Reconstructive techniques following low anterior resection for carcinoma of the rectum
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INTRODUCTION: Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied.EVIDENCE ACQUISITION: PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31st, 2023.EVIDENCE SYNTHESIS: Considerable heterogeneity existed among different study findings. Reservoir techniques, including CJP, SEA, and TCP, exhibited reduced stool frequency, decreased urgency, and improved continence status compared to SCA, particularly in the short term. CJP maintained this advantage into the intermediate term. Other functional outcomes were similar among the techniques. However, these functional improvements did not translate into enhanced Quality of Life (QoL). TCP was associated with an elevated risk of anastomotic leaks. Other surgical outcomes remained comparable across all four techniques. Sexual outcomes also exhibited no significant variation. Some studies suggested that the size of the side limb in CJP or SEA may not significantly impact functional outcomes, implying that neorectum capacity may not be the primary determinant of improved function. The precise physiological mechanism underlying these findings remains unknown.CONCLUSIONS: In the short and intermediate terms, reservoir techniques demonstrated superior functional outcomes, but long-term performance was comparable among all techniques. Notably, enhanced functional outcomes did not translate to improved Quality of Life. TCP, while effective, is linked to an increased risk of anastomotic complications, necessitating cautious utilization.Keywords:
Pouch
The levels of grooming activities were measured in the marsupial Macropus eugenii for females without young in the pouch during the breeding season, and for females with young in the pouch at intervals throughout the pouch life (250 days) of the young. Grooming associated with the pouch was found to increase rapidly after parturition and also to change qualitatively as the young became older. The level of other grooming recorded did not change. Although 82% of pouch cleaning activities recorded occurred in close association with other grooming activities, there was no regular sequence of grooming and pouch cleaning activities, apart from the general association of grooming of different parts of the body - pouch, anterior surface, flank. The results are discussed in relation to the importance of stimulation from the young in the initiation and maintenance of maternal behaviour; the presence of the young is necessary for the maintenance of pouch cleaning.
Pouch
Macropus
Tammar wallaby
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Pouch
Involution (esoterism)
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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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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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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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Objective To assess the long term effect of indiana pouch procedure after total cystectomy. Methods The Indiana-pouch procedure had been improved as follows: after the end of ureter being made as nipple-like, it was implanted into the pouch with a tunnel way under bladder mucous for more than 2.0cm at least. So there were double ways to anti-reflux of urine. The process of pouch mucous was ameliorated too. Result After being follow-ups of half a year, the mean capacity of pouch was 610ml (520-900ml) and the mean filling pressure of the pouch was 10.4+2.8cmH2O. There was no evidence of ureter reflux and hydroneophrosis. Conclusions Indiana pouch procedure is fairly good for urinary diversion with high capacity, low pressure, minimal complications and catheteritation being easy.
Pouch
Urinary diversion
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