简介：AbstractPreoperative neoadjuvant chemoradiotherapy, combined with total mesorectal excision, has become the standard treatment for advanced localized rectal cancer (RC). However, the biological complexity and heterogeneity of tumors may contribute to cancer recurrence and metastasis in patients with radiotherapy-resistant RC. The identification of factors leading to radioresistance and markers of radiosensitivity is critical to identify responsive patients and improve radiotherapy outcomes. MicroRNAs (miRNAs) are small, endogenous, and noncoding RNAs that affect various cellular and molecular targets. miRNAs have been shown to play important roles in multiple biological processes associated with RC. In this review, we summarized the signaling pathways of miRNAs, including apoptosis, autophagy, the cell cycle, DNA damage repair, proliferation, and metastasis during radiotherapy in patients with RC. Also, we evaluated the potential role of miRNAs as radiotherapeutic biomarkers for RC.

简介：AbstractWith the changing lifestyle and the acceleration of aging in the Chinese population, the incidence and mortality of colorectal cancer (CRC) have risen in the last decades. On the contrary, the incidence and mortality of CRC have continued to decline in the USA since the 1980s, which is mainly attributed to early screening and standardized diagnosis and treatment. Rectal cancer accounts for the largest proportion of CRC in China, and its treatment regimens are complex. At present, surgical treatment is still the most important treatment for rectal cancer. Since the first Chinese guideline for diagnosis and treatment of CRC was issued in 2010, the fourth version has been revised in 2020. These guidelines have greatly promoted the standardization and internationalization of CRC diagnosis and treatment in China. And with the development of comprehensive treatment methods such as neoadjuvant chemoradiotherapy, targeted therapy, and immunotherapy, the post-operative quality of life and prognosis of patients with rectal cancer have improved. We believe that the inflection point of the rising incidence and mortality of rectal cancer will appear in the near future in China. This article reviewed the current status and research progress on surgical therapy of rectal cancer in China.

简介：Laparoscopicrectalsurgerycontinuestobeachallengingoperationassociatedtoasteeplearningcurve.Roboticsurgicalsystemshavedramaticallychangedminimallyinvasivesurgery.Three-dimensional,magnifiedandstableview,articulatedinstruments,andreductionofphysiologictremorsleadingtosuperiordexterityandergonomics.Therefore,roboticplatformscouldpotentiallyaddresslimitationsoflaparoscopicrectalsurgery.Itwasaimedatreviewingcurrentliteratureonshort-termclinicalandoncological(pathological)outcomesafterroboticrectalcancersurgeryincomparisonwithlaparoscopicsurgery.Asystematicreviewwasperformedfortheperiod2002to2014.Atotalof1776patientswithrectalcancerunderwentminimallyinvasiverobotictreatmentin32studies.Afterroboticandlaparoscopicapproachtooncologicrectalsurgery,respectively,meanoperatingtimevariedfrom192-385min,andfrom158-297min;meanestimatedbloodlosswasbetween33and283mL,andbetween127and300mL;meanlengthofstayvariedfrom4-10d;andfrom6-15d.Conversionafterroboticrectalsurgeryvariedfrom0%to9.4%,andfrom0to22%afterlaparoscopy.Therewasnodifferencebetweenrobotic(0%-41.3%)andlaparoscopic(5.5%-29.3%)surgeryregardingmorbidityandanastomoticcomplications(respectively,0%-13.5%,and0%-11.1%).Regardingimmediateoncologicoutcomes,respectivelyamongroboticandlaparoscopiccases,positivecircumferentialmarginsvariedfrom0%to7.5%,andfrom0%to8.8%;themeannumberofretrievedlymphnodeswasbetween10and20,andbetween11and21;andthemeandistalresectionmarginwasfrom0.8to4.7cm,andfrom1.9to4.5cm.Roboticrectalcancersurgeryisbeingundertakenbyexperiencedsurgeons.However,thequalityoftheassembledevidencedoesnotsupportdefiniteconclusionsaboutmoststudiesvariables.Roboticrectalcancersurgeryisassociatedtoincreasedcostsandoperatingtime.Italsoseemstobeassociatedtoreducedconversionrates.Othershort-termo

