Radical Resection Of Rectal Carcinoma Research Articles

The value of multi-parameter diffusion and perfusion magnetic resonance imaging for evaluating epithelial-mesenchymal transition in rectal cancer

PurposeEpithelial-mesenchymal transition (EMT) is characterized by a decreased expression of E-cadherin and an increased expression of vimentin, which is associated with poor prognosis in rectal cancer. This study aimed to explore the feasibility of using multi-parameter diffusion and perfusion magnetic resonance imaging (MRI) to evaluate the expression of E-cadherin and vimentin. MethodsOne hundred and ten patients with rectal cancer, who underwent preoperative multi-parameter diffusion and perfusion MRI and subsequent radical resection of rectal carcinoma, were included in this prospective study. The expression of E-cadherin, vimentin, vascular endothelial growth factor (VEGF), and Ki67 was identified by immunohistochemical test and MRI morphology features; quantitative parameters were analyzed and combined diagnostic models were created by binary logistic regression. The receiver operating characteristics curve with area under the curve (AUC) was used to evaluated diagnostic performance. Interobserver agreement for MRI parameters was evaluated by intraclass correlation coefficient. ResultsIn the low expression E-cadherin group, the VEGF expression was significantly higher than the high expression group (60.5% vs 37.3%, P < 0.05), and the Ki67 expression had no significant difference (P > 0.05). In the high expression vimentin group, the Ki67 expression was significantly higher than the low expression group (77.3% vs 56.1%, P < 0.05), and the VEGF expression was not significantly significant (P > 0.05). MRI morphological features had no significant diagnostic efficacy for E-cadherin and vimentin expression in rectal cancer (P > 0.05). There were positive and negative correlations between apparent diffusion coefficient (ADC) values with E-cadherin and vimentin expression (P < 0.05), the Ktrans and Kep values were negatively and positively correlated with the expression of E-cadherin and vimentin (P < 0.05). The ADC value (b = 3000 s/mm2) had mild significant diagnostic efficiencies for low E-cadherin expression and high vimentin expression (AUC = 0.63 and 0.644, P < 0.05), the Ktrans and Kep values had significant diagnostic efficiencies (AUC = 0.801 and 0.724, P < 0.05; AUC = 0.722 and 0.628, P < 0.05, respectively). The combined model of ADC, Ktrans, and Kep values had good diagnostic efficiencies for low E-cadherin expression and high vimentin expression (AUC = 0.814 and 0.728, P < 0.05). ConclusionThe quantitative parameters of diffusion (with ultra-high b-values) and perfusion MRI can assess the major biomarkers of EMT in rectal cancer, and the combined diagnostic model could further improve the evaluating efficiency for EMT, which possibly can provide valuable information for non-invasive and preoperative assessment of the tumor microenvironment.

Endoscopic submucosal dissection for a precancerous lesion emerging at the anastomotic site after radical resection of rectal carcinoma.

Endoscopic submucosal dissection for a precancerous lesion emerging at the anastomotic site after radical resection of rectal carcinoma.

A huge bladder diverticulum in an elderly: A case report

An 81-year-old male patient presented to the department of gastroenterology with increasing lower abdominal pain for 2 years, aggravated with bloody stool for 1 month. Computed tomographic examination revealed a huge cyst (207 × 93 × 208 mm3) in the abdominal cavity, absence of bladder, thickening and strengthening of the rectal wall, and benign prostatic hyperplasia. Colonoscopy showed colon cancer and surgery was planned. Interestingly, after magnetic resonance imaging and cystography, we found colon cancer and a large bladder diverticulum rather than tumor metastasis or others. Severe bacteremia occurred in the elderly chronic obstructive pulmonary disease patient before operation. After careful consideration, we decided to take a large risk and combined urology and gastrointestinal surgery professionals to carry out bladder diverticulectomy, cystostomy, radical resection of rectal carcinoma, and so on. Fortunately, the patient recovered well after the operation. In addition to the common tumor metastasis and cystadenoma, the abdominal mass should also be alert to the rare bladder diverticulum, which eventually leads to diagnostic confusion. Multidisciplinary diagnosis and treatment has become an important treatment for complex diseases.

