Laparoscopic-assisted Resection Research Articles

Comparetive analysis of laparoscopic-assisted and open liver resection for large hepatic tumors

Background: This study aimed to assess outcomes of Laparoscopic-Assisted Resection(LAR) and Open Liver Resection(OLR) for large (≥ 8 cm) liver tumors. Methods: A prospectively collected database of 350 liver resection was reviewed from January of 2015 to August 2017. The data for patients undergoing LAR comparing with OLR for large liver tumors were analyzed. Results: During the period studied, 30 LARs and 43 OLR were performed (females, 54 %; mean age, 55.4 years) for large tumors. Patients with benign tumors were 20 in LAR and 27 in OLR group. Patients with malignant tumors were 10 in LAR and 16 in OLR group. The mean diameter of tumor in LAR group was 126 mm and in OLR - 120 mm (p>0,05). The median operative time was 382 min in LAR and 350 min in OLR group(p>0,05), and the blood loss was 310 ml for LAR and 790 ml for OLR group(p< 0,05). The Clavien-Dindo complications IIIa-b were 10% in LAR and 11,6% in OLR (p>0,05), and no mortality occurred during a 90-day period. Conclusion: The findings showed that LAR is feasible and safe for large liver tumors, has less blood loss and can be performed with acceptable morbidity.

Single-port laparoscopic-assisted resection for a large abdominal cystic lymphangioma: a case report

BackgroundWe report the case of a young woman with a large abdominal cystic lymphangioma that was successfully resected using single-port laparoscopic-assisted cystectomy. This avoided the need for a large surgical incision, as would result during conventional laparotomy.Case presentationA 17-year-old young woman was admitted to our hospital complaining of abdominal pain that had persisted for 3 days. Computed tomography revealed a 10 × 10 × 10-cm low-density area in the mid-abdomen, and magnetic resonance imaging showed a large abdominal cystic lesion. A mesenteric cyst was suspected, and single-port laparoscopic-assisted resection was performed. The cyst fluid was aspirated using a tissue adhesive, a suction tube with negative pressure, and a 16-gage over-the-needle catheter and syringe. The tumor size was reduced without any spillage of cyst fluid into the abdominal cavity. Then, the shrunken cystic tumor was successfully removed via the small wound and resected outside the abdomen. Pathological findings revealed an abdominal cystic lymphangioma derived from the greater omentum.ConclusionsOur procedure was easy to perform and required no special materials. Therefore, it could be applied to various cases, such as for abdominal cystic diseases.

A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism

BackgroundCholesterol crystal embolism (CCE) is caused by small crystals of cholesterol dispersed from atherosclerotic plaques of the aorta. There is an increasing interest in CCE because of the increased use of endovascular treatments. Here, we report a rare case of intestinal stenosis caused by CCE after functional end-to-end anastomosis (FEEA). To our knowledge, this is the first report of CCE causing such an anastomotic stenosis.Case presentationA 77-year-old male patient underwent laparoscopy-assisted low anterior resection and protective ileostomy for rectal carcinoid tumor. He was admitted to our hospital with ileus 1 year after stoma closure. Eosinophils and creatine kinase level were slightly elevated. Computed tomography revealed a stricture with thickened intestinal wall just distal to the anastomosis site of the ileostomy. The wall of the descending aorta appeared shaggy due to thrombosis. The patient underwent laparoscopic small-bowel resection because ileus reoccurred after any oral intake.Histopathological findings of the resected specimen showed fibrotic changes distal to the anastomosis site, and needle-shaped cholesterol embolus was observed in the submucosal layer. Thus, the stenosis was considered to be caused by CCE.ConclusionThis appears to be the first published report of stenosis due to CCE at such an anastomotic site. Intestinal CCE is difficult to diagnose preoperatively and is associated with poor prognosis. If eosinophilia is present or shaggy aorta is observed, CCE should be suspected to make correct diagnosis and prevent recurrence of CCE.

