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Da Vinci robotic surgery for gastric cancer has been performed and accepted gradually in domestic and abroad,due to the advantages of defibrillation,three dimensional (3D) view and flexible,precise,stable operation.However,its indication is controversy,surgical process,lymphadenectomy,digestive reconstruction need to be further regulated.There is lack of prospective case-control study of large sample on short and long term efficacy.Therefore,problems and strategies in the Da Vinci robotic surgery for gastric cancer should be analyzed and evidence-based researches should be strengthened to provide tangible and credible evidence for the Da Vinci robotic surgery for gastric cancer.
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Objective To investigate the clinical efficacy of Da Vinci robot-assisted radical resection for right colon cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 85 patients with right colon cancer who were admitted to the First Hospital Affiliated to Army Medical University from August 2013 to February 2019 were collected.There were 56 males and 29 females,aged from 29 to 84 years,with an average age of 60 years.All patients underwent Da Vinci robot-assisted radical resection of right colon cancer,named right hemicolon D3 + complete mesocolic excision,and received infection prevention and total parenteral nutrition treatment after surgery.According to clinical pathological staging of guideline issued by National Comprehensive Cancer Network,patients underwent postoperative chemotherapy within 1 year after surgery.Observation indicators:(1) treatment status;(2) postoperative pathological examination;(3) follow-up.Follow-up was conducted using outpatient examination,telephone interview and mail every 3 months within 1 year after surgery,every 6 months from 1 to 3 years after surgery,and once a year from 3 to 5 years after surgery up to March 2019.The postoperative tumor metastasis and survival of patients were obtained.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were expressed as absolute number.Survival rates were calculated using life-table method.Results (1) Treatment status:85 patients underwent Da Vinci robot-assisted right hemicolon D3 + complete mesocolic excision successfully.The operation time,volume of intraoperative blood loss,time for postoperative outof-bed activities,time to recovery of gastrointestinal function,time to liquid diet intake were (178±28) minutes,(85±33) mL,(2.9± 1.8) days,(3.1 ± 2.7) days,(3.9± 1.9) days,respectively.There was no perioperative death.Eleven patients had postoperative complications including 5 of anastomotic leakage,2 of anastomotic bleeding,2 of pulmonary infection,1 of gastric emptying disorder and 1 of incomplete intestinal obstruction;they were cured and discharged after conservative treatment.All the 85 patients received postoperative infection prevention and total parenteral nutrition support,including 64 receiving systemic intravenous chemotherapy with 6 -8 cycles of FOLFOX or XELOX,7 receiving 6-8 cycles of oral capecitabine,and 14 receiving no chemotherapy.(2) Postoperative pathological examination:the number of harvested lymph nodes was 20± 11 and 25 had lymph node metastasis.The length of proximal and distal cutting edge of the specimens was (16±5) cm and (9±5)cm,respectively.There was no cancerous cell on the cutting edge.High-differentiated adenocarcinoma,moderatedifferentiated adenocarcinoma,moderate-differentiated tubular adenocarcinoma,low-differentiated adenocarcinoma,mucinous adenocarcinoma,tubular combined with mucinous adenocarcinoma were detected in 2,40,14,16,9,4 patients,respectively.There were 8,28,24,5,12,8 patients in Ⅰ stage,Ⅱ A stage,Ⅱ B stage,Ⅱ C stage,ⅢB stage,Ⅲ C stage of TNM staging,respectively.(3) Follow-up:85 patients were followed up for 1-67 months,with a median follow-up time of 19 months.During the follow-up,1 of 85 patients had liver metastasis at 14 months after surgery and had survived after radiofrequency ablation treatment up to the end of follow-up.Three cases died of abdominal tumor metastases,1 of which in Ⅱ C stage died at 32 months after surgery,1 in Ⅲ B stage died at 4 months after surgery and 1 in Ⅲ B stage died at 16 months after surgery.The 1-,3-year overall survival rates were 97.1％ and 94.0％,respectively.Conclusion Da Vinci robot-assisted radical resection of right colon cancer is safe and feasible,with good short-and long-term outcomes.
