V6 The feasibility of laparoscopic rectal resection for cancer
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Introduction: Total mesorectal excision (TME) has offered the lowest recurrence rates and best survival in rectal cancer patients. Recently several multi‐centre trials have demonstrated the feasibility of laparoscopic colonic resections for cancer. However the technical difficulties and lack of supporting data has prevented surgeons from attempting laparoscopic TME for operable rectal cancer. We present a video demonstration of lap TME technique performed at our unit for rectal cancer resections. Methods: The surgical technique involves using two 10 mm and two 5 mm ports to perform rectal resections. Adherence to advanced oncological principles like high tie of IMA and IMV is the rule. Splenic flexure is routinely mobilised for mid to low rectal cancers. Total mesorectal excision is performed using diathermy hook. Rectal washout is performed before transection of the rectum using lap stapler device. Results: Between October 2006–December 2007, 30 rectal cancers have been operated laparoscopically at our institution using this technique. There were four APER and 26 anterior resections. The median age was 72 years with a median BMI of 25. Median operative time was 235 min with a median hospital stay of 7 days. There were no leaks. Conclusions: With proper training and experience, laparoscopic rectal cancer resection is technically feasible and safe to perform with good oncological outcomes.Intracavitary hyperthermia was applied to the rectum of normal pigs at 43°, 44°, 45°, 46°, 47° and 48°C for 30 min. A score of temperature-induced histological changes of each specimen was made 48 h after heating. The scores from each specimen and temperature were used for regression analysis. Judging from the regression lines of the scores obtained for rectum and oesophagus, we conclude that the thermosensitivity of the rectum is about 1°C higher than that of the oesophagus. It suggested that 43°C/30 min could be a safe dose for normal rectum. The thermosensitivity of swine rectum is discussed.
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Advances in the surgical management of rectal cancer have placed the quality of total mesorectal excision (TME) as the major predictor in overall survival. A standardized TME technique along with quality increases the percentage of patients undergoing a complete TME. Quality measurements of TME will place increasing demands on surgeons maintaining competence with present and future techniques. These efforts will improve the outcome of the rectal cancer patients.
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We present a case of a 40-year-old woman with smallcell carcinoma (SCC) of the rectum. She had profuse bleeding in rectum for 5 d. By colonoscopy, polyps were determined in the rectum and biopsies were carried out.Histopathologically, the polyps were adenomatous. Because of the profuse bleeding in rectum, she underwent low anterior resection. After the diagnosis of SCC, she received intravenous chemotherapy with standard doses of siklofosfamid, adriamycin, and vepesid. Nevertheless,intracranial metastases were revealed and she died 6 mo after the operation.
Adenomatous polyps
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Enema
Obstructed defecation
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To investigate the clinicopathological differences in laterally spreading tumor (LST) from the rectum and colon. Methods: Clinicopathological records of 198 patients with LST (116 cases in rectum, 82 cases in colon) from the Second Xiangya Hospital of Central South University between January 2012 and January 2017 were evaluated. Results: A total of 198 colorectal LST were included. According to the endoscopic classification, nodular mixed type (LST-GM), homogeneous type (LST-GH), flat elevated type(LST-FE) and pseudodepressed type (LST-PD) were 127(64.1%), 13(6.6%), 41(20.7%) and 17(8.6%), respectively. LST-GM was predominant in the rectum (71.7%), while LST-FE was predominant in the colon (78.0%), with significant difference (P<0.01). The mean size of LST was (52.03±35.62) mm or (25.37±11.56) mm in the rectum or the colon, with significant difference between them (P<0.01). High grade intraepithelial neoplasia frequency was higher in the rectum than that in the colon (31.0% vs 18.3%), while the low grade intraepithelial neoplasia frequency was lower in the rectum than that in the colon (61.2% vs 75.6%) (both P<0.05). The mean size of LST-GM and LST-GH diameter were larger in the rectum than that in the colon, and the malignant potential of LST-GM was higher in the rectum than that in the colon. The percentage of high grade intraepithelial neoplasia + invasive carcinoma was 41.8% and 22.2%, respectively (both P<0.05). LST in colon was mostly treated with endoscopic mucosal resection, while LST in rectum was treated by endoscopic submucosal dissection predominantly. Conclusion: LSTs from the rectum and colon show different clinicopathological characteristics to some extent. LST-GM is predominant in the rectum, while LST-FE is predominant in the colon. The malignant potential of LST-GM is higher in the rectum than that in the colon.目的：研究直肠和结肠来源的侧向发育型肿瘤(laterally spreading tumor，LST)的临床病理特征之间的差异。方法：回顾性分析中南大学湘雅二医院2012年1月至2017年1月确诊的198例LST患者(直肠116例，结肠82例)的临床病理资料。结果：198例患者按内镜分型来看，结节混合型127例(64.1%)，颗粒均一型13例(6.6%)，扁平隆起型41例(20.7%)，假凹陷型17例(8.6%)；结节混合型更常见于直肠(71.7%)，扁平隆起型更常见于结肠(78.0%)，两者差异有统计学意义(P<0.01)；直肠LST直径为(52.03±35.62) mm，结肠LST直径为(25.37±11.56) mm，两者比较差异有统计学意义(P<0.01)；直肠LST与结肠LST相比较，高级别上皮内瘤变的比例更高(分别为31.0%和18.3%)，低级别上皮内瘤变的比例则较低(分别为61.2%和75.6%)(均P<0.05)；直肠LST与结肠LST相比较，结节混合型和颗粒均一型的直径更大，结节混合型拥有更高的恶性潜能(高级别瘤变+浸润癌的百分率分别为41.8%和22.2%)(均P<0.05)；结肠LST多采用内镜下黏膜切除术治疗，直肠LST多采用内镜黏膜下剥离术治疗。结论：直肠LST与结肠LST表现出某些不同的临床病理特征，结节混合型LST更常见于直肠，扁平隆起型LST更常见于结肠，直肠结节混合型LST可能具有更高的恶性潜能。.
