Navigating Solitary Rectal Ulcer Syndrome: A Surgeon's Conundrum With Rectal Carcinoma in a Young Adult.

Solitary rectal ulcer syndrome is a rare, chronic, and benign disorder. It can be observed as ulcers in the rectal mucosa, solitary or multiple lesions. It can often be misdiagnosed with other intestinal morbidities, due to its clinical similarities. It can be diagnosed by clinical symptoms, radiological tools, and histopathological examination. Management is carried out by conservative methods such as lifestyle and dietary modifications with medical and surgical therapy. This is a case of a 37-year-old female with a major complaint of per-rectal bleeding. Proctoscopy revealed an irregular-ulcerated mass in the rectum, which was managed conservatively. The patient showed improved symptoms after a colonoscopy, at a six-month follow-up.

The Sexual Dimorphism in Rectum and Protein Digestion Pathway Influence Sex Pheromone Synthesis in Male Bactrocera Dorsalis.

Sexual dimorphism is a crucial aspect of mating and reproduction in many animals, yet the molecular mechanisms remain unclear. In Bactrocera dorsalis, sex pheromones trimethylpyrazine (TMP) and tetramethylpyrazine (TTMP) are specifically synthesized by Bacillus strains in the male rectum. In the female rectum, Bacillus strains are found, but TMP and TTMP are not, indicating sexually dimorphic differences in sex pheromone synthesis. Our anatomical observations and precursor measurements revealed significant differences in rectal structure and ammonium levels between sexes.  In vitro and in vivo experiments reveal that ammonium is vital for sex pheromone synthesis in rectal Bacillus strains. Comparative transcriptome analysis identified ammonium-producing genes (carboxypeptidase B and peptide transporter) in the protein digestion pathway that show much higher expression in the male rectum than in the female rectum. Knocking down the expression of either carboxypeptidase B (or inhibiting enzyme activity) or peptide transporter decreases rectal ammonium levels significantly, resulting in the failure of sex pheromone synthesis in the male rectum. This study provides insights into the presence of sexual dimorphism in internal organs and their functionalities in male-specific sex pheromone synthesis and has significant implications for understanding the molecular mechanisms underlying sex pheromone synthesis by symbionts in insects.

Dosimetric impact of variable air cavity within PTV for rectum cancer.

PURPOSE: The aim of this study is to determine the impact of rectal air volume changes on treatment plan quality, and subsequently inform daily cone-beam computed tomography (CBCT) evaluation constraints, in terms of acceptable rectal air volume during treatment. METHODS: Twelve rectal cancer patients who exhibited rectal air within the PTV on their planning CT were selected. A study was conducted to evaluate the deterioration in plan quality due to expanding air volume. For each case, the air cavity volume was isotropically expanded in three dimensions using predefined margins of 3, 5, 7, and 10 mm, while deforming bladder and rectum contours. A constraint was applied to the bony anatomy to restrict the deformation. Treatment plans were then generated for all twelve patients by recalculating the reference plan with the expanded air cavity volume. RESULTS: As the air cavity expanded, the maximum relative change in D98% coverage, compared to the reference plan, decreased by 10.8% ± 3.5%, while the D2% increased by 3.5% ± 0.9%. The positioning of the air cavity notably influenced the D98% variability with the 3 mm expansion. D98% coverage falls below 95% when the air cavity volume exceeds 17 cm3. On average, D2% coverage increased by 0.5% with each expansion. At the largest expansion, extensive coverage of 102% and 105% isodoses was observed compared to the reference plan. CONCLUSION: Air cavity volumes above 17 cm3 can potentially degrade the high-dose PTV coverage while increasing the regions covered by the 102% and 105% isodoses. Clinical CBCT guidelines were deduced, recommending a maximum threshold of 3.2 cm in diameter in any direction.

Evaluation and Management of Traumatic Rectal Injury.