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Objective@#To explore the technical characteristics and short-term clinical efficacy of robotic-assisted intersphincteric resection (ISR) for patients with low rectal cancer.@*Methods@#A retrospective cohort study was used. Inclusion criteria: (1) rigid colonoscopy showed lower margin of the tumor ≤5 cm from the anal verge; (2) preoperative rectal MRI or endorectal ultrasound revealed staging T1-2, or T3 patients receiving concurrent chemoradiotherapy; (3) patients less than 70 years old with good function of anal sphincter before surgery; (4) no synchronous multiple primary carcinoma, and no distant metastasis; (5) the method of operation was agreed by the patient. Exclusion criteria: (1) T4 stage tumors; (2) sphincter dysfunction before operation; (3) recurrent tumors; (4) lower edge of tumors beyond the dentate line; (5) death due to non-rectal cancer during follow-up and unsatisfactory follow-up data. The clinical data of 21 patients with low rectal cancer meeting inclusion criteria undergoing robotic-assisted ISR at our department from January 2015 to June 2018 were collected. Parameters during and after operation were observed. Anorectal manometry was performed at 3, 6, and 12 months after the operation, and anal function was evaluated at 3, 6, and 12 months after the closure of the stoma by Kirwan classification and Wexner fecal incontinence score. The key steps of the operation are as follows: according to the principle of total mesorectal excision, the robot continued to enter into the levator ani hiatusdistally, and dissectin the sphincter space; according to the scope of sphincter resection, ISRwas divided into partial ISR, subtotal ISR, and total ISR; subtotal and total ISR usually needed to be combined with transanal pathway. The reconstruction of digestive tract was performed by double stapler anastomosis under laparoscope orhand-sewnanastomosis under direct vision, and preventive ileostomy was completed in the right lower abdomen.@*Results@#Of 21 patients, 13 were male and 8 were female with mean age of (57.5±16.3) years. All the patients successfully completed the operation without conversion to laparotomy. Fourteen cases (66.7%) adopted partial ISR through complete transabdominal approach, 6 cases (28.6%) adopted the subtotal ISR through combined transabdominal and transanal approachs, and 1 case (4.8%) adopted the total ISR through the combined transabdominal and transanal approachs. The total operation time was (213.1±56.3) minutes, including (27.3±5.4) minutes for mechanical arm installation and (175.7±51.6) minutes for robotic operation. The amount of intraoperative hemorrhage was (62.8±23.2) ml, and no blood transfusion was performed in any patient. All patients underwent prophylactic ileostomy, and the stoma was closed 3-6 months after the operation. Except one case of anastomotic leakage, all other stomas were closed successfully. The postoperative hospitalization time was (7.6±2.2) days, and time to fluid intake was (3.3±0.9) days. One case of anastomotic leakage, one case of anastomotic stenosis, one case of inflammatory external hemorrhoids and one case of urinary retention occurred after surgery,and all of them were cured by conservative treatment. The mean diameter of tumors was (2.9±1.2) cm, and the number of harvested lymph node was 12.8 ± 3.3. In the whole group, the circumcision margin was negative, the proximal margin was (12.2 ± 2.1) cm, the distal margin was (1.1 ± 0.4) with all negative, and the R0 resection rate was 100%. The results of anorectal manometry showed that the preoperative rest pressure, rectal maximum squeeze pressure, initial sensory volume and maximum tolerated volume were (45.19±8.46) mmHg, (128.18±18.80) mmHg, (44.33±10.11) ml and (119.00±19.28) ml, respectively;these parameters reduced significantly 3 months after operation and they were (23.44±5.54) mmHg, (93.72±12.15) mmHg, (17.72±5.32) ml and (70.44±10.9) ml, respectively. The differences were statistically significant (all P<0.001). The resting pressure and the rectal maximum squeeze pressure returned to preoperative levels 12 months after operation, which were (39.33±6.64) mmHg and (120.58±16.47) mmHg, respectively (both P>0.05), while the initial sensory volume and the maximum tolerated volume failed to reach the preoperative state, which were (30.67±7.45) ml and (92.25±10.32) ml, respectively (both P<0.05). The patients were followed up for (22.1±10.6) months without local recurrence and distant metastasis. Eighteen patients were evaluated for anal function: Kirwan classification was grade I for 6 cases, grade II for 7 cases, grade III for 4 cases, and grade IV for 1 case; Wexner incontinence score was 8.6±0.8; 14 cases had good defecation control.@*Conclusion@#The clinical efficacy of ISR with Da Vinci robot in the treatment of low rectal cancer is satisfactory.
