Miyajima Nobuyoshi, Fukunaga Masaki, Hasegawa Hirotoshi, Tanaka Jun-ichi, Okuda Junji, Watanabe Masahiko
Department of Gastroenterological and General Surgery, St. Marianna University Toyoko Hospital, 3-435 Kosugi-cho Nakahara-ku, Kawasaki, Japan.
Surg Endosc. 2009 Jan;23(1):113-8. doi: 10.1007/s00464-008-0078-7. Epub 2008 Sep 19.
The aim of this study was to clarify the feasibility of laparoscopic surgery for rectal cancer retrospectively in 28 centers throughout Japan.
Between May 1994 and February 2006, 1,057 selected patients with rectal cancer underwent laparoscopic surgery. All the data regarding the patient details, and operative and postoperative outcome were collected retrospectively.
Mean follow-up was 30 months. Procedures included anterior resection in 938, abdominoperineal resection in 107, Hartmann's procedure in 10, and others in two patients. Conversion to open procedures occurred in 77 patients (7.3%). Postoperative surgical complications developed in 235 patients (22.2%), including anastomotic leakage in 84 (9.1%). Median length of postoperative hospital stay was 15 days (7-271 days). Patients with upper rectal cancer had shorter hospital stay than those with lower rectal cancer (14 versus 18 days, p < 0.01). Tumor-node-metastases (TNM) stage included 83(7.9%) stage 0, 495 (46.8%) stage I, 197 (18.6%) stage II, 230 (21.8%) stage III, and 52 (4.9%) stage IV. Recurrence was developed in 67 patients (6.6%) of the 1,011 curatively treated patients. Local recurrence occurred in 11 patients (1.0%). There was no port-site metastasis. Of the 1,011 curatively treated patients, the 3-year disease-free survival rate was 100% in stage 0, 94.6% in stage I, 82.1% in stage II, and 79.7% in stage III.
Laparoscopic surgery is feasible and safe in selected patients with rectal cancer, with favorable short-term and mid-term outcome.
本研究旨在回顾性地阐明在日本全国28个中心对直肠癌患者进行腹腔镜手术的可行性。
1994年5月至2006年2月期间，1057例经挑选的直肠癌患者接受了腹腔镜手术。回顾性收集了所有关于患者详细信息、手术及术后结果的数据。
平均随访时间为30个月。手术方式包括938例前切除术、107例腹会阴联合切除术、10例Hartmann手术以及2例其他手术。77例患者（7.3%）中转开腹手术。235例患者（22.2%）发生术后手术并发症，其中84例（9.1%）发生吻合口漏。术后住院时间中位数为15天（7 - 271天）。上段直肠癌患者的住院时间短于下段直肠癌患者（14天对18天，p < 0.01）。肿瘤-淋巴结-转移（TNM）分期包括0期83例（7.9%）、I期495例（46.8%）、II期197例（18.6%）、III期230例（21.8%）和IV期52例（4.9%）。1011例接受根治性治疗的患者中有67例（6.6%）复发。局部复发11例（1.0%）。无切口种植转移。在1011例接受根治性治疗患者中，0期患者3年无病生存率为100%，I期为94.6%，II期为82.1%，III期为79.7%。
对于部分直肠癌患者，腹腔镜手术可行且安全，具有良好的短期和中期效果。
