Santoro Emanuele, Carboni Fabio, Ettorre Giuseppe Maria, Lepiane Pasquale, Mancini Pietro, Santoro Roberto, Santoro Eugenio
General Surgery and Transplant Division, San Camillo Hospital, Rome, Italy.
Updates Surg. 2010 Dec;62(3-4):135-41. doi: 10.1007/s13304-010-0029-4.
This study aimed to evaluate the early results of colorectal laparoscopic surgery with special attention to surgical and medical complications. The risk factors of such surgery are also investigated on the basis of a large series of operated cases: the preoperative knowledge of such factors could guide the operative program and the postoperative treatment with reduction of complications and improvement of the outcome. Between 1998 and 2008, 492 patients had been submitted to colorectal laparoscopic surgery by the same team: 387 for cancer and 105 for benign disease. All colorectal surgical operations are included in the series. No selection of the patients was made: laparoscopy was performed in all cases accepting the procedure. Several risk factors have been analysed in cases of fistula (age, pathology sex, type of the operation, cancer stages, preoperative radiochemotherapy, stool diversion and team experience) and in cases of medical complications (age, pathology, cancer stages and type of operation). The overall results in this series of laparoscopic colorectal operated cases are similar to other results published at present by the main surgical Department all over the world; no mortality and low number of medical (2.4%) and surgical complications (9.3%), with no differences also with the best open surgery series. Complete or partial conversion to open surgery was required in few cases (1.2%) and same others (1.4%) were operated again for bleeding or sudden anastomotic leakage. Regarding the risk factors in such surgery, a good correlation has been discovered between anastomotic leakage and the team experience, the age over 70 of the patients, the rectal tumour site in man, the advanced tumour stages, the previous radiochemotherapy, while medical complications seem to depend on advanced patients age and advanced cancer stages. Laparoscopic colorectal surgery at present is going to be considered the gold standard in the large majority of colorectal diseases including all cancer stages in the preoperative balance and in the early postoperative follow-up a special attention is required to same risk factors like the advanced patients age, the extended cancers, the low positioned rectal tumours. Complications are more frequent at the beginning of the experience of the surgical team and if more than one risk factors coexist, but it do not represent contraindication to laparoscopic surgery.
本研究旨在评估结直肠腹腔镜手术的早期结果，特别关注手术和医疗并发症。基于大量手术病例对该类手术的风险因素进行了调查：术前了解这些因素可指导手术方案及术后治疗，从而减少并发症并改善预后。1998年至2008年间，同一团队对492例患者实施了结直肠腹腔镜手术：其中387例为癌症患者，105例为良性疾病患者。该系列纳入了所有结直肠外科手术。未对患者进行选择：所有接受该手术的病例均采用腹腔镜手术。对瘘管病例（年龄、病理类型、性别、手术类型、癌症分期、术前放化疗、粪便改道及团队经验）和医疗并发症病例（年龄、病理类型、癌症分期及手术类型）的多种风险因素进行了分析。该系列腹腔镜结直肠手术病例的总体结果与目前全球主要外科科室发表的其他结果相似；无死亡病例，医疗并发症发生率低（2.4%），手术并发症发生率低（9.3%），与最佳开放手术系列相比也无差异。少数病例（1.2%）需要完全或部分转为开放手术，另有一些病例（1.4%）因出血或突然吻合口漏而再次手术。关于此类手术的风险因素，已发现吻合口漏与团队经验、患者年龄超过70岁、男性直肠肿瘤部位、肿瘤晚期、先前的放化疗之间存在良好相关性，而医疗并发症似乎取决于患者年龄较大和癌症分期较晚。目前，腹腔镜结直肠手术在大多数结直肠疾病中被视为金标准，包括术前评估的所有癌症分期，术后早期随访时，对于年龄较大的患者、进展期癌症、低位直肠肿瘤等风险因素需特别关注。在手术团队经验初期以及存在多个风险因素共存时，并发症更为常见，但这并不构成腹腔镜手术的禁忌证。
