Research Article - Biomedical Research (2018) Volume 29, Issue 5
Comparison of short-term therapeutic effects between laparoscopic surgery and laparotomy combined with new adjuvant radiochemotherapy in progressive stage-rectal carcinoma
1Department of Gastrointestinal Urology, Tianyou Hospital Affiliated of Wuhan University of Science and Technology, Wuhan, Hubei, PR China
- *Corresponding Author:
- Jianhua Meng
Department of Oncology
The Second Hospital of Wuhan Iron And Steet (Group) CORP
Accepted date: November 30, 2017
Objective: This study aimed to discuss the short-term therapeutic effects of laparoscopic surgery and laparotomy with new adjuvant radiochemotherapy on rectal carcinoma in the progressive stage.
Methods: A total of 120 patients with rectal carcinoma in our hospital from May 2014 to February 2016 were selected and categorized into the control group (n=60) and treatment group (n=60) by random number table method. All respondents were simultaneously treated by new adjuvant radiochemotherapy. The control group was treated by laparotomy, whereas the treatment group received laparoscopic surgery. Operation mode, intraoperative conditions, post-operative rehabilitation effect, and occurrence rate of complications in the near future were compared between the two groups.
Results: No significant difference of operation mode (e.g., Dixon operation, Miles operation, and Hartmann operation) was observed between the treatment group and control group (P>0.05). The operation time of the control group was shorter than that of the treatment group, but the intraoperative blood loss of the treatment group was far higher (P<0.05). No significant differences were found between the two groups in terms of cases of intraoperative blood transfusion, remote cutting marginal distance of Dixon operation, number of assessable lymph glands, number of lymphoma transfer, and cases of terminal ileum fistulization of Dixon operation (P>0.05). The time of exhaustion, time of defecation, and time of feeding after operation and Length of Stay (LOS) of the treatment group were shorter than that of the control group (P<0.05). The control group and treatment group presented no statistically significant difference in view of the occurrence rate of post-operative complications (P<0.05).
Conclusions: Laparoscopic surgery combined with new adjuvant radiochemotherapy has outstanding therapeutic effect on rectal carcinoma in the progressive stage and high safety. It can be promoted as the first clinical therapy for rectal carcinoma in the progressive stage.
New adjuvant radiochemotherapy, Laparotomy, Laparoscopic surgery, Rectal carcinoma, Progressive stage
Rectal carcinoma is a common gastrointestinal tumor in clinics and accounts for about 70% in total colorectal cancer . Recent applications and development of new adjuvant radiochemotherapy contribute its outstanding progresses in clinical therapy of locally advanced rectal carcinoma. This treatment can relieve tumor loads to some extent, reduce gross tumor volume significantly, and increase the success rate of excision . In particular, this therapy creates opportunities to the application of inguinal orchiectomy and apparently increases the rate of anal preservation. At present, radical operation is the first choice for locally advanced rectal carcinoma . With the promotion and generalization of laparoscopic radical rectectomy for rectal cancer in clinics, its therapeutic effect has won trust and approval of attending doctors and patients . In this study, 120 patients with rectal carcinoma in the progressive stage in our hospital from May 2014 to February 2016 were selected as the research subjects. Research results are introduced in the following text.
Information and Methods
A total of 120 patients with rectal carcinoma in our hospital from May 2014 to February 2016 were selected and divided into the control group (n=60) and treatment group (n=60) by random number table method. The control group had 36 males and 24 females with ages of 24-80 (53.8 ± 4.2) in average. The control group had 10 cases of mucinous adenocarcinoma, 27 cases of poorly differentiated adenocarcinoma, 12 cases of moderately differentiated adenocarcinoma, and 11 cases of highly differentiated adenocarcinoma. Among them, 32 cases had complications with hypertension, 20 cases with diabetes, and 28 cases with coronary heart disease. The treatment group had 38 males and 22 females with ages of 25-81 (54.9 ± 4.1) in average. Meanwhile, the treatment group had 9 cases of mucinous adenocarcinoma, 25 cases of poorly differentiated adenocarcinoma, 14 cases of moderately differentiated adenocarcinoma, and 12 cases of highly differentiated adenocarcinoma. Among them, 35 cases had complications with hypertension, 22 cases with diabetes, and 26 cases with coronary heart disease. General information of two groups were processed by the corresponding version of statistical software, which found no significant difference (P>0.05).
