Northern and Yorkshire Cancer Registry and Information Service, St James's Institute of Oncology, St James's University Hospital, Leeds, UK.
Br J Surg. 2013 Mar;100(4):553-60. doi: 10.1002/bjs.9023. Epub 2013 Jan 3.
Clinical guidelines recommend that, where clinically appropriate, laparoscopic tumour resections should be available for patients with colorectal cancer. This study aimed to examine the introduction of laparoscopic surgery in the English National Health Service.
Data were extracted from the National Cancer Data Repository on all patients who underwent major resection for a primary colorectal cancer diagnosed between 2006 and 2008. Laparoscopic procedures were identified from codes in the Hospital Episode Statistics and National Bowel Cancer Audit Project data in the resource. Trends in the use of laparoscopic surgery and its influence on outcomes were examined.
Of 58 135 resections undertaken over the study period, 10 955 (18·8 per cent) were attempted laparoscopically. This increased from 10·0 (95 per cent confidence interval (c.i.) 8·1 to 12·0) per cent in 2006 to 28·4 (25·4 to 31·4) per cent in 2008. Laparoscopic surgery was used less in patients with advanced disease (modified Dukes' stage 'D' versus A: odds ratio (OR) 0·45, 95 per cent c.i. 0·40 to 0·50), rectal tumours (OR 0·71, 0·67 to 0·75), those with more co-morbidity (Charlson score 3 or more versus 0: OR 0·69, 0·58 to 0·82) or presenting as an emergency (OR 0·15, 0·13 to 0·17). A total of 1652 laparoscopic procedures (15·1 per cent) were converted to open surgery. Conversion was more likely in advanced disease (modified Dukes' stage 'D' versus A: OR 1·56, 1·20 to 2·03), rectal tumours (OR 1·29, 1·14 to 1·46) and emergencies (OR 2·06, 1·54 to 2·76). Length of hospital stay (OR 0·65, 0·64 to 0·66), 30-day postoperative mortality (OR 0·55, 0·48 to 0·64) and risk of death within 1 year (hazard ratio 0·60, 0·55 to 0·65) were reduced in the laparoscopic group.
Laparoscopic surgery was used more frequently in low-risk patients.
临床指南建议，在临床合适的情况下，应向结直肠癌患者提供腹腔镜肿瘤切除术。本研究旨在检查腹腔镜手术在英国国家医疗服务体系中的引入情况。
从国家癌症数据库中提取了所有在 2006 年至 2008 年间接受原发性结直肠癌主要切除术的患者的数据。从医院病例统计数据和国家肠道癌症审计项目数据中的代码中确定了腹腔镜手术。研究了腹腔镜手术使用的趋势及其对结果的影响。
在研究期间进行的 58135 例切除术中有 10955 例（18.8%）为腹腔镜尝试。这一比例从 2006 年的 10.0%（95%置信区间（CI）8.1-12.0）增加到 2008 年的 28.4%（25.4-31.4）。在患有晚期疾病（改良 Dukes'分期 D 与 A：比值比（OR）0.45，95%CI 0.40-0.50）、直肠肿瘤（OR 0.71，0.67-0.75）、合并症较多（Charlson 评分 3 分或以上与 0：OR 0.69，0.58-0.82）或表现为急症（OR 0.15，0.13-0.17）的患者中，腹腔镜手术的使用较少。共有 1652 例腹腔镜手术（15.1%）转为开腹手术。在晚期疾病（改良 Dukes'分期 D 与 A：OR 1.56，1.20-2.03）、直肠肿瘤（OR 1.29，1.14-1.46）和急症（OR 2.06，1.54-2.76）患者中，转化为开腹手术的可能性更大。腹腔镜组的住院时间（OR 0.65，0.64-0.66）、30 天术后死亡率（OR 0.55，0.48-0.64）和 1 年内死亡风险（风险比 0.60，0.55-0.65）均降低。
腹腔镜手术在低危患者中应用更为广泛。
