Anal function and quality of life analysis after laparoscopic modified Parks for ultra-low rectal cancer patients

Ding, Haibo; Li, Jian; Chen, Yuxiang; Liu, Yang; Zha, Peng; Liao, Xin

doi:10.1186/s12957-020-1801-7

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…Many previous studies have proved that obesity is an important risk factor for prolonged operation time [23]. Especially for ultra-low rectal cancer, obesity and narrow pelvis will increase the di culty of free and anastomosis, thus increasing the operation time [24]. However, this study found that BMI was not an independent risk factor affecting the operation time of CSPO.…”

Section: Discussioncontrasting

confidence: 57%

Evaluation of the Learning Curve for Conformal Sphincter Preservation Operation in The Treatment of Ultra-Low Rectal Cancer

Ding

Wang

et al. 2021

Preprint

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Background: To investigate the learning curve of conformal sphincter preservation operation (CSPO) in the treatment of ultra-low rectal cancer and to further expore the influencing factors of operation time.Methods: From August 2011 to April 2020, 108 consecutive patients with ultra-low rectal cancer underwent CSPO by the same surgeon in the department of colorectal surgery of Changhai Hospital. The moving average and cumulative sum control chart (CUSUM) curve were used to analyze the learning curve. The preoperative clinical baseline data, postoperative pathological data, postoperative complications and survival data were compared before and after the completion of learning curve. The influencing factors of CSPO operation time were analyzed by univariate and multivariate analysis.Results: According to the results of moving average and CUSUM method, CSPO learning curve was divided into learning period (1-45 cases) and learning completion period (46-108 cases). There was no significant difference in preoperative clinical baseline data, postoperative pathological data, postoperative complications and survival data between the two stages. Compared with the learning period, the operation time (P < 0.05), blood loss (P < 0.05), postoperative flatus and defecation time (P < 0.05), liquid diet time (P < 0.05) and postoperative hospital stay (P < 0.05) in the learning completion period were significantly reduced, and the difference was statistically significant. Univariate and multivariate analysis showed that distance of tumor from anal verge (≥ 4cm vs. <4cm, P=0.039) and T stage (T3 vs. T1-2, P=0.022) were independent risk factors for prolonging the operation time of CSPO.Conclusions: For surgeons with laparoscopic surgery experience, about 45 cases of CSPO are needed to cross the learning curve. At the initial stage of CSPO, beginners are recommended to select patients with ultra-low rectal cancer whose distance of tumor from anal verge is less than 4cm and tumor stage is less than T3 for practice, which can enable beginners to reduce the operation time, accumulate experience, build self-confidence and shorten the learning curve on the premise of safety.

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Section: Discussioncontrasting

confidence: 57%

Evaluation of the Learning Curve for Conformal Sphincter Preservation Operation in The Treatment of Ultra-Low Rectal Cancer

Ding

Wang

et al. 2021

Preprint

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“…Mainly, laparoscopic tumor-specific mesorectal excision (TSME) has been utilized for upper rectal cancer [ 22 ]. Many problems that cannot be solved by conventional laparotomy, such as anus-preserving surgery for rectal cancer with anal distance less than 5cm, can be solved by laparoscopic technique, which significantly improves the life quality of patients [ 23 , 24 ]. Laparoscopic surgery has many advantages, such as a clear vision of operation, small incision, mild postoperative pain, and short hospital stay [ 25 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

Zhao

et al. 2021

World J Surg Onc

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Background Protective ileostomy is always applied to avoid clinically significant anastomotic leakage and other postoperative complications for patients receiving laparoscopic rectal cancer surgery. However, whether it is necessary to perform the ileostomy is still controversial. This meta-analysis aims to analyze the efficacy of ileostomy on laparoscopic rectal cancer surgery. Methods Cochrane Library, EMBASE, Web of Science, and PubMed were applied for systematic search of all relevant literature, updated to May 07, 2021. Studies compared patients with and without ileostomy for laparoscopic rectal cancer surgery. We applied Review Manager software to perform this meta-analysis. The quality of the non-randomized controlled trials was assessed using the Newcastle-Ottawa scale (NOS), and the randomized studies were assessed using the Jadad scale. Results We collected a total of 1203 references, and seven studies were included using the research methods. The clinically significant anastomotic leakage rate was significantly lower in ileostomy group (27/567, 4.76%) than that in non-ileostomy group (54/525, 10.29%) (RR = 0.47, 95% CI 0.30–0.73, P for overall effect = 0.0009, P for heterogeneity = 0.18, I2 = 32%). However, the postoperative hospital stay, reoperation, wound infection, and operation time showed no significant difference between the ileostomy and non-ileostomy groups. Conclusion The results demonstrated that protective ileostomy could decrease the clinically significant anastomotic leakage rate for patients undergoing laparoscopic rectal cancer surgery. However, ileostomy has no effect on postoperative hospital stay, reoperation, wound infection, and operation time. The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis.

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“…Patient follow-up varied from 6 months to 5 years. Only four 30 , 34 , 35 , 37 of the included studies provided preoperative QoL data and then followed patients up; two other papers 26 , 41 provided serial QoL measurements, but not preoperative data. Thirteen studies provided only one measure of postoperative QoL, with no preoperative data.…”

Section: Resultsmentioning

confidence: 99%

Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review

et al. 2021

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Background Low rectal cancers could be treated using restorative (anterior resection, AR) or non-restorative procedures with an end/permanent stoma (Hartmann’s, HE; or abdominoperineal excision, APE). Although the surgical choice is determined by tumour and patient factors, quality of life (QoL) will also influence the patient's future beyond cancer. This systematic review of the literature compared postoperative QoL between the restorative and non-restorative techniques using validated measurement tools. Methods The review was registered on PROSPERO (CRD42020131492). Embase and MEDLINE, along with grey literature and trials websites, were searched comprehensively for papers published since 2012. Inclusion criteria were original research in an adult population with rectal cancer that reported QoL using a validated tool, including the European Organization for Research and Treatment of Cancer QLQ-CR30, QLQ-CR29, and QLQ-CR38. Studies were included if they compared AR with APE (or HE), independent of study design. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Outcomes of interest were: QoL, pain, gastrointestinal (GI) symptoms (stool frequency, flatulence, diarrhoea and constipation), and body image. Results Nineteen studies met the inclusion criteria with a total of 6453 patients; all papers were observational and just four included preoperative evaluations. There was no identifiable difference in global QoL and pain between the two surgical techniques. Reported results regarding GI symptoms and body image documented similar findings. The ROBINS-I tool highlighted a significant risk of bias across the studies. Conclusion Currently, it is not possible to draw a firm conclusion on postoperative QoL, pain, GI symptoms, and body image following restorative or non-restorative surgery. The included studies were generally of poor quality, lacked preoperative evaluations, and showed considerable bias in the data.

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Anal function and quality of life analysis after laparoscopic modified Parks for ultra-low rectal cancer patients

Cited by 6 publications

References 40 publications

Evaluation of the Learning Curve for Conformal Sphincter Preservation Operation in The Treatment of Ultra-Low Rectal Cancer

Evaluation of the Learning Curve for Conformal Sphincter Preservation Operation in The Treatment of Ultra-Low Rectal Cancer

The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review

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