Laparoscopic Anterior Resection Research Articles

ThTP7.10 Does robotic anterior resection improve the outcomes for patients with rectal cancer over standard laparoscopic surgery?

Abstract Background Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS). Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS’s controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS. Aims To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness. Methods A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database. 141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review. Results Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p=0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p=0.03, 0.0001<, 0.001<, 0.001). Overall, R-AR had lower rates of intraoperative complications. Conclusions Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.

Development and validation of a nomogram for predicting operating time in laparoscopic anterior resection of rectal cancer.

The goal of this study is to create and verify a nomogram estimate operating time in rectal cancer (RC) patients based on clinicopathological factors and MRI/CT measurements before surgery. The nomogram was developed in a cohort of patients who underwent laparoscopic anterior resection (L-AR) for RC. The clinicopathological and pelvis parameters were collected. Risk factors for a long operating time were determined by univariate and multivariate logistic regression analyses, and a nomogram was established with independent risk factors. The performance of the nomogram was evaluated. An independent cohort of consecutive patients served as the validation dataset. The development group recruited 159 RC patients, while 54 patients were enrolled in the validation group. Independent risk factors identified in multivariate analysis were a distance from the anal verge <5 cm (P = 0.024), the transverse diameter of the pelvic inlet (P < 0.001), mesorectal fat area (P = 0.017), and visceral fat area (P < 0.001). Then, a nomogram was built based on these four independent risk factors. The C-indexes of the nomogram in the development and validation group were 0.886 and 0.855, respectively. And values of AUC were the same with C-indexes in both groups. Besides, the calibration plots showed satisfactory consistency between actual observation and nomogram-predicted probabilities of long operating time. A nomogram for predicting the risk of long operating duration in L-AR of RC was developed. And the nomogram displayed a good prediction effect and can be utilized as a tool for evaluating operating time preoperatively.

Transatmospheric ileal stoma manometry can be applied for the early detection of stoma outlet obstruction.

Stoma outlet obstruction (SOO) is a common complication of diverting ileostomy and usually detected at the advanced stage when the intestine is obviously obstructed. The objective of this study is to explore the efficacy of transatmospheric ileal stoma manometry (TISM) in early detection of SOO before the manifestation of intestinal obstruction. A single-center prospective study was performed in patients scheduled to undergo reversal ileostomy and laparoscopic anterior rectal resection and diverting ileostomy in Second Affiliated Hospital of Zhejiang University School of Medicine from 1st July 2022 to 31st December 2022. The stoma pressure was measured by TISM at different time points. The mean stoma pressure of the 30 patients before reversal ileostomy was 5.21 cmH2O which was considered as normal standard of stoma pressure, and ranged from 1.2 to 8.56 cmH2O. After excluding two patients with anastomotic leakage, a total of 38 patients who were subjected to laparoscopic anterior rectal resection and diverting ileostomy were further included in this study. The incidence of anastomotic leakage was 5% and that of SOO was 12.5%. The mean postoperative obstruction time was 5.2 (3-7) days and the mean time from elevated stoma pressure to diagnosed as SOO was 2.8 (2-4) days in the five patients who developed SOO. The pressure measured at the third stoma manometry time point (second day after return of gut function) (10.23 vs. 6.04 cmH2O, p<0.001) and the postoperative hospital stay (10 vs. 8.49 days, p=0.028) showed significantly difference between the SOO and non-SOO groups. The pressures measured at the first time point (before return of gut function) (4 vs. 4.49 cmH2O, p=0.585), the second time point (the day of return of gut function) (6.8 vs. 5.62 cmH2O, p=0.123), and the fourth time point (discharge day) (5.88 vs. 5.9 cmH2O, p=0.933) showed no significant difference in both groups. TISM can be utilized for early detection of SOO and can be incorporated as a novel diagnostic method together with abdominal CT scan to realize the goal of ERAS.

