Comparative Analysis Of Short-term Clinical Efficacy Of Handassisted Laparoscopic And Laparoscopic-assisted Colorectal Cancer Surgery

Objective : Comparing the short-term clinical efficacy of hand-assisted laparoscopy and laparoscopy-assisted radical resection of colorectal cancer after matching the propensity score.Explore the advantages of hand-assisted laparoscopy in colorectal cancer surgery,so as to provide a reference for the further development of hand-assisted laparoscopy.Methods: Use propensity score matching and retrospective research methods.A total of 561 patients with colorectal cancer were treated with hand-assisted laparoscopic surgery(HALS)and laparoscopic-assisted surgery(LAS)for radical colorectal cancer resection from September 2018 to September 2020,Department of Gastrointestinal Surgery,the First Affiliated Hospital of Nanchang University.Among them,177 cases were in the hand-assisted laparoscopic group and 384 cases were in the laparoscopic-assisted group.Use 1:1 propensity score to adjust for potential baseline confounding factors between the two groups,Including age,gender,tumor markers,BMI,ASA classification,clinical TN staging and other preoperative data.After matching,analyze the oncology results and perioperative efficacy of the two groups.Results:(1)Propensity score matching was performed on 561 patients,including 145 in the hand-assisted laparoscopic group and 145 in the laparoscopic assisted group,totaling 290 cases.There were no statistically significant differences in gender,tumor location,BMI,clinical stage,tumor markers,and abdominal surgery history between the two groups before and after the propensity score matching(P>0.05);The age of matching forehand assisted laparoscopic group is(61.93±11.34)years old,ASA classification(level II,level III,level IV)were 12,164,and 1 cases respectively,A total of 59 cases of medical complications.The abovementioned indicators of the laparoscopic assisted group were(59.24±11.94)years old,4,379,1 case,and 74 cases,Differences between groups are statisticallysignifican(t P<0.05).After matching,the above-mentioned indexes of patients in thehandassisted laparoscopic group were(61.56±10.79)years old,2,142,1 case,and42 cases,The above-mentioned indexes of the laparoscopic assisted group were(62.03±11.12)cases,2,143,0 cases,and 37 cases,The differences between groups were not statistically significant(P>0.05).(2)The operation time of the hand-assisted laparoscopic group after matching is150.00(120,180)min,The operation time of the laparoscopic assisted group was180.00(157,227)min,Differences between groups are statistically significant(P<0.05).(3)After matching,the conversion rate to laparotomy in the hand-assisted laparoscopic group was 1(0.7%),The conversion rate to laparotomy in the laparoscopic assisted group was 8(5.5%),Differences between groups are statistically significant(P<0.05).(4)After matching,the plasma albumin of the hand-assisted laparoscopic groupwas 32.44±4.34 g/L on the first postoperative day,Plasma albumin on the first day after operation in the laparoscopic assisted group was 31.48±3.28 g/L,Differencesbetween groups are statistically significan(t P<0.05).The plasma albumin of the twogroups on the 4th day after operation was 35.14±3.28 g/L and 33.15±3.15g/L,respectively.Differences between groups are statistically significant(P<0.05).(5)intraoperative blood loss,number of dissected lymph nodes,positive number of dissected lymph nodes,perioperative complications,treatment cost and postoperative recovery were compared between the two groups after matching,The differences were not statistically significant(P>0.05).Conclusion: Hand-assisted laparoscopic colorectal cancer surgery can achieve minimally invasive effects and short-term treatment effects similar to laparoscopicassisted colorectal cancer surgery.Hand-assisted laparoscopic surgery takes less time and the conversion rate is low.In order to allow more patients to benefit from laparoscopic technology,it is worthy of further promotion and application in primary hospitals.