Laparoscopic surgery for rectal cancer

Although laparoscopic colon cancer surgery is widely accepted as a feasible alternative to open surgery, there is still limited evidence on the use of the laparoscopic approach for rectal cancer. Although laparoscopic rectal surgery is a technically demanding procedure with a steep learning curve because of adherence to the oncologic principle of total mesorectal excision, the laparoscopic approach has some advantages over open surgery, including not only less invasiveness but also a good surgical view of the deep pelvis through its magnification effect. At this time, information is still lacking on the long-term outcomes and efficicacy of laparoscopic rectal cancer surgery based on large-scale, randomized, controlled trials, and many clinical guidelines recommend that laparoscopic rectal cancer surgery should only be performed with expertise under a clinical trial setting. Nationwide surveys show the numbers of laparoscopic rectal cancer surgery cases are increasing in Japan, and about 20% of rectal cancer operations are performed laparoscopically, but concerns about the concurrently increasing anastomotic leakage rate should be noted. The development of laparoscopic instruments specifically to facilitate dissection and transection of the rectum in the deep pelvis is expected to increase the future widespread adoption of this procedure.     

Laparoscopic rectal surgery for middle and lower rectal cancer

Background  

The usefulness of laparoscopic low anterior resection for middle and lower rectal cancer remains controversial.     

腹腔镜用于早期子宫内膜癌手术的体会

目的:探讨腹腔镜手术治疗早期子宫内膜癌的可行性.方法:回顾分析2007年7月至2010年7月手术治疗43例早期子宫内膜癌患者的临床资料,其中19例行腹腔镜分期手术,24例行开腹手术,对比分析两组手术时间、术中出血量、胃肠功能恢复时间、术后病率、切口感染率、清扫淋巴结数量、术后住院时间、住院总费用等.结果:两组患者年龄、...     

腹腔镜直肠前切除术治疗低位直肠癌的体会

<正>腹腔镜技术的应用范围越来越广泛,腹腔镜结肠直肠癌根治术已在国内外广泛开展。然而对于低位直肠癌的保肛手术(前切除术),开腹完成已属较高难度。腹腔镜下能否完成此类手术、术后疗效如何,目前国内研究报道较少。本     

Laparoscopic surgery of rectal carcinoma. Radical oncology and late results

The rectal cancer is one of the big challenges for laparoscopic surgery. From August 1993 to October 1999, at our hospital 108 rectal cancers including all UICC stages were laparoscopically operated on, 83 cases of them with curative intention. 77% of the carcinomas were situated in the middle or lower rectal third. A rectal amputation was performed in 13% of the cases, a continuity resection in 87%. All valid histopathological quality criteria were fulfilled: en bloc resection, total mesorectal excision, distal tumor free resection edge, and truncal dissection of the lower mesenteric artery. 25 lymph nodes per specimen were histopathologically described on average. All preparations of curative operations were assessed as R0 resections. In a median follow up of 30 months we saw locoregional recurrences in 1.2% and a recurrence-free survival in 90%. In a subpopulation with 4 years follow up, the rate of local recurrences was 2%, and the recurrence-free survival 85.7%. The value of multimodal therapy concepts in total mesorectal excision cannot be assessed at present yet. Laparoscopic rectal surgery is a very effective treatment option for rectal cancer, but it should be practiced only in specialized centres.     

腹腔镜下腹壁无切口直肠癌切除术

目的 探讨无切口腹腔镜下直肠癌切除术的临床应用价值.方法 对37例直肠癌患者行无切口腹腔镜下直肠癌切除术行回顾分析总结.结果 37例手术均成功,平均手术时间120 min,平均术中出血70 ml,术后平均胃肠蠕动恢复时间为38 h,平均住院时间为7d,无明显并发症.结论 无切口腹腔镜下直肠癌切除术安全可行,无腹部切口手术损伤小、恢复快,值得推广应用.     

Laparoscopic rectal surgery: rectal cancer, pelvic pouch surgery, and rectal prolapse

With the increasing popularity of minimally invasive approaches to surgery, laparoscopic techniques are being applied increasingly to more complex procedures. Surgeons who are interested in gaining skill and confidence with the techniques of rectal mobilization and resection initially should consider attempting procedures for benign disease. Patients who have rectal prolapse, who often have wide, accommodating pelvic anatomy, are the logical choice with whom to begin the laparoscopic rectal experience. Laparoscopic restorative proctocolectomy is more technically challenging. Laparoscopic proctectomy for rectal cancer probably should remain in the hands of well-trained, high-volume, experienced surgeons who have built a dedicated team for treatment of these patients, and who track their outcomes prospectively.     

