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Laparoscopic radical resection of left hemicolon cancer is difficult in lymph node dissection, splenic flexure dissociation and digestive tract reconstruction. The high resolution recognition ability of 4K laparoscopic system can help complete mesocolic excision and neuroprotec-tion of the left colon. The authors discuss the key points of 4K totally laparoscopic radical resection of left hemicolon cancer and intraperitoneal overlap digestive reconstruction through surgical examples.
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Colorectal cancer is the fourth most malignant tumors in China, among which the left hemicolon cancer accounts for about 5%?6%. Due to the complex anatomy around the left hemicolon, being adjacent to the pancreas, spleen, kidney, ureter and other important organs, its vascular and nerve distribution is variably distributed, leading difficulties in laparoscopic radical surgery for left hemicolon cancer. In surgical practice, the 4K laparoscopic system has shown its features of high-definition amplification, good color reproduction, and clear anatomy, etc. However, there is still no clear consensus on its application in the radical resection for the left hemicolon cancer. The authors summarize clinical practice, explore the technique key points of 4K laparoscopic D 3 resection with complete mesocolic excision for the left hemicolon cancer.
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With the development of laparoscopic technology, surgeon's requirements for precise anatomy are gradually increasing. Laparoscopic system has great advantages in the selection of anatomical level, the protection of nerve and blood vessel in surgery. 4K laparoscopic system can provide high-definition vision of operative field, which is conducive to precise anatomical operation. The authors share the practical team cooperation experience of laparoscope left hemi-colectomy for colon cancer in order to provide references for surgical colleagues.
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Objective: To compare the effects of 3 treatment strategies (emergent surgery, self-expanding metallic stents, self-expanding metallic stents plus neoadjuvant chemotherapy) on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer. Methods: A retrospective cohort study was conducted. Clinical data of patients with complete obstructive left hemicolon cancer admitted to General Surgery Department of Beijing Chaoyang Hospital between January 2017 and October 2019 were retrospectively collected. Patient inclusion criteria: (1) complete obstructive left hemicolon cancer was confirmed through clinical manifestation and abdominal computed tomography; (2) adenocarcinoma was confirmed by postoperative pathology; (3) emergent radical resection of primary tumor was performed with temporary stoma, or radical resection of primary tumor and primary anastomosis was performed without stoma, 7 to 14 days after completion of insertion of self-expanding metallic stents. Patients who did not receive stoma reversion after emergent operation were excluded. According to different therapies, patients were divided into three groups: emergent surgery (ES) group, self-expanding metallic stents (SEMS) group and self-expanding metallic stents plus neoadjuvant chemotherapy (SEMS+NAC) group. Wexner score for incotinence (higher score indicates the worse anal function), Vaizey score (>10 indicates fecal incontinence) and low anterior resection syndrome (LARS) scale (higher score indicates the worse anal function) were applied to evaluate anal function of patients among groups at postoperative 1-, 6- and 12-month. EORTC QLQ-C30 questionnaire was used to assess the quality of life. Risk factors of decreased anal function were identified by logistic regression analysis. Results: A total of 72 patients were enrolled, including 27 (37.5%) patients in ES group, 23 (31.9%) in SEMS group and 22 (30.6%) in SEME+NAC group. The baseline characteristics including age, gender, tumor location, comorbidities, total blood loss, operation time and postoperative complications, were comparable among groups, except that the proportion of laparoscopic surgery was significantly lower in ES group (4/27, 14.9%) than that in SEMS (15/23, 65.2%) and SEMS+NAC group (16/22, 72.7%) with significant difference (P<0.001). The follow-up ended up to October 2020, and the overall follow-up rate was 79.2% (57/72). No significant differences existed in the Wexner score of patients among groups at postoperative 1-, 6- and 12-month (all P>0.05). The Vaizey scores at postoperative 1-month in ES, SEMS and SEMS+NAC group were 7 (0-17), 3 (0-7) and 4 (0-8) respectively with significant difference (H=18.415, P=0.001), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). Vaizey scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The LARS scores at postoperative 1-month in ES, SEMS and SEMS+NAC groups were 20 (0-37), 15 (0-24) and 16 (0-28) respectively with significant difference (H=3.660, P=0.036), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC groups (P>0.05). LARS scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The QLQ-C30 score revealed that the social function of patients in SEMS group and SEMS+NAC group was significantly better than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). The logistic regression analysis revealed that only ES was an independent risk factor of decreased anal function (OR=2.264, 95% CI: 1.098-4.667, P=0.027). Conclusion: Compared to ES, SEMS may improve quality of life and short-term anal function of patients with complete obstructive left hemicolon cancer.
