Short-term Results Of Laparoscopic Surgery Versus Open Surgery In T4a Stage Right Colon Cancer Patients With Complete Mesorectal Excision

Objective:To compare the safety and feasibility of laparoscopic surgery and open surgery in the treatment of T4a stage right colon cancer patients with total mesangial resection.Methods:From December 2010 to December 2015,96patients with right colon cancer were treated with complete mesorectal excision,including 44 cases in open surgery group and 52 cases in laparoscopic surgery.The complications,survival rate and recurrence rate of tumor were compared between two groups.Results:①In the laparoscopic surgery group,the intraoperative blood loss was significantly less than the open surgery group,the incision length was significantly shorter than that the open surgery group,and the first time of evacuation and hospitalization time were significantly shorter than the open surgery group(P<0.001).There were no significant differences in the operating time and the number of detected lymph nodes between the two groups(P>0.05).②There were no significant differences in postoperative complications such as anastomotic leakage,incision infection,intestinal obstruction and lymphatic leakage between two groups(P>0.05).③The overall survival rates in laparotomy group and laparoscopy group were 91%and 96%(P=0.454)respectively,and the local recurrence rate and rate of distant metastasis in open surgery group were 18%and 14%respectively,which showed no significant differences when compared with 12%and 15%in laparoscopic surgery group(P=0.478,0.316).Laparoscopy and laparotomy group two groups of intestinal wall distance high ligation points mean value of the minimum distance(9.2 cm and 8.9cm),respectively(P>0.05),no statistical significance,laparoscopy and laparotomy group two groups of tumors from high ligation respectively the average point distance(14.6 cm and 13.4 cm)no statistical significance(P>0.05),and laparoscopy and laparotomy group two groups of mean value of the area of the mesocolon respectively(176.2 cm and 174.3 cm)no statistical significance(P>0.05),and laparoscopy and laparotomy group insufflate the length of the average of the two groups,respectively(32.4 cm and 33.6 cm)no statistical significance(P>0.05).Laparoscopy and laparotomy group the average of the two groups of patients age,respectively(62.4 and 64.2)no statistical significance(P>0.05),laparoscopic group(14 cases)and laparotomy group(16 cases)with preoperative intestinal obstruction no statistical significance(P>0.05);Laparoscopy and laparotomy group tumor the size of the average of the two groups,respectively(6.3 cm and 6.8 cm)no statistical significance(P>0.05),laparoscopic group(2case)and laparotomy group(4cases),have a period of liver resection no statistical significance(P>0.05).④Preoperative examination of the patients,preoperative examination of the laparoscope group and the open abdominal group,AFP,CEA,CA125,CA199,CA724,WBC,RBC,etc.(P>0.05)were not statistically significant.Postoperatively in patients with laparoscopic patients and laparotomy group average per person on an average day out fluid volume(1913,196),respectively(P>0.05),no statistical significance,postoperatively in patients with laparoscopic patients and laparotomy group average per person on an average day into the fluid volume(2406,2520),respectively(P>0.05),no statistical significance.Conclusion:It is safe and feasible to implement total laparoscopic mesangial resection for T4a stage right colon cancer patients.