The purpose of this study was to investigate the pathological features and survival of 85 early stage colorectal cancer (CRC) patients who underwent endoscopy followed by radical surgery.

The data of 85 patients who were diagnosis as early stage CRC patient in Cancer Hospital, Chinese Academy of Medical Sciences between Sep.2011 and Sep.2019 were retrospectively collected. The clinicopathological features and survival of the patients were analyzed.

Among the 85 patients, 78 (91.7%) had high risk factors after endoscopic treatment (e.g., the endoscopic resection margin could not be evaluated, the resection margin was positive, the depth of submucosal infiltration was greater than 1 000 μm, the differentiation was poor, accompanied by vascular tumor thrombosis and nerve invasion, etc.). Sixty-six patients (74.2%) had neither residual tumor nor lymph node metastasis after radical resection. One patient (1.2%) had both residual tumor and lymph node metastasis. There were 9 patients (10.6%) with residual tumor. Pathological findings showed lymph node metastasis in another 11 patients (12.9%). Analysis showed that lymph node metastasis was easy to occur under the microscope with pathological accompanied by vascular infiltration (χ²=5.057, P=0.039). The median follow-up time was 24.0 months (P₂₅-P₇₅:12.0~41.1). Among the follow-up patients, two were lost to follow-up, and the remaining 83 patients had no recurrence or metastasis, and all survived.

The treatment of patients with high risk factors after endoscopic resection of early colorectal cancer should be carefully considered. Vascular infiltration may be one of the risk factors for lymph node metastasis. Additional radical surgery is safe and reliable.

To investigate the clinical significance and prognosis of supplemental right hemicolectomy for patients with appendix tumor presented with appendicitis after emergency surgery.

The clinical pathologic data of 32 patients with appendix tumor underwent rescue right hemicolectomy after emergency surgery were retrospectively collected and analyzed to assess the impact of the rescue surgery on prognosis.

Among all patients presented with appendicitis, thirty patients underwent single appendectomy in other hospitals, and two underwent appendectomy and ileocecoectomy. The pathology consultation of 15 patients was diagnosed as carcinoid (carcinoid group) in our hospital, while 17 patients were diagnosed as adenocarcinoma, mucinous adenocarcinoma and signet cell carcinoma (non-carcinoid group). All 32 patients were received rescue right hemicolectomy. Neither residual cancer nor lymph node metastasis was found in carcinoid group, however, residual cancer or lymph node metastasis was found in 11 (64.7%) patients in non-carcinoid group. After a median follow-up of 60.5 (12~156) months, there was no recurrence or metastasis and death in carcinoid group, while there were six patients with disease progression and four deaths in non-carcinoid group. The 5-year disease-free survival (DFS) and overall survival (OS) rates are 67.6% and 68.6%, respectively.

Patients, with appendix tumor diagnosed as carcinoid after emergency surgery, received rescue right hemicolectomy and could achieve favorable prognosis. However, for patients diagnosed as adenocarcinoma, mucinous adenocarcinoma and signet cell carcinoma, there was a high incidence of residual cancer and lymph node metastasis, and supplemental right hemicolectomy should be carried out early to definite the final pathological stage, guide treatment and improve prognosis.

To investigate the safety and postoperative quality of life for patients with ulcerative colitis (UC) treated with one-stage total colorectal resection and ileal pouch anal anastomosis (IPAA).

The clinical and postoperative clinical data and quality of life scores of 22 patients with UC who underwent IPAA treatment from January 2014 to December 2015 in the Gastrointestinal Surgery Center of West China Hospital of Sichuan University were retrospectively analyzed.

