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Objective:To investigate the incidence and influencing factors of anastomotic leakage after laparoscopic anterior resection for rectal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 804 patients with rectal cancer who were admitted to Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from January 2017 to December 2019 were collected. There were 521 male and 283 female, aged 63(range, 27-94)years. All 804 patients underwent laparoscopic anterior resection for rectal cancer. Observation indicators: (1) surgical situations; (2) incidence of postoperative anastomotic leakage; (3) follow-up; (4) influencing factors of postoperative anastomotic leakage; (5) subgroup analysis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribu-tion were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the chi-square test or independent sample t test. Factors with P≤0.2 in univariate analysis were included in multivariate Logistic regression analysis. Results:(1) Surgical situations. All 804 patients underwent laparoscopic radical resection of upper and middle rectal cancer successfully, with the operation time and volume of intraoperative blood loss as 135(range, 118-256)minutes and 30(range, 5-350)mL. All 804 patients completed end-to-end colon rectal anastomosis, including 287 patients with reinforced sutures at the anastomotic site, and 517 patients with routine anastomosis. (2) Incidence of postoperative anastomotic leakage. Of the 804 patients, 40 patients had postoperative anastomotic leakage, with the incidence rate as 4.98%(40/804). (3) Follow-up. All 804 patients were followed up for 32(range, 6-49)months. None of patient died during the perioperative period. (4) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that unreinforced suture at the anastomotic site was an independent risk factor for postoperative anastomotic leakage ( odds ratio=2.78, 95% confidence interval as 1.21-6.37, P<0.05). (5) Subgroup analysis. Of the 804 patients, 202 patients received neoadjuvant therapy and 602 patients did not receive neoadjuvant therapy. Of the 602 patients who did not receive neo-adjuvant therapy, cases with postoperative anastomotic leakage was 6 in the 253 patients with reinforced sutures, versus 21 in the 349 patients with routine sutures, showing a significant difference between them ( χ2=4.56, P<0.05). Conclusion:Unreinforced anastomosis at the anasto-motic site is an independent risk factor for anastomotic leakage after laparoscopic anterior rectal resection, especially for rectal cancer patients without neoadjuvant radiochemotherapy.
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Objective:To investigate the clinical efficacy of laparoscopic resection of retrorectal cystic lesions.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 58 patients undergoing laparoscopic resection of retrorectal cystic lesions in the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from August 2012 to August 2019 were collected. There were 5 males and 53 females, aged from 15 to 70 years, with a median age of 38 years. All the 58 patients underwent laparoscopic resection of retrorectal cystic lesions and the combined operation through the transsacral approach was chosen according to the patient condition. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative histopathological examination; (4) follow-up. Patients were followed up regularly using outpatient examination once every 6 months during the first postoperative year and once every 12 months after the first postoperative year. The recurrence of cysts was evaluated by computed tomography or magnetic resonance imaging examinations during the follow-up up to August 2020. Measurement data with normal distribution were represented as Mean± SD and measurement data with skewed distribution were described as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations: of the 58 patients, 54 cases underwent laparoscopic resection of retrorectal cystic lesions and 4 cases underwent laparoscopic resection of retrorectal cystic lesions combined with the transsacral approach operation. One of the 58 patients who had a huge cyst surrounding the rectum underwent transverse colostomy after repairing the damage of separated posterior wall of rectum. Two cases underwent preventive transverse colostomy because the external rectal wall heat injury could not be excluded after separation of the tight adhesion between cyst and rectum. The operation time and volume of intraoperative blood loss were (123±56)minutes, 20 mL(range, 5?500 mL) of 54 cases who underwent laparoscopic resection of retrorectal cystic lesions and (232±38)minutes, 90 mL(range, 30?800 mL) of 4 cases who underwent laparoscopic resection of retrorectal cystic lesions combined with the transsacral approach operation, respectively. (2) Postoperative situations: 7 of the 58 patients had complica-tions. Of the 7 patients, 2 cases had postoperative rectal fistula and were cured after the treatment of transverse colostomy combined with pelvic drainage, 2 cases had postoperative urinary tract infection and were relieved after anti-infection treatment, 2 cases had urinary retention after removal of catheter and were recovered after 3 weeks of re-indwelling catheter, and 1 case had poor incision healing of transsacral and was healed after wound dressing change. The duration of postoperative hospital stay of the 58 patients was (7±4)days. (3) Postoperative histopathological examination: results of the postoperative histopathological examination showed that there were 26 of 58 patients with epidermoid cyst, 20 patients with teratoma (2 cases with mature teratoma accompanied by mucinous adenocarcinoma and 1 case with mature teratoma accompanied by neuroendocrine carcinoma), 10 patients with dermoid cyst, and 2 patients with tailgut cyst. (4) Follow-up: 57 of the 58 patients were followed up for 2-85 months, with a median follow-up time of 51 months. Of the 57 patients who were followed up, 1 patient was diagnosed with buttock subcutaneous cyst at postoperative 8 months and treated with local excision, 1 patient was diagnosed with a small presacral cyst recurrence by pelvic magnetic resonance imaging at postoperative 6 months and continued follow-up as the cyst without obvious enlargement, and the other 55 patients had no cyst recurrence.Conclusion:The laparoscopic resection of retrorectal cystic lesions is safe and feasible.
