Research progress of colorectal surgery in 2021 and future prospects / 中华胃肠外科杂志

In recent years, with the wide application of immune score and liquid biopsy to guide the accurate diagnosis and precise treatment of colorectal cancer, colorectal surgery develops more rationally and scientifically. The strategy of organ function protection in colorectal surgery gradually attracts more and more attention. The continuous development of comprehensive treatments, such as targeted therapy and immunotherapy, provides more choices for colorectal cancer patients. Several significant progress in surgical strategies for benign colorectal diseases challenges the traditional concepts as well. The advances in medical science and the innovation of concepts and ideas set high new standards for the development of colorectal surgery in China. Efforts are required to improve the standardization of diagnosis and treatment of colorectal disease. There is still a long way to go to explore patient-centered new technologies, new concepts and new fields of accurate diagnosis and precise treatment in colorectal surgery.

Research progress of different bowel reconstructions for postoperative functional protection during low anterior resections of rectal cancer / 中华胃肠外科杂志

Straight coloanal anastomosis (SCA), colonic J-pouch anastomosis (CJP), transverse coloplasty pouch anastomosis (TCP), and side-to-end anastomosis (SEA) are the most commonly used procedures of bowel reconstructions in the low anterior resections (LAR) of rectal cancer. Different bowel reconstruction procedures greatly affect postoperative bowel function, urinary function and sexual function. SCA is the most traditional procedure. CJP has been studied extensively and well-developed reconstruction method; however, recent studies have shown that CJP has the highest morbidity of complications, so the clinical application of CJP is limited. SEA is not inferior to CJP and SCA in the short-term and long-term defecation function, urination function, and sexual function, with reliable operational safety, so it is expected to become an alternative to SCA and CJP. The research on TCP is lacking, but there are some related clinical trials currently underway, and the results are worth expecting. The improvement and innovation of bowel reconstructions provide a bright prospect for better functional prognosis in patients with rectal cancer.

Investigation on the status quo of diagnosis and treatment related to the protection of defecation function in sphincter-preserving resections for rectal cancer: a cross-sectional study of Chinese colorectal surgeons / 中华胃肠外科杂志

Objective: To understand the current status of diagnosis and treatment regarding the protection of defecation function in Chinese surgeons performing sphincter-preserving resections (SPR) for rectal cancer in order to discover the problems existing in the function protection during SPR and provide support and reference for the standardized clinical management of rectal cancer. Methods: A cross-sectional survey was performed. Colorectal surgeons who obtained the medical qualifications and volunteered to participate in this study were included, and respondents with incomplete information were excluded. From October 18 to 22, 2020, randomized sampling was conducted among Chinese colorectal surgeons from Chinese Association of Colorectal Surgeons, Chinese Colorectal Cancer Committee, Chinese Sexology Association Anal functional Surgery Committee and National Health Commission Capacity Building and Continuing Education Committee. The questionnaire included basic information of the respondents, assessment of defecation function before SPR, intraoperative details, postoperative follow-up, evaluation and intervention of patients with low anterior resection syndrome (LARS). Observation indicator: results of the questionnaire survey. Result: A total of 231 questionnaires were collected, and 230 were effective, with an effective rate of 99.6%. Among these participants, 217 (94.3%) were males; 107 (46.5%) had medical doctor degrees; 129 (56.1%) were national commission members in colorectal surgery; 137 (59.6%) performed more than 50 SPR operations per year; 211 (91.7%) assessed defection function by auxiliary examinations before SPR. Rigid sigmoidoscopy (n=116, 55.0%) and anorectal manometer (n=81, 38.4%) were the most commonly used method. Among the 230 respondents, 64.8% (n=149) of surgeons used 2D laparoscopy for SPR surgery most commonly, and 51.3% (n=118) of surgeons performed direct colorectal anastomosis for reconstruction, and 98.3% (n=226) used staplers during anastomosis. All the surgeons indicated that they would follow up patients after SPR, and outpatient clinic was the most common method (84.4%, 184/230). When LARS occurred, 50.0% (115/230) of surgeons chose defecation function scale and 78.7% (181/230) actively provided guidance and intervention for patients. Conclusions: Chinese colorectal surgeons still have shortcomings in the protection of defecation function during SPR for rectal cancer. They do not make enough preoperative functional evaluation and postoperative functional recovery estimate for patients. The knowledge and use of defecation function scales and interventions on LARS are expected to be standardized.