Safety and efficacy of left colic artery preservation in laparoscopic anterior resection for lower rectal cancer.

Background: To evaluate the safety and efficacy of left colic artery (LCA) preservation in laparoscopic anterior resection with D3 lymphadenectomy for lower rectal cancer. Methods: A total of 117 patients with lower rectal cancer who received laparoscopic anterior resection were retrospectively analyzed. Results: No differences were detected in terms of the numbers of harvested lymph nodes and metastatic lymph nodes, the intraoperative and postoperative complications or the postoperative recurrence and survival rates between the two groups (p>0.05), but the LCA preservation group showed a lower anastomotic leakage rate than the LCA nonpreservation group (2/49 vs 12/68). Conclusion: LCA preservation may help reduce the incidence of anastomotic leakage without impairing surgical and oncological outcomes.

A retrospective audit of robotic versus laparoscopic anterior resection for diverticular disease in a single surgeon’s experience

Background: There has been a shift towards elective resection for recurrent or complicated diverticular disease to prevent recurrent episodes of diverticulitis. Our study aims to compare the outcomes in elective robotic and laparoscopic anterior resection for diverticular disease by a single surgeon experienced in both techniques. Methods: This is a retrospective study of patients who underwent elective anterior resections at Nepean Public Hospital, Nepean Private Hospital, and Sydney Adventist Hospital (SAN) in the last 10 years. The single surgeon is an experienced surgeon who has performed laparoscopic anterior resections from January 2013 to December 2018; and mainly robotic anterior resections from January 2018 to July 2022. The primary outcome of this study was to determine if there were any differences in length of stay and post-operative complications in laparoscopic and robotic anterior resections. Secondary outcome measures included operating time, rate of conversion to open surgery, and 30-day mortality and morbidity. Results: There were 53 patients included in this study. There was no significant difference in conversion to open rates (p=0.528), mean operative time (p=0.095), stoma formation rates (p=0.528) and post-operative complication rates (0.609). Length of stay was significantly shorter in the robotic group (p=0.024), and a higher proportion of patients who had laparoscopic surgery stayed for ≥6 days (p=0.08). There were no anastomotic leakages, or 30-day mortality and morbidity. Conclusions: Robotic anterior resection is a feasible approach in experienced hands and produces comparable results to laparoscopic anterior resection for diverticular disease in terms of length of stay, post-operative complications, and operative timings.

O134 Does robotic anterior resection improve the outcomes for patients with rectal cancer over standard laparoscopic surgery?

Abstract Introduction Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS). Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS's controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS. Aims To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness. Methods A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database. 141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review. Results Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p=0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p=0.03, 0.0001&amp;lt;, 0.001&amp;lt;, 0.001). Overall, R-AR had lower rates of intraoperative complications. Conclusion Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.

Establishment of a nomogram model in predicting risk factors of post-operative complications after laparoscopic anterior resection for rectal cancer.

We aimed to analyse the risk factors of complications after laparoscopic anterior resection of rectal cancer, and to establish a nomogram prediction model and evaluate its accuracy. We retrospectively analysed the clinical data of 180 patients undergoing laparoscopic anterior resection of rectal cancer. Univariate analysis and multivariate logistic regression analysis were used to screen the potential risk factors of post-operative complications of Grade II and establish a nomogram model. The receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination and coincidence of the model, and the calibration curve was used to internally verify. A total of 53 patients (29.4%) with rectal cancer had Grade II post-operative complications. Multivariate logistic regression analysis showed that age (odds ratio [OR] =1.085, P < 0.001), body mass index ≥24 kg/m 2 (OR = 2. 763, P = 0. 008), tumour diameter ≥5 cm (OR = 3. 572, P = 0.002), tumour distance from anal margin ≤6 cm (OR = 2.729, P = 0.012) and operation time ≥180 min (OR = 2.243, P = 0.032) were independent risk factors for Grade II post-operative complications. The area under the ROC was 0.782 (95% confidence interval: 0.706-0.858, sensitivity: 66.0%, specificity: 76.4%) in the nomogram prediction model. Hosmer-Lemeshow goodness-of-fit test showed χ2 = 9.350, P = 0.314. Based on five independent risk factors, the nomogram prediction model has a good predictive performance for post-operative complications after laparoscopic anterior resection of rectal cancer, which is helpful to early identify high-risk people and formulate clinical intervention measures.