Clinical application of enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma

Objective: To explore the clinical safety and feasibility of enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma. Methods: From May 1, 2017 to May 1, 2018, 46 patients who underwent laparoscopic-assisted radical resection for rectal carcinoma with enterostomy using running suture of dermis and seromuscular layer in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively enrolled in this study. Data regarding clinicopathologic characteristics, operation and postoperative outcomes, stoma-related complications and functions of stoma were collected and analyzed. Results: All of the 46 patients successfully underwent this operation. Among them, 30 patients underwent laparoscopic-assisted abdominoperineal resection for rectal cancer with sigmoidostomy and 16 patients underwent laparoscopic-assisted low anterior resection for rectal cancer with loop ileostomy. The mean operation time was 115.3 minutes and intraoperative blood loss was 86.1 ml. The mean time for enterostomy was 14.1 minutes. The average time to flatus, time to fluid diet intake and length of hospital stay were 1.8 days, 2.9 days and 6.5 days, respectively. During the follow-up period, three patients suffered from stomal edema, two patients suffered from parastomal hernia, and two patients suffered from skin inflammation surrounding stoma. None of re-operation related stoma and severe mobility such as stomal stenosis, stomal necrosis, stomal prolapse, stomal retraction and stomal mucocutaneous separation occurred. Thirty-five patients recovered with satisfactory stomal function, two with middle function and one with poor function. Conclusion: Enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma is a safe and feasible procedure with a satisfactory short-term effect.

Multicenter surveillance study of surgical site infection and its risk factors in radical resection of colon or rectal carcinoma

BackgroundColorectal surgery is associated with high rates of surgical site infection (SSI). We investigated SSI in radical resection of colon or rectal carcinoma and its epidemiological distribution in 26 hospitals in China.MethodsWe conducted prospective surveillance of patients who underwent radical resection of colon or rectal carcinoma in 26 selected hospitals from January 2015 to June 2016.An information system monitored all of the surgical inpatients. Infection control professionals observed the inpatients with suspected SSI who had been screened by the system at the bedside. The infection status of the incisions was followed up by telephone 1 month after the operation.ResultsIn total, 5729 patients were enrolled for the two operations; SSIs occurred in 206 patients, and the infection rate was 3.60%. The incidence of SSI after radical resection of rectal carcinoma (5.12%; 119/2323) was 2.1 times higher than that after radical resection of colon carcinoma (2.55%; 87/3406) (P < 0.0001). Additionally, in the colon versus rectal groups, the rate of superficial incisional SSI was 0.94% versus 2.28% (P < 0.0001), the rate of deep incisional SSI was 0.56% versus 1.11% (P = 0.018), and the rate of organ space SSI was 1.06% versus 1.72% (P = 0.031), respectively. The most common pathogens causing SSIs after radical resection of colon carcinoma were Escherichia coli (21/38) and Pseudomonas aeruginosa (5/38). Escherichia coli (24/65) and Enterococcus spp. (14/65) were the two most common pathogens in the rectal group. The multivariate logistic regression analysis showed that only the operating time and number of hospital beds were common independent risk factors for SSIs after the two types of surgery.ConclusionThis multicenter study showed that there were significant differences in the incidence of SSIs, three types of SSIs, and some risk factors between radical resection of colon carcinoma and rectal carcinoma.

Pseudomyxoma peritonei induced by low-grade appendiceal mucinous neoplasm accompanied by rectal cancer: a case report and literature review

BackgroundPseudomyxoma peritonei (PMP) is a disease involving the peritoneum characterized by the production of large quantities of mucinous ascites. PMP has a low incidence, is difficult to diagnose, and has a guarded prognosis. PMP induced by low-grade appendiceal mucinous neoplasm is extremely rare, and PMP accompanied by rectal cancer is even rarer.Case presentationWe present a unique case of a 70-year-old male with PMP induced by low-grade appendiceal mucinous neoplasm accompanied by rectal cancer. The patient’s clinical, surgical, and histologic data were reviewed. The patient had persistent distended abdominal pain without radiating lower back pain, abdominal distension for 1 month, and no exhaustion or defecation for 4 days. A transabdominal ultrasound-guided biopsy was performed on the first day. The patient received an emergency exploratory laparotomy because of increased abdominal pressure. We performed cytoreductive surgery, enterolysis, intestinal decompression, special tumour treatment and radical resection of rectal carcinoma. The postoperative course was uneventful. The postoperative histological diagnoses were PMP, low-grade appendiceal mucinous neoplasm and rectal medium differentiated adenocarcinoma. At the 1-year follow-up visit, no tumour recurrence was observed by computed tomography (CT). We also performed a literature review.ConclusionsWe should be aware that PMP can rarely be accompanied by rectal cancer, which represents an easily missed diagnosis and increases the difficulty of diagnosis and treatment. Additionally, there are some typical characteristics of PMP with respect to diagnosis and treatment.

