Department of Surgery, Dalhousie University, Halifax, NS.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
Curr Oncol. 2020 Jun;27(3):e251-e258. doi: 10.3747/co.27.5829. Epub 2020 Jun 1.
Randomized trials have demonstrated equivalent oncologic outcomes and decreased morbidity in patients with rectal cancer who undergo laparoscopic surgery (lapsx) compared with open surgery (opensx). The objective of the present study was to compare short-term outcomes after lapsx and opensx in a real-world setting.
A national discharge abstract database was used to identify all patients who underwent rectal cancer resection in Canada (excluding Quebec) from April 2004 through March 2015. Short-term outcomes examined included same-admission mortality and length of stay (los).
Of 28,455 patients, 82.4% underwent opensx, and 17.6%, lapsx. The use of lapsx increased to 34% in 2014 from 5.9% in 2004 ( < 0.0001). Same-admission mortality was lower among patients undergoing lapsx than among those undergoing opensx (1.08% and 1.95% respectively, < 0.0001). On multivariable analysis, the odds of same-admission mortality with lapsx was 36% lower than that with opensx (odds ratio: 0.64; = 0.003). Median los was shorter after lapsx than after opensx (5 days and 8 days respectively, = 0.0001). The strong association of lapsx with shorter los was maintained on multivariable analysis controlling for patient, surgeon, and hospital factors.
For patients with rectal cancer, shorter los and decreased same-admission mortality are associated with the use of lapsx compared with opensx.
随机试验已经证明，接受腹腔镜手术（lapx）的直肠癌患者与接受开放手术（opensx）的患者相比，其肿瘤学结果相当，发病率降低。本研究的目的是在真实环境中比较 lapx 和 opensx 的短期结果。
利用国家出院摘要数据库，从 2004 年 4 月至 2015 年 3 月，确定在加拿大（魁北克除外）行直肠癌切除术的所有患者。检查的短期结果包括同院死亡率和住院时间（los）。
在 28455 例患者中，82.4%行 opensx，17.6%行 lapx。lapx 的使用率从 2004 年的 5.9%增加到 2014 年的 34%（<0.0001）。lapx 组的同院死亡率低于 opensx 组（分别为 1.08%和 1.95%，<0.0001）。多变量分析显示，lapx 组的同院死亡率比 opensx 组低 36%（比值比：0.64；=0.003）。lapx 后 los 中位数短于 opensx（分别为 5 天和 8 天，=0.0001）。在多变量分析中，在控制患者、外科医生和医院因素后，lapx 与较短的 los 之间仍存在很强的关联。
对于直肠癌患者，与 opensx 相比，使用 lapx 与较短的 los 和降低的同院死亡率相关。
