腹腔镜手术与开腹手术治疗结直肠癌的临床疗效比较

目的比较腹腔镜手术与开腹手术治疗结直肠癌患者的临床疗效。方法选取2012-02~2015-10该院收治的结直肠癌患者76例,根据手术方式的不同分为腹腔镜组(n=39)和开腹组(n=37)。腹腔镜组采用腹腔镜手术治疗,开腹组采用传统开腹手术治疗,比较两组患者切口长度、手术时间、术中失血量、术后肛门排气时间、开始进流食时间、下床活动时间、住院时间、淋巴结清扫数目以及术后并发症发生情况。结果腹腔镜组切口长度、术中失血量、术后肛门排气时间、开始进流食时间、下床活动时间、住院时间均明显小于或低于开腹组,差异有统计学意义(P0.05),两组淋巴结清扫数目比较差异无统计学意义(P0.05)。腹腔镜组并发症发生率为7.69%(3/39),开腹组为27.03%(10/37),差异有统计学意义(P0.05)。结论腹腔镜下结直肠癌手术具有安全、创伤小、恢复快、并发症少等优点。     

腹腔镜结直肠癌切除即刻中转开腹手术的临床分析

目的 分析腹腔镜结直肠癌根治术中转开腹手术的原因.方法 回顾性分析2006-02～2010-02采用腹腔镜行结直肠癌根治手术的108例患者的资料,分析中转开腹手术15例的原因.结果 因腹腔内出血中转5例,肿瘤较低位1例,肿瘤较大2例,腹内脏器损伤2例,腹腔严重粘连3例,肥胖1例,吻合口渗漏1例.结论 腹腔镜行结直肠癌根治术具有一定的中转开腹手术率,腹腔脏器损伤和腔内出血是中转开腹的主要原因.     

腹腔镜手术治疗结直肠癌的临床疗效观察

腹腔镜辅助结直肠癌根治术是安全可行的,具有切口小、术后疼痛轻、恢复快、住院时间短等优点,但其疗效仍然有争议[1].为此本文对腹腔镜结直肠癌手术、开腹手术进行比较,探讨腹腔镜结直肠癌手术的临床效果.     

腹腔镜手术治疗中晚期结直肠癌对比开腹手术的临床研究

目的 探讨腹腔镜手术治疗中晚期结直肠癌的可行性、安全性及治疗优势.方法 采用与同期开腹手术相比较的方法,将行中晚期结直肠癌切除的患者分为腹腔镜组(57例)和开腹组(56例),比较两组围手术期情况、不能够切除肝转移癌灶的处理情况及标本的临床病理结果,评价各组的肿瘤根治性、手术安全性、术后恢复情况及随访结果.结果 腹腔镜组术中出血量、术后离床时间、肛门排气时间、术后住院日数及术后并发症均明显减少(P＜0.05);术后应用吗啡镇痛的剂量明显减少(P＜0.01);腹腔镜下能够完成传统开腹手术肝转移癌灶的不同处理(P＞0.05);肿瘤根治性相关临床病理学结果提示两组病例完全可以达到相同的根治程度(P＞0.05);两组在局部复发和病死率方面差异无统计学意义(P＞0.05).结论 腹腔镜行中晚期结直肠癌切除术创伤小,术后恢复快,根治性确切,具有可行性、安全性及微创优势,急诊手术亦是可行的.     

腹腔镜手术在中老年结直肠癌患者治疗中的运用效果及应激反应

目的探讨腹腔镜手术在中老年结直肠癌患者治疗中的运用效果及应激反应。方法中老年结直肠癌患者68例随机分为对照组和观察组,其中,对照组采用开腹手术治疗,观察组采用腹腔镜手术治疗,观察两组临床治疗效果。同时,比较两组手术时间、术中出血量、术后进食时间,对比两组手术中出现的应激反应。结果两组手术时间、术中出血量、肛门排气时间、术后进食时间及应激反应差异有统计学意义(P0.05)。结论中老年结直肠癌患者采用腹腔镜手术治疗取得了良好效果,减少了患者术后并发症情况,同时,患者出现的应激反应情况比较少,有助于恢复。     

