Safety and effectiveness of esophagojejunostomy through extracorporeal versus intracorporeal methods after laparoscopic total gastrectomy / 中华胃肠外科杂志

Objective: To compare the safety and effectiveness of esophagojejunostomy (EJS) through extracorporeal and intracorporeal methods after laparoscopic total gastrectomy (LTG). Methods: A retrospective cohort study was carried out. Clinicopathological data of 261 gastric cancer patients who underwent LTG, D2 lymphadenectomy, and Roux-en-Y EJS with complete postoperative 6-month follow-up data at the General Surgery Department of Nanfang Hospital from October 2018 to June 2021 were collected. Among these 261 patients, 139 underwent EJS with a circular stapler via mini-laparotomy (extracorporeal group), while 122 underwent intracorporeal EJS (intracorporeal group), including 43 with OrVil(TM) anastomosis (OrVil(TM) subgroup) and 79 with Overlap anastomosis (Overlap subgroup). Compared with the extracorporeal group, the intracorporeal group had higher body mass index, smaller tumor size, earlier T stage and M stage (all P<0.05). Compared with the Overlap subgroup, the Orvil(TM) subgroup had higher proportions of upper gastrointestinal obstruction and esophagus involvement, and more advanced T stage (all P<0.05). No other significant differences in the baseline data were found (all P>0.05). The primary outcome was complications at postoperative 6-month. The secondary outcomes were operative status, intraoperative complication and postoperative recovery. Continuous variables with a skewed distribution are expressed as the median (interquartile range), and were compared using Mann-Whitney U test. Categorical variables are expressed as the number and percentage and were compared with the Pearson chi-square, continuity correction or Fisher's exact test. Results: Compared with the extracorporeal group, the intracorporeal group had smaller incision [5.0 (1.0) cm vs. 8.0 (1.0) cm, Z=-10.931, P=0.001], lower rate of combined organ resection [0.8% (1/122) vs. 7.9% (11/139), χ(2)=7.454, P=0.006] and higher rate of R0 resection [94.3% (115/122) vs. 84.9 (118/139), χ(2)=5.957, P=0.015]. The morbidity of intraoperative complication in the extracorporeal group and intracorporeal group was 2.9% (4/139) and 4.1% (5/122), respectively (χ(2)=0.040, P=0.842). In terms of postoperative recovery, the extracorporeal group had shorter time to liquid diet [(5.1±2.4) days vs. (5.9±3.6) days, t=-2.268, P=0.024] and soft diet [(7.3±3.7) days vs. (8.8±6.5) days, t=-2.227, P=0.027], and shorter postoperative hospital stay [(10.5±5.1) days vs. (12.2±7.7) days, t=-2.108, P=0.036]. The morbidity of postoperative complication within 6 months in the extracorporeal group and intracorporeal group was 25.9% (36/139) and 31.1%, (38/122) respectively (P=0.348). Furthermore, there was also no significant difference in the morbidity of postoperative EJS complications [extracorporeal group vs. intracorporeal group: 5.0% (7/139) vs. 82.% (10/122), P=0.302]. The severity of postoperative complications between the two groups was not statistically significant (P=0.289). In the intracorporeal group, the Orvil(TM) subgroup had more estimated blood loss [100.0 (100.0) ml vs.50.0 (50.0) ml, Z=-2.992, P=0.003] and larger incision [6.0 (1.0) cm vs. 5.0 (1.0) cm, Z=-3.428, P=0.001] than the Overlap subgroup, seemed to have higher morbidity of intraoperative complication [7.0% (3/43) vs. 2.5% (2/79),P=0.480] and postoperative complications [37.2% (16/43) vs. 27.8% (22/79), P=0.286], and more severe classification of complication (P=0.289). Conclusions: The intracorporeal EJS after LTG has similar safety to extracorporeal EJS. As for intracorporeal EJS, the Overlap method is safer and has more potential advantages than Orvil(TM) method, and is worthy of further exploration and optimization.

