Department of General Surgery, Misericordia and Dolce Hospital, Piazza dell'Ospedale 5, 59100 Prato (Po), Italy.
Surg Endosc. 2011 Sep;25(9):2919-25. doi: 10.1007/s00464-011-1643-z. Epub 2011 Mar 18.
Whether laparoscopic colorectal resection improved recovery within an enhanced recovery program was investigated.
This study was designed as a query of a prospectively maintained colorectal database to identify 350 patients who underwent elective colorectal resection with primary anastomosis for colorectal cancer between January 1, 2005 and December 31, 2009. Patients were categorized into two groups (laparoscopic and open resection), and demographic, treatment, and outcome variables were independently reviewed for accuracy. A detailed fast-track protocol was prepared and distributed to all patients, department doctors, and nurses to standardize the treatment.
A total of 209 patients underwent laparoscopic-assisted colorectal resection, and 141 had open surgery. There was no difference between the two groups in terms of age, sex, BMI, ASA, comorbidity, previous abdominal surgery, preoperative chemoradiotherapy, cancer site, and AJCC 2002 staging. Twenty-three patients in the laparoscopic group required conversion to an open procedure due to hemorrhage, tumor extension, or technical difficulties. Laparoscopic patients had earlier tolerance of diet, bowel movement, flatus and stool canalization, mobilization, suction drain removal, and interruption of analgesic drug administration. Length of postoperative stay was shorter (4 vs. 7 days, p = 0.0004) and fewer postoperative nonsurgical complications (3 vs. 13% p = 0.009) were registered for the laparoscopic group.
This study suggests that within an enhanced recovery program, laparoscopic resection may provide the best short-term clinical outcomes for patients with resectable colorectal cancer.
本研究旨在探讨腹腔镜结直肠切除术在加速康复方案中是否能改善患者的恢复情况。
本研究通过查询前瞻性结直肠数据库，共纳入 2005 年 1 月 1 日至 2009 年 12 月 31 日期间接受择期结直肠切除术且行一期吻合术治疗结直肠癌的 350 例患者。患者分为两组（腹腔镜组和开放组），分别独立审查两组的人口统计学、治疗和结果变量，以确保准确性。制定了详细的快速康复方案，并分发给所有患者、科室医生和护士，以规范治疗。
共 209 例患者接受了腹腔镜辅助结直肠切除术，141 例行开放手术。两组在年龄、性别、BMI、ASA、合并症、既往腹部手术、术前放化疗、肿瘤部位和 AJCC 2002 分期等方面无差异。腹腔镜组中有 23 例患者因出血、肿瘤扩散或技术困难需要转为开放手术。腹腔镜组患者更早耐受饮食、排便、放屁和排便、下床活动、拔除引流管和停止使用镇痛药物。术后住院时间更短（4 天 vs. 7 天，p=0.0004），术后非手术并发症发生率更低（3% vs. 13%，p=0.009）。
本研究表明，在加速康复方案中，腹腔镜结直肠切除术可为可切除结直肠癌患者提供最佳的短期临床结果。
