BACKGROUND Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality.Surgical intervention remains the cornerstone for curative treatment.However,Due to the complexity of these proced...BACKGROUND Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality.Surgical intervention remains the cornerstone for curative treatment.However,Due to the complexity of these procedures,patients often experience postoperative complications.Prehabilitation has been suggested as a tool to decrease postoperative morbidity and improve recovery by optimising patients preoperatively to handle the stress of surgery.AIM To evaluate the effectiveness of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation before hepatic,biliary,or pancreatic cancer resections.All data were analysed using Review Manager Software 5.4,and the metaanalysis was performed with a random-effect model analysis.RESULTS A total of 8 studies were included(n=568),recruiting adult patients undergoing hepatic,biliary,or pancreatic cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation[risk ratio(RR):0.79,95%CI:0.66-0.95,Z=2.52,P=0.01].No statistically significant difference was found in postoperative readmission rate(RR:1.31,95%CI:0.79-2.17,Z=1.05,P=0.29),major complications(RR:1.08;95%CI:0.61-1.92,Z=0.28,P=0.78),length of stay(standardised mean difference:-0.11,95%CI:-0.31 to 0.1,Z=1.05,P=0.29),or mortality(RR:0.28,95%CI:0.01-6.51,Z=0.79,P=0.43).CONCLUSION Prehabilitation was found to be effective in reducing postoperative complications following surgical intervention for hepatobiliary or pancreatic cancer.展开更多
BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,...BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,these procedures are associated with significant postoperative morbidity and prolonged recovery times.Prehabilitation aims to combat this by physically and psychologically optimising patients preoperatively to handle the stress of surgery and improve postoperative outcomes.AIM To evaluate the effectiveness of prehabilitation in patients undergoing gastric or oesophageal cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation in patients undergoing gastric or oesophageal cancer resections.All data were analysed using Review Manager Software 5.4,and the meta-analysis was performed with a random-effect model analysis.RESULTS A total of 16 studies were included(n=1479),recruiting adult patients undergoing gastric or oesophageal cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation(Odds ratio:0.43,95%CI:0.31-0.58,Z=25.28,P<0.00001).Additionally,prehabilitation was associated with a lower postoperative readmission rate(risk ratio:0.58,95%CI:0.35-0.96,Z=2.10,P=0.04)and a shorter length of stay[standardised mean difference(SMD):-0.19,95%CI:-0.37 to-0.02,Z=2.21,P=0.03]compared to no-prehabilitation.Prehabilitation was also found to improve preoperative 6-minute walking distance(6-MWD)compared to no-prehabilitation(SMD:0.72,95%CI:0.21-1.23,Z=2.75,P=0.006).No statistical difference was found in postoperative 6-MWD,mortality,and severe complications.CONCLUSION Prehabilitation was found to be effective in reducing postoperative morbidity and improving preoperative physical health in patients undergoing gastric or oesophageal cancer resections.展开更多
BACKGROUND In endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),submucosal lifting agents such as crystalloid-oil emulsion solution(COES)are used for improved effect.Starch-based polysaccharid...BACKGROUND In endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),submucosal lifting agents such as crystalloid-oil emulsion solution(COES)are used for improved effect.Starch-based polysaccharide solution(SPS),which in powder form acts as effective hemostatic agent,are now available as an alternative lifting agent.AIM To compare SPS to COES outcomes as lifting agents in colonic EMR and ESD.METHODS This is a retrospective study of patients who underwent colonic EMR or ESD and received submucosal injection of either SPS or COES at a single academic center from March 2021 to November 2023.A total of 79 patients were included in the COES group and 99 patients in the SPS group from chart review.Intraprocedural bleeding was defined as bleeding during a procedure requiring hemostatic intervention.Adverse events included were perforation or post-procedure gastrointestinal bleed within the first 30-day period.Data were analyzed using t-test and χ^(2) test.RESULTS Successful resection was achieved in all 178 patients.Average lesion size in SPS group was 2.6 cm vs 2.4 cm in COES group.Average procedure time was 22 minutes shorter in the SPS group(P<0.05).Intraprocedural bleeding was 24.1%more frequent in COES group(P<0.01).The 30-day adverse events were 9.37%more frequent in the COES group(P<0.01).En bloc resection was achieved 22.2%more frequently in patients receiving SPS submucosal injection(P<0.01).CONCLUSION SPS colonic submucosal injection appears to be beneficial over COES,as it is associated with lower intraprocedural bleeding,less adverse events,shorter procedures,and more frequent en bloc resections.展开更多
Intraductal papillary mucinous neoplasms(IPMNs) can involve the main pancreatic duct(MD-IPMNs) or its secondary branches(BD-IPMNs) in a segmental of multifocal/diffuse fashion.Growing evidence indicates that BDIPMNs a...Intraductal papillary mucinous neoplasms(IPMNs) can involve the main pancreatic duct(MD-IPMNs) or its secondary branches(BD-IPMNs) in a segmental of multifocal/diffuse fashion.Growing evidence indicates that BDIPMNs are less likely to harbour cancer and in selected cases these lesions can be managed non operatively.For surgery,clarification is required on:(1) when to resect an IPMN;(2) which type of resection should be performed;and(3) how much pancreas should be resected.In recent years parenchyma-sparing resections as well as laparoscopic procedures have being performed more frequently by pancreatic surgeons in order to decrease the rate of postoperative pancreatic insufficiency and to minimize the surgical impact of these operations.However,oncological radicality is of paramount importance,and extended resections up to total pancreatectomy may be necessary in the setting of IPMNs.In this article the type and extension of surgical resections in patients with MD-IPMNs and BD-IPMNs are analyzed,evaluating perioperative and long-term outcomes.The role of standard and parenchyma-sparing resections is discussed as well as different strategies in the case of multifocal neoplasms.展开更多
