs) in human colon cancer samples, and in mice in an immunocompetent syngeneic setting were verified using scRNA-seq datasets, multiplex immunofluorescence staining, and flow cytometry. After fluorescence-activated cell sorting, flow cytometry and qRT-PCR and transwell and colony formation assays were used to evaluate the phenotype and functions of PD-L2+TAMs. Immune checkpoint inhibitors (ICIs) therapy prediction analysis was performed using TIDE and TISMO. Last, a series of targeted small-molecule drugs with promising therapeutic effects were predicted using the GSCA platform. Results PD-L2 was expressed in all the common human cancer types and deteriorated outcomes in multiple cancers. PPI network and Spearman’s correlation analysis revealed that PD-L2 was closely associated with many immune molecules. Moreover, both GSEA results of KEGG pathways and GSEA results for Reactome analysis indicated that PD-L2 expression played an important role in cancer immune response. Further analysis showed that PD-L2 expression was strongly associated with the infiltration of immune cells in tumor tissue in almost all cancer types, among which macrophages were the most positively associated with PD-L2 in colon cancer. According to the results mentioned above, we verified the expression of PD-L2 in TAMs in colon cancer and found that PD-L2+TAMs population was not static. Additionally, PD-L2+TAMs exhibited protumor M2 phenotype and increased the migration, invasion, and proliferative capacity of colon cancer cells. Furthermore, PD-L2 had a substantial predictive value for ICIs therapy cohorts. Conclusion PD-L2 in the TME, especially expressed on TAMs, could be applied as a potential therapeutic target.

目的 探讨原始荧光模式下吲哚菁绿(ICG)荧光血管造影技术辅助直肠癌根治术中肠系膜下动脉(IMA)分支分型及保留左结肠动脉(LCA)的可行性.方法 回顾性分析2022年6～12月在中国医学科学院肿瘤医院由同一术者手术治疗的32例直肠癌病人的资料.采用高分辨增强CT影像技术、ICG荧光血管造影技术判断IMA分型,并与IMA裸化后解剖分型比较.观察影像分型、荧光分型与解剖分型的符合率,分析ICG荧光血管造影技术辅助LCA保留的近期结局.结果32例术前影像分型:I型15例(46.8.％),Ⅱ型7例(21.9％),Ⅲ型4例(12.5％),Ⅳ型3例(9.4％),未能辨认分型3例(9.4％);术中均顺利完成IMA血管分型,包括Ⅰ型17例(53.1％),Ⅱ型11例(34.3％),Ⅲ型2例(6.3％),Ⅳ型2例(6.3％).影像分型符合率为81.3％,荧光分型符合率为100％,两者差异有统计学意义(P=0.032).除2例Ⅳ型,其余30例均成功保留LCA.IMA根部淋巴结清扫时间(15.5±7.1)min,术后住院时间中位数7(6,8)d.无中转开放手术病例.1例发生术后腹腔出血,行二次手术止血,无肠梗阻、吻合口漏等并发症发生.结论 原始荧光模式下术中ICG荧光血管造影技术较术前影像判断IMA分支分型准确率更高,并可辅助LCA保留,值得临床进一步关注和研究.

BACKGROUND:Laparoscopic surgery is controversial for patients with clinical T4b colorectal cancer (CRC) who require multivisceral resection (MVR). This study aims to explore and compare the safety and long-term oncological outcomes of laparoscopic surgery and open surgery for patients with clinical T4b CRC. MATERIALS AND METHODS:This study was a retrospective cohort study based on a multicentre database. According to the operation method, the patients were divided into a laparoscopic MVR group and an open MVR group. The short-term and long-term outcomes were compared. RESULTS:From January 2010 to December 2021, a total of 289 patients in the laparoscopic MVR group and 349 patients in the open MVR group were included. After propensity score matching, patients were stratified into a laparoscopic MVR group (n = 163) and an open MVR group (n = 163). Compared with the open MVR group, the laparoscopic MVR group had less blood loss (100 vs. 200, p < 0.001), a shorter time to first flatus (3 vs. 4, P < 0.001), a shorter postoperative hospital stay (10 vs. 12, P < 0.001), and a lower incidence of surgical site infection (2.5 % vs. 8.0 %, P = 0.043). The Kaplan-Meier curves showed that the two groups had similar overall survival (P = 0.283) and disease-free survival (P = 0.152). CONCLUSION:Compared with open MVR, laparoscopic MVR had less blood loss, fewer surgical site infection complications, faster recovery and a shorter hospital stay. The long-term survival outcome of laparoscopic MVR was not inferior to that of open MVR.

