腹腔镜辅助结直肠切除术作为 T4 期结肠癌患者的一种具有肿瘤安全性的替代方法：一项倾向评分匹配队列研究。
Laparoscopy-assisted colectomy as an Oncologically safe alternative for patients with stage T4 Colon Cancer: a propensity-matched cohort study.
机构信息
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China.
出版信息
BMC Cancer. 2018 Apr 3;18(1):370. doi: 10.1186/s12885-018-4269-x.
BACKGROUND
It is still controversial whether laparoscopy-assisted colectomy (LAC) is suitable for patients with stage T4 colon cancer. This study aimed to compare the short- and long-term outcomes of LAC and open colectomy (OC) for patients with pathologic T4 colon cancer.
METHODS
Data of eligible patients with colon cancer in our institution from March 2004 to September 2014 were retrospectively reviewed. The patients were followed up to September 2016. Propensity score matching was performed to control the bias.
RESULTS
Two hundred and forty two patients were selected by propensity score matching, with 121 patients in the LAC group and 121 in the OC group. Mean operating time and rate of intraoperative blood transfusion were similar between two groups. In LAC group, shorter time to first flatus and first liquid intake were observed in patients with pT4b stage disease, but not for patients with pT4a stage disease. Less blood loss and shorter length of postoperative hospital stay were examined in LAC group, including pT4a and pT4b stages. Conversion was required in 9.1% (11 out of 121) cases. DFS and OS were similar between LAC and OC groups. The 5-year DFS rate was 64.2% for pT4a stage and 35.5% for pT4b stage in LAC group, and 62.9% and 33.7% in OC group for pT4a (p = 0.374) and pT4b (p = 0.385) stage respectively. For 5-year OS rates, two groups did not differ in pT4a stage (LAC 69.2% vs. OC 66.0%, p = 0.151) and pT4b stage (LAC 37.5% vs. OC 38.1%, p = 0.510).
CONCLUSIONS
Laparoscopic colectomy appears to be safe for selected patients with pT4 colon cancer in centres with expertise in minimally invasive surgery.
背景
腹腔镜辅助结直肠切除术（LAC）是否适用于 T4 期结肠癌患者仍存在争议。本研究旨在比较 LAC 和开腹结直肠切除术（OC）治疗病理 T4 期结肠癌患者的短期和长期结果。
方法
回顾性分析 2004 年 3 月至 2014 年 9 月我院符合条件的结肠癌患者数据，随访至 2016 年 9 月。采用倾向评分匹配法控制偏倚。
结果
通过倾向评分匹配，共选择了 242 例患者，其中 LAC 组 121 例，OC 组 121 例。两组的平均手术时间和术中输血率相似。在 LAC 组中，pT4b 期患者的首次排气和首次液体摄入时间较短，但 pT4a 期患者则不然。LAC 组的出血量和术后住院时间较短，包括 pT4a 和 pT4b 期。LAC 组有 9.1%（11/121）的患者需要中转开腹。LAC 组和 OC 组的 DFS 和 OS 相似。LAC 组 pT4a 期的 5 年 DFS 率为 64.2%，pT4b 期为 35.5%，OC 组 pT4a 期为 62.9%，pT4b 期为 33.7%（p=0.374）。pT4a 期（LAC 组 69.2% vs. OC 组 66.0%，p=0.151）和 pT4b 期（LAC 组 37.5% vs. OC 组 38.1%，p=0.510）两组 5 年 OS 率无差异。
结论
在微创外科专业中心，腹腔镜结直肠切除术似乎对选择的 T4 期结肠癌患者是安全的。
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