Application of double-pouch anastomosis in laparoscopic radical resection of rectal cancer assisted by small incision / 中华胃肠外科杂志

OBJECTIVE@#To explore the feasibility, safety and the economical efficiency of double-pouch anastomosis in laparoscopic radical rectal cancer assisted by small incisions.@*METHODS@#Clinical data of 224 patients undergoing gastrointestinal surgery at Taizhou People's Hospital of Jiangsu Province from January 2011 to December 2017 were retrospectively analyzed. Indusion criteria: patients were diagnosed as primary rectal adenocarcinoma by preoperative enteroscopy pathology, the distance of the tumor to anal margin was from 4 to 15 cm, and patients were treated with laparoscopic total mesorectal excision(TME) through small incision. Patients were divided into two groups according to different anastomosis method, double-pouch group(108 cases) and single-pouch group (116 cases). The surgical indexes, tumor safety indexes, short-term efficacy and economic indexes were compared between the two groups.@*RESULTS@#There was no significant difference between two groups in baseline data, operative time, blood loss, number of lymph nodes dissection, average length of proximal and distal bowel, or incidence of urination and sexual dysfunction (all P>0.05). Compared with the single-pouch group, the double-pouch group presented lower anastomotic secondary bleeding rate [0.9%(1/108) vs. 6.0% (7/116), χ²=4.238, P=0.040], lower incidence of anastomotic leakage[1.9%(2/108) vs. 7.8%(9/116), χ²=4.179, P=0.041], lower incidence of anastomotic stricture [1.9% (2/108) vs. 8.6% (10/116), χ²=5.054, P=0.025], shorter hospital stay [(13.4±3.9) days vs. (15.9±9.8) days, t=2.524, P=0.013] and less average hospitalization costs [(34 000±7 000) yuan vs. (46 000±23 000) yuan, t=5.047,P0.05).@*CONCLUSION@#Laparoscopic TME assisted by small incision with double-pouch anastomosis is a safe, feasible and economical method.

Unidirectional barbed suture used in laparoscopic transabdominal preperitoneal hernia repair / 中华全科医师杂志

The clinical data of 42 patients undergoing laparoscopic transabdomical preperitoneal ( TAPP) hernia repair in Taizhou People′s Hospital from January 2015 to June 2016 were retrospectively analyzed.In this series, 22 patients used VicrylTM polyglactin suture (group A) and 20 patients used the unidirectional barbed suture (group B).The clinical efficacy and postoperative complications were compared between the two groups.There were no significant differences in volume of intraoperative blood loss [(7.3 ± 3.2) vs.(7.9 ±3.2)ml],length of postoperative hospital stay [(14.6 ±1.2) vs.(4.8 ±1.1)d], pain scores [visual analogue scale (VAS),1.9 ±0.9 vs.2.1 ±1.0] at the first-day after operation,body discomfort(1 vs.0 case),and incidence of chronic pain and recurrence between the two groups (P>0.05). The time of operation and peritoneum suturation in group B was markedly shorter than that in group A [(34.3 ±7.1) vs.(40.4 ±9.9) min, (9.8 ±1.8) vs.(13.1 ±4.8) min, both P <0.05].Both unidirectional barbed suture and VicrylTM polyglactin suture are safe ,effective in peritoneum suturation for inguinal hernia repair; however , the unidirectional barbed suture has advantages of shorter operation time and less difficulty of surgical procedure .

