Curative effect analysis of laparoscopic total mesorectal excision for the middle-lower rectal caner_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Xiaoding ¹ , YANG Lie ² , HE Chengjun ¹ , LI Junchuan ¹ , YANG Liu ¹ ,  CHEN Tinghao ¹

1. Department of General Surgery, The First People’s Hospital of Ziyang, Ziyang, Sichuan 641300, P. R. China;
2. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

CHEN Tinghao, Email: cthyyl@msn.com

Keywords：

middle-lower rectal cancer; laparoscopy; total mesorectal excision; short-term outcome

DOI：

10.7507/1007-9424.201806054

Video：

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Objective To evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.Methods The pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.Results Two patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).Conclusion Laparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.

Citation： YANG Xiaoding, YANG Lie, HE Chengjun, LI Junchuan, YANG Liu, CHEN Tinghao. Curative effect analysis of laparoscopic total mesorectal excision for the middle-lower rectal caner. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1459-1463. doi: 10.7507/1007-9424.201806054 Copy

1.	鄭民華. 不斷提高腹腔鏡直腸癌外科規范化治療水平. 中華普外科手術學雜志: 電子版, 2013, 7(2): 81-84.
2.	周總光. 腹腔鏡直腸癌根治應關注的若干問題. 中華普外科手術學雜志: 電子版, 2013, 7(2): 85-87.
3.	鄭民華. 我國腹腔鏡結直腸外科的發展. 腹腔鏡外科雜志, 2010, 15(6): 401-403.
4.	鄧祥兵, 孟文建, 張元川, 等. 直腸前間隙Denovilliers筋膜分層結構及與前列腺血管分支的關系. 中華胃腸外科雜志, 2013, 16(5): 489-493.
5.	鄭民華, 胡艷艷, 陸愛國, 等. 腹腔鏡與開腹直腸全系膜切除術治療低位直腸癌的臨床對比研究. 中華胃腸外科雜志, 2004, 7(3): 177-180.
6.	余江, 張策, 王亞楠, 等. 腹腔鏡與開腹全直腸系膜切除術治療中低位直腸癌的同期臨床對照研究. 中華胃腸外科雜志, 2009, 12(6): 573-576.
7.	Hida K, Okamura R, Sakai Y, et al. Open versus laparoscopic surgery for advanced low rectal cancer: a large, multicenter, propensity score matched cohort study in Japan. Ann Surg, 2018, 268(2): 318-324.
8.	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.
9.	付濤, 劉寶華. 腹腔鏡直腸切除術. 臨床外科雜志, 2014, 22(4): 234-236.
10.	Lujan J, Valero G, Biondo S, et al. Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4, 970 patients. Surg Endosc, 2013, 27(1): 295-302.
11.	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.
12.	Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis, 2012, 14(6): e277-e296.
13.	Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol, 2010, 11(7): 637-645.
14.	范瑩, 吳碩東, 于宏, 等. 腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究. 中國普外基礎與臨床雜志, 2009, 16(5): 384-388.
15.	王向陽, 陳勇, 龐典付, 等. 腹腔鏡結直腸癌根治性手術的臨床療效分析. 中國普通外科雜志, 2012, 21(4): 403-406.
16.	Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg, 2009, 96(9): 982-989.
17.	王樹彥, 陳宗祐. 結直腸癌腹腔鏡手術與開腹手術的短期療效比較. 復旦學報: 醫學版, 2010, 37(1): 92-99.
18.	van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLORⅡ): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3): 210-218.
19.	Martínez-Pérez A, Carra MC, Brunetti F, et al. Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: a systematic review and meta-analysis. World J Gastroenterol, 2017, 23(44): 7906-7916.
20.	林祥, 楊濟峰, 李劍. 中、低位直腸癌應用腹腔鏡直腸全系膜切除術治療的臨床研究. 齊齊哈爾醫學院學報, 2014, 35(1): 63-64.
21.	熊懿. 腹腔鏡直腸全系膜切除術治療中、低位直腸癌的臨床療效分析. 中國普通外科雜志, 2015, 24(4): 616-618.
22.	傅衛, 袁炯, 王德臣, 等. 腹腔鏡直腸全系膜切除術治療中、低位直腸癌的臨床安全性對比研究. 中國微創外科雜志, 2007, 7(6): 502-505.
23.	Lee SD, Park SC, Park JW, et al. Laparoscopic versus open surgery for stageⅠ rectal cancer: long-term oncologic outcomes. World J Surg, 2013, 37(3): 646-651.
24.	孔祥興, 李軍, 丁克峰. 結直腸癌加速康復外科開展的要點和難點. 中華胃腸外科雜志, 2016, 19(3): 260-261.
25.	González QH, Rodríguez-Zentner HA, Moreno-Berber JM, et al. Laparoscopic vs open total mesorectal excision for treatment of rectal cancer. Rev Invest Clin, 2008, 60(3): 205-211.
26.	李俊, 譚憶廣, 周志濤, 等. 腹腔鏡直腸全系膜切除治療中下段直腸癌臨床療效的探討. 中華腫瘤防治雜志, 2010, 17(22): 1865-1867.
27.	孫延東, 吳國豪, 張波, 等. 腹腔鏡與開腹手術治療直腸癌的臨床對照研究. 中華胃腸外科雜志, 2014, 17(4): 369-372.
28.	Deans C, Yeo MS, Soe MY, et al. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg, 2011, 35(3): 617-624.

