Tan K K, Chong C S, Tsang C B, Koh D C
National University Health System, Department of Surgery, Division of Colorectal Surgery, Singapore.
Med J Malaysia. 2013 Aug;68(4):348-52.
Oncologic outcomes following laparoscopic abdomino-perineal resection (APR) for distal rectal cancer are infrequently reported. This study aims to compare the long term outcomes between laparoscopic and open APR in distal rectal cancers.
A retrospective review of all patients who underwent APR for distal rectal cancer from May 2001 to November 2009 was performed.
Forty-two patients, median age 60 (24 - 86) years, formed the study group. Laparoscopic resection was attempted in 16 patients and was successful in all but one. Patients with recurrent diseases, previous abdominal operations and neoadjuvant chemoradiation were more likely to undergo open APR. There were no differences in the T-staging, number of lymph nodes harvested or the final stage of the disease between the two groups. The laparoscopic APR group had a shorter median length of hospitalization (7 vs. 10 days, p < 0.05), but longer operative duration (300 vs. 240 minutes, p > 0.05). Excluding the 9 (21.4%) patients with metastatic disease on presentation, 13 (39.4%) developed recurrence after a median follow up of 24 (4 - 107) months. Twenty (47.6%) patients died from their advanced disease subsequently while one (2.4%) died from a noncancer related cause. Analysis showed that tumour stage and circumferential resection margin positivity were associated with a poorer survival. The types of approach had no significant impact on the survival.
Laparoscopic APR for distal rectal cancer yields similar oncologic outcomes as open APR. Long-term outcome is determined by the tumour stage and circumferential resection margin and not the approach.
腹腔镜腹会阴联合切除术（APR）治疗低位直肠癌的肿瘤学结局鲜有报道。本研究旨在比较腹腔镜与开放APR治疗低位直肠癌的长期结局。
对2001年5月至2009年11月期间所有接受APR治疗低位直肠癌的患者进行回顾性研究。
42例患者构成研究组，中位年龄60（24 - 86）岁。16例患者尝试行腹腔镜切除术，除1例失败外其余均成功。复发性疾病、既往腹部手术史及新辅助放化疗患者更可能接受开放APR。两组间T分期、清扫淋巴结数目或疾病最终分期无差异。腹腔镜APR组中位住院时间较短（7天对10天，p < 0.05），但手术时间较长（300分钟对240分钟，p > 0.05）。排除9例（21.4%）初诊时即有转移的患者，中位随访24（4 - 107）个月后，13例（39.4%）出现复发。20例（47.6%）患者随后死于晚期疾病，1例（2.4%）死于非癌症相关原因。分析显示肿瘤分期和环周切缘阳性与较差的生存率相关。手术方式对生存率无显著影响。
腹腔镜APR治疗低位直肠癌的肿瘤学结局与开放APR相似。长期结局取决于肿瘤分期和环周切缘，而非手术方式。
