Department of Surgery, Colorectal Unit, Hospital Universitario de Bellvitge, 08907 Barcelona, Spain.
Colorectal Dis. 2010 Jan;12(1):24-31. doi: 10.1111/j.1463-1318.2008.01720.x.
The aim of this prospective observational study was to compare the quality of total mesorectal excision between laparoscopic and open surgery for rectal cancer.
In April 2006, the Spanish Association of Surgeons started an audited teaching programme. The project was similar to the Norwegian one and several training courses were arranged. Patients were classified into two groups: laparoscopic rectal resection (LR) and open rectal resection (OR). The quality of the mesorectum was scored: complete, nearly complete or incomplete. The circumferential margin (CRM) was considered positive, if tumour was located 1 mm or less from the surface of the specimen.
Between 2006 and 2008, 604 patients underwent rectal resection with total mesorectal excision for rectal cancer: 209 patients were included in the LR group and 395 patients in the OR group. There were no differences in terms of number of lymph nodes affected, distance of the tumour from CRM. The mesorectum was complete in 464 (76.8%), nearly complete in 91 (15.1%) and incomplete in 49 patients (8.1%). CRM was negative in 534 patients (88.4%). No differences were observed between the two groups. The overall postoperative morbidity rate was 38.8% in LR group and 44.6% in OR group (P = 0.170). Overall postoperative mortality rate was 2.5%. One patient died (0.5%) in the LR group and 14 patients died (3.5%) in the OR group (P = 0.021).
Laparoscopic resection for rectal cancer is feasible with the quality of mesorectal excision and postoperative outcomes similar to those of open surgery.
本前瞻性观察研究旨在比较腹腔镜与开腹直肠癌全系膜切除术的质量。
2006 年 4 月，西班牙外科医师协会开始了一项审核教学计划。该项目与挪威的项目类似，并安排了几轮培训课程。患者被分为两组：腹腔镜直肠切除术（LR）和开腹直肠切除术（OR）。直肠系膜的质量评分如下：完全、接近完全或不完全。如果肿瘤位于标本表面 1 毫米或以内，则环周切缘（CRM）被认为是阳性。
2006 年至 2008 年间，604 例接受直肠癌全系膜切除术的直肠癌患者接受了直肠切除术：209 例患者纳入 LR 组，395 例患者纳入 OR 组。两组在受影响的淋巴结数量、肿瘤与 CRM 的距离方面无差异。464 例（76.8%）的直肠系膜完全，91 例（15.1%）的直肠系膜接近完全，49 例（8.1%）的直肠系膜不完全。534 例（88.4%）的 CRM 为阴性。两组间无差异。LR 组术后总发病率为 38.8%，OR 组为 44.6%（P=0.170）。总的术后死亡率为 2.5%。LR 组有 1 例患者（0.5%）死亡，OR 组有 14 例患者（3.5%）死亡（P=0.021）。
腹腔镜直肠癌切除术是可行的，其系膜切除质量和术后结果与开腹手术相似。
