Evaluating the results of radical laparoscopic surgery treatment of rectal cance

rt failure, hypertension, stroke, chronic asthma, bronchial asthma, uncontrolled or life-threatening diabetes. - Anal cancer, prostate colon cancer. - Temporary treatment of rectal cancer. 2.2. RESEARCH METHODS 2.2.1. Research design - Study design: prospective descriptive study, combined with longitudinal comparison to monitor and evaluate results after laparoscopic surgery. 2.2.2. Research variables All information was collected by questionnaires through sample cases, direct patient visits, multithreaded computer tomography, tumor invasion assessment, GPB comparison and evaluation of surgical results. including: 2.2.2.1. General characteristics of studied patients - Age, gender, occupation. - Serum CEA test - Colonoscopy by soft tube 2.2.2.2. Multithreaded computer tomography in rectal cancer Using the 64-reading computerized tomography machine Dawy GE ligh speed including 2CPU and 4 screens of US origin. Multithreaded computer tomography of pelvic region and intravenous contrast injection to assess: - Evaluating tumor characteristics, including: tumor size, tumor density according to the perimeter of the rectum (accounting for 1/2, 2/4, 3/4 and the circumference). Level of invasive tumor, assessment of degree of pelvic and pelvic lymph node metastasis, evaluation of distant metastasis, evaluation of stage of disease, assessment of invasive level of rectal cancer on computerized tomography multi-sequence according to the division of Thoeni in 2 stages: localized tumor in rectum wall, invasive tumor. 2.2.2.3. Anatomy results after surgery * Macrobody: Postoperative tumors were assessed for macrobody lesions in terms of location, size, shape, and properties; Cut a slice at the 2cm invasive position to assess the degree of rectal wall invasion. Lymph nodes are analyzed for evaluation: location, size, number of lymph nodes. * Microbody: Tumors and lymphomas are read and analyzed by GPB specialists. 2.2.2.4. Assess the stage of rectal cancer * Classify TNM according to UICC 2010 2.2.2.5. Results in radical laparoscopic surgery of rectal cancer: Surgical characteristics, operation time: in minutes. Accident during surgery: Bleeding, vaginal perforation, ureteral damage, bladder. posterior urethral lesion, blood transfusion during surgery. 2.2.2.6. Early results after laparoscopic radical surgery for rectal cancer Death after surgery. Complications after surgery: intra-abdominal bleeding; peritonitis; Postoperative urinary retention; infection of the abdominal incision; infection of the episiotomy incision; artificial anal prolapse, artificial anal lag; splitting of abdominal wall; early bowel obstruction after surgery ... Time to return to peristalsis, bladder sonde withdrawal time after surgery, hospitalization time after surgery: in days. 2.2.2.7. Results after radical surgery rectal cancer Periodic examination and monitoring, record the following information: - Postoperative sequelae, the rate of local recurrence and metastases. - Evaluate sexual function after surgery - A number of factors affecting total and non-surgical survival time: age, gender, CEA before surgery, tumor size, degree of differentiation of tumor cells, degree of invasion, metastasis lymphadenopathy and the stage of the disease ... 