Abstract: Objective:To investigate clinical effect of the cephalomedial to lateral and traditional medialtolateral approaches for laparoscopic radical resection of rectal cancer.
Methods:The retrospective cohort study was adopted. The clinical data of 82 patients with rectal cancer who underwent laparoscopic radical resection of rectal cancer at the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between June 2015 and October 2015 were collected. Thirty patients undergoing cephalomedial to lateral approach and 52 patients undergoing traditional medialtolateral approach were respectively allocated into the CML group and ML group. Cephalomedial to lateral approach procedures included that peritoneum at surface of the abdominal aorta located at the cephalic inferior mesenteric artery (IMA) was excised and then opening the left Toldt space. Observation indexes: (1) operation situations: operation time, time to open the left Toldt space, time of lymph node dissected around IMA, volume of intraoperative blood loss, number of lymph node dissected, number of No.253 lymph node dissected, distance to distal resection margin, (2) postoperative situations: postoperative complications, duration of postoperative hospital stay, (3) followup situations: postoperative survival, tumor recurrence and metastasis. Patients were followed up by outpatient examination and telephone interview up to April 2016. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using the t test. Count data were analyzed using the chisquare test.
Results:(1) Operation situations: 82 patients underwent successful laparoscopic radical resection of rectal cancer, without conversion to open surgery and perioperative death. Time to open the left Toldt space was (8± 6)minutes in the CML group. Operation time, time of lymph node dissected around IMA, volume of intraoperative blood loss, number of lymph node dissected, number of No.253 lymph node dissected and distance to distal resection margin were (107±24)minutes, (9±6)minutes, (91±27)mL, 18.1±7.0, 3.5±2.2, (2.5±0.9)cm in the CML group and (102±15)minutes, (15±4)minutes, (94±26)mL, 16.2±5.7, 1.6±0.7, (2.6±1.8)cm in the ML group, respectively, with no statistically significant difference in operation time, volume of intraoperative blood loss, number of lymph node dissected and distance to distal resection margin between the 2 groups (t=1.079,-0.455, 1.368,-0.150, P>0.05) and with statistically significant differences in time of lymph node dissected around IMA and number of No.253 lymph node dissected between the 2 groups (t= -4.264,-4.268, P<0.05). Pathological examination showed that No.253 lymph node of 1 patient with stage ⅢC in the CML group was positive, and positive rate of tumor in the CML group was 1/12. (2) Postoperative situations: 5 and 9 patients in the CML group and ML group had respectively postoperative complications, some of them were combined with multiple complications. Intestinal obstruction, anastomotic leakage, anastomotic bleeding, incision infection, urinary tract infection and duration of hospital stay were 2, 1, 1, 1, 1, (10±3)days in the CML group and 3, 4, 0, 1, 2, (11±6)days in the ML group, respectively, showing no statistically significant difference in postoperative complications and duration of hospital stay between the 2 groups (χ²=0.941, t=-0.697, P>0.05). (3) Followup situations: 82 patients were followed up for 6-10 months with a median time of 8 months, without the occurrence of tumor recurrence and metastasis and tumorrelated death.
Conclusion:Compared with traditional medialtolateral approach, cephalomedial to lateral approach is safe and feasible for laparoscopic radical resection of rectal cancer, and it cannot extend the operation time, with an advantage of No.253 lymph node dissection.