BACKGROUND Colon cancer is a significant health issue in China,with high incidence and mortality rates.Surgical resection remains the primary treatment,with the introduction of complete mesocolic excision in 2009 impr...BACKGROUND Colon cancer is a significant health issue in China,with high incidence and mortality rates.Surgical resection remains the primary treatment,with the introduction of complete mesocolic excision in 2009 improving precision and outcomes.Laparoscopic techniques,including laparoscopic-assisted right hemicolectomy(LARH)and total laparoscopic right hemicolectomy(TLRH),have further advanced colon cancer treatment by reducing trauma,blood loss,and recovery time.While TLRH offers additional benefits such as faster recovery and fewer complications,its adoption has been limited by longer operative times and technical challenges.AIM To compare the short-term outcomes of TLRH and LARH for the treatment of right-sided colon cancer and explore the advantages and feasibility of TLRH.METHODS Clinical data from 109 right-sided colon cancer patients admitted between January 2019 and May 2021 were retrospectively analyzed.Patients were divided into an observation group(TLRH,n=50)and a control group(LARH,n=59).Study variables were operation time,intraoperative bleeding volume,postoperative hospital stays,length of surgical specimen,number of lymph nodes dissected,and postoperative inflammatory factor levels of the two groups of patients.The postoperative complications were analyzed and compared,and survival,recurrence,and remote metastasis rates of the two groups were compared during a 2-year follow-up period.RESULTS The TLRH group showed the advantages of reduced intraoperative bleeding,shorter hospital stays,and quicker recovery.Lymph node dissection outcomes were comparable,and postoperative inflammatory markers were lower in the TLRH group.Complication rates were similar.Short-term follow-up(2 years)revealed no significant differences in recurrence,metastasis,or survival rates.CONCLUSION Compared to LARH,TLRH offers significant advantages in terms of reducing surgical trauma,lowering postoperative inflammatory factor levels,and mitigating the impact on intestinal function.This approach contributes to a shorter hospital stay and promotes postoperative recovery in patients.The study suggests that TLRH may offer favorable outcomes for colorectal cancer patients.展开更多
In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraao...In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraaortic lymph nodes.While NCCN guidelines recommend the removal of 10-12 lymph nodes for ade-quate oncological resection,achieving complete oncological resection involves more than just meeting these numerical targets.Various techniques have been developed and studied over time to attain optimal oncological outcomes.A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric vessels.Complete excision of the visceral and parietal mesocolon ensures the intact removal of the specimen,while D3 lymphade-nectomy targets all draining regional lymph nodes.Although these principles emphasize different aspects,they ultimately converge to achieve the same goal of complete oncological resection.This article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.展开更多
AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, la...AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma. METHODS: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival. RESULTS: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resum?early activity in the LRH group were significantly shorter than those in the ORH group (2.24±0.56 vs 3.25±1.29 d, 13.94?.5 vs 18.25±5.96 d, 3.94±1.64 vs 5.45±1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%). CONCLUSION: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure.展开更多
AIM: to evaluate the feasibility, safety, and oncologic outcomes of laparoscopic extended right hemicolectomy (LERH) for colon cancer. METHODS: Since its establishment in 2009, the Southern Chinese Laparoscopic Colore...AIM: to evaluate the feasibility, safety, and oncologic outcomes of laparoscopic extended right hemicolectomy (LERH) for colon cancer. METHODS: Since its establishment in 2009, the Southern Chinese Laparoscopic Colorectal Surgical Study (SCLCSS) group has been dedicated to promoting patients' quality of life through minimally invasive surgery. The multicenter database was launched by combining existing datasets from members of the SCLCSS group. The study enrolled 220 consecutive patients who were recorded in the multicenter retrospective database and underwent either LERH (n = 119) or open extended right hemicolectomy (OERH) (n = 101) for colon cancer. Clinical characteristics, surgical outcomes, and oncologic outcomes were compared between the two groups. RESULTS: There were no significant differences in terms of age, gender, body mass index (BMI), history of previous abdominal surgery, tumor location, and tumor stage between the two groups. The blood loss was lower in the LERH group than in the OERH group [100 (100-200) mL vs 150 (100-200) mL, P < 0.0001]. The LERH group was associated with earlier first flatus (2.7 +/- 1.0 d vs 3.2 +/- 0.9 d, P < 0.0001) and resumption of liquid diet (3.6 +/- 1.0 d vs 4.2 +/- 1.0 d, P < 0.0001) compared to the OERH group. The postoperative hospital stay was significantly shorter in the LERH group (11.4 +/- 4.7 d vs 12.8 +/- 5.6 d, P = 0.009) than in the OERH group. The complication rate was 11.8% and 17.6% in the LERH and OERH groups, respectively (P = 0.215). Both 3-year overall survival [LERH (92.0%) vs OERH (84.4%), P = 0.209] and 3-year disease-free survival [LERH (84.6%) vs OERH (76.6%), P = 0.191] were comparable between the two groups. CONCLUSION: LERH with D3 lymphadenectomy for colon cancer is a technically feasible and safe procedure, yielding comparable short-term oncologic outcomes to those of open surgery. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparos...As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.展开更多
A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal...A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.展开更多