2.2.3. Endoscopic surgical procedure * Equipment: Complete for a laparoscopic surgery * Preparation before surgery: - Preparation of colon before surgery - Anesthesia: intubation. * Patient posture and position of surgeon * The surgical stages 2.2.4. Data processing - Data were managed and analyzed by SPSS 22.0 software. The difference was statistically significant between groups when p <0.05. CHAPTER 3 RESEARCH RESULTS 3.1. SOME GENERAL CHARACTERISTICS OF RECTAL CANCER PATIENTS 3.1.1. Age and gender Table 3.1. Distribution by age and gender Age group Male Female Total Number of patients Rate (%) Number of patients Rate (%) Number of patients Rate (%) ≤40 6 5.1 3 2.5 9 7.6 41- 50 4 3.4 8 6.8 12 10.2 51- 60 24 20.3 15 12.7 39 33.1 61- 70 17 14.4 16 13.6 33 28.0 >70 years old 13 11.0 12 10.2 25 21.2 Total 64 54.2 54 45.8 118 100.0 ` ± SD 59.8 ± 12.2 60.2 ± 12.8 60.0 ± 12.5 (26 - 86) p>0.05 - The average age of male patients (59.8 ± 12.2 years) was not different from female patients (60.2 ± 12.8 years), p> 0.05. - Male account for 54.2%, female is 45.8%. The male to female ratio is 1.19. 3.1.4. Subclinical characteristics Table 3.3 Cancer fetal antigen characteristics (CEA) CEA concentration (ng/ml) Number of patients (n = 118) Rate (%) Normal 89 75.4 High 29 24.6 (± SD) 7.8 ± 30.8 Median (smallest - largest) 3.2 (0 - 330) - High serum CEA concentration in rectal cancer patients had 29/118 patients, accounting for 24.6%. - Average concentration of 7.8 ± 30.8 ng / ml. 3.1.5. Histological characteristics of rectal cancer Table 3.6. Histopathological characteristics of rectal cancer Histopathological characteristics Number of patients Rate (%) Macrobody (n= 118) Ulcers 13 11.0 Swells 42 35.6 Ulcerative swelling 61 51.7 Infiltrates 2 1.7 Microbody (n= 118) Adenocarcinoma 118 100 Degree of differentiation (n= 118) High 19 16.1 Moderate 87 73.7 Weak 12 10.2 - Evaluation of macrobody showed that ulcerative body accounted for the highest proportion (51.7%), followed by warts (35.6%) and ulcers (11.0%). There is 1.7% of infiltrates. - Of the 118 patients with rectal carcinoma, the majority had moderate degree of differentiation (73.7%), 16.1% with high grade and 10.2% with poor differentiation. Table 3.7. Features of lymph node metastasis of rectal cancer Đặc điểm di căn hạch Number of patients Rate (%) Location of lymph node metastases (n= 118) Zero 80 67.8 Around the rectum 22 18.6 In front of the overhang 3 2.5 Inferior mesenteric 13 11.0 Number of lymph nodes (n= 118) (stage N) Zero (N0) 80 67.8 1- 3 (N1) 28 23.7 ≥4 (N2) 10 8.5 Assessing lymph node status in surgery saw: - Number of lymph nodes: 67.8% of cases without lymph node metastases (N0); 23.7% of cases metastases from 1 to 3 lymph nodes (N1); only 8.5% of metastases ≥4 lymph nodes (N2). - Locations of lymph node metastasis: lymph nodes around the rectum (18.6%), anterior lymph nodes (2.5%), mesenteric lymph nodes (11.0%). Table 3.8. Stage of rectal cancer disease on anatomical pathology AJCC TNM Dukes Number of patients Rate % Stage 0 TisN0M0 - 3 2.5 Stage I T1N0M0; T2N0M0 A 30 25.4 Stage II IIa T3N0M0 B 44 37.3 IIb T4aN0M0 B 3 2.5 IIc T4bN0M0 B 0 0 Sub-total 47 39.8 Stage III IIIa T1-2N1-2aM0 C 2 1.7 IIIb T3-4aN1M0; T2-3N2aM0; T1-2N2bM0 C 31 26.3 IIIc T4aN2aM0; T3-4N2bM0; T4bN1-2M0 C 5 4.2 Sub-total 38 32.2 Anatomy of postoperative disease in 118 rectal cancer surgery patients found: - According to TNM classification, stage 0 is 2.5%; Phase I is 25.4%; Phase II is 39.8% (IIa: 37.3% and IIb: 2.5%); Stage III is 32.2% (IIIa is 1.7%; IIIb is 26.3%; IIIc is 4.2%). There are no cases of stage IV. - Classified by Duckes: Dukes A period is 25.4%; Dukes B is 39.8% and Dukes C is 32.2%. 