ObjectiveTo summary the standard treatment for early gastric cancer.
MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded.
ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences.
ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
Objective
To compare the short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B aortic dissection (AD).
Methods
A total of 45 patients (37 acute AD and 8 chronic AD) with complex type B AD were admitted to Nanjing First Hospital from January 2012 to June 2016, including 37 males and 8 females. All patients were confirmed by computed tomography angiography (CTA), and ultrasonic cardiogram (UCG) to rule out valvular diseases, aortic root and ascending aorta lesion, and pericardial effusion. According to different treatments, patients were divided into two groups: the open surgery group (OS group) with a total of 25 patients (20 males, 5 females, a mean age of 50.16±10.87 years); the hybrid technique group (HT group) with a total 20 patients (18 males, 2 females, mean age of 51.31±8.11 years). The short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B AD were compared.
Results
All the patients were discharged successfully. There was no death, cognitive impairment, cerebral infarction, hemiplegia, paraplegia, coma and other neurological complications in both groups. In the OS group, one patient suffered acute kidney injury and received renal replacement therapy (RRT), whose renal function was returned to normal prior to discharge; one patient was transferred to ICU again owing to pericardial effusion, respiratory failure and lung infection; one patient underwent debridement surgery because of postoprative sternal dehiscence. In the HT group, one patient with recurrent chest pain five days after endovascular aortic repair, whose CTA showed hematoma of aortic arch and ascending aorta caused by reverse tear, underwent Sun’s procedure immediately. All patients received CTA examination three months after operation in outpatient room. In the OS Group, the tear of AD was closed well by stent-graft and no leakage or shunt was detected in CTA. The rate of thrombosis formation in thoracic aortic false lumen was 100.0%. Meanwhile, in the HT Group, there was one patient with type Ⅱ leakage and the rate of thrombosis formation in thoracic aortic false lumen was 94.7%.
Conclusion
For complex type B AD without optimal "landing zone" in descending aorta, open surgery is recommended as the first choice for experienced team because of its less costs and perfect results; hybrid technique which can achieve quicker recovery with less surgical trauma still has serious complications such as leakage, reverse tear, and so on.
ObjectiveTo investigate the advantage and short- and medium-term effectivenesses of paramedian incision minimally invasive transforaminal lumbar interbody fusion (mini-TLIF) by comparing with open TLIF.
MethodsA retrospective analysis was made on the clinical data of 54 patients with single segmental lumbar degenerative disease who accorded with the inclusion criteria between January 2012 and March 2014. Open TLIF was performed in 26 patients (open group), mini-TLIF in 28 cases (minimally invasive group). There was no significant difference in gender, age, disease duration, etiology, and affected segments between 2 groups (P>0.05). The indexes of surgical trauma, systemic inflammatory response, clinical outcome, and interbody fusion rate were compared between 2 groups.
ResultsDural rupture occurred in 1 case of open group, L5 nerve root injury in 1 case of minimally invasive group. All patients obtained primary healing of incision. The operation time, intraoperative blood loss, and postoperative drainage of minimally invasive group were significantly lower than those of open group (P<0.05). C-reactive protein, leucocyte count, and creatine kinase-MM (CK-MM) of open group were significantly higher than those of minimally invasive group at 24 hours after operation (P<0.05). At 7 days after operation, the CK-MM of minimally invasive group was significantly lower than that of open group (P<0.05), but no significant difference was found in C-reactive protein and leucocyte count between 2 groups (P>0.05). The follow-up time was 1.2-3.1 years in open group and 1.4-2.9 years in minimally invasive group. At 1 year after operation, the Oswestry disability index (ODI) and visual analogue scale (VAS) scores were significantly improved in 2 groups (P<0.05). Minimally invasive group was better than open group in ODI and VAS score of back pain (P<0.05), but VAS score of leg pain showed no significant difference (P>0.05). According to the Suk interbody fusion standard, solid fusion was obtained in 18 cases, probable fusion in 4 cases, and nonunion in 4 cases, and the fusion rate was 84.61% in open group; solid fusion was obtained in 21 cases, probable fusion in 3 cases, and nonunion in 4 cases, and the fusion rate was 85.71% in minimally invasive group; and the interbody fusion rates showed no significant difference between 2 groups (χ2=0.072, P=0.821).
ConclusionCompared with open TLIF, paramedian incision mini-TLIF has advantages of minimal surgical trauma and little blood loss for single-level lumbar degenerative disease. The short- and medium-term effectivenesses are satisfactory.
Objective
To compare the difference of traumatic related index in serum and its significance between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF.
Methods
Sixty patients were enrolled by the entry criteria between May and November 2012, and were divided into MIS-TLIF group (n=30) and open TLIF group (n=30). There was no significant difference in gender, age, type of lesions, disease segment, and disease duration between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, and postoperative hospitalization time were recorded, and the pain severity of incision was evaluated by visual analog scale (VAS). The serum levels of C-reactive protein (CRP) and creatine kinase (CK) were measured at preoperation and at 24 hours postoperatively. The levels of interleukin 6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) in serum were measured at preoperation and at 2, 4, 8, and 24 hours after operation.
