Pecorelli Nicolò, Amodeo Salvatore, Frasson Matteo, Vignali Andrea, Zuliani Walter, Braga Marco
Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
Int J Colorectal Dis. 2016 Jul;31(7):1283-90. doi: 10.1007/s00384-016-2587-5. Epub 2016 Apr 18.
To evaluate the impact of laparoscopy compared to open surgery on long-term outcomes in a large series of patients who participated in a randomized controlled trial comparing short-term results of laparoscopic (LPS) versus open colorectal resection.
This is a retrospective review of a prospective database including 662 patients with colorectal disease (526, 79 % cancer patients) who were randomly assigned to LPS or open colorectal resection and followed every 6 months by office visits. The primary endpoint of the study was long-term morbidity. Secondary outcomes included 10-year overall, cancer-specific, and disease-free survivals. All patients were analyzed on an intention-to-treat basis.
Fifty-eight (8.8 %) patients were lost to follow-up. Median follow-up was 131 (IQR 78-153) months in the LPS group and 126 (IQR 52-152) months in the open group (p = 0.121). Overall, long-term morbidity rate was 11.8 % (36/309) in the LPS versus 12.6 % (37/295) in the open group (p = 0.770). Incisional hernia rate was 5.8 % (18/309) in the LPS group versus 8.1 % (24/295) in the open group (p = 0.264). Adhesion-related small-bowel obstruction occurred in five (1.6 %) patients in the LPS versus four (1.4 %) patients in the open group (p = 1.000). In 497 cancer patients, 10-year overall survival was 45.3 % in the LPS group and 40.9 % in the open group (p = 0.160). No difference was found in cancer-specific and disease-free survivals, also when patients were stratified according to cancer stage.
In this series, LPS colorectal resection was not associated with a lower long-term morbidity rate when compared to open surgery. Overall, cancer-specific and disease-free survivals were similar in cancer patients who were treated with LPS and open surgeries.
在一系列参与随机对照试验的患者中，评估腹腔镜手术与开放手术相比对长期预后的影响，该随机对照试验比较了腹腔镜结直肠切除术（LPS）与开放结直肠切除术的短期结果。
这是一项对前瞻性数据库的回顾性研究，该数据库包含662例结直肠疾病患者（526例，79%为癌症患者），这些患者被随机分配接受LPS或开放结直肠切除术，并每6个月进行一次门诊随访。该研究的主要终点是长期发病率。次要结局包括10年总生存率、癌症特异性生存率和无病生存率。所有患者均按意向性分析。
58例（8.8%）患者失访。LPS组的中位随访时间为131（IQR 78 - 153）个月，开放手术组为126（IQR 52 - 152）个月（p = 0.121）。总体而言，LPS组的长期发病率为11.8%（36/309），开放手术组为12.6%（37/295）（p = 0.770）。LPS组的切口疝发生率为5.8%（18/309），开放手术组为8.1%（24/295）（p = 0.264）。LPS组有5例（1.6%）患者发生粘连相关的小肠梗阻，开放手术组有4例（1.4%）患者发生（p = 1.000）。在497例癌症患者中，LPS组的10年总生存率为45.3%，开放手术组为40.9%（p = 0.160）。在癌症特异性生存率和无病生存率方面未发现差异，根据癌症分期对患者进行分层时也是如此。
在本系列研究中，与开放手术相比，LPS结直肠切除术并未降低长期发病率。总体而言，接受LPS和开放手术治疗的癌症患者的癌症特异性生存率和无病生存率相似。