AIM To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy(RHCPD) for locally advanced right-sided colon cancer(LARCC).METHODS We retrospectively reviewed the database of Saitama Medical ...AIM To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy(RHCPD) for locally advanced right-sided colon cancer(LARCC).METHODS We retrospectively reviewed the database of Saitama Medical Center, Jichi Medical University, between January 2009 and December 2016. During this time, 299 patients underwent radical right hemicolectomy for right-sided colon cancer. Among them, 5 underwent RHCPD for LARCC with tumor infiltration to adjacent organs. Preoperative computed tomography(CT) was routinely performed to evaluate local tumor infiltration into adjacent organs. During the operation, we evaluated the resectability and the amount of infiltration into the adjacent organs without dissecting the adherent organs from the cancer. When we confirmed that radical resection was feasible and could lead to R0 resection, we performed RHCPD. The clinical data were carefully reviewed, and the demographic variables, intraoperative data, and postoperative parameters were recorded.RESULTS The median age of the 5 patients who underwent RHCPD for LARCC was 70 years. The tumors were located in the ascending colon(three patients) and transverse colon(two patients). Preoperative CT revealed infiltration of the tumor into the duodenum in all patients, the pancreas in four patients, the superior mesenteric vein(SMV) in two patients, and tumor thrombosis in the SMV in one patient. We performed RHCPD plus SMV resection in three patients. Major postoperative complications occurred in 3 patients(60%) as pancreatic fistula(grade B and grade C, according to International Study Group on Pancreatic Fistula Definition) and delayed gastric empty. None of the patients died during their hospital stay. A histological examination confirmed malignant infiltration into the duodenum and/or pancreas in 4 patients(80%), and no patients showed any malignant infiltration into the SMV. Two patients were histologically confirmed to have tumor thrombosis in the SMV. All of the tumors had clear resection margins(R0). The median follow-up time was 77 mo. During this period, two patients with tumor thrombosis died from liver metastasis. The overall survival rates were 80% at 1 year and 60% at 5 years. All patients with node-negative status(n = 2) survived for more than seven years.CONCLUSION This study showed that the long-term survival is possible for patients with LARCC if RHCPD is performed successfully, particularly in those with node-negative status.展开更多
Objective: The aim of the study was to investigate the clinical value of superior mesenteric vascular intrathecal approach in right hemicolectomy. Methods: We retrospectively studied the clinical data of 132 patients ...Objective: The aim of the study was to investigate the clinical value of superior mesenteric vascular intrathecal approach in right hemicolectomy. Methods: We retrospectively studied the clinical data of 132 patients who had right hemicolectomy from June 2007 to June 2010, including 68 cases with superior mesenteric vascular intrathecal approach to resect specimen, and compared the operation time, blood loss, hospital stay and the number of dissected lymph nodes with patients treated with conventional surgery. Results: Compared the vascular intrathecal approach with conventional approach, the operation time and blood loss were decreased significantly, the number of Dukes C No. 3 lymph node dissection was increased, while the incidence of postoperative complications and hospital stay were equivalent to traditional surgery group. Conclusion: The use of vascular intrathecal approach in right hemicolectomy can significantly shorten the operation time and reduce bleeding and improve surgical radical outcomes.展开更多
BACKGROUND Pure natural orifice transluminal endoscopic surgery(NOTES)for colorectal cancer is a complex procedure and rarely used in clinical practice because of the ethical concerns and technical challenges,includin...BACKGROUND Pure natural orifice transluminal endoscopic surgery(NOTES)for colorectal cancer is a complex procedure and rarely used in clinical practice because of the ethical concerns and technical challenges,including loss of triangulation,in-line orientation,and instrument collision.Transvaginal(v)NOTES,however,can overcome these technical challenges.We report a case of pure vNOTES right hemicolectomy for colon cancer,attached with surgical video.CASE SUMMARY A 65-year-old woman with a 2-year history of intermittent diarrhea was diagnosed with ascending colon adenocarcinoma by colonoscopy and biopsy.Pure vNOTES right hemicolectomy was performed with complete mesocolic excision by well-experienced surgeons.The operative time was 200 min and the estimated blood loss was 30 mL.No intraoperative or postoperative complications occurred within 30 d after the surgery.The visual analog scale pain score on postoperative day 1 was 1 and dropped to 0 on postoperative days 2 and 3.The patient was discharged at postoperative day 6.The pathologic specimen had sufficient clear resection margins and 14 negative harvested lymph nodes.CONCLUSION vNOTES right hemicolectomy,performed by well-experienced surgeons,overcomes the technical challenges of pure NOTES and may be feasible for colon cancer.展开更多
Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tum...Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tumors have been encountered.Recently,several laparoscopic operations have been reported in patients with SIT.We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy.Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy.Techniques themselves was not different from those in ordinary cases.Thus,curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.展开更多
BACKGROUND Complete mesocolic excision(CME)with central vascular ligation(CVL)was proposed by Hohenberger in 2009.The CME principle has gradually become the technical standard for colon cancer surgery.How to achieve C...BACKGROUND Complete mesocolic excision(CME)with central vascular ligation(CVL)was proposed by Hohenberger in 2009.The CME principle has gradually become the technical standard for colon cancer surgery.How to achieve CME with CVL in laparoscopic right hemicolectomy(LRH)is controversial,and a unified standard approach is not yet available.In recent years,the authors’team has integrated the theory of membrane anatomy,tried to combine the cephalic approach with the classic medial approach(MA)for technical optimization,and proposed a cranialmedial mixed dominant approach(CMA).AIM To explore the feasibility of operational approaches for LRH with CME.METHODS In this retrospective cohort study,the clinical data of 57 patients with right-sided colon cancer(TNM stage I,II,or III)who underwent LRH with CME from January 2016 to June 2020 were collected and summarized.There were 31 patients in the traditional MA group and 26 in the CMA group.RESULTS There were no significant differences in baseline data between the two groups.The operation was shorter and the number of lymph nodes dissected was higher in the CMA group than in the MA group,but there was no significant difference in the number of positive lymph nodes,intraoperative blood loss,postoperative exhaust time,feeding time,postoperative hospital stay or postoperative complication incidence.CONCLUSION Our study shows that the CMA is a safe and feasible procedure for LRH with CME and has a unique advantage.展开更多
