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, 张震, 等. 腹腔镜直肠癌 D3 淋巴结清扫联合盆底自主神经保留术的疗效及安全性. 中华实验外科杂志, 2015, 32(4): 721-723.
2.	曾志强, 霍景山, 陶世明, 等. 腹腔镜直肠癌全系膜切除根治术与开放手术对盆腔自主神经的影响.中国普通外科杂志, 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.	张俊文, 彭艳红, 冯瑰丽, 等. 可视前列腺症状评分在良性前列腺增生症中的临床应用. 现代泌尿外科杂志, 2015, 20(12): 851-854, 862.
5.	蔡阳. 男性性功能障碍相关问卷的应用进展. 中华男科学杂志, 2014, 20(9): 840-845.
6.	凌云志, 张宏, 丛进春, 等. 腹腔镜保留盆腔自主神经直肠癌根治术对患者排尿及男性性功能影响的 Meta 分析.中国医刊, 2015, 50(2): 39-44.
7.	曾焕虹, 付卫. 国外腹腔镜手术治疗直肠癌的现状及研究进展. 中国微创外科杂志, 2016, 16(7): 650-655.
8.	黄诚, 李永翔, 陈本鑫, 等. 腹腔镜与开腹保留盆腔自主神经的低位直肠癌根治术对男性性功能的影响. 实用医学杂志, 2015, 31(14): 2291-2294.
9.	张昊, 任宇鹏, 刘放, 等. 新辅助治疗联合 3D 腹腔镜手术在局部晚期低位直肠癌中的应用体会. 腹腔镜外科杂志, 2016, 21(12): 899-902.
10.	秦诚, 陈延林, 苏庆, 等. 腹腔镜辅助电凝钩法直肠癌根治术的疗效分析. 中华消化外科杂志, 2016, 15(8): 789-794.
11.	周海涛, 周志祥, 梁建伟, 等. 无切口腹腔镜下直肠外翻技术的直肠癌低位前切除术的近期疗效. 中华肿瘤杂志, 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.	李焱宁. 开腹手术与腹腔镜手术治疗结直肠癌的远期疗效及患者生活质量的对比研究. 腹腔镜外科杂志, 2016, 21(10): 768-771.
14.	刘彦, 卢晓明, 陶凯雄, 等. 腹腔镜辅助直肠癌根治术对盆腔自主神经保护的操作要点. 腹部外科, 2014, 27(6): 428-431.
15.	鲁德斌, 刘西平, 胡林忠, 等. 腹腔镜与开腹手术治疗直肠癌疗效及对患者应激反应、免疫功能和生活质量的影响. 海南医学院学报, 2016, 22(3) :289-291, 295.
16.	谢波, 钱军, 喻大军, 等. 腹腔镜与开腹直肠癌手术对围手术期患者应激和免疫功能的影响. 广东医学, 2016, 37(20): 3068-3070.
17.	李瑾, 张成, 蒋会勇, 等. 应用达芬奇机器人手术系统辅助直肠癌前切除术 11 例体会. 中国普外基础与临床杂志, 2012, 19(12): 1319-1322.
18.	罗爱静, 毛平, 杨金福, 等. 激励干预对腹腔镜下直肠癌术后永久结肠造口患者自我效能及生活质量的影响.中国内镜杂志, 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.	王永鹏, 佟昕, 张庆彤, 等. 腹腔镜直肠癌前切除术中转开腹影响因素的多因素分析. 中国微创外科杂志, 2016, 16(8): 694-697, 719.
22.	姚宏伟, 刘荫华. 基于循证医学证据的腹腔镜直肠癌手术疗效评价. 中华外科杂志, 2017, 55(1): 28-31.
23.	闫军, 李亮. 腹腔镜与传统开腹手术治疗直肠癌的安全性及远期疗效比较. 标记免疫分析与临床, 2015, 22(2): 109-112.
24.	孙涛, 周鑫, 傅卫, 等. 新辅助放化疗对腹腔镜中低位直肠癌根治术围术期结果的影响. 中国微创外科杂志, 2017, 17(3): 197-201.
25.	郑民华, 马君俊. 腹腔镜低位直肠癌保肛手术的评价. 中国普外基础与临床杂志, 2012, 19(6): 583-585.

