Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Surg Endosc. 2012 Jul;26(7):1971-6. doi: 10.1007/s00464-011-2137-8. Epub 2012 Jan 12.
The effects of conversion to open surgery during laparoscopic resection for colorectal cancer on long-term oncologic outcomes still are unclear.
All 450 laparoscopic colorectal resections for cancer performed at a single center between 1994 and 2008 and included in a prospectively maintained database were considered. Patients who required conversion to open surgery (CONV) were matched 1:2 with laparoscopically completed cases (LAP) and 1:5 with open surgery cases (OPEN) for age, American Society of Anesthesiologists (ASA) score, year of surgery, tumor location, and tumor stage. Fisher's exact, chi-square, and Wilcoxon tests were used as appropriate. Kaplan-Meier curves were compared to analyze survival.
In this study, 31 CONV cases were independently compared with 62 LAP and 155 OPEN cases. Compared with the LAP and OPEN patients, the CONV patients were characterized by a numerically higher rate of preoperative comorbidity (61.3% vs LAP, 51.6; P = 0.4 and OPEN, 48.4%; P = 0.2), male gender (77.4% vs LAP, 59.7%; P = 0.09 and OPEN, 58.1%; P = 0.05), and a significantly higher mean body mass index (29.6 vs LAP, 26.8; P = 0.012 and OPEN, 28.8; P = 0.3). The pathologic tumor stage, location, and chemotherapy and radiotherapy rates were comparable among the groups. After a median follow-up period of 4.1, 4.2, and 4.6 years, the 5-year disease-free survival rate was significantly lower for the CONV patients (40.2%) than for the LAP (70.7%, P = 0.01) or the OPEN (63.3%, P = 0.04) patients. However, the 5-year cancer-specific survival rates were similar among the CONV (94.4%), LAP (86.1%, P = 0.36), and OPEN (84.9%, P = 0.14) patients.
Conversion to open surgery does not affect oncologic outcomes, although CONV patients have increased comorbidity rates affecting long-term mortality.
腹腔镜结直肠癌切除术中转开腹手术对长期肿瘤学结果的影响仍不清楚。
纳入了 1994 年至 2008 年期间在一家单中心进行的所有 450 例腹腔镜结直肠癌切除术患者，这些患者均被纳入了一个前瞻性维护的数据库中。所有需要中转开腹手术（CONV）的患者与腹腔镜下完成的病例（LAP）按年龄、美国麻醉医师协会（ASA）评分、手术年份、肿瘤位置和肿瘤分期进行 1:2 配对，并与开腹手术病例（OPEN）进行 1:5 配对。使用 Fisher 精确检验、卡方检验和 Wilcoxon 检验进行适当的比较。使用 Kaplan-Meier 曲线进行比较以分析生存情况。
在这项研究中，31 例 CONV 病例与 62 例 LAP 和 155 例 OPEN 病例进行了独立比较。与 LAP 和 OPEN 患者相比，CONV 患者术前合并症的发生率更高（61.3% vs LAP，51.6%；P=0.4 和 OPEN，48.4%；P=0.2），男性比例更高（77.4% vs LAP，59.7%；P=0.09 和 OPEN，58.1%；P=0.05），平均体重指数更高（29.6 vs LAP，26.8；P=0.012 和 OPEN，28.8；P=0.3）。各组的肿瘤病理分期、位置和化疗、放疗率相似。在中位随访 4.1、4.2 和 4.6 年后，CONV 患者的 5 年无病生存率显著低于 LAP（70.7%，P=0.01）或 OPEN（63.3%，P=0.04）患者。然而，CONV（94.4%）、LAP（86.1%，P=0.36）和 OPEN（84.9%，P=0.14）患者的 5 年癌症特异性生存率相似。
中转开腹手术不会影响肿瘤学结果，尽管 CONV 患者的合并症发生率更高，这会影响长期死亡率。
