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4K laparoscopy brings opportunities and challenges to the development of rectal surgery. 4K laparoscopy can truly provide the structure of abdominal and pelvic fascia, so that surgeons can see more subtle anatomical structure. The clear and real picture under 4K laparoscopic system can reduce visual fatigue of surgeons, which make the operation easier and safer. Radical resection of right colon cancer includes complete mesocolic excision and D 3 lymphadenectomy. Through 4K laparoscopic system, surgeons can easily observe the fascia structure of right mesocolon and its mesenteric bed, distinguish the vascular anatomical relationship at the mesenteric root, which make D 3 lymphadenectomy safer with dissection of lymph nodes completely. The authors comprehensively analyze the related research progress at home and abroad, and systematically elaborate the region of dissection and significance of 4K laparoscopic right hemicolectomy for right colon cancer.
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Objective To investigate the application value of parallel and cross-to-overlap anastomosis method (PCOA) in three-dimensional (3D) laparoscopic radical resection of right hemicolon cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 138 patients who underwent 3D laparoscopic radical resection of right hemicolon cancer at Henan Provincial People's Hospital between July 2016 and July 2019 were collected.There were 83 males and 55 females,aged from 30 to 76 years,with a median age of 64 years.All the 138 patients with right hemicolon tumors were diagnosed as malignant tumors by enteroscopy and pathological examination before operation.The lymph node dissection and radical resection of right hemicolon cancer were performed according to the 9th edition of Japanese General Rules for Cancer of Colon,Rectum and Anus of the Japanese Colorectal Cancer Association.Observation indicators:(1) surgical situations;(2) postoperative conditions;(3) follow-up.Follow-up was conducted by outpatient examination or telephone interview to detect survival of patients and tumor recurrence and metastasis up to September 2019.Measurement data with normal distribution were represented as Mean ± SD.Measurement data with skewed distribution were represented as M (range).Count data were represented as percentages or absolute numbers.Results (1) Surgical situations:all the 138 patients underwent 3D laparoscopic radical resection of right hemicolon cancer using PCOA to reconstruct digestive tracts,without conversion to open surgery.The operation time,time for PCOA,and volume of intraoperative blood loss was (151.0±54.0)minutes,(20.1±2.0)minutes,and (60±21) mL.(2) Postoperative situations:the time to first flatus,time to semi-liquid food intake,length of auxiliary incision,and incidence rate of postoperative complications were (2.5±0.4)days,(4.0± 1.3)days,(3.0±0.2) cm,and 3.62％ (5/138),respectively.Of the 5 patients with postoperative complications,1 patient with intestinal obstruction was cured after conservative treatment including gastrointestinal decompression and nutritional support,1 patient with anastomotic leakage was cured after conservative treatment including gastrointestinal decompression,local patency drainage,infection control and nutritional support,1 patient with ascites and abdominal infection was cured after computed tomography-guided percutaneous catheter drainage,1 patient with incisional infection was cured by controlling infection,strengthening dressing changes,local irrigation and drainage,1 patient with pulmonary infection was cured after anti-infective treatment.The number of lymph nodes dissected after surgery,duration of postoperative hospital stay,and hospital expenses were 19±8,(7.2±4.1) days,and (4.8± 1.4) × 104 yuan.All the 138 patients were confirmed as colonic adenocarcinoma by postoperative pathological examination,including 27 cases of poorly differentiated adenocarcinoma,92 cases of moderately differentiated adenocarcinoma,10 cases of highly differentiated adenocarcinoma,and 9 cases of mucinous adenocarcinoma.(3) Follow-up:133 of 138 patients were followed up for 2-38 months,with a median follow-up time of 18 months.During the follow-up,2 patients died,1 of which was detected multiple liver metastases at postoperative 16 months and died at postoperative 21 months,and the other was detected multiple liver metastases at postoperative 20 months and died at postoperative 24 months.Eight patients had distant metastasis,including 5 cases of liver metastasis,1 case of lung metastasis,and 2 cases of abdominal metastasis.The 10 patients with death and tumor metastasis were confirmed as stage Ⅲ by postoperative pathological examination,and the other 123 patients were generally in good condition.Conclusion PCOA is safe and effective for 3D laparoscopic radical resection of right hemicolon cancer.
