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Comparative Study of Large-Calibre Transanal Tube Usage after Rectal Cancer Anterior Resection for Prophylaxis of Anastomotic Leakage

Objective　To assess the effectiveness of large-calibre (7.5#) transanal tube drainage and decompression on prevention from anastomotic leakage following anterior resection for rectal cancer. Methods　Clinical data of 346 consecutive patients (M/F=1.39, age range 32-84 years, median age 58.5 years) undergone anterior resection for rectal cancer in this institute from January 2006 to December 2008 were analyzed retrospectively. Results　The anastomotic leakage rate was 0 (0/185) and 5.59%(9/161) in patients with or without receiving large-calibre transanal tube drainage respectively. The anastomotic leakage rate was significantly decreased by large-calibre transanal tube drainage after anterior resection for rectal cancer (χ2=8.526, P=0.004). Eight cases of anastomotic leakage were treated conservatively and the other one required further surgical interventions. No perioperative death occurred in this series. Conclusion　In this study, the large-calibre transanal tube drainage and decompression is effective in protecting rectal anastomosis and decreasing the rate of anastomotic leakage.

A Prospective Study on Application of Cecostomy Depression Intubation for Prevention of Anastomotic Leakage after Low Anterior Resection for Rectal Cancer

目的 探讨盲肠管道式造口持续减压方法防治直肠癌低位前切除术后吻合口漏的临床价值。方法 选择120例拟行直肠癌低位前切除手术患者，按机械抽样法随机分成2组，60例为盲肠管道式造口减压组（盲肠减压组），另外60例行常规手术作为对照。分析2组患者术后吻合口漏、消化道反应、呼吸系统感染及腹腔感染发生的差异及出现吻合口漏后的住院时间、开始进食时间和住院总费用。结果 盲肠减压组与常规手术组相比，发生吻合口漏〔(5.0%（3例）比13.3%（8例）〕、消化道反应〔15.0%（9例）比48.3%（29例）〕、呼吸系统感染〔11.7%（7例）比26.7%（16例）〕及腹腔感染〔11.7%（7例）比21.7%（13例）〕者均明显减少(Plt;0.05)。盲肠减压组中发生吻合口漏的患者与常规手术组中发生吻合口漏的患者相比，漏后住院时间〔（39±3） d比（53±4） d〕更短，进食〔（14±2） d比（25±3） d〕更早，住院总费用〔（39 620±2 033）元比（46 750±2 131）元〕降低，差异均有统计学意义(Plt;0.05)。结论 盲肠管道式造口持续减压能有效降低直肠癌低位前切除术后吻合口漏的发生率。

Specification and Innovation of Application Technique in Colorectal Surgery

Cause Analysis of Stoma Recurrence after Anterior Resection of Rectal Cancer (Report of 91 Cases)

ObjectiveTo investigate the cause of stoma recurrence after anterior resection of rectal cancer and discover the methods of prevention and treatment.MethodsA total 91 patients with stoma recurrence after anterior resection of rectal cancer (or Dixon) were analysed retrospectively between 1985 and 1996. Fourtyseven patients experienced reradical resection (Miles), 27 cases palliative resection, and 11 cases only exploration. Thirtytwo cases had been followed up for 5 years and obtained 1，3，5year survival rate for reradical radical resection (Miles). Diagnosis and treatment of stomal recurrence after Dixon were evaluated. ResultsOne, three and fiveyear survival rate of reradical resection (Miles) was 93%，77%，45% respectively.ConclusionTo amplify blindly the adaptation of Dixon is to raise the rate of stoma recurrence. Digital rectal examination and fiberopic colonoscopy (and biopsy) are very essential methods for the diagnosis of stoma recurrence, and we strive to do reradical resection (Miles) for the patients with stoma recurrence after Dixon’s operation.

