Koulas Spyridon G, Pappas-Gogos George, Spirou Spyridon, Roustanis Evangelos, Tsimogiannis Konstantinos E, Tsirves Georgios, Tsimoyiannis Evangelos C
Department of General Surgery, "G. Hatzikosta" General Hospital, Ioannina, Greece.
JSLS. 2009 Oct-Dec;13(4):564-73. doi: 10.4293/108680809X12589998404489.
This was a retrospective study that evaluated the surgical outcomes of laparoscopic surgery (LS) for rectal cancer, in comparison with a case control series of open surgery (OS), during an 8-year period.
Between October 1998 and December 2006, 203 patients with rectal malignancies underwent colectomy; 146 of them had colectomy with the traditional technique (OS), while 57 underwent resection of rectal cancer laparoscopically (LS). The LS group was compared with 60 patients from the OS group (selected from the 146 OS group patients), matched by size, sex, age, anatomical location of the tumor, type, extent of resection, and pathological stage. Data were obtained from patients' medical records. Statistical analysis was performed with the t test and chi-square test. All data are expressed as mean +/- standard error of the mean (SEM).
Mean age of the LS group was 63.7+/-12 years versus 69+/-12 years in the OS group. There were more men than women in both the laparoscopic (33 males, 24 females) and OS groups (35 men, 25 women). The mean follow-up period was 38 months and 78 months for LS and OS groups, respectively. The procedure included low anterior resection (43 in LS and 45 in OS), and 13 patients in both groups underwent abdominoperineal resection and 3 transanal resections (2 in OS and 1 in LS). Mean tumor size was 4.2+/-2.12cm in the LS versus 5.2+/-2.02cm in the OS group. Conversion to an open procedure occurred in 4 patients (6.7%), all in the first 20 cases. Postoperative complications developed in 28 patients (11.7%), 13 in the LS group and 15 in the OS group. Median operative time was longer, but median blood loss was significantly lower in the LS group. The length of hospital stay was significantly shorter for the LS group.
Laparoscopic surgery is feasible and safe for patients with rectal cancer and provides benefits during the postoperative period without increased morbidity or mortality.
这是一项回顾性研究，在8年期间内，评估了腹腔镜手术（LS）治疗直肠癌的手术效果，并与开放手术（OS）的病例对照系列进行比较。
1998年10月至2006年12月期间，203例直肠恶性肿瘤患者接受了结肠切除术；其中146例采用传统技术进行结肠切除术（OS），而57例接受了腹腔镜直肠癌切除术（LS）。将LS组与OS组中的60例患者（从146例OS组患者中选出）进行比较，根据肿瘤大小、性别、年龄、肿瘤解剖位置、类型、切除范围和病理分期进行匹配。数据来自患者的病历。采用t检验和卡方检验进行统计分析。所有数据均以平均值±平均标准误差（SEM）表示。
LS组的平均年龄为63.7±12岁，而OS组为69±12岁。腹腔镜组（33例男性，24例女性）和OS组（35例男性，25例女性）中男性均多于女性。LS组和OS组的平均随访期分别为38个月和78个月。手术包括低位前切除术（LS组43例，OS组45例），两组均有13例患者接受了腹会阴联合切除术，3例接受经肛门切除术（OS组2例，LS组1例）。LS组的平均肿瘤大小为4.2±2.12cm，而OS组为5.2±2.02cm。4例患者（6.7%）转为开放手术，均在前20例病例中。28例患者（11.7%）出现术后并发症，LS组13例，OS组15例。LS组的中位手术时间较长，但中位失血量显著较低。LS组的住院时间明显较短。
腹腔镜手术对直肠癌患者可行且安全，在术后阶段具有益处，且不增加发病率或死亡率。