3.2. RESULTS OF RECTAL CANCER DIAGNOSIS VIA MULTITHREADED COMPUTER TOMOGRAPHY 3.2.1. Result of diagnosing the degree of invasion through multithreading computer tomography Table 3.10. Assess the extent of invasive rectal cancer through computer tomography Invasive features on computerized tomography Number of patients (n = 118) Rate (%) Thick wall of rectum (mm), (± SD), median (largest - smallest) 2.14 ± 4.27 1.6 (0.1- 45.0) Tumor height (mm), (± SD) median (largest - smallest) 4.72 ± 4.54 4 (0.2 - 47.0) Tumor circumference Difficult to assess 2 1.7 <1/4 9 7.6 1/4 – 1/2 28 23.7 1/2 – 3/4 45 38.1 >3/4 34 28.8 The degree of invasion Tx: Difficult to evaluate 1 0.8 T1: In the wall (<6mm) or in the intestine 5 4.2 T2: Wall thickness> 6mm but has not invaded surrounding tissue 22 18.6 T3: Wall thickening and invading of surrounding tissue 86 72.9 T4: Invading nearby organs 4 3.4 - On computerized tomography, the average thickness of rectal wall is 2.14±4.27mm; The height of the average tumor is 4.72 ± 4.54mm. - The majority of patients have tumor size compared to the rectum from 1/4 to 1/2 (23.7%), 1/2 to 3/4 (38.1%) and> 3/4 of the circumference (28.8%); tumor size is less than 1/4 circumference and difficult to assess, accounting for low percentage (7.6% and 1.7%). - The extent of tumor invasion (T): highest in T3 (72.9%), followed by T2 (18.6%), T1 and T4 accounted for low rate (4.2% and 3.4 %). There is 1 case (0.8%) of T stage not identified. Table 3.11. Compare the degree of invasive cancer of rectum through computerized tomography with pathology Stage T on pathological surgery Stage T on computerized tomography (Number of patients,%) Total Tx T1 T2 T3 T4 Tis 1 100.0% 2 40.0% 0 0 0 3 2.5% T1 0 3 60.0% 1 4.5% 0 0 4 3.4% T2 0 0 18 81.8% 9 10.5% 1 25.0% 28 23.7% T3 0 0 2 9.1% 70 81.4% 1 25.0% 73 61.9% T4 0 0 1 4.5% 7 8.1% 2 50.0% 10 8.5% Tổng số 1 100.0% 5 100.0% 22 100.0% 86 100.0% 4 100.0% 118 100.0% Comparing the invasion of colorectal cancer through multithreaded computer tomography with GPB found the highest proportion of diagnosed matches in the Tx stage (1/1 patient), followed by T2 (81.8 %%), T3 (81.4%), T1 (60.0%) and T4 (50.0%). 3.2.2. Diagnosis of lymph node metastasis through multithreaded computer tomography Table 3.14. Reconstructing lymph node metastases stage of rectal cancer via multithreaded computer tomography with pathology Stage N on pathological surgery Stage N on computerized tomography (Number of patients,%) Total N0 N1 N2 N0 39 95.1% 16 50.0% 25 55.6% 80 67.8% N1 2 4.9% 16 50.0% 10 22.2% 28 23.7% N2 0 0 10 22.2% 10 8.5% Total 41 100.0% 32 100.0% 45 100.0% 118 100.0% Comparing the lymph node metastatic stage of rectal cancer through multithreaded computer tomography with pathology showed that the incidence of computed tomography was highest at stage N0 (95.1%), followed by N1 ( 50.0%) and N2 (22.2%). 