Martínek L, Dostalík J, Gunka I, Gunková P, Vávra P
Chirurgická klinika FN Ostrava.
Rozhl Chir. 2009 Dec;88(12):725-9.
The aim of our study was to compare oncological results of laparoscopic assisted coloctomy and open colectomy in the treatment of nonmetastatic colon cancer.
In this prospective nonrandomised clinical trail a group of elective laparoscopic or open resections in patients with the colon adenocarcinom was evaluated in the period between January 2001 and December 2006. The primary endpoint was overall survival, disease free survival and recurrence.
A total of 220 patients were included in the analysis, of which 119 were operated laparoscopically and 101 by open technique. The median follow up period was 59 months (range 25-91) in the laparoscopic group and 68 months (range 25-96) in the open group (p = 0.0003). No statistically significant difference was found between the two treatment modalities regarding combined overall and disease-free survival for all stages (p = 0.16 resp. p = 0.27). With a respect of the tumor stage, there was a tendency of higher overall survival in favour of the laparoscopic group in the stage III, however the difference was not statistically significant (p = 0.07). During the follow up period the disease recurred in the laparoscopic and open group in 22 (18%), respective 20 (20%) patients (p = 0.78). The regression analysis showed that operative technique didn't influence neither overall or disease-free survival (p = 0.16, respective p = 0.27).
Long-term results support laparoscopic colon cancer surgery as a safe and effective alternative to open surgery.
本研究旨在比较腹腔镜辅助结肠切除术与开放性结肠切除术治疗非转移性结肠癌的肿瘤学结果。
在这项前瞻性非随机临床试验中,对2001年1月至2006年12月期间一组接受择期腹腔镜或开放性切除术的结肠腺癌患者进行了评估。主要终点是总生存期、无病生存期和复发情况。
共有220例患者纳入分析,其中119例行腹腔镜手术,101例行开放手术。腹腔镜组的中位随访期为59个月(范围25 - 91个月),开放组为68个月(范围25 - 96个月)(p = 0.0003)。在所有分期的总生存期和无病生存期联合方面,两种治疗方式之间未发现统计学显著差异(p = 0.16和p = 0.27)。就肿瘤分期而言,Ⅲ期患者中腹腔镜组有总生存期更高的趋势,但差异无统计学意义(p = 0.07)。随访期间,腹腔镜组和开放组分别有22例(18%)和20例(20%)患者疾病复发(p = 0.78)。回归分析表明手术方式对总生存期和无病生存期均无影响(p = 0.16和p = 0.27)。
长期结果支持腹腔镜结肠癌手术作为开放性手术的一种安全有效的替代方法。