Objective:To explore the clinical value of laparoscopic abdominoperineal resection(LAPR) with pelvic peritoneum closure for patients with low rectal cancer.Methods:The clinicopathological data of 90 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection from Mar 2014 to Jan 2019 at the Subei People's Hospital of Jiangsu Province were retrospectively analyzed. These patients were divided into closed pelvic floor peritoneum group (study group, n=42) and without pelvic floor peritoneum group (control group, n=48) . Results:The postoperative hospital stay of the study group was shorter than that of the control group[(10.8±3.0) d vs. (12.4±3.1) d, t=2.569, P=0.013]. There was no statistically significant difference in the operation time , intraoperative blood loss , time to first flatus ,first time of getting out of bed between the two groups. Perineal incision infection and perineal incision dehiscence occurred in 2 cases and 1 case in the study group, and 10 cases and 9 cases in the control group respectively (χ 2= 5.007, P=0.025; χ 2=6.077, P=0.033). In the study group, there were 0 cases of perineal hernia, 1 case of pelvic floor peritoneal hernia and 2 cases of adhesive intestinal obstruction, while those in the control group were 7 cases, 8 cases and 9 cases, respectively (χ 2=6.642, P=0.013; χ 2=5.079, P=0.033; χ 2=4.085, P=0.043). Conclusion:Laparoscopic abdominoperineal resection with pelvic peritoneum closure significantly reduces the incidence of postoperative perineal-related complications and shorten postoperative hospital stay.

Objective:To evaluate the safety and feasibility of laparoscopic selective lateral lymph node dissection (LLND) for radical resection of rectal cancer.Methods:From Dec 2018 to Jul 2020, at the Department of Gastrointestinal Surgery of Northern Jiangsu People's Hospital laparoscopic radical resection of rectal cancer was performed in 32 cases and radical resection plus selective LLND in 26 cases.Results:The operation time in the LLND group was significantly longer than that in the simple radical resection group [247(179-405) min vs. 146(118-258) min, Z=-5.169, P<0.001], but there was no significant difference in intraoperative bleeding [68(45-500) ml vs. 56(25-500) ml, Z=-1.598, P=0.110], postoperative ventilation time [2.5(1-6) d vs. 3.0(1-6) d, Z=-0.120, P=0.905], postoperative hospital stay [9.0(7-17) d vs. 9.5(6-14) d, Z=-1.050, P=0.294] and hospitalization costs [(49 000±3 000) RMB vs. (48 000±3 000) RMB, t=-1.072, P=0.289] between the two groups. The incidence of postoperative complications in the two groups was 19% and 27% respectively (χ 2=0.551, P=0.458). The number of lateral lymph node dissection in LLND group was 8(6-16), 5 of 26 patients had lateral lymph node metastasis, with a metastasis rate of 19%. Conclusion:Laparoscopic radical resectim plus selective LLND for rectal cancer harvests more lateral lymph node metastasis without causing higher complications .

Objective:To compare laparoscopic-assisted distal gastrectomy (LADG) and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) for early gastric cancer (EGC). Methods:Firty-two EGC patients from Sep 2018 to Aug 2020 in Northern Jiangsu People's Hospital were divided into LAPPG group ( n=21) and LADG group ( n=31). Results:The average operation time in the LAPPG and LADG groups was (173±30) min and (144±31)min, respectively ( t=3.34, P=0.002). The average levels of Hb and albumin (ALB) in the LAPPG group were (128.7±16.0) g/L and (41.2±4.8) g/L respectively 3 months after gastrectomy, ( t=2.482, P=0.016 and t=2.097, P=0.041) compared to LADG group at (118.2±14.1) g/L, (38.4±4.7) g/L. According to the Clavien-Dindo classification, the incidence of complications above grade Ⅱ was 19.0% in LAPPG group and 22.6% in LADG group, and the difference was not statistically significant ( χ2=0.007, P=0.934). The PGSAS-45 questionnaire scoring results show that LAPPG scores were lower in the dumping syndrome and life dissatisfaction subscales ( t=-2.706, P=0.008 and t=-2.893, P=0.004) Conclusion:LAPPG procedure for the treatment of EGC patients is safe and feasible, promoting early postoperative nutritional recovery. In adition to less dumping syndrome and better postoperative quality of life .