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.	郑民华. 不断提高腹腔镜直肠癌外科规范化治疗水平. 中华普外科手术学杂志: 电子版, 2013, 7(2): 81-84.
2.	周总光. 腹腔镜直肠癌根治应关注的若干问题. 中华普外科手术学杂志: 电子版, 2013, 7(2): 85-87.
3.	郑民华. 我国腹腔镜结直肠外科的发展. 腹腔镜外科杂志, 2010, 15(6): 401-403.
4.	邓祥兵, 孟文建, 张元川, 等. 直肠前间隙Denovilliers筋膜分层结构及与前列腺血管分支的关系. 中华胃肠外科杂志, 2013, 16(5): 489-493.
5.	郑民华, 胡艳艳, 陆爱国, 等. 腹腔镜与开腹直肠全系膜切除术治疗低位直肠癌的临床对比研究. 中华胃肠外科杂志, 2004, 7(3): 177-180.
6.	余江, 张策, 王亚楠, 等. 腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的同期临床对照研究. 中华胃肠外科杂志, 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.
9.	付涛, 刘宝华. 腹腔镜直肠切除术. 临床外科杂志, 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.	范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究. 中国普外基础与临床杂志, 2009, 16(5): 384-388.
15.	王向阳, 陈勇, 庞典付, 等. 腹腔镜结直肠癌根治性手术的临床疗效分析. 中国普通外科杂志, 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.	王树彦, 陈宗祐. 结直肠癌腹腔镜手术与开腹手术的短期疗效比较. 复旦学报: 医学版, 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, 杨济峰, 李剑. 中、低位直肠癌应用腹腔镜直肠全系膜切除术治疗的临床研究. 齐齐哈尔医学院学报, 2014, 35(1): 63-64.
21.	熊懿. 腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床疗效分析. 中国普通外科杂志, 2015, 24(4): 616-618.
22.	傅卫, 袁炯, 王德臣, 等. 腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床安全性对比研究. 中国微创外科杂志, 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.	孔祥兴, 李军, 丁克峰. 结直肠癌加速康复外科开展的要点和难点. 中华胃肠外科杂志, 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, 谭忆广, 周志涛, 等. 腹腔镜直肠全系膜切除治疗中下段直肠癌临床疗效的探讨. 中华肿瘤防治杂志, 2010, 17(22): 1865-1867.
27.	孙延东, 吴国豪, 张波, 等. 腹腔镜与开腹手术治疗直肠癌的临床对照研究. 中华胃肠外科杂志, 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. 郑民华. 不断提高腹腔镜直肠癌外科规范化治疗水平. 中华普外科手术学杂志: 电子版, 2013, 7(2): 81-84.
2. 周总光. 腹腔镜直肠癌根治应关注的若干问题. 中华普外科手术学杂志: 电子版, 2013, 7(2): 85-87.
3. 郑民华. 我国腹腔镜结直肠外科的发展. 腹腔镜外科杂志, 2010, 15(6): 401-403.
4. 邓祥兵, 孟文建, 张元川, 等. 直肠前间隙Denovilliers筋膜分层结构及与前列腺血管分支的关系. 中华胃肠外科杂志, 2013, 16(5): 489-493.
5. 郑民华, 胡艳艳, 陆爱国, 等. 腹腔镜与开腹直肠全系膜切除术治疗低位直肠癌的临床对比研究. 中华胃肠外科杂志, 2004, 7(3): 177-180.
6. 余江, 张策, 王亚楠, 等. 腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的同期临床对照研究. 中华胃肠外科杂志, 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.
9. 付涛, 刘宝华. 腹腔镜直肠切除术. 临床外科杂志, 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. 范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究. 中国普外基础与临床杂志, 2009, 16(5): 384-388.
15. 王向阳, 陈勇, 庞典付, 等. 腹腔镜结直肠癌根治性手术的临床疗效分析. 中国普通外科杂志, 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. 王树彦, 陈宗祐. 结直肠癌腹腔镜手术与开腹手术的短期疗效比较. 复旦学报: 医学版, 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, 杨济峰, 李剑. 中、低位直肠癌应用腹腔镜直肠全系膜切除术治疗的临床研究. 齐齐哈尔医学院学报, 2014, 35(1): 63-64.
21. 熊懿. 腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床疗效分析. 中国普通外科杂志, 2015, 24(4): 616-618.
22. 傅卫, 袁炯, 王德臣, 等. 腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床安全性对比研究. 中国微创外科杂志, 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. 孔祥兴, 李军, 丁克峰. 结直肠癌加速康复外科开展的要点和难点. 中华胃肠外科杂志, 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, 谭忆广, 周志涛, 等. 腹腔镜直肠全系膜切除治疗中下段直肠癌临床疗效的探讨. 中华肿瘤防治杂志, 2010, 17(22): 1865-1867.
27. 孙延东, 吴国豪, 张波, 等. 腹腔镜与开腹手术治疗直肠癌的临床对照研究. 中华胃肠外科杂志, 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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