Curative effect analysis of 3D laparoscopic incision-free simultaneous resection for elderly patients with rectal cancer and liver metastasis

Abstract

Objective To explore the feasibility of 3D laparoscopic incision-free simultaneous resection for elderly patients with rectal cancer and liver metastasis. Methods From March 2015 to March 2017, the clinical data of fifty-six cases (aged over eighty) with low rectal cancer and simultaneous liver metastasis operated in the Affiliated Shanghai East Hospital of Tongji University were retrospectively analyzed. Forty-three cases underwent 3D laparoscopy surgery without incision (incision-free group) which was described as transrectal extraction of specimen and transanal endorectal eversion and transection, and thirteen cases underwent open surgery (open group). Liver resection was simultaneously performed for liver metastases. The operation time, amount of bleeding, hospitalization length after operation, VAS pain score, interval to first flatus, interval to first oral intake, postoperative lymph node number, tumor resection margin length, postoperative complication rate and disease free survival (DFS) rate were analyzed between the two groups. Results There was no significant difference in operation time (t=1.887, P=0.375). Compared with the open group, the bleeding, interval to first flatus, interval to first oral intake and average hospitalization length after operation were less and VAS scores were lower in incision-free group, the differences were significant (t=7.841, 16.118, 12.105, 3.803, 10.922, all P<0.01). Postoperative complications occurred in nine cases (20.9%) of the incision-free group, including Clavien-Dindo grade in seven cases and grade Ⅱ in two cases, grade complications occurred in three patients (23.1%) in the open group. There was no significant difference in the incidence and severity of complications between the two groups (Z=1.342, P=0.180). The length of lower incision margin in incision-free group and open group were (3.9±1.3) cm and (4.0±1.7) cm,the number of lymph nodes detected after operation were (13.1±4.6) and (13.5±2.8) respectively, with no significant differences (t=0.226, 0.296, P=0.835, 0.773). There was no significant difference in the 1-year DFS between the two groups (62.8% vs 61.5%, χ2=0.007, P=0.935). Conclusion Transanal specimen extraction-laparoscopic simultaneous resection in low rectal cancer with liver metastasis is safe and feasible, and may reduce postoperative bleeding, shorten postoperative recovery time and relieve pain of patients. Key words: Rectal neoplasms; Natural orifice specimen extraction; Laparoscopes; Liver metastasis; Simultaneous resection