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

The introduction of total mesorectal excision and the use of neoadjuvant therapy has led to improved prognosis of rectal cancer. Circumferential resection margin(CRM) is one of the main prognostic factors. Positive CRM is associated with adverse prognosis. It is of clinical significance to clarify different patterns of CRM involvement, the exact definitions, and associated factors. TME quality assessment and accurate determination of CRM involvement are crucial in the pathologic examination of rectal cancer. Extended abdominoperineal resection during which the levator muscles are resected en bloc with the anus and lower rectum may be superior than conventional abdominoperineal resection (APR) in terms of obtaining a negative CRM.
Humans ; Perineum ; pathology ; surgery ; Prognosis ; Rectal Neoplasms ; diagnosis ; pathology ; surgery ; Rectum ; pathology ; surgery

The optimal goals in the surgical treatment of rectal cancer are curative resection, anal sphincter preservation, and preservation of sexual and voiding functions. The quality of complete resection of rectal cancer and the surrounding mesorectum can determine the prognosis of patients and their quality of life. With the emergence of total mesorectal excision in the field of rectal cancer surgery, anatomical sharp pelvic dissection has been emphasized to achieve these therapeutic goals. In the past, the rates of local recurrence and sexual/ voiding dysfunction have been high. However, with sharp pelvic dissection based on the pelvic anatomy, local recurrence has decreased to less than 10%, and the preservation rate of sexual and voiding function is high. Improved surgical techniques have created much interest in the surgical anatomy related to curative rectal cancer surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of dissection. A complete understanding of rectum anatomy and the adjacent pelvic organs are essential for colorectal surgeons who want optimal oncologic outcomes and safety in the surgical treatment of rectal cancer.
Rectum/pathology/*surgery ; Rectal Neoplasms/pathology/*surgery ; Pelvis/*surgery ; Magnetic Resonance Imaging ; Humans ; Dissection/methods

Adult ; Colitis ; diagnosis ; surgery ; Cysts ; diagnosis ; surgery ; Female ; Humans ; Rectum ; pathology ; surgery

OBJECTIVETo analyze the factors related to sphincter preserving(SP) operation for lower rectal cancer.

METHODSClinicopathological data of 316 patients with lower rectal cancer 1-5 cm from the anorectal line who underwent surgical resection from Aug. 1994 to Nov. 2005 were analyzed. The whole period was divided into two period based on the introduction of TME in Jan. 1999. The SP rates, leakage between the two period were compared.

RESULTSThe SP rate increased significantly from 44.9 % in period I (Aug. 1994-Dec. 1998) to 76.2 % in period II (Jan. 1999-Nov. 2005)(P=0.000). The factors significantly influencing SP were the distance from the anorectal line, sex, period, circumference of intramural spread, histological differentiation (P< 0.05). Significant differences were detected between the two period in sex, volume of blood transfusion, Dukes' stage (P< 0.05). The rate of leakage were 2.7 % and 1.3 % in the two period (P > 0.05).

CONCLUSIONSOver 12 years, the SP rate of rectal cancers 1-5 cm from the anorectal line was significantly increased and volume of blood transfusion reduced obviously due to the introduction of TME. These surgical techniques, however, have no effect on the operating time and leakage rates.

Anal Canal ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery

OBJECTIVETo assess the advantage and disadvantage of laparoscopic abdomino-perineal resection and open abdominoperineal resection for low rectal cancer.

METHODSPatients with low rectal cancer, collected from July 2003 to April 2006, were randomly divided into laparoscopic abdominoperineal resection group (37 cases) and open abdominoperineal resection group (37 cases). Operation time, number of lymph node removed, intra-operative blood loss, time to pass flatus, time to ambulate, time to discharge, complications, early recurrence, and economical cost were compared between the 2 groups.

RESULTSAll patients were performed successfully. For the first 10 patients, operation time of laparoscopic group was significantly longer than that of open group, but there was no significant difference between the 2 groups. Intra-operative blood loss of laparoscopic group was significantly less than that of open group, but it was reverse for the first 10 patients. There was no significant difference in time to pass flatus between the 2 groups. Time to ambulate in laparoscopic group was significantly earlier than that in open group. There was no significant difference in time to discharge between the 2 groups, but it was earlier for perineum closure in laparoscopic group. Relative complications of laparoscopic group, including pulmonary infection, abdominal wound infection or split, were significantly less than those of open group. There was no significant difference in number of lymph nodes removed, early recurrence between the 2 groups. Operation cost of laparoscopic group was significantly higher than that of open group, but there was no significant difference.