Crebanine N-oxide, a natural aporphine alkaloid isolated from Stephania hainanensis, induces apoptosis and autophagy in human gastric cancer SGC-7901 cells

Objective: To investigate the cytotoxic effects and the potential mechanisms of crebanine N-oxide in SGC-7901 gastric adenocarcinoma cells. Methods: The cytotoxicity of crebanine N-oxide was evaluated by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide assay and cellular morphology was observed under a microscope. Cell apoptosis was determined by flow cytometry using propidium iodide staining. The expression levels of apoptotic-related proteins, cleaved caspase-3, cytochrome C, p53 and Bax, and autophagy-related proteins p62, beclin1 and LC3 were detected by Western blotting assays. Results: Crebanine N-oxide treatment significantly inhibited the proliferation of SGC-7901 cells in a dose-dependent and time-dependent manner via induction of G

Sericin regulates proliferation of human gastric cancer MKN45 cells through autophagic pathway / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of sericin on the proliferation of human gastric cancer MKN45 cells and explore the underlying molecular mechanism.</p><p><b>METHODS</b>MKN45 cells were transfected by LC3 double fluorescent autophagic virus, and the positive cells screened by puromycin were divided into blank group, sericin group and sericin∓3-MA group. After incubation with sericin for 48 h, the cells were examined for proliferation, apoptosis and cell cycle using CCK-8 assay and flow cytometry. Cell autophagy was detected by transmission electron microscopy (TEM) and fluorescent inverted microscope, and the autophagy-related markers including LC3, p62 and Beclin proteins were detected with Western blotting. Nude mice bearing gastric cancer xenograft were treated with normal saline or sericin injections (n=5) and the changes in the tumor volume and weight were measured.</p><p><b>RESULTS</b>Compared with the blank group, MKN45 cells with sericin treatment showed significantly inhibited proliferation both in vitro and in nude mice. Autophagosomes were observed in sericin-treated cells under TEM and fluorescent inverted microscope. Sericin treatment of the cells significantly increased the cell apoptosis (P<0.01), caused obvious cell cycle arrest in G/M phase (P<0.01), up-regulated the expressions of both LC3-2 and Beclin, and down-regulated the expression of p62. The autophagy inhibitor 3-MA obviously antagonized the effects of sericin on cell apoptosis, cell cycle and autophagic protein expressions.</p><p><b>CONCLUSION</b>Sericin can inhibit the proliferation of human gastric cancer MKN45 cells by regulating cell autophagy to serve as potential anti-tumor agent.</p>

Association between the score of preoperative nutritional risk screening and anastomotic leakage following anterior resection for the rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the association between the score of preoperative Nutritional Risk Screening 2002 (NRS 2002) and anastomotic leakage following anterior resection for the rectal cancer.</p><p><b>METHODS</b>Clinical data of 641 patients with rectal cancer undergoing anterior resection in Nanfang Hospital, Southern Medical University between January 2003 and July 2012 were analyzed retrospectively. Preoperative nutritional status was evaluated using NRS 2002. Association of clinicopathologic characteristics with postoperative anastomotic leakage was examined using univariate χ(2) and Logistic regression model.</p><p><b>RESULTS</b>Among the 641 patients, postoperative anastomotic leakage occurred in 26 (4.1%) cases. The proportion of anastomotic leakage in patients with the NRS 2002 score ≥3 was significantly higher than that in patients with the score <3 (6.9% vs. 2.1%, P=0.002). After the adjustment of factors as age, distance of anastomosis above the anal margin, and pathological staging, NRS 2002 score ≥3 was identified as an independent risk factor for anastomotic leakage following anterior resection for rectal cancer (OR=3.198, 95%CI:1.324-7.722, P=0.010).</p><p><b>CONCLUSION</b>The use of the NRS 2002 for preoperative evaluation on patient's nutritional status may help to predict the occurrence of anastomotic leakage following anterior resection for rectal cancer, which may be involved in the indication of protecting ileostomy in clinical practice.</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>

Clinical application of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach.</p><p><b>METHODS</b>Between October 2005 and January 2012, 21 consecutive patients underwent laparoscopic-assisted total proctocolectomy by medial-to-lateral approach in Department of General Surgery in Nanfang Hospital. The clinical data and follow-up results were reviewed.</p><p><b>RESULTS</b>Twenty cases underwent laparoscopic resection successfully, and 1 case (4.8%) was converted to open surgery because of serious peritoneal cavity adhesion. The mean operative time was (237.1±64.2) min and intraoperative blood loss was (90.0±77.7) ml. The mean time to first flatus was (2.7±0.8) days. The mean postoperative hospital stay was (11.8±5.7) days. Three patients (14.3%) experienced postoperative complications, including anastomotic leakage (n=1), lymphatic leakage (n=1), and anastomotic stricture (n=1). The median follow-up was 22 months (4-60 months). There were two deaths including one patient died of progressive disease 5 months after surgery and the other died of multiple organ failure.</p><p><b>CONCLUSIONS</b>The advantages of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach include simplified surgical procedure, clearly revealed surgical plane, and shortened operative time. This procedure is safe and feasible in the experienced department of laparoscopic colorectal surgery.</p>

