Department of Digestive Surgery and Surgical Oncology - Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris XIII, 125 rue de Stalingrad, 93000, Bobigny, France.
Department of Digestive Surgery, Surgical Oncoloy and Metabolic Surgery - Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
Surg Endosc. 2020 May;34(5):2120-2126. doi: 10.1007/s00464-019-06995-5. Epub 2019 Jul 19.
Perioperative outcomes of repeat laparoscopic colorectal resection (LCRR) have not been extensively reported.
Patients who underwent LCRR from 2010 to 2018 in an expert center were retrieved from a prospectively collected database and compared to 2:1 matched sample. Matching was based on demographics, surgical indication [colorectal cancer (CRC) or benign condition], and type of resection (right-sided resection or left-sided resection or proctectomy).
Twenty-three patients underwent repeat LCRR with a median time of 36 months between the primary and the repeat LCRR. They were 12 (52%) men with a mean age of 64.9 years (31-87) and a median BMI of 21.4 kg/m (17.7-34). Indication for repeat LCRR was CRC, dysplasia, anastomotic stricture, and inflammatory bowel disease in 11 (48%), 5 (22%), 4 (17%), and 3 (13%) patients, respectively. A right-sided resection, a left-sided resection, and proctectomy were reported in 11 (48%), 8 (35%), and 4 (17%) patients, respectively. Median blood loss reached 211 mL (range 0-2000 mL). Thirteen (57%) patients required conversion to laparotomy including 12 for intense adhesions. The median length of hospital stay was 7.5 days (5-20). Two (9%) major complications (Clavien-Dindo ≥ 3) were reported: 1 (4%) anastomotic fistula and 1 (4%) postoperative hemorrhage, without mortality. Among patients who underwent repeat LCRR for CRC, histopathological examination showed R0 resection in all patients, with at least 12 lymph nodes harvested in ten (91%) patients. After matched case-control analysis that compared to primary LCRR, conversion rate (p = 0.03), operative time (p = 0.03), and intraoperative blood loss (p = 0.0016) were significantly increased in repeat LCRR, without impact on postoperative outcomes.
Repeat LCRR seems to be feasible and safe in expert hands without compromising the oncologic outcomes. Intense postoperative adhesions and misidentification of blood supply might lead to conversion to laparotomy. Real benefits of laparoscopic approach for repeat LCRR should be assessed in further studies.
重复腹腔镜结直肠切除术（LCRR）的围手术期结果尚未得到广泛报道。
从一个前瞻性收集的数据库中检索了 2010 年至 2018 年期间在专家中心接受 LCRR 的患者，并与 2:1 匹配的样本进行了比较。匹配基于人口统计学、手术指征[结直肠癌（CRC）或良性疾病]和切除类型（右半结肠切除术、左半结肠切除术或直肠切除术）。
23 例患者接受了重复 LCRR，初次手术和重复 LCRR 之间的中位时间为 36 个月。其中 12 例（52%）为男性，平均年龄为 64.9 岁（31-87 岁），平均 BMI 为 21.4kg/m（17.7-34）。11 例（48%）患者的重复 LCRR 指征为 CRC、发育不良、吻合口狭窄和炎症性肠病，5 例（22%）、4 例（17%）和 3 例（13%）分别为吻合口狭窄、炎症性肠病。报告的右半结肠切除术、左半结肠切除术和直肠切除术分别为 11 例（48%）、8 例（35%）和 4 例（17%）。中位失血量为 211ml（0-2000ml）。13 例（57%）患者需要转为开腹手术，其中 12 例因粘连严重。中位住院时间为 7.5 天（5-20 天）。2 例（9%）发生严重并发症（Clavien-Dindo≥3）：1 例（4%）吻合口瘘，1 例（4%）术后出血，无死亡。在因 CRC 行重复 LCRR 的患者中，组织病理学检查显示所有患者均为 R0 切除，其中 10 例（91%）至少有 12 枚淋巴结被切除。与初次 LCRR 进行匹配病例对照分析后，重复 LCRR 的中转率（p=0.03）、手术时间（p=0.03）和术中出血量（p=0.0016）显著增加，但术后结局无影响。
在专家手中，重复 LCRR 似乎是可行和安全的，不会影响肿瘤学结果。严重的术后粘连和血供错误识别可能导致转为开腹手术。重复 LCRR 腹腔镜方法的实际益处应在进一步的研究中进行评估。
