Objective
To understand status of technical realization, present development, faced problems, and application prospects of reduced-port laparoscopic surgery for rectal cancer, and to analyze safety and feasibility so as to provide theoretical and practical basis for clinical application and promotion.
Method
By searching the databases such as Medline, Embase, and Wanfang, etc., the relevant literatures about reduced-port laparoscopic surgery for rectal cancer were collected and reviewed.
Results
At present, the most common reduced-port laparoscopic surgery was the 1-port laparoscopic surgery, 2-port laparoscopic surgery, and 3-port laparoscopic surgery. The 1-port laparoscopic surgery had the effects of minimal invasiveness and cosmesis, but it was difficult to perform. The 2-port laparoscopic surgery for rectal cancer preserved as far as possible the effect of minimal invasiveness, the difficulty of procedure was reduced greatly, which was easy to be learnt and promoted. The experience of the 3-port laparoscopic surgery for rectal cancer contributed to the technical development of the 1-port laparoscopic surgery, with no need for the assisted incision for intraoperative specimen. The reduced-port laparoscopic surgery for rectal cancer was technically feasible and safe, which possessed the equal or better short-term outcomes as compared with the conventional 5-port laparoscopic or open surgery beside the radical resection for rectal cancer. However, the stringent technique for the laparoscopic surgery was necessary and it needed to overcome the learning curve.
Conclusions
Reduced-port laparoscopic surgery has some obvious advantages in minimal invasiveness, cosmesis, and enhanced recovery. More large-sample, multi-center, randomized controlled trials are eager to further confirm safety, effectiveness, and feasibility of reduced-port laparoscopic surgery for rectal cancer.
ObjectiveTo compare the short-term outcome of 3-port and 5-port laparoscopic assisted radical resection for middle and high rectal cancer.MethodsWe retrospectively analyzed the clinical characteristics of 67 patients with middle and high rectal cancer who were treated in the Gastrointestinal Ward of Center of General Surgery in General Hospital of Western Theater Command of the Chinese People’s Liberation Army from January 2018 to December 2018. The operative, pathological, recent postoperative related indicators, and follow-up results of the two groups were compared and analyzed.ResultsAmong all the enrolled patients, 33 cases received 3-port laparoscopic surgery (3-port group) and 34 cases received 5-port laparoscopic surgery (5-port group). The total length of incision and the pain score of the Visual Analog Scale (VAS) on the 3rd postoperative day of the 3-port group were significantly better than those of the 5-port group (P<0.05). Peripheral incisal margins were negative in both two groups. However, there were no statistically significant differences in indicators such as operative time, intraoperative blood loss, operative conversion rate, hospitalization expenses, length of the distal margins, number of positive lymph nodes, number of lymph nodes harvested, time to the first flatus, time to the first ambulation, time to urinary catheter removal, time to drainage tube removal, time to the first oral intake, postoperative hospital stay, and postoperative complication rate (P>0.05). Thirty cases of the 3-port group were followed up for 12–24 months (median of 19 months), as well as 29 cases of 5-port group were followed up for 12–24 months (median of 19.5 months). There were no significant differences on the incidences of intestinal obstruction, local recurrence, distant metastasis, and death between the two groups (P>0.05).ConclusionCompared with the conventional 5-port laparoscopic surgery, the 3-port laparoscopic surgery could shorten the total length of incision and reduce the surgical trauma, suggesting that it is safe and effective.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
ObjectiveTo explore the security and feasibility of simultaneous laparoscopic surgery for synchronous colorectal cancer liver metastasis (SCRLM). MethodThe data of 36 patients underwent simultaneous surgery for SCRLM in the Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University from March 2015 to December 2021 were retrospectively collected, and the perioperative outcomes, postoperative morbidity and survival were analyzed. ResultsThe surgical procedure of all 36 enrolled patients were accomplished. The operation time was (328.9±85.8) min. The intraoperative blood loss was 100 (50, 150) mL and 4 cases (11.1%) needed intraoperative transfusion. The time to first flatus was (2.9±0.8) d and the time to liquid diet was (3.2±1.0) d. The average postoperative VAS score was 1.9±0.3. The postoperative length of stay was (6.8±4.3) d, 5 (13.9%) cases developed postoperative complications, which were cured by conservative treatment. No severe complications and death occurred within 30 days after surgery. After a median follow-up of 24.7 months, 15 cases (41.7%) experienced recurrence or metastasis and 1 case (2.8%) died. The 1-, 2- and 3-year disease-free survival rates were 89.8%, 55.0%, 29.2%, respectively. The 1-, 2- and 3-year overall survival rates were 100.0%, 100.0%, 87.5%, respectively. There was no significant differences in disease-free survival rates (χ2=1.675, P=0.196) and OS (χ2=0.600, P=0.439) between patients with (n=26) or without (n=10) neoadjuvant. ConclusionsSimultaneous laparoscopic surgery seems to be a secure and feasible strategy for patients with SCRLM, with considerable survival benefits and short-term outcomes including small incision, little bleeding, quick recovery and low complication rate. More high-quality clinical studies are desirable in the future to further confirm the efficacy and safety of this operation.
Single-incision laparoscopic sleeve gastrectomy (SILSG) was first described in 2008, which could effectively control excess body weight and treat metabolic diseases relevant to obesity in a long term. Over more than a decade of refinement and technical advancement, precise and standardized surgical techniques have become critical for ensuring treatment efficacy and reducing the rate of postoperative complications. Thus, this review summarizes the evolution of SILSG, further understanding and emphasizing the importance of standardized and precise surgical procedures.
ObjectiveTo evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.MethodsA literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.ResultsA total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].ConclusionsRobotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.
