［Abstract］　Objective　To explore the factors influencing pathological complete response(pCR) to neoadjuvant concurrent chemoradiotherapy in locally advanced rectal cancer. Methods　The clinical data of 226 patients with locally advanced rectal cancer who were admitted to Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College from January 2013 to May 2017 were retrospectively collected. All of the patients received neoadjuvant concurrent chemoradiotherapy and surgery. Multivariate logistic regression was used to analyze the correlation between pCR and clinicopathologic factors such as tumor location, tumor T stage, maximum tumor diameter, extramural vascular invasion(EMVI) and mesorectal fascia(MRF) invasion. The differences in disease-free survival(DFS) and overall survival(OS) were compared between pCR group and non-pCR group. Results　The preoperative T stage being T₃ stage［OR(95%CI)=3.978(1.227-12.897), P=0.021］, the maximum tumor diameter less than 4 cm［OR(95%CI)=2.439(1.046-5.685), P=0.039］ and distance from tumor to dentate line less than or equal to 5 cm［OR(95%CI)=3.154(1.229-8.094), P=0.017］ were independent influencing factors of obtaining pCR in locally advanced rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy. The 5-year DFS(82.1% vs 67.6%, P=0.046) and OS(87.2% vs 68.5%, P=0.015) in the patients of the pCR group were better than those in the patients of the non-PCR group. Conclusion　The rectal cancer patients with preoperative T₃ stage, the maximum tumor diameter less than 4 cm and the distance from tumor to dentate line less than or equal to 5 cm can benefit from neoadjuvant concurrent chemoradiotherapy, and the patients who achieve pCR obtain better prognosis.]]> 2024/5/31 12:04:36 DU Jinbo, QIU Wenlong, MEI Shiwen, HU Gang, QUAN Jichuan, ZHUANG Meng, WANG Xishan, TANG Jianqiang 5true ［Abstract］　Objective　To explore the application of laparoscopic intersphincteric resection(ISR) by transanal specimen eversion combined with modified Bacon operation in ultra-low anal preservation for lower rectal cancer. Methods　The clinical data of 6 cases with lower rectal cancer who underwent laparoscopic radical resection and ultra-low anal preservation with ISR by transanal specimen eversion combined with modified Bacon operation in the Department of Colorectal Surgery of Sichuan Cancer Hospital from March 2023 to December 2023 were retrospectively analyzed. The short-term clinical effects were explored and the surgical skills were summarized. Results　All the operations were accomplished successfully in the 6 patients, with operation durations ranging from 200 to 320 minutes and an average duration of 256.7 minutes. Intraoperative blood loss ranged from 20 to 100 milliliters, with an average blood loss of 48.3 milliliters. After operation, 1 patient developed prolapse of the external intestinal segment and underwent reoperation for resection, and 2 patients developed local mesenteric ischemia of the external intestinal segment and improved after conservative treatment. All the patients recovered successfully and were discharged from the hospital 6 to 11 days after operation, with an average postoperative hospital stay of 8.2 days. All the patients underwent second-stage external intestinal segment resection and anoplasty 21 days after surgery, and were discharged from the hospital 3 to 6 days after operation, with an average postoperative hospital stay of 4.3 days. All the patients were followed up until March 2024, and no tumor recurrence and metastasis were observed, and Wexner incontinence scores ranged from 1 to 5 points 3 months after the second-stage operation with average scores of 3.2 points, and the anal continence function was satisfactory. Conclusion　Laparoscopic ISR by transanal specimen eversion combined with modified Bacon operation can help to achieve accurate resection of distal tumors, can greatly reduce the operational difficulty of transanal resection and avoid preventive enterostomy, and the postoperative anal function is satisfactory, which is expected to become a new choice for ultra-low anal preservation surgery for lower rectal cancer.]]> 2024/5/31 12:04:36 1,2, WANG Wuyi², RUI Yuanyi², YI Bo², CHEN Chao², FENG Xiaopei², ZHANG Jingbo², ZHENG Yangchun^1,2]]> LI Jiaze^1,2, WANG Wuyi², RUI Yuanyi², YI Bo², CHEN Chao², FENG Xiaopei², ZHANG Jingbo², ZHENG Yangchun^1,2 4true ［Abstract］　Objective　To explore the occurrence and related factors of ischemic necrosis of externally placed intestinal tube after modified Bacon operation, as well as the treatment measures. Methods　The clinical data of 81 patients with low rectal cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2018 to March 2024 were retrospectively analyzed. Among the 81 patients, there were 8 cases with ischemic necrosis of externally placed intestinal tubes and 73 cases without ischemic necrosis of externally placed intestinal tubes. The occurrence