Wu Qing-Bin, Deng Xiang-Bing, Zhang Xu-Bing, Kong Ling-Hong, Zhou Zong-Guang, Wang Zi-Qiang
1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .
2 West China School of Medicine, Sichuan University , Chengdu, China .
J Laparoendosc Adv Surg Tech A. 2018 Jun;28(6):637-644. doi: 10.1089/lap.2017.0630. Epub 2018 Jan 11.
To compare the short-term and long-term outcomes of laparoscopic versus open surgery for low rectal cancer.
Patients with low rectal cancer who underwent laparoscopic or open surgery at our department from January 2009 to December 2013 were enrolled in this retrospective study. The primary end points were 3-year local recurrence and overall and disease-free survival (DFS) rates. Secondary end points were intraoperative and postoperative outcomes.
Laparoscopic group had longer operative time (165.0 versus 140.0, P < .001), less blood loss (20.0 versus 40.0, P < .001), shorter length of incision (5.0 versus 18.0, P < .001), and more lymph node harvested (11.0 versus 9.0, P = .002). However, time to first flatus (P = .941), postoperative hospital stay (P = .095), postoperative complications (P = .155), and 30-day mortality (P = .683) was similar between two groups. With the median follow-up period of 65 months, the 3-year local recurrence rate was 4.3% in laparoscopic group and 7.5% in open group (P = .077); the 3-year overall and DFS rates were similar in two groups (85.9% versus 88.8%, P = .229 and 76.9% versus 79.2%, P = .448, respectively); and the overall and DFS curves were comparable between two groups (hazard ratio [HR] = 0.858, 95% confidence intervals [CI] 0.709-1.037, P = .112 and HR = 1.076, 95% CI 0.834-1.389, P = .275, respectively).
Laparoscopic surgery is safe and has equivalent long-term oncologic outcomes for low rectal cancer when compared to open surgery. Furthermore, large-scale, prospective randomized clinical trials are needed to confirm the present findings.
比较腹腔镜手术与开放手术治疗低位直肠癌的短期和长期疗效。
本回顾性研究纳入了2009年1月至2013年12月在我科接受腹腔镜或开放手术的低位直肠癌患者。主要终点为3年局部复发率、总生存率和无病生存率（DFS）。次要终点为术中及术后结果。
腹腔镜组手术时间较长（165.0对140.0，P＜0.001），失血量较少（20.0对40.0，P＜0.001），切口长度较短（5.0对18.0，P＜0.001），清扫淋巴结较多（11.0对9.0，P = 0.002）。然而，两组首次排气时间（P = 0.941）、术后住院时间（P = 0.095）、术后并发症（P = 0.155）及30天死亡率（P = 0.683）相似。中位随访期为65个月，腹腔镜组3年局部复发率为4.3%，开放组为7.5%（P = 0.077）；两组3年总生存率和DFS率相似（分别为85.9%对88.8%，P = 0.229；76.9%对79.2%，P = 0.448）；两组总生存曲线和DFS曲线具有可比性（风险比[HR]=0.858，95%置信区间[CI]0.709 - 1.037，P = 0.112；HR = 1.076，95%CI 0.834 - 1.389，P = 0.275）。
与开放手术相比，腹腔镜手术治疗低位直肠癌安全且长期肿瘤学疗效相当。此外，需要大规模、前瞻性随机临床试验来证实本研究结果。