对比分析手辅助腹腔镜与腹腔镜结直肠癌手术的疗效及安全性

目的探讨手辅助腹腔镜和腹腔镜下结直肠癌手术的临床疗效及其安全性。方法选取2011年12月至2014年12月我院收治的50例结直肠癌手术患者作为研究组,行手辅助腹腔镜治疗;选取同期结直肠癌手术患者70例作为对照组,行腹腔镜治疗;比较两组的临床疗效及术后并发症情况。结果两组患者在手术时间、出血量、术中副损伤、胃管留置时间、下床活动时间、肠道功能恢复时间的比较上,研究组均明显优于对照组,差异具有统计学意义(P<0.05);总并发症率研究组均明显低于对照组,差异具有统计学意义(χ2=6.91,P<0.05)。结论手辅助腹腔镜对结直肠手术患者的治疗具有损伤低、手术时间短、胃肠道功能恢复迅速等优点;其在临床应用中操作简单易于掌握,实用性高,针对复杂性的肿瘤根治性切除治疗安全性更佳。     

腹腔镜结直肠癌根治术治疗结直肠癌患者的疗效观察及对胃肠功能的影响研究

目的探讨腹腔镜结直肠癌根治术治疗结直肠癌患者的临床疗效以及对胃肠功能的影响。方法选取62例结直肠癌患者为研究对象,采取数字表法随机分为腹腔镜直肠癌根治术组及开腹结直肠癌根治术组各31例。结果腹腔镜组手术时间与开腹手术时间比较差异无显著性;出血量(84.77±12.06)mL、住院时间(10.20±1.40)d、并发症发生率(22.58%)、肠鸣音恢复时间(2.76±0.05)d、排气时间(2.51±1.03)d、进食时间(53.20±20.04)h等均明显低于开腹组(P<0.05)。结论腹腔镜结直肠癌根治术治疗结直肠癌,术中出血量少、手术时间短、住院时间短、并发症低,且对胃肠功能造成的影响小。     

快速康复外科在基层医院腹腔镜结直肠癌手术中的应用

目的:评估快速康复外科在基层医院腹腔镜结直肠癌手术中的应用效果。方法:纳入2017年1月至2018年12月在我院行腹腔镜结直肠癌手术的患者116例为研究对象,根据围术期康复方案,将其分成A组(67例)和B组(49例),分别接受快速康复方案和传统康复方案。结果:A组患者口渴感,饥饿感,均低于B组(11.9%和53.1%,...     

老年结直肠癌腹腔镜手术患者术后肠梗阻发生率及影响因素

目的探讨老年结直肠癌腹腔镜手术患者术后肠梗阻的发生率及影响因素。方法选择2013年1月至2017年2月在该院进行腹腔镜手术治疗的老年结直肠癌患者288例为研究对象,术后至少随访30 d,记录术后肠梗阻的发生率;根据术后是否发生肠梗阻分为肠梗阻组和非肠梗阻组,采用单因素和多因素logistic回归分析法分析其影响因素。结果 288例老年结直肠癌腹腔镜手术患者,术后30 d内肠梗阻的发生率为6.25%(18/288);单因素分析显示:性别、年龄、术前肠梗阻、肿瘤位置、TNM分期、吸烟史、腹部手术史、手术时间、肿瘤分化程度等是老年结直肠癌腹腔镜手术术后肠梗阻发生的影响因素(P0.05);多因素分析显示:男性、年龄≥70岁、术前有肠梗阻、直肠癌、TNM分期为Ⅲ～Ⅳ期及手术时间≥2 h是老年结直肠癌腹腔镜手术术后肠梗阻发生的危险因素(P0.05)。结论老年结直肠癌腹腔镜手术患者术后肠梗阻的危险因素较多,医护人员应采取相应的预防措施,尽可能降低术后肠梗阻的发生率,提高治疗水平。     

结直肠癌肝转移21例临床分析

统计表明，近50％的结直肠癌患者会发生肝脏转移并最后导致死亡。而局限于肝脏转移的结直肠癌患者惟一有效的治疗方法是进行原发病灶和肝脏切除术。我院近年来治疗21例结直肠肝脏转移患者，现就其诊治体会分析如下。     