Traumatic injury to the rectum is rare but associated with high morbidity and mortality. In recent years, diagnostic and treatment recommendations for these complex injuries have changed. While rare, it is critical for general surgeons to understand the basic principles of injury assessment, damage control, and definitive management of traumatic rectal injuries. This article reviews the literature regarding the evaluation and management of traumatic rectal injuries.

Indocyanine Green (ICG) Fluorescence in the Assessment of Vascularity of Anastomotic Margins in Colorectal Surgery in a Lower Middle-Income Country (LMIC) Hospital.

Background and Objective: One of the uses of indocyanine green (ICG) in the surgical field is the evaluation of the anastomotic margins in colorectal surgery. This is of particular importance because fluorescence imaging may aid in detecting vascular compromise, allowing the surgeon to change the resection margin thereby decreasing the chance of an anastomotic leak. To date, there has been no study with its use locally. This study aimed to determine whether the use of ICG can safely identify if the margins of resection are well-vascularized in patients undergoing left-sided colon or rectal surgery, which in turn may reduce anastomotic leak rates. Methods: Through a retrospective study design, the investigators gathered data of patients who underwent left-sided colon or rectal surgery. The groups were divided into those with and without the use of ICG and a comparative data on the anastomotic leak rates were analyzed. Results: Eighty-six (86) patients with similar patient characteristics, tumor staging, and surgical approach were compared. Both the leak rates identified during the initial hospital stay and at 30 days post-operatively were lower in those where ICG was used (p=0.035, p=0.047, respectively) than those where ICG was not used. Conclusion: ICG fluorescence imaging may reduce the anastomotic leak rates in patients undergoing colorectal surgery.

Rectal stenosis after circular mechanical anastomosis; the influence of stapler size.

BACKGROUND: The incidence of benign anastomotic stenosis (BAS) after radical surgery for rectal cancer ranges from 2 to 30%. There are few data regarding the factors related to its occurrence. One of these factors is the diameter of the circular mechanical staplers (CMS) used. METHODS: Observational study with prospective data recording of consecutive patients with non-disseminated rectal cancer operated on at two hospitals with special dedication to rectal cancer. Patients underwent low anterior resection (LAR) of the rectum with colorectal anastomosis created using CMS of diameters of either 28-29 or 31-33 mm. The primary endpoint was BAS. Secondary variables were demographic and patient-dependent data, and preoperative, intraoperative, immediate postoperative and mid-term data. The incidence of BAS was compared in the groups in which the different stapler diameters were used. RESULTS: Between 2012 and 2022, 239 patients were included. BAS was recorded in 39 (16.3%). In the analysis of factors related to its occurrence, the only significant variable was stapler diameter (p = 0.002, 95% CI 7.27-23.53), since rates of BAS were lower in the 31-33 mm group. Similarly, in the logistic regression analysis, stapler size was not associated with postoperative complications or anastomotic dehiscence (OR 3.5, 95% CI 1.2-10.5). Comparing stapler groups, BAS was detected in 35 of 165 patients (21%) in the 28-29 mm group but in only four out of 74 (5.6%) in the 31-33 mm group (p = 0.002, 95% CI 7.27-23.53). Ileostomy closure took longer and was less frequent in the 28-29 mm group. CONCLUSIONS: The rate of BAS after LAR was not negligible, since it was recorded in 39 of 239 patients (16.3%). The use of a 31-33 mm CMS was associated with a lower incidence of BAS. Therefore, the use of larger staplers is tentatively recommended; however, clinical trials are now required to confirm these results.

Evaluation of immune checkpoint inhibitors for colorectal cancer: A network meta­analysis.