and treatment measures of ischemic necrosis of externally placed intestinal tubes after modified Bacon operation were recorded, and the related factors affecting ischemic necrosis of externally placed intestinal tubes after modified Bacon operation were analyzed. Results　Postoperative complications occurred in 20 cases(24.69%), including 8 cases of ischemic necrosis of externally placed intestinal tubes. Among the 8 cases of ischemic necrosis of externally placed intestinal tubes, 3 cases had peritonitis after ischemic necrosis of externally placed intestinal tubes, and emergency sigmoidostomy was performed on them, and the other 5 cases had ischemic necrosis of externally placed intestinal tubes near the anal margin, without local and systemic symptoms, and conservative treatment was successful. Among the 20 case with postoperative complications, 12 cases had anastomotic stenosis and underwent treatment of anal dilation. There were no cases of incision infection, anastomotic leakage and death within 30 days after operation. The patients′ age, body mass index(BMI), sphincter tension status and mesorectal tension status were correlated with ischemic necrosis of externally placed intestinal tubes(P<0.05). Conclusion　Related factors for ischemic necrosis of externally placed intestinal tubes after modified Bacon operation include age, BMI, sphincter tension status and mesorectal tension status. The selection of patients, sufficient preoperative anal dilation, injection of botulinum toxin and regular postoperative observation are effective measures to prevent ischemic necrosis of externally placed intestinal tubes.]]> 2024/5/31 12:04:37 WANG Yuhang, HU Junhong, LI Guobin, CHANG Yuan, ZHANG Zhenfei 3true ［Abstract］　Objective　To explore the relationship between double-negative T cells(DNT) ratio in peripheral blood and prognosis of advanced rectal cancer after neoadjuvant therapy. Methods　The clinical data of 219 patients with rectal cancer who were admitted to the Department of Colorectal Surgery of Shanxi Cancer Hospital from January 2017 to December 2021 were retrospectively collected. The indicator of DNT ratio of the patients after neoadjuvant therapy was collected, and the median value was taken as the cut-off value, and the patients were divided into high level DNT group(DNT≥3%, 125 cases) and low level DNT group(DNT<3%, 94 cases). The indicators of TNM stage, pathological tumor regression grade(TRG), neurovascular invasion and survival prognosis were compared between the two groups. Results　There were no significant differences in gender, age, body mass index, distance from tumor lower bound to the anus, preoperative tumor stage(cT stage, cN stage), and perirectal fascia invasion between the two groups(P>0.05). Compared with the patients in the high level DNT group, the patients in the low level DNT group had lower rate of neurovascular invasion(P=0.014), and better survival prognosis(P=0.014). Conclusion　After neoadjuvant therapy, DNT ratio in peripheral blood is significantly correlated with neurovascular invasion and survival prognosis of the patients with rectal cancer. The patients in the low level DNT group have a lower rate of neurovascular invasion and a longer overall survival period.]]> 2024/5/31 0:00:00 1, GUO Yuting², ZHANG Yixun³, WEI Qiang¹, LIU Haiyi³]]> ZHAO Xinxuan¹, GUO Yuting², ZHANG Yixun³, WEI Qiang¹, LIU Haiyi³ 2true ［Abstract］　Objective　To review the diagnosis and treatment process for a case of situs inversus totalis complicated with gastric cancer and gastrointestinal stromal tumor and to analyze the safety of surgery for situs inversus totalis complicated with gastric cancer. Methods　The diagnosis and treatment data of a patient with situs inversus totalis complicated with gastric cancer and gastrointestinal stromal tumor who was admitted to Air Force Medical Center, PLA in December 2020 were collected. The domestic and foreign literature reports on situs inversus totalis complicated with gastric cancer were searched, and the clinical diagnosis and treatment data and surgical situation of the patients in the reported literature were analyzed. Results　The patient underwent exploratory laparotomy and radical gastrectomy for gastric cancer(Billroth Ⅱ, precolonic, peristalsis in sequence+Brown′s anastomosis) under general anesthesia. The surgical process was smooth, with a surgical duration of 180 minutes and a bleeding volume of 100 mL. There were no postoperative complications. Conclusion　The surgical approach for a patient with situs inversus totalis complicated with gastric cancer is not different from the conventional surgical approach of gastric cancer. After completing preoperative evaluation, selecting a reasonable surgical approach is safe and feasible.]]> 2024/5/31 12:04:37 1, XU Zuxin², DONG Zhiwei¹, YU Pengfei¹, LI Hao¹, GU Guoli¹]]> ZHANG Zhi¹, XU Zuxin², DONG Zhiwei¹, YU Pengfei¹, LI Hao¹, GU Guoli¹ 1true