To study postoperative anorectal dynamic change in ultra-low rectal cancer patients undergoing laparoscopic intersphincteric resection.Clinical and follow-up data of 26 ultra-low rectal cancer patients undergoing laparoscopic intersphincteric resection in our department from January 2007 to January 2013 were retrospectively analyzed (observation group). Thirty rectal cancer patients undergoing laparoscopic low anterior resection by the same surgical team in the same period from the Medical Record Room were randomly extracted as control group. The observation indexes included preoperative and postoperative anal resting pressure(ARP), anal maximum squeeze pressure (AMSP), rectal maximum tolerable volume (RMTV), rectal anal inhibition reflex (RAIR) and Wexner anal function scores (0 means normal).There were no significant differences in clinical baseline data between the two groups(all P>0.05), except the distance from lower edge of tumor to dentate line [(2.9±0.4) cm in observation group vs. (5.0±0.5) cm in control group, P=0.000]. There were no differences in preoperative anorectal manometry and Wexner anal function score between two groups (all P>0.05). The average follow-up time in observation group and control group was 14.5 months and 14.0 months respectively. Three months after operation, significant differences between observation group and control group (all P=0.000) were as follows: defecation frequency [(6.0±1.5) times/day vs. (2.5±1.0) times/day], Wexner anal function score(5.0±0.9 vs. 2.9±1.2), ARP [(32.0±6.7) mmHg vs. (45.0±8.2) mmHg], AMSP [(90.1±6.9) mmHg vs. (110.0±7.5) mmHg], RMTV [(61.0±7.2) ml vs. (91.1±7.5) ml] and positive rate of RAIR [11.5%(3/26) vs. 66.7%(20/30)]. One year after surgery, there were no significant differences in defecation frequency, Wexner anal function scores, ARP, AMSP and RMTV between the two groups (all P>0.05), however the difference in positive rate of RAIR was still significant[38.5%(10/26) vs. 93.3%(28/30), P=0.000].Laparoscopic intersphincteric resection for ultra- low rectal cancer can achieve satisfactory anorectal dynamic effect.
Abstract Background: Some patients with breast cancer are diagnosed with locally advanced breast cancer (LABC). At present, there are no obvious reports on LABC radiotherapy, chemotherapy, and breast-conserving benefit population. Method: The cases of LABC confirmed by pathology from 2010 to 2015 were searched through the Surveillance Epidemiology and End Results (SEER) database. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated by plotting Kaplan-Meier curves. The log rank test (Mantel-Cox) was used to analyze the difference between the groups, and the benefit population of LABC was determined after for age, TNM stage, grade, treatment methods. Results: A total of 34474 LABC patients were included, 22477 (65.2%) were Luminal A, 1418 (4.1%) were Luminal B, 4911 (14.3%) were triple-negative breast cancer, 2461 (7.1%) were HER2-enriched, and 3207 (9.3%) were three positive breast cancer. Kaplan-Meier curves of 5-year OS and BCSS were plotted for LABC patients with different molecular types of breast conserving surgery and mastectomy. Overall the LABC with breast conserving and total mastectomy was 77.8%, 84.6% ,68.4% and 77.2%. Luminal A LABC with breast conserving and total mastectomy was 79.9%,87.5%, 72.3% and 81.5%.Luminal B LABC with breast-conserving and total mastectomy were 79.3% , 83.1%, 70.8% and 77.1%. TNBC LABC with breast-conserving and total mastectomy were 61.0% ,68.4%, 47.5% and 56.2%. HER2-enriched LABC with breast-conserving and total mastectomy were 77.7%, 80.5%, 67.2% and 75.2%. TPBC LABC with breast-conserving and total mastectomy were 84.9%, 91.8%, 75.5% and 82.1%, respectively. Except for the Luminal B LABC BCSS surgery method, there was no significant difference (P=0.058), all the others were statistically significant (P<0.05). Conclusions: This study found that in the selective population, OS and BCSS of patients with LABC undergoing breast conserving surgery were significantly better than those of mastectomy.This study also found that LABC could be considered for highly differentiated, NO stage TPBC without chemotherapy.