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>

Evaluation of robotic gastrectomy for gastric cancer based on the current evidence / 中华胃肠外科杂志

Surgical modality undoubtedly has been developing rapidly resulting from the improvement of minimally invasive approach and instruments. Robotic gastrectomy for gastric cancer, as one of the most common performed operations worldwide, is playing a key role in maximizing potential benefits for both patients and surgeons. Most studies have demonstrated its satisfactory short-term outcomes including fast postoperative recovery course and similar oncological adequacy, while followed by several disadvantages or pitfall such as longer operation time, relatively high costs, and uncertain long-term outcome. However, the role of robotic gastrectomy is still controversial. This article is a review about robotic gastrectomy for treating gastric cancer based on the current evidence in terms of technology, application, clinical trials, and future prospects.

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.

Vascular anatomy of the right colon and vascular complications during laparoscopic surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the vascular anatomy and complications of the right colon under laparoscope.</p><p><b>METHODS</b>Videotapes of 55 laparoscopic extended right hemicolectomy with D3 lymphadenectomy were reviewed and the anatomic relationship and bleeding vessels were determined.</p><p><b>RESULTS</b>The superior mesenteric vein, superior mesenteric artery, ileocolic artery, and middle colic artery were present in all the patients. The right colic artery was present in 45.5%(25/55) of the patients. The incidence of the gastrocolic venous trunk was 74.5%. The overall incidence of intraoperative bleeding was 43.6%. Vessels in the pre-pancreatic region including the right gastroepiploic artery, the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding than the middle colic vein and artery (16.4% vs. 14.5%). Intraoperative bleeding significantly prolonged the overall operative time and lymphadenectomy time.</p><p><b>CONCLUSIONS</b>The vascular anatomy of the right colon is intricate and variable and laparoscopic extended right hemicolectomy with D3 lymphadenectomy is associated with a high risk of hemorrhage. Understanding the vessels anatomic relationship of the right colon is valuable to decrease vascular complication.</p>

Anatomic observation of annular distribution of perirectal fascia and space around the mesorectum / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the regional anatomy of the rectum including the perirectal fasciae and spaces.</p><p><b>METHODS</b>Twenty-one cadavers (15 males and 6 females) were embalmed and their vessels were visualized by injection with color dye. From the cadavers, 30 hemipelvis and 6 three-quarter pelvis were harvested. The perirectal fasciae and spaces and the pelvic autonomic nerves were dissected and examined.</p><p><b>RESULTS</b>Three tissue layers were dissected from the inside to the periphery including the proper rectal fascia enveloping the mesorectum, the presacral fascia, and the piriformis fascia fused with the sacral periosteum. The mesorectum comprised 2 parts with the classical posterolateral fat covered by the proper rectal fascia posteriorly and the anterior fat covered by the posterior layer of Denonvilliers fascia anteriorly. Extending anteriorly to the anterior layer of Denonvilliers fascia, the presacral fascia bisected the space between the mesorectum and the piriformis fascia into the retrorectal space and the presacral space. The retrorectal space extended cranially to the left retrocolic space, anterior to the space between the 2 layers of Denonvilliers fascia(prerectal space).</p><p><b>CONCLUSIONS</b>From the inside to the periphery, the proper rectal fascia, the presacral fascia, and the muscular fascia are distributed in an annular pattern around the mesorectum. The presacral fascia divides the perirectal space into 2 annular parts, the central retrorectal space and the peripheral presacral space. The retrorectal space is the ideal surgical plane for total mesorectal excision.</p>

Effect of 5-fluorouracil aerosol on the growth of human gastric cancer cell line MKN-45 in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of simulated intraperitoneal 5-fluorouracil (5-Fu) aerosol chemotherapy (AIPC) on the proliferation, apoptosis, and cell cycle of human gastric cancer cell line MKN-45 in vitro.</p><p><b>METHODS</b>The gastric cancer cells MKN-45 were treated with 5-Fu aerosol for 30 min under the pressure of 8 mmHg, and those treated with normal saline (NS) aerosol served as the control. The cell proliferation after the treatment was detected by MTT assay, and flow cytometry and FITC Annexin V/PI kit were used to detect the cell apoptosis and changes in the cell cycle.</p><p><b>RESULTS</b>MTT assay showed a significantly greater inhibition rate of the cell proliferation in 5-Fu aerosol group than in NS group [(31.13∓3.51)% vs (4.65∓1.99)%, P<0.001]. FCM analysis also showed a significantly higher cell apoptotic rate in 5-Fu aerosol group than in NS group [(12.00∓0.92)% vs (2.65∓0.52)%, P<0.001]. Compared with saline treatment, treatment with 5-Fu aerosol resulted in a greater proportion of G1 phase cells [(51.83∓1.95)% vs (36.41∓2.33)%, P<0.001] with a lowered proportion of S phase cells [(16.72∓2.36)% vs (45.20∓3.27)%, P<0.001].</p><p><b>CONCLUSION</b>Simulated 5-Fu AIPC can inhibit the proliferation, induce cell apoptosis and cause cell cycle arrest at G1 phase in gastric cancer cells.</p>

