PurposeThis study aims to compare the outcomes of repair/redo ileal pouch-anal anastomosis (repair/redo-IPAA) with the conversion of IPAA to continent ileostomy (CI) in an effort to prevent the need for a permanent ileostomy (IS) following IPAA failure.MethodsThis research involved a retrospective analysis of surgical records, employing descriptive statistics and Kaplan-Meier survival analysis.ResultsAmong 57 patients with an IPAA, up to three revisions were necessary due to complications or complete failure. Ultimately, repair/redo-IPAA preserved the IPAA in 14 patients (24.6%), conversion to CI salvaged the pouch in 21 patients (36.8%), and IS was unavoidable in 22 patients (38.6%). The cumulative probability of requiring conversion surgery was calculated to be 54.0% at 20 years, thereby reducing the cumulative risk of IS to 32.3%. The 20-year cumulative probability of pouch salvage by repair/redo IPAA was only 21.9%. However, this rate increased to 67.7% when conversion procedures were considered. Following repair/redo-IPAA, only 8.3% of patients reported evacuation frequencies of ≤ 4 during the day, and 16.7% were evacuation-free at night. In contrast, after conversion to CI, 98.0% of patients reported a maximum of four evacuations in a 24-h period. After undergoing repair/redo IPAA, between half and two-thirds of patients reported experiencing incontinence or soiling, while complete continence was achieved in all patients following conversion to CI. Notably, the majority of patients expressed overall satisfaction with their respective procedures. A positive correlation was identified between very high subjective satisfaction and positive objective surgical outcomes exclusively in patients who underwent conversion to CI. ConclusionWhen complications or failure of IPAA occur, conversion to CI emerges as a highly viable alternative to repair/redo IPAA. This conclusion is supported by the observation that patient satisfaction appears to be closely tied to stable surgical outcomes. To reinforce these findings, further prospective studies are warranted.

The incidence of anastomotic leak after right hemicolectomy for cancer is relatively low, but it may be misjudged. In recent years, the results of some multi-center or nationwide registration studies in Europe have shown that the incidence of anastomotic leak is significantly higher than that of eastern countries. The reasons of these differences may be the different nature of the studies, the lack of rigor in diagnostic criteria or diagnostic methods, the difference in the level of specialization of hospitals or surgeons, and so on. Timely treatment of preoperative comorbidities, reasonable selection of preoperative bowel preparation and anastomotic technique/method might reduce the occurrence of anastomotic leak. The current evidence shows complete mesocolic excision (CME) does not increase the risk of anastomotic leak. The clinical features of ileo-colic anastomotic leak are different from those of rectal surgery. The mild cases can be treated conservatively, and the severe cases are suggested to receive timely diverting ileostomy.

Background: The association of adenocarcinoma of the colon and neuroendocrine tumor (NET) of the small bowel has been previously described in Crohn's disease (CD), however the concomitance of both neoplasms is extremely rare. Here, the author reports a rare case of both rectal adenocarcinoma and small-bowel NET in a young male with long-standing CD. Case Report: The patient presented with clinical and radiological features of intestinal obstruction 2 years posttotal colectomy and end ileostomy for rectal cancer and found to have ileal NET. Conclusion: Small-bowel NET symptoms can mimic CD and is a rare entity, but physicians should suspect NETs in CD patients presenting with intestinal obstruction.

Context When intestinal gangrene is evident or suspected, surgical laparotomy is mandatory where the affected segment is resected with a safety margin of 5–10 cm, and the remaining part is either anastomosed or diverted on anterior abdominal wall as stoma. Stomas protect against the risks of anastomotic leakage and permit close examination of the bowel by inspection and/or endoscopy; however, it affects the quality of life. Aims To evaluate the perioperative outcomes of patients of mesenteric vascular occlusion in relation to the method of surgical intervention with either primary anastomosis or diverting ileostomy. Settings and design The study was a prospective, randomized comparative study. It involved all eligible patients fulfilling the inclusion criteria of the study. It was conducted at Mansoura Emergency Hospital in the period from November 2016 till November 2019. Patients and methods A total of 100 patients were recruited into the current study and divided into two groups after resection of gangrenous part: stoma group and anastomosis group. Statistical analysis Data were fed to the PC and analyzed using SPSS, version 26.0. Results Overall, 100 cases had a mean age of 53.0±7.6 years, with the range of 38.0–77.0 years. It included 66 (66%) males and 34 (34%) females. The leakage rate was significantly higher in the anastomotic group (18 cases), whereas it was experienced only in two (4%) cases in the other group (P<0.001). Consequently, postoperative mortality was higher in the same group (nine cases) (P=0.025). Conclusions The diverting stoma appeared to be a safer procedure to perform in mesenteric vascular occlusion with respect to morbidity and mortality rates but needs a strict nutritional, psychological, and special home care to enhance quality of life.

