ObjectiveTo investigate the value of postoperative CT examination for evaluation of local complications in patients with low rectal carcinoma after total mesorectal excision with anal sphincter preservation. MethodsThe patients with low rectal carcinoma who received total mesorectal excision (TME) with anal sphincter preservation were examined using contrastenhanced CT in one year period from May 2009 to May 2010. Particular attention was paid to the presence of anastomotic leakage, local recurrence and status of lymph nodes. ResultsTotal of 82 patients (52 men, 30 women； mean age 57.8 years old； range 25.74 years old) were included in the study. Over a mean 10-month follow-up， 8 cases （9.8%） had clinically or surgically confirmed anastomotic leak, 6 cases （7.3%） had local recurrence around the anastomotic site， and 4 cases （4.9%） showed pelvic and distant metastatic lymphadenopathy. ConclusionPostoperative CT examination, including baseline and follow-up CT studies, is very useful for diagnosing anastomotic leakage, local tumor recurrence and lymphadenopathy.
Objective To introduce the surgical technique and results of total mesorectal excision (TME) for rectal cancer. Methods Reviews.Results As a result of TME, local recurrence rates have declined from 20%-30% to 3%-8%, 5-year survival rate have risen to 75%, and the rates of sphincter preservation have risen too.Conclusion Total mesorectal excision reduces the local recurrence rates and raise the survival figures after excision of rectal cancer. Patients have a high quality of life.
Objective To introduce the total mesorectal excision (TME)under the laparoscope and with the ultrosonic scalpel. Methods Under the laparoscope and with the ultrosonic scalpel, total mesorectal excision in 3 patients was performed. In operation, alone the parietal layer of pelvic fascia and inside the automatic nerve trunk, the mesorectum was excised with the ultrasonic scalpel. Results Three patients got final recovery, no damage to the viscera in operation occurred. Average hemorrhage amount was about 100ml. Intestinal function recovered within 24 hours, average in hospital time was 10.3 days. After 4 months, 3 patients got good living quality without recurrence and metastasis.Conclusion TME under the laparoscope is a new progress of less damageable operation. Compared with the traditional open laparotomy,it has some advantage. But it requires high technology and expensive equipments, and the case is still very limited in use.
Objective To study the relationship between autonomic nerve preservation and sexual and urinary functions after total mesorectal excision in patients with cancer of the lower rectum, and to explore improved nursing methods for these patients. Methods Eligible patients with cancer of the lower rectum were non-randomly assigned to either a control group (n=278)or an autonomic nerve-preserving group （n=263）. The recovery time of micturition desire, catherization time, lower urinary tract infection rate, residual urine, severity of urinary disorders and sexual disorders were observed. Results The recovery time of micturition desire, catherization time, lower urinary tract infection rate, residual urine, severity of urinary disorders and sexual disorders were lower in the autonomic nerve-preserving group than in the control group. (Plt;0.05) . Conclusion Autonomic nerve preservation radical resection leads to better maintenance of urinary and sexual functions for patients with cancer of the lower rectum. Nursing should be focused on the prevention of urinary tract complications and the rehabilitation of sexual and urinary functions.
Objective To investigate the application of air leak test combined with methylene blue solution leak test in the detection of anastomotic leakage after total mesorectal excision （TME） in rectal cancer. Methods In total of132 patients with rectal cancer underwent Dixon according to TME in our hospital from Mar. 2010 to Mar. 2013 were enrolled. All patients were randomly divided into air leak test group （n=65） and air leak＋methylene blue solution leak test group （n=67）. The intestinal anastomosis of patients in air leak test group were clamped at 2 cm from the upper endof bowel， then injecting 500 mL distilled water to pelvic， and placing 24# Foley catheter through the anus. The catheter balloon was injected with water to close anus， and then injected with 50 mL gas to find the anastomotic leakage where bubbles happened， and then repaired it. Patients of air leak＋methylene blue solution leak test group were treated with methylene blue solution test in addition. After sucking out of the distilled water in pelvic and gas in the rectum， 1 bottle of methylene blue solution （20 mg） and 50 mL saline were injected， observing the location where the methylene blue solutionleaking out and repaired it. Results Three cases （4.62%） of anastomotic leakage were found during operation in air leak test group， and 9 cases （13.85%） were found after operation. Of the 9 cases， 5 cases were cured with placement of adeq-uate drainage and symptomatic treatment， 3 cases were cured with anal patch， and 1 case was cured with transverse colon fistula and drainage. In total of 15 cases （22.39%） were found anastomotic leakage， 2 cases of them were found by air leak test and another 13 cases were found by methylene blue solution leak test during operation in air leak＋methylene bluesolution leak test group， but no one suffered anastomotic leakage after operation. Compared with air test group， detectionrate of anastomotic leakage during operation was higher （P＜0.05）， and incidence rate of anastomotic leakage after opera-tion was lower in air leak＋methylene blue solution leak test group （P＜0.05）. Conclusions Large anastomotic leakage can be found by using air leak test， and small and hidden leakage can be found by using methylene blue solution leak test， combination method of the two experiments is better. Repair can be performed effectively under direct vision.
