Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
Eur J Surg Oncol. 2018 Jul;44(7):1025-1030. doi: 10.1016/j.ejso.2018.03.022. Epub 2018 Apr 5.
Non-inferiority of the laparoscopic approach for stage II/III colon cancer has not been clearly established. This study aimed to evaluate the long-term outcomes of laparoscopic versus open D3 surgery.
Subjects were 1230 consecutive patients with stage II/III colon cancer, who were referred to the National Cancer Center Hospital from 2004 to 2013. Open surgery was performed in 821 (67%) patients, and laparoscopic surgery was performed in 409 (33%). Propensity score analyses with overall survival as the primary endpoint were performed in three different propensity score methods.
Regression adjustment using the propensity score as a linear predictor in the model showed similar overall survival between laparoscopic and open surgeries [hazard ratio (HR), 0.98 (95% CI [0.64-1.46]; p = 0.916)]. Stratification analysis of the entire cohort revealed that, among five strata, only the highest stratum (clinical T2/T3, clinical N0/N1, tumor size <6 cm, and body mass index (BMI) < 28) had an HR of <1 (0.37). In the other four strata, open surgery was favored as reflected by HRs of >1 (1.13-1.26). The propensity score-matched cohort (365 matched pairs), from which patients with advanced disease and high BMI were excluded, yielded an HR of 0.93 (95% CI [0.57-1.52]; p = 0.772).
Laparoscopic surgery appeared to be a safe and reasonable option for patients with stage II/III colon cancer in general. Patients with high BMI, clinical N2 and T4 disease, and tumor size ≥6 cm might require prudent selection of surgical approach.
腹腔镜治疗 II/III 期结肠癌的非劣效性尚未得到明确证实。本研究旨在评估腹腔镜与开腹 D3 手术的长期疗效。
本研究纳入了 2004 年至 2013 年期间在国家癌症中心医院就诊的 1230 例 II/III 期结肠癌患者。其中 821 例（67%）患者接受了开腹手术，409 例（33%）患者接受了腹腔镜手术。采用三种不同的倾向评分方法，以总生存期为主要终点进行倾向评分分析。
在模型中使用倾向评分作为线性预测因子进行回归调整后，腹腔镜手术与开腹手术的总生存期相似[风险比（HR），0.98（95%可信区间[0.64-1.46]；p=0.916)]。对全队列进行分层分析显示，在五个分层中，只有最高分层（临床 T2/T3、临床 N0/N1、肿瘤大小<6cm 和 BMI<28）的 HR<1（0.37）。在其他四个分层中，HR>1（1.13-1.26）提示开腹手术更有利。排除了进展期疾病和 BMI 较高的患者后，倾向评分匹配队列（365 对匹配）的 HR 为 0.93（95%可信区间[0.57-1.52]；p=0.772）。
腹腔镜手术似乎是 II/III 期结肠癌患者安全合理的选择。对于 BMI 较高、临床 N2 和 T4 疾病以及肿瘤大小≥6cm 的患者，可能需要谨慎选择手术方式。
