The raison d’etre of laparoscopic surgery of colonic tumours is supported by many I/a level evidence. There are a lot of excellent early and late results regarding sigmoid and upper third rectum tumours in favour of laparoscopic surgery. There are not many literature proposals like this regarding chemo-irradiated tumours. One hundred ninety-six patients received neoadjuvant treatment due to lower and middle third rectum tumours in the Borsod-Abaúj-Zemplén County Hospital between the 1st of January 2006 and the 31st of December 2011. Twelve patients out the 196 were not followed up, so we analysed 184 patients’ data. We performed laparoscopic surgery on 67 patients. Conversion happened on 15 patients out of the 67 cases. Open surgery was performed on 117 patients. We strived for the ligation of the inferior mesenteric artery at the origin, the sparing of the autonomic nerves and the precise implementation of TME. The splenic flexure has been taken down during the operations that involved resection. The Dukes stages as well as the, ASA stages were similar in both groups. There was no significant difference in the patients’ BMI either. The length of the removed specimens and the tumour size were similar too. The defining factors of recurrence are the involvement of the circumferential resection margin (CRM) and the complete execution of the TME. These were appropriate in our laparoscopic cases, and we did not find a significant difference in between the groups (Chi-square test, = 0.94). The operation time was similar in the laparoscopic, converted and open surgeries, and there was no significant difference either. The shortest postoperative care time was in the laparoscopic group, but the Mann-Whitney test did not reveal a significant difference. Similarly to literature data, we experienced much less wound-related complications like infections and fever in the laparoscopic group. There was a significant difference in terms of transfusion demand comparing the laparoscopic and open operation groups, to the detriment of the open surgery group (Chi-square test, = 0.04). We did not find a significant difference in recurrence or survival during follow-up of the patients. In addition to the short-term advantages of laparoscopic surgery, it is a safe procedure for the chemo-irradiated rectum tumours even from an oncological point of view. Both open and laparoscopic surgery requires high-level competency and qualification and these must be performed in centres.
Evaluating lactate prognostic value in children suspected of acetaminophen-induced liver failure in Liberia.
January 30, 2020
October 12, 2012
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