3.2.3. Phase diagnosis results through computerized tomography Table 3.16. Diagnosis of stage of rectal cancer on computerized tomography AJCC TNM Dukes Number of patients (n= 118) Rate (%) Stage 0 TisN0M0 - 1 0.8 Stage I T1N0M0; T2N0M0 A 18 15.3 Stage II IIa T3N0M0 B 21 17.8 IIb T4aN0M0 B 1 0.8 IIc T4bN0M0 B - - Sub-total 22 18.6 Stage III IIIa T1-2N1-2aM0 C 7 5.9 IIIb T3-4aN1M0;T2-3N2aM0;T1-2N2bM0 C 67 56.8 IIIc T4aN2aM0; T3-4N2bM0;T4bN1-2M0 C 3 2.5 Sub-total 77 65.3 On computerized tomography images of 118 rectal cancer patients: - Classification according to TNM: period 0 is 0.8%; Phase I is 15.3%; Phase II is 18.6%; Phase III is 65.3%. There were no cases of distant metastasis (stage IV). - Classified by Duckes: Dukes A period is 15.3%; Dukes B is 18.6% and Dukes C is 65.3%. Table 3.17. Reconstructing rectal cancer stage by multithreaded computer tomography with pathology Stage of rectal cancer on pathological surgery Stage of rectal cancer on computed tomography (Number of patients,%) Total (n = 118) Stage 0 Stage I Stage II Stage III Stage 0 1 100.0% 2 11.1% 0 0 3 2.5% Stage I 0 16 88.9% 1 4.5% 13 16.9% 30 25.4% Stage II 0 0 19 86.4% 28 36.4% 47 39.8% Stage III 0 0 2 9.1% 36 46.8% 38 32.2% Total 1 100.0% 18 100.0% 22 100.0% 77 100.0% 118 100.0% Comparison of diagnosis of stage rectal cancer through multithreaded computer tomography with GPB found the highest proportion of diagnosis matching in stage 0 (1/1 patient), followed by stage I (88.9% ), Phase II (86.4%) and the lowest is Stage III (46.8%). Table 3.18. Diagnostic value for rectal cancer stage according to AJCC of multireaded computed tomography Stage of rectal cancer (AJCC) on computerized tomography Stage of rectal cancer (AJCC) on pathological surgery Stage 0 Stage I Stage II Stage III Sensitivity (%) 33.3 53.3 40.4 94.7 Specificity (%) 100 97.7 95.7 48.7 Positive forecast value (%) 100 88.8 86.3 46.7 Negative forecast value (%) 1.7 14.0 29.1 4.8 Accuracy (%) 98.3 86.4 73.7 63.5 - The sensitivity of diagnosis of rectal cancer stage of multidisciplinary computed tomography ranges from 33.3% to 94.7%. - The specificity for diagnosing the stage of rectal cancer in multi-computed tomography ranges from 48.7% to 100%. - Positive predictive value in rectal cancer stage diagnosis of multi-computed tomography ranged from 46.7% to 100.0%. - Negative predictive value in rectal cancer stage diagnosis of multidisciplinary computed tomography ranged from 1.7% to 29.1%. - The accuracy in diagnosing rectal cancer stage of multithreading computer tomography ranges from 63.5% to 98.3%. 3.3. LAPAROSCOPIC SURGERY METHOD OF RADICAL TREATMENT OF RECTAL CANCER 3.3.2. Surgical time Table 3.22. Time for laparoscopic surgery to treat rectal cancer Surgical time (minutes) Cut the rectum and connect immediately (n= 81) Miles surgery (n= 37) Total (n= 118) Number of patients Rate (%) Number of patients Rate (%) Number of patients Rate (%) <150 20 24.7 5 13.5 25 21.2 ≥150 61 75.3 32 86.5 93 78.8 ± SD 170.0 ± 42.1 174.6 ± 30.0 171.4 ± 38.6 (82- 330) p p>0.05 - The average laparoscopic surgery time is 171.4 ± 38.6 minutes (the shortest: 82 minutes; the longest: 330 minutes). The majority of patients had surgery time ≥150 minutes (78.8%). - The average laparoscopic surgery time in the immediate rectal segmentation group (170.0 ± 42.1 minutes) was not different from the Miles surgery group (174.6 ± 30.0 minutes), p> 0.05 Table 3.26. Time of hospitalization after surgery Time of hospitalization after surgery (day) Cut the rectum and connect immediately (n= 81) Miles surgery (n= 37) Total (n= 118) Number of patients Rate (%) Number of patients Rate (%) Number of patients Rate (%) <7 6 7.4 4 10.8 10 8.5 ≥7 75 92.6 33 89.2 108 91.5 `± SD 8.7 ± 3.9 7.7 ± 2.3 8.4 ± 3.5 (5- 35) p p>0.05 Average hospitalization time after surgery: 8.4 ± 3.5 days (shortest: 5 days and longest: 35 days). Most patients had a hospital stay of ≥7 days after surgery (91.5%). The postoperative hospital stay in the Miles surgical group (7.7 ± 2.3 days) tended to be shorter than the immediate rectal incision (8.7 ± 3.9 days), but the difference No statistical significance (p> 0.05). 