不列颠哥伦比亚基于人群的队列中腹腔镜结肠癌手术的结果：是否与临床试验一样好？

Outcomes of laparoscopic colon cancer surgery in a population-based cohort in British Columbia: are they as good as the clinical trials?

机构信息

University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Am J Surg. 2012 Oct;204(4):411-5. doi: 10.1016/j.amjsurg.2011.11.015. Epub 2012 May 17.

DOI:10.1016/j.amjsurg.2011.11.015

PMID:22607740

Abstract

BACKGROUND

Randomized controlled trials have shown equivalent outcomes for laparoscopic-assisted colectomy (LAC) and open colectomy (OC) when performed by well-trained surgeons experienced in both techniques. Our goal was to evaluate the outcomes of LAC at a population level.

METHODS

Using the prospectively collected Gastrointestinal Cancer Outcomes Unit database from the British Columbia Cancer Agency, short- and long-term outcomes in patients with colon cancer treated with LAC and OC were compared from 2003 to 2008 inclusive.

RESULTS

There was a statistically significant increase in the proportion of LAC from 2003 to 2008 (P < .001). LAC was more likely to be performed in the elective setting (P < .001) and for smaller tumors (P < .001). A similar proportion of patients had a minimum of 12 lymph nodes identified by pathology (58% vs 60%, P = not significant). Disease-free survival was similar for the 2 groups after adjusting for stage, emergency presentation, and adjuvant chemotherapy. There was no difference in overall survival.

CONCLUSIONS

The introduction of LAC for colon cancer in British Columbia outside of optimized clinical trial conditions appears to be effective and safe.

摘要

背景

随机对照试验表明，对于经验丰富的外科医生进行的腹腔镜辅助结直肠切除术（LAC）和开放结直肠切除术（OC），其结果是等效的。我们的目标是在人群水平上评估 LAC 的结果。

方法

使用不列颠哥伦比亚癌症机构胃肠道癌症结果单位的前瞻性收集数据库，从 2003 年至 2008 年 inclusive 比较了接受 LAC 和 OC 治疗的结肠癌患者的短期和长期结果。

结果

从 2003 年到 2008 年，LAC 的比例有统计学意义的增加（P <.001）。LAC 更可能在选择性环境中进行（P <.001），并且肿瘤较小（P <.001）。病理检查至少有 12 个淋巴结的患者比例相似（58%比 60%，P = 无显著差异）。在调整分期、紧急情况和辅助化疗后，两组的无病生存率相似。总生存率无差异。