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Objective To summarize and analyze our experiences uponperforming laparoscopic resection ofpresacral cysts,at the aim of generalizing the minimally invasive surgery in the treatment of this disease.Methods The clinical data of 33 patients with presacral cysts treated by laparoscopy in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from November 2012 to June 2017 were retrospectively analyzed.The operation time, the incidence of intraoperative and postoperative complications and the length of hospital stay were counted.Results Tumor excision was completed according to the plan without conversion to open surgery.The average operation time was ( 124.4 ± 63.0) minutes.There were 1 case of rectal injury and 1 case of presacral venous plexus hemorrhage.The complications were 6%.Postoperative rectal leakage occurred in 2 cases ( 6%).The average hospitalization time after operation was ( 6.7 ± 4.3) days.Of 33 cases, 2 cases were lost.One case had recurrence of presacral cyst one year after operation.Conclusion Laparoscopic resection of presacral cysts is technically feasible,and helps to improve intraoperative exposure,increase operating space and improve the resection rate of tumors.
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Objective To assess the effect of preoperative enteral nutrition on malignant digestive tumors patients with nutritional risk.Methods A prospective clinical study was conducted on 73 malignant digestive tumors patients who were admitted in Department of General Surgery,Peking Union Medical College Hospital from January to June in 2015.Seventy-three patients were screened preoperatively by NRS 2002 and then divided into two groups:enteral nutrition group (n =31) and control group (n =42).Patients in enteral nutrition group were given oral or tube feeding elemental diet for 7-10 days before operation.Patients in control group ate normally.Both patients were given intravenous nutritional support postoperatively.The data of body weight,body mass index,blood total protein,albumin,pre-albumin and incidence of postoperative complications were compared on admission and before operation.Measured data were expressed as (x) ± s.The t-test was used to compare the indexes between groups.The paired t-test was used for comparison between admission and before surgery;the count data were expressed as frequency and percentage (％),comparison between groups use Chi-square test or Fisher's exact probability method.Results The nutritional status including body weight,body mass index,blood total protein,albumin and pre-albumin were significantly improved pre-operatively in enteral nutrition group (P ＜ 0.05),and postoperative complications including wound dehiscence,pneumonia and anatomotic leakage in enteral group were 9.68％,6.45％ and 3.23％ separately,which were less than that in control group (14.4％,11.9％ and 7.14％),however,the result was not significantly different (P ＞ 0.05).Conclusion Pre-operative enteral nutrition is safe and efficacy,which is helpful for malignant digestive tumors patients with nutritional risk.
