Analyzing some surgical laparoscopic techniques manage for sigma colon cancer. Subjects and methods: A prospective, conventional, descriptive study was conducted on 58 sigma colon cancer patients.
Jourrnal of military pharmaco-medicine n09-2019 CHARACTERS OF RADICAL LAPAROSCOPIC TECHNIQUE IN TREATMENT OF SIGMA COLON CANCER AT 103 MILITARY HOSPITAL Ngo Gia Khanh1; Nguyen Thanh Long2 Nguyen Van Khoa1; Nguyen Van Xuyen1 SUMMARY Objectives: Analyzing some surgical laparoscopic techniques manage for sigma colon cancer Subjects and methods: A prospective, conventional, descriptive study was conducted on 58 sigma colon cancer patients Results: Time of operation: 143.02 ± 38.797 mins Method of operation: left hemicolectomy: 1.72%, distal left colectomy: 13.79%, sigmoidectomy: 31.04%, colon and upper rectum resection (44.83%), colon resection and colonostomy: 8.62% Using trocars: 89.66% 100% complete mesocolic excision Laparotomy incision in underumbilical midline 36.21%, in left lower quadrant: 36.21%; 100% of colon incision was at least cm from tumor Using circular stapler: 79.31% Conlusion: Laparoscopy can perform colon incision at safe margins, and complete mesocolic excision, using trocars may be suitable for surgery, the most using methods were sigmoidectomy and colon-upper rectum resection, most using laparotomic incisions were underumbilical midline and in left lower quadrant, using circular stapler: 79.31% * Keywords: Sigma colon cancer; Laparoscopic surgery; Characters of technique INTRODUCTION Sigma colon cancer accounts for the highest rate in colon cancer In Vietnam it ranks from 28.5% to 46.4% [1, 2] Radical surgery of colon cancer requires goals Firstly, reaching to the safe margins of colon; secondly, removing the mesocolic toward the root of colon supplying artery; thirdly, margin around the tumor Thus, the difference location of tumor in sigma colon may lead to difference in surgical method One method is applied for every tumor of sigma colon strickly may make not only unnessesary larger margins but also increase time of operation and risks of complication Laparoscopic surgery is minimal invasive one with many advantages If laparoscopic surgery is applied to sigma colon cancer, the treatment may be better This research has aim: Analyzing some surgical laparoscopic techniques in management of sigma colon cancer SUBJECTS AND METHOD Subjects 58 sigma colon cancer patients, treated by radical laparoscopic surgery at the Abdominal Surgery Department, 103 Military Hospital from - 2013 to - 2018 103 Miliatary Hospital Viet Duc Hospital Corresponding author: Nguyen Thanh Long (thanhlongdr1vietduc@gmail.com) Date received: 09/10/2019 Date accepted: 22/11/2019 277 Jourrnal of military pharmaco-medicine n09-2019 * Criteria selection: Patients had diagnosis of sigma colon cancer by colon endoscopy during surgery and pathology; treated by radical laparoscopic surgery, had full record, taking part in our research - Main symptoms: Abdominal pain: 84.48%, stool with muscus or blood: 70.69%, alimentary disorder: 46.55%, lost weight: 29.31%, tumor touchable: 3.44% * Exclusion criteria: Tumor was not located at sigma colon, patients had unresectable metastasis, did not agree treat by radical laparoscopic surgery, lost data, did not agree take part in research - Type of cell: 100% of adenocarcinoma Method Intervention, cross-sectional descriptive study * Steps of research: - All patients were examined, had experiments, underwent colon endoscopy, preoperative bowel preparation - Materials, equipment: laparoscopic set of Karl-Storz with equipment - The method of surgery: Left hemicolectomy, distal left colectomy, sigmoidectomy, colon and upper rectum resection, colon resection and colonostomy * Variable of research: - Patient and tumor: Age, sex, symptoms, tumor invasive, pathology - Character of technique: Time of operation, method of operation, number of trocar, complete mesocolic excision, location of abdominal incision, distance of colon incision from tumor, method of tract reconstruction * Data analysis: Using the software SPSS 20.0 RESULTS AND DISCUSSION Characteristics of patient and tumor - Average age: 59.19 ± 12.94 (29 to 86); male/female: 1.07/1 278 - Tumor invasive: T1: 0%, T2: 12.07%, T3: 44.83%, T4: 43.10% Characteristics of technique * Time of operation: 143.02 ± 38.797 mins in average (75 to 270) Time of operation was one of factors showing the difficulty of method Huu Hoai Anh reported average time of laparoscopic sigmoidectomy was 106.4 minutes [3] Desiderio indicated that time of left colectomy in treatment of sigma colon cancer was 264.5 minutes [4] The different time among the researches may due to the difference in applied method of operation, protocol of each center and the qualification of surgeon * Type of operation: Left hemicolectomy: patients (1.72%); distal left colectomy: patients (13.79%); sigmoidectomy: 18 patients (31.04%); colon and upper rectum resection: 26 patients (44.83%); colon resection and colonostomy: patients (8.62%) Colon and upper rectum resection and sigmoidectomy was the most common, accounting for 44.83% and 31.04%, individually These two techniques showed less of resection than left hemicolectomy, the using of circular stapler for anastomosis was more suitable cases (8.62%) could not make anastomosis due to