Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Division of Colorectal Surgery, Department of Surgery, Biomedical Park Hospital, National Taiwan University Hospital, Hsinchu, Taiwan, ROC.
Sci Rep. 2020 Nov 23;10(1):20347. doi: 10.1038/s41598-020-77317-2.
The role of minimally invasive surgery (MIS) to treat clinically T4 (cT4) colorectal cancer (CRC) remains uncertain and deserves further investigation. A retrospective cohort study was conducted between September 2006 and March 2019 recruiting patients diagnosed as cT4 CRC and undergoing MIS at a university hospital and its branch. Patients' demography, clinicopathology, surgical and oncological outcomes, and radicality were analyzed. A total of 128 patients were recruited with an average follow-up period of 33.8 months. The median time to soft diet was 6 days, and the median postoperative hospitalization periods was 11 days. The conversion and complication (Clavien-Dindo classification ≥ II) rates were 7.8% and 27.3%, respectively. The 30-day mortality was 0.78%. R0 resection rate was 92.2% for cT4M0 and 88.6% for pT4M0 patients. For cT4 CRC patients, the disease-free survival and 3-year overall survival were 86.1% and 86.8% for stage II, 54.1% and 57.9% for stage III, and 10.8% and 17.8% for stage IV. With acceptable conversion, complication and mortality rate, MIS may achieve satisfactory R0 resection rate and thus lead to good oncological outcomes for selected patients with cT4 CRC.
微创手术（MIS）治疗临床 T4（cT4）结直肠癌（CRC）的作用仍不确定，值得进一步研究。本研究回顾性分析了 2006 年 9 月至 2019 年 3 月期间在一所大学医院及其分支机构接受 MIS 治疗的 cT4 CRC 患者的临床病理资料。分析了患者的人口统计学、临床病理学、手术和肿瘤学结果以及根治性。共纳入 128 例患者，平均随访 33.8 个月。半流食时间中位数为 6 天，术后中位住院时间为 11 天。转化率和并发症（Clavien-Dindo 分类≥Ⅱ级）发生率分别为 7.8%和 27.3%。30 天死亡率为 0.78%。cT4M0 和 pT4M0 患者的 R0 切除率分别为 92.2%和 88.6%。对于 cT4 CRC 患者，Ⅱ期、Ⅲ期和Ⅳ期的无病生存率和 3 年总生存率分别为 86.1%和 86.8%、54.1%和 57.9%、10.8%和 17.8%。在可接受的转化率、并发症发生率和死亡率下，MIS 可能为选择的 cT4 CRC 患者实现满意的 R0 切除率，从而带来良好的肿瘤学结果。
