Araújo Sergio Eduardo Alonso, Seid Victor Edmond, Bertoncini Alexandre, Campos Fabio Guilherme, Sousa Afonso, Nahas Sergio Carlos, Cecconello Ivan
Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Hepatogastroenterology. 2011 Sep-Oct;58(110-111):1545-54. doi: 10.5754/hge11114. Epub 2011 Jul 15.
BACKGROUND/AIMS: Laparoscopic total mesorectal excision for rectal cancer is under scrutiny. This study aimed at analyzing feasibility, adequacy of resection, impact on early outcomes after neoadjuvant chemoradiation therapy, and to investigate trend towards indication of laparoscopy for sphincter-preservation in a single university medical center.
Patients with distal rectal cancer submitted to neoadjuvant treatment followed by laparoscopic total mesorectal excision were prospectively enrolled. The studied parameters were: demographics, previous surgery, BMI, type of operation, rate of sphincter-preserving surgery, duration of surgery, conversion, specimen retrieval, lymphadenectomy, distal and radial margins, intra and postoperative morbidity, reoperations, hospital stay, and mortality.
From January 2000 to July 2010, 68 patients were enrolled. Mean age was 60 (30-87) years. There were 27 anterior and 41 abdominoperineal resections. Six patients underwent a totally laparoscopic resection and coloanal anastomosis. There was a trend (p=0.003) towards more sphincter-preserving surgery. Conversion was 4.5%. Intraoperative complication was 7.4%. Postoperative complications occurred in 15%. Mortality was 3%. Lymph-node harvest was 11 (0-33). Mean distal margin was 2.5cm (1-4). Radial margins were positive in 3 (10%) cases.
Laparoscopic total mesorectal excision after neoadjuvant treatment is feasible and safe. Sphincter-preserving laparoscopic oncologic rectal surgery has been accomplished more frequently.
背景/目的：直肠癌的腹腔镜全直肠系膜切除术正在接受审视。本研究旨在分析其可行性、切除的充分性、新辅助放化疗后对早期结局的影响，并调查在单一大学医学中心腹腔镜用于保肛手术指征的趋势。
前瞻性纳入接受新辅助治疗后行腹腔镜全直肠系膜切除术的低位直肠癌患者。研究参数包括：人口统计学资料、既往手术史、体重指数、手术类型、保肛手术率、手术时长、中转率、标本获取、淋巴结清扫、远切缘和径切缘、术中和术后发病率、再次手术、住院时间及死亡率。
2000年1月至2010年7月，共纳入68例患者。平均年龄60（30 - 87）岁。其中27例行前切除术，41例行腹会阴联合切除术。6例患者接受了全腹腔镜切除术及结肠肛管吻合术。保肛手术有增多趋势（p = 0.003）。中转率为4.5%。术中并发症发生率为7.4%。术后并发症发生率为15%。死亡率为3%。平均淋巴结清扫数目为11（0 - 33）枚。平均远切缘为2.5cm（1 - 4cm）。3例（10%）患者径切缘阳性。
新辅助治疗后行腹腔镜全直肠系膜切除术是可行且安全的。保肛的腹腔镜肿瘤性直肠手术实施得更为频繁。
