Doctor
"Mr. Jia, your rectal cancer is too close to the anus. We must strive to protect the anus on the basis of ensuring the radical treatment of the tumor."
patient
"Doctor, I know that the tumor is malignant, but please be sure to cure the tumor as much as possible on the basis of the anus. If the surgery cannot protect the anus, I will give up the treatment."
This is a real preoperative conversation between the anorectal surgeons and patients in Xinhua Hospital.
The story is like this:
A week before the National Day holiday, the Department of Anorectal Surgery of Xinhua Hospital admitted Lao Jia, a patient with rectal cancer from Inner Mongolia.
The rectal cancer that Lao Jia replaced was very low, and it was difficult to protect the anus. Lao Jia traveled to many hospitals across the country and finally came to Xinhua Hospital.
According to his son Xiao Jia, the father is looking for a doctor thousands of miles away, his wish is simple and clear, and he only wants to protect his anus! After receiving many negative replies, I found Professor Du Peng of Xinhua Hospital. The results of the
examination show that the tumor diameter is 3cm and the preoperative stage is cT2N0M0, and radical resection can be performed. However, the lower edge of the tumor is very close to the anal canal, only about 1.5 cm.
The pelvic space of men is small, and the tumor is located at the lowest point of the pelvic shaped like a "funnel". It is really a big challenge for surgeons to completely remove the tumor, ensure sufficient safe margins, and protect the anus.
Professor Du Peng believed through physical examination and preoperative evaluation that although the tumor position was very low, fortunately, it had not invaded the external anal sphincter and levator anal muscle, which left a window for radical surgery and retained the anus. Finally, he decided to perform laparoscopic radical transspherical interspinocrine rectal cancer surgery (ISR surgery) for Lao Jia. During the
operation, Professor Du Peng led the surgical team composed of Professor Zhou Hui, Professor Liu Yun, Dr. Ding Wenjun and Dr. Song Jingluo. Through skillful laparoscopic surgery, after completing D3 lymph node dissection, it accurately entered the anatomical gap. While performing radical surgery, it carefully preserved the pelvic nerves and gradually freed to the distal end of the tumor.
Professor Liu Yun, who is pregnant with many "anal protection techniques" for low-level rectal cancer, after determining the distal edge of the tumor in the perineum, he easily entered the internal and external sphincter space of the anus and freed from the anus to the proximal end.
Two groups of doctors met smoothly through two surgical approaches of the abdomen-perineal area. On the basis of ensuring a sufficient safe distance from the lower edge of the tumor, the tumor was completely removed and the anal function was retained.
Postoperative pathological tips: The lower edge of the tumor is 1.5 cm away from the distal rectal margin, the two sides and the peripheral edges are negative, and the lymph nodes in the dissection area are negative. The "extreme" anal protection of rectal cancer is achieved.
After listening to the story,
Are there still many questions
Intestinal cancer science question and answer time is up!
Q: How to judge whether rectal cancer can protect the anus?
For low-level rectal cancers that require radical surgery, whether anal protection can be maintained and what surgical method should be chosen first, we should pay attention to the distance between the lower edge of the tumor from the upper edge of the anal canal anatomy (dentate line). In theory, the possibility of anal protection is only if this distance exceeds 1 cm.
It is worth noting that distance is not the only factor that determines whether anal protection can be maintained. The size of the tumor, the depth of infiltration, whether there is lymph node metastasis, distant metastasis, anastomosis conditions, systemic basic conditions, body shape, pelvic conditions, etc. are all factors that surgeons need to consider when making surgical decisions.
Because these are closely related to the radical surgery of the tumor, whether the anal protection surgery can be completed satisfactorily as scheduled, whether it will affect the risk of local recurrence and the prognosis.
Q: What are the advantages of the Department of Anorectal Surgery in Shanghai Xinhua Hospital in the field of anal protection surgery for rectal cancer?
Shanghai Xinhua Hospital Colorectal Anal Surgery (Anorectal Surgery) is a national key clinical discipline, the leading unit of Shanghai Jiaotong University Colorectal Cancer Diagnosis and Treatment Center and Shanghai Colorectal Oncology Center.
has accumulated rich experience in standardized diagnosis and treatment of colorectal cancer, laparoscopic radical surgery for colorectal cancer, low-level rectal cancer anal protection surgery, etc., and preoperative downward-stage conversion treatment for locally advanced rectal cancer.
uses double stapler technology, transanal drag-out rectal cancer surgery, transanal rectal total mesangial resection (taTME surgery), interspermectomy (ISR surgery), etc., and the anus is "insured as long as possible" is covered by radical surgery.
Department has a Da Vinci robotic surgery platform, a laparoscopic minimally invasive integrated operating room platform, and a surgical colonoscopic diagnosis and treatment platform, providing every rectal cancer patient with professional and accurate individual diagnosis and treatment plans.
Q: What advantages does robotic surgery bring to low-level rectal cancer surgery?
Robot-assisted radical remediation surgery has been included in the Shanghai medical insurance reimbursement scope, effectively reducing the medical expenses burden of citizens using new technologies and new projects, and bringing benefits to patients for treatment.
According to the latest robotic surgery participated by 11 centers nationwide, comparing the multi-center randomized controlled clinical research results of laparoscopic radical rectal cancer surgery, robotic surgery can significantly improve the anal preservation rate, the complete tumor resection rate, and improve the surgical effect.
Da Vinci robot assisted radical rectal cancer surgery has the following characteristics:
1, clearer and more realistic 3D surgical field of view, with intelligent image processing function, three-dimensional vision can be magnified 10-15 times, greatly increasing the accuracy of the surgery.
2. The robot arm has 7 degrees of freedom. In narrow surgical areas that cannot be reached by human hands, especially low-level rectal surgery, the arm can flexibly pass in a space of 360 degrees and filter the shaking of human hands. It has stability and accuracy that cannot be matched by human hands. In particular, the robot arm flexibly rotates, solving the problem of low-level deep operation of rectal cancer, and it is easy to remove ultra-low-level rectal tumors.
3. Small trauma, reduce postoperative pain, shorten hospital stay, reduce blood loss, reduce postoperative adhesions caused by tissue trauma and inflammatory reactions during the operation, increase cosmetic effects, and resume work and life faster.
Q: How to further improve the chances of rectal cancer protecting anus?
For patients whose initial diagnosis and evaluation results indicate that radical surgical resection is not possible and the difficulty of anal maintenance is difficult, it does not mean that there is no chance. Some patients with rectal cancer can reduce the tumor and reduce the period through preoperative neoadjuvant chemotherapy and radiotherapy, and finally obtain radical surgical resection or anal maintenance opportunity.
The Department of Anorectal Surgery of Xinhua Hospital is the leading unit of the Colorectal Cancer Diagnosis and Treatment Center of Shanghai Jiaotong University. It has multidisciplinary treatment teams in the intestinal cancer such as surgery, oncology, radiotherapy, and imaging department, which protects the patients with bowel cancer in all aspects.
Department introduction
Shanghai Xinhua Hospital's Department of Anorectal Surgery has always taken standardized full-process management of colorectal cancer surgery and comprehensive diagnosis and treatment as the discipline's characteristics. It has characteristics and technical advantages in laparoscopic radical colorectal cancer surgery, low- and ultra-low-level extreme anal protection surgery, Da Vinci robot surgery, and standardized colorectal cancer multidisciplinary diagnosis and treatment teams that seamlessly connect colorectal cancer surgery. He has rich experience in surgical diagnosis and treatment of ulcerative colitis, Crohn's disease, and benign anal diseases.
