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Objective:To investigate the safety and mid-term efficacy of robotic versus laparoscopic total mesorectal excision surgery in rectal cancer.Methods:A total of 240 patients were diagnosed with rectal cancer at the Anorectal Department of Gansu Provincial Hospital from Aug 2015 to Mar 2021, 112 patients underwent laparoscopic total mesorectal excision (L-TME group) and 128 patients did robotic-assisted total mesorectal excision (R-TME group).Results:Compared to the R-TME group, the L-TME group had higher conversion rate (5.4% vs. 0.8%, χ2=4.417, P=0.036), higher incidence of complications (32.1% vs. 17.2%, χ2=7.290, P=0.007), higher circumferential resection margin involvement (7.1% vs. 1.6%, χ2=4.658, P=0.031), lower 3-year DFS and OS(74.1% vs. 85.2%, χ2=4.962, P=0.026) and (81.3% vs. 91.4%, χ2=5.494, P=0.019), lower 3-year DFS and OS in AJCC stage Ⅲ(52.5% vs. 76.1%, χ2=5.799, P=0.016) and (65.0% vs. 84.8%, χ2=4.787, P=0.029). Conclusion:R-TME can achieve better oncological outcomes and is more beneficial for RC patients compared with L-TME, especially for those with stage Ⅲ rectal cancers.
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Objective To compare effectiveness and short-term outcomes between robotic-assisted and laparoscopic surgery for radical resection of rectal cancer.Methods A total of 410 patients diagnosed with rectal cancer,undergoing robotic-assisted surgery (RAS) for rectal cancer (215 cases) and conventional laparoscopic surgery(CLS) for rectal cancer (195) from Jan 2016 to Dec 2018 were included into the present study.Operative characteristics,postoperative complications and pathologic parameters were evaluated between RAS and CLS group.Results The RAS group had less intraoperative blood loss[(107 ± 46) ml vs.(147 ±35)ml,t =3.695,P＜0.05],longer operation time[(209 ±55)min vs.(195 ± 55)min,t=2.508,P＜0.05],earlier first flatus[(3.4 ± 1.4)d vs.(5.3 ± 1.6)d,t =-14.952,P＜ 0.05],and first liquid diet time [(4.3 ± 1.5) d vs.(6.2 ± 2.6) d,t =-9.109,P ＜ 0.05],more number of dissected lymph nodes[(12.6 ± 4.3) vs.(10.6 ± 4.5),t =4.468,P ＜ 0.05] compared with those in the CLS group.But more expensive total hospitalization costs[(71 775 ±45 089) yuan vs.(66 789 ± 16 721) yuan,t =4.224,P ＜ 0.05].Conclusion Compared with laparoscopic surgery,robotic-assisted surgery has less blood loss,shorter time of first flatus,more lymph nodes yield.
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Objective To evaluate preoperative multislice CT angiography (MSCTA) in guidance for laparoscopic right colon cancer the complete mesocolon resection (CME).Methods From September 2014 to May 2016 data of 24 patients undergoing laparoscopic CME right colon cancer surgery,were reviewed for the guidance of MSCTA over operative surgery.Results Preoperative MSCTA clearly showed superior mesenteric vascular anatomical variation and its branch,which was in closely consistent with that seen during the operation.The superior mesenteric arteries and veins (SMA/SMV) and the ileum colon arteries and veins (ICA/ICV) were seen in all the 24 cases.There are four main types anatomic variation of gastrocolic trunk (Henle trunk),of which most often consisting of three branchs (type B),accounting for about 46％.The time of completely dissecting anatomical Henle trunk was significantly longer than that for the ileum colon vessels and the middle vessels dissection (P ＜ 0.05).Conclusion Preoperative MSCTA can clearly present anatomic variation of SMV/SMA and its branch,precisely navigate the laparoscopic right colon cancer CME surgery,reducing the incidence of intraoperative vascular complications and improving the quality of surgery.
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Objective To explore the clinical significance of lymph node micrometastases in stage Ⅱ rectal cancer patients. Methods Forty-two patients with rectal cancer underwent total mesorectal exci-sion between January 2000 and August 2001 were included, 484 lymph nodes were studied in paraffin blocks that had previously been considered free by conventional histopathological examination. These lymph nodes were submitted to immunohistochemical analysis using cytokeratin 20 (CK20) monoclonal antibodies to identify micrometastases. Five-year follow-up information was obtained on these patients. Observed survival rates and assessed respectively in the patients with and without micrometastases. Results Micrometastases were detected in 33 lymph nodes (6.8% ,33/484) of 15 cases (35.7%, 15/42). The five-year survival rate was 40.0% in the patients with micrometastases, whereas in the patients without micrometastases, the survival rate was 92.6%(P = 0.000,by the Log-rank test). By multivariate Cox regression analysis, lymph node mi-cromctastases was closely correlated with post-operative recurrence or metastases, the value of RR was 11.435. Conclusions Detection of micrometastases is an important prognostic tool in stage Ⅱ rectal can-cer. In this study, lymph nodes micrometastases is an independent prognostic factor for overall survival. These patients maybe get benefit from adjuvant chemotherapy.