Selection standards and exclusion standards
Selection standards included the diagnosis of the adenocarcinoma of rectum by tissue biopsy, no distant metastasis, estimated feasible surgical excision, and menopause period of ≥ 12 months. Possibilities of pregnancy were eliminated. Blood routine examination as well as liver, kidney, and cardio-pulmonary functions were examined after 2 w of concurrent radiochemotherapy before the operation. No surgical contraindication and surgical tolerance were found. Patients had no other forms of radiochemotherapy.
Exclusion standards included patients who used immunosuppressor and antineoplastic biological and radiochemotherapy before, had cognitive disorder or mental diseases, experienced allergic history or belonged to an allergic constitution, and had other types of malignant tumors or participated in other types of intervention clinical test.
Radiochemotherapy: Conventional fractionated radiotherapy was performed to patients before operation by using Neusoft NMS-R600 linear top-speed device (1.8 Gy/time for five times/week). The total dosage was controlled within 45-50 Gy. Radiotherapy was carried out by FOLFOX4. Specifically, intravenous dripping of 100 mg/m2 oxaliplatin was offered at d 1. Moreover, intravenous dripping of 200 mg/m2 calcium folinate and intravenous dripping of 500 mg/m2 5-fluorouracil were given for 1-5 d. One period lasted for 3 w, and two periods of therapy were offered. Operation was performed 2 w after radiotherapy.
The control group used laparotomy, whereas the treatment group adopted laparoscopic surgery. Both groups selected total mesorectal excision and lymphadenectomy and implemented terminal ileum fistulization according to intraoperative conditions. The treatment group was operated by five-hole method, and sample incision was protected by notched protection bag.
Operation modes included Dixon operation, Miles operation, and Hartmann operation. Intraoperative conditions included operation time, intraoperative blood loss, cases of intraoperative blood transfusion, remote cutting marginal distance of Dixon operation, number of assessable lymph glands, number of lymphoma transfer, and cases of terminal ileum fistulization of Dixon operation. Post-operative recovery included time of exhaustion, time of defecation, and time of feeding after operation and LOS. Complications observed were disruption of wound, infection of wound, bleeding of anastomotic stoma, anastomotic fistula, serious pulmonary infection, urinary tract infection, rectovaginal fistula, and uroschesis.
Relevant data were input into SPSS22.0. Relevant measurement data were expressed in x̄ ± s and examined by ttest. Relevant enumeration data were expressed in % and examined by χ2-test. P<0.05 indicated a statistically significant difference.
No significant difference of operation mode (e.g., Dixon operation, Miles operation, and Hartmann operation) was observed between the treatment group and control group (P>0.05) (Table 1).
|Group||Miles operation||Hartmann operation||Dixon operation|
|Control (n=60)||41 (68.3)||6 (10.0)||21 (35.0)|
|Treatment (n=60)||45 (75.0)||4 (6.7)||27 (45.0)|
Table 1: Comparison of operation modes between two groups (n (%)).
Basic intraoperative conditions
The operation time of the control group was shorter than that of the treatment group, but the intraoperative blood loss of the treatment group was far higher (P<0.05) than that of the control group. No significant differences were found between the two groups in terms of the cases of intraoperative blood transfusion, remote cutting marginal distance of Dixon operation, number of assessable lymph glands, number of lymphoma transfer, and cases of terminal ileum fistulization of Dixon operation (P>0.05) (Table 2).
|Basic intraoperative condition||Control (n=60)||Treatment (n=60)||t/χ2||P|
|Operation time (min)||132.6 ± 38.4||160.5 ± 46.1||3.7490||0.0003|
|Intraoperative blood loss (ml)||232.5 ± 116.3||135.2 ± 60.4||5.9859||0.0000|
|Cases of terminal ileum fistulization of Dixon operation (cases)||8 (13.3)||5 (8.3)||0.7764||0.3782|
|Number of lymphoma transfer (pc)||2.2 ± 1.4||1.9±1.5||1.1787||0.2407|
|Number of assessable lymph glands (pc)||6.5 ± 2.1||6.3±1.7||0.5967||0.5517|
|Remote cutting marginal distance of Dixon operation (cm)||4.2 ± 1.7||4.8±1.9||1.8973||0.0600|
|Cases of intraoperative blood transfusion (cases)||12 (20.0)||8 (13.3)||0.9600||0.3272|
Table 2: Comparison of basic intraoperative conditions between two groups.