unclean colon, high age, weakness Jourrnal of military pharmaco-medicine n09-2019 trocars: patients (8.62%); trocars: 52 patients (89.66%); trocars: patients (1.72%) Most patients were treated with trocars We found that using trocars was enough for surgery, including: observating, desecting, vessel cutting, making anastomosis… There was one case with trocars (one more in upper gastric area) due to left hemicolectomy The under umbilical midline incision had advantages such as can examine two margins of colon well, can perform anastomosis by circular stapler or hand, but it damaged more tissues of abdominal wall The incision at lower quadrant (Rutherford Morrison incision) was at the thin area of abdominal wall, shorter than other incision, but only suitable when the distal margin had been cut by liner stapler * Perform complete mesocolic excision (CME): * The distance of colon incision from tumor: 100% of patients had CME following the technique of Werner Hohenberger [6] In laparoscopic surgery, dissecting “from middle to lateral” was more suitable, some advantages Vessel cutting and lympho harvesting were performed from the beginning of operation when the operation area was still clear, would be more exactly All the patients in research of Huynh Thanh Long were treated colon cancer by laparoscolic surgery had also been performed CME [4] 100% of patients had the incision at colon at least cm from the tumor The average proximal distance from tumor was 14.43 ± 4.381 cm, average distance from tumor was 8.10 ± 4.183 cm Hashiguchi Y reported that lymph node harvesting more than cm from the tumor did not improve staging accuracy [7] * Number of trocar: Table 1: Location of abdominal incision Location of abdominal incision n Rate (%) Suprapubic 12.07 Under umbilical midline 21 36.21 At left lower quadrant 21 36.21 Left paramedian 6.8 Have colonostomy 8.62 58 100 (Rutherford morrison) Total The most incision was under umbilical midline (36.21%) and at lower quadrant (Rutherford Morrison incision) (36.21%) Table 2: Alimentary tract reconstruction method Alimentary tract reconstruction method Making anastomosis n Rate (%) Circular stapler 46 79.31 Hand-sewn 12.07 8.62 58 100 Colostomy Total The rate of stapled anastomosis in research was 79.31% Fayek I.S stated the anastomosis time was shorter than by hand-sewn, but there was no difference in complication, time of staying [8] There were cases of hand-sewn due to the fact that circular stapled device could not reach to distal margin, so had to be made by hand 279 Jourrnal of military pharmaco-medicine n09-2019 CONCLUSION Researching 58 sigma colon cancer patients treated by radical laparoscopic surgery, we had some conclusion: Laparoscopic surgery can perform colon incision to safe margin, all patients had CME, trocars can be used for operation with rate of 89.66%, the most used method were colon and upper rectum resection (44.83%) and sigmoidectomy (31.04%), the mostly used abdominal incision were under umbilical midline (36.21%) and at lower quadrant (Rutherford Morrison incision) (36.21%), the rate of stapled anastomosis was 79.31% REFERENCES Bùi Diệu, Nguyễn Thị Hoài Nga, Nguyễn Văn Hiếu Một số đặc điểm ung thư đại tràng qua nghiên cứu 906 trường hợp đến khám điều trị Bệnh viện K Tạp chí Ung thư học Hội Ung thư Việt Nam 2013, số 4, tr.250-253 Tơ Quang Huy, Nguyễn Đại Bình, Vũ Thanh Phương, Đồn Trọng Tú Ung thư biểu mơ đại trực tràng xếp loại Dukes A-B-C: thời gian sống thêm năm yếu tố ảnh hưởng Tạp chí Ung thư học Hội Ung thư Việt Nam 2013, tr.284-288 280 Hữu Hoài Anh Nghiên cứu kết phẫu thuật cắt đại tràng nội soi điều trị ung thư đại tràng trái Luận án Tiến sỹ Y học Viện Nghiên cứu Khoa học Y Dược lâm sàng 108 2017 Huỳnh Thanh Long Nghiên cứu mức độ di hạch đánh giá kết điều trị triệt ung thư đại tràng phẫu thuật nội soi Học viện Quân y Luận án Tiến sỹ Y học 2018 Desiderio J et al Laparoscopic versus open left colectomy in patients with sigmoid colon cancer: Prospective cohort study with long-term follow-up J Surg 2014, 12 (8), pp.745-750 Hohenberger W et al Standardized surgery for colonic cancer: Complete mesocolic excision and central ligation-technical notes and outcome Colorectal Dis 2009, 11 (4), pp.354-364; discussion 364-365 Hashiguchi Y et al Optimal margins and lymphadenectomy in colonic cancer surgery Br J Surg 2011, 98 (8), pp.1171-1178 Rorvig S et al Is the longitudinal margin of carcinoma-bearing colon resections a neglected parameter? Clinical Colorectal Cancer 2014, 13 (1), pp.68-72 Fayek I.S Evaluation of stapled versus hand-sewn techniques for colo-rectal anastomosis after low anterior resection of mid-rectal carcinoma: A study on 50 patients Asian Pac J Cancer Prev 2014, 15 (13), pp.5427-5431 ... difficulty of method Huu Hoai Anh reported average time of laparoscopic sigmoidectomy was 106.4 minutes [3] Desiderio indicated that time of left colectomy in treatment of sigma colon cancer was...Jourrnal of military pharmaco-medicine n09-2019 * Criteria selection: Patients had diagnosis of sigma colon cancer by colon endoscopy during surgery and pathology; treated by radical laparoscopic. .. location of abdominal incision, distance of colon incision from tumor, method of tract reconstruction * Data analysis: Using the software SPSS 20.0 RESULTS AND DISCUSSION Characteristics of patient