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简介：AbstractMany patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

简介：AbstractBackground:Rectal cancer (RC) is a malignant tumor that seriously threatens human health. Long non-coding RNAs (lncRNAs) play a vital role in tumor regulation. Nevertheless, their exact expression features and functions remain obscure, and therefore was the aim of the current study.Methods:We utilized the Affymetrix human GeneChip to screen differentially expressed profiles of lncRNAs and mRNAs from the cancer tissues and matched paracancer tissues of 6 RC patients. Gene Ontology (GO) and pathway enrichment analyses identified crucial functions and pathways of the aberrantly expressed mRNAs. We used quantitative real-time polymerase chain reaction to verify the significant expression differences of 11 candidate lncRNAs between the cancer and paracancer tissues. LncRNA-mRNA coexpression networks were built by calculating the Pearson correlation value to identify significant correlation pairs. Online bioinformatics tools GEPIA2, ONCOMINE, and PROGgeneV2 were used to mine the expression and prognosis of three crucial mRNAs and six verified lncRNAs. Competing endogenous RNA networks were constructed by predicting microRNA response elements and calculating free energy.Results:We found 1658 differentially expressed lncRNAs (778 up-regulated and 880 down-regulated) and 1783 aberrantly expressed mRNAs (909 up-regulated and 874 down-regulated). GO and pathway enrichment analyses revealed the vital functions of the differentially expressed mRNAs, including cell proliferation, cell migration, angiogenesis, and cellular response to zinc ion. The canonical signaling pathways mainly included the interleukin-17, cell cycle, Wnt, and mineral absorption signaling pathways. Six lncRNAs including AC017002.2 (P= 0.039), cancer susceptibility 19 (CASC19) (P= 0.021), LINC00152 (P= 0.013), NONHSAT058834 (P= 0.007), NONHSAT007692 (P= 0.045), and ENST00000415991.1 (P= 0.045) showed significant differences in expression levels between the cancer tissue and paracancer tissue groups. AC017002.2, NONHSAT058834, NONHSAT007692, and ENST00000415991.1 have not yet been reported in RC. The crucial mRNAs myelocytomatosis viral oncogene (MYC), transforming growth factor beta induced (TGFBI), and solute carrier family 7 member 5 (SLC7A5) were selected. AC017002.2 and LINC00152 were positively correlated with MYC, TGFBI, and cytochrome P450 family 2 sub-family B member 6 (All r > 0.900, P < 0.050). NONHSAT058834 was positively associated with MYC (r = 0.930, P < 0.001), and CASC19 was positively correlated with SLC7A5 (r= 0.922, P < 0.001).Conclusion:This study offers convincing evidence of differentially expressed lncRNAs and mRNAs as potential biomarkers in RC.

简介：客观最近的证据建议Oct-4高度在几癌症被表示，并且它的表示贡献肿瘤生长。在这研究，我们在直肠的腺癌调查了Oct-4表示的水平，并且在这些情况中评估了Oct-4表示的预示的意义。Oct-4的immunohistochemical表达式在52件修理福尔马林的嵌入石蜡的手术后的直肠的腺癌织物样品被计算的方法。关于临床的结果的Oct-4的immunoreactivity的影响被Kaplan-Meier和木头等级决定。结果Oct-4的表示水平从0～18.5%。在Oct-4之间没有重要协会表示和性，年龄(P=0.123)，临床的阶段(P=0.391)，和组织学的等级(P=0.056)(P=0.772)。有Oct-4的否定、积极的表示的3年的本地没有复发的率是83.5%和75.0%，分别地(P=0.583)。有Oct-4的否定、积极的表示的3年的没有转移的率是88.6%和61.9%，分别地(P=0.035)。有Oct-4的否定、积极的表示的3年的全面幸存率是77.9%和49.0%，分别地(P=0.037)。结果建议那胚胎的干细胞标记Oct-4表情的结论可以与直肠的腺癌在病人有预示的意义。然而，更多和更大的研究被要求证实这。

