Comparison of curative efficacy and prognosis between fluorescent laparoscopic and conventional laparoscopic radical resection of colorectal cancer / 肿瘤研究与临床

Objective:To compare the efficacy and prognosis between fluorescent laparoscopic and conventional laparoscopic radical resection of colorectal cancer.Methods:A total of 114 colorectal cancer patients in Bishan District People's Hospital of Chongqing from June 2019 to January 2021 were selected as the research objects, and they were divided into two groups according to the diagnosis and treatment time. Forty-four patients receiving treatment from June 2019 to February 2020 were enrolled as group A, and 70 patients receiving treatment from March 2020 to January 2021 were set as group B. Patients in group A received fluorescent laparoscopic radical resection of colorectal cancer, and patients in group B received conventional laparoscopic radical resection of colorectal cancer. The operation time, intraoperative blood loss, metastatic lymph node clearance rate, clinical efficacy (the overall response rate was calculated as complete remission + partial remission), postoperative complication rate and recurrence rate within 1 year were compared between the two groups.Results:The clearance rate of metastatic lymph nodes was 86.95% (40/46) in group A, which was higher than 72.22% (52/72) in group B, and the difference was statistically significant ( χ2 = 3.55, P = 0.049). There were no statistical differences in operation time and intraoperative blood loss between the two groups (all P > 0.05). The overall response rate was 86.36% (38/44) in group A, which was higher than 74.28% (52/70) in group B, and the difference was statistically significant ( χ2 = 5.03, P = 0.024). The incidence of complications in group A was 9.09% (4/44), which was not significantly different from that in group B (11.42%,8/70) ( χ2 = 0.16, P = 0.692). The recurrence rate within 1 year of group A was 11.36% (5/44), which was lower than that of group B (24.42%, 15/70), but the difference was not statistically significant ( χ2 = 1.89, P = 0.169). Conclusions:Compared with conventional laparoscopy, fluorescent laparoscopic radical resection of colorectal cancer has better clinical efficacy, higher clearance rate of metastatic lymph nodes, and does not increase the incidence of postoperative metastasis and complications.

Application of indocyanine green in complex upper urinary tract repair surgery / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical application of indocyanine green (ICG) visualization by near infrared fluorescence laparoscopy (NIFL) in complex upper urinary tract reconstructions surgery.@*METHODS@#This was a retrospective study of 7 patients who underwent complex surgeries of ureteral reconstruction between May 2019 and October 2019. There were 6 males and 1 female with the age ranging from 24 to 57 years (median age was 47 years). There were 5 cases of right ureteral strictures, of which 3 were proximal ureteral strictures and 2 were multiple and long ureteral strictures caused by radiotherapy. There were 2 cases of left ureteral strictures, of which 1 was ureteropelvic junction stricture and 1 was proximal ureteral stricture. There were 4 cases of secondary repair operations and 3 cases of primary operations. All the patients underwent laparoscopic surgery via the abdominal approach. ICG was injected into the ureter via nephrostomy tube during the operations, and the diseased ureter was identified by NIFL. Among the patients, 2 cases underwent IUPU (Institute of Urology, Peking University) modified ileal ureter replacement, 2 cases underwent ureteroureterostomy, 2 cases underwent appendiceal onlay flap ureteroplasty, and 1 case underwent lingual mucosa onlay flap ureteroplasty.@*RESULTS@#All the operations were successfully completed without open conversion. The localization and separation of ureteral lesions were completed under NIFL. The mean operative time was 187 (135-300) min. The duration of ureteral separation was 15-27 min, and the mean time was 18 min. The estimated blood loss was 15-200 mL, the mean estimated blood loss was 50 mL. There was one patient with ileal ureter replacement who had fever after surgery and responded well to antibiotics. The mean (range) length of postoperative hospital stay was 7 (6-10) days and no postoperative complications of a high grade (Clavien-Dindo Ⅲ and Ⅳ) occurred. Up to now, the mean follow-up duration was 9 (6-11) months, and no indocyanine green toxicity occurred. All D-J stents and nephrostomy were removed successfully 2 months after the operation. Ultrasound showed no obvious hydronephrosis, and CTU (computed tomography urography) showed that the urinary tract was unobstructed and the kidney function was normal.@*CONCLUSION@#The application of ICG in the complex upper urinary tract reconstructive surgery is a safe and easy method to help surgeon to identify the ureter which may reduce the risk of iatrogenic damage and protect the ureteral blood supply.

Comparative study of fluorescence vs.high-definition laparoscopy in extended pelvic lymph node dissection plus radical prostatectomy for patients with locally advanced prostate cancer / 中华泌尿外科杂志

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND)and oncological outcome by fluorescence laparoscopic radical prostatectomy (FLRP) versus high-definition laparoscopic radical prostatectomy (HD-LRP) for men with locally advanced prostate cancer (LAPCa).Methods In a prospective trial,we recruited 51 patients with T3a-bNxM0 prostate cancer from July 2015 to April 2018.Patients were assigned to study group or control group according to random number method,and were underwent either FLRP + ePLND or HD-LRP + ePLND.21 in the study group were injected with 5 mg of indocyanine green (ICG) into the bilateral lobes of the prostate transperineally guiled by transrectal ultrasound 30 min before surgery for lymphography.During the surgical procedure a fluorescence laparoscope,optimized for detection in the near infrared range,was used to visualize the lymph nodes (green fluorescent) in the dissection region in the study group while a common laparoscopy introduced in control one.Lymph nodes were removed in the external iliac vessiles,internal iliac artery,obturator fossa regions,common iliac regions and presacral regions in both groups.Radical prostatectomy was completed in the both groups by similar steps.The operation time,blood loss,number of removed lymph nodes and positive lymph nodes,complication rate,biochemical recurrence (BCR) and metastasis free survival rates in 2 years were recorded and compared in the two groups.Results 51 eligible patients were selected,including 21 in the study group and 30 in the control group.The mean age of biopsy of study group and control one were (66.4 ± 7.7) and (66.8 ± 7.4),the mean age PSA (23.5 ± 16.8) ng/ml and (26.0 ± 20.1) ng/ml,the mean Gleason score of biopsy (8.1 ± 1.0) and (7.9 ± 0.9) respectively,and there was no statistical significant difference between two groups.The mean operation time of study group and control one were (45.9 ± 4.6) min and (56.4 ± 3.2) min,the mean removed lymph nodes were (27.7 ± 5.6) and (22.1 ±5.6) respectively,and there was statistical significant difference between two groups (all P ＜ 0.05).Lymph nodes invasion in pathology were reported in 8 cases(38.1％)in the study groups while 9 (30.0 ％) in the control one;the proportion of positive lymph node (metastasis) were 3.2％ (19/583) and 3.4％ (23/663) in the two groups respectively and no statistically significant difference was noted between the two groups.Lymphorrhagia occurred in 4 cases in the control group,and there was no serious complications in both groups.The median follow-up time was 20 (7-33) month and during this time,BCR observed of 1 (4.7％) in the study group and 8 (26.7％) in the control;meanwhile,the MFSR was recorded of 100.0％ (0)in the study group and 86.7％ (4)in the control one,showing a statistically significant difference between the two groups(P =0.04).Conclusions Comparing with LRP,FLRP achieved better results of LN dissection,which will improve oncological outcomes.