腹腔镜结直肠癌手术的长期疗效
Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer.
作者信息
Lee Jeong-Eun, Joh Yong-Geul, Yoo Sang-Hwa, Jeong Geu-Young, Kim Sung-Han, Chung Choon-Sik, Lee Dong-Gun, Kim Seon Hahn
机构信息
Department of Surgery, Hansol Hospital, Seoul, Korea.
出版信息
J Korean Soc Coloproctol. 2011 Apr;27(2):64-70. doi: 10.3393/jksc.2011.27.2.64. Epub 2011 Apr 30.
PURPOSE
The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer.
METHODS
Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resection between January 2001, and December 2003, we analyzed sex, age, stage, complications, hospital stay, mean operation time and blood loss. The overall survival rate, disease-free survival rate and recurrence rate were investigated for 271 patients who could be followed for more than three years.
RESULTS
Tumor-node-metastasis (TNM) stage I cancer was present in 55 patients (18.1%), stage II in 116 patients (38.3%), stage III in 110 patients (36.3%), and stage IV in 22 patients (7.3%). The mean operative time was 200 minutes (range, 100 to 535 minutes), and the mean blood loss was 97 mL (range, 20 to 1,200 mL). The mean hospital stay was 11 days and the mean follow-up period was 54 months. The mean numbers of resected lymph nodes were 26 and 21 in the colon and the rectum, respectively, and the mean distal margins were 10 and 3 cm. The overall morbidity rate was 26.1%. The local recurrence rates were 2.2% and 4.4% in the colon and the rectum, respectively, and the distant recurrence rates were 7.8% and 22.5%. The five-year overall survival rates were 86.1% in the colon (stage I, 100%; stage II, 97.6%; stage III, 77.5%; stage IV, 16.7%) and 68.8% in the rectum (stage I, 90.2%; stage II, 84.0%; stage III, 57.6; stage IV, 13.3%). The five-year disease-free survival rates were 89.8% in the colon (stage I, 100%; stage II, 97.7%; stage III, 74.2%) and 74.5% in the rectum (stage I, 90.0%; stage II, 83.9%; stage III, 59.2%).
CONCLUSION
Laparoscopic surgery for colorectal cancer is a good alternative method to open surgery with tolerable oncologic long-term results.
目的
多项研究报告了腹腔镜结直肠癌切除术的长期结果，但关于腹腔镜直肠癌手术结果的报告有限。我们调查了腹腔镜结直肠癌切除术后的长期结局，包括五年总生存率、无病生存率和复发率。
方法
利用前瞻性收集的2001年1月至2003年12月期间接受腹腔镜切除术的303例结直肠癌患者的数据，我们分析了性别、年龄、分期、并发症、住院时间、平均手术时间和失血量。对271例能够随访三年以上的患者进行了总生存率、无病生存率和复发率的调查。
结果
55例（18.1%）为肿瘤-淋巴结-转移（TNM）I期癌症，116例（38.3%）为II期，110例（36.3%）为III期，22例（7.3%）为IV期。平均手术时间为200分钟（范围100至535分钟），平均失血量为97毫升（范围20至1200毫升）。平均住院时间为11天，平均随访期为54个月。结肠和直肠切除淋巴结的平均数分别为26个和21个，平均远端切缘分别为10厘米和3厘米。总发病率为26.1%。结肠和直肠的局部复发率分别为2.2%和4.4%，远处复发率分别为7.8%和22.5%。结肠的五年总生存率为86.1%（I期，100%；II期，97.6%；III期，77.5%；IV期，16.7%），直肠为68.8%（I期，90.2%；II期，84.0%；III期，57.6%；IV期，13.3%）。结肠的五年无病生存率为89.8%（I期，100%；II期，97.7%；III期，74.2%），直肠为74.5%（I期，90.0%；II期，83.9%；III期，59.2%）。
结论
腹腔镜结直肠癌手术是一种替代开放手术的良好方法，具有可耐受的肿瘤学长期结果。
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