All of the 22 patients were successfully enrolled and were treated with IPAA. A total of 18 patients had 20 complications/time, including 2 cases of moderate-to-severe complications (Clavien-Dindo III~IV), one case of thoracic puncture with pleural effusion, one patient was treated with ICU due to postoperative pulmonary infection. There was no anastomotic leakage of all the patients. The average number of bowel movements was (6.75±1.24) times/day and (4.18±1.00) times/day at 3 months and 12 months after surgery. The overall Cleveland quality of life assessment (CGQL) was (0.85±0.08) and (0.92±0.06).

For patients with UC for elective surgery, one-stage IPAA treatment is safe and feasible, and the postoperative defecation function and quality of life are satisfactory.

To explore the effect and significance of structured training through the clinical work carried out by the trainees after undergoing structured training of transanal total mesorectal excision (taTME).

Statistical analysis of 20 surgical outcomes, postoperative complications, and subjective proficiency evaluation of taTME surgery performed after training through retrospective analysis.

Twenty patients were divided into the first 10 cases (group A) and the latter 10 cases (group B) for grouping comparison. There was no statistical difference in the occurrence of surgical bleeding, preventive ostomy and anastomotic leakage, and there was no difference in the total operation time between the two groups, the time of perineal operation (t=2.557, P=0.05) and the time of the anus platform (t=4.575, P<0.01) were significantly lower than that of group A. There were more patients with manual anastomosis in group B than those in group A. There was no statistical difference in the evaluation indexes of prostate or vaginal posterior wall identification and suture of the two groups of patients. There were statistical differences in the evaluation of the quality of the anastomosis (t=8.667, P<0.05).

Before carrying out a taTME operation, through structured training, this reasonable teaching method can enable clinicians to deeply grasp the anatomical structure of pelvic perianal, shorten the learning curve, improve the safety of operation and protect the rights and interests of patients.

Surgical resection of liver metastases is the best treatments for colorectal liver metastases, and can cure some patients or substantially prolong their survival. More patients received preoperative chemotherapy in practice, however the severity of chemotherapy associated liver injury and its effect on the safety of surgery was still in need of accurate evaluation. Indocyanine green (ICG) clearance test is one of the means of quantitative evaluation of hepatic reserve function, and successfully reflects abnormalities in hepatic reserve function in cirrhosis liver. However, whether ICG test can reflect the effects of chemotherapy induced liver injury on hepatic reserve function was still controversial. This article briefly reviews the principle and applications of ICG clearance and the correlation between ICG abnormalities and chemotherapeutic liver damage and its severity degrees. The usefulness of ICG test in the estimation of the postoperative risk of morbidity after liver resection and factors that may influence ICG index was also explored.

To evaluate of the recent safety and feasibility of intraoperative intraperitoneal chemotherapy with Raltitrexed for colorectal cancer patients.

The clinical data of colorectal cancer patients undergoing surgery from the National Cancer Center from July 2017 to October 2018 were retrospectively analyzed. 80 colorectal cancer patients who underwent radical surgery were divided into two groups. The Raltitrexed group (40 patients), who received intraoperative intraperitoneal perfusion chemotherapy with Raltitrexed and the control group (40 patients), who did not receive intraoperative intraperitoneal perfusion chemotherapy. Analysis of the recent safety differences between the two groups in terms of postoperative complications, liver and kidney function, hematological toxicity, and time of gastrointestinal function recovery.

There was no significant differences in the incidence of postoperative complications, liver and kidney function, blood toxicity and recovery time of gastrointestinal function between the two groups (all P>0.05).

Intraoperative perfusion with Raltitrexed for patients with colorectal cancer has good safety and tolerability, and does not increase postoperative complications.

To evaluate the risk of anastomotic leakage after anterior resection for rectal.

From March 2005 to August 2009, 338 rectal cancer patients who underwent anterior resection of the Department of General Surgery in the Affiliated Changzheng Hospital of Second Military Medical University were selected as the subjects. All patients experienced a total mesorectal excision operation. Univariate and multivariate analysis were performed to determine risk factors for anastomotic leakage.