目的 分析腹腔镜直肠癌超低位前切除术吻合口漏的危险因素.方法 回顾性分析2012年6月至2021年2月由同一手术团队收治的381例行直肠癌超低位前切除术患者的临床资料,分析影响术后吻合口漏发生的危险因素.结果 直肠癌超低位前切除术后吻合口漏的总体发生率为9.19％.单因素分析结果显示吻合口漏在性别、新辅助同步放化疗、是否保留左结肠动脉(LCA)、侧方淋巴结清扫、吻合口距肛缘距离及肿瘤N分期的分组中存在差异.进一步行多因素logistic回归分析结果显示,术后吻合口漏发生的独立危险因素包括新辅助同步放化疗[OR(95％CI):5.213(2.214～12.272);P=0.000]、未保留LCA[OR(95％CI):2.725(1.186～6.261);P=0.018]、吻合口距肛缘距离≤2 cm[OR(95％CI):3.104(1.126～8.559);P=0.029].结论 新辅助同步放化疗、未保留LCA及吻合口距肛缘距离≤2 cm是腹腔镜直肠癌超低位前切除术后吻合口漏发生的独立危险因素.

Objective To study the short-term outcomes of laparoscopic right hemicolectomy with transvaginal specimen extraction without abdominal incisions(CRC-NOSES Ⅷ A) for radical resection of colon cancer comparing with laparoscopic right hemicolectomy with transabdominal specimen extraction. Methods Clinical data of the patients with complete laparoscopic right hemicolectomy including 29 cases in transvaginal group and 29 cases in transabdominal group were collected. Comparision between two groups was done for preoperative clinical features, intraoperative indexes, post-operative complications, female sexual function score to charify the impact of the two methods of specimen removal on patients. Results There were no significant differences in intraoperative blood loss, fever and bleeding after operation, intestinal obstruction, anastomotic leakage and other postoperative complications between two groups. Compared with transabdominal group, operative time prolonged [(151.52±33.73) min vs. (179.59±47.02) min, P=0.012 0] and postoperative hospital stay decreased (7.14 d vs. 6.07 d, P=0.013 0) in transvaginal group. The female sexual activity recovered more quickly with less discomfort caused by the scar in transvaginal group and there was no statistical difference in postoperative female sexual function score between two groups. Conclusions CRC-NOSES Ⅷ A could be safe and feasible when compared with conventional laparoscopic hemicolectomy with transabdominal specimen extraction for radical resection of colon cancer. The patients in transvaginal group had less sensation of scars and faster recovery of sexual activity.

Abstract Background p50-associated cyclooxygenase-2 extragenic RNA (PACER) is a recently identified antisense long non-coding RNA (lncRNA) located on the upstream of the promoter region of cyclooxygenase-2 (COX-2). Preliminary studies have suggested that PACER is involved in the regulation of COX-2 expression in macrophagocyte and osteosarcoma cells. However, the role of this lncRNA in colorectal cancer (CRC) remains elusive. Here, we investigated the expression of PACER and its effect on cell proliferation and invasion to explore the role of PACER in CRC. Methods Real-time quantitative PCR (RT-qPCR) analysis was used to evaluate the expression of PACER in CRC tissues and cells. Methyl thiazolyl tetrazolium (MTT) analysis was then used to investigate the inhibition effect of PACER knock-down in cell proliferation. The promoting role of this lncRNA on invasion by CRC cells was analysed by wound-healing assays, colony-formation assay, and transwell assays. We then used fluorescence in situ hybridization (FISH) to establish the subcellular localization of PACER. COX-2 protein levels were quantified by Western blot analysis and grayscale scanning analysis following the knock-down of PACER. Luciferase assay was carried out to monitor the modulation of the COX-2 promoter region by PACER. Tumor xenografts models were used to investigate the impact of PACER on the tumorigenesis of CRC cells in vivo. Enzyme-linked immunosorbent assay (ELISA) was then used to quantify prostaglandin E2 (PGE2) production upon knock-down of PACER. Results RT-qPCR analysis revealed that PACER was highly expressed in CRC tissues and cells, and a high PACER-expression level was associated with poor prognosis. MTT assay, wound-healing assay, colony-formation assay, and transwell assay revealed that PACER enhanced CRC-cell proliferation, invasion, and metastasis in vitro. Analysis of lncRNA localization by FISH showed that it mainly resided in the nucleus. RT-qPCR showed that PACER increased mRNA levels of COX-2. Western blot analysis demonstrated, under normal circumstances, that knock-down of PACER decreased the COX-2 protein level. In the case of p50 absence, COX-2 protein increased rapidly and remained highly expressed after knocking down PACER. Luciferase assay revealed that PACER modulated the COX-2 promoter region. Mouse xenograft models of CRC revealed that PACER promoted colorectal tumorigenesis in vivo. ELISA revealed that PACER knock-down inhibited PGE2 production. Conclusions PACER modulates COX-2 expression through the nuclear factor kappa B (NF-κB) pathway in CRC. An increased level of PACER enhances proliferation, migration, and invasion of tumor cells by increasing COX-2 and PGE2 synthesis.