[Robotic versus laparoscopic total mesorectal excision with partial preservation of Denonvilliers fascia: a comparative study of short-term efficacy and urinary and erectile function]

Objective: Postoperative sexual and urinary dysfunctions are common in rectal cancer patients. This study was conducted to compare the short-term efficacy and the impact of surgery on urinary and erectile functions between laparoscopy and robotic-assisted total mesorectal excision (TME) with partial preservation of Denonvilliers fascia. Methods: A retrospective cohort study was carried out. Clinical data of 276 patients with low rectal cancer who underwent TME with partial preservation of Denonvilliers fascia in our department between January 2016 and March 2019, including 143 in robotic group and 133 in laparoscopic group, were analyzed. All the patients were positioned by rigid rectoscope, and the distance between the tumor and the anal verge was ≤7 cm. The urinary and erectile functions were followed up at postoperative 12-month and evaluated by IPSS score (0-7 points as mild symptoms, 8-19 points as moderate symptoms, 20-35 points as severe symptoms; the excellent rate was defined as the rate of mild symptoms) and IIEF-5 score (score ≥ 22 as no dysfunction, 12-21 as mild, 8-11 as moderate, and 5-7 as severe) respectively. Results: There were no significant differences in operation ways between the two groups (P>0.05). The operation time of the robotic group was longer than that of the laparoscopic group [(312.5±75.4) minutes vs. (273.9±65.6) minutes, t=4.514, P<0.001]. However, in patients with higher body mass index (BMI ≥25 kg/m(2)), there was no significant difference in operation time between the two groups [(309.3±78.5) minutes vs. (276.1±75.3) minutes, t=1.751, P=0.085]. The time to postoperative flatus [(1.3±0.4) days vs. (1.5±1.0) days, t=-2.037, P=0.046], defecation [1 (1-5) days vs. 1 (1-12) days, Z=-2.209, P=0.008] and liquid diet [(1.0±0.1) days vs. (1.2±0.1) days, t=3.195, P=0.002] in the robotic group were all shorter than those in the laparoscopic group. While postoperative length of hospital stay in the robotic group was longer than that in the laparoscopic group [(8.5±5.5) days vs. (7.2±3.3) days, t=2.419, P=0.016]. There were no significant differences between the two groups in intraoperative blood loss, conversion rate, morbidity of postoperative complications, positive rate of distal resection margin, positive rate of circumferential resection margin, and the number of resected lymph nodes (all P>0.05). At postoperative 12 months, none of the robotic group nor the laparoscopic group had severe urinary dysfunction, and the overall excellent rate of urinary function reached 97.6% (83/85) and 98.4% (61/62) respectively. The rate of normal and mild erectile dysfunction in the robotic group and the laparoscopic group were 92.2% (47/51) and 92.6% (38/41) respectively (P>0.05). There was no significant difference between the two groups was found regarding the urinary and erectile function (both P>0.05). Conclusions: Compared with laparoscopic, the robotic TME with partial preservation of Denonvilliers fascia has no significant differences in surgical safety and short-term efficacy. They have similar advantages in the protection of urinary and erectile function. Meanwhile the robotic surgery presents faster postoperative recovery of gastrointestinal function.

Correlation between gene polymorphism and opioid efficacy in patients with gastric or intestinal cancer

OBJECTIVE

To explore the correlation between gene polymorphism and opioid efficacy in patients with gastric or intestinal cancer.

PATIENTS AND METHODS

Fifty-nine patients who underwent laparoscopic surgery for gastric or intestinal cancer under general anesthesia were included and randomly divided into oxycodone (n=30) and sufentanil groups (n=29) by reproducible random number generation method. Single nucleotide polymorphisms (SNPs) of four alleles: μ-opioid receptor gene OPRM1 A118G, cytochrome P450 (CPY450) enzyme system: CPY3A4*1G, CYP3A5*3, and CYP2D6*10 were detected by PCR-pyrosequencing. Patients in sufentanil group received intravenous sufentanil injection during anesthesia induction, intraoperative maintenance, and postoperative analgesia, while those in oxycodone group received oxycodone. Patients' postoperative VAS score, opioid use, and prevalence of adverse reactions were recorded.

