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Objective To compare the clinical efficacy and short-term prognosis of laparoscopic radical resection of right colon cancer guided by superior mesenteric artery and superior mesenteric vein.Methods 80 patients with right colon cancer of cT2-4 and/or N0-2M0 admitted from January 2020 to October 2022 were selected as the research objects,and they were randomly divided into observation group and control group,with 40 patients in each group.The observation group was treated with SMA-oriented laparoscopic radical resection of right colon cancer,while the control group was treated with SMV-oriented laparoscopic radical resection of right colon cancer.The curative effect and prognosis of the two groups were compared.Results There was no significant difference between the two groups in general condition,operation time,gastric tube placement time,recovery time of farting,postoperative fasting time,postoperative drainage time,postoperative nutritional index,total incidence of complications and postoperative hospitalization time(P>0.05).The lymph nodes in the observation group were significantly more than those in the control group,and the difference was statistically significant(P<0.05).In the observation group,the lymph nodes in the anterior and left side of superior mesenteric artery were examined(No.D3),and 273 lymph nodes were detected,and Seven patients(17.5% )were diagnosed with D3 metastasis,and 13 lymph nodes were positive(5.2% ).Conclusion Laparoscopic radical resection of right colon cancer guided by superior mesenteric artery,without increasing the incidence of complications and high safety,can more thoroughly clean lymph nodes and reduce tumor recurrence,which is expected to significantly improve the prognosis of patients.
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Objective To compare the effects of laparoscopic surgery with various approaches on intestinal barrier function,red blood cell immunity,and prognosis in patients with right hemicolectomized colon cancer.Methods A prospective selection of 110 patients with right hemicolectomized colon cancer admitted to our hospital from April 2019 to April 2021 was conducted.Patients were divided into groups A(n= 55)and B(n= 55)using a simple randomization method.During the treatment period,two cases of loss of follow-up occurred in Group A and three in Group B.Finally,53 from Group A and 52 participants from Group B completed the study.Both groups underwent laparoscopic surgery.Group A underwent a cephalic approach,whereas Group B underwent an intermediate approach.The periopera-tive indexes,complications,prognosis,intestinal barrier function(endotoxin,D-lactic acid,and diamine oxidase),red blood cell immune complex rate(RBC-ICR),RBC-C3b receptor rosette rate(RBC-C3bRR),and erythrocyte adhesion to tumor cell rosette rate(TRR)of the two groups were determinedd.Results Group A had less intraoperative bleeding,shorter central lymph node dissection time,shorter operative time,and lower complication rate(P＜0.05)than Group B.Endotoxin,diamine oxidase,and D-lactate levels in both groups were higher 3 d after surgery than before surgery(P＜0.05).Three days after surgery,the RBC-ICR of both groups was higher than before surgery,whereas the TRR and RBC-C3bRR were lower than before surgery(P＜0.05).After 1 year of follow-up,no statistically sig-nificant difference in distant metastasis,local recurrence,and survival rates were observed between the two groups(P＞0.05).Conclusion The two approaches used in this study have similar effects in right hemicolectomized colon cancer.The cephalic approach for laparoscopic sur-gery shortened the surgical time and reduced complications.
