Allaix Marco E, Giraudo Giuseppe, Ferrarese Alessia, Arezzo Alberto, Rebecchi Fabrizio, Morino Mario
Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
World J Surg. 2016 Dec;40(12):3052-3062. doi: 10.1007/s00268-016-3631-x.
Only few studies have compared laparoscopic total mesorectal excision (LTME) and open total mesorectal excision (OTME) for rectal cancer with follow-up longer than 5 years. The aim of this study was to compare 10-year oncologic outcomes after LTME and OTME for nonmetastatic rectal cancer.
We conducted a retrospective analysis of a prospective database of rectal cancer patients undergoing LTME or OTME. Statistical analyses were performed on an ''intention-to-treat'' basis and by actual treatment. Overall survival (OS) and disease-free survival (DFS) were compared by using the Kaplan-Meier method. A multivariable analysis was performed to identify predictors of poor survival.
Between April 1994 and August 2005, a total of 153 LTME patients and 154 OTME patients were included. Similarly, 10-year OS and DFS after LTME and OTME were observed: 76.8 versus 70.6 % (P = 0.138) and 69.1 versus 67.6 % (P = 0.508), respectively. Conversion to OTME did not adversely affect OS and DFS. Stage-by-stage comparison showed no significant differences between LTME and OTME. No significant differences were observed in local recurrence rates after LTME and OTME (6.5 vs. 7.8 %, P = 0.837). Median time until local recurrence was 24.5 (range, 12-56) months after LTME and 22 (6-64) months after OTME (P = 0.777). Poor tumor differentiation, lymphovascular invasion, and a lymph node ratio of 0.25 or more were the independent predictors of poorer OS and DFS.
This retrospective study with long follow-up did not show significant differences between the two groups in OS and DFS.
仅有少数研究比较了腹腔镜全直肠系膜切除术（LTME）和开放全直肠系膜切除术（OTME）治疗直肠癌且随访时间超过5年的情况。本研究的目的是比较LTME和OTME治疗非转移性直肠癌后的10年肿瘤学结局。
我们对接受LTME或OTME的直肠癌患者的前瞻性数据库进行了回顾性分析。基于“意向性治疗”原则并按实际治疗情况进行统计分析。采用Kaplan-Meier法比较总生存期（OS）和无病生存期（DFS）。进行多变量分析以确定生存不良的预测因素。
1994年4月至2005年8月期间，共纳入153例LTME患者和154例OTME患者。同样，观察到LTME和OTME后的10年OS和DFS：分别为76.8%对70.6%（P = 0.138）和69.1%对67.6%（P = 0.508）。转为OTME对OS和DFS没有不利影响。逐阶段比较显示LTME和OTME之间无显著差异。LTME和OTME后的局部复发率无显著差异（6.5%对7.8%，P = 0.837）。LTME后至局部复发的中位时间为24.5（范围12 - 56）个月，OTME后为22（6 - 64）个月（P = 0.777）。肿瘤分化差、淋巴管侵犯以及淋巴结比率为0.25或更高是OS和DFS较差的独立预测因素。
这项长期随访的回顾性研究未显示两组在OS和DFS方面存在显著差异。