Colorectal cancer (CRC) is challenging to treat due to its high metastatic rate. Recent strategies have focused on combining immune checkpoint inhibitors (ICIs) with other treatments. The aim of the present study was to conduct a network meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and adverse effects of different ICI treatments for CRC. A literature search for RCTs was conducted using PubMed, the Cochrane Library, Embase, ClinicalTrials.gov and Web of Science databases, covering the period from the inception of each database until April 2024. A total of 12 RCTs involving 2,050 participants were selected for inclusion in the analysis. The network meta-analysis employed the MetaInsight tool to assess multiple endpoints. The criteria for study selection were based on the Population, Intervention, Comparison, Outcome and Studies framework as follows: i) Population, patients with CRC; ii) intervention, studies using ICI to treat CRC; iii) comparison, active comparators, including placebo; iv) outcome, overall survival, progression-free survival, objective response rate and adverse events; and v) study design, RCTs. The results of the analysis revealed that programmed cell death-ligand 1 (PD-L1) inhibitors significantly improved overall survival time [mean difference (MD), 2.28 months; 95% confidence interval (CI), 0.44 to 4.11], while programmed cell death protein 1 (PD-1) inhibitors exhibited a superior progression-free survival time (MD, 4.79 months; 95% CI, 3.18 to 6.40) compared with active comparators. However, none of the ICI treatments had significant differences in odds ratios for the objective response rate and adverse events compared with active comparators. These findings indicate that treatment with PD-L1 and PD-1 inhibitors improved the overall survival time and delayed disease progression in patients with CRC. These findings offer valuable insights for future research aimed at improving CRC patient outcomes.

Dealing with rectum motion during radiotherapy: How can we anticipate it?

Introduction: Intra- and inter-fraction rectum motion is important for pelvic radiotherapy (RT). This study assesses how RT session duration, the presence or the absence of an intra-rectal tumour, and the distance from the anorectal junction (ARJd) impact rectal motion. Materials and methods: Analyses used cone-beam computed tomographies (CBCTs) from RT patients treated for rectal and prostate cancer. Three structures were evaluated: (1) the entire rectum in patients without a rectal tumour (RectumProstate); (2) the non-invaded portion (RectumRectum) and (3) the tumour-invaded portion (RectumTumour) in rectal cancer patients.Intrafraction motion was assessed using the Hausdorff distance 95% and the Mean distance-to-agreement between structures delineated on the first CBCT and the 2 subsequent CBCTs within a same RT session. Interfraction motion was quantified by comparing structures delineated on the planning-CT and the first CBCT of each session.Linear mixed model evaluated rectum motion in relation to time, tumour presence, and ARJd, respectively. Results: We included 10 patients with and 10 without rectal cancer, collecting 385 CBCTs. A significant correlation (p < 0.05) between rectum motion and RT session duration was found. Intrafraction motion was significantly higher in prostate cancer patients (RectumProstate motion > RectumRectum and RectumTumour, p < 0.01). For interfraction motion, only the mean distance to agreement was significantly higher for RectumProstate (p < 0.05). Motion increased significantly with ARJd for all three structures (p < 0.001). Conclusions: Session duration, absence of a tumour, and ARJd are associated with larger intra- and interfraction rectal motion. This highlights the need for tailored RT treatment, including online-adaptive RT, to manage intra- and interfraction variations. Rectal motion should be handled differently for patients with prostate cancer and those with rectal cancer.

Incidence and risk factors for colorectal cancer in Africa: a systematic review and meta-analysis.

INTRODUCTION: Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide. There is a significant burden of mortality from colorectal cancer in Africa. Due to the heterogeneity of dietary and lifestyle practices throughout Africa, our work sought to define risk factors for the development of CRC in the African continent. METHODS: We systematically searched PubMed, Embase, Global Health, CINAHL, Cochrane CENTRAL, and African Index Medicus for studies written in English, examining the incidence and risk factors of CRC in Africa. A systematic analysis was done to compare different risk factors in constituent studies. A meta-analysis random effects model was fitted to estimate the pooled incidence of CRC. RESULTS: Of 2471 studies screened, 26 were included for the quantitative analysis; 20 in the incidence analysis, and six in the risk factor analysis. The overall ASIR per 100,000 person-years of CRC for males and females was 7.51 and 6.22, respectively. The highest incidence rates were observed between 2012 and 2021. Risk factors for CRC in Africa include tobacco smoking, and consumption of red meat, butter, and alcohol. Protective factors included, regular consumption of fruits and regular physical activity. CONCLUSION: The incidence of CRC in Africa is higher than that suggested by previous studies. Our study shows that nonmodifiable and modifiable factors contribute to CRC in Africa. High-quality studies conducted on generalizable populations that examine risk factors in a comprehensive fashion are required to inform primary and secondary prevention initiatives for CRC in Africa.