Robotic colorectal surgery: more than a fantastic toy?

There has been a rapid rise in the number of robotic colorectal procedures worldwide since the da Vinci Surgical System robotic technology was approved for surgical procedures in the year 2000. Several recent meta-analyses and systematic reviews have shown a significant difference in outcomes between robotic and laparoscopic rectal cancer surgery. However, these results from pooled data have not been supported by the initial results reported from the Robotic assisted versus laparoscopic assisted resection for rectal cancer trial. In this article, we examine the current evidence for robotic colorectal surgery, assess its features and functionality, evaluate its learning curve and provide our perspective on its future.

Neuroendocrine Tumor Arising From Meckel's Diverticulum Unexpectedly Diagnosed After Diverticulectomy and in Which Multiple Lymph Node Metastases Were Found After Reoperation: A Case Report.

A 47-year-old man with progressive anemia possibly due to digestive tract bleeding was referred to our hospital. Contrast-enhanced computed tomography of the abdomen showed a 2-cm tumor lesion arising near the small intestine. Enteroscopy revealed a 3-cm submucosal tumor at the ileum. A gastrointestinal stromal tumor of the small intestine was suspected, and the patient underwent surgery. During the operation, a diverticulum approximately 60 cm orad to the terminal ileum and a tumor at the top of the diverticulum were observed. Considering the location, Meckel's diverticulum was suspected. No lymphadenopathy was present in the mesentery. Laparoscopy-assisted resection of the diverticulum without lymph node dissection was performed. The histological diagnosis of the tumor was a well-differentiated neuroendocrine tumor. Given the possibility of lymph node metastasis, we performed a second operation to remove the small intestine and lymph nodes. Histologically, 7 of the 18 dissected lymph nodes were metastatic. The postoperative course was uneventful, and the patient survived without tumor recurrence for another 2 years 8 months. Neuroendocrine tumors of Meckel's diverticulum are aggressive. Therefore, small intestinal resection along with lymph node dissection might be necessary as part of the surgical strategy.

Laparoscopic-assisted Resection of Small Intestinal Stenosis due to Cholesterol Crystal Embolization

Laparoscopic-assisted Resection of Small Intestinal Stenosis due to Cholesterol Crystal Embolization

Endoscopic Submucosal Dissection Efficacy, Safety and Feasibility in Patients With Inflammatory Bowel Disease: A Single Center Experience

Introduction: Patients with inflammatory bowel disease, both Crohn's disease (CD) and ulcerative colitis (UC), are at a higher risk for getting colorectal cancer and dysplasia. Endoscopic submucosal dissection (ESD), due to its superiority in achieving en bloc resection has replaced endoscopic mucosal resection (EMR) in management of large polyps (>25 mm). Owing to sub mucosal fibrosis in IBD patients, safety and efficacy of ESD has always been a matter of discussion. We would like to report the largest single center case series, reporting the safety, feasibility and efficacy of ESD for curative resection of selected, large, nonpolypoid neoplasms in patients with IBD Methods: A total of 7 patients with IBD were identified from a prospectively maintained database of patients undergoing ESD at our center, between 2014 and 2017. Demographic and clinical data was collected for all patients. ESD was performed by a single operator, using the standard basic ESD technique. Post procedure complications were also noted. Results: Out of 142 patients undergoing colonic ESD, 7 (4.9%) patients had IBD. Five (71.4%) patients were male, with average age being 54.0±17.3 years. Three (42.8%) patients had polyp located in ascending colon, while 1 (14.2%) patient each had polyp located in cecum, transverse colon, splenic flexure and descending colon. Based on final pathology polyps ranged in size from 25 mm to 70 mm, with average size of the polyp being 40.7 mm. Six (85.7%) out of 7 polyps were flat lesions. En bloc resection was achieved in 6 (85.7%) patients. One (14.2%) patient end up requiring laparoscopic assisted resection. Three (42.8%) patients had low grade dysplasia, 3 had high grade dysplasia, with 1 (14.2%) patient having sessile serrated adenoma. No perforations or significant bleeding (requiring hospitalization) was observed in the patients. All patients underwent 6 months surveillance colonoscopy with no recurrence of dysplasia. Conclusion: ESD is safe, effective and feasible in patients with IBD, despite presence of significant submucosal fibrosis.Table: Table. Clinical and Demographic Variables

