Del Rio Paolo, Cataldo Celeste, Cozzani Federico, Pedrazzi Giuseppe, Bonati Elena, Dell'abate Paolo
Ann Ital Chir. 2019;90:225-230.
Most of the studies on laparoscopic surgery in the treatment of colorectal cancer analyzed the oncological or surgical outcome. It remains to be clarified, if laparoscopic surgery leads to a significant reduction in the incidence of systemic complications in the postoperative period.
We undertook a quantitative and qualitative assessment of non-surgical complications arising in our patients during the postoperative stay ,in relation to laparoscopic surgery compared to open surgery for colorectal cancer. In the study, 426 patients were recruited. The interventions were performed by an open technique for 225 patients, in VL for 145 patients and 56 patients were subjected to intraoperative conversion.
The correlation between surgical technique and onset cardiac complications showed a higher rate of onset of these in open (11.7%) than the VL technique (5.5%). Same result for pulmonary complications (open 13.2%, VL 3.4%) and renal (open 5.7%, VL 1.4%). Average age of patients treated with open surgery 75 years, average operating time duration 169 minutes. Average age patients treated in VL 69 years, average operating time duration 175 minutes. A possible benefit of videolaparoscopic rectal surgery on non-surgical complications has also been investigated, but a significant conclusion has not been reached due to the small number of adverse events found in the reference sample. The evaluation of the duration of the operating session in relation to non-surgical complications showed an increase in the occurrence of pulmonary, renal and systemic adverse events. There was also a significantly greater risk of pulmonary complications in male patients (M 12.7%, F 6.8%). Finally, by stratifying patients by age, a significant positive correlation emerged in the onset of pulmonary complications in the subgroup of patients aged ≥ 70 years, operated with open technique (open 14.6%, vl 3.8).
The data analysed shows a reduction of pulmonary and renal cardiac adverse events after laparoscopic oncological surgery, it has not come to a conclusion for rectal cancer. There is also an increase in adverse events related to the duration of the operating session, the male sex and the age ≥ 70 years, thus enhancing the hypothesis that elderly patients are actually the population who can ultimately benefit more of minimally invasive surgical techniques.
Adverse eventColectomy, Colorectal cancer, Laparoscopy, Open surgery.
大多数关于腹腔镜手术治疗结直肠癌的研究分析了肿瘤学或手术结果。腹腔镜手术是否会导致术后全身并发症发生率显著降低仍有待阐明。
我们对患者术后住院期间出现的非手术并发症进行了定量和定性评估，比较了腹腔镜手术与结直肠癌开放手术。本研究招募了426例患者。225例患者采用开放技术进行干预，145例患者采用腹腔镜手术，56例患者术中进行了术式转换。
手术技术与心脏并发症发生之间的相关性显示，开放手术组这些并发症的发生率（11.7%）高于腹腔镜手术组（5.5%）。肺部并发症（开放手术组13.2%，腹腔镜手术组3.4%）和肾脏并发症（开放手术组5.7%，腹腔镜手术组1.4%）也是如此。接受开放手术患者的平均年龄为75岁，平均手术时长为169分钟。接受腹腔镜手术患者的平均年龄为69岁，平均手术时长为175分钟。还研究了腹腔镜直肠手术对非手术并发症的潜在益处，但由于参考样本中发现的不良事件数量较少，尚未得出明确结论。对手术时长与非手术并发症的评估显示，肺部、肾脏和全身不良事件的发生率有所增加。男性患者发生肺部并发症的风险也显著更高（男性12.7%，女性6.8%）。最后，按年龄对患者进行分层后，采用开放技术手术的≥70岁患者亚组中，肺部并发症的发生存在显著正相关（开放手术组14.6%，腹腔镜手术组3.8%）。
分析数据显示，腹腔镜肿瘤切除术后肺部、肾脏和心脏不良事件有所减少，但直肠癌方面尚未得出结论。与手术时长、男性性别以及年龄≥70岁相关的不良事件也有所增加，从而强化了这样一种假设，即老年患者实际上是最终能从微创外科技术中获益更多的人群。
不良事件；结肠切除术；结直肠癌；腹腔镜检查；开放手术