The incidence of anastomotic leakage was 9.2%. Univariate analysis and multivariate analysis revealed that age (OR: 3.380, 95%CI: 1.346~8.489), BMI (OR: 11.828, 95%CI: 4.123~33.858), tumor location (OR: 6.304, 95%CI: 162~18.382), and intestinal obstruction (OR: 6.675, 95%CI: 2.164~20.594) were independent factors for anastomotic leakage.

The incidence of anastomotic leakage after anterior resection of rectum was related to the factors such as gender, age, BMI index, tumor location and intestinal obstruction. For patients with risk factors such as men, advanced age, obesity, low rectal cancer, intestinal obstruction, postoperative anastomotic leakage risk will increase.

A new type of open-loop anoscope was used in tissue selective rectal mucosal resection and anastomosis (TST), and the clinical efficacy and safety of this method were evaluated.

Forty-eight patients with grade Ⅲ and Ⅳ prolapsed hemorrhoids were selected as subjects, and an anal anastomat was performed using an open-loop anoscope. Observe the operation and completion, the amount of tissue removed, the time spent on surgery, the length of postoperative hospital stay, the postoperative pain score, the feeling of anal bulge, and the presence or absence of complications.

All 48 patients successfully completed the operation without interruption or midway change of the surgical plan. Intraoperative operation is smooth, no abnormalities in the instrument, nail removal, and failure to fire. There was less bleeding during the operation and no uncontrollable bleeding occurred. The average operation time was (21.3±5.5) minutes, the average tissue resection amount was (11.6±1.9) mL, and the average postoperative hospital stay was (4.8±1.7) days. After 6 months of follow-up, there was no clinical stenosis and potential subclinical relative stenosis in the entire group.

The application of open-loop anal mirror in TST can selectively remove enough prolapsed mucosa while preserving part of the normal rectal wall, avoiding serious complications such as rectal stenosis and rectal vaginal fistula from the technical source. Postoperative pain, anal bulge, and defecation dysfunction are also relatively mild, which can be regarded as a simple, safe and effective surgical procedure.

To evaluate the efficacy of MRI of high resolution layer in rectal cancer at 3.0T magnetic resonance (MR) for diagnosing rectal cancer, and analyze the relationship between apparent diffusion coefficient (ADC) values and pathological results of tumor.

We retrospectively analyses 75 patients with radical surgical and pathological proved rectal cancer. All patients received high resolution layer rectal 3.0T MRI, to evaluate the correlation between MRI and pathology by estimating invasive depth and measuring the ADC value in different type of group.

The diagnostic accuracy of high resolution layer rectal MRI for pathological changes in T1, T2, T3, and T4 was 0%, 38.1%, 72%, 14.3% in the group of non-preoperative therapy, and 50%, 33%, 75%, 0% in the group of preoperative therapy. There was poor consistency between T stage of MRI and pathology whether in group of non-preoperative therapy (κ=0.200) or preoperative therapy (κ=0.270). There was no significant correlation between the ADC value of tumors and groups of various T stage. There was also no significant correlation between the ADC value of tumors and groups of various differentiation grades. Non-preoperative therapy group (F=0.074, P=0.929; F=0.737, P=0.496) and preoperative therapy group (F=1.889, P=0.783; F=4.385, P=0.627). There was a significant difference between the patients with lymph metastasis and those without lymph metastasis in non-preoperative therapy group (F=0.073, P=0.012), and there was no significant difference in preoperative therapy group (F=0.035, P=0.793).

The diagnostic accuracy of high resolution layer rectal MRI for pathological changes in T3 is high, but the overall accuracy rate is low. ADC value of high resolution layer rectal MRI has some value in evaluated the lymph metastasis and need further study.

To evaluate lymph node dissection effect after using carbon nanoparticles in laparoscopic radical resection for rectal cancer.

