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To compare the application among intensity-modulated radiotherapy (IMRT), three-dimensional conformal radiotherapy(3D-CRT) and conventional radiotherapy (CRT) for locally advanced middle-low rectal cancer.From January 2015 to December 2016, 93 locally advanced middle-low rectal cancer patients with clinical stage cT3N+M0 or cT4N0/+M0 who underwent preoperative concurrent chemoradiotherapy at Department of Colorectal Surgery, the Third Affiliated Hospital of Kunming Medical University and had complete data were enrolled in this retrospective cohort study. Patients were divided into IMRT group (17 cases), 3D-CRT group (28 cases) and CRT group (48 cases) according to different radiotherapy methods. The frequency and dose of CRT were 1 time/day, 5 times/week, for a total of 5 weeks, with a single dose of 2.0 Gy, the total dose was 50 Gy. Frequency and dose of 3D-CRT and IMRT were 1 time/day, 5 times/week, for a total of 23 to 28 times, with a single dose of 1.8 to 2.0 Gy, and a total dose of 45.0 to 50.4 Gy. The chemotherapy regimen was performed with capecitabine tablets at a dose of 825 mg/mThere was no significant difference in the baseline data among the three groups (all P0.05). The proportion of patients receiving permanent ostomy in the IMRT group and the 3D-CRT group was 29.4%(5/17) and 32.1%(9/28) respectively, which was lower than 58.3%(28/48) in CRT group, and the difference was statistically significant (χ²=7.982, P=0.030), while this proportion was not significantly different between IMRT and 3D-CRT group(χ²=0.037, P=0.848). The pathologic complete response(pCR) rate was 23.7%(22/93) in the whole study, and the pCR rate was 39.3%(11/28) in the 3D-CRT group, which was higher than that of CRT group and IMRT group [12.5%(6/48) and 29.4%(5/17)], and the difference was statistically significant (χ²=7.407, P=0.025), while there was no significant difference in pCR rate between CRT group and IMRT group (χ²=2.554, P=0.110). There was no adverse reaction of grade 3 or above in all three groups. No significant difference in the incidence of bone marrow suppression, abnormal liver and kidney function markers, digestive tract reaction or radiation dermatitis was found(all P0.05). After receiving concurrent chemoradiotherapy, the proportion of CD3/CD4 cells in the IMRT group and the CRT group decreased compared with that before treatment(23.1±9.3 vs. 31.1±10.9, 27.4±10.7 vs. 33.6±7.2, respectively); the proportion of CD3/CD8 cells was up-regulated (36.1±15.2 vs. 24.8±10.9, 30.9±14.4 vs. 24.0±8.3,respectively), and the differences were statistically significant (both P0.05), while the above indexes before and after treatment were not significantly different in the 3D-CRT group(all P0.05). After treatment, the proportion of CD4/CD8 cells in IMRT group decreased (0.8±0.6 vs. 1.6±1.0, t=3.838, P=0.003), while this proportion was not significantly different in CRT group and 3D-CRT group(all P0.05).IMRT and 3D-CRT can reduce the rate of permanent stoma. 3D-CRT can increase pCR rate. No obvious advantage is shown in IMRT as compared with 3D-CRT in the short-term efficacy. On the contrary, an immunosuppressive status may occur. Therefore, 3D-CRT is recommended as the best preoperative treatment strategy for patients with locally advanced middle-low rectal cancer, especially for those with immunosuppression status.

The laparoscopic approach is rapidly becoming the preferred method of treatment for patients with early gastric cancer due to advantages of minimally invasive surgery. As laparoscopic experience has accumulated, laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy has become a valuable alternative for the treatment of patients with advanced gastric cancer. However, laparoscopic gastric surgery is demanding from a technical point of view, especially when a D2 lymphadenectomy is performed. Surgeons seeking to undertake LADG are concerned about unpredictable intraoperative bleeding that may occur during LADG. Comprehensive knowledge of the perigastric vascular anatomy is essential for LADG with D2 lymphadenectomy.

