Lezoche Emanuele, Feliciotti Francesco, Paganini Alessandro M, Guerrieri Mario, De Sanctis Angelo, Campagnacci Roberto, D'Ambrosio Gianfranco
Department of Surgery Paride Stefanini II, Clinica Chirurgica, University La Sapienza, Viale del Policlinico, 00161 Rome, Italy.
Hepatogastroenterology. 2002 Sep-Oct;49(47):1185-90.
BACKGROUND/AIMS: Laparoscopic rectal resection for malignancy is still debated. Concern has been expressed regarding the lack of significant data from larger patient series with longer periods of follow-up. The aims of this study were to compare long-term outcome with a minimum follow-up of four years in unselected patients undergoing either laparoscopic rectal resection or open rectal resection for cancer.
From May 1992 to August 1997 all electively admitted patients with rectal cancer were included in a prospective non-randomized study. Written information was submitted to each patient and the location in each group (laparoscopic or open) was related to the patient's choice. The inclusion protocol criteria excluded T1 tumors. All 68 T2-T4 patients underwent preoperative radiotherapy (5.040 cGy), completed with chemotherapy in selected cases (patients below 70 years of age). Long-term results were compared between the two groups. Follow-up time of both groups ranged between 48 and 96 months (mean, 49.4 months).
Excluding patients who underwent a palliative resection or conversion to open surgery and deaths not related to cancer, 53 pts (29 laparoscopic rectal resection, 24 open rectal resection) out of 68 are available and are the object of this study. No patient was lost to follow-up. No wound recurrence was observed. The local recurrence rate after laparoscopic rectal resection was 24.1% vs. 25% after open rectal resection (P = 0.799). Distant metastases occurred in 20.7% of patients in the LLR group (laparoscopic rectal resection) vs. 25% in the ORR group (open rectal resection) (P = 0.980). Cumulative survival probability after laparoscopic rectal resection and open rectal resection was 0.690 and 0.625 (P = 0.492), respectively. Cumulative survival probability for Duke's stage A, B and C in the LRR group vs. the ORR group was 1.000 vs. 0.900 (P = 0.585), 0.667 vs. 0.636 (P = 0.496) and 0.429 vs. 0.445 (P = 0.501), respectively. Sixteen laparoscopic rectal resection patients (55.2%) and 12 open rectal resection patients (50%) are presently disease free (P = 0.979).
Long-term results after laparoscopic resection of rectal cancer were comparable to those after conventional resection, with a trend in favor of the laparoscopic approach that does not reach a statistically significant difference, possibly due to the limited size of the sample.
背景/目的：腹腔镜直肠癌切除术仍存在争议。有人担心缺乏来自更大患者系列且随访时间更长的重要数据。本研究的目的是比较接受腹腔镜直肠癌切除术或开放性直肠癌切除术的未选择患者至少随访四年的长期结果。
从1992年5月至1997年8月，所有择期入院的直肠癌患者均纳入一项前瞻性非随机研究。向每位患者提供书面信息，每组（腹腔镜或开放）的选择与患者的选择相关。纳入方案标准排除T1期肿瘤。所有68例T2 - T4期患者均接受术前放疗（5040 cGy），部分病例（70岁以下患者）还进行了化疗。比较两组的长期结果。两组的随访时间在48至96个月之间（平均49.4个月）。
排除接受姑息性切除术或转为开放手术的患者以及与癌症无关的死亡患者后，68例患者中有53例（29例腹腔镜直肠癌切除术，24例开放性直肠癌切除术）可供本研究使用。无患者失访。未观察到伤口复发。腹腔镜直肠癌切除术后局部复发率为24.1%，开放性直肠癌切除术后为25%（P = 0.799）。腹腔镜直肠癌切除术组（LLR组）20.7%的患者发生远处转移，开放性直肠癌切除术组（ORR组）为25%（P = 0.980）。腹腔镜直肠癌切除术和开放性直肠癌切除术后的累积生存概率分别为0.690和0.625（P = 0.492）。LLR组与ORR组中杜克分期A、B和C的累积生存概率分别为1.000对0.900（P = 0.585）、0.667对0.636（P = 0.496）和0.429对0.445（P = 0.501）。16例腹腔镜直肠癌切除术患者（55.2%）和12例开放性直肠癌切除术患者（50%）目前无疾病（P = 0.979）。
腹腔镜直肠癌切除术后的长期结果与传统切除术后的结果相当，腹腔镜手术方法有一定优势，但未达到统计学显著差异，可能是由于样本量有限。
