A randomized clinical trial comparing the initial vascular approach to the inferior mesenteric vein versus the inferior mesenteric artery in laparoscopic surgery of rectal cancer and sigmoid colon cancer.

BACKGROUND: The inferior mesenteric artery approach with a selective lateral splenic flexure mobilization is the most widely used initial step in laparoscopic rectal and left colon surgery. Surgery started through the inferior mesenteric vein (IMV) with systematic medial mobilization (MM) has some theoretical advantages that have never been analyzed in a clinical trial. The aim of this study was to compare the two techniques with regards to surgical technique variables (conversion, surgical time, bleeding, morbidity, and mortality) and pathological outcomes. METHODS: A single-blinded, randomized, controlled trial of patients operated electively by laparoscopic with curative intention for rectal or sigmoid cancer was performed at a single, specialized colorectal surgery department from April 2016 to October 2017. RESULTS: 49 patients were included in each group. There were no statistical differences in patient demographics between the two approaches. Pathological outcomes did not differ between the two groups. Intra-operative characteristics showed a higher conversion rate in patients in which the inferior mesenteric artery was dissected first (p = 0.031). The artery approach also increased intra-operative bleeding (p = 0.049), but there were no differences regarding operative time. On multivariate analysis, the artery approach was associated with a higher risk of conversion (OR 8.68; p = 0.050). Post-operatory complications did not differ between artery and vein dissection. CONCLUSIONS: In our study, the initial approach by the IMV with a systematic MM of the splenic flexure has allowed us to reduce the conversion rate without increasing complications or the surgical time. No differences were observed in the pathological results. Both approaches seem to be safe and effective and well-trained laparoscopic surgeons should have the two techniques available to them for use as needed.

Video-assisted surgery in gastric cancer.

INTRODUCTION: The present study presents the initial results of the use of video-assisted surgery in the curative intent treatment of gastric cancer in a specialised unit of esophago-gastric pathology. METHODS: Since December 2002 we have substituted laparotomy for video-assisted surgery for the surgical treatment of gastric cancer. We report our initial experience in 28 patients. In 20 we performed a total gastrectomy with Roux Y esophago-jejunum reconstruction. In another 8 cases we performed subtotal gastrectomy with Roux Y reconstruction. The anastomoses in total gastrectomy were performed with laparoscopy with the EEA head descending via the endo-esophageal route. The resected piece is extracted via minimum laparotomy. The associated complete lympadenectomy D2 was performed in the tumours of the gastric antrum and D1 plus the lymph node groups 7, 8, 9 and proximal 11 at the second level in the gastric body and fundus. RESULTS: The mean duration of intervention was 222 minutes and the mean blood loss was 185 ml. Mortality was 3.7% and morbidity was 19%. There was a reduction in post-operative analgesia requirements and the mean hospital stay was 11 days. CONCLUSIONS: Gastric resection and related lympadenectomy can be performed using video-assisted surgery in a manner that is as safe as conventional surgery and, further, has considerable advantages. The greater complexity requires that the surgical team is better trained in the use of the laparoscopy technique. In the few studies on the theme, there appears to be no oncological inconveniences associated with the technique.

Video-assisted surgery in gastric cancer

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Introduction. The present study presents the initialresults of the use of video-assisted surgery in thecurative intent treatment of gastric cancer in a specialisedunit of esophago-gastric pathology.Methods. Since December 2002 we have substitutedlaparotomy for video-assisted surgery for the surgicaltreatment of gastric cancer. We report our initialexperience in 28 patients. In 20 we performed a totalgastrectomy with Roux Y esophago-jejunum reconstruction.In another 8 cases we performed subtotalgastrectomy with Roux Y reconstruction. Theanastomoses in total gastrectomy were performedwith laparoscopy with the EEA head descendingvia the endo-esophageal route. The resected piece isextracted via minimum laparotomy. The associatedcomplete lympadenectomy D2 was performed inthe tumours of the gastric antrum and D1 plus thelymph node groups 7, 8, 9 and proximal 11 at thesecond level in the gastric body and fundus.Results. The mean duration of intervention was 222minutes and the mean blood loss was 185 ml. Mortalitywas 3.7% and morbidity was 19%. There was areduction in post-operative analgesia requirementsand the mean hospital stay was 11 days.Conclusions. Gastric resection and related lympadenectomycan be performed using video-assistedsurgery in a manner that is as safe as conventionalsurgery and, further, has considerable advantages.The greater complexity requires that the surgicalteam is better trained in the use of the laparoscopytechnique. In the few studies on the theme, thereappears to be no oncological inconveniences associatedwith the technique