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Objective: To investigate the operative techniques and postoperative effects of ultralow anterior excision for rectal cancer., Methods: From October 1996 to October 2006, 508 cases with rectal carcinoma at or below the peritoneal reflection with potential to preserve the anal function were divided into two groups. Of the patients, 365 cases underwent ultralow anterior excision and instrumental anastomosis, and 143 cases underwent manual colon-anal anastomosis (Parks operation)., Results: In the group with anterior excision, the operations were all completed in the abdominal cavity, and avulsion of distal occlusive end occurred in 3 cases (0.9%), unsuccessful anastomosis happened in 2 cases (0.6%), unsatisfactory anastomosis with incomplete anastomosis circle turned out in 18 cases (5.6%). In the Parks operation group, the anastomosis was carried out manually at the anus and in abdominal cavity. Postoperative defecation function (times, soiling underwear, feeling of urgent defecation) in the group anterior excision was clearly better than that in the group of Parks operation (P < 0.05); difficulty of defecation (sense of residual stool, prolonging of defecation, cathartic usage) was also better in the group with anterior excision (P < 0.05). The anastomosis leakage rate was 3.5% in anterior excision group, compared to 5.6% in Parks operation group (P > 0.05). Anastomotic stenosis occurred in 77 cases (22.5%) in anterior excision group, and 40 cases (27.9%) in Parks operation group (P > 0.05). The local recurrence rate and 5-year survival rate were 11.8% and 68.8% in anterior excision group, and 10.1% and 66.8% in Parks operation group, respectively (P > 0.05)., Conclusions: Although there is no significant differences in local recurrence and 5-year survival rate between the two groups, the function and difficulty of defecation with instrumental anastomosis demonstrates clear advantages over Parks operation.

Objective: To investigate the essentials of operation and the postoperative effect of right hemicolonic carcinoma with anterograde clearance of lymph nodes., Methods: One hundred and thirty-five patients with right hemicolonic infiltrated carcinoma, who were eligible for radical excision (D(3)), were divided into 2 groups. Among them, the anterograde clearance of lymph nodes was performed on 56 cases; the retrograde clearance was performed on 79 cases. Both groups showed no significant difference in age, sex, Dukes' staging and pathological type., Results: The average time of operation: the anterograde group was (180 +/- 40) min; the retrograde group was (180 +/- 20) min. The average amount of bleeding: the anterograde group was (200 +/- 80) ml; the retrograde group was (200 +/- 30) ml. The cleared number of lymph nodes: the anterograde group were 6.3 +/- 4.2, 2.6 +/- 3.1, 1.5 +/- 2.3 in paracolon, middle and radicel of vasorum respectively, the total number was 11.4 +/- 8.6; the retrograde group were 6.4 +/- 2.2, 2.8 +/- 2.1, 1.1 +/- 1.1 respectively, the total number was 10.8 +/- 5.6 (P > 0.05). The postoperative metastasis to liver: the anterograde group was 8 cases (13.9%); the retrograde group was 21 cases (26.6%, P < 0.05). The 5-year survival rate: the anterograde group was 72.8% (41/56); the retrograde group was 65.5% (52/79) (P < 0.05)., Conclusions: The operative technique of the excision was little difficulty and complexity, and it could fit well with the requirement of non touch isolation, and act to cut down the postoperative metastasis to liver and to elevate 5-year survival rate.

Objective: To consider the relationship to survival rate and quality of life with pararectal lymphadenectomy for lower carcinoma of rectum., Methods: The radical operation was performed on 780 cases of progressive cancer located at peritoneal reflection or below it, Among them, 352 cases only cleared in abdominal cavity, 428 cases coupled with extra-peritoneal histopathological type., Results: Urinary function injured, the group cleared in abdominal cavity was 12 cases, accounted for 3.6%; the group coupled with extra-peritoneal clearance was 225 cases, for 52.5% (P < 0.01). Sexual function damaged (only for male), the abdominal cavity group was 23 cases, for 12.6% (23/185); the coupled group was 127 cases, for 53.4% (127/238), (P < 0.01). Local relapse rate, the abdominal cavity group was 15.8% (56/352); the coupled group was 8.6% (41/428), (P < 0.05). 5-year survival rate, the abdominal cavity group was 52.2%; the coupled group was 58.5% (P < 0.05)., Conclusion: By contrast, although abdominal cavity coupled with extraperitoneal lymphadenectomy acted to cut down local relapse and to elevate 5-year survival rate, the postoperative quality of life appeared to be seriously affected.

Objectives: To evaluate the effect and the indication of local resection for rectal cancer below the peritoneal reflection., Methods: One hundred and thirty-four patients with early rectal carcinoma whose masses were >or= 5 cm or