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Objective@#To explore the short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction.@*Methods@#A cohort study was carried out. The clinical data of consecutive patients with high rectal cancer who underwent robotic radical resection at the Department of General Surgery of The First Affiliated Hospital of Nanchang University from June 2017 to January 2018 were retrospectively analyzed. Inclusion criteria: (1) preoperative diagnosis of rectal cancer, and distance from tumor to anal margin≥10 cm undercolonoscopy; (2) T1-3 assessed by preoperative imaging examination, and no distant metastasis; (3) female, age≥50 years old, body mass index ≤ 30 kg/m2; (4) without radiotherapy and chemotherapy before surgery; (5) implementation of robotic radical surgery for high rectal cancer. Fourteen female patients undergoing transvaginal removal of specimen without abdominal incision were included in the no incision group with age of (62.2±9.3) years old and distance from tumor to anal verge of (12.5±0.9) cm. As the match of 1:2, 28 simultaneous patients of high rectal cancer undergoing traditional robotic surgery (surgery interval <8 months) were enrolled to the control group, with age of (60.6±12.8) years old and distance from tumor to anal verge of (11.3±3.8) cm. Short-term efficacy and safty were compared between two groups. Follow-up ended in September 2018.@*Results@#There was no significant difference in baseline data between the two groups (all P>0.05). Compared with the control group, the no incision group had longer operation time [(149.6±15.6) minutes vs. (130.9±12.9) minutes, t=-4.135, P<0.001], shorter time to postoperative flatus [(40.9 ±2.6) hours vs. (51.9±2.9) hours, t=12.049, P<0.001], lower pain score on the operation day and the first day after surgery (using Changhaipainstick) [(3.1±0.4) points vs. (4.6±0.7) points, t=7.458, P<0.001; (2.5±0.3) points vs. (3.3±0.5) points, t=6.142, P<0.001], shorter time to ground activity [(15.6±2.0) hours vs. (24.3±2.5) hours, t=11.102, P=0.030], and shorter postoperative hospital stay [(6.1±0.8) days vs. (7.2±1.3) days, t=2.806, P=0.008], whose differences were statistically significant. There were no significant differences in intraoperative blood loss, proportion of postoperative analgesia patients, and complication within 30 days after surgery (all P>0.05). In the no incision group and the control group,the tumor size was (3.1±0.4) cm and (3.6±0.9) cm, the proximal margin distance was (9.1±1.5) cm and (9.8±1.5) cm, the distal margin distance was (4.3±0.4) cm and (4.5±0.4) cm, the number of harvested lymph node was 15.8±2.4 and 15.2 ± 2.5, and the number of positive lymph node was 0.6±1.3 and 1.1±2.4, respectively, whose differences were not statistically significant (all P>0.05). The mean followed-up period was 10 months (7-14 months) in the no incision group, and 14 months (10-18 months) in the control group. No local recurrence and distant metastasis were found in both groups.@*Conclusion@#Robotic radical resection for high rectal cancer with transvaginal specimen extraction is safe and feasible with advantages of rapid postoperative recovery, less postoperative pain and short hospital stay.
ABSTRACT
Objective?To investigate the feasibility, safety, operating essentials and the short-term therapeutic effect of total laparoscopic resection for colorectal cancer by Natural Orifice Specimen Extraction (NOSES).?Methods?The clinical data of 50 patients underwent total laparoscopic resection for colorectal cancer by NOSES from January 2016 to June 2017 were retrospectively analyzed.?Results?All of the 50 patients with colorectal cancer successfully received total laparoscopic resection by NOSES. None of the patients had serious postoperative complications and death related to the operation. The average operating time was (140.0 ± 29.0) minutes. The blood loss was (70.0 ± 23.4) ml. The number of lymph nodes harvested were (14.0 ± 2.3). There was no bacteria infection in abdominopelvic cavity post-operation and no recurrence occurred until the end of postoperative follow- up. Postoperative time of bed rest was (2.0 ± 0.5) days. The time of the first anal exhaust was (2.0 ± 0.5) days. The postoperative hospitalization stay was (8.5 ± 3.0) days. There was none case of lung infection while one case of anastomotic leakage. No cancer cells remained in resection margin. No local recurrence and metastasis was found in all patients after follow-up for 3 to 24 months.?Conclusion?Total laparoscopic resection for colorectal cancer by NOSES is safe and feasible, and has the advantage of minimally invasive, less pain, rapid rehabilitation, good cosmetic effect and less postoperative complications.
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Objective To assess the feasibility and short-term effect of transanal everted extraction of laparoscopic rectal excision without abdominal incision.Methods Eleven patients were operated by transanal everted extraction of laparoscopic rectal excision without abdominal incision.Results All the operations were accomplished successfully,the average operative duration was (189.5±25.2) min,the intra-operative blood loss volume was (25.4±9.4) ml,the average time to flatus was (38.9±8.6) h,the average postoperative hospital stay was (12.7±2.5) d,and the number of lymph nodes harvested was 13.5±4.1.There were no post-operative complications.Conclusion The technique of transanal everted extraction of laparoscopic rectal excision without abdominal incision is safe and feasible,but the long-term effects need more observation.