Clinical efficacy of laparoscopic transabdominal preperitoneal hernia repair and risk analysis affecting postoperative complications

Objective To explore the clinical efficacy of laparoscopic transabdominal preperitoneal (TAPP)hernia repair and risk factors affecting postoperative complications. Methods The retrospective case-control study was conducted. The clinical data of 595 patients who received laparoscopic TAPP hernia repair in the First Affiliated Hospital of Soochow University from February 2008 to August 2016 was collected. Operations were performed by the same doctors′ team. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up situations; (4) risk factors affecting complications after laparoscopic TAPP hernia repair. Follow-up using outpatient examination and telephone interview was performed to detect the recovery time of non-restricted activity, postoperative complications and hernia recurrence up to February 2017. Measurement data with normal distribution were represented as ±s. The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model. Results (1) Surgical situations: 595 patients underwent laparoscopic TAPP hernia repair using the heavy meshes. Overall operation time and overall volume of blood loss were (55±25) minutes and (7±5)mL, including operation time of (50±20)minutes in 502 unilateral hernias and operation time of (81±29)minutes in 93 bilateral hernias. Of 595 patients, 34 had incarcerated hernia, the contents of hernia: greater omentum, small intestine and sigmoid colon were detected in 21, 11 and 2 patients, respectively, with an incarcerated time of 2-21 hours; 4 with incarcerated hernia induced small intestinal necrosis received laparoscopy-assisted small intestinal resection + anastomosis, 1 with sigmoid colon necrosis received necrotic sigmoid canal resection + sigmoidostomy and 29 received repair after the contents restoration of hernia. Operation time and volume of intraoperative blood loss in 34 patients with incarcerated hernia were (84±39)minutes and (12±6)mL. Thirteen of 595 patients (10 with indirect hernia and 3 with direct hernia) had recurrent hernia, and operation time and volume of intraoperative blood loss were (75±26)minutes and (10±5)mL. (2) Postoperative situations: time to initial exsufflation of 595 patients was (19±12)hours. Of 595 patients, 590 took fluid diet at 6 hours postoperatively and 5 undergoing enterectomy took fluid diet at 24 hours postoperatively. The pain score at 1 day postoperatively and duration of hospital stay were respectively 2.5±1.4 and (2.1±1.9)days. (3) Follow-up situations: of 595 patients, 593 recovered non-restricted activity at 2 weeks postoperatively and 2 didn′t recover non-restricted activity at 2 weeks postoperatively. Of 595 patients, 542 were followed up for 6-60 months, with a median time of 31 months. Fifty-seven, 25, 13 and 1 patients were respectively complicated with seroma, surgical pain, urinary retention and enteroparalysis, they were improved by symptomatic treatment, and the same patient can have multiple complications. There were no severe complications which needed surgical intervention, such as vascular injury, damnify of intestinal canal and poke hole hernia. Of 2 patients with recurrence of hernia, 1 with right indirect hernia had recurrence of direct hernia and then received Lichtenstein tension-free hernia repair, and 1 received treatment in other hospital. (4) Risk factors affecting complications after laparoscopic TAPP hernia repair: results of univariate analysis showed that age, diameter of hernia sac, incarcerated hernia, recurrent hernia, operation time and volume of intraoperative blood loss were related factors affecting complications after laparoscopic TAPP hernia repair (χ2=6.657, 55.296, 44.305, 5.253, 117.461, 100.722, P<0.05). Results of multivariate analysis showed that diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL were independent risk factors affecting complications after laparoscopic TAPP hernia repair (OR=3.610, 11.315, 12.401, 7.346, 95% confidence interval: 2.009-6.486, 3.579-35.772, 5.408-28.437, 3.739-14.434, P<0.05). Conclusion Laparoscopic TAPP approach for inguinal hernia is safe and effective, and diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL are independent risk factors affecting complications after laparoscopic TAPP hernia repair. Key words: Hernia, inguinal; Transabdominal preperitoneal hernia repair; Risk factor; Laparoscopy

