Zhang Guang-Tan, Zhang Xue-Dong
Department of General Surgery, The People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Zhengzhou, China.
Surg Laparosc Endosc Percutan Tech. 2017 Aug;27(4):e57-e65. doi: 10.1097/SLE.0000000000000428.
The role of hand-assisted laparoscopic and pure laparoscopic surgery for locally advanced colorectal cancer invading or adhering to neighboring organs is controversial. This study evaluated the safety and feasibility of laparoscopic multivisceral resection for colorectal cancer.
This study included 201 patients who underwent multivisceral resection for locally advanced colorectal cancer from January 2007 to December 2013 in the Department of General Surgery, Henan Provincial Hospital. Perioperative outcomes and long-time outcomes were compared among hand-assisted laparoscopic, laparoscopic and open resections.
Estimated blood loss, wound length, time to the first flatus, and postoperative hospital stay were significantly less or shorter in the hand-assisted laparoscopic surgery (HALS) and laparoscopic surgery group than in open surgery (OS) group. There were no significant differences in tumor size, retrieved lymph nodes, and R0 resection rate of the primary tumor among the 3 groups. Surgeries started as laparoscopic surgery were completed in that manner 76.6% of the time with 10.6% being converted to OS and 12.8% converted to HALS and there were only 2 conversions (2.2%) to OS in the HALS group. No significant difference was noted for overall morbidity rate and reoperation rate among the 3 groups. The overall observed 5-year survival rate was 60.5% in the laparoscopic group, 55.4% in the HALS group, and 47.7% in the open group. There was no significant difference among the 3 groups in the 5-year survival rate.
Hand-assisted laparoscopic and pure laparoscopic multivisceral resection for locally advanced colorectal cancer is safe and feasible in selected patients. HALS can be used judiciously to reduce the rate of conversion to an open procedure and may be a better alternative for laparoscopic approach.
对于侵犯或粘连邻近器官的局部进展期结直肠癌，手辅助腹腔镜手术和单纯腹腔镜手术的作用存在争议。本研究评估了腹腔镜多脏器切除治疗结直肠癌的安全性和可行性。
本研究纳入了2007年1月至2013年12月在河南省人民医院普通外科接受多脏器切除治疗局部进展期结直肠癌的201例患者。比较了手辅助腹腔镜手术、腹腔镜手术和开放手术的围手术期结局及长期结局。
手辅助腹腔镜手术（HALS）组和腹腔镜手术组的估计失血量、伤口长度、首次排气时间和术后住院时间均显著少于开放手术（OS）组。三组间肿瘤大小、获取的淋巴结数量及原发肿瘤的R0切除率无显著差异。以腹腔镜手术开始的手术，76.6%以该方式完成，10.6%转为OS，12.8%转为HALS，HALS组仅有2例（2.2%）转为OS。三组间总体发病率和再次手术率无显著差异。腹腔镜组的总体5年生存率为60.5%，HALS组为55.4%，开放组为47.7%。三组间5年生存率无显著差异。
对于选择的患者，手辅助腹腔镜和单纯腹腔镜多脏器切除治疗局部进展期结直肠癌是安全可行的。HALS可谨慎使用以降低转为开放手术的比例，可能是腹腔镜手术更好的替代方法。
