Objective:To investigate the clinical efficacy and prognosis of simultaneous resection of synchronous colorectal liver metastasis in patients admitted in different phases.Methods:The retrospective cohort study was conducted. The clinicopathological data of 346 patients who underwent simultaneous resection of synchronous colorectal liver metastasis in the First Affiliated Hospital of Naval Medical University (Changhai Hospital of Shanghai) from January 2000 to April 2021 were collected. There were 217 males and 129 females, aged (58±12)years. Patients under-went simultaneous resection of synchronous colorectal liver metastasis. Observation indicators: (1) clinicopathological features of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021; (2) surgical and postoperative situations of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021; (3) analysis of prognosis of patients with synchro-nous colorectal liver metastasis in 2000?2010 and 2011?2021. Follow-up was conducted using telephone interview or outpatient examination to detect survival of patients. The follow-up was performed once every 3 months, including blood routine test, liver and kidney function test, car-cinoembryonic antigen (CEA) test, CA19-9 test, abdominal B-ultrasound examination, and once every 6 months, including chest computed tomography (CT) plain scan, liver magnetic resonance imaging (MRI) and/or CT enhanced scan, abdominal or pelvic MRI and/or CT enhanced scan, within postoperative 2 year. The follow-up was performed once every 6?12 months within postoperative 2?5 years including above reexaminations. Electronic colonoscopy was performed once a year after operation. The follow-up was up to November 12, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distuibution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the rank sum test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used to conduct survival analysis. Results:(1) Clinicopathological features of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021. Of the 346 patients, 59 cases underwent simultaneous resection within 2000?2010 and 287 cases underwent simultaneous resection within 2011?2021. The gender (males and females), cases with or without fundamental diseases, cases with the number of lymph nodes harvested in primary lesion as <12 or ≥12, the tumor diameter of primary lesion, the tumor diameter of liver metastasis lesion, the number of liver metastasis lesions, cases with or without preoperative treatment, cases with or without postoperative treatment, cases with adjuvant therapy as perioperative treatment, surgery or other treatment were 47, 12, 36, 23, 19, 40, (5.5±2.4)cm, (2.1±0.7)cm, 1.6±0.5, 59, 0, 16, 16, 0, 16, 43 in patients admitted in 2000?2010, respectively. The above indicators in patients admitted in 2011?2021 were 170, 117, 121, 166, 58, 229, (4.2±2.0)cm, (3.0±2.0)cm, 1.9±1.4, 208, 79, 34, 235, 74, 29, 184, respectively. There were significant differences in the above indicators between patients admitted in 2000?2010 and 2011?2021 ( χ2=8.73, 7.02, 4.07, t= 4.40, ?6.04, ?3.10, χ2=21.05, 28.82, 26.68, P<0.05). (2) Surgical and postoperative situations of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021. Cases with surgical methods as complete open surgery or laparoscopy combined with open surgery, the operation time, time to postoperative initial liquid food intake, cases with or without postoperative complications, cases with postoperative duration of hospital stay as ≤10 days or >10 days were 58, 1, (281±57)minutes, (5±1)days, 33, 26, 14, 45 in patients admitted in 2000?2010, respec-tively. The above indicators in patients admitted in 2011?2021 were 140, 147, (261±82)minutes, (3±1)days, 233, 54, 198, 89, respectively. There were significant differences in the above indicators between patients admitted in 2000?2010 and 2011?2021 ( χ2=49.04, t=2.24, 7.53, χ2=17.56, 26.02, P<0.05). There was no death in the 346 patients. (3) Analysis of prognosis of patients with synchro-nous colorectal liver metastasis in 2000?2010 and 2011?2021. Of the 346 patients, 295 cases were followed up for 47(range, 1?108)months. Of the 29 patients admitted in 2000?2010 who were followed up, there were 27 cases died. The median survival time, 1-, 3-, 5-year overall survival rates, 1-, 3-, 5-year disease free survival rates of patients admitted in 2000?2010 were 18.0 months (95% confidence interval as 12.7?23.3 months), 82.8%, 11.5%, 3.8%, 53.6%, 8.3%, 4.2%, respec-tively. Of the 266 patients admitted in 2011?2021 who were followed up, there were 109 cases died. The median survival time, 1-, 3-, 5-year overall survival rates, 1-, 3-, 5-year disease free survival rates of patients admitted in 2011?2021 were 54.0 months (95% confidence interval as 38.1?70.4 months), 93.3%, 61.8%, 47.0%, 68.2%, 33.7%, 28.3%, respectively. There were significant differences in overall survival rate and disease free survival rate between patients admitted in 2000?2010 and 2011?2021 ( χ2=47.57, 9.17, P<0.05). Conclusions:With the increase of the operation volume of simultaneous resection of synchronous colorectal liver metastasis, the operation time, time to postoperative initial liquid food intake, postoperative duration of hospital stay and postoperative complications have significantly decreased, while the overall survival rate and disease free survival rate have significantly increased.