Effective utilization of polypectomy in endoscopic salvage treatment of rectal neuroendocrine tumors: a retrospective cohort study.

Purpose: Current guidelines recommend endoscopic resection for rectal neuroendocrine tumors (RNETs) under 10 mm. Incomplete resections necessitate salvage procedures, highlighting the need for complete R0 resection. This study evaluates the efficacy and safety of wide hot snare polypectomy (WHSP) compared to endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the salvage treatment of small RNETs. Methods: This retrospective study was conducted at Korea University Guro Hospital from January 2018 to December 2022. It compared the outcomes of salvage resections for RNETs ≤10 mm using 2 approaches: ESD and EMR vs. WHSP. Demographics, tumor characteristics, and clinical outcomes were compared. Efficacy was evaluated by the histological complete resection rate and procedure time, while safety was assessed by the incidence of complications. Results: Out of 135 patients undergoing salvage resection for RNET, 14 who underwent transanal excision were excluded. Of the remaining 121, 99 underwent EMR or ESD, and 22 underwent WHSP. Baseline characteristics were similar between the 2 groups. The WHSP group demonstrated a significantly higher R0 resection rate (72.7% vs. 49.5%, P = 0.010) and a shorter median procedure time (3.5 minutes vs. 8.3 minutes). No complications were reported in the WHSP group. Conclusion: WHSP is a rapid, straightforward, safe, and effective approach for the salvage treatment of RNETs less than 10 mm in diameter, particularly in patients without additional risk factors.

Rectum necrosis in a patient with severe COVID19 infection after CAR-T therapy: a case report.

BACKGROUND: Coronavirus disease 2019 (COVID19) can cause gastrointestinal complications as well as respiratory tract disease. Coagulation abnormalities and thrombosis frequently occur in COVID19, especially in cases with severe clinical outcome. The relationship between gastrointestinal perforation and coagulopathy due to COVID19 remains unclear. CASE PRESENTATION: A 49-year-old female received Chimeric antigen receptor T (CAR-T) therapy for an early recurrence of diffuse large B-cell lymphoma (DLBCL) that was refractory to chemotherapy. She was diagnosed with cytokine release syndrome (CRS) because of a fever and oxygen desaturation, and administered tocilizumab. Forty days after completing CAR-T therapy, she was infected with COVID19 and transferred to our hospital. Her general condition worsened and she developed COVID19 pneumonia, and then steroid pulse therapy was started. While her respiratory condition improved, she experienced pain in the anal region and computed tomography (CT) revealed a rectal perforation. An emergency surgery was undertaken, and the lower rectum wall was found to be completely necrotic. Removal of the necrotic part of the rectum tissue, and drainage and lavage of necrotic tissue in the pelvic cavity were performed. The remaining rectum was resected with partial sigmoidectomy, but we could not make the anal stump closed. In addition, an end colostomy in the sigmoid colon was performed. Histopathological findings showed thromboses in the rectal mesentery veins. After the first surgery, the pelvic abscess cavity persisted and her high-grade fever continued. Reoperation was laparoscopically performed, and she underwent a resection of anal canal with residual necrotic rectal and mesorectal tissue, and a drainage of the pelvic abscess. After the reoperation, her general condition improved and CT showed that the abscess cavity had significantly improved. CONCLUSIONS: Gastrointestinal perforation, especially rectal necrosis due to coagulopathy caused by severe COVID19 infection, is a rare but life-threatening complication. Physicians should have a high degree of clinical suspicion for timely diagnosis and management, and surgical intervention is necessary in cases of rectal necrosis.

