Clinical effect of laparoscopic radical resection of colorectal cancer based on propensity score matching

BACKGROUND The incidence of colorectal cancer(CRC)is increasing annually.Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice.AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching(PSM).METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital,Xiangya School of Medicine,Central South University(The First People’s Hospital of Changde City)were analyzed retrospectively.The control group included patients who underwent open surgery(n=43),and those who underwent laparoscopic surgery formed the observation group(n=57).The baseline information of both groups was equipoised using 1×1 PSM.Differences in the perioperative parameters,inflammatory response,immune function,degree of pain,and physical status between the groups were analyzed.RESULTS Thirty patients from both groups were successfully matched.After PSM,baseline data showed no statistically significant differences between the groups:(1)Periop-erative parameters:The observation group had a longer surgery time,less intra-operative blood loss,earlier first ambulation and first anal exhaust times,and shorter gastric tube indwelling time than the control group;(2)Inflammatory response:24 h after surgery,the levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)between groups were higher than preoperatively.IL-6,CRP,and TNF-αlevels in the observation group were lower than in the control group;(3)Immune function:At 24 h after surgery,counts of CD4-positive T-lymphocytes(CD4+)and CD4+/CD8-positive T-lymphocytes(CD8+)in both groups were lower than those before surgery,whereas CD8+was higher than that before surgery.At 24 h after surgery,both CD4+counts and CD4+/CD8+in the observation group were higher than those in the control group,whereas CD8+counts were lower;(4)Degree of pain:The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery;and(5)Physical status:One month after surgery,the Karnofsky performance score in the observation group was higher than that in the control group.CONCLUSION Laparoscopic radical resection of CRC has significant benefits,such as reducing postoperative pain and postoperative inflammatory response,avoiding excessive immune inhibition,and contributing to postoperative recovery.

Laparoscopic vs open surgery for gastric cancer: Assessing time, recovery, complications, and markers

BACKGROUND Gastric cancer(GC)is one of the most common cancers worldwide.Morbidity and mortality have increased in recent years,making it an urgent issue to address.La-paroscopic radical surgery(LRS)is a crucial method for treating patients with GC;However,its influence on tumor markers is still under investigation.The data of 194 patients treated at Chongqing University Cancer Hospital bet-ween January 2018 and January 2019 were retrospectively analyzed.Patients who underwent traditional open surgery and LRS were assigned to the control(n=90)and observation groups(n=104),respectively.Independent sample t-tests andχ2 tests were used to compare the two groups based on clinical efficacy,changes in tumor marker levels after treatment,clinical data,and the incidence of posto-perative complications.To investigate the association between tumor marker levels and clinical efficacy in patients with GC,three-year recurrence rates in the two groups were compared.RESULTS Patients in the observation group had a shorter duration of operation,less in-traoperative blood loss,an earlier postoperative eating time,and a shorter hospital stay than those in the control group(P<0.05).No significant difference was observed between the two groups regarding the number of lymph node dissections(P>0.05).After treatment,the overall response rate in the control group was significantly lower than that in the observation group(P=0.001).Furthermore,after treatment,the levels of carbohydrate antigen 19-9,cancer antigen 72-4,carcinoembryonic antigen,and cancer antigen 125 decreased significantly.The observation group also exhibited a significantly lower incidence rate of postoperative complications compared to the control group(P<0.001).Additionally,the two groups did not significantly differ in terms of three-year survival and recurrence rates(P>0.05).CONCLUSION LRS effectively treats early gastric cancer by reducing intraoperative bleeding,length of hospital stays,and postoperative complications.It also significantly lowers tumor marker levels,thus improving the short-term prognosis of the disease.

Identification of multiple risk factors for colorectal cancer relapse after laparoscopic radical resection