Clinical study of preserving left colic artery during laparoscopic total mesorectal excision for the treatment of rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, safety, radicality and short-term outcome of preserving left colic artery (LCA) during laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer.</p><p><b>METHODS</b>From January 2013 to December 2016,136 patients with mid-lower rectal cancer received laparoscopic TME in the Gastrointestinal Surgery Department of Taizhou People's Hospital of Jiangsu Province. Patients with rectal tumor within 10 cm to the anal verge were enrolled into the study. All the enrolled patients had complete data of pathology and follow-up. Those receiving neoadjuvant chemoradiotherapy, with severe base diseases, multifocal tumor, tumor invasion of surrounding tissues, fixation of tumor, recurrent tumor, complications such as acute ileus, bleeding, perforation were excluded. In this study, 72 patients did not undergo preservation of LCA (high ligation group) and 64 patients underwent preservation of LCA (low ligation group). Operative parameters, clinicopathological data and short-term outcome were collected and compared between two groups.</p><p><b>RESULTS</b>The baseline data including gender, age, body mass index, tumor stage, and distance of tumor from anal verge of two groups were comparable (P>0.05). The differences between two groups about the mean time of operation and the operative blood loss were not significant [(164.0±12.6) min vs. (167.3±9.4) min, (30.0±3.6) ml vs. (30.1±3.0) ml, all P>0.05]. There was no operative death in both groups. Differences in the lymph node dissection (13.7±2.6 vs. 13.3±2.1) and the specimen length of proximal resection margin [(16.4±1.9) cm vs. (16.7±2.1) cm] or distal resection margins [(3.9±0.6) cm vs. (4.1±0.9) cm] between high and low ligation groups were not significant (all P>0.05). Compared with high ligation group, the low ligation group had higher rate of sphincter preservation [92.2% (59/64) vs. 79.2% (57/72), χ=4.580, P=0.032], lower rate of anastomotic leakage [1.6% (1/64) vs. 9.7% (7/72), χ=4.075, P=0.044], anastomotic stenosis [3.1% (2/64) vs. 12.5%(9/72), χ=4.006, P=0.045], and voiding and sexual dysfunction [6.3%(4/64) vs. 18.1%(13/72), χ=4.317, P=0.038]. Mean time of follow-up was 19 months. In high ligation group, the local recurrent rate was 5.56%, distant metastasis rate was 13.89%, overall survival rate was 90.28%, disease-free survival rate was 80.56%, while in low ligation group, the local recurrence rate was 4.69%, distant metastasis rate was 12.50%, overall survival rate was 90.63%, disease-free survival rate was 82.81%, whose differences between two groups were not significant (all P>0.05).</p><p><b>CONCLUSION</b>Preservation of LCA during laparoscopic TME for the treatment of rectal cancer is safe and feasible, which can reduce the incidence of anastomotic leakage and stenosis, and voiding and sexual dysfunction.</p>

Clinical significance of No.12 lymph node dissection for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical significance of No.12 lymph node dissection for advanced gastric cancer with D2 lymphadenectomy.</p><p><b>METHODS</b>Clinicopathologic data and No.12 lymph node dissection of 256 advanced gastric cancer patients undergoing radical operation in our department between January 2005 and December 2010 were retrospectively summarized and the influence factors of metastasis in No.12 lymph nodes were analyzed.</p><p><b>RESULTS</b>Of 256 patients, 179 were male and 77 were female with the average age of 59.2 years. Tumor located in the upper of stomach in 24 cases, middle of stomach in 41 cases, lower of stomach in 174 cases, multi-focus or diffuse distribution of stomach in 17 cases. Tumor diameter was <3 cm in 39 cases, 3 to 5 cm in 100 cases, >5 cm in 117 cases. Serum carcinoembryonic antigen (CEA) level increased in 61 cases, serum carbohydrate antigens (CA)72-4 increased in 56 cases and CA19-9 increased in 61 cases. The number of No.12 lymph nodes resected from all the patients was 1 152, and the average number was 4.5±1.9. The metastasis rate of No.12 lymph nodes was 9.4%(24/256) after hematoxylin eosin staining (positive group). All the patients received effective follow-up to December 2015, and the average follow-up time was 101.2 months. The median survival time of positive No.12 group (24 cases) was 29.8 months and of negative No.12 group (232 cases) was 78.2 months, whose difference was statistically significant (χ=21.715, P=0.000). Univariate analysis found that No.12 lymph node metastasis was not associated with age, gender, tumor differentiation (all P>0.05), but was associated with tumor location, tumor diameter, invasive depth (all P<0.05), and was closely associated with Borrmann type, outside metastatic lymph nodes of No.12 and high levels of serum CEA, CA72-4 and CA19-9 (all P=0.000). Multivariate regression analysis found that tumor location (RR=2.452, 95%CI:1.537 to 3.267, P=0.000), Borrmann type (RR=1.864, 95%CI:1.121 to 3.099, P=0.016) and number of outside metastatic lymph nodes of No.12 (RR=2.979, 95%CI: 2.463 to 3.603, P=0.000) were the independent risk factors of the No.12 metastasis (P<0.05).</p><p><b>CONCLUSIONS</b>Metastasis in No.12 lymph nodes indicates poorer prognosis. The No.12 lymph nodes of advanced gastric cancer patients with curative resection, especially those with the tumor located in the lower part, Borrmann type IIII(, outside metastatic lymph nodes of No.12, should be regularly cleaned.</p>

