Humans ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery

Humans ; Rectum/surgery* ; Liposarcoma/surgery* ; Biomarkers, Tumor

Hirschsprung Disease ; surgery ; Humans ; Laparotomy ; Postoperative Care ; Rectum ; surgery

To evaluate the protection of proximal colon segment by analyzing blood supply disorder of proximal colon segment during laparoscopic proctosigmoidectomy(11 cases) in the Chaoyang Hospital of Capital Medical University. It is concluded that the disorder of blood supply of proximal colon segment during laparoscopic proctosigmoid surgery has two reasons. One is the anatomic factor of mesenteric vessels; the other is the inappropriate operative procedure. It is recommended that left colonic artery should be retained, and inferior mesenteric artery should be handled at a low level, thus, the risk of proximal intestine blood supply disorder caused by vascular anatomy variation can be reduced.
Colon, Sigmoid ; surgery ; Humans ; Laparoscopy ; methods ; Rectum ; surgery

Primary endometrioid adenocarcinoma of the rectovaginal septum is rare. Its pathogenesis is not clear and there is no standard treatment. One patient with endometrioid adenocarcinoma of the rectovaginal septum arising from deep infiltrative endometriosis was admitted to Qingdao Municipal Hospital. The patient presented with incessant menstruation and abdominal distension. She had bilateral ovarian endometriotic cystectomy 6 years ago. Imaging findings suggested a pelvic mass which might invade the rectovaginal septum. Pathological results of primary surgery confirmed endometrioid carcinoma of the pelvic mass arising from the rectovaginal septum. Then she had a comprehensive staged surgery. Postoperative chemotherapy was given 6 times. No recurrence or metastasis was found during the 2-year follow-up. The possibility of deep infiltrating endometriosis and its malignant transformation should be considered in the differential diagnosis of a new extragonadal pelvic lesion in a patient with a history of endometriosis, which would avoid misdiagnosis and missed diagnosis.
Female ; Humans ; Carcinoma, Endometrioid/surgery* ; Endometriosis/surgery* ; Rectum ; Vagina ; Cystectomy

With the development of surgical techniques, adjuvant and neoadjuvant therapy, the survival of patients with rectal cancer after surgery has improved significantly, while the organ dysfunction remains an important factor affecting quality of life of patients. In order to improve the awareness of Chinese surgeons in organ function protection for the treatment of rectal cancer, standardize the evaluation method and surgical procedure, reduce the incidence of organ dysfunction, and ultimately improve the quality of life of patients, Colorectal and Anal Function Surgeons Committee of China Sexology Association, Organ Function Protection Committee of Chinese College of Colorectal Cancer, and Colon and Rectal Surgeons Committee of Chinese College of Surgeons jointly organized experts in related fields, in combination with domestic and foreign research and clinical practice, to discuss and formulate a Chinese expert consensus on the protection of pelvic organ function in the rectal cancer surgery, including the definition, risk factors, assessment methods, prevention and treatment of organ dysfunction after rectal cancer surgery.
China ; Consensus ; Humans ; Quality of Life ; Rectal Neoplasms/surgery* ; Rectum/surgery*

The application of extralevator abdomino-perineal excision (ELAPE) and total mesorectal excision has improved the prognosis of rectal cancer. However, compared with anterior resection for rectal cancer, the circumferential resection margin (CRM) positive rate and intraoperative perforation (IOP) rate are still high. The ELAPE can reduce the CRM positive rate and IOP rate, therefore reduce postoperative local recurrence rate and increase the survival rate of patients. The disadvantage of its trauma, longer operative time, and higher perineum complication in ELAPE is controversial. This review mainly discusses the key points of operative procedure, advantages and disadvantages, research status and development prospects of ELAPE.
Digestive System Surgical Procedures ; methods ; Humans ; Mesentery ; surgery ; Perineum ; surgery ; Prognosis ; Rectal Neoplasms ; surgery ; Rectum ; surgery

OBJECTIVETo evaluate the clinical efficacy of intersphincteric resection in the sphincter- preserving operation for ultra-lower rectum cancer.

METHODSThirty-one rectal cancer patients with the distal edge of the tumour less than 2 cm from the dentate line were evaluated. Eighteen advanced rectal cancer patients received preoperative chemo-radiation. Total mesorectal excision (TME) was performed with the rectum immobilized down, and the puborectal ligament and partial levator cut to the level of the dentate line. In some well-exposed patients, it was possible to further immobilize the rectum between the external sphincter ring and the rectum inner sphincter wall. In anal approach,good exposure was attained and the cut-line was made vertically to the anal canal 2 cm below the lower edge of the tumor, and further intersphincteric immobilization was made upright. Colon or colon pouch were anastomosed to the distal anal wall.

RESULTSThere was no peri-operative death. Thirty patients had good fecal control. Twenty-nine patients showed no evidence of recurrence or metastasis after follow-up for 12 months. Recurrence occurred in one case 1 year after operation. Another one had higher CEA 19.9 level, but without evidence of metastasis.

CONCLUSIONRadical resection can be attained and anal sphincter preserved by intersphincter resection which is an alternative sphincter-preserving operation.

Anal Canal ; surgery ; Follow-Up Studies ; Humans ; Mesentery ; surgery ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Treatment Outcome

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.
Autonomic Pathways/surgery* ; Humans ; Proctectomy ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Transanal Endoscopic Surgery

Total mesorectal excision (TME) has become the gold standard for mid-low rectal cancer surgery. However, for some patients with obesity and narrow pelvis, there are great challenges in both open and laparoscopic surgery. Transanal total mesorectal excision (taTME) uses a transanal approach, in " bottom-up" direction, which reduces the difficulty of distal mesorectal excision and may improve the quality of the TME specimen. The taTME provides a direct sight of the tumor and the distal resection margin is more precise. However, whether taTME can achieve complete total mesorectal excision, especially for mid-rectal cancer, is still controversial. This study compares the quality and integrity of mesorectum among open surgery, laparoscopic surgery, and taTME surgery according to TME principles and quality evaluation criteria of TME specimen. In conclusion, the integrity of mesorectum of taTME specimens for low-rectal cancer is good. But for the mid-rectal cancer, the integrity of mesorectum of taTME specimens and long-term efficacy are still controversial and need high-level evidence support.
Humans ; Laparoscopy ; Mesocolon ; Obesity ; Rectal Neoplasms ; Rectum ; surgery