Clinical prognostic multivariate analysis of incidental gallbladder cancer: a case controlled retrospective study / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic risk factors in incidental gallbladder cancer (IGBC) and evaluate the effect of laparoscopic cholecystectomy (LC) applied in treating IGBC.</p><p><b>METHODS</b>The retrospective study enrolled 55 patients with incidental gallbladder adenocarcinoma treated between January 2001 and December 2008. The patients were divided into three groups according to different surgical approaches: laparoscope group (n = 23), conversion group (n = 6) and laparotomy group (n = 26). Survival analysis and Cox regression model were applied to comparing the difference of survival rate between three groups and to analyzing the related prognostic risk factors of IGBC.</p><p><b>RESULTS</b>The overall 1-, 3- and 5-year survival rates were 74.3%, 47.7% and 35.8% respectively. And the median survival time was 36 months. The outcome of survival rate between three groups was not different statistically. Cox regression analysis indicated that pathologic T stage was an independent risk factor influencing IGBC (OR = 2.75, P = 0.00). The prognosis was getting worse according to the rising depth of tumor invasion. However, the other factors, such as surgical approach, tumor incisional implantation, ect.were not related to the prognosis (P > 0.05).</p><p><b>CONCLUSION</b>The factor of pathologic T stage is related to the prognosis of IGBC for which LC, compared with open cholecystectomy, should not be regarded as a negative factor in treatment.</p>

Impact of previous abdominal operations on the outcome of laparoscopic colorectal cancer surgery: a non-randomized cohort study / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the impact of previous abdominal operations on the outcome of laparoscopic colorectal cancer surgery and to evaluate the feasibility and safety of laparoscopic reoperation in treatment for colorectal cancer.</p><p><b>METHODS</b>According to the statistical standards, 653 consecutive patients treated from March 2002 and March 2009 were enrolled in this study. The patients were divided into three groups: upper abdominal surgery group (n = 48), middle-lower abdominal surgery group (n = 110) and non-previous abdominal surgery group (n = 495). Demographic, pathoanatomical and surgical data were compared among the three groups.</p><p><b>RESULTS</b>There was no significant differences in demographic, pathoanatomical data and post-operative complications among the three groups. Compared with the other two groups, middle-lower abdominal surgery subgroup had a higher intra-operative conversion rate due to intra-abdominal adhesion (4.2%, 11.8% and 3.8% in upper abdominal surgery group, middle-lower abdominal surgery group and non-previous abdominal surgery group, respectively). And no significant differences was found in operating time [(132 ± 36), (141 ± 42), (132 ± 36) min], intra-operation blood loss [(58 ± 50), (81 ± 99), (57 ± 57) ml], blood transfusion rate (6.3%, 10.9%, 7.9%), low sphincter-preserving surgery rate (47.1%, 44.7%, 55.2%), time of first flatus passage [(2.5 ± 1.4), (2.9 +/- 1.7), (2.5 ± 2.1) d], fasting time [(5 ± 4), (5 ± 4), (4 ± 3) d], hospital stay [(17 ± 9), (15 ± 8), (16 ± 10) d] between the three groups.</p><p><b>CONCLUSIONS</b>The history of previous abdominal operations should not be regarded as a contraindication for laparoscopic colorectal cancer reoperation. The laparoscopic reoperation for colorectal cancer is safe and feasible.</p>

Safety study of laparoscopic surgery for colorectal cancer in elderly patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the outcomes of laparoscopic colorectal surgery in elderly (> or = 70 years) and younger(< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly.</p><p><b>METHODS</b>From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older(Elder Group), and 15 patients less than 70 years(Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups.</p><p><b>RESULTS</b>Elder group had a higher ASA degree(P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO(3) value and PaCO(2) value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucosa(PgCO(2)) increased significantly at the end of operation. Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, perfusion, and blood chemistry were not significantly different.</p><p><b>CONCLUSIONS</b>For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.</p>

