ABSTRACT
Objective To evaluate the feasibility,safety,post-operative short and long-term outcomes of laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric carcinoma without serosal invasion.Method From May 2007 to May 2013,54 cases of advanced gastric antral cancer without serosal invasion underwent laparoscopic-assisted D2 radical distal gastrectomy (laparoscopic group),54 demographically and pathologically-matched cases undergoing open surgery served as control.The surgical risk,post-operative recovery and follow-up results were compared.Result Surgery was successful in all patients.The mean operation time in laparoscopic group and open group was (168 ± 31) mins and (157 ±20) min respectively,the difference was significant (t =2.237,P =0.027) ; Intra-operative blood loss was (151 ± 56) ml and (213 ± 86) ml (t =4.45,P =0) ; Post-operative intestinal function recovery time was (2.7 ± 0.7) d and (3.4 ± 0.5) d (t =5.4,P =0) ; Lymph node dissection number was (26.4 ± 4.2) and (24.8 ±5.2) (t =1.769,P=0.08).Post-operative complication rate was 4％ and 11％ (P =0.142).There was no perioperative mortality in either group.Post-operative pathological stage of Ⅰ B,Ⅱ A,Ⅱ B,ⅢA was 8,17,24,5 cases in laparoscopic group and 9,14,23,8 cases in open surgery group.108 cases were followed up from 7 to 79 months.In laparoscopic group,8 cases had local recurrence or distal mestastasis,and 4 cases died from tumor; In open group,9 cases had local recurrence or distal mestastasis,and 6 cases died from tumor.Conclusions Laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric cancer without serosal invasion is feasible,safe and advantageous in minimal invasion and rapid recovery,with good short and long-term outcomes.
ABSTRACT
Objective To evaluate the feasibility,safety and outcome of laparoscopic total mesorectal excision with sphincter preservation in the treatment of low rectal cancer.Methods From April 2004 to April 2007,laparoscopic total mesorectal excision with sphincter preservation for low rectal carcinoma was performed in 25 cases.The intraoperative risk.recovery,short-term and oncological outcomes of these patients were compared with 25 cases of conventional Dixon's operation.The controls,matched for age,sex,mass margin distance from the anus,Dukes stage,were selected from conventional Dixon's operations performed at the same period as laparoscopic group.T test and Chi-square test were used.Results Laparoscopic procedure was successful in 24 cases while one was converted to Bacon operation.The mean operation time(197±36)min in laparoscopic group was significantly longer than those(172±51)min in open group(t=2.12,P=0.04).The mean operative blood loss was(157±105)ml in laparoscopic group and(304±237)ml in open group(t=-2.95,P=0.01).No significant differences were detected between two groups in specimen length and number of lymph nodes excised.The bowel function was restored earlier in laparoseopic group than that in open group.The overall morbidity rates were 16%and 28%,and the local recurrence rates were 8%and 4%in the two groups respectively.Conclusion Laparoscopic total mesorectal excision is a feasible,safe,minimally invasive technique for rectal cancer.which provides better short-term outcomes and similar oncological outcomes compared with the traditional open procedure.