Objective:To investigate the influencing factors of functional constipation（FC）in submariners during navigation.Methods:The clinical data of 740 submariners returning from navigation were analyzed by questionnaire. The chi-square（ χ 2）test and multiple logistic regression analysis were used to conduct univariate and multivariable analyses of factors that may influence the occurrence of FC in submariners during navigation，such as sailing time，fresh fruit and vegetable supply，water intake，years of service，education background，body mass index（BMI），seasickness，exercise frequency，and defecation assistance devices. Results:Sailing time（ χ 2=32.704， P<0.001），fresh fruit and vegetable supply（ χ 2=6.829， P<0.001），water intake（ χ 2=41.156， P<0.001），BMI（ χ 2=6.858， P=0.009），exercise frequency（ χ 2=17.701， P<0.001），and defecation assistance devices（ χ 2=6.171， P=0.013）were related factors of the occurrence of FC in submariners during navigation. Multiple logistic regression analysis showed that sailing time（ OR：0.134，95% CI：0.069-0.260， P<0.001），water intake（ OR：0.121，95% CI：0.060-0.244， P<0.001），BMI（ OR：0.550，95% CI：0.384-0.788， P=0.001），exercise frequency（ OR：0.032，95% CI：0.012-0.084， P<0.001），and defecation assistance devices（ OR：0.580，95% CI：0.351-0.959， P=0.034）were independent risk factors of the occurrence of FC in submariners during navigation. Conclusion:The occurrence of FC in submariners during navigation may be related to factors such as long sailing time，low water intake，high BMI，lack of exercise，and no available defecation assistance devices.

Objective:To investigate the influencing factors of functional constipation（FC）in submariners during navigation.Methods:The clinical data of 740 submariners returning from navigation were analyzed by questionnaire. The chi-square（ χ 2）test and multiple logistic regression analysis were used to conduct univariate and multivariable analyses of factors that may influence the occurrence of FC in submariners during navigation，such as sailing time，fresh fruit and vegetable supply，water intake，years of service，education background，body mass index（BMI），seasickness，exercise frequency，and defecation assistance devices. Results:Sailing time（ χ 2=32.704， P<0.001），fresh fruit and vegetable supply（ χ 2=6.829， P<0.001），water intake（ χ 2=41.156， P<0.001），BMI（ χ 2=6.858， P=0.009），exercise frequency（ χ 2=17.701， P<0.001），and defecation assistance devices（ χ 2=6.171， P=0.013）were related factors of the occurrence of FC in submariners during navigation. Multiple logistic regression analysis showed that sailing time（ OR：0.134，95% CI：0.069-0.260， P<0.001），water intake（ OR：0.121，95% CI：0.060-0.244， P<0.001），BMI（ OR：0.550，95% CI：0.384-0.788， P=0.001），exercise frequency（ OR：0.032，95% CI：0.012-0.084， P<0.001），and defecation assistance devices（ OR：0.580，95% CI：0.351-0.959， P=0.034）were independent risk factors of the occurrence of FC in submariners during navigation. Conclusion:The occurrence of FC in submariners during navigation may be related to factors such as long sailing time，low water intake，high BMI，lack of exercise，and no available defecation assistance devices.

