保留左结肠动脉的腹腔镜直肠癌低位前切除术的长期疗效

[Long-term outcomes of laparoscopic low anterior resection of rectal carcinoma with preservation of the left colic artery].

作者信息

Shen Jian, Li Minzhe, Du Yanfu, Xie Dehong, Qu Hao, Zhang Yudong

机构信息

Department of General Surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University,Beijing 100020, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jun 25;20(6):660-664.

PMID:28643311

Abstract

OBJECTIVE

To investigate the long-term outcomes of laparoscopic low anterior resection of rectal carcinoma with preservation of the left colic artery(LCA).

METHODS

Clinicopathological and follow-up data of 322 cases with rectal carcinoma undergoing laparoscopic low anterior resection in Department of General Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2007 to December 2011 were retrospectively analyzed. According to the different surgical methods of inferior mesenteric artery (IMA), cases were divided into the trial group (LCA preservation plus lymph nodes around IMA root dissection, 168 cases) and the control group(origin of IMA ligation, 154 cases). The 5-year rates of disease-free survival(DFS) and overall survival(OS) were compared between two groups.

RESULTS

There were no statistically significant differences in the baseline data between the two groups. The follow-up rate was 91.1%(153/168) during 5-60 months in the trial group, and 90.3%(139/154) during 6-60 months in the control group. The number of patients who developed death, local recurrence and metastasis were 49(32.0%), 9(5.9%) and 62(40.5%) in the trial group, and 44(31.7%), 9(6.5%) and 52(37.4%) in the control group, respectively, without significant differences(all P>0.05). The 5-year DFS and OS rates were 57.2% and 69.5% in the trial group, and 59.7% and 70.1% in the control group, and the differences were not significant between the two groups(all P>0.05). After stratification by TNM stage, the 5-year DFS rates of I( stage, II( stage and III( stage were 80.4%, 62.5% and 45.1% in the trial group, and 82.6%, 66.0% and 48.8% in the control group; the 5-year OS rates of I( stage, II( stage and III( stage were 90.2%, 76.2% and 56.7% in the trial group, and 94.4%, 74.3% and 60.5% in the control group, respectively, and the differences were not significant as well (all P>0.05).

CONCLUSION

The long-term outcomes after laparoscopic low anterior resection of rectal carcinoma with preservation of LCA and dissection of lymph nodes around root of IMA are comparable with ligation at origin of IMA.

摘要

目的

探讨保留左结肠动脉（LCA）的腹腔镜直肠癌低位前切除术的远期疗效。

方法

回顾性分析2007年1月至2011年12月在首都医科大学附属北京朝阳医院普通外科行腹腔镜直肠癌低位前切除术的322例患者的临床病理及随访资料。根据肠系膜下动脉（IMA）的不同手术方式，将患者分为试验组（保留LCA并清扫IMA根部周围淋巴结，168例）和对照组（结扎IMA起始部，154例）。比较两组的5年无病生存率（DFS）和总生存率（OS）。

结果

两组基线资料差异无统计学意义。试验组5 - 60个月随访率为91.1%（153/168），对照组6 - 60个月随访率为90.3%（139/154）。试验组死亡、局部复发和转移患者数分别为49例（32.0%）、9例（5.9%）和62例（40.5%），对照组分别为44例（31.7%）、9例（6.5%）和52例（37.4%），差异均无统计学意义（均P>0.05）。试验组5年DFS率和OS率分别为57.2%和69.5%，对照组分别为59.7%和70.1%，两组差异无统计学意义（均P>0.05）。按TNM分期分层后，试验组Ⅰ期、Ⅱ期和Ⅲ期的5年DFS率分别为80.4%、62.5%和45.1%，对照组分别为82.6%、66.0%和48.8%；试验组Ⅰ期、Ⅱ期和Ⅲ期的5年OS率分别为90.2%、76.2%和56.7%，对照组分别为94.4%、74.3%和60.5%，差异均无统计学意义（均P>0.05）。