Analysis Of Laparoscopic Radical Resection Of Colorectal Cancer Based On Membrane Anatomy

Objective:From gastrointestinal surgery based on the anatomy of the membrane,laparoscopic colorectal cancer radical resection operation situation,the incidence of postoperative complications,postoperative local recurrence and metastasis rate,5-year survival rate,the minimally invasive colorectal cancer surgery of the influence factors of safety,efficacy and prognosis of tumor,in order to understand the effect of laparoscopic colorectal cancer surgery,our department Add new evidence-based medical evidence for laparoscopic colorectal cancer surgery.Methods:In this retrospective study,patients with colorectal cancer who underwent laparoscopic radical colorectal cancer resection based on membrane anatomy from January 2012 to January 2017 in the Gastrointestinal Surgery Department of The People’s Hospital of Inner Mongolia Autonomous Region were selected as the study subjects according to the proposed inclusion and exclusion criteria.Clinical data of patients(hospitalization number,gender,age,height,weight,BMI,physical condition,age at first diagnosis,main diagnosis,date of diagnosis,tumor site,maximum tumor diameter,distance from lower rectal tumor margin to anal margin,tumor markers,pathological type,degree of differentiation and detailed TNM stage,etc.)were collected.Operative information(auxiliary incision length,operative time,intraoperative blood loss,number of lymph node dissection,time of first postoperative anal exhaust,length of hospital stay);Surgical complications and the incidence of anastomotic leakage,incision site infection,postoperative intraperitoneal hemorrhage,gastrointestinal bleeding,abdominal cavity infection,pulmonary infection,urinary tract infections,chyle leakage,postoperative ileus,cardiovascular accident,cerebrovascular accident,thrombotic disease),and postoperative complications by Clavin-Dindo grading system of grading;Postoperative local recurrence rate(pelvic,lymph node,anastomosis,perineum,operative area or surrounding organs)and distant metastasis rate;With the date of disease diagnosis as the starting point and 5 years(60 months)or death as the end point of follow-up,5-year survival was counted.Follow-up tables were made by referring to the core fields of CSCO case registration database,followed up by outpatient review,case reference and telephone follow-up,and clinical data database was established to analyze the efficacy and prognostic factors of laparoscopic radical resection of colorectal cancer based on membrane anatomy.All data were statistically analyzed by SPSS 26.0 software.The count data were expressed as the number of cases and rate(%),and χ2 test was used for comparison between groups.The measurement data of normal distribution were expressed as mean ± standard deviation(x ± S).Kaplan-meier method was used to draw the survival curve.Log-rank test was used to compare the difference of survival curve and screen the factors influencing the prognosis of colorectal cancer.Cox regression model was used for multivariate analysis.P<0.05 was considered statistically significant.Results:1.A total of 815 patients with colorectal cancer were admitted to the Department of Gastrointestinal Surgery of our hospital from January 2012 to January 2017.Excluding patients who did not meet the study criteria,170 patients meeting the study criteria were included in this study,including 82 patients with rectal cancer,including 48 males and 34 females,aged 44-89 years.The average age was(61.76±14.37)years;BMI17.15～28.39kg/m2,average(23.44±2.82);Auxiliary incision(5.89±2.21)cm,operation time(176.62±38.37)min,intraoperative blood loss(126.74±42.31)ml,number of lymph nodes dissected(15.17±6.87),first postoperative exhaust time(2.25±1.54)days,Postoperative hospital stay was(12.87±4.58)days.There were 88 patients with colon cancer,including 42 males and 46 females,aged from 32 to 82 years,with an average of(61.56±11.62)years.BMI16.23～29.55kg/m2,average(23.31±3.07);Auxiliary incision(6.34±2.58)cm,operation time(187.27±42.39)min,intraoperative blood loss(135.13±37.25)ml,number of lymph nodes dissected(18.06±7.79),first postoperative exhaust time(2.68±1.56)days,Postoperative hospital stay was(13.75±4.62)days.2.Among postoperative rectal cancer patients,anastomotic fistula occurred in 2 cases,postoperative intestinal obstruction occurred in 3 cases,auxiliary incision infection occurred in 5 cases,auxiliary incision hernia occurred in 1 case,and non-surgical complications occurred in 2 cases,including 1 case of pulmonary infection and 1 case of urinary tract infection.The total incidence of complications was 15.85%,according to the clavien-Dindo complication classification:Class Ⅰ was 2.4%(2/82),class Ⅱ 7.3%(6/82),1.2%-a level Ⅲ(1/82),Ⅲ-b 2.4%(2/82),Ⅳ-a level of 1.2%(1/82),the Ⅳ-b 1.2%(1/82),no complications Ⅴ level;Among postoperative colon cancer patients,anastomotic fistula occurred in 2 cases,intestinal obstruction occurred in 4 cases,auxiliary incision infection occurred in 2 cases,abdominal infection occurred in 2 cases,and non-surgical complications occurred in 3 cases,including 1 case of pulmonary infection and 2 cases of urinary tract infection.The total incidence of complications was 14.77%.According to the clavien-Dindo complication classification:Class Ⅰ was 3.4%(3/88),class Ⅱ 6.8%(6/88),1.1%-a level Ⅲ(1/88),Ⅲ-b 1.1%(1/88),Ⅳ-a level of 2.3%(2/88),no Ⅳ-grade b and Ⅴcomplications occurred.None of the above patients had postoperative abdominal bleeding,gastrointestinal bleeding,chylous leakage,cardiovascular accidents,cerebrovascular accidents,thrombotic diseases and other complications.3.170 patients were followed up for 5 years after surgery;Local recurrence rate was 10.98%(9/82),distant metastasis rate was 20.73%(17/82),mortality rate was 18.29%(15/82),overall survival rate was 81.71%.Local recurrence rate was 11.36%(10/88),distant metastasis rate was 25.00%(22/88),mortality rate was 20.45%(18/88)and overall survival rate was 79.55%.4.Cox multivariate analysis showed that there were statistically significant differences in the distance between tumor and anal margin,degree of differentiation,TNM stage,T stage and N stage mortality of rectal cancer patients(P<0.05).There were statistically significant differences in the degree of differentiation,TNM stage,T stage and N stage mortality of colon cancer patients(P<0.05).Conclusion:1.Based on membrane anatomy,laparoscopic radical resection of colorectal cancer not only has the advantages of reducing intraoperative trauma,reducing intraoperative bleeding and accelerating postoperative recovery of patients,but also can increase lymph node clearance rate and reduce postoperative complications.Although the operation time is relatively prolonged,it does not affect the prognosis of patients.2.Membrane-based surgery can improve the complete resection rate of tumor and reduce intraoperative tumor spread,thus reducing the local recurrence rate and distant metastasis rate of tumor,and enabling patients to have a higher 5-year survival rate.3.The results showed that the distance between tumor and anal margin,degree of differentiation,TNM stage,T stage and N stage were independent prognostic factors for rectal cancer.The degree of tumor differentiation,TNM stage,T stage and N stage were independent prognostic factors of colon cancer.Therefore,for stage Ⅰ to Ⅲcolorectal cancer,tumor stage and grade related indexes still have the greatest influence on prognosis,while other indexes have relatively little effect.