A CASE OF BOWEL PERFORATION IN A CRITICALLY ILL PATIENT ADMITTED WITH SARS-COV2

A straightforward, systematic and reproducible framework for junior registrars to adopt when learning the handsewn ileostomy closure technique.

Objective To evaluate the clinical outcome of the modified three-needle method for preventive ileostomy. Methods From April 2018 to August 2018, a retrospective analysis was performed in 13 patients who underwent laparoscopic radical resection of rectal cancer. The preventive ileostomy was modified by the three-needle method. The procedure was as following. The first and second needle was all sutured between the rectus abdominis muscle, and the suture passed through the avascular zone of the mesentery on the both sides. We tighten the first suture; The second needle and the third needle was performed in the distal and proximal intestines of the stoma. Finally ostomy was opened and suture was made between the whole layer of the stoma to the skin. Results All the 13 patients were performed successfully. The average operation time was(139.62±47.01) min, , and the average intraoperative blood loss was (56.15±32.54) ml. One patient had ostomy skin mucosal separation after operation and recovered after conservative treatment. There were no complications such as stoma mucosal separation from the skin, stoma collapse, ostomy prolapse, fistula necrosis, stenosis, infection and other complications. Conclusion The operative procedure is simple and easy with less complications, and the operation time is relatively decreased, and it is easy for the close of stoma. The surgical procedure of the preventive ileostomy is further improved. The general condition is good, safe and feasible. Key words: Rectal neoplasms; Ileostomy; Three-needle method

Objective To investigate the risk factors for anastomotic leakage (AL) after laparoscopic intersphincteric resection (Lap-ISR) for patients with low-lying rectal cancer. Methods This retrospective study was conducted in the Characteristic Medical Center of PLA Rocket Force from Jun 2011 to Nov 2018. 151 patients undergoing Lap-ISR were enrolled for this study. Results All patients in this series had a defunctioning ileostomy. The overall leakage rate was 17.2% (26/151), including peri-operative AL (n=20) and delayed AL (n=6). In accordance with the grading system of the International Study Group of Rectal Cancer, there were 24 patients (15.9%) with AL Grade B (requiring active therapeutic intervention) and two patients (1.3%) with AL Grade C (requiring re-laparotomy). Univariate analysis showed that BMI (≥ 25 kg/m2), tumor annularity (≥ 3/4) and operation time (≥ 240 min) were associated with AL (P<0.05). Multivariate analysis showed that operation time (≥ 240 min, OR=7.390, 95% CI: 2.483-21.988, P=0.000), tumor annularity (≥ 3/4, OR=6.233, 95% CI: 1.932-20.107, P=0.002) and higher BMI (≥ 25 kg/m2,OR=3.523, 95% CI: 1.275-9.738, P=0.015) were independently predictive of AL. Conclusion Tumor annularity, operation time and higher BMI are independently associated with symptomatic AL after Lap-ISR. Key words: Rectal neoplasms; Anastomotic leakage; Risk factors; Laparoscopy

Rectal cancer represents a challenge for the general surgeon as patients’ quality of life after the management of the neoplasm is starting to become more and more important. Our review is focused on loop ileostomies and the reasons why their closure might be delayed. We have tried to gather these reasons all together from our experience and from the literature in order to understand whether there are any aspects that can be improved. After a thorough search through different scientific databases we managed to include a total of 29 articles in our research and the information gathered has led to the conclusions of this narrative review. There are many reasons why the closure of an ileostomy might be delayed. While some of them are related to the patient and cannot be controlled or prevented (age, comorbidities), most of the factors that can interfere are preventable (adjuvant therapy, postoperative complications, patient’s wish). Keywords: ileostomy; rectal cancer; low anterior resection

Idiopathic megacolon is an acquired disease of unknown pathogenesis characterized by massive dilatation and aperistalsis of the colon. Idiopathic megacolon typically manifests as abnormal bowel movements, abdominal pain, and bloating. We report a case of adult idiopathic megacolon with intestinal obstruction. Subtotal colectomy and ileostomy were performed for his treatment. Then the diagnosis, differential diagnosis and treatment of adult idiopathic megacolon be discussed. Key words: Constipation; Intestinal obstruction; Idiopathic megacolon

