Anthuber Matthias, Fuerst Alois, Elser Florian, Berger Rita, Jauch Karl-Walter
Department of Surgery, University Hospital Regensburg, Germany.
Dis Colon Rectum. 2003 Aug;46(8):1047-53. doi: 10.1007/s10350-004-7279-5.
This study was conducted to investigate the feasibility of laparoscopic resection of rectal cancer and to compare early outcome data with the results of the conventional technique.
From January 1996 to March 2002, 435 patients with primary rectal cancer were operated on at our institution. Low-risk, small rectal tumors treatable by local excision, rectal cancer recurrences, and emergency cases were excluded from the analysis. Three hundred thirty-four patients were operated on by the conventional open approach. One hundred one selected patients underwent surgery by the laparoscopic technique.
Because of the selection process, significantly more patients with early tumor stages were operated on by laparoscopy. There were no differences in mean operation time, morbidity, mortality, or the anastomotic leakage rate; however, the need for intraoperative transfusion, mean stay in the intensive care unit, and length of hospital stay were reduced significantly.
In terms of the intraoperative and early postoperative course, the laparoscopic resection of rectal cancer in a selected cohort of patients compares favorably with the open technique. Because follow-up time is limited to date, only very preliminary information can be given on tumor-related outcome data. However, these preliminary data appear to suggest that rectal cancer resection can be performed by laparoscopy in accordance with established principles of cancer therapy and that port-site metastases are not a relevant clinical problem. Prospective, randomized trials are required to determine whether the laparoscopic approach will play a significant role in the treatment of rectal cancer in the future.
本研究旨在探讨腹腔镜直肠癌切除术的可行性，并将早期结果数据与传统技术的结果进行比较。
1996年1月至2002年3月，我院对435例原发性直肠癌患者进行了手术。分析排除了可通过局部切除治疗的低风险小直肠肿瘤、直肠癌复发患者及急诊病例。334例患者采用传统开放手术方法进行手术。101例选定患者采用腹腔镜技术进行手术。
由于选择过程，腹腔镜手术治疗的早期肿瘤阶段患者明显更多。平均手术时间、发病率、死亡率或吻合口漏率无差异；然而，术中输血需求、在重症监护病房的平均停留时间和住院时间均显著减少。
就术中和术后早期过程而言，在选定的患者队列中，腹腔镜直肠癌切除术与开放技术相比具有优势。由于目前随访时间有限，关于肿瘤相关结果数据只能提供非常初步的信息。然而，这些初步数据似乎表明，腹腔镜直肠癌切除术可根据既定的癌症治疗原则进行，且端口部位转移不是一个相关的临床问题。需要进行前瞻性随机试验来确定腹腔镜手术方法未来是否会在直肠癌治疗中发挥重要作用。
