ABSTRACT
Objective To investigate the therapeutic efficacy of laparoscopic surgery for treatment of the patients with advanced gastric cancer.Methods A total of 120 patients with advanced gastric cancer treated by D2 radical resection of distal gastric cancer from January 2015 to January 2017 in Affiliated Hospital of Guangdong Medical University were retrospectively analyzed.According to the method of operation,the patients were divided into laparoscopic group (60 cases) and laparotomy group (60 cases).The operation-related indexes,operation curative effect indexes and postoperative recovery were compared between the two groups by using x 2 test and t test.Results The operation time of the laparoscopic group was longer than that of the laparotomy group [(197±21) min vs.(178±23) min,t =4.759,P ＜ 0.001].Some parameters in the laparoscopic group were lower than those in the laparotomy group (all P ＜ 0.05),including intraoperative blood loss [(111±30) ml vs.(221±52) ml,t =14.103],the length of the surgical incision[(6.1±1.3) cm vs.(17.3±3.2) cm,t =25.117],postoperative anal evacuation time [(90±14) h vs.(110±18) h,t =6.983],the postoperative bed-out time [(2.9±0.8) d vs.(4.8±1.4) d,t =9.127],the postoperative liquid dietary intake time [(4.3±0.9) d vs.(5.7±1.2) d,t =7.230],and hospital stay time [(13.2±2.5) d vs.(15.5±3.2) d t =4.387].There were no statistical differences in the number of removed lymph nodes,the number of first-site removed lymph nodes,the number of second-site removed lymph nodes,the distance from the distal margin to the tumor,and the distance from the proximal margin to the tumor (t values 1.351,0.912,1.240,0.876,and 0.840 respectively,all P ＞ 0.05);The incidence of operative complications in the laparoscopic group was lower than that in the laparotomy group [6.67 ％ (4/60) vs.20.00 ％ (12/60),X 2 =4.615,P =0.032].Conclusion Laparoscopic surgery in the treatment of advanced gastric cancer patients has a favorable effect,with reliable results,less trauma,postoperative recovery and fewer complications.
ABSTRACT
Objective To observe and compare the safety and short-term outcomes of laparoscopic surgery (LS)versus conventional open surgery(OS)for stage Ⅱor Ⅲ rectal cancer(RC). Methods One hundred and six patients with stage ⅡorⅢRC were divided into LS group(n=53)and OS group(n=53)according to the random double blind method. The related outcomes of two groups were compared ,including surgical duration , intraoperative blood loss , length of incision , distal margin length , proximal margin length , the number of lymph node dissection,residual cancer rate,exhaust time,first ambulation time,and postoperative hospital stay. Results Intraoperative blood loss,length of incision,postoperative hospital stay,exhaust time and the first ambu-lation time in LS group were significantly different from those in OS group (P < 0.05 for all comparisons). And there were no significant differences between the two groups in surgical duration ,the number of lymph node dissec-tion,distal margin length,proximal margin length and residual cancer rate(P > 0.05). Conclusions Laparo-scopic technology is safe and feasible in treating rectal carcinoma,with less trauma,quicker recovery,and shorter hospital stay.
ABSTRACT
Objective To observe and compare the safety and short-term outcomes of laparoscopic surgery (LS)versus conventional open surgery(OS)for stage Ⅱor Ⅲ rectal cancer(RC). Methods One hundred and six patients with stage ⅡorⅢRC were divided into LS group(n=53)and OS group(n=53)according to the random double blind method. The related outcomes of two groups were compared ,including surgical duration , intraoperative blood loss , length of incision , distal margin length , proximal margin length , the number of lymph node dissection,residual cancer rate,exhaust time,first ambulation time,and postoperative hospital stay. Results Intraoperative blood loss,length of incision,postoperative hospital stay,exhaust time and the first ambu-lation time in LS group were significantly different from those in OS group (P < 0.05 for all comparisons). And there were no significant differences between the two groups in surgical duration ,the number of lymph node dissec-tion,distal margin length,proximal margin length and residual cancer rate(P > 0.05). Conclusions Laparo-scopic technology is safe and feasible in treating rectal carcinoma,with less trauma,quicker recovery,and shorter hospital stay.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the association of early diarrhea and fecal volume with anastomotic leakage after low anterior resection (LAR) of rectal cancer.</p><p><b>METHODS</b>Clinical data of 541 patients with rectal cancer undergoing LAR at The Affiliated Hospital of Guangdong Medical College between January 2007 and January 2017 were analyzed retrospectively. Early postoperative diarrhea was defined as at least one occurrence of more than 50 ml watery stool or at least four times defecation per day within 7 days after surgery. The volume of fecal discharge from the transanal drain was measured at daily intervals for 3 days after surgery. Association of early diarrhea and anastomotic leakage was analyzed using logistic regression model. The accuracy of fecal volume in predicting anastomotic leakage was evaluated using receiver operating characteristics (ROC) curve.</p><p><b>RESULTS</b>There were 319 males and 222 females with mean age of 59.3 years. Early postoperative diarrhea occurred in 99(18.3%) patients, and 41(7.6%) patients developed anastomotic leakage. The incidence of anastomodc leakage in patients with early diarrhea was significantly higher as compared to those without early diarrhea (15.2% vs. 5.9%, P=0.000). Multivariate analysis revealed that early diarrhea (OR=33.940, 95%CI: 8.423 to 89.240) and the distance between the tumor and the anal verge less than 7 cm (OR=13.085, 95%CI: 2.117 to 44.556) were independent risk factors for anastomotic leakage, while the presence of a transanal tube was an independent protective factor (OR=0.474, 95%CI: 0.122 to 0.881). The total fecal volume for 3 days after surgery was calculated in 162 patients with a transanal tube. The median fecal volume was 210 (100 to 4360) ml and 60 (0 to 480) ml in patients with and without anastomotic leakage respectively(P=0.000). ROC curve showed that the cut-off value of fecal volume for anastomotic leakage was 110 ml and the area under the curve was 0.824 with a high sensitivity of 85.7% and specificity of 81.3%.</p><p><b>CONCLUSIONS</b>Early postoperative diarrhea after LAR procedure of rectal cancer may be an early predictor of anastomotic leakage, and fecal volume for 3 days after surgery ≥110 ml can accurately predict anastomotic leakage. Active prevention and management of early postoperative diarrhea may reduce the risk of anastomotic leakage.</p>