Techniques in Coloproctology最新文献

Background: In laparoscopic colectomy, overlap anastomosis (OA) is the most standard method of intracorporeal anastomosis. To avoid narrowing the anastomotic area, the closure of the enterotomy is often performed with handsewn running sutures of the monofilament. The purpose of this study was to compare two porcine in vitro colon models of stapled versus handsewn closure of enterotomy in intracorporeal OA.

Methods: In total, 40 porcine in vitro colon OA models (20 cases in the stapled closure, SC group, in which the enterotomy was closed with a stapler, and 20 cases in the handsewn closure with monofilament, HC group) were created, and anastomotic area with maximum intensity projection-computed tomography, anastomotic time, and leakage pressure were measured.

Results: In the anastomotic area, there was no significant difference between in the SC group and HC group (474.0 ± 105.0 mm² versus 502.6 ± 155.6 mm², p = 0.552). The anastomotic time was significantly shorter in the SC group than in the HC group (185.9 ± 38.3 s versus 292.4 ± 67.8 s, p < 0.001). The leakage pressure was significantly higher in the SC group than in the HC group (30.1 ± 3.8 mmHg versus 21.6 ± 5.3 mmHg, p < 0.001).

Conclusions: The findings of this study using porcine in vitro colon model showed that, in OA, the anastomotic area was similar, anastomotic time was significantly shorter, and leakage pressure was significantly higher in SC compared with HC. The results suggest that SC may be superior to HC when performing intracorporeal OA in laparoscopic surgery for colon cancer.

Background: Proper intestinal anastomosis healing in colorectal surgery relies on optimal microcirculation, with surgeons choosing between the hand-sewn and stapled techniques. However, the impact of these methods on the microcirculation remains unclear. This study used laser speckle contrast imaging (LSCI) to objectively assess the impact of hand-sewn and stapled techniques on microcirculation in a porcine model during open surgery and examined microcirculatory changes during hypotension and norepinephrine (NE) correction.

Methods: Ten healthy female pigs underwent midline laparotomy, with one hand-sewn and one stapled anastomosis in both the small intestine and colon. LSCI measurements were obtained before creation (baseline), immediately after anastomosis (T₀), after 1 h of rest (T₆₀), during induced hypotension, and after NE infusion. Measurements were performed directly on the anastomosis, adjacent tissue, and an untouched area of the intestine.

Results: At T₀, microcirculation significantly decreased across all anastomosis types, with hand-sewn anastomoses experiencing a greater decline than stapled anastomoses. An improvement was noted at T₆₀ for all anastomoses. Hypotension worsened microcirculation in all anastomosis types, and NE infusion did not improve microcirculation despite increased and stabilized mean arterial pressure (MAP).

Conclusions: Stapled anastomoses initially exhibited superior microcirculation compared with hand-sewn anastomoses, but the disparity disappeared after 1 h. Hypotension significantly impairs simple anastomotic microcirculation. Moreover, while NE is effective in stabilizing the general blood pressure, it contributed to further diminishment in intestinal microcirculation, especially around anastomoses. Thus, the use of NE postoperatively may be considered a risk factor for anastomotic leakage.

Background: Colorectal cancer (CRC) is a significant health burden, with lymph node dissection (LND) playing a critical role in staging and guiding treatment. However, the optimal extent of LND for the oldest-old population (aged ≥ 90 years) remains undefined because of insufficient targeted clinical data. This study aimed to compare the short-term outcomes of D3 versus non-D3 LND in Stage II-III CRC in oldest-old patients.

Methods: This retrospective cohort study utilized data from the Setouchi Colorectal Neoplasm Registration database, including 282 oldest-old patients with CRC treated between 2011 and 2022. Patients were stratified into D3 and non-D3 LND groups, with inverse-probability-weighted regression adjustment implemented to address potential confounding factors. Postoperative complications and hospital stays were analyzed using regression models and descriptive statistics.

Results: D3 LND resulted in significantly higher lymph node harvests in both Stage II and Stage III patients (p < 0.01). There were no significant differences in overall or major postoperative complications between D3 and non-D3 groups. Hospital stays were comparable for Stage II patients but shorter for Stage III patients in the D3 group (p < 0.01). Complication rates ranged from 28% to 47.7%, with surgical site infections and pneumonia being the most common.

Conclusions: D3 LND can be safely performed in oldest-old patients with CRC without increasing postoperative complications or extending hospital stays. These findings support the feasibility of extensive LND in this age group, but further studies are needed to evaluate its oncological benefits.

