This study evaluated the safety and short-term efficacy of laparoscopic complete mesocolic excision (CME) compared to open CME for the treatment of right hemicolon cancer. The study retrospectively reviewed 88 patients - 40 who underwent laparoscopic CME and 48 who underwent open CME. The laparoscopic CME group had a longer operating time but shorter time to first flatus and time to get out of bed compared to the open CME group. There were no significant differences in the number of harvested lymph nodes, hospital stay length, or postoperative complications between the two groups. The study concluded that laparoscopic CME is a safe and effective minimally invasive surgery for right hemicolon cancer.
Isolated traumatic rupture of the duodenum: Case report - Perforations, prefe...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Laparoscopic Natural Orifice Specimen Extraction (NOSE) Total Colectomy with ...semualkaira
The benefit of laparoscopic surgery in terms of
reduced pain and fewer cosmetic problems is not always obvious,
and surgeons continue to seek the best ways to limit incision trauma and improve outcomes in laparoscopic colorectal surgery
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
Isolated traumatic rupture of the duodenum: Case report - Perforations, prefe...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Laparoscopic Natural Orifice Specimen Extraction (NOSE) Total Colectomy with ...semualkaira
The benefit of laparoscopic surgery in terms of
reduced pain and fewer cosmetic problems is not always obvious,
and surgeons continue to seek the best ways to limit incision trauma and improve outcomes in laparoscopic colorectal surgery
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
Isolated Splenic Metastases from Rectal Carcinoma Five Years after Surgery: C...semualkaira
Primary splenic tumors and splenic metastases are uncommon, and
metastatic splenic tumors are even rarer [1]. According to reports,
the most common source of splenic metastases include melanoma,
tumors of the breast, lung, ovary, colon, stomach, and pancreas [2-
3]. Splenic metastases after rectal cancer surgery is very rare. This
paper reports a case of a patient with splenic metastases from rectal cancer 5 years after surgery. We discuss the route of metastasis
and treatment of this case.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Gastrointestinal Cancer: Research & Therapy is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Gastrointestinal Cancer.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Gastrointestinal Cancer. Gastrointestinal Cancer: Research & Therapy accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Gastrointestinal Cancer.
Gastrointestinal Cancer: Research & Therapy strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Gastrointestinal Cancer: Research & Therapy is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Gastrointestinal Cancer.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Gastrointestinal Cancer. Gastrointestinal Cancer: Research & Therapy accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Gastrointestinal Cancer.
Gastrointestinal Cancer: Research & Therapy strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Information about Lap vs Open Colorectal Resection by Dr Dhaval Mangukiya.
Details of Factors compared, COST Trial, CLASSIC Trial, COLOR Trial, COREAN Trial, ALCCS Trial, Summary, SAGES Guidelines,
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Similar to A laparoscopic complete mesocolic excision for the surgical treatment of right hemicolon cancer (20)
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
A laparoscopic complete mesocolic excision for the surgical treatment of right hemicolon cancer
1. Safety and Short-term Efficacy of a Laparoscopic Complete Mesoco-
lic Excision for the Surgical Treatment of Right Hemicolon Cancer
Original article
Ting Li et al 29
Clin Surg Res Commun 2018; 2(2): 29- 33
Ting Li*, Xiang-Ling Meng, Wei Chen
Abstract
Objective: This study was designed to evaluate the safety and short-term efficacy of a laparoscopic complete
mesocolic excision (CME) in patients with right hemicolon cancer.
Methods: A total of 88 patients with right hemicolon cancer were retrospectively reviewed. Forty patients
underwent laparoscopic CMEs, and 48 patients underwent open CMEs. The clinical data were analyzed and
the outcomes were compared between the two groups.
Result: There was no significant difference between the laparoscopic CME group and open CME group with
regard to the harvested lymph node number (16.60±3.20 vs. 15.33±3.10, respectively, P=0.060), hospital stay
length (18.15±5.17 days vs. 17.21±4.47 days, respectively, P=0.360), and postoperative complications (10.0%
vs. 10.4%, respectively, P=0.950). The operation time in the laparoscopic CME group (3.02±0.55 hours) was
significantly longer than that in the open CME group (2.58±0.50 hours, P=0.004). The time to first flatus
(3.28±0.75 days vs 3.92±0.71 days, respectively, P=0.001) and getting out of bed time (1.95±0.75 days vs
3.54±0.71 days, respectively, P=0.001) were both earlier in the laparoscopic CME group than in the open CME
group.