Modified strategy of anesthesia for laparoscopic radical resection of rectal carcinoma: ultrasound-guided anterior quadratus lumborum block combined with general anesthesia

Objective To evaluate the efficacy of ultrasound-guided anterior quadratus lumborum block combined with general anesthesia for laparoscopic radical resection of rectal carcinoma. Methods A total of 80 patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 40-64 yr, scheduled for elective laparoscopic radical resection of rectal carcinoma, were divided into 2 groups (n=40 each) using a random number table method: anterior quadratus lumborum block combined with general anesthesia group(group QG)and general anesthesia group(group G). In group QG, anterior quadratus lumborum block was performed with 0.33% ropivacaine 25 ml and dexamethasone 5 mg under ultrasound guidance before operation, and the same procedure was performed on the other side.Combined intravenous-inhalational anesthesia was applied, propofol 3-5 μg/ml and remifentanil 3-5 ng/ml were given by target-controlled infusion, and cisatracurium was intermittently injected in two groups.Patient-controlled intravenous analgesia with sufentanil 2 μg/kg was used for postoperative analgesia.The analgesic pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval.Bruggrmann comfort scale(BCS)scores were recorded at 1, 6, 12, 24 and 48 h after operation(T1-5). Tramadol was used for rescue analgesic after operation.The consumption of remifentanil and sufentanil, requirement for tramadol, occurrence of adverse reactions and patients′ satisfaction with postoperative analgesia were recorded.The emergence time, first ambulation time, time to first flatus/poo and length of hospital stay were also recorded.The development of anterior quadratus lumborum block-related complications was recorded. Results Compared with group G, BCS scores were significantly increased at T4, 5, the consumption of remifentanil, requirement for tramadol and incidence of nausea and vomiting were decreased, patients′ satisfaction with postoperative analgesia was increased, and the emergence time, first ambulation time, time to first flatus/poo and length of hospital stay were shortened in group QG(P<0.05). Conclusion Ultrasound-guided anterior quadratus lumborum block combined with general anesthesia can reduce the consumption of opioids in the perioperative period and is helpful in improving outcomes when used for laparoscopic radical resection of rectal carcinoma. Key words: Psoas muscles; Nerve block; Anesthesia, general; Colorectal surgery; Laparoscopy

Xiangbin prescription for the recovery of gastrointestinal function after abdominal surgery (the XBPRS trial): study protocol for a randomized controlled trial

BackgroundMost patients who undergo abdominal surgery recover bowel movements within a week; however, some suffer prolonged intestinal paralysis or postoperative ileus (POI) leading to complications, such as infection and intestinal adhesions, which can extend hospitalization and increase readmission rates, and consequently increasing healthcare costs. Chinese medicine is effective for accelerating the recovery of gastrointestinal function after abdominal surgery. Xiangbin prescription (XBP) is the standard prescription for this purpose in our hospital; however, randomized controlled trials of it have not yet been conducted.Methods/designThis double-blind, randomized controlled clinical trial aims to recruit patients who have undergone abdominal surgery and experienced postoperative dysmotility to evaluate the efficacy and safety of XBP for preventing POI and accelerating recovery. The research will tackle the common problem of slow recovery of gastrointestinal function after surgery. The participants will be patients who undergo laparoscopic radical resection of rectal carcinoma or laparoscopic panhysterectomy of a benign lesion. Primary outcome measures will be time to first flatus, defecation, normal bowel sounds, and liquid/semi-liquid/general diet. Good Clinical Practice (GCP) standards of efficacy and safety will also be evaluated, along with objective investigation of the mechanism of action of ghrelin.DiscussionThis pivotal trial will be a standardized, scientific, clinical trial designed to evaluate the use of XBP for the recovery of gastrointestinal function after surgery, and it will conform to international standards for clinical trials for the recognition of traditional Chinese medicine.Trial registrationChinese Clinical Trial Registry, ID: ChiCTR-TRC-14004156. Registered on 3 January 2014.

