Lee Sung Chul, Huh Jung Wook, Lee Woo Yong, Yun Seong Hyeon, Kim Hee Cheol, Cho Yong Beom, Park Yoon Ah, Shin Jung Kyong
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Int J Colorectal Dis. 2020 Mar;35(3):395-402. doi: 10.1007/s00384-019-03489-7. Epub 2019 Dec 23.
The goal of this study was to evaluate the long-term oncologic outcomes after laparoscopic converted surgery for patients with colon cancer.
Retrospective database of consecutive curative-intent laparoscopic-assisted surgery for primary stage I-III colon cancer was reviewed from 2000 to 2013. The patients were divided into non-conversion and conversion groups. The patient characters, operative features, perioperative parameters, pathologic features, and oncologic outcomes were compared.
A total of 4010 patients were included in the study: 3929 in the non-conversion group and 81 (2%) in the conversion group. The median follow-up period was 63.9 months. There were significant differences in age, preoperative clinical T-stage, and tumor size between the groups. In operative details between the two groups, there were also significant differences in access to surgery, tumor location, cancer obstruction, cancer perforation, and estimated blood loss (P < 0.001). The two most common reasons for conversion were adhesion (n = 37, 46%) and bleeding (n = 21, 26%). Multivariate analysis showed that conversion was an independent predictor of both overall survival (OS) (P < 0.001) and disease-free survival (P = 0.003). The 5-year OS rate of the conversion group was 79.6%, and that of the non-conversion group was 96.2% (P < 0.001). The multivariate predictors of conversion were age, type of surgery, cancer obstruction, cancer perforation, and clinical T-stage.
Conversion to open surgery may affect patient survival and recurrence after laparoscopic-assisted surgery for colon cancer. Our data suggest that conversion is associated with poor outcomes, but we should not hesitate to convert it to patients who have difficulty in laparoscopic surgery.
本研究旨在评估结肠癌患者腹腔镜中转手术后的长期肿瘤学结局。
回顾性分析2000年至2013年期间连续进行的针对I-III期原发性结肠癌的根治性腹腔镜辅助手术的数据库。将患者分为未中转组和中转组。比较两组患者的特征、手术特点、围手术期参数、病理特征和肿瘤学结局。
本研究共纳入4010例患者，其中未中转组3929例，中转组81例（2%）。中位随访时间为63.9个月。两组患者在年龄、术前临床T分期和肿瘤大小方面存在显著差异。在两组手术细节方面，手术入路、肿瘤位置、癌性梗阻、癌性穿孔和估计失血量也存在显著差异（P<0.001）。中转的两个最常见原因是粘连（n=37，46%）和出血（n=21，26%）。多因素分析显示，中转是总生存期（OS）（P<0.001）和无病生存期（P=0.003）的独立预测因素。中转组的5年总生存率为79.6%，未中转组为96.2%（P<0.001）。中转的多因素预测因素为年龄、手术类型、癌性梗阻、癌性穿孔和临床T分期。
结肠癌腹腔镜辅助手术后中转开腹手术可能影响患者生存和复发。我们的数据表明，中转与不良结局相关，但对于腹腔镜手术困难的患者，我们应毫不犹豫地进行中转。