Split-Liver and living-related donor liver transplantation are the newest and both technically and ethically most challenging developments in liver transplantation and have contributed to a reduction in donor shortage...Split-Liver and living-related donor liver transplantation are the newest and both technically and ethically most challenging developments in liver transplantation and have contributed to a reduction in donor shortage.We report the technical aspects of surgical procedures performed to achieve a partial graft from a cadaveric and a live donor.展开更多
Objective To review the methods of the stability reconstruction after resections of primary malignant spinal tumors.Methods From January 1999 to January 2009,38 cases of primary malignant spinal turmors underwenttumor
Liver resection for hepatocellular carcinoma(HCC)is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-li...Liver resection for hepatocellular carcinoma(HCC)is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis.The aim of this review is to assess current indications,advantages and limits of laparoscopic surgery for HCC resections.We also discussed the possible evolution of this surgical approach in parallel with new technologies.展开更多
Liver metastasis of colorectal cancer is common. Resection of solitary tumors of primary and metastatic colorectal cancer can have a favorable outcome. Open resection of primary colorectal tumor and liver metastasis i...Liver metastasis of colorectal cancer is common. Resection of solitary tumors of primary and metastatic colorectal cancer can have a favorable outcome. Open resection of primary colorectal tumor and liver metastasis in one operation or in separate operations is currently common practice. Reports have shown that synchronous resections do not jeopardize short or long-term surgical outcomes and that this is a safe and effective approach in open surgery. The development of laparoscopic colorectal surgery and laparoscopic hepatectomy has made a minimally invasive surgical approach to treating colorectal cancer with liver metastasis feasible. Synchronous resections of primary colorectal tumor and liver metastasis by laparoscopy have recently been reported. The efficacy and safety of laparoscopic colorectal resection and laparoscopic hepatectomy have been proven separately but synchronous resections by laparoscopy are in hot debate. As it has been shown that open resection of primary colorectal tumor and liver metastasis in one operation results in an equally good short-term outcome when compared with that done in separate operations, laparoscopic resection of the same in one single operation seems to be a good option. Recent evidencehas shown that this new approach is a safe alternative with a shorter hospital stay. Large scale randomized controlled trials are needed to demonstrate the effectiveness of this minimally invasive approach.展开更多
Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection...Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection(OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have dividedthis review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection(LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy(LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.展开更多
AIM To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS Between 9/2002 and 7/2013, 175 consecutive liver resections(n = 101 major anatomical and n = 74 large atypical >...AIM To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS Between 9/2002 and 7/2013, 175 consecutive liver resections(n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients(143 surgeries). Accompanying, 37 wedge resections(specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by waterjet. The median central venous pressure was 4 mmH g(range: 5-14). Data was collected prospectively. RESULTS The median age of patients was 60 years(range: 16-85). Preoperative chemotherapy was used in 70 cases(49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL(range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures(15%). The median weight of anatomically resected liver specimens was 525 g(range: 51-1850 g). One patient died postoperatively. Biliary leakages(n = 5) were treated conservatively. Temporary liver failure occurred in two patients.CONCLUSION Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.展开更多
While pancreatic cancer is still characterized by early systemic spread and poor outcomes,the treatment of this disease has changed significantly in recent years due to major advancements in systemic therapy and advan...While pancreatic cancer is still characterized by early systemic spread and poor outcomes,the treatment of this disease has changed significantly in recent years due to major advancements in systemic therapy and advanced surgical techniques.Broader use of effective neoadjuvant approaches combined with aggressive surgical operations within a multidisciplinary setting has improved outcomes.Borderline resectable pancreatic cancer is characterized by tumor vascular invasion,and is a setting where the combination of potent neoadjuvant chemotherapy and aggressive surgical methods,including vascular resections and reconstructions,shows its full potential.Hopefully,this will lead to improved local control and curative treatment in a number of patients with this aggressive malignancy.展开更多
To evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only. METHODSThe new method of extreme liver resection consists of a two-stage hepatectomy. The first st...To evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only. METHODSThe new method of extreme liver resection consists of a two-stage hepatectomy. The first stage involves a right hepatectomy with middle hepatic vein preservation and induction of left lobe congestion; the second stage involves a left lobectomy. Thus, the remnant liver is represented by the segment 4 only (with or without segment 1, ± S1). Five patients underwent the new two-stage hepatectomy (congestion group). Data from volumetric assessment made before the second stage was compared with that of 10 matched patients (comparison group) that underwent a single-stage right hepatectomy with middle hepatic vein preservation. RESULTSThe two stages of the procedure were successfully carried out on all 5 patients. For the congestion group, the