Huscher Cristiano G S, Bretagnol Frederic, Corcione Francesco
Oncologic Surgery, Ospedale Rummo, Benevento, Italy.
World J Surg. 2015 Aug;39(8):2045-51. doi: 10.1007/s00268-015-3050-4.
Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection.
All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method.
We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (P<0.001) were associated with cancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (P<0.001).
In high-volume centers and non-selective patients, laparoscopic colorectal resection for cancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.
有力证据已证实腹腔镜手术在结直肠癌切除术中的益处，但它仍是一项具有挑战性的手术。目前尚不清楚在特定患者中如此有前景的结果在实际临床中是否能转化为良好的风险效益比。我们开展了一项多中心全国性观察性登记研究，以评估腹腔镜结直肠癌切除术后的手术及肿瘤学长期结局。
纳入2001年至2004年间所有接受腹腔镜结直肠癌切除术的患者。数据来自意大利10个高容量中心（每年≥40例结直肠癌腹腔镜切除术）的前瞻性全国数据库。手术技术和随访均标准化。采用Kaplan-Meier法分析生存率。
我们报告了1832例结肠癌患者（58.5%）和直肠癌患者（41.5%）。TNM分期为0-I-II期的患者有1044例（57%），III-IV期的患者有788例（43%）。1820例患者（99.3%）接受了全腹腔镜手术。中转开腹率为10.5%。术后发病率和30天死亡率分别为17%和1.2%。临床吻合口漏发生率为8.3%（n = 152）。R0切除率为95%。中位随访时间为54.2个月，癌症复发率为13.3%。5年时，无癌生存率为86.7%。多因素分析显示，年龄（P = 0.001）和TNM分期（P < 0.001）与无癌生存率相关。癌症复发的预测因素为性别（P = 0.029）和TNM分期（P < 0.001）。
在高容量中心和非选择性患者中，腹腔镜结直肠癌切除术可取得良好的手术效果和令人满意的长期肿瘤学结局。即使在腹腔镜时代，年龄、性别和TNM分期仍是肿瘤学结局最有力的预测因素。
