腹腔镜扩大全直肠系膜切除术治疗局部进展期低位直肠癌的可行性和疗效

The Feasibility and Efficacy of Laparoscopic Extended Total Mesorectal Excision for Locally Advanced Lower Rectal Cancer.

作者信息

Nonaka Takashi, Fukuda Akiko, Maekawa Kyoichiro, Nagayoshi Shigeki, Tokunaga Takayuki, Takatsuki Mitsutoshi, Kitajima Tomoo, Taniguchi Ken, Fujioka Hikaru

机构信息

Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan

Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.

出版信息

In Vivo. 2018 May-Jun;32(3):643-648. doi: 10.21873/invivo.11287.

DOI:10.21873/invivo.11287

PMID:29695572

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6000797/

Abstract

BACKGROUND/AIM: Extended total mesorectal excision (ETME) is defined as en bloc resection of the adjacent organs outside the mesorectal fascia, that is indicated in cases with locally advanced lower rectal cancer (T4 tumor). The aim of this study was to evaluate the clinical and oncological outcomes of laparoscopic ETME (L-ETME) for locally advanced lower rectal cancer.

PATIENTS AND METHODS

The present study analyzed clinical outcomes and oncological outcomes of 11 consecutive patients who underwent L-ETME for cT4 lower rectal cancer in Nagasaki Medical Center between 2012 and 2015.

RESULTS

Of the 11 patients, 7 underwent neoadjuvant therapy, and 7 underwent pelvic node dissection. One case (7.1%) underwent resection of anterior organs (prostate), 6 cases (54.5%) had resection of the lateral organs (neurovascular bundle, hypogastric nerve, pelvic plexus, ovary, and internal iliac blood vessels) and 4 cases (36.4%) had resection of both anterior and lateral organs. In all cases enrolled in this study, R0 resection was achieved. The median operation time and intraoperative blood loss were 416 min and 350 ml, respectively. The postoperative complication rate was 18.2% (2/11). The 3-year overall survival rate was 79.5%, and the 3-year local recurrence-free survival rate was 87.5%. There was no mortality and no re-operation in this series.

CONCLUSION

The results of the present study suggest that L-ETME is feasible and has efficacy for locally advanced lower rectal cancer.

摘要

背景/目的：扩大全直肠系膜切除术（ETME）定义为在直肠系膜筋膜外整块切除相邻器官，适用于局部晚期低位直肠癌（T4期肿瘤）病例。本研究的目的是评估腹腔镜扩大全直肠系膜切除术（L-ETME）治疗局部晚期低位直肠癌的临床和肿瘤学结局。

患者与方法

本研究分析了2012年至2015年期间在长崎医疗中心接受L-ETME治疗cT4低位直肠癌的11例连续患者的临床结局和肿瘤学结局。

结果

11例患者中，7例接受了新辅助治疗，7例接受了盆腔淋巴结清扫术。1例（7.1%）患者切除了前方器官（前列腺），6例（54.5%）患者切除了侧方器官（神经血管束、腹下神经、盆腔丛、卵巢和髂内血管），4例（36.4%）患者同时切除了前方和侧方器官。本研究纳入的所有病例均实现了R0切除。中位手术时间和术中出血量分别为416分钟和350毫升。术后并发症发生率为18.2%（2/11）。3年总生存率为79.5%，3年局部无复发生存率为87.5%。本系列中无死亡病例，也未进行再次手术。