Clavien-Dindo classification of complications after complete mesocolic excision in laparoscopic radical resection of right hemicolon cancer and analysis on its influencing factors / 中华胃肠外科杂志

Objective@#To investigate the Clavien-Dindo (CD) classification of complications after complete mesocolic excision (CME) in laparoscopic radical resection of right-sided hemicolon cancer and its influencing factors.@*Methods@#A retrospective case-control study was performed. Inclusion criteria: (1) the adenocarcinoma located at colon from cecum to hepatic flexure; (2) laparoscopic right hemicolectomy with CME was completed. Exclusion criteria: (1) patients had severe organ dysfunction before operation; (2) tumor invaded adjacent organs or developed distant organ metastasis; (3) emergency surgery; (4) failure of laparoscopic surgery, and conversion to laparotomy; (5) without complete clinical data. Finally, clinical data of 141 patients in our hospital form March 2015 to February 2019 were retrospectively analyzed. CD grading standard was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyse were used to analyze the factors that might affect the complications. Survival analysis was conducted by grouping the indicators with statistically significant difference in multivariate analysis. Kaplan-Meier method was used to draw the survival curve and log-rank test was used to analyze the difference.@*Results@#Of the 141 patients, 89 were male and 52 were female with mean age of (61.8±11.0) years. All the operations completed successfully. A total of 37 postoperative complications were developed in 26 (18.4%) patients had postoperative 37 cases of complications, mainly including 7 delayed incision healing, 6 diarrhea, and 5 respiratory dysfunction. According to CD classification standard, grade I, II, and IV a complication rates were 40.5% (15/37), 56.8% (21/37), and 2.7% (1/37) respectively. Univariate analysis showed that age ≥ 65 years (χ2=4.338, P=0.037), BMI ≥ 28 kg/m2 (χ2=5.971, P=0.015), and preoperative hemoglobin < 100 g/L (χ2=3.985, P=0.046) were risk factors of postoperative complications. Multivariate analysis testified that age ≥ 65 years (OR=7.991, 95%CI: 2.203 to 28.983, P=0.002) and body mass index (BMI) ≥ 28 kg/m2 (OR=4.231, 95%CI: 1.034 to 17.322, P=0.045) were independent risk factors for complications after laparoscopic CME surgery for right-sided hemicolon cancer. All the patients were followed up for median time of 24 (1-48) months. The log-rank test showed that there were no significant differences in the cumulative survival rate between patients of age < 65 years and age ≥ 65 years (χ2=0.986, P=0.321), and between those with BMI < 28 kg/m2 and BMI ≥ 28 kg/m2 (χ2=0.370, P=0.543).@*Conclusions@#The main complications after CME in laparoscopic radical resection of right hemicolon cancer are CD grade I and II. Elderly and obesity are independent risk factor for postoperative complications. Before the operation, reasonable preventive measures should be taken for the elderly and the obese in order to reduce postoperative complications.

Long-term outcomes of laparoscopic low anterior resection of rectal carcinoma with preservation of the left colic artery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the long-term outcomes of laparoscopic low anterior resection of rectal carcinoma with preservation of the left colic artery(LCA).</p><p><b>METHODS</b>Clinicopathological and follow-up data of 322 cases with rectal carcinoma undergoing laparoscopic low anterior resection in Department of General Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2007 to December 2011 were retrospectively analyzed. According to the different surgical methods of inferior mesenteric artery (IMA), cases were divided into the trial group (LCA preservation plus lymph nodes around IMA root dissection, 168 cases) and the control group(origin of IMA ligation, 154 cases). The 5-year rates of disease-free survival(DFS) and overall survival(OS) were compared between two groups.</p><p><b>RESULTS</b>There were no statistically significant differences in the baseline data between the two groups. The follow-up rate was 91.1%(153/168) during 5-60 months in the trial group, and 90.3%(139/154) during 6-60 months in the control group. The number of patients who developed death, local recurrence and metastasis were 49(32.0%), 9(5.9%) and 62(40.5%) in the trial group, and 44(31.7%), 9(6.5%) and 52(37.4%) in the control group, respectively, without significant differences(all P>0.05). The 5-year DFS and OS rates were 57.2% and 69.5% in the trial group, and 59.7% and 70.1% in the control group, and the differences were not significant between the two groups(all P>0.05). After stratification by TNM stage, the 5-year DFS rates of I( stage, II( stage and III( stage were 80.4%, 62.5% and 45.1% in the trial group, and 82.6%, 66.0% and 48.8% in the control group; the 5-year OS rates of I( stage, II( stage and III( stage were 90.2%, 76.2% and 56.7% in the trial group, and 94.4%, 74.3% and 60.5% in the control group, respectively, and the differences were not significant as well (all P>0.05).</p><p><b>CONCLUSION</b>The long-term outcomes after laparoscopic low anterior resection of rectal carcinoma with preservation of LCA and dissection of lymph nodes around root of IMA are comparable with ligation at origin of IMA.</p>

