The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors （GISTs） would produce better perioperative and similar oncologic outcomes compared with open...The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors （GISTs） would produce better perioperative and similar oncologic outcomes compared with open surgical resection in Chinese patients. Thirty-six gastric GISTs cases were divided into a minimally invasive laparoscopic group and open resection group, depending on the surgical approach that was used. The general preoperative information, operative time, incision length, intraoperative blood loss, postoperative time to first flatulence, postoperative complications, postoperative hospital stay, total hospitalization costs, and such follow-up data as recurrence, metastasis, and mortality rates were compared between two groups. Among the 36 gastric GISTs, 15 received laparoscopic surgical treatment （laparoscopy group, n=15）, and 21 received routine open resection treatment （open resection group, n=21）. The laparoscopy group and the open resection group showed statistically significant differences （P〈0.05） in incision length （7.8±2.3 vs. 16.9±3.8 cm）, postoperative time to first flatulence （3.8±1.3 vs. 5.1±2.1 d）, postoperative hospitalization time （7.6±2.5 vs. 11.3±3.7 d）, and total cost of hospitalization （RMB 28,239±5,521 vs. RMB 23,761±5,362）. There were no statistically significant differences （P〉0.05） between the laparoscopy group and the open resection group in operative time （147.8±59.3 vs. 139.2±62.1 min） and intraoperative blood loss （149.8±98.9 VS. 154.2±99.3 mL）. Both groups had no postoperative complications, no recurrence and metastasis, and no postoperative mortality. There were no statistically significant differences between the two groups in postoperative complications, postoperative recurrence and metastasis, and postoperative mortality. In conclusion, compared with open resection, the laparoscopic resection of gastric GISTs offers the advantages of less trauma, faster recovery, and shorter hospital stay.展开更多
Background:Laparoscopic resection(LR)of perihilar cholangiocarcinoma(pCCA)is still in the exploratory stage due to its exacting technical requirements,and its feasibility remains controversial.The objective of this st...Background:Laparoscopic resection(LR)of perihilar cholangiocarcinoma(pCCA)is still in the exploratory stage due to its exacting technical requirements,and its feasibility remains controversial.The objective of this study was to compare the short-and long-term outcomes of LR and open resection(OR)of pCCA.Methods:This study analyzed the data of pCCA patients who underwent LR or OR from January 2012 to January 2020 at Southwest Hospital.Inverse probability of treatment weighting(IPTW)and propensity score matching(PSM)were used to balance the baseline characteristics between the LR and OR groups.The short-and long-term outcomes were compared between the LR and OR groups.Results:Forty-five patients in the LR group and 243 in the OR group were analyzed.After IPTW and PSM,the amount of intraoperative blood loss,incidence of surgical site infections(SSIs),length of stay(LOS),and number of perioperative blood transfusions(PBTs)were significantly lower in the LR group than in the OR group(after IPTW:P<0.001,P=0.009,P=0.01,P<0.001 respectively;after PSM:P<0.001,P=0.003,P=0.03,P=0.04 respectively).Only after IPTW was the 30-day mortality rate significantly lower in the LR group than in the OR group(P=0.005).There was no significant difference in overall survival(OS)or recurrence-free survival(RFS)between the two groups after IPTW or PSM.Conclusions:LR of pCCA is an achievable procedure whose long-term outcomes are similar to those of OR,and LR outperforms OR in short-term outcomes such as intraoperative blood loss,SSI,LOS,30-day mortality,and PBTs.It is believed that it is safe and feasible to treat pCCA with LR after rigorous patient selection.展开更多
Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlyi...Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlying mechanisms are not clear.This study was to find out whether systemic inflammation plays an important role.Methods:A total of 103 patients with early-stage HCC under liver resection were enrolled(LLR group,n=53;OLR group,n=50).The expression of 9 inflammatory cytokines in patients at preoperation,postoperative day 1(POD1)and POD7 was quantified by Luminex Multiplex assay.The relationships of the cytokines and the postoperative outcomes were compared between LLR and OLR.Results:Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative levels.Compared to OLR,the POD1 levels of granulocytemacrophage colony-stimulating factor(GM-CSF),interleukin-6(IL-6),IL-8,and monocyte chemoattractant protein-1(MCP-1)in the LLR group were significantly lower.Higher POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during operation.The levels of these cytokines were positively associated with postoperative liver injury,and the length of hospital stay.Importantly,a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver resection.Conclusions:Significantly lower level of GM-CSF,IL-6,IL-8,and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.展开更多
AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citat...AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.展开更多
AIM: To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.
BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still con...BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still controversial.AIM To compare laparoscopic radical resection(LRR)with traditional open radical resection(ORR)in managing GBC.METHODS A comprehensive search of online databases,including Medline(PubMed),Cochrane Library,and Web of Science,was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023.A meta-analysis was subsequently performed.RESULTS A total of 18 retrospective studies were identified.In the long-term prognosis,the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival(TFS).LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis(TNM)Ⅱstage subgroup vs the ORR group(P=0.04).In the short-term prognosis,the LRR group had superiority over the ORR group in the postoperative length of stay(POLS)(P<0.001).The sensitivity analysis showed that all pooled results were robust.CONCLUSION The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNMⅡdisease and POLS.Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.展开更多
Objective: to explore the application value of open fistula resection in anal fistula surgery. Methods: 108 patients with anal fistula were selected from June 2019 to June 2020, 54 patients with traditional fistulecto...Objective: to explore the application value of open fistula resection in anal fistula surgery. Methods: 108 patients with anal fistula were selected from June 2019 to June 2020, 54 patients with traditional fistulectomy as control group and 54 patients with open fistulectomy as observation group. Results: the hospitalization time, wound healing time and VAS score of the observation group were (8.61 ± 2.15) d, (17.24 ± 2.93) D and (1.92 ± 0.65) d respectively, which were lower than those of the control group (P < 0.05);the incidence of complications in the observation group and the control group were 1.85% (1 case) and 12.96% (7 cases), lower in the observation group, and P < 0.05;the treatment satisfaction in the observation group and the control group were 96.30% (52 cases) and 79.63% (43 cases), respectively, with significant difference between the two groups, P < 0.05. Conclusion: the effect of open fistulectomy in the treatment of anal fistula is good, the pain is light, the pain is small, the postoperative recovery is fast, the complications are less, and the patient's nursing satisfaction is also relatively high, it is recommended to be popularized in clinic.Keywords: open fistula resection;anal fistula surgery;therapeutic effect;pain;postoperative recovery;postoperative complications;satisfaction展开更多
AIM To review evidence on the short-term clinical outcomes of laparoscopic(LRR) vs open rectal resection(ORR) for rectal cancer.METHODS A systematic literature search was performed using Cochrane Central Register, MED...AIM To review evidence on the short-term clinical outcomes of laparoscopic(LRR) vs open rectal resection(ORR) for rectal cancer.METHODS A systematic literature search was performed using Cochrane Central Register, MEDLINE, EMBASE, Scopus, Open Grey and Clinical Trials.gov register for randomized clinical trials(RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes. Articles published in English from January 1, 1995 to June, 30 2016 that met the selection criteria were retrieved and reviewed. The Preferred Reporting Items for Systematic reviews and Meta-Analysis(PRISMA) statements checklist for reporting a systematic review was followed. Random-effect models were used to estimate mean differences and risk ratios. The robustness and heterogeneity of the results were explored by performing sensitivity analyses. The pooledeffect was considered significant when P < 0.05.RESULTS Overall, 14 RCTs were included. No differences were found in postoperative mortality(P = 0.19) and morbidity(P = 0.75) rates. The mean operative time was 36.67 min longer(95%CI: 27.22-46.11, P < 0.00001), the mean estimated blood loss was 88.80 ml lower(95%CI:-117.25 to-60.34, P < 0.00001), and the mean incision length was 11.17 cm smaller(95%CI:-13.88 to-8.47, P < 0.00001) for LRR than ORR. These results were confirmed by sensitivity analyses that focused on the four major RCTs. The mean length of hospital stay was 1.71 d shorter(95%CI:-2.84 to-0.58, P < 0.003) for LRR than ORR. Similarly, bowel recovery(i.e., day of the first bowel movement) was 0.68 d shorter(95%CI:-1.00 to-0.36, P < 0.00001) for LRR. The sensitivity analysis did not confirm a significant difference between LRR and ORR for these latter two parameters. The overall quality of the evidence was rated as high. CONCLUSION LRR is associated with lesser blood loss, smaller incision length, and longer operative times compared to ORR. No differences are observed for postoperative morbidity and mortality.展开更多
BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resecti...BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor site.RESULTS： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs 1.There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group.CONCLUSIONS： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.展开更多
Background:It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients.However,what type of procedures can benefit most from a laparoscopic approach has been inve...Background:It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients.However,what type of procedures can benefit most from a laparoscopic approach has been investigated poorly thus far.The aim of this study is thus to define the extent of advantages of laparoscopic over open liver surgery for lesions in the anterolateral(AL)and posterosuperior(PS)segments.Methods:In this international multicentre retrospective cohort study,laparoscopic and open minor liver resections for lesions in the AL and PS segments were compared after propensity score matching.The differential benefit of laparoscopy over open liver surgery,calculated using bootstrap sampling,was compared between AL and PS resections and expressed as a Delta of the differences.Results:After matching,3,040 AL and 2,336 PS resections were compared,encompassing open and laparoscopic procedures in a 1:1 ratio.AL and PS laparoscopic liver resections were more advantageous in comparison to open in terms of blood loss,transfusion rate,complications,and length of stay.However,AL resections benefitted more from laparoscopy than PS in terms of overall and severe complications(D-difference were 4.8%,P=0.046 and 3%,P=0.046)and blood loss(D-difference was 195 mL,P<0.001).Similar results were observed in the subset for high-volume centres,while in recent years no significant differences were found in the differential benefit between AL and PS segments.Conclusions:The advantage of laparoscopic over open liver surgery is greater in the AL segments than in the PS segments.展开更多
Despite established evidence on the advantages of laparoscopy in colon cancer resection,the use of laparoscopy for rectal cancer resection is still controversial.The initial concern was mainly regarding the feasibilit...Despite established evidence on the advantages of laparoscopy in colon cancer resection,the use of laparoscopy for rectal cancer resection is still controversial.The initial concern was mainly regarding the feasibility of laparoscopy to achieve an adequate total mesorectal excision specimen.These concerns have been raised following early studies demonstrating higher rates of circumferential margins positivity following laparoscopic resection,as compared to open surgery.Similar to colon resection,patients undergoing laparoscopic rectal cancer resection are expected to benefit from a shorter length of hospital stay,less analgesic requirements,and a faster recovery of bowel function.In the past decade there have been an increasing number of large scale clinical trials investigating the oncological and perioperative outcomes of laparoscopic rectal cancer resection.In this review we summarize the current literature available on laparoscopic rectal cancer surgery.展开更多
Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatect...Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffu- sion. Additional researches are necessary to determine the best technique to improve the procedure results.展开更多
Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open l...Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.展开更多
Objective: This paper aims to observe the high-quality care activities for patients with radical gallbladder cancer, and to understand the pain and complications. Methods: Observation object: 62 patients with open gal...Objective: This paper aims to observe the high-quality care activities for patients with radical gallbladder cancer, and to understand the pain and complications. Methods: Observation object: 62 patients with open gallbladder cancer. Collection time: January 2020 to October 2021. Group according to the random number table method, KR group (routine nursing mode intervention), MA group (high-quality nursing mode intervention), to ensure that 31 patients in each group. Postoperative pain, complication rate, quality of