Experience of laparoscopic salvage surgery for locally recurrent rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of the laparoscopic salvage surgery for locally recurrent rectal cancer.</p><p><b>METHODS</b>Seven cases with recurrent rectal carcinoma treated by laparoscopic salvage surgery from February 2004 to July 2005 were retrospectively analyzed. Among them, four were males and 3 females, and the median age was 60 years (range 37-74). Three cases of recurrence were after conventional anterior resection, 2 after laparoscopic-assist anterior resection, 1 after laparoscopic-assist Parks' procedure, and 1 with pars sacral fistula after per-sacral-local resection for three times. Image examination (CT scanning) was taken preoperatively to evaluate the locally recurrence and exclude the distant metastases. The laparoscopic-assist procedure with or without a hand-assist technique was used in this study.</p><p><b>RESULTS</b>Six cases with the recurrent lesion of central type were treated by salvage surgical procedure as follows: 3 laparoscopic-assist anterior resection, 1 laparoscopic-assist abdominoperineal resection, 1 laparoscopic-assist posterior exenteration, and 1 laparoscopic-assist proctocolectomy with a terminal ileum stoma. All of them were R0 resection confirmed by postoperative pathological examination. The other one with the lesion of combination type was treated with the procedure of laparoscopic-assist sigmoid colostomy. A hand-assist technique was used in 2 cases. The mean operation time, bleeding and hospital day was (211 +/- 13) min, (200 +/- 91) ml, and (15 +/- 10) d, respectively. No conversion and complication occurred.</p><p><b>CONCLUSION</b>Laparoscopic salvage surgery for locally recurrent rectal cancer is safe and feasible when taken by experienced laparoscopic colorectal surgeon to the cases with the recurrent lesion of central type.</p>

Comparison of inflammatory response after laparoscopic and conventional surgery for colorectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the systemic and local inflammatory response after laparoscopic and conventional surgery for colorectal carcinoma.</p><p><b>METHODS</b>From April 2004 to August 2004, 51 colorectal cancer patients undergoing laparoscopic (n=25) and conventional open (n=26) colorectal resection were enrolled in the study. The general clinical data,and inflammatory response were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in age, sex, pre-operative levels of haemoglobin and albumin, Dukes stage and surgical procedure between the two groups (P > 0.05). Laparoscopic surgery had more advantages over conventional open surgery such as incision, operating time, recovery time of bowel function, and hospitalization. On postoperative day (POD) 1, WBC count [(7.30+/- 2.62)x10(9)/L], and the serum levels of IL-10 [(19.46+/- 3.31)pg/ml] and C-reactive protein (CRP) [(2.76+/- 2.17)mg/dl] were significantly lower in laparoscopic group than those in conventional group (P< 0.05), but there were no differences on POD 4 between the two groups (P > 0.05). There were no significant differences in the volume of peritoneal drainage fluid, and levels of IL-10, TNF and CRP in it on POD 1 between the two groups, but the volume of peritoneal drainage fluid decreased significantly from POD 2, and the level of IL-10 in it was significantly lower on POD 4 in laparoscopic group than that in conventional group.</p><p><b>CONCLUSIONS</b>In early stage after operation,intra- peritoneal inflammatory response caused by laparoscopic surgery is similar to that by conventional open surgery, but systemic inflammatory response is slighter than that by conventional open surgery for colorectal carcinoma.</p>

Value of endoscopy combined with laparoscopy in treatment of colorectal polyps and polyp canceration / 上海第二医科大学学报

Objective To investigate the value of endoscopy combined with laparoscopy in the treatment of colorectal polyps and polyp canceration.Methods Different combinations of endoscopic and laparoscopic procedures were employed and the clinical efficacies were compared.Results From January 2004 to September 2006,46 cases with colorectal polyp were treated with endoscopy combined with laparoscopy.Among them,5 cases(10.87%)underwent laparoscopic-assisted endoscopic polypectomy,30(65.22%)endoscopic-assisted laparoscopic resection,6(13.04%)synchronously endoscopic and laparoscopic resection.Five cases were performed further operation after endoscopic polypectomy.According to the pathological findings,21(45.7%)were proved to be polyp canceration,among which 6 were advanced carcinoma,and 3 were found metastasis to the lymph nodes.Among the 41 cases of laparoscopic resection,there was no conversion to an open surgery.Anastomotic leakage was found in 2 cases and anastomotic bleeding in 1.In the 5 cases of laparoscopic-assisted endoscopic polypectomy,no complication was observed.During the period of follow-up(1 to 21 months),no recurrence was detected.Conclusion Endoscopy combined with laparoscopy extends the safety and indications of endoscopic polypectomy,and is minimally invasive to the patients.It is an ideal procedure in the treatment of colorectal polyps and poly carceration.

