Bosker Robbert J I, Van't Riet Esther, de Noo Mirre, Vermaas Maarten, Karsten Tom M, Pierie Jean-Pierre
Department of Surgery, Deventer Hospital, Deventer, The
Department of Epidemiology, Deventer Hospital, Deventer, The Netherlands.
Dig Surg. 2019;36(1):27-32. doi: 10.1159/000486400. Epub 2018 Feb 7.
There is ongoing debate whether laparoscopic right colectomy is superior to open surgery. The purpose of this study was to address this issue and arrive at a consensus using data from a national database.
Patients who underwent elective open or laparoscopic right colectomy for colorectal cancer during the period 2009-2013 were identified from the Dutch Surgical Colorectal Audit. Complications that occurred within 30 days after surgery and 30-day mortality rates were calculated and compared between open and laparoscopic resection.
In total, 12,006 patients underwent elective open or laparoscopic surgery for right-sided colorectal cancer. Of these, 6,683 (55.7%) underwent open resection and 5,323 (44.3%) underwent laparoscopic resection. Complications occurred within 30 days after surgery in the laparoscopic group in 26.1% of patients and in 32.1% of patients in the open group (p < 0.001). Thirty-day mortality was also significantly lower in the laparoscopic group (2.2 vs. 3.6% p < 0.001).
In this non-randomized, descriptive study conducted in the Netherlands, open right colectomy seems to have a higher risk for complications and mortality as compared to laparoscopic right colectomy, even after correction for confounding factors.
腹腔镜右半结肠切除术是否优于开放手术一直存在争议。本研究的目的是利用来自国家数据库的数据解决这一问题并达成共识。
从荷兰结直肠手术审计中确定2009年至2013年期间因结直肠癌接受择期开放或腹腔镜右半结肠切除术的患者。计算并比较开放手术和腹腔镜手术切除术后30天内发生的并发症及30天死亡率。
共有12006例患者因右侧结直肠癌接受了择期开放或腹腔镜手术。其中，6683例（55.7%）接受了开放手术切除，5323例（44.3%）接受了腹腔镜手术切除。腹腔镜组术后30天内2·1%的患者发生并发症，开放组为32·1%（p<0·001）。腹腔镜组的30天死亡率也显著较低（2·2%对3·6%，p<0·001）。
在荷兰进行的这项非随机描述性研究中，即使校正混杂因素后，开放右半结肠切除术与腹腔镜右半结肠切除术相比，似乎并发症和死亡率风险更高。
