Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-10-6, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
J Gastrointest Surg. 2013 Jul;17(7):1299-305. doi: 10.1007/s11605-013-2222-5. Epub 2013 May 8.
The role of laparoscopic surgery for locally advanced colorectal cancer invading or adhering to neighboring organs is controversial. This study evaluated the safety and feasibility of laparoscopic multivisceral resection for colorectal cancer.
This study included 126 patients who underwent multivisceral resection for primary colorectal cancer invading or adhering to neighboring organs or structures between July 2005 and November 2012 at our institution. Perioperative outcomes were compared between laparoscopic and open resections.
Laparoscopic and open multivisceral resections were performed in 60 and 66 patients, respectively. Conversion to open surgery occurred in 6.7 % of patients. The median operative time was significantly longer (271 vs. 227 min), but the median blood loss was significantly less (40 vs. 205 mL), in the laparoscopic compared with the open group. The R0 resection rate of the primary tumor (95 vs. 98.5 %), number of lymph nodes harvested (18 vs. 18), and postoperative complications (28 vs. 24 %) were comparable between the groups. The median length of hospital stay was significantly shorter (13.5 vs. 18 days) in the laparoscopic compared with the open group.
Laparoscopic multivisceral resection for colorectal cancer invading or adhering to neighboring organs is safe and feasible in selected patients.
腹腔镜手术治疗局部晚期侵犯或黏附邻近器官的结直肠癌的作用存在争议。本研究评估了腹腔镜联合脏器切除术治疗结直肠癌的安全性和可行性。
本研究纳入了 2005 年 7 月至 2012 年 11 月在我院接受原发性结直肠癌侵犯或黏附邻近器官或结构的联合脏器切除术的 126 例患者。比较了腹腔镜和开放性切除术的围手术期结果。
60 例患者接受了腹腔镜联合脏器切除术，66 例患者接受了开放性联合脏器切除术。有 6.7%的患者中转开腹手术。与开放性组相比，腹腔镜组的中位手术时间显著延长（271 分钟 vs. 227 分钟），但中位出血量显著减少（40 毫升 vs. 205 毫升）。腹腔镜组和开放性组的肿瘤 R0 切除率（95% vs. 98.5%）、淋巴结清扫数目（18 枚 vs. 18 枚）和术后并发症发生率（28% vs. 24%）相当。腹腔镜组的中位住院时间明显短于开放性组（13.5 天 vs. 18 天）。
对于选择合适的患者，腹腔镜联合脏器切除术治疗侵犯或黏附邻近器官的结直肠癌是安全可行的。