This paper briefly described the present state of the use of major medical equipment in an island hospital. The intermittent idleness of the equipment increased the difficulty of maintenance. The gap between the current medical and equipment preparation, such as reagents, instruments, and equipment, and the demand for medical support was a major obstacle for diagnosis and treatment. Harsh climate, incomplete hospital information system, and poor handover process of medical staffs during rotation were the main challenges for medical equipment management in remote island hospitals. It is suggested that the island hospital improve its management regulation of medical instruments and equipment, ensure sufficient stock of key equipment and reagents, establish a regional medical consortium model to make full use of remote consultation and artificial intelligence in medical imaging, and make reasonable use of hospital ships to balance and coordinate medical resources for island hospitals, so as to effectively improve the medical support capacity on islands.

This paper briefly described the present state of the use of major medical equipment in an island hospital. The intermittent idleness of the equipment increased the difficulty of maintenance. The gap between the current medical and equipment preparation, such as reagents, instruments, and equipment, and the demand for medical support was a major obstacle for diagnosis and treatment. Harsh climate, incomplete hospital information system, and poor handover process of medical staffs during rotation were the main challenges for medical equipment management in remote island hospitals. It is suggested that the island hospital improve its management regulation of medical instruments and equipment, ensure sufficient stock of key equipment and reagents, establish a regional medical consortium model to make full use of remote consultation and artificial intelligence in medical imaging, and make reasonable use of hospital ships to balance and coordinate medical resources for island hospitals, so as to effectively improve the medical support capacity on islands.

Colorectal cancer is a malignant tumor with increasing incidence in China. Chemotherapy or neoadjuvant therapy are needed when the patients have deep tumor invasion of distant metastasis due to the hidden clinical manifestations and limited screening methods for the colorectal cancer. With many side effects of the current chemo-medications and the drug resistance, researchers are actively exploring new chemotherapy drugs for colorectal cancer. Paclitaxel is a first-line chemotherapy drug for the treatment of breast cancer, ovarian cancer, pancreatic cancer and other malignant tumors. Colorectal cancer cells are prone to become resistant to paclitaxel and the treatment efficiency was limited. However, new drug delivery systems and the combination drug therapy can enhance the treatment efficiency. This article reviews the effective treatment strategies of paclitaxel for colorectal cancer with the hope for new ideas and more effective chemotherapy.