3.5. DISTANT RESULTS AFTER RADICAL LAPAROSCOPIC TREATMENT OF RECTAL CANCER 107/118 patients (90.7%) were monitored after surgery with an average time of 29.3 ± 8.3 months (2- 47 months) 3.5.1. Sequelae, recurrence and death after surgery Table 3.28. Recurrence and death rates after surgery in patients with rectal cancer Death, recurrence Number of patients (n= 107) Rate (%) Time (± SD) [median] Death 10 9.3 23.3 ± 11.4 (1- 36) [median: 25.0] Recurrence 16 15.0 26.0 ± 9.8 (7.0- 47.0) [median: 25.5] - The recurrence rate is 15.0%. The average relapse time was 26.0 ± 9.8 months (7- 47 months) [median: 25.5 months]. - The death rate is 9.3%. The average time of death was 23.3 ± 11.4 months (1-36 months) [median: 25.0 months] 3.5.2. Complete survival time and disease-free survival Table 3.29. Complete survival time of rectal cancer patients Complete survival time (month) Number of died patients (n= 10) Rate (%) (±SE) 12 2 98.1 ± 1.3 24 5 94.9 ± 2.2 36 10 83.7 ± 5.5 ±SE (KTC 95%) 43.8 ± 0.9 (KTC 95%: 42.0- 45.7) The overall survival rate of 12, 24 and 36 months was 98.1%; 94.9% and 83.7%. The average overall survival time was 43.8 ± 0.9 months (95% CI: 42.0 - 45.7). Figure 3.1. Complete survival time of rectal cancer patients Table 3.30. Disease-free survival time of rectal cancer patients Disease-free survival time (month) Number of relapsed patients (n = 16) Rate (%) (±SE) 12 2 98.1 ± 1.3 24 6 93.8 ± 2.4 36 15 76.9 ± 6.0 47 16 - ±SE (KTC 95%) 42.5 ± 1.0 (KTC 95%: 40.3- 44.6) The rate of survival without disease 12, 24 and 36 months was 98.1%; 93.8% and 76.9%. The median non-disease survival time was 42.5 ± 1.0 (95% CI: 40.3-44.6) Figure 3.2. Disease-free survival time of rectal cancer patient CHAPTER 4 DISCUSSION 4.1. CHARACTERISTICS OF STUDIED SUBJECTS 4.1.1. Age Rectal cancer is increasing, usually after 40 years of age and increases most in the age group of 50-70 years. Through research, the average age of patients is 60.0 ± 12.5 years old. (26-86 years old). The mean age of male patients (59.8±12.2 years) was not different from female patients (60.2 ±12.8 years), p> 0.05. 4.1.2. Gender The majority of studies show that the proportion of rectal cancer patients is male than female. Male patients have a harder time predicting surgery than female patients due to the narrower pelvic anatomy. The research results show that men account for 54.2%, women are 45.8%. The male to female ratio is 1.19. This is also consistent with some studies on the sex of rectal cancer patients. 4.1.3. Distribution of patients by geography Research shows that patients in rural areas still account for the majority (79.7%), including some remote provinces such as Lai Chau, Cao Bang and Dien Bien. This result is similar to that of Pham Van Binh researched at National Cancer Hospital (2012), 72.59% of rural patients. 