Effect analysis of three-dimensional and two-dimensional laparoscopic radical resection of colorectal cancer / 中华消化外科杂志

ABSTRACT

Objective To explore the clinical effect of three-dimensional (3D) and two-dimensional (2D) laparoscopic radical resection of colorectal cancer.Methods The retrospective cohort study was adopted.The clinical data of 83 patients who underwent laparoscopic radical resection of colorectal cancer at the People's Hospital of Zhengzhou University from March 2014 to November 2015 were collected.Forty-two patients undergoing 2D laparoscopic radical resection of colorectal cancer between March 2014 and December 2014 were allocated into the 2D group and 41 patients undergoing 3D laparoscopic radical resection of colorectal cancer between January 2015 and November 2015 were allocated into the 3D group.All the patients in the 2 groups underwent 2D or 3D laparoscopic radical resection of colorectal cancer based on the principles of lymph node dissection and tumor-free survival.Observation indicators included:(1) surgical situations:operation time,volume of intraoperative blood loss,number of lymph node dissected,(2) postoperative recovery:recovery time of gastrointestinal function,postoperative complications,duration of postoperative hospital stay,hospital expenses,(3) postoperative pathological situations:length of colorectal specimens,distance from tumor to distal incision margin,(4) follow-up.All the patients were followed up to detect postoperative survival,tumor metastasis and recurrence using outpatient examination and telephone interview up to March 2016.Measurement data with normal distribution were presented as x-± s and comparison between groups was analyzed using the t test.Count data were analyzed using chi-square test or Fisher exact probability.Results (1) Surgical situations:all the patients underwent successful laparoscopic radical resection of colorectal cancer,without conversion to open surgery and perioperative death.Operation time,volume of intraoperative blood loss and number of lymph node dissected were (171 ±18) minutes,(112±18)mL,14.0 ± 1.4 in the 2D group and (125 ± 13) minutes,(101 ± 16)mL,14.6 ± 0.9 in the 3D group,respectively,with statistically significant differences between the 2 groups (t =-13.091,-2.962,-3.623,P ＜0.05).(2) Postoperative recovery:recovery time of gastrointestinal function was (3.0 ± 0.6) days in the 2D group and (3.0 ± 0.6) days in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =3.423,P ＞ 0.05).Incidence of postoperative complications in the 2D and 3D groups was 7.1％ (3/42) and 4.9％ (2/41),respectively,with no statistically significant difference between the 2 groups (P ＞0.05).One,1,1 patients in the 2D group were respectively complicated with anastomotic fistula,intra-abdominal hemorrhage and intra-abdominal infection,1 and 1 patients in the 3D group were respectively complicated with anastomotic fistula and intestinal paralysis,and they were improved by symptomatic treatment.Duration of postoperative hospital stay and hospital expenses was (10.0 ±0.8)days,(7.0 ± 1.4) × 104 yuan in the 2D group and (10.0 ±0.6)days,(7.3 ± 1.5) x 104 yuan in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =15.716,0.941,P ＞ 0.05).(3)Postoperative pathological situations:length of colorectal specimens and distance from tumor to distal incision margin were (18 ± 7) cm,(4.7 ± 0.6) cm in the 2D group and (20 ± 8) cm,(4.9 ± 0.7)cm in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =0.742,1.401,P ＞0.05).(4)Follow-up:of 83 patients,82 were followed up for 5-24 months with a median time of 12 months.During the follow-up,there was no occurrence of tumor-related death and recurrence and metastasis of sites of puncture.Intra-abdominal tumor recurrence,recurrence of anastomotic tumor and tumor distant metastasis were detected in 3,2,1 patients in the 2D group and 2,1,1 patients in the 3D group,with no statistically significant difference between the 2 groups (P ＞ 0.05).Conclusion Compared with 2D laparoscopic radical resection of colorectal cancer,3D laparoscopic radical resection of colorectal cancer is safe and feasible,and it can also reduce intraoperative blood loss and increase the rate of lymph node dissected,with a good short-term outcome.