Conclusion: A laparoscopic CME is a safe and effective minimally invasive surgery for the treatment of right
hemicolon cancer.
Keywords: colon cancer; complete mesocolic excision; laparoscope
Corresponding author: Ting Li
Mailing address: Department of Gastrointestinal Surgery,
the First Affiated Hospital of Anhui Medical University, Hefei
230022, China
Address: Jixi Road No.218, Hefei, Anhui, 230022, China
E-mail: tingli_022@163.com
lon cancer have improved over the last decade [5,6]
. In-
creasing evidence has reported that CMEs contribute
to a decreased recurrence rate and increased five-year
survival [4,7,8]
. At present, a CME is considered to be the
standard surgical method for treating colon cancer.
Laparoscopy is a minimally invasive technique that
can allow one to visualize the inside of the abdominal
cavity with a special camera, and the application of lap-
aroscopic surgery was a significant revolution in clin-
ical practice [9]
. When compared with traditional open
surgery, a laparoscopic surgery has the advantages of a
smaller incision, less pain, and a more rapid recovery.
Moreover, laparoscopy has been widely used in gas-
trointestinal malignancy surgeries. A CME can also be
guided via a laparoscope, and this procedure is called
a laparoscopic CME. It has been reported that a laparo-
scopic CME provides a better prognosis for colon can-
cer treatment [10,11]
. Feng et al. first introduced the lap-
aroscopic CME procedure for right hemicolon cancer
[12]
; however, the literature regarding this technology
for the surgical treatment of right hemicolon cancer is
relatively sparse.
In this study, the clinical data of patients with right
hemicolon cancer who underwent laparoscopic CMEs
was retrospectively reviewed, and the safety and short-
term efficacy were evaluated.
INTRODUCTION
Colon cancer is a common gastrointestinal malignan-
cy, and it is becoming more common among younger
age groups [1]
. There are several therapeutic options for
the treatment of colon cancer. However, surgery is the
most frequently used and efficient method for all stages
of colon cancer [2]
. The concept of a total mesorectal ex-
cision (TME) was first introduced in 1986 by Heald and
Ryall, and it was considered to be the standard surgical
treatment for rectal cancer [3]
. In 2009, Hohenberger et
al. first proposed that a TME could be translated into a
surgical treatment for colon cancer, and this was called
a complete mesocolic excision (CME) [4]
. This technique
is performed in order to obtain a complete separation
of the mesocolon from the parietal plane, while the sup-
plying arteries and draining veins are ligated at their
roots. This technique has been proven to achieve lower
local recurrence rates and better overall survival. With
the development of the CME, radical resections for co-
Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
DOI: 10.31491/CSRC.2018.6.016
Creative Commons 4.0
2. Ting Li et al 30
Published online: 26 June 2018
ANT PUBLISHING CORPORATION
METHODS
General patient information
A total of 88 patients with right hemicolon cancer were
enrolled from January 2012 through December 2015.
Forty patients underwent laparoscopic CMEs and 48
patients underwent open CMEs. Those cases with no
history of chemotherapy and/or radiotherapy under-
went enteroscopies, and they were diagnosed with co-
lon cancer via a pathological diagnosis. Those patients
with distant metastases and unresectable tumors were
excluded via the examination of chest x-ray films, chest
computed tomography (CT) scans, abdominal and pel-
vic brightness (B) scan ultrasonography, CT scans, and/
or magnetic resonance imaging (MRI). The surgery was
chosen after full communication with the patients and
their dependents. The general information of the pa-
tients in both groups is shown in Table 1.
Surgical procedure
Laparoscopic CME
After administering general anesthesia, the patient was
placed in the supine position with their legs apart. A
10-mm trocar was inserted into the umbilical region
for the camera port, and a 12-mm trocar was inserted
into the left midclavicular line 5 cm bellow the costal
margin for the main operating port. The 5-mm trocars
were inserted into the anterior superior iliac spine on
both sides and the midpoint of the umbilical cord, as
well as the right costal arch midclavicular line 5 cm be-
low the costal margin for the assistant operating ports.
