The safety and long-term survival after laparoscopic surgery versus open surgery for colon cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the short-term outcomes and 5-year recurrence, overall survival, and disease-free survival of laparoscopic assisted surgery for colon cancer.</p><p><b>METHODS</b>The clinical and pathologic data were compared between the patients who underwent colectomy during March 2003 to July 2008 and assigned in laparoscopic group (n = 92) and open group (n = 285) according the surgical approach. The 5-year overall survival, disease-free survival, and recurrence rate were analyzed for all patients who were followed-up for more than 36 months in either of the groups.</p><p><b>RESULTS</b>The laparoscopic colectomy was associated with manifested less blood loss (50(50) ml) (Z = -8.292, P < 0.01), early return of bowel function (the evacuation time was (3.0 ± 1.0) days, and the meal time after operation was (4.0 ± 1.3) days) (t = -6.475 and -4.871, P < 0.01), and longer length (cm) of distal resection margin ((10 ± 4) cm vs. (9 ± 4) cm, t = 3.527, P = 0.000). The 5-year overall survival of the laparoscopic group and the open group were 63.6% and 61.8% respectively. The 5-year disease-free survival of the I-III stage patients in the laparoscopic group and the open group were 69.5% and 65.5% respectively, and the local recurrence were 8.7% and 13.6% (all P > 0.05).</p><p><b>CONCLUSION</b>The laparoscopic colectomy for colon cancer is safe in short-term clinical results and non-inferior to the open colectomy in long-term oncological outcomes.</p>

Risk factors associated with postoperative complications of D2 radical resection for local advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the risk factors of postoperative complications following D2 radical resection for advanced gastric cancer.</p><p><b>METHODS</b>From June 2004 to May 2011, 483 patients with local advanced gastric cancer who underwent radical gastrectomy with D2 lymph node dissection were enrolled in the study, including 132 patients of LAG (27.3%) and 351 patients of open procedure (72.7%). Clinicopathological data and postoperative complications were reviewed retrospectively. Postoperative complications were classified into overall and severe complications according to Clavien-Dindo Classification. Multivariate logistic model was used to identify risk factors of postoperative complications.</p><p><b>RESULTS</b>The overall incidence of postoperative overall and severe complications and mortality were 12.4% (60/483), 2.5% (12/483) and 0.2% (1/483), respectively. Univariate analysis showed that no significant differences were found in overall and severe complications between the two surgical approaches (13.6% vs. 12.0%, P=0.620; 3.0% vs. 2.3%, P=0.743). Furthermore, multivariate analysis showed that age ≥60 years, preoperative comorbidity and intraoperative blood loss >300 ml were independent risk factors associated with overall postoperative complications. Remarkably, intraoperative blood loss >300 ml was also an independent risk factor for severe postoperative complications.</p><p><b>CONCLUSIONS</b>LAG with D2 lymph node dissection for local advanced gastric cancer is technically feasible and safe. However, the elderly, preoperative comorbidity and increased intraoperative blood loss are associated with elevated risk of complications. Decreased intraoperative bleeding may reduce the potential postoperative complications.</p>

Quality control of laparoscopic surgery for gastric cancer / 中华胃肠外科杂志

As the improvement of technique and accumulation of experience in the past decade, the development of laparoscopic surgery has been in the advanced phase for the minimally invasive surgery for the management of gastric cancer. Even laparoscopic surgery has severaladvantages such as faster recovery courses and improved quality of life, however, surgical quality control for oncology must always be the most important consideration. The quality control system consists of accurate clinical staging, patient selection, intraoperative standard operating procedure, proper education and training course, data management for clinicopathologic information, and evidence-based studies.