AIM:To compare short term outcomes of elective laparoscopic and open right hemicolectomy(RH) in an elderly population.METHODS:All patients over the age of 70 undergoing elective RH at Ninewells Hospital and Perth Roya...AIM:To compare short term outcomes of elective laparoscopic and open right hemicolectomy(RH) in an elderly population.METHODS:All patients over the age of 70 undergoing elective RH at Ninewells Hospital and Perth Royal Infirmary between January 2006 and May 2011 were included in our analysis.Operative details,hospital length of stay,morbidity and mortality was collected by way of proforma from a dedicated prospective database.An extracorporeal anastomosis was performed routinely in the laparoscopic group.The primary endpoints for analysis were morbidity and mortality.Our secondary endpoints were operative duration,length of hospital stay and discharge destination.RESULTS:Two hundred and six patients were included in our analysis.One hundred and twenty-five patients underwent an open resection and 81 patients had a laparoscopic resection.The mean operating time was significantly longer in the laparoscopic group(139 ± 36 min vs 197 ± 53 min,P = 0.001).The mean length of hospital stay was similar in both groups(11.2 ± 7.8 d vs 9.6 ± 10.7 d,P = 0.28).The incidence of postoperative morbidities was 27% in the open group and 38% in the laparoscopic group(P = 0.12).Overall inhospital mortality was 0.8% in open procedures vs 1% in laparoscopic.CONCLUSION:Laparoscopic RH was associated with a significantly longer operative time compared to open RH.In our study,laparoscopic RH was not associated with reduced post-operative morbidity or significantly shorter length of hospital stay.展开更多
To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or per...To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.展开更多
Background: Nowadays, laparoscopic colectomy is considered a safe and effective surgical technique regarding short- and long-term outcomes, as well as specific oncologic outcomes. The anastomosis can be created intra-...Background: Nowadays, laparoscopic colectomy is considered a safe and effective surgical technique regarding short- and long-term outcomes, as well as specific oncologic outcomes. The anastomosis can be created intra- or extracorporeally. The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Aim of the Study: The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Methods: In the period from December 2014 to January 2019, all patients underwent laparoscopic right hemicolectomy for cancer colon who presented to surgical oncology department—south Egypt cancer institute and general surgery department—Assiut University was analyzed. Data like age, sex, body mass index (BMI), operative technique, operative times, blood loss, intra- and post-operative complications, pathology and hospital stay were reported and analyzed. Results: Twenty three (69.7%) patients underwent extracorporeal anastomosis while intracorporeal anastomosis was performed in ten (30.3%) patients. There was no significant difference in patient characteristics and demographic data in both groups (P > 0.05). There was no statistically significant difference in operative (operative time, blood loss or length of hospital stay) and postoperative (ileus, anastomotic leak, wound infection, incisional hernia, readmission, reoperation or deaths) details in the 2 groups except in length of the incision which was significantly shorter in the IA group (5.500 ± 1.269) vs. (6.565 ± 1.308) for EA (P = 0.015). Conclusion: No significant difference in short term outcomes of laparoscopic-assisted and total laparoscopic right colectomy. Intracorporeal anastomosis had shorter incision which may decrease wound-related complications.展开更多
BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition causing functional obstruction of the third portion of the duodenum.Postoperative SMAS following laparoscopic-assisted radical right hemicolectom...BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition causing functional obstruction of the third portion of the duodenum.Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.AIM To analyze the clinical features,risk factors,and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.METHODS We retrospectively analyzed clinical data of 256 patients undergoing laparoscopicassisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022.The occurrence of SMAS and its countermeasures were evaluated.Among the 256 patients,SMAS was confirmed in six patients(2.3%)by postoperative clinical presentation and imaging features.All six patients were examined by enhanced computed tomography(CT)before and after surgery.Patients who developed SMAS after surgery were used as the experimental group.A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group.The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group.The preoperative body mass index(BMI)of the experimental group and the control group was calculated.The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded.The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared.The differences in angle,distance,BMI,type of lymphadenectomy and surgical approach between the experimental and control groups were compared,and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.RESULTS In the experimental group,the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery(P<0.05).The aortomesenteric angle,distance and BMI were significantly higher in the control group than in the experimental(P<0.05).There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups(P>0.05).CONCLUSION The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication.Over-cleaning of lymph fatty tissues may also be associated with this complication.展开更多
