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Objective To evaluate laparoscopic π-shaped esophageal jejunostomy vs.laparoscopic assisted end-to-side esophageal jejunostomy in]D2 radical total gastrectomy for middle third gastric cancer.Methods From July 2015 to July 2017,154 patients undergoing laparoscopic D2 radical total gastrectomy were divided into group of laparoscopic assisted end-to-side esophageal jejunostomy (92 cases) and the group of totally laparoscopic π-shaped esophageal jejunostomy (62 cases).Results The group of totally laparoscopic π-shaped esophageal jejunostomy was not statistically different in tumor pathology and postoperative complications with laparoscopic assisted group,but was better than the later in anastomotic reconstruction surgery time (21 ± 3) min vs.(30 ± 3) min,t =17.56,P =0.000,incision length (6.7 ±1.1) cm vs.(10.5 ± 1.7) cm,t =15.72,P =0.000 and anastomotic complications (3％ vs.13％,x2 =4.320,P =0.038).Conclusions Totally laparoscopic π-shape esophageal jejunostomy is safe,feasible,better than hand assisted procedures.
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<p><b>OBJECTIVE</b>To investigate the feasibility of endoscopic metallic stent as a bridge to elective laparoscopic surgery in patients with malignant colorectal obstruction.</p><p><b>METHODS</b>Clinical data of 63 patients with obstructive colorectal cancer who underwent endoscopic metallic stent insertion under radiologic monitoring at the Longyan First Hospital between June 2012 and August 2016 were analyzed retrospectively. After complete remission of the obstruction, all the patients received multi-disciplinary team (MDT) evaluation to make the further treatment strategy. The subsequent surgery included open and laparoscopic procedures, and the short-term efficacy of these two procedures was compared.</p><p><b>RESULTS</b>There were 30 male and 33 female patients with age of 30 to 90 (mean 67) years, including 3 cases of ascending colon cancer, 4 cases of transverse colon cancer, 12 cases of descending colon cancer, 26 cases of sigmoid cancer, and 19 cases of rectal cancer. Only one patient (1.6%) developed sigmoid perforation at 3 hours after stent placement, and underwent emergency laparotomy with Hartmann procedure. The remaining 62 patients had bowel movements. After MDT evaluation, 10 patients (16.1%) were treated with palliative chemotherapy because they were unfit for surgery or for diffuse distant metastases. A total of 52 patients underwent radical surgery after a mean interval from stent insertion of 10 days (7-20 days), including open (n=18, including two cases with conversion to open surgery) and laparoscopy (n=34). The baseline data between open and laparoscopy groups were similar (all P>0.05). Primary anastomosis was successfully performed in all the patients without preventive stoma. Compared to open group, laparoscopy group had faster bowel movement [(2.88±1.06) d vs. (4.05±2.43) d, P=0.022] and shorter postoperative hospital stay [(7.85±0.96) d vs. (9.82±4.41) d, P=0.002]. There were no statistically significant differences in operative time, intraoperative blood loss, number of harvested lymph node, and postoperative complication rate between two groups (all P>0.05).</p><p><b>CONCLUSIONS</b>Endoscopic metallic stent placement can effectively remove malignant colorectal obstruction, and thus enables surgeons to perform an elective radical surgery, avoiding emergency surgery with stoma and unnecessary surgery for patients with distant metastasis. In the era of enhanced recovery after surgery, the endoscopic metallic stent placement combined with laparoscopic procedures, as a less invasive alternative, is effective and safe.</p>
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Objective To analyse the effect with or without short course radiotherapy before laparoscopc surgery for middle and low locally advanced rectal cancer.Methods Clinical and pathological data of 145 patients confirmed with stage T3 or T4 middle and low locally advanced rectal cancer by pathology were retrospectively analyzed.69 cases were in preoperative short course radiotherapy group and 76 cases went directly to laparoscopic surgery.Results There was no statistical difference in the operation time,(140 ± 17) min vs.(136 ± 17) min,t =-3.04,P =0.761,for blood loss,(65 ±38)ml vs.(76 ±33)ml,t =-1.72,P =0.086.Less abdominal perineal resection was performed in preoperative short term radiotherapy group than in upfront surgery group,though the difference was not statistically significant (P =0.600).Postoperative complications were 16％ and 16％ respectively,x2 =0.001,P =0.98.The 2 year local recurrence rate was 6％ and 17％ respectively,x2 =2.246,P =0.035.There was no significant difference in 2 year distant metastasis rate between the two groups,x2 =0.000,P =0.99,nor the difference in 2 year's survival rate,87％ vs.87％,x2 =0.000,P =0.986.Conclusions Preoperative short course radiotherapy can reduce the local recurrence rate of middle and low locally advanced rectal cancer,without increasing the difficulty of operation and postoperative complications,but long time survival fails to improve.