Eighty patients accepted laparoscopic radical resection for rectal cancer in People′s Hospital of Beijing Daxing District from August 2016 to August 2017 were selected. They were randomly assigned as carbon nanoparticles group and control group, with forty patients in each group. Patients in carbon nanoparticles group received rejection of carbon nanoparticles into submucosal layer at the inferior border and lateral wall of tumor under enteroscopy guidance at two different times (16~18 hours before operation and during operation), and there were twenty patients at each time. Resection range was determined according to the location of tumor. Surgical specimens were delivered to department of pathology within thirty minutes after tumors were resected, and special person was assigned to assist lymph node sorting.

The amount of detecting lymph node in carbon nanoparticles group was more than control group (t=3.32, P<0.05), and positive (metastasis) rate in black dyed lymph node was higher than non-black dyed (χ²=42.76, P<0.001), the difference was statistically significant. There was no significant difference in the amount of detecting lymph node and lymph node positive (metastasis) rate between patients rejecting carbon nanoparticles sixteen~eighteen hours before operation and during operation (χ²=0.032, P>0.05).

The application of carbon nanoparticles can increase the amount of detecting lymph nodes during laparoscopic radical resection for rectal cancer, and black dyed lymph nodes which are traced by carbon nanoparticles have higher positive rate. The effect of rejecting carbon nanoparticles sixteen~eighteen hours before operation is confirmed, also it is helpful to arrange clinical work, so this technique deserves generalization and application.

To analyze parameters associated with rectal cancer N stage of computer tomography and clinicopathological characteristics and combination of both to evaluate it′s role in rectal cancer preoperative N stage.

Clinical data of 300 patients with mid-low rectal cancer who underwent radical resection for rectal carcinoma at the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, from July 2010 to July 2013 were retrospectively collected. According to the postoperative pathologic lymph node status the patients were classified into 2 groups: group N-(n=164) and group N+ (n=136). To analyze computer tomography image and clinicopathological characteristics which affects the stage of lymph nodes. And to analyze the combination of both to evaluate it′s role in rectal cancer preoperative N stage.

Compared with N- group, N+ group had higher CEA (Z=-3.636, P<0.001), larger tumor size (t=-4.460, P<0.05), higher T staging (Z=-4.895, P<0.05), and higher differentiation grade (Z=-4.861, P<0.05). No significant difference was observed between two groups in terms of gender, age, CA199, tumor location, surgical procedure, and tumor type (P>0.05). Besides, N+ group had more numbers of lymph nodes (Z=-5.134, P<0.001), longer mean major axis diameter (t=-6.462, P<0.05) and longer mean short axis diameter (t=-6.900, P<0.05), longer largest major axis diameter (Z=-4.128, P<0.001) and longer largest short axis diameter (t=-7.183, P<0.05), and higher mean grey level (Z=-6.560, P<0.001). Lymph node location between two groups had significant difference (χ²=8.202, P<0.05). In multivariate analysis, only T staging and differentiation grade were the independent influence factors of lymph node staging. According to the combination results, combining image factors and CEA, T stage and differentiation grade can improve the diagnostic specificity to over 80%.

T staging and differentiation grade were identified as independent influence factors for lymph node staging. Combining image factors and CEA, T stage and differentiation grade could improve the diagnostic specificity to over 80%. However, the sensitivity and accuracy was still low. Further study is needed to find a new way to evaluate lymph node staging.

Since anti-cancer therapeutic methods is progressing, response evaluated criteria is subsequently upstated. From WHO and RECIST criteria for chemotherapy, CHOI criteria and CT morphology for anti-angiogenesis therapy, to the newest criteria for immunotherapy. Each criteria was raised and established during the challenge to the original one. Here, we summarized the progression of response evaluation criteria according to different anti-cancer therapeutic regimen.

To analyze clinical efficacy of laparoscopic rectal suspension with basin repair combined with the PPH for rectal internal mucosal prolapse.