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<p><b>OBJECTIVE</b>To investigate the feasibility of segmental pylorus-reservation gastrectomy in patients with early gastric cancer.</p><p><b>METHOD</b>A retrospective cohort study on clinical data of 6 patients strictly met the criteria of early gastric cancer locating in the middle of the stomach undergoing laparoscopic segmental gastrectomy from January 2014 to April 2016 at Department of General Surgery, Peking Union Medical College Hospital was carried out. Preoperative clinical staging revealed T1N0M0 for all the cases. One case received endoscopic mucosa resection(EMR) first, and postoperative pathology showed moderate differentiated adenocarcinoma invading substratum of mucosa, so a complementary laparoscopic segmental gastrectomy was performed. Surgical procedure was laparoscopic segmental gastrectomy with D1 or D2 lymph node dissection. Vagus nerve was not reserved during lymph node dissection in lesser curvature side. Number of resected lymph node, postoperative complication and long-term gastric function were observed.</p><p><b>RESULT</b>Of 6 cases, 3 were male and 3 were female with age ranging from 55 to 59 years old. The distal resection margin was (4.6±0.5) cm away from pylorus. The average number of resected lymph node was 18.3±7.5 without metastasis. Follow-up time was 1 to 29 months for all the 6 cases and no relapse or metastasis was found during the follow-up. In 4 cases with follow-up beyond 1 year, 3 cases had slight distension in superior belly after meal and dyspepsia; another one case had vomiting nocturnal occasionally. Gastroscope examination one year after operation found food residue in all the cases. Images indicated the decrease of stomach size in all the cases. Two cases had esophagogastric reflux. All the patients had delayed gastric emptying symptoms after operations and were relieved within one year.</p><p><b>CONCLUSIONS</b>It is technically feasible to perform laparoscopic segmental gastrectomy in patients with early gastric cancer. Whether vagus nerve should be reserved requires further investigation.</p>
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Female , Humans , Male , Middle Aged , Gastrectomy , Methods , Gastroesophageal Reflux , Epidemiology , Gastroparesis , Epidemiology , Laparoscopy , Methods , Lymph Node Excision , Methods , Neoplasm Staging , Postoperative Complications , Epidemiology , Retrospective Studies , Stomach Neoplasms , General Surgery , Treatment Outcome , Vagus Nerve , General Surgery , Vomiting , EpidemiologyABSTRACT
Objective To investigate the surgery-related complications and risk factors of ileocolic Crohn's disease (CD).Methods The retrospective case-control study was conducted.The clinicopathological data of 52 patients with ileocolic CD who underwent surgery at the Peking Union Medical College Hospital from January 2010 to April 2016 were collected.Observation indicators:(1) surgery-related complications,(2) risk factors analysis of surgery-related complications:gender,age of onset,preoperative body mass index (BMI),course of disease,smoking history,history of appendectomy,perianal lesions,oral ulcer,C-reactive protein (CRP),erythrocyte sedimentation rate,disease behavior,short crohn's disease activity index (sCDAI),preoperative amino salicylic acid therapy,preoperative hormone therapy,preoperative antituberculosis therapy,preoperative immunosuppressive agents therapy,preoperative biologic agents therapy,emergency operation,surgical method and ileocolic anastomosis method,(3) follow-up.The follow-up using outpatient examination and telephone interview was performed to detect recurrence of disease up to August 2016.Measurement data with normal distribution were represented as-x ± s.The univariate analysis was done using the chi-square test,and multivariate analysis was done using the Logistic regression model.Results (1) Surgery-related complications:of 52 patients,12 had postoperative complications.Four patients complicated with wound infection had good healing of the wound after debridement and dressing change.Of 4 patients with abdominal infection,3 were improved by anti-infection symptomatic treatment and 1 die of septic shock at postoperative day 1.One patient with intestinal obstruction had a smooth recovery after open adhesiolysis.One patient with intestinal fistula discharged from hospital due to a critical condition under families' requestion.One patient with acute cholecystitis and 1 with acute pancreatitis were respectively improved by conservative treatment.(2) Risk factors analysis of surgery-related complications:theresult of univariate analysis showed that sCDAI and emergency operation were the factors infecting surgery-relatedcomplications of ileocolic CD (x2 =6.299,8.494,P ＜ 0.05).The result of multivariate analysis showed that sCDAI was an independent factor infecting surgery-related complications of ileocolic CD [OR =2.716,95％ confidence interval (CI):1.216-6.066,P ＜ 0.05].(3) Follow-up:all the 52 patients were followed up for 5-76 months with a median time of 39 months.During the follow-up,15 had recurrence of diseases and then underwent medical treatment.Conclusions Patients with ileocolic CD are easily complicated with wound infection and abdominal infection in the active period,and sCDAI is an independent factor infecting surgery-related complications of ileocolic CD.
