Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.
Dis Colon Rectum. 2010 Oct;53(10):1400-8. doi: 10.1007/DCR.0b013e3181e5e0b1.
Laparoscopy-assisted surgery has technical drawbacks compared with open surgery, although laparoscopic surgery has become widely adopted with evidence of oncological safety for colon cancer treatment. The oncological risk of technical difficulties during laparoscopic surgery for colorectal cancer has not been previously reported. We aimed to investigate whether a technical difficulty encountered during laparoscopic surgery can be considered a recurrence-related factor for colorectal cancer.
Data from 427 patients who underwent laparoscopic surgery for colorectal cancer between May 2003 and December 2007 were analyzed. An intraoperative technical difficulty was defined as a significant deviation from the ordinary surgical procedure. All conversions to open surgery and iatrogenic bowel perforation during laparoscopic surgery were included as technical difficulties. The Cox proportional-hazards regression model was used to evaluate the recurrence-related factor in the various risk factors including technical difficulty.
Technical difficulties were found in 44 (10.3%) patients, which included 17 (3.9%) conversions to open surgery and 10 (2.4%) with iatrogenic bowel injury. Technical difficulties were encountered more frequently in men compared with women (13.5% vs 6.0%, P = .013), and for cancers located in the mid and low rectum, splenic flexure, and descending colon. The recurrence rates were higher in patients with technical difficulties (local recurrence, 2.6% vs 6.7%, P < .05; systemic recurrence, 6.3% vs 13.6%, P < .05) with a mean follow-up duration of 45.9 months. Multivariate analysis by the Cox proportional-hazards regression model showed that a technical difficulty was an independent factor related to recurrence after laparoscopic surgery (odds ratio, 2.374; 95% CI, 1.006-5.600; P = .048).
This study has demonstrated that a technical difficulty during laparoscopy-assisted surgery jeopardizes oncological safety. It is suggested that surgeons should be prepared to minimize technical difficulties during laparoscopy-assisted surgery.
与开放手术相比，腹腔镜辅助手术存在技术上的缺陷，尽管腹腔镜手术已经广泛应用，并且有证据表明其在结肠癌治疗方面具有肿瘤安全性。但腹腔镜结直肠癌手术中技术困难的肿瘤学风险尚未得到报道。我们旨在研究腹腔镜手术过程中遇到的技术困难是否可以被视为结直肠癌的复发相关因素。
分析了 2003 年 5 月至 2007 年 12 月期间接受腹腔镜结直肠癌手术的 427 例患者的数据。术中技术困难被定义为与普通手术程序有显著偏差。所有腹腔镜手术中转开腹和医源性肠穿孔均被视为技术困难。采用 Cox 比例风险回归模型评估包括技术困难在内的各种危险因素中的复发相关因素。
44 例（10.3%）患者出现技术困难，其中 17 例（3.9%）中转开腹，10 例（2.4%）发生医源性肠损伤。男性患者比女性患者更常出现技术困难（13.5%比 6.0%，P =.013），并且技术困难更常见于中低位直肠、脾曲和降结肠的癌症患者。技术困难患者的复发率更高（局部复发率为 2.6%比 6.7%，P <.05；全身复发率为 6.3%比 13.6%，P <.05），中位随访时间为 45.9 个月。Cox 比例风险回归模型的多变量分析显示，腹腔镜手术后的技术困难是与复发相关的独立因素（比值比，2.374；95%置信区间，1.006-5.600；P =.048）。
本研究表明，腹腔镜辅助手术中的技术困难危及肿瘤学安全性。建议外科医生应做好准备，尽量减少腹腔镜辅助手术中的技术困难。