Clinicopathological features of endometriosis­associated adenocarcinoma of the rectum: A report of two cases.

Endometriosis-associated adenocarcinoma of the rectum is rare and is usually misdiagnosed as colorectal carcinoma or other gynecological tumors. In the current report, the clinicopathological features of endometriosis-associated adenocarcinoma of the rectum in 2 patients were retrospectively analyzed and a literature review regarding this rare malignancy is presented. Case 1, a 49-year-old postmenopausal female patient, was admitted to Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology (Wuhan, China) due to a pelvic mass. Pelvic MRI revealed a 4.5×3.7-cm mass in the rectal wall, which severely adhered to the uterine wall. Microscopically, moderately differentiated glandular adenocarcinoma diffusely extended throughout all intestinal wall layers. Adenomyosis was found in the uterine body adherent to the rectum. Case 2, a 38-year-old reproductive female patient, presented with hematochezia. Histopathology of the resected tumor demonstrated benign endometriosis foci and atypical hyperplasia glands contiguous with endometrioid carcinoma invading the intestinal wall, and no other primary tumor sites were found, which satisfied the criteria for the diagnosis of malignant transformation of endometriosis of the rectum. Immunohistochemical (IHC) staining of both tumors revealed a Müllerian origin but not an intestinal origin. Furthermore, next-generation sequencing detected mutations of the BRCA1 (c.329dup), KRAS (c.35G>T), PIK3CA (c.3140A>G) and PTEN (c.750_751del) genes, and that microsatellite instability was high in case 1. In conclusion, endometriosis-associated adenocarcinoma of the rectum is a rare malignant tumor that should be distinguished from colorectal carcinoma for optimal treatment. Surgery and pathologic examination with IHC staining, even with molecular analysis, are essential for the final diagnosis. Primary cytoreductive surgery with resection of all macroscopic detectable lesions should be performed whenever possible. More prospective, multicenter, large-scale trials are required to examine the regimens and therapeutic value of adjuvant chemotherapy or radiology.

Gangrena de Fournier secundaria a cuerpo extraño: Reporte de caso / Fournier's gangrene secondary to a foreign body: Case report

Introducción. La gangrena de Fournier es un proceso infeccioso progresivo que compromete piel, tejido celular subcutáneo, grasa y fascia subyacente, con una incidencia de 1,6 pacientes por cada 100.000 personas/año. Se considera una urgencia quirúrgica, que requiere de manejo oportuno, ya que puede llegar a ser fatal, con una tasa de mortalidad del 20 al 35 %, que es más alta en hombres, en la tercera década de la vida y en pacientes inmunocomprometidos. Caso clínico. Se presenta el caso clínico de un paciente masculino de 44 años de edad, quien cursó con gangrena de Fournier secundaria a una espina de pescado de 5 cm de largo, incrustada en la unión anorrectal. Resultados. El paciente fue manejado por urología y cirugía general, requirió hospitalización en la Unidad de Cuidados Intensivos y curaciones por parte de terapia enterostomal, con resultados satisfactorios. Conclusiones. Sus posibles causas son múltiples y en ocasiones puede ser desencadenada por un factor externo, como un cuerpo extraño. Uno de los factores predisponentes es la obesidad. El diagnóstico oportuno y un tratamiento con intervención multidisciplinaria mejoran la sobrevida y la calidad de vida de los pacientes.

Introduction. Fournier's gangrene is a progressive infectious process that involves skin, subcutaneous tissue, fat and underlying fascia, with an incidence of 1.6 per 100,000 people/year. It is considered a surgical emergency, which requires timely management since it can be fatal, with a mortality rate of 20 to 35%, which is higher in men, in the third decade of life and in immunocompromised patients. Clinical case. Clinical case. A 44-year-old male patient is presented with Fournier's gangrene secondary to a 5 cm long fishbone embedded in the anorectal junction. Results. The patient was managed by urology and general surgery, requiring hospitalization in the ICU and treated by enterostomal therapy with satisfactory results. Conclusions. Its possible causes are multiple and sometimes it can be triggered by an external factor, such as a foreign body. One of the predisposing factors is obesity. Timely diagnosis and treatment with multidisciplinary intervention improve survival and quality of life of patients

End-to-end anastomosis provides similar quality-of-life, compared with other reconstructive techniques six months following total mesorectal excision: Systematic review and meta-analysis.