Clinical application of curved cutter stapler in laparoscopic anterior resection of low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To make a preliminary assessment of the feasibility of Endo GIATM Radial Reload with Tri-StapleTM Technology(Radial Reload) in laparoscopic anterior resection of low rectal cancer.</p><p><b>METHODS</b>Clinical data of 21 low rectal cancer patients undergoing laparoscopic anterior resection with the Radial Reload in our department between July 2014 and July 2015 were retrospectively analyzed.</p><p><b>RESULTS</b>All the rectums were achieved complete transection by the first stapler device firing and all the operations were performed successfully. No patient were converted to open surgery. The operative time ranged from 110.0 to 180.0(140.5±16.6) minutes, the blood loss ranged from 50.0 to 100.0(66.8±11.4) ml, and the distal resection margin ranged from 1.0 to 3.0(1.8±0.7) cm. Tumor cells were not discovered in all the postoperative pathological samples of distal resection margin. Among 21 cases, stage I( was found in 14 cases, stage II( in 4 cases and stage III( in 3 cases. There were no anastomotic bleeding and anastomotic leakage. There was no local recurrence and distant metastasis during a median follow-up of 6 months(1 to 13 months) postoperatively.</p><p><b>CONCLUSION</b>The application of Radial Reload in laparoscopic anterior resection of low rectal cancer is feasible with satisfactory efficacy.</p>

Efficacy analysis of laparoscopic curve resection for gastric gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of curved cutter stapler in laparoscopic curve resection for gastric gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>A retrospective clinical study was carried out with the clinical data of 19 cases of gastric GIST, who received laparoscopic curve resection with the curved cutter stapler during the period between January 2015 and December 2015 in Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University. Curved cutter stapler was used intraoperatively to run curve resection for stomach, at least 0.5 cm away from the tumor outer margin. If the curved cutter stapler could not completely cut off the gastric wall at first time, the linear cutter stapler would be used secondly to cut off the remaining gastric wall.</p><p><b>RESULTS</b>All the cases were successfully performed under laparoscopy, without conversion to open surgery and the occurrence of severe complications. Fourteen(73.7%) patients received complete transection by the first curved cutter stapler, the other 5(26.3%) cases accepted complete transection by the second linear cutter stapler. The operative time ranged from 50 to 100(71.8±12.7) minutes, the blood loss ranged from 20 to 50 (33.6±7.4) ml, the postoperative exhaust time ranged from 1 to 4 (2.4±0.9) days, the postoperative hospital stay ranged from 5 to 9(6.8±1.1) days. There was no patient suffered from incision infection, delayed gastric emptying, anastomotic leakage and anastomotic bleeding. The postoperative pathological examination confirmed that all the cases were GIST. The tumor length ranged from 1.5 to 5.5(2.9±1.1) cm, the resection margin ranged from 0.5 to 2.0(1.2±0.4) cm and all the patients had negative resection margins. Of the 19 cases, 8(42.1%) were classified as very low risk, 5(26.3%) as low risk, 5(26.3%) as moderate risk and 1(5.3%) as high risk according to the National Institute of Health classification. Six patients with moderate and high risk were treated with imatinib. In the follow-up time of 5 to 16 months(mean 10 months) after operation, no distant metastasis and local recurrence occurred in all the cases.</p><p><b>CONCLUSION</b>The application of curved cutter stapler in laparoscopic curve resection for GIST is safe and feasible with good short-term efficacy.</p>

Changes of sex hormone levels and sexual function in male patients after liver transplantation / 中华普通外科杂志

