Efficacy of hybrid versus traditional central approach for laparoscopic radical resection of rectal cancer
Objective:To investigate the clinical efficacy of hybrid approach versus traditional central approach in laparoscopic radical resection of rectal cancer.Methods:A retrospective analysis was performed on the clinical data of 64 patients who underwent laparoscopic radical rectal resection and anterior sacral anastomosis for rectal cancer at our hospital from January 2020 to June 2020, and they were divided into two groups according to the surgical approach used (32 patients each were operated via the hybrid approach, and the traditional central approach. Outcome measures evaluated included surgical parameters (operation time, blood loss, time of separating the left Toldt's fascia after inferior mesenteric artery separation, time to postoperative exhaust, and time to postoperative discharge time), surgical complications (anastomotic fistula, intestinal obstruction, urinary retention, and anastomotic bleeding), and follow-up indicators (survival, local recurrence, and distant metastasis of the tumor at 1 year after surgery). Measurement data with a normal distribution are expressed as the mean±standard deviation, and the t-test was used for comparison between groups. Counting data were compared by the chi-square test.Results:A total of 62 patients in the two groups successfully completed laparoscopic radical resection of rectal cancer, and there was no accidental death occurred during the perioperative period and no conversion to open surgery. There was no significant difference between the hybrid approach group and the traditional central approach group in operation time [(109.75±5.76) min vs (108.16±2.65) min, P＞0.05], intraoperative blood loss [(90.62±3.97) ml vs (92.12±1.96) ml, P＞0.05], time to postoperative exhaust [(2.28±0.96) d vs (2.31±0.47) d, P＞0.05], and time to postoperative discharge [(6.91±1.09) d vs (6.89±1.84) d, P＞0.05]. However, the time of separating the left Toldt's fascia was significantly shorter in the hybrid approach group than in the traditional central approach group [(6.50±1.50) min vs (15.63±1.68) min, P＜0.05]. There were four cases of postoperative complications in the hybrid approach group and seven cases in the control group, and there was no significant difference between the two groups (χ2＝0.98, P=0.32). All the 64 patients in the two groups received postoperative follow-up. The time of follow-up ranged from 4~10 months, with a median of 7 months. No recurrence, distant metastasis, or tumor-related death occurred during the follow-up period.Conclusion:The hybrid approach is as safe and effective as the traditional central approach in laparoscopic radical resection of rectal cancer, and it can shorten the time of separating the left Toldt's fascia.
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