Anastomotic leakage(AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low an...Anastomotic leakage(AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection(LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.展开更多
Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoa...Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.展开更多
AIM:To analyze the clinical manifestations and risk fac-tors of complications in laparoscopic low anterior resection(LAR)for rectal cancer patients.METHODS:A series of 132 consecutive patients who received laparoscopi...AIM:To analyze the clinical manifestations and risk fac-tors of complications in laparoscopic low anterior resection(LAR)for rectal cancer patients.METHODS:A series of 132 consecutive patients who received laparoscopic LAR for rectal cancer in our center were included.The etiology,diagnosis,treatment and prevention of rectal cancer were studied among the patients with surgery-related complications using both univariate and multivariate regression analysis.RESULTS:No conversion to open surgery was observed and 5 cases converted to hand-assisted laparoscopic operation.The overall morbidity rate was 20.5%.Complications occurred during the operation in 7 patients(5.3%),within 30 postoperative days in 24 patients(18.2%),and within 3 mo in 2 patients(1.5%).The most significant complications were anastomotic leak-age(9.1%)and anastomotic hemorrhage(5.3%).Sizeand location of tumor,pathological staging and preoperative nutrition were significant factors associated with LAR complications,while gender,age and pathological type showed no relevance.Binary logistics regression showed that the size and location of tumor,and pathological staging were independent factors of laparoscopic LAR.All the complications were treated during their onset of clinical manifestations by interventional or conservative therapy.CONCLUSION:Anastomotic leakage is a major com-plication in laparoscopic LAR.The complications may be associated with tumor size and site,and pathological stage.Interventional therapies are of value in the management of laparoscopic LAR complications.展开更多
文摘Anastomotic leakage(AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection(LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.
基金Supported by NBCRI,Symptomatic Breast Unit,University Hospital Galway
文摘Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.
文摘AIM:To analyze the clinical manifestations and risk fac-tors of complications in laparoscopic low anterior resection(LAR)for rectal cancer patients.METHODS:A series of 132 consecutive patients who received laparoscopic LAR for rectal cancer in our center were included.The etiology,diagnosis,treatment and prevention of rectal cancer were studied among the patients with surgery-related complications using both univariate and multivariate regression analysis.RESULTS:No conversion to open surgery was observed and 5 cases converted to hand-assisted laparoscopic operation.The overall morbidity rate was 20.5%.Complications occurred during the operation in 7 patients(5.3%),within 30 postoperative days in 24 patients(18.2%),and within 3 mo in 2 patients(1.5%).The most significant complications were anastomotic leak-age(9.1%)and anastomotic hemorrhage(5.3%).Sizeand location of tumor,pathological staging and preoperative nutrition were significant factors associated with LAR complications,while gender,age and pathological type showed no relevance.Binary logistics regression showed that the size and location of tumor,and pathological staging were independent factors of laparoscopic LAR.All the complications were treated during their onset of clinical manifestations by interventional or conservative therapy.CONCLUSION:Anastomotic leakage is a major com-plication in laparoscopic LAR.The complications may be associated with tumor size and site,and pathological stage.Interventional therapies are of value in the management of laparoscopic LAR complications.