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Objective The aim of this study was to investigate the risk factors for delayed postoperative ileus(PPOI)in colon cancer patients undergoing complete laparoscopic right hemicolectomy combined with intraperitoneal thermal perfusion chemotherapy(HIPEC),and establish a risk prediction model.Methods A retrospective analysis was performed on the case data of 68 colon canc-er patients who underwent complete laparoscopic right hemicolectomy combined with HIPEC at the Department of General Surgery,the First Medical Center of PLA General Hospital from January 2018 to January 2021.The incidence of PPOI was statistically analyzed,and its risk factors were analyzed.A nomogram of risk prediction model was constructed and the effectiveness was verified.Results Among the 83 patients,26 cases(31.3％)developed PPOI.Multivariate logistic regression analysis showed that diabetes(OR=14.820,95％CI:2.819-77.918),previous abdominal surgery(OR=6.514,95％CI:1.433-29.604),preoperative Hb＜9 g/L(OR=5.338,95％CI:1.197-23.809),intraoperative hemorrhage more than 200 mL(OR=4.869,95％CI:1.213-19.544),and not close the mesangial hiatal(OR=5.462,95％CI:1.408-21.186)were the risk factors for PPOI.Based on the results of multiva-riate analysis,a risk prediction model for ROC curve and PPOI nomogram was constructed.The internal validation consistency index(C-index)was 0.85(95％CI:0.735-0.957).Conclusion The risk factors for PPOI after complete laparoscopic right hemicolec-tomy combined with HIPEC are diabetes,previous abdominal surgery,preoperative Hb＜9 g/L,intraoperative hemorrhage more than 200 mL,and failure to close the mesangial hiatal.The constructed nomogram of risk prediction model for PPOI after complete laparo-scopic right hemicolectomy has a good evaluating effect and clinical application value.
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OBJECTIVE@#To explore the clinical value of three-dimensional (3D) visualization technique in laparoscopic D3 radical resection of right colon cancer.@*METHODS@#We retrospectively analyzed the clinical data of 73 patients with right colon cancer undergoing laparoscopic D3 radical operation in our hospital between May, 2019 and March, 2021. Among these patients, 41 underwent enhanced CT examination with 3D visualization reconstruction to guide the actual operation, and 32 underwent enhanced CT examination only before the operation (control group). In 3D visualization group, we examined the coincidence rate between the 3D visualization model and the findings in surgical exploration of the anatomy and variations of the main blood vessels, supplying vessels of the tumor, and the tumor location, and the coincidence rate between the actual surgical plan for D3 radical resection of right colon cancer and the plan formulated based on the 3D model. The operative time, estimated blood loss, unexpected injury of blood vessels, number of harvested lymph nodes, mean time of the first flatus, complications, postoperative hospital stay and postoperative drainage volume were compared between the two groups.@*RESULTS@#The operative time was significantly shorter in 3D visualization group than in the control group (P < 0.05). The volume of blood loss, proportion of unexpected injury of blood vessel, the number of harvested lymph nodes, time of the first flatus, proportion of complications, postoperative hospital stay and postoperative drainage volume did not differ significantly between the two groups (P > 0.05). In the 3D visualization group, the 3D visualization model clearly displayed the shape and direction of the colon, the location of the tumor, the anatomy and variation of the main blood vessels and the blood vessels supplying the cancer, and showed a coincidence rate of 100% with the findings by surgical exploration. The surgical plan for D3 radical resection of right colon cancer was formulated based on the 3D model also showed a coincidence rate of 100% with the actual surgical plan.@*CONCLUSION@#The 3D visualization reconstruction technique allows clear visualization the supplying arteries of the tumor and their variations to improve the efficiency, safety and accuracy of laparoscopic D3 radical resection of right colon cancer.
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Humanos , Neoplasias do Colo/cirurgia , Flatulência/cirurgia , Imageamento Tridimensional , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objective: To investigate the short-term clinical efficacy and complications of laparoscopic radical right hemicolectomy via the head-tail and medial approaches. Methods: Clinical data of 91 patients admitted for laparoscopic radical right hemicolectomy at Affiliated Hospital of Xuzhou Medical University between January 2015 and December 2019 were retrospectively analyzed. Of those patients, 50 and 41 patients underwent laparoscopic radical right hemicolectomy via the head-tail and medial approaches, respectively. According to the clinical indicators such as operation time, amount of intraoperative blood loss, rate of injury of Henle trunk and its branches (an indicator of conversion to laparotomy), number of lymph nodes dissected, number of positive lymph nodes, postoperative intestinal function recovery time, postoperative abdominal drainage tube removal time, postoperative hospitalization time, and postoperative complications, the potential advantages of laparoscopic radical right hemicolectomy via the head-tail approach were evaluated and analyzed. Results: The operation time was significantly shorter [180 (150-188) min vs. 210 (180-255) min, P0.05). Conclusions: Compared with the commonly used medial approach in clinical practice, laparoscopic radical right hemicolectomy via the head-tail approach showed obvious improvement with respect to operative time, amount of intraoperative blood loss, and the injury rate of Henle trunk and its branches. Thus, the head-tail approach had higher operative safety and is thus worthy of further clinical application.
