Clinical Efficacy of Laparoscopic Radical Colorectal Cancer Treatment for Colorectal Cancer and Its Effect on Immune Function

Objective:To explore the therapeutic effect of laparoscopic radical colorectal cancer treatment in colorectal cancer patients.Methods:A total of 50 colorectal cancer patients treated between August 2018 and August 2023 were randomly divided into two groups:Group A underwent laparoscopic radical colorectal cancer surgery,while Group B received open surgery.Clinical indicators,inflammatory factors,immune function indicators,and complications were compared between the two groups.Results:Group A showed significantly shorter operation times,faster recovery times,and reduced hospital stays compared to Group B.Additionally,Group A had less abdominal drainage and intraoperative bleeding(P<0.05).Levels of interleukin(IL)-4,IL-6,ultrasensitive C-reactive protein(hs-CRP),and tumor necrosis factor-alpha(TNF-α)were lower in Group A compared to Group B(P<0.05).Furthermore,immune function indicators,including CD3+,CD4+,CD8+,and CD4+/CD8+ratios,were better in Group A(P<0.05).The complication rate in Group A was also lower than in Group B(P<0.05).Conclusion:Laparoscopic radical treatment for colorectal cancer is efficient and feasible,causing minimal immune function impairment and inflammatory response.It also shortens postoperative recovery time.

Is fascial closure required for a 12-mm trocar?A comparative study on trocar site hernia with long-term follow up

BACKGROUND Despite the infrequency of trocar site hernias(TSHs),fascial closure continues to be recommended for their prevention when using a≥10-mm trocar.AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.METHODS Between July 2010 and December 2018,all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed.All patients underwent cross-sectional imaging for TSH assessment.Clinicopathological characteristics were recorded.Incidence rates of TSH and postoperative results were analyzed.RESULTS Of the 254 patients included,70(111 ports)were in the fascial closure(closed)group and 184(279 ports)were in the nonfascial closure(open)group.The median follow up duration was 43 mo.During follow up,three patients in the open group developed TSHs,whereas none in the closed group developed the condition(1.1%vs 0%,P=0.561).All TSHs occurred in the right lower abdomen.Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain.The open group had a significantly shorter operative time and lower blood loss than the closed group.CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed.However,further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.

Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections:a literature-based review of published studies

Objective:To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections(LCR).Methods:Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated.Results:There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR.The most common approaches were periumbilical midline incision(1260 reported case in the literature),transverse incision(583 reported cases in the literature)in the right-or left iliac fossa,depending on the side of colonic resection,and Pfannensteil incision(293 reported cases in the literature).Periumbilical midline incision was associated with the higher risk of developing incisional hernia(odds ratio 53.72;95%confidence interval 7.48–386.04;Z=3.96;P=0.0001).In terms of surgical site infection(SSI),there was no difference between the three common approaches to specimen retrieval.Transanal and transvaginal approaches were associated with higher risk of SSI.Conclusions:Midline,transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR.Midline incision was associated with higher risk of incisional hernia.Risk of SSI was similar in all three common approaches.The transanal and transvaginal approaches pose a higher risk of SSI.These conclusions are based on the combined outcome of published case series,case reports and comparative studies.Randomized,controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.