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Objective@#To investigate the application value of parallel and cross-to-overlap anastomosis method (PCOA) in three-dimensional (3D) laparoscopic radical resection of right hemicolon cancer.@*Methods@#The retrospective cross-sectional study was conducted. The clinicopathological data of 138 patients who underwent 3D laparoscopic radical resection of right hemicolon cancer at Henan Provincial People′s Hospital between July 2016 and July 2019 were collected. There were 83 males and 55 females, aged from 30 to 76 years, with a median age of 64 years. All the 138 patients with right hemicolon tumors were diagnosed as malignant tumors by enteroscopy and pathological examination before operation. The lymph node dissection and radical resection of right hemicolon cancer were performed according to the 9th edition of Japanese General Rules for Cancer of Colon, Rectum and Anus of the Japanese Colorectal Cancer Association. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect survival of patients and tumor recurrence and metastasis up to September 2019. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were represented as percentages or absolute numbers.@*Results@#(1) Surgical situations: all the 138 patients underwent 3D laparoscopic radical resection of right hemicolon cancer using PCOA to reconstruct digestive tracts, without conversion to open surgery. The operation time, time for PCOA, and volume of intraoperative blood loss was (151.0±54.0)minutes, (20.1±2.0)minutes, and (60±21)mL. (2) Postoperative situations: the time to first flatus, time to semi-liquid food intake, length of auxiliary incision, and incidence rate of postoperative complications were (2.5±0.4)days, (4.0±1.3)days, (3.0±0.2)cm, and 3.62%(5/138), respectively. Of the 5 patients with postoperative complications, 1 patient with intestinal obstruction was cured after conservative treatment including gastrointestinal decompression and nutritional support, 1 patient with anastomotic leakage was cured after conservative treatment including gastrointestinal decompression, local patency drainage, infection control and nutritional support, 1 patient with ascites and abdominal infection was cured after computed tomography-guided percutaneous catheter drainage, 1 patient with incisional infection was cured by controlling infection, strengthening dressing changes, local irrigation and drainage, 1 patient with pulmonary infection was cured after anti-infective treatment.The number of lymph nodes dissected after surgery, duration of postoperative hospital stay, and hospital expenses were 19±8, (7.2±4.1)days, and (4.8±1.4)×104 yuan. All the 138 patients were confirmed as colonic adenocarcinoma by postoperative pathological examination, including 27 cases of poorly differentiated adenocarcinoma, 92 cases of moderately differentiated adenocarcinoma, 10 cases of highly differentiated adenocarcinoma, and 9 cases of mucinous adenocarcinoma. (3) Follow-up: 133 of 138 patients were followed up for 2-38 months, with a median follow-up time of 18 months. During the follow-up, 2 patients died, 1 of which was detected multiple liver metastases at postoperative 16 months and died at postoperative 21 months, and the other was detected multiple liver metastases at postoperative 20 months and died at postoperative 24 months. Eight patients had distant metastasis, including 5 cases of liver metastasis, 1 case of lung metastasis, and 2 cases of abdominal metastasis. The 10 patients with death and tumor metastasis were confirmed as stage Ⅲ by postoperative pathological examination, and the other 123 patients were generally in good condition.@*Conclusion@#PCOA is safe and effective for 3D laparoscopic radical resection of right hemicolon cancer.
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Background: Colon cancer is one of the most common malignant tumor of digestive system. There are differences in pathogenesis, biological behavior, gene expression between left and right hemicolon cancer. Aims: To investigate the differences in clinicopathological features, microsatellite instability (MSI) and K-ras gene mutation between left and right hemicolon cancer. Methods: Data of 144 patients with colon cancer diagnosed by postoperative pathology from June 2017 to June 2018 at Qingdao Municipal Hospital were collected. MSI was assessed by immunohistochemistry, K-ras gene mutation was detected by PCR. The differences in clinicopathological features, MSI and K-ras gene mutation between the two groups were compared. Results: Right hemicolon cancer was more common in female, and left hemicolon cancer was more common in male. The incidence of lymph node metastasis, positivity rate of CEA and MSI in right hemicolon cancer were significantly higher than left hemicolon cancer (P<0.01), while the K-ras gene mutation rate in left hemicolon cancer was significantly higher than right hemicolon cancer (P<0.05). The K-ras gene mutation in left hemicolon cancer was correlated with gender, lymph node metastasis and positivity rate of CEA (P<0.05). MSI in right hemicolon cancer was correlated with gender, age, and lymph node metastasis (P<0.05). Conclusions: There are differences in the MSI and K-ras gene mutation between left hemicolon cancer and right hemicolon cancer, which can be used as the reference for diagnosis, individualized treatment and prognosis of colon cancer.
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Objective To investigate the local anatomical characteristics of the associated membrane and mesangial space in the complete mesocolic excision (CME) of right hemicolectomy and provide the surgical practical anatomical evidence to CME.Methods The experimental study was conducted.Department of Anatomy of Capital Medical University provided 20 adult cadavers.The surgical pictures came from Beijing Friendship Hospital of Capital Medical University.The local anatomy of CME in 20 cadavers was simulated after fascia perfusion.Observation indicators:(1) the local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens;(2) observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing;(3) distribution and variation of superior vessels of rightsemi mesocolon.Results (1) The local anatomy of the visceral fascia and parietal fascia was studied by simulating the operation of CME in cadaver specimens:posterior lobe of the interposition mesocolon merged completely with visceral fascia,parietal fascia and front fascia of duodenum,and superior mesenteric vein (SMV) and superior mesenteric artery (SMA) were found.The ureters and reproductive vessels were covered with Gerota fascia,with a complete membrane structure.The specimens from simulated CME in 20 adult cadavers and CME of right hemicolectomy accorded with a requirement of CME.(2) Observing the integrity and barrier action of the visceral layer of the membrane after fascia perfusion solution freezing:posterior lobe of the right-semi mesocolon merged completely with visceral fascia,with a complete parietal fascia structure and without exudation of fascia perfusion solution.The right ureter and reproductive vessels were completely covered with Gerota fascia.The serosal surface of right-semi mesocolon maintained integity,with exudation of fascia perfusion solution.(3) Distribution and variation of superior vessels of right-semi mesocolon:major blood vessels of right-semi colon included superior mesenteric vessels,including SMA and SMV.The major branches of vessels included ileocolic artery,right colic artery,middle colic artery,right and left branches of middle colic artery,ileocolic vein,middle colic vein and gastrocolic stem.The gastrocolic stem and main stem of right colic artery had more variations.Conclusion The posterior lobe of the interposition mesocolon merges with fascia,and complete visceral fascia,can be separated,these provide anatomical evidences for safety and radical resection of right hemicolectomy based on following the principles of CME.