Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
World J Surg. 2013 Mar;37(3):646-51. doi: 10.1007/s00268-012-1846-z.
Laparoscopic resection is increasingly being performed for rectal cancer. However, few data are available to compare long-term outcomes after open versus laparoscopic surgery for early-stage rectal cancer.
Included in this retrospective study were 160 patients who underwent surgery for stage I rectal cancer between 2001 and 2008. Perioperative outcomes, overall survival (OS), and disease-free survival (DFS) were compared for open versus laparoscopic surgery.
Altogether, 85 patients were treated using open surgery and 80 with laparoscopic surgery. Postoperative mortality (0 vs. 1.3%; p = 1.00), morbidity (31.3 vs. 25.0%; p = 0.38), and harvested lymph nodes (22.5 vs. 20.0; p = 0.84) were similar for the two groups. However, operating time was longer (183.8 vs. 221.0 min; p = 0.008), volume of intraoperative bleeding was less (200.0 vs. 150.0 ml; p = 0.03), time to first bowel movement was shorter (3.54 vs. 2.44 days; p < 0.001), rate of superficial surgical-site infection was lower (7.5 vs. 0%; p = 0.03), and postoperative hospital stay was shorter (11.0 vs. 8.0 days; p < 0.001) in the laparoscopy group than in the open surgery group. At 5 years, there was no difference in OS (98.6 vs. 97.1%; p = 0.41) or DFS (98.2 vs. 96.4%; p = 0.30) between the open and laparoscopy groups.
Long-term outcomes of laparoscopic surgery for stage I rectal cancer were comparable to those of open surgery. Laparoscopic surgery, however, produced more favourable short-term outcomes than open surgery.
腹腔镜切除术越来越多地用于直肠癌的治疗。然而，对于早期直肠癌的开放手术与腹腔镜手术的长期结果，目前仅有少数数据可供比较。
本回顾性研究纳入了 2001 年至 2008 年间接受 I 期直肠癌手术的 160 例患者。比较了开放手术与腹腔镜手术的围手术期结果、总生存期（OS）和无病生存期（DFS）。
共有 85 例患者接受了开放手术，80 例患者接受了腹腔镜手术。两组患者的术后死亡率（0 与 1.3%；p = 1.00）、发病率（31.3 与 25.0%；p = 0.38）和采集的淋巴结数（22.5 与 20.0；p = 0.84）相似。然而，腹腔镜组的手术时间较长（183.8 与 221.0 分钟；p = 0.008），术中出血量较少（200.0 与 150.0 毫升；p = 0.03），首次排气时间较短（3.54 与 2.44 天；p < 0.001），浅表手术部位感染率较低（7.5 与 0%；p = 0.03），术后住院时间较短（11.0 与 8.0 天；p < 0.001）。5 年时，开放组与腹腔镜组的 OS（98.6 与 97.1%；p = 0.41）和 DFS（98.2 与 96.4%；p = 0.30）无差异。
腹腔镜治疗 I 期直肠癌的长期结果与开放手术相当。然而，腹腔镜手术的短期结果优于开放手术。
