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Objective: At present, though the laparoscopic delta-shaped anastomosis and overlapping delta-shaped anastomosis have been gradually applied to complete laparoscopic radical resection of left hemicolon cancer, the comparative evaluation of their efficacy has not been mentioned in the published literatures. This study aims to explore the safety, feasibility and short-term efficacy of overlapping delta-shaped anastomosis (ODA) in totally laparoscopic left hemicolectomy. Methods: A retrospective cohort study was performed. The clinical and pathological data of patients who underwent totally laparoscopic left hemicolectomy at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2017 to October 2020 were retrospectively analyzed. The case inclusion criteria were as follows: (1) age of 18-75 years; (2) body mass index (BMI) of 18.5-30 kg/m(2); (3) descending colonic and proximal sigmoid colonic adenocarcinoma was confirmed by preoperative colonoscopy and pathology. The exclusion criteria: (1) multiple primary colorectal cancers; (2) uncontrolled or poorly controlled diabetes mellitus, immune system diseases, or hematological diseases; (3) severe intestinal obstruction; (4) left transverse colonic or splenic flexure colonic adenocarcinoma; (5) distant metastasis of liver, lung and other viscera determined by enhanced computed tomography in the chest, abdomen and pelvis. According to the above criteria, a total of 115 patients with left hemicolon cancer were enrolled. All the patients underwent totally laparoscopic left hemicolectomy. Patients who underwent laparoscopic traditional delta-shaped anastomosis were selected as the control group. Patients who underwent laparoscopic ODA were selected as the ODA group. Effects of these two laparoscopic reconstruction methods on postoperative recovery and perioperative complications were analyzed and compared. Results: A total of 60 patients were enrolled in the ODA group, including 32 males and 28 females, with mean age of (57.3±10.4) years and body mass index (BMI) of (25.0±3.1) kg/m(2). While mean 55 patients were enrolled in the control group, including 31 males and 24 females, with mean age of (56.7±9.9) years and BMI of (24.4±2.9) kg/m(2). There was no statistically significant differences between the two groups in gender, age, BMI, American Society of Anesthesiologist (ASA) classification, TNM staging, preoperative abdominal surgery history, neoadjuvant chemotherapy and nutritional status (levels of hemoglobin, lymphocyte count, prealbumin, and albumin) (all P >0.05). All the patients in both groups received R0 resection without conversion to open laparotomy or conversion to extra-abdominal anastomosis. The digestive tract reconstruction time of the ODA group was significantly shorter than that of the control group [(15.1±1.7) minutes vs. (15.9±2.4) minutes, t =-2.053, P =0.042]. There were no statistically significant differences in the total operation time, intraoperative blood loss, length of skin incision, tumor size, proximal and distal margins, harvested lymph nodes, postoperative first ambulatory time, and postoperative hospital stay (all P >0.05). However, the time to the first flatus and the first defecation in the ODA group was significantly shorter as compared to control group [(1.5±0.5) days vs. (1.7±0.5) days, t =-2.028, P =0.045; (3.1±0.6) days vs. (3.4±0.7) days, t =-2.095, P =0.039], indicating faster intestinal function recovery in patients with ODA. The morbidity of postoperative complication was 6.7% (4/60) in the ODA group and 7.3% (4/55) in the control group and no significant difference was found (χ(2)=0.016, P =0.898). Two cases of incision infection, 1 case of lung infection, and 1 case of intra-abdominal infection occurred in the ODA group, while 3 cases of lung infection and 1 case of intra-abdominal infection occurred in the control group. All these complications were resolved after conservative treatment, and no secondary operation was performed due to complications. Conclusion: Compared with the traditional delta-shaped anastomosis, ODA is associated with a faster recovery of postoperative intestinal function without increasing the morbidity of postoperative complications, and has the satisfactory short-term efficacy.