BACKGROUND Colorectal cancer(CRC)is a common life-threatening disease that often requires surgical intervention,such as laparoscopic radical resection.However,despite successful surgeries,some patients experience disease relapse.Identifying the risk factors for CRC relapse can help guide clinical interventions and improve patient outcomes.AIM To determine the risk factors that may lead to CRC relapse after laparoscopic radical resection.METHODS We performed a retrospective analysis using the baseline data of 140 patients with CRC admitted to our hospital between January 2018 and January 2020.All included participants were followed up until death or for 3 years.The baseline data and laboratory indicators were compared between the patients who experienced relapse and those who did not experienced relapse.RESULTS Among the 140 patients with CRC,30 experienced relapse within 3 years after laparoscopic radical resection and 110 did not experience relapse.The relapse group had a higher frequency of rectal tumors with low differentiation and lymphatic vessel invasion than that of the non-relapse group.The expression of serum markers and the prognostic nutritional index were lower,whereas the neutrophil-to-lymphocyte ratio,expression of cytokeratin 19 fragment antigen 21-1,vascular endothelial growth factor,and Chitinase-3-like protein 1 were significantly higher in the relapse group than those in the non-relapse group.The groups did not differ significantly based on other parameters.Logistic regression analysis revealed that all the above significantly altered factors were independent risk factors for CRC relapse.CONCLUSION We identified multiple risk factors for CRC relapse following surgery,which can be considered for the clinical monitoring of patients to reduce disease recurrence and improve patient survival.

Short- and long-term results of open vs laparoscopic multisegmental resection and anastomosis for synchronous colorectal cancer located in separate segments

BACKGROUND It remains unclear whether laparoscopic multisegmental resection and ana-stomosis(LMRA)is safe and advantageous over traditional open multisegmental resection and anastomosis(OMRA)for treating synchronous colorectal cancer(SCRC)located in separate segments.AIM To compare the short-term efficacy and long-term prognosis of OMRA as well as LMRA for SCRC located in separate segments.METHODS Patients with SCRC who underwent surgery between January 2010 and December 2021 at the Cancer Hospital,Chinese Academy of Medical Sciences and the Peking University First Hospital were retrospectively recruited.In accordance with the RESULTS LMRA patients showed markedly less intraoperative blood loss than OMRA patients(100 vs 200 mL,P=0.006).Compared to OMRA patients,LMRA patients exhibited markedly shorter postoperative first exhaust time(2 vs 3 d,P=0.001),postoperative first fluid intake time(3 vs 4 d,P=0.012),and postoperative hospital stay(9 vs 12 d,P=0.002).The incidence of total postoperative complications(Clavien-Dindo grade:≥II)was 2.9%and 17.1%(P=0.025)in the LMRA and OMRA groups,respectively,while the incidence of anastomotic leakage was 2.9%and 7.3%(P=0.558)in the LMRA and OMRA groups,respectively.Furthermore,the LMRA group had a higher mean number of lymph nodes dissected than the OMRA group(45.2 vs 37.3,P=0.020).The 5-year overall survival(OS)and disease-free survival(DFS)rates in OMRA patients were 82.9%and 78.3%,respectively,while these rates in LMRA patients were 78.2%and 72.8%,respectively.Multivariate prognostic analysis revealed that N stage[OS:HR hazard ratio(HR)=10.161,P=0.026;DFS:HR=13.017,P=0.013],but not the surgical method(LMRA/OMRA)(OS:HR=0.834,P=0.749;DFS:HR=0.812,P=0.712),was the independent influencing factor in the OS and DFS of patients with SCRC.CONCLUSION LMRA is safe and feasible for patients with SCRC located in separate segments.Compared to OMRA,the LMRA approach has more advantages related to short-term efficacy.

Single-incision laparoscopic colorectal surgery for cancer: State of art

A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery.During the last years,a great effort has been made to research for minimizing parietal trauma,yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity.New techniques,such as natural orifice transluminal endoscopic surgery(NOTES)and single-incision laparoscopy(SIL)have been developed in order to reach the goal of"scarless"surgery.Although NOTES may seem not fully suitable or safe for advanced procedures,such as colectomies,SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use.The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus,perform even complex procedures which require extraction of large surgical specimens orintestinal anastomosis.The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation.However,SIL raises a number of specific new challenges compared with the laparoscopic conventional approach.A reduced capacity for triangulation,the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues.The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement,especially for oncologic cases.

Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients

AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy(LAC) in elderly colorectal cancer patients with open colectomy(OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups.RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC(mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss(mean difference =-93.3738, 95%CI:-132.3437 to-54.4039, P < 0.0001), overall morbidity(OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection(OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus(OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications(OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes(median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival(mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival(mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes(mean difference =-0.1360, 95%CI:-4.0553-3.7833, P = 0.9458).CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.