Laparoscopic Resection for Colorectal Cancer in Octogenarians: Results in a Decade

Objectives This study was designed to evaluate the results of laparoscopic resection for colorectal cancer in octogenarians. Methods Patients aged 80 years or older who underwent elective laparoscopic resection for colorectal cancer from July 1, 1996 to June 30, 2006 were recruited for analysis, with the following exceptions: 1) patients who did not give informed consent; 2) unfit for operative treatment; 3) presented as surgical emergencies; 4) multiple previous abdominal operations; or 5) locally advanced tumors. Operating time, blood loss, length of hospital stay, mortality and morbidities, including anastomotic dehiscence, pulmonary and wound sepsis, disease recurrence, and patient survival were used to measure outcome. Results During a ten-year period, laparoscopic colorectal cancer resection was attempted in 101 octogenarians. The median age was 83 (range, 80–95) years and 45 patients were males. The median operating time was 110 (range, 60–245) minutes, with a median blood loss of 50 (range, 0–1,000) ml. Conversion was required in only one case with a leakage rate of 3.3 percent. The overall morbidity and operative mortality rate were 17 and 3 percent, respectively. With a median follow-up of 24 (range, 0–102) months, 22 patients developed recurrence, with 8 of those still surviving. The overall five-year survival is 51 percent. Conclusions Our experience confirms that laparoscopic colorectal cancer resection in selected octogenarians is safe and feasible. Aside from the obvious short-term benefits, the long-term oncologic outcomes are favorable.     

Palliative Laparoscopic Resections for Stage IV Colorectal Cancer

Purpose Issues surrounding the safety and efficacy of palliative laparoscopic resections for patients with Stage IV colorectal cancer have not been explicitly examined in the literature. This article describes our experience with laparoscopic procedures for patients with Stage IV colorectal cancer and compares their perioperative outcomes to a contemporaneous group of patients with clinically curable (Stages I–III) disease. Methods A prospective database of laparoscopic resections for colorectal cancer performed between 1991 and 2002 was reviewed. Data regarding patient demographics, perioperative morbidity and mortality, operative times, conversion rates, and length of stay were extracted. Statistical analysis included chi-squared and Student's t-tests as required and P ≤ 0.05 was considered significant. Results A total of 375 cases were identified, of these 49 (13 percent) underwent laparoscopic palliative resections while 326 (87 percent) patients had resections for cure. When comparing palliative to curative procedures, there were no differences in intraoperative (4 percent vs. 9 percent) or postoperative complications (14 percent vs. 12 percent), perioperative mortality (8 percent vs. 4 percent), or length of hospital stay. Patients with Stage IV disease had largertumors (5.4 ± 2.3 cm vs. 4.6 ± 2.6 cm, P = 0.04) which contributed to an increased rate of conversion (22 percent vs. 11 percent, P = 0.05) with most conversions secondary to tumor fixation or bulk (64 percent) preventing determination of resectability. Conclusions A palliative laparoscopic resection is a safe and feasible option and presents acceptable morbidity and mortality in patients with Stage IV colorectal cancer. Importantly, in this difficult group ofpatients, our results compare favorably with those from previously published series of open procedures. Presented at the European Association for Endoscopic Surgery Congress, Glasgow, Scotland, June 15 to 18, 2003.     

Laparoscopic Resection for Colorectal Cancer in Japan

The first laparoscopic surgery for colorectal cancer in Japan was reported in 1992. In the early phase, many cases were indicated for early cancer. The number of operations has been increasing year by year, and now even some advanced cases undergo laparoscopic surgery. According to questionnaires administered in 2003 by the Japan Society for Endoscopic Surgery, more than half of 3,892 cases were indicated for advanced cancer. In 2004, the 60th biannual meeting of the Japanese Society for Cancer of the Colon and Rectum took up "the current status of laparoscopic resection for colorectal cancer" as one of the main topics of the meeting, and conducted a questionnaire survey of the member’s opinions to laparoscopic resection for colorectal cancer prior to the meeting. It was revealed that at least ninety institutes had already performed a laparoscopic resection for colorectal cancer. In order to evaluate the feasibility of laparoscopic resection for colorectal cancer, a randomized control study comparing laparoscopic and open resection of colorectal cancer was started in 2004. This study is scheduled to collect 818 cases. The characteristic of this study was to enroll only advanced cancer cases. The primary endpoint is the survival, while the secondary end points are disease-free survival, early postoperative course, adverse events and conversion to open surgery. As more surgeons perform laparoscopic colorectal surgery, the importance for education and credentialing has been discussed. The Japan Society for Endoscopic Surgery started a system to qualify the surgeon’s technique for endoscopic and laparoscopic surgery in 2004. One hundred and three surgeons took the examination for laparoscopic colorectal surgery in 2004, and 43 passed. Reprints are not available.     