care, quality of life, and psychological status in the two groups were observed. Results: Comparison of pain conditions, The VAS score of the MA group was a (1.24 ± 0.15) score, The KR group is (1.85 ± 0.36) points, The former is even lower (t8.709, P<0.05);Comparison of the complication rates, One case in the MA group, For 3.23%, In the KR group, in 7 cases, For 22.58%, The former is even lower (25.167, P<0.05);Quality of care comparison, Better in the MA group (231.083,22.810,30.357,33.219), (P<0.05);Comparison of the quality of life between the two patient groups, Better in the MA group (216.395,27.904,20.453,12.597), (P<0.05);Comparison of the psychological conditions, The SAS and SDS scores were even lower in the MA group (220.855,33.117, P<0.05). Conclusion: High-quality nursing activities in the perioperative nursing of patients with open gallbladder cancer, reduce the rate of complications, and improve the quality of patients.展开更多
Background:It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients.However,what type of procedures can benefit most from a laparoscopic approach has been inve...Background:It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients.However,what type of procedures can benefit most from a laparoscopic approach has been investigated poorly thus far.The aim of this study is thus to define the extent of advantages of laparoscopic over open liver surgery for lesions in the anterolateral(AL)and posterosuperior(PS)segments.Methods:In this international multicentre retrospective cohort study,laparoscopic and open minor liver resections for lesions in the AL and PS segments were compared after propensity score matching.The differential benefit of laparoscopy over open liver surgery,calculated using bootstrap sampling,was compared between AL and PS resections and expressed as a Delta of the differences.Results:After matching,3,040 AL and 2,336 PS resections were compared,encompassing open and laparoscopic procedures in a 1:1 ratio.AL and PS laparoscopic liver resections were more advantageous in comparison to open in terms of blood loss,transfusion rate,complications,and length of stay.However,AL resections benefitted more from laparoscopy than PS in terms of overall and severe complications(D-difference were 4.8%,P=0.046 and 3%,P=0.046)and blood loss(D-difference was 195 mL,P<0.001).Similar results were observed in the subset for high-volume centres,while in recent years no significant differences were found in the differential benefit between AL and PS segments.Conclusions:The advantage of laparoscopic over open liver surgery is greater in the AL segments than in the PS segments.展开更多
文摘The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors （GISTs） would produce better perioperative and similar oncologic outcomes compared with open surgical resection in Chinese patients. Thirty-six gastric GISTs cases were divided into a minimally invasive laparoscopic group and open resection group, depending on the surgical approach that was used. The general preoperative information, operative time, incision length, intraoperative blood loss, postoperative time to first flatulence, postoperative complications, postoperative hospital stay, total hospitalization costs, and such follow-up data as recurrence, metastasis, and mortality rates were compared between two groups. Among the 36 gastric GISTs, 15 received laparoscopic surgical treatment （laparoscopy group, n=15）, and 21 received routine open resection treatment （open resection group, n=21）. The laparoscopy group and the open resection group showed statistically significant differences （P〈0.05） in incision length （7.8±2.3 vs. 16.9±3.8 cm）, postoperative time to first flatulence （3.8±1.3 vs. 5.1±2.1 d）, postoperative hospitalization time （7.6±2.5 vs. 11.3±3.7 d）, and total cost of hospitalization （RMB 28,239±5,521 vs. RMB 23,761±5,362）. There were no statistically significant differences （P〉0.05） between the laparoscopy group and the open resection group in operative time （147.8±59.3 vs. 139.2±62.1 min） and intraoperative blood loss （149.8±98.9 VS. 154.2±99.3 mL）. Both groups had no postoperative complications, no recurrence and metastasis, and no postoperative mortality. There were no statistically significant differences between the two groups in postoperative complications, postoperative recurrence and metastasis, and postoperative mortality. In conclusion, compared with open resection, the laparoscopic resection of gastric GISTs offers the advantages of less trauma, faster recovery, and shorter hospital stay.
