Kim Ik Yong, Kim Bo Ra, Kim Hyun Soo, Kim Young Wan
Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea.
Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea.
Onco Targets Ther. 2015 Nov 19;8:3441-8. doi: 10.2147/OTT.S93420. eCollection 2015.
To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery.
A total of 100 consecutive stage IV patients undergoing open (n=61) or laparoscopic (n=39) major resection were analyzed. There were four cases (10%) of conversion to laparotomy in the laparoscopy group.
Pathological T4 tumors (56% vs 26%), primary colon cancers (74% vs 51%), and larger tumor diameter (6 vs 5 cm) were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39%) and low anterior resection was more common in the laparoscopy group (39%, P=0.002). Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100%) than with open surgery (56%), although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups.
Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage IV patients, tumor factors such as primary rectal tumor, peritoneal carcinomatosis, or liver metastasis may not be absolute contraindications for a laparoscopic approach.
确定IV期结直肠癌患者原发性肿瘤腹腔镜切除术与开放切除术临床特征的差异。我们还评估了腹腔镜手术和开放手术后的短期及肿瘤学结局。
对100例连续接受开放手术（n = 61）或腹腔镜手术（n = 39）的IV期患者进行分析。腹腔镜组有4例（10%）转为开腹手术。
病理T4肿瘤（56% 对26%）、原发性结肠癌（74% 对51%）以及更大的肿瘤直径（6对5 cm）在开放手术中更为常见。右半结肠切除术在开放手术组更常见（39%），低位前切除术在腹腔镜组更常见（39%，P = 0.002）。尽管差异无统计学意义，但腹腔镜手术（100%）比开放手术（56%）更常切除肝Ⅱ、Ⅲ、Ⅳb、Ⅴ和Ⅵ段的肝转移灶。在结肠癌和直肠癌中，腹腔镜手术和开放手术的平均手术时间及30天并发症发生率无差异。在这两种癌症中，腹腔镜组的平均恢复软食时间和住院时间更短。腹腔镜手术从手术到开始化疗的平均时间明显短于开放手术。在结肠癌和直肠癌中，腹腔镜手术组和开放手术组的2年癌症特异性生存率和无进展生存率相似。
基于我们的研究结果，对于无相邻器官侵犯的原发性肿瘤患者以及无原发性肿瘤相关症状的患者，腹腔镜手术可作为初始治疗方法。在部分IV期患者中，原发性直肠肿瘤、腹膜癌转移或肝转移等肿瘤因素可能并非腹腔镜手术的绝对禁忌证。