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Phantom syndrome is a common sequela after limb amputation, whereas phantom rectum syndrome after rectum resection was rarely reported. This study attempted to examine the prevalence and characters of phantom rectum syndrome in Chinese patients. From the hospital records, eighty-one cases received rectum resection for carcinoma of the rectum were included. A written inquiry by a questionnaire was used. The data were obtained by the responded questionnaire. Chi-squared and Fisher's exact tests were used for data analysis. Of 81 cases collected, 55 cases responded and entered the study. The prevalence of phantom rectum syndrome was 40%, and in 55% of these or 22% of all patients this phantom sensation was painful. The age (53.0 ± 14.6 years, p < 0.05) of the patients with painful phantom rectum syndrome was significantly lower than that of the patients with non-painful phantom rectum syndrome (64.4 ± 6.9 years) and the patients without phantom rectum syndrome (62.8 ± 11.1 years). Patients with high educational level exhibited higher occurrence of painful phantom rectum syndrome. A higher prevalence of phantom rectum syndrome and painful phantom rectum syndrome were observed in patients with preoperative pain. The phantom rectum syndrome after rectum resection in Chinese patients really exists and the occurrence of painful phantom rectum syndrome is related to young age, high educational level and preoperative pain.
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Introduction: Rectal cancer treatment has changed over the last several decades. Total mesorectal excision (TME) has proven to be the gold standard in rectal cancer surgery. Transanal total mesorectal excision (TaTME) and robotic total mesorectal excision (RoTME) for low and mid rectal cancer are implemented to overcome some of the difficulties of the laparoscopic approach. The aim of this study is to show a single-center experience in the learning curves of both RoTME and TaTME.
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Tumours of the upper rectum, and many in the middle third, are not accessible to endorectal ultrasound staging because of the difficulty in reaching all sites of the rectum with a rigid probe. The aim of this prospective study was to assess whether using a dedicated rectosigmoidoscope, endorectal ultrasonography (ERUS) can accurately stage any rectal lesion irrespective of its distance from the anal verge.A total of 173 consecutive patients with a primary rectal tumour were included. A rotating, high multifrequency (5.0-10 MHz) endoprobe was introduced through a dedicated rectosigmoidoscope and advanced above the lesion. A computer allowed for three-dimensional (3D) reconstruction of 2D images. Treatment was selected on the basis of 3D-ERUS findings. ERUS staging was correlated with pathological staging.The depth of invasion was correctly determined by 3D-ERUS in 78.2% of tumours of the lower rectum, 76.4% of tumours extending between the lower and middle third of the rectum, 80.9% of tumours of the middle third of the rectum, 78.5% of tumours extending between the middle and upper third of the rectum and 78.9% of tumours of the upper rectum. The accuracy for the absence of lymph node metastases was 81.2% for tumours of the lower rectum, 78.5% for tumours extending between the lower and middle third of the rectum, 85.7% for tumours of the middle third of the rectum, 83.3% for tumours extending between the middle and upper third of the rectum and 78.5% for tumours of the upper rectum. Analysis showed that there was no difference between the various tumour sites.Our findings indicate that using a dedicated proctosigmoidoscope, tumours of the upper and middle third of the rectum are equally accessible to ultrasonographic evaluation. The distance of the tumour from the anal verge does not influence the accuracy of examinations considered adequate by the operator.
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