Recent progress and hotspots in colorectal surgery / 中华普通外科杂志

With the rapid development of science and technology, new technologies and methods for the diagnosis and treatment of colorectal cancer are constantly emerging, which has improved the survival of patients with colorectal cancer. At the same time, the progress in surgical technology is also changing profoundly due to information technology revolution. From open surgery to minimally invasive surgery, to robot-assisted surgery, AI technology, three-dimensional stereotactic technology, as well as the emergence of enhanced reality and digital diagnosis technology, all have greatly promoted the surgical treatment of colorectal cancer. Colorectal surgery has also become more precise, personalized, and more focused on reducing surgical trauma, protecting organ function, and improving patients' quality of life. This article aims to review the new progress and research hotspots in the surgical treatment of colorectal cancer in recent years from several aspects including organ preservation strategy, adjuvant/neoadjuvant treatment, minimally invasive surgery, difficult colorectal surgery, as well as liquid biopsy technology.

A randomized controlled trial on sodium hyaluronate gel in prevention of postoperative intestinal adhesion / 中华普通外科杂志

Objective:To evaluate the efficacy and safety of sodium hyaluronate gel in preventing adhesion after prophylactic enterostomy.Methods:One hundred and twenty four patients from 6 hospitals were enrolled in this prospective multi-center randomized controlled trial. Patients were randomized into the study group ( n=59) or the control group ( n=65).All patients underwent prophylactic enterostomy. Patients of study group received odium hyaluronate gel for adhesion-prevention,while those in control group did not receive any adhesion-prevention treatment. The incidence of moderate to severe adhesion around the incision in the stoma area were evalutated during stoma reduction surgery. Results:The incidence of moderate to severe adhesion around the incision in the stoma area was 6.3% in the study group, the difference was statistically significant ( P<0.05) compared to that of the control group (32.6%). Conclusion:Sodium hyaluronate gel can safely and effectively reduce the incidence of moderate and severe adhesions after abdominal surgery.

The impact to operation safety of preoperative renal artery embolization for management of diameter≥10 cm renal cell carcinoma / 中华外科杂志

Objective@#To study the impact to operation safety of preoperative renal artery embolization for management of ≥10 cm renal cell carcinoma.@*Methods@#The clinical data of 239 cases with ≥10 cm renal cell carcinoma which all had underwent operation in Department of Urology, Peking University First Hospital from January 2002 to December 2014 were retrospectively analyzed. Fifty-three patients underwent preoperative renal artery embolization (therapeutic group) and 186 patients did not (control group). The effect of embolization on operative time, transfusion requirements, hospitalization, ICU stay and perioperative complications were analyzed by comparing the two groups using rank sum test and χ2 test or Fisher exact test.@*Results@#Comparing the therapeutic group and control group, there was significant difference in tumor location (on the left or right). The mean age, sex, mean primary tumor size, and TNM stage were similar in both groups. Comparing the therapeutic group and control group, there were more open surgeries in therapeutic group (96.2% vs. 82.3%, χ2=6.438, P=0.013). There were no significant differences in mean operative time (238 (525) minutes vs. 208 (583) minutes, Z=-2.182, P=0.062). The mean blood transfusion (700 (1 900) ml vs. 925 (8 800) ml, Z=-1.064, P=0.006) had significant difference. The therapeutic group had a longer mean hospitalization (21 (50) days vs. 15 (79) days, Z=-4.322, P=0.000) and higher rate of intensive care unit stay (54.7% vs. 34.4%, χ2=6.103, P=0.027). There was no significant difference in perioperative complications between two groups (0 vs.3.2%, P=0.408).@*Conclusion@#Preoperative renal artery embolization in ≥10 cm renal cell carcinoma patients undergoing operation provides benefit in increasing operation safety and reducing perioperative death.

Clinical features and prognosis of rare subtypes of renal cell carcinoma / 中华外科杂志

Objective@#To investigate the clinical features and prognosis of rare subtypes of renal cell carcinoma.@*Methods@#This retrospective study collected the data of 52 rare subtypes of renal cell carcinoma of patients who underwent surgery from January 2002 to December 2014 at Department of Urology, Peking University First Hospital. There were 12 patients with collecting duct carcinoma, 5 patients with Xp11.2 translocation renal cell carcinoma, 5 patients with mucinous tubular and spindle cell carcinoma, 30 patients with unclassified renal cell carcinoma. The study group included 25 male and 27 female patients, with mean age of 52 years. The mean tumour size was (6.5±3.9) cm (range: 1.5 to 21.0 cm). The basic clinical features, gross appearance, Fuhrman nuclear grade, TNM staging and prognosis of rare subtypes of RCC were studied. The OS curves were obtained for rare subtypes of renal cell carcinoma using the Kaplan-Meier method and compared using a Log-rank test.@*Results@#The rate of lymph node and distant metastasis were 34.6% (18/52) and 17.3% (9/52). Malignancies were screened and detected by color Doppler ultrasonography or CT scan, however, no case was diagnosed before operation or aspiration, all cases were confirmed by the pathological examination. The average period of postoperative follow-up process was 65 months, and the mean survival time was (34±23) months.@*Conclusion@#The clinical features of rare subtypes of renal cell carcinoma are similar to those of clear cell renal cell carcinoma, while the imaging changes will be helpful for diagnosis before operation.