Long-term survival outcome of laparoscopic liver resection for hepatocellular carcinoma

Long-term survival is the most important outcome measurement of a curative oncological treatment.For hepatocellular carcinoma(HCC),the long-term disease-free and overall survival of laparoscopic liver resection(LLR)is shown to be non-inferior to the current standard of open liver resection(OLR).Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR.It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence.On the other hand,since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized,it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR.Despite the paucity of level 1 evidence,the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled,matched comparative studies.Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions.On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence,the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.

Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

AIM:To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrec-tomy in a single unit.METHODS:From February 2000 to September 2004,all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial.Primary endpoint was cancer-related survival and secondary endpoints were overall survival,evaluation of surgical complications and mortality.RESULTS:Fifty-eight patients were enrolled.Forty-seven patients were followed-up(range 11-103,me-dian 38 mo).Four patients were lost at follow up.Twenty-two patients underwent a laparoscopic gastric surgery(LGS)and 25 had a standard open procedure(OGS).No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate(50% vs 52%,P = 1),and 5 years overall mortal-ity rate(54.5% vs 56%,P = 1).Accordingly,cancer-related and overall survival probability by Kaplan-Meier method showed comparable results(P = 0.81 and P = 0.83,respectively).We found no differences in surgical complications in the 2 groups.There was no conversion to open surgery in this series.CONCLUSION:LGS is as effective as OGS in the man-agement of advanced gastric cancer.However LGS can-not be recommended routinely over OGS for the treat-ment of advanced gastric cancer.

Simple instruments facilitating achievement of transanal total mesorectal excision in male patients

AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.