Single-incision laparoscopic surgery for colorectal cancer

AIM: To determine the effect of single-incision laparoscopic colectomy(SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy(CLC).METHODS: A systematic review was performed using MEDLINE for the time period of 2008 to December 2014 to retrieve all relevant literature. The search terms were "laparoscopy", "single incision", "single port", "single site", "SILS", "LESS" and "colorectal cancer". Publications were included if they were randomized controlled trials, case-matched controlled studies, or comparative studies, in which patients underwent single-incision(SILS or LESS) laparoscopic colorectal surgery. Studies were excluded if they were non-comparative, or not including surgery involving the colon or rectum. A total of 15 studies with 589 patients who underwent SILC for colorectal cancer were selected.RESULTS: No significant differences between the groups were noted in terms of mortality or morbidity. The benefit of the SILC approach included reduction in conversion rate to laparotomy, but there were no significant differences in other short-term clinical outcomes between the groups. Satisfactory oncological surgical quality was also demonstrated for SILC for the treatment of colorectal cancer with a similar average lymph node harvest and proximal and distal resection margin length as multiport CLC.CONCLUSION: SILC can be performed safely with similar short-term clinical and oncological outcomes as multiport CLC.

Present laparoscopic surgery for colorectal cancer in Japan

In many clinical studies,laparoscopic surgery(LS) for colon cancer has been shown to be less invasive than open surgery(OS) while maintaining similar safety.Furthermore,there are no significant differences between LS and OS in long-term outcomes.Thus,LS has been accepted as one of the standard treatments for colon cancer.In the treatments of rectal cancer as well,LS has achieved favorable outcomes,with many reports showing long-term outcomes comparable to those of OS.Furthermore,the magnification in laparoscopy improves visualization in the pelvic cavity and facilitates precise manipulation,as well as providing excellent educational effects.For these reasons,rectal cancer has seemed to be well indicated for LS,as has been colon cancer.The indication for LS in the treatment of locally advanced rectal cancer,which is relatively unresectable(e.g.,cancer invading other organs),remains an open issue.In recent years,new techniques such as singleport and robotic surgery have begun to be introduced for LS.Presently,various clinical studies in our country as well as in most Western countries have demonstrated that LS,with these new techniques,are gradually showing long-term outcomes.

Effect of screening colonoscopy frequency on colorectal cancer mortality in patients with a family history of colorectal cancer

BACKGROUND Colorectal cancer is a common malignant tumor in China,and its incidence in the elderly is increasing annually.Inflammatory bowel disease is a group of chronic non-specific intestinal inflammatory diseases,including ulcerative colitis and Crohn’s disease.We included the clinicopathological and follow-up data of patients with colorectal cancer who underwent laparoscopic colectomy or open colectomy at our Gastrointestinal Department between January 2019 and December 2022.Surgical indicators,oncological indicators,and survival rates were compared between the groups.The results of 104 patients who met the above criteria were extracted from the database(laparoscopic colectomy group=63,open colectomy group=41),and there were no statistically significant differences in the baseline data or follow-up time between the two groups.RESULTS Intraoperative blood loss,time to first ambulation,and time to first fluid intake were significantly lower in the laparoscopic colectomy group than in the open colectomy group.The differences in overall mortality,tumor-related mortality,and recurrence rates between the two groups were not statistically significant,and survival analysis showed that the differences in the cumulative overall survival,tumor-related survival,and cumulative recurrence-free rates between the two groups were not statistically significant.CONCLUSION In elderly patients with colorectal cancer,laparoscopic colectomy has better short-term outcomes than open colectomy,and laparoscopic colectomy has superior long-term survival outcomes compared with open colectomy.

Medium-term surgical outcomes and health-related quality of life after laparoscopic vs open colorectal cancer resection: SF-36 health survey questionnaire

BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.

Simplifying Laparoscopic Surgery for Left Side Colon and Rectal Cancer Using Linear Stapler for Vascular Ligation: A Prospective Cohort Study

Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques;thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.

Simultaneous laparoscopic multi-organ resection combined with colorectal cancer:Comparison with non-combined surgery

