Silecchia G, Perrotta N, Giraudo G, Salval M, Parini U, Feliciotti F, Lezoche E, Morino M, Melotti G, Carlini M, Rosato P, Basso N
Dipartimento di Chirurgia Paride Stefanini, Università La Sapienza Roma, Italy.
Dis Colon Rectum. 2002 Sep;45(9):1172-7; discussion 1177. doi: 10.1007/s10350-004-6386-7.
The purpose of the present study was to evaluate prospectively the abdominal wall recurrence rate after laparoscopic resection for colorectal cancer, to analyze the impact of the learning curve on abdominal wall recurrence, and to assess the outcome of those patients.
The Italian Registry of Laparoscopic Colorectal Surgery database was analyzed to obtain data on cancer patients with abdominal wall recurrence, concomitant local or distant metastases, and interval between initial surgery and diagnosis of trocar site or minilaparotomy recurrences. The records of the initial procedures and the technique of specimen removal were reviewed.
From January 1992 to July 2000, 2,583 patients (1,753 cases of carcinomas and 830 cases of benign diseases) were recorded. The malignant lesions were located on the right colon in 19 percent, the left colon in 48.8 percent, and rectum in 32.2 percent. Sixteen patients with histologic evidence of colorectal adenocarcinoma recurrences at the abdominal wall were observed (0.9 percent). Ten patients presented an advanced stage (III for 7 patients and IV for 3 patients). Eleven cases occurred during the learning curve period (the first 50 consecutive cases). The median survival time after abdominal wall recurrence diagnosis was 16 (range, 12-60) months. By July 2000 only two patients were alive.
The results of the Italian prospective Registry of Laparoscopic Colorectal Surgery confirm that the incidence of abdominal wall recurrences is similar to that reported in open studies (<1 percent). Most abdominal wall recurrences occurred in the learning curve period, suggesting that surgical experience may play a role in the development of this outcome. The prognosis of these patients is very poor.
本研究旨在前瞻性评估腹腔镜结直肠癌切除术后腹壁复发率,分析学习曲线对腹壁复发的影响,并评估这些患者的预后情况。
对意大利腹腔镜结直肠癌手术注册数据库进行分析,以获取有关腹壁复发、伴有局部或远处转移以及初次手术与套管针穿刺部位或小切口剖腹手术复发诊断之间间隔时间的癌症患者数据。回顾初次手术记录和标本切除技术。
1992年1月至2000年7月,记录了2583例患者(1753例癌症和830例良性疾病)。恶性病变位于右半结肠的占19%,左半结肠的占48.8%,直肠的占32.2%。观察到16例有组织学证据表明结直肠癌腹壁复发的患者(0.9%)。10例患者处于晚期(7例为III期,3例为IV期)。11例发生在学习曲线阶段(连续的前50例)。腹壁复发诊断后的中位生存时间为16个月(范围12 - 60个月)。到2000年7月,仅有2例患者存活。
意大利腹腔镜结直肠癌手术前瞻性注册研究结果证实,腹壁复发的发生率与开放手术研究报告的相似(<1%)。大多数腹壁复发发生在学习曲线阶段,表明手术经验可能在这一结果的发生中起作用。这些患者的预后非常差。