Laparoscopic total mesorectal excision for rectal cancer surgery

The introduction of total mesorectal excision in the early 1980s has improved local control and survival in patients with rectal cancer. Laparoscopic resections for colonic malignancies are gaining acceptance in the light of the recent evidence of oncologic adequacy from randomized clinical trials. Technical difficulties and the difference in the natural history of the disease have excluded rectal cancer from major clinical trials comparing laparoscopic to conventional rectal surgery. This review examined the feasibility, safety and oncologic outcomes of reported laparoscopic total mesorectal excision for surgical treatment of operable rectal cancer.     

腹腔镜技术和改良Parks手术在低位直肠癌保肛术中的应用

目的探讨应用腹腔镜技术和改良Parks手术治疗低位直肠癌的安全性及有效性。方法回顾分析2007-05～2010-02我院应用腹腔镜技术和改良Parks手术治疗低位直肠癌16例患者的临床资料。结果 16例手术均顺利完成,手术时间(161.2±55.4)min,术中出血量(144.7±94.5)ml,术后肛门排气时间(3.2±0.8)d,术后腹腔引流量(190.2±67.3)ml。术后出现吻合口瘘1例,经保守治疗好转,无输尿管损伤、排尿障碍及大便失禁等并发症。术后随访14例,时间为1～31个月,中位随访时间为14个月;失访2例。手术后大便次数增加7例,均在1年左右恢复至近正常状态。1例C期患者于术后9个月结肠镜检发现局部复发需行第二次手术,其他病例未发现复发、转移。结论短期结果提示应用腹腔镜技术和改良Parks手术治疗低位直肠癌是安全、有效的。     

Sphincter-preserving surgery for rectal cancer]

Although optimal treatment of tumors at mid and distal rectum continues to be a matter of great debate to oncologic surgeons, a surgical goal of sphincter preservation should be considered in all patients with an intact sphincter. There are growing evidences and indications that sphincter-preserving procedure might be a valid alternative to conventional modality in tumors of the mid or lower rectum. Traditionally, an abdominoperineal resection with permanent colostomy would be the sole surgical option. Recently, a variety of sphincter-preserving procedures are performed in majority of distal rectal cancers with acceptable oncologic and optimal functional results. Several recent advances may further influence future treatment strategies and many issues are, at present, under evaluation. Here, some of the most relevant topics regarding current methods of sphincter-preserving procedures with their oncologic and functional results are discussed to establish the guideline of surgical treatment in rectal cancer.     

Laparoscopic surgery in rectal cancer: a retrospective analysis

Background  

Laparoscopic resection for the cure of rectal cancer is still a matter of debate. Laparoscopic approach is more complex and with a long learning curve, which may results in an increase in morbidity and mortality. This study aimed to retrospectively analyze the impact of laparoscopic resection for rectal cancer on operative outcome of a hospital in a developing country.     

Laparoscopic surgery for rectal cancer: a single-centre experience of 120 cases

Introduction  

For colorectal surgeons, laparoscopic rectal cancer surgery poses a new challenge. The defence of the questionable oncological safety tempered by the impracticality of the long learning curve is rapidly fading. As a unit specialising in minimally invasive surgery, we have routinely undertaken rectal cancer surgery laparoscopically since 2005.     