Objective To evaluate the feasibility and clinical outcomes of laparoscopic total mesorectal excision (TME) in treating mid-low rectal cancer. Methods From March 2005 to July 2008, 74 patients with mid-low rectal cancer undergoing laparoscopic TME in Zhejiang Cancer Hospital were collected. The data of clinicopathologic parameters were analyzed. Results Laparoscopic TME was performed on 74 patients with mid-low rectal cancer. No operative death occurred in this group. No case was converted to open procedure. The mean operation time was 187 min. The mean operative blood loss was 90 ml. The mean postoperative hospital stay was 10 d. Bowel function was restored on 46 h after operation on average. The mean distance between tumor and the section edge was 3.1 cm. The average number of lymph node dissection was 19.7. The sphincter preservation rate was 97% in patients with tumor 6 cm above the anal verge. The follow-up times were 2-44 months, average 25 months. The incidence of complications was 9.5%. No tumor cell port site implantation or distant metastasis happened. One case was pelvic recurrence， no patient was dead.Conclusion Laparoscopic TME is a feasible, safe and minimally invasive technique for the patients with mid-low rectal cancer, achieving the principles of TME.
Objective To study the effect of laparoscopic total mesorectal excision and per anum rectal pull-type of anastomosis on male patients with low rectal cancer. Methods The successful experiences of anus saving operation on 23 male patients with low rectal cancer were summarized. Results A laparoscopic total mesorectal excision technique was used, with the full separation of the rectum at the bottom. After pulling out the distal rectum together with the cancer from the anus, the transection of the proximal tumor was performed. The end-to-end anastomosis of rectum and descending colon was performed by tubular stapler. Anus was reserved successfully in the 23 cases. There was no left-tumor stump after surgery detected by postoperative pathological examinations, no anastomotic leakage, and no operative death. Conclusions To the relatively narrow male pelvis, laparoscopic total mesorectal excision and per anum rectal pull-through resection and anastomosis is safe and reliable for anus saving in low rectal cancer. It can simplify the operation, and raise the success rate of sphincter preserving in surgery of low rectal cancer.
Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.
Objective To prospectively evaluate the health-related quality of life (HRQOL) outcomes in patients undergoing laparoscopic total mesorectal excision (LTME) with anal sphincter preservation (ASP) for low rectal cancers. Methods From June 2001 to March 2004, 125 patients undergoing LTME and 103 patients undergoing OTME were included in this study. The international standard questionnaires (QLQ-C30 and QLQ-CR38) were used to evaluate the conditions of patients at 3 periods after surgery respetively: 3-6 months, 12-18 months, gt;24 months. Results In contrast to OTME patients, the LTME ones showed significantly better physical function during 3-6 months after surgery, less micturition problems within 12-18 months, less male sexual problems and better sexual function during 12-18 months after surgery, with better sexual enjoyment after postoperative 24 months. Both groups showed significant improvement in most subscales from the first to the second assessment, and improvement in sexual enjoyment from the second to the third assessment. The sexual function, micturition problems and male sexual problems in LTME group significantly improved from the first to the second assessment, whereas the sexual function in OTME group improved from the second to the third assessment.Conclusion Patients undergoing LTME for low rectal cancers have bette postoperative HRQOL than patients undergoing OTME, with better physical function, micturition function, overall sexual and male sexual functions in short term, and better sexual enjoyment in the long term. The HRQOL of both LTME and OTME patients may be expected to improve over time, particularly in the first postoperative year.