ABSTRACT
Objective: To investigate the effect of visceral obesity on the short-term outcomes after radical operation for mid-low rectal cancers. Methods: We conducted a prospective study on patients who underwent selective rectal cancer resection at The Second Affili-ated Hospital of Wenzhou Medical University between April 2017 and October 2018. The cutoff visceral fat area (VFA) for visceral obe-sity was≥134.6 cm2 for men and≥91.1 cm2 for women. Results: A total of 127 patients were included in the study, of whom 64 were diagnosed as having visceral obesity and 63 as having non-visceral obesity. The patients with visceral obesity had a higher body mass index (BMI) (P<0.001) than those without visceral obesity. The proportions of female patients and those who had a laparoscopy-assist-ed surgery were higher in the visceral obesity group than in the non-visceral obesity group. We found no significant differences in age, albumin level, hemoglobin count, American Society of Anesthesiologists (ASA) stage, Nutritional Risk Screening (NRS) 2002 score, Charlson comorbidity index, tumor location, TNM stage, lymphatic invasion, and laparoscopy-assisted surgery between the two groups. The postoperative complication rate was significantly higher in the visceral obesity group than in the non-visceral obesity group (35.9% vs . 19% , P=0.033). A multivariate Logistic regression analysis revealed that visceral obesity [odds ratio (OR)=2.732, P=0.019] and NRS 2002 scores of≥3 (OR=2.574, P=0.042) were independent risk factors for postoperative complications. Conclusions:Visceral obesity was an independent risk factor for complications after surgery for mid-low rectal cancers.
ABSTRACT
OBJECTIVE: To analyze the risk factors and relationship between intestinal flora imbalance and anastomotic leakage after laparoscopic rectal cancer lower anterior resection(LAR)in patients with middle-low rectal cancer.METHODS: Clinical data of 155 patients with mid to low rectal cancer who underwent laparoscopic lower anterior resection at Peking Union Medical College Hospital from November 2016 to April 2019 were retrospectively analyzed.Postoperative intestinal flora imbalance and anastomotic leakage were evaluated,and statistical results were gained.RESULTS: Of the 155 patients,34(21.9%)patients had postoperative intestinal flora imbalance. Twenty patients of anastomotic leakage after operation(12.9%)were discovered,and 18 patients(11.6%)had both anastomotic leakage and intestinal flora imbalance. Univariate and multivariate logic regression analysis showed that intestinal flora imbalance(χ~2=25.674,OR=90.398,P0.05).CONCLUSION: The early diagnosis of postoperative intestinal floraimbalance in rectal cancer patients depends more on clinical experience. Intestinal floraimbalance,the enlargement of tumor diameterare risk factors for anastomotic leakage,and protective enterostomy would reduce the incidence of anastomotic leakage.
ABSTRACT
Background and purpose:Anastomotic leakage and low anterior resection syndrome(LARS) are both common complications in dual-anastomosis for patients with low rectal cancer. The aim of this study was to observe and explore the signiifcance and role of vertical cutting of the closed distal rectum in dual-anastomosis for patients with low rectal cancer.Methods:A total number of 120 patients with mid-low rectal cancer who admitted to and completed laparoscopic rectal cancer resection in the Department of General Surgery, the First Afifliated Hospital of Soochow University from Feb. 2010 to Jun. 2014 were pair-matched into Groups A and B based on their gender,age, tumor size, the distance of lower edge to the dentate line and tumor staging, etc. For the 55 patients in Group A (observation group), the rectum distal end was closed vertically instead of horizontally while disposing “the ifrst intestinal anastomosis”, intestine-intestine anastomosis was conducted in an “end-corner” approach when dealing with “the second intestinal anastomosis”, upper corner (“dog ear”) of the closed line in the distal end of the rectum was removed, the lower corner (“dog ear”) of the closed line in the distal end of the rectum was removed using vascular occlusion clamp method, and the T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. For the 65 patients in Group B (control group), laparoscopic dual anastomosis was conducted using conventional method, and the two “dog-ears” and “dangerous triangles” were kept without any treatment. The clinical outcomes of the two groups of patients were analyzed retrospectively. Results:In group A, It was convenient to complete the operation when the “dog ears” and “dangerous triangle” on the vertical line after cutting the closed distal rectum vertically by “end-corner” anastomosis. The axis of intestine formed a certain angle making the closed distal rectum into “ampulla” sample without “dog ears”. the “dangerous triangle” were strengthened with absorbable suture. In group B, The distal and proximal intestine located on the same axis after intestine-intestine anastomosis leaving two “dog ears” and a “dangerous triangle”. The general clinical data of patients in the two groups were comparable and not signiifcantly different (P>0.05). The two groups of patients showed no signiifcant differences in blood loss, postoperative drainage, postoperative anastomotic bleeding, anal exhaust time, and length of hospital stay (P>0.05). However, the operation time as well as the numbers of anastomotic ifstula occurrence, defecation, tenesmus and post-operation re-ostomy differed significantly (P<0.05).Conclusion:Vertical cutting of the closed distal rectum with dual anastomosis made the “new” intestine closer to the physiological bending and morphology of the rectum, meanwhile, it simpliifed the approach of removing “dog ear” and strengthening “dangerous triangle”, ifnally it signiifcantly reduced the incidence of post-surgical complications.