Although the research reports on locally advanced breast cancer (LABC) are increasing year by year, there are few reports on T1 LABC axillary lymph node metastasis (ALNM). By establishing a prediction model for T1 LABC ALNM, this study provides a reference value for the probability of ALNM of related patients, which helps clinicians to develop a more effective and individualized treatment plan for LABC.
Objective
To investigate the treatment and prevention of anastomotic leakage after low anterior resection in patients with middle or lower rectal cancer.
Methods
Clinical data of 764 patients with middle or lower rectal cancer undergoing laparoscopic low anterior resection (LLAR) from February 2002 to December 2014 in our department were retrospectively analyzed. They were divided into two groups: dual drainage tube and intra-rectal tube group (group A) and conventional group (group B) according to different treatments after operation. Three hundred and thirty-four cases received extraperito-neal dual drainage tube in the meantime, intra-rectal drainage tube was placed transanally in the rectum upper anastomosis (group A); the other 430 cases just received extraperitoneal dual tube (group B). The incidence of postoperative anastomotic leakage, drainage tube indwelling duration, hospitalization dura-tion, hospitalization expense, reoperation rate and incidence of anastomotic stricture within 6 months after operation were compared between the two groups.
Results
Anastomotic leakage after low anterior resec-tion operation was found in 36 cases (4.7%), including 13 cases (3.9%) in group A, and 23 cases (5.2%) in group B, and there was no statistically significant difference (χ2=0.888, P=0.336). Drainage tube indwell-ing duration, hospitalization duration, hospitalization expense of group A was (9.6±3.2) d, (15.4±5.2) d, (43 572±3 224) yuan, and that of group B was (15.2±4.8) d, (20.3±6.6) d, (53 387±4 792) yuan, respectively; the differences between the two groups were statistically significant (t=18.382, 13.494, 32.170, all P<0.01). Two cases in group A and 12 cases in group B underwent reoperationd because of anastomotic leak-age after LLAR, with statistically significant difference (χ2=4.730, P=0.030). No case with anastomotic stricture was found in group A, while 5 cases were found in group B within 6 months after operation.
Conclusion
For middle and lower rectal cancer patients undergoing LLAR operation, placing extra-perioneal dual tube in the dorsal site of an anastomosis for drainage and placing intra-rectal drainage tube in the rectum upper anastomosis, combined with Alprostadil injection is benefit to decrease the rate of anastomotic leakage, and helpful for conservative therapy for anastomotic leakage.
Key words:
Rectal neoplasms; Anastomotic leakage; Low anterior resection; Dual drainage tube
To explore the causes of postoperative anastomotic leakage of colorectal cancer.A total of 1462 cases with colorectal cancer undergoing laparoscopic operation and intestinal anastomosis at our department over the last decade were analyzed retrospectively. Data analysis was performed with SPSS 13.0. The risk factors were analyzed by binary Logistic regression while the annual incidence of anastomotic leakage by trend χ(2) test.Thirty anastomotic leakage occurred in 1462 cases with an incidence rate of 2.1%. There were significant correlations of anastomotic leakage with body built, tumor location, tumor size, operation time (χ(2) = 6.117, 50.167, 36.693, 4.481, P = 0.013, 0.000, 0.000, 0.034). However, there was no correction with gender, age or histological type (P = 0.871, 0.775, 1.000). Then the significance check of binary Logistic regression equation was performed. Tumor location was an independent risk factor of postoperative anastomotic leakage for colorectal cancer. The relative risk was 2.056. The annual incidence of anastomotic leakage was statistically insignificant (χ(2) = 1.827, P = 0.176). And the difference was.The occurrence of anastomotic leakage after colorectal cancer surgery is significantly correlated with body built, tumor location, tumor size and operation time. And tumor location below peritoneal reversal is an independent risk factor of anastomotic leakage.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)