Application value of cruciform anastomosis in the laparoscopic radical resection of colon cancer / 中华消化外科杂志

ABSTRACT

Objective To evaluate the safety and feasibility of cruciform anastomosis in the laparoscopic radical resection of colon cancer.Methods The retrospective descriptive study was adopted.The clinicopathologic data of 9 patients with colon cancer who were admitted to the Shanxi Provincial Caner Hospital between December 2011 to October 2013 were collected.After the laparoscopic free colon and dissection of lymph nodes,the proximal and distal ends of the colon tumor were cut off using an ENDO-GIA,cutting one small incision on the both side of stump,and ENDO-GIA was put into the incision to staple the mesentery of colonic wall,finally,the beak-like common incision was closed by ENDO-GIA and digestive tract construction was conducted.Observation indices(1)operative indicesoperation time,time of cruciform colon anastomosis,volume of intraoperative blood loss,conversion to open surgery.(2)Tumor indicesnumber of lymph nodes dissected,distance to resection margin,R resection.(3)Surgical complicationsanastomotic stoma incompetence,anastomotic leakage,anastomotic stenosis,twisting of bowel,wound liquefaction infection.(4)Postoperative recovery timetime for initial out-of-bed activity,time to anal exsufflation,time for fluid diet intake,duration of postoperative hospital stay.(5)Follow-up situationsfollow-up using outpatient examination was conducted up to April 2014.Karnofsky performance status(KPS)score was used to evaluate the health conditions and tumor recurrence of anastomotic stoma and colonic cavity stenosis were detected by fibercoloscope.Measurement data with normal distribution were presented as x±s.Results(1)Operative indices9 patients received successful total laparoscopic resection of colon cancer+D3 lymph node dissection+cruciform anastomosis,without conversion to open surgery.Operation time,time of cruciform colon anastomosis and volume of intraoperative blood loss were respectively(140±50)minutes,(43±26)minutes and(62±56)mL.(2)Tumor indicesthe number of lymph nodes dissected was 17±6 percase.The distance to resection margin was more than 8 cm,and pathological findings showed no residual cancer.(3)Surgical complications9 patients had no postoperative complications.(4)Postoperative recovery timetime for initial out-of-bed activity,time to anal exsufflation,time for fluid diet intake and duration of hospital stay were respectively(1.8±0.9)days,(2.4±1.2)days,(3.6±1.7)days and(9.6±2.5)days.All the patients were discharged from hospital at postoperative day 12,without the occurrence of readmission within postoperative day 30.(5)Follow-up situationsall the patients were followed up by outpatient examination at postoperative month 6,with KPS score≥90 and without the occurrence of tumor recurrence of anastomotic stoma and colonic cavity stenosis.Conclusion Cruciform anastomosis in the laparoscopic radical resection of colon cancer is safe and feasible.