overall volume of the left hemiliver had increased 103% (mean increase from 438 mL to 890 mL) at 4 wk after the first stage of the procedure. Hypertrophy of the future liver remnant (i.e., segment 4 ± S1) was higher than that of segments 2 and 3 (144% vs 54%, respectively, P < 0.05). The median remnant liver volume-to-body weight ratio was 0.3 (range, 0.28-0.40) before the first stage and 0.8 (range, 0.45-0.97) before the second stage. For the comparison group, the rate of hypertrophy of the left liver after right hepatectomy with middle hepatic vein preservation was 116% ± 34%. Hypertrophy rates of segments 2 and 3 (123% ± 47%) and of segment 4 (108% ± 60%, P > 0.05) were proportional. The mean preoperative volume of segments 2 and 3 was 256 ± 64 cc and increased to 572 ± 257 cc after right hepatectomy. Mean preoperative volume of segment 4 increased from 211 ± 75 cc to 439 ± 180 cc after surgery. CONCLUSIONThe proposed method for extreme hepatectomy with preservation of segment 4 only represents a technique that could allow complete resection of multiple bilateral liver metastases.展开更多
BACKGROUND The management of cystic dystrophy of the duodenal wall(CDDW),or groove pancreatitis(GP),remains controversial.Although pancreatoduodenectomy(PD)is considered the most suitable operation for CDDW,pancreas-p...BACKGROUND The management of cystic dystrophy of the duodenal wall(CDDW),or groove pancreatitis(GP),remains controversial.Although pancreatoduodenectomy(PD)is considered the most suitable operation for CDDW,pancreas-preserving duodenal resection(PPDR)has also been suggested as an alternative for the pure form of GP(isolated CDDW).There are no studies comparing PD and PPDR for this disease.AIM To compare the safety,efficacy,and short-and long-term results of PD and PPDR in patients with CDDW.METHODS A retrospective analysis of the clinical,radiologic,pathologic,and intra-and postoperative data of 84 patients with CDDW(2004-2020)and a comparison of the safety and efficacy of PD and PPDR.RESULTS Symptoms included abdominal pain(100%),weight loss(76%),vomiting(30%)and jaundice(18%)and data from computed tomography,magnetic resonance imaging,and endoUS led to the correct preoperative diagnosis in 98.8%of cases.Twelve patients were treated conservatively with pancreaticoenterostomy(n=8),duodenum-preserving pancreatic head resection(n=6),PD(n=44)and PPDR(n=15)without mortality.Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR(93%)and PD(84%)compared to the other treatment modalities(18%).New onset diabetes mellitus and severe exocrine insufficiency occurred after PD(31%and 14%),but not after PPDR.CONCLUSION PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW.The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease.Early detection of CDDW provides an opportunity for pancreas-preserving surgery.展开更多
Colorectal cancer is one of the most prevalent tumours,but with improved treatment and early detection,its prognosis has greatly improved in recent years.However,when the tumour is locally advanced at diagnosis or if ...Colorectal cancer is one of the most prevalent tumours,but with improved treatment and early detection,its prognosis has greatly improved in recent years.However,when the tumour is locally advanced at diagnosis or if there is local recurrence,it is more difficult to perform a complete tumour resection,and there may be a residual macroscopic tumour.In this paper,we review the literature on residual macroscopic tumour resections,concerning both locally advanced primary tumours and recurrences,evaluating the main problems encountered,the treatments applied,the prognosis and future perspectives in this field.展开更多
Objective:The authors present outcomes of robotic liver resections in comparison with open technique questioning the need to have experience of laparoscopy for such procedures before transition to robotic assisted.Mat...Objective:The authors present outcomes of robotic liver resections in comparison with open technique questioning the need to have experience of laparoscopy for such procedures before transition to robotic assisted.Materials and methods:Retrospective review of liver resections done robotically from February 2015 to June 2017 compared to matched control cohort of open cases from January 2012 to December 2016.Results:Twenty-one patients in the study groupwere comparedwithmatched control of 42 open cases(1:2 ratio).The types of procedure were similar in both the groups.There were 4 left lateral hepatectomy,3 left hepatectomy,and 1 left hepatectomy with hepatico-jejunostomy,3 right hepatectomy,3 right posterior sectorectomy,4 bisegmentectomy and 4 mono-segmentectomy.There were 9 patients with primary liver cancer,2 each with livermetastasis and carcinoma gall bladder and 8 patients had benign liver disease.Mean blood losswas 370±311ml in the robotic group compared to 451±330ml in control group(p=0.06).Minor complications developed in 19.0%of robotic cases compared to 40.5%in open surgery,while major complications occurred in 4.7%of robotic cases compared to 7.1%of open cases.Mean hospital staywas 5.3±0.8 days for the robotic group and 7.7±4.2 days for open group(p=0.02).Local tumor recurrence occurred in 1 out of 13 resections done for malignancy in the robotic group and 7 out of 26 in the open group.Conclusion:This study highlights the utility of surgical robots for segmental and complex liver resections with equivalent outcomes and decreased length of hospital stay compared to open surgery without having experience of same with the laparoscopy.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide.With the advances in surgical technology,oncological treatment,and critica...Pancreatic ductal adenocarcinoma(PDAC)is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide.With the advances in surgical technology,oncological treatment,and critical care,extended pancreatic resections including vascular resections have become more frequently performed in specialised centres.Furthermore,the boundaries of resectability continue to be pushed in order to achieve a potentially curative approach in selected patients in combination with neoadjuvant and adjuvant treatment strategies.This review gives an overview on the current state of venous and arterial resections in PDAC surgery with particular attention given to the minimally invasive approach.展开更多
