Comparison of efficacy between laparoscopic versus open complete mesocolic excision for colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the differences in long-term outcomes between laparoscopic and open complete mesocolic excision(CME) for colon cancer.</p><p><b>METHODS</b>A total of 273 patients with colon cancer who underwent CME at the Fujian Medical University Union Hospital from September 2000 to December 2008 were divided into laparoscopic(LP, n=147) and open(OP, n=126) groups in a non-random manner. The oncologic and long-term outcomes were compared.</p><p><b>RESULTS</b>No significant differences were seen in the length of distal and proximal margin, and number of lymph nodes(all P>0.05). Median postoperative follow up was 50 months. Local regional recurrence rates (LP 6.1% vs. OP 7.9%) and distal metastasis rates(LP 23.8% vs. OP 16.7%) were similar between the two groups(all P>0.05). The 5-year overall survival rates (LP 69.4% vs. OP 74.0%, P=0.840) and 5-year disease-free survival rates(LP 68.5% vs. OP 70.9%, P=0.668) between the two groups were not statistically different.</p><p><b>CONCLUSIONS</b>Laparoscopic CME has the same oncologic clearance effects compared with open CME for colon cancer. It might become a new standardized surgery for colon cancer.</p>

Risk factors of postoperative chyle leak following complete mesocolic excision for colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the incidence, risk factors and preventative methods associated with chyle leak following complete mesocolic excision(CME) for colon cancer.</p><p><b>METHODS</b>Clinical data of 592 patients with colon cancer undergoing CME in the department of Colorectal Surgery in the Fujian Medical University Union Hospital from September 2000 to September 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>Chyle leak occurred in 46 patients(7.7%). The incidence of postoperative chyle leak following right CME hemicolectomy was 13.3%(30/226), significantly higher than that after left CME hemicolectomy (4.4%). On univariate analysis, chyle leak following CME was associated with tumor size(P<0.05), tumor location(P<0.01), and lymph nodes harvested(P<0.01). Multivariate logistic regression revealed that tumor location and lymph nodes harvested were independent risk factors associated with chyle leak following CME(P<0.05).</p><p><b>CONCLUSIONS</b>Tumor location and lymph nodes harvested are independent risk factors for chyle leak following complete mesocolic excision for colon cancer. When the drainage output suddenly increases after oral intake resumption, the chyle test of ascitic fluid should be performed for early diagnosis and prompt management.</p>

Comparing the influencing factors of anastomotic bleeding in rectal carcinoma resection between laparoscopic and open radical approaches / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To observe the occurrence of anastomotic bleeding following laparoscopic and open radical resection for rectal carcinoma, and to explore its contributing factors.</p><p><b>METHODS</b>Two hundred and sixty-three cases of rectal carcinoma undergone radical resection were divided into 2 groups, laparoscopic surgery (LS) group (n=86) and open surgery (OS) group (n=177). According to the different locations of anastomotic stoma and with or without preventive colostomy, the two groups were divided into AR sub-group and LAR/UAR sub-group, colostomy sub-group and non-colostomy sub-group. After analyzing the incidence of anastomotic bleeding in each sub-group, a logistic regression model was established to determine the relationships between anastomotic bleeding and three contributing factors including surgical approaches (LS or OS), location of stoma (AR or LAR/UAR) and preventive colostomy.</p><p><b>RESULTS</b>Anastomotic bleeding occurred on 16 out of 263 patients with radical resection of rectal cancer (6.1%). The rates of anastomotic bleeding in LS group and OS group were 9.3% and 4.5%, in colostomy and non-colostomy were 8.1% and 5.5%, and in AR group and LAR/UAR group were 3.3% and 12.1% respectively, there were no significant differences between them (P>0.05). Comparing the two different surgical approaches (LS vs OS), the coefficient of regression, odd ratio and standard coefficient of regression for LS were 1.319, 3.741 and 0.342 respectively. In comparison of the locations of anastomosis (AR vs LAR/UAR), the three index for LAR/UAR were 2.460, 11.704, and 0.632 respectively. Comparing colostomy with non-colostomy, the three index for colostomy were -1.394, 0.248, and -0.327 respectively.</p><p><b>CONCLUSIONS</b>Anastomotic bleeding after radical rectectomy is related to the choice of surgical approach, location of anastomosis and with or without preventive colostomy. Both LS and LAR/UAR are risk factors, and preventive colostomy is a protective factor. Regarding to the significance of three factors, location of anastomosis takes the first place, following by surgical method and with or without preventive colostomy.</p>

Comparison of surgical complication rate between laparoscopic and open radical resection for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the surgical complication rate between laparoscopic and open radical resection for colorectal cancer.</p><p><b>METHODS</b>From September 2000 to December 2005, 491 cases with colorectal cancer were divided into two groups prospectively and nonrandomly,and received radical laparoscopic operation (LP, n=214) and open operation (OP, n=277). The intra- and post-operative complication rate were compared between the two groups.</p><p><b>RESULTS</b>In laparoscopic groups, 14 cases (6.54%,14/214) were converted to open surgery,because of intra-operative complications in 7 cases,obesity or large tumors in 5 cases,narrow- pelvis in one case and retroperitoneal tumor in one case. The intra-operative complication rate was 4.8% (10/207) in LP group and 3.6% (10/277) in OP group (P > 0.05, chi2=0.446). There were no differences in post- operative intestinal obstruction, stoma leak, stoma bleeding, chyle leak, pulmonary infection except incision infection(5.5% vs 14.1%, P< 0.05) between LP and OP groups. The overall postoperative complication rate was 23.5% (47/200) in LP group and 36.8% (102/277) in OP group (P< 0.01, chi2=9.598).</p><p><b>CONCLUSIONS</b>There is no difference in intra-operative complication rate between LP and OP groups,but the post-operative complication rate is significantly lower in LP group than that in OP group.</p>