The Prevalence of Back Pain in Patients Operated on Due to Colorectal Cancer Depending on the Type of Surgical Procedure Performed

Purpose: Low back pain presents a serious challenge for numerous medical specialties. The purpose of this study was to assess disability due to low back pain in patients operated on due to colorectal cancer depending on the type of surgery performed. Methods: This prospective observational study was carried out in the period of July 2019 through March 2020. Included in the study were patients with colorectal cancer for scheduled surgeries including anterior resection of rectum (AR), laparoscopic anterior resection of rectum (LAR), Hartmann’s procedure (HART), or abdominoperineal resection of rectum (APR). The Oswestry Low Back Pain Disability Questionnaire was used as the research tool. The study patients were surveyed at three time points: before surgery, six months after surgery, and one year after surgery. Results: The analysis of study results revealed that an increase in the degree of disability and functioning impairment occurred in all groups between time points I and II, with the differences being statistically significant (p &lt; 0.05). The inter-group comparative analysis of the total Oswestry questionnaire scores revealed statistically significant differences, with the impairment of function being most severe within the APR group and least severe within the LAR group. Conclusion: The study results showed that low back pain contributes to impaired functioning of patients operated on due to colorectal cancer regardless of the type of procedure performed. A reduction in the degree of disability due to low back pain was observed one year after the procedure in patients having undergone LAR.

Interaction between the intestinal flora and the severity of diversion colitis after low anterior resection of rectal cancer.

Diversion colitis (DC) is nonspecific inflammation of the distal intestinal mucosa following disruption of colonic continuity with colonic dysfunction. The colonscopic score is a good tool for differentiating the severity of patients with DC. At present, no studies have analyzed the pathogenesis of DC from the perspective of the diversity and and differences of intestinal flora. Retrospective study: Clinical information were collected from patients with low rectal cancer admitted to the Department of Anorectal Surgery, Changzheng Hospital, from April 2017 to April 2019. These patients underwent laparoscopic low anterior resection (LAR) combined with terminal ileum enterostomy (dual-chamber). We used chi-square test to comparethe clinical baseline information, clinical symptoms, and colonscopic characteristics between different severity of DC. Propsective oberservational study: We recruited 40 patients with laparoscopic anterior low resection combined with terminal ileum enterostomy and they were further classified into mild group and severe group according to the scores of colonscopic examinations for DC. 16s-rDNA sequencing was carried out to analyze the diversity and and differences of intestinal flora in the intestinal lavage fluid of the two groups. In retrospective study, we found that age, BMI, history of diabetes, and symptoms associated with the stoma state were the independent risk factors that affect DC severity (P<0.05). Meanwhile, age, BMI, history of diabetes and colonscopic score were found to be independent risk factors affecting the severity of diarrhea after ileostomy closure surgery(P<0.05), which was consistent with our results of differentiating the severity of DC under endoscopy; In propsective oberservational study, 40 patients with low rectal cancer recruited by sample size calculation, 23 were in the mild group and 17 in the severe group. The results of 16s-rDNA sequencing showed that intestinal flora with high enrichment values primarily consisted of Bifidobacteriales and Prevotella in mild group, whereas that in the severe group consisted of Providencia and Dorea. The functional predictions on such two types of intestinal flora were mainly focused on lipid synthesis, glycan synthesis, metabolism, and amino acid metabolism pathways. After ileostomy closure surgery, a series of severe clinical symptoms might appear in DC patients. There are significant differences in local and systemic inflammatory responses, composition of intestinal flora between DC patients with different colonscopic scores, which provide a basis for the clinical interventional treatment for DC in patients with permanent stoma.

