Chen Chin-Fan, Lin Yi-Chieh, Tsai Hsiang-Lin, Huang Ching-Wen, Yeh Yung-Sung, Ma Cheng-Jen, Lu Chien-Yu, Hu Huang-Ming, Shih Hsiang-Yao, Shih Ying-Ling, Sun Li-Chu, Chiu Herng-Chia, Wang Jaw-Yuan
Department of Surgery, Division of Trauma and Critical Care, Kaohsiung Medical University Hospital; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
J Minim Access Surg. 2018 Oct-Dec;14(4):321-334. doi: 10.4103/jmas.JMAS_155_17.
Three operative techniques have been used for colorectal cancer (CRC) resection: Conventional laparotomy (CL) and the mini-invasive techniques (MITs)- laparoscopic-assisted surgery (LAS) and mini-laparotomy (ML). The aim of the study was to compare the short- and long-term outcomes of patients undergoing the three surgical approaches for Stage I-III CRC resection.
This study enrolled 688 patients with Stage I-III CRC undergoing curative resection. The primary endpoints were perioperative quality and outcomes. The secondary endpoints were oncological outcomes including disease-free survival (DFS), overall survival (OS) and local recurrence (LR).
Patients undergoing LAS had significantly less blood loss (P < 0.001), earlier first flatus (P = 0.002) and earlier resumption of normal diet (P = 0.025). Although post-operative complication rates were remarkably higher in patients undergoing CL than in those undergoing MITs (P = 0.002), no difference was observed in the post-operative mortality rate (P = 0.099) or 60-day re-intervention rate (P = 0.062). The quality of operation as assessed by the number of lymph nodes harvested and rates of R0 resection did not differ among the groups (all P > 0.05). During a median follow-up of 5.42 years, no significant difference was observed among the treatment groups in the rates of 3-year late morbidity, 3-year LR, 5-year LR, 5-year OS or 5-year DFS (all P > 0.05).
Patients undergoing CL had higher post-operative morbidities. Moreover, the study findings confirm the favourable short-term and comparable long-term outcomes of LAS and ML for curative CRC resection. Therefore, both MITs may be feasible and safe alternatives to CL for Stage I-III CRC resection.
三种手术技术已用于结直肠癌（CRC）切除：传统开腹手术（CL）以及微创技术（MITs）——腹腔镜辅助手术（LAS）和小切口开腹手术（ML）。本研究的目的是比较接受这三种手术方式进行I-III期CRC切除的患者的短期和长期结局。
本研究纳入了688例接受根治性切除的I-III期CRC患者。主要终点是围手术期质量和结局。次要终点是肿瘤学结局，包括无病生存期（DFS）、总生存期（OS）和局部复发（LR）。
接受LAS的患者失血量明显更少（P < 0.001），首次排气更早（P = 0.002），恢复正常饮食更早（P = 0.025）。虽然接受CL的患者术后并发症发生率明显高于接受MITs的患者（P = 0.002），但术后死亡率（P = 0.099）或60天再次干预率（P = 0.062）没有差异。各组间通过获取的淋巴结数量和R0切除率评估的手术质量没有差异（所有P > 0.05）。在中位随访5.42年期间，各治疗组在3年晚期发病率、3年LR、5年LR、5年OS或5年DFS发生率方面没有观察到显著差异（所有P > 0.05）。
接受CL的患者术后发病率更高。此外，研究结果证实了LAS和ML在根治性CRC切除方面具有良好的短期结局和相当的长期结局。因此，对于I-III期CRC切除，两种MITs可能是CL可行且安全的替代方案。
