Zmora O, Gervaz P, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, Fort Lauderdale, FL 33309, USA.
Surg Endosc. 2001 Aug;15(8):788-93. doi: 10.1007/s004640080151. Epub 2001 Jun 12.
Laparoscopic colorectal surgery has been associated with less postoperative pain, an early return of bowel function, a shorter period of hospitalization and disability, and better cosmetic results. However, the application of laparoscopic techniques to the curative resection of colorectal cancer is still controversial, owing to reports of cancer recurrence at the port site wounds. The accumulation of numerous such reports in a relatively short period raised concern that there might be an extraordinary high rate of port site metastases after laparoscopic colorectal surgery. This concern has led to intense clinical and basic research aimed at determining the incidence and causes of wound recurrence and developing preventative measures to address this problem. Despite these efforts, it is still not clear whether port site metastasis is really an inherent drawback to laparoscopic cancer surgery.
In this review of the literature on port site metastasis, we gathered data from clinical series of laparoscopic surgery for colorectal cancer. We eliminated series of <50 patients, since they may be flawed by the learning curve required for this technically demanding procedure.
The rate of port site recurrences in the 1737 patients who participated in these series was 1%. Although the methods and criteria for patient selection in these studies varied, this figure appears to be comparable to the incidence reported for other malignancies and for laparotomies performed to treat colorectal cancer.
This review suggests that wound recurrence may actually be the result of an unfortunate learning curve, rather than an inherent concern. However, we must await the final results of large randomized studies before drawing any definitive conclusions.
腹腔镜结直肠手术与术后疼痛减轻、肠功能早期恢复、住院和残疾时间缩短以及美容效果更好相关。然而，由于有报道称端口部位伤口出现癌症复发，腹腔镜技术在结直肠癌根治性切除中的应用仍存在争议。在相对较短的时间内积累了大量此类报道，引发了人们对腹腔镜结直肠手术后端口部位转移率可能异常高的担忧。这种担忧促使开展了深入的临床和基础研究，旨在确定伤口复发的发生率和原因，并制定预防措施来解决这一问题。尽管做出了这些努力，但端口部位转移是否真的是腹腔镜癌症手术的固有缺陷仍不明确。
在本次关于端口部位转移的文献综述中，我们收集了腹腔镜结直肠癌手术临床系列的数据。我们排除了患者数量少于50例的系列，因为对于这种技术要求较高的手术，这些系列可能因学习曲线而存在缺陷。
参与这些系列的1737例患者中，端口部位复发率为1%。尽管这些研究中患者选择的方法和标准各不相同，但这个数字似乎与其他恶性肿瘤以及结直肠癌开腹手术报道的发生率相当。
本次综述表明，伤口复发可能实际上是不幸的学习曲线的结果，而非固有问题。然而，在得出任何明确结论之前，我们必须等待大型随机研究的最终结果。
