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Objective:To investigate the effect of rectal draw-out laparoscopic anterior resection on gastrointestinal motility and prognosis in patients with low rectal cancer.Methods:A total of 140 patients with low rectal cancer who received treatment in Chongqing Ninth People′s Hospital from May 2017 to May 2018 were selected, including 82 males and 58 females, aged from 35 to 78 years with an average age of (59.33±9.12) years.According to the operation methods, all patients were divided into observation group (transanal pullout laparoscopic anterior resection of rectal cancer, n=70) and the control group (laparoscopic assisted anterior rectal resection, n=70). Independent sample t test or χ2 test were used to compare operation-related indicators, occurrence of complications, changes of fluid gastric emptying, small intestinal transport capacity, gastrin and motilin in 2 groups. Kaplan-meier survival curve was plotted to compare tumor progression-free survival (PFS) and overall survival (OS) in two groups. The two groups of PFS and OS were compared by log-rank test. Results:The operative time, intraoperative blood loss, postoperative drainage volume, and postoperative recovery time of the observation group were lower than those of the control group, the ability of liquid gastric emptying 24 h after operation, small intestine transport function at 24 h and 48 h after operation, the capacity of liquid gastric emptation, intestinal transport function 24 h and 48 h postoperatively, gastrin and motilin levels at 24 h, 48 h and 72 h postoperatively were significantly higher than those of the control group, with statistically significant differences ( P<0.05). Two years PFS (85.71% vs. 81.43%) and OS (92.86% vs. 90.00%) after surgery between the observation group and the control group were not statistically significant ( P>0.05). Conclusion:The anterior resection of rectal cancer by draw-out laparoscope is safe and radical, without increasing postoperative complications. Moreover, the recovery of gastrointestinal function is earlier than traditional laparoscopic assisted rectal cancer resection, which is conducive to improving the postoperative quality of life of patients, and is worthy of clinical promotion.
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Objective@#To investigate the risk factors and computed tomography (CT) diagnostic accuracy of anastomotic leakage after resection of rectal cancer (Dixon) .@*Methods@#This retrospective study was conducted in Peking University First Hospital from January 2013 to June 2015. A cohort of 452 patients with rectal cancer was enrolled in the study. All the patients underwent anterior resection. The relationship between clinical-pathological data (including sex, age, body mass index (BMI) , presence of diabetes, hypohemoglobin (Hb < 90 g/L) , hypoalbuminemia (Alb < 35 g/L) , the distance from the lower edge of the tumors to the anus, tumor diameter, tumor differentiation, tumor TNM stage, neoadjuvant therapy status, ligation of the left colonic artery (LCA) , preventive colostomy, and anastomotic leakage was analyzed retrospectively. Univariate analysis using χ2 test and multivariate analysis by using the Ordered Classification Arguments Logistic regression model.@*Results@#Of all the cases, 281 and 171 patients were men and women, respectively. The median age was 64 years (range, 18-88 years) . Forty-seven patients (10.4%) were diagnosed with anastomotic leakage, and the median diagnostic time of anastomotic leakage was 6.5 days (range, 3-31 days) . One patient with anastomotic leakage died because of respiratory failure within 1 month postoperatively; 11 patients underwent salvage colostomy performed 2-34 days (median, 7 days) after the first surgery. All the 11 patients underwent colostomy closure within 2 years. The other 35 patients recovered by antibiotic and peritoneal lavage treatment. The mean length of postoperative hospital stay in patients without anastomotic leakage was 8.4±2.4 days, which was significantly shorter than that in patients with anastomotic leakage (34.6±15.7 days) , and the difference was statistically significant (t = 24.127, P = 0.008) . The results of the univariate analysis showed that BMI≥28 kg/m2 (χ2 = 7.550, P = 0.000) , diabetes mellitus (χ2 = 5.055, P = 0.025) , Hb < 90 g/L preoperatively (χ2 = 5.718, P = 0.017) , Alb < 35 g/L preoperatively (χ2 = 8.096, P = 0.004) , distance of < 6 cm from the lower edge of the tumors to the anus (χ2 = 8.205, P = 0.004) and LCA ligation (χ2 = 16.540, P = 0.000) were risk factors for the occurrence of anastomotic leakage. Multivariate analysis showed that BMI≥28 kg/m2 (OR = 1.758, 95%CI: 1.265-2.454, P = 0.021) , distance of < 6 cm from the lower edge of the tumors to the anus (OR=1.530, 95%CI: 1.035-2.117, P = 0.037) , LCA ligation (OR = 1.551, 95%CI: 1.035-2.131, P = 0.042) were independent risk factors for anastomotic leakage. The CT diagnostic sensitivity of anastomotic leakage was 91.2% (31/34) . The false positive rate of CT for diagnosing anastomotic leakage was zero 7 days after the Dixon procedure.@*Conclusion@#Important factors, including BMI of patients, LCA ligation, and the distance from the lower edge of the tumors to the anus are related with anastomotic leakage. The individual treatments should be considered based on the patient′s clinical condition. CT was recommended 7 days postoperatively when anastomotic leakage was highly suspected.
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Objective:To investigate the reasons of anastomotic leakage following learning curve by laparoscopic anterior resection of rectal cancer.Methods:From December,2011 to March,2015,the clinical information of 179 patients in our hospital who underwent dixon of rectal cancer were collected.The patients were divided into a laparoscopic learning group,a laparotomy group and a laparoscopic group,The reasons of anastomotic leakage for each group were comparatively analyzed.Repeated cutting of anastomotic stoma was compared between the laparoscopic learning group and the laparoscopic group.The male,age,obesity,nutrition complications and the position of anastomotic stoma were compared among the 3 groups.Results:The rate of anastomotic leakage in the laparoscopic learning group was significantly higher than that in the laparotomy group and the laparoscopic group (P＜0.05).Repeated cutting was a significant risk factor in the laparoscopic learning group (P＜0.05),but not in the laparoscopic group.Except obesity,the four factors were significant risk factors in the laparoscopic learning group (P＜0.05).All of the five factors were not the significant risk factors in the laparotomy group and the laparoscopic group (P＞0.05).Conclusion:The operation technical shortcoming is the major factor in the learning of the laparoscopic anterior resection of rectal cancer.In order to reduce the rate of anastomotic leakage in the learning curve period,the selection of patients following the laparoscopic anterior resection of rectal cancer should avoid the following factors:male,older age,the low position of the tumor and the nutrition complications.