Li X C, Li Z Y, Luo Z W, Bi X Y, Cai J Q
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2020 May 23;42(5):413-418. doi: 10.3760/cma.j.cn112152-112152-20190814-00526.
To compare the safety and outcome between total laparoscopic and laparoscopy-assisted synchronous resection for colorectal cancer patients with liver metastases. The data of patients who underwent total laparoscopic or laparoscopy-assisted simultaneous resection of primary colorectal cancer and liver metastases in our hospital between December 2008 and December 2016 were collected and analyzed. The total laparoscopic surgery patients were matched 1∶2 to the laparoscopy-assisted surgery patients based on the propensity score. 22 patients were classified in the total laparoscopic group and 44 patients were classified in the laparoscopy-assisted group. The intraoperative conditions and postoperative outcomes of the two groups were compared. There was no difference in the preoperative baseline data between the two groups (>0.05). The median operative time were 317.50 and 267.50 minutes in the total laparoscopic group and the laparoscopy-assisted group, respectively, and the median intraoperative blood loss were 100 and 200 ml, both with no statistically significant differences (>0.05). There were 1 case of intraoperative blood transfusion in the total laparoscopic group and 5 cases in the laparoscopy-assisted group, with no statistically significant difference (=0.650). The median postoperative hospital stay in the two groups were 11.0 and 10.0 days, the median postoperative defecation time were 4.0 and 4.0 days and postoperative complication rates were 13.6% and 20.5%, and none of these differences were statistically significant (>0.05). However, no Clavien-DindoⅡ level and above complications occurred in total laparoscopic group. The median disease-free survival (DFS) were 15.0 and 15.7 months in the total laparoscopic group and the laparoscopy-assisted group, the overall survival (OS) were 25.9 and 37.6 months, respectively, with no statistically significant differences (>0.05). Laparoscopy-assisted approaches are similar, so the appropriate approach should be chosen according to the clinical condition and surgeon's experience.
比较全腹腔镜与腹腔镜辅助同步切除对结直肠癌肝转移患者的安全性及治疗效果。收集并分析2008年12月至2016年12月期间在我院接受全腹腔镜或腹腔镜辅助同步切除原发性结直肠癌及肝转移灶患者的数据。基于倾向评分将全腹腔镜手术患者与腹腔镜辅助手术患者按1∶2进行匹配。全腹腔镜组22例患者，腹腔镜辅助组44例患者。比较两组的术中情况及术后结局。两组术前基线数据无差异（>0.05）。全腹腔镜组和腹腔镜辅助组的中位手术时间分别为317.50分钟和267.50分钟，中位术中出血量分别为100 ml和200 ml，差异均无统计学意义（>0.05）。全腹腔镜组术中输血1例，腹腔镜辅助组5例，差异无统计学意义（=0.650）。两组术后中位住院时间分别为11.0天和10.0天，术后中位排便时间均为4.0天，术后并发症发生率分别为13.6%和20.5%，这些差异均无统计学意义（>0.05）。然而，全腹腔镜组未发生Clavien-DindoⅡ级及以上并发症。全腹腔镜组和腹腔镜辅助组的中位无病生存期（DFS）分别为15.0个月和15.7个月，总生存期（OS）分别为25.9个月和37.6个月，差异均无统计学意义（>0.05）。腹腔镜辅助手术方式相似，应根据临床情况及术者经验选择合适的手术方式。
