Wei Mingtian, Zhang Xubing, Ma Pingfan, He Wanbin, Bi Liang, Wang Ziqiang
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu The People's Hospital of Leshan, Leshan, China.
Medicine (Baltimore). 2018 Aug;97(35):e11907. doi: 10.1097/MD.0000000000011907.
An increasing proportion of patients aged more than 70 years old are suffering from colorectal cancers. This study aimed to compare the short- and long-terms outcomes between open surgery (OS) or conventional laparoscopic surgery (LS) and hand-assisted laparoscopic surgery (HALS) in treatment of these elderly patients with right colon cancers.We retrospectively reviewed patients who underwent right colon resections for cancers in our institution between June, 2009 and December, 2014. Short- and long-terms outcomes including surgical endpoints, postsurgical recovery data, postoperative morbidity and mortality, overall survival and disease-free survival were compared among OS, LS, and HALS groups. All data were analyzed by SPSS 22.0.Finally, 69 consecutive patients (OS = 26, LS = 24, HALS = 19) with right colon cancers were included in the analysis. Compared with OS, HALS was associated with less time to first anus exhaust (P = .013), first liquid diet (P = .045), and first soft diet (P = .036). Meanwhile, there were significant less operative time (P = .0027), blood loss (P < .001), and less time to first liquid diet (P = .009) in HALS, compared with LS. In regards to long-term outcomes, there were no significant differences in overall survival and disease-free survival among the 3 groups.Compared with OS or LS, HALS may be more favorable in the treatment of elderly right colon cancers with decreased surgical time and postoperative recovery, and comparable cancer-specific survivals.
70岁以上的患者患结直肠癌的比例越来越高。本研究旨在比较开放手术（OS）或传统腹腔镜手术（LS）与手辅助腹腔镜手术（HALS）治疗这些老年右半结肠癌患者的短期和长期疗效。我们回顾性分析了2009年6月至2014年12月在我院接受右半结肠癌切除术的患者。比较了OS、LS和HALS组的短期和长期疗效，包括手术终点、术后恢复数据、术后发病率和死亡率、总生存率和无病生存率。所有数据均采用SPSS 22.0进行分析。最后，69例连续的右半结肠癌患者（OS = 26例，LS = 24例，HALS = 19例）纳入分析。与OS相比，HALS组首次排气时间（P = 0.013）、首次流食时间（P = 0.045）和首次软食时间（P = 0.036）更短。同时，与LS相比，HALS组手术时间显著缩短（P = 0.0027）、失血量减少（P < 0.001）、首次流食时间更短（P = 0.009）。在长期疗效方面，三组的总生存率和无病生存率无显著差异。与OS或LS相比，HALS在治疗老年右半结肠癌方面可能更具优势，手术时间和术后恢复时间缩短，癌症特异性生存率相当。