Case-matched study of short-term effects of 3D vs 2D laparoscopic radical resection of rectal cancer

BackgroundThe purpose of this study is to compare and evaluate the security and efficacy of 3D vs 2D laparoscopy in rectal cancer treatment.MethodsForty-six patients who suffered from rectal cancer and went on laparoscopic radical resection of rectal carcinoma in Peking University Shougang Hospital from Feb. 2015 to Mar. 2016 were included in the study. They were randomly divided into two groups. The 23 patients operated with the 3D system were compared with 23 patients operated with the 2D system by perioperative data.ResultsThere were no significant differences in age, sex, pathological type, tumor differentiation, TNM staging, and surgical procedures (P > 0.05). The average operating time of 3D laparoscopic surgery group (172.2 ± 27.5 min) was shorter than that of 2D group (192.6 ± 22.3) (P < 0.05); the rate of transfer to laparotomy is lower in 2D group (72.7%) than in 3D group (86.4%), but they have no significant difference; and the intraoperative blood loss (247.0 ± 173.6 ml vs 282.6 ± 195.6 ml), postoperative passage of flatus (2.8 ± 0.8 days vs 3.1 ± 1.0 days), and indwelling catheter time (5.6 ± 1.9 days vs 6.3 ± 2.0 days) in 3D group and 2D group (P > 0.05) were not significantly different. There were no differences in other complications between the two groups. No significantly different recrudescence and death rates were found between the two groups (P > 0.05).ConclusionThe 3D laparoscopy shortens the operation time of rectum cancer. 3D laparoscopic surgery is more efficient in treatment of rectal cancer than 2D laparoscopy and is worth of being generalized.

Comparison of clinical curative effects between laparoscopic and traditional open surgery for the treatment of rectal cancer

Objective To investigate and compare the clinical efficacy and safety of laparoscopic and traditional open surgery in the rectal cancer surgery. Methods From March 2007 to February 2013, 86 patients with radical resection of rectal carcinoma in General Surgery Department of Pinggu District Hospital of Beijing were selected as research objects, according to random number table method, they were divided into laparoscopic group(n=43) and laparotomy group(n=43). The laparoscopic group was given laparoscopic radical resection of rectal cancer, the laparotomy group was given traditional open surgery.The baseline data, operative incision length, intraoperative blood loss, operative time, postoperative hospital stay, total number of lymph nodes cleaning, exhaust time, time to get out of bed, hospitalization expenses, VAS score and postoperative complications between the two groups were observed and compared.And the survival rates of the two groups were compared. Results .The operative incision length of laparoscopic group was shorter than laparotomy group((4.20±1.15) cm vs.(16.53±4.62) cm), the intraoperative blood loss was less than laparotomy group((167.43±16.24) ml vs.(220.74±22.53) ml), postoperative hospital stay, exhaust time, time to get out of bed were shorter than laparotomy group((8.26±2.09) d vs.(13.52±2.97) d, (3.24±1.42) d vs.(4.23±1.60) d, (3.07±0.84) d vs.(4.23±1.29) d), the hospitalization expenses was higher than laparotomy group(all P 0.05). The 5 year overall survival rate of laparoscopic group was 52.6%, the laparotomy group was 47.4%, there was no significant difference between the two groups(χ2=0.465, P>0.05). Conclusion The clinical efficacy of laparoscopic and traditional open surgery in the rectal cancer surgery are the same, and laparoscopic radical surgery is safe and effective, it has the advantages of less trauma, less complications and quick recovery, is worth popularizing. Key words: Laparoscope; Traditional open surgery; Rectal cancer; Clinical efficacy; Complication

Endoscopic extraperitoneal radical prostatectomy after radical resection of pT1-pT2 rectal cancer: a report of thirty cases.