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<p><b>OBJECTIVE</b>To evaluate the long-term clinical outcomes between laparoscopic and open distal gastrectomy with D2 lymph dissection for advanced gastric cancer.</p><p><b>METHODS</b>Clinical data of 377 cases of laparoscopic distal gastrectomy and 301 cases of open distal gastrectomy with D2 lymph dissection at the Southwest Hospital, the Third Military Medical University from January 2004 to June 2010 were retrospectively analyzed. Patients were followed up until September 2015. Surgical outcomes, postoperative complications and long-term survival were compared between the two groups.</p><p><b>RESULTS</b>Compared with conventional open group, laparoscopic group was associated with lower intraoperative blood loss [(125±89) ml vs. (290±161) ml, t=-15.942, P=0.000], shorter time to oral intake [(2.9±0.7) days vs. (4.1±1.6) days, t=-12.120, P=0.000], quicker bowel function retum[(2.7±1.4) days vs. (3.6±1.6) days, t=-7.804, P=0.000], shorter postoperative hospital stay [(7.7±3.6) days vs. (10.1±4.1) days, t=-8.107, P=0.000]. In addition, there were no significant differences in the operative time[(207±57) minutes vs. (202±43) minutes, P>0.05], number of retrieved lymph nodes(33±13 vs. 31±15, P>0.05), resection margin length(P>0.05) between two groups. The postoperative complication morbidity in laparoscopic group was significantly lower than that in open group[7.2%(22/377) vs. 12.6%(38/301), χ(2)=5.762, P=0.016]. Within perioperative period, 7 patients underwent operation again due to complication and 1 case died of peritoneal bleeding in laparoscopic group; 6 patients underwent re-operation and 2 cases died of peritoneal infection with hepatic failure and lung infection with respiratory failure. During the median follow-up of 86 months (range from 3-140 months), relapse occurred in 171(45.4%) patients and 183(48.5%, among them, 156 cases died of primary disease) patients died in laparoscopic group; relapse occurred in 140(46.5%) patients and 151(50.2%, among them, 127 cases died of primary disease) patients died in open group. The difference in overall 5-year survival rate between two groups was not statistically significant (51.5% vs. 49.8%, χ(2)=0.142, P=0.706). No significant difference was seen in 5-year disease-free survival rate (49.1% vs. 47.8%, χ(2)=0.062, P=0.803). Stratified analysis based on TNM stage also showed no significant difference in 5-year overall or disease-free survival rate(both P>0.05).</p><p><b>CONCLUSION</b>Laparoscopic distal gastrectomy with D2 lymph dissection for advanced gastric cancer has better short-term efficacy and similar long-tern efficacy as compared to open surgery.</p>
Subject(s)
Humans , Blood Loss, Surgical , Defecation , Disease-Free Survival , Gastrectomy , Methods , Gastroenterostomy , Laparoscopy , Length of Stay , Lymph Node Excision , Neoplasm Recurrence, Local , Operative Time , Postoperative Complications , Postoperative Period , Retrospective Studies , Stomach Neoplasms , General Surgery , Survival Rate , Treatment OutcomeABSTRACT
Da Vinci robotic surgical system have some advantages of defibrillation,three-dimensional (3D) view and flexible operation,and it has been gradually applied in radical gastrectomy,colorectal cancer radical resection,complex hepatic resection,biliary tract surgery,partial resection of pancreas and pancreaticoduodenectomy in the fiell of digestive surgery,with satisfactory clinical efficacy.Compared with traditional laparoscopic and open operations,Da Vinci robotic surgical system is more precise and flexible,with advantages of minimal invasion and good application value,however,longer operation time,expensive surgery cost and indefinite long-term efficacy of malignant tumor need to be further improved.
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Laparoscopic surgery for gastric cancer with the advantages of slight pain,micro-invasive trauma and fast recovery has been accepted gradually by most surgeons and increasingly used in the field of surgery.However,how to establish a standardized laparoscopic surgery procedure for gastric cancer and improve the operation skills need to be solved urgently.Meanwhile,a reliable technical support of laparoscopic surgery for gastric cancer should be provided by controlling strictly the operation indications,standardizing surgical procedures,building a standardized training system,improving perioperative management and applying enhanced recovery program in patients with gastric cancer,and it will provide greater benefits to more and more patients.