To explore regional anatomy of fasciae and spaces related to laparoscopic right hemicolectomy (LRC).Seven cadavers and 49 patients undergoing LRC for cancer were observed. Computed tomography (CT) images of patients and healthy individuals were reviewed.Between ascending mesocolon and prerenal fascia (PRF), there was a right retrocolic space (RRCS), which communicated in all directions. Anterior, posterior, medial, lateral, cranial, and caudal boundaries of the RRCS were ascending mesocolon, PRF, superior mesenteric vein, peritoneal reflexion at right paracolic sulcus, inferior margin of transverse part of duodenum, and inferior margin of the mesentery root, respectively. Between transverse mesocolon and pancreas and duodenum, there was a transverse retrocolic space (TRCS), which was bounded cranially by root of transverse mesocolon. On CT images of healthy individuals, PRF was noted as slender line of middle density, continuing to transverse fascia, and the retrocolic spaces were unidentifiable. For patients with right colon cancer, PRF and right retrocolic space might be easier to be identified.The RRCS and the TRCS are natural surgical spaces. The PRF is natural surgical plane in LRC for cancer.

To analyze the vascular anatomy and complications of the right colon under laparoscope.Videotapes of 55 laparoscopic extended right hemicolectomy with D3 lymphadenectomy were reviewed and the anatomic relationship and bleeding vessels were determined.The superior mesenteric vein, superior mesenteric artery, ileocolic artery, and middle colic artery were present in all the patients. The right colic artery was present in 45.5%(25/55) of the patients. The incidence of the gastrocolic venous trunk was 74.5%. The overall incidence of intraoperative bleeding was 43.6%. Vessels in the pre-pancreatic region including the right gastroepiploic artery, the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding than the middle colic vein and artery (16.4% vs. 14.5%). Intraoperative bleeding significantly prolonged the overall operative time and lymphadenectomy time.The vascular anatomy of the right colon is intricate and variable and laparoscopic extended right hemicolectomy with D3 lymphadenectomy is associated with a high risk of hemorrhage. Understanding the vessels anatomic relationship of the right colon is valuable to decrease vascular complication.

To explore the regional anatomy of the rectum including the perirectal fasciae and spaces.Twenty-one cadavers (15 males and 6 females) were embalmed and their vessels were visualized by injection with color dye. From the cadavers, 30 hemipelvis and 6 three-quarter pelvis were harvested. The perirectal fasciae and spaces and the pelvic autonomic nerves were dissected and examined.Three tissue layers were dissected from the inside to the periphery including the proper rectal fascia enveloping the mesorectum, the presacral fascia, and the piriformis fascia fused with the sacral periosteum. The mesorectum comprised 2 parts with the classical posterolateral fat covered by the proper rectal fascia posteriorly and the anterior fat covered by the posterior layer of Denonvilliers fascia anteriorly. Extending anteriorly to the anterior layer of Denonvilliers fascia, the presacral fascia bisected the space between the mesorectum and the piriformis fascia into the retrorectal space and the presacral space. The retrorectal space extended cranially to the left retrocolic space, anterior to the space between the 2 layers of Denonvilliers fascia(prerectal space).From the inside to the periphery, the proper rectal fascia, the presacral fascia, and the muscular fascia are distributed in an annular pattern around the mesorectum. The presacral fascia divides the perirectal space into 2 annular parts, the central retrorectal space and the peripheral presacral space. The retrorectal space is the ideal surgical plane for total mesorectal excision.

To evaluate the accuracy of sentinel lymph node mapping(SLM) in patients with rectal cancer by single-photon emission computed tomography (SPECT-CT) lymphoscintigraphy and carbon nanoparticles suspension injection.Twelve patients with clinical T(1-2)N(0)M(0) rectal cancer were selected and locally injected with technetium-(99m)sulfur-colloid and carbon nanoparticles suspension by endoscope one day before surgery, followed by SPECT-CT scanning 1, 3 and 5 hours later. Radioactive isotope(RI) uptake of each sentinel node(SN) basin with location preoperatively determined by SPECT-CT was postoperatively calculated using gamma probe. Nodes with the highest RI uptake, the number of which was also pre-determined by SPECT-CT, was defined as SNs. Immunohistochemical cytokeratin staining was performed for all the SNs and non-SNs.The rate of sentinel node detection was 91.7%(11/12) with at least one SN(1-3) per patient. Ten cases showed metastasis-negative in SNs as well as all the resected regional nodes by immunohistochemical cytokeratin staining. Only one patient had positive nodes in both SN and non-SNs. The accuracy of SLM was 100%.SPECT-CT lymphoscintigraphy and carbon nanoparticles suspension injection can effectively detect the anatomic location and number of sentinel nodes, and improve the accuracy of SLM for rectal cancer.