Objective To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer. Methods The prospective study was conducted. The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected. According to random number table, patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage I opening were allocated into experimental group, and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group. Observation indicators: (1) comparison of postoperative clinical endpoints indices; (2) comparison of postoperative complications; (3) comparison of stress response indices. Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients. The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge. The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation. Patients returned to hospital if there was any discomfort after discharge, and were re-admitted if necessary. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Results Eighty-eight patients were screened for eligibility, including 61 males and 27 females, aged from 44 to 74 years, with an average age of 61 years. There were 45 patients in the experimental group and 40 in the control group, respectively. (1) Comparison of postoperative clinical endpoints indices: the operation time, time to first semiliquid diet, postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses were (122±9)minutes, (5.1±1.6)days, (54±8)hours, 18.6±1.5, (6.7±1.2)days, (53 269±2 888)yuan in the experimental group, and (128±10)minutes, (6.4±2.4)days, (65±7)hours, 17.1±1.3, (8.1±1.4)days, (59 419±1 921)yuan in the control group, respectively. There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716, 1.329, P>0.05). There were significant differences in the postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses between the two groups (t=8.688, 5.850, 3.897, 11.707, P 0.05). The incidence of system complications was 17.8%(8/45) in the experimental group, including 2 case of acute urinary retention, 2 of incisional infection, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities; the incidence of system complications was 20.9%(9/43) in the control group, including 1 case of acute urinary retention, 1 of incisional infection, 1 of intestinal obstruction, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities, 1 of anastomotic fistula; there was no significant difference in the incidence of system complications between the two groups (χ2=0.140, P>0.05). There was no death in the two groups. Patients with postoperative anastomotic leakage in the experimental group were recovered and discharged after re-surgical exploration and continuous abdominal irrigation, and the remaining patients were discharged after active conservative treatment. (3) Comparison of stress response indices: from preoperation to postoperative 5 days, the C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) were changed from (2.2±0.7)ng/L to (43.9±12.0)ng/L, from (12.2±1.9)fmmol/L to (11.3±1.4)fmmol/L, from (95±17)ng/L to (107±14)ng/L in the experimental group, and from (2.2±0.8)ng/L to (58.8±10.7)ng/L, from (11.6±1.6)fmmol/L to (12.7±1.3)fmmol/L, from (94±16)ng/L to (117±13)ng/L in the control group, respectively, showing significant differences in the changing trends of CRP, TNF-α, IL-6 between the two groups (F=260.042, 55.428, 120.337, P 0.05). Conclusion Compared with stage Ⅱ opening, stage Ⅰ opening of prophylactic ileostomy in laparoscopic rectal resection for low rectal cancer is safe and effective, which can reduce postoperative stress response and promote patients′ rehabilitation. Key words: Rectal neoplasms; Rectal cancer; Infection; Ileostomy; Stoma opening; Stress response; Postoperative recovery

Background Right Hemicolectomy (RHC) is a common procedure for various right-sided colon pathologies; cancer colon or terminal ileum, perforated appendix with unhealthy cecal base, traumatic injuries and other less commonly indications. Ileo-colic anastomosis is the preferred next step following resection of the diseased segment, however, in certain situations, ileostomy (IL) and mucus fistula (MF) may be done due to excessive soiling or post-leakage of ileo-colic an astomosis or due to bad general condition of patient at this situation. Analternative approach can be done in such cases, which is the construction of aside-to side ileo-colic anastomosis which is then brought out in the right abdominal wall anastoma, so that reconstruction can be done with out midline laparotomy. Here, in our study we did a short term comparison between two groups of patients underwent ileosto my with mucousfistula.The first under went posterior wall anastomosis and the second without. Aim of Study Compare between Two groups of patients post RHC; one underwent ILM Group A: underwent ileostomy and mucusfistula with posterior wall anastomosis. Group B: operated up on by ileostomy and mucus fistula without posterior wall anastomosis. Results Twenty-three patients underwent ileostomy and mucus fistula through single skin opening with posterior wall anastomosis, while 25 patients were through 2 skin openings without posterior wall anastomosis. No statistically significant difference between both groups regarding postoperative stoma-related complications. Restoration of continuity showed significantly more rate of wound infection in-case of ileostomy and mucus fistula through separate skin openings that’s attributed to midline laparotomy. Conclusion Ileostomy and mucus fistula through single skin opening with posterior wall anastomosis, is associated with similar complications rate to separate skin openings ileostomy and mucus fistula, however, its less risk of wound related SSI along with its ramifications as wound dehiscence and incisional hernia, due to avoidance of midline laparotomy when restoring bowel continuity is a worthy advantage.