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Objective To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected.There were 33 males and 17 females,aged from 33 to 86 years,with an average age of 63 years.All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment.The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction.Observation indicators:(1) anatomical type of Henle trunk;(2) the length of Henle trunk and surgical trunk;(3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA).Measurement data with normal distribution were represented as Mean±SD,and count data were represented as absolute numbers.Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images.Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.Bland-Ahman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.Results (1) Anatomical type of Henle trunk:on the 2D coronal images,43 of 50 patients had the Henle trunk and 7 had no Henle trunk.On the 3D vascular reconstructed images,44 of 50 patients had the Henle trunk and 6 had no Henle trunk.There were 2,21,17,3 patients classified as type 0,Ⅰ,Ⅱ,Ⅲ of Henle trunk on the 2D coronal images of 43 patients.There were 6,19,16,3 patients classified as type 0,Ⅰ,Ⅱ,Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients.Six patients with no Henle trunk,2 in type 0,18 in type Ⅰ,15 in type Ⅱ,and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images.The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ =0.830,95％ confidence interval:0.705-0.956,P＜0.05).(2) The length of Henle trunk and surgical trunk:on the 2D coronal images,43 of 50 patients had the length of Henle trunk as (10±5)mm,and 42 of 50 patients had the length of surgical trunk as (34± 12)mm.On the 3D vascular reconstructed images,44 of 50 patients had the length of Henle trunk as (9±5)mm,and 43 of 50 patients had the length of surgical truck as (35± 12)mm.The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872,0.979,P＜0.05).Bland-Altman plot showed a high consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images (P＜0.05).(3) The positional relationship between ICV and ICA:on the 2D coronal images,24 of 50 patients had anterior crossing between ICV and ICA,26 had posterior crossing between ICV and ICA.On the 3D vascular reconstructed images,24 of 50 patients had anterior crossing between ICV and ICA,26 had posterior crossing between ICV and ICA.There was a complete consistency in the positional relationship between ICV and ICA on the 2D coronal images and on 3D vascular reconstructed images.Conclusion Abdominal enhanced CT coronal imaging and 3D vascular reconstruction have the similar evaluation effects for position of critical blood vessels in right colon cancer,with a good consistency.
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Objective@#To compare the evaluation effects of abdominal enhanced computed tomography (CT) coronal imaging versus three-dimensional (3D) vascular reconstruction for critical blood vessels in right colon cancer.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with right colon cancer who were admitted to Changhai Hospital Affiliated to Naval Medical University from January to September in 2018 were collected. There were 33 males and 17 females, aged from 33 to 86 years, with an average age of 63 years. All the 50 patients underwent abdominal multi-slice CT examination on the same CT equipment. The CT examination data were analyzed by two-dimensional (2D) coronal imaging and 3D vascular reconstruction. Observation indicators: (1) anatomical type of Henle trunk; (2) the length of Henle trunk and surgical trunk; (3) the positional relationship between ileocolic vein (ICV) and ileocolic artery (ICA). Measurement data with normal distribution were represented as Mean±SD, and count data were represented as absolute numbers. Kappa coefficients were used to measure the consistency between anatomical types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images. Pearson coefficients were used to evaluate the correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images. Bland-Altman method was used to assess the consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images.