1. 鄭民華. 不斷提高腹腔鏡直腸癌外科規范化治療水平. 中華普外科手術學雜志: 電子版, 2013, 7(2): 81-84.
2. 周總光. 腹腔鏡直腸癌根治應關注的若干問題. 中華普外科手術學雜志: 電子版, 2013, 7(2): 85-87.
3. 鄭民華. 我國腹腔鏡結直腸外科的發展. 腹腔鏡外科雜志, 2010, 15(6): 401-403.
4. 鄧祥兵, 孟文建, 張元川, 等. 直腸前間隙Denovilliers筋膜分層結構及與前列腺血管分支的關系. 中華胃腸外科雜志, 2013, 16(5): 489-493.
5. 鄭民華, 胡艷艷, 陸愛國, 等. 腹腔鏡與開腹直腸全系膜切除術治療低位直腸癌的臨床對比研究. 中華胃腸外科雜志, 2004, 7(3): 177-180.
6. 余江, 張策, 王亞楠, 等. 腹腔鏡與開腹全直腸系膜切除術治療中低位直腸癌的同期臨床對照研究. 中華胃腸外科雜志, 2009, 12(6): 573-576.
7. Hida K, Okamura R, Sakai Y, et al. Open versus laparoscopic surgery for advanced low rectal cancer: a large, multicenter, propensity score matched cohort study in Japan. Ann Surg, 2018, 268(2): 318-324.
8. 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.
9. 付濤, 劉寶華. 腹腔鏡直腸切除術. 臨床外科雜志, 2014, 22(4): 234-236.
10. Lujan J, Valero G, Biondo S, et al. Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4, 970 patients. Surg Endosc, 2013, 27(1): 295-302.
11. 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.
12. Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis, 2012, 14(6): e277-e296.
13. Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol, 2010, 11(7): 637-645.
14. 范瑩, 吳碩東, 于宏, 等. 腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究. 中國普外基礎與臨床雜志, 2009, 16(5): 384-388.
15. 王向陽, 陳勇, 龐典付, 等. 腹腔鏡結直腸癌根治性手術的臨床療效分析. 中國普通外科雜志, 2012, 21(4): 403-406.
16. Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg, 2009, 96(9): 982-989.
17. 王樹彥, 陳宗祐. 結直腸癌腹腔鏡手術與開腹手術的短期療效比較. 復旦學報: 醫學版, 2010, 37(1): 92-99.
18. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLORⅡ): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3): 210-218.
19. Martínez-Pérez A, Carra MC, Brunetti F, et al. Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: a systematic review and meta-analysis. World J Gastroenterol, 2017, 23(44): 7906-7916.
20. 林祥, 楊濟峰, 李劍. 中、低位直腸癌應用腹腔鏡直腸全系膜切除術治療的臨床研究. 齊齊哈爾醫學院學報, 2014, 35(1): 63-64.
21. 熊懿. 腹腔鏡直腸全系膜切除術治療中、低位直腸癌的臨床療效分析. 中國普通外科雜志, 2015, 24(4): 616-618.
22. 傅衛, 袁炯, 王德臣, 等. 腹腔鏡直腸全系膜切除術治療中、低位直腸癌的臨床安全性對比研究. 中國微創外科雜志, 2007, 7(6): 502-505.
23. Lee SD, Park SC, Park JW, et al. Laparoscopic versus open surgery for stageⅠ rectal cancer: long-term oncologic outcomes. World J Surg, 2013, 37(3): 646-651.
24. 孔祥興, 李軍, 丁克峰. 結直腸癌加速康復外科開展的要點和難點. 中華胃腸外科雜志, 2016, 19(3): 260-261.
25. González QH, Rodríguez-Zentner HA, Moreno-Berber JM, et al. Laparoscopic vs open total mesorectal excision for treatment of rectal cancer. Rev Invest Clin, 2008, 60(3): 205-211.
26. 李俊, 譚憶廣, 周志濤, 等. 腹腔鏡直腸全系膜切除治療中下段直腸癌臨床療效的探討. 中華腫瘤防治雜志, 2010, 17(22): 1865-1867.
27. 孫延東, 吳國豪, 張波, 等. 腹腔鏡與開腹手術治療直腸癌的臨床對照研究. 中華胃腸外科雜志, 2014, 17(4): 369-372.
28. Deans C, Yeo MS, Soe MY, et al. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg, 2011, 35(3): 617-624.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Curative effect analysis of laparoscopic total mesorectal excision for the middle-lower rectal caner

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