基金supported by Chongqing‘Direct Ph.D.Express’Research Project(CSTB2022BSXM-JCX0017)Chongqing Natural Science Foundation General Project(CSTB2022NSCQ-MSX0204).
文摘Background:Laparoscopic resection(LR)of perihilar cholangiocarcinoma(pCCA)is still in the exploratory stage due to its exacting technical requirements,and its feasibility remains controversial.The objective of this study was to compare the short-and long-term outcomes of LR and open resection(OR)of pCCA.Methods:This study analyzed the data of pCCA patients who underwent LR or OR from January 2012 to January 2020 at Southwest Hospital.Inverse probability of treatment weighting(IPTW)and propensity score matching(PSM)were used to balance the baseline characteristics between the LR and OR groups.The short-and long-term outcomes were compared between the LR and OR groups.Results:Forty-five patients in the LR group and 243 in the OR group were analyzed.After IPTW and PSM,the amount of intraoperative blood loss,incidence of surgical site infections(SSIs),length of stay(LOS),and number of perioperative blood transfusions(PBTs)were significantly lower in the LR group than in the OR group(after IPTW:P<0.001,P=0.009,P=0.01,P<0.001 respectively;after PSM:P<0.001,P=0.003,P=0.03,P=0.04 respectively).Only after IPTW was the 30-day mortality rate significantly lower in the LR group than in the OR group(P=0.005).There was no significant difference in overall survival(OS)or recurrence-free survival(RFS)between the two groups after IPTW or PSM.Conclusions:LR of pCCA is an achievable procedure whose long-term outcomes are similar to those of OR,and LR outperforms OR in short-term outcomes such as intraoperative blood loss,SSI,LOS,30-day mortality,and PBTs.It is believed that it is safe and feasible to treat pCCA with LR after rigorous patient selection.
基金This study was supported by Shenzhen Fundamental Research Program-General Program(No.JCYJ20210324114403010).
文摘Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlying mechanisms are not clear.This study was to find out whether systemic inflammation plays an important role.Methods:A total of 103 patients with early-stage HCC under liver resection were enrolled(LLR group,n=53;OLR group,n=50).The expression of 9 inflammatory cytokines in patients at preoperation,postoperative day 1(POD1)and POD7 was quantified by Luminex Multiplex assay.The relationships of the cytokines and the postoperative outcomes were compared between LLR and OLR.Results:Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative levels.Compared to OLR,the POD1 levels of granulocytemacrophage colony-stimulating factor(GM-CSF),interleukin-6(IL-6),IL-8,and monocyte chemoattractant protein-1(MCP-1)in the LLR group were significantly lower.Higher POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during operation.The levels of these cytokines were positively associated with postoperative liver injury,and the length of hospital stay.Importantly,a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver resection.Conclusions:Significantly lower level of GM-CSF,IL-6,IL-8,and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.
文摘AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.
文摘AIM: To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.
文摘BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still controversial.AIM To compare laparoscopic radical resection(LRR)with traditional open radical resection(ORR)in managing GBC.METHODS A comprehensive search of online databases,including Medline(PubMed),Cochrane Library,and Web of Science,was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023.A meta-analysis was subsequently performed.RESULTS A total of 18 retrospective studies were identified.In the long-term prognosis,the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival(TFS).LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis(TNM)Ⅱstage subgroup vs the ORR group(P=0.04).In the short-term prognosis,the LRR group had superiority over the ORR group in the postoperative length of stay(POLS)(P<0.001).The sensitivity analysis showed that all pooled results were robust.CONCLUSION The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNMⅡdisease and POLS.Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.
