Bemelman W A, Gouma D J
Academisch Medisch Centrum, Universiteit van Amsterdam, afd Chirurgie, Amsterdam.
Ned Tijdschr Geneeskd. 2005 Sep 24;149(39):2148-52.
Two randomised controlled studies comparing laparoscopic-assisted and open surgery for colorectal cancer (the CLASICC and COLOR trials) have been published recently. There is now sufficient evidence that laparoscopic-assisted surgery is as effective as open surgery for cancer of the colon. There is no difference in short-term results (hospital mortality and complications) or 3-year survival rates. The substantial learning curve is a potential drawback for rapid implementation in daily practice and the procedure is associated with extra costs. The impact of the introduction of fast-track surgery has to be considered as another important way to reduce hospital stay. Wide application of laparoscopic-assisted resection of rectal cancer is not justified yet due to impaired short-term outcomes, such as increased circumferential resection margins and urogenital complications.
最近发表了两项比较腹腔镜辅助手术和开放性手术治疗结直肠癌的随机对照研究(CLASICC和COLOR试验)。现在有充分证据表明,腹腔镜辅助手术治疗结肠癌与开放性手术同样有效。短期结果(医院死亡率和并发症)或3年生存率没有差异。显著的学习曲线是在日常实践中快速实施的一个潜在缺点,并且该手术会产生额外费用。必须将引入快速康复外科的影响视为缩短住院时间的另一种重要方法。由于短期结果受损,如环周切缘增加和泌尿生殖系统并发症,腹腔镜辅助直肠癌切除术的广泛应用尚不具备合理性。