4.2. CLINICAL AND SUBCLINICAL CHARACTERISTICS OF RECTAL CANCER 4.2.2. Subclinical characteristics of rectal cancer 4.2.2.1. Cancer fetal antigen characteristics (CEA) Many studies show that CEA levels increase over 60% of patients with colorectal cancer, especially rising 80% to 100% in the advanced stage, especially when there is distant metastases in the liver, lungs ... According to Duong Xuan Loc et al. (2011), the majority of patients with CEA cancer marker increased above 10 ng /ml (72.2%) and CA19.9 increased over 37 ng / ml by 15.6%. . The study showed that the average CEA concentration of rectal cancer patients was 7.8 ± 30.8 ng / ml. High serum CEA levels in rectal cancer patients had 29/118 patients, accounting for 24.6%. This is also consistent with the comment of Trinh Hong Son (2011) 40.7% of patients with high CEA; 88% of CEA cases> 5 ng / ml are stage T3 and T4 cancers. The CEA rate increased among the very differentiated, moderate and inferioriated groups, respectively, by 30.8%; 42.9%; 51.2%, the difference is statistically significant with p <0.05. However, all studies agree that the CEA test is not sensitive enough and specific enough to be used in rectal cancer screening, but that it is most significant in the prognosis for monitoring local recurrence and distant metastases after surgery. 4.2.3. Histological characteristics of rectal cancer Study on tumor characteristics in surgery with moderate differentiation (74.8%), 15.7% in high-grade cases and 9.6% in low-grade cases. According to TNM classification, stage 0 is 2.5%; Phase I is 25.4%; Phase II is 39.8%; Phase III is 32.2%. There are no cases of stage IV. Results of Vo Quoc Hung (2013) showed that: adenocarcinoma: 87.4%; Mucous adenocarcinoma: 6.3%; squamous cell carcinoma: 5.4%; Ring cell adenocarcinoma: 0.9%. Ung Van Viet (2017) studied 227 rectal cancer patients who found that most cases (78.4%) had tumor differentiation as average. There are 3.1% of cases with poor differentiation. 4.3. VALUES OF MULTITHREADED COMPUTER TOMOGRAPHY IN THE DIAGNOSIS OF RECTAL CANCER Multithreaded computer tomography helps to assess the condition of the tumor (location, size, distance from the anus edge, invasion of the superior mesenteric weight, lymph node metastasis ...). In addition, it is also possible to assess the distant metastasis status without the need for additional film. 4.3.1. Multithreaded computer tomography values in the diagnosis of invasive degree Computerized tomography does not have the ability to describe rectal anatomical layers, so the accuracy of computed tomography in assessing tumor invasion with the wall of the rectum varies from 25 % to 80%. Li XT et al. (2016) analyzed 9 studies on computerized tomography in 407 patients with rectal cancer found that sensitivity and specificity in T stage diagnosis were 89% (95% CI: 77% - 95%) and 80% (95% CI: 72% - 86%). Assessing the extent of tumor invasion on computerized tomography according to Thoeni found the most in T3 (72.9%), followed by T2 (18.6%), T1 and T4 accounted for a low rate (4.2) % and 3,4%). There was 1 case (0.8%) without determination of stage T. Evaluation of multithreaded computer tomography in diagnosis of invasive level (T1, T2, T3 and T4) found the sensitivity ranged from 70.0 % to 95.8%. Specificity ranges from 80.0% to 100.0%. Accuracy ranges from 88.1% to 97.4%. The sensitivity, specificity, and accuracy of computed tomography in the diagnosis of rectal cancer invasion in our study are similar to those of other authors. 