Objective To evaluate hand-assisted laparoscopic distal gastrectomy for the treatment of advanced gastric cancer.Methods From Oct 2013 to Oct 2014, 77 advanced gastric carcinoma patients underwent hand-assisted laparoscopic total gastrectomy with regional lymph node dissection.Results The overage operating time was (295 ± 3) min and the amount of blood loss was (110 ± 17)ml.Postoperative oral feeding began at (3.6 ± 0.4) d.Postop hospital stay was (8.7 ± 0.6) d.The average dissected lymph node was (49.2 ± 1.3).Postopatrative complications developed and cured conservatively in 11 cases.After 4-16 mos follow-up no local recurrence nor metastasis was found.Conclusions Hand-assisted laparoscopic D2 total gastrectomy for advanced gastric cancer is both technically feasible and safe.

Objective To investigate the feasibility and safety of hand assisted laparoscopic total gastrectomy with D2 lymphadenectomy for advanced cardiac cancer compared with open surgery.Methods 174 patients suffering cardiac,upper,middle or whole gastric cancer operated in our department from October 2013 to October 2014 were divided into open surgery group and laparoscopic group.Perioperative parameters were compared between the two groups.Results Patients in loparoscopic group were associated with significantly less operative blood loss [(110 ± 17) ml vs.(345 ± 95) ml,t =4.95,P =0.011],and shorter postoperative hospital stay [(8.7 ± 0.6) d vs.(14.3 ± 2.1) d,t =0.26,P =0.031],but longer operative time [(295 ± 37) min vs.(215 ± 23) min,t =3.78,P =0.004],compared with that of open surgery.There was no significant difference in the numbers of lymph node dissection between the two groups.Esophagus resection length in open group was (4.0 ± 1.2) cm,and that was (4.1 ±1.0)cm in laparoscopic group (t =0.95,P =0.147).Two patients in open group had positive margins and underwent thoracoabdominal resection.There was no difference in major complications between the two groups.Conclusion Hand assisted laparoscopic total gastrectomy for advanced cardiac carcinoma is a safe,feasible,and oncologically sound procedure compared to open procedure.

Objective To evaluate the feasibility and safety of hand assisted laparoscopic total gastrectomy for gastric cancer by two different operative approaches.Methods 191 patients of proximal or gastric corpus cancer operated at our department from Jan 2015 to Dec 2017 were divided into two groups:by outer omental bursa approach group (OBA) and through inner omental bursa approach group (IBA).Operative time,estimated blood loss,number of lymph node retrieval,times of analgesic injection,time to the first flatus and postoperative hospital stay were compared between the two groups.Results Estimated blood loss,times of analgesic injection,time to the first flatus and postoperative hospital stay were not statistically different between the two groups.The operative time was significantly shorter in the IBA than the OBA.There were no significant differences in tumor size,retrieved lymph nodes,AJCC/UICC staging and resection margins between the two groups.Conclusion Hand assisted laparoscopic total gastrectomy by the outer omental bursa approach is technically feasible and safe,and allows for adequate lymphadenectomy.

Objective To evaluate the clinical curative effect and prognosis of hand-assisted laparoscopic (HALS) and laparoscopic assisted surgery for Siewert Ⅱ,Ⅲ gastroesophageal junction adenocarcinoma (AEG).Methods A retrospective analysis of 105 patients with advanced Siewert type Ⅱ and Ⅲ AEG between Jan 2012 and Jan 2013 was made on the operation time,amount of blood loss,number of lymph nodes dissected,postoperative complications,postoperative hospital stay and postoperative 5-year survival rate.Results HALS resulted in significantly shorter operation time and the average postoperative hospital stay [(203±54) min比(283±72) min,t=-4.902,P=0;(10±4) d 比(13±3)d,t=-0.939,P =0.002] for advanced Siewert type Ⅱ and Ⅲ AEG.There was no conversion to open surgery in HALS group,while there was 3 cases in laparoscopy assisted surgery group (x2 =4.118,P =0.042).5 year overall survival (OS) in HALS group was 46.7％ (95％ CI39.98-53.88),and it was 60.9％ for stage Ⅱ patients 37.8％ for stage Ⅲ.5 years OS rate was not significantly different between the two groups.Conclusion HALS compared with laparoscopy assisted surgery in the treatment of advanced Siewert type Ⅱ and type Ⅲ AEG has shorter operation time,higher safety operation,shorter postoperative recovery time.The number of patients with postoperative complications and the 5-year survival rate after surgery are not significantly different between the two groups.