Development of artificial blood loss and duration of excision score to evaluate surgical difficulty of total laparoscopic anterior resection in rectal cancer.

Total laparoscopic anterior resection (tLAR) has been gradually applied in the treatment of rectal cancer (RC). This study aims to develop a scoring system to predict the surgical difficulty of tLAR. RC patients treated with tLAR were collected. The blood loss and duration of excision (BLADE) scoring system was built to assess the surgical difficulty by using restricted cubic spline regression. Multivariate logistic regression was used to evaluate the effect of the BLADE score on postoperative complications. The random forest (RF) algorithm was used to establish a preoperative predictive model for the BLADE score. A total of 1,994 RC patients were randomly selected for the training set and the test set, and 325 RC patients were identified as the external validation set. The BLADE score, which was built based on the thresholds of blood loss (60 ml) and duration of surgical excision (165 min), was the most important risk factor for postoperative complications. The areas under the curve of the predictive RF model were 0.786 in the training set, 0.640 in the test set, and 0.665 in the external validation set. This preoperative predictive model for the BLADE score presents clinical feasibility and reliability in identifying the candidates to receive tLAR and in making surgical plans for RC patients.

Transanal Natural Orifice Specimen Extraction Following Combined Laparoscopic Anterior Resection and Liver Resection.

Seow-En, Isaac F.R.C.S.1; Koh, Ye-Xin F.R.C.S.2; Tan, Emile Kwong-Wei F.R.C.S.3 Author Information

Development of a machine learning algorithm to predict complications of total laparoscopic anterior resection and natural orifice specimen extraction surgery in rectal cancer

BackgroundTotal laparoscopic anterior resection (tLAR) and natural orifice specimen extraction surgery (NOSES) has been widely adopted in the treatment of rectal cancer (RC). However, no study has been performed to predict the short-term outcomes of tLAR using machine learning algorithms to analyze a national cohort. MethodsData from consecutive RC patients who underwent tLAR were collected from the China NOSES Database (CNDB). The random forest (RF), extreme gradient boosting (XGBoost), support vector machine (SVM), deep neural network (DNN), logistic regression (LR) and K-nearest neighbor (KNN) algorithms were used to develop risk models to predict short-term complications of tLAR. The area under the receiver operating characteristic curve (AUROC), Gini coefficient, specificity and sensitivity were calculated to assess the performance of each risk model. The selected factors from the models were evaluated by relative importance. ResultsA total of 4313 RC patients were identified, and 667 patients (15.5%) developed postoperative complications. The machine learning model of XGBoost showed more promising results in the prediction of complication than other models (AUROC 0.90, P < 0.001). The performance was similar when internal and external validation was used. In the XGBoost model, the top four influential factors were the distance from the lower edge of the tumor to the anus, age at diagnosis, surgical time and comorbidities. In risk stratification analysis, the rate of postoperative complications in the high-risk group was significantly higher than in the medium- and low-risk groups (P < 0.001). ConclusionThe machine learning model shows potential benefits in predicting the risk of complications in RC patients after tLAR. This novel approach can provide reliable individual information for surgical treatment recommendations.

Double-stapled anastomosis without "dog-ears" reduces the anastomotic leakage in laparoscopic anterior resection of rectal cancer: A prospective, randomized, controlled study.

