Zealand University Hospital, Center for Surgical Science, Department of Surgery, Roskilde, Denmark.
Copenhagen University Hospital Herlev, Center for Minimally Invasive and Robotic Surgery, Department of Surgery, Herlev, Denmark.
Dis Colon Rectum. 2019 Apr;62(4):438-446. doi: 10.1097/DCR.0000000000001304.
High-quality surgical resection of colonic cancer, including dissection along the embryologic mesocolic plane, translates into improved long-term oncological outcomes.
This study aimed to identify risk factors for compromised specimen quality and to evaluate the specimen quality of patients undergoing laparoscopic and open resection for colonic cancer.
This is a retrospective observational study.
This database study is based on the prospective national Danish Colorectal Cancer Database including patients undergoing intended curative elective colonic cancer surgery from January 1, 2010 through December 2013.
A total of 5143 patients (1602 open resections; 3541 laparoscopic resections) with colonic cancer were included.
Risk factors for poor resection quality were identified through uni- and multivariate logistic regression analysis. The surgical approach was assessed by propensity score-matched regression analysis. Poor resection quality was defined as resections in the muscularis plane accompanied by R0 resection, or resections in any resection plane accompanied by R1 resection.
Overall, 4415 (85.8%) of the resections were considered good and 728 (14.2%) were considered poor. After multivariate analysis, neoadjuvant oncological treatment, advanced tumor stage (T3-4), advancing N stage (N1-2), open tumor perforation, and open surgery significantly increased the risk of poor resection quality. In a propensity score-matched sample (n = 1508 matched pairs), matched for age, sex, ASA score, BMI, neoadjuvant treatment, tumor stage, and tumor location, open resection was still associated with a higher risk of poor resection quality compared with laparoscopic resection (OR, 1.4; 95% CI, 1.1-1.8; p = 0.002).
Retrospective design was a limitation of this study.
In this nationwide propensity score-matched database study, laparoscopic resection was associated with a higher probability of good resection quality compared with open resection for colonic cancer. Risk factors for compromised specimen quality were neoadjuvant oncological treatment, locally advanced tumor stage (T3-4), advanced N stage (N1-2), open tumor perforation, and open surgery. See Video Abstract at http://links.lww.com/DCR/A830.
高质量的结直肠癌切除术，包括沿着胚胎系膜平面进行解剖，可转化为改善长期肿瘤学结果。
本研究旨在确定影响标本质量的风险因素，并评估接受腹腔镜和开放性结直肠癌切除术患者的标本质量。
这是一项回顾性观察性研究。
本数据库研究基于前瞻性的丹麦结直肠癌数据库，包括 2010 年 1 月 1 日至 2013 年 12 月期间接受结直肠癌根治性选择性手术的患者。
共纳入 5143 例结直肠癌患者（1602 例开放性切除术；3541 例腹腔镜切除术）。
通过单因素和多因素逻辑回归分析确定不良切除质量的危险因素。通过倾向评分匹配回归分析评估手术方法。不良切除质量定义为在肌层平面进行的切除伴有 R0 切除，或在任何切除平面进行的切除伴有 R1 切除。
总体而言，4415 例（85.8%）切除术被认为质量良好，728 例（14.2%）被认为质量较差。多因素分析后，新辅助肿瘤治疗、肿瘤进展期（T3-4）、进展期 N 期（N1-2）、肿瘤穿孔和开放性手术显著增加了不良切除质量的风险。在倾向评分匹配样本（n=1508 对匹配）中，年龄、性别、ASA 评分、BMI、新辅助治疗、肿瘤分期和肿瘤位置匹配后，开放性切除术与腹腔镜切除术相比，仍与不良切除质量的风险较高相关（OR，1.4；95%CI，1.1-1.8；p=0.002）。
本研究为回顾性设计，存在局限性。
在这项全国性的倾向评分匹配数据库研究中，与开放性结直肠癌切除术相比，腹腔镜切除术与更高的良好切除质量概率相关。影响标本质量的危险因素是新辅助肿瘤治疗、局部进展期肿瘤（T3-4）、进展期 N 期（N1-2）、肿瘤穿孔和开放性手术。在 http://links.lww.com/DCR/A830 上观看视频摘要。