AIM To evaluate disparities in the treatment of hepatocellular carcinoma(HCC) based on gender.METHODS A retrospective database analysis using the Nationwide Inpatient Sample(NIS) was performed between 2010 and 2013. A...AIM To evaluate disparities in the treatment of hepatocellular carcinoma(HCC) based on gender.METHODS A retrospective database analysis using the Nationwide Inpatient Sample(NIS) was performed between 2010 and 2013. Adult patients with a primary diagnosis of hepatocellular carcinoma determined by International Classification of Disease 9(ICD-9) codes were included. Univariate analysis and multivariate logistic regressions were performed to analyze differences in treatment, mortality, features of decompensation, and metastatic disease based on the patient's gender.RESULTS The analysis included 62582 patients with 45908 men and 16674 women. Women were less likely to present with decompensated liver disease(OR = 0.84, P < 0.001) and had less risk of inpatient mortality when compared to men(OR = 0.75, P < 0.001). Women were more likely to receive inpatient resection(OR = 1.31, P < 0.001) or an ablation(OR = 1.22, P = 0.028) than men. There was no significant difference between men and women in regard to liver transplantation and transcatheter arterial chemoembolization(TACE).CONCLUSION Gender impacts treatment for hepatocellular carcinoma. Women are more likely to undergo an ablation or resection then men. Gender disparities in transplantation have resolved.展开更多
Anastomosis is a crucial step in radical cancer surgery. Despite being a daily practice in gastrointestinal surgery, anastomotic leakage (AL) stands as a frequent postoperative complication. Because of increased morbi...Anastomosis is a crucial step in radical cancer surgery. Despite being a daily practice in gastrointestinal surgery, anastomotic leakage (AL) stands as a frequent postoperative complication. Because of increased morbidity, mortality, combined with longer hospital stay, the rate of re-intervention, and poor oncological outcomes, AL is considered the most feared and life-threatening complication after colorectal resections. Furthermore, poor functional outcomes with a higher rate of a permeant stoma in 56% of patients this could negatively affect the patient’s quality of life. This a narrative review which will cover intraoperative anastomotic integrity assessment and preventive measures in order to reduce AL. Although the most important prerequisites for the creation of anastomosis is well-perfused and tension-free anastomosis, surgeons have proposed several preventive measures, which were assumed to reduce the incidence of AL, including antibiotic prophylaxis, intraoperative air leak test, omental pedicle flap, defunctioning stoma, pelvic drain insertion, stapled anastomosis, and general surgical technique. However, lack of clear evidence of which preventive measures is superior over the other combined with the fact that the decision remains based on the surgeon’s choice. Despite the advances in surgical techniques, AL remains a serious health problem associated with increased morbidity, mortality with additional cost. Many preventative measures were employed with no clear evidence supporting the superiority of stapled anastomosis over hand-Sewn anastomosis, coating of the anastomosis, or pelvic drain. Defunctioning stoma, when justified it could decrease the leakage-related complications and the incidence of reoperation. MBP combined with oral antibiotics still recommended.展开更多
BACKGROUND Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevat...BACKGROUND Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevated morbidity rates are not clearly defined. AIM To systematically review the literature on oncologic long-term outcomes and morbidity and mortality in cancer surgery a systematic review of the literature was performed. METHODS PubMed was searched for relevant articles (published from 2000 to 2018). Retrieved abstracts were independently screened for relevance and data were extracted from selected studies by two researchers. RESULTS Included were 37 studies with 3112 patients receiving MVR for colorectal cancer (1095 for colon cancer, 1357 for rectal cancer, and in 660 patients origin was not specified). The most common resected organs were the small intestine, bladder and reproductive organs. Median postoperative morbidity rate was 37.9%(range: 7% to 76.6%) and median postoperative mortality rate was 1.3%(range: 0% to 10%). The median conversion rate for laparoscopic MVR was 7.9%(range: 4.5% to 33%). The median blood loss was lower after laparoscopic MVR compared to the open approach (60 mL vs 638 mL). Lymph-node harvest after laparoscopic MVR was comparable. Report on survival rates was heterogeneous, but the 5-year overall-survival rate ranged from 36.7% to 90%, being worst in recurrent rectalcancer patients with a median 5-year overall survival of 23%. R0 -resection, primary disease setting and no lymph-node or lymphovascular involvement were the strongest predictors for long-term survival. The presence of true malignant adhesions was not exclusively associated with poorer prognosis. Included were 16 studies with 1.600 patients receiving MVR for gastric cancer. The rate of morbidity ranged from 11.8% to 59.8%, and the main postoperative complications were pancreatic fistulas and pancreatitis, anastomotic leakage, cardiopulmonary events and post-operative bleedings. Total mortality was between 0% and 13.6% with an R0 -resection achieved in 38.4% to 100% of patients. Patients after R0 resection had 5-year overall survival rates of 24.1% to 37.8%. CONCLUSION MVR provides, in a selected subset of patients, the possibility for good long-term results with acceptable morbidity rates. Unlikelihood of achieving R0 -status, lymphovascular- and lymph -node involvement, recurrent disease setting and the presence of metastatic disease should be regarded as relative contraindications for MVR.展开更多
