Campana Juan P, Pellegrini Pablo A, Rossi Gustavo L, Ojea Quintana Guillermo, Mentz Ricardo E, Vaccaro Carlos A
Section of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
Int J Colorectal Dis. 2017 Jun;32(6):907-912. doi: 10.1007/s00384-017-2776-x. Epub 2017 Feb 15.
To compare the intraoperative and postoperative outcomes between right laparoscopic colectomy (RLC) and left laparoscopic colectomy (LLC) for colon cancer.
Patients who underwent elective RLC or LLC for colon cancer between January 2004 and December 2014 were identified and elected for a retrospective analysis. Primary outcomes were technical difficulty (including operative time, intraoperative complications, and conversion rate) and postoperative outcome (including postoperative complications, length of hospital stay, reinterventions, readmissions, and mortality).
A total of 547 patients (mean age: 68.5 years old; 48.4% males) were analyzed. The RLC group had a higher mean age (71 vs 65; p < 0.001), ASA 3/4 grade (36 vs 26%; p = 0.02), and comorbidity rate (61 vs 48%, p = 0.003). Regarding technical difficulty, no difference was found between the groups in intraoperative complications (4.1 vs 5.9%; p = 0.34) or conversion rate (6.2 vs 3.9%, p = 0.24). Mean operative time was significantly shorter for RLC (162 vs 185 min, p < 0.001). Regarding postoperative outcome, the RLC group had a higher overall morbidity (20.5 vs 13.3%, p = 0.03), ileus (10.6 vs 2.4%, p < 0.001), and a longer hospital stay (4.7 vs 3.9 days, p = 0.003), with no differences regarding reoperations, readmissions, or mortality. The multivariate analysis showed that RLC were independently associated with a longer operative time and postoperative ileus.
RLC for colon cancer was independently associated with a shorter operative time, an increased risk of ileus, and a longer hospital stay than left laparoscopic colectomy in high-volume centers.
比较右半结肠癌腹腔镜切除术（RLC）与左半结肠癌腹腔镜切除术（LLC）的术中及术后结果。
确定2004年1月至2014年12月期间因结肠癌接受择期RLC或LLC手术的患者，并进行回顾性分析。主要结局指标包括技术难度（包括手术时间、术中并发症及中转率）和术后结局（包括术后并发症、住院时间、再次手术、再次入院及死亡率）。
共分析了547例患者（平均年龄：68.5岁；男性占48.4%）。RLC组患者的平均年龄更高（71岁对65岁；p<0.001），美国麻醉医师协会（ASA）3/4级比例更高（36%对26%；p=0.02），合并症发生率更高（61%对48%，p=0.003）。在技术难度方面，两组术中并发症发生率（4.1%对5.9%；p=0.34）及中转率（6.2%对3.9%，p=0.24）无差异。RLC组的平均手术时间显著更短（162分钟对185分钟，p<0.001）。在术后结局方面，RLC组的总体发病率更高（20.5%对13.3%，p=0.03），肠梗阻发生率更高（10.6%对2.4%，p<0.001），住院时间更长（4.7天对3.9天，p=0.003），再次手术、再次入院及死亡率方面无差异。多因素分析显示，RLC与更长的手术时间及术后肠梗阻独立相关。
在大容量中心，结肠癌RLC与LLC相比，独立相关的因素为手术时间更短、肠梗阻风险增加及住院时间更长。