Anastomotic leakage (AL) is a major cause of postoperative morbidity and mortality in the treatment of colorectal cancer. The aim of this study was to investigate whether the resection of "dog-ears" in laparoscopic anterior resection of rectal cancer (called modified double-stapling technique, MDST) could reduce the rate of AL in patients with middle and high rectal cancer, as compared with the conventional double-stapling technique (DST). The clinical data of 232 patients with middle and high rectal cancer were prospectively collected from September 2015 to October 2018. They were randomly divided into the MDST group (n = 116) and the DST group (n = 116) and the data were prospectively analyzed. Morbidity and AL rate were compared between the two groups. Patient demographics, tumor size, and time of first flatus were similar between the two groups. No difference was observed in the operation time between the two groups. The AL rate was significantly lower in the MDST group than in the DST group (3.4 vs. 11.2%, p = 0.032). The age and anastomotic technique were the factors associated with AL according to the multivariate analysis. The location of the AL in the DST group was further investigated, revealing that AL was in the same place as the "dog-ears" (11/13, 84.6%). Our prospective comparative study demonstrated that MDST have a better short-term outcome in reducing AL compared with DST. Therefore, this technique could be an alternative approach to maximize the benefit of laparoscopic anterior resection on patients with middle and high rectal cancer. The "dog-ears" create stapled corners potentially ischemic, since they represent the area with high incidence of AL.(NCT:02770911).

An Unusual Case of Abdominal Wall Recurrence in a Case of Carcinoma Rectum Following Low Anterior Resection

Abstract Port site metastasis (PSM) following laparoscopic surgery for gastrointestinal cancers is a poorly understood phenomenon and the incidence is rare. This is a case report of a patient who had recurrence in the port site 4 years following a laparoscopic anterior resection. The incidence of PSM, although rare at present, is likely to increase in the following years due to the increase in the number of minimally invasive surgeries.

Predicting bowel function after diverting stoma closure in patients with rectal cancer.

Patients with rectal cancer undergoing laparoscopic anterior resection and diverting stomas often suffer from bowel dysfunction after stoma closure, impairing their quality of life. This study aims to develop a machine learning tool to predict bowel function after diverting stoma closure. Clinicopathological data and post-operative follow-up information from patients with mid-low rectal cancer after diverting stoma closure were collected and analyzed. Patients were randomly divided into training and test sets in a 7:3 ratio. A machine learning model was developed in the training set to predict major low anterior resection syndrome (LARS) and evaluated in the test set. Decision curve analysis (DCA) was used to assess clinical utility. The study included 396 eligible patients who underwent laparoscopic anterior resection and diverting stoma in Tongji Hospital affiliated with Huazhong University of Science and Technology from 1 January 2012 to 31 December 2020. The interval between stoma creation and closure, neoadjuvant therapy, and body mass index were identified as the three most crucial characteristics associated with patients experiencing major LARS in our cohort. The machine learning model achieved an area under the receiver operating characteristic curve (AUC) of 0.78 [95% confidence interval (CI): 0.74-0.83] in the training set (n=277) and 0.74 (95% CI: 0.70-0.79) in the test set (n=119), and area under the precision-recall curve (AUPRC) of 0.73 and 0.69, respectively, with sensitivity of 0.67 and specificity of 0.66 for the test set. DCA confirmed clinical applicability. This study developed a machine learning model to predict major LARS in rectal cancer patients after diverting stoma closure, aiding their decision-making and counseling.

Necrotizing Fasciitis as an Early Postoperative Complication of Non-perforated Non-metastatic Rectal Cancer: Case Report and a Review of the Literature

Background: Necrotizing fasciitis is a life-threatening condition characterized by a rapid onset and aggressive degradation of the patient’s condition due to its fair prognosis. The brisk rate of necrotizing fasciitis evolution often makes diagnosing and treating it difficult, thus becoming fatal and incompatible with life. Case report: The authors report a rare case of a 62 years old woman, who had undergone a laparoscopic anterior rectal resection intervention. The patient presented stable with no co-morbidities. She had suffered different gastrointestinal symptoms during the last 2 months such as anorexia, diarrhea, and abdominal discomfort. She had also lost 6 kg in a 2-month time period. Imaging examinations (contrast CT) detected a rectal tumor stage CT4a N1 M0. No bowel perforations were detected. The team faced no perioperative complications. Later that day, she referred to having moderated pain around the surgical wounds that developed two days later with pain and mild diffuse hematoma in the left flank. This developed into necrotizing fasciitis and despite all the efforts she had an exitus lethalis on the 9 th postoperative day. Conclusions: Necrotizing fasciitis still remains a challenge to many specialists. In the context of malignancies, it is sometimes seen as a complication of perforated colon tumors. However, cases such as this, represent a challenge to many doctors due to their insidious characteristics. That is why it is important to search further into the mechanisms of this pathology. Keywords: necrotizing fasciitis, colorectal cancer, postoperative complication. DOI: 10.7176/ALST/96-01 Publication date: December 31 st 2022

