Hahn Koo-Yong, Baek Se-Jin, Joh Yong-Geul, Kim Seon-Hahn
Department of Surgery, Seongnam Central Hospital, Seongnam, Korea.
J Laparoendosc Adv Surg Tech A. 2012 Jul-Aug;22(6):561-6. doi: 10.1089/lap.2011.0422. Epub 2012 Jun 12.
Although the advantages of laparoscopic colectomy have been demonstrated, there are few data available on laparoscopic resection of transverse colon cancer. The purpose of this study was to assess operative outcomes, long-term survival, and disease recurrence after laparoscopic resection of transverse colon cancer.
Prospective data were collected from 58 patients with transverse colon cancer among 1141 colorectal cancer cases undergoing laparoscopic resection between February 2001 and July 2009. Cancers located in both flexures were excluded.
The surgical procedures included 39 extended right hemicolectomies, 11 extended left hemicolectomies, 5 transverse colectomies, and 3 total abdominal colectomies. The mean operating time was 216 minutes, and the mean operative blood loss was 111 mL. The average harvested lymph nodes were 35.8. The proximal and distal resection margins were 20.27 cm and 15.23 cm, respectively. Eight patients developed minor complications postoperatively, but these cases were controlled conservatively without interventions. One patient was converted to an open procedure because of severe adhesions. There were no surgery-related deaths. The mean follow-up period was 40.5 months. There were no local recurrences during the follow-up period. Systemic recurrence developed in four patients: two in the liver and two with peritoneal seeding. The overall and disease-free survival rates at 5 years were 84.6% and 89.3%, respectively.
Compared with previously published multicenter studies such as the COST, COLOR, and CLASICC trials, the long-term outcomes of this study demonstrate that transverse colon cancer can safely be resected using the laparoscopic technique in experienced hands.
尽管腹腔镜结肠切除术的优势已得到证实，但关于腹腔镜下横结肠癌切除术的可用数据较少。本研究的目的是评估腹腔镜下横结肠癌切除术后的手术效果、长期生存率和疾病复发情况。
前瞻性收集了2001年2月至2009年7月期间1141例行腹腔镜切除术的结直肠癌病例中的58例横结肠癌患者的数据。位于结肠两曲的癌症患者被排除。
手术方式包括39例扩大右半结肠切除术、11例扩大左半结肠切除术、5例横结肠切除术和3例全腹结肠切除术。平均手术时间为216分钟，平均术中失血量为111毫升。平均清扫淋巴结数为35.8枚。近端和远端切缘分别为20.27厘米和15.23厘米。8例患者术后出现轻微并发症，但这些病例经保守治疗得到控制，无需干预。1例患者因严重粘连改为开放手术。无手术相关死亡。平均随访时间为40.5个月。随访期间无局部复发。4例患者发生全身复发：2例肝转移，2例腹膜种植转移。5年总生存率和无病生存率分别为84.6%和89.3%。
与先前发表的多中心研究如COST、COLOR和CLASICC试验相比，本研究的长期结果表明，在经验丰富的医生手中，使用腹腔镜技术可安全切除横结肠癌。
