Law Wai Lun, Poon Jensen T C, Fan Joe K M, Lo Siu Hung
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong.
Ann Surg Oncol. 2009 Jun;16(6):1488-93. doi: 10.1245/s10434-009-0418-4. Epub 2009 Mar 17.
Laparoscopic resection for advanced rectal cancer has not been widely accepted, and there are only few studies with survival data. This study aimed to compare the survival of patients who underwent laparoscopic and open resection for stage II and III rectal cancer.
Consecutive patients (open resection: n = 310; laparoscopic resection: n = 111) who underwent curative resection for stage II and III rectal cancer from June 2000 to December 2006 were included. The operative details, postoperative complications, postoperative outcomes, and survival data were collected prospectively. Comparison was made between patients who had laparoscopic and open surgery.
The age, gender, medical morbidity, types of operation, and American Society of Anesthesiologists (ASA) status were similar between the two groups. There was also no difference in the mortality, morbidity, and pathological staging. Laparoscopic resection was associated with significantly less blood loss and shorter hospital stay. With the median follow-up of 34 months, there was no difference in local recurrence rates. The 5-year actuarial survivals were 71.1% and 59.3% in the laparoscopic and open groups, respectively (P = .029). In the multivariate analysis, laparoscopic resection was one of the independent significant factors associated with better survival (P = .03, hazards ratio: 0.558, 95% confidence interval: 0.339-0.969). Other independent poor prognostic factors included lymph node metastasis, poor differentiation, perineural invasion, presence of postoperative complications, and no chemotherapy.
Laparoscopic resection for locally advanced rectal cancer is associated with more favorable overall survival when compared with open resection.
腹腔镜下切除晚期直肠癌尚未被广泛接受，仅有少数研究提供了生存数据。本研究旨在比较接受腹腔镜和开放手术切除II期和III期直肠癌患者的生存率。
纳入2000年6月至2006年12月期间接受II期和III期直肠癌根治性切除的连续患者（开放手术组：n = 310；腹腔镜手术组：n = 111）。前瞻性收集手术细节、术后并发症、术后结局和生存数据。对接受腹腔镜手术和开放手术的患者进行比较。
两组患者的年龄、性别、合并症、手术类型及美国麻醉医师协会（ASA）分级相似。死亡率、发病率和病理分期也无差异。腹腔镜切除术的失血量明显较少，住院时间较短。中位随访34个月，局部复发率无差异。腹腔镜组和开放组的5年预期生存率分别为71.1%和59.3%（P = 0.029）。多因素分析显示，腹腔镜切除术是与更好生存相关的独立显著因素之一（P = 0.03，风险比：0.558，95%置信区间：0.339 - 0.969）。其他独立的不良预后因素包括淋巴结转移、低分化、神经侵犯、术后并发症的存在以及未进行化疗。
与开放手术相比，腹腔镜下切除局部晚期直肠癌的总体生存率更高。