Survival in Colorectal Cancer Patients With Urinary Tract Invasion

Purpose We compared overall survival and disease-free survival in colorectal cancer patients with and without invasion of urinary organs. Methods We clarified the potential predictors of the overall and disease-free survivals after surgery, the factors associated with direct tumor invasion of the urinary organs, postoperative complications, recurrence sites, and survival in patients with and without urinary organ resection in 171 patients with Stage III colorectal cancer who underwent surgery, including 23 patients with tumor invasion of the urinary organs and 148 patients without invasion. Results Old age (65 years or older), rectal cancer, and macroscopic Type 3 and 4 disease were found to be independent poor prognostic factors for the overall and disease-free survivals in all patients. The overall and disease-free survivals in patients with direct tumor invasion of the urinary organs were not shorter than those in patients without invasion. A large extent of tumors located in the cross-sectional circumference of the bowel (≥72 percent) and a large maximum tumor size (>50 mm) were significant tumor characteristics associated with positive direct tumor invasion of the urinary organs by sigmoid and rectal cancers. Although the local recurrence of patients with tumor invasion of the urinary organs occurred more frequently in patients without invasion, there were no differences in the overall and disease-free survivals between the patients without a urinary organ resection and those with a local resection of urinary bladder or ureter. Conclusions The survival of patients with a urinary invasion was not shorter than that of patients without urinary invasion.     

Colorectal Cancer Mortality in First-Degree Relatives of Early-Onset Colorectal Cancer Cases

PURPOSE: Estimates of familial colorectal cancer risks are useful in genetic counseling and as a guide to determining entry into screening programs and trials of chemoprevention. Furthermore, they provide an insight into the contribution of the known colorectal cancer genes to the familial risk of the disease. There is a paucity of data about the familial colorectal cancer risk associated with early-onset disease outside the recognized cancer predisposition syndromes. METHODS: This was a retrospective cohort study. The parents and siblings of 205 patients with colorectal cancer aged less than 55 years at diagnosis were studied for mortality and cancer incidence. RESULTS: The overall standardized mortality ratio of colorectal cancer compared with the Northern Irish population was 3.54 (95 percent confidence interval, 2.59–4.79). There was some evidence that a family history of colorectal cancer is associated with a greater risk of colon (4.16; 95 percent confidence interval, 2.83–5.91) rather than rectal cancer (2.62; 95 percent confidence interval, 1.43–4.40). Risks in parents (2.54; 95 percent confidence interval, 1.45–3.72) were lower than in siblings (6.15; 95 percent confidence interval, 3.90–9.23). CONCLUSION: First-degree relatives of patients with early-onset disease are at a marked increase in risk. There is evidence that risks vary depending on the type of affected relative and by the site of colorectal cancer. This information should be considered in formulating screening strategies.     

