Department of Surgery, Seoul Veterans' Hospital, Dunchon 2-dong, Gangdong-gu, Seoul, South Korea.
Surg Endosc. 2012 Feb;26(2):493-500. doi: 10.1007/s00464-011-1907-7. Epub 2011 Oct 20.
Laparoscopic resection for colorectal cancer has become popular. However, no previous studies have compared the laparoscopic and open approaches for colorectal cancer adherent to adjacent organs. This study analyzed the short- and long-term survival outcomes after laparoscopic multivisceral resection of the locally advanced primary colorectal cancer compared with open procedure in an effort to address appropriate patient selection.
From a prospectively collected database, 54 patients with locally advanced primary colorectal cancer who had undergone multivisceral resection from March 2001 to September 2009 were identified. Laparoscopic and open surgeries were selectively performed for 38 and 16 patients, respectively.
The two groups had similar demographics, with no differences in age, sex, and comorbidity. However, five emergency or urgency operations were included in the open group. No differences existed between the two groups in terms of tumor node metastasis (TNM) staging, histologic tumor infiltration rates, or curative resection rates. Three patients (7.9%) in the laparoscopic group required conversion to open procedure. In the laparoscopic group, the operation time was longer (330 vs. 257 min; p = 0.018), the volume of blood loss was less (269 vs. 638 ml; p = 0.000), and the time until return of bowel movement was shorter (3.7 vs. 4.7 days; p = 0.029) than in the open group. The perioperative morbidity rates were similar in the two groups (21.1% vs. 43.7%; p = 0.107), and no perioperative mortality occurred in either group. The mean follow-up period after curative resection was 40 months in the laparoscopic group and 35 months in the open group. The two groups showed similar rates for local recurrence (7.7% vs. 27.3%; p = 0.144) and distant metastasis (15.4% vs. 45.5%; p = 0.091). The overall 5-year survival rate was 60.5% for the laparoscopic group and 47.7% for the open group (p = 0.044, log-rank test). In terms of TNM stages, the overall 5-year survival rate for pathologic stage 3 disease was 58.3% for the laparoscopic group and 25% for the open group (p = 0.022, log rank test), but no difference was noted for the stage 2 patients (p = 0.384).
No adverse long-term oncologic outcomes of laparoscopic resection were observed in this study. Although inherent limitations exist in this nonrandomized study, laparoscopic multivisceral resection seems to be a feasible and effective treatment option for colorectal cancer for carefully selected patients. Patients with colon cancer should be much more carefully selected for laparoscopic multivisceral resection than patients with rectal cancer because anatomic uncertainty can make oncologic en bloc resection incomplete.
腹腔镜结直肠切除术已得到广泛应用。然而，既往研究均未比较腹腔镜与开腹手术治疗结直肠与毗邻器官粘连的效果。本研究旨在探讨腹腔镜结直肠多脏器切除术治疗局部进展期原发性结直肠癌的短期和长期生存结局，以确定合适的患者选择。
从前瞻性收集的数据库中，确定了 2001 年 3 月至 2009 年 9 月期间接受多脏器切除术的 54 例局部进展期原发性结直肠癌患者。分别对 38 例患者选择性地进行了腹腔镜手术和开腹手术，16 例患者则进行了开腹手术。
两组患者的人口统计学特征相似，年龄、性别和合并症无差异。然而，开腹组有 5 例为急诊或紧急手术。两组在肿瘤淋巴结转移（TNM）分期、组织学肿瘤浸润率或根治性切除率方面无差异。腹腔镜组有 3 例（7.9%）需要转为开腹手术。在腹腔镜组，手术时间更长（330 分钟 vs. 257 分钟；p = 0.018），出血量更少（269 毫升 vs. 638 毫升；p = 0.000），肠蠕动恢复时间更短（3.7 天 vs. 4.7 天；p = 0.029）。两组围手术期并发症发生率相似（21.1% vs. 43.7%；p = 0.107），两组均无围手术期死亡。腹腔镜组的中位随访时间为 40 个月，开腹组为 35 个月。两组局部复发率（7.7% vs. 27.3%；p = 0.144）和远处转移率（15.4% vs. 45.5%；p = 0.091）相似。腹腔镜组的 5 年总生存率为 60.5%，开腹组为 47.7%（p = 0.044，log-rank 检验）。在 TNM 分期方面，腹腔镜组病理分期为 3 期的患者 5 年总生存率为 58.3%，开腹组为 25%（p = 0.022，log rank 检验），而 2 期患者无差异（p = 0.384）。
本研究未观察到腹腔镜切除术的不良长期肿瘤学结局。尽管本非随机研究存在固有局限性，但腹腔镜多脏器切除术似乎是一种可行且有效的治疗选择，适用于精心选择的患者。与直肠患者相比，结肠癌患者更需要仔细选择腹腔镜多脏器切除术，因为解剖学的不确定性可能导致肿瘤整块切除不完全。
