OBJECTIVETo compare the postoperative complications following laparoscopic and open colorectal cancer resection.

METHODSFrom January 2000 to September 2011, 910 patients underwent laparoscopic surgery and 434 open surgery. The postoperative complications were compared between the two groups.

RESULTSForty-eight patients (5.3%, 48/910) in the laparoscopic group were converted to open operation, of whom 36 (75.0%, 36/48) were due to difficulty in procedure and exposure from obesity and narrow pelvis. The overall complication rate was 20.3% (185/910) in the laparoscopic group and 25.3%(110/434) in the open group (χ2=4.316, P<0.05). For patients with a diverting stoma, the anastomotic leak rate was 2.1% (3/145) and 2.2% (2/93) (χ2=0.002, P>0.05), anastomotic bleeding rate was 3.4% (5/145) and 4.3% (4/93) (χ2=0.113, P>0.05). For patients without a diverting stoma, the anastomotic leak rate was 3.1% (22/699) and 1.0% (3/301) (χ2=3.993, P<0.05), anastomotic bleeding rate was 1.6% (11/699) and 2.3% (7/301) (χ2=0.673, P>0.05), bowel obstruction rate was 3.4% (31/910) and 5.8% (25/434) (χ2=4.077, P<0.05), chyle leak rate was 5.8% (53/910) and 3.7% (16/434) (χ2=2.757, P>0.05), urinary retention rate was 1.5% (14/910) and 1.6% (7/434) (χ2=0.011, P>0.05), wound infection rate was 2.2% (20/910) and 4.6% (20/434) (χ2=5.913, P<0.05), pulmonary infection rate was 6.4% (58/910) and 10.6% (46/434) (χ2=7.349, P<0.05).

CONCLUSIONThe overall postoperative complication rate in laparoscopic surgery is significantly lower than that in open surgery.

Aged ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; adverse effects ; Laparotomy ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies

Anastomotic leakage (AL) has always been a persistent issue for colorectal surgeons. It is still difficult to reduce the incidence of AL despite the advances in technology and equipment. With the development of evidence-based medicine, increasing high-risk factors for AL have been identified. How to efficiently and systematically combine and quantify these isolated risk factors to provide a scientific early warning of AL in clinical practices and help surgeons in choosing the optimal prophylactic strategies, is of great significance for reducing the incidence of AL. There are generally two types of AL prediction models in colorectal surgery, including prognostic models (for preoperative and intraoperative AL prediction) and diagnostic models (for early warning and improving the early diagnosis rate of AL). Prophylactic strategies for AL include stabilizing the underlying diseases, improving anemia and hypoalbuminemia, choosing an appropriate operative time window, and emphasizing and improving anastomotic techniques (including choosing an appropriate size of stapler). However, a prophylactic ostomy is still the most common method for surgeons. However, how to reduce the morbidity of complications following prophylactic ostomy and how to avoid the conversion of the prophylactic stoma to permanent stoma need further study.
Humans ; Anastomotic Leak/etiology* ; Colorectal Surgery/adverse effects* ; Digestive System Surgical Procedures/adverse effects* ; Anastomosis, Surgical/methods* ; Risk Factors

OBJECTIVETo compare the outcomes of laparoscopic colorectal surgery in elderly (> or = 70 years) and younger(< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly.

METHODSFrom Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older(Elder Group), and 15 patients less than 70 years(Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups.

RESULTSElder group had a higher ASA degree(P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO(3) value and PaCO(2) value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucosa(PgCO(2)) increased significantly at the end of operation. Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, perfusion, and blood chemistry were not significantly different.

CONCLUSIONSFor laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.

Age Factors ; Aged ; Colorectal Neoplasms ; surgery ; Humans ; Laparoscopy ; adverse effects ; Middle Aged ; Prospective Studies

In the past several years of 21 century, there are many updates of concepts on the diagnosis and treatment of colorectal cancer, which indicates the era of experience-based medicine has been gradually replaced by that of evidence-based medicine. Despite emerging evidence from randomized controlled trials(RCT) and meta-analyses questioning its use, concurrent suggestion on the indication of preoperative bowel preparation has not been reached. The authors agree with the opinion of The Huang Jia-si Textbook of Surgery(7th Edition). Preoperative bowel preparation should be emphasized before the consensus is confirmed, though there are so many trials showing that bowel preparation before elective colorectal surgery was unnecessary. In the authors' consideration, compared with the Westerner, the Chinese prefer to the food style of low fat and high cellulose, which would make more food residue. So whether the oversea finding of the preoperative bowel preparation is fit for the colorectal patients in China is questioned. Therefore large-sample, multi-centre, prospective RCT is expected to be carried out by the national academic organization, by which high-ranking evidence suitable for the Chinese could be obtained.
Colorectal Surgery ; Elective Surgical Procedures ; Enema ; adverse effects ; methods ; Humans ; Preoperative Care

Colorectal Neoplasms ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; adverse effects ; trends

OBJECTIVETo compare the systemic and local inflammatory response after laparoscopic and conventional surgery for colorectal carcinoma.

METHODSFrom April 2004 to August 2004, 51 colorectal cancer patients undergoing laparoscopic (n=25) and conventional open (n=26) colorectal resection were enrolled in the study. The general clinical data,and inflammatory response were compared between the two groups.

