Brachet Contul Riccardo, Grivon Manuela, Fabozzi Massimiliano, Millo Paolo, Nardi Mario Junior, Aimonetto Stefania, Parini Umberto, Allieta Rosaldo
Department of General, Laparoscopic Colorectal and Bariatric Surgery, "Umberto Parini" Regional Hospital, viale Ginevra 3, 11100, Aosta, Italy,
J Gastrointest Surg. 2014 Apr;18(4):796-807. doi: 10.1007/s11605-013-2441-9. Epub 2014 Jan 18.
The oncologic efficacy of laparoscopic total mesorectal excision (TME) for middle-low rectal cancer is still under discussion because of the few long-term data. This study reports the results arising from a single-institution experience during a 18-year period.
Data about 132 consecutive laparoscopic TME performed between January 1994 and January 2012 were analysed with Kaplan-Meier method and a uni- and multi-variate analysis was conducted to define independent survival predictors.
A total of 116 sphincter-preserving operations and 16 abdominoperineal resections were performed. Postoperative mortality and morbidity were 0.8 and 18.2%, with a rate of anastomotic leakage of 13.8%. Average follow-up was 85.9 months (range 13-210). Actuarial local recurrence rate was 4.13% at 5 years (any pelvic recurrence developed after 3 years from surgery). Overall and disease-free survival was respectively 83 and 79.8% at 5 years, 71 and 73% at 10 years and then remained constant until 18 years. Survival was correlated only to tumour stage and the type of surgery.
Laparoscopic TME for extraperitoneal rectal cancer shows long-term oncologic outcomes similar to open rectal resections.
由于长期数据较少，腹腔镜全直肠系膜切除术（TME）治疗中低位直肠癌的肿瘤学疗效仍存在争议。本研究报告了一家机构18年间的单中心经验结果。
分析了1994年1月至2012年1月期间连续进行的132例腹腔镜TME的数据，采用Kaplan-Meier法进行分析，并进行单因素和多因素分析以确定独立的生存预测因素。
共进行了116例保留括约肌手术和16例腹会阴联合切除术。术后死亡率和发病率分别为0.8%和18.2%，吻合口漏发生率为13.8%。平均随访85.9个月（范围13 - 210个月）。5年时精算局部复发率为4.13%（任何盆腔复发均在术后3年以后出现）。5年时总生存率和无病生存率分别为83%和79.8%，10年时分别为71%和73%，此后至18年保持稳定。生存率仅与肿瘤分期和手术类型相关。
腹腔镜TME治疗腹膜外直肠癌的长期肿瘤学结果与开放性直肠切除术相似。