Background: In traditional laparoscopic colorectal cancer surgery, the surgeon’s method assess intestinal stumps blood supply is subject to certain subjectivity and blindness. Indocyanine green (ICG) real-time blood ...Background: In traditional laparoscopic colorectal cancer surgery, the surgeon’s method assess intestinal stumps blood supply is subject to certain subjectivity and blindness. Indocyanine green (ICG) real-time blood perfusion fluorescence angiography in laparoscopic radical resection of rectal cancer has great potential clinical value and can visually judge intestinal tract blood supply to improve the surgery safety, reduce postoperative complications, and ensure the recovery of patients after surgery. Objective: To explore the efficacy of the intraoperative use of indocyanine-green fluorescence angiography in laparoscopic rectal resections in patients with rectal cancer. Methods: In the present study, 109 rectal cancer patients were included and assigned to different surgical groups [ICG and control groups] for analysis. Statistical analysis was carried out for various common postoperative complications in the two groups. Finally, the patients in the ICG fluorescence imaging group had a timely adjustment of the proximal resection of the intestinal tube before the proximal bowel of the lesion was cut off when the intestinal blood supply was insufficiently assessed by fluorescence imaging. Two subgroups, the adjustment and the non-adjustment groups, were analyzed. Results: Compared with the control group, the postoperative anal ventilation time in the ICG group was shorter than that in the control group (P 0.05). In addition, the postoperative complications were lower than those in the control group, and the differences were statistically significant (P 0.05). However, the distance between the tumor from the anal verge in the adjustment group was smaller than that in the non-adjustment group, and the difference was statistically significant (P 0.01). Conclusion: Compared with conventional laparoscopic radical resection of rectal cancer, ICG real-time indocyanine green fluore- scence angiography was safe and feasible. This technique is a promising intraoperative tool for the assessment of bowel perfusion especially suitable for patients with lower rectal cancer.展开更多
文摘BACKGROUND Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality.Surgical intervention remains the cornerstone for curative treatment.However,Due to the complexity of these procedures,patients often experience postoperative complications.Prehabilitation has been suggested as a tool to decrease postoperative morbidity and improve recovery by optimising patients preoperatively to handle the stress of surgery.AIM To evaluate the effectiveness of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation before hepatic,biliary,or pancreatic cancer resections.All data were analysed using Review Manager Software 5.4,and the metaanalysis was performed with a random-effect model analysis.RESULTS A total of 8 studies were included(n=568),recruiting adult patients undergoing hepatic,biliary,or pancreatic cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation[risk ratio(RR):0.79,95%CI:0.66-0.95,Z=2.52,P=0.01].No statistically significant difference was found in postoperative readmission rate(RR:1.31,95%CI:0.79-2.17,Z=1.05,P=0.29),major complications(RR:1.08;95%CI:0.61-1.92,Z=0.28,P=0.78),length of stay(standardised mean difference:-0.11,95%CI:-0.31 to 0.1,Z=1.05,P=0.29),or mortality(RR:0.28,95%CI:0.01-6.51,Z=0.79,P=0.43).CONCLUSION Prehabilitation was found to be effective in reducing postoperative complications following surgical intervention for hepatobiliary or pancreatic cancer.
文摘BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,these procedures are associated with significant postoperative morbidity and prolonged recovery times.Prehabilitation aims to combat this by physically and psychologically optimising patients preoperatively to handle the stress of surgery and improve postoperative outcomes.AIM To evaluate the effectiveness of prehabilitation in patients undergoing gastric or oesophageal cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation in patients undergoing gastric or oesophageal cancer resections.All data were analysed using Review Manager Software 5.4,and the meta-analysis was performed with a random-effect model analysis.RESULTS A total of 16 studies were included(n=1479),recruiting adult patients undergoing gastric or oesophageal cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation(Odds ratio:0.43,95%CI:0.31-0.58,Z=25.28,P<0.00001).Additionally,prehabilitation was associated with a lower postoperative readmission rate(risk ratio:0.58,95%CI:0.35-0.96,Z=2.10,P=0.04)and a shorter length of stay[standardised mean difference(SMD):-0.19,95%CI:-0.37 to-0.02,Z=2.21,P=0.03]compared to no-prehabilitation.Prehabilitation was also found to improve preoperative 6-minute walking distance(6-MWD)compared to no-prehabilitation(SMD:0.72,95%CI:0.21-1.23,Z=2.75,P=0.006).No statistical difference was found in postoperative 6-MWD,mortality,and severe complications.CONCLUSION Prehabilitation was found to be effective in reducing postoperative morbidity and improving preoperative physical health in patients undergoing gastric or oesophageal cancer resections.
文摘BACKGROUND In endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),submucosal lifting agents such as crystalloid-oil emulsion solution(COES)are used for improved effect.Starch-based polysaccharide solution(SPS),which in powder form acts as effective hemostatic agent,are now available as an alternative lifting agent.AIM To compare SPS to COES outcomes as lifting agents in colonic EMR and ESD.METHODS This is a retrospective study of patients who underwent colonic EMR or ESD and received submucosal injection of either SPS or COES at a single academic center from March 2021 to November 2023.A total of 79 patients were included in the COES group and 99 patients in the SPS group from chart review.Intraprocedural bleeding was defined as bleeding during a procedure requiring hemostatic intervention.Adverse events included were perforation or post-procedure gastrointestinal bleed within the first 30-day period.Data were analyzed using t-test and χ^(2) test.RESULTS Successful resection was achieved in all 178 patients.Average lesion size in SPS group was 2.6 cm vs 2.4 cm in COES group.Average procedure time was 22 minutes shorter in the SPS group(P<0.05).Intraprocedural bleeding was 24.1%more frequent in COES group(P<0.01).The 30-day adverse events were 9.37%more frequent in the COES group(P<0.01).En bloc resection was achieved 22.2%more frequently in patients receiving SPS submucosal injection(P<0.01).CONCLUSION SPS colonic submucosal injection appears to be beneficial over COES,as it is associated with lower intraprocedural bleeding,less adverse events,shorter procedures,and more frequent en bloc resections.
