The First Affiliated Hospital, Jinan University, Guangzhou, China.
Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China.
J Laparoendosc Adv Surg Tech A. 2021 Jun;31(6):638-647. doi: 10.1089/lap.2020.0588. Epub 2020 Nov 5.
Mucinous colorectal adenocarcinoma (MAC) has a higher incidence of local extension, leading to lower overall resection rates. Few studies have investigated the outcomes of laparoscopic surgery for MACs to date. Therefore, we aimed to elucidate the validity of laparoscopic surgery for mucinous adenocarcinoma (MAC). This study analyzed short-term and long-term outcomes between laparoscopic and open surgery for MACs from 2008 to 2018. Multivariate analyses were used to define prognostic factors of overall survival (OS) and disease-free survival (DFS). Patients in the laparoscopy (LAP) group had significantly less blood loss, fewer days to first flatus and to diet, and shorter length of hospital stay. The 3-year and 5-year DFS rates for all stages combined were 65.7% and 62.5% in the LAP group compared with 60.5% and 57.6% in the open (OPEN) surgery group ( = .521). The 3-year and 5-year OS rates for all stages combined were 72.3% and 67.3% in the LAP group compared with 72.6% and 67.8% in the OPEN group ( = .934). OS and DFS in stage II, stage III, and pathological T4 (pT4) stage patients who underwent laparoscopic surgery did not differ from patients who underwent open surgery. Multivariate analysis showed that stage pT4, pN2, and carcinoembryonic antigen (CEA) were significant predictors of OS. Independent factors, including intraoperative blood transfusion, stage pT4, pN2, CEA, and CA19-9, carbohydrate antigen 19-9, have a great effect on DFS. Laparoscopic surgery is a safe and feasible option for mucinous colorectal AC, which provides faster postoperative recovery and less intraoperative blood loss.
黏液性结直肠腺癌 (MAC) 具有更高的局部扩展发生率,导致总体切除率较低。迄今为止,很少有研究调查腹腔镜手术治疗 MAC 的结果。因此,我们旨在阐明腹腔镜手术治疗黏液性腺癌 (MAC) 的有效性。本研究分析了 2008 年至 2018 年期间腹腔镜和开放手术治疗 MAC 的短期和长期结果。多变量分析用于定义总生存 (OS) 和无病生存 (DFS) 的预后因素。腹腔镜 (LAP) 组患者的出血量明显减少,首次排气和饮食的天数以及住院时间更短。所有分期的 3 年和 5 年 DFS 率分别为 LAP 组的 65.7%和 62.5%,而开放 (OPEN) 手术组的 60.5%和 57.6%(= 0.521)。所有分期的 3 年和 5 年 OS 率分别为 LAP 组的 72.3%和 67.3%,而 OPEN 组的 72.6%和 67.8%(= 0.934)。接受腹腔镜手术的 II 期、III 期和病理 T4(pT4)期患者的 OS 和 DFS 与接受开放手术的患者没有差异。多变量分析显示,pT4 期、pN2 期和癌胚抗原 (CEA) 是 OS 的显著预测因素。术中输血、pT4 期、pN2 期、CEA 和 CA19-9、碳水化合物抗原 19-9 等独立因素对 DFS 有很大影响。腹腔镜手术是黏液性结直肠 AC 的一种安全可行的选择,可加快术后恢复并减少术中出血量。