CACA guidelines for holistic integrative management of rectal cancer （2024 Edition）fully refers to the latest researches at home and abroad， integrates experts' opinions in relevant fields and forms an updated version.In the epidemiology section， according to the latest data of the National Cancer Center， the detailed data of incidence and mortality of colorectal cancer were updated.In the screening section， the beginning age for general population screening has changed to 45 years old.In the surgical section， novel evidences have been added to total mesocolectomy， natural orifice specimen extraction surgery， “robotic” surgery and transanal total mesorectal excision.In the internal medicine section， novel evidences have been added to immunotherapy， and it is recommended that patients with dMMR/MSI-H status can consider immunotherapy.Besides， based on the latest researches， the chemotherapy cycles for high-risk stage Ⅱ patients and low-risk stage Ⅲ patients have been updated.In the radiotherapy section， the principles of preoperative neoadjuvant chemoradio-therapy were refined and reset， and different plans were developed based on tumor staging， microsatellite status and anal preservation intention.The principles of combined chemoradiotherapy for rectal cancer and the opportunity of surgery after chemoradiotherapy were also updated.In the traditional Chinese medicine section， the principle of “treatment based on syndrome differentiation” has been changed to “the combination of treatment based on disease differentiation and treatment based on syndrome differentiation”.At last， the current edition have added “treatment based on syndrome differentiation during rectal cancer follow-up period” section and the application of nonpharmacological therapies in traditional Chinese medicine.
Hemorrhoids are the most common anorectal diseases.He'nan Province has a large population， and it is estimated that more than 30 million people in the province suffer from hemorrhoids.In order to improve the comprehensive understanding and diagnosis and treatment level of primary medical staffin Henan Province， also to provide specific and feasible diagnosis and treatment norms for primary medical institutions， the He'nan Provincial Medical Doctor Association， the Committee of Colorectal Anal Surgeons，based on the search and reading of relevant literatures， with reference to China Hemorrhoid Diagnosis and Treatment Guide （2020）， combined with the actual situation of primary medical institutions and medical personnel in He'nan Province， the definition， classification， epidemiology， etiology， pathogenesis， diagnosis，differential diagnosis， referral recommendations， treatment， disease management and other aspects of hemorrhoids were comprehensively elaborated.
Colorectal surgery has experienced a leap-forward development in the past two hundred years， and this process can be generally divided into four stages.From the stage of reductive surgery， radical surgery， extended radical surgery to the current stage of functional surgery， the surgical methods and treatment concepts have also undergone tremendous changes.In this process， the three milestone breakthroughs of anesthesia， asepsis， and blood transfusion have put the development of surgery on the fast track.The rapid development of medicine depends on the development of other disciplines， such as optics， electricity，engineering， pharmacy， aesthetics， etc.， and the progress of multiple disciplines is reflected in medicine.To this day， in the development of colorectal surgery， there are many core treatment concepts and principles.This article reviews the “four stages” of the development of colorectal surgery to date， refines the “three concepts”，summarizes the “two principles”， emphasizes the “two safety”， condenses the “two perceptions”， proposes the“one core”， and shares the “N skills”， to look back on the past， summarize experience， and look forward to the future.
Colorectal cancer liver metastasis （CRLM） is the most important cause of death in colorectal cancer patients， which seriously threatens the life safety of people and hinders the prosperity and development of society and economy.With the increasing incidence of colorectal cancer in our country，the harm of CRLM is becoming more and more obvious.In this context， how to establish a scientific and effective CRLM model to promote the in-depth understanding of the tumor invasion and metastasis process，reveal the corresponding mechanism， evaluate the effect of different diagnosis and treatment schemes， and finally realize the early prevention and treatment of CRLM should be the focus and difficulty of current research.Traditional CRLM models include carcinogen induction model， orthotopic model， heterotopic model，xenogenic implantation model and genetically engineered mouse model.In recent years， with the continuous progress of science and technology， new modeling methods such as microfluidic chip model have emerged，providing more updating options.In this paper， relevant literature at home and abroad was reviewed， and the advantages and disadvantages of traditional mouse models and emerging modeling methods were discussed in depth， aiming to compare the advantages and disadvantages of each modeling method and introduce the latest research results， so as to provide certain guidance for the scientific establishment of CRLM model and ultimately bring more scientific personalized treatment for CRLM patients.
