The traditional single-disciplinary treatment has been transformed into a multi-disciplinary comprehensive treatment,because of the further understanding of oncology.Multi-disciplinary team (MDT) is the representative of this change.MDT has a unique model of organization and conduction.It improves the prognosis of patients through multi-disciplinary conference and standardized individualized treatment.MDT has been applied in metastatic colorectal cancer for a long time,and remarkable achievements have been made.With the development of molecular biology and the application of new targeted agents,MDT has also been progressing to adapt to the trend of modern medicine.

Colorectal cancer is a systemic disease that requires multidisciplinary treatment. The comprehensive quality of colorectal surgeon directly impacts on the efficacy of diagnosis and treatment of colorectal cancer. Multidisciplinary teams help surgeons enhance their ability of evidence-based medicine, improve the quality of main specialty, expand the knowledge of other specialty, enhance the doctor-patient communication, and increase the research level. Thus, multidisciplinary teams can improve the comprehensive quality of colorectal surgeons.
Colorectal Neoplasms ; diagnosis ; therapy ; Colorectal Surgery ; Communication ; Evidence-Based Medicine ; methods ; Humans ; Interdisciplinary Communication ; Patient Care Team ; standards ; Physician-Patient Relations ; Quality of Health Care ; Surgeons ; standards

Since its inception, the surgical robot system with technical advantages has quickly become a new trend in surgery, and has been widely used at home and abroad. A large number of retrospective studies and a small number of randomized controlled studies have shown that compared with traditional laparoscopic surgery, robotic surgery presented some improvements, such as lower conversion rate, less urinary and sexual dysfunction, and less intraoperative blood loss, though more convincing evidence is needed. Robotic colorectal cancer surgery started late in China, but developed rapidly. Not only the number of surgeries has increased rapidly, but also many new surgeries have been innovated. Meanwhile, many problems emerged, such as lack of unified technical specifications, and excessive dependence on imported surgical robot equipment. Through high-quality clinical researches and big data analyses, the formulation of standardization, the establishment of training system, and the combination of medicine, research and production, robotic surgery will continue to lead the development trend of surgery in the new era.

Since its inception, the surgical robot system with technical advantages has quickly become a new trend in surgery, and has been widely used at home and abroad. A large number of retrospective studies and a small number of randomized controlled studies have shown that compared with traditional laparoscopic surgery, robotic surgery presented some improvements, such as lower conversion rate, less urinary and sexual dysfunction, and less intraoperative blood loss, though more convincing evidence is needed. Robotic colorectal cancer surgery started late in China, but developed rapidly. Not only the number of surgeries has increased rapidly, but also many new surgeries have been innovated. Meanwhile, many problems emerged, such as lack of unified technical specifications, and excessive dependence on imported surgical robot equipment. Through high-quality clinical researches and big data analyses, the formulation of standardization, the establishment of training system, and the combination of medicine, research and production, robotic surgery will continue to lead the development trend of surgery in the new era.

After more than a decade of development, the role of robotic rectal cancer surgery has been established. However robotic right hemicolectomy has just commenced. For rectal cancer surgery, the Da Vinci system is more flexible, accurate, and stable than traditional laparoscopy. The robotic surgery is safe and efficient, and protects the pelvic autonomic nerve function better. At the same time, robotic surgery is easy to learn, promoting its popularization. In robotic right hemicolectomy, the surgery suitable for Da Vinci system is also improved. Da Vinci system is not perfect. High cost is a major obstacle to the wide applications. Lack of tactile feedback and limited mobility of robotic arms also should not be ignored. The next generation of robotic system may make up for these deficiencies through a number of new technologies. The combination of robotics with single port laparoscopic techniques and multi-organ resections is expected to expand the advantages of robotic surgery in colorectal cancer and promote its development.
Colectomy ; Colorectal Neoplasms ; Humans ; Laparoscopy ; Rectal Neoplasms ; Robotic Surgical Procedures

