Jayne David G, Guillou Pierre J, Thorpe Helen, Quirke Philip, Copeland Joanne, Smith Adrian M H, Heath Richard M, Brown Julia M
Academic Unit of Surgery, St James's University Hospital, Leeds, United Kingdom.
J Clin Oncol. 2007 Jul 20;25(21):3061-8. doi: 10.1200/JCO.2006.09.7758.
The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results from randomized trials have indicated that laparoscopic surgery for colon cancer is as effective as open surgery in the short term. Few data are available on rectal cancer, and long-term data on survival and recurrence are now required.
The United Kingdom Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (UK MRC CLASICC; clinical trials number ISRCTN 74883561) trial study comparing conventional versus laparoscopic-assisted surgery in patients with cancer of the colon and rectum. The randomization ratio was 2:1 in favor of laparoscopic surgery. Long-term outcomes (3-year overall survival [OS], disease-free survival [DFS], local recurrence, and quality of life [QoL]) have now been determined on an intention-to-treat basis.
Seven hundred ninety-four patients were recruited (526 laparoscopic and 268 open). Overall, there were no differences in the long-term outcomes. The differences in survival rates were OS of 1.8% (95% CI, -5.2% to 8.8%; P = .55), DFS of -1.4% (95% CI, -9.5% to 6.7%; P = .70), local recurrence of -0.8% (95% CI, -5.7% to 4.2%; P = .76), and QoL (P > .01 for all scales). Higher positivity of the circumferential resection margin was reported after laparoscopic anterior resection (AR), but it did not translate into an increased incidence of local recurrence.
Successful laparoscopic-assisted surgery for colon cancer is as effective as open surgery in terms of oncological outcomes and preservation of QoL. Long-term outcomes for patients with rectal cancer were similar in those undergoing abdominoperineal resection and AR, and support the continued use of laparoscopic surgery in these patients.
本研究旨在报告在英国医学研究委员会（MRC）结肠癌腹腔镜辅助手术与传统开放手术比较（CLASICC）试验背景下，腹腔镜辅助手术与传统开放手术相比的长期结果。随机试验结果表明，结肠癌腹腔镜手术在短期内与开放手术效果相同。直肠癌方面的数据较少，目前需要生存和复发的长期数据。
英国医学研究委员会开展的结肠癌传统手术与腹腔镜辅助手术比较（UK MRC CLASICC；临床试验编号ISRCTN 74883561）试验，比较结肠癌和直肠癌患者的传统手术与腹腔镜辅助手术。随机化比例为2:1，倾向于腹腔镜手术。现已根据意向性治疗原则确定了长期结果（3年总生存率[OS]、无病生存率[DFS]、局部复发率和生活质量[QoL]）。
共招募794例患者（526例腹腔镜手术，268例开放手术）。总体而言，长期结果无差异。生存率差异为：OS为1.8%（95%CI，-5.2%至8.8%；P = 0.55），DFS为-1.4%（95%CI，-9.5%至6.7%；P = 0.70）；局部复发率为-0.8%（95%CI，-5.7%至4.2%；P = 0.76），生活质量（所有量表P>0.01）。腹腔镜前切除术（AR）后环周切缘阳性率较高，但这并未转化为局部复发率的增加。
就肿瘤学结果和生活质量的保留而言，成功的结肠癌腹腔镜辅助手术与开放手术效果相同。接受腹会阴联合切除术和AR的直肠癌患者的长期结果相似，并支持在这些患者中继续使用腹腔镜手术。
