University of Portsmouth, School of Health and Care Professions, St Andrews Court, St Michael's road, Portsmouth, PO1 2PR, UK.
Poole Hospital NHS Trust, Longfleet road, Poole, BH15 2JB, UK.
Langenbecks Arch Surg. 2020 Jun;405(4):479-490. doi: 10.1007/s00423-020-01892-1. Epub 2020 May 29.
Obesity, neoadjuvant-radiotherapy, tumour proximity to the anal verge and previous abdominal surgery are factors that might increase the intra-operative difficulty of laparoscopic rectal cancer surgery. However, whether patients with these 'high-risk' characteristics are subject to worse short- or long-term outcomes is debated. The aim of this study is to examine the short- and long-term clinical and oncological outcomes of patients receiving laparoscopic rectal surgery with any of these high-risk characteristics and compare them with patients that do not possess any of these high-risk features.
For the purpose of this study data from consecutive patients receiving laparoscopic rectal cancer resections between 2006 and 2016 from two centres were analysed. High-risk patients were defined as patients with either one of the following characteristics: BMI ≥ 30, neoadjuvant chemoradiotherapy, tumour < 8 cm from the anal verge and previous abdominal surgery.
A total of 313 patients were identified (227 high risk, 86 low risk). Short-term outcomes were similar between the two groups with the exception of blood loss and length of stay, which were higher in the high-risk group (10 vs 2.5 ml, p = 0.045; 7 vs 5 days, p = 0.001). There were no statistically significant differences in 5-year overall survival (79.7% vs 79.8%, p = 0.757), disease-free survival (76.8% vs 69.3%, p = 0.175), distant disease-free interval (84.8% vs 79.7%, p = 0.231) and local recurrence-free interval (100%, 97.4%, p = 0.162) between the two groups.
Similar short- and long-term outcomes can be achieved in high-risk and low-risk patients receiving laparoscopic rectal surgery. The presented data support the suitability of laparoscopic surgery for this group of patients.
肥胖、新辅助放疗、肿瘤距肛门边缘的距离以及既往腹部手术是可能增加腹腔镜直肠癌手术难度的因素。然而，这些“高危”特征的患者是否会出现短期或长期预后更差仍存在争议。本研究旨在检查接受任何一种高危特征的腹腔镜直肠手术的患者的短期和长期临床及肿瘤学结果，并将其与不具有任何高危特征的患者进行比较。
为了进行这项研究，对来自两个中心的 2006 年至 2016 年间接受腹腔镜直肠癌切除术的连续患者的数据进行了分析。高危患者被定义为具有以下特征之一的患者：BMI≥30、新辅助放化疗、肿瘤距肛门边缘<8cm 和既往腹部手术。
共确定了 313 名患者（227 名高危患者，86 名低危患者）。两组患者的短期结果相似，但高危组的出血量和住院时间较高（10 比 2.5ml，p=0.045；7 比 5 天，p=0.001）。两组患者的 5 年总生存率（79.7%比 79.8%，p=0.757）、无病生存率（76.8%比 69.3%，p=0.175）、远处无病间隔（84.8%比 79.7%，p=0.231）和局部无复发生存期（100%比 97.4%，p=0.162）均无统计学差异。
接受腹腔镜直肠手术的高危和低危患者可获得相似的短期和长期结果。所提供的数据支持腹腔镜手术适用于这组患者。