@*Results@#(1) Anatomical type of Henle trunk: on the 2D coronal images, 43 of 50 patients had the Henle trunk and 7 had no Henle trunk. On the 3D vascular reconstructed images, 44 of 50 patients had the Henle trunk and 6 had no Henle trunk. There were 2, 21, 17, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 2D coronal images of 43 patients. There were 6, 19, 16, 3 patients classified as type 0, Ⅰ, Ⅱ, Ⅲ of Henle trunk on the 3D vascular reconstructed images of 44 patients. Six patients with no Henle trunk, 2 in type 0, 18 in type Ⅰ, 15 in type Ⅱ, and 3 in type Ⅲ had the same anatomical type of Henle trunk on the 2D and 3D images. The consistency between anatomic types of Henle trunk on 2D coronal images and on 3D vascular reconstructed images was high (κ=0.830, 95% confidence interval: 0.705-0.956, P<0.05). (2) The length of Henle trunk and surgical trunk: on the 2D coronal images, 43 of 50 patients had the length of Henle trunk as (10±5)mm, and 42 of 50 patients had the length of surgical trunk as (34±12)mm. On the 3D vascular reconstructed images, 44 of 50 patients had the length of Henle trunk as (9±5)mm, and 43 of 50 patients had the length of surgical truck as (35±12)mm. The correlation between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images was positive (r=0.872, 0.979, P<0.05). Bland-Altman plot showed a high consistency between the length of Henle trunk and surgical trunk on 2D coronal images and on 3D vascular reconstructed images (P<0.05). (3) The positional relationship between ICV and ICA: on the 2D coronal images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. On the 3D vascular reconstructed images, 24 of 50 patients had anterior crossing between ICV and ICA, 26 had posterior crossing between ICV and ICA. There was a complete consistency in the positional relationship between ICV and ICA on the 2D coronal images and on 3D vascular reconstructed images.@*Conclusion@#Abdominal enhanced CT coronal imaging and 3D vascular reconstruction have the similar evaluation effects for position of critical blood vessels in right colon cancer, with a good consistency.
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Right colon cancer is a kind of clinically common colorectal cancer.Surgical resection is the main treatment and the only curative method for patients.Improvement of surgical methods in recent years is one of the hotspots in the surgical treatment of colorectal cancer.There are controversies in laparoscopic surgery or traditional open surgery,intestine resection extent,D3 radical surgery or complete mesocolic excision,selective arterial guidance or venous guidance,pyloric lymph nodes (No.6 group lymph nodes) dissection,and most of the issues are currently lacking of prospectively randomized controlled trials.Therefore,this article discusses the above problems.At the same time,in view of the complicated operation of right hemicolectomy,and the greater risk of surgery,the author consulted the relevant literature and combined his clinical experience to introduce the key techniques of the operation.
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Objective To investigate the clinical efficacy of Da Vinci robot-assisted radical resection for right colon cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 85 patients with right colon cancer who were admitted to the First Hospital Affiliated to Army Medical University from August 2013 to February 2019 were collected.There were 56 males and 29 females,aged from 29 to 84 years,with an average age of 60 years.All patients underwent Da Vinci robot-assisted radical resection of right colon cancer,named right hemicolon D3 + complete mesocolic excision,and received infection prevention and total parenteral nutrition treatment after surgery.According to clinical pathological staging of guideline issued by National Comprehensive Cancer Network,patients underwent postoperative chemotherapy within 1 year after surgery.Observation indicators:(1) treatment status;(2) postoperative pathological examination;(3) follow-up.Follow-up was conducted using outpatient examination,telephone interview and mail every 3 months within 1 year after surgery,every 6 months from 1 to 3 years after surgery,and once a year from 3 to 5 years after surgery up to March 2019.The postoperative tumor metastasis and survival of patients were obtained.