文摘Objective: to explore the application value of open fistula resection in anal fistula surgery. Methods: 108 patients with anal fistula were selected from June 2019 to June 2020, 54 patients with traditional fistulectomy as control group and 54 patients with open fistulectomy as observation group. Results: the hospitalization time, wound healing time and VAS score of the observation group were (8.61 ± 2.15) d, (17.24 ± 2.93) D and (1.92 ± 0.65) d respectively, which were lower than those of the control group (P < 0.05);the incidence of complications in the observation group and the control group were 1.85% (1 case) and 12.96% (7 cases), lower in the observation group, and P < 0.05;the treatment satisfaction in the observation group and the control group were 96.30% (52 cases) and 79.63% (43 cases), respectively, with significant difference between the two groups, P < 0.05. Conclusion: the effect of open fistulectomy in the treatment of anal fistula is good, the pain is light, the pain is small, the postoperative recovery is fast, the complications are less, and the patient's nursing satisfaction is also relatively high, it is recommended to be popularized in clinic.Keywords: open fistula resection;anal fistula surgery;therapeutic effect;pain;postoperative recovery;postoperative complications;satisfaction
文摘AIM To review evidence on the short-term clinical outcomes of laparoscopic(LRR) vs open rectal resection(ORR) for rectal cancer.METHODS A systematic literature search was performed using Cochrane Central Register, MEDLINE, EMBASE, Scopus, Open Grey and Clinical Trials.gov register for randomized clinical trials(RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes. Articles published in English from January 1, 1995 to June, 30 2016 that met the selection criteria were retrieved and reviewed. The Preferred Reporting Items for Systematic reviews and Meta-Analysis(PRISMA) statements checklist for reporting a systematic review was followed. Random-effect models were used to estimate mean differences and risk ratios. The robustness and heterogeneity of the results were explored by performing sensitivity analyses. The pooledeffect was considered significant when P < 0.05.RESULTS Overall, 14 RCTs were included. No differences were found in postoperative mortality(P = 0.19) and morbidity(P = 0.75) rates. The mean operative time was 36.67 min longer(95%CI: 27.22-46.11, P < 0.00001), the mean estimated blood loss was 88.80 ml lower(95%CI:-117.25 to-60.34, P < 0.00001), and the mean incision length was 11.17 cm smaller(95%CI:-13.88 to-8.47, P < 0.00001) for LRR than ORR. These results were confirmed by sensitivity analyses that focused on the four major RCTs. The mean length of hospital stay was 1.71 d shorter(95%CI:-2.84 to-0.58, P < 0.003) for LRR than ORR. Similarly, bowel recovery(i.e., day of the first bowel movement) was 0.68 d shorter(95%CI:-1.00 to-0.36, P < 0.00001) for LRR. The sensitivity analysis did not confirm a significant difference between LRR and ORR for these latter two parameters. The overall quality of the evidence was rated as high. CONCLUSION LRR is associated with lesser blood loss, smaller incision length, and longer operative times compared to ORR. No differences are observed for postoperative morbidity and mortality.
文摘BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor site.RESULTS： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs 1.There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group.CONCLUSIONS： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.
文摘Background:It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients.However,what type of procedures can benefit most from a laparoscopic approach has been investigated poorly thus far.The aim of this study is thus to define the extent of advantages of laparoscopic over open liver surgery for lesions in the anterolateral(AL)and posterosuperior(PS)segments.Methods:In this international multicentre retrospective cohort study,laparoscopic and open minor liver resections for lesions in the AL and PS segments were compared after propensity score matching.The differential benefit of laparoscopy over open liver surgery,calculated using bootstrap sampling,was compared between AL and PS resections and expressed as a Delta of the differences.Results:After matching,3,040 AL and 2,336 PS resections were compared,encompassing open and laparoscopic procedures in a 1:1 ratio.AL and PS laparoscopic liver resections were more advantageous in comparison to open in terms of blood loss,transfusion rate,complications,and length of stay.However,AL resections benefitted more from laparoscopy than PS in terms of overall and severe complications(D-difference were 4.8%,P=0.046 and 3%,P=0.046)and blood loss(D-difference was 195 mL,P<0.001).Similar results were observed in the subset for high-volume centres,while in recent years no significant differences were found in the differential benefit between AL and PS segments.Conclusions:The advantage of laparoscopic over open liver surgery is greater in the AL segments than in the PS segments.
