ObjectiveTo explore feasibility and advantages of hand-assisted laparoscopic radical resection for remnant gastric cancer. MethodsThe clinical data of 26 patients with remnant gastric cancer who underwent hand-assisted laparoscopic (hand-assisted group, n=13) or open (open group, n=13) radical resection from December 2007 to May 2016 in this hospital were retrospectively analyzed. The perioperative outcomes were compared between these two groups. ResultsThere was no conversion to open surgery in the hand-assisted group. Compared with the open group, the incision length was significantly reduced (P=0.000), the intraoperative blood loss was significantly decreased (P=0.038), postoperative the first anal exhaust time was significantly shortened (P=0.025) in the hand-assisted group. The operation time, the number of lymph nodes dissection, and the incidence of postoperative complications had no statistically significant differences between these two groups (P>0.05). ConclusionThe preliminary results of limited cases in this study show that hand-assisted laparoscopic radical resection for remnant gastric cancer is safe and feasible, it has several advantages including small incisions, mild intraoperative hemorrhage, rapid postoperative recovery, better recent clinical therapeutic outcome and so on as compared with open surgery.
ObjectiveTo summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
Objective To compare the difference of traumatic related index in serum and its significance between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF. Methods Sixty patients were enrolled by the entry criteria between May and November 2012, and were divided into MIS-TLIF group (n=30) and open TLIF group (n=30). There was no significant difference in gender, age, type of lesions, disease segment, and disease duration between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, and postoperative hospitalization time were recorded, and the pain severity of incision was evaluated by visual analog scale (VAS). The serum levels of C-reactive protein (CRP) and creatine kinase (CK) were measured at preoperation and at 24 hours postoperatively. The levels of interleukin 6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) in serum were measured at preoperation and at 2, 4, 8, and 24 hours after operation. Results The operation time, intraoperative blood loss, and postoperative hospitalization time of MIS-TLIF group were significantly smaller than those of open TLIF group (P lt; 0.05), and the VAS score for incision pain in MIS-TLIF group was significantly lower than that of open TLIF group at 1, 2, and 3 days after operation (P lt; 0.05). The levels of CRP, CK, IL-6, and IL-10 in MIS-TLIF group were significantly lower than those in open TLIF group at 24 hours after operation (P lt; 0.05), but there was no significant difference between 2 groups before operation (P gt; 0.05). No significant difference was found in TNF-α level between 2 groups at pre- and post-operation (P gt; 0.05). Conclusion Compared with the open-TLIF, MIS-TLIF may significantly reduce tissue injury and systemic inflammatory reactions during the early postoperative period.
Objective To review the latest comparative research of minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open approach. Methods The domestic and foreign literature concerning the comparative research of minimally invasive TLIF and traditional open TLIF was reviewed, then intraoperative indicators, length of hospitalization, effectiveness, complication, fusion rate, and the effect on paraspinal muscles were analyzed respectively. Results Minimally invasive TLIF has less blood loss and shorter length of hospitalization, but with longer operation and fluoroscopic time. Minimally invasive surgery has the same high fusion rate as open surgery, however, its effectiveness is not superior to open surgery, and complication rate is relatively higher. In the aspect of the effect on paraspinal muscles, in creatine kinase, multifidus cross-sectional area, and atrophy grading, minimally invasive surgery has no significant reduced damage on paraspinal muscles. Conclusion Minimally invasive TLIF is not significantly superior to open TLIF, and it does not reduce the paraspinal muscles injury. But prospective double-blind randomized control trials are still needed for further study.
Objective To systematically review the efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision (TME) for the treatment of rectal cancer. Methods The PubMed, EMbase, The Cochrane Library, and ClinicalTrials.gov databases were electronically searched to identify cohort studies on robotic, laparoscopic-assisted, and open TME for rectal cancer published from January 2016 to January 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Subsequently, network meta-analysis was performed using RevMan 5.4 software and R software. Results A total of 24 studies involving 12 348 patients were included. The results indicated that among the three types of surgical procedures, robotic TME showed the best outcomes by shortening the length of hospital stay, reducing the incidence of postoperative anastomotic fistula and intestinal obstruction, and lowering the overall postoperative complication rate. However, differences in the number of dissected peritumoural lymph nodes were not statistically significant. Conclusion Robotic TME shows better outcomes in terms of the radicality of excision and postoperative short-term outcomes in the treatment of rectal cancer. However, clinicians should consider the patients’ actual condition for the selection of surgical methods to achieve individualised treatment for patients with rectal cancer.