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were expressed as absolute number.Survival rates were calculated using life-table method.Results (1) Treatment status:85 patients underwent Da Vinci robot-assisted right hemicolon D3 + complete mesocolic excision successfully.The operation time,volume of intraoperative blood loss,time for postoperative outof-bed activities,time to recovery of gastrointestinal function,time to liquid diet intake were (178±28) minutes,(85±33) mL,(2.9± 1.8) days,(3.1 ± 2.7) days,(3.9± 1.9) days,respectively.There was no perioperative death.Eleven patients had postoperative complications including 5 of anastomotic leakage,2 of anastomotic bleeding,2 of pulmonary infection,1 of gastric emptying disorder and 1 of incomplete intestinal obstruction;they were cured and discharged after conservative treatment.All the 85 patients received postoperative infection prevention and total parenteral nutrition support,including 64 receiving systemic intravenous chemotherapy with 6 -8 cycles of FOLFOX or XELOX,7 receiving 6-8 cycles of oral capecitabine,and 14 receiving no chemotherapy.(2) Postoperative pathological examination:the number of harvested lymph nodes was 20± 11 and 25 had lymph node metastasis.The length of proximal and distal cutting edge of the specimens was (16±5) cm and (9±5)cm,respectively.There was no cancerous cell on the cutting edge.High-differentiated adenocarcinoma,moderatedifferentiated adenocarcinoma,moderate-differentiated tubular adenocarcinoma,low-differentiated adenocarcinoma,mucinous adenocarcinoma,tubular combined with mucinous adenocarcinoma were detected in 2,40,14,16,9,4 patients,respectively.There were 8,28,24,5,12,8 patients in Ⅰ stage,Ⅱ A stage,Ⅱ B stage,Ⅱ C stage,ⅢB stage,Ⅲ C stage of TNM staging,respectively.(3) Follow-up:85 patients were followed up for 1-67 months,with a median follow-up time of 19 months.During the follow-up,1 of 85 patients had liver metastasis at 14 months after surgery and had survived after radiofrequency ablation treatment up to the end of follow-up.Three cases died of abdominal tumor metastases,1 of which in Ⅱ C stage died at 32 months after surgery,1 in Ⅲ B stage died at 4 months after surgery and 1 in Ⅲ B stage died at 16 months after surgery.The 1-,3-year overall survival rates were 97.1％ and 94.0％,respectively.Conclusion Da Vinci robot-assisted radical resection of right colon cancer is safe and feasible,with good short-and long-term outcomes.
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Objective To investigate the application value of superior mesenteric artery (SMA)-oriented complete mesocolic excision (CME) in the treatment of right colon cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 955 patients with right colon cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to June 2018 were collected.There were 514 males and 441 females,aged from 18 to 96 years,with a median age of 65 years.Of the 955 patients,377 undergoing SMA-oriented CME of right colon with the lymph node dissection along the left boundary of SMA were allocated into SMA-oriented group,and 578 undergoing superior mesenteric vein (SMV)-oriented CME of right colon with the lymph node dissection along the left boundary of SMV were allocated into SMV-oriented group.Observation indicators:(1) intraoperative and postoperative conditions;(2) postoperative complications;(3) postoperative pathological examinations;(4) follow-up and survival situations.Follow-up was performed by telephone interview and outpatient examination once every 3-6 months within 2 years after surgery and once a year after 2 years up to January 2019,using tumor recurrence and metastasis or death as the end point.Follow-up included physical examination and tumor marker test,including carcino embryonic antigen,CA19-9,chest and abdomen CT examination and enteroscopy.Measurement data with skewed distribution were described as M (P25,P75),and comparison between groups was done using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi square test.Ordinal data were analyzed using the rank sum test.Kaplan-Meier