González Quintín H, Rodríguez-Zentner Homero A, Moreno-Berber J Manuel, Vergara-Fernández Omar, de León Héctor Tapia-Cid, López-R Federico, Jonguitud Luis A, Ramos Roberto, Castañeda-Argáiz Roberto
Departamento de Cirugía, Servicio de Colon y Recto Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F.
Rev Invest Clin. 2008 May-Jun;60(3):205-11.
Because definitive long-term results are not yet available, the oncologic safety of laparoscopic surgery in rectal cancer remains controversial. Laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). However, few prospective randomized studies have been performed.
The main purpose was to evaluate whether there are relevant differences in safety and efficacy after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary academic medical center.
This comparative non-randomized prospective study analyzes data of 20 patients with middle and low rectal cancer treated with low anterior resection (LAR) or abdomino perineal resection (APR) from November 2005 to April 2006. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using chi2 test and Student's t-test.
Ten patients underwent LTME and 10 patients underwent OTME. No conversion was required in the LTME group. Mean operating time was shorter in the laparoscopic group (LTME) (186.7 vs. 204.4 min, p < 0.007). Less intraoperative blood loss and fewer postoperative complications were seen in the LTME group. An earlier return of bowel motility was achieved after laparoscopic surgery. There was no 30-day mortality and the overall morbidity was 20% in the LTME group vs. 40% in the OTME group. The mean number of harvested lymph nodes was greater in the laparoscopic group than in OTME group (10.2 +/- 2.5 vs. 8.3 +/- 3). Mean follow-up time was 12 months (range 9-15 months). No local recurrence was found.
LTME is a feasible procedure with acceptable postoperative morbidity and low mortality, however it is technically demanding. This series confirms its safety, while oncologic results are at present comparable to the OTME published series, with limitation of a short follow-up period though. Further randomized studies are necessary to evaluate long-term clinical outcome.
由于尚无确切的长期结果，腹腔镜手术治疗直肠癌的肿瘤学安全性仍存在争议。与开放全直肠系膜切除术（OTME）相比，腹腔镜全直肠系膜切除术（LTME）治疗直肠癌已被认为具有若干短期优势。然而，很少有前瞻性随机研究。
主要目的是评估在一家三级学术医疗中心，选择性LTME治疗直肠癌与OTME相比，在安全性和疗效方面是否存在相关差异。
这项比较性非随机前瞻性研究分析了2005年11月至2006年4月接受低位前切除术（LAR）或腹会阴联合切除术（APR）治疗的20例中低位直肠癌患者的数据。通过病历或直接与患者联系进行随访。使用卡方检验和学生t检验进行统计分析。
10例患者接受LTME，10例患者接受OTME。LTME组无需中转。腹腔镜组（LTME）平均手术时间较短（186.7对204.4分钟，p<0.007）。LTME组术中失血更少，术后并发症更少。腹腔镜手术后肠道蠕动恢复更早。LTME组无30天死亡率，总体发病率为20%，而OTME组为40%。腹腔镜组收获的淋巴结平均数量多于OTME组（10.2±2.5对8.3±3）。平均随访时间为12个月（范围9 - 15个月）。未发现局部复发。
LTME是一种可行的手术，术后发病率可接受且死亡率低，然而技术要求较高。本系列证实了其安全性，尽管目前肿瘤学结果与已发表的OTME系列相当，但随访期较短。需要进一步的随机研究来评估长期临床结果。
