Carlo Staudacher, Andrea Vignali, Department of Surgery, IRCCS San Raffaele, University Vita-Salute, Via Olgettina 60, 20132 Milan, Italy.
World J Gastrointest Surg. 2010 Sep 27;2(9):275-82. doi: 10.4240/wjgs.v2.i9.275.
At present time, there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions, lower morbidity rate and earlier recovery compared to open surgery. Technical limitations and a steep learning curve have limited the wide application of mini-invasive surgery for rectal cancer. The present article discusses the current status of laparoscopic resection for rectal cancer. A review of the more recent retrospective, prospective and randomized controlled trial (RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed. A particular emphasis was dedicated to mid and low rectal cancers. Few prospective and RCT trials specifically addressing laparoscopic rectal cancer resection are currently available in the literature. Improved short-term outcomes in term of lesser intraoperative blood loss, reduced analgesic requirements and a shorter hospital stay have been demonstrated. Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin. This data however was not confirmed by other prospective comparative studies. Moreover, a similar local recurrence rate has been reported in RCT and comparative series. Similar findings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any definitive conclusions. On the basis of available data in the literature, the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence. With respect to long-term survival, a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.
目前，有随机对照研究的证据表明，腹腔镜切除术治疗结肠癌的成功率更高，与开放手术相比，腹腔镜切除术的切口更小、发病率更低、恢复更快。技术限制和陡峭的学习曲线限制了微创手术在直肠癌中的广泛应用。本文讨论了腹腔镜直肠癌切除术的现状。回顾了最近关于腹腔镜直肠癌切除术的回顾性、前瞻性和随机对照试验（RCT）数据，包括经肛门内镜微创手术和机器人的作用。特别强调了中低位直肠癌。目前文献中很少有专门针对腹腔镜直肠肿瘤切除术的前瞻性和 RCT 试验。已经证明，在术中出血量较少、减少镇痛需求和缩短住院时间方面，短期结果得到了改善。最近在最大的腹腔镜直肠癌 RCT 试验中，人们对腹腔镜在肿瘤学方面的适当性提出了担忧，因为环周切缘的发生率增加了。然而，其他前瞻性比较研究并没有证实这一数据。此外，RCT 和比较系列报告了相似的局部复发率。尽管报告了总体生存率和无病生存率的相似发现，但在所有这些研究中，随访时间都太短，目前可用的 RCT 试验也没有得出任何明确的结论。基于文献中的现有数据，微创方法治疗直肠癌具有一些短期优势，在局部复发方面似乎没有任何劣势。关于长期生存，目前还不能给出明确的答案，因为目前正在进行的侧重于长期生存的 RCT 试验的结果仍有待充分阐明这一问题。
