Ptok H, Kube R, Schmidt U, Köckerling F, Gastinger I, Lippert H
Institute of Quality Control in Operative Medicine, University Hospital of Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany.
Eur J Surg Oncol. 2009 Dec;35(12):1273-9. doi: 10.1016/j.ejso.2009.06.006. Epub 2009 Jul 16.
Comparisons of open and laparoscopic colon cancer resection have shown that laparoscopy offers an oncologically safe option. However, there are no data on long-term influence of converted resection, despite conversion rates of up to 30% and the general observation that short-term outcome is significantly worsened. The aim was to compare the long-term results of primary open resection (OR), purely laparoscopic resection (LR-p) and converted resection (LR-c).
In a prospective study at 282 German hospitals demographic, tumor- and treatment-related data and disease-free survival were compared in the three groups.
8015 of 8307 patients with OR, 280 of 290 patients with LR-p and 55 of 56 patients with LR-c were followed for 39.5 months (median). Overall, no statistically significant differences were seen for five-year DFS (74.8%, 81.3% and 65.6%). However, for patients in stage II with conversion, the five-year DFS was significantly poorer (43.3%) than for OR (80.5%; p=0.003) and LR-p patients (92.5%; p=0.001). For stages I and III no differences were observed.
Conversion of laparoscopic colon cancer resection worsens DFS in locally advanced stage II carcinoma. There is a need to reduce the conversion rate by adequate patient selection for laparoscopic resection by experienced surgeons.
开放性与腹腔镜结肠癌切除术的比较表明，腹腔镜手术提供了一种肿瘤学上安全的选择。然而，尽管中转率高达30%，且普遍观察到短期结果明显恶化，但关于中转切除的长期影响尚无数据。目的是比较原发性开放性切除（OR）、单纯腹腔镜切除（LR-p）和中转切除（LR-c）的长期结果。
在德国282家医院进行的一项前瞻性研究中，比较了三组患者的人口统计学、肿瘤及治疗相关数据和无病生存率。
8307例接受OR手术的患者中有8015例、290例接受LR-p手术的患者中有280例、56例接受LR-c手术的患者中有55例接受了为期39.5个月（中位数）的随访。总体而言，五年无病生存率（DFS）未见统计学显著差异（分别为74.8%、81.3%和65.6%）。然而，对于II期中转患者，其五年DFS显著低于OR患者（80.5%；p=0.003）和LR-p患者（92.5%；p=0.001）。I期和III期未见差异。
腹腔镜结肠癌切除术中转可使局部进展期II期癌的DFS恶化。有必要通过经验丰富的外科医生对腹腔镜切除术进行适当的患者选择来降低中转率。
