Watanabe Masahiko
Nihon Geka Gakkai Zasshi. 2015 Sep;116(5):297-301.
Randomized clinical trials (RCTs) comparing laparoscopic surgery (LS) with open surgery (OS) in patients with colon cancer showed no statistical differences in, safety, and long-term outcomes. LS for colon cancer has become a standard procedure. LS for rectal cancer has also shown advantages, although RCTs showed no significant differences between groups in the long-term outcome. The magnification of laparoscopy enables surgeons to operate precisely in the narrow pelvis while sparing the autonomic nerves and nerves to the anal sphincter. Good visualization of the pelvis offers better education and will likely be used more frequently for rectal cancer. Invasion of rectal cancer to other organs and massive tumors are, however, technically demanding. The younger generation is more susceptible to Crohn's disease and inflammatory bowel disease (IBD), and high recurrence rates mean more reoperations. Esthetic outcomes and minimal adhesion maximize the advantages of LS in treating Crohn's disease and IBD. Total proctocolectomy LS for IBD and ulcerative colitis is safe and minimally invasive. However, LS may take longer than OS, and emergencies such as toxic megacolon and massive hemorrhage remain contraindications. Ongoing clinical trials should reveal the feasibility of these new LS procedures in robotic and single-port surgery.
比较腹腔镜手术（LS）与开放手术（OS）治疗结肠癌患者的随机临床试验表明，在安全性和长期预后方面无统计学差异。结肠癌的腹腔镜手术已成为标准术式。直肠癌的腹腔镜手术也显示出优势，尽管随机临床试验表明两组在长期预后上无显著差异。腹腔镜的放大功能使外科医生能够在狭窄的骨盆中精确操作，同时保留自主神经和肛门括约肌神经。骨盆的良好视野提供了更好的操作条件，并且可能会更频繁地用于直肠癌手术。然而，直肠癌侵犯其他器官以及肿瘤巨大时，手术技术要求较高。年轻一代更容易患克罗恩病和炎症性肠病（IBD），高复发率意味着更多的再次手术。美观效果和最小粘连最大化了腹腔镜手术在治疗克罗恩病和炎症性肠病方面的优势。用于炎症性肠病和溃疡性结肠炎的全直肠结肠切除术腹腔镜手术是安全且微创的。然而，腹腔镜手术可能比开放手术耗时更长，诸如中毒性巨结肠和大出血等紧急情况仍然是手术禁忌证。正在进行的临床试验应揭示这些新型腹腔镜手术在机器人手术和单孔手术中的可行性。