method was used to calculate survival time and rate,and draw survival curve.Log-rank test was used for survival analysis.Patients with loss to follow-up were involved in survival analysis as censored data.Results (1) Intraoperative and postoperative conditions:the operation time,volume of intraoperative blood loss,duration of postoperative hospital stay were 100 minutes (90 minutes,110 minutes),50.0 mL (50.0 mL,70.0 mL),8 days (8 days,10 days) in the SMA-oriented group,and 110 minutes (90 minutes,135 minutes),50.0 mL (50.0 mL,122.5 mL),10 days (8 days,12 days) in the SMV-oriented group,showing significant differences between the two groups (Z=-5.400,-5.799,-7.461,P＜0.05).After the exclusion of 47 patients unsuitable for defecation analysis because of postoperative complications,365 in the SMA-oriented group and 543 in the SMV-oriented group were analyzed.The time to first defecation,the maximum number and the median number of daily defecation postoperatively were 5 days (3 days,5 days),2.0 (1.0,2.5),1.0 (1.0,1.0) in the SMA-oriented group,which showed no significant difference from 4 days (3 days,5 days),2.0 (1.0,3.0),1.0 (1.0,1.0) in the SMV-oriented group (Z=-1.622,-1.541,-1.024,P＞ 0.05).(2) Postoperative complications:cases with postoperative complications,cases with incisional liquefaction or infection,cases with anastomostic leakage,cases with delayed gastric emptying,cases with intra-abdominal bleeding,cases with complete or incomplete ileus,cases with anastomostic bleeding,cases with intra-abdominal infection,cases with disruption of wound,the number of death were 55,10,3,3,2,2,1,1,1,1 in the SMA-oriented group,which showed no significant difference from 83,30,13,4,3,8,3,6,2,3 in the SMV-oriented group,respectively (x2 =0.045,3.662,2.926,0.034,0.001,1.604,0.352,1.873,0.048,0.352,P＞0.05).There were 32 of 377 patients in the SMA-oriented group and 14 of 578 in the SMV-oriented group with chylous leakage,showing a significant difference between the two groups (x2 =18.312,P＜ 0.05).Patients with chylous leakage were improved after conservative treatment,without reoperation.Patients with other complications were improved after anti-infection,fluid infusion,and reoperation.Four of 955 patients died after surgery.(3) Postoperative pathological examinations:patients with stage Ⅰ,stage Ⅱ,and stage Ⅲ (pathological TNM staging),patients with high-differentiation,mid-differentiation,and low-differentiation (tumor differentiation degree),length of intestine specimen,number of positive lymph nodes,maximum tumor diameter,patients with cancer nodules,patients with vascular invasion,patients with perineural invasion were 57,174,146,30,174,173,23 cm (21 cm,26 cm),0 (0,2),5.0 cm (3.0 cm,6.0 cm),37,81,53 in the SMA-oriented group,which showed no difference from 66,280,232,33,303,242,23 cm (21 cm,25 cm),0 (0,2),5.0 cm (3.5 cm,6.0 cm),80,108,82 in the SMV-oriented group (Z=-1.020,-0.216,-0.243,-0.220,-0.814,x2=3.441,1.127,0.003,P＞0.05).The number of harvested lymph nodes was 22.0 (17.0,27.0) and 18.0 (15.0,22.0) in the SMA-oriented group and SMV-oriented group,respectively,with a significant difference between the two groups (Z=-7.800,P＜0.05).There were 202 patients extracted for further analysis.The number of harvested lymph nodes and harvested central lymph nodes was 25.0 (20.0,31.3),5.0 (3.0,8.0) of 166 patients in the SMA-oriented group,and 21.5 (18.0,28.8),1.5 (0,4.5) of 36 patients in the SMV-oriented group,respectively,showing significant differences between the two groups (Z =-1.995,-4.309,P＜0.05).(4) Follow-up and survival situations:840 of 955 patients including 346 in the SMA-oriented group and 494 in the SMV-oriented group were followed up for 1.0-73.2 months,with a median time of 31.5 months.SMA-oriented group had a higher 5-year overall survival rate than SMV-oriented group (91.8％ vs.84.9％,x2 =4.384,P＜0.05),but had no significant difference in the 5-year tumor-free survival rate compared with the SMV-oriented group (84.4％ vs.78.2％,x2=2.158,P＞0.05).Conclusion Compared with SMV-oriented CME of right colon,SMA-oriented CME of right colon is safe and feasible,with larger number of harvested lymph nodes,which can achieve complete lymph node dissection.