Time of exhaustion, time of defecation and time of feeding after operation and LOS of the treatment group are shorter than those of the control group (P<0.05) (Table 3).
|Group||Control group (n=60)||Treatment group (n=60)||t value||P value|
|Time of exhaustion||3.9 ± 0.9||3.1 ± 1.0||4.7941||0.0000|
|Time of defecation||4.8 ± 1.0||4.1 ± 0.7||4.6234||0.0000|
|Time of feeding||4.6 ± 0.9||3.7 ± 0.8||6.0258||0.0000|
|LOS||14.9 ± 4.1||11.8 ± 3.2||4.8054||0.0000|
Table 3: Comparison of post-operative recovery between two groups (͞x ± s, d).
The control group and treatment group presented no statistically significant difference in the occurrence rate of post-operative complications (P<0.05) (Table 4).
|Complication||Control group (n=60)||Treatment group (n=60)||χ2 value||P value|
|Uroschesis||5 (8.3)||3 (5.0)||0.5357||0.4642|
|Serious pulmonary infection||10 (16.7)||7 (11.7)||0.6168||0.4322|
|Urinary tract infection||4 (6.7)||2 (3.3)||0.7018||0.40222|
|Rectovaginal fistula||1 (1.7)||0 (0.0)||1.0084||0.3153|
|Disruption of wound||2 (3.3)||0 (0.0)||2.0339||0.1538|
|Infection of wound||4 (6.7)||1 (1.7)||1.8783||0.1705|
|Anastomotic fistula||3 (5.0)||1 (1.7)||1.0345||0.3091|
|Bleeding of anastomotic stoma||6 (10.0)||3 (5.0)||1.0811||0.2985|
Table 4: Comparison of post-operative complications between two groups (n (%)).
Rectal carcinoma in the progressive stage is a very common tumor type in clinics. Morbidity increases yearly due to the changes in the environment and lifestyle . Rectal carcinoma has high fatality rate and threats the life of patients. Synchronous adjuvant radiochemotherapy before the operation reduces tumor volume mainly through local radiotherapy and general chemotherapy before the operation . It can reduce local recurrence and clinical stages and increase excision effect. The application of radiochemotherapy of rectal carcinoma in the progressive stage has been extensively reported . Although this therapy can cause a series of acute untoward effects (e.g., gastrointestinal tract infection and myelosuppression) in a short period, the total tolerance after a certain period is relatively ideal and operation is feasible .
Laparoscopic surgery can achieve long-term effect similar with that of laparotomy. It has advantages of minimally invasive, low occurrence rate of complications, quick recovery in a short period, and high clinical approval . At present, few researches focus on the treatment of rectal carcinoma in the progressive stage by combining the new adjuvant radiochemotherapy as well as laparotomy and laparoscopic surgery. Although the treatment group took longer time to finish the operation than the control group in this study, intraoperative blood loss was fewer, which basically agrees with those of the conclusions of related literature. The new adjuvant radiochemotherapy can cause fibroplasias and tissue edema, which can prolong the overall operation time and increase operation difficulties and risks of short-term complications . Sharp separation was performed with an ultrasound knife under a laparoscope, which can provide a clear operating field and reduce blood loss and inflammatory depth. Moreover, the new adjuvant radiochemotherapy not only guarantees general excision but also increases the rate of anal preservation compared with laparotomy. In this study, the two groups showed no significant differences in other indexes (P>0.05) and in the occurrence rate of post-operative complications (P>0.05). However, the treatment group underwent shorter time of exhaustion, time of defecation, and time of feeding after operation and LOS compared with the control group (P<0.05). This finding revealed the advantages of laparoscopic surgery. Early feeding after operation is good to facilitate gastrointestinal function recovery and nutritional supplement while reducing the risks of complications.
Laparoscopic surgery combined with new adjuvant radiochemotherapy has outstanding therapeutic effect on rectal carcinoma in the progressive stage and exhibits high safety. Therefore, this can be promoted as the first clinical therapy for patients with rectal carcinoma in the progressive stage.
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