IntroductionEndoscopic extraperitoneal radical prostatectomy (EERPE) has gained popularity for the treatment of localized prostate cancer. However, prior complex lower abdominal or pelvic surgery can complicate subsequent EERPE. To date, there have been few reports on patients who underwent EERPE after radical resection of pT1-pT2 rectal cancer.AimTo present our experience with EERPE in patients after radical resection of pT1-pT2 rectal carcinoma and introduce a simple and effective way to create an extraperitoneal working space.Material and methodsThirty patients after radical resection of pT1-pT2 rectal carcinoma were treated with EERPE for biopsy-proven localized prostate cancer. Operation time, estimated blood loss, conversion to open surgery rate, transfusion rate and transurethral catheter time were recorded. Meanwhile, functional outcome (continence and potency) and oncological outcome were reviewed.ResultsThe average operative time was 168 min. Mean blood loss was 195 ml. There was no need for conversion to open surgery or transfusion. The catheter was removed on postoperative day (POD) 7.8. After a mean follow-up time of 53.1 months, 3 patients had a prostate-specific antigen level relapse over 0.1 ng/ml. At the follow-up time, 26 patients were completely continent, and 4 needed 1–2 pads/day. Of the 6 patients who underwent neurovascular bundle preservation, none have experienced return of erections at the last follow-up time.ConclusionsEndoscopic extraperitoneal radical prostatectomy after radical resection of rectal carcinoma appears promising, with feasibility in experienced hands. The operative data, postoperative urinary incontinence and oncological outcomes appear encouraging, but the rate of erectile dysfunction seems to be disappointing.

Safety and efficacy of intraoperative iodine‐125 seed implantation brachytherapy for rectal cancer patients: A retrospective clinical research

This pilot study was performed to evaluate the risk of anastomotic leakage (AL) and pelvic autonomic nerve dysfunction, and the effects of (125) I brachytherapy after intraoperative permanent implantation of iodine-125 seeds within the patients with rectal carcinoma. In a cohort consisting of 80 rectal cancer patients who received potentially curative resection of rectal carcinoma with implantation of (125) I brachytherapy or radical resection of rectal carcinoma underwent total mesorectal excision. The incidences of AL, fecal incontinence, urinary dysfunction, and sexual dysfunction were calculated for comparison, and risk factors for these complications were analyzed by logistic regression. Rates of tumor recurrence and overall survival were evaluated. Six out of 17 (35.29%) patients in the (125) I implant group and 1 out of 34 (2.94%) patients in the non-implant group were complicated with AL (P = 0.006). The incidences of urinary dysfunction (P = 0.005) and fecal incontinence (P = 0.023) were significantly different between the two groups. Multivariate analyses revealed that (125) I brachytherapy was an independent risk factor for AL (odds ratio, 18.702; 95%CI, 1.802-194.062; P = 0.014) and urinary dysfunction (odds ratio, 4.340; 95%CI, 1.158-16.264; P = 0.029), respectively. At postoperative 2-year, the recurrence rates were 5.56% in the (125) I implant group and 9.09% in the non-implant group (P = 0.029). Intraoperative implantation of (125) I brachytherapy significantly increases the risk of AL, fecal incontinence, urinary dysfunction, and improves local control and do not improve overall survival after total mesorectal excision.

Effect of dexmedetomidine and tramadol on perioperative insulin resistance in patients undergoing radical resection of rectal carcinoma

Objective To evaluate the effect of dexmedetomidine and tramadol on perioperative insulin resistance in patients undergoing radical resection of rectal carcinoma. Methods Sixty ASA I or II patients undergoing radical resection of rectal carcinoma were randomly divided into 3 groups(n=20 each): dexmedetomidine group(group D), tramadol group(group T), control group(group C). Group D was given dexmedetomidine intravenously at 1μg/kg 15min before induction of anesthesia followed by a continuous infusion of 0.5μg·kg-1·h-1 until the abdomen was closed,and group T was given tramadol intravenously at 1.5mg/kg 15min before induction of anesthesia followed by a continuous infusion of 0.5mg·kg-1·h-1 until the abdomen was closed, whereas group C received the same volume of normal saline. Venous blood samples were taken at 30min before anesthesia induction(T1),1 h after the beginning of the operation(T2),1h after operation(T3),24h after operation(T4)for determination of blood concentrations of glucose(BG), insulin(INS), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α). Insulin resistance(HOMAIR)and insulin sensitivity index(QUICKI)were calculated.The numbers of patients with PONV were studied respectively. Results The serum IL-6,TNF-α,BG,INS concentrations and HOMA-IR were significantly lower while ISI was significantly higher in both group D[t=7.71,3.37,8.78,8.73,11.45,2.82(T 2),3.04,2.95, 12.75,10.73,16.09,2.92(T3),11.26,2.45,11.40,5.10,14.5,2.51(T4),all P<0.05]and group T[t= 3.02,2.59,2.93,7.76,6.32,2.03(T 2),8.78,2.27,4.14,8.83,7.68,2.12(T 3),6.10,2.05,3.71,2.35,7.12,2.09 (T4),all P<0.05]at T 2,T 3 and T4 than those in group C. The serum TNF-αconcentration and HOMA-IR were significantly lower while ISI was significantly higher in group D[t=6.68,4.58,2.05(T2),9.01,6.66,2.23 (T3),7.54,5.5,2.02(T4),all P<0.05]at T 2,T3 and T 4 than those in group T. The numbers of patients with PONV were significantly higher in group T than those in group D and group C(χ2=26.13,18.75,all P<0.05). Conclusion Both dexmedetomidine and tramadol can attenuate perioperative insulin resistance in patients undergoing Radical Resection of Rectal Carcinoma, and the decrease the consentrations of IL-6 and TNF-α may be involved in the mechanism. The roles of prevention of perioperative insulin resistance in dexmedetomidine group are superior to tramadol group. The incidence of PONV is less in a dexmedetomidine group than that in a tramadol group. Key words: Insulin resistance; Interleukin-6; Tumor necrosis factor-α; Dexmedetomidine; Tramadol

