Analysis of efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Peng , ZHANG Dechun

Department of Gastrointestinal Surgery, People’s Hospital of Pengzhou City, Pengzhou, Sichuan 611900, P.R.China;

Corresponding?author：

ZHANG Peng, Email: 497139476@qq.com

Keywords：

rectal cancer; laparoscope; lymphatic dissection; pelvic autonomic nerve preservation

DOI：

10.7507/1007-9424.201611063

Video：

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Objective To investigate efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer. Methods Seventy-three patients underwent D3 radical resection of rectal cancer with pelvic autonomic nerve preservation from March 2015 to October 2016 in the People’s Hospital of Pengzhou City were collected, then were divided into a laparoscopic surgery group (38 cases) and an open surgery group (35 cases) according to the choice of operation. The intraoperative and postoperative indexes were compared between these two groups, and the urination and sexual functions at preoperation and on month 1 after operation for male patient with rectal cancer were evaluated. Results ① The age, gender, tumor diameter, TNM stage, and tumor location had no significant differences between these two groups (P>0.05). ② Compared with the open surgery group, the intraoperative blood loss was less (P<0.05), but the operation time was longer (P<0.05) in the laparoscopic surgery group. The number of lymph node dissection had no significant difference between these two groups (P>0.05). ③ The anal exhaust time and hospitalization stay in the laparoscopic surgery group were significantly shorter than those in the open surgery group (P<0.05), and the incidences of postoperative infection, intestinal adhesion, and intestinal obstruction were significantly lower in the laparoscopic surgery group as compared with the open surgery group (P<0.05). ④ The IPSS score of urination function and the IIEF-5 score of sexual function on month 1 after operation had no significant differences between these two groups (P>0.05), but compared with the preoperative points, the IPSS score was significantly increased, the IIEF-5 score was significantly decreased in the same group (P<0.05). Conclusion The preliminary results of limited cases in this study show that laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer is safe and effective, it has some advantages of mild invasion, lower complication rate, and fast covery.

Citation： ZHANG Peng, ZHANG Dechun. Analysis of efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(7): 843-847. doi: 10.7507/1007-9424.201611063 Copy

