Feasibility and Safety of Laparoscopic Radical Colectomy for T4b Colon Cancer at a University Hospital in Vietnam

Effect of general anesthesia combined with epidural block on hemorheology in elderly patients with laparoscopic radical resection of colorectal cancer: A randomized controlled trial

BackgroundLaparoscopic surgery is widely used in the field of clinical surgery due to its minimal trauma, minimal bleeding, short hospital stay, and fast postoperative recovery. There were several studies found that elderly patients undergoing laparoscopic surgery are more prone to coagulation disorders, increased blood viscosity, and the influence of CO2 pneumoperitoneum, which can easily lead to changes in blood rheology There are no studies have investigated the effects on blood rheology of general anesthesia combined with epidural block on hemorheology in elderly patients undergoing laparoscopic radical resection of rectal cancer. This trial investigated to explore the effect of general anesthesia combined with epidural block on blood rheology in elderly patients undergoing laparoscopic radical resection of rectal cancer, providing experimental basis for clinical anesthesia to regulate blood rheology characteristics and prevent hyperviscosity and its complications.MethodsA total of 60 patients undergoing laparoscopic radical resection of colorectal cancer, aged 60-75 years, with American Society of Anesthesiologists physical status III, were enrolled in this study. All the subjects were randomly divided into general anesthesia group (group G, n = 30) and general anesthesia in combination with epidural block group (group G + E, n = 30) according to a random number table. Patients in the group G received the general anesthesia alone while those in the group G + E were given the combined epidural block based on anesthetic method of group G. The arterial blood gas indexes (pH, PaCO2 and HCO3-) and hemodynamic indexes(Hŋb, Lŋb,ηp, EAI, Hct and ESR) were measured at four time points: before induction of general anesthesia (T0), 5 min before establishment of pneumoperitoneum (T1), 30 min after establishment of pneumoperitoneum (T2) and 30 min after elimination of pneumoperitoneum (T3).ResultsThere was no significant statistical difference (p > 0.05) in pH, PaCO2, and HCO3- between the two groups at T1, T2, and T3. At T0, there was no significant difference (p > 0.05) in Hŋb, Lŋb, ηp, Erythrocyte Aggregation Index (EAI), Hct, and Erythrocyte Sedimentation Rate (ESR) between the two groups. However, these indices were significantly lower in group G + E than in group G (p < 0.05) at T1, T2, and T3.ConclusionCombining general anesthesia with epidural block can effectively reduce the hemorheological indexes of patients and improve the hemorheological state in elderly patients with malignant tumors undergoing laparoscopic surgery.

Comparison of short- and long-term outcomes between laparoscopic and open multivisceral resection for clinical T4b colorectal cancer: A multicentre retrospective cohort study in China

BACKGROUND

Laparoscopic surgery is controversial for patients with clinical T4b colorectal cancer (CRC) who require multivisceral resection (MVR). This study aims to explore and compare the safety and long-term oncological outcomes of laparoscopic surgery and open surgery for patients with clinical T4b CRC.

MATERIALS AND METHODS

This study was a retrospective cohort study based on a multicentre database. According to the operation method, the patients were divided into a laparoscopic MVR group and an open MVR group. The short-term and long-term outcomes were compared.

RESULTS

From January 2010 to December 2021, a total of 289 patients in the laparoscopic MVR group and 349 patients in the open MVR group were included. After propensity score matching, patients were stratified into a laparoscopic MVR group (n = 163) and an open MVR group (n = 163). Compared with the open MVR group, the laparoscopic MVR group had less blood loss (100 vs. 200, p < 0.001), a shorter time to first flatus (3 vs. 4, P < 0.001), a shorter postoperative hospital stay (10 vs. 12, P < 0.001), and a lower incidence of surgical site infection (2.5 % vs. 8.0 %, P = 0.043). The Kaplan-Meier curves showed that the two groups had similar overall survival (P = 0.283) and disease-free survival (P = 0.152).

CONCLUSION

Compared with open MVR, laparoscopic MVR had less blood loss, fewer surgical site infection complications, faster recovery and a shorter hospital stay. The long-term survival outcome of laparoscopic MVR was not inferior to that of open MVR.