Associated risk factors of peritoneal metastasis in colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate risk factors associated with peritoneal metastasis in colorectal cancer.</p><p><b>METHODS</b>Clinicopathological data of 873 patients with colorectal cancer treated at the Nanfang Hospital of Southern Medical University from January 2003 to December 2008 were retrospectively analyzed. The associations between peritoneal metastasis and clinicopathological factors were evaluated by univariate analysis including independent-samples t test and χ(2) test, and multivariable logistic regression analysis.</p><p><b>RESULTS</b>Univariate analysis showed that age(P=0.032), tumor size(P=0.001), tumor differentiation(P=0.008), depth of bowel wall invasion(P=0.000), lymph node metastasis(P=0.000), serum carcinoembryonic antigen (CEA) level(P=0.003), and serum carbohydrate antigen 19-9(CA19-9) level(P=0.009) were associated with peritoneal metastasis. On multivariable logistic regression analysis, depth of bowel wall invasion, lymph node metastasis, serum CEA level and CA19-9 level remained as significant risk factors(all P<0.05).</p><p><b>CONCLUSION</b>Depth of bowel wall invasion, lymph node metastasis, serum CEA level, and CA19-9 level are risk factors for peritoneal metastasis in colorectal cancer.</p>

Application of ⁹⁹mTc-SPECT-CT and carbon nanoparticles suspension injection in sentinel lymph node mapping for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of sentinel lymph node mapping(SLM) in patients with rectal cancer by single-photon emission computed tomography (SPECT-CT) lymphoscintigraphy and carbon nanoparticles suspension injection.</p><p><b>METHODS</b>Twelve patients with clinical T(1-2)N(0)M(0) rectal cancer were selected and locally injected with technetium-(99m)sulfur-colloid and carbon nanoparticles suspension by endoscope one day before surgery, followed by SPECT-CT scanning 1, 3 and 5 hours later. Radioactive isotope(RI) uptake of each sentinel node(SN) basin with location preoperatively determined by SPECT-CT was postoperatively calculated using gamma probe. Nodes with the highest RI uptake, the number of which was also pre-determined by SPECT-CT, was defined as SNs. Immunohistochemical cytokeratin staining was performed for all the SNs and non-SNs.</p><p><b>RESULTS</b>The rate of sentinel node detection was 91.7%(11/12) with at least one SN(1-3) per patient. Ten cases showed metastasis-negative in SNs as well as all the resected regional nodes by immunohistochemical cytokeratin staining. Only one patient had positive nodes in both SN and non-SNs. The accuracy of SLM was 100%.</p><p><b>CONCLUSION</b>SPECT-CT lymphoscintigraphy and carbon nanoparticles suspension injection can effectively detect the anatomic location and number of sentinel nodes, and improve the accuracy of SLM for rectal cancer.</p>

