Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
Dig Surg. 2011;28(5-6):404-9. doi: 10.1159/000332007. Epub 2011 Dec 20.
BACKGROUND/AIMS: To evaluate the short-term surgical outcomes of laparoscopic intersphincteric resection (ISR) for lower rectal cancer, and to compare them with a case-control series of open ISR.
Between July 2002 and March 2011, 29 patients with lower rectal cancer underwent laparoscopic ISR, and 22 of 29 patients who underwent laparoscopic ISR were compared with the control open ISR group of patients matched for age, gender, operative procedure and pathological stage.
There was no perioperative mortality, 8 complications occurred in 7 patients, and the morbidity rate was 24.1% (7/29). Leakage occurred in 1 patient (3.4%) in the laparoscopic ISR group. Regarding the matched case-control study, the operative time was significantly longer (p = 0.0007), but blood loss was significantly lower (p = 0.0003) in the laparoscopic ISR group. The median postoperative hospital stay was 8 days in the laparoscopic ISR group, which was significantly shorter than in the open ISR group (14 days). Postoperative complication rates were similar. In the laparoscopic ISR group, the levels of C-reactive protein on postoperative days 1-3 were significantly lower than in the open ISR group.
Laparoscopic ISR for lower rectal cancer provides benefits in the early postoperative period without increasing morbidity or mortality.
背景/目的：评估腹腔镜经肛门直肠内括约肌切除术（ISR）治疗低位直肠癌的短期手术效果，并与开腹 ISR 的病例对照系列进行比较。
2002 年 7 月至 2011 年 3 月，29 例低位直肠癌患者接受了腹腔镜 ISR，其中 29 例患者中有 22 例与开腹 ISR 组进行了比较，该组患者在年龄、性别、手术方式和病理分期方面相匹配。
无围手术期死亡，7 例患者发生 8 例并发症，发病率为 24.1%（7/29）。腹腔镜 ISR 组有 1 例（3.4%）发生漏诊。关于匹配的病例对照研究，腹腔镜 ISR 组的手术时间明显延长（p = 0.0007），但出血量明显减少（p = 0.0003）。腹腔镜 ISR 组的中位术后住院时间为 8 天，明显短于开腹 ISR 组（14 天）。术后并发症发生率相似。在腹腔镜 ISR 组，术后第 1-3 天的 C 反应蛋白水平明显低于开腹 ISR 组。
腹腔镜 ISR 治疗低位直肠癌在不增加发病率或死亡率的情况下，可在术后早期获益。