The investigation into the mechanism of action of traditional Chinese medicine and its bioactive components against colorectal cancer primarily relies on in vitro colorectal cancer cell lines and related xenograft animal models.However， organoid has emerged as a potent alternative method that can faithfully recapitulate the genetic characteristics of donors and predict treatment efficacy for individual patients.In this review， we summarize the current literature on the application of colorectal cancer organoids in traditional Chinese medicine research， highlighting their unique value in advancing basic research and providing a solid theoretical foundation for broader clinical implementation of traditional Chinese medicine in treating colorectal cancer.
To investigate the expression of KDM4C in colon cancer tissue and its clinical implications.
Methods
The expression of KDM4C in colon cancer was detected using immunohistochemistry.The relationship between KDM4C and clinical pathological factors as well as prognosis was analyzed.The expression status of KDM4C was also analyzed using TCGA database， and its relationship with survival prognosis was further investigated using the Kaplan-Meier method.Single-cell analysis from GSE108989 was performed to examine the distribution of KDM4C across various cell types.A quanTIseq approach was utilized to explore the correlation between KDM4C and immune cell infiltration in colon cancer.The effect of KDM4C on the proliferation and drug sensitivity of cancer cells was assessed using CCK-8 experiment.
Results
KDM4C expression in colon cancer tissues was higher than that in adjacent non-cancerous tissues （Z= -5.722， P＜0.001）.The expression of KDM4C was correlated with tumor size （χ2=6.473， P=0.011）， invasion depth （χ2=4.146， P=0.020）， lymph node metastasis （χ2=6.473， P=0.011），TNM staging （χ2=5.840， P=0.016）， and chemotherapy resistance （χ2=5.38， P=0.032）.TCGA database revealed significantly higher expression of KDM4C mRNA in colon cancer compared to normal colon mucosal tissue （Z= -2.297， P＜0.001）.Survival analysis indicated that patients with high KDM4C expression had a significantly lower overall survival rate compared to those with low expression， the difference being statistically significant.Subgroup analysis revealed that patients with high KDM4C expression in right-sided colon cancer had significantly lower overall survival compared to those with low expression， （χ2=4.691，P=0.0303）.Single-cell sequencing analysis of GSE108989 showed that KDM4C was expressed in CD4Tconv，CD8T， CD8Tex， Tprolif， and Treg cells.Immunoinfiltration analysis revealed that KDM4C expression was associated with infiltration by B cells， M2 macrophages， neutrophils， and Tregs.Downregulation of KDM4C expression inhibited the proliferation activity of colorectal cancer cells HCT116 and SW480， and enhanced their sensitivity to oxaliplatin.
Conclusion
High KDM4C expression is associated with poor survival prognosis in colon cancer.Downregulation of KDM4C can inhibit the proliferation of colorectal cancer cells，and enhance their chemosensitivity.
To explore the effect of initiative irrigation and drainage treatment on postoperative wounds and cytokines in patients with high complex anal fistula.
Methods
This study was a prospective multi-center randomized controlled trial involving 160 patients who were operated on high complex anal fistulas in the Colorectal Surgery Department of 7 hospitals in Jiangsu Province.Patients were randomly assigned to receive IIDT or standard gauze dressing （control group） at a 1：1 ratio.The primary outcome was pain scores within 7 days.Secondary outcomes were quality-of-life scores， healing time，fistula closure rate and the relevant cytokine indexes.
Results
A total of 72 patients were included in each group.Demographics， preoperative comorbidities， and fistula type were comparable between the two groups.Additionally， no significant difference in fistula closure rate was observed between the control and IIDT groups （93.1% vs.91.7%， χ2=0.098， P=0.754）.During the 5 days of IIDT， the maximum pain score in 7 days（Z= -10.262， P＜0.001） and the pain scores on the postoperative day1， 3， 5 and 7 were lower than those of the control group （Z= -10.533， P＜0.001； Z= -10.548， P＜0.001； Z= -10.594， P＜0.001； Z= -10.578， P＜0.001）.In the case of QOL scores， patients in the IIDT group had significantly higher score in physical functioning，physical pain， general health， vitality， social functioning， and mental health（Z= -10.358， P＜0.001； Z= -3.358，P＜0.001； Z= -2.506， P=0.012； Z= -2.564， P=0.010； Z= -5.632， P＜0.001； Z= -7.617， P＜0.001）.By day 5， HE and Masson staining revealed fewer inflammatory cells and more fibroblasts in the IIDT group， the expression levels of VEGF， FGF-2， and TGF-β in the IIDT group were significantly upregulated from baseline（t=2.576，P=0.011； t= -2.268， P=0.025； t=2.009， P=0.046）， whereas a notable reduction was found in inflammatory cytokine concentrations （TNF-α、IL-1β、IL-6） （t=22.891， P＜0.001； t= -3.320， P=0.001； t=2.037， P=0.044）.Western blot analysis revealed that phosphorylated p38 （p-p38） protein was significantly upregulated in the granulation tissue of patients receiving IIDT compared to those in the control group（t= -2.209， P＜0.001）.
