Observation of perioperative indices of laparoscopic right hemicolectomy with cephalic mixed approach and caudal approach
Su Shi1, He Zhipeng1, Mei Xianghuang1, Zhang Ke2, Guan Xiaoqi2, Yang Jingcheng2, Lyu Jiake1, Guo Wei1
1Department of Gastrointestinal Surgery, Heji Hospital, Changzhi Medical College, Changzhi 046000, China; 2Department of General Surgery, Graduate School of Changzhi Medical College, Changzhi 046000, China
Abstract：Objective This study aimed to observe the perioperative indices of mixed cephalic approach and caudal approach in laparoscopic right colectomy. Methods This study was a retrospective cohort study. Clinical data of 67 patients with right half colon cancer who underwent laparoscopic right hemicolectomy in the Department of Gastrointestinal Surgery, Heji Hospital Affiliated to Changzhi Medical College from December 2019, to December 2022, were analyzed retrospectively. The patient were 27-81(60.4±12.7) years old,34 were males,and 33 were females.In accordance with the surgical approach, the patients were divided into cephalic mixed approach group (n=35) and caudal approach group (n=32). The cephalic mixed approach group consisted of 17 males and 18 females aged 27-68 (59.3±12.0) years, and the caudal approach group was composed of 17 males and 15 females aged 30-81 (61.7±13.5) years. The clinical baseline data and perioperative indicators (including operation time, intraoperative blood loss, number of lymph node dissection, and postoperative complications) between the two groups were compared. Results No significant difference was found in the baseline data, such as gender,age,body mass index,and clinical TNM staging, between the two groups (all P values >0.05). The operation was successfully conducted in both groups. The operative time of the cephalic mixed approach group was (155±27) min, which was shorter than that of the caudal approach group (245±31) min. The intraoperative blood loss of the cephalic mixed approach group was (53±6) mL, which was lower than that of the caudal approach group (90±10) mL, with significant difference (t = 12.78, 3.32, all P values <0.05). The numbers of intraoperative lymph nodes dissection were 16 ± 2 in the cephalic mixed approach group and 20±3 in the caudal approach group. The first exhaust time of the cephalic mixed approach group and the caudal approach group were (5.2±0.8) and (5.5±1.3) days, respectively. The first feeding time were (6.7±0.8) days in the cephalic mixed approach group and (7.2±1.7) days in the caudal approach group. The postoperative hospital stay of the cephalic mixed approach group was (11.3±1.9) days, and that of the caudal approach group was (12.0±3.3) days. Four patients had postoperative complications of the cephalic mixed approach group (11.4%, 4/35), and six patients had postoperative complications of the caudal approach group(18.8%, 6/32). No significant difference was found between the two groups (all P values >0.05). Conclusion The cephalic mixed approach is safer than the caudal approach because of shorter operation time and less bleeding during laparoscopic right hemicolectomy.
苏石, 何志鹏, 梅相煌, 张珂, 关小奇, 杨靖承, 吕佳科, 郭伟. 头侧混合入路与尾侧入路腹腔镜右半结肠切除术围术期指标的观察[J]. 中华解剖与临床杂志, 2024, 29(4): 257-261.
Su Shi, He Zhipeng, Mei Xianghuang, Zhang Ke, Guan Xiaoqi, Yang Jingcheng, Lyu Jiake, Guo Wei. Observation of perioperative indices of laparoscopic right hemicolectomy with cephalic mixed approach and caudal approach. Chinese Journal of Anatomy and Clinics, 2024, 29(4): 257-261.
卫洪波, 黄江龙. 腹腔镜右半结肠癌扩大切除术意义的纷争[J].中华普外科手术学杂志(电子版),2018,12(3):189-193. DOI: 10.3877/cma.j.issn.1674-3946.2018.03.003.Wei HB,Huang JL.Dispute of the clinical significance of laparoscopic complete mesocolic excision and extended (D3) lymphadenectomy for right colon cancer[J]. Chin J Oper Proc Gen Surg (Electronic Version),2018,12(3):189-193. DOI: 10.3877/cma.j.issn.1674-3946.2018.03.003.
[2]
郑民华, 何子锐. 腹腔镜右半结肠癌根治术的热点与未来发展[J].中华普外科手术学杂志(电子版),2019,13(5):433-436. DOI: 10.3877/cma.j.issn.1674-3946.2019.05.001.Zheng MH, He ZR.Focus and future of laparoscopic radical resection of right colon cancer[J]. Chin J Oper Proc Gen Surg (Electronic Version),2019,13(5):433-436. DOI: 10.3877/cma.j.issn.1674-3946.2019.05.001.
[3]
郑民华, 马君俊. 腹腔镜右半结肠癌根治术的难点与争议[J].中华普外科手术学杂志(电子版),2018,12(3):181-184. DOI: 10.3877/cma.j.issn.1674-3946.2018.03.001.Zheng MH, Ma JJ.The difficulties and controversies of laparoscopic right hemicolectomy[J]. Chin J Oper Proc Gen Surg (Electronic Version),2018,12(3):181-184. DOI: 10.3877/cma.j.issn.1674-3946.2018.03.001.
