Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Surgery. 2010 Aug;148(2):378-85. doi: 10.1016/j.surg.2010.05.019.
Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009.
A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency (%) or median (interquartile range).
Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39% were women, and the median BMI was 27 (24-31) kg/m(2). Diagnoses included 194 colon cancers (CC, 56.7% stage I/II), 129 rectal cancers (RC, 62.7% stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14% vs 10%; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28% vs 30%; P = .72). There was 1 mortality (0.5%). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80% and 88% (CC and RC, respectively), and disease free survival 79% and 85%, respectively.
Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.
手助腹腔镜手术（HALS）是腹腔镜辅助手术的一种成熟替代方法，但关于其在结直肠癌（CRC）中的适用性的数据有限。我们报告了在 2004 年至 2009 年间接受 HALS 的大量 CRC 患者的短期结果。
使用前瞻性维护的数据库来识别所有 CRC 患者。结肠癌（CC）和直肠癌（RC）患者分别考虑。排除了 3 例同时患有 CC 和 RC 的患者。数据为频率（%）或中位数（四分位距）。
2004 年至 2009 年间，323 例 CRC 患者接受了 HALS 手术。中位年龄为 65（53-73）岁，39%为女性，BMI 中位数为 27（24-31）kg/m2。诊断包括 194 例结肠癌（CC，56.7%为 I/II 期）和 129 例直肠癌（RC，62.7%为 I/II 期）。CC 的手术时间短于 RC（157 分钟对 204 分钟；P<.0001）。CC 和 RC 病例中转开腹的比例相似（14%对 10%；P=.38）；淋巴结检出也相似（18 对 18；P=.45）。总住院时间为 5（4-7）天。在 30 天时，CC 和 RC 患者的术后并发症发生率相似（28%对 30%；P=.72）。有 1 例死亡（0.5%）。对于有 3 年随访的亚组（73 例 CC 和 45 例 RC 患者），总体生存率分别为 80%和 88%（CC 和 RC），无病生存率分别为 79%和 85%。
使用 HALS 技术可以安全切除结肠癌和直肠癌。转换率低，并发症发生率预期，住院时间短，淋巴结检出数量高。
