Zhang Zhanzhi, Zhang Benqiang Rao Zhipeng Sun Nengwei
General Surgery Department, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P. R. China.
J BUON. 2019 Mar-Apr;24(2):464-469.
To investigate the perioperative clinicopathologic outcome and postoperative survival of sphincter-sparing surgery by laparoscopic and open approach for patients with rectal cancer. Μethods: From January 1, 2008 to December 31, 2011, laparoscopic sphincter-sparing surgery and open sphincter-sparing surgery was performed in 228 patients with rectal cancer who were included in this study as open group (N=112) and laparoscopic group (N=116), respectively. The average follow-up time was approximately 5 years.
Spearman's test showed that there was a slight negative correlation in overall survival and American Society of Anesthesiologists (ASA) grade (Spearman's r=-0.146, p=0.028), History of abdominal surgery (Spearman's r=-0.134, p=0.044) of all patients was statistically significant. There was no significant difference in survival between laparoscopic and open group (p=0.988). Kaplan-Meier curves showed that the total overall survival rates after laparoscopic and open sphincter-sparing surgery were similar in both groups. Log rank test showed that there were significant differences in overall survival among different ypTNM stages (pathological TNM after neoadjuvant chemotherapy) (p=0.002) and Charlson comorbidity index (p=0.03).
Compared with open approach, laparoscopic sphincter-sparing surgery of rectal cancer had less intraoperative bleeding, less postoperative complications and faster recovery of intestinal function after operation. Survival of open surgery and laparoscopic rectal sphincter preservation surgery was similar in both groups. ypTNM stage and Charlson comorbidity index are the risk factors affecting the survival of patients with rectal cancer.
探讨腹腔镜和开放手术保肛治疗直肠癌患者的围手术期临床病理结果及术后生存率。方法：2008年1月1日至2011年12月31日，对228例直肠癌患者分别行腹腔镜保肛手术和开放保肛手术，分为开放组（N = 112）和腹腔镜组（N = 116）。平均随访时间约5年。
Spearman检验显示，所有患者的总生存率与美国麻醉医师协会（ASA）分级（Spearman秩相关系数r = -0.146，p = 0.028）、腹部手术史（Spearman秩相关系数r = -0.134，p = 0.044）呈轻度负相关，差异有统计学意义。腹腔镜组和开放组的生存率差异无统计学意义（p = 0.988）。Kaplan-Meier曲线显示，腹腔镜和开放保肛手术后两组的总生存率相似。Log秩检验显示，不同ypTNM分期（新辅助化疗后的病理TNM）（p = 0.002）和Charlson合并症指数（p = 0.03）的总生存率有显著差异。
与开放手术相比，腹腔镜直肠癌保肛手术术中出血少、术后并发症少且术后肠功能恢复快。开放手术和腹腔镜直肠保肛手术两组患者的生存率相似。ypTNM分期和Charlson合并症指数是影响直肠癌患者生存的危险因素。