To construct a clinical database for laparoscopic colorectal surgery in Chinese population using computerized technique.A clinical database system was constructed and used in multi-/single-center studies on laparoscopic colorectal surgery.The data of more than 1200 cases in the Nanfang Hospital during the past year were collected retrospectively. The database was used as the platform for "Southern China Laparoscopic Colorectal Surgery Study Group (SCLCSG)" and was used in the first stage of the clinical research of "Multicenter retrospective study of laparoscopic and open procedure for colorectal cancer" among 11 hospitals in Southern China. In order to test the system, the database was also used in "comparative study on oncologic results of laparoscopic versus open radical resection for rectal carcinoma".The evaluation system is reliable and efficient. This system has established a clinical database for laparoscopic colorectal cancer surgery and can be widely applied for the clinical research for colorectal cancer.

To develop a clinical database system of gastric cancer surgery integrated with data mining function for better management of clinical data and better performance of both retrospective and prospective studies.Core fields for clinical data were determined based on the JGCA(13th and 14th edition) and UICC gastric cancer staging system. Microsoft Visual Basic and VistaDB were used for programming. The database structure was designed according to data mining theory and clinical workflow.After one year of development and refinement, data of over 600 patients from our hospital were retrospectively entered, and function tests were satisfactory. This system was accepted as the database platform for the Chinese Laparoscopic Gastrointestinal Surgery Study Group (CLASS) and was successfully used in the first stage of the Multicenter Retrospective Study of the Feasibility of Laparoscopy for Gastric Cancer among 30 hospitals from both Mainland China and Hong Kong. The data mining function met the requirements, which could carry out complex search with visualized presentation. Descriptive analyses could be performed with the analysis function. Efficient communication among institutions could be executed by data import and export with excellent compatibility and without errors.The system has established a clinical database of approximately 4000 fields with data mining function. This system can be widely applied for the clinical research for gastric cancer.

To evaluate the feasibility, safety, radicality and short-term outcome of laparoscopic total mesorectal excision(TME) in comparison with open procedure for the middle-lower rectal cancer.From November 2005 to October 2008, 93 patients with middle-lower rectal cancer received laparoscopic total mesorectal excision (LTME group), while 105 patients underwent conventional open TME (OTME group). The operative procedures, clinicopathological data and short-term outcome were collected and compared between the 2 groups.(1) Comparison of surgical procedures. The demographic data of LTME and OTME groups were comparable (P0.05). Four (4.3%) patients were converted to open procedure in LTME group. The anal sphincter preserved procedure accounted for 82.8% in LTME group and 81.9% in OTME group. The difference was not significant (P0.05). (2) Comparison of perioperative surgical data. The mean operating time was (164.6+/-35.6) min in LTME group, significantly longer than that in OTME group (141.9+/-29.4) min (P0.001). The operative blood losses were (51.4+/-20.2) ml and (180.0+/-64.7) ml in LTME and OTME group respectively, the difference was significant (P0.001). The analgesia requirement, time for bowel movement retrieval, time to liquid food intake, time to resuming early activity and hospital stay in LTME group were significant lower or shorter than those in OTME group (P0.001). There was no operative death in both groups. (3) Comparison of operative complications. The overall morbidity rate was 11.8% in LTME group, and 12.4% in OTME group, the difference was not significant (P0.05). The major complications were equivalent between two groups. (4) Comparison of specimen. No significant differences were observed between two groups in terms of specimen length, lymph node harvest and negative distal margin. (5) Follow-up results. The mean follow-up time was 19 months. The recurrent rate and overall survival rate were 4.4% and 97.8% in LTME group, with no significant difference compared to those in OTME group (7.3% and 97.9%, P0.05).Laparoscopic TME for middle-low rectal cancer is safe and feasible, and can potentially offer all the benefits of a minimally invasive approach and achieve satisfactory oncological outcome,which may lead to a better future of the TME technique.