BMI and pelvimetry help to predict the duration of laparoscopic resection for low and middle rectal cancer

BackgroundIn rectal cancer surgery, recent studies have found associations between clinical factors, especially pelvic parameters, and surgical difficulty; however, their findings are inconsistent because the studies use different criteria. This study aimed to evaluate common clinical factors that influence the operative time for the laparoscopic anterior resection of low and middle rectal cancer.MethodsPatients who underwent laparoscopic radical resection of low and middle rectal cancer from January 2018 to December 2020 were retrospectively analyzed and classified according to the operative time. Preoperative clinical and magnetic resonance imaging (MRI)-related parameters were collected. Logistic regression analysis was used to identify factors for predicting the operative time.ResultsIn total, 214 patients with a mean age of 60.3 ± 8.9 years were divided into two groups: the long operative time group (n = 105) and the short operative time group (n = 109). Univariate analysis revealed that the male sex, a higher body mass index (BMI, ≥ 24.0 kg/m2), preoperative treatment, a smaller pelvic inlet (< 11.0 cm), a deeper pelvic depth (≥ 10.7 cm) and a shorter intertuberous distance (< 10.1 cm) were significantly correlated with a longer operative time (P < 0.05). However, only BMI (OR 1.893, 95% CI 1.064–3.367, P = 0.030) and pelvic inlet (OR 0.439, 95% CI 0.240–0.804, P = 0.008) were independent predictors of operative time. Moreover, the rate of anastomotic leakage was higher in the long operative time group (P < 0.05).ConclusionLaparoscopic rectal resection is expected to take longer to perform in patients with a higher BMI or smaller pelvic inlet.

Advantages of ligating the rectum with gauze pad band in laparoscopic anterior resection of rectal cancer: a propensity score matched analysis

PurposeIt is difficult to maintain sufficient tension throughout laparoscopic anterior resection with total mesorectal excision, which causes a decline in surgical quality. We used a soft, inexpensive gauze pad band pulling the rectal tube to analyze the effect of surgery.MethodsA gauze pad band was positioned at the proximal of the tumor, followed by fastening the rectal tube and ligating the rectum. 233 patients undergoing laparoscopic anterior resection for mid to low rectal cancer were enrolled between January 2018 and December 2020. After propensity score matching, 63 cases were selected in gauze pad band group and 126 cases were selected in traditional group. The two groups were compared in preoperative, intraoperative, and pathological characteristics.ResultsCompared to traditional group, the median operation duration (203 min vs. 233 min, p < 0.001) and the median intraoperative bleeding (48 ml vs. 67 ml, p < 0.001) were lesser in gauze pad band group. A higher percentage of one cartridge transection of rectum (36/63 vs. 51/126, p = 0.030), shorter length of cartridges used (6.88 ± 1.27 cm vs. 7.28 ± 1.25 cm, p = 0.040), and longer distal resection margin (2.74 ± 0.76 cm vs. 2.16 + 0.68 cm, p < 0.001) were found in the gauze pad band group. The completeness of total mesorectal excision (61/63 vs. 109/126, p = 0.022), harvested lymph nodes (19 vs. 17, p < 0.001) and positive lymph nodes (1 vs. 0, p = 0.046) were higher in gauze pad band group.ConclusionLigation of the rectum with a gauze pad band allows for a reduction in operative time and intraoperative bleeding while increasing the rate of one cartridge transection. It also protected the quality of total mesorectal excision and membrane anatomy.Trial registration: Not applicable.