1.	李霆, 孟翔凌, 張震, 等. 腹腔鏡直腸癌 D3 淋巴結清掃聯合盆底自主神經保留術的療效及安全性. 中華實驗外科雜志, 2015, 32(4): 721-723.
2.	曾志強, 霍景山, 陶世明, 等. 腹腔鏡直腸癌全系膜切除根治術與開放手術對盆腔自主神經的影響.中國普通外科雜志, 2013, 22(6): 800-802.
3.	Arezzo A, Passera R, Scozzari G, et al. Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc, 2013, 27(5): 1485-1502.
4.	張俊文, 彭艷紅, 馮瑰麗, 等. 可視前列腺癥狀評分在良性前列腺增生癥中的臨床應用. 現代泌尿外科雜志, 2015, 20(12): 851-854, 862.
5.	蔡陽. 男性性功能障礙相關問卷的應用進展. 中華男科學雜志, 2014, 20(9): 840-845.
6.	凌云志, 張宏, 叢進春, 等. 腹腔鏡保留盆腔自主神經直腸癌根治術對患者排尿及男性性功能影響的 Meta 分析.中國醫刊, 2015, 50(2): 39-44.
7.	曾煥虹, 付衛. 國外腹腔鏡手術治療直腸癌的現狀及研究進展. 中國微創外科雜志, 2016, 16(7): 650-655.
8.	黃誠, 李永翔, 陳本鑫, 等. 腹腔鏡與開腹保留盆腔自主神經的低位直腸癌根治術對男性性功能的影響. 實用醫學雜志, 2015, 31(14): 2291-2294.
9.	張昊, 任宇鵬, 劉放, 等. 新輔助治療聯合 3D 腹腔鏡手術在局部晚期低位直腸癌中的應用體會. 腹腔鏡外科雜志, 2016, 21(12): 899-902.
10.	秦誠, 陳延林, 蘇慶, 等. 腹腔鏡輔助電凝鉤法直腸癌根治術的療效分析. 中華消化外科雜志, 2016, 15(8): 789-794.
11.	周海濤, 周志祥, 梁建偉, 等. 無切口腹腔鏡下直腸外翻技術的直腸癌低位前切除術的近期療效. 中華腫瘤雜志, 2015, 37(1): 63-66.
12.	Boutros M, Hippalgaonkar N, Silva E, et al. Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery: a large single-center comparative study. Dis Colon Rectum, 2013, 56(6): 679-688.
13.	李焱寧. 開腹手術與腹腔鏡手術治療結直腸癌的遠期療效及患者生活質量的對比研究. 腹腔鏡外科雜志, 2016, 21(10): 768-771.
14.	劉彥, 盧曉明, 陶凱雄, 等. 腹腔鏡輔助直腸癌根治術對盆腔自主神經保護的操作要點. 腹部外科, 2014, 27(6): 428-431.
15.	魯德斌, 劉西平, 胡林忠, 等. 腹腔鏡與開腹手術治療直腸癌療效及對患者應激反應、免疫功能和生活質量的影響. 海南醫學院學報, 2016, 22(3) :289-291, 295.
16.	謝波, 錢軍, 喻大軍, 等. 腹腔鏡與開腹直腸癌手術對圍手術期患者應激和免疫功能的影響. 廣東醫學, 2016, 37(20): 3068-3070.
17.	李瑾, 張成, 蔣會勇, 等. 應用達芬奇機器人手術系統輔助直腸癌前切除術 11 例體會. 中國普外基礎與臨床雜志, 2012, 19(12): 1319-1322.
18.	羅愛靜, 毛平, 楊金福, 等. 激勵干預對腹腔鏡下直腸癌術后永久結腸造口患者自我效能及生活質量的影響.中國內鏡雜志, 2015, 21(5): 465-470.
19.	Schiphorst AH, Doeksen A, Hamaker ME, et al. Short-term follow-up after laparoscopic versus conventional total mesorectal excision for low rectal cancer in a large teaching hospital. Int J Colorectal Dis, 2014, 29(1): 117-125.
20.	Tanis PJ, Buskens CJ, Bemelman WA. Laparoscopy for colorectal cancer. Best Pract Res Clin Gastroenterol, 2014, 28(1): 29-39.
21.	王永鵬, 佟昕, 張慶彤, 等. 腹腔鏡直腸癌前切除術中轉開腹影響因素的多因素分析. 中國微創外科雜志, 2016, 16(8): 694-697, 719.
22.	姚宏偉, 劉蔭華. 基于循證醫學證據的腹腔鏡直腸癌手術療效評價. 中華外科雜志, 2017, 55(1): 28-31.
23.	閆軍, 李亮. 腹腔鏡與傳統開腹手術治療直腸癌的安全性及遠期療效比較. 標記免疫分析與臨床, 2015, 22(2): 109-112.
24.	孫濤, 周鑫, 傅衛, 等. 新輔助放化療對腹腔鏡中低位直腸癌根治術圍術期結果的影響. 中國微創外科雜志, 2017, 17(3): 197-201.
25.	鄭民華, 馬君俊. 腹腔鏡低位直腸癌保肛手術的評價. 中國普外基礎與臨床雜志, 2012, 19(6): 583-585.