Laparoscopic-Assisted Resection for Advanced Colorectal Cancer in Solid Organ Transplant Recipients

ABSTRACTAim: To evaluate the feasibility, short- and long-term outcomes, and safety of laparoscopic resection for advanced colorectal cancer (CRC) in solid organ transplant recipients. Methods: Between September 2001 and April 2016, five patients who underwent laparoscopic-assisted resection for CRC after solid organ transplantation were included in this study. Their clinical data were retrospectively analyzed with regard to patient demographics, immunosuppressive therapy, tumor characteristics, surgical outcomes, and follow-up data. Results: Four kidney and one heart transplant recipients were included. Laparoscopic-assisted low anterior resection was performed in four patients with rectal or rectosigmoid junction cancer, and sigmoidectomy was done in one with sigmoid colon cancer. One kidney transplant patient received a protective loop transverse colostomy. All resections achieved complete tumor removal with tumor-free margins and total mesorectal excision, with an average number of 14 lymph nodes harvested. Most tumors were in stage III (n = 3), one was in stage II, and one in stage IV. The mean duration of surgery, intraoperative blood loss, and postoperative hospital stay were 144 min, 105 mL, and 8.8 days, respectively. No major complications occurred and graft function stayed well. During a mean follow-up period of 62 months, two patients developed metastasis and died eventually. Conclusion: Laparoscopic resection for advanced CRC in organ transplant recipients is technically feasible and therapeutically safe, and seems to have the advantages of few postoperative complications, short recovery time, and acceptable oncological outcomes.

Safety and Feasibility of a Laparoscopy-Assisted Non-Anatomic Resection Technique for Hepatocellular Carcinoma Located at Right Posterior Segments in Cirrhotic Patients: A Case-Controlled Study with Propensity Score Matching

Purpose: The aim of this study was to compare the short- and long-term outcomes of laparoscopy-assisted resection for right posterior segment (LAR-RPS) with open resection (OR-RPS) performed by experienced hepatobiliary surgeons. Methods: This was a prospective comparative nonrandomized study. Results: The groups were comparable in terms of baseline demographics and clinicopathological data. Reduced operative time (254.88 ± 78.56 vs. 347.95 ± 82.56 min; p = 0.04) and estimated blood loss (477 ± 756 vs. 712 ± 836 mL; p = 0.03) were observed in LAR-RPS. Also, significant less duration of hospital stay (7.53 ± 2.68 vs. 12.57 ± 3.21 days; p < 0.001) was associated with LAR-RPS compared to OR-RPS. Long-term oncologic outcomes were comparable in 2 groups, in terms of both the overall and disease-free survival rates (p = 0.450 and 0.463, respectively). Conclusions: This study confirms that laparoscopic-assisted resection is a safe and effective operative procedure in those cirrhotic patients with a lesion in the right posterior section of the liver. When compared to the open approach, the laparoscopic-assisted approach reduces operative time and blood loss, as well as the length of hospital stay.

Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection\u2014a retrospective 8-year observational study

PurposeSurgical outcome is influenced by multiple patient-specific factors and operative expertise of the surgeon. Clinical relevance of medical technical innovations often remains unclear even though laparoscopic surgical procedures are characterized by continual advancement of various devices. Lately, in dissection and sealing technology, fast-cutting ultrasonic scissors are combined with simultaneous bipolar coagulation (bimodal dissection device (BDD)). We investigated how this new technology, operative expertise, and patient-specific factors (body mass index, age) influence operation time in laparoscopic-assisted sigmoid resection.MethodsBetween 2008 and 2016, 161 laparoscopic sigmoid resections (52% conventional dissection device (CDD); 48% BDD) performed in a single center were retrospectively evaluated. Biometric patient data, complication rates, and surgery duration, reflecting the learning curve, were analyzed. Operations were performed by experienced surgeons (n = 3) and trainees (n = 4).ResultsMinor postoperative complications (e.g., impaired wound healing, non-revisional secondary bleeding) occurred in 11 cases (6.8%). Major complications (e.g., bleeding requiring revision, anastomotic leakage) were observed in 3.7%. No heat-related coagulation damage was observed. BDD reduced operation time for both experienced (CDD 150 min, BDD 125 min; p < 0.001) and trainee surgeons (CDD 169 min, BDD 135 min; p = 0.036). Reduction of operation time (indicative of a learning curve in progress) was observed for all surgeons. The curve was steeper using BDD.ConclusionsPatient-specific factors did not have a significant effect on operation time. Even taking the learning curve into account, a combination of ultrasonic dissection and simultaneous bipolar coagulation reduces operation time of laparoscopic-assisted sigmoid resection, regardless of surgeon’s expertise.

Application research of presacral space drainage tube combined with subcutaneous vacuum pressure suction in the laparoscopic-assisted abdominoperineal resection

To study the management for the perineal incision after laparoscopic-assisted abdominoperineal resection for rectal cancer. Clinical data of 87 patients undergoing laparoscopic Miles operation for lower rectal cancer from June 2009 to February 2014 were collected and studied. Presacral space drainage group: presacral space drainage tube was applied in 42 patients. Combined drainage group: presacral space drainage tube combined with subcutaneous vacuum pressure suction was applied in 45 cases. In combined drainage group, except the presacral drainage tube, another drainage tube was placed subcutaneously and connected to a negative pressure ball, which was fixed on the lateral anterior of perineal wound by the further incision and drainage. After subcutaneous tube was placed for 2 weeks, as drainage fluid was limpid and <15 ml/d for 3 days, meanwhile no obvious pelvic fluid was detected by ultrasound, and the wound healed quite well without redness and edema, then the subcutaneous tube with the negative pressure ball could be removed. There were 51 males and 36 females with the mean age of 26-78(56.9±10.8) years old. The laparoscopic Miles operation was successfully completed in all the cases without death and complications. The drainage tube was placed for 4-13(8.0±2.5) days in presacral space drainage group, and for 4-14(6.7±2.4) days in combined drainage group. The subcutaneous tube was placed for 14-24(15.8±3.0) days. The primary healing rate of perineal wound in presacral space drainage group and combined drainage group was 66.7%(28/42) and 91.1%(41/45) respectively, while the perineal wound infection rate was 21.4%(9/42) and 4.4%(2/45) respectively, whose differences between two groups were both significant (χ2=7.911, P=0.005 and χ2=5.674, P=0.017). Presacral space drainage tube combined with subcutaneous vacuum pressure suction in laparoscopic-assisted abdominoperineal resection for rectal cancer has better efficacy and lower infection rate for perineal incision, which is worth wide application.

Diagnosis and treatment of gastric duplication in children: A case report.

Gastric duplication is a rare congenital abnormality, and its diagnosis and treatment may be challenging in certain children. The present study reported four cases of gastric duplication who were followed-up and treated in the Children's Hospital of Zhejiang University between March 2010 and March 2015. The study aimed to increase the knowledge on this disease in order to improve the diagnosis and treatment, as well as decrease the possibility of misdiagnosis. Diagnosis could not be confirmed by the clinical manifestation, ultrasonography and computed tomography (CT). Therefore, laparoscopic examination and laparotomy were conducted, which confirmed the gastric duplication, and resection was performed according to the type of gastric duplication. Two patients received laparoscopy-assisted resection by removing the duplicated gastric tube through the navel, while one patient received total laparoscopic resection, and one patient received laparoscopy and laparotomy. The surgical procedures were performed without any issues, and no complications appeared following the surgery. The preoperative symptoms disappeared completely, and the patients recovered well according to the follow-ups conducted at 1 month, 1 year and 3 years for all four cases. In conclusion, gastric duplication is a rare condition and its preoperative diagnosis is difficult, and laparotomy is an effective method for diagnosis. Laparoscopy-assisted resection or total laparoscopic resection is preferred for uncomplicated gastric duplications, and simple excision can achieve a good therapeutic effect.

