Department of General Surgery, Rongchang People's Hospital, Chongqing 250012, China.
Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
World J Gastroenterol. 2024 Aug 14;30(30):3574-3583. doi: 10.3748/wjg.v30.i30.3574.
The incidence of rectal cancer is increasing worldwide, and surgery remains the primary treatment modality. With the advent of total mesorectal excision (TME) technique, the probability of tumor recurrence post-surgery has significantly decreased. Surgeons' focus has gradually shifted towards minimizing the impact of surgery on urinary and sexual functions. Among these concerns, the optimal dissection of the rectal lateral ligaments and preservation of the pelvic floor neurovascular bundle have become critical. To explore the optimal surgical technique for TME and establish a standardized surgical protocol to minimize the impact on urinary and sexual functions, we propose the eight-zone dissection strategy for pelvic floor anatomy.
To compare the differences in surgical specimen integrity and postoperative quality of life satisfaction between the traditional pelvic floor dissection strategy and the innovative eight-zone dissection strategy.
We analyzed the perioperative data of patients who underwent laparoscopic radical resection of rectal cancer at Qilu Hospital of Shandong University between January 1, 2021 and December 1, 2023. This study included a total of 218 patients undergoing laparoscopic radical surgery for rectal cancer, among whom 109 patients underwent traditional pelvic floor dissection strategy, and 109 patients received the eight-zone dissection strategy.
There were no significant differences in general characteristics between the two groups. Patients in the eight-zone dissection group had higher postoperative specimen integrity (88.1% 78.0%, = 0.047). At the 3-month follow-up, patients in the eight-zone surgery group had better scores in urinary issues (6.8 ± 3.3 5.3 ± 2.5, = 0.045) and male sexual desire (2.2 ± 0.6 2.5 ± 0.5, = 0.047) compared to the traditional surgery strategy group.
This study demonstrates that the eight-zone dissection strategy for laparoscopic lateral ligament dissection of rectal cancer is safe and effective. Compared with the traditional pelvic floor dissection strategy, this approach can reduce the risk of nerve injury and minimize the impact on urinary and sexual functions. Therefore, we recommend the clinical application of this strategy to better serve patients with rectal cancer.
全球范围内直肠癌的发病率正在上升，手术仍然是主要的治疗方式。随着全直肠系膜切除术（TME）技术的出现，手术后肿瘤复发的概率显著降低。外科医生的关注点逐渐转向将手术对尿和性功能的影响降至最低。在这些关注中，直肠侧韧带的最佳解剖和盆腔底部神经血管束的保留已变得至关重要。为了探讨 TME 的最佳手术技术，并建立一个标准化的手术方案，以最大限度地减少对尿和性功能的影响，我们提出了盆腔底部解剖的八区解剖策略。
比较传统盆腔底部解剖策略和创新的八区解剖策略在手术标本完整性和术后生活质量满意度方面的差异。
我们分析了 2021 年 1 月 1 日至 2023 年 12 月 1 日期间在山东大学齐鲁医院接受腹腔镜直肠癌根治术的患者的围手术期数据。本研究共纳入 218 例接受腹腔镜直肠癌根治术的患者，其中 109 例患者采用传统盆腔底部解剖策略，109 例患者接受八区解剖策略。
两组患者的一般特征无显著差异。八区解剖组患者术后标本完整性更高（88.1%比 78.0%， = 0.047）。在 3 个月随访时，八区手术组患者在尿问题（6.8 ± 3.3 比 5.3 ± 2.5， = 0.045）和男性性欲（2.2 ± 0.6 比 2.5 ± 0.5， = 0.047）方面的评分均优于传统手术策略组。
本研究表明，腹腔镜直肠癌侧韧带解剖的八区解剖策略是安全有效的。与传统的盆腔底部解剖策略相比，这种方法可以降低神经损伤的风险，并最大限度地减少对尿和性功能的影响。因此，我们建议将这种策略应用于临床，以更好地服务于直肠癌患者。
