经单孔腹腔镜行低位前切除术治疗高位直肠癌的安全性及可行性。
Safety and feasibility of single-port laparoscopic low anterior resection for upper rectal cancer.
机构信息
Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan.
Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan.
出版信息
Am J Surg. 2018 Dec;216(6):1101-1106. doi: 10.1016/j.amjsurg.2018.03.022. Epub 2018 Mar 26.
BACKGROUND
Single-port surgery for rectal cancer is challenging and controversial. The aim of this study was to compare the short-term outcomes of single-port laparoscopic low anterior resection (S-LAR) to multi-port laparoscopic low anterior resection (M-LAR) for upper rectal cancer.
METHODS
From January 2011 to December 2015, a total of 93 patients who underwent S-LAR (n = 44) or M-LAR (n = 49) without protective diverting ileostomy for upper rectal cancer were identified. Tumors were located between the inferior margin of the second sacral vertebra and the peritoneal reflection. Short-term outcomes were compared between groups.
RESULTS
S-LAR was successful in 75% of cases: 25% of cases required one additional port. Operative factors, perioperative outcomes, oncological outcomes did not differ significantly between groups. In patients with stage I-III disease, the 3-year relapse-free survival rate was significantly higher in the S-LAR group than in the M-LAR group (p = 0.032). The 3-year overall survival rate was similar between groups.
CONCLUSIONS
S-LAR is safe, feasible and can provide satisfactory oncological outcomes in selected patients with upper rectal cancer.
背景
单孔腹腔镜直肠癌手术具有挑战性和争议性。本研究旨在比较单孔腹腔镜低位前切除术（S-LAR）与多孔腹腔镜低位前切除术（M-LAR）治疗高位直肠癌的短期疗效。
方法
2011 年 1 月至 2015 年 12 月，共纳入 93 例未行保护性预防性回肠造口术的高位直肠癌患者，行 S-LAR（n=44）或 M-LAR（n=49）。肿瘤位于第二骶椎下缘至腹膜反折之间。比较两组患者的短期疗效。
结果
S-LAR 手术成功率为 75%：25%的患者需要增加一个辅助切口。两组患者的手术因素、围手术期结果、肿瘤学结果无显著差异。在 I-III 期疾病患者中，S-LAR 组的 3 年无复发生存率显著高于 M-LAR 组（p=0.032）。两组患者的 3 年总生存率相似。
结论
S-LAR 是一种安全、可行的方法，可为特定的高位直肠癌患者提供满意的肿瘤学疗效。
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