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Analysis and Evaluation of the Operative Approaches of the Rectal Cancer

Author: ZhangHongWei
Tutor: LiGuoDong
School: Jilin University
Course: Clinical
Keywords: Rectal cancer Dixon operation Miles operation TME sphincter preservation radical rectal surgery local recurrence neoadjuvant radio- chemotherapy adjuvant radio-chemotherapy
CLC: R735.37
Type: Master's thesis
Year: 2009
Downloads: 95
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Abstract


ObjectiveTo investigate the choice of the operation for all kinds of rectal cancer and make the best judgment for the patients who get rectal cancer.Methods1.To analyze retrospectively the clinical data of 152 in rectal cancer in the General Surgery Center of Ji Lin University from January 2006 to December 2008.Analyse the clinic data : the gender and age of patients, histological class- ifycation、pathological stage and distance from the anal margin of tumor,the choice of operation, mortality related to the operation,postoperative complica- tions including:anastomotic bleeding ,anastomotic leakage,anastomotic stenosis, dysfunction of anal sphincter, dysfunc- tion of urinary bladder and sexual dysfunction, locale recurrence and distant metastasis,and the effect of the choice of operation and prognosis by neoadjuvant radio-chemotherapy with adjuvant radio-chemotherapy.2.Follow-up by clinic reexamination and telephone mainly.3.Application of SPSS 14.0 statistical software for analysis, count data usingχ2 test whether there is significant difference(n <40 when the use of Fisher exact probability test).Result1.Dukes stages: A period of 29 cases, B period of 59 cases, C period of 48 cases, D period of 15 cases, one case of carcinoma in situ. Radical surgery and extended radical operation of 95.4 percent,although progress to Dukes D , still 60% (9 / 15) radical surgery is feasible as long as the patients’body conditions is permission.2.Histologic classification:63 cases of well-differenttiated adenocarcino- ma,75 cases of differentiated adenocarcinoma,3 cases of poorly differentiated adenocarcinoma,6 cases of mucinous adenocarcinoma, 1 case of papillary adenocarcinoma, signet-ring cell carcinoma 1 case, 1 case of malignant melan- oma, 1 case of squamous cell cancer, 1 case of carcinoma in situ. 98% is Well-differentiated adenocarcinoma and differentiated adenocarcinoma, Dixon and Miles surgery is still the main technique;Do not have conventional lateral lymph node dissection.3.Pathological examination confirmed 57 cases of mesenteric lymph node metastasis, lymph node metastasis lateral one case, accounting for the total number of lateral lymph node metastasis in 1.4%。4. Tumor from the anal margin of 1-3cm 28 cases ,3-5cm 31 cases ,5-9cm 54 cases ,9-15cm 39 cases; there are 143 patients with radical resection of rectal cancer surgery, surgery of the total number of 94.1% (143 / 152), rectal cancer below peritoneal reflection and on the reflection with Dixon + PANP + TME surgery were 69 cases, accounting for 48.2% of radical resection (69/143), in which the lateral lymphonode dissection were 33 cases, 36 cases did not have lateral lymphonode dissection , above peritoneal reflection 36 cases of Dixon + PANP surgery, accounted for 25.2% (36/143)in radical resection, the Miles + TME surgery were 36 cases, accounting for 25.2% of radical resection (36/143), local radical excision in 2 cases ( Transabdominal 1 case, transanal 1 case), accounting for 1.4% of radical resection (2 / 143), 2 cases of extended radical operation, accounting for 1.4%, palliative resection in 7 cases , accounting for 4.6% (7 / 152), of which 6 cases of Hartmann surgery, 3 cases of simple tumor excision.5.Postoperative anastomotic bleeding in 4 cases, anasto- motic leakage in 3 cases, anastomotic stenosis in 5 cases, 3 cases of obstruction caused by intestinal adhesion, sphincter-saving surgery within 3 months of anal sphincter dysfunction occur in 15 cases, there are still six months after anal dysfunction in 5 cases, after a month 6 cases of voiding dysfunction, sexual dysfunction in 17 cases, of which 11 cases of erectile dysfunction, ejaculatory dysfunction14;χ2-test showed that the operation occurred Miles sexual dysfunction more than Dixon surgery.6.Double stapling in low and ultra-low rectal cancer application of rectal sphincter-saving rate is 76.3%.7.Patients with rectal cancer can benefit from neoadjuvant radio- chemotherapy,postoperative adjuvant chemotherapy can reduce the recurrence rate and prolong disease-free survival time.Conclusion1.Based on the differences of patients to choose the most beneficial surgical procedures, do the best to preserve the natural anus and to reduce the damage: above the peritoneal reflection Dixon surgery and TME is enough ;cancer that below and on peritoneal reflection that have sphincter-saving condition, Dixon + TME + PANP is suitable,do not conventional lateral lymph node dissection; for those who can not preserve sphincter function ,Miles surgery and TME is the last choice; Near the anus and make sure that is in the early stage ,which can choose local excision. It still reach radical standards.2.Technical conditions permit and make sure no contraindication, you can choose to minimally invasive surgical procedures, such as laparoscopic radical resection of rectal cancer,tranasal endoscopic microsurgery.3.Application of double stapling device Positively to improve the low and ultra-low sphincter-saving rate of rectal cancer;4.Implementation of integrated therapy:neoadjuvant radio-chemotherapy—surgery—"sandwich" radiotherapy and chemotherapy after surgery.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Intestinal neoplasms > Rectal cancer
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