Background: Radical resection for mid and low rectal cancer is probably the most challenging type of surgery in colorectal surgery, especially in a narrow male pelvis. In this study, we aimed to define a simple and effective evaluation method based on magnetic resonance imaging (MRI) and body mass index (BMI) to predict the operation difficulty of radical resection for mid and low rectal cancer in male patients.

Methods: A total of 264 male patients who underwent total mesorectal excision (TME) due to primary rectal cancer located in the mid and low rectum (distal tumor margin distance from the anal verge ≤ 7 cm) were retrospectively included in the study. An angle SAU° [formed by two lines: line 1 (connecting the anteroinferior border of the fifth sacral vertebra and center point of anus) and line 2 (connecting internal urethral orifice and center point of anus)] was measured using the built-in software of MRI for every patient. The patients were categorized into four groups according to the angle SAU° and BMI. The operative time, estimated blood loss, TME quality, and anastomotic leakage (AL) were compared between group 1 and group 2 as well as between group 3 and group 4.

Results: Group 1 included 111 patients with angle SAU° > 60 and BMI < 25 kg/m²; group 2 included 51 patients with angle SAU° ≤ 60 and BMI < 25 kg/m²; group 3 included 74 patients with angle SAU° > 60 and BMI ≥ 25 kg/m²; group 4 included 28 patients with angle SAU° ≤ 60 and BMI ≥ 25 kg/m². The operative time, estimated blood loss, and the rate of AL in group 1 and group 3 were significantly less than those in group 2 and group 4, respectively (P < 0.05). Similarly, the TME quality in group 1 and group 3 was significantly better than that in group 2 and group 4, respectively (P < 0.05).

Conclusion: Angle SAU° based on MRI combined with BMI is a simple and effective evaluation method to predict the difficulty in TME for male patients with mid and low rectal cancer. It may also have value in predicting AL.

Background: In laparoscopic preresection, the use of double anastomosis techniques creates a potential anastomotic angle (called a "dog-ear"), which represents an area with a high incidence of anastomotic leakage.

Methods: This prospective study, conducted from July 2022 to July 2023, ultimately included 471 patients undergoing laparoscopic colorectal cancer surgery using dual anastomosis techniques. Among them, 179 patients had one or two stapled corners removed during the surgery using a modified double stapling technique (MDST), while 292 patients did not have stapled corners removed during surgery using the traditional double stapler technique (DST). The incidence of anastomotic fistula and the probability of anastomotic bleeding within 30 days after operation were analyzed.

Results: In the surgery, 179 patients had one or two dog-ears removed, constituting the MDST group (n = 179). The remaining 292 patients did not have a dog-ear removed, constituting the no dog-ear removal group (DST group, n = 292). Statistical analysis revealed a significant difference between the two groups in terms of anastomotic leakage (6 [3.4%] vs 23 [7.9%]; relative risk 0.426; 95% CI 0.177-1.025; p = 0.047). Additionally, a significant difference was observed in preventing anastomotic bleeding by removing one or both dog-ears (7 [3.9%] vs 30 [10.3%], relative risk 0.381; 95% CI 0.171-0.848; p = 0.013).

Conclusions: This prospective study indicates that removing one or both dog-ears during surgery is beneficial in preventing anastomotic leakage and anastomotic bleeding.

Background: The ANSUR surgical unit^® is a newly formulated robot that plays the roles of both the first assistant and scopist. This surgical unit was approved as a medical device in Japan in 2023. We report the first case of robot-assisted laparoscopic sigmoid resection for sigmoid colon cancer using the ANSUR surgical unit.

Methods: Robot-assisted laparoscopic sigmoid resection using the ANSUR surgical unit was planned for a 69-year-old woman with advanced sigmoid colon cancer.

Results: Tumor resection was successfully completed without conversion to open surgery. The operative time was 147 min, and the estimated blood loss was 36 mL. The roll-in, roll-out, docking, and undocking times were 182, 36, 387, and 41 s, respectively. No mechanical failure or malfunction of the surgical unit was observed. Moreover, no adverse events related to the surgical unit were observed. The patient was discharged 5 days postoperatively without complications. The histopathological diagnosis was T3N1aM0, stage IIIB, with clear proximal and distal resection margins. During follow-up 30 days later, an uneventful patient recovery was noted.

Conclusions: This is the first case of robot-assisted laparoscopic sigmoid resection for sigmoid colon cancer using the ANSUR surgical unit. The procedure was performed with technical and oncological safety.

