ObjectiveTo explore necessity, safety, and clinical significance of pelvic floor reconstruction following laparoscopic abdominoperineal resection for low rectal cancer. MethodsThirty-seven patients with low rectal cancer admitted to our hospital from July 2013 to January 2016 were collected, who were divided into reconstruction group and non-reconstruction group according to the pelvic floor reconstruction or not. The complications were compared in two groups. ResultsThe laparoscopic abdominoperineal resections were successfully completed in all the patients with low rectal cancer, there was no case of conversion to open surgery. The operative time was (173.6±18.3) min, the suture time of pelvic floor peritoneal was (28.6±7.5) min. The postoperative following-up was 3-24 month. There were 5 cases (22.7%) of complications in the non-reconstruction group, included 2 cases of adhesive intestinal obstruction, 1 case of perineal incision hernia, 1 case of pelvic effusion and infection, 1 case of radiation enteritis caused by radiotherapy. There was 1 case (6.7%) of adhesive intestinal obstruction in the reconstruction group. Although the incidence of postoperative complications in the reconstruction group was lower than that in the non-reconstruction group, there was no significant difference between these two groups (χ2=2.367, P=0.096 1). ConclusionThe preliminary results of limited cases in this study show that it is not essential for pelvic floor reconstruction following laparoscopic abdominoperineal resection for rectal cancer, but it could obviously decrease difficulty of operation for postoperative reoperation, especially for postoperative radiotherapy patients, and prevent occurrence of radiation enteritis. It is still necessary because it is more consistent with principle of open surgery, Hem-o-lok 3-0 Angiotech Quilltm clip or barbed suture closure of pelvic peritoneum, it is technically safe and feasible.
ObjectiveTo compare the clinical recovery and immune response between laparoscopic-assisted and open D2 gastrectomy for advanced gastric cancer. MethodsThe clinical data of 53 patients with advanced gastric cancer from January 2012 to October 2013 were studied prospectively. According to random number table, patients were randomly divided into laparoscopic-assisted group(LA group, n=27) and open operation group(OO group, n=26). Operative time, blood loss, time to passage of flatus, time to resume soft diet, after bed time, postoperative hospital stay, and number of retrieved lymph nodes were compared respectively between the two groups. The changes in CD3, CD4+, CD8+, IgG, IgA, IgM, and CRP were examined respectively by using flow cytometry and immunoturbidimetric assays on the preoperative day 1, and on the postoperative day 1 and 7. ResultsThe operative time was longer significantly in LA group than that in OO group(P < 0.05). The mean blood loss, the first flatus time, after bed time, and postoperative hospital stay in the two groups were all different statistically(P < 0.05), and all were better in LA group. However, the mean number of retrieved lymph nodes and the time to resume soft diet were not significantly different in the two groups(P > 0.05). On the day 1 and 7 after operation, the CD3, CD4+, and CD8+ significantly decreased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). On the day 1 after operation, the levels of IgG, IgA, and IgM significantly decreased as compared with those preoperatively in two groups(P < 0.05). Those immunoglobulin in LA group recovered to close to the level before surgery, but in OO group sustained lower level(P < 0.05). On the day 1 and 7 after operation, CRP level significantly increased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). Those changes of above index were not significantly different between the LA group and OO group on the day 1 after operation(P > 0.05). All index recovered gradually in the two groups on the day 7 after operation and were better in LA group(P < 0.05, except IgA). ConclusionLaparoscopic radical gastrectomy for advanced gastric cancer resulted in a quicker clinical recovery and a lesser depression to the perioperative cellular and humoral immune function.