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0.05).The median therapy fees in the open group was nine thousand yuan vs.eleven thousand yuan in the laparoscopic group,and the difference was significant(P
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Objective To evaluate the feasibility,safety and short-term outcome of laparoscopic-assisted surgery for colorectal cancer.Methods From August 2001 to November 2004,laparoscopic resection of colorectal carcinoma were performed in 112 cases,including right hemicolectomy(n=23),left himicolectomy(n=7),radical resection of sigmoid cancer(n=15),Dixon procedure(n=49),and Miles procedure(n=18).Results One hundred and five patients underwent laparoscopic resection successfully,7 cases were converted to open surgery because of hemorrhage,obesity or adhesion with adjacent organ,6 of which were left colon or rectal cancer.The mean operating time was(161.2?48.6)min,and the mean operative blood loss was 78.5 mL.There were 8 cases occurred postoperative complications,and no mortality during perioperative period.The length of upper and lower segment of resection for colonic cancer was (14.5?3.2)cm and(11.0?2.6)cm respectively.The length of upper and lower segment of resection for rectal cancer was(15.3?2.7)cm and(2.8?1.6)cm,respectively.The mean number of lymph nodes dissected was(8.2?4.6),and lymph node metastases were found in 49 cases.One hundred and seven cases(95.5%) were followed up for 8-44 months,of which,7 cases had local recurrence and 6 cases had distant metastases.No case of trocar port tumor implantation was observed.Conclusions Laparoscopic surgery for colorectal cancer is feasible and safe,can result in the same outcome as open radical surgery,and has the advantages of mini-invasive procedure.
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Objective To explore the feasibility and value of laparoscopic-assisted surgery(LAS) for colorectal cancer.Methods The clinical data of 51 cases of LAS for colorectal cancer were reviewed retrospectively.Of them,3 cases were converted to open operation,and in 48 cases LAS for colorectal cancer was completed.Among them,9 cases underwent right hemicolectomy,8 cases left hemicolectomy,14 cases sigmoid resection,9 cases rectal anterior resection,and 6 cases Miles operation.Results No intra-operative deaths occurred. The average operation time was 195(150-320)min with 120(40-300)mL average blood loss.The average number of lymph nodes excised was 8(2-26).The time of bowel function recovery was 20-72h after operation.The average hospital stay after operation was 8(7-10)d.No major intra-operative blood loss nor postoperative complications were observed.The follow-up time was from 3-54months for 45(88.2%) patients.Two cases with Ducke′s C rectal cancer died,one died of liver metastasis 17 months after operation,and the another died of diffuse peritoneal metastasis 19 months after operation.There was no trocar port tumor metastasis and no local tumor recurrence at the small abdominal incision.Conclusions LAS of colorectal cancer is technically feasible and has advantages such as less surgical trauma,less bleeding and quick recovery.It is a mini-invasive,safe and efficient treatment for colorectal cancer.
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Objective To determine the effect and safety of metallic stents in the treatment of acute malignant colorectal obstruction.Methods From May,2000 to June,2003, self-expanding metallic stents were implanted in 15 patients with acute left colonic obstruction caused by malignancies. The postoperative remission and complications were observed.Results Stents were implanted successfully in 12 cases(80.0%,12/15).Of the 12 cases,the obstruction were all disappeared within 24h. No death or colonic perforation happened in this series. Stent migration and anal pain developed each in one case after stent implantation. Elective radical resection was performed on 8 cases after bowel preparation and supportive therapy; and stents reserved permanently in other 4 cases. Conclusions The implantation of self-expanding metallic stents is a safe and effective method for the temporary remission or permanent treatment of acute left-colonic or rectal obstruction caused by malignancies,it can instead of colostomy.
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Objective To study the feasibility of laparoscopic resection of colorectal cancer.Methods A(retrospectively) analysis of the clinical data of 110 patients with colorectal cancer treated by laparoscopic(resection) during last three years was made.Of them,24 cases were converted to open operation.In 86 (cases),laparoscopic resection of colorectal cancer was completed.Among them,5 cases underwent right(hemicolectomy),2 cases left hemicolectomy,10 cases sigmoidectomy,22 cases Dixon′s operation,46 cases of Miles operation,and 1 case total colorectomy.Results No patient died within 30 days postoperatively in this series.The average operation time was 225(120-360) min with average 135(20-400) mL blood loss.The average number of lymph nodes excised was 8.7(1-30).The average number of positive lymph nodes was 2.2(0-24).Six cases had intraoperative complications,including 1 case of ureteral injury and 5 cases of intra-abdominal bleeding.These patients were immediately converted to open surgery.There were 6 cases with postoperative complications,among them,2 cases of urinary leakage,2 cases of massive bleeding and 2 cases of intestinal obstruction.All of them recovered after reoperation.The time of bowel funtion(recovering) was 12-72h after operation.The hospital stay after operation was 8.6(7-15)days.The median follow-up was 14.3 months(range 1-33) for 100(90.9%) patients.There was no port-site tumor(metastasis) and no tumor recurrence at the small abdominal incision.Six to fifteen months after opteration,3 cases had diffase peritoneal metastases.1 case of Miles resection had perineal metastasis 3 months after(surgery).Conclusions Laparoscopic resection of colorectal cancer is technically feasible,and have(advantages),such as less surgical trauma,less bleeding,less gastrointestinal interference and quicker(recovery).Laparoscopic radical operation for colorectal cancer can meet the requirements of safety and radical operation.