Objective:To investigate the "V" -shaped anatomical approach in the prevention of bile duct injury during laparoscopic complex cholecystectomy and its clinical application value.Methods:The patients with complex gallbladder from June 2020 to June 2021 in the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology were selected as the research objects, and they were randomly divided into observation group and control group, with 60 cases in each group. All patients underwent laparoscopic cholecystectomy. The observation group underwent laparoscopic cholecystectomy through the triangle "V" shape of the gallbladder, and the control group did not use the "V" shape anatomy. The operation status, complications and postoperative recovery of the two groups of patients were compared.The measurement data of normal distribution were expressed by ( Mean± SD), and t test was used for comparison between groups, and chi-square test was used for comparison between groups of count data. Results:The conversion rate to laparotomy, intraoperative bleeding and operation time of observation group were 3.33%, (97.31±13.27) mL, (65.27±13.82) min, which were significantly lower than those in the control group[8.33%, (111.27±25.18) mL, (81.35±12.12) min], the differences between the two groups were statistically significant( P<0.05). The incidence of biliary injury, total incidence of complications of the observation group were 0, 8.33%, which were significantly lower than those in the control group(6.67%, 28.33%), the differences between the two groups were statistically significant( P<0.05). The postoperative exhaust time, drainage tube retention time, hospitalization cost and hospitalization time of the observation group were (9.89±3.58) h, (32.58±5.17) h, (3 142.92±137.93) yuan, (4.73±1.42) d, and significantly lower than those in the control group [(11.65±2.45) h, (46.18±6.49) h, (3 424.29±156.34) yuan, (5.38±1.25) d], the differences between the two groups were statistically significant ( P<0.05). Conclusions:For laparoscopic complex cholecystectomy, the use of the triangular "V" -shaped gallbladder anatomical approach is more conducive to the operation, can reduce the patient's operation time and intraoperative blood loss, reduce the rate of intraoperative conversion to laparotomy, and reduce biliary tract injury and bile leakage. Such as the incidence of complications, prompting patients to recover as soon as possible, it is worthy of clinical application and promotion.

Objective:To investigate the risk factors associated with anastomotic leakage after robotic surgery in mid-low rectal cancer.Methods:A retrospective case-control study method was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) pathologically confirmed rectal cancer; (3) distance <10 cm from tumor to anal margin; (4) robotic anterior rectal resection. Patients with previous history of colorectal cancer surgery, distant metastases or other malignant tumors, undergoing emergency surgery, with severe abdominal adhesions or those receiving combined organ resection were excluded. Based on the above criteria, 636 patients undergoing robotic radical sphincter-preserving surgery for mid-low rectal cancer in Zhongshan Hospital from January 2015 to December 2018 were included in this study, including 398 males (62.6%) and 238 females (37.4%) with a mean age of (61.9±11.3) years. Sixty-eight cases (10.7%) received neoadjuvant chemoradiotherapy. Amony the 636 included patients, 123(19.3%) underwent natural orifice specimen extraction surgery (NOSES) and 15 (2.3%) underwent preventive stoma. According to the cirteria developed by the International Rectal Cancer Research Group in 2010, the anastomotic leakage was classified as grade A (no requirement of intervention), B (requirement of intervention), and C (requirement of operation). Logistic regression was used to analyze the relationship between anastomotic leakage and clinicopathological factors. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results:Anastomotic leakage occurred in 38 cases (6.0%). The grading of anastomotic leakage was grade A in 13 cases (2.0%), grade B in 19 cases (3.0%), and grade C in 6 cases (0.9%). The 3-year disease-free survival rate of patients with anastomotic leakage and without anastomotic leakage was 83.5% and 83.6% respectively ( P=0.862); the 3-year overall survival rate of the two group was 85.1% and 87.5% respectively ( P=0.296). The results of univariate logistic regression analysis showed that male ( P=0.011), longer operation time ( P=0.042), distance ≤5 cm from tumor to anal margin ( P=0.012), more intraoperative blood loss ( P=0.048) were associated with anastomotic leakage (all P<0.05). NOSES was not associated with anastomotic leakage ( P=0.704). Multivariate analysis confirmed that male (OR=3.03, 95%CI: 1.37 to 7.14, P=0.010), operation time ≥180 minutes (OR=2.04, 95%CI: 1.03 to 3.99, P=0.040), distance ≤5 cm from tumor to anal margin (OR=2.56, 95%CI:1.28 to 5.26, P=0.008) were independent risk factors for anastomotic leakage. Conclusion:Male, short distance from tumor to anal margin, and long operation time are independent risk factors for anastomotic leakage in patients undergoing robotic mid-low rectal cancer radical surgeries. These patients need to be cautiously treated during surgery.