Resection of rectal cancer resembling submucosal tumor that was preoperatively diagnosed with endoscopic ultrasound-guided biopsy

BackgroundColorectal cancer (CRC) resembling submucosal tumor (SMT; CRC/SMT) is very rare. Because its biopsy is challenging, accurate preoperative diagnosis is also very rare.Case presentationA 55-year-old woman with a high serum carcinoembryonic antigen level underwent a computed tomography colonoscopy, which showed extrinsic rectum compression. A coronal magnetic resonance image showed a 4-cm low-intensity tumor between her rectum and sacrum. Endoscopic ultrasound (EUS) showed a 30-mm low-echoic lesion originating from the rectum. Pathological examination of specimen obtained with EUS-guided fine-needle aspiration biopsy (EUS-FNAB) revealed adenocarcinoma. Immunohistochemical staining showed the tumor to be positive for both CK20 and CDX2 and negative for CK7, indicating that it was a rectal cancer. We performed a laparoscopy-assisted low-anterior resection with dissection of the regional lymph nodes after eight chemotherapy cycles. Macroscopically, tumor was completely covered by normal rectal mucosa, but showed a 2-mm bulge on the mucosa. Histological examination revealed a moderately differentiated adenocarcinoma, mainly located at the subserosal layer and severely invaded to lymphatic and blood vessels. The mucosal layer was not exposed to the cancer components, and her postoperative course was uneventful.ConclusionEUS-FNAB was useful in preoperative accurate diagnosis of this very rare tumor. We also review the literature and discuss CRC/SMT.

Comparison of short-term outcomes of transrectal specimen extraction during laparoscopic sigmoid radical resection versus conventional laparoscopically assisted procedure

To compare the short-term outcomes between transrectal specimen extraction during laparoscopic sigmoid radical resection and conventional laparoscopy-assisted sigmoid radical resection. Sixteen patients(transrectal specimen extraction group,4 females and 12 males), who were planned to undergo laparoscopically assisted sigmoid radical resection with BMI<28 kg/m2 and were evaluated as T1-T3 tumor by iconography without distant metastasis, were selected to undergo transrectal specimen extraction during laparoscopic sigmoid radical resection from December 2015 to April 2016 in the Department of Anorectal Surgery of Changhai Hospital. The procedure of specimen extraction was as follows: Perineal anal expansion was performed. The rectum was cut in rectal distal ligature within the abdominal cavity. Telescope cover was placed through Trocar hole in right low abdomen and rectal stump was pulled out of the body through the anus to form an access tunnel. Planned resected bowel was placed in the tunnel and the specimen was dissociated and removed completely from anus. Each patient in transrectal specimen extraction group was individually matched with two patients who underwent laparoscopically assisted sigmoid radical resection by gender, age, BMI and date of surgery. The perioperative outcomes and pathological evaluation of surgical specimen of two groups were retrospectively collected and compared. The differences of baseline data (gender, age, BMI, distance from tumor to anal verge measured by colonoscopy and clinical tumor category) between two groups were not significant (all P>0.05). Compared to laparoscopy-assisted group, transrectal specimen extraction group presented longer operation time [(140.6±8.3) minutes vs. (122.2±26.2) minutes, t=-3.629, P=0.001], and more blood loss[(43.8±9.2) ml vs. (35.3±10.2) ml, t=-2.795, P=0.008], but shorter time to first flatus [(43.1±8.3) hours vs. (52.0±11.4) hours, t=2.756, P=0.008] and lower pain score at operative day and the first postoperative day (3.8±0.8 vs. 4.8±1.1, t=3.558, P=0.001; 2.6±0.6 vs. 3.8±0.8, t=5.165, P=0.000). The case ratio of additional analgesia [6.3%(1/16) ns. 18.8%(6/32)], postoperative hospital stay [(6.8±3.4) days vs. (5.6±0.8) days] and postoperative morbidity of complication [12.5%(2/16) vs. 9.4%(3/32)] were not significantly different between the two groups (all P>0.05). Within postoperative 30-day follow-up, transrectal specimen extraction group had ileus in one patient and anastomotic leakage in one patient, and laparoscopy-assisted group had fat necrosis of assisted incision in two patients and gastric retention in one patient. There were also no significant differences in specimen length[(18.2±4.8) cm vs. (19.8±5.7) cm, P>0.05], tumor size [(4.0±1.2) cm vs. (4.4±1.5) cm, P>0.05] and number of harvested lymph node (14.6±2.6 vs. 16.0±3.0, P>0.05] between two groups. During follow-up of 7-10(mean 9) months of transrectal specimen extraction group and 2-16 (mean 7) months of laparoscopically assisted group, no tumor local relapse and distant metastasis were found in the both groups. As compared to laparoscopy-assisted sigmoid radical resection, transrectal specimen extraction laparoscopic sigmoid radical resection has better short-term efficacy, meanwhile they have comparable oncologic clearance.

