The Construction Of Statistics And Analysis System Of Laparoscopic Colorectal Cancer Surgery Data And Its Clinical Application

Objective:The aim of this study was to evaluate the controversial issues of laparoscopic colorectal surgery according to Chinese data through the integration of advantageous resources, formation of the favorable research platform, and development of multi/single-center study.Methods:Evaluation system of laparoscopic colorectal surgery was built and applied to carry out multi-/single-center study basing on the Clinical Data Mining Software which was adapt to data structure of laparoscopic colorectal surgery,and capable of conducting both retro-and prospective clinical researches, scientifically managing and deeply analyzing the clinical data, and satisfying the requirment of multilateral cooperations.Results The data of more than 1200 cases were collected retrospectively in Nanfang hospital during the past year. To mention that the software, as the database for "Southern China Laparoscopic Colorectal Surgery Study Group -- SCLCSG", was also applied in the first stage of clinical research of "Multicentral retrospective study of laparoscopic and open procedure for colorectal cancer " among 11 hospitals from Southern China.In order to test this evaluation system,the research of "comparative study on oncologic results of laparoscopic versus open radical resection for rectal carcinoma" was completed successfully.The evaluation system was proved to be operative, safe, reliable and efficient.Conclusion The evaluation system and software have reached our primary expecting targets.And it is hoped to be widely used in the study of laparoscopic colorectal surgery and achieve the goal of extending and upgrading within networks in the future.Objective To compare the oncologic results between laparoscopic and open approach for the treatment of rectal cancer.Methods Five hundred and twenty patients with rectal cancer from Jan.2003 to Dec.2008 were non-randomly divided into laparoscopic and open operation group. Local recurrence, distant metastasis and survival rate were compared between two groups.Results 186 cases received laparoscopic resection and 334 cases received open operation. There were no statistically significant difference(SSD) in demographic datas between two groups (P>0.05). Mean follow-up was 30.3 months. No SSD was observed in 3-year cumulative total survival rate (83% after LS and 80% after OS),distant metastases rate (12.5% after LS and 15.6% after OS, P=0.368) and incidence of incision seeding (0.6% after LS and 0% after OS, P=0.189). The difference in local recurrences rate (4.8% after LS and 10.7% after OS, P=0.028) and 3-year cumulative disease-free survival rate(81% after LS and 68% after OS) between two groups reach statistical significance. The difference in cumulative total survival probability, cumulative disease-free survival probability, local recurrences and distant metastasis according to the TNM stage I and II between two groups did not reach statistical significance. The difference in cumulative disease-free survival probability and local recurrences according to the TNM stage III reach statistical significance(P=0.045 and P=0.047).Conclusion Oncologic results of laparoseopic resection are similar to those of open resection for rectal carcinoma.Objective To evaluate the feasibility, safety and outcome of radical resection for rectal cancer in elderly patients with common comorbidities.Methods From Jan.2003 to Dec.2008, a total of 192 elderly cases of rectal cancer and common comorbidities seen in our hospital were recruited and were non-randomizely divided into 2 groups:LAP group (n=91) and OPEN group (n=101). The operative procedures, clinicopathological data and outcomes were collected and compared.Results There were no statistically significant difference(SSD) in demographic data and comorbidities composition between two groups (P>0.05);No SSD was observed in rate of sphincter preservation,mean operating time,hospital stay and overall morbidity rate [85.7% vs 85.1%, (194±61)min vs (187±58)min,(14±8)d vs (14±8)d,24.2% vs 28.7%,respectively].The operating blood loss, time for bowel movement return, time to liquid food intake and time to resume early activity in the LAP group were significant lower or shorter than those in OPEN group[(108±78)ml vs (270±600)ml,(3±1)d vs (4±1)d,(4±1)d vs (5±2)d,(3±1)d vs (5±1)d, respectively]. Distance of distal margin in LAP group was longer obviously;No SSD was observed in the rate of 3-year cumulative survival, total recurrence, local recurrence and distant metastasis.The difference in cumulative survival probability according to the TNM stageⅠ,ⅡandⅢbetween two groups did not reach statistical significance.Conclusion We suppose that laparoscopic surgery is safe and feasible to the elderly patients with rectal cancer and comorbidities.