家族性腺瘤性息肉病患者行开腹和腹腔镜结肠切除术的腹壁间叶性肿瘤风险。

Risk of desmoid tumours after open and laparoscopic colectomy in patients with familial adenomatous polyposis.

机构信息

Colorectal Surgery Unit, Department of Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy; Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, USA.

出版信息

Br J Surg. 2014 Apr;101(5):558-65. doi: 10.1002/bjs.9411. Epub 2014 Feb 3.

DOI:10.1002/bjs.9411

PMID:24493089

Abstract

BACKGROUND

Desmoid tumour (DT) is a main cause of death after prophylactic colectomy in patients with familial adenomatous polyposis (FAP). The purpose of this study was to evaluate the impact of prophylactic laparoscopic colectomy on the risk of developing DT in patients with FAP.

METHODS

The database of a single institution was reviewed. Patients with classical FAP with defined genotype who underwent either open or laparoscopic colectomy between 1947 and 2011 were included in the study. The impact of various demographic and clinical features on the risk of developing DT was assessed.

RESULTS

A total of 672 patients underwent prophylactic colectomy: 602 by an open and 70 by a laparoscopic approach. With a median (range) follow-up of 132 (0-516) months in the open group and 60 (12-108) months in the laparoscopic group, 98 patients (16·3 per cent) developed DT after an open procedure compared with three (4 per cent) following laparoscopic surgery. The estimated cumulative risk of developing DT at 5 years after surgery was 13·0 per cent in the open group and 4 per cent in the laparoscopic group (P = 0·042). In multivariable analysis, female sex (hazard ratio (HR) 2·18, 95 per cent confidence interval 1·40 to 3·39), adenomatous polyposis coli mutation distal to codon 1400 (HR 3·85, 1·90 to 7·80), proctocolectomy (HR 1·67, 1·06 to 2·61), open colectomy (HR 6·84, 1·96 to 23·98) and year of surgery (HR 1·04, 1·01 to 1·07) were independent risk factors for the diagnosis of DT after prophylactic surgery.

CONCLUSION

Laparoscopic surgery decreased the risk of DT after prophylactic colectomy in patients with FAP.

摘要

背景

在家族性腺瘤性息肉病（FAP）患者中，预防性结肠切除术的主要死亡原因是硬纤维瘤（DT）。本研究旨在评估预防性腹腔镜结肠切除术对 FAP 患者发生 DT 的风险的影响。

方法

回顾单一机构的数据库。纳入 1947 年至 2011 年间接受开放或腹腔镜结肠切除术的经典 FAP 患者，这些患者具有明确的基因型。评估各种人口统计学和临床特征对发生 DT 风险的影响。

结果

共有 672 例患者接受了预防性结肠切除术：602 例采用开放性手术，70 例采用腹腔镜手术。在开放性组的中位（范围）随访时间为 132（0-516）个月，在腹腔镜组为 60（12-108）个月，98 例（16.3%）患者在开放性手术后发生 DT，而 3 例（4%）患者在腹腔镜手术后发生 DT。术后 5 年发生 DT 的累积风险估计值为开放性组 13.0%，腹腔镜组 4.0%（P=0.042）。多变量分析显示，女性（风险比（HR）2.18，95%置信区间 1.40 至 3.39）、1400 密码子下游的结直肠腺瘤性息肉病突变（HR 3.85，1.90 至 7.80）、直肠结肠切除术（HR 1.67，1.06 至 2.61）、开放性结肠切除术（HR 6.84，1.96 至 23.98）和手术年份（HR 1.04，1.01 至 1.07）是预防性手术后诊断为 DT 的独立危险因素。