RESULTS

The genotype distribution of OPRM1 A118G, CYP3A4*1G, CYP3A5*3, and CYP2D6*10 in Chinese gastric cancer/intestinal cancer patients accorded with the Hardy-Weinberg law (p>0.05). OPRM1 A118G polymorphism correlated with postoperative VAS score and medication dosage, in oxycodone group (p<0.05), while it didn't with those of sufentanil group. The VAS scores in GG group were higher than that in AA group and AG group at T6-T9, (p<0.05); the postoperative pain remedies times in GG group were more than that in the AA and AG groups (p=0.002). CYP3A4*1G polymorphism related to postoperative VAS score, medication dosage and prevalence of adverse reactions in sufentanil group (p<0.05), while it didn't with those of oxycodone group (p>0.05). The total intraoperative medication in AA group was less than that in GG and GA groups (p<0.01), with a higher prevalence of respiratory depression (p=0.01). Nor was there any correlation of CYP3A5*3 and CYP2D6*10 polymorphisms with the efficacy, postoperative VAS score, pain remedies times, postoperative 24 h medication dosage, or prevalence of adverse reactions in oxycodone and sufentanil groups.

CONCLUSIONS

Gene polymorphism affects the efficacy and adverse reactions of opioids in patients undergoing laparoscopic gastric or intestinal cancer surgery.

Evaluation of the direct nitrate reductase assay for rapid detection of extensively drug-resistant tuberculosis

SETTING

Jiangxi, China.

OBJECTIVE

To evaluate the performance of the direct nitrate reductase assay (D-NRA) for rapid, low-cost detection of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) in high-burden, resource-limited settings.

METHODS

A total of 225 smear-positive sputum samples were collected from consecutive drug-resistant TB subjects. Samples were processed at the Province TB Reference Laboratory and tested for susceptibility to rifampicin (RMP), isoniazid (INH), ofloxacin (OFX), kanamycin (KM) and capreomycin (CPM) by D-NRA, using the indirect Löwenstein-Jensen proportion method (LJ-PM) as reference.

RESULTS

Of the 225 smear-positive sputum samples, 214 isolates were identified as Mycobacterium tuberculosis and analysed for further comparison. The sensitivity of the D-NRA in the detection of resistance to RMP, INH, OFX, KM and CPM was respectively 95.1% (97/102), 93.1% (135/145), 97.4% (76/78), 88.9% (40/45) and 90.6% (29/32); specificity was respectively 100% (112/112), 97.1% (67/69), 100% (136/136), 98.8% (167/169) and 96.7% (176/182). The median time to culture positivity was significantly shorter for NRA than for the indirect LJ-PM (14 days vs. 70 days, P < 0.001).

CONCLUSION

D-NRA showed high sensitivity and specificity in the rapid diagnosis of MDR- and XDR-TB in a high-burden, resource-limited setting.

Evaluation of indirect drug susceptibility testing using the MODS assay for the detection of XDR-TB in China

SETTING

The First Affiliated Hospital of Nanchang University and the Chest Hospital of Jiangxi Province, Jiangxi, China.

OBJECTIVE

To assess the performance and feasibility of the microscopic observation drug susceptibility (MODS) assay for the simultaneous detection of multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) in a high-burden, resource-limited setting.

METHODS

A total of 208 archived clinical isolates of Mycobacterium tuberculosis were used to compare MODS with the conventional proportion method for the rapid detection of resistance to rifampicin (RMP) and isoniazid (INH), as well as to the second-line drugs ofloxacin (OFX) and kanamycin (KM).

RESULTS

Sensitivity was respectively 94.5%, 91%, 96.2% and 91.5% for RMP, INH, OFX and KM, and specificity was respectively 97.5%, 96%, 100% and 98.7%. Results for MODS were obtained in a median time of 7 days (range 5-17).

CONCLUSION

The MODS assay offers a simple, rapid, economical and feasible method for the detection of M. tuberculosis resistance to first- and second-line drugs in resource-limited settings.