文摘Intraductal papillary mucinous neoplasms(IPMNs) can involve the main pancreatic duct(MD-IPMNs) or its secondary branches(BD-IPMNs) in a segmental of multifocal/diffuse fashion.Growing evidence indicates that BDIPMNs are less likely to harbour cancer and in selected cases these lesions can be managed non operatively.For surgery,clarification is required on:(1) when to resect an IPMN;(2) which type of resection should be performed;and(3) how much pancreas should be resected.In recent years parenchyma-sparing resections as well as laparoscopic procedures have being performed more frequently by pancreatic surgeons in order to decrease the rate of postoperative pancreatic insufficiency and to minimize the surgical impact of these operations.However,oncological radicality is of paramount importance,and extended resections up to total pancreatectomy may be necessary in the setting of IPMNs.In this article the type and extension of surgical resections in patients with MD-IPMNs and BD-IPMNs are analyzed,evaluating perioperative and long-term outcomes.The role of standard and parenchyma-sparing resections is discussed as well as different strategies in the case of multifocal neoplasms.
文摘Split-Liver and living-related donor liver transplantation are the newest and both technically and ethically most challenging developments in liver transplantation and have contributed to a reduction in donor shortage.We report the technical aspects of surgical procedures performed to achieve a partial graft from a cadaveric and a live donor.
文摘Objective To review the methods of the stability reconstruction after resections of primary malignant spinal tumors.Methods From January 1999 to January 2009,38 cases of primary malignant spinal turmors underwenttumor
文摘Liver resection for hepatocellular carcinoma(HCC)is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis.The aim of this review is to assess current indications,advantages and limits of laparoscopic surgery for HCC resections.We also discussed the possible evolution of this surgical approach in parallel with new technologies.
文摘Liver metastasis of colorectal cancer is common. Resection of solitary tumors of primary and metastatic colorectal cancer can have a favorable outcome. Open resection of primary colorectal tumor and liver metastasis in one operation or in separate operations is currently common practice. Reports have shown that synchronous resections do not jeopardize short or long-term surgical outcomes and that this is a safe and effective approach in open surgery. The development of laparoscopic colorectal surgery and laparoscopic hepatectomy has made a minimally invasive surgical approach to treating colorectal cancer with liver metastasis feasible. Synchronous resections of primary colorectal tumor and liver metastasis by laparoscopy have recently been reported. The efficacy and safety of laparoscopic colorectal resection and laparoscopic hepatectomy have been proven separately but synchronous resections by laparoscopy are in hot debate. As it has been shown that open resection of primary colorectal tumor and liver metastasis in one operation results in an equally good short-term outcome when compared with that done in separate operations, laparoscopic resection of the same in one single operation seems to be a good option. Recent evidencehas shown that this new approach is a safe alternative with a shorter hospital stay. Large scale randomized controlled trials are needed to demonstrate the effectiveness of this minimally invasive approach.
文摘Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection(OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have dividedthis review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection(LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy(LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.
文摘AIM To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS Between 9/2002 and 7/2013, 175 consecutive liver resections(n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients(143 surgeries). Accompanying, 37 wedge resections(specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by waterjet. The median central venous pressure was 4 mmH g(range: 5-14). Data was collected prospectively. RESULTS The median age of patients was 60 years(range: 16-85). Preoperative chemotherapy was used in 70 cases(49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL(range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures(15%). The median weight of anatomically resected liver specimens was 525 g(range: 51-1850 g). One patient died postoperatively. Biliary leakages(n = 5) were treated conservatively. Temporary liver failure occurred in two patients.CONCLUSION Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.
文摘While pancreatic cancer is still characterized by early systemic spread and poor outcomes,the treatment of this disease has changed significantly in recent years due to major advancements in systemic therapy and advanced surgical techniques.Broader use of effective neoadjuvant approaches combined with aggressive surgical operations within a multidisciplinary setting has improved outcomes.Borderline resectable pancreatic cancer is characterized by tumor vascular invasion,and is a setting where the combination of potent neoadjuvant chemotherapy and aggressive surgical methods,including vascular resections and reconstructions,shows its full potential.Hopefully,this will lead to improved local control and curative treatment in a number of patients with this aggressive malignancy.
文摘To evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only. METHODSThe new method of extreme liver resection consists of a two-stage hepatectomy. The first stage involves a right hepatectomy with middle hepatic vein preservation and induction of left lobe congestion; the second stage involves a left lobectomy. Thus, the remnant liver is represented by the segment 4 only (with or without segment 1, ± S1). Five patients underwent the new two-stage hepatectomy (congestion group). Data from volumetric assessment made before the second stage was compared with that of 10 matched patients (comparison group) that underwent a single-stage right hepatectomy with middle hepatic vein preservation. RESULTSThe two stages of the procedure were successfully carried out on all 5 patients. For the congestion group, the overall volume of the left hemiliver had increased 103% (mean increase from 438 mL to 890 mL) at 4 wk after the first stage of the procedure. Hypertrophy of the future liver remnant (i.e., segment 4 ± S1) was higher than that of segments 2 and 3 (144% vs 54%, respectively, P < 0.05). The median remnant liver volume-to-body weight ratio was 0.3 (range, 0.28-0.40) before the first stage and 0.8 (range, 0.45-0.97) before the second stage. For the comparison group, the rate of hypertrophy of the left liver after right hepatectomy with middle hepatic vein preservation was 116% ± 34%. Hypertrophy rates of segments 2 and 3 (123% ± 47%) and of segment 4 (108% ± 60%, P > 0.05) were proportional. The mean preoperative volume of segments 2 and 3 was 256 ± 64 cc and increased to 572 ± 257 cc after right hepatectomy. Mean preoperative volume of segment 4 increased from 211 ± 75 cc to 439 ± 180 cc after surgery. CONCLUSIONThe proposed method for extreme hepatectomy with preservation of segment 4 only represents a technique that could allow complete resection of multiple bilateral liver metastases.
