https://scholars.lib.ntu.edu.tw/handle/123456789/558623
標題: | Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer | 作者: | JIN-TUNG LIANG HONG-SHIEE LAI |
公開日期: | 2014 | 出版社: | Springer New York LLC | 卷: | 28 | 期: | 5 | 起(迄)頁: | 1727-1733 | 來源出版物: | Surgical Endoscopy | 摘要: | Background: Our objective was to evaluate the quality of surgery regarding application of the robotic approach to perform D3 lymph node dissection over the inferior mesenteric artery (IMA) with preservation of the left colic artery (LCA) and autonomic nerves for the treatment of distal rectal cancer, which has not been reported before, although it has been successfully performed by some surgeons laparoscopically. Methods: Patients with distal rectal cancer posing risk factors for anastomotic leakage were recruited and underwent the present robotic procedure, which was standardized and presented in the attached video file. Patients' surgical outcomes were prospectively evaluated. Results: A total of 26 patients with distal rectal cancer were operated on via the present robotic approach. The number of cleared lymph nodes was 26.1 ± 7.2 (range 10-44). The operation time was 307.3 ± 74.1 min (including docking time). The blood loss was 190.5 ± 225.8 ml. Anastomotic leakage occurred in one (1/16, 6 %) patient without preoperative chemoradiation therapy, and wound infection of port sites was detected in two (2/26, 7.6 %) patients. The patients had quick convalescence, as evaluated by the recovery of flatus passage (48.0 ± 12.0 h), hospitalization (14.6 ± 4.8 days), and degree of postoperative pain (2.5 ± 0.5, visual analog scale). The median duration for indwelling urine Foley catheter was 6.0 days (range 3.0-28). The voiding function after removal of the urine Foley catheter was good (International Prostate Score Symptom [IPSS] 0-7) in 22 (84.6 %) patients, fair (IPSS 8-14) in three (11.5 %), and poor (IPSS 15-35) in one (3.8 %). The median time of return to partial activity, full activity, and work was 2.0, 4.0, and 6.0 weeks, respectively. Conclusions: By using the three-armed Da Vinci? robotic system in our clinical setting, quality surgery of the D3 lymph node dissection around the IMA with preservation of the LCA and autonomic nerves, in which the adequacy of lymph node harvest and the security of blood supply over distal colon were juggled, can be achieved for patients with distal rectal cancer posing risk factors of anastomotic failure. ? 2013 Springer Science+Business Media. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84900332245&doi=10.1007%2fs00464-013-3340-6&partnerID=40&md5=285c2152f129cb63e111a79eb5ad1c98 https://scholars.lib.ntu.edu.tw/handle/123456789/558623 |
ISSN: | 0930-2794 | DOI: | 10.1007/s00464-013-3340-6 | SDG/關鍵字: | antineoplastic agent; adult; aged; anastomosis leakage; article; autonomic nerve; bleeding; chemoradiotherapy; clinical article; convalescence; female; Foley balloon catheter; graft preservation; hospitalization; human; indwelling catheter; inferior mesenteric artery; International Prostate Symptom Score; left colic artery; lymph node dissection; male; operation duration; postoperative pain; priority journal; rectum cancer; robotics; surgical technique; treatment outcome; very elderly; visual analog scale; wound infection; autonomic nerve; cancer staging; colon; follow up; inferior mesenteric artery; innervation; laparoscopy; lymph node; lymph node dissection; lymph node metastasis; middle aged; pathology; procedures; Rectal Neoplasms; retrospective study; robotics; secondary; surgery; vascularization; Adult; Aged; Aged, 80 and over; Autonomic Pathways; Colon; Female; Follow-Up Studies; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Mesenteric Artery, Inferior; Middle Aged; Neoplasm Staging; Rectal Neoplasms; Retrospective Studies; Robotics |
顯示於: | 醫學系 |
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