Background: The efficacy of intersphincteric resection (ISR) surgery for patients with lower rectal cancer remains unclear compared to abdominoperineal resection (APR). The aim of this study is to compare the oncologic outcomes for lower rectal cancer patients after ISR and APR through a systematic review and meta-analysis. Materials and Methods: A systematic electronic search of the Cochrane Library, PubMed, EMBASE, and MEDLINE was performed through January 12, 2022. The primary outcomes included 5-year disease-free survival (5y-DFS) and 5-year overall survival. Secondary outcomes included circumferential resection margin involvement, local recurrence, perioperative outcomes, and other long-term outcomes. The pooled odds ratios, mean difference, or hazard ratios (HRs) of each outcome measurement and their 95% CIs were calculated. Results: A total of 20 nonrandomized controlled studies were included in the qualitative analysis, with 1217 patients who underwent ISR and 1135 patients who underwent APR. There was no significant difference in 5y-DFS (HR: 0.84, 95% CI: 0.55–1.29; P=0.43) and 5-year overall survival (HR: 0.93, 95% CI: 0.60–1.46; P=0.76) between the two groups. Using the results of five studies that reported matched T stage and tumor distance, we performed another pooled analysis. Compared to APR, the ISR group had equal 5y-DFS (HR: 0.76, 95% CI: 0.45–1.30; P=0.31) and 5y-LRFS (local recurrence-free survival) (HR: 0.72, 95% CI: 0.29–1.78; P=0.48). Meanwhile, ISR had equivalent local control as well as perioperative outcomes while significantly reducing the operative time (mean difference: −24.89, 95% CI: −45.21 to −4.57; P=0.02) compared to APR. Conclusions: Our results show that the long-term survival and safety of patients is not affected by ISR surgery, although this result needs to be carefully considered and requires further study due to the risk of bias and limited data.

Purpose Erectile dysfunction (ED) is a common postoperative complication of pelvic surgery for which there is currently no effective treatment. This study investigated the therapeutic effects and potential mechanisms of adipose derived mesenchymal stem cells-derived mitochondria (ADSCs-mito) transplantation in a rat model of bilateral cavernous nerve injury (CNI) ED. Materials and Methods We isolated mitochondria from ADSCs and tested their quality. In vivo , twenty male Sprague Dawley rats were randomly divided into four groups: sham operation group and CNI groups that received intracavernous injection of either phosphate buffer solution, ADSCs-mito or ADSCs. Two weeks after therapy, the erectile function of the rats was evaluated and the penile tissues were harvested for histologic analysis and western blotting. In vitro , the apoptosis rate, reactive oxygen species (ROS), mitochondria derived active oxygen (mtROS) and adenosine triphosphate (ATP) levels were detected in corpus cavernosum smooth muscle cells (CCSMCs) after the incubation with ADSCs-mito. In addition, intercellular mitochondrial transfer was visualized by co-culture of ADSCs and CCSMCs. Results The ADSCs, ADSCs-mito and CCSMCs were isolated and identified successfully. ADSCs-mito transplantation notably restored the erectile function and smooth muscle content of CNI ED rats. Moreover, the levels of ROS, mtROS and cleaved-caspase 3 were reduced and the levels of superoxide dismutase and ATP were increased after ADSCs-mito transplantation. In CNI ED rats, the mitochondrial structure of cells in penile tissues was destroyed. ADSCs could transfer its own mitochondria to CCSMCs. Pre-treatment with ADSCs-mito could significantly decrease apoptosis rate, ROS levels and mtROS levels as well as restore the ATP level in CCSMCs. Conclusions ADSCs-mito transplantation significantly ameliorated ED induced by CNI, with similar potency to ADSCs treatment. The ADSCs-mito might exert their effects via anti-oxidative stress, anti-apoptosis and modulating energy metabolism of CCSMCs. Mitochondrial transplantation should be a promising therapeutic method for treating CNI ED in the future.

Purpose Pathological features and lymph node staging plays an important role in treatment decision-making. Yet, the preoperative accurate prediction of pathological features and lymph node metastasis (LNM) is challenging. Methods In this prospective study, a total of 37 patients diagnosed with histologically confirmed rectal cancer who underwent pelvic 3.0T magnetic resonance imaging (MRI) were enrolled. MRI images of both the primary tumor alongside the lymph nodes and specimens were performed with a node-to-node match and labeling. The correlation analysis, least absolute shrinkage, and selection operator (LASSO) logistic regression (LR), backward stepwise LR were mainly used for radiomics feature selection and modeling. The univariate and multivariate backward stepwise LR were used for preoperative clinical predictors selection and modeling. Results A total of 487 lymph nodes including 39 metastatic lymph nodes and 11 tumor deposits were harvested from 37 patients. The texture features of the primary tumors could successfully predict tumor differentiation using a well-established model (area under the curve (AUC) = 0.798). Sixty-nine matched lymph nodes were randomly divided into a training cohort (n = 39) and a validation cohort (n = 30). Three independent risk factors were obtained from 56 texture parameters closely related to LNM. A prediction model was then successfully developed, which provided AUC values of 0.846 and 0.733 in the training and test cohort, respectively. Further, tumor deposits produced a higher radiomics score (Rad-score) compared with LNM (P = 0.042). Conclusion The study provides two non-invasive and quantitative methods, which respectively predict the tumor differentiation and regional LNM for rectal cancer preoperatively. Ultimately, these are favorable when producing treatment protocols for rectal cancer patients.

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