Background:Traditional right hemicolectomy(TRH)is the standard treatment for patients with nonmetastatic right colon cancer.However,the ileocecum,a vital organ with mechanical and immune functions,is removed in these ...Background:Traditional right hemicolectomy(TRH)is the standard treatment for patients with nonmetastatic right colon cancer.However,the ileocecum,a vital organ with mechanical and immune functions,is removed in these patients regardless of the tumor location.This study aimed to evaluate the technical and oncological safety of laparoscopic ileocecal-sparing right hemicolec-tomy(LISH).Method:Patients who underwent LISH at two tertiary medical centers were matched 1:2 with patients who underwent TRH by pro-pensity score matching based on sex,age,body mass index,tumor location,and disease stage.Data on surgical and perioperative outcomes were collected.Oncological safety was evaluated in a specimen-oriented manner.Lymph nodes(LNs)near the ileocolic ar-tery(ICA)were examined independently in the LISH group.Disease outcomes were recorded for patients who completed one year of follow-up.Results:In all,34 patients in the LISH group and 68 patients in the TRH group were matched.LISH added 8 minutes to the dissection of LNs around the ileocolic vessels(groups 201/201d,202,and 203 LNs),without affecting the total operation time,blood loss,or peri-operative adverse event rate.Compared with TRH,LISH had a comparable lymphadenectomy quality,specimen quality,and safety margin while preserving a more functional bowel.The LISH group had no cases of LN metastasis near the ICA.No difference was detected in the recurrence rate at the 1-year follow-up time point between the two groups.Conclusion:In this dual-center study,LISH presented comparable surgical and oncological safety for patients with hepatic flexure or proximal transverse colon cancer.展开更多
BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated b...BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.展开更多
BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with di...BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with different characteristics.The focus of this study was to investigate the safety and clinical efficacy of three different surgical procedures,namely,robotic-assisted surgery(RAS),handassisted laparoscopic surgery(HALS)and conventional laparoscopic surgery(CLS),for the dissection of malignant tumors of the left hemicolon and the effect of these procedures on long-term prognosis.AIM To determine which procedures are best for patients with malignant tumors of the left hemicolon and the safety and clinical efficacy of three different surgical procedures.METHODS A retrospective analysis of the clinical data of 224 patients with left hemicolonic malignancies admitted to the Department of General Surgery of the First Affiliated Hospital of Nanchang University from June 2015 to June 2024 was conducted.Patient data were analyzed to determine tumor stage,duration of surgery,number of lymph nodes cleared,incidence and severity of postoperative complications,amount of intraoperative bleeding,overall survival(OS),and progressionfree survival.RESULTS The short-term postoperative outcomes after RAS,HALS and CLS were compared.The leukocyte and absolute neutrophil counts on postoperative day 4 were highest after RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The length of postoperative hospital stay was highest after CLS,followed by RAS and then HALS,and the differences were statistically significant(P<0.05).The postoperative recovery time of gastrointestinal function was shortest after HALS,followed by RAS and CLS,which had equal values,and the differences were statistically significant(P<0.05).Hospitalization costs were highest among patients who underwent RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The OS among patients who underwent HALS,CLS,and RAS did not significantly differ(P=0.384).CONCLUSION There were no significant differences between procedures in the number of lymph nodes cleared or OS,and all procedures successfully achieved radical dissection of the malignant tumors.HALS had lower hospitalization costs and shorter postoperative recovery time of gastrointestinal function,and CLS performed between HALS and RAS.Different surgical procedures have varying impacts on the length of postoperative hospital stay and the degree of postoperative inflammation,so selection should be individualized to each patient.展开更多
Background:According to previous guidelines,the lymph nodes around the right side of the superior mesenteric artery(SMA)should be dissected and removed en bloc.However,due to the technical challenge and the risk of co...Background:According to previous guidelines,the lymph nodes around the right side of the superior mesenteric artery(SMA)should be dissected and removed en bloc.However,due to the technical challenge and the risk of complications,most surgeons perform the dissection along the axis of the superior mesenteric vein(SMV).Herein,we described an‘artery-first’approach for laparoscopic radical extended right hemicolectomy with complete mesocolic excision(CME).Methods:A total of 22 cases were collected from January to October 2016.The right side of the SMA and SMV were exposed and separated,and the No.203,No.213 and No.223 lymph nodes were dissected en bloc.Toldt’s fascia was dissected and expanded laterally to the ascending colon,cranial to the pancreas head.The caudal root of the mesentery and lateral attachments of the ascending colon were completely mobilized.Results:There were 9 male and 13 female patients,with a mean age of 63.1(range,39–83)years and the mean body mass index was 24.6(range,18.3–37.7)kg/m^(2).The mean operative time was 192.5(range,145–240)minutes and the mean intraoperative blood loss was 55.0(range,10–300)ml.The mean number of harvested lymph nodes was 27.0(range,13–55)and the time to flatus and hospital stay were 35.0(range,26–120)hours and 7.5(range,5–20)days,respectively.Minor complications occurred in two patients and no post-operative death was observed.Conclusions:The preliminary results suggest that the reported approach may be a feasible and safe procedure that is more in accordance with the principles of CME.展开更多
Background and objective:Intra-corporeal delta-shaped anastomosis(IDA)is an important development in laparoscopic digestive-tract reconstruction.We applied it in laparoscopic right hemicolectomy for right colon cancer...Background and objective:Intra-corporeal delta-shaped anastomosis(IDA)is an important development in laparoscopic digestive-tract reconstruction.We applied it in laparoscopic right hemicolectomy for right colon cancer and compared the short-term outcomes between the patients treated with IDA and conventional extracorporeal anastomosis(EA).Methods:Between 1 January 2016 and 1 October 2017,36 and 50 patients who underwent IDA and EA,respectively,were included.Data on clinicopathological characteristics,surgical outcomes,post-operative recovery and complications were collected and compared between the two groups.Results:Surgical outcomes and clinicopathological characteristics were similar between the two groups except the length of incision,which was significantly shorter in the IDA group than in the EA group(4.660.6 vs 5.660.7 cm,P<0.001).The time to ground activities,fluid diet intake and post-operative hospitalization did not differ between the groups;however,the time to first flatus was significantly shorter in the IDA group than in the EA group(2.860.5 vs 3.260.8 days,P=0.004).The post-operative visual analogue scale for pain was lower in the IDA group than in the EA group on post-operative Day 1(4.060.7 vs 4.561.0,P=0.002)and post-operative Day 3(2.760.6 vs 3.460.6,P<0.001).The surgical complication rates were 8.3 and 16.0%in the IDA and EA groups(P=0.470),respectively.No complications such as anastomotic bleeding,stenosis and leakage occurred in any patient.Conclusions:IDA is safe and feasible and shows more satisfactory short-term outcomes than EA.展开更多