Colorectal malignancy ranked third globally in cancer incidence with 1.9 million cases and nearly 1 million deaths in 2020. Rectal cancer is primarily treated with total mesorectal excision (TME). This study examines surgical, functional, and quality-of-life (QoL) outcomes for different anastomosis types. Pre-registered on PROSPERO (CRD42022368907), the systematic search on November 8, 2022, covered three databases: MEDLINE (via PubMed), Embase, and Cochrane Central. Randomized controlled trials (RCT) assessing adults post-TME, comparing end-to-end anastomosis (EEA) to colonic J-pouch (CJP) and/or side-to-end anastomosis (SEA) were eligible. 29 studies out of 4459 were included. EEA vs. CJP showed no significant differences in anastomotic leakage (AL) (RR: 1.03; CI: [0.84-1.26]) or mortality (RR: 0.77; CI: [0.30-1.98]). At 12 months, the mean bowel movement difference was 1.59/day (CI: [(-)0.66-3.84]). QoL at six and 12 months was similar (SMD: -0.22; CI: [(-)0.82-0.37]). Compared with SEA, EEA had similar AL ratios (RR: 1.59; CI: [0.54-4.72]) and QoL at six months (SMD: -0.04; CI: [(-)0.66-0.58]). EEA demonstrates surgical efficacy comparable to other techniques. Six months postoperatively, EEA's impact on QoL appears similar to CJP or SEA, irrespective of daily stool frequency.

Whole spinal pneumorrhachis following perforation of the rectum: A case report.

Spinal pneumorrhachis is a relatively rare condition. Herein, we describe a case of whole spinal pneumorrhachis. A 68-year-old male, with a history of total proctocolectomy due to ulcerative colitis, had fever, diarrhea, and inflammatory reactions. Computed tomography (CT) revealed extensive epidural pneumorrhachis in the spinal canal from the cervical to sacral vertebrae. The patient was diagnosed with perforation of the rectal anastomosis and retroperitoneal abscess. Antibiotics were administered, and the abscess cavity was reduced on the follow-up CT. Pneumorrhachis in the spinal canal is often found only in the cervical, thoracic, or lumbar regions and is rarely found in the entire spinal canal. Spinal pneumorrhachis resulting from perforation of the colon or rectum has only been reported in 6 previous cases. To differentiate diseases that cause pneumorrhachis in the spinal canal, retroperitoneal abscess, and emphysema associated with perforation of the colon and rectum should be considered.

Transition From Epstein-Barr Virus (EBV)-Positive Rectal Hodgkin Lymphoma to Diffuse Large B-Cell Lymphoma in the Lung.

We report a distinctive case of sequential lymphomas in a 72-year-old male, initially diagnosed with Epstein-Barr virus (EBV)-positive rectal classic Hodgkin lymphoma (cHL), followed by the development of diffuse large B cell lymphoma (DLBCL) in the lung. This rare progression underscores the complexity of lymphomas associated with EBV infection and their unpredictable clinical courses. The patient's journey began with symptoms of intractable diarrhea, low appetite, and significant weight loss, leading to the diagnosis of stage 4B cHL, managed initially with brentuximab/doxorubicin, vinblastine, dacarbazine (AVD) chemotherapy. Despite a partial response, surveillance identified a transition to DLBCL, marked by new pulmonary lesions. This case highlights the clinical and diagnostic challenges in managing sequential lymphomas, emphasizing the role of EBV in lymphomagenesis and the potential for clonal evolution from a common precursor cell. The therapeutic approach evolved from targeted chemotherapy to consideration of advanced treatments such as autologous stem cell transplant and chimeric antigen receptor (CAR) T-cell therapy, reflecting the aggressive nature and poor prognosis of the disease. This case contributes to our understanding of the EBV's impact on lymphoma progression and underscores the need for vigilant monitoring and adaptive treatment strategies in similar clinical scenarios.