AIM: To access the short-term outcomes of simultaneous laparoscopic surgery combined with resection for synchronous lesions in patients with colorectal cancer. METHODS: Between March 1996 and April 2010 prospectively collected data were reviewed from 93 consecutive patients who had colorectal cancer and underwent simultaneous multiple organ resection (combined group) and 1090 patients who underwent conventional laparoscopic right hemicolectomy or laparoscopic low/ anterior resection for colorectal cancer (non-combined group). In the combined group, there were nine gastric resections, three nephrectomies, nine adrenalectomies, 56 cholecystectomies, and 21 gynecologic resections. In addition, f ive patients underwent simultaneous laparoscopic resection for three organs. The patient demographics, intra-operative outcomes, surgical morbidity, and short-term outcomes were compared between thetwo groups (the combined and non-combined groups). RESULTS: There were no signifi cant differences in the clinicopathological variables between the two groups. The operating time was signifi cantly longer in the combined group than in the non-combined group, regardless of tumor location (laparoscopic right hemicolectomy and laparoscopic low/anterior resection groups; P = 0.048 and P < 0.001, respectively). The other intraoperative outcomes, such as the complications and open conversion rate, were similar in both groups. The rate of post-operative morbidity in the combined group was similar to the non-combined group (combined vs non-combined, 15.1% vs 13.5%, P = 0.667). Oncological safety for the colon and synchronous lesions were obtained in the combined group. CONCLUSION: Simultaneous laparoscopic multiple organ resection combined with colorectal cancer is a safe and feasible option in selected patients.

Comparison of clinical efficacy and postoperative inflammatory response between laparoscopic and open radical resection of colorectal cancer

BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has increased annually,which has seriously threatened the health and quality of life of patients.In the treatment of CRC,both laparoscopic and radical resection are widely used.AIM To explore and discuss clinical efficacy and postoperative inflammatory response of laparoscopic and open radical resection of CRC.METHODS A total of 96 patients with CRC diagnosed in our hospital from March 2016 to April 2021 were selected,and were divided into the study group(n=48)and control group(n=48)using a simple random method.The control group was treated with open radical resection of CRC,and the study group was treated with laparoscopic radical resection of CRC.The perioperative conditions(operation time,intraoperative blood loss,the recovery time of gastrointestinal function,number of lymph node dissections and length of hospital stay),inflammatory response index levels[interleukin(IL)-6,IL-8,IL-10,C-reactive protein(CRP)]before and after operation,pain stress response indices[levels of neuropeptide(NPY),prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT)],and the incidence of the complications between the two groups were counted.RESULTS The operation time in the study group was(186.18±33.54 min),which was longer than that of the control group(129.38±26.83 min),but the intraoperative blood loss(111.34±21.45 mL),recovery time of gastrointestinal function(25.35±4.55 h),and hospital stay(10.09±2.38 d)were better than those in the control group(163.77±32.41 mL,36.06±7.13 h,13.51±3.66 d)(P<0.05).There was no significant difference in the number of lymph node dissections between the study group(15.19±3.04)and the control group(16.20±2.98)(P>0.05).There was no significant difference between the levels of serum IL-6(9.79±4.11 ng/mL),IL-8(3.79±1.71 ng/L),IL-10(48.96±12.51 ng/L)and CRP(7.98±2.33 mg/L)in the study group and the control group(10.56±3.78 ng/mL,4.08±1.45 ng/L,50.13±11.67 ng/L,8.29±2.60 mg/L)before the operation(P>0.05).After the operation,there was no significant difference between the levels of serum IL-6(19.11±6.68 ng/mL).There was no significant difference in serum NPY(109.79±13.46 UG/L),PGE2(269.54±37.34 ng/L),5-HT(151.70±18.86 ng/L)between the study group and the control group(113.29±15.01 UG/L,273.91±40.04 ng/L,148.85±20.45 ng/L)before the operation(P>0.05).The incidence of the complications in the study group(4.17%)was lower than that of the control group(18.75%)(P<0.05).CONCLUSION Laparoscopic radical resection of CRC can reduce surgical trauma,inflammatory response and pain stress caused by surgery,which shortens rehabilitation of patients,with a low incidence of complications.

Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease.The last decade has seen increasing numbers of surgeons trained to a high standard in minimallyinvasive surgery.However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery.There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes.The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery(LCS)in the emergency setting.The literature is broadly divided by the underlying pathology;that is,inflammatory bowel disease,diverticulitis and malignant obstruction.There were no randomized trials and the majority of the studies were case-matched series or comparative studies.The overall trend was that LCS is associated with shorter hospital stay,par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection,the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation.

Mini-invasive surgery for colorectal cancer

Laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades. Accumulating data have demonstrated that laparoscopic colectomy is associated with better short-term outcomes and equivalent oncologic outcomes when compared with open surgery. However, some controversies regarding the oncologic quality of mini-invasive surgery for rectal cancer exist. Meanwhile, some progresses in colorectal surgery, such as robotic technology, single-incision laparoscopic surgery, natural orifice specimen extraction, and natural orifice transluminal endoscopic surgery, have been made in recent years. In this article, we review the published data and mainly focus on the current status and latest advances of mini-invasive surgery for colorectal cancer.

