Clinical Reseach Of Laparoscopic Total Mesorectal Excision In Low Rectal Carcinoma Surgery

Background As the popular digestive malignancy,the morbidity of rectal cancer ascend in resent years.Now surgery is still the most important method for treating rectal cancer.Surgery following the principle of total mesorectal excision(TME)can reduce the local recurrence remarkably and improve survival.Laporoscopic TME surgery is increasing for low rectal cancer in the past few years.Objective Investigate the safety,oncological radical,recovery after operation and postoperative effect of laparoscopic TME in low/ultralow rectal carcinoma.Methods Retrospective analysis the patients with low/ultralow rectal carcinoma from January2012 to June 2014,64 cases of laparoscopic total mesorectal excision(L-TME)and 72 cases of open total mesorectal excision(O-TME)were compared about operation index,oncological radical and postoperative effect.Results1.The operating time in L-TME group was significantly longer than O-TME group,were(162.4±42.0)min and(146.1±31.2)min,P=0.011.The blood loss in L-TME group were significantly less than O-TME group,(87.6±52.2)ml and(199.4±95.8)ml,P=0.000.No statistically significant difference was detected between two groups in the probability anal reservation,distal margin or lymph node harvest(90.6% and 86.1%,P =0.415;(10.1±-2.5)and(10.8±3.4),P = 0.126;(2.34±0.47)cm and(2.47±0.69)cm,P=0.203).52 cases(81.3%)with mesorectum integrity level 1 in L-TME group were significantly better than 45 cases(62.5%)in O-TME group(P=0.016).2.The L-TME group was significantly less than the O-TME group in the need of analgesia drugs,intestinal function recovery time and length of hospital stay(15.6% and30.6%,P=0.040;(66.7±12.2)h and(99.9±19.1)h,P=0.000;(7.7±1.0)d and(9.2±1.6)d,P=0.000).No significant difference was detected between two groups in postoperative complication rate(15.6% and 19.4%,P=0.560).3.Postoperative follow-up there was no significant difference between two groups in the anal function(86.2% and 77.4%,P=0.214).4 cases of local recurrence and 6 cases of distant metastatis in L-TME group,the local recurrence rate was 6.25% and relapse rate was 15.63%,including TNM stage Ⅰ 0,stage Ⅱ 2 cases of distant metastatis,stage Ⅲ 4cases of local recurrence and 4 cases of distant metastatis.6 cases of local recurrence and 6cases of distant metastatis in O-TME group,the local recurrence rate was 8.33% and relapse rate was 16.67%,including TNM stage Ⅰ 0,stage Ⅱ 2 cases of local recurrence and 2 cases of distant metastatis,in stage Ⅲ the numbers were 4 both.There were no significant difference between two groups in local recurrence or the total relapse(6.25%and 8.83%,P=0.746;15.63% and 16.67%,P=0.869).No significant difference of total relapse was detected in different TNM stage(TNM Ⅱ: 2/64 and 4/72,P = 0.684;Ⅲ 8/64 and 8/72,P = 0.802).Conclusion Laparoscopic TME in follow the radical principle of tumor has the following advantages: less surgical blood loss,better integrity of mesorectum excision,faster recovery of intestinal function,less need of analgesia,shorter length of hospital stay.