Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Dis Colon Rectum. 2011 Jan;54(1):6-14. doi: 10.1007/DCR.0b013e3181fd19d0.
The aim of the study is to assess the safety and oncologic feasibility of laparoscopic-assisted resection for rectal cancer vs open rectal resection as a phase II pilot study for a planned randomized control trial.
A case-matched controlled prospective analysis of 54 patients who underwent laparoscopic-assisted resection for stage I to III (no T4) rectal cancer within 12 cm of the anal verge from 2002 to 2005 was performed. Patients were matched with contemporary patients who underwent open rectal cancer surgery (n = 108) in a 1 to 2 fashion. The perioperative clinical outcomes, postoperative pathology, and oncologic outcomes were compared between the groups.
The demographic data did not differ significantly between the groups. The laparoscopic group manifested early return of bowel function (P = .003). The complication rate was 22.2% in the laparoscopic group and 32.4% in the open group (P = .178). Local recurrence was similar (2.0% laparoscopic, 4.2% open, P = .417). The 5-year overall and disease-free survival rate also were similar (overall survival, 90.8% laparoscopic, 88.5% open, P = .261; disease-free survival, 80.8% laparoscopic, 75.8% open. P = .390).
The laparoscopic-assisted resection for rectal cancer was acceptable in terms of oncologic outcomes and perioperative clinical outcomes. The present data are the basis for a large-scale randomized trial for comparison of laparoscopic and open rectal cancer surgeries (American College of Surgeons Oncology Group Z6051).
本研究旨在评估腹腔镜辅助直肠切除术治疗直肠癌的安全性和肿瘤学可行性，作为计划进行的随机对照试验的 II 期试点研究。
对 2002 年至 2005 年间接受腹腔镜辅助直肠切除术治疗 I 期至 III 期（无 T4）距肛门 12cm 以内直肠肿瘤的 54 例患者进行了病例匹配对照前瞻性分析。按照 1:2 的比例与同期接受开放式直肠癌手术的患者（n=108）进行匹配。比较两组患者的围手术期临床结局、术后病理和肿瘤学结局。
两组患者的人口统计学数据无显著差异。腹腔镜组患者术后肠道功能恢复较早（P=0.003）。腹腔镜组的并发症发生率为 22.2%，开放组为 32.4%（P=0.178）。局部复发率相似（腹腔镜组 2.0%，开放组 4.2%，P=0.417）。5 年总生存率和无病生存率也相似（总生存率，腹腔镜组 90.8%，开放组 88.5%，P=0.261；无病生存率，腹腔镜组 80.8%，开放组 75.8%，P=0.390）。
腹腔镜辅助直肠切除术在肿瘤学结果和围手术期临床结果方面是可以接受的。目前的数据为比较腹腔镜和开放直肠癌手术的大规模随机试验提供了依据（美国外科医师学院肿瘤学组 Z6051）。
