Law Wai Lun, Lee Yee Man, Choi Hok Kwok, Seto Chi Leung, Ho Judy W C
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong.
Dis Colon Rectum. 2006 Aug;49(8):1108-15. doi: 10.1007/s10350-006-0551-0.
This study was designed to compare the outcomes of laparoscopic anterior resection with open operation for mid and upper rectal cancer.
A total of 265 patients who underwent elective laparoscopic or open anterior resection for cancer of the mid and upper rectum from June 2000 to December 2004 were included. Data about the patients' demographics, operative details, postoperative outcome, and disease status were collected prospectively. Comparison of the outcome between laparoscopic and open resection was performed.
The median age of the 265 patients was 69 (range, 27-91) years, and laparoscopic anterior resection was performed in 98 patients (37 percent). There was no difference in the age, gender, comorbidities, and level of tumor between the two groups. The operating time was longer in the laparoscopic group (200 vs. 127 minutes; P < 0.01), but the blood loss was less (200 vs. 250 ml; P = 0.027). The overall operative mortality was 1.8 percent, and the complication rate was 27.9 percent. Significantly more patients with early diseases (Stage I and Stage II) were operated with laparoscopic approach. There was no difference in the mortality or morbidity between the two groups. Anastomotic leakage occurred in five patients with open resection and one with laparoscopic resection (P = 0.418). Patients with laparoscopic resection had an earlier return of bowel function and earlier resumption of diet as well as a shorter median hospital stay (7 vs. 8 days; P < 0.001). With the median follow-up of the surviving patients for 21.2 months, the three-year local recurrence rates for those with open and laparoscopic resection were 4.9 and 3.3 percent, respectively (P = 0.513). In patients with Stage I and Stage II disease, the three-year cancer-specific survivals for open and laparoscopic resection were 89.8 and 88.6 percent, respectively (P = 0.882), whereas those of patients with Stage III disease were 65.6 and 55.5 percent, respectively (P = 0.911).
Laparoscopic anterior resection for mid and proximal rectal cancer is a safe option with short-term advantages compared with open operation. The oncologic outcomes of patients who underwent laparoscopic anterior resection were not compromised, with similar local recurrence rate and the cancer-specific survival rate as patients who underwent open resection.
本研究旨在比较腹腔镜前切除术与开放手术治疗中高位直肠癌的疗效。
纳入2000年6月至2004年12月期间接受择期腹腔镜或开放前切除术治疗中高位直肠癌的265例患者。前瞻性收集患者的人口统计学数据、手术细节、术后结局和疾病状态。对腹腔镜切除术和开放切除术的疗效进行比较。
265例患者的中位年龄为69岁（范围27 - 91岁），其中98例（37%）接受了腹腔镜前切除术。两组患者在年龄、性别、合并症和肿瘤分期方面无差异。腹腔镜组手术时间较长（200分钟对127分钟；P < 0.01），但失血量较少（200毫升对250毫升；P = 0.027）。总体手术死亡率为1.8%，并发症发生率为27.9%。采用腹腔镜手术方式治疗的早期疾病（I期和II期）患者明显更多。两组在死亡率或发病率方面无差异。开放切除组有5例患者发生吻合口漏，腹腔镜切除组有1例（P = 0.418）。接受腹腔镜切除术的患者肠功能恢复更早、饮食恢复更早，中位住院时间更短（7天对8天；P < 0.001）。存活患者的中位随访时间为21.2个月，开放切除组和腹腔镜切除组的三年局部复发率分别为4.9%和3.3%（P = 0.513）。在I期和II期疾病患者中，开放切除组和腹腔镜切除组的三年癌症特异性生存率分别为89.8%和88.6%（P = 0.882），而III期疾病患者的三年癌症特异性生存率分别为65.6%和55.5%（P = 0.911）。
与开放手术相比，腹腔镜前切除术治疗中高位直肠癌是一种安全的选择，具有短期优势。接受腹腔镜前切除术患者的肿瘤学结局未受影响，局部复发率和癌症特异性生存率与接受开放切除术的患者相似。
