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Resumen Introducción: El tratamiento estándar del cáncer del recto localmente avanzado (CRLA) actual es multimodal. La cirugía mínimamente invasiva es factible en el manejo de este tumor, aunque existe controversia sobre sus resultados alejados. Objetivo: Comparar los resultados inmediatos y alejados de una serie laparoscópica (CL) con una serie de cirugía convencional (CA) intervenidos por CRLA. Materiales y Método: Revisión retrospectiva de ambas técnicas de abordaje en un periodo de 14 años. Se analiza la morbilidad, los resultados patológicos, la recidiva local y la sobrevida a largo plazo. Para estimar las curvas de sobrevida se utilizó el método de Kaplan-Meier. Para comparar las curvas de sobrevida se usó el test de log-rank. Resultados: Se compara 163 pacientes intervenidos por CL con 164 operados mediante CA. Ambos grupos resultaron equivalentes en cuanto a las variables demográficas, morbilidad perioperatoria y estadios patológicos finales, salvo un menor tiempo de hospitalización en el grupo CL (p = 0,007). Los tumores bajos recibieron radioterapia preoperatoria en el 90% de los casos. La recidiva local global y la sobrevida a largo plazo no muestran diferencias de acuerdo al tipo de abordaje. Al excluir los pacientes con una lesión en el recto superior se aprecia que los tumores de recto bajo tienen peor pronóstico, independiente de la técnica empleada (p = 0,007). Conclusiones: La CL es equivalente a la CA en el manejo multimodal del CRLA. La inclusión de tumores del recto superior tiende a mejorar artificialmente los resultados de la cirugía en cuanto a recidiva local y sobrevida global.
Introduction: Total mesorectal excison and preoperative radiotherapy are important components of multimodal treatment in patients with a low locally advanced rectal cancer. Short-term results of laparoscopic surgery has proven to be safe but oncological results are unclear. Aim: To compare short-term and oncologic outcomes of laparoscopic and open resection of locally advanced rectal cancer operated on in the same period. Materials and Method: A total of 327 patientes with rectal cancer treated by open and laparoscopic curative surgery were retrospectively reviewed. Long-term follow up was compared using Kaplan-Meier curves and survival data were tested by log rank test. Results: Demographic data, levels of carcinoembryonaric antigen, perioperative morbidity and pathologic stages were similar in both groups, except for less inhospital time in laparoscopic group (p = 0.007). Over 90% of middle and low tumors recived preoperative radiotherapy. Local recurrence and overall survival shows no difference between both groups. Low and middle rectal cancer showed worst prognosis than tumors of the high rectum, no matter of type of surgery (p = 0.007). Conclusions: Laparoscopic surgery is non-inferior to open resection for pathological and oncological outcomes. It's not convenient to include on trials lesions located in the high rectum, usually treated with primary surgery as colon cancer.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Rectal Neoplasms/surgery , Laparoscopy/methods , Rectal Neoplasms/mortality , Rectal Neoplasms/radiotherapy , Surgical Procedures, Operative/adverse effects , Treatment OutcomeABSTRACT
Objective To investigate the clinical efficacy of endoscopic resection,laparoscopic resection and open resection in the treatment of gastric stromal tumor (GIST).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 254 GIST patients who were admitted to the First Affiliated Hospital of Army Medical University between January 2007 and June 2017 were collected.The endoscopic submucosal dissection (ESD) and laparoscopic or open wedge resection of GIST were performed according to the patients' conditions.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to June 2017.Measurement data with normal distribution were represented as-x±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative recovery situations:of 254 patients,112 underwent ESD,including 111 with successful operation and 1 with intraoperative conversion to open surgery due to excessive bleeding-induced blurred operating view,93 underwent successful laparoscopic wedge resection of GIST and 49 underwent successful open wedge resection of GIST.The operation time,volume of intraoperative blood loss,time for initial fluid diet intake,duration of hospital stay and hospital expenses were respectively (75±21) minutes,(6.9±0.5)mL,(2.8±0.9)days,(5.5 ± 0.2)days,(22 167±1 364) yuan in patients with ESD and (137±65) minutes,(48.1±2.6)mL,(3.9±1.4) days,(8.3 ± 2.2)days,(32 937±1 823) yuan in patients with laparoscopic operation and (168± 60) minutes,(157.2± 10.3) mL,(5.8± 1.7) days,(11.3 ± 3.5) days,(38 462± 1 961) yuan in patients with open operation.Two patients with ESD had subcutaneous emphysema and didn't receive special treatment,and then emphysema disappeared after 2 days.No complication was detected in patients with laparoscopic or open operations.