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新辅助放化疗后直肠癌的腹腔镜手术与开放手术:倾向评分匹配研究的长期结果

Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: Long-term outcomes of a propensity score matched study.

作者信息

Seshadri Ramakrishnan Ayloor, Swaminathan Rajaraman, Srinivasan Ayyappan

机构信息

Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India.

Department of Epidemiology, Biostatistics and Tumor Registry, Cancer Institute (WIA), Chennai, India.

出版信息

J Surg Oncol. 2018 Mar;117(3):506-513. doi: 10.1002/jso.24868. Epub 2017 Oct 16.

Abstract

BACKGROUND AND OBJECTIVES

Laparoscopic resection for rectal cancer has short-term benefits when compared to open resection. The aim of this study was to compare the long-term oncological outcomes of laparoscopic and open resection for rectal cancer following neoadjuvant chemoradiation (NCRT).

METHODS

In this propensity matched study, a series of 72 patients who underwent laparoscopic surgery for rectal cancer following NCRT between 2004 and 2010 (Lap group) were matched with 72 patients who underwent open surgery for rectal cancer in the same period (Open group). The survival and recurrence patterns were compared between the two groups.

RESULTS

After a median follow-up of 69.5 months (range 1-138 months), local recurrence rate was observed in 4 patients (5.5%) and 7 patients (9.7%) in the Lap and Open groups, respectively (P = 0.35). The 5- and 10-year disease-free survival in the Lap and Open groups were 61.3% versus 47.9% and 48.8% versus 41%, respectively (P = 0.16). The 5- and 10-year overall survival was 66.9% versus 60.2% and 49% versus 46.2% in the Lap and Open groups, respectively (P = 0.38).

CONCLUSION

Laparoscopic surgery following NCRT for low and mid third rectal cancers was associated with similar long-term oncological outcomes when compared to open surgery.

摘要

背景与目的

与开放手术相比,腹腔镜直肠癌切除术具有短期优势。本研究旨在比较新辅助放化疗(NCRT)后腹腔镜与开放直肠癌切除术的长期肿瘤学结局。

方法

在这项倾向匹配研究中,将2004年至2010年间接受NCRT后腹腔镜直肠癌手术的72例患者(腹腔镜组)与同期接受开放直肠癌手术的72例患者(开放组)进行匹配。比较两组的生存和复发模式。

结果

中位随访69.5个月(范围1 - 138个月)后,腹腔镜组和开放组分别有4例(5.5%)和7例(9.7%)出现局部复发(P = 0.35)。腹腔镜组和开放组的5年及10年无病生存率分别为61.3%对47.9%和48.8%对41%(P = 0.16)。腹腔镜组和开放组的5年及10年总生存率分别为66.9%对60.2%和49%对46.2%(P = 0.38)。

结论

对于中低位直肠癌,NCRT后腹腔镜手术与开放手术相比,具有相似的长期肿瘤学结局。

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