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Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer:A propensity score matching analysis

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 670-680页

作者： Hajime Kayano Nana Mamuro Yutaro Kamei Takashi Ogimi Hiroshi Miyakita Toshio Nakagohri Kazuo Koyanagi Masaki Mori Seiichiro Yamamoto Department of Gastroenterological Surgery Tokai University School of MedicineIsehara 259-1193KanagawaJapan

BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or *** IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor ***,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been *** cavity in *** Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological *** Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two *** addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA *** IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

关键词： Colon cancer intracorporeal anastomosis 3-year disease-free survival Recurrence Surgical site infection Postoperative biological response

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Evaluating bacterial contamination and surgical site infection risks in intracorporeal anastomosis: Role of bowel preparation

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1953-1955页

作者： Junho Lee Department of Surgery Hanyang UniversityCollege of MedicineSeoul 04763South Korea

We recently read the study by Kayano et al on intracorporeal anastomosis(IA)for colon cancer,which assessed bacterial contamination and medium-term onco-logical outcomes and affirmed that IA is analogous to extracorporeal anastomosis in reducing intraperitoneal bacterial risk and achieving similar oncological *** commentary addresses gaps,particularly concerning bowel preparation and surgical site infections(SSIs),and highlights the need for comprehensive details on the bowel preparation methods that are currently employed,including mecha-nical bowel preparation,oral antibiotics(OA),their combination,and specific OA *** emphasize the necessity for further analyses that investigate these me-thods and their correlation with SSI rates,to enhance clinical protocol guidance and optimize surgical *** meticulous analyses are essential for refi-ning strategies to effectively mitigate SSI risk in colorectal surgeries.

关键词： intracorporeal anastomosis Surgical site infection Mechanical bowel preparation Oral antibiotics Bacterial contamination Colon cancer

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Peroral traction-assisted natural orifice trans-anal flexible endoscopic rectosigmoidectomy followed by intracorporeal colorectal anastomosis in a live porcine model

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World Journal of Gastrointestinal Endoscopy 2020年第11期12卷 451-458页

作者： Hong Shi Su-Yu Chen Zhao-Fei Xie Rui Huang Jia-Li Jiang Juan Lin Fang-Fen Dong Jia-Xiang Xu Zhi-LiFang Jun-Jie Bai Ben Luo Department of Digestive Endoscopy Fujian Cancer HospitalFujian Medical University Cancer HospitalFuzhou 350014Fujian ProvinceChina School of Medical Technology and Engineering Fujian Medical UniversityFuzhou 350122Fujian ProvinceChina School of Clinical Medicine Fujian Medical UniversityFuzhou 350122Fujian ProvinceChina

BACKGROUND Compared to traditional open surgery,laparoscopic surgery has become a standard approach for colorectal cancer due to its great superiorities including less postoperative pain,a shorter hospital stay,and better quality of *** 2007,Whiteford et al reported the first natural orifice trans-anal endoscopic surgery(NOTES)sigmoidectomy using transanal endoscopic *** date,all cases of NOTES colorectal resection have included a hybrid laparoscopic approach with the use of established rigid *** To introduce a novel technique of peroral external traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis by using only currently available and flexible endoscopic instrumentation in a live porcine *** Three female pigs weighing 25-30 kg underwent NOTES rectosigmoid *** preoperative work-up and bowel preparation,general anesthesia combined with endotracheal intubation was *** dual-channel therapeutic endoscope was *** dioxide insufflation was performed during the *** procedure of trans-anal NOTES rectosigmoidectomy included the following eight steps:(1)The rectosigmoid colon was tattooed with India ink by submucosal injection;(2)Creation of gastrostomy by directed submucosal tunneling;(3)Peroral external traction using endoloop ligation;(4)Creation of rectostomy on the anterior rectal wall by directed 3 cm submucosal tunneling;(5)Peroral external traction-assisted dissection of the left side of the colon;(6)Transanal rectosigmoid specimen transection,where an anvil was inserted into the proximal segment after purse-string suturing;(7)intracorporeal colorectal end-toend anastomosis using a circular stapler by a single stapling technique;and(8)Closure of gastrostomy using endoscopic *** animals were euthanized immediately after the procedure,abdominal exploration was performed,and the air-under-water leak test was carried *** The

关键词： Transanal Natural orifice trans-anal endoscopic surgery Rectosigmoidectomy intracorporeal anastomosis External traction

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A comparative study of totally laparoscopic distal gastrectomy versus laparoscopic-assisted distal gastrectomy in gastric cancer patients: Short-term operative outcomes at a high-volume center

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Chinese Journal of Cancer Research 2018年第5期30卷 537-545页

作者： Won Ho Han Amir Ben Yehuda Deok-Hee Kim Seung Geun Yang Bang Wool Eom Hong Man Yoon Young-Woo Kim Keun Won Ryu Center for Gastric Cancer National Cancer Center Department of Surgery Assaf Harofeh Medical Center

Objective： Laparoscopic gastrectomy has been established as a standard treatment for early gastric cancer, and its use is increasing recently. Compared with the conventional laparoscopy-assisted distal gastrectomy （LADG）, totally laparoscopic distal gastrectomy （TLDG） involves intracorporeal reconstruction, which can avoid the additional incision, resulting in pain reduction and early recovery. This study aimed to compare the short-term postoperative outcomes of TLDG vs. LADG in gastric cancer in a high-volume ***： A retrospective cohort study was conducted on 1,322 patients who underwent laparoscopic distal gastrectomy from June 2012 to June 2017 at the National Cancer Center, Korea. LAD G was performed in the early period before July 2015, and TLDG was applied in the later period. Postoperative short-term outcomes were compared in terms of complication and clinical course between the two groups. Pain score was measured by rating the pain intensity from 0 to 10 points on postoperative day （POD） 1 and 3. Results： A total of 667 patients underwent LADG and 655 patients underwent TLDG. Clinieopathologic characteristics were not different in both groups. Intraoperative estimated blood loss （EBL） was significantly lower in the TLDG group （P〈0.001）. Postoperative pain scores were significantly lower in the TLDG group than in the LADG group on POD 1 （5.1±1.5 vs. 4.8±1.4, P=0.015）. First flatus passage after operation was significantly earlier in the TLDG group （3.4±0.8 d vs. 3.2±0.6 d, P〈0.001）. There were no differences in postoperative complications and hospital stay between the two groups. Conclusions： Based on the reported short-term postoperative outcomes, TLDG is safe and feasible as well as LADG. Moreover, compared with LADG, TLDG can reduce intraoperative EBL and postoperative pain and enhance the bowel motility in gastric cancer surgery.

关键词： Distal gastrectomy gastric cancer intracorporeal anastomosis laparoscopic surgery

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Totally laparoscopic gastrectomy for gastric cancer: A systematic review and meta-analysis of outcomes compared with open surgery

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World Journal of Gastroenterology 2014年第42期20卷 15867-15878页

作者： Ke Chen Yu Pan Jia-Qin Cai Xiao-Wu Xu Di Wu Yi-Ping Mou Department of General Surgery Sir Run Run Shaw Hospital School of Medicine Zhejiang University

AIM: To systematically review the surgical outcomes of totally laparoscopic gastrectomy (TLG) vs open gastrectomy (OG) for gastric cancer.

关键词： Gastric cancer Gastrectomy intracorporeal anastomosis Laparoscopy Meta-analysis Survival

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