Effect of laparoscopic complete mesocolic excision combined with immunotherapy and its impact on immune function and tumor markers in elderly patients with colon cancer

Objective

To determine the effect of laparoscopic complete mesocolic excision combined with immunotherapy and its impact on immune function and tumor markers in elderly patients with colon cancer.

Methods

This is a clinical comparative study. Eighty elderly patients with colon cancer hospitalized in the No.2 Hospital of Baoding from May 2020 to May 2022 were randomly divided into two groups, with 40 cases in each group. Patients in the study group received laparoscopic complete mesocolic resection combined with ubenimex orally. While patients in the control group received routine open surgery. The surgical indexes, surgical complications, and the changes of immune molecules and tumor markers before and after treatment were compared between the two groups.

Results

The amount of intraoperative bleeding, retention time of drainage tube and postoperative length of stay in the hospital in the study group were significantly better than those in the control group (p=0.000). The incision length of the study group was significantly shorter than that of the control group, the number of lymph nodes removed during the operation was significantly higher than that of the control group, and the incidence of surgical complications was significantly lower than that of the control group (p<0.05). After treatment, the levels of immune molecules in the study group were remarkably higher than those in the control group (p<0.05), while the levels of tumor markers were much lower than those in the latter group (p=0.000).

Conclusion

Laparoscopic complete mesocolic excision combined with immunotherapy exhibits a superior therapeutic effect to traditional open surgery in elderly patients with colon cancer, and is worthy of clinical promotion.

Laparoscopic and robotic multivisceral resection in colorectal cancer: A case series and systematic review

PURPOSE

Multivisceral resection (MVR) with open approach is the standard surgical treatment for locally advanced colorectal cancer. However, the medical literature concerning the practice of minimally invasive MVR in order to reduce postoperative complications and hospital stay has been growing exponentially over the last years. The present study aimed to examine our experience and to provide a systematic review about the results and complications of minimally invasive MVR.

METHODS

Data of patients that underwent minimally invasive MVR for locally advanced colorectal cancer from 2015 to 2021 were retrospectively reviewed. The literature was searched for studies concerning minimally invasive MVR for colorectal cancer.

RESULTS

A total of 39 laparoscopic MVR were performed in our department. Complications occurred in 14 patients (35.9%) with major complications in five patients (18.82%) according to Clavien-Dindo classification. Conversion was required in one case (2.56%) with subsequent mortality (2.56%). Pathologic adjacent organs or structures invasion was observed in 30 patients (76.9%) and positive resection margin occurred in two cases (5.2%). Twenty-two studies including 1055 patients were identified after literature search. In these studies, laparoscopic surgery and robotic surgery were performed in 90.15% and 9.85% of the patients, respectively. R0 resection was established in 95% of cases, conversion rate varied between 0% and 41.7%, and postoperative mortality ranged between 0% and 7.7% in the included articles.

CONCLUSION

Minimally invasive approach may be a safe option for patients requiring MVR for locally advanced colorectal cancer, with equivalent oncological results and could result in better early postoperative outcomes to open approach. However, further studies on this topic are needed to confirm the results of the current study.

Global Mapping of Interventions to Improve Quality of Life of Patients with Cancer: A Protocol for Literature Mining and Meta-Analysis

Cancer led to nearly 10 million deaths in 2020, as reported by the World Health Organization (WHO). Consequently, both biomedical therapeutics and psychological interventions have been implemented to decrease the burden of this non-communicable disease. However, the research conducted so far has only described some aspects of these interventions, which may increase the health-related quality of life of cancer patients. Therefore, a systematic review is necessary to depict an overall picture of the cancer interventions globally. Then, the impact of these interventions on the preference-based health-related quality of life of cancer patients may be synthesized. The protocol is developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Web of Science database is used to retrieve the literature using four keyword terms: quality of life (QoL), cancer, interventions, and health utility. Then, we draw the global mapping diagram and conduct the meta-analysis for this research. Additionally, longitudinal measurements are used to estimate the changes in the health utility of patients during the interventions. Thus, this systematic review can provide insight into the impact of interventions on increasing the health-related quality of life (HRQL) of cancer patients.