Kim Seon-Hahn, Park In-Ja, Joh Yong-Geul, Hahn Koo-Yong
Colorectal Division, Department of Surgery, Digestive Disease Center, DongGuk University Hospital, Goyang.
Surg Endosc. 2006 Aug;20(8):1197-202. doi: 10.1007/s00464-005-0599-2. Epub 2006 Jul 24.
This study aimed to prospectively evaluate operative safety and mid-term oncologic outcomes of laparoscopic rectal cancer resection performed by a single surgeon.
Three hundreds twelve patients (male, 181) were enrolled in this analysis. 257 patients (82.4%) had tumors located below 12 cm from the anal verge. Distribution of TNM stages was 0:I:II:III:IV = 4.2%:17.9%:32.4%:37.2%:8.3%. 225 patients (71.1%) had T3/T4 lesions. Pre- and post-operative radiation was given in 6 and 20 patients, respectively.
Sphincter-preserving operation was performed in 85.9%. Mean operating time was 212 minutes. Conversion rate was 2.6%. Overall morbidity rate was 21.1%. Anastomotic leakage occurred in 6.4%. Operative mortality rate was 0.3%. Mean number of harvested nodes was 23. Mean distal tumor-free margin was 2.8 cm. The circumferential resection margin was positive in 13 patients (4.2%). With a mean follow-up of 30 months in the stage I-III patients, the local recurrence rate was 2.9%. Systemic recurrence occurred in 11.7%. No port-site recurrence was observed.
Laparoscopic resection of rectal cancer provided safe operative parameters and adequate mid-term oncologic outcomes. When considering a high volume of advanced and low-lying cancers but rather narrow indication to radiotherapy, the 2.9% local recurrence rate seems promising data. Long-term follow-up is mandatory to draw conclusion.
本研究旨在前瞻性评估由单一外科医生实施的腹腔镜直肠癌切除术的手术安全性和中期肿瘤学结局。
312例患者（男性181例）纳入本分析。257例患者（82.4%）肿瘤位于距肛缘12 cm以下。TNM分期分布为0期：I期：II期：III期：IV期 = 4.2%：17.9%：32.4%：37.2%：8.3%。225例患者（71.1%）有T3/T4病变。分别有6例和20例患者术前行放疗和术后行放疗。
保肛手术率为85.9%。平均手术时间为212分钟。中转开腹率为2.6%。总体并发症发生率为21.1%。吻合口漏发生率为6.4%。手术死亡率为0.3%。平均清扫淋巴结数为23枚。平均远端切缘距肿瘤为2.8 cm。13例患者（4.2%）环周切缘阳性。I - III期患者平均随访30个月，局部复发率为2.9%。远处复发率为11.7%。未观察到切口种植转移。
腹腔镜直肠癌切除术提供了安全的手术参数和良好的中期肿瘤学结局。考虑到大量晚期和低位癌患者且放疗适应证较窄，2.9%的局部复发率似乎是有前景的数据。需要长期随访才能得出结论。