Results
The operation time, intraoperative blood loss, and postoperative hospitalization time of MIS-TLIF group were significantly smaller than those of open TLIF group (P lt; 0.05), and the VAS score for incision pain in MIS-TLIF group was significantly lower than that of open TLIF group at 1, 2, and 3 days after operation (P lt; 0.05). The levels of CRP, CK, IL-6, and IL-10 in MIS-TLIF group were significantly lower than those in open TLIF group at 24 hours after operation (P lt; 0.05), but there was no significant difference between 2 groups before operation (P gt; 0.05). No significant difference was found in TNF-α level between 2 groups at pre- and post-operation (P gt; 0.05).
Conclusion
Compared with the open-TLIF, MIS-TLIF may significantly reduce tissue injury and systemic inflammatory reactions during the early postoperative period.
ObjectiveTo systematically review the effectiveness and safety of laparoscopic total mesorectal excision(LTME) vs. open total mesorectal excision (OTME) in treating rectal cancer.
MethodsRandomized controlled trials (RCTs) about LTME vs. OTME for rectal cancer were searched in PubMed, The Cochrane Library (Issue 4, 2014), EMbase, CNKI, CBM and WanFang Data from the date of their establishment to April 2014. Other relevant journals and references of included studies were also searched manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2.
ResultsA total of fifteen RCTs involving 2 268 patients were enrolled. The results of meta-analysis indicated that:a) for effectiveness, LTME and OTME were alike in resection length of the intestine (MD=-0.52, 95%CI-1.29 to 0.25, P=0.18), dissection number of lymph nodes (MD=-0.11, 95%CI-0.75 to 0.52, P=0.73), 1-year survival rate (RR=0.99, 95%CI 0.96 to 1.02, P=0.52), and 3-year survival rate (RR=0.99, 95%CI 0.93 to 1.04, P=0.63) with no significant difference. For safety, LTME had longer operation time (MD=29.64, 95%CI 14.90 to 44.39, P < 0.000 1); caused less intra-operative bleeding (MD=-105.51, 95%CI-133.95 to-77.08, P < 0.000 01); and shortened post-operative anal exsufflation time (MD=-0.99, 95%CI-1.35 to-0.62, P < 0.000 01), catheterization time (MD=-2.02, 95%CI-2.20 to-1.83, P < 0.000 01) as well as hospital stay (MD=-3.47, 95%CI-4.20 to-2.74, P < 0.000 01). Besides, LTME had less postoperative complications such as anastomotic leak (RR=0.67, 95%CI 0.37 to 1.22, P=0.19) and wound infection (RR=0.43, 95%CI 0.26 to 0.73, P=0.002). However, LTME and OTME were alike in the incidence of intestinal obstruction (RR=0.53, 95%CI 0.28 to 1.00, P=0.05).
ConclusionCurrent evidence indicates that LTME and OTME are alike in effectiveness, but LTME could cause less bleeding, shorten time of catheterization, post-operative anal exsufflation and hospital stay with less post-operative complications. Due to the limited quantity and quality of the included studies, more larger sample, multicenter, high quality RCTs are needed to verify the above conclusion.
Objective
To compare the quality of life after laparoscopic and open surgery for gastric stromal tumor patients.
Methods
We collected the data of the patients undergoing the gastric stromal tumor surgery from May 2011 to August 2016 in West China Hospital of Sichuan University, and compared the basic data, complications, micturition time, hospital stay time, bleeding volume and hospitalization expenses. SF-36 scale was used to evaluate the quality of life. Then, SPSS 19.0 software was used for data analysis.
Results
Eighty nine patients involving 31 laparoscopic patients and 58 open surgery patients were included. There was no statistical significance in basic line between two groups. The laparoscopic group had shorter micturition time and hospital stay time, less intraoperative bleeding and lower hospitalization costs, the differences between two groups were statistically significant (P<0.05). But there were no significant differences between two groups in the operation time and postoperative complication rate. The SF-36 quality of life scale of laparoscopic group and open surgery group were 737.7±68.3 and 665.1±138.1, respectively. The laparoscopic surgery group had higher scores in validity (VT), social function (SF) and mental health (MH) than those in open surgery group with significant differences (P<0.05).
Conclusion
Laparoscopic surgery is safe and effective for the patients with stromal tumor. Patients in laparoscopic group have shorter recovery time and higher quality of life than open surgery group. Due to the limited of study design, more high quality studies are needed to verify above conclusion.
Objective
To review the latest comparative research of minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open approach.
Methods
The domestic and foreign literature concerning the comparative research of minimally invasive TLIF and traditional open TLIF was reviewed, then intraoperative indicators, length of hospitalization, effectiveness, complication, fusion rate, and the effect on paraspinal muscles were analyzed respectively.