ObjectiveTo investigate the advantage and short- and medium-term effectivenesses of paramedian incision minimally invasive transforaminal lumbar interbody fusion (mini-TLIF) by comparing with open TLIF. MethodsA retrospective analysis was made on the clinical data of 54 patients with single segmental lumbar degenerative disease who accorded with the inclusion criteria between January 2012 and March 2014. Open TLIF was performed in 26 patients (open group), mini-TLIF in 28 cases (minimally invasive group). There was no significant difference in gender, age, disease duration, etiology, and affected segments between 2 groups (P>0.05). The indexes of surgical trauma, systemic inflammatory response, clinical outcome, and interbody fusion rate were compared between 2 groups. ResultsDural rupture occurred in 1 case of open group, L5 nerve root injury in 1 case of minimally invasive group. All patients obtained primary healing of incision. The operation time, intraoperative blood loss, and postoperative drainage of minimally invasive group were significantly lower than those of open group (P<0.05). C-reactive protein, leucocyte count, and creatine kinase-MM (CK-MM) of open group were significantly higher than those of minimally invasive group at 24 hours after operation (P<0.05). At 7 days after operation, the CK-MM of minimally invasive group was significantly lower than that of open group (P<0.05), but no significant difference was found in C-reactive protein and leucocyte count between 2 groups (P>0.05). The follow-up time was 1.2-3.1 years in open group and 1.4-2.9 years in minimally invasive group. At 1 year after operation, the Oswestry disability index (ODI) and visual analogue scale (VAS) scores were significantly improved in 2 groups (P<0.05). Minimally invasive group was better than open group in ODI and VAS score of back pain (P<0.05), but VAS score of leg pain showed no significant difference (P>0.05). According to the Suk interbody fusion standard, solid fusion was obtained in 18 cases, probable fusion in 4 cases, and nonunion in 4 cases, and the fusion rate was 84.61% in open group; solid fusion was obtained in 21 cases, probable fusion in 3 cases, and nonunion in 4 cases, and the fusion rate was 85.71% in minimally invasive group; and the interbody fusion rates showed no significant difference between 2 groups (χ2=0.072, P=0.821). ConclusionCompared with open TLIF, paramedian incision mini-TLIF has advantages of minimal surgical trauma and little blood loss for single-level lumbar degenerative disease. The short- and medium-term effectivenesses are satisfactory.
ObjectiveTo systematically evaluate the stress response of laparoscopic surgery (LS) and conventional open surgery (OS) in patients with colorectal cancer. MethodsThe literatures about the immune stress response of LS and OS for colorectal cancer were collected from PubMed, Springer, OVID, Cochrane library, CNKI, VIP Database, and Wanfang Database from May 2001 to September 2014. RevMan 5.3 software was used for data analysis. ResultsFifteen randomized controlled trials including 881 patients were brought into this Meta analysis, of 881 patients, 424 patients were treated with LS and 457 patients were treated with OS. The results of Meta-analysis showed that:①At 24, 72, and 120 hours after surgery, the levels of interleukin (IL-6) in LS group were all lower than those of OS group at same time point[24 h (WMD=-27.78, 95% CI:-43.24--12.32, P < 0.01), 72 h (WMD=-13.23, 95% CI:-19.89--6.57, P < 0.01), 120 h (WMD=-16.51, 95% CI:-30.13--2.89, P=0.02)]. ②At 24, 72, and 120 hours after surgery, the levels of C reactive protein (CRP) in LS group were all lower than those of OS group at same time point[24 h (WMD=-31.11, 95% CI:-47.49--14.73, P < 0.01), 72 h (WMD=-29.81, 95% CI:-49.99--9.64, P < 0.01), 120 h (WMD=-32.03, 95% CI:-45.34--18.71, P < 0.01)]. ③There was no significant difference between the 2 groups in WBC level at 24 hours after surgery (WMD=-0.63, 95% CI:-1.80-0.54, P=0.29), but the WBC levels of LS group at 72 hours and 120 hours after surgery were lower than those of OS group[72 h (WMD=-0.21, 95% CI:-0.41--0.01, P=0.04), 120 h (WMD=-0.86, 95% CI:-1.66--0.06, P=0.03). ④There was no significant difference between the 2 groups in cortisol level at 24 hours and 72 hours after surgery[24 h (WMD=-60.19, 95% CI:-194.77-74.39, P=0.38), 72 h (WMD=-13.83, 95% CI:-43.94-16.28, P=0.37). ⑤There was no significant difference between the 2 groups in blood glucose level at 24 hours and 72 hours after surgery[24 h (WMD=-0.95, 95% CI:-2.74-0.84, P=0.30), 72 h (WMD=-0.69, 95% CI:-2.05-0.66, P=0.32)]. ⑥There was no significant difference between the 2 groups in insulin level (WMD=-0.52, 95% CI:-1.87-0.82, P=0.45) at 24 hours after surgery. ⑦There was no significant difference between the 2 groups in tumor necrosis factor (TNF) level at 24 hours after surgery (WMD=-4.18, 95% CI:-9.39-1.04, P=0.12). ConclusionCompared with open radical surgery, laparoscopic radical surgery for colorectal cancer causes less stress and less effect on the immune function, it also can reduce postoperative complications and can be propitious to faster body recovery.