Background: Robotic-assisted total mesorectal excision (RaTME) and transanal TME (TaTME) are well-established approaches for rectal cancer with promising oncological outcomes. Concerns about postoperative defecatory, urinary, and sexual dysfunction have been raised and the impact on patients' quality of life remained uncertain. This study compared anorectal and urogenital functional outcomes after RaTME and TaTME.

Methods: Patients with mid to low rectal cancer who underwent sphincter-saving surgery between January 2016 and December 2021 were reviewed. Questionnaires regarding low anterior resection syndrome (LARS), Wexner incontinence score, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were administered at 1, 3, 6, and 12 months after index operation without stoma or after stoma closure.

Results: Two hundred patients were included with 108 and 92 patients in the RaTME and TaTME group, respectively. After matching, 74 patients were analyzed in each group. LARS scores were significantly lower in the RaTME group than the TaTME group at 6 months (27 [interquartile range (IQR) 13-36] vs 30 [IQR 24-39], p = 0.038) but similar at 12 months (27 [IQR 13-33] vs 29 [IQR 13-36], p = 0.369) after stoma closure. Urinary function deteriorated after both operations but recovered at 6 months after RaTME and 12 months after TaTME. For sexual function, IIEF scores remained similar in the two groups.

Conclusion: RaTME provided better anorectal function with lower LARS score at initial postoperative 6 months but similar after 1 year. Urinary function recovered earlier at 6 months after RaTME while sexual function was comparable between two groups.

Objective: This study aims to compare the clinical efficacy of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLS) in the treatment of rectal cancer, assessing the advantages and disadvantages of both surgical approaches.

Methods: A propensity score matching (PSM) method was used to analyze 221 patients with rectal cancer treated at Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital) from January 2022 to January 2025. The NOSES group included 24 cases, while the CLS group included 197 cases. After 1:1 matching, 46 cases (23 in each group) were included. This study compared surgical time, blood loss, white blood cell count, C-reactive protein (CRP), visual analog scale (VAS) scores, time to passage of flatus, postoperative hospital stay, hospitalization costs, complications, and additional analgesia requirements between the two groups.

Results: The NOSES group showed significant advantages in time to passage of flatus (1.78 ± 0.60 d versus 3.57 ± 1.08 d, P < 0.001), time to get out of bed (1.13 ± 0.34 d versus 1.70 ± 0.47 d, P < 0.001), and VAS scores on postoperative days 1 (1.70 ± 0.56 versus 3.30 ± 1.26, P < 0.001), 3 (1.48 ± 0.51 versus 2.91 ± 1.24, P < 0.001), and 7 (1.13 ± 0.55 versus 2.30 ± 1.36, P < 0.001) compared with the CLS group. The NOSES group also required no additional analgesia (χ² = 9.684, P = 0.002). No significant differences were observed in surgical time, blood loss, or complication rates (P > 0.05).

Conclusions: NOSES effectively alleviates postoperative pain, demonstrates significant minimally invasive advantages, and facilitates short-term patient recovery, highlighting its clinical value.

Background: Patients with lateral lymph node metastasis (LLNM) present particular challenges for both diagnosis and treatment. This study aimed to assess whether indocyanine green (ICG)-assisted lymph node mapping with near-infrared imaging (NIRI) enhances the effectiveness of lateral lymph node dissection (LLND) by further categorizing the lateral lymph nodes in patients with mid-low rectal cancer.

Methods: Submucosal indocyanine green injection was performed on the distal margin of the rectal cancer. In the ICG-LLND group, the lymphatic drainage pathway and distribution of lateral lymph nodes (LLNs) were explored using a laparoscopic NIRI system. Pathological evaluations were conducted for both the ICG-LLND group and the control group.

Results: The ICG-LLND group demonstrated a significantly shorter postoperative hospital stay compared to the control group, both before (P < 0.001) and after (P = 0.001) matching. While blood loss and operating time were similar between groups, the ICG-LLND group had fewer cases of anastomotic leakage (P = 0.206). Postoperative lymph node harvesting was significantly higher in the ICG-LLND group, with more total lymph nodes (P = 0.001) and lateral lymph nodes (P = 0.002) harvested. The number of harvested lymph nodes in the obturator and internal iliac regions was also higher in the ICG-LLND group (P = 0.001), and the number of positive lymph nodes in these regions was significantly greater before (P = 0.027) and after (P = 0.013) matching. Univariate and multivariate analyses showed that ICG-LLND, nCRT, and positive pN stage were associated with increased lymph node harvest.

Conclusions: ICG-LLND improved lateral lymph node harvest, particularly obturator lymph nodes, and shortened postoperative hospital stay without increasing complications. This technique may enhance surgical outcomes in patients requiring lymph node dissection.