[4]
Guillou PJ, Quirke P, Thorpe H, et al.Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial[J]. Lancet, 2005,365(9472):1718-1726. DOI: 10.1016/S0140-6736(05)66545-2.
[5]
Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial[J]. Lancet Oncol, 2009,10(1):44-52. DOI: 10.1016/S1470-2045(08)70310-3.
[6]
Leung KL, Kwok SP, Lam SC, et al.Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial[J]. Lancet, 2004,363(9416):1187-1192. DOI: 10.1016/S0140-6736(04)15947-3.
[7]
Jayne DG, Guillou PJ, Thorpe H, et al.Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group[J]. J Clin Oncol, 2007,25(21):3061-3068. DOI: 10.1200/JCO.2006.09.7758.
[8]
李子禹, 吴舟桥, 季加孚. 中国胃肠肿瘤外科术后并发症诊断登记规范专家共识(2018版)[J]. 中国实用外科杂志, 2018, 38(6):7. DOI: 10.19538/j.cjps.issn1005-2208.2018.06.01.Li ZY, Wu ZQ, Ji JF.Expert consensus on the diagnosis and registration of postoperative complications in gastrointestinal tumor surgery in China (2018 Edition)[J]. Chin J Prac Surg, 2018, 38(6):7. DOI: 10.19538/j.cjps.issn1005-2208.2018.06.01
[9]
Hasegawa S, Kawamura J, Nagayama S, et al.Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers[J]. Surg Endosc, 2007,21(9):1657. DOI: 10.1007/s00464-007-9305-x.
[10]
Liang JT, Lai HS, Lee PH.Laparoscopic medial-to-lateral approach for the curative resection of right-sided colon cancer[J]. Ann Surg Oncol, 2007,14(6):1878-1879. DOI: 10.1245/s10434-006-9153-2.
[11]
Pigazzi A, Hellan M, Ewing DR, et al.Laparoscopic medial-to-lateral colon dissection: how and why[J]. J Gastrointest Surg, 2007,11(6):778-782. DOI: 10.1007/s11605-007-0120-4.
[12]
Rotholtz NA, Bun ME, Tessio M, et al.Laparoscopic colectomy: medial versus lateral approach[J]. Surg Laparosc Endosc Percutan Tech, 2009,19(1):43-47. DOI: 10.1097/SLE.0b013e31818e91f3.
[13]
Fujita J, Uyama I, Sugioka A, et al.Laparoscopic right hemicolectomy with radical lymph node dissection using the no-touch isolation technique for advanced colon cancer[J]. Surg Today, 2001,31(1):93-96. DOI: 10.1007/s005950170230.
[14]
Matsuda T, Iwasaki T, Sumi Y, et al.Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach: anatomical and embryological consideration[J]. Int J Colorectal Dis, 2017,32(1):139-141. DOI: 10.1007/s00384-016-2673-8.
[15]
邹瞭南, 李洪明, 万进. 腹腔镜尾侧入路右半结肠癌根治性切除的安全性、可行性及临床应用价值[J].中华结直肠疾病电子杂志,2016,5(3):238-243. DOI: 10.3877/cma.j.issn.2095-3224.2016.03.009.Zou LN, Li HM, Wan J.The safety, feasibility and clinical application of laparoscopic radical right hemicolectomy using a caudal-to-cranial approach[J]. Chin J Colorec Dis,2016,5(3):238-243. DOI: 10.3877/cma.j.issn.2095-3224.2016.03.009.
[16]
张峰, 朱求实, 王满贞, 等. 腹腔镜右半结肠癌根治术两种入路方法的对照研究[J].中华普外科手术学杂志(电子版),2020,14(2):152-154. DOI: 10.3877/cma.j.issn.1674-3946.2020.02.014.Zhang F, Zhu QS, Wang MZ, et al.A randomized controlled study of laparoscopic radical resection of right colon cancer by using two different approaches[J]. Chin J Oper Proc Gen Surg (Electronic Version),2020,14(2):152-154. DOI: 10.3877/cma.j.issn.1674-3946.2020.02.014.
[17]
郑波波, 王楠, 吴涛, 等. 改良中间入路与传统中间入路在腹腔镜右半结肠切除术中的比较研究[J].中华胃肠外科杂志,2015,18(8):812-816. DOI: 10.3760/cma.j.issn.1671-0274.2015.08.025.Zheng BB, Wang N, Wu T,et al.Comparison of cranial-to-caudal medial versus traditional medial approach in laparoscopic right hemicolectomy:a case-control study[J]. Chin J Gastrointest Surg,2015,18(8):812-816. DOI: 10.3760/cma.j.issn.1671-0274.2015.08.025.
2024, Vol. 29 
