Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Comprehensive Planning Office, Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
J Surg Res. 2014 Apr;187(2):438-44. doi: 10.1016/j.jss.2013.10.039. Epub 2013 Oct 22.
The efficacy of laparoscopic treatment of rectal cancer remains unclear, and little is known about its effect on sphincter preservation. We compared short-term outcomes of laparoscopically assisted and open surgeries following neoadjuvant chemoradiotherapy (CRT) for mid and low rectal cancer.
This study enrolled 137 patients with mid-low rectal cancer who underwent curative resection, 51 by laparoscopically assisted (Lap group) and 86 by conventional open (Open group) surgeries, following neoadjuvant CRT from July 2007 to July 2012. The clinical and surgical findings of the two groups of patients were prospectively collected and analyzed.
Three patients (5.9%) in the Lap group were converted to an open procedure. The mean operating times were similar in both groups. The Lap group had a significantly higher rate of sphincter preservation (62.7% versus 41.9%, P = 0.018) and significantly lower mean blood loss than the Open group. Mean times to first flatus, start of a normal diet, and overall postoperative hospitalization were longer for open surgery. The complication rate (11.8% versus 31.4%, P = 0.009) was significantly lower in the Lap group. Mean distal resection margin, involvement of the circumferential resection margin (2.0% versus 3.5%, P = 1.000), and mean lymph nodes harvested (12 versus 11; P = 0.242) were equivalent in the two groups.
Laparoscopically assisted surgery following neoadjuvant CRT is safe for patients with rectal cancer and provides favorable short-term benefits but without compromising oncologic outcomes. This sphincter-preserving procedure may be a treatment of choice for patients with lower rectal cancer.
腹腔镜治疗直肠癌的疗效尚不清楚，其对肛门保留的影响知之甚少。我们比较了新辅助放化疗（CRT）后中低位直肠癌腹腔镜辅助和开放手术的短期疗效。
本研究纳入了 137 例接受根治性切除术的中低位直肠癌患者，其中 51 例行腹腔镜辅助手术（Lap 组），86 例行传统开放手术（Open 组），均于 2007 年 7 月至 2012 年 7 月接受新辅助 CRT。前瞻性收集并分析两组患者的临床和手术资料。
Lap 组有 3 例（5.9%）中转开腹。两组的平均手术时间相似。Lap 组保肛率明显高于 Open 组（62.7%比 41.9%，P=0.018），术中出血量明显少于 Open 组。开放手术后首次排气、开始正常饮食和总住院时间较长。Lap 组的并发症发生率（11.8%比 31.4%，P=0.009）明显较低。两组的远端切缘平均距离、环周切缘受累（2.0%比 3.5%，P=1.000）和平均淋巴结检出数（12 比 11；P=0.242）相当。
新辅助 CRT 后行腹腔镜辅助手术治疗直肠癌安全，可获得良好的短期疗效，且不会影响肿瘤学结局。对于低位直肠癌患者，这种保肛手术可能是一种治疗选择。