From March 2011 to November 2012, 94 cases of patients who had internal rectal mucosal prolapse were treated.Patients were divided into two groups in terms of different surgical techniques.Group A (n=48) received laparoscopic rectal suspension with basin repair combined with the PPH,Group B (n=46) received PPH.Longo Score and Wexner Score,postoperative effect,postoperative complications in the two groups were assessed respectively before surgery and 24 months after surgery.

The average preoperative Longo score of A,B two groups were 15.39±4.15、14.86±3.06,after 24 months fell to 5.37±0.87、7.84±1.23. Group A (t=16.37, P<0.01) and group B (t=14.46, P<0.01) within the group of preoperative and postoperative comparative difference was statistically significant. Average Longo score of group A after 24 months were significantly lower than those of group B (t=-11.28, P<0.01), the difference was statistically significant.The average preoperative Wexner score of A, B two groups were 14.25±3.37、14.58±3.14, after 24 months fell to 4.85±0.51、7.52±0.94. Group A (t=19.11, P<0.01) and group B (t=14.61, P<0.01) within the group of preoperative and postoperative comparative difference was statistically significant.Average Wexner score of group A after 24 months were significantly lower than those of group B (t=-17.21, P<0.01), the difference was statistically significant. The total effective rate among the two groups was statistically significant (χ²=5.84, P<0.05). The complications of two groups were not statistically insignificant (χ²=0.20, P>0.05).

The short term efficacy of laparoscopic rectal suspension with basin repair combined with the PPH is better than PPH, but the long term effect need further research.

In recent years, as some new technology applied in the clinical practice of rectal cancer, such as neoadjuvant therapy, multidisciplinary team (MDT) and so on, the influence of accurate preoperative assessment for patients is not only associated with operation selection and prognosis assessment, but also related with reasonable choice of personalized comprehensive treatment plan and process. Furthermore, it also can provide survival benefit and improve the quality of life for patients. Therefore, the precision preoperative assessment is critical for patients with rectal cancer. The purpose of this study is to given an overview to precision preoperative assessment of rectal cancer and provide reference for clinical oncologists.

To evaluate the effect of fast rehabilitation nursing pathway in postoperative patients with colorectal cancer.

Patients between Jun 2016 and Nov 2016 were randomly divided into control group and the experimental group. The control group was treated with routine nursing, and the experiment group adopted the fast rehabilitation nursing pathway. The two groups were compared with 48 h patients′ anxiety state, postoperative pain in 24 h, degree of satisfaction of hospitalized patients before discharge, opium dose after surgery, postoperative hospitalization days.

Comparing with control group, the fast rehabilitation nursing group has lower postoperative 48 h SAS score (t=7.99, P<0.05) and 24 h VAS score (t=3.12, P<0.05), patient satisfaction improved significantly, the dose of opium days after surgery (t=2.46, P<0.05)and the postoperative hospital stay (t=3.42, P<0.05) was significantly less than the control group.

In the patients with colorectal cancer, fast rehabilitation nursing pathway can reduce the pain, improve the anxiety state of patients, reduce the postoperative dose of opium, shorten the length of hospital stay and improve the satisfaction of patients during hospitalization.

To explore the value of CTA in the preoperative examination of laparoscopic assisted colon cancer.

Fifty-eight patients with colon cancer who intended to treat with laparoscopic colon cancer radical resection from May 2013 to July 2016 were divided into two groups according to the different methods of preoperative examination. All patients received preoperative abdominal CT examination and the CTA group patients combined with VR technology could show the major mesenteric major blood vessels. Surgical indicators were comparied including operation time, intraoperative blood loss, lymph node number and postoperative exhaust time. Postoperative complications were including incision infection, anastomosis anastomotic fistula and postoperative intestinal obstruction.

