ObjectiveTo summarize experiences of laparoscopic extralevator abdominoperineal excision (ELAPE) in treatment of advanced low rectal cancer. MethodsThe clinical data of 46 patients with advanced low rectal cancer underwent laparoscopic ELAPE in our center from January 2012 to May 2015 were retrospectively analyzed.During the procedures,the anus and its surrounding tissue were individually resected by perineal approach with jackknife position.The pelvic perinium was closed laparoscopically.The operation time,intraoperative blood loss,retrieval of lymph nodes,radial margin,and postoperative complications were recorded. ResultsThe procedures were successfully performed without any intraoperative complications,complications associated with laparoscopy,or conversion to the open approach.The operation time was (175.3±26.5) min.The intraoperative blood loss was (55.7±28.6) mL.The number of lymph node retrieval was 16.3±7.7.No positive radial margin was identified. ConclusionSufficient resection of circumferential tissue,lower intraoperative perforation rate and satisfactory circumferential margin-negative rate could be achieved by laparoscopic ELAPE in treatment of advanced low rectal cancer.
ObjectiveTo evaluate the safety and efficacy of Roux-en-Y reconstruction with isolated pancreatico-jejunostomy after pancreaticoduodenectomy. MethodsSystematically literature search was performed through PubMed, EMBASE, Cochrane Library, Wanfang, VIP, and CNKI from the earliest to November 30, 2015. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing outcomes of Roux-en-Y reconstruction with isolated pancrea-ticojejunostomy and conventional pancreaticojejunostomy were searched. The data were applied meta-analysis by RevMan 5.3. ResultsSeven trials were involved, two RCTs including 367 patients and five CCTs including 431 patients. Meta-analysis result showed that there was no statistic significant difference in pancreas fistula between Roux-en-Y reconstruction with isolated pancreaticojejunostomy and conventional pancreaticojejunostomy. ConclusionRoux-en-Y reconstruction with isolated pancreaticojejunostomy after pancreaticoduodenectomy is not superior to conventional pancreaticojejunostomy regarding pancreatic fistula rate or other relevant outcomes.