Yamamoto Seiichiro, Hinoi Takao, Niitsu Hiroaki, Okajima Masazumi, Ide Yoshihito, Murata Kohei, Akamoto Shintaro, Kanazawa Akiyoshi, Nakanishi Masayoshi, Naitoh Takeshi, Kanehira Eiji, Shimamura Tsukasa, Suzuka Ichio, Fukunaga Yosuke, Yamaguchi Takashi, Watanabe Masahiko
Division of Gastrointestinal Surgery, Hiratsuka City Hospital, 19-1-1, Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan.
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Gastroenterol. 2017 Jun;52(6):695-704. doi: 10.1007/s00535-016-1262-5. Epub 2016 Sep 20.
The aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery.
We conducted a propensity score-matched case-control study of colorectal cancer (CRC) patients aged ≥80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P-values of <0.05 were considered statistically significant.
LAP resulted in a significantly longer surgical time (220 vs. 170 min, p < 0.001), but significantly less intraoperative blood loss (39 vs. 100 ml, p < 0.001). A number of postoperative recovery-related parameters, including the length of the hospitalization period (12 vs. 14 days, p = 0.002), and the days to the resumption of fluid (2 vs. 3 days, p < 0.001) and solid food intake (4 vs. 5 days, p < 0.001), were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 %, p = 0.009) and the frequency of postoperative ileus (7 vs. 19 %, p = 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease-free survival did not differ between the two groups.
In this population, LAP can be performed safely in elderly CRC patients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.
本研究的目的是探讨腹腔镜手术（LAP）在有腹部手术史老年患者中的技术及肿瘤学可行性。
我们对2003年至2007年间在41家医院接受治疗的年龄≥80岁的结直肠癌（CRC）患者进行了倾向评分匹配的病例对照研究。我们纳入了601例有腹部手术史且接受0至III期CRC根治性和择期手术的患者。经过匹配程序后，每个队列纳入153例患者。比较了LAP和开放手术（OS）的手术结果。P值<0.05被认为具有统计学意义。
LAP导致手术时间显著延长（220分钟对170分钟，p<0.001），但术中失血量显著减少（39毫升对100毫升，p<0.001）。一些与术后恢复相关的参数，包括住院时间（12天对14天，p=0.002）、恢复流食时间（2天对3天，p<0.001）和恢复固体食物摄入时间（4天对5天，p<0.001），LAP组明显更好。此外，LAP组的总体发病率（43%对66%，p=0.009）和术后肠梗阻发生率（7%对19%，p=0.023）显著更低，而其他发病率在两组之间无显著差异。在生存分析中，两组的总生存期和无病生存期无差异。
在该人群中，有腹部手术史的老年CRC患者可安全地进行LAP，且LAP术后发病率低于OS。