ObjectiveTo compare the clinical outcomes of laparoscopic magnetic compression cholangiojejunostomy (LMCCJ) with laparoscopic hand-sutured cholangiojejunostomy (LHSCJ). MethodsA retrospective case-control study was performed. From January 2019 to May 2022, 37 patients, who underwent laparoscopic treatment in this hospital, were enrolled in this study. There were 16 cases in the LMCCJ group and 21 cases in the LHSCJ group. The demographic information, procedure time to complete bilioenteric reconstruction, postoperative hospital stay, operative complications, magnets expulsion time, and follow-up results were collected and analyzed. ResultsThere were no statistical differences in the baseline data such as the gender, age, composition of primary diseases, preoperative total bilirubin, and preoperative common bile duct diameter between the two groups (P＞0.05). The outer diameter of the magnets was (10.50±0.97) mm, the expulsion time of the magnets was (49.69±37.58) d, and the expulsion rate of the magnets was 100% (16/16). There was no intestinal obstruction or gastrointestinal perforation caused by the retention of the magnets. The procedure time to complete bilioenteric reconstruction in the LMCCJ group was statistically shorter than that in the LHSCJ group [(11.31±3.40) min vs. (24.81±3.40) min, t=11.96, P＜0.01]. There was no statistical difference in the total bilirubin level at the first week after surgery between the two groups (U=142.0, P=0.80). The postoperative hospital stay in the LMCCJ group was longer than that in the LHSCJ group [(28.31±14.11) d vs. (16.19±7.56) d, t=3.36, P＜0.01]. During the perioperative period, there was no bleeding or biliary infection in the two groups, but one case of biliary leak in the LHSCJ group. In all 37 patients were followed-up for (548.8±259.2) d. During the follow-up period, the incidence rates of biliary intestinal anastomosis stenosis, tumor recurrence, and mortality had no statistical differences between the two groups (P＞0.05). ConclusionFrom the results of comparative analysis in this study, it can be concluded that LMCCJ is not only safe equally, but also easier and less time-consuming as compared with LHSCJ.
ObjectiveTo summarize the current common clinical laparoscopic gastrointestinal tumor surgical localization methods, and to provide reference for clinicians to choose reasonable localization methods. MethodThe domestic and foreign literatures related to laparoscopic gastrointestinal tumor surgical localization methods were searched and reviewed. ResultsThe common localization methods for laparoscopic gastrointestinal tumor surgery were imaging localization, preoperative endoscopic localization, intraoperative endoscopic localization and intraoperative fluorescence localization, among which abdominal enhanced CT and endoscopic-related localization methods were the most commonly used localization methods in clinical practice at present. ConclusionA variety of methods are available for surgeons to choose from, and the precise localization of tumors is better facilitated by combining multiple methods.
Objective This study aimed to explore the experience of secondary excision for retrorectal cystic lesions. Method We retrospectively reviewed the medical records of patients who underwent secondary laparoscopic excision of retrorectal cystic lesions at the Department of General Surgery at our hospital between August 2012 and August 2021. Results Twelve patients [male: 5; female: 7; age: (31.8±11.5) years old (18–60 years old)] were evaluated. The lesions ranged from 5.8 to 15.0 cm in diameter [(10.0±3.5) cm]. Seven patients had epidermoid cysts, three patients had mature teratoma, one patient had mature teratoma with low-grade mucinous neoplasm and one patient had cyst with mucinous carcinoma. Laparoscopic excision of retrorectal cystic lesions was performed in ten patients, and laparoscopy combined transsacrococcygeal approach was performed in two patients. The median operative time was 137.5 min (80–240 min), and the median blood loss was 30 mL (10–200 mL). No patient experienced complications of Clavien-Dindo grade Ⅲa or worse, one patient experienced complications of Clavien-Dindo grade Ⅱa after operation. The mean duration of hospitalization was (5.9±1.4) d (3–7 d). The follow-up period ranged from 3 to 108 months, and the median follow-up time was 43-month, and one patient recurred during the follow-up period. Conclusions Attention should be paid to the initial diagnosis and treatment of retrorectal cystic lesions, particularly in children. Routine evaluation using preoperative pelvic MRI and the adoption of an appropriate surgical approach are recommended to reduce secondary operations. Surgery should be performed by surgeons experienced in rectal andpelvic surgeries.
Objective To explore the incidence of postoperative recurrence of abdominal incisional hernia and its related risk factors. Methods The clinical data of 213 patients with abdominal incisional hernia treated in the General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2019 were collected retrospectively, and the incidence of postoperative recurrence of abdominal incisional hernia and its related influencing factors were analyzed. Results A total of 213 patients underwent a complete follow-up. The follow-up time was 3 to 60 months, and the median follow-up time was 46 months. A total of 24 cases (11.27%) of hernia recurred after surgery. The univariate analysis results showed that body mass index (BMI), hernia ring size, incarceration, recurrent hernia, history of multiple abdominal operations, postoperative incision complications, factors such as increased abdominal pressure, and whether the patch were used for postoperative recurrence of abdominal incisional hernia influences (P<0.05). Further logistic multi-factor analysis results showed that BMI [OR=1.14, 95%CI (1.01, 1.29), P=0.040], incarcerated hernia [OR=8.94, 95%CI (1.94, 40.98), P=0.005], recurrent hernia [OR=10.91, 95%CI (2.09, 56.84), P=0.005], and hernia ring size [OR=1.15, 95%CI (1.03, 1.28), P=0.010] were related to the recurrence of abdominal incisional hernia after surgery (P<0.05). Conclusions The risk factors for hernia recurrence after abdominal incisional hernia repair include recurrent hernia, incarcerated hernia, hernia ring size, and BMI. For patients with high-risk factors, corresponding measures should be taken to prevent hernia recurrence.