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简介：Objective:Toassesstheresponserateofpatientswithrectaladenocarcinomatoneoadjuvanttherapyandtoidentifythepredictorsofhistologicalregressionafterneoadjuvantradiotherapy(RT)orconcurrentchemoradiotherapy(CCRT).Methods:Thisstudyrecruited64patients.Thepatientshadresectablecancerofthelowerandthemiddlerectum(T3/T4and/orN+)withoutdistantmetastasisandreceivedneoadjuvantRTorCCRTfollowedbyradicalsurgerywithtotalmesorectalexcision(TME)betweenJanuary2006andDecember2011.Thepatientswereclassifiedintonon-response(NR),partialresponse(PR),andpathologiccompleteresponse(pCR)basedontheDworaktumorregressiongradingsystem.Results:Themedianageofpatientswas57years(rangingfrom22to85).Atotalof24patientsweretreatedwithneoadjuvantCCRT,whereas40patientsweretreatedwithRTalone.Abdominoperinealresection(APR)wasperformedon29patients(45%).AnteriorresectionwithTMEwasperformedon34patients(53%).Onepatienthadlocalresection.Histologically,12(19%),24(73%),and28(44%)patientsexhibitedpCR,PR,andNR,respectively.Univariateanalysisrevealedthatthepredictorsoftumorregressionwereasfollows:theabsenceoflymphnodeinvolvementfrominitialimaging(cN0)(P=0.021);normalinitialcarcinoembryonicantigen(CEA)level(P=0.01);hemoglobinlevel≥12g/dl(P=0.009);CCRT(P=0.021);andtumordownstaginginimaging(P=0.001).MultivariateanalysisshowedthatthemainpredictorsofpCRwereCTcombinedwithneoadjuvantRT,cN0stage,andtumorregressiononimaging.Conclusions:IdentifyingthepredictorsofpCRfollowingneoadjuvanttherapyaidstheselectionofresponsivepatientsfornonaggressivesurgicaltreatmentandpossiblesurveillance.

简介：AbstractBackground:Colorectal cancer is harmful to the patient’s life. The treatment of patients is determined by accurate preoperative staging. Magnetic resonance imaging (MRI) played an important role in the preoperative examination of patients with rectal cancer, and artificial intelligence (AI) in the learning of images made significant achievements in recent years. Introducing AI into MRI recognition, a stable platform for image recognition and judgment can be established in a short period. This study aimed to establish an automatic diagnostic platform for predicting preoperative T staging of rectal cancer through a deep neural network.Methods:A total of 183 rectal cancer patients’ data were collected retrospectively as research objects. Faster region-based convolutional neural networks (Faster R-CNN) were used to build the platform. And the platform was evaluated according to the receiver operating characteristic (ROC) curve.Results:An automatic diagnosis platform for T staging of rectal cancer was established through the study of MRI. The areas under the ROC curve (AUC) were 0.99 in the horizontal plane, 0.97 in the sagittal plane, and 0.98 in the coronal plane. In the horizontal plane, the AUC of T1 stage was 1, AUC of T2 stage was 1, AUC of T3 stage was 1, AUC of T4 stage was 1. In the coronal plane, AUC of T1 stage was 0.96, AUC of T2 stage was 0.97, AUC of T3 stage was 0.97, AUC of T4 stage was 0.97. In the sagittal plane, AUC of T1 stage was 0.95, AUC of T2 stage was 0.99, AUC of T3 stage was 0.96, and AUC of T4 stage was 1.00.Conclusion:Faster R-CNN AI might be an effective and objective method to build the platform for predicting rectal cancer T-staging.Trial registration:chictr.org.cn: ChiCTR1900023575; http://www.chictr.org.cn/showproj.aspx?proj=39665.