Patients in the CTA group had a shorter duration of operation than the CT group (t=-2.115, P=0.039). The intraoperative blood loss of CTA group was significantly lower than that of CT group (t=-2.349, P=0.031). The number of lymph nodes in the CTA group had no significant difference with that in the CT group (t=1.813, P=0.076). There had no significant difference in the postoperative exhaust time and incidence of postoperative incision infection and postoperative intestinal obstruction between CTA group and CT group (P>0.05) . There was no anastomotic fistula in the CTA group and 3 (13.04%) anastomotic fistulas in the CT group (Χ²=2.522, P>0.05).

CT angiography, mastering of mesenteric vessels of preoperative, not only shortened the operation time, but also reduced the unnecessary vascular injury bleeding, preoperative knowledge of mesenteric blood vessels and lymph node processing range, which was possibly helpful to reduce the occurrence of postoperative complications.

The rate of malnutrition in colorectal cancer is higher than non-gastrointestinal tumor, and perioperative nutrition support can improve preoperative nutritional status of patients effectively.However, the preoperative nutrition assessment is the foundation of reasonable perioperative nutrition intervention, the author systemically reviewed the methods of nutrition assessment.

To study the therapeutic efficacy of modified Bresler procedure for the treatment of obstructed defecation syndrome (ODS) associated with rectocele and rectal mucosal prolapse.

A descriptive retrospective study from Jan 2014 to June 2015 was undertaken. 29 female patients with ODS caused by rectocele and rectal mucosal prolapse were treated with modified Bresler procedure.

The average operation time is (31.1±5.5)min, the average intraoperative blood loss is (16.3±7.5)ml, and average postoperative hospitalization time is (7.2±1.3)days. The Wexner score of constipation before the operation is (17.79±2.30), while the scores were (6.71±1.18) and (6.90±1.42) in three or six months after the operation. The defecography value before the operation is (3.6±0.4) cm, while the value is (0.7±0.2) cm in six months after the operation. The difference is significant (t=3.15, P<0.01).

The modified Bresler procedure for the treatment of ODS associated with rectocele and rectal mucosal prolapse is safe and effective, but it still needs to be proved by a larger sample size study.

To investigate the short-term effect and safety of anti-malignant ascites treated with intraperitoneal injection of bevacizumab.

46 colorectal cancer patients with uncontrolled malignant ascites at the A?liated Hospital of Guilin Medical College from 2010 to 2014 were enrolled in this study. Investigate the VEGF value of malignant ascites and analyze the survival time of two groups.

The mean VEGF value of control group is 671.8±499.15 pg/mL, and has not statistically significant than treatment group (mean value: 1225.11±609.71 pg/mL). In treat group, the mean VEGF value is 1225.11±609.71 pg/mL before treatment. The median survival time of non-paracentesis is 6 months (1~21 months). In contrast with control group, the time of non-paracentesis is significantly longer in treatment group (6.328, P<0.05). After treatment, the mean VEGF value is 317.69±172.14 pg/mL in treatment group. There is statistically significant than control group. In survival analysis, treatment group shows signi?cantly better overall survival (OS) (P<0.05).

For a part of appropriate patients, treated with intraperitoneal injection of bevacizumab is an effective and safety method.

Multidisciplinary management of rectal cancer has evolved significantly, leading to the particular importance of neoadjuvant therapy. Concurrently improving the resectability, neoadjuvant therapy may lead to an effective tumor down-staging of locally advanced rectal cancer in varying degrees. It is significant to assess tumor response after neadjuvant therapy for altering the subsequent treatment options that are considered. Magnetic resonance imaging is the recommended imaging technique for local staging of rectal cancer before surgery, and the role which plays in evaluation of response to neoadjuvant therapy is still under study. The value of conventional MR depends on morphological changes in assessment of therapeutic effect. Nevertheless, there are still some limitations. Functional MR combines information of detailed anatomy with that of tumor biology, providing comprehensive status on tumor morphological features, quantitative indicators and their changes as a result of treatment. It has the potential to assess the response to neoadjuvant therapy more accurately.