腹腔镜直肠癌前切除术

基于COLOR II等研究结果,腹腔镜直肠癌手术的地位得以逐步确立。手术切除是直肠癌最重要的治疗方法,对于上段直肠癌,前切除术是标准术式;对于中下段直肠癌,需遵循全直肠系膜切除(TME)的原则,选择低位前切除术或者腹会阴联合切除术。R0切除是手术治疗的核心要素,这包括两层含义:其一是淋巴结清扫范围需要达到D2水平,其二是标本的远、近端切缘以及环周切缘均需为阴性。准确地解剖出肠系膜下动脉、左结肠动脉以及直肠上动脉,是保证淋巴清扫范围的基础,循"神圣平面"解剖分离直肠系膜是环周切缘阴性和标本完整的保证。     

腹腔镜下治疗不可切除胰腺癌(附10例报道)

目的探讨腹腔镜诊断胰腺癌不可切除之后的微创治疗。方法回顾分析10例腹腔镜诊断胰腺癌不可切除后,进一步经腹腔镜微创治疗肿瘤的技术操作和患者恢复情况。结果3例腹腔镜下胃网膜右动脉置入化疗泵和7例无水乙醇注射均成功,肿瘤区域显影良好,无副损伤和并发症,患者早期恢复顺利。结论腹腔镜下胃网膜右动脉置入化疗泵和注射无水乙醇治疗晚期胰腺癌方法简单可靠,对于腹腔镜诊断胰腺癌不可切除的晚期肿瘤患者提供了微创治疗技术。     

腹腔镜直肠癌外科临床诊治中的问题与对策

腹腔镜直肠癌手术以其创伤小,患者术后恢复快等优势,逐渐成为结直肠外科手术的主要方式。然而,腹腔镜直肠癌手术的规范化过程中也面临着一系列问题。临床医师除了掌握规范的手术技巧外,更重要的是要掌握直肠癌诊治中涉及的一系列重要问题,首先是重视术前肿瘤的临床分期;其次要重视直肠系膜的解剖学概念,了解直肠癌相关的神经保护,功能保留;第三要熟悉直肠癌根治中的基本概念;第四要重视直肠癌外科手术领域的观念更新;最后要注重开放手术技能的训练。临床医师应该站在医学的最前沿,跟上医学发展的脚步,用最先进的理念,精湛的技艺,完美的治疗,为直肠癌患者提供高水准的医疗照顾。     

经肛门内镜微创手术治疗直肠上皮内瘤变和早期直肠癌

目的探讨经肛门内镜微创手术（TEM）治疗直肠上皮内瘤变（IN）和早期直肠癌的临床价值。方法选择15例直肠肿瘤患者采用TEM行局部切除术。根据活检病理结合直肠腔内超声检查（EUS）术前诊断低级别IN8例，高级别IN4例，早期直肠癌3例。肿瘤距肛缘的距离4—15（平均7．2）cm，肿瘤直径1—4（平均1．8）cm，肿瘤占据肠腔周径比例10％～40％（平均20％）。结果15例直肠肿瘤均获完整切除（黏膜下切除5例，全层切除10例），各切缘均阴性。手术时间为40．90（平均57）min；术中出血量为10-60（平均35）ml。术后住院时间为2-9（平均4．5）d。术后病理确诊：直肠低级别IN5例，高级别IN6例，早期黏膜下浸润癌（pT1期）和进展期癌（pT2期）各2例。术前EUS评估肿瘤浸润肠壁深度的准确率为86．7％（13／15）。15例术后随访2．10（平均6）个月，肿瘤无局部复发。结论TEM微创、显露良好、切除精确、能获取高质量的肿瘤标本用于准确的病理分期，是治疗直肠IN和早期直肠癌的理想术式。术前EUS检查对TEM病例的选择十分重要。     

腹腔镜联合折刀位直肠癌腹会阴根治术

目的:探讨腹腔镜联合折刀位直肠癌腹会阴根治术(Miles手术)的可行性.方法:2008年6月至2010年7月为38例低位直肠癌及肛管癌患者施行腹腔镜腹会阴根治术,15例以常规截石位行腹腔镜手术(截石位组),23例先折刀位行会阴部手术,再取平卧位行腹腔镜腹部手术(折刀位组).对比分析两组患者手术情况、术后开始下床活动时间...     

Evidence-based surgery of rectal carcinoma

The surgery of rectal cancer has seen significant development in recent years. When there is a multitude of therapeutic options available, it is essential to identify what can be considered a proven standard or, at least, what has to be included in planning a surgical treatment. Therefore, at this point of time a distal resection margin of 2 cm, total mesorectal excision, en-bloc resection of adherent structures, colonic pouch reconstruction after very deep resections and limitation of local excision to T1/G1 tumors have to be regarded as standards of the surgical strategy.     

Laparoscopic surgery for rectal cancer: The state of the art

At present time, there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions, lower morbidity rate and earlier recovery compared to open surgery. Technical limitations and a steep learning curve have limited the wide application of mini-invasive surgery for rectal cancer. The present article discusses the current status of laparoscopic resection for rectal cancer. A review of the more recent retrospective, prospective and randomized controlled trial (RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed. A particular emphasis was dedicated to mid and low rectal cancers. Few prospective and RCT trials specifically addressing laparoscopic rectal cancer resection are currently available in the literature. Improved short-term outcomes in term of lesser intraoperative blood loss, reduced analgesic requirements and a shorter hospital stay have been demonstrated. Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin. This data however was not confirmed by other prospective comparative studies. Moreover, a similar local recurrence rate has been reported in RCT and comparative series. Similar findings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any definitive conclusions. On the basis of available data in the literature, the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence. With respect to long-term survival, a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.