Department of Abdominal Surgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, the Netherlands.
Department of Surgery, Spaarne Gasthuis, Haarlem, the Netherlands.
J Gastrointest Surg. 2019 Oct;23(10):2007-2018. doi: 10.1007/s11605-018-3931-6. Epub 2018 Sep 5.
Conversion and anastomotic leakage in colorectal cancer surgery have been suggested to have a negative impact on long-term oncologic outcomes. The aim of this study in a large Dutch national cohort was to analyze the influence of conversion and anastomotic leakage on long-term oncologic outcome in rectal cancer surgery.
Patients were selected from a retrospective cross-sectional snapshot study. Patients with a benign lesion, distant metastasis, or unknown tumor or metastasis status were excluded. Overall (OS) and disease-free survival (DFS) were compared between laparoscopic, converted, and open surgery as well as between patients with and without anastomotic leakage.
Out of a database of 2095 patients, 638 patients were eligible for inclusion in the laparoscopic, 752 in the open, and 107 in the conversion group. A total of 746 patients met the inclusion criteria and underwent low anterior resection with primary anastomosis, including 106 (14.2%) with anastomotic leakage. OS and DFS were significantly shorter in the conversion compared to the laparoscopic group (p = 0.025 and p = 0.001, respectively) as well as in anastomotic leakage compared to patients without anastomotic leakage (p = 0.002 and p = 0.024, respectively). In multivariable analysis, anastomotic leakage was an independent predictor of OS (hazard ratio 2.167, 95% confidence interval 1.322-3.551) and DFS (1.592, 1077-2.353). Conversion was an independent predictor of DFS (1.525, 1.071-2.172), but not of OS.
Technical difficulties during laparoscopic rectal cancer surgery, as reflected by conversion, as well as anastomotic leakage have a negative prognostic impact, underlining the need to improve both aspects in rectal cancer surgery.
结直肠癌手术中的中转和吻合口漏被认为对长期肿瘤学结果有负面影响。本研究旨在分析荷兰大型全国队列中，直肠癌手术中转和吻合口漏对长期肿瘤学结果的影响。
从回顾性横断面快照研究中选择患者。排除良性病变、远处转移或肿瘤或转移状态未知的患者。比较腹腔镜、中转和开放手术的总生存期（OS）和无病生存期（DFS），以及吻合口漏患者和无吻合口漏患者的生存期。
在 2095 名患者的数据库中，有 638 名患者符合纳入腹腔镜组的标准，752 名符合纳入开放组的标准，107 名符合纳入中转组的标准。共有 746 名患者符合接受低位前切除术和一期吻合术的纳入标准，其中 106 名（14.2%）发生吻合口漏。与腹腔镜组相比，中转组的 OS 和 DFS 明显更短（p=0.025 和 p=0.001），与无吻合口漏的患者相比，吻合口漏患者的 OS 和 DFS 也明显更短（p=0.002 和 p=0.024）。多变量分析显示，吻合口漏是 OS（危险比 2.167，95%置信区间 1.322-3.551）和 DFS（1.592，1077-2.353）的独立预测因素。中转是 DFS（1.525，1.071-2.172）的独立预测因素，但不是 OS 的独立预测因素。
腹腔镜直肠癌手术中出现的技术困难（表现为中转）和吻合口漏对预后有负面影响，这突出表明需要改善直肠癌手术中的这两个方面。
