Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, PR China.
BMC Cancer. 2020 Aug 14;20(1):761. doi: 10.1186/s12885-020-07255-9.
This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC).
Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS).
Of 373 patients who met the criteria for inclusion, 198 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P<0.001) and more blood loss volume (P = 0.015) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (16.2% vs. 8.1%, P = 0.082). There was no significant difference in local recurrence between the two groups (9.1% vs. 4.0%, P = 0.251), whereas distant metastasis was inclined to be more frequent in LRC patients compared with M/HRC (21.2% vs. 12.1%, P = 0.086). The LRC group showed significantly inferior 5-year OS (77.0% vs. 86.4%, P = 0.033) and DFS (71.2% vs. 86.2%, P = 0.017) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of DFS (HR = 2.305, 95% CI 1.203-4.417, P = 0.012).
Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of DFS.
本研究旨在评估腹腔镜下低位直肠癌（LRC）与中高位直肠癌（M/HRC）切除术后的短期和长期结果。
回顾性分析了 2009 年至 2015 年间接受腹腔镜根治性切除术的直肠癌患者的资料。通过倾向性评分分析进行 1:1 匹配后，比较 LRC 组和 M/HRC 组的围手术期和肿瘤学结果。采用多变量分析确定总生存（OS）和无病生存（DFS）的独立因素。
符合纳入标准的 373 例患者中，198 例患者进行了匹配分析。与 M/HRC 相比，LRC 组的腹腔镜手术操作时间更长（P<0.001），出血量更多（P=0.015），术后并发症发生率也较高（16.2% vs. 8.1%，P=0.082）。两组局部复发率无显著差异（9.1% vs. 4.0%，P=0.251），但 LRC 组远处转移的发生率高于 M/HRC 组（21.2% vs. 12.1%，P=0.086）。LRC 组的 5 年 OS（77.0% vs. 86.4%，P=0.033）和 DFS（71.2% vs. 86.2%，P=0.017）均显著低于 M/HRC 组。多变量分析表明，肿瘤位置是 DFS 的独立预测因素（HR=2.305，95%CI 1.203-4.417，P=0.012）。
直肠癌的肿瘤位置显著影响腹腔镜手术后的临床和肿瘤学结果，是 DFS 的独立预测因素。