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OBJECTIVE: To investigate the feasibility and short-term outcomes of laparoscopic D3 lymphadenectomy along the left of SMA for right colon cancer.METHODS: The clinical data of 134 patients with right colon cancer admitted from June 2015 to March 2017 in Department of Gastrointestinal Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. A total of 57 patients received the laparoscopic D3 lymphadenectomy along the left of SMA and 77 patients received the laparoscopic D3 lymphadenectomy along the left of SMV.RESULTS: There was no statistical difference between the two groups in operation time,intra-operative blood loss,time of liquid intake and post-operative hospital stay,but the SMA group had a longer duration of tube drainage and larger total volume of drainage[(471.4±285.6)mL vs.(352.2±305.7)mL,(7.0±4.9)d vs.(5.7±2.0)d,P=0.02 和 P=0.03]. The SMA group harvested more lymph nodes than the SMV group(26.5±6.7 vs. 21.3±7.8,P<0.0001). However,the SMA group had a higher rate of post-operative complications(28.1% vs. 13.0%, P=0.04).CONCLUSION: Laparoscopic D3 lymphadenectomy along the left side of SMA for right colon cancer is feasible but had a higher rate of post-operative complications.
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Objective To evaluate the experience of laparoscopic complete mesocolic excision (CME) for right colon cancer.Methods 45 patients with right colon cancer underwent laparoscopic CME were selected as research subjects(laparoscopy group),and 40 patients with right colon cancer underwent open CME were selected as control group(open group).The clinical effects of the two groups were observed .Results All the 45 cases were successfully performed with laparoscopic CME and 40 specimens were evaluated pathologically as mesocolic plane surgery. The average time for passage of flatus in the laparoscopy group [(3.43 ±0.72)d] was less than that in the open group [(4.10 ±0.99)d,P =0.039,P <0.05].The average time of leaving bed [(3.39 ±0.66)d] in the laparoscopy group was significantly less than that in the open group [(4.20 ±0.79)d,P =0.005,P <0.05].The mean operative time of the laparoscopy group [(160.93 ±20.91)min] was longer than that of the open group [(103.00 ±24.29)min,P =0.000,P <0.05].The average number of total lymph nodes removed of the laparoscopy group [(23.16 ±8.21)] was higher than that of the open group [(19.06 ±7.48)],but the difference was not statistically significant between the two groups (P =0.102,P >0.05).The overall postoperative complication rate of the laparoscopy group was 13.33%,which was lower than 22.50% of the open group,but the difference was not statistically significant between the two groups(P =0.268,P >0.05).Conclusion Laparoscope complete mesocolic excision for right colon cancer is safe and feasible.
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Objective To compare the advantages and disadvantages of two approaches of laparoscopic radical resection for right colon cancer.Methods The data of 41 patients with right colon cancer in our hospital from March 2015 to December 2016 were analyzed retrospectively,who were randomly divided into the caudal-to-cranial group(n=23) and classical medial-to-lateral group(n=18) according to different approaches.The operation time,intraoperative blood loss,conversion rate,the number of lymph nodes dissection,hospital stay time and postoperative complications between two groups were compared.Results The operation time,intraoperative blood loss,the conversion rate of the caudal-to-cranial group were better than those of the classical medial-to-lateral group,the differences were significant(P<0.05).There was no significant difference in hospital stay time,the number of lymph nodes dissection and postoperative complications between two groups.Conclusion Laparoscopic radical resection for right colon cancer by caudal-to-cranial approach is easy to operate and dissect,it can shorten the operation time,decrease the intraoperative blood loss,which is worthy of clinical promotion.