简介：AbstractBackground:Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy (NCRT). This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched analysis.Methods:In total, 1296 patients with NCRT or post-operative chemoradiotherapy (PCRT) were enrolled in this study between January 2008 and December 2015. Propensity score matching was used to correct for differences in baseline characteristics between the two groups. After propensity score matching, the metastasis pattern, including metastasis sites and timing, was compared and analyzed.Results:After propensity score matching, there were 408 patients in the PCRT group and 245 patients in the NCRT group. NCRT significantly reduced local recurrence (4.1% vs. 10.3%, P = 0.004), but not distant metastases (28.2% vs. 27.9%, P= 0.924) compared with PCRT. In both the NCRT and PCRT groups, the most common metastasis site was the lung, followed by the liver. The NCRT group developed local recurrence and distant metastases later than the PCRT group (median time: 29.2 [18.8, 52.0] months vs. 18.7 [13.3, 30.0] months, Z=-2.342, P= 0.019; and 21.2 [12.2, 33.8] vs. 16.4 [9.3, 27.9] months, Z=-1.765, P = 0.035, respectively). The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group (39/114, 34.2%) and NCRT group (21/69, 30.4%). However, 20.3% (14/69) of the distant metastases appeared in the 3rd year in the NCRT group, while this number was only 13.2% (15/114) in the PCRT group.Conclusions:The predominant site of distant metastases was the lung, followed by the liver, for both the NCRT group and PCRT group. NCRT did not influence the predominant site of distant metastases, but the NCRT group developed local recurrence and distant metastases later than the PCRT group. The follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.

简介：AbstractBackground:Postoperative chylous ascites is an infrequent condition after colorectal surgery and is easily treatable. However, its effect on the long-term oncological prognosis is not well established. This study aimed to investigate the short-term and long-term impact of chylous ascites treated with neoadjuvant therapy followed by rectal cancer surgery and to evaluate the incidence of chylous ascites after different surgical approaches.Methods:A total of 898 locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery between January 2010 and December 2018 were included. The clinicopathological data and outcomes of the patients with chylous ascites were compared with those of the patients without chylous ascites. The primary endpoint was recurrence-free survival (RFS). To balance baseline confounders between groups, propensity score matching (PSM) was performed for each patient with a logistic regression model.Results:Chylous ascites was detected in 3.8% (34/898) of the patients. The incidence of chylous ascites was highest after robotic surgery (6.9%, 6/86), followed by laparoscopic surgery (4.2%, 26/618) and open surgery (1.0%, 2/192, P = 0.021). The patients with chylous ascites had a significantly higher number of lymph nodes harvested (15.6 vs. 12.8, P = 0.009) and a 3-day longer postoperative hospital stay (P = 0.017). The 5-year RFS rate was 64.5% in the chylous ascites group, which was significantly lower than the rate in the no chylous ascites group (79.9%; P = 0.007). The results remained unchanged after PSM was performed. The chylous ascites group showed a nonsignificant trend towards a higher peritoneal metastasis risk (5.9% vs. 1.6%, P = 0.120). Univariate analysis and multivariate analysis confirmed chylous ascites (hazard ratio= 3.038, P < 0.001) as an independent negative prognostic factor for RFS.Conclusions:Considering the higher incidence of chylous ascites after laparoscopic and robotic surgery and its adverse prognosis, we recommend sufficient coagulation of the lymphatic tissue near the vessel origins, especially during minimally invasive surgery.

简介：AbstractBackground:Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery. However, the complications of stoma and stoma reversal surgery should not be underestimated. Furthermore, in some patients, stoma reversal failed. Here, we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed.Methods:In total, 154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed. Patients were divided into two groups according to whether their stoma got reversed or not. The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed.Results:The mean follow-up time was 47.54 (range 4.0-164.0) months. During follow-up, 19.5% of the patients suffered stoma-related long-term complications. Only 79 (51.3%) patients had their stomas reversed. The morbidity of complications after reversal surgery was 45.6%, and these mainly consisted of incision-related complications. Multivariate analyses showed that pre-treatment comorbidity (HR =3.17, 95% CI 1.27-7.96, P =0.014), postoperative TNM stage (HR =2.55, 95% CI 1.05-6.18, P =0.038), neoadjuvant therapy (HR =2.75, 95% CI 1.07-7.05, P =0.036), anastomosis-related complications (HR =4.52, 95% CI 1.81-11.29, P =0.001), and disease recurrence (HR =24.83, 95% CI 2.90-213.06, P =0.003) were significant independent risk factors for a defunctioning stoma to be permanent.Conclusions:Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage, but the stoma itself and its reversal procedure are associated with high morbidity of complications, and many defunctioning stomas eventually become permanent. Therefore, surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients. In addition, doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.

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