Clinical analysis of laparoscopic D2 lymphadenectomy for distal gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVES</b>To investigate the surgical approach, feasibility and surgical outcomes of laparascopic distal gastrectomy D2(LDGD2).</p><p><b>METHODS</b>Fifty-four patients who underwent LDGD2 were examined in terms of pathologic findings, operative outcomes, and complications. A simple and effective surgical procedure was as follows: gastrocolic ligament--transverse mesocolon anterior lobe--pancreatic capsule--4sb--4d--6--14v, 8a--12a--9--7--11p, 1--3--5--lesser omental bursa. Efficacy and feasibility of this procedure was analyzed.</p><p><b>RESULTS</b>The mean operative time was (236±51) minutes, the mean number of lymph nodes was(18±5), the mean positive lymph nodes were 0-14, the mean blood loss was(217±65) ml, and postoperative mean hospital stay was(15±4) days.</p><p><b>CONCLUSIONS</b>LDGD2 for lower and lower-middle gastric cancer is feasible and safe, and can meet the oncological demand.</p>

Impact of laparoscopic colorectal surgery on the peritoneal microstructural injury and expression of t-PA/PAI-1 / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the influence of laparoscopic colorectal cancer resection on the peritoneal microstructure injury and expression of t-PA/PAI-1 molecules.</p><p><b>METHODS</b>A total of 50 patients with colorectal cancer were prospectively enrolled between June 2011 and February 2012 in the Shanxi Provincial Hospital and were assigned into laparoscopic group (LO, n=27) and conventional laparotomy group (CO, n=23) based on patients expectancy and surgeon decision. Optical microscope and scanning electron microscope were employed for comparison of the postoperative peritoneal injury between LO and CO. Before and after surgery, t-PA and PAI-1 of peritoneal tissue were determined by ELISA in both groups.</p><p><b>RESULTS</b>Optical microscope and scanning electronic microscopy scan indicated less serosal injury in LO group than that in CO group with regard to serosa integrity, continuity of covering adipocytes and mesothelial cells, and the aggregation level of inflammatory cells (P<0.01). The injury score was 38.22 in CO in and 14.67 in LO and the difference was statistically significant (P<0.01). No significant differences were found between LO and CO in terms of postoperative t-PA in the omentum, t-PA and PAI-1 in the intestinal serosa tissue (P>0.05), however PAI-1 in the omentum was significantly lower in LO group compared to CO group (P<0.05).</p><p><b>CONCLUSION</b>Laparoscopic radical resection for colorectal cancer causes less peritoneal structural injury and less influence on the fibrinolytic capacity, which may contribute to less postoperative adhesion.</p>