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<p><b>OBJECTIVE</b>To assess the effect of radical laparoscopy-assisted gastrectomy(LG) for patients with chronic obstructive pulmonary disease (COPD).</p><p><b>METHODS</b>Clinical data of 340 gastric cancer patients with COPD undergoing radical gastrectomy with lymphadenectomy at Southwest Hospital, Third Military Medical University between January 2010 and October 2013 were analyzed retrospectively. The clinical outcomes for the 262 patients with COPD who underwent LG(LG group) were compared with those of 78 patients with COPD who underwent open gastrectomy(OG group). During LG, pneumoperitoneum was maintained at an insuffiation pressure of 8 mmHg to 10 mmHg. The primary endpoint was postoperative pulmonary complication(PPC). To predict factors related to PPC, univariate and multivariate logistic analyses were carried out.</p><p><b>RESULTS</b>Intraoperative blood loss was significantly less in the LG group [(131.2±14.7) ml] than in the OG group [(246.7±49.0) ml; t=-13.445, P=0.000], but operation time was significantly longer [(220.4±19.1) min vs. (194.2±31.5) min; t=6.877, P=0.000]. The findings showed PPC to be significantly less frequent in the LG group(5.3%,14/262) than in the OG group (15.4%, 12/78)(χ(2)=8.581, P=0.003). The severity of COPD was independent risk factor for PPC(P=0.031, HR=1.456, 95%CI:1.306-1.789). No independent predictor of PPCs was found in type of operative approach (open vs laparoscopic; P=0.126).</p><p><b>CONCLUSION</b>The LG procedure with insuffiation pressure of pneumoperitoneum is tolerated for gastric cancer patients with mild or moderate COPD.</p>
Subject(s)
Humans , Blood Loss, Surgical , Feasibility Studies , Gastrectomy , Laparoscopy , Lymph Node Excision , Operative Time , Postoperative Complications , Pulmonary Disease, Chronic Obstructive , Retrospective Studies , Risk Factors , Stomach Neoplasms , General SurgeryABSTRACT
Although the surgical procedure and approach of da Vinci robotic surgical system-assisted radical resection of gastric cancer are gradually mature,it is rarely used for the resection of gastric stump cancer because of the complexity and low resection rate.In November of 2012,resection of gastric stump cancer using da Vinci robotic surgical system was performed in the Southwest Hospital.The short-term efficacy was satisfactory after the follow-up for 12 months.Da vinci robotic surgical system has the advantages of clear vision,easy manipulation of abdominal adhesion detaching,flexible operation and stable traction during resection of gastric stump cancer.
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Objective To investigate the clinical value of a new anvil inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer.Methods The clinical data of 21 patients with gastric cancer who received laparoscopic radical proximal gastrectomy or radical total gastrectomy at the Southwest Hospital from March 2010 to February 2011 were retrospectively analyzed.Five trocars were inserted through the abdominal wall of the patients.After perigastric lymphadenectomy and mobilization of esophagus,an incision was made on the esophagus above the tumor,and then the anvil with drawn wire attached was inserted into the esophagus.An endo-cutter was applied to cut the esophagus adjacent to the incision left the drawn wire untouched,and then the stem of the anvil was pulled out by the drawn wire for laparoscopic anastomosis. Results The operations were successfully accomplished under the laparoscope with no conversion to open surgery.Fifteen patients received laparoscopic radical total gastrectomy and 6 received laparoscopic radical proximal gastrectomy. The mean operation time,volume of blood loss,time to off-bed activity,passage of flatus and postoperative duration of hospital stay were (257 ± 38) minutes,( 119 ± 32) ml,(2.5 ± 0.5 ) days,( 3.7 ± 0.8 ) days and (7.5 ± 2.6) days,respectively.No perioperative mortality,anastomotic bleeding or anastomotic fistula was detected.One patient was complicated with pulmonary infection + pleural effusion and was cured by conservative treatment; 1 was complicated with anastomotic stenosis which was alleviated by gastroscopic balloon dilation; 1 was complicated by incisional infection and was cured by medical treatment after drainage.No cancer cells were detected at the anastomotic ring or resection margin of the specimen.There were 4 patients with well-differentiated adenoma,8 with moderate-differentiated adenoma and 9 with poor-differentiated mucinous adenoma.There were 5 patients in stage Ⅰ,10 in stage Ⅱ and 6 in stage Ⅲ (UICC staging).Twenty-one patients were followed up for a mean period of (11 ±4) months (range,6-17 months ),no tumor recurrence or metastasis was detected. Conclusions The new technique for anvil insertion is safe,effective and easy for manipulation and learn.It offers a new approach for laparoscopic digestive tract reconstruction.
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Laparoscopic surgery has been adopted for the treatment of gastric cancer in recent years around the world.New advances in these techniques have been achieved. This paper provides an overview of the clinical outcome of laparoscopic surgery for early gastric cancer and advanced gastric cancer,the application of laparoscopy-assisted pylorus-preserving gastrectomy,the technical characteristics of laparoscopy-assisted total gastrectomy,the values of single-incision laparoscopically assisted surgery and the application status and prospect of robotassisted laparoscopic gastrectomy for gastric cancer.