Objective:To investigate the risk factors associated with anastomotic leakage after robotic surgery in mid-low rectal cancer.Methods:A retrospective case-control study method was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) pathologically confirmed rectal cancer; (3) distance <10 cm from tumor to anal margin; (4) robotic anterior rectal resection. Patients with previous history of colorectal cancer surgery, distant metastases or other malignant tumors, undergoing emergency surgery, with severe abdominal adhesions or those receiving combined organ resection were excluded. Based on the above criteria, 636 patients undergoing robotic radical sphincter-preserving surgery for mid-low rectal cancer in Zhongshan Hospital from January 2015 to December 2018 were included in this study, including 398 males (62.6%) and 238 females (37.4%) with a mean age of (61.9±11.3) years. Sixty-eight cases (10.7%) received neoadjuvant chemoradiotherapy. Amony the 636 included patients, 123(19.3%) underwent natural orifice specimen extraction surgery (NOSES) and 15 (2.3%) underwent preventive stoma. According to the cirteria developed by the International Rectal Cancer Research Group in 2010, the anastomotic leakage was classified as grade A (no requirement of intervention), B (requirement of intervention), and C (requirement of operation). Logistic regression was used to analyze the relationship between anastomotic leakage and clinicopathological factors. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results:Anastomotic leakage occurred in 38 cases (6.0%). The grading of anastomotic leakage was grade A in 13 cases (2.0%), grade B in 19 cases (3.0%), and grade C in 6 cases (0.9%). The 3-year disease-free survival rate of patients with anastomotic leakage and without anastomotic leakage was 83.5% and 83.6% respectively ( P=0.862); the 3-year overall survival rate of the two group was 85.1% and 87.5% respectively ( P=0.296). The results of univariate logistic regression analysis showed that male ( P=0.011), longer operation time ( P=0.042), distance ≤5 cm from tumor to anal margin ( P=0.012), more intraoperative blood loss ( P=0.048) were associated with anastomotic leakage (all P<0.05). NOSES was not associated with anastomotic leakage ( P=0.704). Multivariate analysis confirmed that male (OR=3.03, 95%CI: 1.37 to 7.14, P=0.010), operation time ≥180 minutes (OR=2.04, 95%CI: 1.03 to 3.99, P=0.040), distance ≤5 cm from tumor to anal margin (OR=2.56, 95%CI:1.28 to 5.26, P=0.008) were independent risk factors for anastomotic leakage. Conclusion:Male, short distance from tumor to anal margin, and long operation time are independent risk factors for anastomotic leakage in patients undergoing robotic mid-low rectal cancer radical surgeries. These patients need to be cautiously treated during surgery.

The Corona Virus Disease 2019 (COVID-19) since December, 2019 has a wide range of infection due to the strong infectious characteristics. Both medical staff and patients are at increased risk of infection. It is an urgent clinical problem for specialist doctors to work with diagnosis and treatment of cancer patients during the epidemic situation. Based on the colorectal cancer diagnosis and treatment guidelines (2019 CSCO guideline), combined with their own experience, the authors propose the overall management strategies for colorectal cancer patients. This strategies cover the key diagnosis and treatment of colorectal cancer, and provide targeted clinical practice. These work will be helpful for colorectal cancer specialists to carry out the diagnosis and treatment of colorectal cancer effectively under the epidemic of COVID-19.

After more than a decade of development, the role of robotic rectal cancer surgery has been established. However robotic right hemicolectomy has just commenced. For rectal cancer surgery, the Da Vinci system is more flexible, accurate, and stable than traditional laparoscopy. The robotic surgery is safe and efficient, and protects the pelvic autonomic nerve function better. At the same time, robotic surgery is easy to learn, promoting its popularization. In robotic right hemicolectomy, the surgery suitable for Da Vinci system is also improved. Da Vinci system is not perfect. High cost is a major obstacle to the wide applications. Lack of tactile feedback and limited mobility of robotic arms also should not be ignored. The next generation of robotic system may make up for these deficiencies through a number of new technologies. The combination of robotics with single port laparoscopic techniques and multi-organ resections is expected to expand the advantages of robotic surgery in colorectal cancer and promote its development.