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Objective To investigate the therapeutic measures of unresectable primary liver cancer (PLC) with transcatheter arterial chemoembolization(TACE).Methods The clinical data,treatment measures and followed up data of 312 patients with unresectable primary liver cancer from January 1991 to March 2010 were analyzed retrospectively.Of these 312 patients, different dosages, measures of transcatheter arterial chemoembolization together with immunotherapy and nutritional support treatments were given to the patients according to their own statements, including the patency of portal vein (evaluated by portography), the range, blood supply and lipiodol concentration of the lesions (evaluated by hepatic arteriography), and the systemic conditions.Some of these patients also accepted cryotherapy, radio frequency ablation (RFA), percutaneous ethanol injection therapy.Results Two hundred and eighty-seven patients were followed up (92％).Forty-two cases accepted the two-stage operation as the lesions were localized or reduced.In these 42 patients, 34 cases accepted the hepatectomy, 8 cases accepted the cryotherapy.The 1,3 and 5 year survival rate of all patients were 87.6％, 33.1％ and 13.2％.Conclusion TACE for unresectable primary liver cancer should be used individually and comprehensivly.Surgical treatment should be taken once the lesions can be resected.
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<p><b>OBJECTIVE</b>To investigate the feasibility of laparoscopic approach for totally mesocolic resection and D3 lymphadenectomy in right colectomy.</p><p><b>METHODS</b>A retrospective study was conducted to analyze the operating time, blood loss, lymph node retrieval, postoperative complications and converting rate. The relationships of 3-year disease-free survival (DFS), 3-year overall survival (OS) to gender, age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), T-staging, N-staging and TNM classification were also analyzed by Kaplan-Meier surviving curve and Log-rank test.</p><p><b>RESULTS</b>A total of 111 patients were enrolled in present study. There were 50 male and 61 female patients. The average operating time was (168 ± 42) minutes, blood loss was (81 ± 63) ml, lymph node retrieval was (30 ± 12). The converting rate to open surgery was 1.8%. There was no death within 30 days after operation. The 3-year DFS and 3-year OS was 86.5% and 93.7% respectively. The short-term complications occurred in 17.1% of the patients, including diarrhea (7 cases), ileus (3 cases), urinary infection (3 cases), wound dehiscence (2 cases) and so on. With the T staging progress, DFS and OS in patients showed a gradual decline, but the difference did not reach statistical significance (P > 0.05). TNM classification had relation to DFS (χ(2) = 6.985, P = 0.030), while N-staging showed significant relations both to DFS and OS (χ(2) = 14.397, P = 0.001; χ(2) = 16.699, P = 0.000).</p><p><b>CONCLUSION</b>Laparascopic approach to right hemicolectomy with complete mesocolic resection and D3 lymphadenectomy is safe and has satisfied oncological outcome.</p>
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Aged , Female , Humans , Male , Middle Aged , Colectomy , Methods , Colonic Neoplasms , General Surgery , Disease-Free Survival , Laparoscopy , Lymph Node Excision , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To investigate the diagnosis,treatment and pathological characteristics of minute and small early gastric cancer(M EGC and S EGC).Methods The clinical and pathological parameters,and the diagnosis and treatment of 28 patients with M EGC or S EGC admitted to our hospital in recent 10 years were analysed retrospectively.Results There were 10 patients (12.4%) with M EGC,18( 22.2 %)with S EGC,and the proportion of M and S EGC in early GC is 34.6%.The diagnosis rate of gastric barium examination was 8.3% and that of gastroscopy with biopsy was 78.8%.All the carcinomas located in the body and antrum of the stomach.D1 radical gastrectomy(RGC) was performed on 6 patients and D2 RGC on the other 22 patients.The depth of tumor invasion in S EGC was significantly deeper than that in M EGC(P