Significance of MRI-based radiomics in predicting pathological complete response to neoadjuvant chemoradiotherapy of locally advanced rectal cancer: A narrative review.

Neoadjuvant chemoradiotherapy is the standard treatment for patients with locally advanced rectal cancers owing to its ability to downstage primary tumours. Some patients can achieve pathological complete response after neoadjuvant therapy, and can adopt a "watch and wait" treatment strategy to avoid overtreatment. Therefore, it is essential to develop strategies for predicting responses to neoadjuvant therapy. Radiomics has shown great potential in extracting tumour features from high-throughput medical images for the construction of mathematics models for predicting the effects of anticancerous therapies. Herein, we explored MRI-based radiomics and found that it can predict responses of locally advanced rectal cancers to chemoradiation. Efficient radiomics model allow early-stage prediction of the effect of neoadjuvant chemoradiotherapy on locally advanced rectal cancers. It helps clinicians to make informed therapeutic decisions. In this review, we discuss the workflow of radiomics, and summarize the clinical application of MRI-based radiomics in predicting pathological complete response to neoadjuvant chemoradiotherapy of locally advanced rectal cancer.

Laparoscopic versus open surgery for rectal neuroendocrine tumors: a multicenter real-world study.

BACKGROUND: Owing to the lack of evidence-based medical studies with large sample sizes, the surgical approach for the radical resection of rectal neuroendocrine tumors remains controversial. METHODS: We retrospectively collected the medical records of patients with rectal neuroendocrine tumors who underwent radical resection at 17 large tertiary care hospitals in China between January 1, 2010, and April 30, 2022. All patients were divided into laparoscopic and open surgery groups. After propensity score matching to reduce confounders, the postoperative and oncologic outcomes were compared between the groups. RESULTS: We enrolled 174 patients with rectal neuroendocrine tumors who underwent radical surgery. After random matching, 124 patients were included in the comparison (62, laparoscopic surgery group; 62, open surgery group). The laparoscopic surgery group had fewer complications (14.5% vs. 35.5%, P = 0.007) and superior relapse-free survival (P = 0.048). Subgroup analysis revealed that the laparoscopic surgery group had fewer complications (10.9% vs. 34.7%, P = 0.004), shorter postoperative hospital stays (9.56 ± 5.21 days vs. 12.31 ± 8.61 days, P = 0.049) and superior relapse-free survival (P = 0.025) in the rectal neuroendocrine tumors ≤ 4 cm subgroup. CONCLUSIONS: Laparoscopic surgery was associated with improved postoperative outcomes and oncologic prognosis for patients with rectal neuroendocrine tumors ≤ 4 cm; it can serve as a safe and feasible option for radical surgery of rectal neuroendocrine tumors.

The urinary tract reconstruction in a robot-assisted surgery for rectal malignancy with combined prostate and seminal vesicle resection.

INTRODUCTION: In certain cases of rectal malignancy in which invasion is confined to the prostate and/or seminal vesicles, bladder-sparing surgery may be chosen instead of total pelvic exenteration. However, even if the bladder is preserved, postoperative urinary dysfunction and vesicourethral anastomotic leakage are concern. MATERIALS AND SURGICAL TECHNIQUE: We employ various techniques based on robot-assisted radical prostatectomy for reconstructing the urinary tract. These techniques include advanced reconstruction of vesicourethral support, total anatomical reconstruction, and a method called anterior reconstruction. In addition, suture fixation of bladder to the anterior abdominal wall, and re-approximation of bladder by peritoneal suture were done. DISCUSSION: Reliable robot-assisted vesicourethral anastomosis and reinforcement of the anastomotic wall could potentially enhance the self-voiding rate and decrease the risk of anastomotic failure.