Study on the clinical effects of closed excision in laparoscopic total mesorectal excision of rectal cancer

doi:10.3877/cma.j.issn.2095-3224.2018.03.007

Abstract

Abstract:

Objective

To evaluate the clinical effects of closed excision (CE) in laparoscopic total mesorectal excision (TME) of rectal cancer.

Methods

Fifty-four patients with primary rectal cancer were enrolled in this study from February 2011 to June 2014. Thirty patients underwent CE + TME laparoscopic radical surgery and 24 patients were treated with TME laparoscopy radical surgery. All patients received chemotherapy by arterial infusion during surgery. Surgical indicators including the operative time, intraoperative blood loss, number of lymph node dissected, ratio of positive circumferential resection margin, postoperative recovery time, anal exhaust time, catheter retention time, hospitalization time, postoperative complications and the proportion of local recurrence within 1 year after the surgery.

Results

The intraoperative blood loss of CE + TME group were significantly lower than those of TME group (t=11.775, P<0.001). The operation time (t=2.207, P=0.035), postoperative anal exhaust time (t=2.059, P=0.045), catheter retention time (t=2.083, P=0.042) and the proportion of local recurrence (P=0.047) of CE + TME group were also significantly lower than those of TME group. The lymph node dissected (t=9.613, P<0.001) of CE+ TME group was significantly higher than that of TME group (P<0.01).

Conclusion

CE can significantly reduce the local recurrence rate of TME, and has potent clinical application value.

Key words: Rectal neoplasms, Closed excision, Total mesorectal excision, Ultrasonic knife, Clinical effect

Zhijun Tan, Changsheng Li, Yuying Liu. Study on the clinical effects of closed excision in laparoscopic total mesorectal excision of rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(03): 232-236.

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References 12

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分组	例数	年龄[岁，M（QR）]	性别（n，男/女）	瘤径（cm，±s）	术式（n，PR/LAR）	分化程度（n，低/中/高）	瘤组织下缘距齿状线距离（n，≤5 cm/5～10 cm）	TNM分期（n.Ⅰ/Ⅱ/Ⅲ）
CE＋TME组	30	51.5（39.0~63.0）	21/9	3.23±0.72	26/4	6/15/9	21/9	6/18/6
TME组	24	53.0（32.0~67.0）	18/6	3.08±0.57	18/6	5/12/7	14/10	4/13/7
t/Z/χ²值	?	Z=-0.217	χ²=0.166	t=0.612	χ²=1.203	χ²=0.008	χ²=0.796	χ²=0.624
P值	?	0.825	0.684	0.409	0.273	0.996	0.372	0.732

分组	例数	年龄[岁，M（QR）]	性别（n，男/女）	瘤径（cm，±s）	术式（n，PR/LAR）	分化程度（n，低/中/高）	瘤组织下缘距齿状线距离（n，≤5 cm/5～10 cm）	TNM分期（n.Ⅰ/Ⅱ/Ⅲ）
CE＋TME组	30	51.5（39.0~63.0）	21/9	3.23±0.72	26/4	6/15/9	21/9	6/18/6
TME组	24	53.0（32.0~67.0）	18/6	3.08±0.57	18/6	5/12/7	14/10	4/13/7
t/Z/χ²值	?	Z=-0.217	χ²=0.166	t=0.612	χ²=1.203	χ²=0.008	χ²=0.796	χ²=0.624
P值	?	0.825	0.684	0.409	0.273	0.996	0.372	0.732

分组	例数	手术时间（min，±s）	术中出血量（mL，±s）	淋巴结清扫数目（n，±s）	CRM阳性比例（n，阳性/阴性）
CE＋TME组	30	174±29	47±23	9.7±1.2	4/26
TME组	24	192±32	102±46	5.3±2.9	3/21
t/χ²值	?	t=2.207	t=11.775	t=9.613	χ²=0.008
P值	?	0.035	<0.001	<0.001	0.928

分组	例数	手术时间（min，±s）	术中出血量（mL，±s）	淋巴结清扫数目（n，±s）	CRM阳性比例（n，阳性/阴性）
CE＋TME组	30	174±29	47±23	9.7±1.2	4/26
TME组	24	192±32	102±46	5.3±2.9	3/21
t/χ²值	?	t=2.207	t=11.775	t=9.613	χ²=0.008
P值	?	0.035	<0.001	<0.001	0.928

分组	例数	恢复饮食时间[d，M（Q_R）]	肛门排气时间（h，±s）	导尿管置留时间（d，±s）	住院时间（d，±s）
CE＋TME组	30	2（1~11）	61.8±6.2	4.8±1.6	8.7±3.4
TME组	24	2（1~16）	64.7±3.4	5.6±1.1	9.5±2.7
t/Z/χ²值	?	Z=-0.358	t=2.059	t=2.083	t=1.291
P值	?	0.307	0.045	0.042	0.392
分组	例数	吻合口漏发生比例（n，复发/未复发）	肠梗阻发生比例（n，复发/未复发）	切口感染发生比例（n，复发/未复发）	术后1年复发比例（n，复发/未复发）
CE＋TME组	30	2/28	1/29	1/29	0/30
TME组	24	1/23	2/22	1/23	3/21
t/Z/χ²值	?	χ²=0.159	χ²=0.635	χ²=0.03	χ²=3.97
P值	?	0.617	0.533	0.740	0.047

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