Objective To investigate the effects of the multidisciplinary cooperative management intervention model on the self-management efficacy of patients with ileostomy irritant dermatitis. Methods Among the patients with irritative dermatitis in the ileostomy section of the Anorectal Surgery and Ostomy Clinic of Hwamei Hospital, the Chinese Academy of Sciences, 72 patients, who visited the clinic from August 2016 to August 2018, met the inclusion criteria and were finally included in the study. According to the random number table method, 36 patients each were assigned to the control and observation groups respectively. There were no significant differences in age, sex and education between the two cohorts. The control groups were compared. The control group was treated with routine nursing methods. The observation group underwent multidisciplinary nursing intervention that was based on the routine measures of the control group. The Chinese version of the cancer self-management efficacy was used as the questionnaire survey that was administered before and after treatment. The results were compared and analyzed between the patient groups. The independent sample t-test was used to compare the results between the groups, and the paired sample t-test was used for intra-group comparisons. Results After intervention, the total scores of self-management efficacy and positive attitude, self-decompression and self-decision scores were higher in the observation group than in the control group (t=4.192, 3.095, 4.123, 2.267, P<0.05). The scores of self-administration efficacy and each dimension of the two groups were higher than those before intervention, and the difference was statistically significant (P<0.01). After the intervention, 3 patients （10.0%） in the observation group with recurrent dermatitis and 13 patients （43.3%） in the control group. The recurrence rate of the observation group was significantly lower than that of the control group (χ2= 8.357, P<0.05). Conclusion Multidisciplinary cooperative management can improve the self-management efficacy of patients with irritating dermatitis and reduce the incidence of this condition.

Objective To investigate the long-term efficacy of pure transanal total mesorectal excision (PtaTME) for middle-low rectal cancer. Methods The retrospective descriptive study was conducted. The clinicopathological data of 18 patients with middle-low rectal cancer who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from July 2014 to August 2016 were collected. There were 7 males and 11 females, aged (58±13) years, with a range from 40 to 84 years. The body mass index was (22±3)kg/m2. All the 18 patients underwent PtaTME. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) follow-up and survival. Follow-up using inpatient reexamination, outpatient examination, and telephone interview were performed to detect anastomotic complications, anal function, urinary retention, sexual dysfunction, survival and tumor recurrence and metastasis once every 3 months within postoperative 6 months, once every 6 months from 6 months to 3 years, and once a year after 3 years up to June 2019. The measurement data with normal distribution were represented as Mean±SD, and the measurement data with skewed distribution were represented as M (range). Count data were expressed as percentages. Survival rates were calculated by the Kaplan-Meier method. Results (1) Surgical and postoperative conditions: 18 patients successfully underwent PtaTME, without conversion to open surgery. The operation time, volume of intraoperative blood loss, distance between anastomosis and anal verge, time to first flatus, time to urinary catheter removal, and duration of postoperative hospital stay were (202±68)minutes, 50 mL (range, 20-400 mL), (4.5±2.0)cm, 2 days (range, 2-7 days), 3 days (range, 2-5 days), and 7 days (range, 5-10 days) in the 18 patients, respectively. There was no perioperative complication. Among 18 patients, 4 underwent preventive ileostomy. (2) Postoperative pathological examinations: the length of surgical specimens, the number of lymph node dissection, distance from tumor to the distal margin were (11.0±3.0)cm, 12±6, and 1.0 cm (range, 0.8-3.7 cm), respectively. The 18 patients had complete mesorectal membrane excision, with negative proximal margin, distal margin, and circumferential margin. Tumor pathological staging: there were 2 cases in Tis stage, 4 in T1 stage, 7 in T2 stage, and 5 in T3 stage; 16 in N0 stage, 1 in N1 stage, and 1 in N2 stage. Tumor histological classification: 2 patients had carcinoma in situ, 9 had moderately differentiated adenocarcinoma, and 7 had high-differentiated adenocarcinoma. (3) Follow-up and survival: 18 patients were followed up for 34.0-59.0 months, with a median follow-up time of 57.5 months. During the follow-up, 4 patients developed grade B anastomotic leakage and were cured after conservative treatment. One patient developed anastomotic recurrence at 2 years after surgery, and no recurrence was found after surgical resection of the recurrent lesion. Four patients with prophylactic ileostomy had the stoma closured, and the anus function was satisfactory after surgery. There was no urinary retention or sexual dysfunction in the 18 patients. Of the 18 patients, 17 had tumor free survival after surgery. The 3-year disease-free survival rate was 94.4%, and the 3-year overall survival rate was 100.0% in 18 patients. Conclusion PtaTME can achieve high quality of specimen, which is safe and feasible for the treatment of rectal cancer. Key words: Rectal neoplasms; Rectal cancer; Total mesorectal excision; Pure transanal total mesorectal excision; Long-term efficacy