文摘BACKGROUND Colon cancer is a significant health issue in China,with high incidence and mortality rates.Surgical resection remains the primary treatment,with the introduction of complete mesocolic excision in 2009 improving precision and outcomes.Laparoscopic techniques,including laparoscopic-assisted right hemicolectomy(LARH)and total laparoscopic right hemicolectomy(TLRH),have further advanced colon cancer treatment by reducing trauma,blood loss,and recovery time.While TLRH offers additional benefits such as faster recovery and fewer complications,its adoption has been limited by longer operative times and technical challenges.AIM To compare the short-term outcomes of TLRH and LARH for the treatment of right-sided colon cancer and explore the advantages and feasibility of TLRH.METHODS Clinical data from 109 right-sided colon cancer patients admitted between January 2019 and May 2021 were retrospectively analyzed.Patients were divided into an observation group(TLRH,n=50)and a control group(LARH,n=59).Study variables were operation time,intraoperative bleeding volume,postoperative hospital stays,length of surgical specimen,number of lymph nodes dissected,and postoperative inflammatory factor levels of the two groups of patients.The postoperative complications were analyzed and compared,and survival,recurrence,and remote metastasis rates of the two groups were compared during a 2-year follow-up period.RESULTS The TLRH group showed the advantages of reduced intraoperative bleeding,shorter hospital stays,and quicker recovery.Lymph node dissection outcomes were comparable,and postoperative inflammatory markers were lower in the TLRH group.Complication rates were similar.Short-term follow-up(2 years)revealed no significant differences in recurrence,metastasis,or survival rates.CONCLUSION Compared to LARH,TLRH offers significant advantages in terms of reducing surgical trauma,lowering postoperative inflammatory factor levels,and mitigating the impact on intestinal function.This approach contributes to a shorter hospital stay and promotes postoperative recovery in patients.The study suggests that TLRH may offer favorable outcomes for colorectal cancer patients.
文摘In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraaortic lymph nodes.While NCCN guidelines recommend the removal of 10-12 lymph nodes for ade-quate oncological resection,achieving complete oncological resection involves more than just meeting these numerical targets.Various techniques have been developed and studied over time to attain optimal oncological outcomes.A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric vessels.Complete excision of the visceral and parietal mesocolon ensures the intact removal of the specimen,while D3 lymphade-nectomy targets all draining regional lymph nodes.Although these principles emphasize different aspects,they ultimately converge to achieve the same goal of complete oncological resection.This article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.
基金Supported by Science and Technology Development Foundation of Shanghai,No. 024119106
文摘AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma. METHODS: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival. RESULTS: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resum?early activity in the LRH group were significantly shorter than those in the ORH group (2.24±0.56 vs 3.25±1.29 d, 13.94?.5 vs 18.25±5.96 d, 3.94±1.64 vs 5.45±1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%). CONCLUSION: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure.
基金Supported by National High Technology Research and Development Program of China,No.2012AA021103the Program of Guangdong Provincial Department of Science and Technology,No.2012A030400012+1 种基金the Major Program of Science and Technology Program of Guangzhou,No.201300000087the Sub-project under National Science and Technology Support Program,No.2013BAI05B00
文摘AIM: to evaluate the feasibility, safety, and oncologic outcomes of laparoscopic extended right hemicolectomy (LERH) for colon cancer. METHODS: Since its establishment in 2009, the Southern Chinese Laparoscopic Colorectal Surgical Study (SCLCSS) group has been dedicated to promoting patients' quality of life through minimally invasive surgery. The multicenter database was launched by combining existing datasets from members of the SCLCSS group. The study enrolled 220 consecutive patients who were recorded in the multicenter retrospective database and underwent either LERH (n = 119) or open extended right hemicolectomy (OERH) (n = 101) for colon cancer. Clinical characteristics, surgical outcomes, and oncologic outcomes were compared between the two groups. RESULTS: There were no significant differences in terms of age, gender, body mass index (BMI), history of previous abdominal surgery, tumor location, and tumor stage between the two groups. The blood loss was lower in the LERH group than in the OERH group [100 (100-200) mL vs 150 (100-200) mL, P < 0.0001]. The LERH group was associated with earlier first flatus (2.7 +/- 1.0 d vs 3.2 +/- 0.9 d, P < 0.0001) and resumption of liquid diet (3.6 +/- 1.0 d vs 4.2 +/- 1.0 d, P < 0.0001) compared to the OERH group. The postoperative hospital stay was significantly shorter in the LERH group (11.4 +/- 4.7 d vs 12.8 +/- 5.6 d, P = 0.009) than in the OERH group. The complication rate was 11.8% and 17.6% in the LERH and OERH groups, respectively (P = 0.215). Both 3-year overall survival [LERH (92.0%) vs OERH (84.4%), P = 0.209] and 3-year disease-free survival [LERH (84.6%) vs OERH (76.6%), P = 0.191] were comparable between the two groups. CONCLUSION: LERH with D3 lymphadenectomy for colon cancer is a technically feasible and safe procedure, yielding comparable short-term oncologic outcomes to those of open surgery. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.
