老年结直肠癌患者行开放手术与腹腔镜手术的随机对照研究的长期结果（Eld Lap 研究）。

Long-term results of a randomized study comparing open surgery and laparoscopic surgery in elderly colorectal cancer patients (Eld Lap study).

机构信息

Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan.

Department of Surgery, Koga Community Hospital, 2-30-1 Daikakuji, Yaizu, Shizuoka, 425-0088, Japan.

出版信息

Surg Endosc. 2021 Oct;35(10):5686-5697. doi: 10.1007/s00464-020-08026-0. Epub 2020 Sep 28.

DOI:10.1007/s00464-020-08026-0

PMID:32989541

Abstract

BACKGROUND

We reported favorable short-term results of laparoscopic surgery in a randomized study comparing open and laparoscopic surgery for elderly patients with colorectal cancer (CRC). The purpose of this study is to clarify the long-term outcomes of the laparoscopic surgery for elderly patients with CRC.

METHODS

The inclusion criteria were ≥ 75 years, adenocarcinoma, ≤ T4a, M0 and elective surgery. The patients were randomly allocated to open or laparoscopic surgery according to the tumor location. The survival rates, recurrence and reasons for death were compared.

RESULT

One hundred patients (right colon 43, left colon 28, rectum 29) were included in each group. Eight patients who underwent open surgery and 2 patients who underwent laparoscopic surgery were excluded from the analysis because of metastatic diseases and other malignancies found during the operations. One hundred ninety patients (98 open, 98 laparoscopic) were analyzed. There was no difference in the backgrounds excluding more patients with vascular invasion in the laparoscopic rectal cancer. There were no differences in the 5-year overall survival rate (open vs. laparoscopic; 78.9% vs. 82.1%, p = 0.638), 5-year disease-free survival rate (70.5% vs. 62.8%, p = 0.276), 5-year recurrence-free survival rate (76.1% vs. 72.1%, p = 0.419), or 5-year cancer-specific survival rate (86.1% vs. 80.5%, p = 0.208). No differences in survival were detected in the analyses of stage and tumor location. There was no significant difference in the overall recurrence rate or recurrence site. However, distant lymph node metastases and local recurrences were more common after laparoscopic surgery than after open surgery. There was no difference in the cause of death. More than half of the patients died from other diseases in both groups (57.9% vs. 52.6%, p = 0.765).

CONCLUSION

Laparoscopic surgery showed similar long-term results compared to open surgery in elderly patients with CRC. Laparoscopic surgery is an effective surgical procedure for elderly patients with CRC.

摘要

背景

我们曾报道过腹腔镜手术治疗老年结直肠癌（CRC）患者的短期疗效良好，该研究为随机对照研究，比较了腹腔镜手术与开腹手术的疗效。本研究旨在明确腹腔镜手术治疗老年 CRC 患者的长期疗效。

方法

纳入标准为年龄≥75 岁、腺癌、肿瘤局限于 T4a 及以下、M0 期且接受择期手术的患者。根据肿瘤部位，将患者随机分配至开腹手术组或腹腔镜手术组。比较两组患者的生存率、复发情况及死亡原因。

结果

每组各纳入 100 例患者（右半结肠 43 例、左半结肠 28 例、直肠 29 例）。因术中发现转移病灶或其他恶性肿瘤，8 例开腹手术患者和 2 例腹腔镜手术患者被排除在分析之外。共 190 例患者（开腹 98 例，腹腔镜 98 例）纳入分析。排除更多血管侵犯患者后，腹腔镜直肠肿瘤患者的背景资料无差异。两组患者的 5 年总生存率（开腹 vs. 腹腔镜；78.9% vs. 82.1%，p=0.638）、5 年无病生存率（70.5% vs. 62.8%，p=0.276）、5 年无复发生存率（76.1% vs. 72.1%，p=0.419）和 5 年癌症特异性生存率（86.1% vs. 80.5%，p=0.208）均无差异。在按分期和肿瘤部位进行的分析中，生存率也无差异。两组患者的总体复发率或复发部位无差异。然而，腹腔镜手术后远处淋巴结转移和局部复发更为常见。两组患者的死亡原因也无差异。两组患者中，超过一半的患者死于其他疾病（57.9% vs. 52.6%，p=0.765）。