Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA.
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
J Gastrointest Surg. 2018 Aug;22(8):1412-1417. doi: 10.1007/s11605-018-3751-8. Epub 2018 Mar 28.
Long-term oncologic outcomes after minimally invasive surgery (MIS) for rectal adenocarcinoma compared to open surgery continue to be debated. We aimed to review our high-volume single-institution outcomes in MIS rectal cancer surgery.
A retrospective review of a prospectively collected database was completed of all consecutive adult patients with rectal adenocarcinoma treated from January 2005 through December 2011. Stage IV or recurrent disease was excluded. Demographics and operative and pathologic details were reviewed and reported. Primary endpoints include survival and recurrence.
A total of 324 patients were included and median follow-up was 54 months (IQR = 37.0, 78.8). The mean age was 58.2 ± 14.1 years. Tumors were in the upper rectum in 111 patients, mid-rectum in 113 patients, and lower rectum in 100 patients. Stage III disease was most common (49.4%). Overall conversion to open procedure rate was 13.9%. The circumferential radial margin was positive in only 1 patient (0.3%) and the mean lymph node yield was 24.7 ± 17.2. Cancer recurred in 42 patients (13%), 10 (2.5%) patients developed local recurrence, 32 (9.8%) developed distant metastasis, and 2 (0.6%) patients had both. The 5-year overall survival for stage 0, 1, 2, and 3 disease is 96, 91, 80, and 77%, respectively (p = 0.015).
In carefully selected rectal cancer patients treated with MIS, long-term outcomes of survival and recurrence appear to compare favorably to previously published series.
与开放式手术相比，微创外科（MIS）治疗直肠腺癌的长期肿瘤学结果仍存在争议。我们旨在回顾我们在 MIS 直肠癌症手术方面的高容量单机构结果。
对 2005 年 1 月至 2011 年 12 月连续接受直肠腺癌治疗的所有成年患者的前瞻性收集数据库进行了回顾性审查。排除 IV 期或复发性疾病。回顾并报告了人口统计学以及手术和病理细节。主要终点包括生存和复发。
共纳入 324 例患者，中位随访时间为 54 个月（IQR = 37.0，78.8）。平均年龄为 58.2 ± 14.1 岁。111 例患者的肿瘤位于直肠上段，113 例患者位于直肠中段，100 例患者位于直肠下段。III 期疾病最为常见（49.4%）。总的中转开放手术率为 13.9%。仅 1 例（0.3%）患者的环周放射状边缘阳性，平均淋巴结检出量为 24.7 ± 17.2。42 例（13%）患者癌症复发，10 例（2.5%）患者局部复发，32 例（9.8%）患者远处转移，2 例（0.6%）患者两者兼有。0 期、1 期、2 期和 3 期疾病的 5 年总生存率分别为 96%、91%、80%和 77%（p = 0.015）。
在接受 MIS 治疗的精心选择的直肠癌患者中，生存和复发的长期结果似乎与先前发表的系列结果相当。
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