Objective:To investigate the application value of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy.Methods:The retros-pective cohort study was conducted. The clinicopathological data of 121 patients who underwent laparoscopic radical total gastrectomy in Henan Provincial People′s Hospital from January 2019 to February 2022 were collected. There were 53 males and 68 females, aged (68±12)years. Of the 121 patients, 72 patients using the traditional approach in the surgery were divided into the control group, and 49 patients using the "six steps with six windows" approach in the surgery were divided into the experiment group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers or percen-tages, and comparison between groups was conducted using the chi-square test. Results:(1) Surgical situations. All 121 patients underwent laparoscopic radical total gastrectomy successfully, without laparotomy conversion. The operation time, volume of intraoperative blood loss, number of lymph nodes dissected were (250±50)minutes, (150±34)mL, 41±6 in the control group, versus (180±16)minutes, (55±13)mL, 51±5 in the experiment group, showing significant differences in the above indicators between the two groups ( t=11.04, 21.47, 9.42, P<0.05). (2) Postoperative situations. The times of postoperative analgesic injection, time to postoperative ?rst ?atus, duration of postoperative hospital stay, postoperative pathological staging (stage Ⅰ, stage Ⅱ, stage Ⅲ), incidence of postoperative complication were 3.4±1.6, (4.0±1.4)days, (13.1±2.0)days, 9, 32, 31, 15.3%(11/72) in the control group, versus 3.5±1.7, (4.1±1.5)days, (13.1±1.7)days, 6, 25, 18, 16.3%(8/49), showing no significant difference in the above indicators between the two groups ( t=0.35, 0.18, 0.03, Z=0.55, χ2=0.02, P>0.05). There was no perioperative death in both groups of patients. Conclusion:Appli-cation of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy is safe and feasible.

Objective:To investigate the application value of hybrid approach in laparoscopic radical resection of left hemicolon cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 96 patients with left hemicolon cancer who were admitted to Henan Provincial People′s Hospital between January 2015 and March 2018 were collected. There were 52 males and 44 females, aged from 29 to 75 years, with an average age of 61 years. Patients underwent laparoscopic radical resection of left hemicolon cancer. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative pathological examination; (3) postoperative chemotherapy; (4) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival, tumor recurrence and metastasis of patients up to October 2019. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Results:(1) Surgical situations and postoperative recovery: all the 96 patients underwent laparoscopic radical resection of left hemicolon cancer with hybrid approach. Of 96 patients, 5 underwent laparoscopic multiple organ resection including 2 combined with splenectomy, 2 combined with gastric wall wedge resection, 1 combined with splenectomy and distal pancreatectomy; 7 underwent hand-assisted laparoscopic surgery including 5 undergoing multiple organ resection due to tumor invasion, 2 combined with terminal ileostomy due to poor exposure caused by severe obstruction in proximal intestinal canal; 84 underwent laparoscopic-assisted surgery. There was no intraoperative conversion to laparotomy. Of 96 patients, 3 received posterior ileum anastomosis, 2 received rotating ascending colon anastomosis, 91 received in situ anastomosis. Operation time, volume of intraoperative blood loss, and time to first flatus were 140 minutes (range, 70-250 minutes), 50 mL (range, 30-140 mL), 2 days (range, 1-4 days), respectively. Of 96 patients, 5 had postoperative incision infection, 5 had pulmonary infection, 3 had adhesive intestinal obstruction, 1 had anastomotic leakage, and they were cured after conservative treatment. Duration of postoperative hospital stay of the 96 patients was 8 days(range, 5-27 days). (2) Postoperative pathological examination: of the 96 patients, the number of lymph nodes dissected and length of surgical specimen were 19 (range, 13-25) and 35 cm (range, 25-50 cm). All the 96 patients had negative surgical margin. Pathological T staging of 96 patients: 5 patients were in pT1 stage, 46 in pT2 stage, 37 in pT3 stage, 8 in pT4 stage. Pathological N staging of 96 patients: 32 patients were in pN0 stage, 47 in pN1 stage, 17 in pN2 stage. Pathological types of 96 patients: 7 patients had mucinous adenocarcinoma, 16 had poorly differentiated adenocarcinoma, 46 had moderately differentiated adenocarcinoma, and 27 had well differentiated adenocarcinoma. (3) Postoperative chemotherapy: 68 of the 96 patients underwent standard chemotherapy of XELOX regimen, and 28 had no chemotherapy. (4) Follw-up: 86 patients were followed up for 19-58 months, with a median time of 11 months. During the follow-up, all the 86 patients survived, of which 82 had no tumor recurrence, 3 survived with tumor after detection of liver metastasis, and 1 survived with tumor after detection of liver and pulmonary metastasis.Conclusion:The hybrid approach is safe and feasible in the laparoscopic radical resection of left hemicolon cancer.