White Ian, Greenberg Ron, Itah Refael, Inbar Roy, Schneebaum Shlomo, Avital Shmuel
Department of Surgery A, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
JSLS. 2011 Apr-Jun;15(2):182-7. doi: 10.4293/108680811X13071180406439.
Long-term outcome of patients following conversion during laparoscopic surgery for colorectal cancer is not often reported. Recent data suggest a negative impact of conversion on long-term survival. This study aimed to evaluate the impact of conversion on the perioperative outcome and on long-term survival in patients who underwent laparoscopic resection for curable colorectal cancer.
Evaluation of our prospective in-hospital collected data of patients who underwent laparoscopic surgery for curable colorectal cancer over a 5-year period. Long-term data were collected from our outpatient's clinic data and personal contact when necessary.
During the study period, 175 patients were operated on laparoscopically for curable colon cancer (stage I-III). Mean follow-up was 33±18 months with a minimum follow-up of 12 months. For various reasons, 25 patients (14.4%) had to be converted to open surgery. Short-term outcome revealed a trend towards longer operations, a higher rate of surgical complications, and a longer hospital stay in the converted group. Five-year, Kaplan-Meier, disease-free analysis was worse for converted patients. Overall survival did not differ between the 2 groups. Cox proportional hazards regression analysis revealed that conversion and AJCC stage were independent risk factors for recurrence.
Conversion in laparoscopic surgery for curable colorectal cancer is associated with a worse perioperative outcome and worse disease-free survival.
腹腔镜结直肠癌手术中转开腹患者的长期预后情况鲜少被报道。近期数据表明中转开腹对长期生存有负面影响。本研究旨在评估中转开腹对接受腹腔镜根治性结直肠癌切除术患者围手术期结局及长期生存的影响。
对我们前瞻性收集的5年间接受腹腔镜根治性结直肠癌手术患者的住院数据进行评估。必要时从门诊数据及个人联系中收集长期数据。
在研究期间，175例患者接受了腹腔镜下可根治性结肠癌手术（Ⅰ-Ⅲ期）。平均随访时间为33±18个月，最短随访时间为12个月。由于各种原因，25例患者（14.4%）不得不中转开腹。短期结局显示，中转开腹组手术时间更长、手术并发症发生率更高且住院时间更长。Kaplan-Meier法分析显示，中转开腹患者的5年无病生存率更差。两组的总生存率无差异。Cox比例风险回归分析显示，中转开腹和美国癌症联合委员会（AJCC）分期是复发的独立危险因素。
腹腔镜根治性结直肠癌手术中转开腹与更差的围手术期结局及更差的无病生存率相关。