文摘BACKGROUND The management of cystic dystrophy of the duodenal wall(CDDW),or groove pancreatitis(GP),remains controversial.Although pancreatoduodenectomy(PD)is considered the most suitable operation for CDDW,pancreas-preserving duodenal resection(PPDR)has also been suggested as an alternative for the pure form of GP(isolated CDDW).There are no studies comparing PD and PPDR for this disease.AIM To compare the safety,efficacy,and short-and long-term results of PD and PPDR in patients with CDDW.METHODS A retrospective analysis of the clinical,radiologic,pathologic,and intra-and postoperative data of 84 patients with CDDW(2004-2020)and a comparison of the safety and efficacy of PD and PPDR.RESULTS Symptoms included abdominal pain(100%),weight loss(76%),vomiting(30%)and jaundice(18%)and data from computed tomography,magnetic resonance imaging,and endoUS led to the correct preoperative diagnosis in 98.8%of cases.Twelve patients were treated conservatively with pancreaticoenterostomy(n=8),duodenum-preserving pancreatic head resection(n=6),PD(n=44)and PPDR(n=15)without mortality.Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR(93%)and PD(84%)compared to the other treatment modalities(18%).New onset diabetes mellitus and severe exocrine insufficiency occurred after PD(31%and 14%),but not after PPDR.CONCLUSION PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW.The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease.Early detection of CDDW provides an opportunity for pancreas-preserving surgery.
文摘Colorectal cancer is one of the most prevalent tumours,but with improved treatment and early detection,its prognosis has greatly improved in recent years.However,when the tumour is locally advanced at diagnosis or if there is local recurrence,it is more difficult to perform a complete tumour resection,and there may be a residual macroscopic tumour.In this paper,we review the literature on residual macroscopic tumour resections,concerning both locally advanced primary tumours and recurrences,evaluating the main problems encountered,the treatments applied,the prognosis and future perspectives in this field.
文摘Objective:The authors present outcomes of robotic liver resections in comparison with open technique questioning the need to have experience of laparoscopy for such procedures before transition to robotic assisted.Materials and methods:Retrospective review of liver resections done robotically from February 2015 to June 2017 compared to matched control cohort of open cases from January 2012 to December 2016.Results:Twenty-one patients in the study groupwere comparedwithmatched control of 42 open cases(1:2 ratio).The types of procedure were similar in both the groups.There were 4 left lateral hepatectomy,3 left hepatectomy,and 1 left hepatectomy with hepatico-jejunostomy,3 right hepatectomy,3 right posterior sectorectomy,4 bisegmentectomy and 4 mono-segmentectomy.There were 9 patients with primary liver cancer,2 each with livermetastasis and carcinoma gall bladder and 8 patients had benign liver disease.Mean blood losswas 370±311ml in the robotic group compared to 451±330ml in control group(p=0.06).Minor complications developed in 19.0%of robotic cases compared to 40.5%in open surgery,while major complications occurred in 4.7%of robotic cases compared to 7.1%of open cases.Mean hospital staywas 5.3±0.8 days for the robotic group and 7.7±4.2 days for open group(p=0.02).Local tumor recurrence occurred in 1 out of 13 resections done for malignancy in the robotic group and 7 out of 26 in the open group.Conclusion:This study highlights the utility of surgical robots for segmental and complex liver resections with equivalent outcomes and decreased length of hospital stay compared to open surgery without having experience of same with the laparoscopy.
文摘Pancreatic ductal adenocarcinoma(PDAC)is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide.With the advances in surgical technology,oncological treatment,and critical care,extended pancreatic resections including vascular resections have become more frequently performed in specialised centres.Furthermore,the boundaries of resectability continue to be pushed in order to achieve a potentially curative approach in selected patients in combination with neoadjuvant and adjuvant treatment strategies.This review gives an overview on the current state of venous and arterial resections in PDAC surgery with particular attention given to the minimally invasive approach.
文摘AIM To evaluate disparities in the treatment of hepatocellular carcinoma(HCC) based on gender.METHODS A retrospective database analysis using the Nationwide Inpatient Sample(NIS) was performed between 2010 and 2013. Adult patients with a primary diagnosis of hepatocellular carcinoma determined by International Classification of Disease 9(ICD-9) codes were included. Univariate analysis and multivariate logistic regressions were performed to analyze differences in treatment, mortality, features of decompensation, and metastatic disease based on the patient's gender.RESULTS The analysis included 62582 patients with 45908 men and 16674 women. Women were less likely to present with decompensated liver disease(OR = 0.84, P < 0.001) and had less risk of inpatient mortality when compared to men(OR = 0.75, P < 0.001). Women were more likely to receive inpatient resection(OR = 1.31, P < 0.001) or an ablation(OR = 1.22, P = 0.028) than men. There was no significant difference between men and women in regard to liver transplantation and transcatheter arterial chemoembolization(TACE).CONCLUSION Gender impacts treatment for hepatocellular carcinoma. Women are more likely to undergo an ablation or resection then men. Gender disparities in transplantation have resolved.