Role of multidisciplinary cooperation in the diagnosis and treatment of pelvic floor disorder disease / 中华胃肠外科杂志

The pelvic floor disorder disease (PFDD) typically originates from supportive tissue defects or injuries in the pelvic floor with a wide spectrum of symptoms such as urinary incontinence, pelvic organ prolapse, sexual dysfunction, fecal incontinence and chronic pelvic pain. But its etiology is complex, involving multiple systems and organs. So the best management of PFDD requires the implementation of multidisciplinary team (MDT). Pelvic floor centers have been developed abroad to provide pelvic floor services. In the setting of PFDD, the concept of MDT starts lately and develops slowly in China. The MDT approach was demonstrated to improve general rehabilitation, psychological state and quality of life. However, there is no unified standardization for MDT diagnosis and treatment of PFDD at home and abroad. Meanwhile, the personnel composition, responsibilities, training, and operation mode of the MDT need to be further developed. Perfecting the management mode of MDT team members, establishing standardized training programs and assessment criteria play crucial role in the future development of MDT in PFDD.

Significance of the intact of the fascia propria in protection of pelvic plexus during total mesorectal excision / 中华胃肠外科杂志

Total mesorectal excision (TME) is the gold standard of surgical treatment for mid and low rectal cancer. It aims to improve the oncological outcomes as well as preserve anal sphincter, sexual and urinary function. Compared with sympathetic nerve injury alone, pelvic plexus and neurovascular bundle (NVB) injury has significant effect on postoperative sexual dysfunction, especially erectile function. Since the lateral surgical plane of TME is narrow and densely packed, dissecting outside the plane causes pelvic plexus injury, while dissecting inside it results in residual mesorectum. In this commentary, we review the research progress of lateral fascial anatomy of TME, and describe the anatomical characteristics of rectosacral fascia based on our previous research results. The prehypogastric fascia acts as a "fascia barrier" when dissecting the lateral space constantly from posterior to anterior. In addition, the pelvic plexus fuses with the prehypogastric fascia which is considered as the outer side layer of rectosacral fascia laterally. Thus, the rectosacral fascia should be dissected at the level of S4 vertebral body posterior to the rectum in an arc shape and then enter the superior-levator space. Before dissecting the lateral spaces, the anterior space of the rectum should be dissected first. After an "U" shape cutting of the Denonvilliers' fascia, the lateral space should be dissected from anterior to posterior. Finally, the lateral attachment of rectosacral fascia is transected to ensure the integrity of the mesorectum without damaging the pelvic plexus.

Pros and cons of perioperative therapy in the protection of organ function in rectal cancer / 中华胃肠外科杂志

The goal of rectal cancer treatment should be to better protect organ function and improve patients' quality of life on the basis of ensuring radical resection. The current evidence has proved the superiority of perioperative chemoradiotherapy in reducing local recurrence and improving long-term survival. From the perspective of organ function protection, however, perioperative chemoradiotherapy has both disadvantages and advantages. Despite the great help in improving long-term outcomes, adverse reactions of chemoradiotherapy can aggravate defecation, urination and sexual dysfunction. Also, for patients with significant or complete remission, if the treatment strategy of local resection or close follow-up is selected, organ function can be preserved to the greatest extent. The key to the choice of treatment is to evaluate preoperatively whether pathological complete response is achieved. It should be kept in mind that preserving organ itself is not the same as protecting organ function. For patients who need perioperative chemoradiation, the optimal treatment methods should be chosen based on the patient's condition. Surgeons should fully evaluate organ function before operation, select the appropriate treatment strategy, pay special attention to the protection of important organs and nerves during surgeries, and carry out close postoperative follow-up and organ function rehabilitation as soon as possible, so as to reduce the incidence of dysfunction and the impact on the quality of life.