Laparoscopic surgery for rectal prolapse and outlet obstruction

PURPOSE: The aim of this study was to assess the outcome of both laparoscopic suture rectopexy and resection-rectopexy in the treatment of complete and incomplete rectal prolapse, outlet obstruction, or both. METHODS: Data from surgery were collected prospectively. Semiannual follow-up was performed by assessment of recurrence, continence, and constipation using patients' history, physical examination, continence score, and anorectal manometry. Statistical analysis was performed by chi-squared test and Student'st-test (P<0.05 was accepted as statistically significant). RESULTS: Between September 1992 and February 1997, 72 patients (68 females) with a mean age of 62 (range, 23–88) years were treated laparoscopically. Indications for surgery were rectal prolapse in 21 patients, rectal prolapse combined with outlet obstruction in 36 patients, and outlet obstruction alone in 15 patients. Standard procedure was a laparoscopic suture rectopexy. A sigmoid resection was added in 40 patients. Mean duration of surgery was 227 (range, 125–360) minutes for rectopexy and 258 (range, 150–380) minutes for resection-rectopexy. Conversion was necessary in 1.4 percent (n=1). Overall complication rate was 9.7 percent (n=7) and mortality rate was 0 percent. Mean postoperative hospitalization was 15 (range, 6–47) days. All patients with a minimal follow-up of two years (n=53) could be enrolled in a prospective follow-up study (mean follow-up, 30 months). No recurrence of rectal prolapse had to be recognized. Sixty-four percent of patients with incontinence before surgery were continent or had improved continence. In patients experiencing constipation preoperatively, constipation was improved or completely removed in 76 percent. No additional symptoms of constipation occurred after surgery. CONCLUSION: Laparoscopic procedures in the treatment of pelvic floor disorders,e.g., rectal prolapse or outlet obstruction, lead to acceptable functional results. However, follow-up has to be extended and long-term results of recurrence, continence, and constipation have to be evaluated.     

腹腔镜腹会阴联合切除术治疗低位直肠癌

目的探讨按照全直肠系膜切除(TME)原则，腹腔镜腹会阴联合切除术(Miles)治疗低位直肠癌的可行性。方法按照TME治疗原则，在腹腔镜辅助下，对14例低位直肠癌患者实施TME腹会阴联合切除术。结果14例患者均手术顺利。手术时间120～240分钟，平均180分钟．术中出血30～180ml，平均50ml；术后1～2天恢复胃肠功能并下床活动，住院5～14天，平均为6天。术后6例应用镇痛剂，无术中及术后并发症发生。结论腹腔镜腹会阴联合切除术治疗低位直肠癌，能完全达到TME要求，且创伤小、术后疼痛轻、恢复快。     

Laparoscopic surgery for rectal prolapse and pelvic floor disorders

Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.     

The quality of life after rectal cancer surgery]

Surgery is a definite treatment for rectal cancer by resecting the tumor. Surgeon not only aims to cure the patient but aims to relieve distressing symptoms as well. Unfortunately, patients may suffer adverse consequences from such surgery. The operative dissection of the rectum may damage the pelvic autonomic nerves disturbing bladder and sexual function. The construction of a permanent colostomy following an abdominoperineal resection may be associated with one or more physical problems as well as clinically significant psychosocial problems as well. The advances in knowledge of tumor biology and the improvements of surgical techniques and devices result in an increasing number of sphincter saving procedures such as low anterior resection. Although avoiding permanent stoma is generally regarded as a favorable outcome measure, patients undergoing sphincter-saving surgery may develop a number of unpleasant symptoms, typically fecal soiling and urgency, especially with low anastomosis. It is evident that the consequences of rectal surgery have an important bearing on quality of life. Although differences in definition exist, quality of life may be regarded as representing an individual's ability to carry out daily activities, as well as satisfaction with personal performance and with balance between disease control and adverse effects of treatment. In addition to traditional endpoints, such as survival and disease recurrences, assessing quality of life is necessary to provide a proper, comprehensive understanding of the outcome of surgery and other forms of treatment.     

Laparoscopic low anterior resection for early rectal cancer

Severe superimposed infection during open abdomen treatment with development of intra-abdominal sepsis is a challenging complication associated with high mortality rates. We report our experience with VAC-Instill^® therapy (KCI, San Antonio, USA) used for treatment of an infected open abdomen following pancreatic surgery. A literature search revealed no analogous case reports using VAC-Instill^® therapy for treatment of an infected laparostomy. The encouraging result of the case presented seems to indicate that VAC-Instill^® therapy could be used as adjunctive treatment in the management of the infected open abdomen when traditional therapy fails to control the infection.     

Laparoscopic versus open surgery for rectal cancer: a meta-analysis of 3-year follow-up outcomes

purpose

We wished to evaluate the effectiveness of laparoscopic and open surgery for patients with rectum cancer through a meta-analysis.

