Department of General Surgery, Aosta Valley Regional Hospital Umberto Parini, via Adamello, 16, 11100, Aosta, Italy.
Surg Endosc. 2010 Sep;24(9):2085-91. doi: 10.1007/s00464-010-0902-8. Epub 2010 Feb 21.
This study aimed to compare the short- and medium-term results obtained by totally laparoscopic right colectomy (TL) with those obtained by laparoscopically assisted right colectomy (LAC) for the treatment of right colon cancer.
A retrospective study compared two nonstatistically different groups (50 TL and 50 LAC cases) managed for nonmetastatic malignant tumors. The study outcomes included operative time, length of minilaparotomy, intraoperative complications, postoperative pain, time to resumption of the gastrointestinal functions, permanence of abdominal drain, analgesic therapy duration, postoperative complications, hospitalization time, number of harvested lymph nodes, and distant metastases onset.
The mean operative times were 78 ± 25 min (TL group) and 92 ± 22 min (LAC group) (p < 0.05). The findings showed a lower postoperative pain level associated with a reduction in analgesic consumption (p > 0.05) and earlier restoration of digestive function in the TL group than in the LAC group. The mean hospital stays were approximately 5 days (TL) and 7 days (LAC) (p < 0.05). No complications occurred either intra- or postoperatively, and similarly, the TL group experienced no mortality. In comparison, the LAC group had a 30% complication rate (p < 0.05). The complications included one case of intraoperative small bowel lesion, three cases of postoperative respiratory infections, three cases of anastomotic leakage, two cases of intestinal occlusion, three cases of minilaparotomy infection, one case of postoperative femoral neurosis, one case of postoperative heart attack, and one case of postoperative pancreatitis. The mortality rate was 0%. Neither group had a recurrence of the neoplastic disease during a 4-year follow-up period.
The findings seem to demonstrate that TL right colectomy is feasible and safe, yielding results comparable with those of the open approach but offering improved postoperative patient comfort. The limits of this retrospective comparative study do not allow definitive conclusions to be drawn despite the encouraging data for the next prospective randomized studies.
本研究旨在比较全腹腔镜右半结肠切除术（TL）与腹腔镜辅助右半结肠切除术（LAC）治疗右半结肠癌的短期和中期结果。
回顾性研究比较了两组非统计学差异的患者（TL 组 50 例，LAC 组 50 例），均为非转移性恶性肿瘤。研究结果包括手术时间、小切口长度、术中并发症、术后疼痛、胃肠道功能恢复时间、引流管留置时间、镇痛治疗持续时间、术后并发症、住院时间、淋巴结清扫数量和远处转移发生情况。
TL 组和 LAC 组的平均手术时间分别为 78±25 分钟和 92±22 分钟（p<0.05）。TL 组术后疼痛程度较低，镇痛药物消耗减少（p>0.05），消化功能恢复较早。TL 组和 LAC 组的平均住院时间分别约为 5 天和 7 天（p<0.05）。TL 组无术中或术后并发症，无死亡病例；而 LAC 组并发症发生率为 30%（p<0.05），包括术中小肠损伤 1 例，术后呼吸感染 3 例，吻合口漏 3 例，肠梗阻 2 例，小切口感染 3 例，术后股神经病变 1 例，心肌梗死 1 例，胰腺炎 1 例。两组在 4 年随访期间均无肿瘤疾病复发。
TL 右半结肠切除术是可行且安全的，其结果与开放手术相当，但可提高术后患者舒适度。尽管数据令人鼓舞，但本回顾性比较研究的局限性不允许得出明确结论，需要进一步进行前瞻性随机研究。