Efficacy of gonadotropin-releasing hormone analogues in protecting ovarian function of premenopausal breast cancer patients undergoing chemotherapy: A meta-analysis / 肿瘤

Objective: To evaluate the therapeutic efficacy of gonadotropin-releasing hormone analogues (GnRHa) in protecting ovarian function of premenopausal breast cancer patients undergoing chemotherapy. Methods: The randomized controlled trials of GnRHa protecting ovarian function of premenopausal breast cancer patients undergoing chemotherapy were collected from PubMed, Cochrane Library, EMbase, China National Knowledge Infrastructure (CNKI) and Wanfang Databases, and the date range was from the establishment of the databases to March 2018. According to the inclusion and exclusion criteria, the literatures about amenorrhea rate, premature ovarian failure (POF) rate, menstrual recurrence rate, pregnancy rate, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in premenopausal breast cancer patients after chemotherapy combined with GnRHa or chemotherapy alone were screened out. The outcome measurements were odds ratio (OR) and 95% confidence interval (CI). The Meta-analysis was performed using RevMan 5.3 software. Results: A total of 17 randomized controlled trials involving 1 590 patients were included in this Metaanalysis. As compared with chemotherapy alone, the chemotherapy combined with GnRHa increased the amenorrhea rate during chemotherapy (OR = 11.14, 95% CI: 4.83-25.72, P < 0.000 01), reduced the POF rate (OR = 0.35, 95% CI: 0.25-0.50, P < 0.000 01), while improved the menstrual recurrence rate (OR = 2.90, 95% CI: 1.88-4.49, P < 0.000 01) and pregnancy rate (OR = 1.81, 95% CI: 1.08-3.02, P = 0.02). Moreover, three studies showed that the levels of FSH and LH in chemotherapy combined with GnRHa group were lower than those in chemotherapy alone group, and there were significant differences in two studies (both P < 0.01). Conclusion: Chemotherapy combined with GnRHa can increase the menstrual recurrence rate and pregnancy rate of premenopausal breast cancer patients after chemotherapy, suggesting that GnRHa has a protective effect on ovarian function of those patients.

Gonadotropin-releasing hormone agonists for the protection of ovarian function in premenopausal patients treated by chemotherapy: a meta-analysis / 肿瘤研究与临床

Objective To evaluate systematically the effectiveness of gonadotropin-releasing hormone agonist (GnRHa) administration before chemotherapy and/or during chemotherapy for the protection of ovarian function in premenopausal women. Methods PubMed, Cochrane Library, Medline, Embase, China Biomedical Literature Database, CNKI were searched to collect the clinical randomized control trail (RCT) of ovarian function protection in premenopausal women receiving chemotherapy by using GnRHa. RevMan5.3 software was used to analyze the incidence of early premature ovarian insufficiency (POI), menstrual recovery rate, pregnancy rate and other indicators. Results A total of 12 articles were included, including a total of 1509 premenopausal women who received chemotherapy for malignant diseases. GnRHa combined with chemotherapy reduced the incidence of POI (OR = 0.36, 95％ CI 0.23-0.56, P < 0.01) and improved the menstrual recovery rate during follow-up (OR = 2.49, 95％ CI 1.72-3.60, P < 0.01). GnRHa combined with chemotherapy could increase the pregnancy rate of patients aged 35 years and older (OR = 2.04, 95％ CI 1.08-3.83, P = 0.03). Conclusion GnRHa administration before chemotherapy and/or during chemotherapy may prevent the chemotherapy damage to ovarian function, reduce the incidence of POI, and improve the recovery rate of menstruation.

Effect of Shenfuhuang Injection on Function of Organs and Mortality of Septic Rats / 中国中医药信息杂志

Objective To investigate the effect of Shenfuhuang injection (SFH Injection) on function of organs and mortality of septic rats, using a sepsis mode by cecal ligation puncture(CLP). Methods 140 male Wistar rats were randomly divided into four groups: normal control group, sham operation group, CLP group (being further divided into 2, 8, 24, 48 h subgroups), SFH injection treatment group (being further divided into 2, 8, 24, 48 h subgroups, drug were inraveous injected just after operation and per 12 h). The mortality of animals and altering organ’s function were observed within 7 days. Results Compared to CLP model, mortality of Septic rats in SFH injection group was significant lower, and the treatment prolonged survival duration. SFH Injection group owned lower numerical values of ALT, AST, BUN and Cr in serum. Conclusion SFH Injection can obviously decline the mortality of septic rats and play an important role in protecting organ function.