机构治疗结果应成为决定是否对直肠癌进行腹腔镜直肠切除术的一个决定因素。

Institutional Outcomes Should Be a Determinant in Decision to Perform Laparoscopic Proctectomies for Rectal Cancer.

作者信息

Ofshteyn Asya, Weaver Allson B, Brady Justin T, Idrees Jay, Coronado Wendy M, Steele Scott R, Reynolds Harry, Steinhagen Emily, Stein Sharon L

机构信息

Surgery, University Hospitals Cleveland Medical Center / University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA.

General Surgery, University Hospitals Cleveland Medical Center / University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA.

出版信息

Cureus. 2020 Apr 14;12(4):e7666. doi: 10.7759/cureus.7666.

DOI:10.7759/cureus.7666

PMID:32419994

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7226664/

Abstract

Purpose Minimally invasive rectal cancer (RC) resection has become common, despite recent high-profile trials failing to show non-inferiority to open proctectomy. We hypothesized that at a high-volume center, laparoscopic resection may have superior outcomes compared to those seen in ALaCaRT and ACOSOG Z6051. Methods Retrospective review of patients undergoing laparoscopic proctectomy from 2007 to 2015 for RC was performed at a high-volume center. Primary outcome was successful resection defined by negative circumferential resection margin (CRM) and distal margin (DM), and complete total mesorectal excision (TME). Results A total of 89 patients were included. Of 33 patients with TME grading, 31 (93.9%) had complete/near complete TME, and 29 (87.9%) had a "successful resection" compared with 81.7% in ACOSOG and 82% in ALaCART trials using same criteria. CRM was ≥1 mm in 87 (97.8%) of patients. Mean DM was 3.8 cm; 97.8% of patients had negative DM. Conclusion High-volume centers can achieve similar high quality RC outcomes to those demonstrated in recent trials. Institutional outcomes should determine optimal surgical technique.

摘要

目的尽管近期备受瞩目的试验未能显示微创直肠癌（RC）切除术不劣于开放性直肠切除术，但该手术已变得普遍。我们推测，在一个高容量中心，腹腔镜切除术可能比在ALaCaRT和ACOSOG Z6051试验中观察到的结果更优。方法在一个高容量中心对2007年至2015年接受腹腔镜直肠切除术治疗RC的患者进行回顾性研究。主要结局是通过阴性环周切缘（CRM）和远切缘（DM）以及完全直肠系膜全切除（TME）来定义的成功切除。结果共纳入89例患者。在33例有TME分级的患者中，31例（93.9%）有完全/接近完全的TME，29例（87.9%）有“成功切除”，而使用相同标准的ACOSOG试验和ALaCART试验中的比例分别为81.7%和82%。87例（97.8%）患者的CRM≥1 mm。平均DM为3.8 cm；97.8%的患者DM为阴性。结论高容量中心可以取得与近期试验中相似的高质量RC治疗效果。机构的治疗效果应决定最佳手术技术。