文摘Anastomosis is a crucial step in radical cancer surgery. Despite being a daily practice in gastrointestinal surgery, anastomotic leakage (AL) stands as a frequent postoperative complication. Because of increased morbidity, mortality, combined with longer hospital stay, the rate of re-intervention, and poor oncological outcomes, AL is considered the most feared and life-threatening complication after colorectal resections. Furthermore, poor functional outcomes with a higher rate of a permeant stoma in 56% of patients this could negatively affect the patient’s quality of life. This a narrative review which will cover intraoperative anastomotic integrity assessment and preventive measures in order to reduce AL. Although the most important prerequisites for the creation of anastomosis is well-perfused and tension-free anastomosis, surgeons have proposed several preventive measures, which were assumed to reduce the incidence of AL, including antibiotic prophylaxis, intraoperative air leak test, omental pedicle flap, defunctioning stoma, pelvic drain insertion, stapled anastomosis, and general surgical technique. However, lack of clear evidence of which preventive measures is superior over the other combined with the fact that the decision remains based on the surgeon’s choice. Despite the advances in surgical techniques, AL remains a serious health problem associated with increased morbidity, mortality with additional cost. Many preventative measures were employed with no clear evidence supporting the superiority of stapled anastomosis over hand-Sewn anastomosis, coating of the anastomosis, or pelvic drain. Defunctioning stoma, when justified it could decrease the leakage-related complications and the incidence of reoperation. MBP combined with oral antibiotics still recommended.
文摘BACKGROUND Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevated morbidity rates are not clearly defined. AIM To systematically review the literature on oncologic long-term outcomes and morbidity and mortality in cancer surgery a systematic review of the literature was performed. METHODS PubMed was searched for relevant articles (published from 2000 to 2018). Retrieved abstracts were independently screened for relevance and data were extracted from selected studies by two researchers. RESULTS Included were 37 studies with 3112 patients receiving MVR for colorectal cancer (1095 for colon cancer, 1357 for rectal cancer, and in 660 patients origin was not specified). The most common resected organs were the small intestine, bladder and reproductive organs. Median postoperative morbidity rate was 37.9%(range: 7% to 76.6%) and median postoperative mortality rate was 1.3%(range: 0% to 10%). The median conversion rate for laparoscopic MVR was 7.9%(range: 4.5% to 33%). The median blood loss was lower after laparoscopic MVR compared to the open approach (60 mL vs 638 mL). Lymph-node harvest after laparoscopic MVR was comparable. Report on survival rates was heterogeneous, but the 5-year overall-survival rate ranged from 36.7% to 90%, being worst in recurrent rectalcancer patients with a median 5-year overall survival of 23%. R0 -resection, primary disease setting and no lymph-node or lymphovascular involvement were the strongest predictors for long-term survival. The presence of true malignant adhesions was not exclusively associated with poorer prognosis. Included were 16 studies with 1.600 patients receiving MVR for gastric cancer. The rate of morbidity ranged from 11.8% to 59.8%, and the main postoperative complications were pancreatic fistulas and pancreatitis, anastomotic leakage, cardiopulmonary events and post-operative bleedings. Total mortality was between 0% and 13.6% with an R0 -resection achieved in 38.4% to 100% of patients. Patients after R0 resection had 5-year overall survival rates of 24.1% to 37.8%. CONCLUSION MVR provides, in a selected subset of patients, the possibility for good long-term results with acceptable morbidity rates. Unlikelihood of achieving R0 -status, lymphovascular- and lymph -node involvement, recurrent disease setting and the presence of metastatic disease should be regarded as relative contraindications for MVR.
文摘Background: In traditional laparoscopic colorectal cancer surgery, the surgeon’s method assess intestinal stumps blood supply is subject to certain subjectivity and blindness. Indocyanine green (ICG) real-time blood perfusion fluorescence angiography in laparoscopic radical resection of rectal cancer has great potential clinical value and can visually judge intestinal tract blood supply to improve the surgery safety, reduce postoperative complications, and ensure the recovery of patients after surgery. Objective: To explore the efficacy of the intraoperative use of indocyanine-green fluorescence angiography in laparoscopic rectal resections in patients with rectal cancer. Methods: In the present study, 109 rectal cancer patients were included and assigned to different surgical groups [ICG and control groups] for analysis. Statistical analysis was carried out for various common postoperative complications in the two groups. Finally, the patients in the ICG fluorescence imaging group had a timely adjustment of the proximal resection of the intestinal tube before the proximal bowel of the lesion was cut off when the intestinal blood supply was insufficiently assessed by fluorescence imaging. Two subgroups, the adjustment and the non-adjustment groups, were analyzed. Results: Compared with the control group, the postoperative anal ventilation time in the ICG group was shorter than that in the control group (P 0.05). In addition, the postoperative complications were lower than those in the control group, and the differences were statistically significant (P 0.05). However, the distance between the tumor from the anal verge in the adjustment group was smaller than that in the non-adjustment group, and the difference was statistically significant (P 0.01). Conclusion: Compared with conventional laparoscopic radical resection of rectal cancer, ICG real-time indocyanine green fluore- scence angiography was safe and feasible. This technique is a promising intraoperative tool for the assessment of bowel perfusion especially suitable for patients with lower rectal cancer.
