Ramacciato Giovanni, D'Angelo Francesco, Aurello Paolo, Nigri Giuseppe, Valabrega Stefano, Pezzoli Francesca, Ravaioli Matteo, Cescon Matteo, Cucchetti Alessandro, Lauro Augusto, Del Gaudio Massimo, Ercolani Giorgio
UOC Chirurgia Generale D, Azienda Ospedaliera Sant'Andrea, Roma II Facoltà di Medicina e Chirurgia, Università La Sapienza, Roma.
Chir Ital. 2008 Jan-Feb;60(1):1-7.
Since 2001 we have conducted a prospective randomised study of right laparoscopic-assisted hemicolectomy vs open right hemicolectomy for right colon cancer in order to assess the differences in intraoperative and postoperative results as well as oncological clearance. Thirty-three patients with right colon cancer received laparoscopic-assisted right hemicolectomy (LRH) and were compared with 33 patients who underwent open right hemicolectomy (ORH). We analysed morbidity and mortality, number of postoperative days of starving, postoperative days tolerating a liquid diet and a soft diet, duration of postoperative ileus, as well as the distance of the resection margin from the tumour (< 5 cm or >5 cm), and the number of lymph nodes found in the resected specimen. We also compared the length of operative time, blood loss, and any associated surgery. Morbidity occurred in 1 patient undergoing LRH (3.0%) as against 4 patients (12.1%) in the ORH group (p < 0.05). Postoperative ileus lasted 3.15 days (range: 3-5 days) in the LRH group vs 3.0 days (range: 1-4 days) in the ORH group. Median operative time was 251 min (range: 130-360 min) in the LRH group vs 222.9 min (range: 135-360 min) in the ORH group, while blood loss amounted to a median of 135 mi (range: 100-300 ml; SD +/- 42.9 mi) in the LRH group vs. 404.1 ml (range: 250-1000 ml; SD +/- 159.3 ml) in the ORH group (p <0.05). The distance of the resection margin from the tumour was more than 5 cm in both groups. In the LRH group a median of 12.7 lymph nodes were removed (range: 9-31; SD +/- 4.5) vs. 18 lymph nodes in the ORH group (range: 8-29; SD +/- 3.9) (p < 0.05). Associated surgery was performed in 15.1% of cases in both groups. In our experience LRH presents a statistically significant advantage in terms of morbidity and blood loss compared to ORH. Equivalent oncological clearance was obtained, fulfilling the stated criteria of 5 cm free resection margins and number of lymph nodes resected, though we removed fewer lymph nodes in LRH compared to ORH (p < 0.05).
自2001年以来，我们开展了一项前瞻性随机研究，比较腹腔镜辅助右半结肠切除术与开放性右半结肠切除术治疗右半结肠癌的效果，以评估术中、术后结果以及肿瘤清除方面的差异。33例右半结肠癌患者接受了腹腔镜辅助右半结肠切除术（LRH），并与33例行开放性右半结肠切除术（ORH）的患者进行比较。我们分析了发病率和死亡率、术后禁食天数、能耐受流食和软食的术后天数、术后肠梗阻持续时间，以及切除边缘距肿瘤的距离（<5 cm或>5 cm），还有切除标本中发现的淋巴结数量。我们还比较了手术时间、失血量以及任何相关手术情况。LRH组有1例患者发生并发症（3.0%），而ORH组有4例患者发生并发症（12.1%）（p<0.05）。LRH组术后肠梗阻持续3.15天（范围：3 - 5天），ORH组为3.0天（范围：1 - 4天）。LRH组中位手术时间为251分钟（范围：130 - 360分钟），ORH组为222.9分钟（范围：135 - 360分钟），而LRH组失血量中位数为135毫升（范围：100 - 300毫升；标准差±42.9毫升），ORH组为404.1毫升（范围：250 - 1000毫升；标准差±159.3毫升）（p<0.05）。两组切除边缘距肿瘤的距离均超过5 cm。LRH组切除淋巴结的中位数为12.7个（范围：9 - 31个；标准差±4.5个），ORH组为18个（范围：8 - 29个；标准差±3.9个）（p<0.05）。两组均有15.1%的病例进行了相关手术。根据我们的经验，与ORH相比，LRH在并发症和失血量方面具有统计学上的显著优势。虽然LRH组切除的淋巴结比ORH组少（p<0.05），但获得了等效的肿瘤清除效果，满足了规定的5 cm切缘阴性和切除淋巴结数量的标准。