The pneumoperitoneum pressure was maintained at
13 to 14 mmHg.
Aroutineabdominalexplorationwasperformedtocon-
firm the tumor location. After determining the locations
of the superior mesenteric vein and ileocolic vessel, the
right mesocolon was incised up to Toldt’s space, and
the duodenum was exposed using an ultrasound knife
2 cm below the ileocolic vessel. An incision was made
in the posterior peritoneum along the front left side of
the superior mesenteric vein, and the pericolic mesen-
teric lymph nodes and adipose tissue were dissected.
The ileocolic and right colic artery and vein were fully
exposed and skeletonized, and the vessel roots were li-
gated using a Hem-o-lock vascular clamp. The ascend-
ing mesorectum was raised, and the fusion fascial space
between the posterior mesorectum (Toldt’s fascia) and
the prerenal fascia (Gerota’s fascia) was entered. An in-
cision was made along the fusion fascial space up to the
junction of the ascending colon and the lateral abdomi-
nal wall, being careful not to damage to the ureters and
reproductive blood vessels. After dissociating upward
to expose the head of the pancreas and the descend-
ing and horizontal parts of the duodenum, the lymph
nodes in front of the pancreas and the surrounding
lymph nodes in the right gastroepiploic vessels were
removed. The surgical trunk was exposed at the roots
of the mesentery, and its surrounding lymph nodes and
adipose tissue were removed. The right branches of the
blood vessels in the colon were located and cut. If the
tumor was located next to the middle of the transverse
colon, the roots of the blood vessels in the colon were
interrupted using a clip. An ultrasonic blade was used
to cut the right omentum majus to the right of the gas-
tric retinal vascular arch, continuing on to incise the he-
patocolic ligament and the right ligamentum phrenico-
colicum towards the right. An incision was then made
downward on the right side of the peritoneum of the
ascending colon along the right paracolic sulcus. This
incision met the medial separating surface, completing
the dissociation of the right colon and its entire mes-
entery. The specimens from the excision underwent an
ilecolostomy, the abdominal cavity was rinsed with dis-
tilled water, and a drainage tube was placed under the
right side of the liver.
Open CME
The cecum, ascending colon, flexura hepatica coli, right
transverse colon, and mesangial vessels and lymph
nodes were removed. Five centimeters of the distal il-
eum and omentum majus were also removed. The sur-
gical procedure was consistent with the main points of
a CME, and it was performed via the sharp incision of
the fascia and high ligation of the central vessels. The
lymph nodes in the roots of the mesenteric vessels were
carefully removed.
Data collection
The data from all the patients undergoing the CMEs
was recorded and compared between the two groups,
including the operation time, getting out of bed time,
dissected lymph node number, time to first flatus, and
postoperative complications. Each patient received a
follow-up in order to determine any tumor recurrenc-
Laparosc
opicCME
Open CME Pvalue
Cases 40 48
Age (years) 59.52 60.81 0.611
±12.42 ±11.63
Gender 0.508
Female 18 25
Male 22 23
TNM stage 0.872
I 4 4
II 27 34
III 9 10
Table 1 . General information of patients
3. Ting Li et al 31
Clin Surg Res Commun 2018; 2(2): 29- 33
es or metastases. The duration of the follow-up ranged
from 1 to 46 months.
Statistical analysis
The statistical analysis was performed using SASS 12.0
software. The categorical data were compared using a
χ2 test, and the measurement data were compared with
an independent samples t test. A P value of less than
0.05 was considered to be statistically significant.
RESULTS
Surgical procedure
The general information from Table 1 shows that there
were no statistical differences in the age, gender, and
Tumor, Node, Metastasis (TNM) stage between the
laparoscopic CME and open CME groups (P>0.05). All
of the laparoscopic and open CME operations were fin-
ished smoothly, and no surgery-related or perioperative
deaths occurred in any of the cases. As shown in Table
2, the operation time in the open CME group was statis-
tically shorter than that in the laparoscopic CME group
(3.02±0.55 vs. 2.58±0.50 hours, P=0.004). The patholo-
gy reports showed no statistical difference in the har-
vested lymph node number between the two groups
(16.60±3.20 vs. 15.33±3.10, respectively, P=0.060).
