［Abstract］　Colorectal cancer(CRC) is highly heterogeneous in the process of occurrence and development. Clinically, patients with the same pathological stage have significant differences in treatment response and survival rate. The traditional tumor morphological classification can not fully reflect the heterogeneity of colorectal tumors and can not meet the needs of modern tumor treatment. Therefore, it is necessary to carry out molecular typing according to the heterogeneity of colorectal tumors to guide the precise treatment strategy of CRC. At present, clinical work is based on tumor TNM stage, tumor grade, microsatellite status, vascular and neural tract infiltration and other parameters to formulate the treatment plans for CRC and predict the prognosis. The mutation states of KRAS, NRAS and BRAF are also routinely detected in patients with metastatic CRC to predict the response to anti-epidermal growth factor receptor targeted therapy. In recent years, four different molecular types of CRC have been described, which have correlation between treatment and prognosis. In addition, the studies on the characteristics of inflammatory infiltration show that there are significant differences in the number and location of inflammatory cells in different types of colorectal tumors. In conclusion, all these parameters help to divide the patients into different treatment subgroups and prognosis subgroups, and provide a basis for the individualized and precise treatment of CRC.]]> 2022/7/30 18:40:21 HU Bang, REN Dong-lin 6true ［Abstract］　Objective　To analyze the risk factors for anastomotic leakage in laparoscopic ultra-low anterior resection of rectal cancer. Methods　The clinical data of 381 patients undergoing ultra-low anterior resection of rectal cancer who were treated by the same surgical team from June 2012 to February 2021 were retrospectively analyzed. The risk factors affecting postoperative anastomotic leakage were analyzed. Results　The overall incidence of anastomotic leakage after ultra-low anterior resection of rectal cancer was 9.19%. The results of univariate analysis showed that there were differences in the grouping of gender, neoadjuvant chemoradiotherapy, whether to preserve the left colonic artery(LCA), lateral lymph node dissection, the distance from anastomosis to anal margin and N stage. The results of further logistic multivariate regression analysis showed that the independent risk factors of postoperative anastomotic leakage included neoadjuvant chemoradiotherapy［OR(95%CI): 5.213(2.214-12.272); P=0.000］, non-preservation of LCA［OR(95%CI): 2.725(1.186-6.261); P=0.018］, distance from anastomosis to anal margin≤2 cm［OR(95%CI): 3.104(1.126-8.559); P=0.029］. Conclusion　Neoadjuvant chemoradiotherapy, non-preservation of LCA and distance from anastomosis to anal margin≤2 cm are the independent risk factors of anastomotic leakage after laparoscopic ultra-low anterior resection of rectal cancer.]]> 2022/7/30 18:40:21 HU Gang, LIU Jun-guang, MEI Shi-wen, et al. 5true ［Abstract］　Objective　To study the efficacy of Da Vinci Robot System in intersphincteric resection(ISR) of low rectal cancer. Methods　The clinical data of low rectal cancer patients who underwent robotic ISR or laparoscopic ISR in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Nanchang University from March 2015 to March 2021 were retrospectively analyzed. The patients were divided into the robotic ISR group(50 cases) and the laparoscopic ISR group(51 cases) according to different operation methods. The perioperative indicators, postoperative pathological data, postoperative anal function and 2-year disease-free survival(DFS) were compared between the two groups. Results　Compared with the laparoscopic ISR group, the robotic ISR group had shorter operation time, shorter postoperative exhaust time and shorter postoperative liquid diet time, lower defecation frequency, lower low anterior resection syndrome(LARS) scores, and there were significant differences between the two groups(P<0.05). There were no significant differences between the two groups in intraoperative blood loss, postoperative hospital stay, postoperative short-term complications, postoperative pathological results and 2-year DFS(P>0.05). Conclusion　Compared with laparoscopic ISR, robotic ISR has less trauma, better autonomic nerve protection and better anal function protection for patients with low rectal cancer. Robotic ISR is worthy of clinical application.]]> 2022/7/30 0:00:00 HUANG Pan, LI Zheng-rong, CAO Yi, et al. 4true ［Abstract］　Objective　To evaluate the application effects of ultrasonic scalpel combined with bipolar coagulation in laparoscopic lateral pelvic lymph node dissection(LLND) for rectal cancer. Methods　The clinical data of 120 patients who underwent laparoscopic radical resection of rectal cancer at the Department of General Surgery of Shanxi Provincial People′s Hospital from January 2015 to December 2020 were retrospectively analyzed. All the patients underwent LLND during the operation. The patients were divided into the ultrasonic scalpel combined with bipolar coagulation group(the observation group, 68 cases) and the ultrasonic scalpel group(the control group, 52 cases) according to different operation methods. The intraoperative indicators, postoperative complications and medium-term survival prognosis were compared between the