Objective To report the experience of rectal injury during laparoscopic radical prostatectomy(LRP). Methods The clinical data for 3 patients with iatrogenic rectal injury in LRP in our hospital between January 2015 and October 2018 were retrospectively analyzed. The data of these three patients were as follows: age 69-79 year, mean 74.3 year; BMI 25.6-28.6 kg/m2, mean 27.1 kg/m2; preoperative PSA 5.7-74.1 ng/ml, mean 32.7 ng/ml; prostate volume 55.2-80.3 ml, mean 65.3 ml; preoperative TMN stage T1b-3aN0M0, preoperative Gleason score 6-8. One patient received neoadjuvant hormonal therapy; one patient did HoLEP three month before LRP. Surgical method: When rectal injury was noted, we continued our dissection between the correct layers until prostatectomy was completed. Then the wound in the rectum was thoroughly checked and irrigated with diluted povidone iodine. The wound was trimmed according to the wound condition, and the suture was conducted by absorbable silk at three layers: the rectal mucosa layer, the outer layer of the rectal wall, the posterior layer of the fascia. Then we rinsed the wound with iodophor and completed the urethral reconstruction. Results The operative time was 138-210 min, mean 166.7 min, and repair time was 30-41 min, mean 34.3 min. The intraoperative blood loss was 110-215 ml, mean 158.3 ml. Rectal injury occurred during prostatic apical dissection in 1 patients, during dissection of Denonvilliers fascia in 2 patient. The size of the lesions was 1.0-1.5 cm, mean 1.2 cm. All of the rectal injuries were recognized during the operation, and three-layered sutures were used for the primary repair. None of the cases required ileostomy procedure. Diet recovery time was 6-7 d, mean 6.3 d. The duration of transurethral catheter insertion was 10-14 d, mean 12.3 d. The pathological stage was T2~3bN0M0, pathological Gleason score 6-9, and 1 case surgical margin positivity in the apical region of the prostate. No case occurred urorectal fistulas.2 cases received adjuvant androgen deprivation therapy. Conclusions Primary repair with laparoscopic three-layered suturing might be sufficient for the treatment of rectal injuries that occur during LRP if the lesion was small and the margin was clean. Key words: Prostatectomy; Laparoscope; Rectal injury

As an extremely rare malformation, congenital pouch colon is characterized by shortened colon, markedly dilated pouch and anorectal malformations. In boys, pouch usually terminates in a colovesical fistula; in girls, terminal fistula opens into urethra or vestibule. Clinical presentations are typical and and its diagnosis is easily made by a large gas shadow or air-fluid level on radiograph. Its clinical managements and surgical options have remained controversial. Staged repair is performed after colostomy or ileostomy. Yet tubularization of dilated segment is dependent on the length of normal colon. Key words: Colon, abnormalities; Congenital pouch colon

Objective To investigate the surgical indication and surgical procedures for Crohn disease. Methods Clinical data of 47 cases with Crohn disease were retrospectively analyzed. Results The main clinical manifestations were abdominal pain ( 35 cases), diarrhea (16 cases), emaciation and fatigue( 12 cases), abdominal mass (9 cases), intestinal obstruction (31 cases), intestinal adhesion (18 cases), intestinal perforation( 8 cases), intestinal bleeding ( 11 cases) , internal fistula ( 4 cases), abdominal abscess( 4 cases). Preoperative enteroscopy was performed in 23 cases, and 7 cases were diagnosed as Crohn′s disease. Operative procedures included colectomy in 15 cases, small bowel resection and intestinal adhesion lysis in 29 cases, ileostomy in 3 cases. Postoperative complications occurred in 13 cases, including incision dehiscence in 2 cases, intestinal fistula in 5 cases, there were 2 cases of stress ulcer, pulmonary infection in 1 case and short bowel syndrome in 1 case, early postoperative inflammatory bowel obstruction in 2 cases and death in 1 case. 44 patients were followed-up, for an average of 6.8 years. Recurrence of Crohn′s disease was found in 11 cases and canceration in 3 cases. Conclusions Surgery is still the mainstay for Crohn′s disease, and close follow-up is important for disease recurrence and canceration. Key words: Crohn disease; Surgical procedures, operative; Complications