Learning curve of laparoscopic D2 gastrectomy for gastric cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the learning curve for an experienced laparoscopic colorectal surgeon in performing to laparoscopic D2 gastrectomy for gastric cancer.</p><p><b>METHODS</b>From July 2004 to July 2009, 70 patients undergoing laparoscopic D2 gastrectomy performed by a single surgical team were retrospectively evaluated. The patients were divided into groups A to G (n=10) based on the surgery date, and the operation time, estimated blood loss (EBL), conversion to open surgery, number of lymph nodes harvested, complications, and recovery indicators were compared.</p><p><b>RESULTS</b>No statistical differences were found among the groups in age, gender, gastrectomy approach, EBL, number of lymph nodes harvested, time to flatus, or postoperative hospital stay (P>0.05). No significant differences were found in the operation time between groups A and B (P=0.999) or among the other 5 groups (P>0.05), but the operation time in groups A (300.00-/+104.59 min) and B (261.00-/+40.50 min) were significantly longer than that in the other 5 groups (C: 191.30-/+23.11 min, D: 188.60-/+31.38 min, E: 181.10-/+20.18 min, F: 167.50-/+32.81 min, and G: 161.30-/+29.03 min). Compared with that in group A, the time to liquid diet decreased significantly in the remaining 6 groups (P<0.05). Conversion to open surgery occurred in two cases (2.86%, both in group B), 2 patients in group B and another 2 in group C developed intraoperative complications, and one in group C had postoperative complication, with the total incidence of complication of 7.14% in this series.</p><p><b>CONCLUSION</b>A well-trained laparoscopic colorectal surgeon, by following the standard surgical procedures, are likely to overcome the learning curve smoothly after performing approximately 20 cases of laparoscopic D2 gastrectomy for gastric cancer.</p>

Development and implementation of a clinical data mining system for gastric cancer surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To develop a clinical database system of gastric cancer surgery integrated with data mining function for better management of clinical data and better performance of both retrospective and prospective studies.</p><p><b>METHODS</b>Core fields for clinical data were determined based on the JGCA(13th and 14th edition) and UICC gastric cancer staging system. Microsoft Visual Basic and VistaDB were used for programming. The database structure was designed according to data mining theory and clinical workflow.</p><p><b>RESULTS</b>After one year of development and refinement, data of over 600 patients from our hospital were retrospectively entered, and function tests were satisfactory. This system was accepted as the database platform for the Chinese Laparoscopic Gastrointestinal Surgery Study Group (CLASS) and was successfully used in the first stage of the Multicenter Retrospective Study of the Feasibility of Laparoscopy for Gastric Cancer among 30 hospitals from both Mainland China and Hong Kong. The data mining function met the requirements, which could carry out complex search with visualized presentation. Descriptive analyses could be performed with the analysis function. Efficient communication among institutions could be executed by data import and export with excellent compatibility and without errors.</p><p><b>CONCLUSION</b>The system has established a clinical database of approximately 4000 fields with data mining function. This system can be widely applied for the clinical research for gastric cancer.</p>

Peritoneal structural injury in laparoscopic versus open radical resection for colorectal cancer: a prospective controlled study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the differences in peritoneal microstructure injury between laparoscopic and open radical resection for colorectal cancer.</p><p><b>METHODS</b>A total of 50 patients with colorectal cancer were consecutively assigned into laparoscopic group (LO, n=27) and conventional laparotomy group (CO, n=23). Prospectively comparative analyses of operative time, intraoperative blood loss, number of lymph node harvest, positive rate of lymph nodes, length of specimen and resection margin involvement were performed. Optical microscope and scanning electron microscope were used to detect postoperative peritoneal injury between patients who received laparoscopic surgery or open surgery.</p><p><b>RESULTS</b>Compared with the CO group, operative time [(150.6+/-39.5) min vs (183.0+/-39.2) min, P<0.05] and intraoperative blood loss [(80.0+/-75.2) ml vs (234.5+/-235.3) ml, P<0.01] were significantly less in the LO group. No significant differences were found between two groups in length specimen, number of lymph nodes harvest, positive rate of lymph nodes, and all resection margins were negative (P>0.05). Optical microscope indicated less serosal injury in the LO group as compared to the CO group with regard to serosal integrity, continuity of covering adipocyte and mesothelial cell, and the aggregation level of erythrocytes and inflammatory cells (P<0.01). Scanning electronic microscopy showed more severe injury to colorectal serosa, mesothelium and basement membrane in the CO group as compared to the LO group.</p><p><b>CONCLUSION</b>With equal degree of radical resection, laparoscopic technique for colorectal cancer causes less peritoneal structural injury as compared with open surgery.</p>

