Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Best Pract Res Clin Gastroenterol. 2014 Feb;28(1):29-39. doi: 10.1016/j.bpg.2013.11.017. Epub 2013 Dec 10.
The laparoscopic approach for colorectal cancer resection has been evolved from an experimental procedure with oncological concerns to routine daily practice within a period of two decades. Numerous randomized controlled trials and meta-analyses have shown that laparoscopic resection results in faster recovery with similar oncological outcome compared to an open approach, both for colon and rectal cancer. Besides improved cosmesis, other long-term advantages seem to be less adhesion related small bowel obstruction and reduced incisional hernia rate. Adequate patient selection and surgical experience are of crucial importance. Experience can be gradually expanded step by step, by increasing the complexity of the procedure. A decision to convert should be made early in the procedure, because the outcome after a reactive conversion is worse than initial open resection or strategic conversion. The additive value of new techniques such as robotic surgery has to be proven in randomized studies including a cost-effectiveness assessment.
腹腔镜结直肠癌切除术的发展经历了从一个具有肿瘤学顾虑的实验性手术，到在二十年的时间内成为常规日常实践的过程。大量随机对照试验和荟萃分析表明，与开放手术相比，腹腔镜切除术在结直肠癌的治疗中具有更快的恢复速度和相似的肿瘤学结果。除了改善美容效果外，其他长期优势似乎还包括较少粘连相关的小肠梗阻和降低切口疝的发生率。适当的患者选择和手术经验至关重要。经验可以通过逐步增加手术的复杂性来逐步扩展。应该在手术早期就做出转换的决定，因为反应性转换后的结果比初始的开放性切除或策略性转换更差。机器人手术等新技术的附加价值需要在包括成本效益评估的随机研究中得到证明。