Prospective Evaluation of the Quality of Life of Patients after Surgical Treatment of Rectal Cancer: A 12-Month Cohort Observation.

This study constitutes a prospective, three-stage evaluation of quality of life among patients receiving surgical treatment for colorectal cancer depending on the type of surgery performed (open anterior resection, laparoscopic anterior resection, abdominoperineal resection, or Hartmann’s procedure). The study included 82 patients treated at the Surgical Oncology Outpatient Department of the Oncology Center in Bydgoszcz from June 2019 to August 2021. The study tools consisted of diagnostic surveys and analyses of medical records. The standardized study tools were the surveys EORTC QLQ-C30 and QLQ-CR29. In addition, a proprietary questionnaire was developed to collect demographic data. Quality of life was measured at three time-points: the day before the surgery and 6 and 12 months post-surgery. Statistically significant differences (p < 0.05) were observed in the domains of role functioning (III, p = 0.030), body image (II, p < 0.001; III, p < 0.001), sexual functioning (II, p = 0.037), buttocks/anal area/rectum pain (III, p = 0.031), and embarrassment (II, p = 0.022; III, p = 0.010). Statistically significant differences in the functional and symptom scale scores were also observed within each group at different stages of cancer treatment. As shown by our study, the quality of life of patients treated for colorectal cancer is determined not only by the operating technique but also by sociodemographic and clinical factors. The use of minimally invasive surgical techniques enables patients to return to their social roles more quickly and improves their self-assessment of body image.

The Impact of Surgical Techniques in Patients with Rectal Cancer on Spine Mobility and Abdominal Muscle Strength-A Prospective Study.

Simple SummaryThe aim of our study was to evaluate the spine joint mobility, muscle strength and chest mobility in patients undergoing surgery for colorectal cancer following abdominoperineal resection, or laparoscopic or open resection of the rectum. The studied patients were examined three times: prior to surgery, three months after surgery and six months after surgery. Three months after surgery, all study groups showed a reduction in the range of spine joint mobility, reduction in chest mobility and a reduction in the rectus abdominis and oblique muscle strength. Six months after surgery, an improvement was observed in terms of mobility and muscle strength. The dynamics of improvement were the greatest in patients undergoing laparoscopic anterior resection.The aim of this non-randomized study was to evaluate the impact of spine joint mobility and chest mobility on inhalation and exhalation, and to assess the abdominal muscle strength in patients undergoing surgery for colorectal cancer with one of the following methods: anterior resection, laparoscopic anterior resection or abdominoperineal resection. In patients who were successively admitted to the Department of Surgical Oncology at the Oncology Center in Bydgoszcz, the impact of spine joint mobility, muscle strength and chest mobility on inhalation and exhalation wasassessed three times, i.e., at their admission and three and six months after surgery. The analysis included 72 patients (18 undergoing abdominoperineal resection, the APR group; 23 undergoing laparoscopic anterior resection, the LAR group; and 31 undergoing anterior resection, the AR group). The study groups did not differ in terms of age, weight, height, BMIor hospitalization time (p > 0.05). Three months after surgery, reductions in spine joint mobility regarding flexion, extension and lateral flexion, as well asreductions in the strength of the rectus abdominis and oblique muscles, were noted in all study groups (p < 0.05). In comparison between the groups, the lowest values suggesting the greatest reduction in the range of mobility were recorded in the APR group. Surgical treatment and postoperative management in colorectal cancer patients caused a reduction in spine mobility, abdominal muscle strength and chest mobility. The patients who experienced those changes most rapidly and intensively werethose undergoing abdominoperineal resection.