Laparoscopic assisted multi-visceral resection in stage IV rectal cancer

Hepatic metastasis is the difficult part and key point in treating colorectal cancer. Meanwhile, there still exists an argument that if doing hepatic metastasis of colorectal cancer resection simultaneously. Our center is carrying on multidisciplinary treatments of hepatic metastasis of colorectal cancer and has gained some outcomes from the clinical trials. According to the features of this case, we should get simultaneous resection of both primary and metastatic tumor following by the pre-operation MDT discussion. Here, we show the achievement of laparoscopy-assisted right hemicolectomy combined with liver resection. We want to share the experiences and discuss with each other.

Laparoscopic-assisted resection for colorectal cancer without incision at abdomen versus traditional laparoscopic resection: A Meta-analysis

To evaluate the safety, feasibility and effectiveness of laparoscopic-assisted resection of colorectal cancer without incision at abdomen vs the traditional laparoscopic resection. Methods: We retrieved literature published from August, 2005 to August, 2015 to compare laparoscopic-assisted resection for colorectal cancer without incision at abdomen with the traditional laparoscopic resection. The clinical indicators were extracted from literature met inclusion criteria. The RevMan 5.3 software with a Meta-analysis was used. Results: Seven literature with a total of 621 patients, including 262 in laparoscopic-assisted resection of colorectal cancer without auxiliary incision at abdomen group (NOSE group) and 359 in conventional laparoscopic colorectal resection group (LAP group), were enrolled. The Meta-analysis showed that the total complication rate in the NOSE group was significantly less than that in the LAP group (OR=0.31, 95% CI 0.18 to 0.53, P<0.05). Complications of incision in the NOSE group were less than those in the LAP group (OR= 0.15, 95% CI 0.05 to 0.40, P=0.0002). Postoperative bleeding (OR=1.52, 95% CI 0.38 to 6.18, P=0.55), intestinal obstruction (OR= 0.30, 95% CI 0.09 to 0.98, P=0.05), anastomotic complications (OR=0.92, 95% CI 0.28 to 3.07, P=0.89), and other related complications (OR=0.63, 95% CI 0.23 to 1.66, P=0.35) showed no significant difference between the 2 groups (P>0.05). Hospitalization (MD=-0.66, 95% CI -1.33 to 0.01, P=0.05), duration of surgery (MD=14.78, 95% CI -1.75 to 31.31, P=0.08), bleeding amount (MD=-12.81, 95% CI -40.36 to 14.74, P=0.36), the tumor size (SMD=-0.40, 95% CI -0.87 to 0.08, P=0.10), the number of lymph node dissection (MD=-0.49, 95% CI 1.80 to 0.82, P=0.46), and the recurrence of 2-year follow-up (OR=1.15, 95% CI 0.38 to 3.50, P=0.81) were not statistically significant between the 2 groups. Time of gas passage (SMD=-0.62, 95% CI -0.82 to -0.42, P<0.001) and time of regular diet after surgery (SMD=-0.60, 95% CI -1.15 to 0.05, P=0.03) in the NOSE group were earlier than those in the LAP group. The postoperative pain score (MD=-1.49, 95% CI -1.97 to -1.01, P<0.001) in the NOSE group was significantly lower than that in the LAP group. Cosmetic surgery in the NOSE group had a higher index (MD=1.37, 95% CI 0.59 to 2.14, P=0.0005) compared with that in the LAP group. Conclusion: Laparoscopic-assisted resection for colorectal cancer without auxiliary incision at abdomen can obviously reduce the incidence of incision complications, and the patients can recover early and incision is showed more cosmetic. The method is safe, feasible, and effective.