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Objective To explore the efficacy of laparoscopy-assisted radical gastrectomy for patients with gastric cancer. Methods The clinical data of 726 patients who received laparoscopy-assisted radical gastrectomy for gastric cancer at the Southwest Hospital from January 2004 to April 2010 were retrospectively analyzed. The operation time, operative blood loss, number of lymph nodes dissected, length of hospital stay and mobidity were evaluated using t test or chi-square test. The survival of the patients were evaluated by Kaplan-Meier method.Results Laparoscopy-assisted radical gastrectomy was successfully carried out on 707 patients, and 19 patients were converted to open surgery. The mean operation time, operative blood loss, number of lymph nodes dissected were (179 ±52)minutes, (87 ±51) ml and 33 ± 14, respectively. The average distances of proximal and distal resection margin to the tumors were (6.3 ± 1.9)cm and (5.6 ± 1.7)cm, respectively. The average time to flatus, time to fluid diet and length of hospital stay were (2.9 ± 1.4) days, (3.1 ± 1.7) days and (7.9 ± 3.5) days,respectively. The peri- and postoperative mobidities were 2.2% (16/726) and 4.0% (29/726), respectively. A total of 685 patients were followed up for 6-82 months (mean, 48.3 months), and the 5-year survival rate was 58.4%. Conclusions Laparoscopy-assisted radical gastrectomy is a feasible procedure with minimal trauma, low morbidity and quick recovery of patients.
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ObjectiveTo evaluate the feasibility, safety and the long-termoutcomes of laparoscopy-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC).MethodsWe retrospectively analyzed the clinical and follow-up data of 346 cases after LADG from January 2004 to June 2009, compared with 313 cases after conventional open distal gastrectomy (ODG) for advanced gastric cancer at the same period at our hospital. The surgical safety, postoperative complications, survival rate, and the recurrence and metastasis of cancer were compared.ResultsThere was no significant difference at the average time of LADG and ODG procedures (211 ± 56) min vs.(204 ±41 ) min, but blood loss during operation and length of incision in LADG group were significantly less than in the ODG group. The proximal and distal length were, respectively, (6. 3 ± 2. 0) cm and (5. 7 ± 1.7 ) cm in LADG group and (6. 3 ±2. 1 ) cm and (5.6 ± 1.6) cm in ODG group, the difference was not significant. The number of lymph node dissections was also similar: (33 ± 13) in LADG group and (33 ± 16) in ODG group. The incidence of postoperative complications in LADG group was significantly lower than that in ODG group ( 6. 7％ vs.13. 1％, P ＜ 0. 05). During the follow-up period of 6-72 months (average 37 months), the 1-, 3-and 5-year survival rates were, respectively, 87. 2％, 57. 2％ and 50. 3％ in LADG group and 87. 1％, 54. 1％and 49. 2％ in ODG group, the difference was not significant. The differences in recurrence and metastasis between the two groups were not statistically significant.ConclsionLaparoscopy-assisted gastrectomy for advanced gastric cancer is not significantly different with open surgery in postoperative survival rate or recurrence. It is less traumatic and of fewer complications.
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Objective To summarize the experience in application of da Vinci robotic surgical system in radical resection of rectal cancer,and investigate the proper position of trocars and operative techniques.Methods The clinical data of 13 patients who received radical resection of rectal cancer accomplished by the da Vinci robotic surgical system at the Southwest Hospital from February 2010 to February 2011 were retrospectively analyzed.The patients were in lithotomy position and received combined intravenous anesthesia.Five or 4 trocars were used.Miles procedures were performed on patients with lower tumor position,and the other patients received Dixon procedure.Results The operation was successfully performed on all patients.Five trocars were selected for the first 3 patients,and 4 trocars for the other 10 patients.Nine Dixon procedures and 4 Miles procedures were selected.The mean operation time was 217.3 minutes (range,160-260 minutes).The mean operative blood loss was 53.3 ml (range,40-70 ml) in Dixon procedure and 120.0 ml (range,90-130 ml) in the Miles procedure,and no blood transfusion was needed.The mean number of lymph nodes dissected was 13.9 (range,8-21 ),and the time to bowel movement was 3.2 days (range,2-5 days).Two patients were complicated with pulmonary infection,1 with urinary tract infection,and they were cured by antimicrobial therapy.No other morbidity or mortality was found.The results of postoperative pathological examination showed that there were no residual cancer cells at the resection margin,and the distance between the resection margin and the tumor was 6.3 cm (range,3-10 cm).There were 1 patient in stage Ⅰ,5 in stage Ⅱ and 7 in stage Ⅲ.The mean time of follow-up was 5.9 months (range,3-12 months),and no recurrence or metastasis was found during follow-up.ConclusionsRadical resection of rectal cancer with da Vinci robotic surgical system utilizing 4 trocars has the advantages of minimally invasive surgery with fast recovery as well as the ease of dissection afforded by the surgical robot.