Effects of different anesthesia on immune function in patients with colorectal cancer radical mastectomy

Objective To investigate the effects of different anesthesia methods on immunity in patients underwent radical resection of rectal carcinoma.Methods 82 patients underwent radical resection of rectal carcinoma were divided into two groups,each group had 41 cases.A group received total intravenous anesthesia while B group received total intravenous anesthesia combined with eqidural anesthesia.CD3＋,CD4＋,CD4＋/CD8＋,CD3＋HLA-DR＋and NK cells were inspected before induction of anesthesia（T0）,2 h after skin incision（T1）,2 h（T2） and 24 h（T3） after the end of operation.The T-lymphocyte subsets,activated T cells and NK cells were measured by flow cytometry. Visual analogue scale（VAS） was observed at T2 and T3.Results The VAS score of T2,T3 in A group[（3.86 ± 0.46）points,（3.62 ±0.26）points]were higher than those in B group[（1.67 ±0.57）points,（1.94 ±0.42）points] （all P〈0.05）.The percentages of CD3＋,CD4＋,CD4＋/CD8＋,CD3＋HLA-DR＋and NK cells of T1,T2,T3 were lower than those of T0 in A group（all P〈0.05）;The percentages of CD3＋,CD4＋,CD4＋/CD8＋,CD3＋HLA-DR＋and NK cells of T1, T2 were lower than those of T0 in B group （ all P 〈0.05 ）;The percentages of CD3＋, CD4＋, CD4＋/CD8＋, CD3＋HLA-DR＋ and NK cells of T1, T2, T3 in A group were lower than those in B group （ all P 〈0.05 ）. Conclusion Total intravenous anesthesia combined with eqidural anesthesia produces less immune suppression than total intravenous anesthesia. Key words: Rectal Neoplasms Surgical Procedures; Operative Anesthesia; Epidural Immunity

Effects of different head-down tilt angles on respiratory mechanics and cerebral circulation during laparoscopic radical resection of rectal carcinoma

Objective To evaluate the effects of different head-down tilt (HDT) angles on respiratory mechanics and cerebral circulation during laparoscopic radical resection of rectal carcinoma in the patients.Methods Thirty patients of both sexes,aged 40-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index ＜ 30 kg/m2,scheduled for elective laparoscopic radical resection of rectal carcinoma,were included in the study.Anesthesia was induced with midazolam,fentanyl,propofol and cis-atracurium and maintained with targetcontrolled infusion of propofol and remifentanil and cis-atracurium when needed.At 5 min after supine position,5 min after 30° HDT,5 min after 35° HDT,5 min after 40° HDT,and 30 min after pneumoperitoneum (T1-5),airway pressure (Paw),peak airway pressure (PIP),lung compliance (Cpat) and jugular bulb blood pressure (JBP) were recorded.Blood samples were taken from the radial artery and jugular bulb for blood gas analysis and arterial partial pressure of oxygen (PaO2),partial pressure of carbon dioxide in artery (PaCO2),arterial oxygen saturation (SaO2),jugular bulb oxygen partial pressure (PjvO2),and jugular bulb venous saturation (SjvO2) were recorded at each time point mentioned above.Results Paw,PIP,MAP,PaCO2,JBP,PjvO2 and SjvO2 were significantly increased as compared with those obtained when the patients were in supine position,increased gradually with the increasing HDT angles,and decreased to the level obtained when the patients were in supine position at 30 min after pneumoperitoneum.Cpat and PaO2 were significantly decreased as compared with those obtained when the patients were in supine position decreased gradually with the decreasing HDT angles,and increased to the level obtained when the patients were in supine position at 30 min after pneumoperitoneum.Conclusion HDT-induced effects on respiratory mechanics and cerebral circulation increase with increasing angles during laparoscopic radical resection of rectal carcinoma; thus the optimum HDT angle is smaller than 40° for the patients undergoing this kind of surgery. Key words: Head-down tilt ; Respiratory mechanics ; Cerebrovascular circulation ; Laparoscoys ; Colorectal surgery