OBJECTIVE: To investigate the surgical efficacy and prognostic factors of T3NxM0 middle-low rectal cancer without neoadjuvant therapy. METHODS: Clinical data of patients with middle-low rectal cancer undergoing TME surgery with T3NxM0 confirmed by postoperative pathology at Colorectal Surgery Department of Changhai Hospital from January 2008 to December 2010 were analyzed retrospectively. INCLUSION CRITERIA: (1)no preoperative neoadjuvant chemoradiotherapy (nCRT); (2) complete preoperative evaluation, including medical history, preoperative colonoscopy or digital examination, blood tumor marker examination, and imaging examination; (3) distance between tumor lower margin and anal verge was ≤ 10 cm; (4) negative circumferential resection margin (CRM-). Finally, a total of 331 patients were included in this study. According to the number of metastatic lymph node confirmed by postoperative pathology, the patients were divided into N0 group without regional lymph node metastasis (190 cases) and N+ group with regional lymph node metastasis (141 cases). The perioperative conditions, local recurrence, distant metastasis and prognostic factors were analyzed. RESULTS: Compared to N0 group in the perioperative data, N+ group had higher ratio of tumor deposit [29.8%(42/141) vs. 0, χ²=64.821, P<0.001] and vascular invasion [7.1%(10/141) vs. 0.5%(1/190),χ²=10.860, P<0.001]. There were no significant differences in tumor diameter, number of lymph nodes detected, positive nerve invasion, degree of tumor differentiation, morbidity of postoperative complication and postoperative adjuvant chemotherapy rate between the two groups (all P>0.05). The median follow-up period was 73.4 months. The merged 5-year local recurrence rate was 2.7%(9/331), 5-year distant metastasis rate was 23.3% (77/331), 5-year disease-free survival (DFS) rate was 73.4%, and 5-year overall survival (OS) rate was 77.2%. Multivariate analysis showed that lymph node metastasis (HR=3.120, 95%CI: 1.918 to 5.075, P<0.001), nerve invasion (HR=0.345, 95%CI: 0.156 to 0.760, P=0.008) and vascular invasion (HR=0.428, 95%CI: 0.189 to 0.972, P=0.043) were independent risk factors for DFS in patients with T3NxM0 rectal cancer after operation. Preoperative carcinoembryonic antigen level (HR=1.858, 95%CI:1.121 to 3.079, P=0.016), lymph node metastasis (HR=3.320, 95%CI: 1.985 to 5.553, P<0.001) and nerve invasion (HR=0.339, 95%CI: 0.156 to 0.738, P=0.006) were independent risk factors for OS in patients with T3NxM0 rectal cancer after operation. CONCLUSIONS Optimal local control rate of middle-low rectal cancer patients with T3NxM0 and CRM- can be achieved by standard TME surgery alone. For patients with preoperative elevated blood carcinoembryonic antigen level, regional lymph node metastasis, or neurovascular invasion confirmed by pathology after surgery, adjuvant chemoradiotherapy should be actively applied after surgery to improve prognosis.
Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Mesocolon ; surgery ; Neoadjuvant Therapy ; Neoplasm Staging ; Proctectomy ; methods ; Prognosis ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies

Objective To investigate the prognostic value of neutrophil changes in patients with colorectal cancer.Methods The neutrophils in patients with colorectal cancer were classified into twotypes:peripheral blood neutrophils and tumor-associated neutrophils (TANs).Peripheral blood neutrophils are expressed as neutrophil/lymphocyte ratio (neutrophil to lymphocyte ratio,NLR).Results The 5 year's survival rates of patients with high and low NLR were 75.2％ and 88.2％,respectively.The 5 year's survival rates of patients with high and low TANs were 97.6％ and 64.2％,respectively.The survival rates of patients with low NLR and high TANs;high NLR and high infiltrating TANs;low NLR and low infiltrating TANs;and high NLR and low infiltrating TANs were respectively 100％,95.7％,76.4％ and 53.5％.With the two joining together the ability to distinguish long-term prognosis of patients was significantly better than any one alone.Multivariate regression analysis showed that,high peripheral blood NLR,low TANs infiltration,tumor located in the rectum,TNM staging are independent risk factors for colorectal cancer prognosis.Conclusions NLR in preoperative peripheral blood combined with infiltrating TANs in colorectal cancer tissues can be used as a prognostic indicator for patients with colorectal cancer.High NLR in preoperative peripheral blood combined with low infiltrating TANs in colorectal cancer tissue predicts poor prognosis.

OBJECTIVETo compare the surgical safety and short-term efficacy of minilaparotomy and laparoscopic approach for curative resection of rectal cancer.

