Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, 1104 Ljubljana, Slovenia.
Medicina (Kaunas). 2020 Feb 24;56(2):93. doi: 10.3390/medicina56020093.
: When resecting colon adenocarcinoma, surgeons decide between the use of laparoscopically assisted and open surgery. Laparoscopic resection is known to have short-term benefits over an open operation. However, researchers are not as unified about the long-term findings. The aim of this research is to elaborate on five-year post-operative differences in survival and cancer recurrence between these two different approaches. : 74 enrolled patients were evaluated five years after a primary operation. We collected dates of deaths of deceased patients and time after operation of possible recurrences. Carcinoma staging was done by a pathologist after operation. Blood samples were taken before surgery in order to measure tumor markers (CA19-9 and CEA). : Survival after colonic adenocarcinoma surgery did not differ between the two different surgical approaches ( = 0.151). Recurrence of cancer was not associated with the type of operation ( = 0.532). Patients with recurrence had a 37.6 times greater hazard ratio of dying (95% CI: [12.0, 118]; < 0.001). Advanced age adversely affected survival: patients aged <65 and 65 years had a 97%, and 57% survival rate, respectively. Patients with elevated tumor markers at operation had a 19.1 greater hazard ratio of dying (95% CI: [5.16, 70.4]; p<0.001). Patients with different TNM stages did not have any statistically significant differences in survival (HR = 2.49; 95% CI: [0.67, 9.30]; p = 0.173) (HR = 2.18; 95% CI: [0.58, 8.12]; p = 0.246) or recurrence ( = 0.097). : The obtained results suggest that laparoscopic resection of colon cancer is not inferior from an oncologic point of view and results in a similar long-term survival and disease-free interval. Recurrence of carcinoma, older age at initial operation and elevated tumor markers, above a pre-set threshold at operation, were found to be independent factors of lower survival. We believe that the obtained results will be of benefit when choosing treatment for colon adenocarcinoma.
在切除结肠癌时,外科医生会在腹腔镜辅助手术和开放手术之间做出选择。腹腔镜切除在短期效果上优于开放手术。然而,研究人员对长期结果并不一致。本研究旨在阐述这两种不同方法术后 5 年的生存和癌症复发差异。
纳入的 74 名患者在初次手术后五年进行了评估。我们收集了已死亡患者的死亡日期和可能复发的术后时间。病理学家在手术后对癌分期进行了评估。在手术前采集血样以测量肿瘤标志物(CA19-9 和 CEA)。
结肠癌手术后的生存情况在两种不同手术方式之间没有差异( = 0.151)。癌症复发与手术方式无关( = 0.532)。有复发的患者死亡的危险比增加了 37.6 倍(95%CI:[12.0,118];<0.001)。高龄对生存不利:<65 岁和 65 岁的患者生存率分别为 97%和 57%。手术时肿瘤标志物升高的患者死亡的危险比增加了 19.1 倍(95%CI:[5.16,70.4];p<0.001)。不同 TNM 分期的患者在生存方面没有任何统计学差异(HR=2.49;95%CI:[0.67,9.30];p=0.173)(HR=2.18;95%CI:[0.58,8.12];p=0.246)或复发( = 0.097)。
研究结果表明,从肿瘤学角度来看,腹腔镜切除结肠癌并不劣于传统手术,并且在长期生存和无病间期方面也有相似的效果。肿瘤复发、初次手术时年龄较大和手术时肿瘤标志物升高超过预设阈值是生存率降低的独立因素。我们相信,在选择结肠癌治疗方法时,这些结果将是有益的。