I. Preface
Colorectal cancer is one of the common malignant tumors in China, and the incidence is on the rise. The 5-year survival rate of colorectal cancer after radical surgery hovers between 50% (rectal cancer) and 70% (colon cancer). At present, the diagnosis and treatment of colorectal cancer still emphasize early diagnosis and comprehensive treatment mainly based on surgery.
Radical colorectal cancer surgery can be performed either by traditional open approach or laparoscopic-assisted radical colorectal cancer surgery. Laparoscopic colorectal surgery has been more widely performed worldwide and is one of the most mature surgical procedures in laparoscopic gastrointestinal surgery. Existing clinical studies have shown that with the continuous proficiency of laparoscopic operation technique and shortening of learning curve, the intraoperative and postoperative complications of laparoscopic colorectal surgery are not significantly different from those of open surgery, while the operation time and intraoperative bleeding are comparable or even better than those of open surgery; with the appropriate use of hand-assisted techniques, the rate of intermediate open surgery has also been reduced. The feasibility and safety of laparoscopic colorectal surgery in terms of operation technology has been confirmed. In principle, laparoscopic gastrointestinal tumor surgery must also follow the principles of traditional open surgery for radical tumor treatment, including
1, emphasizing the whole block resection of tumor and surrounding tissues.
2, the principle of non-contact for tumor manipulation
3, adequate incision margins.
4, thorough lymphatic clearance. Long-term follow-up has the same local recurrence rate and 5-year survival rate as traditional surgery.
Most rectal cancers in China occur in the middle and lower rectum. There are several surgical methods for radical rectal cancer treatment, but the classical surgical style is still low anterior rectal resection and combined abdominal perineal radical rectal cancer treatment, and various other modified surgical styles have been less used in clinical practice. lAR is divided into low and ultra-low according to the anastomosis position, and the anastomosis methods are double anastomosis method, transanal colorectal anastomosis and exenteric rectal resection anastomosis. Total mesenteric resection of the rectum can significantly reduce local recurrence of rectal cancer after surgery and improve the 5-year survival rate. Laparoscopic radical rectal cancer surgery should follow the principles of TME.
1, sharp separation in the anterior sacral space under direct vision.
2.Maintaining the integrity of the pelvic fascia visceral layer without damage.
Compared with open TME, laparoscopic TME has the following advantages: more accurate judgment of the pelvic fascia visceral wall bilayer gap and selection of access; more accurate identification and protection of the pelvic plexus by laparoscopy; more complete resection of the rectal mesentery by sharp dissection with ultrasonic knife.
Laparoscopic radical colorectal cancer surgery is a safe and reliable way to cure colorectal cancer, but the operator must have experience in laparoscopic technology and colorectal cancer surgery or be trained in laparoscopic colorectal cancer surgery.
Indications and contraindications for surgery
Indications
The indications for laparoscopic surgery are similar to those for traditional open surgery, including malignant colorectal tumors of various sites. With the development of laparoscopic surgery techniques and instruments, as well as the improvement of anesthesia and general support, the indications for laparoscopic surgery have been greatly expanded.
Contraindications
Tumor diameter >6cm and/or extensive infiltration with surrounding tissues; severe abdominal adhesions, heavy obesity, acute surgery for colorectal cancer (such as acute obstruction, perforation, etc.) and poor cardiopulmonary function are relative contraindications to surgery.
2. Those who have poor general condition and cannot be corrected or improved despite preoperative treatment; those who have serious heart, lung, liver and kidney diseases and cannot tolerate surgery are contraindications to surgery.
III. Surgical equipment and surgical instruments
Conventional equipment
Including high-definition camera and display system, automatic high-flow pneumoperitoneum machine, flushing and suction device, video and image storage equipment. Routine laparoscopic surgical instruments mainly include pneumoperitoneum needle, 5 mm-12 mm puncture cannula, separating forceps, non-invasive bowel grasping and holding forceps, scissors, needle holders, vascular clamps and applicators, retractors and laparoscopic pulling hooks, specimen bags, etc.
Special equipment
Including ultrasonic knife, ligature bundle high energy electric knife, bipolar electrocoagulator, intestinal cutting and suturing device and circular anastomosis clutch.
IV. Surgical methods and types
Laparoscopic colorectal cancer surgery modality
The surgical modalities of laparoscopic colorectal cancer include
1.Whole laparoscopic colorectal surgery: the resection and anastomosis of intestinal segments are done under laparoscopy with anastomosis or suture, which has relatively high technical requirements, longer operation time and higher operation cost.
2, laparoscopic assisted colorectal surgery: the resection or anastomosis of intestinal segments is done through small incisions in the abdominal wall with the assistance of the laparoscope, which is the most used surgical method at present.
3, hand-assisted laparoscopic colorectal surgery: during the operation of laparoscopic surgery, the hand is extended into the abdominal cavity through a small incision in the abdominal wall to assist in the completion of the operation.
Types of laparoscopic colorectal cancer surgery
The main types of laparoscopic colorectal cancer surgery are
1.Laparoscopic right hemicolectomy.
2.Laparoscopic transverse colectomy.
3.laparoscopic left hemicolectomy
4.laparoscopic sigmoid colectomy.
5, laparoscopic anterior rectal resection (L-AR).
6.Laparoscopic combined abdominoperineal resection (L-APR), etc.