Objective To analyze the risk factors inducing tumor cells exfoliating during radical resection of rectal cancer. Methods Sixty patients who were diagnosed as rectal cancer from May 2006 to November 2007 and given radical operations were assigned prospectively in this study. Before cutting the rectal stump below the tumor, saline was instilled into rectum to irrigate the stump. Collected irrigating fluids were sent to pathology laboratory, and the exfoliated malignant cells were tested by HE （haematoxylin and eosin） dyeing and common smear technique. The results of examines were collected and statistical analysis, including a Logistic regression model, was performed. Results Exfoliated malignant cells were found in 27 samples. By univariate analysis, the statistically significant factors defining a high risk of exfoliating were age, tumor size, TNM stage, operation time and operation method (Plt;0.05). Only TNM stage， operation time and operation method were confirmed by Logistic regression analysis to independently result in a statistically significant increased risk of exfoliating. Conclusion Irrigating the rectal stump before cutting down the tumor is essential to avoid local recurrence. The effects of TNM stage, tumor size and operation time are important. Although the laparoscopic surgery is more predominant than conventional surgery for non-neoplasma technology, irrigating is an important process.
ObjectiveTo explore the efficacy of da Vinci robotic surgical system-assisted radical resection of rectal cancer. MethodsThe clinical data of 456 patients who received radical resection of rectal cancer by the da Vinci robotic surgical system at the Southwest Hospital from March 2010 to March 2016 were retrospectively analyzed. Operative time, operative blood loss, number of harvested lymph nodes, hospital stay, and morbidity were evaluated. Resultsda Vinci robotic surgical system-assisted radical resection of rectal cancer were successfully carried out in 445 patients, and other 11 patients were converted to open surgery (2.4%). Of 456 patients, 322 patients underwent anterior resection of rectum procedure (70.6%), 126 patients underwent abdominoperineal excision procedure (27.6%), 8 patients underwent Hartmann procedure (1.8%). The mean operative time was (192±60) min, the mean operative blood loss was (110±93) mL, the mean number of harvested lymph nodes were 19±6, the mean length between distal resection margin and tumor were (3.5±1.8) cm, the mean time for patients taking normal activity was (2.9±1.5) d, the mean time of passage of the first flatus was (2.7±1.7) d, the mean hospital stay was (7.1±1.6) d. Surgical complications occurred in 40 patients (8.8%), and all the patients were recovery before leaving hospital. The mean follow-up time was 29.1-month (3-75 months). There were 70 patients suffered from occurrence or metastasis (16.2%), and 60 patients died (13.9%). Conclusionda Vinci robotic surgical system-assisted radical resection for rectal cancer is a feasible and safe surgical procedure with the minimal trauma, fast recovery, and satisfactory clinical efficacy.