ABSTRACT
Objective:To compare the advantages of high or low inferior mesenteric artery (IMA) ligation in laparoscopic anterior resection of rectum based on CT precise guidance.Methods:One hundred and twenty patients with rectal cancer who underwent laparoscopic anterior resection of rectum in Shanghai Sixth People′s Hospital South Campus from January 2016 to June 2020 were selected. Surgical protocol was selected according to the principle of voluntariness. Sixty-eight cases underwent high IMA ligation (high IMA ligation group), and 52 cases underwent low IMA ligation (low IMA ligation group). The perioperative conditions (operative time, intraoperative blood loss, postoperative anal exhaust time, abdominal drainage, hospitalization time and ileostomy), postoperative pathological data (proximal margin distance, distal margin distance, total number of dissected lymph nodes and number of positive lymph nodes) and postoperative recovery (anastomotic stoma fistula, urinary retention, sexual dysfunction and daily number of defecation) were recorded. The quality of life 6 months after surgery was evaluated by the quality of life instruments for colorectal cancer scale (QLQ-CR38). Patients were followed up for 6 to 36 months, and the local recurrence and distant metastasis were recorded.Results:The postoperative anal exhaust time in low IMA ligation group was significantly shorter than that in high IMA ligation group: (2.87 ± 1.04) d vs. (3.26 ± 1.00) d, and there was statistical difference ( P<0.05); there were no statistical differences in operative time, intraoperative blood loss, abdominal drainage, hospitalization time and rate of ileostomy between 2 groups ( P>0.05). There were no statistical difference in proximal margin distance, distal margin distance, total number of dissected lymph nodes and number of positive lymph nodes between 2 groups ( P>0.05). The incidences of anastomotic stoma fistula, urinary retention and sexual dysfunction in low IMA ligation group were significantly lower than those in high ligation group: 3.85% (2/52) vs. 13.24% (9/68), 3.85% (2/52) vs. 11.76% (8/68) and 5.77% (3/52) vs. 14.71% (10/68), the daily number of defecation was significantly less than that in high ligation group: (2.87 ± 0.98) times vs. (4.05 ± 1.56) times, and there were statistical differences ( P<0.05 or <0.01). The functional dimension, symptom dimension and aggregate score of QLQ-CR38 in low IMA ligation group were significantly higher than those in high ligation group: (15.46 ± 4.22) scores vs. (13.68 ± 3.56) scores, (51.82 ± 13.54) scores vs. (45.65 ± 12.42) scores and (67.28 ± 14.28) scores vs. (59.33 ± 12.85) scores, and there were statistical differences ( P<0.05 or <0.01). There were no statistical difference in the rates of local recurrence and distant metastasis between 2 groups ( P>0.05). Conclusions:The application of low IMA ligation based on CT precise guidance in laparoscopic anterior resection of rectum can obtain the same surgical effect as the high IMA ligation. It can promote the recovery of gastrointestinal function after surgery, reduce the risk of complications, have less effect on the defecation function, which can improve the life quality after the surgery.
ABSTRACT
Objective To investigate the influence of the lymph node micrometastasis and its clinicopathological features on postoperative disease-free survival rate for patients with gastric cancer.Methods The study included 120 patients with pT1-3NoMo gastric cancer. The relationships between clinicopathological features or carcinoembryonic antigen (CEA) positive expression and postoperative disease-free survival rate were analyzed. Results In clinicopathological factors, multivariate analysis identified CEA positive expression was significantly correlated with tumor diameter (P = 0.011 ),depth of tumor invasion (P= 0.027) and lymphatic vessel invasion (P= 0.001 ) in lymph node positively. The average postoperative follow-up was (53.14 ± 16.75) months. There was statistical correlation between the tumor diameter( P = 0.018 ) or depth of tumor invasion ( P = 0.015 ) and postoperative disease-free survival rate. The disease-free survival rate was 90.91% ( 80/88 ), 86.36% ( 19/22 )and 40.00% (4/10) for the lymph node CEA negative,isolated tumor cells (IT Cs) and micrometastasis,respectively. There was significant difference between micrometastasis and the lymph node CEA negative (P= 0.000) or ITCs (P = 0.009), however, the lymph node CEA negative and ITCs was no significant difference (P = 0.438 ). Lymph node micrometastssis of gastric cancer was detected in 10 patients who should belong to stage pN1,the restage rate was 8.33%(10/120). Conclusions If the patients were found micrometastasis in lymph node with high-risk stage pT1-3NoMo gastric cancer for whom chemotherapy may be recommended,because of its high recurrence and poor prognosis.