1. 李霆, 孟翔凌, 張震, 等. 腹腔鏡直腸癌 D3 淋巴結清掃聯合盆底自主神經保留術的療效及安全性. 中華實驗外科雜志, 2015, 32(4): 721-723.
2. 曾志強, 霍景山, 陶世明, 等. 腹腔鏡直腸癌全系膜切除根治術與開放手術對盆腔自主神經的影響.中國普通外科雜志, 2013, 22(6): 800-802.
3. Arezzo A, Passera R, Scozzari G, et al. Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc, 2013, 27(5): 1485-1502.
4. 張俊文, 彭艷紅, 馮瑰麗, 等. 可視前列腺癥狀評分在良性前列腺增生癥中的臨床應用. 現代泌尿外科雜志, 2015, 20(12): 851-854, 862.
5. 蔡陽. 男性性功能障礙相關問卷的應用進展. 中華男科學雜志, 2014, 20(9): 840-845.
6. 凌云志, 張宏, 叢進春, 等. 腹腔鏡保留盆腔自主神經直腸癌根治術對患者排尿及男性性功能影響的 Meta 分析.中國醫刊, 2015, 50(2): 39-44.
7. 曾煥虹, 付衛. 國外腹腔鏡手術治療直腸癌的現狀及研究進展. 中國微創外科雜志, 2016, 16(7): 650-655.
8. 黃誠, 李永翔, 陳本鑫, 等. 腹腔鏡與開腹保留盆腔自主神經的低位直腸癌根治術對男性性功能的影響. 實用醫學雜志, 2015, 31(14): 2291-2294.
9. 張昊, 任宇鵬, 劉放, 等. 新輔助治療聯合 3D 腹腔鏡手術在局部晚期低位直腸癌中的應用體會. 腹腔鏡外科雜志, 2016, 21(12): 899-902.
10. 秦誠, 陳延林, 蘇慶, 等. 腹腔鏡輔助電凝鉤法直腸癌根治術的療效分析. 中華消化外科雜志, 2016, 15(8): 789-794.
11. 周海濤, 周志祥, 梁建偉, 等. 無切口腹腔鏡下直腸外翻技術的直腸癌低位前切除術的近期療效. 中華腫瘤雜志, 2015, 37(1): 63-66.
12. Boutros M, Hippalgaonkar N, Silva E, et al. Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery: a large single-center comparative study. Dis Colon Rectum, 2013, 56(6): 679-688.
13. 李焱寧. 開腹手術與腹腔鏡手術治療結直腸癌的遠期療效及患者生活質量的對比研究. 腹腔鏡外科雜志, 2016, 21(10): 768-771.
14. 劉彥, 盧曉明, 陶凱雄, 等. 腹腔鏡輔助直腸癌根治術對盆腔自主神經保護的操作要點. 腹部外科, 2014, 27(6): 428-431.
15. 魯德斌, 劉西平, 胡林忠, 等. 腹腔鏡與開腹手術治療直腸癌療效及對患者應激反應、免疫功能和生活質量的影響. 海南醫學院學報, 2016, 22(3) :289-291, 295.
16. 謝波, 錢軍, 喻大軍, 等. 腹腔鏡與開腹直腸癌手術對圍手術期患者應激和免疫功能的影響. 廣東醫學, 2016, 37(20): 3068-3070.
17. 李瑾, 張成, 蔣會勇, 等. 應用達芬奇機器人手術系統輔助直腸癌前切除術 11 例體會. 中國普外基礎與臨床雜志, 2012, 19(12): 1319-1322.
18. 羅愛靜, 毛平, 楊金福, 等. 激勵干預對腹腔鏡下直腸癌術后永久結腸造口患者自我效能及生活質量的影響.中國內鏡雜志, 2015, 21(5): 465-470.
19. Schiphorst AH, Doeksen A, Hamaker ME, et al. Short-term follow-up after laparoscopic versus conventional total mesorectal excision for low rectal cancer in a large teaching hospital. Int J Colorectal Dis, 2014, 29(1): 117-125.
20. Tanis PJ, Buskens CJ, Bemelman WA. Laparoscopy for colorectal cancer. Best Pract Res Clin Gastroenterol, 2014, 28(1): 29-39.
21. 王永鵬, 佟昕, 張慶彤, 等. 腹腔鏡直腸癌前切除術中轉開腹影響因素的多因素分析. 中國微創外科雜志, 2016, 16(8): 694-697, 719.
22. 姚宏偉, 劉蔭華. 基于循證醫學證據的腹腔鏡直腸癌手術療效評價. 中華外科雜志, 2017, 55(1): 28-31.
23. 閆軍, 李亮. 腹腔鏡與傳統開腹手術治療直腸癌的安全性及遠期療效比較. 標記免疫分析與臨床, 2015, 22(2): 109-112.
24. 孫濤, 周鑫, 傅衛, 等. 新輔助放化療對腹腔鏡中低位直腸癌根治術圍術期結果的影響. 中國微創外科雜志, 2017, 17(3): 197-201.
25. 鄭民華, 馬君俊. 腹腔鏡低位直腸癌保肛手術的評價. 中國普外基礎與臨床雜志, 2012, 19(6): 583-585.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer

Abstract Full text Figures/Tables Video References Cited by

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