Effect of lower extremity ischemic preconditioning on postoperative cognitive function in elderly patients undergoing radical resection of rectal carcinoma

Objective To evaluate the effect of lower extremity ischemic preconditioning on postoperative cognitive function in the elderly patients undergoing radical resection of rectal carcinoma.Methods Eighty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 65-78 yr,weighing 45-81 kg,undergoing elective radical resection of rectal carcinoma,were randomly divided into 2 groups (n =40 each):control group (group C) and extremity ischemic preconditioning group (group P).Anesthesia was induced with midazolam,etomidate,sufentanil and cisatracurium besylate.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of cisatracurium besylate.BIS value was maintained at 40-60 during operation.The patients underwent three cycles of 5 min left lower extremity ischemia which was induced by a manual cuff-inflator placed on the left lower extremity and inflated to 200 mmHg,followed by 5 min deflation in group P.Patient-controlled intravenous analgesia with sufentanil was used for postoperative analgesia.Before induction,at the end of operation and at 1 and 7 days after operation,blood samples were collected from the jugular bulb for determination of serum S-100β concentrations using ELISA.Postoperative cognitive dysfunction (MMSE score ＜ 24) at 7 days after operation was recorded.Results The serum S-100β concentration was significantly lower at the end of operation and 1 and 7days after operation in group P than in group C (P ＜ 0.05).The incidence of postoperative cognitive dysfunction in both groups was 17.9％ and there was no significant difference between the two groups (P ＞ 0.05).Conclusion Lower extremity ischemic preconditioning can decrease blood S-100β concentrations,but it provides no improvement in postoperative cognitive dysfunction in elderly patients undergoing radical resection of rectal carcinoma. Key words: Ischemic preconditioning; Lower extremity; Cognition disorders; Aged

Insulin-like growth factor receptor-1 overexpression is associated with poor response of rectal cancers to radiotherapy.

To explore the potential correlation between insulin-like growth factor receptor-1 (IGF-1R) expression and rectal cancer radiosensitivity. Eighty-seven rectal cancer patients (cTNM I-III) treated in our department between January 2011 and December 2012 were enrolled. All subjects were treated with preoperative radiotherapy and radical resection of rectal carcinoma. Immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR) were performed to detect IGF-1R expression in pre-treatment and postoperative colorectal cancer specimens. Radiosensitivity for rectal cancer specimens was evaluated by observing rectal carcinoma mass regression combined with fibrosis on HE staining, degree of necrosis and quantity of remaining tumor cells. The relative IGF-1R expression was evaluated for association with tumor radiosensitivity. Immunohistochemistry showed diffuse IGF-1R staining on rectal cancer cells with various degrees of signal density. IGF-1R expression was significantly correlated with cTNM staging (P = 0.012) while no significant association was observed with age, sex, tumor size and degree of differentiation (P = 0.424, 0.969, 0.604, 0.642). According to the Rectal Cancer Regression Grades (RCRG), there were 31 cases of RCRG1 (radiation sensitive), 28 cases of RCRG2 and 28 cases of RCRG3 (radiation resistance) in 87 rectal cancer subjects. IGF-1R protein hyper-expression was significantly correlated with a poor response to radiotherapy (P < 0.001, r = 0.401). RT-PCR results from pre-radiation biopsy specimens also showed that IGF-1R mRNA negative group exhibited a higher radiation sensitivity (P < 0.001, r = 0.497). Compared with the pre-radiation biopsy specimens, the paired post-operative specimens showed a significantly increased IGF-1R protein and mRNA expression in the residual cancer cells (P < 0.001, respectively). IGF-1R expression level may serve as a predictive biomarker for radiosensitivity of rectal cancer before preoperative radiotherapy.