文摘A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.
文摘AIM To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy(RHCPD) for locally advanced right-sided colon cancer(LARCC).METHODS We retrospectively reviewed the database of Saitama Medical Center, Jichi Medical University, between January 2009 and December 2016. During this time, 299 patients underwent radical right hemicolectomy for right-sided colon cancer. Among them, 5 underwent RHCPD for LARCC with tumor infiltration to adjacent organs. Preoperative computed tomography(CT) was routinely performed to evaluate local tumor infiltration into adjacent organs. During the operation, we evaluated the resectability and the amount of infiltration into the adjacent organs without dissecting the adherent organs from the cancer. When we confirmed that radical resection was feasible and could lead to R0 resection, we performed RHCPD. The clinical data were carefully reviewed, and the demographic variables, intraoperative data, and postoperative parameters were recorded.RESULTS The median age of the 5 patients who underwent RHCPD for LARCC was 70 years. The tumors were located in the ascending colon(three patients) and transverse colon(two patients). Preoperative CT revealed infiltration of the tumor into the duodenum in all patients, the pancreas in four patients, the superior mesenteric vein(SMV) in two patients, and tumor thrombosis in the SMV in one patient. We performed RHCPD plus SMV resection in three patients. Major postoperative complications occurred in 3 patients(60%) as pancreatic fistula(grade B and grade C, according to International Study Group on Pancreatic Fistula Definition) and delayed gastric empty. None of the patients died during their hospital stay. A histological examination confirmed malignant infiltration into the duodenum and/or pancreas in 4 patients(80%), and no patients showed any malignant infiltration into the SMV. Two patients were histologically confirmed to have tumor thrombosis in the SMV. All of the tumors had clear resection margins(R0). The median follow-up time was 77 mo. During this period, two patients with tumor thrombosis died from liver metastasis. The overall survival rates were 80% at 1 year and 60% at 5 years. All patients with node-negative status(n = 2) survived for more than seven years.CONCLUSION This study showed that the long-term survival is possible for patients with LARCC if RHCPD is performed successfully, particularly in those with node-negative status.
文摘Objective: The aim of the study was to investigate the clinical value of superior mesenteric vascular intrathecal approach in right hemicolectomy. Methods: We retrospectively studied the clinical data of 132 patients who had right hemicolectomy from June 2007 to June 2010, including 68 cases with superior mesenteric vascular intrathecal approach to resect specimen, and compared the operation time, blood loss, hospital stay and the number of dissected lymph nodes with patients treated with conventional surgery. Results: Compared the vascular intrathecal approach with conventional approach, the operation time and blood loss were decreased significantly, the number of Dukes C No. 3 lymph node dissection was increased, while the incidence of postoperative complications and hospital stay were equivalent to traditional surgery group. Conclusion: The use of vascular intrathecal approach in right hemicolectomy can significantly shorten the operation time and reduce bleeding and improve surgical radical outcomes.
文摘BACKGROUND Pure natural orifice transluminal endoscopic surgery(NOTES)for colorectal cancer is a complex procedure and rarely used in clinical practice because of the ethical concerns and technical challenges,including loss of triangulation,in-line orientation,and instrument collision.Transvaginal(v)NOTES,however,can overcome these technical challenges.We report a case of pure vNOTES right hemicolectomy for colon cancer,attached with surgical video.CASE SUMMARY A 65-year-old woman with a 2-year history of intermittent diarrhea was diagnosed with ascending colon adenocarcinoma by colonoscopy and biopsy.Pure vNOTES right hemicolectomy was performed with complete mesocolic excision by well-experienced surgeons.The operative time was 200 min and the estimated blood loss was 30 mL.No intraoperative or postoperative complications occurred within 30 d after the surgery.The visual analog scale pain score on postoperative day 1 was 1 and dropped to 0 on postoperative days 2 and 3.The patient was discharged at postoperative day 6.The pathologic specimen had sufficient clear resection margins and 14 negative harvested lymph nodes.CONCLUSION vNOTES right hemicolectomy,performed by well-experienced surgeons,overcomes the technical challenges of pure NOTES and may be feasible for colon cancer.
文摘Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tumors have been encountered.Recently,several laparoscopic operations have been reported in patients with SIT.We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy.Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy.Techniques themselves was not different from those in ordinary cases.Thus,curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.
文摘BACKGROUND Complete mesocolic excision(CME)with central vascular ligation(CVL)was proposed by Hohenberger in 2009.The CME principle has gradually become the technical standard for colon cancer surgery.How to achieve CME with CVL in laparoscopic right hemicolectomy(LRH)is controversial,and a unified standard approach is not yet available.In recent years,the authors’team has integrated the theory of membrane anatomy,tried to combine the cephalic approach with the classic medial approach(MA)for technical optimization,and proposed a cranialmedial mixed dominant approach(CMA).AIM To explore the feasibility of operational approaches for LRH with CME.METHODS In this retrospective cohort study,the clinical data of 57 patients with right-sided colon cancer(TNM stage I,II,or III)who underwent LRH with CME from January 2016 to June 2020 were collected and summarized.There were 31 patients in the traditional MA group and 26 in the CMA group.RESULTS There were no significant differences in baseline data between the two groups.The operation was shorter and the number of lymph nodes dissected was higher in the CMA group than in the MA group,but there was no significant difference in the number of positive lymph nodes,intraoperative blood loss,postoperative exhaust time,feeding time,postoperative hospital stay or postoperative complication incidence.CONCLUSION Our study shows that the CMA is a safe and feasible procedure for LRH with CME and has a unique advantage.
