| Objective: To compare laparoscopic surgery with laparotomy for rectal cancer at the same period and evaluate the safety of laparoscopic surgery and its short-term outcome.Methods: The study is a retrospective analysis of 232 rectal cancer patients'clinical data from January to December in 2010. It includes 73 cases of laparoscopic surgery, 6 of which were converted into laparotomy. The rest of 159 underwent laparotomy, of which 2 underwent emergency operation because of acute obstruction and another 2 suffered rectal cancer recurrence. Regardless of the four cases above, there are 155 cases left. So the two groups are totally 228 cases. Meanwhile, the data (sex, age, tumor location and tumor TNM staging) from the two groups have no significant differences. The study adopted the method of controlled clinical research and comparatively analyzed the operative time, bleeding volume, the length of the surgical specimen, the distance of incisal margin, lymph node resected number (postoperative pathology), the time of exercising out of bed, removing catheter, exhausting , having liquid diets, defecation time, postoperative complications and the average length of stay. What's more, the surgical risk, postoperative recovery and tumor radical were compared between the two groups.Results: 73 cases were operated by laparoscopy, of which 6 were converted into laparotomy, 2 converted due to large tumor, 2 due to invading peripheral tissues and organs, 1 due to obesity and 1 due to the influence by CO2 pneumoperitoneum that the patient had a high pressure of CO2 in blood. Others were completed successfully with no intraoperative complications and death, including 2 stomal leak,1 pulmonary infection, 8 incision infection or fat liquefaction. 155 cases were operated by laparotomy, including 3 stomal leak, 2 pulmonary infection, 4 cardiac complications (1 death), 31 incision infection or fat liquefaction, 1 dehiscence of incision, 2 postoperative obstruction, 1 intraperitonealhemorrhage and 1 case urinary tract infection.There was no significant difference in sex, age, tumor location, tumor TNM staging between the two groups(P>0.05).The operative time of the laparoscopy group was longer than the laparotomy group(P<0.05). The bleeding volume of laparoscopy group was less than the laparotomy group(P<0.05). Compared to the length of the surgical specimen, the distance of incisal margin, lymph node resected numbers between the two groups had no obvious difference. The laparoscopy group was superior to the laparotomy group in the time of exercising out of bed, removing catheter, exhausting, having liquid diets and defecation time. In the rate of incision infection or fat liquefaction, the laparoscopy group was lower than the laparotomy group(P<0.05). The remaining complication rate has no statistical difference. The laparoscopy group had a lower rate of total complications compared to the laparotomy group(P < 0.01), and the average length of stay was also shorter in the laparoscopy group.(P<0.05).Conclusions:1.The laparoscopic surgery has advantages over the laparotomy for rectal cancer in short-term outcomes.2. In comparison with the laparotomy, the laparoscopic surgery has a lower rate of postoperative complications for rectal cancer.3. The laparoscopic surgery for rectal cancer is safe and feasible. |