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Humans , Intestinal Obstruction , Postoperative Complications , Quality of Life , Rectal Neoplasms , Retrospective Studies , Syndrome , Treatment OutcomeABSTRACT
Background: Colon cancer is one of the most common malignant tumor of digestive system. There are differences in pathogenesis, biological behavior, gene expression between left and right hemicolon cancer. Aims: To investigate the differences in clinicopathological features, microsatellite instability (MSI) and K-ras gene mutation between left and right hemicolon cancer. Methods: Data of 144 patients with colon cancer diagnosed by postoperative pathology from June 2017 to June 2018 at Qingdao Municipal Hospital were collected. MSI was assessed by immunohistochemistry, K-ras gene mutation was detected by PCR. The differences in clinicopathological features, MSI and K-ras gene mutation between the two groups were compared. Results: Right hemicolon cancer was more common in female, and left hemicolon cancer was more common in male. The incidence of lymph node metastasis, positivity rate of CEA and MSI in right hemicolon cancer were significantly higher than left hemicolon cancer (P<0.01), while the K-ras gene mutation rate in left hemicolon cancer was significantly higher than right hemicolon cancer (P<0.05). The K-ras gene mutation in left hemicolon cancer was correlated with gender, lymph node metastasis and positivity rate of CEA (P<0.05). MSI in right hemicolon cancer was correlated with gender, age, and lymph node metastasis (P<0.05). Conclusions: There are differences in the MSI and K-ras gene mutation between left hemicolon cancer and right hemicolon cancer, which can be used as the reference for diagnosis, individualized treatment and prognosis of colon cancer.
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Objective To explore the value of transanal placement of ileus decompression tube in left colon carcinoma with obstruction. Methods Data of 35 patients with complete malignant colon obstruction, who underwent placement of ileus decompression tube by colonoscopy and fluoroscopy with guidewire from January 2007 to December 2009, were retrospectively studied. Results Tube placement was successfully performed with one procedure in all 35 patients. Phase Ⅰ surgery was achieved in 34 patients at 7 - 10 days after decompression. The tube desquamated in 1 case 2 days after the placement, and was replaced successfully, and the patient received phase Ⅰ resection 8 days after. No perforation or other complications occurred in any cases. Conclusion Placement of ileus decompression tube, assisted with colonoscopy and fluoroscopy, simple and safe, can immediately relieve the symptoms of intestinal obstruction, decrease the risk of emergency operation and help to avoid colonostomy and phase Ⅱ radical operation.
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Objective Summarized the therapeutic effect of colonic irrigation by mannitol in one-stage resection and primary anastomosis for left hemicolon obstruction. Method For 31 cases of left hemicolon obstruction in our hospital, After process was cut, firstly we had done coloclysis with normal saline, metron-idazole and 20% mannitol,then one-stage anastomosis. Results With the exception of three cases of in-cision infection, the rest who start eating 4～5 days after operation were cured and no anastomotic fistula. Conclusion During the colon resection in left hemicolon obstruction, coloclysis with normal saline, met-ronidazole and 20% mannitol, then one-stage anastomosis, the intestinal function were quick recovery and can prevent colonic anastomotic fistula.