1. 李霆, 孟翔凌, 张震, 等. 腹腔镜直肠癌 D3 淋巴结清扫联合盆底自主神经保留术的疗效及安全性. 中华实验外科杂志, 2015, 32(4): 721-723.
2. 曾志强, 霍景山, 陶世明, 等. 腹腔镜直肠癌全系膜切除根治术与开放手术对盆腔自主神经的影响.中国普通外科杂志, 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. 张俊文, 彭艳红, 冯瑰丽, 等. 可视前列腺症状评分在良性前列腺增生症中的临床应用. 现代泌尿外科杂志, 2015, 20(12): 851-854, 862.
5. 蔡阳. 男性性功能障碍相关问卷的应用进展. 中华男科学杂志, 2014, 20(9): 840-845.
6. 凌云志, 张宏, 丛进春, 等. 腹腔镜保留盆腔自主神经直肠癌根治术对患者排尿及男性性功能影响的 Meta 分析.中国医刊, 2015, 50(2): 39-44.
7. 曾焕虹, 付卫. 国外腹腔镜手术治疗直肠癌的现状及研究进展. 中国微创外科杂志, 2016, 16(7): 650-655.
8. 黄诚, 李永翔, 陈本鑫, 等. 腹腔镜与开腹保留盆腔自主神经的低位直肠癌根治术对男性性功能的影响. 实用医学杂志, 2015, 31(14): 2291-2294.
9. 张昊, 任宇鹏, 刘放, 等. 新辅助治疗联合 3D 腹腔镜手术在局部晚期低位直肠癌中的应用体会. 腹腔镜外科杂志, 2016, 21(12): 899-902.
10. 秦诚, 陈延林, 苏庆, 等. 腹腔镜辅助电凝钩法直肠癌根治术的疗效分析. 中华消化外科杂志, 2016, 15(8): 789-794.
11. 周海涛, 周志祥, 梁建伟, 等. 无切口腹腔镜下直肠外翻技术的直肠癌低位前切除术的近期疗效. 中华肿瘤杂志, 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. 李焱宁. 开腹手术与腹腔镜手术治疗结直肠癌的远期疗效及患者生活质量的对比研究. 腹腔镜外科杂志, 2016, 21(10): 768-771.
14. 刘彦, 卢晓明, 陶凯雄, 等. 腹腔镜辅助直肠癌根治术对盆腔自主神经保护的操作要点. 腹部外科, 2014, 27(6): 428-431.
15. 鲁德斌, 刘西平, 胡林忠, 等. 腹腔镜与开腹手术治疗直肠癌疗效及对患者应激反应、免疫功能和生活质量的影响. 海南医学院学报, 2016, 22(3) :289-291, 295.
16. 谢波, 钱军, 喻大军, 等. 腹腔镜与开腹直肠癌手术对围手术期患者应激和免疫功能的影响. 广东医学, 2016, 37(20): 3068-3070.
17. 李瑾, 张成, 蒋会勇, 等. 应用达芬奇机器人手术系统辅助直肠癌前切除术 11 例体会. 中国普外基础与临床杂志, 2012, 19(12): 1319-1322.
18. 罗爱静, 毛平, 杨金福, 等. 激励干预对腹腔镜下直肠癌术后永久结肠造口患者自我效能及生活质量的影响.中国内镜杂志, 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. 王永鹏, 佟昕, 张庆彤, 等. 腹腔镜直肠癌前切除术中转开腹影响因素的多因素分析. 中国微创外科杂志, 2016, 16(8): 694-697, 719.
22. 姚宏伟, 刘荫华. 基于循证医学证据的腹腔镜直肠癌手术疗效评价. 中华外科杂志, 2017, 55(1): 28-31.
23. 闫军, 李亮. 腹腔镜与传统开腹手术治疗直肠癌的安全性及远期疗效比较. 标记免疫分析与临床, 2015, 22(2): 109-112.
24. 孙涛, 周鑫, 傅卫, 等. 新辅助放化疗对腹腔镜中低位直肠癌根治术围术期结果的影响. 中国微创外科杂志, 2017, 17(3): 197-201.
25. 郑民华, 马君俊. 腹腔镜低位直肠癌保肛手术的评价. 中国普外基础与临床杂志, 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

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