Specification and Innovation of Application Technique in Colorectal Surgery

Specification and Innovation of Application Technique in Colorectal Surgery

Clinical Outcome of Fast-Track Surgery for Low/Super-Low Rectal Cancer

Objective To discuss the clinical outcome of fast-track surgery for low/super-low rectal cancer. Methods Between October 2007 and December 2008, 120 patients underwent low/super-low rectal cancer resection without formation of stoma in the West China Hospital were analyzed retrospectively. Postoperative early rehabilitations were compared between fast-track group and traditional group. Results In early rehabilitations, time of first passing flatus, ambulation, oral intake, and pulling out urinary catheter and the hospital stay in fast-track group were significantly earlier than those in traditional group （Plt;0.05）, while there was no significant difference in time of using nasogastric tubes or drains （Pgt;0.05）. There was also no significant difference in postoperative morbidity of complications between the 2 groups （Pgt;0.05）. Conclusion Fast-track surgery for low/super-low rectal cancer is safe and can accelerate recovery with decreased length of hospital stay.

The Low Anterior Resection Syndrome Score after The Intersphincteric Resection for Low Rectal Cancer

ObjectiveThe low anterior resection syndrome (LARS) score is a simple and visual instrument assessing sphincter preserving surgery for low rectal cancer. The purpose of this study is to analyze the feasibility of using LARS score to assess the function after intersphincteric resection for low rectal cancer. MethodsBetween March 2013 and June 2015, 76 patients underwent sphincter preserving surgery for low rectal cancer, 23 cases underwent intersphincteric resection set as ISR group, the other 53 cases received low anterior resection set as LAR group. LARS score, Saito function questionnaire, Wexner score, and European organization for research and treatment of cancer (EORTC) quality of life questionnaire core 30 (QLQ-C30), questionnaire module for colorectal cancer (QLQ-CR29) were compared for the two groups. ResultsThere were 63.2 percent patients (48/76) appeared major LARS, 27.6 percent (21/76) minor LARS and 9.2 percent (7/76) no LARS, there were no statistically difference between the ISR and LAR groups (P=0.727), but the item of incontinence due to liquid stools appeared more obvious in ISR group (P=0.009). The items of faecel incontinence and sore skin for EORTC QLQ-CR29 were serious in ISR group (P < 0.05), the other item of EORTC QLQ-CR29 and EORTC QLQ-C30, Saito function questionnaire, Wexner score were similar between the two groups (all P > 0.05). ConclusionThe anal function after intersphincteric resection is non-inferior to the low anterior resection for low rectal cancer, but both can appear serious low anterior resection syndrome.

凯途双吻合器在低位直肠癌保肛手术中的应用

目的　探讨凯途（CONTOUR）双吻合器在低位直肠癌前切除术中的应用价值。方法　对我院2007年3月至2012年2月期间46例低位直肠癌患者应用凯途双吻合器保肛的治疗经过进行回顾性分析。结果　本组46例患者均一次吻合成功，平均手术时间180min，术中平均出血315mL，吻合口距齿状线距离平均为2.5cm。术后发生吻合口出血1例（2.17%），吻合口漏2例（4.35%），术后直肠阴道瘘1例（2.17%），均经相应治疗而治愈。无吻合口狭窄及死亡病例。术后平均住院时间17.7d。术后平均随访1年均无局部复发及吻合口狭窄，无死亡病例。结论　凯途弧形切割缝合器在低位直肠癌保肛手术中有着较大的优势。

Correlation Analysis of Preoperative Nutritional Risk and Anastomotic Leakage Following Anterior Resection for Rectal Cancer

ObjectiveTo investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer. MethodsA total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model. ResultsAmong the 321 patients, the incidence of postoperative anastomotic leakage was 5.6% (18/321). Single factor analysis showed that the NRS2002 score≥3, clinicalpathologic stage (Ⅲ-Ⅳstage) and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score (OR=4.125, 95% CI=2.062-7.004), clinicalpathologic stage (OR=3.334, 95% CI=2.062-7.004) and the distance of tumor from the anal verge (OR=2.341, 95% CI=2.559-15.838) were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conciusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who's NRS2002 score≥3.