文摘AIM:To compare short term outcomes of elective laparoscopic and open right hemicolectomy(RH) in an elderly population.METHODS:All patients over the age of 70 undergoing elective RH at Ninewells Hospital and Perth Royal Infirmary between January 2006 and May 2011 were included in our analysis.Operative details,hospital length of stay,morbidity and mortality was collected by way of proforma from a dedicated prospective database.An extracorporeal anastomosis was performed routinely in the laparoscopic group.The primary endpoints for analysis were morbidity and mortality.Our secondary endpoints were operative duration,length of hospital stay and discharge destination.RESULTS:Two hundred and six patients were included in our analysis.One hundred and twenty-five patients underwent an open resection and 81 patients had a laparoscopic resection.The mean operating time was significantly longer in the laparoscopic group(139 ± 36 min vs 197 ± 53 min,P = 0.001).The mean length of hospital stay was similar in both groups(11.2 ± 7.8 d vs 9.6 ± 10.7 d,P = 0.28).The incidence of postoperative morbidities was 27% in the open group and 38% in the laparoscopic group(P = 0.12).Overall inhospital mortality was 0.8% in open procedures vs 1% in laparoscopic.CONCLUSION:Laparoscopic RH was associated with a significantly longer operative time compared to open RH.In our study,laparoscopic RH was not associated with reduced post-operative morbidity or significantly shorter length of hospital stay.
文摘To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.
文摘Background: Nowadays, laparoscopic colectomy is considered a safe and effective surgical technique regarding short- and long-term outcomes, as well as specific oncologic outcomes. The anastomosis can be created intra- or extracorporeally. The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Aim of the Study: The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Methods: In the period from December 2014 to January 2019, all patients underwent laparoscopic right hemicolectomy for cancer colon who presented to surgical oncology department—south Egypt cancer institute and general surgery department—Assiut University was analyzed. Data like age, sex, body mass index (BMI), operative technique, operative times, blood loss, intra- and post-operative complications, pathology and hospital stay were reported and analyzed. Results: Twenty three (69.7%) patients underwent extracorporeal anastomosis while intracorporeal anastomosis was performed in ten (30.3%) patients. There was no significant difference in patient characteristics and demographic data in both groups (P > 0.05). There was no statistically significant difference in operative (operative time, blood loss or length of hospital stay) and postoperative (ileus, anastomotic leak, wound infection, incisional hernia, readmission, reoperation or deaths) details in the 2 groups except in length of the incision which was significantly shorter in the IA group (5.500 ± 1.269) vs. (6.565 ± 1.308) for EA (P = 0.015). Conclusion: No significant difference in short term outcomes of laparoscopic-assisted and total laparoscopic right colectomy. Intracorporeal anastomosis had shorter incision which may decrease wound-related complications.
文摘BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition causing functional obstruction of the third portion of the duodenum.Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.AIM To analyze the clinical features,risk factors,and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.METHODS We retrospectively analyzed clinical data of 256 patients undergoing laparoscopicassisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022.The occurrence of SMAS and its countermeasures were evaluated.Among the 256 patients,SMAS was confirmed in six patients(2.3%)by postoperative clinical presentation and imaging features.All six patients were examined by enhanced computed tomography(CT)before and after surgery.Patients who developed SMAS after surgery were used as the experimental group.A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group.The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group.The preoperative body mass index(BMI)of the experimental group and the control group was calculated.The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded.The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared.The differences in angle,distance,BMI,type of lymphadenectomy and surgical approach between the experimental and control groups were compared,and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.RESULTS In the experimental group,the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery(P<0.05).The aortomesenteric angle,distance and BMI were significantly higher in the control group than in the experimental(P<0.05).There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups(P>0.05).CONCLUSION The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication.Over-cleaning of lymph fatty tissues may also be associated with this complication.
基金supported by the Fundamental Research Funds for the Central Universities[grant number 226-2022-00009]the National Natural Science Foundation of China[grant numbers 82072624,11932017,and 82103684]+1 种基金the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China[grant number LHDMY22C060002]the Project of the Regional Diagnosis and Treatment Center of the Health Planning Committee[grant number JBZX-201903].
文摘Background:Traditional right hemicolectomy(TRH)is the standard treatment for patients with nonmetastatic right colon cancer.However,the ileocecum,a vital organ with mechanical and immune functions,is removed in these patients regardless of the tumor location.This study aimed to evaluate the technical and oncological safety of laparoscopic ileocecal-sparing right hemicolec-tomy(LISH).Method:Patients who underwent LISH at two tertiary medical centers were matched 1:2 with patients who underwent TRH by pro-pensity score matching based on sex,age,body mass index,tumor location,and disease stage.Data on surgical and perioperative outcomes were collected.Oncological safety was evaluated in a specimen-oriented manner.Lymph nodes(LNs)near the ileocolic ar-tery(ICA)were examined independently in the LISH group.Disease outcomes were recorded for patients who completed one year of follow-up.Results:In all,34 patients in the LISH group and 68 patients in the TRH group were matched.LISH added 8 minutes to the dissection of LNs around the ileocolic vessels(groups 201/201d,202,and 203 LNs),without affecting the total operation time,blood loss,or peri-operative adverse event rate.Compared with TRH,LISH had a comparable lymphadenectomy quality,specimen quality,and safety margin while preserving a more functional bowel.The LISH group had no cases of LN metastasis near the ICA.No difference was detected in the recurrence rate at the 1-year follow-up time point between the two groups.Conclusion:In this dual-center study,LISH presented comparable surgical and oncological safety for patients with hepatic flexure or proximal transverse colon cancer.