To investigate the effect of laparoscopic-assisted resection of rectal carcinoma on perioperative levels of C-reactive protein (CRP), immunoglobulins(Ig) and complements.Fifty-four patients with rectal carcinoma were divided into laparoscopic group (n=26) and open operation group(n=28) according to the patients' will. C-reactive protein (CRP), IgG, IgA, IgM, C(3), C(4) and CH(50) of peripheral blood were assayed preoperatively and on the 1st, 2nd, 3rd and 7th day postoperatively.Compared with the preoperative period, the CRP levels in both groups were significantly increased on the 1st, 2nd, and 3rd day(P0.01) and peaked on the 2nd day postoperatively. The postoperative CRP levels were significantly lower in the laparoscopic group than those in the open operation group(P0.01). After operation, the immunoglobulin levels were significantly decreased in both groups(P0.01), and there were no significant differences in IgG and IgM. The levels of C(3), C(4) and CH(50) were significantly decreased after operation in both groups(P0.05) and returned to the preoperative levels during postoperative 48-72 hours in laparoscopic group.Laparoscopic-assisted resection of rectal carcinoma results in less wound, lower levels of stress response, and less effect on immune function compared to open surgery, which recovers the immune function of patients more rapidly after operation.

To explore living anatomy of pancreas and peripancreatic spaces,as well as their implications on laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer.Living observation was carried out in 132 patients diagnosed as distal gastric cancer and undergoing laparoscopic gastrectomy with D(2) lymphadenectomy.Spaces between greater omentum and transverse mesocolon continued to pre-pancreatic and retro-pancreatic spaces at inferior margin of pancreas. The pre-pancreatic and retro-pancreatic spaces continued each other at inferior and superior margin of pancreas and extended in all directions. Left gastroepiploic vessels were located in pre-pancreatic spaces at superior margin of pancreatic tail. In retro-pancreatic space at inferior margin of pancreatic neck, superior mesenteric veins were located. In retro-pancreatic spaces or in gastric mesenteries inferior to gastric antrum, right gastroepiploic vessels were located. In spaces between gastric antrum and pancreatic heads, gastroduodenal arteries were located and traced to locate common hepatic arteries. In retro-pancreatic spaces at superior margin of pancreatic body, common hepatic arteries, left gastric arteries,celiac arteries and splenic arteries were located. Hepatopancreatic folds and gastropancreatic folds were landmarks respective to locate common hepatic arteries and left gastric arteries. The aforementioned vessels and spaces in their vagina vasorum continued each other and united as a whole.Laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer is carried out in macroscopic surgical planes of pre-pancreatic space and retro-pancreatic space, as well as their extensions in all directions, and in microscopic surgical planes of spaces in vagina vasorum of perigastric vessels which continue each other, under the guidance of central landmarks of pancreas and concrete landmarks of vessel trunks and their furcations.

To compare the recurrence between laparoscopic resection and conventional open resection for colorectal cancer with meta-analysis.Eligible articles were identified by searches of MEDLINE, EMBASE and the Cochrane database between January 1991 and January 2007 using the terms (laparoscopy, surgery, minimal invasive, colon, intestine, large, colectomy, colonic neoplasms, rectal neoplasms and randomized controlled trial). Prospective randomized clinical trials were eligible if they included patients with colorectal cancer treated by laparoscopic surgery versus open surgery followed-up by recurrence. Data were extracted from these trials by three independent reviewers.Ten trials with recurrence information of 2474 patients were involved. In the combined results, no significant difference in the OR for overall recurrence between the laparoscopic surgery and open surgery group was found (OR 0.95, 95%CI 0.76 to 1.19, P=0.64). Stratified by recurrence type, the combined results of the individual reports showed no significant differences for local recurrence (OR 0.79, 95%CI 0.50 to 1.25,P=0.32), distant metastasis (OR 0.89, 95%CI 0.62 to 1.28, P=0.54) and port-site or wound-site recurrence (OR 1.04,95%CI 0.21 to 5.27,P=0.96) between the two surgical techniques.The recurrence rates for patients with colorectal cancer treated by laparoscopic surgery do not differ significantly from those by open surgery. Longer follow up studies will further define outcomes comparing the two techniques in the treatment of colorectal cancer.