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The operation path, lymph node dissection and reconstruction of the alimentary tract are the three most technical difficulties of laparoscopy-assisted gastrectomy. The essential difference between laparoscopy-assisted gastrectomy and open gastrectomy is the operation path. Based on our clinical experience, we investigated reasonable paths for laparoscopyassisted gastrectomy. Patients were placed in a supine position with their legs apart, and the operator stood on the left side of the patient. Five trocars were placed in the abdominal wall in a curved line. The operation was carried out in the order of greater gastric curvature, the lower region of the pylorus and antrum,the upper region of the pancreas, omentum minus, cardia, and arcuate diaphragm. From May 2004 to April 2010, we successfully carried out 761 laparoscopy-assisted gastrectomies with satisfactory outcomes.
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Objective To investigate the effects of CO_2 pneumoperitoneum on the expression of focal adhesion kinase (FAK) of gastric cancer MKN-45 cells. Methods CO_2 pneumoperitoneum with different pressures was simulated in vitro, and the gastric cancer MKN-45 cells were divided into test and control groups. In the test group, gastric cancer MKN-45 cells were cultured in CO_2 pneumoperitoneum with different pressures [5, 10 or 15 mm Hg (1 mm Hg =0.133 kPa)] for 4 hours. The condition of the cells exposed to CO_2 pneumoperitoneum with a pressure of 15 mm Hg was observed at 0.5, 2 and 4 hours. Gastric cancer MKN-45 cells in control group were cultured at normal atmospheric pressure. The expression of FAK and phosphorylated FAK (FAK Tyr397) of each group was detected by Western blot. Multiple-group analysis was done by one-way ANOVA, and intergroup comparison was done by LSD test. Results In CO_2 pneumoperitoneum with pressures of 5, 10, 15 mm Hg, the expression of FAK was 2.14±0.17, 2.07±0.21 and 2.52±0.26, respectively, and the expression of FAK Tyr397 was 1.82±0.28, 1.93±0.52 and 3.71±0.37, respectively. The expression of FAK and FAK Tyr397 in the control group was 2.43±0.46 and 1.71±0.23, respectively. We found significant differences between the 2 groups (F = 2.171, 26.951, P < 0.01). After gastric cancer MKN-45 cells being treated for 0.5, 2 and 4 hours in CO_2 pneumoperitoneum with a pressure of 15 mm Hg, the expression of FAK Tyr397 was 3.41±0.44, 4.12±0.56 and 5.24±0.41 respectively, which is also significantly different (F =116.119, P < 0.01). The expression of FAK Tyr397 was back to 0.72±0.16 1 hour after the release of CO_2. Conclusions CO_2 pneumoperitoneum with different pressures can not promote the expression of FAK in gastric cancer MKN-45 cells which had been cultured for 4 hours, but can activate FAK through promoting its phosphorylation. The degree of FAK phosphorylation increases with pressure and time, and the activity of FAK decreases to pretreatment level rapidly once pressure is released.
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Objective To investigate the feasibility,method and result of laparoscopic total gastrectomy for gastric cancer. Methods Clinical data of 63 cases of gastric cancer treated with laparoseopic total gastrectomy were analyzed retrospectively. Results In this study,52 cases underwent laparoseopic radical total gastrectomy and 5 cases did laparoseopic palliative total gastrectomy.The procedure Was hand assisted in tlle first 45 cases for fashoning esophagojejunostomy through a small incision.In six cases the procedure was converted to open surgery.The operative time was(312±35)min,the blood loss was(190±50)ml,the number of lymph nodes dissected Was(32±7).It began to pass flatus(4.0±1.2)days postoperatively.It was(4.5±1.5)days to start oral liquids.Patients were up and about on(4.0±1.5)days postoperatively. Minor postoperative complications occurred in 5 cases. Conclusion Laparoscopic total gastrectomy for gastric cancer is safe,feasible,less traumatic and of fast postoperative recovery.