Staudacher Carlo, Vignali Andrea, Saverio Di Palo, Elena Orsenigo, Andrea Tamburini
Department of Surgery, San Raffaele University, Via Olgettina 60, Milan, Italy.
Dis Colon Rectum. 2007 Sep;50(9):1324-31. doi: 10.1007/s10350-007-0289-3.
This study was designed to compare laparoscopic vs. open total mesorectal excision for cancer of the rectum on perioperative outcome and quality of life.
A total of 187 consecutive unselected patients with rectal cancer who underwent total mesorectal excision during a seven-year period were prospectively evaluated. Patients were monitored 30 days for postoperative complications. Quality of life was evaluated before and at one year after surgery.
A total of 108 patients underwent laparoscopic total mesorectal excision, whereas 79 underwent open. Conversion rate was 12 percent. In the laparoscopic group, operating time was 33 minutes longer (P = 0.03) and intraoperative blood loss was lower (P = 0.001). Tumor stage and the number of lymph nodes that were intraoperatively collected were similar in the two groups. The overall morbidity rate was 29.6 percent in the laparoscopic and 27.8 percent in the open (P = 0.78) group. No patient died during the postoperative period. Anastomotic leak rate was similar in the two groups (14.8 percent in laparoscopic vs. 12.6 percent in open; P = 0.88). Patients in the laparoscopic group recovered earlier bowel function (P = 0.01) and experienced a shorter length of stay (P = 0.003). At one-year follow-up, overall quality of life was similar in the two groups. In the laparoscopic group, social functioning item was significantly better (P = 0.05) and trend to a better physical status was observed (P = 0.07).
Laparoscopic total mesorectal excision is safe and feasible, does not jeopardize the complication rate, and has the benefits of much less blood during the operation and shorter hospitalization.
本研究旨在比较腹腔镜与开放全直肠系膜切除术治疗直肠癌的围手术期结局和生活质量。
前瞻性评估了在7年期间连续接受全直肠系膜切除术的187例未经选择的直肠癌患者。对患者进行30天的术后并发症监测。在手术前和术后1年评估生活质量。
共有108例患者接受了腹腔镜全直肠系膜切除术，而79例接受了开放手术。中转率为12%。在腹腔镜组中，手术时间长33分钟（P = 0.03），术中失血量少（P = 0.001）。两组的肿瘤分期和术中采集的淋巴结数量相似。腹腔镜组的总体发病率为29.6%，开放组为27.8%（P = 0.78）。术后期间无患者死亡。两组的吻合口漏率相似（腹腔镜组为14.8%，开放组为12.6%；P = 0.88）。腹腔镜组患者的肠功能恢复较早（P = 0.01），住院时间较短（P = 0.003）。在1年随访时，两组的总体生活质量相似。在腹腔镜组中，社会功能项目明显更好（P = 0.05），并且观察到身体状况有改善的趋势（P = 0.07）。
腹腔镜全直肠系膜切除术安全可行，不增加并发症发生率，且具有术中出血少、住院时间短的优点。