Objective To report 3 cases of pediatric colon carcinoma (PCC), review the relevant literatures and improve its clinical awareness. Methods Clinical data were retrospectively reviewed for 3 PCC cases from August 2006 to August 2017 at Beijing Children Hospital. They were all boys with a median age of 12.3 years at diagnosis. Case 1 presented with abdominal pain, fever and constipation and was diagnosed as colonic perforation by type B ultrasonography. The remaining two cases had abdominal pain and hematochezia and were diagnosed as descending colon mass by type B ultrasonography, computed tomography (CT) and colonoscopy. Literatures related to PCC were retrieved from Pubmed and Cochrane Library databases until April 1, 2018 for analyzing the prognostic factors. Results Case 1 died within one week due to toxic shock after emergent ileostomy and it was confirmed as signet-ring cell carcinoma by postoperative pathology. The clinical stage was IVC. Another 2 cases received FOLFOX chemotherapy after expanded resection for left-sided colon cancer. Pathological examination showed signet ring cell carcinoma and adenocarcinoma respectively. The signet-ring IIIC patient received 10 sessions of chemotherapy, recurred within 6 months and died within 1.5 years. Another IIIB boy had no recurrence after 3 sessions of chemotherapy plus Chinese herbal auxiliary treatment over 8 months postoperatively. A total of 40 literatures were retrieved. One-year survival rate of PCC was under 50%. Tumor location and clinical stage affected the prognosis of PCC. Conclusions As a rare pediatric tumor with a high misdiagnostic rate and a poor prognosis, PCC is definitely diagnosed by CT and colonoscopy. Its major treatment is complete surgical resection plus postoperative chemotherapy. Combined targeted therapy is necessary for advanced PCC patients. Early diagnosis and aggressive treatment are beneficial for improving its overall survival. Key words: Colonic neoplasms; Child; Diagnosis

A protective ileostomy performed during anterior resection in rectal surgery is considered a good practice to prevent anastomotic leakage. A derivative ostomy seems to be able to minimize the clinical consequences of an anastomotic leakage, but not to prevent it. The present study examined the role of the ghost ileostomy in anastomotic leakage following rectal surgery. This study included 82 patients that had undergone anterior rectal resection. A total of 32 patients underwent ghost ileostomy (GH) and 50 patients underwent ileostomy (IL). The incidence of anastomotic leakage was equal to 7.32%, occurring in 3 patients of the IL group (6%) and in 3 patients of the GH group (9.38%), in which the ghost was converted into derivative ileostomy. Therefore, 47 patients with IL (94%) underwent useless ileostomy implementation, and 29 patients (90.62%) with GH avoided ileostomy. In this study no increase in morbidity and mortality rate was observed. Therefore, ghost ileostomy proved to be as safe as ileostomy in terms of outcome, morbidity and mortality.

Objective To analyze the natural orifice specimen extraction surgery′s safety and feasibility in colorectal tumor surgery. Methods A retrospective analysis of 10 patients with natural orifice specimen extraction surgery (NOSES)performed by Northern Jiangsu Province Hospital from Jul. 2016 to Apr. 2018. Results Ten patients completed the natural orifice specimen extraction surgery successfully, and all patients avoided auxiliary incision or sampling through abdominal auxiliary incision. The average operation time was (161±42.4) min, the average intraoperative bleeding volume was (29±27.2) ml, the average number of lymph nodes was (12.3±3.2), the average postoperative exhaust time was (2.8±0.9)d, and the average postoperative discharge time was (11±2.3)d. Anastomotic fistula appeared in one patient, and recovered after ileostomy. Conclusions In colorectal cancer surgery, the NOSES technology was feasible and safe. Key words: Natural orifice transluminal; Colorectal cancer; No auxiliary incision