Objective To review the progress in the treatment of acute Achilles tendon rupture. Methods Recent literature about the treatment of acute Achilles tendon rupture was reviewed and analyzed. Results Treatments of acute Achilles tendon rupture include operative and non-operative treatments. Operative treatments include open surgery and percutaneous minimally invasive surgery. Compared with non-operative treatment, operative treatment can effectively reduce the re-rupture incidence, but it had higher complication incidences of wound infection and nerve injury. Although early functional rehabilitation during non-operative treatment could reduce the re-rupture incidence, there is no consistent orthopaedic device and guideline for functional rehabilitation. Conclusion Both operative and non-operative treatments have advantages and disadvantages for the treatment of acute Achilles tendon rupture. No consistent conclusion is arrived regarding functional recovery. Future studies should explore the strategy of early functional rehabilitation during non-operative treatment and its mechanism of promoting tendon healing.
ObjectiveTo summarized the clinical experience on laparoscopic radical surgery in patients with advanced distal gastric cancer. MethodsThe clinical data of 26 patients with advanced distant gastric cancer undergoing laparoscopic gastrectomy were retrospectively analyzed. ResultsLaparoscopic distal gastrectomy was performed successfully in all patients. The operation time was (283.2±27.6) min (270-450 min) and the blood loss was (178.4±67.4) ml (80-350 ml). The time of gastrointestinal function recovery was (2.8±1.2) d (2-4 d), out of bed activity time was (1.5±0.4) d (1-3 d) and liquid diet feeding was (3.5±1.4) d (3-4 d). The hospital stay was (10.0±2.6) d (7-13 d). The number of harvested lymph nodes was 11 to 34 (17.8±7.3). The distance from proximal surgical margin to tumor was (7.0±2.1) cm (5-12 cm) and the distance from distal surgical margin to tumor was (5.5±1.8) cm (4-8 cm), thus surgical margins were negative in all samples. All patients were followed up for 3-48 months (mean 18.5 months), two patients with poorly differentiated adenocarcinoma died of extensive metastasis in 13 and 18 months, respectively, and other patients survived well. ConclusionsLaparoscopic radical gastrectomy with D2 lymphadenectomy for advanced gastric cancer is safe and feasible. However, the advantage of laparoscopic technique over the conventional open surgery requires further study.
ObjectiveTo compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis. MethodsBetween May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree Ⅰ or Ⅱ) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done. ResultsPrimary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1±1.6) days] was significantly shorter than that of open group [(7.2±2.1) days] (t=2.593, P=0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53%±20.52% in minimally invasive group, and was 64.21%±30.21% in open group, showing no significant difference (t=0.725, P=0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P<0.05), but no significant difference was found between 2 groups (P>0.05). The postoperative other sagittal spino-pelvic parameters were significantly improved (P<0.05) except PI (P>0.05), but there was no significant difference between 2 groups (P>0.05). The correlation analysis showed that ODI value was related to the SVA, SSA, PT, and LL (P<0.05). ConclusionBoth minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion can significantly improve the sagittal spino-pelvic parameters in the treatment of low-degree isthmic lumbar spondylolisthesis. The reconstruction of SVA, SSA, PT, and LL are related to the quality of life.