CONCLUSIONAdvantages of laparoscopic abdominoperineal resection were characterized for not only minimal invasion and good cosmetic outcome but also less blood loss, complications, and earlier postoperative recovery. The operation time, total costs and oncological clearance of laparoscopic abdominoperineal resection patients were comparable with those of open procedure patients.

Abdomen ; surgery ; Aged ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Perineum ; surgery ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; pathology ; surgery ; Treatment Outcome

Objective: To compare the long-term outcomes of intersphincteric (trans-internal and external) sphincter resection (ISR) and abdominoperineal proctocolectomy (APR) for low-grade rectal cancer. Methods: We used a meta-analytic approach to compare these procedures . Published reports comparing ISR and APR for low rectal cancer in Pubmed, Medline, EMBASE and Cochrane, China Knowledge Network (CNKI), China Biomedical Literature Database, and Vipers databases between January 2005 and January 2023 were searched and those meeting the eligibility criteria were selected for extraction of data for analysis. Inclusion criteria were as follows: (1) all reports comparing ISR and APR for low rectal cancer before January 2023; and (2) prospective randomized controlled studies or well-designed cohort studies. Exclusion criteria were as follows: (1) full text not available; (2) duplicate publications, missing primary outcome indicators, and unknown data; and (3) invalid statistical analysis. Results: Sixteen studies with 2498 patients were included in this study. Compared with the APR group, patients in the ISR group were relatively younger (weighted mean difference [WMD]=-1.82, 95%CI=-2.94 to -0.70, P=0.01), had tumors farther from the anal verge (WMD=0.43, 95%CI=0.18 to 0.67, P<0.01), and lower pathological T-stage (T3-4 stage: OR=0.54, 95%CI=0.36 to 0.81, P<0.01). In contrast, there were no statistically significant differences between the two groups in gender (P=0.78), body mass index (P=0.77), or pathological N stage (P=0.09). Compared with the APR group, patients in the ISR group had a lower rate of postoperative complications (OR=0.77, 95%CI=0.60 to 0.99, P=0.04), shorter hospital stay (WMD=-4.30, 95%CI=-7.07 to -1.53, P<0.01), higher 5-year overall survival (HR=0.54, 95%CI=0.33 to 0.88, P=0.01), and higher 5-year disease-free survival (HR=0.65, 95%CI=0.47 to 0.90, P<0.01). Five-year locoregional failure (HR=0.66, 95%CI=0.40 to 1.10, P=0.11) and time to surgery (WMD=-9.71, 95%CI=-41.89 to 22.47, P=0.55) did not differ significantly between the two groups. Conclusion: ISR is a safe and effective alternative to APR for early-stage low-grade rectal cancer.
Humans ; Prospective Studies ; Rectal Neoplasms/pathology* ; Rectum/surgery* ; Proctectomy ; Anal Canal/pathology* ; Treatment Outcome

OBJECTIVETo investigate the appropriate distal resection margin in rectal cancer patients.

METHODSThirty specimens of rectal carcinoma with total mesorectal excision(TME) were studied by flow cytometry and pathological examination. The differences of DNA ploidy status, DNA index (DI), proliferative index (PI), S-phase fraction (SPF) among rectal cancer, 3 cm and 5 cm below the tumor, normal rectum, distal mesorectum 3 cm and 5 cm below the tumor, and normal colon mesentery were analysed by flow cytometry, and were compared with the data of pathological examination.