肋骨転移をきたしたT1b直腸癌の1例

62歳，女性．検診で便潜血陽性を指摘され，当科に紹介となった．大腸内視鏡検査にて下部直腸に10mm大のI sp型腫瘍を認め，内視鏡的粘膜切除術を施行した．tub1，T1b（2,000μm），ly0，v1，budding grade1，HM0（250μm），VM0（500μm）であり，腹腔鏡補助下低位前方切除術+D2郭清術を施行した．病理組織学的に腫瘍の遺残は認めず，総合所見はT1b，N0，M0，Stage Iであった．術後6カ月のCT検査で両側第9肋骨に腫瘤を指摘され，FDG-PET検査を施行したところ，異常集積（SUVmax7.8）を認めた．CTガイド下生検を施行したところ高分化管状腺癌であり，直腸癌の転移と診断した．早期直腸癌術後で肝臓や肺転移を伴わない骨転移は稀であり，文献的考察を加え報告する．

経鼻イレウス管による腸重積整復後に腹腔鏡補助下に切除した小腸癌の1例

患者は81歳の女性で，自己免疫性肝炎のフォローのCTで空腸の腸重積を指摘された．腹膜炎症状や腸管壊死を認めず，経鼻イレウス管を挿入し，バルーンを使用して整復した．整復3日後のCTで重積の再発が疑われたため，腹腔鏡補助下手術を施行した．腹腔鏡の鉗子による触診では，重積部近傍に腫瘤を認識できなかった．しかし，小切開創から空腸を創外へ誘導し，手指による触診をしたところ腫瘤を触知したため，小腸部分切除術を施行した．病理組織学的検査で腫瘤は腺腫内癌と診断された．小腸の腸重積を経鼻イレウス管で整復した報告は過去に認めず，第一に非観血的な整復術を試みることが治療方針の一つになる可能性が示唆された．また，器質性病変を伴った腸重積症に対して整復後に腹腔鏡補助下手術を選択することで，根治性や安全性を損なうことなく，低侵襲性および整容性に優れた手術を施行することができると考えられた．

Pediatric mucinous neoplasm of the appendix presenting as a mucocele: A case report and review of the literature

Mucocele of the appendix is a rare entity in pediatrics, with few case reports in the literature. We present a case of a 17-year-old male with right lower quadrant pain who was found to have an appendiceal mucocele while being evaluated for appendicitis. Laparoscopic-assisted resection was performed, with pathology confirming a low-grade mucinous neoplasm of the appendix, a tumor scarcely described in the pediatric population. He underwent complete resection with negative margins, rendering him cured without the need for any further resection or treatment. We review the literature on this topic.