腹腔镜手术与开放手术治疗II期和III期直肠癌的长期肿瘤学结局：一项回顾性队列研究。
Long-term oncologic outcomes of laparoscopic vs open surgery for stages II and III rectal cancer: A retrospective cohort study.
作者信息
Zhou Zhen-Xu, Zhao Li-Ying, Lin Tian, Liu Hao, Deng Hai-Jun, Zhu Heng-Liang, Yan Jun, Li Guo-Xin
机构信息
Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
出版信息
World J Gastroenterol. 2015 May 14;21(18):5505-12. doi: 10.3748/wjg.v21.i18.5505.
AIM
To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages II and III rectal cancer.
METHODS
This study enrolled 406 consecutive patients who underwent curative resection for stages II and III rectal cancer between January 2000 and December 2009 [laparoscopic rectal resection (LRR), n = 152; open rectal resection (ORR), n = 254]. Clinical characteristics, operative outcomes, pathological outcomes, postoperative recovery, and 5-year survival outcomes were compared between the two groups.
RESULTS
Most of the clinical characteristics were similar except age (59 years vs 55 years, P = 0.033) between the LRR group and ORR group. The proportion of anterior resection was higher in the LRR group than that in the ORR group (81.6% vs 66.1%, P = 0.001). The LRR group had less estimated blood loss (50 mL vs 200 mL, P < 0.001) and a lower rate of blood transfusion (4.6% vs 11.8%, P = 0.019) compared to the ORR group. The pathological outcomes of the two groups were comparable. The LRR group was associated with faster recovery of bowel function (2.8 d vs 3.7 d, P < 0.001) and shorter postoperative hospital stay (11.7 d vs 13.7 d, P < 0.001). The median follow-up time was 63 mo in the LRR group and 65 mo in the ORR group. As for the survival outcomes, the 5-year local recurrence rate (16.0% vs 16.4%, P = 0.753), 5-year disease-free survival (DFS) rate (63.0% vs 63.1%, P = 0.589), and 5-year overall survival (OS) rate (68.1% vs 63.5%, P = 0.682) were comparable between the LRR group and the ORR group. Stage by stage, there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate (stage II: 6.3% vs 8.7%, P = 0.623; stage III: 26.4% vs 23.2%, P = 0.747), 5-year DFS rate (stage II: 77.5% vs 77.6%, P = 0.462; stage III: 46.5% vs 50.9%, P = 0.738), and 5-year OS rate (stage II: 81.4% vs 74.3%, P = 0.242; stage III: 53.9% vs 54.1%, P = 0.459).
CONCLUSION
LRR for stages II and III rectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.
目的
评估腹腔镜手术与开放手术治疗Ⅱ期和Ⅲ期直肠癌后的5年生存率。
方法
本研究纳入了2000年1月至2009年12月期间连续接受Ⅱ期和Ⅲ期直肠癌根治性切除术的406例患者[腹腔镜直肠切除术（LRR），n = 152；开放直肠切除术（ORR），n = 254]。比较两组患者的临床特征、手术结果、病理结果、术后恢复情况及5年生存结果。
结果
LRR组和ORR组除年龄外（59岁 vs 55岁，P = 0.033），大多数临床特征相似。LRR组前切除术的比例高于ORR组（81.6% vs 66.1%，P = 0.001）。与ORR组相比，LRR组估计失血量更少（50 mL vs 200 mL，P < 0.001），输血率更低（4.6% vs 11.8%，P = 0.019）。两组的病理结果相当。LRR组肠道功能恢复更快（2.8天 vs 3.7天，P < 0.001），术后住院时间更短（11.7天 vs 13.7天，P < 0.001）。LRR组的中位随访时间为63个月，ORR组为65个月。在生存结果方面，LRR组和ORR组的5年局部复发率（16.0% vs 16.4%，P = 0.7,53）、5年无病生存率（DFS）（63.0% vs 63.1%，P = 0.589）和5年总生存率（OS）（68.1% vs 63.5%，P = 0.682）相当。按分期来看，LRR组和ORR组在5年局部复发率（Ⅱ期：6.3% vs 8.7%，P = 0.623；Ⅲ期：26.4% vs 23.2%，P = 0.747）、5年DFS率（Ⅱ期：77.5% vs 77.6%，P = 0.462；Ⅲ期：46.5% vs 50.9%，P = 0.738）和5年OS率（Ⅱ期：81.4% vs 74.3%，P = 0.242；Ⅲ期：53.9% vs 54.1%，P = 0.459）方面也无统计学差异。
结论
与开放手术相比，Ⅱ期和Ⅲ期直肠癌的LRR在获得短期益处的同时可产生相当的长期生存率。
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