Yamanashi Takahiro, Nakamura Takatoshi, Sato Takeo, Naito Masanori, Miura Hirohisa, Tsutsui Atsuko, Shimazu Masashi, Watanabe Masahiko
Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Surg Today. 2018 May;48(5):534-544. doi: 10.1007/s00595-017-1621-8. Epub 2017 Dec 29.
For locally advanced pathological T4 (pT4) colon cancer, the safety and feasibility of laparoscopic procedures remain controversial. Therefore, this study aimed to assess short-term and long-term outcomes and to identify the prognostic factors in laparoscopic surgery for pT4 colon cancer.
The study group included 130 patients who underwent laparoscopic radical resection for pT4 colon and rectosigmoid cancer from January 2004 through December 2012. The short-term outcomes, long-term outcomes, and prognostic factors in pT4 colon cancer were analyzed.
The median operative time was 205 min, with a median blood loss of 10 ml. The conversion rate was 3.8%, and 13 patients (10.0%) had postoperative complications. The radial resection margin was positive in 1 patient (0.8%). The median follow-up time was 73 months. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 77.2 and 63.5%, respectively. On a multivariate analysis, a male sex [hazard ratio (HR) 3.09, p < 0.001], lymph node ratio ≥ 0.06 (HR 2.35, p = 0.021), tumor diameter < 38 mm (HR 2.57, p = 0.007), and right-sided colon cancer (HR 2.11, p = 0.047) were significantly related to a poor OS.
These results suggest that laparoscopic surgery for pT4 colon cancer is safe and feasible, and the oncological outcomes are acceptable. Based on the present findings, select patients with locally advanced colon cancer should not be excluded from laparoscopic surgery.
对于局部进展期病理T4（pT4）结肠癌，腹腔镜手术的安全性和可行性仍存在争议。因此，本研究旨在评估pT4结肠癌腹腔镜手术的短期和长期结局，并确定预后因素。
研究组包括2004年1月至2012年12月期间接受pT4结肠癌和直肠乙状结肠癌腹腔镜根治性切除术的130例患者。分析了pT4结肠癌的短期结局、长期结局和预后因素。
中位手术时间为205分钟，中位失血量为10毫升。中转率为3.8%，13例患者（10.0%）出现术后并发症。1例患者（0.8%）切缘阳性。中位随访时间为73个月。5年总生存率（OS）和无复发生存率（RFS）分别为77.2%和63.5%。多因素分析显示，男性（风险比[HR] 3.09，p < 0.001）、淋巴结比率≥0.06（HR 2.35，p = 0.021）、肿瘤直径< 38毫米（HR 2.57，p = 0.007）和右半结肠癌（HR 2.11，p = 0.047）与较差的OS显著相关。
这些结果表明，pT4结肠癌的腹腔镜手术是安全可行的，肿瘤学结局是可接受的。基于目前的研究结果，不应将局部进展期结肠癌患者排除在腹腔镜手术之外。