Application study on regional infusion chemotherapy by celiac trunk during operation in advanced gastric cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility, safety and efficacy of intraoperative regional infusion chemotherapy by celiac trunk in advanced gastric cancer patients.</p><p><b>METHODS</b>One hundred and twenty-six patients with advanced gastric cancer(stageII(-III() were screened from database of Gastrointestinal Surgery Department of Taizhou People's Hospital between January 2008 and December 2010 who underwent R0 resection and D2 lymphadenectomy, received postoperative chemotherapy(XELOX or FOLFOX), and had complete follow-up data. They were divided into infusion chemotherapy group (65 cases) and control group (61 cases) according to regional infusion chemotherapy or not (fluorine 1 000 mg and cisplatin 60 mg). The side effects of chemotherapy, parameters related to the operation, long-term survival and relapse rate were compared between the two groups.</p><p><b>RESULTS</b>The baseline data between the two groups were comparable(all P>0.05). Postoperative III( and IIII( adverse reaction of chemotherapy was not significantly different between the two groups (P>0.05). The time of postoperative intestinal function recovery [(67.9±14.8) hours vs. (68.9±15.0) hours, t=-0.380, P=0.705), volume of postoperative 1-week drainage [(66.1±17.1) ml vs.(61.9±18.2) ml, t=1.478, P=0.142], recent morbidity of complications[55.4%(36/65) vs. 49.2%(30/61), χ=0.256, P=0.613], and the long-term morbidity of complications [16.9% (11/65) vs. 14.8% (9/61), χ=0.111, P=0.739] were all not significantly different between the two groups. The 3-year survival rate and 3-year relapse-free survival rate in infusion chemotherapy group were significantly higher than those in control group(58.4% vs. 37.7%, χ=5.382, P=0.020; 58.4% vs. 34.4%, χ=6.636, P=0.010).</p><p><b>CONCLUSION</b>Regional infusion chemotherapy by celiac trunk during operation for advanced gastric cancer patients is safe and feasible, and can reduce the risk of local recurrence and improve survival rate.</p>

Application of protective appendicostomy after sphicter-preserving surgery for patients with low rectal carcinoma who are at high-risk of anastomotic leakage / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the application of protective appendicostomy after sphicter-preserving surgery for patients with low rectal carcinoma who are at high-risk of anastomotic leakage.</p><p><b>METHODS</b>Clinical data of 74 low rectal cancer cases with high-risk anastomotic leakage undergoing laparoscope-assisted total mesorectal excision(TME) sphincter-preserving operation in our department from September 2013 to September 2014 were analyzed retrospectively. Patients were randomly divided into two groups: 36 patients received appendicostomy and catheter was removed 4 to 6 weeks after operation when sinus tract formation in abdominal wall was identified; 38 patients received traditional ileostomy and stoma closure was performed 3 to 6 months after operation.</p><p><b>RESULTS</b>The operation time was (149.2±9.4) min vs. (146.7±12.7) min, postoperative complication morbidity was 8.3%(3/36) vs. 13.2%(5/38), anastomotic leakage rate was 2.8%(1/38) vs. 2.6%(1/36), mean drainage volume of 1-week stoma was (203.2±76.9) ml vs. (195.8±76.5) ml, intestinal function recovery time was (25.5±5.6) h vs. (24.0±5.8) h in intubation colostomy group and ileostomy group respectively, and these differences were not significant (all P>0.05). While total hospital stay was shorter and cost was less in intubation colostomy group as compared to ileostomy group [(8.8±1.7) d vs. (18.0±1.7) d, (32 000±3000) yuan vs. (51 000±4000) yuan], and these differences were significant (all P<0.05).</p><p><b>CONCLUSION</b>For low rectal cancer patients who are at high-risk of developing anastomotic leakage undergoing sphincter-preserving anterior resection, protective appendicostomy can decrease anastomotic leakage rate, avoid second stoma closure, shorten hospital stay and reduce hospital cost.</p>