(2) Postoperative pathological examination:tumor diameter in patients with ESD,laparoscopic operation and open operation was respectively (2.6± 1.6)cm,(6.1 ±2.2)cm and (6.4±2.3) cm.The cases with positive CD117,discovered on GIST-1 (DOG1),CD34 and smooth muscle actin (SMA) were 106,105,86,17 with ESD and 89,87,59,11 with laparoscopic operation and 46,47,30,8 with open operation,respectively.The extremely low risk,low risk,medium risk and high risk were respectively detected in 67,42,3,0 patients with ESD and 16,36,23,18 patients with laparoscopic operation and 7,20,14,8 in patients with open operation.(3) Follow-up and survival situations:210 of 254 patients were followed up for 6.0-120.0 months,with an average time of 36.0 months,including 86 with ESD,82 with laparoscopic operation and 42 with open operation.During the follow-up,of patients with ESD,3 patients with medium risk respectively received imatinib therapy for 7.0 months,1.5 years and 2.0 years,and postoperative gastroscopy reexaminations every 6 months,without tumor recurrence;81 with extremely low risk and low risk received postoperative gastroscopy reexaminations every 6 months and didn't receive targeted therapy,without tumor recurrence;2 died of non-stromal tumor.The postoperative average survival time,1-,3-and 5-year survival rates were respectively 56.3 months,98.8％ (81/82),91.5％ (75/82),74.4％ (61/82) in patients with laparoscopic surgery and 52.4 months,97.6％ (41/42),85.7％ (36/42),81.0％ (34/42) in patients with open surgery.Conclusions According to patients' conditions,endoscopic resection,laparoscopic resection and open resection are safe and feasible in the treatment of GIST.Endoscopic resection of GIST should be selectively applied to patients with smaller diameter,with advantages of lower hospitalization expenses and better long-term prognosis.
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PURPOSE: This study aimed to compare the results of laparoscopic resection with those of open resection for consecutive colorectal cancer patients who underwent surgery at a single center. METHODS: During the thirty-month period between January 2003 and August 2005, patients with a colorectal adenocarcinoma admitted to our hospital were assessed. Cancers related with FAP or HNPCC, cancers treated with endoscopy or local excision, and recurrent cancers were excluded from the study. Three hundred two laparoscopic resection patients were matched to 302 open resection patients. RESULTS: The mean age of the laparoscopic resection group was 59.5 years while that of the open resection group was 59.4 years. Patients in two groups were similar in terms of gender distribution, level of CEA and ASA, and location and size of tumor. The modified Dukes' stages showed 51 patients in stage A, 33 in stage B1, 62 in stage B2, 17 in stage C1, and 139 in stage C2 for the laparoscopic resection group and 33 in stage A, 52 in stage B1, 82 in stage B2, 18 in stage C1, and 117 in stage C2 for the open resection group (P=0.024). The operative time averaged 9.6 minutes longer in the laparoscopic group (188.9 vs. 179.3 min, P<0.0001). The rate of stoma formation for protection of anastomosis in the laparoscopic group was 4.9% (5.8% in open group). There were significant differences in blood loss (556.2 vs. 952.8 ml, P<0.0001), the amount of intraoperative blood transfusion (1.6 vs. 2.3 unit, P=0.004), the number of harvested lymph nodes (21.1 vs. 16.9, P<0.0001), and the rate of high ligation of IMA (91.7 vs. 75.5%, P<0.0001). The length of the distal resection margins from cancer was longer in the open group (2.9 vs. 3.5 cm, P=0.037). Patients in the laparoscopic group had a faster recovery of bowel function (P<0.0001) and a significant reduction in the mean length of hospital stay (11.5 vs. 16.8 days, P<0.0001). There was no mortality in either group. Early and late complications were comparable. The conversion rate was 1.6 percent. CONSLUSIONS: The benefits of a laparoscopic resection for colorectal cancers are less blood loss and transfusion, faster postoperative bowel motion, a shorter hospital stay, low morbidity, and a large number of harvested lymph nodes. In conclusion, a laparoscopic resection for colorectal cancers can be done safely and effectively and is an acceptable alternative to a conventional open resection.