Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA.
J Gastrointest Surg. 2011 Nov;15(11):1928-38. doi: 10.1007/s11605-011-1663-y. Epub 2011 Sep 10.
Outcomes between laparoscopic (LAPR) and open abdominoperineal resections (OAPR) are poorly described.
After IRB approval, 2005-2008 NSQIP data were used to identify patients undergoing LAPR and OAPR for rectal cancer. Logistic regression identified variables influencing the selection of LAPR vs. OAPR as well as the likelihood of postoperative events. Chi-square analysis was used to compare the incidence of 30-day postoperative events.
One thousand one hundred ninety-seven OAPRs and 143 LAPRs were identified. LAPRs were less likely to have a body mass index (BMI) of ≥30 (p = 0.04) and were associated with equivalent mean operative times (p = 0.36). LAPRs and OAPRs were found to have similar rates of surgical site infections (p = 0.13), transfusion requirements (p = 0.17), myocardial infarction (p = 0.48), and need for reoperation within 30 days (p = 0.20). Neoadjuvant radiotherapy did not directly increase complication rates in either group. Few factors predicted choice of LAPR but included BMI <25 (OR, 1.54; p = 0.02).
Complication rates between LAPR and OAPR were similar despite the greater technical challenge of LAPR. Wound infection rates were equivalent, which may reflect similar rates of perineal wound infections. Few patients are offered LAPR, possibly due to surgeon preferance as opposed to patient factors.
腹腔镜（LAPR）和开放式经腹会阴切除术（OAPR）的结果描述甚少。
在获得机构审查委员会批准后，使用 2005 年至 2008 年的 NSQIP 数据来确定接受腹腔镜和开放性经腹会阴切除术治疗直肠癌的患者。逻辑回归确定了影响 LAPR 与 OAPR 选择的变量以及术后事件发生的可能性。卡方分析用于比较 30 天术后事件的发生率。
共确定了 1197 例 OAPR 和 143 例 LAPR。LAPR 发生 BMI≥30 的可能性较小（p=0.04），且平均手术时间相当（p=0.36）。LAPR 和 OAPR 的手术部位感染发生率（p=0.13）、输血需求（p=0.17）、心肌梗死（p=0.48）和 30 天内再次手术的需求（p=0.20）相似。新辅助放疗并未直接增加两组的并发症发生率。选择 LAPR 的少数因素可以预测，但包括 BMI<25（OR，1.54；p=0.02）。
尽管 LAPR 具有更大的技术挑战，但 LAPR 和 OAPR 的并发症发生率相似。感染率相当，这可能反映了会阴伤口感染的相似发生率。很少有患者接受 LAPR，这可能是由于外科医生的偏好，而不是患者的因素。
