从腹腔镜结肠切除术转为开放性手术是结肠癌患者肿瘤学结局恶化的标志。
Conversion to open from laparoscopic colon resection is a marker for worse oncologic outcomes in colon cancer.
机构信息
Department of Colorectal Surgery, Cleveland Clinic Foundation, Crile Building, 2049 East 100th Street, Cleveland, OH, 44195, USA.
出版信息
Am J Surg. 2019 Mar;217(3):491-495. doi: 10.1016/j.amjsurg.2018.10.042. Epub 2018 Oct 31.
BACKGROUND
This study aimed to evaluate the oncological outcomes of conversion in patients undergoing resection for colon cancer.
METHODS
Patients with stages I-III colon adenocarcinoma operated on between 2000 and 2012 were included. Oncologic outcomes were assessed by surgical approach (laparoscopy vs. open). A secondary analysis compared patients who required conversion to open vs. laparoscopic only.
RESULTS
We identified 1196 patients that met inclusion criteria (28% laparoscopic, 72% open). Overall, 13% of laparoscopic cases were converted to open. There were no differences in 5-year overall survival (OS) (p = 0.258), disease-free survival, (DFS) (p = 0.070), cancer-specific survival (CSS) (p = 0.207), or recurrence (p = 0.216) between laparoscopy and open surgery. However, patients with conversion had a worse OS (p = 0.010) and DFS (p = 0.006) when compared to laparoscopic only.
CONCLUSION
Conversion from laparoscopic to open surgery is a marker for worse survival outcomes. Further investigation is needed to define the underlying cause of these differences.
背景
本研究旨在评估结肠癌患者行切除术时中转开腹的肿瘤学结局。
方法
纳入 2000 年至 2012 年间接受手术治疗的 I-III 期结肠腺癌患者。通过手术方式（腹腔镜与开腹）评估肿瘤学结局。二次分析比较了需要中转开腹与仅中转腹腔镜的患者。
结果
我们确定了符合纳入标准的 1196 例患者（28%腹腔镜，72%开腹）。总体而言，13%的腹腔镜手术中转开腹。腹腔镜组与开腹组的 5 年总生存率（OS）（p=0.258）、无病生存率（DFS）（p=0.070）、癌症特异性生存率（CSS）（p=0.207）或复发率（p=0.216）均无差异。然而，与仅腹腔镜组相比，中转开腹患者的 OS（p=0.010）和 DFS（p=0.006）更差。
结论
从腹腔镜转为开腹手术是生存结局恶化的标志。需要进一步研究来确定这些差异的根本原因。
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