Section of Translational Anaesthesia and Surgery, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds, UK.
Br J Surg. 2010 Nov;97(11):1638-45. doi: 10.1002/bjs.7160.
The UK Medical Research Council CLASICC trial assessed the safety and efficacy of laparoscopically assisted surgery in comparison with open surgery for colorectal cancer. The results of the 5-year follow-up analysis are presented.
Five-year outcomes were analysed and included overall and disease-free survival, and local, distant and wound/port-site recurrences. Two exploratory analyses were performed to evaluate the effect of age (70 years or less, or more than 70 years) on overall survival between the two groups, and the effect of the learning curve.
No differences were found between laparoscopically assisted and open surgery in terms of overall survival, disease-free survival, and local and distant recurrence. Wound/port-site recurrence rates in the laparoscopic arm remained stable at 2.4 per cent. Conversion to open operation was associated with significantly worse overall but not disease-free survival, which was most marked in the early follow-up period. The effect of surgery did not differ between the age groups, and surgical experience did not impact on the 5-year results.
The 5-year analyses confirm the oncological safety of laparoscopic surgery for both colonic and rectal cancer. The use of laparoscopic surgery to maximize short-term outcomes does not compromise the long-term oncological results.
ISRCTN74883561 (http://www.controlled-trials.com).
英国医学研究理事会 CLASICC 试验评估了腹腔镜辅助手术与开腹手术治疗结直肠癌的安全性和疗效。现将 5 年随访分析结果报告如下。
分析了 5 年的结局，包括总生存率、无病生存率以及局部、远处和切口/端口部位复发。进行了两项探索性分析，以评估两组之间年龄（<70 岁或≥70 岁）对总生存率的影响，以及学习曲线的影响。
腹腔镜辅助手术与开腹手术在总生存率、无病生存率以及局部和远处复发方面无差异。腹腔镜组的切口/端口部位复发率稳定在 2.4%。转为开腹手术与总生存率显著降低相关，但与无病生存率无关，且在早期随访中最为明显。手术效果在不同年龄组之间无差异，手术经验也未对 5 年结果产生影响。
5 年分析结果证实了腹腔镜手术治疗结肠癌和直肠癌的肿瘤安全性。为了最大限度地提高短期结局而使用腹腔镜手术不会影响长期肿瘤学结果。
ISRCTN74883561（http://www.controlled-trials.com）。
