Abstract:
Objective To investigate the safety, feasibility and short-term efficacy of laparoscopic radical rectal resection for obese patients with rectal cancer.
Methods The clinical data of 205 obese patients with rectal cancer who received radical resection at the Affiliated Tumor Hospital of Xinjiang Medical University from April 2008 to April 2012 were retrospectively analyzed. All patients were divided into 2 groups according to the surgical procedure and body mass index: 95 patients were in the laparoscopic resection (LR) group (60 cases of Ⅰdegree obesity and 35 cases of Ⅱdegree obesity) and 110 patients were in the open resection (OR) group (65 cases of Ⅰdegree obesity and 45 cases of Ⅱ degree obesity). Patients were followed up till June 2012 by mail and phone call. The differences in intra- and postoperative situations and short-term survival rates of the 2 groups were compared using the t test, chi-square test or Fisher exact probability. The survival curve was drawn by Kaplan-Meier method, and the survival was analyzed using the Log-rank test.
Results For patients with Ⅰdegree obesity, the mean operation time and number of lymph node dissected were (235±25)minutes and 19±6 in the LR group, and (241±23)minutes and 19±6 in the OR group, with no significant difference between the 2 groups (t=-1.416, 0.100, P>0.05). The volume of blood loss, first flatus, duration of postoperative hospital stay, incidence of complications were (195±77)ml, (1.7±0.6)days, (10.9±2.3)days and 21.7%(13/60) in the LR group, and (393±170)ml, (3.8±1.1)days, (15.2±2.6)days, 38.5%(25/65) in the OR group, with significant differences between the 2 groups (t=-8.229,-12.192,-12.002, χ2=4.159, P<0.05). For patients with Ⅱdegree obesity, the mean operation time and number of lymph node dissected were (242±24)minutes and 17±5 in the LR group, and (250±23)minutes and 18±7 in the OR group, with no significant difference between the 2 groups (t=-1.556,-0.397, P>0.05). The volume of blood loss, first flatus, duration of postoperative hospital stay, incidence of complications were (253±96)ml, (1.8±0.7)days, (11.2±2.5)days and 17.1%(6/35) in the LR group, and (443±180)ml, (4.2±1.2)days, (16.2±2.4)days, 37.8%(17/45) in the OR group, with significant differences between the 2 groups (t=-5.634,-11.205,-8.824, χ2=4.092, P<0.05). One hundred and eighty-five patients were followed up, with a median time of 23 months. There was no significant difference in the accumulative survival rate between the 2 groups (χ2=0.203, P>0.05).
Conclusions Laparoscopic radical rectal resection is safe and feasible for obese patients. It could radically dissect tumors without influencing the survival time.
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