Campos Fábio Guilherme, Real Martinez Carlos Augusto, Monteiro de Camargo Mariane Gouveia, Cesconetto Daniele Menezes, Nahas Sérgio Carlos, Cecconello Ivan
1 Colorectal Surgery Division, Gastroenterology Department, Hospital das Clínicas, University of São Paulo , São Paulo, Brazil .
2 Colorectal Surgery Division, University of Campinas, São Paulo, Brazil .
J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):47-52. doi: 10.1089/lap.2017.0397. Epub 2017 Nov 10.
This study compared outcomes after laparoscopic (LAP) or conventional (open) total proctocolectomy with outcomes after ileal J-pouch anal anastomosis (IPAA) at a single institution.
Charts from 133 familial adenomatous polyposis patients (1997-2013) were reviewed. Demographic data (age, sex, color, American Society of Anesthesiologists [ASA] status, previous surgery, and body mass index) and surgical outcomes (length of stay, early and late morbidity, reoperation, and mortality rates) were compared among 63 patients undergoing IPAA.
Demographic features were similar among patients (25 open and 38 LAP). Conversely, colorectal cancer at diagnosis prevailed in the open group (60% versus 31.6%; P = .02). Tumor stages (P = .65) and previous surgery index (20% versus 10.5%; P = .46) were similar. Surgical length was longer for LAP (374 versus 281 minutes, P = .003). Short-term complication rates (28% versus 28.9%), hospital stay (10.9 versus 8.9 days), and total long-term reoperations (28% versus 21%) were not statistically different. However, major late morbidity (16% versus 2.6%; P < .001) and late reoperation rates (16% versus 5.2%; P < .05) were greater among open patients. Both groups did not differ regarding pouch failure rates (8% versus 5.2%). There was no operative mortality in the present series.
(1) LAP IPAA is a safe procedure associated with a low conversion rate, (2) short-term results showed no clear advantages for both approaches, and (3) a greater risk of major late complications and late reoperations should be expected after open procedures.
本研究在单一机构比较了腹腔镜（LAP）或传统（开放）全直肠结肠切除术与回肠J袋肛管吻合术（IPAA）后的结局。
回顾了133例家族性腺瘤性息肉病患者（1997 - 2013年）的病历。比较了63例行IPAA患者的人口统计学数据（年龄、性别、肤色、美国麻醉医师协会[ASA]分级、既往手术史和体重指数）和手术结局（住院时间、早期和晚期发病率、再次手术率和死亡率）。
患者的人口统计学特征相似（25例开放手术和38例腹腔镜手术）。相反，开放手术组诊断时结直肠癌更为常见（60%对31.6%；P = 0.02）。肿瘤分期（P = 0.65）和既往手术指数（20%对10.5%；P = 0.46）相似。腹腔镜手术的手术时间更长（374分钟对281分钟，P = 0.003）。短期并发症发生率（28%对28.9%）、住院时间（10.9天对8.9天）和总的长期再次手术率（28%对21%）无统计学差异。然而，开放手术患者的主要晚期发病率（16%对2.6%；P < 0.001）和晚期再次手术率（16%对5.2%；P < 0.05）更高。两组在袋失败率方面无差异（8%对5.2%）。本系列中无手术死亡病例。
（1）腹腔镜IPAA是一种安全的手术，转换率低；（2）短期结果显示两种方法均无明显优势；（3）开放手术后应预期有更高的主要晚期并发症和晚期再次手术风险。
