Analysis of Postoperative Complications in Patients with Intestinal Obstruction Under Laparoscopic Information Technology

In order to explore the postoperative complications of laparoscopic adhesive release in the treatment of intestinal obstruction, 70 patients with adhesive intestinal obstruction (IO) who visited Banan District People’s Hospital on March 1, 2017 and received surgical treatment on June 30, 2019 were selected as the research objects. The patients were divided into an experimental group (EG) and control group (CG) using random number table, 35 cases in each group. The EG accepted laparoscopic adhesion release, while the CG accepted laparotomy. The time spent during the operation, intraoperative blood loss (IBL), intestinal injury rate and intestinal resection rate, postoperative anal exhaust (PAE) time, hospital stay, feeding time and concurrent symptoms were recorded and compared between the two groups. Multivariate Logistic regression (MLR) model was adopted for the correlation analysis between symptoms after laparoscopic surgery (LS) and basic characteristics of patients and intraoperative information. It was found that the time of LS, IBL, PAE time, hospital stay and feeding time of the EG are greatly lower than that of the CG (P < 0.05). The number of cases of intestinal injury and intestinal resection in the EG was lower than that in the CG. The incidence of intestinal fistula, pulmonary infection, intestinal paralysis, incision infection, renal dysfunction and malnutrition in the EG was also lower than that in the CG. The regression coefficients of concurrent symptoms of LS and operative time and IBL were 0.376 and 0.343, respectively, showing a significant positive correlation (P < 0.05), which indicated that compared with traditional laparotomy, laparoscopic technique can effectively reduce the occurrence of complicated intestinal fistula, pulmonary infection, intestinal paralysis, incision infection, renal dysfunction, malnutrition, and so on. At the same time, ligation and frequent replacement of surgical instruments should be avoided as far as possible during the operation, and the occurrence of concurrent symptoms can be effectively decreased by reducing the operation time, IBL, and postoperative recovery time of patients with IO.

Clinical impact of D3 lymph node dissection preserving left colic artery (LCA) compared to D3 without preserving LCA: Exploratory subgroup analysis of data from randomized controlled trial of laparoscopic versus open surgery for colon cancer from Japan Clinical Oncology Group study JCOG0404.

653 Background: In curative resection of sigmoid colon and rectal cancer, it is unclear whether D3 lymph node dissection preserving left colic artery (LCA) (Group A) is beneficial compared to D3 without preserving LCA (Group B) in terms of clinical outcomes. Preservation of LCA is expected to maintain blood supply which results in preventing anastomotic leakage, intestinal paralysis, and so on. Methods: The data of JCOG0404 (which is a randomized controlled trial comparing open to laparoscopic surgery for stage II/III colon cancer) were used. Eligibility criteria in JCOG0404 included histologically proven colon cancer; T3 or deeper lesion without involvement of other organs; N0-2 and M0. D3 lymph node dissection with or without preserving LCA was identified according to the photographs of the resected field collected for central surgical review in JCOG0404. The short and long-term outcomes were compared between each procedure. Results: Among all randomized 1057 patients in JCOG0404, 631 patients who received assigned sigmoid colectomy and anterior resection were included in the subgroup analysis. The number of patients were 135 in Group A and 496 in Group B. The patient backgrounds did not differ between groups. The median operative time, median blood loss, and the proportion of grade 1 or more anastomotic leakage and intestinal paralysis were not remarkably different (Group A vs. Group B: 185 min vs 186 min, 60 ml vs. 50 ml, 3.0% vs. 5.0%, and 2.2% vs. 3.8%). However, overall postoperative complication occurred more in Group B than in Group A (9.6% and 21.6%, p = 0.022). In terms of efficacy, 5-year relapse-free survival (RFS) and overall survival (OS) tended to be better in Group A than Group B (RFS: 83.7% and 80.5%, HR 1.25 (95% CI 0.79-1.96), OS: 96.3% and 91.1%, HR 2.47 (95% CI 1.13-5.40)). Conclusions: Short and long-term outcomes were better in Group A than Group B. It was considered that D3 lymph node dissection preserving LCA could be alternative treatment for D3 lymph node dissection. Clinical trial information: C000000105.

Caveolin-1 knockout alters β-adrenoceptors function in mouse small intestine

β-Adrenoceptors are G protein-coupled receptors whose functions are closely associated with caveolae in the heart and cultured cell lines. In the gut, they are responsible, at least in part, for the mediation of the sympathetic stimulation that might lead to intestinal paralysis postoperatively. We examined the effect of caveolin-1 knockout on the β-adrenoceptor response in mouse small intestine. The relaxation response to (−)-isoprenaline in carbachol-contracted small intestinal tissue segments was reduced in caveolin-1 knockout mice (cav1−/−) compared with their genetic controls (cav1+/+). Immunohistochemical staining showed that β-adrenoceptor expression was similar in both strains in gut smooth muscle. Selective β-adrenoceptor blockers shifted the concentration response curve (CRC) of (−)-isoprenaline to the right in cav1+/+ intestine, but not in cav1−/−, with greatest shift in case of the β3-blocker, SR59230A. The CRC of the selective β3-agonist BRL 37344 was also shifted to the right in cav1−/− compared with cav1+/+. The cAMP-dependent protein kinase (PKA) inhibitor H-89 shifted the CRC of (−)-isoprenaline to the right in cav1+/+ but not in cav1−/−. H-89 reduced the relaxation due to forskolin and dibutyryl cAMP in cav1+/+ but not in cav1−/−, suggesting a reduction in PKA activity in cav1−/−. In cav1+/+, PKA was colocalized with caveolin-1 in the cell membrane, but PKA immunoreactivity persisted in cav1−/−. Examination of PKA expression in the lipid raft-rich membrane fraction of the jejunum revealed reduced PKA expression in cav1−/− compared with cav1+/+. The results of the present study show that the function of β-adrenoceptors is reduced in cav1−/− small intestine likely owing to reduced PKA activity.