Table 2 Postoperative recovery
Postoperative recovery
The length of the hospital stay for the patients in the
laparoscopic CME group was similar to that in the
open CME group (18.15±5.17 vs. 17.21±4.47 days, re-
spectively, P=0.360). However, the laparoscopic CME
group had a significantly shorter getting out of bed time
(1.95±0.75 vs. 3.54±0.71 days, respectively, P<0.001)
and a significantly shorter time to first flatus (3.28±0.75
vs. 3.92±0.71 days, respectively, P<0.001).
Postoperative complications
The postoperative complication rate in the laparoscop-
ic CME group was 10.0% (4/40), and the complications
included incision infections (n=3) and an intestinal ob-
struction (n=1). The complication rate in the open CME
group was 10.4% (5/48), including incision infections
(n=3), a pulmonary infection (n=1), and postoperative
anastomotic bleeding (n=1). There were no anastomotic
fistulas in either group. Moreover, there was no statis-
tical difference in the postoperative complication rate
between the two groups. During the follow-up (range
from 1 to 46 months), there were two tumor recur-
rence cases in the laparoscopic CME group and three
tumor recurrence cases in the open CME group. In ad-
dition, one patient in the laparoscopic CME group died,
and two patients in the open CME group died during
the follow-up. There were no statistical differences in
the recurrence rates (χ2=0.06, P=0.80) and death rates
(χ2=0.18, P=0.67) between the two groups.
DISCUSSION
The postoperative rectal cancer recurrence rate has
been significantly reduced, and the postoperative sur-
vival rate has been significantly improved since Heald
and Ryall presented the concept of a TME [3,13]
. In 2009,
Hohenberger et al. proposed the standardized applica-
tion of the CME in the radical resection of colon cancer.
They also analyzed a total of 1,329 patients with colon
cancer that had undergone CMEs, and they concluded
that a CME could significantly reduce the recurrence
rate and improve the survival rate [4]
. Based on the ex-
perience of Hohenberger et al., a CME should be per-
formed in the radical resection of colon cancer in or-
der to remove all of the tumors, based on the excision
of the complete mesocolon, and achieve a maximum
lymph node harvest. The CME has brought the new
concept of fine anatomy throughout the entire colon
cancer surgery process. We conducted CMEs based on
laparoscopic right hemicolon cancer resections, and we
observed their short-term efficacy and safety.
After reviewing the clinical data, we discovered that
the incision pain was slighter, and the time to get out of
bed and time to first flatus was earlier in those patients
who underwent laparoscopic CMEs than in those who
underwent open CMEs. This may have been due to the
minimally invasive laparoscopic surgery, with its small
abdominal incision and a slight traumatic reaction,
which are beneficial for the rapid recovery of postoper-
ative intestinal function. Its minimally invasive feature
is also good for preventing pulmonary complications.
In this study, the postoperative complications includ-
ed incision infections in three cases and an intestinal
obstruction in one case, but there were no pulmonary
Laparoscopic CME Open CME P value
Operation time (h) 3.02±0.55 2.58±0.50 0.004
Harvested lymph node number 16.60±3.20 15.33±3.10 0.060
Length of hospital stay (d) 18.15±5.17 17.21±4.47 0.360
Getting out-of-bed time(d) 1.95±0.75 3.54±0.71 <0.001
Time to first flatus(d) 3.28±0.75 3.92±0.71 <0.001
Table 2. Postoperative recovery
DOI: 10.31491/CSRC.2018.6.016
4. Ting Li et al 32
Published online: 26 June 2018
ANT PUBLISHING CORPORATION
correct anatomical level and improving the operation.
CME operations in laparoscopic hemicolectomies for
right colon carcinoma cases have been carried out in
the clinic [19,20]
. They not only elevate the survival rate,
but they also improve the quality of life of the patients
[10]
. This procedure has the advantage of being minimal-
ly invasive, and the patients can achieve rapid recovery
after the surgery. A laparoscopic CME for the treatment
of radical right colon cancer has been proven to be safe
and feasible, and its short-term curative effect is satis-
factory. It is a minimally invasive surgical method with
application prospects; however, the long-term efficacy
requires further study.
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Fourth, the use of an ultrasound knife can significant-
ly reduce blood loss, facilitating the dissection at the
5. Ting Li et al 33
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