Objective To understand status of technical realization, present development, faced problems, and application prospects of reduced-port laparoscopic surgery for rectal cancer, and to analyze safety and feasibility so as to provide theoretical and practical basis for clinical application and promotion. Method By searching the databases such as Medline, Embase, and Wanfang, etc., the relevant literatures about reduced-port laparoscopic surgery for rectal cancer were collected and reviewed. Results At present, the most common reduced-port laparoscopic surgery was the 1-port laparoscopic surgery, 2-port laparoscopic surgery, and 3-port laparoscopic surgery. The 1-port laparoscopic surgery had the effects of minimal invasiveness and cosmesis, but it was difficult to perform. The 2-port laparoscopic surgery for rectal cancer preserved as far as possible the effect of minimal invasiveness, the difficulty of procedure was reduced greatly, which was easy to be learnt and promoted. The experience of the 3-port laparoscopic surgery for rectal cancer contributed to the technical development of the 1-port laparoscopic surgery, with no need for the assisted incision for intraoperative specimen. The reduced-port laparoscopic surgery for rectal cancer was technically feasible and safe, which possessed the equal or better short-term outcomes as compared with the conventional 5-port laparoscopic or open surgery beside the radical resection for rectal cancer. However, the stringent technique for the laparoscopic surgery was necessary and it needed to overcome the learning curve. Conclusions Reduced-port laparoscopic surgery has some obvious advantages in minimal invasiveness, cosmesis, and enhanced recovery. More large-sample, multi-center, randomized controlled trials are eager to further confirm safety, effectiveness, and feasibility of reduced-port laparoscopic surgery for rectal cancer.
ObjectiveTo investigate the clinical value of fine needle aspiration cytology (FNAC) combined with washout fluid detection of parathyroid hormone (PTH) in identifying parathyroid glands during thyroid cancer radical thyroidectomy. MethodsA total of 108 patients who underwent thyroid cancer radical thyroidectomy in Rizhao Central Hospital from June 2020 to December 2022 were selected as the study subjects. During the surgery, highly suspected parathyroid tissues were punctured with fine needle aspiration. FNAC and washout fluid were collected for PTH detection. Using the results of postoperative histopathological examination as the gold standard, the accuracy of different methods in identifying parathyroid glands during surgery was analyzed. ResultsAmong the 73 positive cases, the PTH level in the washout fluid was (591.20±84.30) pg/mL, while in the 35 negative cases, it was (18.69±2.53) pg/mL. The PTH level was significantly higher in the positive cases compared to the negative cases (P＜0.05). Postoperative routine histopathological examination confirmed parathyroid tissues in 91 cases, while in 17 cases, they were confirmed as adipose tissues (11 cases) or lymphoid tissues (6 cases). In the 17 cases confirmed as non-parathyroid tissues, both two methods considered them as non-parathyroid tissues. The sensitivity of puncture eluent in detecting PTH was 80.22% (73/91), that of cytological smear was 70.33% (64/91), and that of puncture eluent combined with cytological smear was 94.50% (86/91). There was no significant difference between the sensitivity of puncture cytology smear and puncture eluent in detecting PTH (P＞0.05). The sensitivity of combined detection of the two methods was higher than that of individual detection, and the difference was statistically significant (P<0.05). ConclusionThe combined detection of PTH by fine needle puncture smear and eluent can improve the accuracy of identification of parathyroid gland during radical thyroidectomy, and is beneficial to the identification and protection of parathyroid gland during surgery.
Objective To systematically evaluate the efficiency of fertility-sparing surgery (FSS) compared with radical comprehensive surgery (RCS) in early stage epithelial ovarian cancer (eEOC). Methods We searched databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Knowledge, CBM, WanFang Data and CNKI to collect the studies about FSS compared with RCS for eEOC from ineaption to August 10th, 2016. Two reviewers independently evaluated the eligibility of identified studies and extracted the data. Then, meta-analysis was performed using Stata 12.0 software. Results Eight studies involving 2 561 patients were included. The results of meta-analysis showed that: compared with RCS, the aggregated RR of overall survival (OS) of FSS (univariate analysis: RR=1.03, 95%CI 0.98 to 1.07,P=0.815; multivariate analysis: RR=0.81, 95%CI 0.52 to 1.28,P=0.255), the cumulative disease free survival (DFS) of FSS (univariate analysis: RR=1.02, 95%CI 0.96 to 1.09,P=0.968; multivariate analysis: RR=1.24, 95%CI 0.65 to 2.39,P=0.115) and the recurrence of FSS (RR=0.86, 95%CI 0.57 to 1.30,P=0.902), there was no significant difference. This pattern also emerged in the subgroup analysis for FIGO IA and IC patients, and the results showed that there was no significant difference between FSS and RCS in IA patients (OS: RR=0.99, 95%CI 0.98 to 1.02,P=0.186; DFS: RR=1.01, 95%CI 0.95 to 1.06,P=0.541); and IC patients (OS: RR=0.95, 95%CI 0.86 to 1.04,P=0.251; DFS: RR=0.94, 95%CI 0.80 to 1.11,P=0.664). Conclusion In eEOC, FSS does not have a negative effect on oncological outcomes compared with RCS. However, well-designed and large-scale trials are needed to verify this outcome in the future.
ObjectiveTo summarize the clinical effect of Da Vinci robot radical gastrectomy for gastric cancer.MethodsA retrospective analysis was performed on 200 patients undergoing radical surgery for Da Vinci robotic gastric cancer from the General Surgery of the 940th Hospital of the Chinese People's Liberation Army from December 2016 to January 2018.ResultsThere were 200 cases of robotic radical gastric cancer, 99 cases of radical distal gastrectomy, and 101 cases of radical total gastrectomy. The operative time was (241.0±33.3) min, intraoperative blood loss was (146.2±110.4) mL, and the number of lymph nodes cleaned was (42±14). The time of first anal exhaustion was (3.1±0.7) d, the time of first meal was (4.3±0.7) d, the postoperative extubation time was (5.3±0.5) d, and the postoperative hospitalization cost was (96 366.50±16 992.87) yuan. Tumor diameter was (4.5±2.0) cm. The degree of tumor differentiation was high differentiation in 7 cases, moderate differentiation in 61 cases and poor differentiation in 132 cases. TNM stage was 1 case in stage Ⅰ, 62 cases in stage Ⅱ and 137 cases in stage Ⅲ. Iauren was divided into intestinal type (78 cases), diffuse type (65 cases) and mixed type (57 cases). The tumor infiltrated into submucosa in 1 case, intrinsic muscularis in 3 cases, subserosal layer in 31 cases and serosal layer in 165 cases. The tumors were located in the upper part of the stomach in 45 cases, the lower part of the stomach in 106 cases, the body of the stomach in 46 cases, the whole stomach in 1 case, and the gastroesophageal junction in 2 cases. Postoperative complications occurred in 8 cases (4%), including anastomotic leakage in 4 cases, duodenal stump fistula in 1 case, tracheoesophageal fistula in 1 case, pulmonary infection in 1 case, and gastroparesis in 1 case.ConclusionThe DaVinci robotic surgical system has less surgical injuries, quicker postoperative recovery, and better clinical efficacy.
ObjectiveTo compare the postoperative complications following laparoscopic and open radical resection for rectal cancer. MethodsThe clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups. Results①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05). ConclusionsThe development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.