Objective: In laparoscopic-assisted left hemicolectomy, previous studies have suggested that preserving the inferior mesenteric artery (IMA) may improve intestinal blood flow and reduce the incidence of anastomotic leakage. However, whether IMA should be retained is controversial currently. This study aims to investigate the short-term efficacy of the inferior mesenteric artery preservation (IMAP) and the inferior mesenteric artery resection (IMAR) on the laparoscopic-assisted radical resection of left hemicolon cancer. Methods: A retrospective cohort study was conducted to collect the clinical data of 195 patients with left colon cancer who underwent laparoscopic surgery in the Colorectal Surgery Department of Cancer Hospital of Chinese Academy of Medical Sciences from October 2012 to February 2019. After D3 radical resection for left semicolon cancer, they were divided into the IMAR group (91 cases), and the IMAP group (104 cases). In IMAR group, the left colon artery (LCA) and 1-2 branches of sigmoid artery (SA) were identified about 5 cm away from the root of the IMA, then the main IMA trunk was transected at the distal end. In IMAP group, the main trunk of IMA was dissected and the lymph nodes around IMA were cleaned. After the LCA and the first branch of SA (SA1) were separated, the LCA and SA1 were closed and cut off at the root. The intraoperative and postoperative data were compared between two groups, including the morbidity of complications within 30 days after operation, postoperative follow-up recovery, operation time, intraoperative blood loss, number of harvested lymph nodes, length of specimens, postoperative passage of gas and hospital stay. Results: The operation was successfully completed in all the cases without any death related to the operation. Compared with the IMAP group, the operation time was shorter [(161.8±48.0) minutes vs. (182.9±49.4) minutes, t =2.985, P= 0.003], the intraoperative blood loss was less [(38.5±30.8) ml vs.(52.9±32.2) ml, t =2.088, P= 0.038], the length of the resected bowel was longer [(19.2±6.0) cm vs.(17.2±5.4) cm, t= -2.447, P =0.015] in the IMAR group, whose differences were statistically significant (all P <0.05). There were no significant differences in the number of harvested lymph nodes, time of postoperative passage of gas and postoperative hospital stay between two groups (all P >0.05). There was no significant difference in overall morbidity of postoperative complications between the two group [6/91 (6.6%) vs. 7/104 (6.7%), χ(2)=0.001, P =0.969]. In the IMAR group, one case developed postoperative abdominal infection, two cases developed incision infection, one case developed lung infection, two cases developed intestinal obstruction, and no anastomotic bleeding occurred. In IMAP group, one case developed postoperative lung infection, one case developed incision infection, one case developed abdominal bleeding, two cases developed intestinal obstruction and two cases developed anastomotic bleeding. There was no anastomotic leakage in either group. All complications were treated by conservative treatment successfully. After a median follow-up of 12 (range 3-24) months, patients in the two groups had good intestinal blood supply after surgery, and there was no clear manifestation of congestive or ischemic enteritis under colonoscopy. Conclusion: Laparoscopic-assisted left hemicolectomy with IMA resection in patients with left hemicolon cancer provides better short-term efficacy safely and feasibly, including shorter operative time, less intraoperative bleeding and without increasing postoperative complications.

