Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, 7 Lakeside, Cleveland, OH, 44106-5047, USA,
Surg Endosc. 2014 Jul;28(7):2129-36. doi: 10.1007/s00464-014-3444-7. Epub 2014 Feb 1.
Laparoscopy is increasingly used for rectal cancer surgery. Laparoscopic surgery is not attempted for some suitable patients because of concerns for conversion or technical difficulty. This study aimed to evaluate oncologic and short-term outcomes for patients undergoing curative resection for rectal cancer via laparoscopic and open approaches.
A prospective database was reviewed to identify rectal cancer resections from 2005 to 2011. Patients who had primary rectal cancer within 15 cm of the anal verge were included in the study. Those with recurrent or metastatic disease were excluded. Patients were assigned to laparoscopic or open approaches preoperatively based on clinical criteria and imaging. All patients underwent a standard total mesorectal excision and followed a standardized enhanced recovery pathway. The oncologic and clinical outcomes were evaluated by approach.
The analysis included 81 patients. The preoperative assignments consisted of 62 laparoscopic (77%) and 19 open (23%) procedures. Nine laparoscopic procedures (14.5%) were converted to open procedures. After a median follow-up period of 25 months, all oncologic outcomes were comparable. Three patients (two laparoscopic, one open) had a positive circumferential margin (≤1 mm). The laparoscopic and open groups were similar in terms of their 3-year disease-free periods (93.6 vs. 88.2%; P = 0.450) and overall survival periods (93.5 vs. 90.9%; P = 0.766). The local recurrence rate was 2.5%.
Laparoscopic resection for rectal cancer can be attempted for most patients. Conversion to open procedure does not compromise clinical or oncologic outcomes. In practice, combining laparoscopic and open surgery optimizes resource use and results in at least equivalent outcomes.
腹腔镜技术在直肠癌手术中应用日益广泛。但一些适合进行腹腔镜手术的患者由于担心中转开腹或技术难度而选择了开放手术。本研究旨在评估腹腔镜和开放手术治疗直肠癌患者的肿瘤学和短期结局。
回顾性分析 2005 年至 2011 年期间的直肠癌手术数据库，纳入距肛缘 15cm 以内的原发性直肠癌患者，排除复发性或转移性疾病患者。根据临床标准和影像学检查，患者术前被分配接受腹腔镜或开放手术。所有患者均接受标准全直肠系膜切除术，并采用标准化的加速康复路径。通过手术方式评估肿瘤学和临床结局。
共纳入 81 例患者，术前分配 62 例（77%）行腹腔镜手术，19 例（23%）行开放手术。9 例（14.5%）腹腔镜手术中转开腹。中位随访 25 个月后，所有肿瘤学结局无差异。3 例（2 例腹腔镜手术，1 例开放手术）切缘阳性（≤1mm）。腹腔镜组和开放组的 3 年无病生存率（93.6%比 88.2%；P=0.450）和总生存率（93.5%比 90.9%；P=0.766）相似。局部复发率为 2.5%。
腹腔镜直肠癌切除术适用于大多数患者，中转开腹并不影响临床或肿瘤学结局。在实际操作中，结合腹腔镜和开放手术可以优化资源利用，并获得至少相当的结局。
