Comparative Study On The Clinical Efficacy Of Different Surgical Approaches In Laparoscopic Radical Surgery For Right Helicolon Cancer In Obese Patients

Objective: To investigate the clinical effect of cephalic and medial approaches in the treatment of obese patients with right colon cancer.Methods:A total of 75 patients receiving laparoscopic radical resection of right colon cancer from January 2018 to January 2023 were collected from the Department of General Surgery,the Fourth Affiliated Hospital of Xinjiang Medical University by digital medical record browser.Patients were divided into obese group and non-obese group according to different body mass index.The obese group was divided into cephalic approach group and middle approach group according to different operations,while the non-obese group was divided into cephalic approach group and middle approach group.The general data,total operation time,intraoperative blood loss,total number of lymph node dissection,number of positive lymph node dissection,anal exhaust time,postoperative indindent time of drainage tube,postoperative pathological data and incidence of complications in obese and non-obese groups were observed and compared respectively for retrospective analysis.Results:There were no statistically significant differences in age,sex,body mass index,preoperative albumin,preoperative hemoglobin and tumor size between the obese cephalic approach group and the non-obese cephalic approach group and the middle approach group(P>0.05).There were no significant differences in tumor site,TNM stage,tumor differentiation degree and neurovascular involvement(P>0.05).There were no significant differences in the number of positive lymph node dissection,anal exhaust time and postoperative indwelling drainage tube time(P>0.05).The Operation time and blood loss in the obese cephalic approach group were lower than those in the middle approach group,and the differences were statistically significant(P<0.05).The total number of lymph nodes dissected by cephalic approach was higher than that by middle approach,and the difference was statistically significant(P<0.05).The complication rate of the cephalic approach group was lower than that of the intermediate approach group,but the difference was not statistically significant(P>0.05).The total operation time in the non-obese cephalic approach group was less than that in the middle approach group,and the difference was statistically significant(P<0.05).The amount of surgical bleeding was similar to that of the middle approach,but the difference was not statistically significant(P>0.05).The total number of lymph nodes dissected by the cephalic approach was lower than that by the middle approach,and the difference was not statistically significant(P>0.05).The rate of surgical complications in the cephalic approach group was lower than that in the middle approach group,and the difference was not statistically significant(P>0.05),Obese and non-obese patients were treated with the intermediate approach,and the total operation time and intraoperative blood loss were significantly higher in obese patients than in non-obese patients,with statistical significance(P<0.05).The cephalic approach was used in obese and non-obese patients,and the total operation time and intraoperative blood loss in obese patients were similar to those in non-obese patients,with no statistical significance(P>0.05).Conclusion: 1 Cephalic approach has certain advantages in the treatment of obese right colon cancer patients in terms of operation time,intraoperative blood loss,total number of lymph nodes dissection.2 The clinical effect of the cephalic approach is comparable to that of the middle approach in the treatment of obese right hemicolon carcinoma,with the former having the advantages of less surgical trauma and fewer postoperative complications.3 Cephalic approach is safe and feasible for obese colon cancer patients to perform laparoscopic radical resection of right colon cancer.