Living anatomical observations on peripancreatic spaces and their implications on laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore living anatomy of pancreas and peripancreatic spaces,as well as their implications on laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer.</p><p><b>METHODS</b>Living observation was carried out in 132 patients diagnosed as distal gastric cancer and undergoing laparoscopic gastrectomy with D(2) lymphadenectomy.</p><p><b>RESULTS</b>Spaces between greater omentum and transverse mesocolon continued to pre-pancreatic and retro-pancreatic spaces at inferior margin of pancreas. The pre-pancreatic and retro-pancreatic spaces continued each other at inferior and superior margin of pancreas and extended in all directions. Left gastroepiploic vessels were located in pre-pancreatic spaces at superior margin of pancreatic tail. In retro-pancreatic space at inferior margin of pancreatic neck, superior mesenteric veins were located. In retro-pancreatic spaces or in gastric mesenteries inferior to gastric antrum, right gastroepiploic vessels were located. In spaces between gastric antrum and pancreatic heads, gastroduodenal arteries were located and traced to locate common hepatic arteries. In retro-pancreatic spaces at superior margin of pancreatic body, common hepatic arteries, left gastric arteries,celiac arteries and splenic arteries were located. Hepatopancreatic folds and gastropancreatic folds were landmarks respective to locate common hepatic arteries and left gastric arteries. The aforementioned vessels and spaces in their vagina vasorum continued each other and united as a whole.</p><p><b>CONCLUSIONS</b>Laparoscopic gastrectomy with D(2) lymphadenectomy for distal gastric cancer is carried out in macroscopic surgical planes of pre-pancreatic space and retro-pancreatic space, as well as their extensions in all directions, and in microscopic surgical planes of spaces in vagina vasorum of perigastric vessels which continue each other, under the guidance of central landmarks of pancreas and concrete landmarks of vessel trunks and their furcations.</p>

Laparoscopic versus open total mesorectal excision for the middle-lower rectal cancer: a clinical comparative study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, safety, radicality and short-term outcome of laparoscopic total mesorectal excision(TME) in comparison with open procedure for the middle-lower rectal cancer.</p><p><b>METHODS</b>From November 2005 to October 2008, 93 patients with middle-lower rectal cancer received laparoscopic total mesorectal excision (LTME group), while 105 patients underwent conventional open TME (OTME group). The operative procedures, clinicopathological data and short-term outcome were collected and compared between the 2 groups.</p><p><b>RESULTS</b>(1) Comparison of surgical procedures. The demographic data of LTME and OTME groups were comparable (P >0.05). Four (4.3%) patients were converted to open procedure in LTME group. The anal sphincter preserved procedure accounted for 82.8% in LTME group and 81.9% in OTME group. The difference was not significant (P >0.05). (2) Comparison of perioperative surgical data. The mean operating time was (164.6+/-35.6) min in LTME group, significantly longer than that in OTME group (141.9+/-29.4) min (P <0.001). The operative blood losses were (51.4+/-20.2) ml and (180.0+/-64.7) ml in LTME and OTME group respectively, the difference was significant (P <0.001). The analgesia requirement, time for bowel movement retrieval, time to liquid food intake, time to resuming early activity and hospital stay in LTME group were significant lower or shorter than those in OTME group (P <0.001). There was no operative death in both groups. (3) Comparison of operative complications. The overall morbidity rate was 11.8% in LTME group, and 12.4% in OTME group, the difference was not significant (P >0.05). The major complications were equivalent between two groups. (4) Comparison of specimen. No significant differences were observed between two groups in terms of specimen length, lymph node harvest and negative distal margin. (5) Follow-up results. The mean follow-up time was 19 months. The recurrent rate and overall survival rate were 4.4% and 97.8% in LTME group, with no significant difference compared to those in OTME group (7.3% and 97.9%, P >0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic TME for middle-low rectal cancer is safe and feasible, and can potentially offer all the benefits of a minimally invasive approach and achieve satisfactory oncological outcome,which may lead to a better future of the TME technique.</p>

Application of laparoscopic surgery following neoadjuvant chemoradiotherapy for mid-low rectal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of laparoscopic surgery following neoadjuvant chemoradiotherapy (CRT) for mid-low rectal cancer.</p><p><b>METHOD</b>A retrospective analysis was conducted among 24 patients with mid-low rectal cancer who received laparoscopic total mesorectal excision (TME) after neoadjuvant CRT. Another 24 patients with mid-low rectal cancer were randomly selected form those undergoing primary laparoscopic TME to serve as the control group. The clinical data and surgical data of the two groups of patients were collected and analyzed comparatively.</p><p><b>RESULTS</b>TME after CRT resulted in significantly lower lymph node yield compared with the control group (7.08-/+6.5 vs 12.5-/+4.1, P<0.05). The two groups were comparable in the operative time, intraoperative blood loss, intestinal function recovery, positive surgical margins, rate of conversion to open surgery, and occurrence of intra- and postoperative complications.</p><p><b>CONCLUSIONS</b>Laparoscopic surgery of mid-low rectal cancer after neoadjuvant CRT can be safe and feasible and produce surgical effects comparable to exclusive laparoscopic surgery.</p>