Objective: To evaluate the safety, feasibility and short-term efficacy of totally laparoscopic left colectomy for left colon cancer by using overlapped delta-shaped anastomosis technique for digestive tract reconstruction. Methods: A retrospective cohort study was conducted to collect the clinical data of 86 patients with left colon cancer who underwent laparoscopic surgery in Cancer Hospital of Chinese Academy of Medical Sciences from October, 2017 to February, 2019. The patients were divided into totally laparoscopic left-sided colectomy (TLLC) (treatment group, n =25 cases) and laparoscopic-assisted left-sided colectomy (LALC) (control group, n =61 cases). The intraoperative and postoperative data were compared between the two groups. Results: There were no surgical-related deaths in both groups. All the patients in the TLLC group underwent laparoscopic resection, while one patient in the LALC group transfer to open surgery. The operation time in TLLC group and LALC group were (164.5±42.3) min and (171.0±43.1) min, respectively, without statistically significant difference ( P =0.516). However, the intraoperative blood loss of patients in the TLLC group was (36.4±22.7) ml, which was significantly less than (52.9±32.2) ml in the LALC group ( P =0.026). The anastomosis time in the TLLC group was (39.1±6.5) min, which was significantly longer than (24.9±5.4) min in the LALC group ( P <0.001). Postoperative exhaust time in the TLLC group was (2.6±0.5) days, which was significantly shorter than (3.3±0.8) days in the LALC group ( P <0.001). The incision length in the TLLC group was (4.2±2.2) cm, significantly shorter than (7.0±2.5) cm in the LALC group ( P <0.001). The length of the resected bowel was (21.0±7.3) cm in the TLLC group, which was significantly longer than (17.5±5.4) cm in the LALC group ( P =0.037). The length of hospital stay in the TLLC group was (6.2±1.9) days, which was significantly shorter than (7.9±1.5) days in the LALC group ( P <0.001). The incidences of postoperative complications in the TLLC group and LALC group were 0 and 4.9% (3/61), respectively, without statistically significant ( P =0.553). No anastomotic complications occurred in both groups. During the follow-up period, neither group of patients was hospitalized again, and no tumor metastasis or recurrence occurred. Conclusions: It is safe and feasible to apply the TLLC with overlapped delta-shaped anastomosis in patients with left colon cancer. It has better short-term effects such as shorter incisions, faster recovery, and shorter postoperative hospital stays, and is worthy of further promotion.

Objective: This study aims to explore the clinical value of fusion indocyanine green fluorescence imaging (FIGFI) in total laparoscopic radical resection for right colon cancer. Methods: From October, 2018 to December, 2018, 15 patients who underwent total laparoscopic radical resection for right colon cancer using FIGFI in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively enrolled in this study. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and complications were collected and analyzed. Results: All patients successfully underwent total laparoscopic radical resection for right colon cancer using FIGFI. 1 patients (6.7%) received extended resection of bowel due to poor blood supply after mesentery excision. The average operation time was 133.7 minutes and intraoperative blood loss was 26.7 ml. The average time to ground activities, fluid diet intake, first flatus and postoperative hospitalization were 19.1 h, 11.7 h, 32.5 h and 5.0 d, respectively. The average length of tumor was 4.5 cm. The average proximal and distal resection margins were 14.9 cm and 12.1 cm, respectively. The average number of lymph nodes retrieved was 29.3 per patient. Only one patient suffered from incisional fat liquefaction after surgery and was managed effectively by regular dressing change. No severe complications such as indocyanine green allergy, anastomotic stenosis, anastomotic leakage, abdominal bleeding, bowel obstruction, pulmonary infection, and abdominal infection occurred in any patients. Conclusions: FIGFI is helpful to judge the blood supply of intestinal segments and anastomotic stoma in total laparoscopic radical resection for right colon cancer quickly. It is a safe and feasible technique with satisfactory short-term effect.

Objective: The aim of this study was to explore the clinical safety, feasibility and short-term effect of overlapped delta-shaped anastomosis in total laparoscopic transverse colectomy. Methods: The records, which were based on China National Cancer Center, of 20 and 31 patients who underwent total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis and laparoscopic-assisted transverse colectomy with conventional extracorporeal anastomosis, from March 2017 to May 2018 were reviewed retrospectively. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications were collected and compared. Results: There was no difference between the two groups in overall operation time, anastomosis time and intraoperative blood loss ( P >0.05), however, the length of incision was significantly shorter in overlapped delta-shaped group [(4.7±0.6) cm vs. (5.5±1.0) cm, P =0.002]. The time to ground activities, first flatus and postoperative hospitalization did not differ between the two groups ( P >0.05). The postoperative visual analogue scale was lower in the overlapped delta-shaped group than the control group on postoperative day 1 (3.7±0.7 vs. 4.2±0.9, P =0.015) and postoperative day 3 (2.7±0.5 vs. 3.2±0.9, P =0.040). The perioperative complication rates were 10.0% and 12.9% in the overlapped delta-shaped group and the control group, respectively, and the difference was not significant ( P =0.753). Conclusion: Compared to conventional extracorporeal anastomosis, total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis was a safe and feasible procedure with satisfactory short-term effect, shorter incision and less postoperative pain.