Prediction of Postoperative Mortality in Elderly Patients With Colorectal Cancer

Purpose This study was designed to develop a model for predicting postoperative mortality in elderly patients undergoing surgery for colorectal cancer. Methods This multicenter study was conducted by using routinely collected clinical data, assessing patients older than aged 80 years, with 30-day operative mortality as the primary end point. Data were collected from The Association of Coloproctology of Great Britain and Ireland database, encompassing 8,077 newly diagnosed colorectal cancer patients undergoing resectional surgery in 79 hospitals between April 2000 to March 2002, The Association of Coloproctology Malignant Bowel Obstruction Study, encompassing 1,046 patients with malignant bowel obstruction in 148 hospitals, between April 1998 to March 1999, and The Wales-Trent audit, encompassing 3,522 newly diagnosed colorectal cancer patients, between July 1992 to June 1993. A multilevel logistic regression model was developed to adjust for case-mix and to accommodate the variability of outcomes between the three study populations. The model was internally validated using a Bayesian resampling technique and tested using measures of discrimination, calibration, and subgroup analysis. Results A total of 2,533 patients satisfied the inclusion criteria, with a 30-day mortality of 15.6 percent. Multivariate analysis identified the following independent risk factors: age (odds ratio for 85–90, 90–95, >95 vs. 80–85 = 1.1, 1.8, 2.9), American Society of Anesthesiology grade (odds ratio for Grade III, IV vs. I–II = 2.7, 6.1), operative urgency (odds ratio for emergency vs. elective = 1.9), no cancer excision vs. resection (odds ratio = 1.2), and metastatic disease (odds ratio for metastases vs. no metastases = 1.9). The model offered adequate discrimination (area under receiver operator curve = 0.732) and excellent agreement between observed and predicted outcomes during eight colorectal procedures (P = 0.885). Conclusions The elderly colorectal cancer model can accurately estimate 30-day mortality in patients older than aged 80 years undergoing surgery for colorectal cancer. Because the mortality can be considerable, this may have important implications when determining management for this group of patients. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004, and the meeting of The Association of Coloproctology of Great Britain and Ireland, Birmingham, United Kingdom, June 28 to July 1, 2004.     

Bacterial Translocation May Influence the Long-Term Survival in Colorectal Cancer Patients

Purpose The purpose of this study was to investigate the association of bacterial translocation with long-term disease-specific and disease-free survival in colorectal cancer patients. Methods This was a prospective cohort study in which 128 and 30 colorectal cancer patients undergoing curative and palliative resections, respectively, were recruited between 1992 and 1997. Samples of mesenteric lymph nodes were harvested for culture before administration of prophylactic antibiotics. Median follow-up for patients without cancer death was 103 (range, 72–147) months. This cohort of patients was internally validated by Dukes staging. Results The cumulative disease-specific survival (time to death) and disease-free survival (time to recurrence) for all patients at five years of follow-up was 55 percent (standard error [SE], 4.4 percent) and 65 percent (SE, 4.8 percent), respectively. Bacteria were isolated from the mesenteric nodes of 23 (15 percent) patients. There was no association between bacterial translocation and nodal metastases, bowel obstruction, and septic complications. Patients with confirmed bacterial translocation had a worse disease-specific survival (n=158, 5-year survivorship estimates±SE, 38 percent±12 percent vs. 58 percent±4.7 percent; P < 0.01) and disease-free survival (n=128, 5-year survivorship estimates±SE, 46 percent±14 percent vs. 66 percent±5 percent; P = 0.004) than those without. Using multivariate Cox regression analysis, bacterial translocation was a predictor of disease-specific survival (P = 0.011) and disease-free survival (P = 0.02) independent of other pathologic prognostic indicators. Conclusion Colorectal cancer patients with bacterial translocation in the mesenteric lymph nodes have a worse outcome. Presented at the meeting of the Society of Academic and Research Surgery, Belfast, Northern Ireland, January 14 to 16, 2004.     

Abdominal Wall Recurrences After Colorectal Resection for Cancer

PURPOSE: The purpose of the present study was to evaluate prospectively the abdominal wall recurrence rate after laparoscopic resection for colorectal cancer, to analyze the impact of the learning curve on abdominal wall recurrence, and to assess the outcome of those patients. METHODS: The Italian Registry of Laparoscopic Colorectal Surgery database was analyzed to obtain data on cancer patients with abdominal wall recurrence, concomitant local or distant metastases, and interval between initial surgery and diagnosis of trocar site or minilaparotomy recurrences. The records of the initial procedures and the technique of specimen removal were reviewed. RESULTS: From January 1992 to July 2000, 2,583 patients (1,753 cases of carcinomas and 830 cases of benign diseases) were recorded. The malignant lesions were located on the right colon in 19 percent, the left colon in 48.8 percent, and rectum in 32.2 percent. Sixteen patients with histologic evidence of colorectal adenocarcinoma recurrences at the abdominal wall were observed (0.9 percent). Ten patients presented an advanced stage (III for 7 patients and IV for 3 patients). Eleven cases occurred during the learning curve period (the first 50 consecutive cases). The median survival time after abdominal wall recurrence diagnosis was 16 (range, 12–60) months. By July 2000 only two patients were alive. CONCLUSIONS: The results of the Italian prospective Registry of Laparoscopic Colorectal Surgery confirm that the incidence of abdominal wall recurrences is similar to that reported in open studies (<1 percent). Most abdominal wall recurrences occurred in the learning curve period, suggesting that surgical experience may play a role in the development of this outcome. The prognosis of these patients is very poor.     

