Clinical Efficacy Comparison Between 65 Laparoscopic Surgeries And Hand-assisted Laparoscopic Surgery For Mid-low Rectal Cancer

Object To explore the clinical efficacy between two operative methods in radical resection of rectal carcinoma,by laparoscope(LAS)and hand assisted laparoscope(HALS)respectively,and summarize application value of the two operative methods for patients with rectal carcinoma.This research provides some reference foundation for the hospital which can carry out laparoscopic treatment of rectal tumors in the future.Methods 65 patients were randomly selected from patients with mid-low rectal cancer in Fuyang people's hospital from Aug.2011 to Aug.2013.According to patients' admission number,they were divided into two groups.Laparoscopic radical resection for rectal cancer was applied to experimental group of 32 patients.Hand-assisted laparoscopic radical resection was applied to control group of 33 patients.This study made statistical analyses for the two groups in blood loss,operation duration,incision length,hospital stay,increment of dissected lymph node number,postoperative exhaust time,postoperative complications,and rates of recurrence and metastasis in 1-year,2-year,3-year and 4-year after operation by follow-up visit.Results The two groups had no statistical difference in preoperative age,BMI,gender,ASA grade,underlying disease and history of abdominal operation(P>0.05).Both LAS group and HALS group had completed radical resection of rectal cancer and lymph node dissection,and had no conversion to open laparotomy.The operation time of HALS group was obviously shortened as compared with LAS group[(181.45±30.15)min vs.(155.30±27.96)min,t=2.734,P=0.008<0.05].The operative incision of HALS group was obviously longer than LAS group[(5.50±0.42)cm vs.(3.70±0.51)cm,t=2.734,t=4.268,P=0.000<0.05].The intraoperative blood loss of HALS group was larger than LAS group[(94.30±11.05)ml vs.(132.89±25.46)ml,t=2.734,P=0.008<0.05].There was no statistical difference of number of cleared lymph nodes,hospital stay,and postoperative exhaust time between two groups[(17.36±6.78)pieces vs.(16.70±7.26)pieces,(15.14±1.02)d vs.(14.90±1.06)d,(3.61±0.61)d vs.(3.33±0.82)d,P>0.05,respectively ].The incidence of postoperative complications has no significant difference in statistics.The 1-year,2-year,3-year and 4-year survival rates of LAS group were all slightly higher than that of HALS group,but the overall recurrence rate of LAS group was a little lower than that of HALS group in 4 years(P > 0.05,respectively).Conclusion Both laparoscopic radical resection and hand-assisted laparoscopic radical resection are minimal invasive surgery with safety and feasibility.In mid-low rectal cancer radical treatment process,laparoscopic radical resection have some special advantages relatively,such as smaller incision,less blood loss,less stimulation of tumor,lower rates of recurrence and metastasis.In addition,if hand-assisted laparoscopic radical resection combines the advantage of laparoscopic radical rectal cancer and the open abdomen,it will be a choice of radical rectal cancer.So selecting the proper operative procedure should be based on the particular condition of our patients,and then promoting it in clinical application.