Impact of circulating tumor cells in colorectal cancer patients undergoing laparoscopic surgery

Laparoscopic surgery has recently been widely used for various benign colorectal diseases as well as colorectal cancer. Although laparoscopic surgery has been shown to be with similar prognostic results for certain groups of colorectal cancer patients. The influence of laparoscopic procedures on the oncologist results, especially freetumor cell spreading is still a concern for some surgeons. Tumor cells found in the peripheral blood of patients with cancer are termed circulating tumor cells(CTCs). Presence of CTCs in the peripheral blood of patients with colorectal cancer has been reported to be associated with disease stage, poor prognosis, tumor progression, response to therapy, and drug resistance. Whether laparoscopic procedure enhances tumor spreading during operation remains unknown. Significantly less CTC detected during laparoscopic surgery than open surgery for colorectal cancer has been reported. In our previous experience, no significant elevation in CTC level was found in most patients during laparoscopic resection of colorectal cancer. We have shown that laparoscopic surgery had no significantly deleterious effect on CTCs in colorectal cancer patients. In this review, we aim at the impact of CTCs in patients with colorectal cancer undergoing laparoscopic surgery. The prognostic significance of CTCs in patients with colorectal cancer will also be addressed.

Effect of laparoscopic radical resection of colorectal cancer on immune status and CRP in patients

Objective: To investigate the effect of laparoscopic radical resection of colorectal cancer on the immune status and CRP. Methods: A total of 90 patients with colorectal cancer treated in our hospital from January 2017 to June 2017 were randomly divided into the observation group and the control group, each with 45 cases. The observation group received laparoscopic surgery, while the control group was given open surgery. The changes of immune indexes and CRP in two groups before and after 3 d and after 7 d were compared. Results: (1) In the control group, the postoperative 3 d and postoperative 7 d, CRP index were (7.87±2.01) mg/dL, (2.81±1.03) mg/dL, the observation group postoperative 3 d and postoperative 7 d, CRP index were (7.01±1.33) mg/dL, (1.59±0.81) mg/dL, compared with before treatment, the difference was statistically significant. The CRP in the observation group postoperative 7 d were significantly lower than those in the control group at the same time period, the difference was significant. The IgM and IgG index level of control group postoperative 3 d respectively (137.04±23.46) IU/mL and (114.36±27.18) IU/mL, compared with preoperative and observation group postoperative 3 d index level (163.07±30.19) IU/mL, (130.24±31.16) IU/mL decreased significantly, the difference was significant. (2) The control group postoperative 3 d CD4+and CD8+index level were respectively (0.49±0.05)×109/L, (0.29±0.08)×109/L. CD8+index level of 7 d after operation was (0.31±0.10)×109/L, which were significantly decreased than 1 d before operation and significantly lower than the same period of observation group indicator level (0.59±0.09)×109/L, (0.35±0.11)×109/L, (0.37±0.12)×109/L, the differences were statistically significant. Conclusion: Compared with open surgery, laparoscopic surgery has less influence on the immune function of patients, and has less inflammatory and stress damage, so it is worthy of clinical application.

Obese patients have similar short-term outcomes to nonobese in laparoscopic colorectal surgery

AIM: To determine whether obese patients undergoing laparoscopic surgery within an enhanced recovery program had worse short-term outcomes.METHODS: A prospective study of consecutive patients undergoing laparoscopic colorectal resection was carried out between 2008 and 2011 in a single institution. Patients were divided in groups based on body mass index(BMI). Short-term outcomes including operative data, length of stay, complications and readmission rates were recorded and compared between the groups. Continuous data were analysed using t-test or oneway Analysis of Variance. χ2 test was used to compare categorical data.RESULTS: Two hundred and fifty four patients were included over the study period. The majority of individuals(41.7%) recruited were of a healthy weight(BMI < 25), whilst 50 patients were classified as obese(19.6%). Patients were matched in terms of the presence of comorbidities and previous abdominal surgery. Obese patients were found to have a statistically significant difference in The American Society of Anesthesiologists grade. Length of surgery and intra-operative blood loss were no different according to BMI.CONCLUSION: Obesity(BMI > 25) does not lead to worse short-term outcomes in laparoscopic colorectal surgery and therefore such patients should not be precluded from laparoscopic surgery.

Laparoscopic colorectal surgery:current status andimplementation of the latest technological innovations

The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studiesand meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients' characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intracorporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.