Methods

We searched PubMed, EMBASE, and Cochrane database until June 30, 2015, to identify eligible studies. Randomized controlled trials comparing laparoscopic with open surgery for rectum cancer were included. Meta-analysis was performed using the search strategy following the requirement of the Cochrane Library Handbook. Three-year overall survival (OS) and disease-free survival (DFS) were the main endpoints.

Results

Eight randomized controlled trials comprising 3145 patients matched the selection criteria. Meta-analysis showed no significant difference between laparoscopic and open surgery in 3-year overall survival (OS) and disease-free survival (DFS) (hazard ratio (HR)_{3-year OS} = 0.83, 95 % CI [0.68–1.01]; P = 0.06; HR_{3-year DFS} = 0.89, 95 % CI [0.75,1.05]; P = 0.16). No evidence of publication bias was observed.

Conclusion

Our meta-analysis supported the notion that based on the 3-year DFS and OS, oncological outcomes are comparable after laparoscopic and open surgery for rectal cancer.

     

Minimally invasive surgery for rectal cancer

This article discusses the results of systematic reviews and meta-analyses addressing short- and long-term outcomes of laparoscopic rectal surgery for rectal cancer. Randomized clinical trials investigating the advantages of the minimally invasive technique compared to open surgery will be critically reviewed.     

早期胃癌的腹腔镜治疗

胃癌是我国最常见的恶性肿瘤之一,其早期诊断和治疔是提高疗效的关键。早期胃癌是指病变仅限于黏膜及黏膜下层,而不论病变的范用和有无淋巴结转移,早期胃癌术后5年生存率可达94％～96％。1994年日本Kitano报道了首例腹腔镜辅助远端胃切除术治疗早期胃癌,经过10余年的发展,腹腔镜手术在早期胃癌治疗上已经成熟,它与开腹手术近、远期疗效相当,2004年日本胃癌协会将腹腔镜胃癌根治术作为IA期胃癌的标准治疗方案之一。本文重点介绍以下3个方面：①早期胃癌腹腔镜治疗的术式和适应证;②早期胃癌腹腔镜治疗的安全性和根治性评价;③我国早期胃癌腹腔镜治疗的现状和展望。     

Laparoscopic colorectal cancer surgery for palliation

PURPOSE: The aim of this study was to review our experience with laparoscopic colorectal cancer surgery for palliative purposes and to assess its safety and efficacy. METHODS: This was a prospective analysis of 30 patients with incurable colorectal cancer considered for laparoscopic surgery for palliative purposes. RESULTS: Resection of a single segment of the bowel was performed in 15 patients (6 right and 1 left colectomies and 8 proctosigmoidectomies). One patient underwent both right colectomy and sigmoidectomy because of double lesions. Stoma creation only was performed in 11 patients (5 colostomies and 6 ileostomies). Three patients were converted to an open procedure. For resection, median operative time was 170 minutes, and median estimated blood loss was 150 ml. For stoma creation, median operative time was 60 minutes, and median blood loss was 50 ml. There were no intraoperative complications. Postoperative death occurred in two severely debilitated patients after stoma creation. One patient developed a pulmonary embolism eight days postoperatively, later dying of pulmonary failure. Another patient died six hours after loop colostomy. Autopsy was refused. There were no other postoperative complications. Median time to passage of flatus was two days and of stool five days after resection and two days for both flatus and stool after stoma creation. Median time to discharge was eight days after resection and seven days after stoma creation. All patients were able to eat and recover normal bowel function. Among the resection group, six patients died (median time to death, 12 months) during a median follow-up period of 13 months. Among the stoma creation group, five patients died (median time to death, 8 months) during median follow-up period of ten months. There were no port-site recurrences. CONCLUSION: The laparoscopic approach for patients with incurable colorectal cancer can provide effective palliation with avoidance of a major laparotomy in the majority of cases.     

Laparoscopic surgery for rectal cancer: short-term benefits and oncologic outcomes using more than one technique

Background  

Several minimally invasive techniques have now been described for rectal cancer resection. Current outcome data for these approaches from high volume, single institutions remain limited. Our aim was to review outcomes in patients undergoing minimally invasive surgery for rectal cancer at our institution in the current era.