Application of laparoscopic local resection for gastric tumors / 上海第二医科大学学报

Objective To evaluate the clinical application of laparoscopic local resection for gastric tumors.Methods Twenty-three patients with gastric tumors who were performed laparoscopic gastric local resection were retrospectively analyzed with the size of tumor,location of tumor,operative time,blood loss during the operation,time for passage of flatus,post-operative hospital stay,operative complications,post-operative pathological findings and result of follow-up.Results Twenty-three patients were successfully performed laparoscopic local resection,including 8 laparoscopic wedge resection(LWR)and 15 intragastric mucosal resections(IGMR),with no conversion to open surgery.The mean size of gastric tumor was(2.8?1.3)cm,the mean operative time was(82.2?35.5)min,the mean blood loss was(26.5?15.3)mL,the length of incision was(3.1?1.1)cm,the time for passage of flatus was(2.1?0.9)d,and the mean post-operative hospital stay was(7.8?2.0)d.Two patients(8.7%)were found with postoperative gastric mucosal blee-ding and were recovered well through non-operative treatment.The median time of follow-up was 12 months(2-45 months),and no recurrent tumor was observed.Conclusion Laparoscopic local resection is a feasible,safe,effective and less invasive procedure for gastric tumors.

Laparoscopic diagnosis and treatment for small intestinal stromal tumors / 上海第二医科大学学报

Objective To evaluate the laparoscopic management in diagnosing and treating small intestinal stromal tumors.MethodsSeventeen patients with small intestinal stromal tumors,who underwent laparoscopic diagnosis and surgical procedures,were retrospectively analyzed with the size of tumor,operative time,blood loss,length of incision,time for passage of flatus,post-operative hospital stay,operative complications and result of follow-up.Results All the 17 patients were diagnosed and treated by laparoscopic partial intestinal resections.The mean diameter of tumors was(3.6?1.3)cm,operative time(62.1?25.7)min,blood loss(17.1?15.2)mL,length of incision(3.4?1.1)cm,time for passage of flatus(2.2?1.2)d and post-operative hospital stay(7.8?2.0)d.As for the complications,one(5.9%)anastomosis bleeding was found and was treated by non-surgical procedure.After follow-up for 2-34 months,no recurrent tumor was found.Conclusion Laparoscopic exploration is useful to diagnose small intestinal stromal tumor accurately,and laparoscopic partial intestinal resection is a safe,effective and less invasive procedure for small intestinal stromal tumors.

A clinical study of laparoscopic colorectal surgery for patients aged 70 years and over / 中华老年医学杂志

Objective To evaluate the safety,efficacy and advantages of laparoscopic colorectal surgery for elderly patients with colorectal cancer.Methods Operation safety,complications,and postoperative recovery of 35 patients aged 70 years and over who underwent laparoscopic colorectal surgery(LAPA group) were analyzed retrospectively and compared with those of 78 elderly patients performed with conventional open surgery(OPEN group) and 35 patients younger than 65 years performed with laparoscopic colorectal surgery(LAPB group) between December 2002 and December 2003.Results No surgery-related death occurred in LAPA group and LAPB group,but 2 deaths were found in OPEN group because of severe pulmonary infection and anastomotic leakage respectively.There were 33 (42.3%) cases of complications in the OPEN group which were significantly more than those in LAPA and LAPB group (P0.05).Local recurrence rate,metachronous metastases rate and cumulative survival probability at 30 months were similar in the LAPA and OPEN groups.Conclusions Laparoscopic colorectal surgery is safe and beneficial to the patients aged 70 years and over and it could be adopted widely.