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Objective To study the clinical implementation strategy analysis about fast track surgery ( FTS) used in right co-lon cancer radical.Methods 72 patients with right colon cancer laparoscopic treatment in our hospital from June , 2013 to Decem-ber, 2014 were randomly selected and divided into observation group ( n=36 ) and control group ( n =36 ) by numeric randomized method.Observation group adopted treatments based on FTS while control group treated with conventional laparoscopic radical prosta-tectomy.Stress reaction, operation time, intraoperative blood loss, exhaust time, defecation time, stop the infusion time, drainage a-mount and postoperative drainage tube root out time, postoperative hospital stay and postoperative complications of two groups were sta-tistically analyzed.Results Preoperative blood cortisol, fasting blood glucose, serum IL-6 and plasma CRP level of two groups, op-eration time and compare differences of 2 groups had no statistical significance (p>0.05).Postoperative 24 h blood cortisol, fasting blood glucose, serum IL-6 and plasma CRP level of two groups were higher than that of preoperative.Postoperative 24 h blood corti-sol, fasting blood glucose, serum IL-6 and plasma CRP level of observation group were lower than that of the control group, and the difference was statistically significant (p<0.05).In observation group, the exhaust time, defecation time, drainage tube root out time, stop infusion time and postoperative hospital stay of observation group were (43.62 ±8.21) h, (50.42 ±6.85) h, (5.51 ± 1.08), (4.12 ±0.85)d and (5.42 ±1.13)d respectively, which were shorter than the (56.65 ±8.26)h , (64.78 ±8.26) h, (9.53 ±4.13)d, (7.78 ±1.43) d and (10.62 ±2.14)d of the control group, and the difference was statistically significant (p <0.05).Rainage amount of observation group[(602.54 ±165.78) ml] was less than that of the control group[(1265.28 ±572.94) ml];And the total complications incidence of observation group (8.33%) was lower than that of the control group (25.00%), and the difference was statistically significant (p<0.05).Conclusion Implementation of laparoscopic treatment based on FTS used in right colon cancer radical can effectively promote patients recovery and reduce complications.thus it is worthy of clinical promotion use.
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Objective To compare the application value of laparoscopic-assisted radical resection of right colon cancer and open radical resection of right colon cancer. Methods Fifty-three patients receiving laparoscopic-assisted radical resection of right colon cancer were selected as the laparoscopy group and fifty-two patients receiving open radical re-section of right colon cancer were selected as the laparotomy group. The operative situation, postoperative functional re-covery situation, postoperative complications, postoperative local recurrence and metastasis situation of the two groups were compared. Results The laparoscopy group had less (shorter) intraoperative blood loss, intestinal exhaust time and length of hospital stay than the laparotomy group(P<0.01); The incidence of postoperative complications of the la-paroscopy group was 9.43%, which was significantly lower than the 30.77%of the laparotomy group(P<0.01);The local recurrence rate and metastasis rate of the laparoscopy group were 7.55% and 3.77%, which were not significantly dif-ferent from the 15.38%and 13.46%of the laparotomy group (P>0.05). Conclusion Compared to open radical resection of right colon cancer, laparoscopic-assisted radical resection of right colon cancer has the advantages of less intraoper-ative blood loss, faster recovery of bowel function, lower incidence of complications and shorter hospital stay, which is in line with radical treatment principles of tumor and worthy of clinical large-sample and long-term follow-up verifica-tion on surgical methods and effects.
RESUMO
PURPOSE: Early recovery of gastrointestinal motility is one of the main advantages of laparoscopic intestinal surgery. However, the reasons for this advantage are still not well known. To compare recovery of bowel motility after laparoscopic-assisted and open surgery for right colon cancer, we analyzed early clinical results, including both the gastric emptying time by using a Sitz-marker(TM) and the intraperitoneal temperature. METHODS: From January 1996 to December 1999, 80 curative right hemicolectomies, which were divided into a laparoscopic-assisted surgery group (LS) with 36 patients and an open surgery group (OS) with 44 patients, were prospectively, but not randomly, studied for recovery of bowel motility. Clinical results, such as the pain score, the time to gas passage, the time to resumption of meals the hospital stay and the gastric emptying time obtained by using a Sitz-markers(TM), were evaluated. At the beginning and the end of the operation, the intraperitoneal temperature was checked at three different points. RESULTS: In the LS and OS groups, the first flatus passed at the 3.0 and the 3.67 postoperative day (POD) and oral intake resumed at the 3.9 and the 5.2 POD, respectively (P0.05), 1.7 and 4.2 at the 3rd POD (P<0.05) and 0 and 1.1 at the 4th POD (P<0.05), respectively. No difference in intraperitoneal temperature was noted. CONCLUSIONS: We found earlier recovery of bowel function after laparoscopic surgery than after open surgery, but could not identify any relationship between bowel function and the possible parameter of intraperitoneal temperature.