METHODSThe retrospective cohort study was adopted. A review of patients scheduled to undergo a curative resection of rectal cancer via minilaparotomy or laparoscopic approach at Department of Colorectal Surgery of Changhai Hospital from June 2016 to May 2017 was carried out. All the patients were confirmed as rectal cancer by postoperative pathology. The following patients were excluded from the study: patients who had acute complete obstruction or perforation; patients underwent Miles or Hartmann procedure; patients who required an elongation of the skin incision in minilaparotomy or a conversion from laparoscopic to open surgery. Finally, 216 patients were enrolled in this study, of whom 143 were performed with minilaparotomy approach (minilaparotomy group) and 73 with laparoscopic approach (laparoscopic group) for curative resection of rectal cancer. For the minilaparotomy technique, a 7 cm longitudinal midline incision was made between the pubic symphysis and umbilicus; a wound retractor was applied to the edge of the wound; lymph node dissection around the inferior mesenteric and artery high ligation of inferior mesenteric artery were performed; by moving the minilaparotomy wound laterally and caudad or cephalad with the S-shaped hook, cautious mobilization of the relevant segment of the bowel loop was performed; bowel anastomosis was achieved by using the double-stapled technique; the gap of the pelvic floor peritoneum and mesentery were routinely closed by the absorbable surgical suture in cases with middle and low position rectal cancer. The surgical safety, the condition of resuming and the morbidity of postoperative complication were compared between the two groups.

RESULTSThere were 145 men and 71 women. Age ranged from 26 to 87 years, with of mean age of 61 years. According to the TNM stage grouping, there were 61 patients with stage I(, 62 with stage II(, 85 with stage III(, and 8 with stage IIII( disease, respectively. These two groups did not differ significantly in terms of age, sex, body mass index, site of tumor, TNM stage(all P>0.05). All the patients completed the operation successfully. The median operation time of minilaparotomy group was significantly shorter than that of laparoscopic group [164(80-296) minutes vs. 230(90-665) minutes, Z=4.410, P=0.000]. The intraoperative medical consumable expense [11000(7000-22000) yuan vs. 23000(12000-47000) yuan, Z=11.759, P=0.000] and the total hospitalization expense [44000(22000-146000) yuan vs. 57000(45000-126000) yuan, Z=9.637, P=0.000] were significantly lower in the minilaparotomy group. There were no significant differences between the two groups in terms of operative blood loss, number of harvested lymph nodes, distance of distal resection margin, positive rate of circumferential resection margin (all P>0.05). The rate of postoperative complication in minilaparotomy group was 7.0%(10/143) and in laparoscopic group was 9.6%(7/73) without significant difference (χ=0.449, P=0.503). There were 2 patients in each group who required readmission to the hospital within postoperative 30 days. The cause of readmission was ileus or acute hyponatremia in minilaparotomy group, and ileus or pevic infection in laparoscopic group. One patient died of brain death caused by acute pulmonary embolism during the perioperative period in minilaparotomy group.

CONCLUSIONSThe minilaparotomy approach for curative resection of rectal cancer is safe and feasible. As compared with laparoscopic approach, it is advantageous to achieve minimal invasiveness and early recovery, but much cheaper and less time consuming.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Laparoscopy ; Laparotomy ; methods ; Male ; Middle Aged ; Operative Time ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Objective To identify clinicopathological features of laterally spreading tumors (LST) and explore the cancera-tion risk factors related with LSTs .Methods A retrospective analysis of clinical and pathological data was made in the patients , who underwent colonoscopy from May 2011 to May 2017 in the Digestive Endoscopy Center of Changhai Hospital and were conformed to the diagnostic criteria of LST and protruded-type adenoma ( PA) .Clinical features and related canceration risk factors of LST and its sub-type were analyzed and compared with those of PA .Results In the LST group, there were 422 patients, with a total of 439 LST le-sions, and in the PA group, there were 432 patients with 465 lesions.Canceration rates of the LST-G group, the LST-NG group and the PA group were respectively 7.72%, 11.69%and 2.58%.Regression analysis indicated that the canceration risk factors of LST were associated with those of PA , and morphological classification , pathogenic sites and polyp size were related canceration risk factors in LST.Morphological typing was LST-NG and pathogenic site was located at the left half colon , and the larger its size , the greater the canceration risk.Patient age, pathogenic site and polyp size were 3 canceration related risk factors of PA .Old age, pathogenic location at the right half colon and larger polyp size were high canceration risk factors .Conclusion LST seems to have greater malignant poten-tial than PA, especially the LST-NG type.The canceration risk factors of LST and PA are obviously different , indicating that the can-ceration mechanism of LST and PA might be entirely different .