ABSTRACT
Objective: To determine the effect of peritoneum reconstruction on postoperative complications after laparoscopic low anterior resection (LAR) for rectal cancer. Methods: Retrospective cohort study and propensity score matching were conducted. Case inclusion criteria: (1) pathologically confirmed rectal adenocarcinoma; (2) 18 to 80 years; (3) patients with middle to low rectal cancer undergoing laparoscopic LAR; (4) patients staging cT1-4aN0-2M0 or ycT1-4aN0-2M0 after neoadjuvant therapy; (5) the distance of 4-10 cm from tumor low margin to anal verge. Exclusion criteria: (1) abdominal surgery history (except appendicitis, cholecystitis, ectopic pregnancy); (2) anastomosis above the peritoneal reflection; (3) tumor distant metastasis or clinical staging of T4b during surgery; (4) conversion to open surgery; (5) severe incapacitating disease (American Society of Anesthesiologists classification IV or V, ASA). A total of 666 patients with middle to low rectal cancer undergoing laparoscopic LAR in The First Affiliated Hospital of Army Medical University from January 2017 to June 2020 were enrolled. There were 473 males and 193 females with the median age of 59 (18-80) years. Laparoscopic LAR with peritoneum reconstruction was performed in 188 cases (PR group), and laparoscopic LAR without peritoneum reconstruction was performed in 478 cases (NPR group). After 1:1 propensity score matching according to 1:1 based on age, gender, body mass index, TNM staging, ASA classification, intraoperative blood loss, distance from tumor low margin to anal edge, 153 cases were included in each group. Postoperative complications were classified according to Clavien-Dindo classification. Anastomotic leakage was defined and graded according to the International Study Group of Rectal Cancer (ISGRC) criteria. Results: After propensity score matching, there were no significant differences in baseline demographic characteristics between the 2 groups (all P>0.05), indicating that these two groups were comparable. (1) Operative conditions: All the patients in both groups completed operation successfully. Compared with the NPR group, the PR group had longer operation time [(181.3±60.3) minutes vs. (168.9±51.5) minutes, t=2.185, P=0.029], shorter postoperative median hospital stay [8 (7, 10) days vs. 9 (7, 11) days, Z=-2.282, P=0.022], and the differences were statistically significant (P<0.05). (2) Postoperative complications: The overall morbidity of postoperative complication in PR group and NPR group was 20.3% (31/153) and 24.2% (37/153) respectively, and the incidence of anastomotic leakage was 9.8% (15/153) and 11.1%(17/153) respectively, whose differences were not statistically significant (both P>0.05). Compared with NPR group, PR group had lower morbidity of grade III to IV complications [3.9% (6/153) vs. 11.1% (17/153), χ(2)=5.688, P=0.017] and lower secondary operation rate [1.3% (2/153) vs. 5.9% (9/153), χ(2)=4.621, P=0.032], the differences were statistically significant (both P<0.05). Though PR group had lower incidence of grade C anastomoic leakage [1.3% (2/153) vs. 3.9% (6/153), χ(2)=2.054, P=0.152], but the differences were not statistically significant. (3) Postoperative inflammation: The difference of the procalcitonin level of both PR and NPR groups at postoperative 1-d, 3-d, and 5-d was statistically significant (F=5.222, P=0.010) in time-dependent manner, while the difference was not significant in the interaction effect (P>0.05). No statistically significant differences in the C-reactive protein level between two groups at postoperative 1-d, 3-d, and 5-d were found (all P>0.05). Conclusion: Peritoneum reconstruction in laparoscopic LAR can decrease the morbidity of postoperative complication of grade III to IV and the reoperation rate, and plays an important role in controlling the inflammatory reaction, which has great clinical value.
Subject(s)
Aged , Aged, 80 and over , Humans , Middle Aged , Anastomotic Leak , Laparoscopy , Peritoneum , Rectal Neoplasms/surgery , Retrospective StudiesABSTRACT
Background There have been an abundance of literature on the analysis of the mechanical characteristic of the sclera at the entire seleral level in high myopia.However,some recent studies on high myopia are focused on the mechanical changes of the sclera on a cellular level. Objective This experiment was purposed to study how transforming growth factor-β2(TGF-β2)affected sclerotic desmocytes and the mechanical behaviors of scleral fibroblasts in the posterior part of the eyes in guinea pigs with experimental myopia. Methods Induced myopic animal models were established by wearing-10.00 D concave lens for 30 days in lateral eyes of 2-week-old guinea pigs.The fellow eyes were used as control group.Another 5 matched animals served as normal controls.The scleral fibroblasts of each group were purified with the tissue explant method and passaged for 2 generations in vitro.Cultured cells were identified by immunochemistry with vimentin,desmin,keratin and S-100 antibodies.Different concentrations of TGF-β2(0,1,10,100mg/L)were added into serum-free DMEM for 24 hours,and the viscoelastic properties of scleral fibroblasts were measured by micropipette aspiration technique. Results Compared with the fellow,eyes and normal control eyes,the equilibrium modulus and apparent viscosity in model eyes were significantly higher(P＜0.05).After treatment of TGF-β2,the equilibrium modulus and apparent viscosity in the model group and fellow eyes were positively correlated with the concentrations of TGF-β2(r=0.743,r=0.533,r=0.654,r=0.576,P＜0.05).Following the addition of 1 mg/L TGF-β2 and 10 mg/L TGF-β2,the equilibrium modulus and apparent viscosity of scleral fibroblasts were significantly reduced in model eyes compared with fellow eyes(P＜0.05).No significant difference was found in the equilibrium modulus and apparent viscosity of scleral fibroblasts between model eyes and fellow eyes after treatment with 100 mg/L TGF-β2(P＞0.05). Conclusion TGF-β2 car increase the mechanic indexes in a concentration.dependent manner.1 mg/L,10 mg/L TGF-β2 can lower the equilibrium modulus and apparent viscosity of scleral fibroblasts of normal eye and thus cause more changes in the mechanical behavior of scleral fibroblasts.