Results
Minimally invasive TLIF has less blood loss and shorter length of hospitalization, but with longer operation and fluoroscopic time. Minimally invasive surgery has the same high fusion rate as open surgery, however, its effectiveness is not superior to open surgery, and complication rate is relatively higher. In the aspect of the effect on paraspinal muscles, in creatine kinase, multifidus cross-sectional area, and atrophy grading, minimally invasive surgery has no significant reduced damage on paraspinal muscles.
Conclusion
Minimally invasive TLIF is not significantly superior to open TLIF, and it does not reduce the paraspinal muscles injury. But prospective double-blind randomized control trials are still needed for further study.
Objective To systematically review the efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision (TME) for the treatment of rectal cancer. Methods The PubMed, EMbase, The Cochrane Library, and ClinicalTrials.gov databases were electronically searched to identify cohort studies on robotic, laparoscopic-assisted, and open TME for rectal cancer published from January 2016 to January 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Subsequently, network meta-analysis was performed using RevMan 5.4 software and R software. Results A total of 24 studies involving 12 348 patients were included. The results indicated that among the three types of surgical procedures, robotic TME showed the best outcomes by shortening the length of hospital stay, reducing the incidence of postoperative anastomotic fistula and intestinal obstruction, and lowering the overall postoperative complication rate. However, differences in the number of dissected peritumoural lymph nodes were not statistically significant. Conclusion Robotic TME shows better outcomes in terms of the radicality of excision and postoperative short-term outcomes in the treatment of rectal cancer. However, clinicians should consider the patients’ actual condition for the selection of surgical methods to achieve individualised treatment for patients with rectal cancer.
ObjectiveTo compare the postoperative complications following laparoscopic and open radical resection for rectal cancer.
MethodsThe clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups.
Results①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05).
ConclusionsThe development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.
ObjectiveTo systematically evaluate the stress response of laparoscopic surgery (LS) and conventional open surgery (OS) in patients with colorectal cancer.
MethodsThe literatures about the immune stress response of LS and OS for colorectal cancer were collected from PubMed, Springer, OVID, Cochrane library, CNKI, VIP Database, and Wanfang Database from May 2001 to September 2014. RevMan 5.3 software was used for data analysis.
ResultsFifteen randomized controlled trials including 881 patients were brought into this Meta analysis, of 881 patients, 424 patients were treated with LS and 457 patients were treated with OS. The results of Meta-analysis showed that:①At 24, 72, and 120 hours after surgery, the levels of interleukin (IL-6) in LS group were all lower than those of OS group at same time point[24 h (WMD=-27.78, 95% CI:-43.24--12.32, P < 0.01), 72 h (WMD=-13.23, 95% CI:-19.89--6.57, P < 0.01), 120 h (WMD=-16.51, 95% CI:-30.13--2.89, P=0.02)]. ②At 24, 72, and 120 hours after surgery, the levels of C reactive protein (CRP) in LS group were all lower than those of OS group at same time point[24 h (WMD=-31.11, 95% CI:-47.49--14.73, P < 0.01), 72 h (WMD=-29.81, 95% CI:-49.99--9.64, P < 0.01), 120 h (WMD=-32.03, 95% CI:-45.34--18.71, P < 0.01)]. ③There was no significant difference between the 2 groups in WBC level at 24 hours after surgery (WMD=-0.63, 95% CI:-1.80-0.54, P=0.29), but the WBC levels of LS group at 72 hours and 120 hours after surgery were lower than those of OS group[72 h (WMD=-0.21, 95% CI:-0.41--0.01, P=0.04), 120 h (WMD=-0.86, 95% CI:-1.66--0.06, P=0.03). ④There was no significant difference between the 2 groups in cortisol level at 24 hours and 72 hours after surgery[24 h (WMD=-60.19, 95% CI:-194.77-74.39, P=0.38), 72 h (WMD=-13.83, 95% CI:-43.94-16.28, P=0.37). ⑤There was no significant difference between the 2 groups in blood glucose level at 24 hours and 72 hours after surgery[24 h (WMD=-0.95, 95% CI:-2.74-0.84, P=0.30), 72 h (WMD=-0.69, 95% CI:-2.05-0.66, P=0.32)]. ⑥There was no significant difference between the 2 groups in insulin level (WMD=-0.52, 95% CI:-1.87-0.82, P=0.45) at 24 hours after surgery. ⑦There was no significant difference between the 2 groups in tumor necrosis factor (TNF) level at 24 hours after surgery (WMD=-4.18, 95% CI:-9.39-1.04, P=0.12).
ConclusionCompared with open radical surgery, laparoscopic radical surgery for colorectal cancer causes less stress and less effect on the immune function, it also can reduce postoperative complications and can be propitious to faster body recovery.