Conclusion
It is feasible approuch for high complex anal fistulas， which can alleviate postoperative pain，accelerate wound growth， reduce the expression of the inflammatory cytokines TNF-α， IL-1β， and IL-6， and promote the expression of the growth factors VEGF， FGF-2， and TGF-β.
To systematically evaluate the efficacy and safety of Ferguson Hemorrhoidectomy （Closed） versus Milligan-Morgan Hemorrhoidectomy （Open） for the treatment of mixed hemorrhoids and to provide an evidence-based basis for surgical protocols.
Methods
CNKI， Wanfang，WIP， CBM and PubMed databases were searched to collect randomized controlled trials （RCTs） of closed hemorrhoidectomy （the study group） versus open hemorrhoidectomy （the control group）， and the years of searching were from January 2000 to May 2024.The quality of the literature was assessed using the bias assessment tool recommended by Cochrane Systematic Reviews after screening and extracting the literature information； Meta-analysis， sensitivity analysis， publication bias analysis and regression analysis were done using STATA 17.0 software.
Results
A total of 30 RCTs with 3 505 patients were included.Meta-analysis showed that compared with open hemorrhoidectomy， closed hemorrhoidectomy had a higher cure rate ［RR=1.16，95% CI （1.08～1.25）， P＜0.01］， shorter wound healing time ［SMD= -1.90， 95%CI （ -2.32～ -1.48）， P＜0.01］，shorter operative time ［SMD= -2.68， 95%CI （ -4.70～ -0.65）， P=0.01］， less intermediate bleeding ［SMD=-6.94， 95%CI（ -10.96～ -2.91）， P＜0.01］， and lower VAS scores on the first postoperative bowel movement［SMD= -0.85， 95%CI （ -1.42～ -0.29）， P＜0.01］， lower probability of postoperative bleeding ［RR=0.65，95%CI （0.51～0.82）， P＜0.01］， shorter hospital stay ［SMD= -0.92， 95%CI （ -1.63～ -0.22）， P=0.01］ and less frequent postoperative bowel difficulties ［RR=0.24， 95%CI （0.07～0.81）， P=0.02］， but the probability of postoperative trabecular dehiscence was higher ［RR=7.66， 95%CI （2.56～22.97）， P＜0.01］.The differences in the rates of trabecular infection， postoperative pain， edema， urinary retention， anal fissure， anal cleanliness，anal stenosis， 24-hour postoperative VAS scores， return to work time， and recurrence rates between the two surgical procedures were not statistically significant （all P＞0.05）.The results of sensitivity analysis showed that the robustness of the results of this study was good.The risk of publication bias analysis showed the possibility of publication bias.
Conclusion
The overall efficacy of closed hemorrhoidectomy is better than open hemorrhoidectomy.Closed hemorrhoidectomy has a higher cure rate， shorter wound healing time， and does not increase the rate of wound infection or anal stenosis， making it a safe and effective procedure.
To explore the effect of visceral fat area and sarcopenia on the surgical treatment and prognosis of patients with colorectal cancer.
Methods
The data of patients treated in Changshu No.2 People's Hospital from June 2017 to March 2019 were reviewed， and the patients meeting the inclusion and exclusion criteria were included one by one.A total of 120 patients with colorectal cancer were included， all of whom underwent abdominal CT examination， bioelectrical impedance analysis， muscle strength measurement， etc.According to the clinical examination results， they can be divided into four groups， one group was patients with simple colorectal cancer（36 cases， group A）， one group was patients with high visceral fat area（≥100 cm2） and colorectal cancer（30 cases， group B）， one group was patients with sarcopenia and colorectal cancer（30 cases， group C）， and one group was patients with high visceral fat area and sarcopenia and colorectal cancer （24 cases， group D）.The perioperative indicators and serum inflammatory factors of the four groups were compared.The influencing factors of prognosis were analyzed.