RESULTSPathological examination showed that there was no tumor invasion 3 cm and 5 cm below the tumor,but the metastasis rates of distal mesorectum 3 cm and 5 cm below the tumor were 26.7% and 6.7% respectively. The DI, PI and SPF of rectal cancer by flow cytometric examination were significantly higher than those of distal rectum 3 cm and 5 cm below the tumor, and normal rectum (P<0.05). The DI, PI and SPF of distal rectum 3 cm below the tumor were also significantly higher than those of distal rectum 5 cm below the tumor, and normal rectum (P<0.05), but there were no significant differences between DI, PI and SPF of distal rectum 5 cm below the tumor and those of normal rectum (P>0.05). The rate of DNA aneuploid of tumor was significantly higher than those of normal rectum and distal rectum 5 cm below the tumor,but there was no significant difference between the rate of DNA aneuploid of tumor and that of distal rectum 3 cm below the tumor. The DI and DNA aneuploid of rectal cancer and distal mesorectum 3 cm and 5 cm below the tumor were significantly higher than those of normal mesorectum,but there were no significant differences between DI and DNA aneuploid of rectal cancer and those of distal mesorectum 3 cm and 5 cm below the tumor. The PI and SPF of rectal cancer were significantly higher than those of normal mesorectum and distal mesorectum 3 cm and 5 cm below the tumor.

CONCLUSIONSRectal cancer is able to invade distal rectum 3 cm below the tumor and distal mesorectum 5 cm below the tumor, and radical resection of rectal cancer should beyond that range.

Adult ; Aged ; Female ; Flow Cytometry ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo investigate the clinical value of transanal endoscopic microsurgery (TEM) for rectal intraepithelial neoplasia (IN) and early rectal carcinoma.

METHODSFifteen patients with rectal tumor were selected to undergo local excision by TEM. The pre-operative diagnosis by biopsy and endoanal ultrasonography (EUS): rectal low-grade IN in 8 cases, high-grade IN in 4 and early rectal carcinoma in 3. The average distance of tumors from the anal verge was 7.2(4-15) cm. The average tumor size was 1.8(1-4) cm. The average proportion of the circumference of bowel lumen involved was 20%(10%-40%).

RESULTSAll the 15 rectal tumors were achieved complete excision (submucosal excision in 5, full-thickness excision in 10), and all the resection margins were clear. The average operating time was 57 (40-90) min. The average blood loss was 35 (10-60) ml. The average post-operative stay was 4.5 (2-9) d. The post-operative pathological diagnosis: rectal low-grade IN in 5 cases, high-grade IN in 6, early submucous invasive carcinoma (pT(1)) in 2, advanced carcinoma (pT(2)) in 2. The diagnostic accuracy of EUS in assessing invasive depth of rectal tumor was 86.7% (13/15). The average follow-up period of 15 patients was 6 (2-10) months. There was no local recurrence occurred.

CONCLUSIONTEM is an ideal minimally invasive procedure for the treatment of rectal IN and early rectal carcinoma, with excellent exposure and accurate excision, providing a high-quality tumor specimen for pathological staging. Pre-operative EUS is very important in selecting patients suitable for resection by TEM.

Adult ; Aged ; Anal Canal ; surgery ; Endoscopy ; Female ; Humans ; Male ; Microsurgery ; Middle Aged ; Rectal Neoplasms ; surgery ; Rectum ; pathology ; surgery

BACKGROUNDTotal mesorectal excision (TME) has increased the rate of sphincter-preservation (SP) for more patients with low-lying rectal cancer. Here, we analyze the change of sphincter preserving rates in lower rectal cancer and their related factors.

METHODSWe reviewed retrospectively the medical records of 316 patients with lower rectal cancers, 1 to 5 cm from the anorectal line, who had surgical resections from August 1994 to November 2005. The 12-year span was divided into 2 periods: period I (August 1994-December 1998) and period II (January 1999-November 2005), based on the date (January 1999) when standard total mesorectal excision (TME) was introduced. The patients were divided into two groups based on the operation: abdominoperineal resection (APR) or SP surgery. SP rates, leakage and other clinico-pathological characteristics were compared between the two time periods and between the two different groups.

RESULTSThe SP rate increased significantly over the 12 years, from 44.9% in period I to 76.2% in period II (P = 0.000). The factors significantly influencing SP included the distance of the tumor from the anorectal line, gender, time period, circumference of intramural spread and histological differentiation (P < 0.05). Significant differences were detected between the two time periods in gender, blood transfusion volume and Dukes' stage (P < 0.05). The leakage rate was 2.7% in period I and 1.3% in period II (P > 0.05).

CONCLUSIONSOver the 12-year period of the study the SP rate in rectal cancers 1 - 5 cm from the anorectal line has increased significantly while the blood transfusion volume has decreased due to the introduction of TME. However, TME had no effect on operating time and leakage rates.

Adult ; Aged ; Anal Canal ; surgery ; Anastomosis, Surgical ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery