Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting / Burghausen, Altötting, Germany.
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany.
PLoS One. 2019 Jun 27;14(6):e0218829. doi: 10.1371/journal.pone.0218829. eCollection 2019.
To assess whether laparoscopy has any advantages over open resection for right-sided colon cancer.
Right hemicolectomy can be performed using either a conventional open or a minimally invasive laparoscopic technique. It is not clear whether these different access routes differ with regard to short-term postoperative outcomes.
Patients documented in the German Society for General and Visceral Surgery StuDoQ|ColonCancer registry who underwent right hemicolectomy were analyzed regarding early postoperative complications according to Clavien-Dindo (primary endpoint), operation (OP) time, length of postoperative hospital stay (LOS), MTL30 and number of lymph nodes retrieved (secondary endpoints).
A total of 4.997 patients were identified as undergoing oncological right hemicolectomy without additional interventions. Of these, 4.062 (81.3%) underwent open, 935 (18.7%) laparoscopic surgery. Propensity score analysis showed a significantly shorter LOS (OR: 0.55 CI 95%0.47-.64) and a significantly longer OP time (OR2.32 CI 1.98-2.71) for the laparoscopic route. Risk factors for postoperative complications, anastomotic insufficiency, ileus, reoperation and positive MTL30 were higher ASA status, higher age and increasing BMI. The surgical access route (open / lap) had no influence on these factors, but the laparoscopic group did have markedly fewer lymph nodes retrieved.
The present registry-based analysis could detect no relevant advantages for the minimally invasive laparoscopic access route. Further oncological analyses are needed to clarify the extent to which the smaller lymph node harvest in the laparoscopic group is accompanied by a poorer oncological outcome.
评估腹腔镜相对于开腹切除术治疗右半结肠癌是否具有优势。
右半结肠切除术可采用传统的开腹或微创腹腔镜技术进行。目前尚不清楚这两种不同的入路方式在短期术后结果方面是否存在差异。
对德国普通和内脏外科协会 StuDoQ|ColonCancer 注册中心记录的接受右半结肠切除术的患者，根据 Clavien-Dindo 分级（主要终点）、手术时间、术后住院时间（次要终点）、MTL30 和淋巴结检出数量分析早期术后并发症。
共确定了 4997 例未接受额外干预的接受肿瘤右半结肠切除术的患者。其中 4062 例（81.3%）接受开腹手术，935 例（18.7%）接受腹腔镜手术。倾向评分分析显示，腹腔镜组的术后住院时间显著缩短（OR：0.55，95%CI 0.47-0.64），手术时间显著延长（OR2.32，95%CI 1.98-2.71）。术后并发症、吻合口不足、肠梗阻、再次手术和阳性 MTL30 的风险因素包括 ASA 状态较高、年龄较大和 BMI 增加。手术入路（开腹/腹腔镜）对这些因素没有影响，但腹腔镜组的淋巴结检出数量明显较少。
本基于注册的分析未能发现微创腹腔镜入路的相关优势。需要进一步的肿瘤学分析来阐明腹腔镜组淋巴结检出数量较少是否会导致较差的肿瘤学结果。
