Lacy Antonio M, García-Valdecasas Juan C, Delgado Salvadora, Castells Antoni, Taurá Pilar, Piqué Josep M, Visa Josep
Department of Surgery, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, 08036 Barcelona, Spain.
Lancet. 2002 Jun 29;359(9325):2224-9. doi: 10.1016/S0140-6736(02)09290-5.
Although early reports on laparoscopy-assisted colectomy (LAC) in patients with colon cancer suggested that it reduces perioperative morbidity, its influence on long-term results is unknown. Our study aimed to compare efficacy of LAC and open colectomy (OC) for treatment of non-metastatic colon cancer in terms of tumour recurrence and survival.
From November, 1993, to July, 1998, all patients with adenocarcinoma of the colon were assessed for entry in this randomised trial. Adjuvant therapy and postoperative follow-up were the same in both groups. The main endpoint was cancer-related survival. Data were analysed according to the intention-to-treat principle.
219 patients took part in the study (111 LAC group, 108 OC group). Patients in the LAC group recovered faster than those in the OC group, with shorter peristalsis-detection (p=0.001) and oral-intake times (p=0.001), and shorter hospital stays (p=0.005). Morbidity was lower in the LAC group (p=0.001), although LAC did not influence perioperative mortality. Probability of cancer-related survival was higher in the LAC group (p=0.02). The Cox model showed that LAC was independently associated with reduced risk of tumour relapse (hazard ratio 0.39, 95% CI 0.19-0.82), death from any cause (0.48, 0.23-1.01), and death from a cancer-related cause (0.38, 0.16-0.91) compared with OC. This superiority of LAC was due to differences in patients with stage III tumours (p=0.04, p=0.02, and p=0.006, respectively).
LAC is more effective than OC for treatment of colon cancer in terms of morbidity, hospital stay, tumour recurrence, and cancer-related survival.
尽管早期关于腹腔镜辅助结肠切除术（LAC）治疗结肠癌患者的报告表明，该手术可降低围手术期发病率，但其对长期疗效的影响尚不清楚。我们的研究旨在比较LAC和开放结肠切除术（OC）在治疗非转移性结肠癌方面对肿瘤复发和生存的疗效。
从1993年11月至1998年7月，对所有结肠癌腺癌患者进行评估，以纳入该随机试验。两组的辅助治疗和术后随访相同。主要终点是癌症相关生存率。数据根据意向性分析原则进行分析。
219名患者参与了研究（LAC组111例，OC组108例）。LAC组患者恢复得比OC组更快，肠鸣音恢复时间（p = 0.001）和经口进食时间（p = 0.001）更短，住院时间更短（p = 0.005）。LAC组的发病率更低（p = 0.001），尽管LAC对围手术期死亡率没有影响。LAC组的癌症相关生存率更高（p = 0.02）。Cox模型显示，与OC相比，LAC与降低肿瘤复发风险（风险比0.39，95%可信区间0.19 - 0.82）、任何原因导致的死亡（0.48，0.23 - 1.01）以及癌症相关原因导致的死亡（0.38，0.16 - 0.91）独立相关。LAC的这种优势归因于III期肿瘤患者的差异（分别为p = 0.04、p = 0.02和p = 0.006）。
在发病率、住院时间、肿瘤复发和癌症相关生存方面，LAC治疗结肠癌比OC更有效。
