Abstract: Objective:To explore the clinical effect of laparoscopic electrocoagulating hook′ method in treatment of rectal cancer.
Methods:The retrospective cohort study was adopted. The clinical data of 237 patients with rectal cancer who were admitted to the Second People′s Hospital of Guangxi Zhuang Autonomous Region from June 2004 to June 2009 were collected. Among 237 patients undergoing radical resection of rectal cancer, 120 using laparoscopic electrocoagulating hook′ method were allocated into the laparoscopic electrocoagulating hook′ group and 117 using laparoscopic ultrasound knife′s method were allocated into the laparoscopic ultrasound knife′s group. Observation indicators included: (1) treatment situations: operation time, volume of intraoperative blood loss, number of lymph node dissected, time to anal exsufflation, time for outofbed activity, duration of hospital stay, treatment expenses and occurrence of complications (anastomotic leakage, intestinal obstruction, postoperative dysuresia and sexual dysfunction), (2) followup situations. Followup using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to December 18, 2014. The colonoscopy, chest X-ray and abdominal computed tomography (CT) were applied to suspected patients with local or distal tumor recurrence. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using t test. Count data were analyzed using chisquare test or Fisher exact probability. The survival curve was drawn by KaplanMeier method, and the survival rate was analyzed using the Logrank test.
Results:(1) Treatment situations: all the patients underwent successful laparoscopic surgery, without conversion to open surgery. Operation time, number of lymph node dissected, time to anal exsufflation, time for outofbed activity and duration of hospital stay were respectively (156±33)minutes, 18±2, (1.5± 0.6)days, (1.5±0.5)days, (7.5±2.5)days in the laparoscopic electrocoagulating hook′ group and (175±21)minutes, 16±4, (1.6±0.5)days, (1.4±0.5)days, (8.0±1.8)days in the laparoscopic ultrasound knife′s group, with no statistically significant difference in the above indexes between the 2 groups (t=25.324, 20.117, 21.477, 1.617, 1.770, P>0.05). Volume of intraoperative blood loss and treatment expenses were respectively (116±12 )mL, (2.4±0.3)×104 yuan in the laparoscopic electrocoagulating hook′ group and (149±25) mL, (2.8±0.2)×104 yuan in the laparoscopic ultrasound knife′s group, with statistically significant differences in the above indexes between the 2 groups (t=212.740, 211.071, P<0.05). Anastomotic leakage, intestinal obstruction and dysuresia or sexual dysfunction were respectively detected in 6, 3, 0 in the laparoscopic electrocoagulating hook′ group and 7, 3, 5 in the laparoscopic ultrasound knife′s group, with no statistically significant difference in the anastomotic leakage and intestinal obstruction between the 2 groups (χ²=0.110, P>0.05) and with a statistically significant difference in the dysuresia or sexual dysfunction between the 2 groups (P<0.05). All the patients received postoperative chemotherapy of FOLFOX regimens for 6 cycles. (2) Followup situations: 226 patients were followed up for a median time of 52 months (range, 11-121 months), and 11 patients lost to followup were included in the study as censored data, including 5 in the laparoscopic electrocoagulating hook′ group and 6 in the laparoscopic ultrasound knife′s group. During the followup, 67 patients were dead, including 58 died of tumor recurrence and metastasis, 4 died of cerebral hemorrhage, 3 died of myocardial infarction and 2 died of renal failure. The overall survival rate and overall survival time were 70.36% and 51 months. The overall local tumor recurrence rate, distal tumor recurrence rate and 5year survival rate were 8.33%(10/120), 25.83%(31/120), 71.7% in the laparoscopic electrocoagulating hook′ group and 7.69%(9/117), 29.06%(34/117), 72.4% in the laparoscopic ultrasound knife′s group, with no statistically significant difference between the 2 groups (χ²=0.033, 0.310, 0.002, P> 0.05).
Conclusion:The laparoscopic electrocoagulating hook′ method in treatment of rectal cancer is safe and effective compared with traditional laparoscopic surgery, and it could also reduce the incidence of autonomic nerverelated complications and treatment expenses.