RESULTSThere were no significant differences in age, sex, pre-operative levels of haemoglobin and albumin, Dukes stage and surgical procedure between the two groups (P > 0.05). Laparoscopic surgery had more advantages over conventional open surgery such as incision, operating time, recovery time of bowel function, and hospitalization. On postoperative day (POD) 1, WBC count [(7.30+/- 2.62)x10(9)/L], and the serum levels of IL-10 [(19.46+/- 3.31)pg/ml] and C-reactive protein (CRP) [(2.76+/- 2.17)mg/dl] were significantly lower in laparoscopic group than those in conventional group (P< 0.05), but there were no differences on POD 4 between the two groups (P > 0.05). There were no significant differences in the volume of peritoneal drainage fluid, and levels of IL-10, TNF and CRP in it on POD 1 between the two groups, but the volume of peritoneal drainage fluid decreased significantly from POD 2, and the level of IL-10 in it was significantly lower on POD 4 in laparoscopic group than that in conventional group.

CONCLUSIONSIn early stage after operation,intra- peritoneal inflammatory response caused by laparoscopic surgery is similar to that by conventional open surgery, but systemic inflammatory response is slighter than that by conventional open surgery for colorectal carcinoma.

Aged ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Inflammation ; Laparoscopy ; adverse effects ; Male ; Middle Aged

The routine bowel preparation before colorectal surgery usually includes mechanical and medicine preparations, with the original purpose of reducing complications such as anastomosis leakage, wound, and abdominal infections. Many domestic hospitals are still employing the methods of three-day bowel preparation, while in the West, the way of this preparation has dramatically changed. In last decade, one-day preparation has been widely accepted internationally, with two major medications of sodium phosphate and polyethylene glycol frequently used in the clinic. It has also been indicated that excessive mechanical and medicinal bowel preparations exert harmful effects on the combined intestinal barrier, and may result in various complications. A few reports have suggested to omit the mechanical bowel preparation before surgery, which is still under controversy, however, well-designed clinical trials are needed to readjust and regulate the duration and intensity of bowel preparation before colorectal surgery in China.
Colorectal Surgery ; Humans ; Intestinal Mucosa ; physiology ; Phosphates ; adverse effects ; therapeutic use ; Polyethylene Glycols ; adverse effects ; therapeutic use ; Preoperative Care ; adverse effects ; methods

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.
Humans ; Quality of Life ; Self Expandable Metallic Stents/adverse effects* ; Colonic Neoplasms/surgery* ; Stents/adverse effects* ; Intestinal Obstruction/surgery* ; Treatment Outcome ; Colorectal Neoplasms/complications* ; Retrospective Studies

BACKGROUNDColorectal surgery was regarded as one of the high risk surgery for post-operative deep vein thrombosis (DVT) and pulmonary embolism. This study aimed at investigating the incidence of venous thromboembolism (VTE) after colorectal surgery for malignancy.

METHODSData were collected from the prospective database of colorectal malignancy from 2000 to 2008. A total of 1421 colorectal (open and laparoscopic) operations were performed for the colorectal malignancy without DVT prophylaxis.

RESULTSOnly seven patients (0.5%) developed symptomatic DVT and one of them had complication of pulmonary embolism without mortality. Open operation for colorectal malignancy was identified as possible risk factor of DVT, however, risk factors like operative time, low anterior resection, sex, age etc. were not identified.

CONCLUSIONRisk of venous thromboembolism after colorectal operation is low in Chinese of our locality and it might be safe to perform colorectal operation for malignancy without DVT prophylaxis.

Aged ; Aged, 80 and over ; Colorectal Neoplasms ; surgery ; Colorectal Surgery ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Pulmonary Embolism ; etiology ; Venous Thrombosis ; etiology

OBJECTIVETo assess the differences in peritoneal microstructure injury between laparoscopic and open radical resection for colorectal cancer.

METHODSA total of 50 patients with colorectal cancer were consecutively assigned into laparoscopic group (LO, n=27) and conventional laparotomy group (CO, n=23). Prospectively comparative analyses of operative time, intraoperative blood loss, number of lymph node harvest, positive rate of lymph nodes, length of specimen and resection margin involvement were performed. Optical microscope and scanning electron microscope were used to detect postoperative peritoneal injury between patients who received laparoscopic surgery or open surgery.

RESULTSCompared with the CO group, operative time [(150.6+/-39.5) min vs (183.0+/-39.2) min, P<0.05] and intraoperative blood loss [(80.0+/-75.2) ml vs (234.5+/-235.3) ml, P<0.01] were significantly less in the LO group. No significant differences were found between two groups in length specimen, number of lymph nodes harvest, positive rate of lymph nodes, and all resection margins were negative (P>0.05). Optical microscope indicated less serosal injury in the LO group as compared to the CO group with regard to serosal integrity, continuity of covering adipocyte and mesothelial cell, and the aggregation level of erythrocytes and inflammatory cells (P<0.01). Scanning electronic microscopy showed more severe injury to colorectal serosa, mesothelium and basement membrane in the CO group as compared to the LO group.

CONCLUSIONWith equal degree of radical resection, laparoscopic technique for colorectal cancer causes less peritoneal structural injury as compared with open surgery.

Aged ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Humans ; Laparoscopy ; adverse effects ; Laparotomy ; adverse effects ; Male ; Middle Aged ; Peritoneum ; injuries ; pathology ; Prospective Studies ; Single-Blind Method