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Objective To investigate the influence of laparoscopic resection of colorectal cancer on (postoperative) micrometastasis of tumor cells.Methods Using cytokeratin,CK-20 mRNA as target gene,the RT-PCR method was used to examine the pre-and post-operative changes in the number of tumor cells in the peripheral blood of 48 cases of colorectal cancer.Results After operation,the number of tumor cells in(peripheral) blood was significantly higher in the laparoscopic surgery group as compared to that of traditional(laparotomy) operation group(P0.05),but was significantly related to positive rate of proliferating cell nuclear antigen(PCNA)(P
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Objective To pay attention to further improving the result of treatment for colorectal cancer (CRC). Methods On the basis of reviewing the current literature, in view of the present situation of the surgical care for CRC patients the issues of improving the treatment of CRC were appraised. Results There is a great discrepancy in the results of surgical treatment for CRC from different hospitals and among different surgeons in terms of the rates of curative resection, operative mortality and morbidity, local recurrence, anastomotic leakage and overall survival. Surgical technique and the knowledge as well as the experience of the surgeons may have an impact on the outcome. Adjuvant chemotherapy and radiation therapy have contributed to the increase of resectability and survival reate and decrease of the recurrence rate after surgery. The availability of new cytostatic agents and other drugs may improve the resectability of liver metastases and prolong the survival in advanced disease. Conclusions Strengthening the specialty training of surgical personals and emphasizing the application of standard adjuvant therapy are the key points for further improving the result of treatment for CRC and other malignancies.
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Objective To study the effects of emergency radical resection and primary anastomosis for colorectal cancer with acute intestinal obstruction.Methods Retrospective investigation of the clinical data of 112 patients with colorectal cancer with acute intestinal obstruction,between Feb 1997 and Feb 2009,was made.All the 112 patient received emergency operation of radical resection and primary anastomosis.Results All the 112 patients recovered and were discharged.In 44 cases a right rectus abdominis incision was made,2 of these 44 cases had incision wound infection and 6 had both incision wound infection and anastomotic leakage.A left rectus abdominis incision was made in 68 cases,and only 1 of 68 had both incision wound infection and anastomotic leakage(P
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Objective To study the surgical managements for obstructive coleratal carcinoma(OCRC).(Methods) Clinical data of 126 patients with OCRC who underwent surgical treatment between January 1995 and December 2004 were reviewed.Results Thirty-five patients received one-stage right hemicolectomy,ten patients received one-stage resection of transverse colon.forty-eight patients received one-stage left(hemicolectomy),eighteen patients received one-stage resection of left colon or proximal rectum with colostomy followed by two-staged anastomosis.For 15 patients with unresectable lesions,colostomy of transverse colon or sigmoid colon was performed.Seventeen patients(13.5%) experienced postoperative complications.The (operative) mortality was 4.8%(6/126).The 1-year,3-year and 5-year overall survival rate was(95.1)%,52.7% and 38.1%,respectively.Conclusions Proper perioperative period managements and(selection) of surgical techniques are important for better results and lower complications in the treatment OCRC.
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Objective To summarize the experience of multiple primary colorectal carcinoma(MPCRC),to improve the level of diagnosis and treatment of MPCRC.Methods The clinical data of 14 cases of MPCRC seen over a 23-year period were retrospectively analysed.Results Amomg the 14 cases,9 cases were synchronous carcinomas and 5 cases were metachronous carcinomas.In the 14 patients,there were 37 carcinoma lesions and they were located as follows;8 lesions in the sigmoid colon,6 in the splenic flexure,6 in the transverse colon,5 in the hepatic flexure,3 in the ascending colon,9 in the desending colon,4 in the rectum and 3 in the cecum.Pathologic classification:19 were adenocarcinoma,7 were tubular adencarcinoma,7 were mucous adenocarcinoma,2 were papillary adenocarcinoma,1 was undifferentiated carcinoma,and 1 was polyp with malignant change.Duckes staging:stage B in 26 cancer lesions;stage C in 10 cancer lesions and stage D in 1 cancer lesion. A total of 21 operations were performed in the 14 patients,including hemicolectomy in 11 instances,extended hemicolectomy in 5,subtotal colectomy in 2,total colectomy in 2,and palliative resection in 1.There was no operative mortality.All 14 cases were followed up for 1～19 years;3 died of cerebral hemorrhage or natural causes.At present,11 patients have survived for 4～17 years. Conclusions The prognosis of MPCRC is good,provided that it is detected early and operation is zealous.Metachronous carcinoma has a better result compared to synchronous carcinoma.The main operation of choice is hemicolectomy or extended hemicolectomy.Total colectomy is considered only when absolutely necessary . Regular postoperative colonoscopy followup should be done.