文摘Despite established evidence on the advantages of laparoscopy in colon cancer resection,the use of laparoscopy for rectal cancer resection is still controversial.The initial concern was mainly regarding the feasibility of laparoscopy to achieve an adequate total mesorectal excision specimen.These concerns have been raised following early studies demonstrating higher rates of circumferential margins positivity following laparoscopic resection,as compared to open surgery.Similar to colon resection,patients undergoing laparoscopic rectal cancer resection are expected to benefit from a shorter length of hospital stay,less analgesic requirements,and a faster recovery of bowel function.In the past decade there have been an increasing number of large scale clinical trials investigating the oncological and perioperative outcomes of laparoscopic rectal cancer resection.In this review we summarize the current literature available on laparoscopic rectal cancer surgery.
文摘Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffu- sion. Additional researches are necessary to determine the best technique to improve the procedure results.
文摘Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.
文摘Objective: This paper aims to observe the high-quality care activities for patients with radical gallbladder cancer, and to understand the pain and complications. Methods: Observation object: 62 patients with open gallbladder cancer. Collection time: January 2020 to October 2021. Group according to the random number table method, KR group (routine nursing mode intervention), MA group (high-quality nursing mode intervention), to ensure that 31 patients in each group. Postoperative pain, complication rate, quality of care, quality of life, and psychological status in the two groups were observed. Results: Comparison of pain conditions, The VAS score of the MA group was a (1.24 ± 0.15) score, The KR group is (1.85 ± 0.36) points, The former is even lower (t8.709, P<0.05);Comparison of the complication rates, One case in the MA group, For 3.23%, In the KR group, in 7 cases, For 22.58%, The former is even lower (25.167, P<0.05);Quality of care comparison, Better in the MA group (231.083,22.810,30.357,33.219), (P<0.05);Comparison of the quality of life between the two patient groups, Better in the MA group (216.395,27.904,20.453,12.597), (P<0.05);Comparison of the psychological conditions, The SAS and SDS scores were even lower in the MA group (220.855,33.117, P<0.05). Conclusion: High-quality nursing activities in the perioperative nursing of patients with open gallbladder cancer, reduce the rate of complications, and improve the quality of patients.
基金Henan Provincial Medical Science and Technology Research Project(LLRGJ20220191)Key Scientific Research Project of Colleges and Universities in Henan Province(23A320033)+4 种基金Henan Provincial Science and Technology Project(232102311080)National Natural Science Foundation of China(82141127)CAMS Innovation Fund for Medical Sciences(CIFMS)(2021-I2M-C&T-B-057)National Key Research and Development Program of China(2023YFC3403800)e Natural Science Foundation of Shandong Province(ZR2020QH177).
文摘Background:It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients.However,what type of procedures can benefit most from a laparoscopic approach has been investigated poorly thus far.The aim of this study is thus to define the extent of advantages of laparoscopic over open liver surgery for lesions in the anterolateral(AL)and posterosuperior(PS)segments.Methods:In this international multicentre retrospective cohort study,laparoscopic and open minor liver resections for lesions in the AL and PS segments were compared after propensity score matching.The differential benefit of laparoscopy over open liver surgery,calculated using bootstrap sampling,was compared between AL and PS resections and expressed as a Delta of the differences.Results:After matching,3,040 AL and 2,336 PS resections were compared,encompassing open and laparoscopic procedures in a 1:1 ratio.AL and PS laparoscopic liver resections were more advantageous in comparison to open in terms of blood loss,transfusion rate,complications,and length of stay.However,AL resections benefitted more from laparoscopy than PS in terms of overall and severe complications(D-difference were 4.8%,P=0.046 and 3%,P=0.046)and blood loss(D-difference was 195 mL,P<0.001).Similar results were observed in the subset for high-volume centres,while in recent years no significant differences were found in the differential benefit between AL and PS segments.Conclusions:The advantage of laparoscopic over open liver surgery is greater in the AL segments than in the PS segments.