two groups. Results　Compared with the control group, the observation group had shorter operative time, less intraoperative blood loss, less drainage volume on the first day after operation, and the differences were statistically significant(P<0.05). There were no significant differences between the two groups in the drainage volume on the second day after operation, the time of removing the drainage tubes, the incidence of urinary retention, the time of urinary catheter removal and the postoperative hospital stay(P>0.05). There was no significant difference in the 3-year overall survival rate between the two groups(P>0.05). Conclusion　The application of ultrasonic scalpel combined with bipolar coagulation can shorten the operative time, reduce intraoperative blood loss and postoperative drainage volume in laparoscopic LLND for rectal cancer, and it has good clinical application value.]]> 2022/7/30 18:40:21 XUE Fei, XU Sheng, LI Xiao-fan, et al. 3true ［Abstract］　Objective　To observe the clinical effect of transumbilical single-incision laparoscopic radical resection of right colon cancer. Methods　The clinical data of 74 patients who underwent laparoscopic radical resection of right colon cancer in Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University from August 2020 to June 2021 were retrospectively analyzed, including 30 cases who received transumbilical single-incision laparoscopic radical resection of right colon cancer(the transumbilical single-incision laparoscopic group) and 44 cases who received traditional five-hole laparoscopic radical resection of right colon cancer(the traditional five-hole laparoscopic group). The operative time, intraoperative blood loss, number of dissected lymph nodes during operation, postoperative ventilation time, postoperative hospital stay, postoperative complications, postoperative tumor recurrence rate and postoperative quality of life were compared between the two groups. Results　There were no significant differences in the intraoperative blood loss, number of dissected lymph nodes during operation, postoperative ventilation time, postoperative hospital stay, postoperative complications and postoperative tumor recurrence rate between the two groups(P>0.05). The operative time in the transumbilical single-incision laparoscopic group was longer than that in the traditional five-hole laparoscopic group. The postoperative pain scores of the transumbilical single-incision laparoscopic group were lower than those of the traditional five-hole laparoscopic group. The scores of quality of life in the transumbilical single-incision laparoscopic group were higher than those in the traditional five-hole laparoscopic group, and the differences were significant(P<0.05). Conclusion　Transumbilical single-incision laparoscopic radical resection of right colon cancer is as effective as traditional five-hole laparoscopic radical resection of right colon cancer. Both surgical methods are safe and effective. The patients receiving transumbilical single-incision laparoscopic radical resection of right colon cancer have less pain and higher quality of life, but their surgical procedures take a longer time.]]> 2022/7/30 18:40:21 WU Jian-guo, LUO Jian-fei, DENG Wen-hong 2true ［Abstract］　Objective　To compare the curative effects of robotic system and laparoscopy on colorectal cancer via natural orifice specimen extraction surgery(NOSES). Methods　The clinical data of 36 patients with colorectal cancer who were admitted to the People′s Hospital of Guangxi Zhuang Autonomous Region from September 2020 to May 2022 were retrospectively analyzed, including 24 cases of sigmoid colon cancer and 12 cases of rectal cancer. According to different operation methods, the patients were divided into the robotic group(16 cases) and the laparoscopic group(20 cases). The general conditions, intraoperative and postoperative conditions, postoperative pathological results and postoperative pain scores were compared between the two groups. Results　The operations were successfully performed on the 36 patients. There were no significant differences between the two groups in gender, age, body mass index, preoperative carcinoembryonic antigen level and maximum tumor diameter(P>0.05). There were no statistically significant differences between the two groups in drainage tube placement time, total drainage volume 3 days after operation, postoperative hospital stay, postoperative complication rate, the proportion of granulocytes on the first day after operation, postoperative pathological tumor stage, nerve invasion, vascular invasion, postoperative pain scores and hospitalization expenses(P>0.05). Compared with the laparoscopic group, the robotic group had less blood loss during operation, shorter exhaust time, shorter time to restore liquid diet, longer operation time, higher level of C-reactive protein on the first day after operation and less number of lymph nodes detected in the specimens, and the differences were statistically significant(P<0.05). Conclusion　The robotic system is feasible for colorectal cancer via NOSES and may have better short-term efficacy than laparoscopic NOSES for colorectal cancer, and makes the patients′ postoperative gastrointestinal function recover faster, and therefore benefits the patients.]]> 2022/7/30 18:40:21 YUAN En-quan, XU Sheng, LIN Jia-wei, et al. 1true