Objective: The aim of this study was to explore the clinical safety and feasibility of intracorporeal delta-shaped anastomosis in total laparoscopic left hemicolectomy. Methods: From January 1, 2017 to October 1, 2017, 11 patients who were diagnosed with left colon cancer and underwent total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis were retrospectively enrolled in this study. Clinicopathologic characteristics, surgical and postoperative outcomes were collected and analyzed. Results: The median operation time was 121.8 minutes and the median time for anastomosis was 14.9 minutes. The median intraoperative blood loss was 45.5 ml. The lengths of the upper and lower segments of resection from colon cancer were 11.4 cm and 8.5 cm, respectively. The median number of lymph nodes retrieved was 29.5. The median time to ground activities, time to flatus, time to fluid diet intake and length of hospital stay were 1.4 days, 3.0 days, 3.8 days and 6.9 days, respectively. Only one patient suffered from incision infection during his hospitalization due to preoperative long-term smoking history. No mobility related to the anastomosis such as anastomotic bleeding, stenosis, obstruction and leakage occurred in any patients. Conclusion: Total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect.

Aim: To introduce an innovative intracorporeal anastomosis technique named overlapped delta-shaped anastomosis (ODA) for colon cancer cases undergoing totally laparoscopic colectomy (TLC) and to assess its feasibility and safety., Methods: From January 2016 to March 2017, a total of 20 consecutive patients with colon cancer accepted TLC and the ODA technique at our medical center. Patient demographics, operative outcomes, perioperative complications, and pathological results were collected and analyzed., Results: We successfully completed TLC and the ODA procedure in all 20 cases, including 6 (30%) males and 14 (70%) females. In total, 11 (55%), 2 (10%), and 7 (35%) cases accepted right hemicolectomy, transverse hemicolectomy, and left hemicolectomy, respectively. None of the surgeries were converted to an open operation. Mean operative time was 178.5 min, and mean estimated blood loss was 58.5 mL. Mean time to first flatus was 2.5 d, and mean postoperative hospitalization duration was 6.8 d. No severe complications occurred, such as anastomotic leakage, snastomotic stenosis, anastomotic bleeding, and wound infection, except for one case who suffered from an abdominal infection and another case who suffered from gastric paralysis syndrome. Tumor recurrence was not observed in any patient during the follow-up period., Conclusion: The ODA technique for colon cancer cases undergoing TLC appears to be safe and feasible, although our current results need to be verified in further studies., Competing Interests: Conflict-of-interest statement: The authors report no relevant conflicts of interest.

Background: Despite the growing acceptance of laparoscopic colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. Recently, natural orifice specimen extraction (NOSE) and intracorporeal anastomosis have been proposed to minimize abdominal wall trauma and improve the quality of laparoscopic colon resections Objective: To evaluate the feasibility and safety of a new approach combining intracorporeal delta-shaped anastomosis and transvaginal specimen extraction for totally laparoscopic sigmoid colectomy., Materials and Methods: Mobilization of bowel and dissection of lymph nodes were performed laparoscopically. After both proximal and distal incisal edges about 10.0 cm distance from sigmoid neoplasm were transected with an Endoscopic Linear Cutter-Straight, a small incision about 1.0 cm was created on the each colon wall of the contralateral side of the mesentery. Then anvils of an Endoscopic Linear Cutter-Straight were inserted into each colon through the small incisions, and incision and anastomosis between the walls of each colon were performed with a linear stapler. A V-shaped anastomosis was made on the wall and the remnant openings was reclosed with the Endoscopic Linear Cutter-Straight. The culdotomy was enlarged with laparoscopic ultrasound dissector. Transvaginal extraction of specimens was accomplished through a wound protector., Results: Surgery was performed for 11 patients with sigmoid cancer. No intraoperative complications or conversions occurred. The mean operating time was 132 min. All the patients were treated laparoscopically without any postoperative complications., Conclusions: The procedures of intracorporeal delta-shaped anastomosis and transvaginal specimen extraction are safe and oncologically acceptable for selected colon cancer cases.