4.3.2. Multithreaded computer tomography values in the diagnosis of lymph node metastases N-stage assessment described lymph node with diameter> 10 mm is considered abnormal. Computerized tomography cannot distinguish benign or malignant lymph nodes. Moreover, malignant ganglia may be diameter <10 mm. 60% of lymph nodes are detected by computerized tomography. Evaluation of multithreaded computer tomography values in the diagnosis of lymph node metastases of rectal cancer showed that the sensitivity ranged from 48.7% to 100.0%. Specificity ranges from 67.5% to 94.7%. The accuracy ranges from 63.5% to 76.2%. According to Dar R. A study, the sensitivity in diagnosing lymph node metastasis is 77%, specificity 87%, accuracy is 84.1%. 4.3.4. The value of multithreading computer tomography in stage diagnosis The value of multithreaded computer tomography in the diagnosis of rectal cancer stage in our study (sensitivity ranges from 33.3% to 94.7%; specificity ranges from 48.7% to 100% The accuracy ranges from 63.5% to 98.3%). 86%, stage N was 84% and the upper mesenteric metastasis was predicted to be 94.5%. 4.4. RESULTS OF RADICAL SURGICAL TREATMENT OF RECTAL CANCER 4.4.1. Surgical method Research shows that radical laparoscopic surgery for rectal cancer mainly cuts the rectum immediately connected (68.6%), 31.4% of cases for rectal resection and perineal surgery are taken. All sphincter and adipose tissue around the anal canal. Most of them have mouth stitching by machine (72.9%); 16.9% by hand and 10.2% without stitching. The rate of machine-connected mouth stitching in the immediate rectal segment (93.8%) was higher than the hand-jointed group (6.2%), the difference was statistically significant with p <0.001. Truong Vinh Quy (2018) operated on 52 patients with low rectal cancer who had sphincter preservation and saw sphincter cut by 26.9%, pre-cut 32.7%, Pull-through 40.4%. The distance for cutting below the u average 2.1 ± 0.6 cm. The distance of the mouth connecting to the anus edge: cutting the sphincter is 2.03 cm, the front is low as 3.29 cm, the Pull-through is 2.95 cm, different with p = 0.0001. 4.4.2. Surgical time In our study, the average laparoscopic surgery time was 171.4 ± 38.6 minutes (82-330 minutes). The majority of patients had surgery time ≥150 minutes (78.8%). Laparoscopic surgery time in the immediately rectalectomy group (170.0 ± 42.1 minutes) was not different from the Miles surgery group (174.6 ± 30.0 minutes), p> 0.05 Ding Z's study showed that laparoscopic surgery time was 271.2 ± 56.2 and open surgery was 216.0 ± 62.7 with p = 0.036. The authors agree that the time of laparoscopic surgery depends on the means, equipment and experience of the surgeon. The laparoscopic surgery time will be shortened if the surgeons are well trained, have experience in laparoscopic surgery and synchronous equipment.. 4.4.3. Accidents and complications during and after surgery Pham Van Binh (2017) surgery to cut the colorectal and connect the device for 53 patients with rectal cancer 2/3 above found no cases of complications during surgery. Complications after surgery were 11.4%, including oral bleeding (3.8%), bladder dysfunction (3.8%), abscess residue (1.9%). Nguyen Anh Tuan et al (2017) laparoscopic surgery to remove the entire mesenteric mesenteritis with short-term XT days before surgery for 32 patients with middle, lower third, rectal cancer, stage II, III showing the rate open surgery 6.3%, complications 6.3%, complications 31.4%. Of 118 patients with radical laparoscopic surgery treatment of rectal cancer, we did not see any patients with major complications such as death in surgery, major artery and venous injury, bladder damage, small intestine ... There are 10 / 118 patients (8.5%)