To explore the clinical value of enhanced computed tomography (enhanced CT), magnetic resonance imaging (MRI), carcinoembryonic antigen (CEA), and cancer antigen 199 (CA199) in the diagnosis of rectal cancer (RC).

A total of 156 patients with RC confirmed by postoperative pathology admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University from March 2018 to November 2020 were included in the malignant group, and 52 patients with chronic proctitis in the benign control group. All patients underwent preoperative enhanced CT, MRI scans, and serum CEA and CA199 tests. The accuracy, sensitivity, and specificity of single and combined enhanced CT, MRI, CEA, and CA199 tests for the clinical staging of RC were calculated.

The postoperative pathological diagnosis showed that 35 cases of 156 RC patients were at T1 stage, 29 cases were at T2 stage, 24 cases were at T3 stage, 11 cases were at T4 stage, 23 cases were at N0 stage, 21 cases were at N1 stage, 8 cases were at N2 stage, 3 cases were at M0 stage, and 2 cases were at M1 stage. The positive rate of MRI in the diagnosis of RC was higher than that of enhanced CT. Serum CEA and CA199 levels in the malignant group were significantly increased compared with the benign group. The sensitivity, specificity, and accuracy of the combined detection were significantly higher than those of the single detection.

Compared with enhanced CT, MRI has a higher detection rate of T and N stage in patients with RC. Combined enhanced CT, MRI, CEA, and CA199 can provide more accurate diagnosis and preoperative staging of RC patients.

• CT
• N stage
• Rectal cancer
• SAA
• miR-155
• microRNA

• China
• Colorectal cancer
• surgical treatment

AIM: To report our experience using mini-laparotomy for the resection of rectal cancer using the total mesorectal excision (TME) technique.

METHODS: Consecutive patients with rectal cancer who underwent anal-colorectal surgery at the authors’ hospital between March 2001 and June 2009 were included. In total, 1415 patients were included in the study. The cases were divided into two surgical procedure groups (traditional open laparotomy or mini-laparotomy). The mini-laparotomy group was defined as having an incision length ≤ 12 cm. Every patient underwent the TME technique with a standard operation performed by the same clinical team. The multimodal preoperative evaluation system and postoperative fast track were used. To assess the short-term outcomes, data on the postoperative complications and recovery functions of these cases were collected and analysed. The study included a plan for patient follow-up, to obtain the long-term outcomes related to 5-year survival and local recurrence.

RESULTS: The mini-laparotomy group had 410 patients, and 1015 cases underwent traditional laparotomy. There were no differences in baseline characteristics between the two surgical procedure groups. The overall 5-year survival rate was not different between the mini-laparotomy and traditional laparotomy groups (80.6% vs 79.4%, P = 0.333), nor was the 5-year local recurrence (1.4% vs 1.5%, P = 0.544). However, 1-year mortality was decreased in the mini-laparotomy group compared with the traditional laparotomy group (0% vs 4.2%, P < 0.0001). Overall 1-year survival rates were 100% for Stage I, 98.4% for Stage II, 97.1% for Stage III, and 86.6% for Stage IV. Local recurrence did not differ between the surgical groups at 1 or 5 years. Local recurrence at 1 year was 0.5% (2 cases) for mini-laparotomy and 0.5% (5 cases) for traditional laparotomy (P = 0.670). Local recurrence at 5 years was 1.5% (6 cases) for mini-laparotomy and 1.4% (14 cases) for traditional laparotomy (P = 0.544). Days to first ambulation (3.2 ± 0.8 d vs 3.9 ± 2.3 d, P = 0.000) and passing of gas (3.5 ± 1.1 d vs 4.3 ± 1.8 d, P = 0.000), length of hospital stay (6.4 ± 1.5 d vs 9.7 ± 2.2 d, P = 0.000), anastomotic leakage (0.5% vs 4.8%, P = 0.000), and intestinal obstruction (2.2% vs 7.3%, P = 0.000) were decreased in the mini-laparotomy group compared with the traditional laparotomy group. The results for other postoperative recovery function indicators, such as days to oral feeding and defecation, were similar, as were the results for immediate postoperative complications, including the physiologic and operative severity score for the enumeration of mortality and morbidity score.

CONCLUSION: Mini-laparotomy, as conducted in a single-centre series with experienced TME surgeons, is a safe and effective new approach for minimally invasive rectal cancer surgery. Further evaluation is required to evaluate the use of this approach in a larger patient sample and by other surgical teams.

• Rectal neoplasm
• Mini-laparotomy
• Survival
• Total mesorectal excision