Zhang Huaqi, Wang Sen, Chen Zhensheng, Luo Tedong, Cao Jinpeng, Li Zhicheng, Ji Yong
Department of Gastrointestinal Surgery, The First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Foshan, China.
Updates Surg. 2025 Apr;77(2):343-353. doi: 10.1007/s13304-025-02071-x. Epub 2025 Jan 18.
The surgical risk is higher for obese patients undergoing laparoscopic left hemicolectomy. To enhance the surgical safety and efficacy for obese patients, we have innovatively integrated the advantages of various surgical approaches to modify a pancreas-guided C-shaped surgical procedure. The safety and quality were assessed through a retrospective analysis. Colon cancer patients who underwent laparoscopic left hemicolectomy were categorized into two groups, C-shaped group and Medial-to-lateral group. Baseline data, operative safety indices, operative quality indices and learning curve were subjected to statistical analysis. The complete mesocolic excision rate and R0 resection rate were 100% in both groups. In terms of surgical safety, C-shaped group experienced significantly less blood loss (50(20) mL vs. 50(50) mL, p = 0.002), shorter total operative time (252.65 ± 50.43 min vs. 280.12 ± 70.45 min, p = 0.004) and no organ damage occurred. All patients were classified into four BMI grades (I: BMI < 18.5 kg/m; II: 18.5 ≤ BMI < 24 kg/m; III: 24 ≤ BMI < 28 kg/m; IV: BMI ≥ 28 kg/m). The total operative time and estimated blood loss were significantly lower in obese patients (BMI grade III and IV) of C-shaped group. In addition, intra-group analysis further confirmed that this modified surgical technique could effectively enhance safety and efficiency for obese patients. Learning curve analysis revealed a significant reduction in total operative time after the completion of 20 surgeries. Utilization of the pancreas-guided C-shaped surgical procedure in obese patients ensures reliable surgical outcomes and significantly increases safety and efficiency. In addition, it is easier to learn and master.
接受腹腔镜左半结肠切除术的肥胖患者手术风险更高。为提高肥胖患者的手术安全性和疗效，我们创新性地整合了各种手术方法的优势，改良出一种胰腺引导的C形手术方法。通过回顾性分析评估其安全性和质量。将接受腹腔镜左半结肠切除术的结肠癌患者分为两组，即C形组和由内侧向外侧组。对基线数据、手术安全指标、手术质量指标和学习曲线进行统计分析。两组的完整结肠系膜切除率和R0切除率均为100%。在手术安全性方面，C形组的失血量明显更少（50(20) mL对50(50) mL，p = 0.002），总手术时间更短（252.65 ± 50.43分钟对280.12 ± 70.45分钟，p = 0.004），且未发生器官损伤。所有患者分为四个BMI等级（I：BMI < 18.5 kg/m；II：18.5 ≤ BMI < 24 kg/m；III：24 ≤ BMI < 28 kg/m；IV：BMI ≥ 28 kg/m）。C形组肥胖患者（BMI等级III和IV）的总手术时间和估计失血量明显更低。此外，组内分析进一步证实，这种改良手术技术可有效提高肥胖患者的安全性和效率。学习曲线分析显示，在完成20例手术后，总手术时间显著缩短。在肥胖患者中应用胰腺引导的C形手术方法可确保可靠的手术效果，并显著提高安全性和效率。此外，它更容易学习和掌握。