ObjectiveTo investigate changes of sex hormone levels and sexual function in male patients after liver transplantation.MethodsBlood samples were taken from 69 male patients receiving liver transplantation pretransplantation and postoperative 3rd,7th,14th day,1st and 3rd month respectively.Serum estradiol and testosterone were measured by radioimmunoassay.Serum sex hormone binding globulin was measured by ELISA.Sixty-nine discharged adult male liver transplant recipients ( age ranging 24 -45 years) with a normally functioning allograft for at least 6 months were questioned on their pre-and post-operativesexualfunction compared with 23adulthealthy controls.ResultsPretransplantation serum estradiol and sex hormone binding globulin were significantly higher (87.56±31.21 vs.26.00 ±9.12,u=9.30,P＜0.0001,134.50±30.68 vs.51.04 ±12.05,u=12.69,P ＜ 0.0001,respectively),and testosterone was lower than normal controls (2.02 ± 1.28 vs.4.82 ± 1.48,u =-8.73,P ＜0.0001 ) and levels were correlated with MELD scores (r =0.80,P ＜0.0001,r =-0.77,P ＜0.0001,r =0.72,P ＜0.0001,respectively).Sex hormone levels were back to normal on postoperative 2nd week (serum estradiol) or 1st month (serum testosterone and sex hormone binding globulin).Compared with pretransplant status,sexual function improved significantly when evaluated on postoperative 6th month.ConclusionsLevels of serum sex hormone were correlated with MELD scores before liver transplant.After liver transplant,estradiol was back to normal level on postoperative 2nd week,testosterone and sex hormone binding globulin back to normal level on postoperative 1 st month.Sexual function significantly improves after liver transplantation.

ADV-TK gene inhibits recurrence and metastasis of hepatocellular carcinoma after curative resection in a nude mouse model / 中华普通外科杂志

Objective To evaluate the effect of ADV-TK gene in its inhibition of the recurrence and metastasis of hepatocellular carcinoma after curative resection in a nude mouse model. Methods In the two experimental groups, GFP-labelled ADV-TK gene transfection was determined 24 h after injection in one-each mouse. Nude mice with inplanted intrahepatic hepatocellular carcinoma underwent curative tumor resection, in the end of the operation ADV-TK gene was injected in incisional margin (11 mice) or retroperitoneally (11 mice). Ganciclovir at a dosage of 50 μg/10 g bw was given in the next day after resection. Mice in control group did not receive ADV-TK gene injection. After six weeks, mice were sacrificed. Results 1. It was showed that organs were all transfected by ADV-TK gene.2. Compared with the control group in which the recurrent tumor number of (8.7±6.5) ,tumor volume of (2933±597) mm3, and recurrence involved liver lobes of (4.3±2.2), that was (0.0±0.0), (0.0±0.0) mm3, and (0.0±0.0)(X2 = 3.05 all P<0.01) in incisional margin gene injection group, and (2.2±1.3), (265±109) mm3, and (2.1±1.3) (X2= 5.32, all P<0.01 ) respectively in intraperitoneally gene injection group.3. Compared with the control group in which the lung metastasis rate of (10/10)、number of distant organ involved by metastasis of (7.2±5.3 ), and serum AFP level of (1322±702), that was (2/10) , (3.2±1.5) and (322±102), (X2=4.33, all P<0.01) in incisional margin group, and ( 1/10)、( 1.8±1.2 ), and (268±133 ) ( X2=7.15, all P<0.01 ) in retroperitoneal group, respectively. Conclusions ADV-TK gene inhibits recurrence and metastasis of HCC after curative resection in this nude mouse model.

Application of Laparoscopic Ultrasonography in Hepatobiliary Surgeries / 中国微创外科杂志

Objective To analyze the clinical value of laparoscopic ultrasonography (LUS) in laparoscopic hepatobiliary surgeries. Methods A total of 156 cases of laparoscopic hepatectomy, hepatic abscess fenestration, and complicated cholecystectomy were analyzed. LUS was used during all the 156 operations; the anatomy and stage of the tumors were investigated. Results In 19 cases of hepatectomy and 39 cases of hepatic abscess fenestration, the direction of critical intrahepatic and extrahepatic ducts were indicated by using LUS, and the operations were performed under the guidance of LUS. Moreover, in 15 cases of complicated cholecystectomy, the tumor was precisely located and further distinguished by LUS. Conclusions Laparoscopic ultrasonography can precisely locate the tumor, guide the treatment, and resolve the problem of reduced feedback in touching for surgeons during laparoscopic hepatobiliary surgeries. It is of value to improve the operative outcomes.