Results
There were no significant differences in postoperative body temperature， first postoperative exhaust time， indwelling catheter time and postoperative exhaust time among the four groups （P＞0.05）.Operation time and blood loss in group D were higher than those in group A （t=18.456， 22.984； P＜0.05）， group B （t=4.535，4.720； P＜0.05） and group C （t=3.383， 4.690； P＜0.05）.The operation time and blood loss of group B were higher than those of group A （t=3.109， 2.373； P＜0.05）， and the operation time and blood loss of group C were higher than those of group A （t=4.104， 2.055； P＜0.05）.The number of lymph node dissection in group D was lower than that in group A （t=9.992， P＜0.05）， group B （t=4.441， P＜0.05） and group C （t=3.567， P＜0.05），and the number of lymph node dissection in groups B and C was lower than that in group A （t=5.539， 6.527；P＜0.05）.The hospital stay of group D was longer than that of group A （t=7.130， P＜0.05）， group B （t=2.188，P＜0.05） and group C （t=2.063， P＜0.05）， and the hospital stay of group B and group C was longer than that of group A （t=5.866， 5.938； P＜0.05）.There was no significant difference in serum levels of inflammatory factors between the four groups before treatment （P＞0.05）.After surgical treatment， all the indexes of patients were increased， and the levels of white blood cell count， C-reactive protein and procalcitonin in group D were higher than those in group A （t=5.908， 14.862， 10.298； P＜0.05） and group B （t=2.947， 4.651， 5.799；P＜0.05）， group C （t=2.384， 3.711， 4.756； P＜0.05）； The indexes of group B were higher than those of group A（t=3.748， 5.114， 4.332； P＜0.05）.The indexes of group C were higher than those of group A （t=3.118， 6.292，6.154； P＜0.05）.The incidence of postoperative complications in group D was higher than that in group A（χ2=8.284， P＜0.05）.The survival rate of group A was 80.56% after 5 years of follow-up， and the difference was statistically significant （P＜0.05）.Univariate/multivariate Logistic regression analysis showed that within 95%CI， TNM stage Ⅲ， tumor size ＞ 5 cm， CEA value ＞ 5 μg/L， high visceral fat area （≥100 cm2） and sarcomia were independent risk factors for 5-year postoperative survival （OR value＞1）.
Conclusion
High visceral fat area and sarcopenia have corresponding effects on patients with colorectal cancer after operation，and the effect of patients with both is more significant， which can aggravate the postoperative inflammatory reaction， increase the incidence of complications， prolong the hospitalization time，and affect the long-term prognosis of patients.
To investigate the application value of laparoscopic transanal one-stage pull-through coloanal anastomosis with no protective stoma （LOPC） in the anal preservation treatment of low rectal cancer.
Methods
A retrospective descriptive research was conducted.Retrospective analysis of the clinical and pathological data of 21 patients with T1～T2 stage low rectal cancer treated with LOPC at He'nan Provincial People's Hospital from February 2020 to March 2023.There were 11 males and 10 females，with a median age of 56 （40～69） years.The patient's intraoperative and postoperative surgical indicators，complications， anal function， and tumor recurrence were all recorded.The deadline for follow-up is September 1，2023.
Results
All 21 patients successfully completed LOPC and retained their anus， without any conversion to open surgery or changes in surgical methods.The median surgical time was 200 （115～280） minutes， with a median bleeding volume of 100 （50～200） milliliters.No protective stoma was performed， and all patients were eligible for R0 resection.An average of 17 （12～26） lymph nodes were cleared， and the average hospital stay was 10 （7～13） days.There were no postoperative anastomotic leakage or perioperative deaths.All patients received postoperative follow-up， with a median follow-up of 12 （6～41） months and a LARS score of 26 （19～40） points at 6 months postoperatively.There was no tumor recurrence or metastasis during the follow-up period.
Conclusion
LOPC is safe and effective for the treatment of low rectal cancer.
