Factors affecting the difficulty of laparoscopy-assisted triple-port anterior resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the factors affecting the operative difficulty of triple-port laparoscopic surgery (TLS) in anterior resection.</p><p><b>METHODS</b>A retrospective case-control study was carried out. Clinical and MRI imaging data of 106 colorectal cancer cases undergoing TLS anterior resection at Department of Colorectal Surgery of Ruijin Hospital between 2013 and 2016 were retrospectively analyzed.</p><p><b>INCLUSION CRITERIA</b>(1) patients receiving TLS anterior resection (Dixon operation); (2) preoperative stageI( to III( malignant tumor;(3) distance of 5-15 cm from inferior margin of tumor to anal verge; and (4) available preoperative rectal MRI.</p><p><b>EXCLUSION CRITERIA</b>(1) patients receiving preoperative adjuvant therapy; (2) patients with low rectal cancer or with local advanced disease; (3) T4b tumor. Rectal MRI was introduced to measure the structure of pelvis. In sagittal view, superior margin of the first sacral vertebrae, superior margin of the third sacral vertebrae, apex of coccyx, and the line of superior margin of pubic symphysis were used to form a pentagon. The 5 lines were marked as N, O, P, Q, R, and the 5 included angles were marked as angle 1, 2, 3, 4, 5. Organs (uterus and prostate) and tumor (transverse diameter, longitudinal diameter, section area, lesion length, distance to circumference cutting edge) were also measured on MRI. The operative time was applied to be the indicator of operative difficulty and patients were divided into 2 groups according to median operative time. Baseline information (age, gender, BMI, distance from inferior margin of tumor to anal verge, operative history, length of tumor), preoperative tumor staging, and MRI measurements (pelvis, tumor, uterus, prostate), etc were compared between two groups. Factors affecting operative difficulty of TLS were analyzed with logistic regression model.</p><p><b>RESULTS</b>Of 106 enrolled patients, 73 were male and 33 female with mean age of (59.8±12.2) years and mean BMI of (22.8±3.3) kg/m; 25 patients had previous abdominal surgery; distance from inferior margin of tumor to anal verge was (7.4±2.0) cm and the tumor diameter was (3.7±1.4) cm; 24, 36 and 46 patients were in stage I(, II( and III( respectively. All operations were completed successfully. The median number of harvested lymph node was 13(11-16); the median length of distal resection margin was 2.5(2.0-3.1) cm; the median operative time was 2.0(1.5-2.6) hours; the median intraoperative blood loss was 50(0-100) ml; the median time to liquid diet was 4(3-5) days; the median hospital stay was 7(6-10) days. Ten cases (9.4%) developed complications within 30 days after surgery. Patients were divided into ≤2 h group and > 2 h group according to median operative time, and both groups had 53 patients. As compared to ≤2 h group, >2 h group had shorter distance from inferior margin of tumor to anal verge [(6.8 ± 1.5) cm vs. (8.0 ± 2.4) cm, t = 3.174, P = 0.004], lower ratio of (R+N)/(O+P)(1.61±0.27 vs. 1.73±0.19, t = 2.494, P = 0.014), larger transverse distance of tumor [(3.45±0.72) cm vs. (3.05±0.89) cm, t = 0.224, P = 0.027]. Multivariate logistic regression analysis showed the distance from inferior margin of tumor to anal verge was the independent factor affecting operative difficulty(OR=0.584, 95%CI:0.429-0.796, P = 0.001).</p><p><b>CONCLUSIONS</b>Surgeons may have less difficulty in performing TLS anterior resection for patients with longer distance from inferior margin of tumor to anal verge. In preoperative assessment of operative difficulty of TLS, comprehensive evaluation should be performed. Distance from inferior margin of tumor to anal verge should be regarded as the main factor, and MRI (R+N)/(O+P) and transverse diameter of tumor should be used as important reference, leading to reasonable choice of cases for TLS and smooth pass of study curve.</p>

Preliminary exploration of right colectomy by laparoscopy-assisted surgery using three ports / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the radicality, safety, feasibility and indication of right colectomy by laparoscopy-assisted surgery using three ports.</p><p><b>METHODS</b>Clinical data of 109 patients undergoing laparoscopy-assisted right colectomy in the Ruijin Hospital from 2013 to 2014 were retrospectively reviewed. Patients were divided into triple-port group(n=65, 3 ports) and traditional group(n=44, 4 or 5 ports). In the triple-port group, 21 cases were converted, including 14 cases added an additional port, 4 cases added 2 ports and 3 cases converted to laparotomy. The radicality, safety and feasibility were compared between the two groups. Difficulty of the triple-port procedure was summarized and the indication was concluded.</p><p><b>RESULTS</b>No significant differences were observed in specimen length, number of harvested lymph node, CME rate, time to resume fluids, postoperative hospital stay, morbidity of complication, reoperation rate, operation time, blood loss and incidental bowel damage between the two groups (all P>0.05). Among triple-port group, body mass index(BMI) and history of previous surgery were significantly different between those succeed and failed in the procedure [(22.4±2.9) kg/m(2) vs. (25.4±3.8) kg/m(2), P=0.001; 22.7%(10/44) vs. 47.6%(10/21), P=0.017], while other factors were not significantly different(all P>0.05).</p><p><b>CONCLUSIONS</b>For right-colectomy, triple-port and traditional laparoscopic procedures are comparable in terms of oncologic clearance, safety and feasibility. In selection of suitable patients for the triple-port procedure, BMI and history of previeus surgery should be considered.</p>

The correlation between cortactin differential expression and metastasis of colorectal cancer / 中华普通外科杂志

ObjectiveTo explore the correlation between cortactin differential expression and metastasis of colorectal cancer by testing the expression of cortactin in cell sublines with different metastatic ability.MethodHuman colon cancer cell line SW1116, and sublines of fifth subcutaneous ( SW1116_5), first, fifth generation (CRCLM1 、CRCLM3 ) characteristic of different liver metastasis were implanted subcutaneously in BALB/c mouse.Tumors were transplanted into the colon, and liver metastasis was observed, Western blotting and real time-PCR was used to detect the varience of cortactin. Transwell assay was applied to evaluate four cell lines migration and invasion ability. Immunohistochemistry was used to analyze the relationship of cortactin and clinicopathological characterizing in 86 cases of colorectal cancer.ResultCRCLM3( 100％ )has higher ability of metastasis than that of CRCLM1 ( 89％ ), SW1116(40％ )and SW1116_5 (44％) respectively. Expression of cortactin in the SW1116, SW1116_5, CRCLM1,CRCLM3 was gradually increased. There were significant differences between four cell lines by comparison between each others ( P ＜ 0.05 ). Immunohistochemical expression of cortactin in 86 cases was positive in 57 cases(66％ ), and negative in 29 cases (34％).ConclusionsDifferent expression of cortactin with colorectal cancer metastasis and clinical stage was positively correlated. Cortactin is a potential indicator for clinical staging and tumor metastasis of colorectal cancer.