Impact of the Implementation of Clinical Pathway on Postoperative Infection Rate

Objectives. To study the impact of the implementation of clinical pathway (CP) on the control of nosocomial infection and to provide an evidence for the management of infection. Methods. We compared and analyzed the average length of stay (LOS), antimicrobial drug usage, catheter and infection rate before and after the implementation of CP, by surveying the conditions of general surgical patients who underwent radical gastrectomy, radical resection of rectal carcinoma and modified radical mastectomy, without the implementation of CP, in 2009, and with the implementation of CP, in 2010. Results. The average LOS of the three categories of surgical patients after the implementation of the CP was significantly shortened, the average LOS of patients who underwent radical gastrectomy was shortened by 6.1 days, the average LOS of patients who underwent radical resection of rectal carcinoma was shortened by 6.29 days, and the average LOS of the patients who underwent modified radical mastectomy was shortened by 6.3 days. The antimicrobial drug usage was significantly reduced, wherein the usage of one antibacterial drug was increased by 25.05%, and the usage of a combination of two antimicrobial drugs was decreased by 19.26%; the usage of a combination of three antibiotics was decreased by 4.5%, while the usage of a combination of four antimicrobial drugs was decreased by 2.13%. The rate of nosocomial infection was decreased from 5.64% to 3.28%. The average number of days of requirement of a urinary catheter and deep vein catheterization was decreased significantly. It was statistically significant (P<0.001). Conclusions. The CP regulates the behavior of medical care staff, strengthens the execution of infection control measures, reduces the risk factors for infection, and effectively reduces the infection rates.

Construction and application of evaluation system of laparoscopic colorectal surgery based on clinical data mining

To construct a clinical database for laparoscopic colorectal surgery in Chinese population using computerized technique. A clinical database system was constructed and used in multi-/single-center studies on laparoscopic colorectal surgery. The data of more than 1200 cases in the Nanfang Hospital during the past year were collected retrospectively. The database was used as the platform for "Southern China Laparoscopic Colorectal Surgery Study Group (SCLCSG)" and was used in the first stage of the clinical research of "Multicenter retrospective study of laparoscopic and open procedure for colorectal cancer" among 11 hospitals in Southern China. In order to test the system, the database was also used in "comparative study on oncologic results of laparoscopic versus open radical resection for rectal carcinoma". The evaluation system is reliable and efficient. This system has established a clinical database for laparoscopic colorectal cancer surgery and can be widely applied for the clinical research for colorectal cancer.

Tissue-engineering nerve repairs pelvic autonomic nerve defects in Beagle dogs

To investigate the outcome of repairing pelvic autonomic nerve defects with the tissue-engineered nerve, in order to provide a new method and experimental evidence for solving sexual disturbance induced by pelvic autonomic nerve injury after radical resection of rectal carcinoma. Bone marrow stromal cells (BMSCs) were purified with density gradient centrifugation. A 10 mm defect of hypogastric nerve was created in 9 Beagle dogs and the 18 hypogastric nerves were randomly divided into three groups. Group A: nerve defects bridged with copolymer of lactic and glycolic acids (PLGA) tube containing BMSCs and collagen protein sponge. Group B: with PLGA tube only containing collagen protein sponge. Group C: with autologous nerve graft. The effect of nerve recovery was evaluated by morphology, HE staining, neurofilament immunohistochemistry staining, electron microscope scanning and measurement quantity of new axon 12 weeks after the transplantation. Twelve weeks after the transplantation, degradation of PLGA tubes showed in group A and group B. The nerves regenerated through defect area to distal end. The density of regeneration nerve fiber in group A and group C were better than that in group B. The difference was significant between group A or group C and group B (P<0.05), and no significant difference was observed between group A and group C(P>0.05). Tissue-engineered nerve, which is constructed by BMSCs mixed with collagen protein sponge and PLGA tube, can be used to bridge and repair the pelvic autonomic nerve defect.