Stormark Kjartan, Søreide Kjetil, Søreide Jon Arne, Kvaløy Jan Terje, Pfeffer Frank, Eriksen Morten T, Nedrebø Bjørn S, Kørner Hartwig
Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Surg Endosc. 2016 Nov;30(11):4853-4864. doi: 10.1007/s00464-016-4819-8. Epub 2016 Feb 23.
Randomized trials show similar outcomes after open surgery and laparoscopy for colon cancer, and confirmation of outcomes after implementation in routine practice is important. While some studies have reported long-term outcomes after laparoscopic surgery from single institutions, data from large patient cohorts are sparse. We investigated short- and long-term outcomes of laparoscopic and open surgery for treating colon cancer in a large national cohort.
We retrieved data from the Norwegian Colorectal Cancer Registry for all colon cancer resections performed in 2007-2010. Five-year relative survival rates following laparoscopic and open surgeries were calculated, including excess mortality rates associated with potential predictors of death.
Among 8707 patients with colon cancer that underwent major resections, 16 % and 36 % received laparoscopic procedures in 2007 and 2010, respectively. Laparoscopic procedures were most common in elective surgeries for treating stages I-III, right colon, or sigmoid tumours. The conversion rate of laparoscopic procedures was 14.5 %. Among all patients, laparoscopy provided higher 5-year relative survival rates (70 %) than open surgery (62 %) (P = 0.040), but among the largest group of patients electively treated for stages I-III disease, the approaches provided similar relative survival rates (78 vs. 81 %; P = 0.535). Excess mortality at 2 years post-surgery was lower after laparoscopy than after open surgery (excess hazard ratio, 0.7; P = 0.013), but similar between groups during the last 3 years of follow-up. Major predictors of death were stage IV disease, tumour class pN+, age > 80 years, and emergency procedures (excess hazard ratios were 5.3, 2.4, 2.1, and 2.0, respectively; P < 0.001).
Nationwide implementation of laparoscopic colectomy for colon cancer was safe and achieved results comparable to those from previous randomized trials.
随机试验表明，结肠癌开放手术和腹腔镜手术后的结果相似，在常规实践中实施后对结果进行确认很重要。虽然一些研究报告了单机构腹腔镜手术后的长期结果，但来自大型患者队列的数据很少。我们调查了在一个大型全国队列中，腹腔镜手术和开放手术治疗结肠癌的短期和长期结果。
我们从挪威结直肠癌登记处检索了2007年至2010年期间所有结肠癌切除术的数据。计算了腹腔镜手术和开放手术后的五年相对生存率，包括与潜在死亡预测因素相关的超额死亡率。
在8707例行大切除术的结肠癌患者中，2007年和2010年分别有16%和36%接受了腹腔镜手术。腹腔镜手术在治疗I-III期、右半结肠或乙状结肠肿瘤的择期手术中最为常见。腹腔镜手术的转换率为14.5%。在所有患者中，腹腔镜手术的五年相对生存率（70%）高于开放手术（62%）（P = 0.040），但在最大的一组接受I-III期疾病择期治疗的患者中，两种手术方式的相对生存率相似（78%对81%；P = 0.535）。术后2年腹腔镜手术的超额死亡率低于开放手术（超额风险比，0.7；P = 0.013），但在随访的最后3年中两组相似。死亡的主要预测因素是IV期疾病、肿瘤分级pN+、年龄>80岁和急诊手术（超额风险比分别为5.3、2.4、2.1和2.0；P < 0.001）。
在全国范围内实施腹腔镜结肠癌切除术是安全的，其结果与先前随机试验的结果相当。