文摘BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.
基金Supported by Jiangxi Provincial Natural Science Foundation of China,No.20224BAB206063.
文摘BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with different characteristics.The focus of this study was to investigate the safety and clinical efficacy of three different surgical procedures,namely,robotic-assisted surgery(RAS),handassisted laparoscopic surgery(HALS)and conventional laparoscopic surgery(CLS),for the dissection of malignant tumors of the left hemicolon and the effect of these procedures on long-term prognosis.AIM To determine which procedures are best for patients with malignant tumors of the left hemicolon and the safety and clinical efficacy of three different surgical procedures.METHODS A retrospective analysis of the clinical data of 224 patients with left hemicolonic malignancies admitted to the Department of General Surgery of the First Affiliated Hospital of Nanchang University from June 2015 to June 2024 was conducted.Patient data were analyzed to determine tumor stage,duration of surgery,number of lymph nodes cleared,incidence and severity of postoperative complications,amount of intraoperative bleeding,overall survival(OS),and progressionfree survival.RESULTS The short-term postoperative outcomes after RAS,HALS and CLS were compared.The leukocyte and absolute neutrophil counts on postoperative day 4 were highest after RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The length of postoperative hospital stay was highest after CLS,followed by RAS and then HALS,and the differences were statistically significant(P<0.05).The postoperative recovery time of gastrointestinal function was shortest after HALS,followed by RAS and CLS,which had equal values,and the differences were statistically significant(P<0.05).Hospitalization costs were highest among patients who underwent RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The OS among patients who underwent HALS,CLS,and RAS did not significantly differ(P=0.384).CONCLUSION There were no significant differences between procedures in the number of lymph nodes cleared or OS,and all procedures successfully achieved radical dissection of the malignant tumors.HALS had lower hospitalization costs and shorter postoperative recovery time of gastrointestinal function,and CLS performed between HALS and RAS.Different surgical procedures have varying impacts on the length of postoperative hospital stay and the degree of postoperative inflammation,so selection should be individualized to each patient.
文摘Background:According to previous guidelines,the lymph nodes around the right side of the superior mesenteric artery(SMA)should be dissected and removed en bloc.However,due to the technical challenge and the risk of complications,most surgeons perform the dissection along the axis of the superior mesenteric vein(SMV).Herein,we described an‘artery-first’approach for laparoscopic radical extended right hemicolectomy with complete mesocolic excision(CME).Methods:A total of 22 cases were collected from January to October 2016.The right side of the SMA and SMV were exposed and separated,and the No.203,No.213 and No.223 lymph nodes were dissected en bloc.Toldt’s fascia was dissected and expanded laterally to the ascending colon,cranial to the pancreas head.The caudal root of the mesentery and lateral attachments of the ascending colon were completely mobilized.Results:There were 9 male and 13 female patients,with a mean age of 63.1(range,39–83)years and the mean body mass index was 24.6(range,18.3–37.7)kg/m^(2).The mean operative time was 192.5(range,145–240)minutes and the mean intraoperative blood loss was 55.0(range,10–300)ml.The mean number of harvested lymph nodes was 27.0(range,13–55)and the time to flatus and hospital stay were 35.0(range,26–120)hours and 7.5(range,5–20)days,respectively.Minor complications occurred in two patients and no post-operative death was observed.Conclusions:The preliminary results suggest that the reported approach may be a feasible and safe procedure that is more in accordance with the principles of CME.
基金This work was supported by Beijing Terry Fox Run Foundation of Cancer Foundation of China(No.LC2016B10)Chinese Academy of Medical Sciences Initiative for Innovative Medicine(CAMS-2017-I2M-4-002)Postgraduate Innovation Fund Project of Peking Union Medical College in 2018(2018-1002-02-26).
文摘Background and objective:Intra-corporeal delta-shaped anastomosis(IDA)is an important development in laparoscopic digestive-tract reconstruction.We applied it in laparoscopic right hemicolectomy for right colon cancer and compared the short-term outcomes between the patients treated with IDA and conventional extracorporeal anastomosis(EA).Methods:Between 1 January 2016 and 1 October 2017,36 and 50 patients who underwent IDA and EA,respectively,were included.Data on clinicopathological characteristics,surgical outcomes,post-operative recovery and complications were collected and compared between the two groups.Results:Surgical outcomes and clinicopathological characteristics were similar between the two groups except the length of incision,which was significantly shorter in the IDA group than in the EA group(4.660.6 vs 5.660.7 cm,P<0.001).The time to ground activities,fluid diet intake and post-operative hospitalization did not differ between the groups;however,the time to first flatus was significantly shorter in the IDA group than in the EA group(2.860.5 vs 3.260.8 days,P=0.004).The post-operative visual analogue scale for pain was lower in the IDA group than in the EA group on post-operative Day 1(4.060.7 vs 4.561.0,P=0.002)and post-operative Day 3(2.760.6 vs 3.460.6,P<0.001).The surgical complication rates were 8.3 and 16.0%in the IDA and EA groups(P=0.470),respectively.No complications such as anastomotic bleeding,stenosis and leakage occurred in any patient.Conclusions:IDA is safe and feasible and shows more satisfactory short-term outcomes than EA.