Morbidity of Temporary Loop Ileostomy in Patients With Colorectal Cancer

Purpose This study was designed to quantify the temporary loop ileostomy-related morbidity in patients with colorectal cancer and contrast the morbidity rates after ileostomy closure before, during, and after the start of adjuvant therapy. Methods Between 1997 and 2004, 120 patients with colorectal carcinoma underwent colorectal resection and creation of a temporary loop ileostomy to protect the low anastomosis. Stoma-related complications and perioperative morbidity after ileostomy closure were assessed retrospectively by reviewing the medical records. Results Sixteen of the 120 patients (13.3 percent) suffered stoma-related complications, requiring early ileostomy closure in three. After ileostomy closure, anastomotic leakage of the ileoileostomy occurred in 3 of the 120 patients (2.5 percent), 2 of them died postoperatively (1.7 percent). The rate of minor complications (16.7 percent in all patients) was much higher in patients undergoing adjuvant chemotherapy or radiochemotherapy (25.5 percent) than in patients receiving no additional therapy (9.2 percent). In the former patients, there was a trend toward fewer complications when ileostomy closure was performed before (12.5 percent), rather than during (42.9 percent) or after (21.2 percent), the start of adjuvant therapy. Conclusions The morbidity following closure of a temporary loop ileostomy in colorectal cancer patients is much higher in patients receiving adjuvant chemotherapy or radiochemotherapy. The morbidity, however, might possibly be lowered to the level of patients receiving no additional therapy if ileostomy closure is performed before the start of adjuvant therapy. Presented at the meeting of the German Society of Surgery, Munich, Germany, April 5 to 8, 2005. Reprints are not available.     

Flat-Type Early Colorectal Cancer Preferentially Develops in Right-Sided Colon in Older Patients

BACKGROUND Flat-type colorectal cancer is frequently reported in Japan and Europe, but its clinical features remain obscure. Thus, we investigated the clinical features of flat-type early colorectal cancer with respect to tumor location and patient age and compared them with those of polypoid-type early and advanced cancer.METHODS Between January 1999 and June 2001, total colonoscopy was performed in 6,178 patients (mean age, 61 years; 4,290 males and 1,888 females). Of these patients, 402 patients with 429 colorectal cancers were found: 202 at advanced stage (invading beyond muscularis propria) and 227 at early stage (carcinoma in situ or invading within submucosa). Early-stage cancer was classified into two macroscopic subgroups: flat-type and polypoid-type.RESULTS Out of 227 early cancers, 44 were flat type and 183 were polypoid. Flat-type early cancer was more frequently located in the right colon (57 percent, 25/44) than polypoid-type cancer (19 percent, 35/183; P < 0.001). Adenomatous component in flat-type early cancer was less frequent than in polypoid-type cancer (23 percent vs. 92 percent, P < 0.001). The proportion of right-sided colon in flat-type early cancer increased with age (33 percent in patients 59 years, 50 percent in patients between 60 and 69 years, and 72 percent in patients 70 years), whereas polypoid-type early cancer showed minimal change (16 percent, 18 percent, and 25 percent, respectively). An increase in the proportion of right-sided colon with age was also found in advanced cancer (20 percent, 38 percent, and 52 percent, respectively).CONCLUSION The incidence of flat-type early cancer in right-sided colon increased with age, similar to the pattern of advanced cancer. This suggests that flat-type early cancer may be a precursor of advanced cancer in the right colon, especially in older people.Presented in part at the meeting of the American Gastroenterological Association, San Diego, California, May 14 to 17, 2000.