Laparoscopic radical resection of rectal neoplasms is still under clinical research currently due to the following 2 reasons. Firstly, compared with open surgery, the longterm efficacy of laparoscopic surgery remains unclear; secondly, the pelvic autonomic nerves are difficult to be exposed and easy to be damaged during the surgery under laparoscope. Till present time, our department has completed 800 cases of laparoscopic radical resection of colorectal neoplasms, in which rectal neoplasms accounted for 70%. For most cases, the pelvic autonomic nerves have been exposed and protected properly. This paper summarized the skills to protect the pelvic autonomic nerves in the laparoscopic total mesorectal excision used for the treatment of rectal neoplasms.

In the latest 50 years,the radical dissection rate of colonic cancer and the 5-year survival rate have been improved as colonic surgery techniques improve.In 1991,Jacob performed the first laparoscopic hemicolorectomy in the world,and data from multiple prospective studies have shown no significant difference between laparoscopic and open radical resection of colonic cancer in aspects of postoperative survival and incidence of tumor recurrence.In the year of 2009,Hohenberger suggested the concept of complete mesocolic excision (CME).Clinical data Showed that CME could further improve the postoperative survival and reduce the incidence of tumor recurrence,and it could become the standard surgical procedure following total mesorectal excision.

Colorectal cancer is a common malignancy in the digestive tract,open and laparoscopic surgery are the main treatment methods.Anastomotic fistula,anastomotic bleeding,ileus,voiding and sexual dysfunction are the common postoperative complications.Chylous fistula,incision infection,pulmonary infection and incision metastasis occasionally occurred.Compared with open surgery,laparoscopic surgery does not increase the postoperative complications,and it can be safely applied in the radical resection of colorectal cancer.

With the common application of total mesorectal excision (TME) technique,the proportion of sphincterpreserving surgery for the mid-low rectal carcinoma is significantly increased.Anastomotic leakage after sphincter-preserving surgery is the most severe complication of rectal surgery,and it is the main reason which will lead to other complications and death.Many researches on the early diagnosis,prevention and treatment of anastomotic leakage are conducted by surgeons at home and abroad,and a further understanding of this complication is deeply realized.

Recurrence and peritoneal metastases are the major factors for the survival of colorectal cancer. With the development in the theory and technique of intraperitoneal chemotherapy,it has become a indispensable adjuvant chemotherapy of the advanced colorectal cancer.

Objective To investigate the risk factors of complications induced by intraperitoneal chemotherapy after radical resection for colorectal cancer,and to summarize the prevention and treatment methods.Methods The clinical data of 234 colorectal cancer patients who received intraperitoneal chemotherapy after radical resection at the Union Hospital of Fujian Medical University from January 1997 to March 2007 were retrospectively analyzed.Risk factors influencing the incidence of complications were determined by analyzing 12 relevant factors with one-way analysis of variance(ANOVA)and Logistic multivariate regression analysis.Results The incidence of complications after intraperitoneal chemotherapy for colorectal cancer was 37.2%(87/234),incidence of catheter-associated complications was 20.5%(48/234),incidence of adhesive ileus was 12.4%(29/234),and the incidence of chemical peritonitis was 19.2%(45/234).The results of one-way ANOVA and Logistic multivariate regression analysis showed that abdominal surgery history,surgical modality,postoperative complications,courses and frequencies of chemotherapy and chemotherapeutics were the risk factors influencing the incidence of complications after intraperitoneal chemotherapy.Conclusions One or two courses of intraperitoneal chemotherapy after radical resection for colorectal cancer is safe with few complications.Chemical peritonitis is the main cause for adhesive ileus after intraperitoneal chemotherapy,maintaining intestinal tract unobstracted during intraperitoneal chemotherapy is effective in preventing adhesive ileus.

