General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy.
General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy.
Eur J Surg Oncol. 2018 Apr;44(4):469-483. doi: 10.1016/j.ejso.2018.01.091.
To investigate the rate of laparoscopic colectomies for colon cancer using registries and population-based studies. To provide a position paper on mini-invasive (MIS) colon cancer surgery based on the opinion of experts leader in this field.
A systematic review of the literature was conducted using PRISMA guidelines for the rate of laparoscopy in colon cancer. Moreover, Delphi methodology was used to reach consensus among 35 international experts in four study rounds. Consensus was defined as an agreement ≥75.0%. Domains of interest included nosology, essential technical/oncological requirements, outcomes and MIS training.
Forty-four studies from 42 articles were reviewed. Although it is still sub-optimal, the rate of MIS for colon cancer increased over the years and it is currently >50% in Korea, Netherlands, UK and Australia. The remaining European countries are un-investigated and presented lower rates with highest variations, ranging 7-35%. Using Delphi methodology, a laparoscopic colectomy was defined as a "colon resection performed using key-hole surgery independently from the type of anastomosis". The panel defined also the oncological requirements recognized essential for the procedure and agreed that when performed by experienced surgeons, it should be marked as best practice in guidelines, given the principles of oncologic surgery be respected (R0 procedure, vessel ligation and mesocolon integrity).
The rate of MIS colectomies for cancer in Europe should be further investigated. A panel of leaders in this field defined laparoscopic colectomy as a best practice procedure when performed by an experienced surgeon respecting the standards of surgical oncology.
通过注册和基于人群的研究调查结肠癌腹腔镜切除术的比例。根据该领域专家的意见，提供一份关于微创（MIS）结肠癌手术的立场文件。
使用 PRISMA 指南对结肠癌腹腔镜手术的比例进行了系统的文献回顾。此外，还使用德尔菲法在四轮研究中达成了 35 名国际专家的共识。共识定义为≥75.0%的协议。关注的领域包括分类学、基本技术/肿瘤学要求、结果和 MIS 培训。
从 42 篇文章中综述了 44 项研究。尽管仍然不理想，但近年来，MIS 治疗结肠癌的比例有所增加，目前在韩国、荷兰、英国和澳大利亚超过 50%。其余欧洲国家尚未进行调查，其比例较低，差异最大，范围为 7-35%。使用德尔菲法，腹腔镜结肠切除术被定义为“使用微创技术进行的结肠切除术，独立于吻合类型”。专家组还定义了被认为对该手术必不可少的肿瘤学要求，并一致认为，当由经验丰富的外科医生进行操作时，应将其标记为指南中的最佳实践，因为应尊重肿瘤外科的原则（R0 手术、血管结扎和结肠系膜完整性）。
欧洲 MIS 结肠癌切除术的比例应进一步调查。该领域的专家小组将腹腔镜结肠切除术定义为经验丰富的外科医生在尊重手术肿瘤学标准的情况下实施的最佳实践程序。
