The feasibility of laparoscopic TSME preserving the left colic artery and superior rectal artery for upper rectal cancer

Comparison of short-term surgical outcomes between high and low tie ligation of the inferior mesenteric artery in robotic rectal cancer surgery: a propensity score matching analysis

Robotic surgery is extensively used for rectal cancer treatment. Nonetheless, studies on whether to preserve the left colonic artery (LCA) during robotic rectal cancer surgery to reduce complications remain scarce and controversial. This study compared short-term outcomes of high tie (HT) and low tie (LT) ligation of the inferior mesenteric artery in 455 patients undergoing robotic rectal cancer surgery between May 2018 and July 2022. Propensity score matching (PSM) minimized selection bias, resulting in 124 patients in each group. The LT group had a longer operative time (P < 0.001), but there were no significant differences in estimated blood loss, lymph node harvest, lymph node positivity, AJCC stage, hospital stay, or costs. Postoperative complications, 30-day mortality, and reoperations were also comparable. Univariate analysis identified hypoalbuminaemia, low tumor location, ASA scores III, and neoadjuvant chemoradiotherapy as risk factors for postoperative complications. Multivariate analysis confirmed low serum albumin and low tumor location as significant factors. Importantly, HT did not increase the risk of complications in either analysis. These findings indicate that high ligation does not adversely affect short-term outcomes and highlight the need for further research to refine surgical strategies.

Isolated metastases to the common iliac and mesorectal lymph nodes suggesting an atypical metastatic route in upper rectal cancer: A case report

INTRODUCTION

Most lymphatic vessels in the upper rectum run parallel to the superior rectal artery and up to the inferior mesenteric artery. Here, we report a rare case of upper rectal cancer with atypical lymphatic spread.

PRESENTATION OF CASE

A 39-year-old woman was diagnosed with upper rectal cancer and isolated lymph node (LN) metastases to the mesorectal and right common iliac LNs. The patient underwent laparoscopic low anterior resection with targeted dissection of the right common iliac LNs. The pathological diagnosis was T3N2M0, and the patient received postoperative adjuvant chemotherapy. One year later, local recurrence was found at the sacral promontory level, where the targeted lymphadenectomy had been performed previously. The recurrent tumor was surgically resected together with the attached presacral fascia. The patient subsequently received postoperative adjuvant chemotherapy, and there was no recurrence one year after the last surgery.

DISCUSSION

Isolated metastases were observed in the right common iliac and mesorectal LNs. The locally recurrent tumor included lymphatic vessels running along the median sacral artery. No metastatic tumor was found in the internal iliac area at the time of the initial diagnosis nor during recurrence. Thus, this case suggests the presence of a rare metastatic route from the mesorectal LN to the common iliac LN via the median sacral lymphatics.

CONCLUSION

Lymphatic spread of rectal cancer may be predictable; however, rare patterns of LN metastasis can exist. The assessment of lymphatic flow is crucial for improving the oncological outcomes of rectal cancer surgery.

Oncology Outcomes of Total Mesorectal Excision with Preservation of Both the Superior Rectum Artery and Left Colonic Artery for Upper-Rectal and Sigmoid Colon Cancers: A Meta-Analysis

Background: Total mesorectal resection (TME) has become the standard surgical procedure for resection of colorectal cancer tumors. We presented a systematic meta-analysis to evaluate the surgical outcomes of laparoscopic TME surgery with preservation or nonpreservation of both the superior rectum artery (SRA) and left colonic artery (LCA) for upper-rectal and sigmoid colon cancers. Methods: The comparative studies were systematically searched on PubMed, Science Direct, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) up to April 2021. Primary outcomes were oncology outcomes. And secondary outcomes involved surgical outcomes of interest and postoperative recovery. Results: Five relevant studies with a total of 761 patients undergoing laparoscopic TME surgery were eligible for meta-analysis. Three hundred seven patients received TME with preservation of both SRA and LCA (Group A), and 454 received TME surgery alone (Group B), respectively. Our results indicated that Group A had a less total postoperative complications (P = .000), lower anastomotic leakage rate (P = .002), shorter length of stay (P = .008), and longer operative time (P = .002). However, there was no significant difference between the two groups in terms of lymph node dissections (P = .188), intraoperative bleeding (P = .474), the first postoperative defecation (P = .943), recurrence rate (P = .547), and conversive rate (P = .504). Conclusions: Based on our meta-analysis, laparoscopic TME surgery with preservation of both the SRA and LCA for upper-rectal and sigmoid colon cancers may significantly receive better clinical and surgical outcomes. More well-designed large sample studies are required to replicate the short-term benefits and long-term oncologic outcomes.

The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

Background

Protective ileostomy is always applied to avoid clinically significant anastomotic leakage and other postoperative complications for patients receiving laparoscopic rectal cancer surgery. However, whether it is necessary to perform the ileostomy is still controversial. This meta-analysis aims to analyze the efficacy of ileostomy on laparoscopic rectal cancer surgery.

Methods

Cochrane Library, EMBASE, Web of Science, and PubMed were applied for systematic search of all relevant literature, updated to May 07, 2021. Studies compared patients with and without ileostomy for laparoscopic rectal cancer surgery. We applied Review Manager software to perform this meta-analysis. The quality of the non-randomized controlled trials was assessed using the Newcastle-Ottawa scale (NOS), and the randomized studies were assessed using the Jadad scale.

Results

We collected a total of 1203 references, and seven studies were included using the research methods. The clinically significant anastomotic leakage rate was significantly lower in ileostomy group (27/567, 4.76%) than that in non-ileostomy group (54/525, 10.29%) (RR = 0.47, 95% CI 0.30–0.73, P for overall effect = 0.0009, P for heterogeneity = 0.18, I² = 32%). However, the postoperative hospital stay, reoperation, wound infection, and operation time showed no significant difference between the ileostomy and non-ileostomy groups.

Conclusion

The results demonstrated that protective ileostomy could decrease the clinically significant anastomotic leakage rate for patients undergoing laparoscopic rectal cancer surgery. However, ileostomy has no effect on postoperative hospital stay, reoperation, wound infection, and operation time. The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-021-02432-x.

Safety and effectiveness evaluation of a two-handed technique combining harmonic scalpel and laparoscopic Peng's multifunction operative dissector in laparoscopic hemihepatectomy

OBJECTIVES

This study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng's multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH).

METHODS

We designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses.

RESULTS

The case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality.

CONCLUSIONS

We demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.