腹腔镜与开放手术行局部进展期低位直肠癌侧方淋巴结清扫术：日本一项大型多中心队列研究的亚组分析
Laparoscopic Versus Open Lateral Lymph Node Dissection for Locally Advanced Low Rectal Cancer: A Subgroup Analysis of a Large Multicenter Cohort Study in Japan.
作者信息
Yamaguchi Tomohiro, Konishi Tsuyoshi, Kinugasa Yusuke, Yamamoto Seiichiro, Akiyoshi Takashi, Okamura Ryosuke, Ito Masaaki, Nishimura Yoji, Shiozawa Manabu, Yamaguchi Shigeki, Hida Koya, Sakai Yoshiharu, Watanabe Masahiko
机构信息
1 Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan 2 Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan 3 Department of Digestive Surgery, Hiratsuka City Hospital, Kanagawa, Japan 4 Department of Surgery, Kyoto University, Kyoto, Japan 5 Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan 6 Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan 7 Department of Colorectal Surgery, Kanagawa Cancer Center, Kanagawa, Japan 8 Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan 9 Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
出版信息
Dis Colon Rectum. 2017 Sep;60(9):954-964. doi: 10.1097/DCR.0000000000000843.
BACKGROUND
Mesorectal excision with lateral lymph node dissection is the standard treatment for locally advanced low rectal cancer in Japan. However, the safety and feasibility of laparoscopic lateral lymph node dissection remain to be determined.
OBJECTIVE
The purpose of this study was to evaluate the safety and feasibility of laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer.
DESIGN
This was a retrospective cohort study using an exact matching method.
SETTING
We conducted a multicenter study of 69 specialized centers in Japan.
PATIENTS
Patients with consecutive midrectal or low rectal adenocarcinoma cancer stage II to III who underwent mesorectal excision with curative intent between 2010 and 2011 were recruited.
MAIN OUTCOME MEASURES
Short-term and oncological outcomes were compared between the laparoscopic and open-surgery groups.
RESULTS
Of the 1500 eligible patients, 676 patients who underwent lateral lymph node dissection were analyzed, including 137 patients who were treated laparoscopically and 539 patients who were treated with open surgery. After matching, the patients were stratified into laparoscopic (n = 118) and open-surgery (n = 118) groups. Operative times in the overall cohort were significantly longer (461 vs 372 min) in the laparoscopic versus the open-surgery group. In the laparoscopic group, the blood loss volume was significantly smaller (193 vs 722 mL), with fewer instances of blood transfusion (7.3% vs 25.5%) compared with the open-surgery group. The postoperative complication rates were 35.8% and 43.6% for the laparoscopic and open-surgery groups (p = 0.10). The 3-year relapse-free survival rates were 80.3% and 72.6% for the laparoscopic and open-surgery groups (p = 0.07).
LIMITATIONS
The study was limited by its retrospective design and potential selection bias.
CONCLUSIONS
Laparoscopic lateral lymph node dissection is safe and feasible for cancer stage II to III low rectal cancer and is associated with similar oncological outcomes as open lateral lymph node dissection. See Video Abstract at http://links.lww.com/DCR/A334.
背景
在日本，直肠系膜切除术联合侧方淋巴结清扫术是局部进展期低位直肠癌的标准治疗方法。然而，腹腔镜侧方淋巴结清扫术的安全性和可行性仍有待确定。
目的
本研究旨在评估腹腔镜与开放侧方淋巴结清扫术治疗局部进展期低位直肠癌的安全性和可行性。
设计
这是一项采用精确匹配法的回顾性队列研究。
地点
我们在日本的69个专科中心进行了一项多中心研究。
患者
招募了2010年至2011年间连续接受直肠系膜切除术且具有根治意图的直肠中下段腺癌II至III期患者。
主要观察指标
比较腹腔镜组和开放手术组的短期和肿瘤学结局。
结果
在1500例符合条件的患者中，对676例行侧方淋巴结清扫术的患者进行了分析，其中137例接受腹腔镜治疗，539例接受开放手术治疗。匹配后，患者被分为腹腔镜组（n = 118）和开放手术组（n = 118）。总体队列中，腹腔镜组的手术时间明显更长（461对372分钟）。与开放手术组相比，腹腔镜组的失血量明显更少（193对722毫升），输血例数更少（7.3%对25.5%）。腹腔镜组和开放手术组的术后并发症发生率分别为35.8%和43.6%（p = 0.10）。腹腔镜组和开放手术组的3年无复发生存率分别为80.3%和72.6%（p = 0.07）。
局限性
本研究受其回顾性设计和潜在选择偏倚的限制。
结论
腹腔镜侧方淋巴结清扫术治疗II至III期低位直肠癌是安全可行的，且与开放侧方淋巴结清扫术具有相似的肿瘤学结局。见视频摘要：http://links.lww.com/DCR/A334 。
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