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Objective To explore the clinical value of intraoperative interorganizational targeted injection chemotherapy (IITIC) in Dixon operation of advanced rectal cancer (ARC).Methods From June 2013 to December 2013,53 patients who suffered from ARC and were treated by operation in our hospital were divided into group A and group B randomly.29 patients in group A were carried out Dixon operation and IITIC,while 24 patients in group B were carried out Dixon operation only.Serum levels of tumor necrosis factoroα (TNF-ot),carcinoembryonic antigen (CEA) and carbohydrate antigen 242 (CA242) were measured and compared for all the patients in perioperative period.Also,Serum levels of white blood cell (WBC),platelet (PLT),alanine aminotransferase (ALT),aspartate aminotransferase (AST) and creatinine (Cr) were measured and compared for all the patients in perioperative period.Postoperative anastomotic fistula,intra-abdominal hemorrhage,intra-abdominal abscess and death were observed and compared between group A and group B.Postoperative follow-up and survival analysis were carried out for patients in both groups.Results The serum levels of TNF-α,CEA and CA242 at each time point were significantly different both in group A and group B (P ＜ 0.05).Furthermore,The serum levels of TNF-α and CA242 were statistically different between group A and group B (P ＜ 0.05),while there was no statistically significant difference in the serum levels of CEA (P ＞ 0.05).The serum levels of WBC,ALT,AST and Cr were not statistically significant difference between group A and group B (P ＞ 0.05),while the serum levels of PLT were statistically significant difference (P ＜ 0.05).All of the 53 patients were not encountered anastomotic fistula,intra-abdominal hemorrhage,intra-abdominal abscess and death.According to survival analysis,the postoperative1-,2-and 3-year cumulative survival rates of the patients in group A were 93.1％,85.9％ and 71.1％,respectively,while those of the patients in group B were 91.5％,78.4％ and 61.0％,respectively.The median survival times of the Patients in group A and group B were 40.0 months and 39.0 months,respectively,the difference was not statistical significant (P ＞ 0.05).Conclusions It is safe and feasible to carry out IITIC in Dixon operation for ARC.IITIC can increase the treatment effect to operation of ARC,which also can improve patients' prognosis.
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Objective The purpose of this study was to assess the safety of carbon dioxide pneumoperitoneum on patients during robotic rectectomy.Methods 50 patients [American Society of Anesthesiologists (ASA) physical status Ⅱ,18 and 65 years of age] underwent rectal cancer surgery were selected in our study.According to whether or not robotic assisted surgery was performed,they were divided into a robotic surgery group (group RS) and a laparoscopic surgery group (group LS) by surgical approach,25 patients in each group.All participants were given the same anesthesia protocol.Arterial blood samples 1 ml was obtained from the left radial artery for blood gas analysis to measure the partial pressure of arterial carbon dioxide (PaCO2) and and calculate the arterial-to-end-tidal carbon dioxide pressure difference (Pa-ETCO2) just 10 min after endotracheal intubation (T0),at 30 min(T1),1 h(T2),2 h(T3) after pneumoperitoneum and 30 minutes after release (T4).Meanwhile,the airway peak pressure was monitored.Blood samples (4 ml) extracted at T0,T3 and T4 were centrifuged and measured the serum levels of interleukin (IL)-6 and IL-10 by enzyme linked immunosorbent assay (ELISA).The time to resuscitation,extubation time,intraoperative medication and perioperative adverse events were all recorded.Results Compared with group LS,PaCO2 in the RS group was increased significantly at T1,T2 and T3 after pneumoperitonum and the IL-6 was lower at T4 (P ＜ 0.05).There were no statistically significant differences in Pa-ETCO2,airway peak pressure,IL-10,time to resuscitation,extubation time and the incidence of adverse events between the two groups (P ＞ 0.05).Conclusions It is safe for normal adult patients performed by intravenous anesthesia during robotic-assisted rectal surgery and the inflammatory response is small,which is beneficial to the patient's postoperative recovery.
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Objective To investigate the curative effect of fast track surgery laparoscopic surgery and traditional laparotomy in elderly patients over 70 years old with rectal cancer and the difference between the two groups was analyzed,and explore the practical value and the advantages in fast track surgery (FTS) laparoscopic surgery in the patients older than 70 years with colorectal cancer.Methods This study was a retrospective analysis,in accordance with the requirements of the laparoscopic group and the laparotomy group,the clinical data of 100 patients over 70 years old with rectal cancer were randomly sampled who were admitted to the second people's Hospital of Hunan province in April 2010-2016 November.Fifty patients underwent FTS laparoscopic assisted rectal cancer,which was set as the experimental group;the other 50 patients underwent conventional open surgery were set as the control group.The clinical data of two groups were compared with preoperative,intraoperative and postoperative related indicators.Results No significant difference was found in the two groups of patients in surgery (P ＞ 0.05).The operative time of experimental group was [(190 ± 35.2) min] longer than the control group [(160.5 ± 29.3) min] (P ＜ 0.05).The incidence of hypercapnia in the experimental group was higher than the control group (P ＜ 0.05).The intraoperative bleeding of the experimental group [(90 ± 40) ml] was significantly less than the control group [(130 ± 60)ml,P ＜0.05].The postoperative exhaust time of the experimental group [(3.01 ± 0.98)d] was shorter than the control group [(3.98 ± 1.38)d,P ＜0.05].The lymph node number of the experimental group (12.86 ±4.87) was not significantly different from control group (13.12 ±4.69,P ＞ 0.05).The hospitalization time of the experimental group [(15.68 ±5.10) d] was significantly shorter than the control group [(20.31 ± 6.78) d,P ＜ 0.05].The wound infection rate of experimental group was significantly lower than the control group (P ＜ 0.05).The anastomotic leakage in experimental group was not significantly different from control group (P ＞ 0.05).No significant difference in anastomotic stenosis was found between the experimental group and the control group (P ＞ 0.05).Conclusions The concept of FTS laparoscopic radical resection of rectal cancer has the advantages including less bleeding,quicker recovery,and less complications.It is safe and feasible and worthy of clinical application.
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Objective To investigate the action and skills of camera-assisted laparoscopic rectal cancer radical surgery.Methods From January 2009 to May 2015,a total of 577 cases with rectal cancer underwent laparoscopic rectal cancer radical surgery,including 152 cases of abdominal perineal resection,and 425 cases of abdominal resection.The skills of camera-assisted operation were summarized.Results All the operations were successfully completed without serious complications.Conclusions Regarding for skills of camera assistant,mastering the clinical topography of rectum,understanding the operational habit of operator,understanding operating procedure and operation characteristics are the necessary condition to complete laparoscopic rectal cancer radical surgery.