Objective To investigate the incidence, cause,prevention and treatment of early postoperative inflammatory intestinal obstruction(EPIIO)in patients undergoing laparoscopic and open radical resection of colorectal cancer. Methods From September 2000 to September 2006,483 cases of colorectal cancer were divided into two groups according the procedures received: laparoscopic surgery(232 cases)and open surgery(251 cases).The incidence of early postoperative intestinal obstruction was compared between the two groups. Results 1.In laparoscopic group,14 cases(5.69%,14/246)were converted to open surgery;2.The incidences of EPIIO in LS and OS group were respectively 3.02%(7/232)and 7.97%(20/251)(P＜0.05,x2=5.60＝.In LS group,6 EPIIO caseswere cured conservatively, one underwent surgery, while in open surgery group,18 cases recovered conservatively, two received surgery. Conclusions 1.Significantly less cases suffered from EPIIO in laparoscopic group.2.Most EPIIO cases will recover conservatively, in cases with repeated symptoms or when strangulation of bowel is suspected open surgery should be attempted.

Obstructing colorectal cancer is one of the acute abdominal diseases which are common in clinical practice.The initial symptoms of 8.0％-33.9％ patients with obstructing colorectal cancer are complete or incomplete acute colonic obstruction.Seventy percent of obstructing colorectal cancer located at the left colon.There are no standard treatment methods for obstructed left colonic carcinoma (OLCC).Previously,a staged procedure was recommended.With the improvement of the intestinal surgical techniques,one-stage resection and anastomosis including intraoperative colonic irrigation,subtotal colectomy,metal stents placement and transanal drainage tube placement were preferred by most of the surgeons.In addition,metal stents placement and transanal drainage tube placement can reduce bowel pressure,which creates the possibility for the treatment of malignant colorectal obstruction by laparoscopes.

Objective To compare the safety and the long-term outcomes of laparoscopic and open radical resection for rectal cancer. Methods The clinical data of 602 patients who received radical resection at the Second Affiliated Hospital of Fujian Medical University from January 2000 to December 2008 were retrospectively analyzed.All patients were divided into the laparoscope group (324 patients) and the open group (278 patients).The numbers of dissected lymph nodes,lengths of proximal and distal resection margins,local recurrence rate,distal metastasis rate,overall survival rates and disease-free survival rates of the 2 groups were compared.All data were analyzed by the independent t test,chi-square test or Fisher exact probability. The survival rates were calculated by the life table method and were analyzed by the Wilcoxon (Gehan) test.Results The number of lymph nodes dissected in the laparoscope group and the open group were 21 ± 8 and 21 ± 9,with no significant difference between the 2 groups (t =1.120,P ＞0.05).The lengths of proximal resection margin were ( 15.1 ±1.3 )cm in the laparoscope group and (15.0 ±0.8)cm in the open group,with no significant difference between the2groups (t =1.452,P ＞0.05).The lengths of distal resection margin were (4.0 ± 1.6)cm in the laparoscope group and (3.3 ± 1.4) cm in the open group,with a significant difference between the 2 groups ( t =5.587,P ＜ 0.05 ).The overall local recurrence rate was 5.6％ (34/602),and no tumor recurrence was detected in the incision and port-site.The local reccurence rates were 6.2％ (20/324) in the laparoscope group and 5.0％(14/278) in the open group,with no significant difference between the 2 groups (x2 =0.363,P ＞ 0.05 ).The overall distal metastasis rate was 11.5％ (69/602),and the distal metastasis rates were 11.1％ (36/324) in the laparoscope group and 11.9％ (33/278) in the open group,with no significant difference between the 2 groups (x2 =0.085,P ＞0.05).The 3- and 5-year survival rates were 87.8％ and 83.0％ in the laparoscope group,and 84.9％ and 79.3％ in the open group,with no significant difference between the 2 groups (P ＞0.05).The 3- and 5-year tumor-free survival rates were 79.4％ and 69.2％ in the laparoscope group,and 79.7％ and 73.1％ in the open group,with no significant difference between the 2 groups ( P ＞ 0.05 ).The follow-up rate was 81.2％ (489/602).Forty-nine patients died,including 20 patients in the laparoscope group and 29 patients in the open group.Conclusion Laparoscopic radical resection for rectal cancer is reliable in the oncological efficacy,and is possible to achieve the similar long-term outcomes as that of open surgery.