Poulin E C, Schlachta C M, Grégoire R, Seshadri P, Cadeddu M O, Mamazza J
Centre for Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Ontario, Canada M5B1W8.
Surg Endosc. 2002 Jun;16(6):989-95. doi: 10.1007/s004640080182. Epub 2002 Feb 28.
Laparoscopic resection for rectal cancer is controversial. Actuarial survival and local recurrence rates have not been determined.
A prospective database containing 80 consecutive unselected laparoscopic resections of rectal cancers performed between November 1991 and 1999 was reviewed. Local recurrence was defined as any detectable local disease at follow-up assessment occurring either alone or in conjunction with generalized recurrence. The tumor node metastases (TNM) classification for colorectal cancers and the Kaplan-Meier method were used to determine staging and survival curves. The mesorectal excision technique was used during surgery.
The median follow-up period was 31 months for patients with stages I, II, and III cancer, and 15.5 months for patients with stage IV cancer. The overall 5-year survival rate was 65.1% for all cancer stages and 72.1% for stages I, II, and III cancer. No trocar-site recurrence was observed. The overall local recurrence rate was 3.75% (3/80) for all cancer stages, and 4.3% (3/70) for stages I, II, and III cancer.
The survival and local recurrence rates for patients with rectal cancer treated by laparoscopic mesorectal excision do not differ negatively from those in the literature for open mesorectal excision. Further validation is needed.
直肠癌的腹腔镜切除术存在争议。精算生存率和局部复发率尚未确定。
回顾了一个前瞻性数据库，该数据库包含1991年11月至1999年期间连续进行的80例未经选择的直肠癌腹腔镜切除术。局部复发定义为随访评估中任何可检测到的局部疾病，可单独出现或与全身复发同时出现。采用结直肠癌的肿瘤淋巴结转移（TNM）分类和Kaplan-Meier方法来确定分期和生存曲线。手术期间采用直肠系膜切除技术。
I、II和III期癌症患者的中位随访期为31个月，IV期癌症患者为15.5个月。所有癌症分期的总体5年生存率为65.1%，I、II和III期癌症为72.1%。未观察到穿刺部位复发。所有癌症分期的总体局部复发率为3.75%（3/80），I、II和III期癌症为4.3%（3/70）。
腹腔镜直肠系膜切除术治疗直肠癌患者的生存率和局部复发率与文献中开放性直肠系膜切除术相比，并无负面影响。需要进一步验证。
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